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Journal of Applied Nursing and Health
Published by Lembaga Chakra Brahmanda Lentera
ISSN : 26671609     EISSN : 28093208     DOI : 10.55018
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Chemistry Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Veterinary
Journal of Applied Nursing and Health (JANH) (Prefix DOI: 10.55018) has published its first volume with p-ISSN: 2657-1609 (SK LIPI: 0005.26571609/JI.3.1/SK.ISSN/2019.05) in 2019 and e-ISSN: 2809-3208 (SK LIPI 005.28093208/K.4/SK.ISSN/2021.12) in 2021. JANH is a health journal that publishes scientific papers for nurses, health academics, and other health practitioners. This journal is published regularly in June and December every year. The Journal of Applied Nursing and Health (JANH) is a peer-reviewed scientific journal. JANH hopes to be able to contribute to increasing evidence-based knowledge in the realm of nursing and health, JANH hopes to be useful and used by the community to improve a better quality of life which in turn has the potential and impact on the advancement of knowledge in nursing and health practice. All JANH papers have a solid, critical, and scientifically sound scientific, evidence, theoretical or philosophical basis in their approach.
Arjuna Subject : Profesi Kesehatan - Profesi Kesehatan (Lain-Lain)
Articles 379 Documents
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The Role of Self-Esteem, Family Relationships, and Social Support With Mental Health Among High School Adolescents: A Cross-Sectional Study Arianti, Diana; Sari, Yuli Permata; Sanusi, Ihsan; Ulva, Fadillah; Ifayanti, Titin
Journal of Applied Nursing and Health Vol. 8 No. 2 (2026): Journal of Applied Nursing and Health
Publisher : Chakra Brahmanda Lentera Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55018/janh.v8i2.663

Abstract

Background: Adolescent mental health has become a major public health concern worldwide. Although self-esteem, family relationships, and social support are recognized as important psychosocial protective factors, evidence regarding their combined contribution to adolescent mental health in the Indonesian context remains limited. This study aimed to examine the associations of self-esteem, family relationships, and social support with mental health among high school adolescents. Methods: This cross-sectional study was conducted among 146 high school students aged 15–18 years in Padang, West Sumatra, Indonesia, and reported in accordance with the STROBE guidelines. Participants were selected using simple random sampling. Self-esteem, family relationships, social support, and mental health were assessed using the Rosenberg Self-Esteem Scale (RSES), Family Adaptability and Cohesion Evaluation Scale IV (FACES-IV), Multidimensional Scale of Perceived Social Support (MSPSS), and General Health Questionnaire-12 (GHQ-12). Data were analyzed using descriptive statistics, chi-square tests, and multivariable ordinal logistic regression, with adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) reported to identify factors associated with adolescent mental health. Results: Bivariate analysis indicated that gender, self-esteem, family dynamics, and social support were significantly correlated with adolescent mental health (all p < 0.05). In the multivariable ordinal logistic regression model, adolescents with low self-esteem had significantly lower odds of being in a higher mental health category compared to those with high self-esteem (AOR = 0.00004; 95% CI: 0.000001–0.002; p < 0.001). Similarly, adolescents with weak family ties had reduced chances of improved mental health compared to those with strong family ties (AOR = 0.0002; 95% CI: 0.000005–0.007; p < 0.001). Gender continued to show a significant association with adolescent mental health (AOR = 82.43; 95% CI: 3.63–1877.76; p = 0.006), while social support lost its significance after adjustment. Conclusion: Self-esteem, family relationships, and social support were significantly associated with adolescent mental health. Although they were not independent predictors in the multivariate model, these factors remain important psychosocial resources. Mental health promotion programs should target multiple psychosocial domains simultaneously, particularly within school and family environments.
Effectiveness of Tafakur Prayer Spiritual Therapy on Psychological, Spiritual Well-Being, and Pain In Cancer Patients: A Randomized Trial Priyanto, Priyanto; Susilo, Eko; Aini, Faridah; Ariani, Yulia Eka; Jannah, Luluk Nur
Journal of Applied Nursing and Health Vol. 8 No. 2 (2026): Journal of Applied Nursing and Health
Publisher : Chakra Brahmanda Lentera Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55018/janh.v8i2.665

Abstract

Background: Despite growing evidence supporting spiritual interventions in cancer care, limited randomized controlled trials have examined the effectiveness of the culturally adapted Tafakur Prayer Spiritual Therapy (TPST). Therefore, this study aimed to evaluate its effectiveness on psychological well-being, spiritual well-being, and pain among hospitalized cancer patients. Methods: A single-masked randomized controlled trial, strictly guided by the CONSORT framework, was conducted. Forty-two hospitalized cancer patients were successfully recruited via purposive sampling and randomly assigned to either a four-day TPST intervention group or a standard-care control group using block permutation. Allocation concealment was ensured. Baseline characteristics were homogeneous. The independent variable was the intervention, and the dependent variables were measured using the Psychological Well-Being Index, the Spiritual Well-Being Scale, and the Brief Pain Inventory. Data were analyzed using independent and paired t-tests with statistical software. Results: Psychological well-being improved significantly in the intervention group compared with controls, demonstrating notable clinical significance for patients  (Mean Difference=9.4, 95% CI=0.70; 18.10, Cohen's d=0.67, p=0.035). Spiritual well-being also showed a significant increase (Mean Difference=13.7, 95% CI=1.64; 25.76, Cohen's d=0.71, p=0.027). Furthermore, pain intensity decreased significantly, successfully shifting these patients to a lower pain category (Mean Difference = -9.3, 95% CI = -15.63 to -2.97, Cohen's d = 0.92, p = 0.005). Conclusion: The culturally structured TPST significantly enhances holistic patient outcomes and alters the subjective pain experience. It should be routinely integrated into standard holistic oncology nursing protocols. Further multicenter randomized controlled trials with larger samples are needed to confirm the long-term effectiveness of this intervention across diverse hospital settings.
Cultural Meanings, Spiritual Adaptation, and Communal Resilience Following Spousal Loss Among Older Adults: An Ethnographic Study Ariyanti, Sri; Jiu, Cau Kim; Anggarawati, Tuti; Pertiwi, Gracia Herni; Sastrini, Yovita Erin
Journal of Applied Nursing and Health Vol. 8 No. 2 (2026): Journal of Applied Nursing and Health
Publisher : Chakra Brahmanda Lentera Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55018/janh.v8i2.671

Abstract

Background: Spousal loss represents a significant life transition in later life, often influencing psychological well-being, social functioning, and personal identity. In rural Indonesian communities, bereavement is embedded within sociocultural contexts where spiritual beliefs, family obligations, and communal caregiving traditions shape how older adults experience and respond to loss. Despite growing attention to bereavement among older populations, ethnographic evidence examining culturally grounded adaptation processes in rural Indonesian settings remains limited. This study aimed to explore the cultural meanings of spousal loss and the adaptation experiences of older adults residing in rural Indonesian communities. Methods: A qualitative ethnographic design guided by Spradley’s ethnographic tradition was employed. Eighteen older adults who had experienced spousal loss were recruited through purposive sampling. Data were collected during six months of field engagement using in-depth interviews, participant observation, field notes, and focus group discussions. Data were analyzed through thematic ethnographic analysis to identify culturally embedded patterns of meaning and adaptation. Results: Four interconnected themes emerged: spiritual acceptance of spousal loss, cultural values fostering resilience, communal caregiving practices, and loneliness after bereavement. Informants understood spousal loss not only as an emotional experience but also as a sociocultural and spiritual transition. Adaptation was facilitated through religious practices, family responsibilities, collective caregiving traditions, and community support, while loneliness and the loss of emotional companionship remained enduring challenges. Conclusion: Adaptation to spousal loss among older adults is deeply influenced by cultural values, spirituality, and community relationships. These findings contribute to a deeper understanding of culturally embedded bereavement processes and provide a foundation for future cross-cultural and intervention-based research addressing grief and adaptation in later life.
Supportive Care Needs and Patient Preferences Among Hemodialysis Patients with Chronic Kidney Disease: A Scoping Review of Evidence for Patient-Centered Kidney Supportive Care Handayani, Meyla Sari; Ibrahim, Kusman; Rahayuwati, Laili; Fauzan, Naufal
Journal of Applied Nursing and Health Vol. 8 No. 2 (2026): Journal of Applied Nursing and Health
Publisher : Chakra Brahmanda Lentera Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55018/janh.v8i2.675

Abstract

Background: Patients with Chronic Kidney Disease (CKD) undergoing maintenance Hemodialysis (HD) face physical, psychological, social, and spiritual challenges that reduce quality of life. This scoping review mapped and synthesised evidence on supportive care needs and patient preferences to inform the development of holistic, person-centred, and culturally responsive Kidney Supportive Care (KSC) models for adults receiving maintenance HD. Methods: This scoping review followed the PRISMA-ScR guidelines and the Arksey and O'Malley methodological framework, guided by the Population–Concept–Context (PCC) approach. Literature searches were conducted on May 25, 2026, across PubMed, Scopus, ScienceDirect, and EBSCOhost. Eligible studies included English- and Indonesian-language publications from 2021–2026 involving adults with CKD receiving maintenance HD. Qualitative, quantitative, and mixed-methods studies, as well as systematic reviews, were included. Study selection, data charting, thematic synthesis, and methodological quality appraisal were conducted using predefined criteria and Joanna Briggs Institute (JBI) critical appraisal tools. Results: Twelve studies met the inclusion criteria. Four overarching themes were identified: (1) multidimensional supportive care needs, including physical symptom management, psychological support, social and financial assistance, spiritual care, and informational needs; (2) patient preferences for patient-centered care, emphasizing effective communication, shared decision-making, family involvement, and respect for spiritual values; (3) barriers to KSC implementation, including workforce limitations, inadequate psychosocial resources, financial burdens, insufficient professional training, and organizational constraints; and (4) strategies to strengthen KSC through interdisciplinary collaboration, Patient-Reported Outcome Measures (PROMs), family engagement, and integrated palliative care approaches. The review also identified evidence gaps regarding culturally adapted supportive care models, caregiver-support interventions, and implementation strategies in resource-limited settings. Conclusion: Cultural beliefs are crucial in shaping treatment choices for ENT conditions. Public awareness campaigns by the Ministry of Health and local health authorities are recommended to educate communities on the benefits and risks of traditional medicine while promoting evidence-based healthcare practices.
Mapping Telehealth Interventions Supporting Self-Management in Coronary Artery Disease: Characteristics, Outcomes, and Evidence Gaps—A Scoping Review Hendriyani, Desy; Pahria, Tuti; Purba, Chandra Isabella Hostanida; Fauzan, Naufal Hafizh
Journal of Applied Nursing and Health Vol. 8 No. 2 (2026): Journal of Applied Nursing and Health
Publisher : Chakra Brahmanda Lentera Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55018/janh.v8i2.678

Abstract

Background: Coronary artery disease (CAD) remains a major cause of morbidity and mortality worldwide, requiring long-term self-management to prevent recurrent cardiovascular events. Telehealth has emerged as a promising approach to support self-management through remote monitoring, education, lifestyle modification, and patient–provider communication. This scoping review aimed to map and synthesise the available evidence on telehealth-supported self-management interventions and their outcomes among adults with CAD. Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and the Arksey and O’Malley framework refined by the Joanna Briggs Institute (JBI). Guided by the Population–Concept–Context (PCC) framework, literature searches were conducted in PubMed, ScienceDirect, Scopus, and EBSCOhost for studies published between 2016 and 2026. Four reviewers independently screened titles, abstracts, and full texts against predefined eligibility criteria. Data were charted using a structured extraction form, and methodological quality was appraised using JBI critical appraisal tools. Findings were synthesised using descriptive evidence mapping and narrative descriptive analysis. Results: Following the screening and eligibility assessment, 17 studies met the inclusion criteria and were included in the final synthesis. The included studies described a wide range of telehealth-supported self-management interventions, including mobile health applications, web-based platforms, telemonitoring systems, wearable devices, text messaging programs, cardiac telerehabilitation, and artificial intelligence-assisted technologies. Narrative descriptive synthesis showed that interventions commonly incorporated self-management components, including physical activity promotion, medication adherence support, dietary modification, smoking cessation, symptom monitoring, and psychosocial support. Across studies, reported outcomes included improvements in self-efficacy, health literacy, physical activity, medication adherence, quality of life, cardiovascular risk-factor management, and selected clinical indicators. Common intervention characteristics included personalized feedback, remote monitoring, nurse-led support, and multidisciplinary collaboration. The evidence also highlighted gaps related to long-term sustainability, implementation in resource-limited settings, digital equity, and adaptation across diverse healthcare contexts. Conclusion: This scoping review mapped the current evidence on telehealth-supported self-management for adults with CAD and demonstrated substantial diversity in intervention modalities, self-management strategies, and reported outcomes. The findings highlight important knowledge gaps related to implementation, sustainability, and equity, particularly in low-resource settings. Future research should prioritize implementation-focused studies, culturally adaptable telehealth models, and long-term evaluations to support the integration of telehealth into secondary prevention and CAD management
Routine Hematologic and Biochemical Profiles in Term Premature Rupture of Membranes: A Retrospective Case-Control Study Widiyanti, Septi; Fairus, Martini; Yuliawati, Yuliawati; Wibowo, Wahyu Dwi Ari
Journal of Applied Nursing and Health Vol. 8 No. 2 (2026): Journal of Applied Nursing and Health
Publisher : Chakra Brahmanda Lentera Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55018/janh.v8i2.684

Abstract

Background: Term premature rupture of membranes (PROM) is a common obstetric complication associated with increased risk of maternal and neonatal morbidity, primarily driven by inflammatory and infectious mechanisms. Although inflammatory pathways have been extensively studied, most evidence focuses on specific biomarkers such as C-reactive protein and cytokines. In contrast, routine hematologic and biochemical parameters—despite being widely available, inexpensive, and part of standard clinical practice—have not been consistently evaluated using PROM, particularly in low-resource settings such as Indonesia. Methods: This retrospective case-control study, reported according to STROBE guidelines, included 90 women (30 term PROM cases and 60 normal delivery controls) selected using systematic random sampling from medical records at Ahmad Yani Regional General Hospital, Indonesia. Inclusion and exclusion criteria were applied to minimize confounding. Eleven complete blood count (CBC) parameters were analyzed, including leukocytes, erythrocytes, hemoglobin, hematocrit, MCV, MCH, MCHC, platelets, RDW, MPV, and blood glucose. Laboratory measurements were performed using the Sysmex XN-550 hematology analyzer and the Pentra C400 automated chemistry analyzer. Data were analyzed using SPSS version 25. Group comparisons were conducted using the Mann–Whitney U test, and effect sizes were calculated using rank-biserial correlation. Results: Significant differences were observed in leukocyte count (p = 0.042), MCV (p = 0.016), MCH (p = 0.009), RDW (p = 0.023), and MPV (p = 0.036). Effect sizes ranged from small to moderate (r = 0.23–0.34), indicating limited clinical magnitude. Other parameters, including erythrocytes, hemoglobin, hematocrit, MCHC, platelets, and blood glucose, showed no significant differences (p > 0.05). Overall, the term PROM was associated with selective and subtle hematologic alterations. Conclusion: Term PROM is associated with mild and selective changes in routine hematologic parameters, particularly those related to inflammatory and erythropoietic activity. Blood glucose, the only biochemical parameter evaluated, remained comparable between groups. These findings suggest limited standalone diagnostic value, and complete blood count (CBC) parameters should be interpreted as supportive indicators within comprehensive obstetric assessment rather than independent diagnostic tools.
Comparative Experimental Study of Drying Temperatures (30°C vs 50°C) on Tannin and Mineral Retention in Moringa oleifera Leaves Fitriyani, Aris; Kuhu, Maisje Marlyn; Widjijati, Widjijati
Journal of Applied Nursing and Health Vol. 8 No. 2 (2026): Journal of Applied Nursing and Health
Publisher : Chakra Brahmanda Lentera Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55018/janh.v8i2.460

Abstract

Background: Moringa oleifera leaves are nutrient-rich plant materials containing minerals and bioactive compounds with potential food and health applications. Drying temperature may affect their composition through moisture reduction and concentration effects. However, evidence comparing moderate drying temperatures (30°C and 50°C) and their impact on tannin and mineral content remains limited. This study aimed to evaluate the effects of drying at 30°C and 50°C on tannin and selected mineral concentrations in moringa leaves. Methods: A quantitative comparative laboratory experimental study was conducted using non-human plant samples. Fresh moringa leaves were dried at 30°C and 50°C under controlled conditions, with each treatment performed in triplicate. Tannin content was determined using UV–Visible spectrophotometry with calibration-based quantification, while mineral concentrations of calcium (Ca), magnesium (Mg), potassium (K), sodium (Na), and iron (Fe) were measured using Atomic Absorption Spectrophotometry (AAS) or ICP-OES. Inferential statistical analyses were conducted following assumption checks to compare measured concentrations between treatments. Results: Drying at 50°C produced consistently higher measured concentrations of tannins and minerals compared with drying at 30°C, indicating a coherent temperature-associated pattern across all analyzed parameters. Iron exhibited the largest numerical difference between treatments. These findings suggest that drying temperature influenced the measured chemical composition of moringa leaf powder, most likely through enhanced moisture reduction and concentration-related analytical effects. Conclusion: Moderate drying temperature (50°C) increased measured tannin and mineral concentrations relative to 30°C under laboratory conditions. However, these differences should be interpreted cautiously, as they likely reflect concentration effects rather than true nutrient retention or improved nutritional efficacy. Further studies incorporating moisture-normalized analysis, bioavailability assessment, and functional evaluation are required before translating these findings into clinical or public health recommendations
Association of Smoking, Obesity, and Psychological Stress with Asthma Severity Among Adult Patients: A Cross-Sectional Study Harun, Lukman; Mira, Mira; Novendra, Alda; Julianto, Julianto
Journal of Applied Nursing and Health Vol. 8 No. 2 (2026): Journal of Applied Nursing and Health
Publisher : Chakra Brahmanda Lentera Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55018/janh.v8i2.666

Abstract

Background: Asthma is a chronic inflammatory airway disease that causes breathing difficulties and affects approximately 12 million people in Indonesia. Smoking status, obesity, and psychological stress have been associated with increased asthma severity and poor outcomes. However, few studies have simultaneously examined the relative influence of these factors on asthma severity among adult patients with asthma in primary healthcare settings. Therefore, this study aimed to analyze the association of smoking status, obesity, and psychological stress with asthma severity. Methods: A quantitative cross-sectional study was conducted among 51 adult asthma patients who had experienced an asthma attack within the previous month and were recruited through purposive sampling. Smoking status was assessed using the Brinkman Index, obesity using Body Mass Index (BMI), psychological stress level using the Perceived Stress Scale (PSS), and asthma severity using clinical classification criteria. Data were analyzed using Spearman’s rank correlation and multivariable ordinal logistic regression, with p < 0.05 considered statistically significant. Results: Among 51 participants, 45.1% had intermittent asthma. Smoking status (r = 0.377, p = 0.006), obesity (r = 0.264, p = 0.041), and psychological stress level (r = 0.375, p = 0.007) were significantly associated with asthma severity. Multivariable ordinal logistic regression revealed that smoking status (aOR = 5.23, 95% CI: 1.35–20.33, p = 0.017) and psychological stress level (aOR = 8.56, 95% CI: 1.64–44.79, p = 0.011) were independently associated with mild persistent asthma compared to those with intermittent asthma. Although obesity contributed significantly to the overall model, its adjusted effect estimates were imprecise and warrant cautious Interpretation. Conclusion: Smoking status and psychological stress were independently associated with asthma severity. Conversely, the association between obesity and asthma severity should be interpreted cautiously because of the imprecise effect estimate and limited statistical power. Of all factors, psychological stress demonstrated the strongest adjusted association with asthma severity.
Association Between Spirituality and Cybersex Behavior Among Twelfth-Grade Adolescents: A Cross-Sectional Study in Surabaya Indonesia Fatimawati, Iis; Arini, Diyah; Faridah, Faridah; Darso, Andreas Alfa Bramantio
Journal of Applied Nursing and Health Vol. 8 No. 2 (2026): Journal of Applied Nursing and Health
Publisher : Chakra Brahmanda Lentera Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55018/janh.v8i2.669

Abstract

Background: Despite increasing internet-related sexual activities among adolescents, evidence regarding the role of spirituality in preventing cybersex behavior remains limited, particularly in Surabaya Indonesia; therefore, this study examined the relationship between spirituality level and cybersex behavior among twelfth-grade adolescents. Methods: A cross-sectional study following STROBE guidelines was conducted among 108 twelfth-grade students at ITP High School Surabaya, selected through simple random sampling from a population of 148. Inclusion criteria were active twelfth-grade students consenting to participate, while exclusion criteria were incomplete questionnaires or absence due to illness. The independent variable was spirituality level, and the dependent variable was cybersex behavior. Data were collected using the Daily Spiritual Experience Scale (DSES) and Internet Sex Screening Test (ISST). Ethical clearance was obtained from the Ethics Committee of Hang Tuah Health Sciences Institute (PE/90/VII/2024/KEP/SHT), and data were analyzed using Spearman’s rho correlation. Results: Univariate analysis showed that 61.1% of respondents exhibited moderate spirituality and 66.7% were classified as at-risk cybersex users. Bivariate statistical analysis revealed a significant moderate negative correlation between spirituality level and cybersex behavior (Spearman’s rho ρ = 0.001, r = -0.310, 95% CI [-0.473, -0.128).. Conclusion: Higher spirituality is significantly associated with lower cybersex behavior among adolescents, suggesting that internal spiritual experiences serve as an essential protective factor. It is recommended that school nurses and educators design spirituality-integrated digital literacy interventions.
Rapid Shallow Breathing Index Measurement, Modifications, and Predictive Performance for Ventilator Weaning in Adult ICU Patients: A Scoping Review Sopyan, Tatang; Priambodo , Ayu Prawesti; Nuraeni, Aan
Journal of Applied Nursing and Health Vol. 8 No. 2 (2026): Journal of Applied Nursing and Health
Publisher : Chakra Brahmanda Lentera Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55018/janh.v8i2.672

Abstract

Background: The Rapid Shallow Breathing Index (RSBI) is widely used to assess readiness for ventilator weaning in mechanically ventilated patients. However, variations in measurement methods, cut-off values, modifications, and predictive performance have resulted in heterogeneous evidence. This scoping review aimed to map the available evidence on RSBI measurement methods, modifications, and predictive performance for ventilator weaning outcomes in adult ICU patients. Methods: This scoping review followed the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The Population–Concept–Context (PCC) framework guided the research question. Literature searches were conducted in PubMed, ScienceDirect, ProQuest, SAGE Journals, and EBSCOhost for English-language primary studies published between 2015 and 2026. Data were extracted using a structured charting process and analyzed through thematic synthesis. Results: Of the 461 identified records, 18 primary studies met the inclusion criteria. Four main themes were identified: conventional RSBI performance, variability in measurement methods and cut-off values, serial RSBI monitoring during spontaneous breathing trials, and diaphragm ultrasound-based RSBI modifications. Conventional RSBI showed variable predictive performance across studies because of differences in patient characteristics, ventilator settings, SBT protocols, measurement techniques, and outcome definitions. Conclusion: RSBI remains a simple and non-invasive bedside parameter for ventilator weaning assessment; however, conventional RSBI should not be used as a stand-alone predictor. Its interpretation should be integrated with comprehensive clinical assessment and patient characteristics. Future multicenter studies are needed to standardize RSBI measurement protocols and validate diaphragm ultrasound-based RSBI modifications across diverse ICU populations.

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