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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 748 Documents
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Physical function among Thai older adults in urban areas: Structural equation modeling Teeranut Harnirattisai; Sararud Vuthiarpa; Apinya Kochamat
Belitung Nursing Journal Vol. 12 No. 5 (2026): September - October
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4532

Abstract

Background: The world, including Thailand, has become an aged society where maintaining physical function is essential for older adults to live independently. Objectives: This study aimed to explore the factors associated with physical function and analyze the structural model of physical function in Thai older adults in urban areas. Methods:  The structural equation model was developed based on social cognitive theory and a review of relevant literature. The study was conducted between 2020 and 2024. A multistage random sampling method was used for sample selection. The study included 302 older adults who met the inclusion criteria. The instruments used were 1) a demographic questionnaire; 2) the Physical Activity Scale for Elderly (PASE); 3) the Physical functions (Physical Performance Test; PPT and hand grip strength); 4) the Self-Efficacy for Physical Activity Scale (SEPAS); 5) the Outcome Expectations for Physical Activity Scale (OEPAS); 6) ahealth literacy questionnaire; 7) the Thai version of the Mini-Mental State Evaluation (MMSE-Thai 2002); and 8) the Social Support Questionnaire (SSQ). Data were analyzed using descriptive statistics, multivariate multiple regression analysis (MMRA), and structural equation modeling (SEM). Results: Most of the sample (81.5%) were female, and 46.69% were married. Using MMRA, the overall results showed that age and self-efficacy for physical activity predicted both physical activity and physical function. For individual indicators of physical activity, R² ranged from 5.8% (leisure-time) to 12.0% (work-related); for physical function indicators, R² ranged from 7.1% (handgrip) to 13.5% (physical performance). Cognitive ability was significantly associated with physical function (β = 0.15, p < 0.05 for handgrip), whereas its association with physical performance was statistically significant but of negligible practical magnitude (β = 0.03, p = 0.044). In MMRA, age was a significant negative predictor of physical activity across all categories, whereas self-efficacy was a positive predictor of leisure-time activity, not household or work-related activities. In SEM, health literacy showed a significant direct path to physical activity, and physical activity mediated the health literacy–physical function relationship. Conclusion: The findings indicate that health literacy, age, and self-efficacy for physical activity are found related to physical activity and physical function. These factors may inform nursing intervention design. But given the limited explanatory power of the current model, caution should be exercised when applying these findings in clinical practice.
Nursing-led pediatric discharge communication and caregiver-reported counseling evaluation in Vietnam: A convergent mixed-methods study Ranh Thi Nguyen; Nguyen Dinh Pham
Belitung Nursing Journal Vol. 12 No. 5 (2026): September - October
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4640

Abstract

Background: Family-centered pediatric discharge care requires communication that prepares caregivers for home management, yet high-volume hospitals may compress nursing education into brief, task-focused encounters. Objective: To examine nursing-led discharge communication, receipt of structured home-care instructions, caregiver-reported counseling evaluation, and organizational barriers in a tertiary pediatric hospital in Vietnam. Methods: A convergent parallel mixed-methods study was conducted from January to June 2025. The quantitative strand included 196 primary family caregivers recruited consecutively; the qualitative strand comprised 11 in-depth interviews with five caregivers and six nursing staff selected purposively. Multivariable logistic regression examined receipt of structured home-care instructions. HC3-robust linear regression examined the continuous seven-item counseling evaluation score using only predictors external to that scale. Reflexive thematic analysis was used for qualitative data, and the strands were integrated through triangulation, narrative weaving, and a joint display. The dichotomized analysis is presented as an exploratory sensitivity supplement only; the primary interpretation is based on the continuous-score robust linear regression model. Results: All caregivers reported individual counseling, but only 36.2% reported receiving specific home-care instructions. Readmission was associated with receipt of structured instructions (adjusted odds ratio = 6.34, 95% CI [3.24, 12.39], p < 0.001). The seven-item counseling evaluation score showed very high internal consistency (Cronbach’s alpha = 0.984). In the continuous-score model, printed-handout exposure correlated with a lower score (β = -0.511, 95% CI [-0.833, -0.188], p = 0.002), whereas digital-channel access was associated with a higher score (β = 0.431, 95% CI [0.006, 0.856], p = 0.047). Qualitative findings identified time pressure, fragmented responsibility, limited comprehension checking, and a gap between supportive interactions and effective discharge preparation. Conclusion: Nursing-led discharge contact was nearly universal, but structured home-care instruction was inconsistent and appeared selectively prioritized. Standardized, risk-sensitive discharge education should guarantee core instructions, embed written and digital materials within interactive teaching, and verify caregiver understanding. The counseling evaluation score reflects perceived counseling quality rather than objectively verified home-care competence.
Health literacy and self-efficacy as predictors of self-care behaviors in patients with hematological malignancies: A multicenter cross-sectional study in northeastern Thailand Ueamporn Summart; Monthida Sangruangake; Chanathip Halak; Phawadee Thongnopkhun Toyn
Belitung Nursing Journal Vol. 12 No. 5 (2026): September - October
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4641

Abstract

Background: Self-care is vital for patients with hematological malignancies (HMs) to manage the severe side effects of chemotherapy. While social support is a traditional focus of care, internal psychological resources may be more critical for sustaining treatment adherence in isolated therapeutic settings. Objective: To determine the prevalence of self-care behaviors and evaluate the extent to which health literacy and self-efficacy predict these behaviors among patients with HMs in northeastern Thailand. Methods: This multicenter, cross-sectional study, conducted from August to December 2025, utilized convenience sampling to recruit 350 patients with HMs from three tertiary hospitals in northeastern Thailand. Data were collected via self-administered questionnaires and analyzed using descriptive statistics and binary logistic regression. The predictive model’s performance was evaluated using the Area Under the Curve (AUC), with significance set at p < 0.05. Results: The prevalence of high self-care behaviors was 61.2% (95% CI = 55.8-66.3). Bivariable analysis showed that social support was initially associated with higher self-care. However, binary logistic regression identified only health literacy (AOR = 18.05, 95% CI = 14.40-20.10) and self-efficacy (AOR = 10.79, 95%CI = 5.70-11.40) as significant independent predictors. Social support did not remain a significant predictor in the final model. The model exhibited excellent discriminant ability with an AUC of 0.86 (95% CI = 0.78-0.91, p < 0.001). Conclusion: High self-care behaviors are common among patients with HMs in northeastern Thailand. Our results show that internal factors, specifically health literacy and self-efficacy, are stronger predictors of self-care than external social support in this treatment-intensive context. These findings underscore the need for oncology nurses to screen for both health literacy and self-efficacy during clinical assessments, enabling early identification of at-risk patients and delivery of targeted interventions to promote effective self-management.
Relationships of gender, duration of living in a foster home, resilience, intimacy of friendship, prosocial behavior, and perceived stigmatization with depression among adolescents in foster homes in Thailand: A correlational study Nutnicha Chayarathee; Patcharin Nintachan; Sopin Sangon
Belitung Nursing Journal Vol. 12 No. 5 (2026): September - October
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4642

Abstract

Background: Adolescents in foster homes encounter difficulties adjusting to new environments and managing life transitions. The separation from their families often results in emotional distress, which may increase their susceptibility to depression. Objective: This descriptive correlational study examined relationships of gender, duration of living in a foster home, resilience, intimacy of friendship, prosocial behavior, and perceived stigmatization with depression among adolescents in foster homes. Methods: Purposive sampling was used to recruit 224 adolescents from two foster homes situated in Bangkok and its surrounding regions. Data were collected from August to December 2023 using a general information questionnaire, the Center for Epidemiologic Studies Depression Scale, the Resilience Inventory, the Friendship Intimacy Scale, the Strengths and Difficulties Questionnaire (as Part of the Assessment of Prosocial Behavior), and the Perceived Stigmatization Questionnaire. Data analysis was conducted using Spearman’s rank correlation. Results: 32.14% of the adolescents reported experiencing depression. Approximately 70.09% of participants were female. Participants were aged 10 to 24 (Mean = 14.29, SD = 3.04). The mean resilience score was 100.87 (SD = 14.48), the mean intimacy of friendship score was 41.54 (SD = 8.77), the mean prosocial behavior score was 6.25 (SD = 1.78), and the mean perceived stigmatization score was 16.50 (SD = 6.23). Gender was significantly correlated with depression (rpb= -0.232, p < 0.001, 95% CI [-0.36, -0.07]). Females reported higher depression scores than males. The duration of living in a foster home, resilience, and the intimacy of friendship showed significant negative monotonic correlations with depression, with correlation coefficients of rs = -0.133 (p < 0.05, 95% CI [-0.27, -0.02]), rs = -0.320 (p < 0.01, 95% CI [-0.44, -0.19]), and rs = -0.150 (p < 0.05, 95% CI [-0.29, -0.01]), respectively. In contrast, perceived stigmatization showed a significant positive monotonic correlation with depression (rs = 0.250, p < 0.01, 95% CI [0.11, 0.36]). Additionally, there was no significant correlation between prosocial behavior and depression. Conclusion: Being female, shorter duration of living in a foster home, less resilience, less intimacy of friendship, and higher perceived stigmatization are related to higher depression in adolescents in foster homes. These results provided information for psychiatric and mental health nurses in planning care to prevent or reduce depression for this vulnerable group of adolescents.
Aesthetic expressions of caring for older persons living in the community among undergraduate nursing students in Thailand: A hermeneutic phenomenological study Busara Muensri; Waraporn Kongsuwan; Feni Betriana
Belitung Nursing Journal Vol. 12 No. 5 (2026): September - October
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4649

Abstract

Background: Caring for older persons has become a vital aspect of community life in an aging society. In this regard, nursing schools are challenged to prepare nursing students for this task. While caring for older persons in the nursing practicum course has been described in the literature, studies describing the experiences of nursing students in caring for older persons in a community or home, particularly in Thailand, are lacking. Understanding the experiences of nursing students is crucial for providing effective teaching and learning methods. Objective: To describe nursing students’ experiences of caring for older persons in a community setting, illuminating these experiences through aesthetic expressions. Methods: Hermeneutic phenomenology underpinning Gadamer’s philosophy was used. The study employed purposive sampling, with participants recruited through a class leader, and included eleven third-year undergraduate nursing students. Those students enrolled in the Geriatric Nursing Practicum course and practiced caring for older people in a community setting during their second year of the nursing program. Data were collected through drawings and individual semi-structured interviews. Data were collected from November 2023 to January 2024. Drawings and interviews were analyzed using Kongsuwan’s interpretive method within a hermeneutic framework. Lincoln and Guba’s criteria were followed to maintain the trustworthiness of the study. Findings: Six thematic categories were identified: 1) building intergenerational relationships as grandchildren–grandparents; 2) understanding the nature and individuality of the older person; 3) collaborating in care rooted in love and happiness; 4) navigating the complexities of caregiving; 5) enhancing motivation and attitudes toward care for older persons; and 6) mutual learning and enrichment. Conclusion: Findings demonstrated that caring for older persons experienced by nursing students is not only a course requirement, but a meaningful experience that promotes relationships, value-based learning, and emotional growth. For nursing education, findings highlight the importance of learning experiences and provide opportunities for students to develop relationships with older persons in a holistic, human-centered care. Aesthetic teaching strategies, including storytelling and drawing, may further support learning outcomes and foster empathy, dignity, and relational understanding. In community nursing practice, findings may inform deeper understanding of caring for older persons in the community, which suggests directions for continued research.
Joint modeling approaches for predicting conversion from mild cognitive impairment to Alzheimer’s disease: A systematic review (1999-2025) Abderazzak Mouiha; Mohammed Masrour; M. Mustapha Zarrouk; Abdelatif Hafid
Belitung Nursing Journal Vol. 12 No. 5 (2026): September - October
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4651

Abstract

Background: Mild cognitive impairment (MCI) is a critical transition stage toward Alzheimer’s disease (AD). While standard longitudinal and survival methods evaluate disease progression separately, joint modeling handles their complex interdependencies. However, no systematic review has exclusively evaluated joint modeling for predicting MCI-to-AD conversion. Objectives: To examine existing joint modeling approaches used to predict Alzheimer’s disease progression, with particular attention to modeling strategies, data sources, biomarkers, and methodological limitations. Methods: Scopus, Web of Science, and PubMed were searched from January 1999 to March 18, 2025. A total of 1614 records were identified, of which 891 duplicates were removed. After screening and assessing eligibility, 32 studies were included. Study selection was conducted in accordance with the PRISMA 2020 guidelines. The methodological quality of the included studies was assessed using a structured five-question quality assessment framework developed for this review. Eligible studies were original, peer-reviewed articles in English applying joint modeling for AD progression. A structured narrative synthesis was performed based on predefined categories, including modeling methodologies, data sources, biomarkers, and methodological limitations. Results: Among the 32 included studies, 50% (16/32) used a linear mixed-effects model combined with a Cox Proportional Hazards model, making this the most common approach. Most studies (60.5%, 20/32) used data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). The limited use of independent external cohorts was identified as a major constraint affecting the generalizability of the reported findings. Conclusion: This review provides a structured synthesis of joint modeling approaches for predicting AD progression and highlights key methodological gaps, particularly in MCI. Despite their growing use and methodological advantages, limited external validation restricts the generalizability of current findings. Clinically, joint modeling can help nurses stratify risk early, improve monitoring, and personalize care for patients at risk of Alzheimer’s disease. Dynamic, individualized predictions can guide cognitive assessment timing, prompt specialist referrals, inform caregiver education, and support proactive management and disease prevention.  Registry:  PROSPERO [CRD420261300219]
Predictors of nursing students’ satisfaction with the clinical learning environment in Kosovo: A multivariate analysis using the Clinical Learning Environment, Supervision and Nurse Teacher framework Musa Oruqi; Elizana Petrela; Hasan Gashi
Belitung Nursing Journal Vol. 12 No. 5 (2026): September - October
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4656

Abstract

Background: A supportive clinical learning environment is essential in nursing education; however, evidence regarding predictors of student satisfaction in Southeast European higher education contexts remains limited. Objective: To identify demographic and item-level CLES+T predictors of nursing students’ overall satisfaction with the clinical learning environment in Kosovo. Methods: A cross-sectional study was conducted between April and May 2025 among 300 undergraduate nursing students. Data were collected using the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) scale, while overall student satisfaction was assessed using a separate single-item measure. Data were analyzed using descriptive statistics, non-parametric tests, and multiple linear regression analyses. The primary demographic model included sex, year of study, and economic status, while a second model included all 34 CLES+T items simultaneously. Results: The demographic model was statistically significant, F(4, 295) = 35.894, p < 0.001, explaining 32.7% of the variance in satisfaction (R² = 0.327; adjusted R² = 0.318). Compared with first-year students, second- and third-year students reported significantly lower satisfaction, while sex and Economic Status were not significant predictors. The CLES+T item-level model was statistically significant, F(34, 265) = 18.319, p < 0.001, explaining 70.2% of the variance (R² = 0.702; adjusted R² = 0.663). The strongest positive predictors were positive joint meetings with the mentor and nurse teacher (β = 0.415), feeling comfortable going to the ward at the start of the shift (β = 0.335), and sufficient meaningful learning situations (β = 0.249). Because several item-level predictors showed elevated multicollinearity, individual coefficients, particularly negative coefficients, should be interpreted cautiously. Conclusion: Nursing students’ satisfaction was associated with both academic year and specific relational, supervisory, and pedagogical characteristics of the clinical learning environment. Supportive mentorship, meaningful learning opportunities, and effective integration of theory and practice remain important components of positive clinical learning experiences.
Factors associated with mental well-being: the role of relational quality among Moroccan nursing students: A cross-sectional study Nissrine Harrafa; Bouchra Berrada; Dounia Benammi; Samira Jaouhar; Oussama Rharib; Majida Mramel; Ibtissam Ouahidi
Belitung Nursing Journal Vol. 12 No. 5 (2026): September - October
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4665

Abstract

Background: Mental well-being is a major public health concern worldwide and is attracting increasing interest, particularly among young university students facing multiple constraints. Objective: This research aimed to investigate how the quality of interpersonal relationships relates to mental well-being among students at high institutes of nursing and health technology in the Fes-Meknes region of Morocco. Methods: This cross-sectional analytical study was conducted from February to June 2023. Data were collected using a self-administered questionnaire distributed to all eligible undergraduate nursing students at institutions in the region; a final sample of 489 participants who provided complete responses was included in the analysis. Bivariate analysis used t-tests for independent samples, one-way ANOVA, and Pearson’s correlation coefficient. Multiple linear regression was used for multivariate analysis. Results: The survey reveals an average level of mental well-being, with a mean score of 38.17 ± 13.16, and an overall relationship quality score with a mean of 25.72 ± 8.020. Family relationship quality, teacher relationship quality, and peer relationship quality were each significantly and positively associated with mental well-being (B = 1.026, 95% CI [0.74, 1.30], p < 0.01; B = 1.194, 95% CI [0.90, 1.48], p < 0.01; B = 0.630, 95% CI [0.34, 0.91], p < 0.01, respectively). The regression model was statistically significant (F (7, 481) = 38.360, p < 0.01). The adjusted R² of 0.35 indicates that 35% of the variance in mental well-being is explained by the included factors. Among these variables, the quality of relationships with teachers showed a notable association, followed by the quality of family relationships and peer relationships. Conclusion: These results demonstrate that student mental well-being is associated with the quality of family relationships and relationships within the educational environment. It is therefore essential to encourage the development of interpersonal skills to promote the mental health of nursing students and university students in general.
Levels of stress and depression among patients with type 1 and type 2 diabetes mellitus in primary care in Kosovo: A cross-sectional study Elvana Podvorica; Edmond Zaimi; Elizana Petrela; Musa Oruqi
Belitung Nursing Journal Vol. 12 No. 5 (2026): September - October
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4667

Abstract

Background: Psychological distress, including stress and depressive symptoms, is common among people with diabetes and may negatively influence self-management and clinical outcomes in primary care settings. Objective: To assess and compare levels of perceived stress and depression among patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Methods: This cross-sectional study included 297 patients with diabetes recruited using convenience sampling from eight primary care centers in Prishtina, Kosovo, between March 2025 and August 2025. Perceived stress was measured using the Perceived Stress Scale (PSS), while depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Demographic characteristics and selected clinical parameters, including waist circumference and systolic and diastolic blood pressure, were obtained from medical records. Categorical and continuous variables were analyzed using chi-square and Mann–Whitney U tests, with Cramér’s V measuring categorical effect size. Statistical significance was set at p < 0.05. Results: Patients with type 1 diabetes mellitus (T1DM) were significantly younger than patients with type 2 diabetes mellitus (T2DM). Exploratory item-level analysis of perceived stress did not demonstrate consistent differences between the groups; however, interpretation of stress-related findings should be approached cautiously due to the low internal consistency of the PSS in the present sample. Depressive symptom severity differed significantly between groups (p = 0.005, Cramér’s V = 0.224). Conclusion: Significant differences were observed in depressive symptom severity between patients with T1DM and T2DM, whereas interpretation of perceived stress findings remains limited. Although these findings support the importance of psychological assessment in diabetes care, they should be interpreted cautiously given the cross-sectional design and methodological limitations of the study. Healthcare professionals, including physicians and nurses,  should routinely screen for depression in diabetes care and provide appropriate follow-up or referral based on symptom severity.
Factors associated with self-management behavior among pregnant women with diet-controlled gestational diabetes mellitus in China: A cross-sectional study Jiali Xu; Tatirat Tachasuksri; Punyarat Lapvongwatana
Belitung Nursing Journal Vol. 12 No. 5 (2026): September - October
Publisher : Belitung Raya Publisher - Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.4683

Abstract

Background: Gestational diabetes mellitus (GDM) poses escalating global health threats, particularly in China, with significant maternal-fetal health risks. Effective self-management is crucial to mitigate adverse maternal-neonatal outcomes. Objective: The aim of this study was to describe the status of self-management behavior and its associated factors in pregnant women with diet-controlled GDM. Methods: A cross-sectional study recruited 160 pregnant women with diet-controlled GDM from the antenatal clinic of the Second Affiliated Hospital of Wenzhou Medical University from August to October 2024. Eligible participants were identified in the hospital’s antenatal registration system and selected using simple random sampling based on assigned queue numbers. Data were collected through self-administered questionnaires assessing SMB, GDM knowledge, illness perception, self-efficacy, social support, and perception of care received. Data were analyzed using SPSS 27.0 with hierarchical multiple regression analysis. Results: A moderate level of SMB was observed in 45.6% of the participants (n = 73). Scores for exercise (M = 13.60, SD = 5.60) and glucose monitoring (M = 11.86, SD = 4.32) ranked lowest among SMB domains. The final hierarchical multiple regression model explained 60.6% of the variance in SMB among pregnant women with GDM (R² = 0.606, F(6,153) = 39.28, p < 0.001). Significant factors associated with SMB included GDM knowledge (β = 0.296, 95% CI: 0.869 to 2.161, p < 0.001), social support (β = 0.252, 95% CI: 0.455 to 1.358, p < 0.001), illness perception (β = 0.188, 95% CI: 0.137 to 0.635, p = 0.003), self-efficacy (β = 0.183, 95% CI: 0.086 to 0.499, p = 0.006), and pregnancy-related anxiety (β = -0.188, 95% CI: -1.187 to -0.286, p = 0.002). Perception of care received was not significantly associated with SMB (β = 0.033, 95% CI: -0.303 to 0.579, p = 0.537). Conclusion: These findings identify potential correlates for further nursing interventions, suggesting that tailored, culturally sensitive education, family-centered support, and multidisciplinary care may be beneficial in supporting SMB. Such efforts should prioritize reducing anxiety while fostering knowledge, self-efficacy, and social support.

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