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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 685 Documents
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Barriers to breastfeeding among mothers in the northern border region of Saudi Arabia: A cross-sectional study E. Esmaeel, Safya; Khalid Alobaidan, Rahaf; Faez K Alenezi, Dana; Salamah F Alanazi, Farah; Maqil T Alanazi, Rahaf; Dhaher A Alharbi, Atheer; Hameed G Alanezi, Haneen; Hussin A Alruwili, Leen; Abu Alsel, Baraah; A Hamid, Omaima; Hassan Abdalla Hashim, Sawsan; E. Bayomy, Hanaa; Fawzy, Manal S.
Belitung Nursing Journal Vol. 11 No. 6 (2025): November - December
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4026

Abstract

Background: Although breastfeeding is widely recognized for its essential nutritional and protective health benefits for infants, exclusive breastfeeding rates remain suboptimal in many populations globally and within Saudi Arabia. There is a paucity of region-specific data detailing the barriers to breastfeeding among mothers, particularly in the Northern Border region. Understanding these barriers is crucial for developing culturally appropriate interventions and public health policies that can enhance breastfeeding practices and maternal support systems. Objective: This study aimed to identify and analyze the barriers affecting exclusive breastfeeding among mothers in the Northern Border region of Saudi Arabia. Methods: A community-based cross-sectional survey was conducted among mothers aged 18 years and older residing in the Northern Border region of Saudi Arabia between February and May 2025. Data were collected using a structured, pre-validated online questionnaire in Arabic, disseminated via social media platforms to ensure broad participation. Descriptive statistics were used to summarize participant characteristics and knowledge levels, while inferential statistics were used to examine associations between demographic factors, knowledge scores, and identified barriers. Results: A total of 453 mothers participated in the study (mean age: 36.9 ± 8.1 years), of whom 91.6% reported prior breastfeeding experience. Knowledge scores ranged from 24 to 60 (mean: 46.1 ± 6.9). Higher knowledge levels were observed among mothers aged over 40 years (p = 0.0001), those with more than four children (p = 0.02), and participants with an average standard of living (p = 0.0001). Previous breastfeeding experience was significantly associated with older age (p <0.001) and employment status (p = 0.03). Working mothers, particularly those employed on shifts or hourly wages, reported significantly more barriers to exclusive breastfeeding (p = 0.001, p = 0.03, p = 0.0006). The most frequently reported challenges included insufficient workplace support and inadequate maternity leave, affecting 69.5% of respondents. Conclusion: Barriers to exclusive breastfeeding in the Northern Border region are predominantly workplace-related and institutional, including limited lactation facilities, lack of designated nursing breaks, rigid work schedules, and insufficient organizational support. Addressing these challenges through the implementation of supportive workplace policies, flexible scheduling, and targeted health education initiatives could substantially improve exclusive breastfeeding rates and promote better maternal and infant health outcomes.
Emotional intelligence and education-related stress among baccalaureate nursing students in Indonesia: A cross-sectional study Tarigan, Mula; Silitonga, Hanna Yudit Lamro; Purba, Jenny Marlindawani; Nurhidayah, Rika Endah; Nilvarangkul, Kessarawan
Belitung Nursing Journal Vol. 11 No. 6 (2025): November - December
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4053

Abstract

Background: Nursing students frequently encounter education-related stress (ES) arising from demanding academic workloads, clinical responsibilities, and personal adjustments during their training. Persistent stress can negatively impact learning outcomes, clinical performance, and psychological well-being. Emotional intelligence (EI), which involves the ability to perceive, understand, and manage emotions in oneself and others, is recognized as a protective factor that helps individuals regulate stress and adapt to challenges. However, research exploring the relationship between EI and ES among nursing students in Indonesia remains limited. Objective: This study examined the association between EI and ES among baccalaureate nursing students at a public university in Indonesia. Methods: A cross-sectional correlational design was conducted from September to November 2024 with 225 participants selected through stratified random sampling. Data were collected using the Indonesian version of the Trait Emotional Intelligence Questionnaire–Short Form and the Indonesian-translated Arabic Higher Education Stress Inventory. Descriptive statistics summarized the levels of EI and ES, while Spearman’s correlation, Mann–Whitney U, and Kruskal–Wallis tests were used to assess associations between variables. Results: Most students demonstrated moderate levels of EI (73.8%) and ES (64%). The median (IQR) scores were 138.00 (29) for EI and 37.00 (8) for ES. A significant negative correlation was found between EI and ES (rₛ = -0.445, p <0.01), indicating that students with higher EI experienced lower stress levels. Among demographic variables, only gender was significantly associated with ES (p = 0.05), with men reporting higher mean ranks than women. Conclusion: The findings highlight the importance of emotional intelligence in mitigating education-related stress among nursing students. Incorporating EI development into nursing curricula through emotional regulation training, reflective practices, and social–emotional learning strategies can build resilience, improve coping skills, and boost students’ academic and clinical performance. Further long-term studies are recommended to investigate the causal relationships and effectiveness of EI-based interventions.
Development and validation of the Lao Clinical Nurse Competency Scale Tamura, Toyomitsu; Phanpaseuth, Souksavanh; Sisoulath, Anousone; Inthaphanith, Phengdy; Kikuchi, Shikino; Koto-Shimada, Kyoko; Fujiwara, Kazumi; Matsuda, Nobuko
Belitung Nursing Journal Vol. 11 No. 6 (2025): November - December
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4094

Abstract

Background: The Ministry of Health in the Lao People’s Democratic Republic (Laos) has developed a national nursing competency framework comprising five domains and 43 items, aligned with the Association of Southeast Asian Nations (ASEAN) core competencies. However, nurses’ actual competencies in Laos have not been systematically evaluated. Objective: This study aimed to develop and validate a measurement scale to assess the clinical competencies of nurses working in healthcare facilities and clinical settings in Laos. Methods: A self-administered questionnaire was created based on the National Competency for Licensed Nurses in Laos (NCLN) and distributed to 359 nurses in Vientiane Capital and Champasak Province in October 2022. Responses from 355 nurses were analyzed. Construct validity was examined using exploratory factor analysis (EFA). Structural equation modeling (SEM) was then performed solely to evaluate the goodness of fit of the proposed model, rather than to confirm the factor structure. Content validity was verified by expert review, and reliability was assessed using the Spearman–Brown coefficient, Cronbach’s alpha, and McDonald’s omega (ω). Results: The EFA identified five factors, comprising 26 items, which explained 73.2% of the variance. The SEM showed an acceptable model fit: X²(289) = 698.2, p <0.001; GFI = 0.86; AGFI = 0.83; CFI = 0.94; RMSEA = 0.066. Expert review confirmed the content validity. Reliability was high (Spearman–Brown = 0.934; Cronbach’s α = 0.880; McDonald’s ω = 0.971). Conclusion: The Lao Clinical Nurse Competency Scale (CAS) demonstrated satisfactory validity and reliability. SEM was used only to assess the model’s goodness of fit, and future studies should conduct confirmatory factor analysis (CFA) using independent samples to verify construct validity.
Predicting factors of aggression among Indonesian middle adolescents with conduct problems in the community: A correlational study Saputra, Fauzan; Uthis, Penpaktr; Suktrakul, Sunisa
Belitung Nursing Journal Vol. 11 No. 6 (2025): November - December
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4109

Abstract

Background: Middle adolescents with conduct problems (CP) are at higher risk for aggression than their peers. However, factors contributing to this phenomenon remain insufficiently understood, particularly in Indonesia. Objective: This study aimed to examine the direct and indirect relationships among parental monitoring, self-esteem, self-control, peer deviance, media violence exposure, academic self-concept, and aggression, using Problem Behavior Theory and supported literature review as a conceptual framework. Methods: A cross-sectional correlational design was employed. Data were collected from May to June 2023 from students aged 14 to 16 years with CP across nine junior high schools in Aceh Province, Indonesia. Instruments included the Parental Monitoring Instrument, Rosenberg Self-Esteem Scale, Brief Self-Control Scale, Deviant Peer Scale, Extended Content-Based Media Exposure Scale, Academic Self-Concept Questionnaire, and Aggression Problem Behavior Frequency Scale Adolescent Rating. Data were analyzed using path analysis with LISREL 8.80 and the Sobel test. Results: A total of 423 students participated in the study. Self-control and peer deviance were directly associated with aggression (z = -1.93, β = -0.19, and z = 2.41, β = 0.35, p <0.05, respectively). Self-esteem showed an indirect association with aggression, mediated by self-control (z = -1.783, β = -0.795, p = 0.038). Peer deviance mediated the effects of parental monitoring and media violence exposure on aggression (z = 2.126, β = 1.020, p = 0.017, and z = 2.14, β = 1.055, p = 0.017, respectively). The model explained 42 percent of the variance in aggression. Conclusion: The findings highlight the importance of regular screening for conduct problems and aggression by community nurses and school-based counseling teachers, as well as the development of interventions focusing on peer deviance and self-control, which were identified as the most significant predictors of aggression.
Nurses’ functional status assessments using the International Classification of Functioning, Disability, and Health across hospital types in Japan: A cross-sectional study Yamamoto, Kanako
Belitung Nursing Journal Vol. 11 No. 6 (2025): November - December
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4123

Abstract

Background: In Japan, patients receiving treatment in advanced acute care hospitals often cannot return home immediately and require ongoing hospitalization. Sequential support is crucial to facilitate long-term recovery and community reintegration. Therefore, functional assessments should extend beyond physical function to include daily activities and participation. However, how nurses across different hospital types in Japan evaluate patients’ functional status using a standardized framework remains unclear. Objective: This study examined how nurses in hospitals with varying care functions assess patients’ functional status, focusing on the application of the International Classification of Functioning, Disability, and Health (ICF) framework. Methods: A cross-sectional survey with a qualitative component was conducted in accordance with the STROBE guidelines. Participants were 200 registered nurses in Japan, each with at least three years of clinical experience. Data were collected from February to March 2025 through an online survey using a commercial research firm’s verified panel of licensed nurses. Quantitative data were analyzed using descriptive statistics, chi-square tests, and one-way analysis of variance (ANOVA). In addition, open-ended responses were analyzed qualitatively to capture contextual perspectives on functional assessment. Results: No significant differences were observed in discharge planning practices among the four hospital types. The Functional Independence Measure was most frequently used in recovery-phase hospitals (p <0.001). Across all hospital types, assessments focused primarily on body functions and structures, while activities and participation domains received comparatively less attention. Qualitative analysis indicated that the focus of patient handovers varied by hospital function, reflecting institutional roles and priorities. Conclusion: Although discharge planning practices were comparable across hospital types, functional assessments remained concentrated on physical aspects, with limited attention to broader domains critical for long-term recovery. These findings highlight the need for a more comprehensive and standardized use of the ICF framework to support patients’ social reintegration and continuity of care across healthcare settings.
Barriers and facilitators affecting nurses’ ability to assess and prevent suicide in general hospitals in the Kingdom of Saudi Arabia: A cross-sectional study Aljedaani, Shafeah; El-Bilsha, Mona
Belitung Nursing Journal Vol. 11 No. 6 (2025): November - December
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4124

Abstract

Background: Suicide is a growing public health concern in Saudi Arabia, where rates have shown a gradual increase over recent decades. Nurses working in general hospital settings often encounter patients at risk but may face barriers that limit their ability to assess and prevent suicide effectively. Understanding these barriers and facilitators is essential to improve nurses’ preparedness and strengthening institutional suicide prevention efforts. Objective: This study aimed to explore the barriers and facilitators influencing nurses’ ability to assess and prevent suicide in general hospitals in the Kingdom of Saudi Arabia, and to identify factors associated with these perceptions. Methods: A quantitative, descriptive cross-sectional design was employed in three major government hospitals in Jeddah between April and May 2025. A structured self-administered questionnaire was developed based on the Capability, Opportunity, and Motivation–Behavior (COM-B) framework and validated through exploratory factor analysis using a randomly split dataset (200 cases for instrument validation and 347 cases for main analysis). The two-factor structure (barriers and facilitators) demonstrated strong construct validity (KMO = 0.962, Bartlett’s χ² = 9185.382, p <0.001) and explained 74.29% of the total variance. Data were analyzed using IBM SPSS version 26. Descriptive statistics summarized participant characteristics and perceptions, while independent-samples t-tests and multiple linear regression analyses examined predictors of perceived barriers and facilitators. Results: Among 347 nurses in the main analysis, the highest-rated barriers were limited time and heavy patient load (M = 3.81, SD = 0.96) and inadequate training (M = 3.72, SD = 0.99). The strongest facilitator was adequate training and continuing education (M = 3.80, SD = 1.05). Regression analyses showed that education level, total years of experience, and years in the current position significantly predicted perceived barriers (F = 12.16, p <0.001), explaining 9.6% of the variance (R² = 0.096), and of facilitators (F = 6.286, p <0.001), explaining 5.2% of the variance (R² = 0.052). Nurses without suicide-prevention training perceived more barriers (p = 0.004), whereas those with prior experience caring for suicidal patients reported greater awareness of both barriers and facilitators (p <0.05). Conclusion: Nurses’ capability, opportunity, and motivation to engage in suicide prevention appear to be influenced by workload pressures, limited training, and organizational factors. Strengthening structured education, implementing standardized assessment protocols, promoting interdisciplinary collaboration, and improving staffing support may enhance nurses’ preparedness and confidence in suicide risk assessment and prevention within general hospital settings.
Exploring antiretroviral treatment discontinuation among people living with HIV in Indonesia: A qualitative study Sujianto, Untung; Amirudin, Ikhwan; Akbar, M Agung; Waluyo, Agung; Nursasi, Astuti Yuni
Belitung Nursing Journal Vol. 11 No. 6 (2025): November - December
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4129

Abstract

Background: Discontinuation of antiretroviral therapy (ART) among people living with HIV (PLHIV) presents significant challenges for HIV care, often leading to physical deterioration, emotional distress, and social isolation. Although prior studies have addressed barriers to adherence, little is known about the experiences of PLHIV following treatment discontinuation in the Indonesian context. Objective: To explore the experiences of Indonesian PLHIV who have discontinued ART. Methods: This qualitative study employed a descriptive phenomenological approach and was conducted in three urban areas of Indonesia (Jakarta, Yogyakarta, and Bandar Lampung) between August and September 2024. Fifteen participants were purposively recruited from community-based organizations. In-depth semi-structured interviews were conducted, transcribed verbatim, and analyzed using Colaizzi’s method to identify themes and meanings in the narratives. Results: Three major themes emerged: (1) Physical and psychological consequences of ARV discontinuation, including fatigue, anxiety, and a sense of losing control; (2) Prolonged social strain and stigma, marked by loss of support and moral judgment from others; and (3) Searching for meaning and coping without treatment, including spiritual resignation and detachment from bodily control. These themes reflect the complex, multidimensional burdens PLHIV face after stopping treatment, particularly in the Indonesian context, where HIV stigma is deeply rooted in sociocultural and religious norms, and access to mental health support remains limited. Conclusion: ART discontinuation is not merely a clinical event but a deeply human experience shaped by physical decline, emotional conflict, social rejection, and existential adaptation. To improve long-term HIV care outcomes, healthcare systems must integrate psychosocial and spiritual support for individuals who disengage from treatment, encouraging re-engagement through nonjudgmental and person-centered care. For nursing practice, this study emphasizes the importance of developing empathetic communication, providing culturally sensitive counseling, and actively addressing stigma during care interactions.
The effectiveness of self-efficacy enhancement for foot care program on HbA1c and foot status in people with type 2 diabetes in Thailand: A quasi-experimental study Terathongkum, Sangthong; Lininger, Jiraporn; Nonpanya, Uraiwan
Belitung Nursing Journal Vol. 11 No. 6 (2025): November - December
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4131

Abstract

Background: Diabetic foot ulceration (DFU) is a common and serious complication in people with type 2 diabetes mellitus (T2DM), leading to morbidity, lower-extremity amputation, and reduced quality of life. Effective interventions focusing on glycemic control, foot care, and exercise are essential to prevent DFU. Objective: This study aimed to evaluate the effectiveness of the 12-week Self-Efficacy Enhancement for Foot Care Program (SEFP) on HbA1c levels and foot status, including peripheral sensory loss and skin and peripheral vascular abnormalities, in people with T2DM in Thailand. Methods: A quasi-experimental study with a two-group pretest-posttest design was conducted between October 2019 and January 2020 with 80 participants (40 per group) recruited from two public health centers in Bangkok. The experimental group received SEFP plus usual nursing care, while the control group received only usual nursing care. The SEFP included diabetes education, behavior modification, foot care, and 10-chair-pose foot exercises, with home visits, telephone follow-ups, and group discussions. Data collection included demographic questionnaires, HbA1c measurements, and foot status assessments using the Semmes-Weinstein Monofilament and clinical examination of skin and vascular abnormalities. Paired t-tests, independent t-tests, and ANCOVA were used to analyze within- and between-group differences. Results: Baseline characteristics were comparable between groups. After the intervention, the experimental group showed significant reductions in HbA1c (t = 5.24, p <0.001) and significant improvements in overall foot status (t = -8.75, p <0.001), peripheral sensory loss (t = -2.97, p = 0.005), and skin and peripheral vascular abnormalities (t = -10.32, p <0.001). ANCOVA revealed significant between-group differences in post-intervention HbA1c (F = 30.56, p <0.001) and foot status measures (overall: F = 61.61, p <0.001; peripheral sensory loss: F = 11.76, p <0.001; skin and vascular abnormalities: F = 56.79, p <0.001). Conclusion: The 12-week SEFP was associated with reductions in HbA1c and improvements in foot status in people with T2DM. This program is potentially recommended for nurses in primary healthcare settings to prevent DFU and enhance clinical outcomes. Long-term studies with objective vascular measures are warranted to confirm sustained effects. Trial Registry Number: Thai Clinical Trials Registry (TCTR20250701002)
Characterizing potential subtypes and influencing factors of self-directed learning competence among clinical nurses in China by latent profile analysis Zhisheng, Zhang; Mingju, Cai; Ruichu, Zhang; Fang, Wang; Shaona, Liao; Anliu, Nie; Xiangfen, Su
Belitung Nursing Journal Vol. 11 No. 6 (2025): November - December
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4144

Abstract

Background: Nurses demonstrate varying levels of self-directed learning competence, which is influenced by multiple individual and contextual factors. Identifying profiles with varying levels of self-directed learning is essential for providing targeted support and training. However, there is limited research exploring the potential profiles of self-directed learning competence among nurses. Objectives: This study aimed to identify distinct latent profiles of self-directed learning competence among nurses and analyze the influencing factors. Methods: A cross-sectional study design was used. Nurses were recruited using a convenience sampling from four tertiary hospitals in Guangzhou, China, between August 2024 and February 2025. The Self-Directed Learning Competence Scale for Nurses was used to assess the self-directed learning Competence of nurses. Latent profile analysis was performed to identify different potential profiles. Pearson’s chi-square test and multinomial logistic regression were used to explore the factors influencing self-directed learning competence. Results: A total of 740 nurses participated. Three latent profiles of self-directed learning competence were identified: low (n = 356, 48.1%), medium (n = 291, 39.3%), and high (n = 93, 12.5%). The self-directed learning competence of nurses was influenced by various factors, including Junior college and below (OR = 0.555, p= 0.043); Monthly number of night shifts = 3~4 (OR = 2.859, p = 0.029); Learning atmosphere = neutral (OR = 0.342, p  = 0.018) and good (OR = 0.412, p = 0.038); Learning willingness (OR = 1.425, p  <0.001), Difficulty of title promotion = difficult (OR = 2.628, p = 0.029) and Job stress (OR = 0.981, p  <0.001). Conclusion: The study revealed diverse profiles of self-directed learning competence among nurses. Nursing managers should design differentiated strategies based on these profiles. Enhancing organizational support and stimulating learning motivation can help improve nurses’ self-directed learning competence, thereby promoting their professional development and improving the overall quality of clinical nursing care.
Effects of a health literacy program on self-management behaviors of patients with uncontrolled type 2 diabetes in Thailand: A quasi-experimental study Sriklo, Mathaka; Sermsinsiri, Kanchita
Belitung Nursing Journal Vol. 12 No. 1 (2026): January - February
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4156

Abstract

Background: Uncontrolled type 2 diabetes results in major complications that threaten patients’ life. Patients with uncontrolled type 2 diabetes often have inadequate health literacy, making them less motivated to perform self-management behaviors for glycemic control. Earlier health literacy interventions were effective in promoting self-management behaviors and reducing blood glucose, but evidence is lacking for those with uncontrolled type 2 diabetes. Objective: This study aimed to investigate the effect of a health literacy program on self-management behaviors of patients with uncontrolled type 2 diabetes. Methods: This two-group quasi-experimental study with pre-posttest design was done between September 2024 and June 2025. The participants were 64 patients with uncontrolled type 2 diabetes who lived in a community in a province in central Thailand selected using simple random sampling. The experimental group (n= 32) underwent the health literacy program with eight weekly sessions along with usual care while the control group (n = 32) was given usual care only.  Data were collected using a Demographic Data Questionnaire, the Functional, Communicative and Critical Health Literacy Scale, the Self-Management Behavior Scale, and hemoglobin A1C (HbA1C) testing. Data analysis was performed with descriptive statistics, paired t-test and independent t-test. Results: No significant between-group differences were noted in baseline data. At post-test, the experimental group had a significantly higher mean score of overall health literacy (t = 3.720, Cohen’s d = 2.67), functional health literacy (t = 0.399, Cohen’s d = 2.43), communicative health literacy (t = 7.90, Cohen’s d = 1.76), and critical health literacy (t = 12.972, Cohen’s d = 3.14), and self-management behavior (t = 21.862, Cohen’s d = 2.84), and a significantly lower level of HbA1C (t = 3.436, Cohen’s d = -0.82) than before receiving the program and than the control group (all p <0.01). Conclusion: This study offers evidence for the program's efficacy in raising health literacy, which in turn improves self-management behavior and decreases HbA1C in patients with uncontrolled type 2 diabetes. Nurses can incorporate program activities in empowering patients for diabetes control by promoting their ability to seek and comprehend health information, communicate effectively during medical visits, and develop critical thinking abilities on diverse health determinants. Trial Registry Number: Thai Clinical Trials Registry (TCTR20250624001)

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