Jurnal Keperawatan Indonesia

Front Matter (Title Page, Table of Content, General Information, and Editorial Team)

Jurnal Keperawatan Indonesia — 2026-07-30

Back Matter (Submission Guideline, Author Guidelines, Order a Print Copy)

Jurnal Keperawatan Indonesia — 2026-07-30

Early Post-Cesarean Anxiety, Nausea, Vomiting, and Pain Under Spinal Anesthesia: Trajectories and Modifiable Predictors

Indah Susanti — 2026-07-30

Recovery after caesarean under spinal anesthesia remains a quality gap, with scarce evidence on modifiable anesthetic practices improving recovery. Data linking the neuraxial technique, nausea, anxiety, and pain remain limited. The objective of this study was to describe postoperative nausea and vomiting, anxiety, and pain at 6, 12, and 24 hours after caesarean section under spinal anesthesia and to examine whether intrathecal adjuvant use, sensory block level, fasting duration, and American Society of Anesthesiologists (ASA) physical status were associated with these outcomes. Cross-sectional study across five hospitals; 534 women undergoing caesarean under spinal anesthesia. Exposures: intrathecal adjuvant, sensory level (≤ T6 and > T6), nil per os (NPO) time, and ASA class. Outcomes: postoperative nausea and vomiting (PONV) using Rhodes Index of Nausea, Vomiting, and Retching (RINVR), anxiety using State-Trait Anxiety-State STAI-S), pain at 6,12,24 h; generalized estimating equations Poisson and linear models. A total of 534 women completed the study (mean age, 31.8 years; mean body mass index, 29.3). Symptom burden was greatest in the early postoperative period: postoperative nausea and vomiting and pain were highest at 6 hours, whereas anxiety peaked at 12 hours. By 24 hours, symptoms had declined, although substantial proportions of women continued to report nausea and pain. Better ASA physical status (class I-II) was associated with lower RINVR and STAI-S. These findings suggest that modifiable perioperative factors may help inform strategies to improve early post-caesarean recovery and guide postoperative nursing monitoring and symptom management.

Development of a Culturally Tailored Care Model for Chronic Disease Management in The Coastal Community: A Modified Delphi Study

Laode Saltar — 2026-07-30

Chronic noncommunicable diseases (NCDs), particularly hypertension and type 2 diabetes mellitus, are increasing in Indonesia’s coastal communities, including the Bajo population of Konawe. Limited healthcare access, cultural barriers, and low preventive health engagement exacerbate disease burden. Culturally tailored interventions are needed to enhance self-awareness and improve chronic disease management. This study aimed to develop and validate a culturally sensitive care model for chronic disease management in the Bajo coastal community using a modified Delphi approach. A three-round modified Delphi method was conducted with 26 panelists representing health professionals, community leaders, policymakers, and family members, recruited through Community Health Centers and community health worker networks. The first round gathered qualitative input on cultural values, traditional practices, barriers, and care model components. The second and third rounds quantitatively assessed proposed components for consensus, defined as ≥75% agreement with ratings ≥4 on a 5-point Likert scale. Eleven of twelve proposed components achieved full consensus. High-priority elements included integration of traditional and biomedical care, family and community involvement, culturally relevant health education, flexible service schedules, and routine free health checks. The panel emphasized communication in local language, engagement of trusted local figures, and culturally competent health workers. One component, the use of local broadcasting media, was rejected because it was perceived as having low feasibility. This study presents a culturally sensitive care framework that operationalizes cultural integration through traditional-biomedical collaboration, family engagement, culturally adapted education, and community-based screening for Indigenous and remote settings. Future studies should prioritize pilot implementation and evaluation of feasibility, acceptability, and health outcomes in coastal settings.

Development of Perineal Electric Massager Experience (Pem-X) to Improve Perineal Elasticity

Suryani Manurung — 2026-07-30

Perineal injury remains a common concern in vaginal childbirth, with a prevalence of 30.6%. Low maternal perineal massage practice is a contributing factor to decreased perineal elasticity and an increased risk of perineal trauma. This pilot study aimed to develop the Perineal Electric Massager Experience (PEM-X) to support mothers in self-guided perineal massage. The research employed a level 4 Research and Development (R&D) method with a one-group pretest-posttest design. The study sample consisted of two parts: the PEM-X prototype and postpartum mothers who had vaginal deliveries. A purposive sampling technique was used to recruit 10 postpartum mothers who had vaginal deliveries for preliminary testing of the device. The device was developed at the Mechatronics Laboratory, with functional testing conducted at the Electromedical Laboratory of Health Polytechnic of the Ministry of Health Jakarta II and the Maternity Laboratory of Health Polytechnic of the Ministry of Health Jakarta I. During the intervention phase, participants used the PEM-X to massage the perineum independently according to the developed protocol. Field testing was conducted at Lebak Bulus Public Health Center. Data were analyzed using descriptive statistics and paired t-tests. The results showed that the PEM-X device operated stably and functioned well. Preliminary findings demonstrated increased perineal elasticity after device use, along with high user satisfaction in terms of comfort and ease of use. In conclusion, the innovative PEM-X device enhances perineal elasticity and has the potential to reduce perineal injury during childbirth. Further studies with a larger sample size are recommended.

Effects of Montessori-Based Stimulation on Fine and Gross Motor Development Among Children with Stunting: A Quasi-Experimental Study

Indah Rahmadaniah — 2026-07-30

Stunting affects not only physical growth but also several aspects of child development, including gross and fine motor skills. Early stimulation interventions, such as Montessori-based activities, have been proposed to enhance developmental outcomes through structured sensorimotor experiences. This study aimed to evaluate the effects of Montessori-based stimulation on motor development among children with stunting and to compare its outcomes with those of conventional stimulation. A quasi-experimental study with intervention and control groups was conducted among 120 children with stunting aged 36–59 months. Participants were allocated to either a Montessori group (n = 60) or a conventional stimulation group (n = 60). The intervention was delivered over 12 weeks, three times per week, with each session lasting 60 minutes. Gross and fine motor development were assessed before and after the intervention using the Pre-Screening Developmental Questionnaire. Within-group changes were analyzed using the Wilcoxon signed-rank test, while between-group differences were examined using the Mann–Whitney U test. The Montessori group showed significant improvements in gross motor development (p = 0.028) and fine motor development (p = 0.003). In the conventional group, only fine motor development improved significantly (p = 0.046), whereas changes in gross motor development were not statistically significant (p = 0.144). However, no significant differences were observed between the Montessori and conventional groups in post-intervention comparisons (p > 0.05). Montessori-based stimulation may contribute to improvements in gross and fine motor development among children with stunting. However, the absence of significant between-group differences suggests that Montessori-based stimulation was not superior to conventional stimulation during the study period. Further studies with larger samples and randomized controlled designs are needed to clarify its role in supporting developmental outcomes in children with stunting.

Emotional Intelligence, Work Engagement, and Turnover Intention Among Hospital Nurses: A Hierarchical Component Analysis

Catrin Catrin — 2026-07-30

High turnover intention among hospital nurses poses serious challenges to healthcare organizations, affecting service quality and workforce stability. Understanding the psychological and organizational factors associated with turnover intention is essential for developing effective retention strategies. This study aimed to examine the relationships among emotional intelligence, work engagement, and turnover intention among hospital nurses, including health‑promoting leadership, workload, and burnout as contextual variables within the model. A cross-sectional study was conducted among 98 nurses working in inpatient units using validated questionnaires. The data were analyzed using partial least squares structural equation modeling (PLS-SEM) with hierarchical component analysis. Emotional intelligence significantly predicted work engagement (β = 0.507, p = 0.001). Work engagement showed a strong negative association with turnover intention (β = −0.610, p < 0.001), while burnout was positively associated with turnover intention (β = 0.385, p = 0.005). In contrast, health-promoting leadership and workload did not show significant effects on work engagement or burnout. Mediation analysis indicated that work engagement significantly mediated the relationship between emotional intelligence and turnover intention (β = −0.309, p = 0.003). The model explained 24.5% of variance in work engagement and 31.6% of variance in turnover intention. These findings suggest that work engagement represents an important pathway linking emotional intelligence to turnover intention among nurses. Strategies aimed at strengthening nurses’ emotional intelligence and fostering work engagement may help reduce turnover intention in hospital settings. This study contributes to the literature by applying hierarchical component analysis within a PLS-SEM framework to simultaneously examine multiple psychological and organizational predictors of turnover intention in the Indonesian hospital context.

Evaluating Mobile Palliative End-of-Life Advanced Care Enhancement (M-PEACE) Usability and Technology Acceptance: Mixed-Methods Design

Ni Luh Putu Inca Buntari Agustini — 2026-07-30

Palliative End-of-Life Care (PEoLC) is a process requiring timely assessment, effective communication, and person-centered decision-making to support patients and families. Although the process can be strengthened through digital health innovations such as Mobile Palliative End-of-Life Advanced Care Enhancement (M-PEACE), its use in PEoLC remains limited. Therefore, this study aimed to evaluate M-PEACE usability and technology acceptance through an explanatory sequential mixed-methods design and explore user experiences in describing quantitative results. The quantitative phase was conducted to assess usability through an adapted System Usability Scale (SUS), and technology acceptance was measured using a modified Technology Acceptance Model (TAM) questionnaire. A total of 106 respondents (median age = 46.5 years) who participated were selected using convenience sampling. The results showed that internal consistency of the modified instruments was excellent (Cronbach’s α = 0.865–0.980). Quantitative analysis showed high agreement across usability, functionality, reliability, and transportability domains (median = 4). Perceived usefulness, ease of use, attitudes, behavioral intention, and trust were also high (median = 4–5). In line with the methodological procedures, the qualitative phase was conducted through semi-structured interviews with patients, family caregivers, and nurses to help explain and deepen the quantitative results. Thematic analysis identified three themes, namely (1) Positive Experience with the Application (user-friendly interface, easy access), (2) Perceived Benefits (motivation booster, better symptom monitoring, enhanced quality of life and dignity at end of life, improved self-care ability), and (3) Improvements Needed (reminders, simpler language, cross-platform access, additional tools, offline functionality). Overall, the integration of quantitative and qualitative results suggested that M-PEACE showed strong usability and acceptance, indicating substantial potential for incorporation into PEoLC service delivery.

Knowledge, Attitudes, and Practices by Women in Cartagena Regarding Breast Self-Examination

Rafael Arnedo Martínez — 2026-07-30

Breast self-examination (BSE), especially when adopted by vulnerable populations, serves as a vital mechanism for the timely detection of breast abnormalities indicative of cancer. As a result, this decreases the public health burden associated with treatment at advanced stages. Therefore, assessing knowledge, attitudes, and practices (KAP) regarding this simple early detection method is a priority. This study examines the relationship between KAP concerning BSE among women in Cartagena, Colombia. A cross-sectional correlational study was conducted with 322 women attending a healthcare facility. Data were gathered using two tools: a sociodemographic profile and a KAP questionnaire. Results showed that most participants were aged 20–29 years (46.3%), cohabiting (66.1%), and had completed secondary education (44.4%). Concerning knowledge, 50.0% demonstrated inadequate levels. Attitudes were rated as fair (49.4%) or deficient (44.1%), and practices were insufficient in 59.9% of participants. Statistically significant correlations were recorded between knowledge and attitudes (P < 0.01), knowledge and practices (P < 0.01), and attitudes and practices (P < 0.01). The findings reveal significant gaps in KAP regarding BSE, heightening the risk of delayed diagnosis. The significant correlations confirm that knowledge is a crucial factor in enhancing preventive behaviors. We conclude that women's knowledge levels are suboptimal and that the domains of knowledge and practice are interconnected and linked to demographic factors. Consequently, nursing professionals should spearhead culturally tailored educational interventions to strengthen early detection and decrease breast cancer morbidity. Recommendations include implementing educational programs, training healthcare personnel, and integrating primary care services with screening initiatives.

REHCARDICARE: A Digital Telerehabilitation Platform for Cardiac Recovery Following a Coronary Artery Bypass Graft

Elvipson Sinaga — 2026-07-30

Post-coronary artery bypass graft (CABG) patients often experience decreased cardiac output, which slows recovery and increases the risk of cardiovascular complications. This research and development study evaluated the preliminary effectiveness of the REHCARDICARE application in increasing cardiac output, a key indicator of successful cardiac rehabilitation. The research also assessed user satisfaction to determine the feasibility of broader implementation. The findings can inform further development of the application. The application development used the (Analysis, Design, Development, Implementation, Evaluation) ADDIE model. The study subjects consisted of 30 post-CABG patients purposively selected at the North Sumatra Integrated Heart Center. An application-based resistance and flexibility training intervention was implemented for eight weeks. Data collection and analysis took place two weeks after the intervention was completed. Using a single-group pretest–posttest design, transthoracic Doppler echocardiography was used to measure cardiac output before and after the intervention. Data analysis involved a paired t-test with a significance level of p < 0.05. Cardiac output significantly increased from 4.12 ± 0.55 L/min to 5.28 ± 0.62 L/min (p = 0.001). The feasibility evaluation showed high user satisfaction (87.5 ± 6.8), indicating that REHCARDICARE was perceived as useful and easy to use, with good patient adherence and no significant safety events. Overall, REHCARDICARE demonstrated improved cardiac output after eight weeks and good user acceptance as a digital cardiac rehabilitation tool for post-CABG patients. It is recommended that this application be structurally integrated into the hospital’s cardiac rehabilitation program, that remote monitoring features, and that further tests be conducted using an experimental design with a control group and a larger sample to strengthen the evidence of clinical effectiveness.

Supportive and Palliative Care: Addressing the Unspoken Burden of Cancer on Significant Others

Esmeraldo De Las Armas, IV — 2026-07-30

A diagnosis such as cancer can cast a long-lasting gloom that affects not only the patient but also their loved ones. This concept analysis represents an effort to understand and explore the nuanced world of supportive and palliative care for significant others of cancer patients, a population that has often been overlooked. Rodgers’ evolutionary model of concept analysis was utilized to examine the concept of supportive and palliative care for significant others of cancer patients. Positive outcomes for both significant others and patients included improved coping mechanisms, reduced caregiver burden, enhanced communication, and better quality of life. However, several challenges remain, including limited access to and awareness of these services. In addition, societal stigma surrounding palliative care and the traditional patient-centered focus may hinder broader integration of such services.