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Belitung Nursing Journal
Published by Belitung Raya Publisher
ISSN : 2528181x     EISSN : 24774073     DOI : -
Core Subject : Health,
Nursing
BNJ contributes to the advancement of evidence-based nursing, midwifery and healthcare by disseminating high quality research and scholarship of contemporary relevance and with potential to advance knowledge for practice, education, management or policy. BNJ welcomes submissions of evidence-based clinical application papers, original research, systematic review, case studies, perspectives, commentaries, letter to editor and guest editorial on a variety of clinical and professional topics.
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Articles 17 Documents
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Search results for , issue "vol. 12 no. 3 (2026): may - june" : 17 Documents clear
The effect of a self-management program through a mobile application on lipid profile among persons with coronary artery disease: A randomized controlled trial study in Thailand Rapin Polsook; Yupin Aungsuroch
Belitung Nursing Journal Vol. 12 No. 3 (2026): May - June
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4161

Abstract

Background: Cholesterol, triglycerides, and low-density lipoprotein levels are key indicators of patients’ self-care in coronary artery disease; although medications can improve lipid profiles, the results often remain above targets. Implementing mobile self-management programs is crucial for reducing the incidence of coronary artery disease, preventing cardiac events, and enhancing well-being. Objective: This study aimed to evaluate the impact of a self-management program on cholesterol, triglycerides, and low-density lipoprotein levels in people with coronary artery disease. Methods: A randomized controlled trial design was employed at a tertiary hospital in Thailand between June 2022 and June 2023. Forty-eight people were randomly assigned to one of two groups: control or experimental. The experimental group used applications and the telephone for four weeks to self-manage cholesterol, triglyceride, and low-density lipoprotein levels, while the control group received conventional care. Data were gathered about cholesterol, triglyceride, and low-density lipoprotein levels. Descriptive statistics, independent t-tests, and dependent t-tests were employed to analyze between-group and within-group differences. Effect sizes (Cohen’s d) with 95% confidence intervals were calculated. Results: Results showed that the experimental group had a statistically significant reduction in cholesterol (t = 2.121, df = 46, p = 0.039), triglyceride (t = 2.060, df= 46, p = 0.046), and low-density lipoprotein levels (t = 2.115, df = 46, p = 0.040) compared to the control group. This study demonstrates that a mobile application self-management program can lower lipid levels. Conclusions: The findings indicate that a mobile application–based self-management program can significantly reduce cholesterol, triglyceride, and low-density lipoprotein levels in people with coronary artery disease in the short term. These findings highlight the crucial role of nurses applying these strategies to enhance patient care. Trial Registry Number: Thai Clinical Trials Registry (TCTR20250129001)
Factors associated with functional status among older adults with colorectal cancer receiving chemotherapy in Thailand: A cross-sectional study Saimai Tumwijit; Surachai Maninet; Natthasa Thanthitaweewat
Belitung Nursing Journal Vol. 12 No. 3 (2026): May - June
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4309

Abstract

Background: Older adults with colorectal cancer who undergo chemotherapy are at high risk of functional status decline. Various demographic and physiological factors influence functional status. However, based on the Theory of Unpleasant Symptoms, few studies have examined the relationships among physiological, psychological, and situational factors, symptom experience, and functional status in older adults with colorectal cancer undergoing chemotherapy. Objective: This study aimed to describe functional status and investigate its associated factors among older adults with colorectal cancer undergoing chemotherapy in Thailand. Methods: A cross-sectional study was conducted among 128 older adults with colorectal cancer receiving chemotherapy. Participants were recruited from a cancer hospital in Northeastern Thailand using multi-stage sampling, followed by systematic random sampling with a random digit table. Data were collected between October 2024 and July 2025 using standardized instruments. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation coefficients, and multiple regression analysis. Results: The findings revealed that participants’ functional status was moderate. Pearson’s correlation coefficient analysis showed that body mass index and social support were positively associated with functional status.  Fatigue, depression, and the number of chemotherapy cycles were negatively associated with functional status. Multiple regression analysis showed that fatigue was the strongest factor negatively associated with functional status (β = -0.375, p < 0.001), followed by depression (β = -0.329, p < 0.001). On the other hand, body mass index (BMI) (β = 0.188, p < 0.05) was positively associated with functional status. The model was statistically significant (R2 = 0.409, F(3,124) = 28.590, p < 0.001), which explaining 40.90% of the variance in functional status. Conclusion: These findings suggest that nurses should implement early screening and proactive nursing interventions to reduce fatigue and depression. Such interventions may include optimizing nutritional status at each chemotherapy cycle and providing family support to help this population preserve functional status.
Nursing knowledge as relational ontology: Toward an enacted, technologically mediated, and globally situated understanding of nursing Gil P. Soriano; Feni Betriana; Kathyrine Calong Calong; Joseph Andrew Pepito; Tetsuya Tanioka; Rozzano Locsin
Belitung Nursing Journal Vol. 12 No. 3 (2026): May - June
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4384

Abstract

Despite substantial theoretical advancement, nursing knowledge continues to be framed by epistemological classifications rather than ontological clarification. The question of what nursing knowledge is, as a mode of existence, remains unanswered, despite existing frameworks that emphasize patterns, types, or domains of knowing. This paper argues that nursing knowledge is best understood as a relational ontology, a performative enactment emerging through practice rather than a collection of categorized components. Nursing knowledge is conceptualized as a unitary process manifested through embodied presence, interpretive meaning-making, and technologically mediated action. This paper illuminates how these aspects do not function as distinct domains but as a single, inseparable mode of being in clinical judgment and caring practices within digitally mediated contexts.
Cardiovascular disease awareness among Indonesian young adults: A cross-sectional study Septa Meriana Lumbantoruan; Deby Kristiani Uligraff
Belitung Nursing Journal Vol. 12 No. 3 (2026): May - June
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4408

Abstract

Background: Cardiovascular diseases (CVDs) are becoming more prevalent worldwide each year, contributing to the leading cause of mortality in both men and women. Awareness of CVD is low, particularly in developing countries. Objectives: This study aimed to identify key variables that determine CVD awareness among young adults. Methods: This study used a cross-sectional, descriptive correlational design and was conducted in accordance with STROBE guidelines. Data were collected across Indonesia via social media from late November 2022 to February 2023. CVD awareness was assessed using the Attitude-Belief-About-Cardiovascular-Disease (ABCD) Risk Questionnaire. Data were analyzed using univariate, bivariate (Fisher’s, Wilcoxon, Spearman, and Kruskal-Wallis), and regression (ordinary least squares and robust) analyses. Results: 270 respondents participated in this study, with average age of 26.88 (SD = 5.55). The mean CVD awareness score was 55.27 (SD = 5.85). Gender, educational background, and body mass index (BMI) all played a role in CVD awareness. Female sex was associated with lower awareness (OLS: B = -1.99, p < 0.001; robust: B = -1.62, p < 0.01), while university attendance was associated with higher awareness (robust: B = 1.64, p = 0.03). Higher BMI was the strongest and most consistent predictor of CVD awareness across models (OLS: B = 0.19, p < 0.001; robust:  B = 0.18, p < 0.001). Conclusion: Young adults (aged ≥ 18-39) in Indonesia demonstrated adequate knowledge of CVD risk factors; however, females, those with lower educational attainment, and individuals with normal weight showed lower levels of CVD awareness. Targeted health education and CVD screening programs are needed for these groups. Nurses play a pivotal role in bridging these awareness gaps by implementing tailored health education initiatives and proactive, community-based screening programs that specifically address the needs of these high-risk subgroups to promote early detection and long-term cardiovascular health.
Resilience, spiritual well-being, and self-esteem among students with disabilities in Jordan: A cross-sectional study Mutaz Fuad Alradaydeh; Mohammad A. Al-Ma’ani; Omar I. Alorani; Mohammad Othman Abudari
Belitung Nursing Journal Vol. 12 No. 3 (2026): May - June
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4417

Abstract

Background: University students with hearing, visual, and motor disabilities report several challenges that is negatively associated with psychological wellbeing. Although the numbers of students with disabilities in higher education is continuously increasing, the nursing related studies about the association of resilience, spiritual well-being, and self-esteem remains limited. Objectives: This study examined the associations among resilience, spiritual well-being, and self-esteem among university students with disabilities. Methods: A cross-sectional correlational design was used. University students with visual, hearing, and motor disabilities in Jordan were recruited through convenience sampling between February and April 2025. Data were collected using an electronic survey that included a demographic questionnaire, the Connor–Davidson Resilience Scale, the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale, and the Rosenberg Self-Esteem Scale. Data were analyzed using descriptive statistics, one-way ANOVA, and Pearson’s correlation. Findings: A total of 110 students participated (mean age = 22.7 years, SD = 4.18); 43.6% had visual disabilities, 36.4% had hearing disabilities, and 20.0% had motor disabilities. The mean resilience score was 71.29 (SD = 17.40) out of 100, the mean spiritual well-being score was 36.30 (SD = 7.12) out of 48, and the mean self-esteem score was 29.60 (SD = 4.79) out of 40. Students with visual disabilities reported significantly higher levels of spiritual well-being (F = 6.09, p = 0.003) and self-esteem (F = 23.26, p < 0.001). Lower self-esteem levels were observed among first-year students (F = 5.39, p = 0.002). Significant positive correlations were found between resilience and spiritual well-being (r = 0.698, p ≤ 0.01), resilience and self-esteem (r = 0.579, p ≤ 0.01), and spiritual well-being with self-esteem (r = 0.602, p ≤ 0.01). Conclusions: The significant positive associations among resilience, spiritual well-being, and self-esteem emphasizing the prompt need for psychological support across different type of disabilities. Continuous nursing assessment and psycho-social intervention for students with disabilities should be considered in the university health programs.
The role of digital health literacy in shaping nurses’ self-efficacy and innovative work behavior: A cross-sectional study Doaa Abd El-Fattah Mousa Edrees; Amal Hamdy Abou Ramadan; Fatma Zaghloul Mahmoud; Ahmed Mansour Almansour; Moataz Maged; Mohamed Gamal Mostafa
Belitung Nursing Journal Vol. 12 No. 3 (2026): May - June
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4452

Abstract

Background: In the evolving digital healthcare landscape, nurses are required to adapt to emerging technologies and demonstrate digital health literacy (DHL) to ensure high-quality patient care. DHL may enhance nurses’ self-efficacy (SE) and foster innovative work behavior (IWB), both of which are essential for professional development and healthcare innovation. Objective: This study aimed to explore the role of digital health literacy in shaping nurses’ self-efficacy and innovative work behavior. Methods: A cross-sectional correlational study was conducted among all available intensive care unit nurses (N = 406) at two university-affiliated hospitals in Egypt. Data were collected between November 2024 and January 2025 using three validated instruments: The Digital Health Literacy Instrument (DHLI), the General Self-Efficacy Scale (GSE), and the Innovative Work Behavior Scale (IWBS). Data analysis included descriptive statistics, Pearson correlation, and multivariate linear regressions. A mediation analysis was further conducted to evaluate the role of self-efficacy in the relationship between digital health literacy and innovative work behavior. Results: Nurses reported a mean digital health literacy score of 68.34 ± 10.61 (75.14% of the maximum possible score). The mean self-efficacy score was (32.36 ± 6.30). Approximately 66% of participants exhibited relatively high scores of innovative work behavior, particularly in the domains of idea generation and implementation. Statistically significant positive correlations were found between DHL and SE (r = 0.688, p < 0.001), DHL and IWB (r = 0.484, p < 0.001), and SE and IWB (r = 0.674, p < 0.001). An adjusted mediation analysis showed that DHL was positively associated with SE (B = 0.443, β = 0.688, p < 0.001, R² = 0.565) and with IWB in the total effect model (B = 0.453, p < 0.001). SE was also positively associated with IWB (B = 0.787, β = 0.604, p < 0.001). After inclusion of SE in the mediation model, the direct effect of DHL on innovative work behavior remained significant. The final mediation model explained 54.8% of the variance in innovative work behavior (R² = 0.548), after controlling for hospital type, age, and department. Mediation analysis indicated that SE partially mediated the association between DHL and IWB. Conclusion: Digital health literacy was positively associated with nurses’ self-efficacy and innovative work behavior, with self-efficacy partially mediating the association within the tested model. These findings suggest that integrating DHL into continuous professional development and nursing curricula may be beneficial to support digital transformation in healthcare.
Psychological distress: Bifactor modeling of the DASS-21 in Chilean healthcare workers Marjory Güilgüiruca-Retamal; Paola Muzatto-Negrón; Adriana Acosta-Ramos; Jacqueline Espinoza-Ibacache; Cristian Pinto-Cortez
Belitung Nursing Journal Vol. 12 No. 3 (2026): May - June
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4460

Abstract

Background: The Depression, Anxiety, and Stress Scale (DASS-21) is widely used to assess mental health symptoms; however, its dimensionality in working populations, particularly healthcare workers, remains under debate. Objective: This study aimed to examine the dimensional structure of the DASS-21 among Chilean healthcare workers to evaluate its suitability as a screening measure of psychological distress in occupational contexts exposed to crises, emergencies, or disasters. Methods: A cross-sectional survey was conducted in 2021 using a non-probabilistic convenience sample of 239 healthcare workers from a hospital in northern Chile. Confirmatory factor analyses were conducted to test four competing models (unidimensional, three correlated factors, second order, and bifactor) using structural equation modeling. Model fit was evaluated using RMSEA, CFI, and TLI, complemented by auxiliary bifactor indices (ECV, ωH, ωHS, PUC, ARPB). Results: All models showed acceptable fit (RMSEA = 0.038–0.065; CFI = 0.974–0.992; TLI = 0.971–0.990). Although the bifactor model demonstrated the best global fit, auxiliary indices supported the dominance of a general factor (ECV = 0.87; ωH = 0.94), with limited reliable variance attributable to the specific factors (ωHS ≤ 0.16). Measurement invariance across sex was supported. Conclusions: In this non-clinical sample characterized by low symptom severity, the DASS-21 operates primarily as an essentially unidimensional measure of psychological distress. From a nursing practice perspective, the total score may be used as a parsimonious screening indicator to support early detection, monitoring, and preventive mental health strategies among healthcare workers.
Resilience as meaning-making: Adolescents’ experiences of cyberbullying in post-conflict Ambon, Indonesia – a qualitative narrative study Nur Setiawati Dewi; Roland Lekatompessy
Belitung Nursing Journal Vol. 12 No. 3 (2026): May - June
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4461

Abstract

Background: Research on cyberbullying has largely focused on psychological outcomes and individual coping strategies, with limited attention to how adolescents narratively construct resilience within specific cultural and historical contexts. In post-conflict societies, adolescents’ responses to cyberbullying are shaped not only by personal resources but also by moral expectations, spiritual discourses, and power-laden digital environments. Objective: This study aimed to explore how adolescents in post-conflict Ambon, Indonesia, narratively construct resilience through their meaning-making of cyberbullying experiences. Methods: A qualitative narrative inquiry design was employed. Participants were recruited using purposive sampling through senior high schools, universities, and youth community networks in urban and semi-urban areas of Ambon, Maluku Province, Indonesia. In-depth narrative interviews were conducted in 2021 with twelve adolescents aged 16–19 years who reported experiences of cyberbullying. Data were analyzed drawing on Riessman’s approach to narrative analysis, focusing on the connections and recurring patterns across narratives through which resilience was articulated and meaning was constructed, rather than treating narratives as linear or unified trajectories. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Five narrative threads were identified through which adolescents narrated resilience in the context of cyberbullying. These narratives did not follow a single or linear pathway but reflected emotional wounding, silence as an ambivalent form of endurance, spiritually mediated meaning-making under constraint, moral restraint as identity negotiation, and tentative efforts to reclaim self-worth through compassion and reframing. Silence and spirituality functioned as culturally shaped resources that at times provided moral coherence or protection, while simultaneously revealing despair, constraint, and limited perceived options within morally regulated and digitally surveilled environments. Conclusion: Adolescents’ resilience to cyberbullying in post-conflict Ambon was narrated not as recovery or empowerment, but as an ongoing and culturally embedded process of endurance, moral negotiation, and partial re-authoring of self-worth. For nursing practice, these findings underscore the importance of narrative-sensitive and culturally responsive approaches that attend to adolescents’ silence, spiritual expressions, and moral frameworks, while fostering safe spaces for meaning-making and psychosocial care.
Predictors of postpartum depression among mothers in Wenzhou, China: A cross-sectional study Yufan Huang; Punyarat Lapvongwatana; Tatirat Tachasuksri
Belitung Nursing Journal Vol. 12 No. 3 (2026): May - June
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4465

Abstract

Background: Postpartum depression (PPD) significantly impacts maternal well-being, infant development, and family functioning. Studies examining interrelationships among multiple predictors using theoretical frameworks in Chinese populations remain limited. Objective: To determine the prevalence of postpartum depression and examine the associations of biological, psychological, and social factors among postpartum women in Wenzhou, China. Methods: A predictive correlational cross-sectional study was conducted at a tertiary hospital in Wenzhou from November to December 2024. Using systematic random sampling, 166 postpartum women aged 20-44 years, within 4 weeks to 6 months postpartum, were recruited. Data were collected using validated instruments, including the Edinburgh Postnatal Depression Scale (EPDS), Rosenberg Self-Esteem Scale, Maternal Breastfeeding Evaluation Scale, Revised Dyadic Adjustment Scale, and Stryker Adjustment Checklist. Multiple regression and mediation analyses using the PROCESS macro with bootstrap resampling were performed to identify significant predictors and examine mediating pathways. Results: The prevalence of PPD (EPDS score ≥9) was 21.1%. Multiple regression analysis revealed that breastfeeding satisfaction (β = -0.419, p < 0.001) and fulfillment of infant gender expectations (β = -0.202, p = 0.006) were significant predictors, together accounting for 28.4% of the variance in PPD symptoms.Mediation analysis indicated that breastfeeding satisfaction partially mediated the relationship between infant gender expectations and PPD. Pregnancy complications, self-esteem, marital satisfaction, and mother-in-law relationships were not statistically significant predictors in the final model. Conclusion: Approximately one in five postpartum women in Wenzhou experienced clinically significant depressive symptoms. Fulfilled gender expectations were associated with lower PPD risk, partially mediated by higher breastfeeding satisfaction, supporting the Biopsychosocial Model. These findings highlight the need for routine PPD screening, satisfaction-focused breastfeeding support, culturally sensitive counseling regarding family gender expectations, and family-centered interventions in postpartum care.
Factors predicting intention to engage in advance care planning among patients with chronic kidney disease in Thailand: A cross-sectional study Kanokwan Linthong; Yaowarat Matchim; Piyawan Kanan; Thatsanee Poosumang
Belitung Nursing Journal Vol. 12 No. 3 (2026): May - June
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4466

Abstract

Background: Chronic kidney disease (CKD) is a progressive condition associated with declining decisional capacity and increased end-of-life care needs. Although advance care planning (ACP) supports patient autonomy and goal-concordant care, engagement remains limited, particularly among patients with pre-dialysis CKD in Thailand. Objectives: To assess the level of intention to engage in ACP and identify factors predicting ACP intention among patients with CKD stages 3–5 in Thailand. Methods: A cross-sectional study was conducted from April to June 2025 among 184 patients aged ≥20 years with CKD stages 3–5 attending nephrology outpatient clinics at five public tertiary-level hospitals. Participants were recruited through purposive sampling using a multistage approach. Data were collected using validated questionnaires and analyzed using descriptive statistics and hierarchical multiple regression. Results: The mean age of participants was 64.48 years (SD = 11.78), and 51.6% were female. The level of intention to engage in ACP was low (M = 16.89, SD = 7.83). Hierarchical regression analysis identified attitudes toward ACP (β = 0.296, p < 0.001), family support (β = 0.220, p = 0.001), perceived self-efficacy in self-management (β = 0.155, p < 0.05), and knowledge of ACP (β = 0.145, p < 0.05) as significant predictors. The final model explained 56.6% of the variance in ACP intention (R² = 0.566), with the independent variables contributing an additional 33.3% beyond demographic and clinical variables (ΔR² = 0.333, p < 0.001). Death anxiety was not a significant predictor. Conclusions: ACP intention among Thai patients with CKD was low, influenced by attitudes, family support, self-efficacy, and ACP knowledge. Nurses should implement family-centered, empowerment-based educational interventions and integrate ACP discussions into routine nephrology care to promote timely and culturally aligned end-of-life decision-making.

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