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Rifky Octavia Pradipta
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Critical Medical and Surgical Nursing Journal
Published by Universitas Airlangga
ISSN : 23551992     EISSN : 2656470X     DOI : 10.20473/cmsnj
Core Subject : Health,
Health Professions Nursing
Critical Medical and Surgical Nursing Journal (CMSNJ) (p-ISSN: 2355-1992), (e-ISSN: 2656-470X) was established at the end of 2012 under Universitas Airlangga. The CMSNJ was prepared in response to the development of nursing/health science and technology to contribute to the development of sustainable quality nursing/health resources. CMSNJ is published two times per year every April and October. Articles published in CMSNJ is written in English since Vol. 10 No. 1 April 2021. Contributors for CMSNJ are researchers, lecturers, students, nurse, registered nurse in Indonesia and worldwide.
Arjuna Subject : Keperawatan - Critical Care
Articles 139 Documents
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Effectiveness of Balloon Blowing Exercise on Oxygen Saturation in COPD Patients: A Pre-Experimental Study Wahyuni, Lutfi; Ramadina, Rizma Dwi; Utami, Hevi Febriari Atika
Critical Medical and Surgical Nursing Journal Vol. 15 No. 1 (2026): APRIL 2026
Publisher : Universitas Airlangga

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Abstract

Introduction: develop hypoxemia and hypercapnia as a result of weakening respiratory muscles. This reduces the oxygen saturation in the bodies of COPD patients. Balloon blowing exercise can improve oxygen transport, aid patients prolong exhalation, and promote healthy lung development, hence increasing oxygen saturation. The goal of this study was to assess the impact of balloon blowing exercise on oxygen saturation in COPD patients. Method: The research method used was pre-experimental with one group pre-post test design. Respondents used were 127 COPD patients through consecutive sampling technique. The instruments used were pulse oximetry and observation sheet. The intervention was carried out routinely 10 minutes per day for 4 weeks. Results: Of the 127 COPD patients, only 2 people did not experience an increase in oxygen saturation after the intervention. The results of the Wilcoxon statistical test obtained a p-value of 0.000. Conclusions: The results showed that balloon blowing exercise is effective in increasing oxygen saturation in COPD patients.
Effect of Combined Warm Salt Water Foot Soak and Murottal Qur’an Therapy on Pain Levels in Gouty Arthritis: A Pre-Experimental Study Isnaini Fidyatus Sa’adah; Virgianti Nur Faridah; Rizky Asta Pramestirini
Critical Medical and Surgical Nursing Journal Vol. 15 No. 1 (2026): APRIL 2026
Publisher : Universitas Airlangga

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Abstract

Introduction: Joint pain is a common complaint among adults and the older adults. Pain caused by gouty arthritis can be managed through both pharmacological and non-pharmacological approaches, including warm saltwater foot soak therapy and listening to Murottal Qur’an. This study aimed to investigate the effect of warm saltwater foot soak therapy combined with murottal Qur’an on pain levels in patients with gouty arthritis. Method: This study employed a pre-experimental one-group pretest-posttest design. The population consisted of 40 older adults with gouty arthritis who participated in the Integrated Health Development Post for Non-Communicable Diseases (Posbindu PTM) in a village in Indonesia. Total sampling was applied, and all respondents received a combined intervention of warm saltwater foot soaks and murottal Qur’an theraphy. Pain data were collected using the Numeric Rating Scale (NRS), observation sheet, and standard operating procedures (SOPs). Data were analyzed descriptively using minimum-maximum values, means, and percentages, followed by Wilcoxon signed-rank test with a significance level of 0.05. Results: Befor the intervention, most respondents (67.5%) experienced moderate pain (pain scale 4–6), with an mean pain score of 4.58 and a pain scale range of 2-8. After the intervention, the majority of respondents (90%) showed improvement, with pain levels decreasing to mild pain (pain scale 1–3), a mean pain score of 2.05, and a pain scale range of 1–4. The mean difference between pre- and post-intervention pain scores was 2.53. Furthermore, statistical analysis showed a significant difference in pain scores before and after the intervention (p < 0.05). Conclusions: Despite the limitations of the pre-experimental design, the findings suggest that the combination of warm saltwater foot soak and murottal Qur’an therapy may help reduce pain levels in patients with gouty arthritis. Further studies using randomized experimental designs are recommended to confirm the effectiveness of this combined theraphy.
Nursing Interventions to Improve Quality of Life in Palliative Cancer Care Patients: A Scoping Review Nuzulullail, Agung Subakti; Puspitasari, Halfie Zaqiyah Gusti; Deli, Dwina Oktavia; Irawan, Dana Prayoga
Critical Medical and Surgical Nursing Journal Vol. 15 No. 1 (2026): APRIL 2026
Publisher : Universitas Airlangga

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Abstract

Introduction: In the last few decades, Quality of Life (QoL) in palliative cancer patients has become an important aspect to consider. Nurses play a crucial role in improving QoL through nursing interventions. However, reviews on the variety of nursing interventions to improve QoL in palliative cancer patients have not been widely conducted. This scoping review aims to identify findings related to nursing interventions and palliative care outcomes for cancer with cancer. Method: The scoping review was conducted through PubMed, ScienceDirect, ProQuest, and EBSCOhost. The Arksey and O’Malley framework was used to address the research question: “What nursing interventions are implemented to improve the QoL of palliative care cancer patients?” Study selection is based on the PRISMA-ScR 2020 guidelines with the scheme P: palliative cancer patients, I: nursing interventions, C: no intervention, and O: improvement in quality of life. The inclusion criteria were original articles published between 2020 and 2025, Randomized Controlled Trials (RCTs), quasi-experimental, and cohort studies. Review articles, protocols, commentaries, and books were excluded. Quality assessment was conducted using the JBI Critical Appraisal tool Results: From 990 records, 8 articles met the criteria. Nursing interventions included education, emotional and spiritual support, mediation, decision-making, nursing planning, nutritional support, comfort care, complementary therapy, and community service coordination. Improvements in QoL were observed in symptom reduction, social support, psychological, information, patient independence, and care satisfaction. Conclusions: Nursing interventions are crucial for improving the QoL of palliative cancer patients. Future research should test nursing interventions in palliative cancer patients, considering culture, special groups, and community services.
Application of The Chin Tuck Against Resistance (CTAR) Exercise to Improve Swallowing Function as Clinical Observation in Stroke Patients With Dysphagia: Case Report Aulia Salsabilla
Critical Medical and Surgical Nursing Journal Vol. 15 No. 2 (2026): JUNE 2026
Publisher : Universitas Airlangga

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Introduction: Dysphagia (difficulty swallowing) is a common condition after a stroke due to the impairment of swallowing muscles. Managing dysphagia plays a crucial role in helping patients meet their nutritional needs through oral intake. Therapeutic exercises that stimulate and strengthen the muscles involved in swallowing are highly recommended for dysphagia rehabilitation, one of which is the Chin Tuck Against Resistance (CTAR) exercise. This case study aims to provide an analysis of nursing care for post-stroke patients with the application of CTAR intervention to improve swallowing ability as clinical observation. Method: The CTAR therapy was carried out over five consecutive days, with two sessions per day, each lasting 15 to 30 minutes. Improvement in swallowing ability was observed in patients with dysphagia after five days of Chin Tuck Against Resistance (CTAR) therapy, with GUSS scores increasing from 12 to 15 in one patient and from 15 to 17 in another and FOIS levels improving from level 3 to 5 in one patient and 5 to 6 in another. Results: Both patients demonstrated improvement in swallowing function following CTAR therapy; however, the timing of improvement differed between cases. Patient 2 showed earlier improvement in GUSS and FOIS scores beginning on Day 4, whereas Patient 1 demonstrated more gradual improvement, with notable increases observed on Day 5. Conclusions: Therefore, this therapy can be considered effective as part of nursing interventions for dysphagia in stroke patients. Further research with larger sample sizes and comparative designs is needed to strengthen the evidence of CTAR’s effectiveness.
The Effect Of Benson Relaxation On Sleep Quality Among Chronic Kidney Disease Patients Undergoing Hemodialisis Wiwit Nor Hidayati; Hepta Nur Anugrahini; Supriyanto Supriyanto; Siswari Yuniarti
Critical Medical and Surgical Nursing Journal Vol. 15 No. 2 (2026): JUNE 2026
Publisher : Universitas Airlangga

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Abstract

Introduction: Patients with chronic kidney disease (CKD) receiving hemodialysis often suffer from sleep disruptions arising from physiological alterations, emotional strain, and recurring treatment sessions. Such disruptions, if unaddressed, diminish patients' overall life satisfaction. This study aimed to determine the effect of Benson relaxation technique on sleep quality among chronic kidney disease (CKD) patients undergoing hemodialysis. Method: This study used a pre-experimental one-group pretest-posttest design. A total of 34 CKD patients undergoing routine hemodialysis were recruited using purposive sampling based on predefined inclusion and exclusion criteria. Benson relaxation was implemented twice weekly for four weeks during hemodialysis sessions. Each session lasted approximately 15 minutes and consisted of deep breathing exercises, repetition of a calming phrase, and passive relaxation until participants reported a subjective feeling of relaxation. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using the McNemar test after categorizing PSQI scores into good and poor sleep quality categories based on the established cutoff score. Results: Pre-intervention assessments revealed universal poor sleep quality across participants. After the intervention, several participants transitioned from poor to good sleep quality. Statistical analysis via McNemar test showed a statistically significant difference in sleep quality categories after the intervention (p < 0.001). Conclusions: Benson relaxation may be considered a complementary nursing intervention that has the potential to improve sleep quality among CKD patients undergoing hemodialysis.
Concept Analysis of Nursing Triage Accuracy Using the Emergency Severity Index: A Walker and Avant Approach Ni Luh Putu Inca Buntari Agustini; Santika Wiadnyana; I Gusti Lanang Suta Jayendra; I Putu Purnamayasa; Ni Made Sari Utami; Putri Dewi Utari; Ni Wayan Sukerti; Ni Luh Dwi Indrayani; I Gede Putu Darma Suyasa
Critical Medical and Surgical Nursing Journal Vol. 15 No. 2 (2026): JUNE 2026
Publisher : Universitas Airlangga

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Introduction: Emergency nursing triage requires accurate and consistent decision-making to ensure patient safety and appropriate care prioritization. The Emergency Severity Index (ESI) is widely used as a five-level triage framework; however, conceptual ambiguity remains regarding nursing triage accuracy in its application. This study aimed to analyze the concept of nursing triage accuracy using ESI through Walker and Avant’s concept analysis method. Method: This study used Walker and Avant’s concept analysis approach. Literature from PubMed and ScienceDirect published between 2020 and 2025 was reviewed to identify concept uses, defining attributes, antecedents, consequences, empirical referents, and illustrative cases. Results: Nursing triage accuracy using ESI was identified as a multidimensional concept. Its defining attributes include clinical judgment, consistency in decision-making, accurate patient prioritization, reliability of clinical decisions, and patient safety-oriented decision-making. Key antecedents include nurses’ competence, emergency nursing experience, ESI training, standard operating procedures, adequate facilities, and healthcare system support. Consequences include improved patient safety, reduced undertriage and overtriage, shorter waiting times, efficient resource allocation, and improved emergency nursing care quality. Conclusions: Nursing triage accuracy using ESI is defined as the nurse’s ability to make accurate, consistent, reliable, and patient safety-oriented triage decisions by assessing patient acuity, recognizing clinical urgency, and prioritizing care appropriately within the ESI framework.
Predictors and HbA1c Profiles in Diabetes Mellitus Patients With and Without Diabetic Foot Ulcer Complications: A Retrospective Approach Gustiasih Gustiasih; Wawan Ramdani; Dwi Prihatingish
Critical Medical and Surgical Nursing Journal Vol. 15 No. 2 (2026): JUNE 2026
Publisher : Universitas Airlangga

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Introduction Diabetes mellitus (DM) is a chronic metabolic disorder frequently complicated by diabetic foot ulcers (DFUs), a leading cause of morbidity and limb amputation. Glycated hemoglobin (HbA1c) is the gold-standard biomarker for long-term glycemic control and is closely linked to DFU risk. This study aimed to compare HbA1c levels between DM patients with and without DFUs and to examined the association of selected sociodemographic characteristics  with HbA1c levels in each group. Method: This retrospective case-control study analyzed hospital electronic medical records of 311 hospitalized patients with DM between January 2023 and December 2024, including 116 patients with DFUs and 195 without DFUs. HbA1c levels, age, sex, and marital status were extracted and analyzed using the Mann-Whitney U test. and Spearman’s rank correlation, with statistical significance set at p < 0.05. Results: Patients with DFU demonstrated significantly lower HbA1c levels (9.20 ± 2.83; p = 0.014) than patients without DFU (10.09 ± 3.02) (p < 0.001). Age was significantly associated with HbA1c levels in the control group (p = 0.001), whereas no significant association was observed in the case group. Marital status showed a significant association in the case group (p = 0.004), while sex was not significantly associated with HbA1c in either group. Conclusions: Hospitalized patients with DFU exhibited lower HbA1c levels than those without DFUs, suggesting that HbA1c measured during hospitalization may reflect the clinical context rather than pre-ulcer glycemic status. Therefore, HbA1c should be interpreted alongside clinical and sociodemographic factors, particularly age and marital status, when assessing patients with DFUs. Future prospective studies incorporating longitudinal HbA1c measurements and comprehensive clinical variables are recommended to clarify the relationship between glycemic control and DFU development
Clinical Factors Associated With Mortality Among Burn Patients: A Retrospective Observational Cohort Study Merina Widyastuti; Natasya Aurelya Putri; Sri Anik Rustini; Sifira Kristiningrum
Critical Medical and Surgical Nursing Journal Vol. 15 No. 2 (2026): JUNE 2026
Publisher : Universitas Airlangga

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Introduction: Burn injuries are a medical emergency requiring prompt treatment in the early phase to prevent complications and death. This study analyzes the relationship between hospital arrival time, inhalation injury, burn etiology, and mortality rates in burn patients. Method: This study employed an observational analytic design with a retrospective observational cohort study for the period from January 2023 to December 2025. The study population consisted of patients with burn injuries treated in the emergency department. Based on medical records, 77 patients were selected using total sampling. Data were analyzed using the chi-square test and the Mann-Whitney U test. Results: The analysis revealed a significant association between inhalation trauma and burn etiology with mortality, both at p = 0.003. Conversely, the timing of patient arrival at the emergency department did not show a statistically significant association with patient outcomes (p=0.690). Conclusions: Mortality among burn patients was significantly associated with inhalation trauma and burn etiology. Time to emergency department arrival showed no significant effect. Clinical management should prioritize early detection of inhalation injury and etiology-specific interventions to reduce mortality.
The Effect of a Web-Based Energy Conservation Intervention on Fatigue Scores Among Patients With Heart Failure Tasya Putri Aulia; Siti Wasliyah
Critical Medical and Surgical Nursing Journal Vol. 15 No. 2 (2026): JUNE 2026
Publisher : Universitas Airlangga

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Introduction: Heart failure is commonly associated with fatigue, which negatively affects physical functioning and quality of life. Website-based energy conservation education may improve access to educational resources and support fatigue management. This study evaluated the effect of website-based energy conservation education on fatigue among patients with heart failure. Method: A quasi-experimental study with a pre-test–post-test control group design was conducted in a secondary healthcare setting. Thirty-six patients with heart failure were recruited using consecutive sampling and allocated to an intervention group (n = 18) or a control group (n = 18). The intervention group received website-based energy conservation education, whereas the control group received leaflet-based education. Fatigue was assessed using the Fatigue Assessment Scale (FAS). Data were analyzed using paired and independent t-tests with a significance level of p < 0.05. Results: The mean fatigue score in the intervention group significantly decreased from 29.44 to 22.78 after the intervention (mean difference = 6.67; 95% CI: 6.25–7.08; paired t-test, p < 0.001). The control group also demonstrated a statistically significant reduction (mean difference = 0.39; 95% CI: 0.09–0.69; paired t-test, p = 0.015), although the improvement was substantially smaller. Independent t-test analysis showed a significant difference in post-intervention fatigue scores between the two groups (p < 0.001). Conclusions: Website-based energy conservation education was more effective than leaflet-based education in reducing fatigue among patients with heart failure. This intervention may serve as a practical nursing strategy to support fatigue management in this population.

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