Journal Keperawatan

Decreased Self-Esteem and Depression Experienced by Elderly People with Stroke

Gardha Rias Arsy — 2025-08-01

Background: Neurological dysfunction, which leads to stroke, is the third leading cause of disability worldwide. Stroke-related conditions, such as paralysis of the extremities, are particularly stressful for the elderly. Feelings of helplessness, depression, and low self-esteem are common. This is because they feel like a burden on their families and are ashamed to burden their children.

Purpose: Exploring the experience of depression and low self-esteem in older adults who have experienced stroke.

Methods: This study used a qualitative method with a phenomenological approach. Seven elderly stroke patients experiencing psychosocial problems and requiring full family support were participants. The sample size was determined using purposive sampling. Participants were selected based on inclusion criteria, including being diagnosed with stroke for more than three years, being able to communicate, and experiencing psychosocial problems. The research used Interpretative Phenomenology Analysis (IPA) as the data analysis technique.

Results: Based on the research results, 3 themes were obtained, namely 1. Feeling like a burden on the family (Living with stroke was felt by participants as a burden for the family), Theme 2: Feeling limited in doing something (All participants considered themselves unable to do physical activities freely) and Theme 3: Experiencing low self-esteem. (The elderly with stroke felt that they were no longer productive, could only depend on their families and experienced feelings of helplessness and worthlessness).

Conclusion: Elderly stroke survivors tend to experience psychological disorders characterized by depression, such as sadness, anger, disappointment, feelings of helplessness, and feeling like a burden on their families. Furthermore, socially, they also tend to have low self-esteem, as evidenced by feelings of being restricted and incapable of engaging in social activities.

The Ability of the Elderly to Follow PROLANIS (Chronic Disease Management Program) Exercise Movements

Duwi PudjiAstuti — 2025-11-23

Background: Over the past five years, the proportion of the elderly population in Indonesia has continued to increase to 12%. The government's efforts to support the health of seniors with chronic diseases include the PROLANIS (Chronic Disease Management Program), which includes structured Exercise Movements to help participants maintain their physical condition and manage their illnesses. As older adults age, they experience a decline in bodily functions, which can impact physical activity limitations, including exercise.

Purpose: To determine the ability of the elderly to carry out PROLANIS exercises at Puskesmas Sibela Surakarta.

Methods: This research is a quantitative study using descriptive methods. The study population was all PROLANIS participants, with a sample of 46 respondents selected based on inclusion criteria: participants registered with PROLANIS program at Puskesmas Sibela Surakarta and participating in exercise movements activities twice a month for 20 minutes. The instrument used was an observation sheet containing the ability of elderly people to participate in exercise movements.

Results: All elderly people routinely do PROLANIS exercises twice a month and the majority of elderly people are able to participate in the exercise movements as a whole, namely 41 people (89.1%) in the first and second meetings.

Conclusion: The majority of elderly PROLANIS participants at Puskesmas Sibela Surakarta were able to complete the entire exercise movements routine at both sessions. This demonstrates that PROLANIS exercise movements can be successfully performed by elderly individuals despite the decline in bodily functions due to aging.

A Study on the Relationship between Self-Management and Quality of Life in End-Stage Renal Disease Patients Undergoing Hemodialysis

Fida' Husain — 2025-11-24

Background: End-Stage Renal Disease (ESRD) is a chronic disease that has a significant impact on patients' physical, psychological, and social functioning. While hemodialysis therapy prolongs life expectancy, it also places a significant physical and emotional burden. This condition can reduce their quality of life. Implementing good self-management behaviors, such as adherence to therapy, dietary adjustments, and emotional management, can help patients adapt and improve their well-being.

Purpose: To identify the relationship between self-management and quality of life in ESRD patients undergoing hemodialysis in Surakarta.

Methods: This study was a quantitative study with a cross-sectional design. The population consisted of 150 patients undergoing HD, and the sampling technique used convenience sampling with a sample size of 80 people. Inclusion criteria included patients undergoing HD for at least 6 months. The instrument used to measure self-management was the HemoDialysis Self-Management Instrument (HDSMI), while quality of life was measured using the Kidney Disease Quality of Life Short Form (KDQOL SF-36). The relationship between the two variables was analyzed using the Chi-square test.

Results: This study found a significant positive relationship between self-management and quality of life in hemodialysis patients (p = 0.000; p < 0.05). Patients with good self-management skills tended to demonstrate higher levels of physical and psychological well-being.

Conclusion: Improved self-management is positively associated with a higher quality of life in patients with end-stage renal disease undergoing hemodialysis. Therefore, nursing interventions should focus on strengthening self-management skills through health education and ongoing psychosocial support.

Strengthening the Regulation of Pokjanal and Pokja from District or City Posyandu in Aceh: A Strategic Study Based on Policy Brief

Irnawati Irnawati — 2025-12-19

Background: The transformation of health services through the rebranding of Integrated Health Posts (Posyandu) as a community-friendly service positioned Posyandu as the primary hub for community-based health services, with a lifecycle approach, from pregnant women to the elderly. However, in Aceh Province, Posyandu's functioning still faces challenges such as limited funding, unequal capacity of cadres, and the suboptimal institutional role of the Posyandu Operational Working Group (Pokjanal) and Working Group (Pokja).

Purpose: To compile policy recommendations in the form of a policy brief regarding the formation and strengthening of regulations for Pokjanal and Pokja Posyandu at the district/city level in Aceh.

Methods: The research employed a strategic review approach based on a policy brief. Data were collected through focus group discussions (FGDs) and in-depth interviews with stakeholders, including the Ministry of Home Affairs, the Ministry of Health, the Health Office, the Community Empowerment Office, the Family Welfare Movement (PKK), the Integrated Health Service Post (Posyandu) working group (Pokjanal), and the National Population and Family Planning Board (BKKBN). Data were analyzed qualitatively through thematic synthesis to formulate policy recommendations.

Results: The findings show that 54% of Posyandu in Aceh are not yet active. Posyandu working groups at the district/city and sub-district levels are not yet functioning optimally, while Posyandu working groups at the village level are still limited. Synthesis of the results of FGDs and interviews resulted in nine policy recommendations, including: socialization of Posyandu's position as a Village Community Institution; affirmation of Posyandu's function as a forum for health and social activities; strengthening the role of working groups in services; increasing the capacity of cadres based on 25 basic competencies; structuring the management structure through Village Regulations/Village Decrees; strengthening lifecycle-based and cross-sectoral services; harmonizing regulations following Law No. 17/2023 concerning Health; and regulating cadre terms of office and incentives.

Conclusion: Optimizing Posyandu in Aceh requires derivative regulations at the district/city level for the formation and strengthening of Pokjanal-Pokja, accompanied by clear institutional support and increasing the capacity of Posyandu cadres so that integrated health services can be sustainable.

Early Detection of Growth and Development of Preschool Children in Transition Areas

Putro Simeulu — 2025-12-23

Background: Early detection of child growth and development plays a crucial role in ensuring children's readiness for formal education and preventing delays in intervention during the golden period of development. The reality in urban-rural transition areas shows that implementation is suboptimal due to low parental participation, limited teacher competency, and the limited availability of tested standardized instruments.

Purpose: To describe the implementation of early childhood growth and development screening at Bungong Jaroe Kindergarten, Aceh Besar, and to identify factors related to the effectiveness of the screening.

Methods: This descriptive research used a case study approach. The study population consisted of all children aged 4–6 years, teachers, parents, and PAUD administrators at Bungong Jaroe Kindergarten. Sampling used purposive sampling, including 20 children, 20 parents, 6 teachers, and 3 PAUD administrators, with inclusion criteria: children aged 4–6 years enrolled at Bungong Jaroe Kindergarten, teachers teaching for at least 1 year, and parents willing to be interviewed. Data collection was conducted through semi-structured interviews, observations, and document reviews. The screening instruments used included the Child Development Card (KKA) and the Developmental Pre-Screening Questionnaire (KPSP), which had previously been tested for validity and reliability. Data were analyzed using thematic analysis.

Results: Implementation of growth and development screening at Bungong Jaroe Kindergarten is suboptimal, reflected in low parental participation only 50%, minimal teacher training, and limited use of standardized instruments. Children's nutritional status indicates a double burden of malnutrition, with 10% undernourished and 35% at risk of overnutrition. Factors related to screening effectiveness include teacher competence, parental awareness, instrument availability, and institutional support.

Conclusion: Early detection of child growth and development at Bungong Jaroe Kindergarten remains limited. Strengthening teacher capacity, increasing parent participation, and developing an integrated monitoring system are needed to improve screening effectiveness.

Joint Pain with Activity of Daily Living (ADL) Levels in Elderly People in Sempalwadak Village, Bululawang Community Health Center Working Area

Sisilia Dwi Agustina — 2025-12-23

Background: Elderly individuals are individuals entering the final stages of human development. As they age, they experience functional decline, particularly in the musculoskeletal system, leading to conditions such as osteoarthritis, rheumatoid arthritis, and gout, which can cause joint pain. Frequent, persistent joint pain can lead to a decline in daily living activities.

Purpose: To determine the relationship between joint pain and the level of Activity of Daily Living (ADL) ability in the elderly in Sempalwadak Village, Bululawang Health Center working area.

Methods: This study used a quantitative correlational design with a cross-sectional approach. The study population was all elderly residents of Sempalwadak Village who were patients at the Bululawang Community Health Center. The sampling technique was total sampling, with a total sample size of 70 elderly residents. The instruments used included the Numeric Rating Scale (NRS) pain scale and the Activity of Daily Living (ADL) form using the Bathel Index, which consists of ten activities. Data analysis used the Spearman rank test.

Results: Based on the Spearman rank test, the p value was obtained = 0.00 (<0.05), which means there is a relationship between joint pain and the level of Activity of Daily Living (ADL) ability in the elderly in Sempalwadak Village, Bululawang Community Health Center working area.

Conclusion: Joint pain is significantly associated with functional independence in carrying out daily activities in older adults. Pain management should be prioritized to maintain ADL capacity in older adults.

Relationship Between Housewives' Knowledge and Mosquito Nest Eradication Efforts in the Wagir Community Health Center Work Area

Hendrikus Umbu Natar — 2025-12-27

Background: Dengue Hemorrhagic Fever (DHF) is a significant public health problem in Indonesia, with increasing prevalence rates influenced by various factors, including knowledge and implementation of Mosquito Nest Eradication. While good knowledge is important, it does not always translate directly to a decrease in DHF cases, necessitating the active role of housewives as agents of health behavior change within the family environment.

Purpose: To determine the relationship between housewives' knowledge and efforts to eradicate mosquito nests in the Wagir Community Health Center Work Area.

Methods: This quantitative correlational study used a cross-sectional design. The study population consisted of 184 housewives, with a sample size of 126 housewives drawn using consecutive sampling. The inclusion criteria included housewives from Sidorahayu Village aged 26-45 years. The instrument used was a questionnaire on knowledge and prevention of mosquito nest eradication. Data analysis used the Spearman rank test.

Results: There is a relationship between the knowledge of housewives and efforts to eradicate mosquito nests in the Wagir Health Center Working Area with a p value = 0.000 (p <0.05) accompanied by an r value = 0.704 where the correlation coefficient value shows a strong and positive relationship.

Conclusion: There is a significant relationship between housewives' knowledge and mosquito nest eradication efforts in the Wagir Community Health Center work area. Higher housewives' knowledge tends to be followed by better implementation of mosquito nest eradication efforts.

Relationship Between Parenting Patterns and the Incidence of Stunting in Toddlers

Nuswatul Khaira — 2025-12-26

Background: Stunting remains a public health problem in Indonesia, including in Palu City, Central Sulawesi, with prevalence increasing from 23.9% to 24.7% in 2022, remaining below the national target for stunting reduction. Several studies have shown that 22.9% of parents practice poor parenting practices, a factor contributing to the high incidence of stunting in toddlers.

Purpose: To determine the relationship between parenting patterns and the incidence of stunting in toddlers in the work area of Tawaeli Health Center, Palu City.

Methods: This type of research is quantitative with a cross-sectional design. The study population was all toddlers aged 24–59 months in the Tawaeli Community Health Center working area. A sample of 70 respondents was selected using a purposive sampling technique, with the inclusion criteria being toddlers who had complete data regarding height and weight and mothers who were willing to be respondents. Data on family parenting patterns were collected using a structured questionnaire, while stunting status was determined based on anthropometric data. Data analysis was performed using the Chi-Square test.

Results: There was a significant relationship between family parenting patterns and the incidence of stunting in toddlers with a p value of 0.02 (p <0.05). Toddlers raised with poor parenting patterns had a higher risk of stunting than toddlers raised with good parenting patterns.

Conclusion: Family parenting patterns are significantly associated with stunting in toddlers aged 24–59 months. Strengthening the family's role through education on appropriate parenting patterns needs to be a focus of pediatric and community nursing interventions in stunting prevention efforts.

Correlation between Gender and Study Period with Clean and Healthy Living Behavior in Nursing Students

Said Taufiq — 2025-12-28

Background: Clean and Healthy Living Behavior in nursing students plays a strategic role not only in maintaining individual health but also as a foundation for developing promotive and preventive competencies that will be applied in nursing practice. Variations in characteristics such as gender and study period have the potential to be factors in the implementation of PHBS in students.

Purpose: To find out the implementation of Clean and Healthy Living Behavior and the relationship between gender and study period of students with Clean and Healthy Living Behavior in the Diploma III Nursing Study Program in North Aceh, Poltekkes Kemenkes Aceh.

Methods: This type of quantitative research uses an analytical approach and a cross-sectional design. The study population was all students of the Diploma III Nursing Study Program in North Aceh, Poltekkes Kemenkes Aceh, with a sample of 132 students selected using a proportional stratified random sampling technique. The instrument used was a Clean and Healthy Living Behavior questionnaire whose validity had been tested (r count value > r table). Data analysis included univariate and bivariate analysis using the Chi-Square test with a significance level of α = 0.05.

Results: There were 77.1% of students who had good Clean and Healthy Living Behavior implementation and 22.9% were in the poor category. The results of the bivariate analysis test showed a significant relationship between gender (p = 0.041) and study period (p = 0.032) with Clean and Healthy Living Behavior implementation in Diploma III Nursing Study Program students.

Conclusion: The majority of Diploma III Nursing students demonstrate good practice of Clean and Healthy Living Behaviors. However, efforts are still needed to improve aspects such as regular health check-ups and physical activity. Furthermore, the length of study period has the potential to improve Clean and Healthy Living Behavior implementation, so a longer study period could provide a greater opportunity for optimal implementation.

Optimizing ICARE-Based Blended Learning to Prepare Nurses for Competitiveness in the Modern Era: Literature Review

Ismailinar Ismailinar — 2025-12-31

Background: The era of the Industrial Revolution 4.0 and Society 5.0 has driven significant changes in higher vocational nursing education to produce globally competitive graduates. In this context, blended learning is a learning strategy that enables the optimal integration of technology and innovation. The implementation of blended learning will be more effective when combined with the ICARE (Introduction, Connection, Application, Reflection, Extension) model because it is valid, practical, and student-centered.

Purpose: To examine the effectiveness and potential optimization of the ICARE-based blended learning model in improving the competency and skills of nursing students.

Methods: This study used a literature review design guided by the PRISMA flowchart. Data sources were obtained from databases such as Google Scholar, ScienceDirect, and ProQuest with the keywords: blended learning, ICARE model, and nursing competence. Selected articles met inclusion and exclusion criteria relevant to the topic of optimizing nursing vocational learning.

Results: Six studies have shown that the implementation of the ICARE-based blended learning model consistently improves student engagement, critical thinking skills, clinical skills, and nurses' work readiness in professional practice settings. The integration of digital technology with a reflective and applied learning approach makes this model valid, practical, and appropriate for modern vocational education.

Conclusion: The ICARE-based blended learning model has strong potential to improve the quality of learning, particularly in vocational and higher education.

The Effect of Health Education Through “ASENTIV” Leaflet Media on The Interest of Woman of Childbearing Age in Performing VIA Tests

Bernadita Widyani — 2025-12-31

Background: The incidence of cervical cancer in Indonesia has increased to 2 per 1,000 population. Low early detection rates are a major contributing factor to the rise in cervical cancer cases. This low coverage is influenced by low interest among women of childbearing age, related to a lack of knowledge, perceived health, and fear of the VIA test. The leaflet "Let's Get Early Detection and Get the VIA Test" is designed as an educational tool that provides information on the importance of early cervical cancer detection and is expected to increase interest in early screening.

Purpose: To determine changes in the interests of women of childbearing age before and after being given health education using the leaflet “Let's Get Early Detection and Get the VIA Test”.

Methods: The study used a pre-experimental method with a one-group pre-test and post-test design. The sample consisted of 40 female respondents of childbearing age (30–50 years old) at the Sukorame Community Health Center in Kediri City, selected using a simple random sampling technique. Data were collected using a modified questionnaire and tested for validity and reliability. Then, data were analyzed using univariate and bivariate analysis with the Wilcoxon signed-rank test to determine differences in interest before and after health education.

Results: There was a significant difference in the interest of women of childbearing age before and after being given health education using the leaflet with a p value = 0.008 (p <0.05).

Conclusion: Health education using the leaflet has shown increased interest in VIA screening among women of childbearing age. These results can serve as a basis for community health centers (Puskesmas) to utilize the leaflet as an educational tool to increase participation in early cervical cancer detection.

The Impact of School-Based Smartphone Addiction Education Programs on High School Students

Isneini Isneini — 2025-12-31

Background: Smartphone addiction is increasing among adolescents and has the potential to lead to various psychological disorders such as depression, anxiety, stress, and low self-esteem. Excessive smartphone use can also disrupt students' concentration in learning, the quality of their social relationships, and their emotional balance. Planned and sustained prevention efforts are needed to minimize the negative impacts of smartphone use on adolescents. In this regard, the school environment plays a very strategic role as a platform for education, character development, and the prevention of addictive behavior towards digital technology.

Purpose: To determine the effect of school-based intervention programs in reducing levels of addiction, stress, anxiety, and depression in senior high school students in Banda Aceh City.

Methods: The study used a quasi-experimental design with a control group. The sample size was determined through a power analysis with a medium effect size, power of 0.80, a 95% confidence level, and an alpha of 0.05. This resulted in 128 respondents, consisting of 64 students in the intervention group and 64 students in the control group, who were randomly selected. The study location was selected using cluster random sampling. The intervention, a school-based smartphone addiction prevention program, was implemented in four 50-minute sessions. The instruments used included the Korean Smartphone Addiction Proneness Scale (K-SAPS) to assess smartphone addiction and the Depression Anxiety Stress Scale (DASS-21) to assess psychosocial status.

Results: There were significant differences between the intervention and control groups on the variables of smartphone addiction (p = 0.000), stress (p = 0.015), anxiety (p = 0.048), depression (p = 0.009), self-esteem (p = 0.000), and emotional status (p = 0.002) after the intervention.

Conclusion: School-based smartphone addiction prevention programs have been shown to be effective in reducing levels of addiction, stress, anxiety, and depression, as well as increasing self-esteem and emotional stability in high school students