Cancer cachexia is a common and debilitating condition among people with gastrointestinal cancer that causes malnutrition, impaired function, and decreased quality of life. In Thailand, evidence about self-care support programs led by advanced practice nurses specifically designed for people with gastrointestinal cancer and cachexia remains limited. This evidence gap warranted the development and evaluation of a contextually appropriate intervention for Thai patients. Utilizing an explanatory sequential mixed-methods design, this study employed a quasi-experimental phase, then a qualitative descriptive phase to evaluate the Advanced practice nurse-led Self-Care Support Program for People with Gastrointestinal Cancer and Cachexia and explore participants’ experiences with the program. The program, developed based on Orem’s Self-Care Deficit Nursing Theory, was led by an advanced practice nurse at a university hospital in Bangkok, Thailand, between August 2024 and February 2025. Thirty-three participants were assigned to the study based on the clinic day they attended: 16 in the intervention group and 17 in the control group. The intervention group received the 12-week Program, and the control group received the hospital’s standard care. The screening instruments included the Thai Depression Screening Tool, the Mini-Cog test, and the Eastern Cooperative Oncology Group Performance Status Scale. The data collection instruments comprised the Personal Information Form, Bioelectrical Impedance Analysis, Cancer Fatigue Scale, Physical Function Test (6-minute walk test and handgrip strength), and Functional Assessment of Anorexia-Cachexia Therapy. Quantitative data were analyzed using descriptive statistics, independent t-tests, and Mann–Whitney U test. Then, 22 participants (12 from the intervention group and 10 from the control group) completed in-depth interviews. Qualitative interview data underwent thematic analysis. Results from the quantitative data demonstrated no significant difference between groups in body composition, fatigue, or quality of life. The intervention group demonstrated a significantly greater improvement on the 6-Minute Walk Test, whereas the control group showed a significantly greater decrease in distance. Thematic analysis of the qualitative data revealed participant experiences in two themes: 1) eating problems associated with cancer treatments and 2) exercise difficulties due to cachexia during illness and treatment. The participants discussed how treatment-related symptoms and fatigue hindered adherence to the program, and how individualized support helped them engage in eating and exercise. These findings support the use of this Program in this population group. Further evaluation of the Program in larger and more diverse samples across multiple settings is warranted before its integration into clinical practice.
Hemodialysis is a critical life-sustaining treatment for individuals with end-stage renal disease. Despite advances in hemodialysis care, many of these individuals continue to demonstrate suboptimal self-management behaviors. Understanding the factors influencing self-management behaviors is essential for developing nursing interventions that effectively address people's needs. This study developed and examined a structural model of self-management behaviors among people with end-stage renal disease undergoing hemodialysis in Thailand. A cross-sectional design was employed. A total of 550 participants were recruited from 11 hemodialysis units using cluster and purposive sampling techniques. Data were collected between March and August 2024 utilizing the Demographic Questionnaire, Family State and Functioning Assessment Scale, Hemodialysis Knowledge Questionnaire, Patient Health Questionnaire, Social Support Questionnaire, Hemodialysis Self-Management Self-Efficacy Questionnaire, 14-item Health Literacy Scale, and the Hemodialysis Self-Management Instrument. Descriptive statistics and structural equation modeling were used for data analysis. The structural model demonstrated a good fit with the empirical data. It revealed that health literacy, hemodialysis-related knowledge, social support, and depression exerted direct positive effects on self-management behaviors. Family functioning positively influenced self-management through indirect effects on depression and social support. Conversely, depression demonstrated a negative indirect effect on self-management behaviors mediated through social support. Collectively, the model accounted for 58.7% of the variance in self-management behaviors. These findings underscore the need for clinical nurses to promote health literacy, treatment-specific knowledge, and robust family support to mitigate depressive symptoms and optimize adherence to self-management. Healthcare policies should prioritize integrating health literacy enhancement, patient education, and family-centered care models into routine hemodialysis services. Furthermore, implementing targeted psychosocial interventions to manage depression and strengthening healthcare team networks may significantly improve long-term patient self-management outcomes.
Perioperative anxiety and emergence delirium are common clinical challenges in children undergoing adenotonsillectomy, which can compromise post-surgical recovery and caregiver satisfaction. This single-center, parallel-group randomized controlled trial evaluated the effects of the nurse-led Interactive Multisensory Preoperative Orientation Program on perioperative outcomes in school-aged children aged 6–12 years undergoing elective adenotonsillectomy. Ninety children at a Grade III tertiary hospital in Anhui, China, were randomly assigned (1:1) to either a control group (n = 45) receiving standard perioperative care or an intervention group (n = 45) receiving the program in addition. Explicitly designed around Kolb’s Experiential Learning Theory, our half-day intervention operationalized the four-stage experiential cycle through operating-room familiarization, interactive storybook debriefing, animated video discussion, and supervised procedural simulation with teach-back. The primary outcome was preoperative anxiety, measured via the modified Yale Preoperative Anxiety Scale–Short Form. Secondary outcomes were measured using the Induction Compliance Checklist, the Pediatric Anesthesia Emergence Delirium Scale, and the Parental Satisfaction Scale. Data were analyzed using descriptive statistics, independent t‑tests, Mann–Whitney U tests, and Chi-square or Fisher's exact tests. Children in the intervention group demonstrated significantly lower preoperative anxiety scores, significantly improved anesthesia induction compliance, and a shorter duration of emergence delirium compared to the control group. Furthermore, parental satisfaction was significantly higher in the intervention group than in the control group. The Interactive Multisensory Preoperative Orientation Program significantly reduces preoperative anxiety and emergence delirium, improves induction compliance, and enhances caregiver satisfaction. Nurses can readily integrate this theory-based program into clinical practice after further testing with different samples. Future multicenter trials should incorporate mediation analyses, cost-effectiveness evaluations, and potential moderators, such as parental anxiety, to further clarify mechanistic pathways.
Human immunodeficiency virus (HIV)-related stigma remains a significant concern in Indonesia, where misconceptions about transmission, moral judgment, and concerns about family reputation may expose children living with HIV and their families to rejection, concealment, and social exclusion. This descriptive phenomenological study aimed to gain a deeper understanding of the lived experiences of parents and primary caregivers caring for children living with HIV in the context of stigma. Seventeen parents and primary caregivers were purposively recruited from three Indonesian regions: Lampung Province, Semarang in Central Java Province, and the Special Region of Yogyakarta. Data were collected through in-depth, semi-structured interviews and analyzed using Colaizzi’s seven-step phenomenological method. Three themes and seven subthemes emerged: anticipating negative judgment from others, concealing the child’s HIV status to avoid discrimination, and withdrawing from social engagement and restricting interaction; these findings demonstrate that caregivers actively protected children through secrecy and restricted social exposure, although these strategies increased emotional burden, constrained communication, and reduced opportunities for social support. Nurses can apply these findings by providing confidential, family-centered, and stigma-sensitive assessments; therapeutic communication; psychosocial counseling; individualized disclosure support; referral to peer and community resources; and culturally responsive HIV education that strengthens family confidence and promotes safe social participation.
Patients undergoing long-term hemodialysis frequently experience profound emotional, existential, and spiritual distress, making end-of-life acceptance an important yet often insufficiently addressed dimension of nursing care. Although nurses are uniquely positioned to provide sustained psychospiritual support across repeated dialysis encounters, limited evidence exists regarding how such care is enacted in routine hemodialysis practice. This study aimed to explore psychospiritual care practices among Indonesian nurses to promote patients' acceptance of end-of-life care among those receiving long-term hemodialysis. A qualitative descriptive study, guided by Husserlian phenomenology, was conducted at two referral hospitals in Indonesia. Ten purposively selected hemodialysis nurses participated as primary informants, while five patients were included solely as triangulation informants to corroborate contextual interpretations. Data were collected through semi-structured in-depth interviews between October and December 2025, transcribed verbatim, and analyzed using Colaizzi’s method. Three themes were identified: Facilitating spiritual meaning-making and existential acceptance in end-of-life care; Supporting patients in recognizing, managing, and reflecting on anger; and Strengthening connectedness, contribution, and spiritual purpose. These themes indicate that nurses promoted end-of-life acceptance by helping patients interpret illness within a spiritual-existential framework, transforming their anger into emotional insight, and reconstructing meaning in life through relationships, contributions, and a spiritually grounded purpose. Psychospiritual care thus emerged not as an additional task, but as a meaning-centred, relational, and nursing practice embedded in routine hemodialysis care. The findings highlight the strategic role of nurses in integrating culturally sensitive psychospiritual support into everyday practice to foster dignity, inner peace, and acceptance at the end of life.
