Background: Despite the availability of evidence-based eye-care protocols, compliance among nurses in intensive care units (ICUs) remains inconsistent. Conceptual ambiguity between adherence, compliance, and protocol implementation has limited the development of valid measures and targeted interventions. Objective: To clarify and define the concept of Eye Care Compliance in ICUs through a systematic concept analysis. Methods: This concept analysis followed the eight-step framework of Walker and Avant. CINAHL Plus, PubMed, Scopus, Web of Science, and ScienceDirect were searched for studies published between 2015 and 2025. Database-specific search strings and eligibility criteria were applied, and studies were screened and selected based on predefined inclusion and exclusion criteria. Results: Of 653 records identified, 19 studies met the inclusion criteria. Eye Care Compliance was clarified as an observable nursing behavior (what nurses do), distinct from protocol compliance (following externally imposed instructions) and protocol implementation (organizational adoption of a guideline). Three defining attributes were identified: (1) consistent care: reliable, repeated delivery of all protocol-specified procedures for all at-risk patients; (2) timely care: alignment of eye-care activities with evidence-based frequency recommendations and the patient’s evolving risk profile; and (3) documented care: systematic recording of assessments, interventions, and their timing to ensure continuity and auditability. Conclusions: Eye Care Compliance is a distinct, nurse-mediated behavioral construct referring to the observable enactment of structured, evidence-based ocular protection in the ICU. This concept is operationalized as the behavior pattern in which ICU nurses systematically perform and record all protocol-specified ocular protection procedures—assessment, cleansing, eyelid closure or protection, and lubrication—for every patient meeting defined risk criterion, at the intervals required by evidence-based guidelines, with each episode documented to ensure care continuity and accountability.
Background:Extravasation is a serious complication of peripheral intravenous (PIV) therapy. It has been linked to mechanical disruption of a PIV line due to inappropriate site selection or securement, and to the pH, concentration, and cytotoxic properties of the infused solution or drug. However, evidence on extravasation in patients receiving noncytotoxic drugs remains limited. Understanding the causes and risk factors in this population is essential for prevention, early detection, and the development of interventions. Objective:To examine demographic and clinical factors associated with extravasation severity in adult Thai patients receiving noncytotoxic drug PIV therapy. Methods:This observational study included 193 participants at high risk of extravasation during PIV therapy. They were recruited from four tertiary hospitals in four regions of Thailand between December 2019 and December 2023 using purposive sampling. Extravasation severity was assessed using an artificial deep neural network for automated screening of skin images via a smartphone application, with confirmation by a dermatologist. Demographic, clinical, and medical data were collected using standardized forms and analyzed with descriptive statistics and Spearman's rank correlation coefficient. Results:Extravasation was mostly mild (47.67%), followed by moderate (31.09%) and severe (21.24%). Extravasation severity was strongly and negatively correlated with drug pH (r = -0.532; p < 0.01), moderately with concentration (r = 0.411), and methods of drug administration (r = 0.327) (p < 0.01). History of IV insertion showed a mild correlation with severity (r = 0.145; p < 0.05) but not with comorbidities, infusion duration, or catheter size. Conclusion:The results highlight the importance of drug administration, especially the pH and type of drug, concentration, and route of administration, which play a critical role in reducing extravasation, thereby improving PIV therapy outcomes. Nurses play a role in preventing and managing extravasation by controlling the drug's pH and concentration, carefully monitoring early signs, and promptly initiating interventions.
Background:Iron deficiency anemia remains a significant public health concern among pregnant women, particularly in rural areas of low- and middle-income countries. Despite routine antenatal care services and iron-folic acid supplementation programs, adherence to supplementation and effective anemia prevention remain challenging. Understanding how pregnant women and healthcare providers experience and respond to these challenges is essential for strengthening anemia prevention efforts in rural maternal health services. Objective:This study aimed to explore the experiences and support needs of pregnant women and healthcare providers in preventing iron deficiency anemia in rural Indonesia. Methods:A qualitative descriptive study was conducted in Seluma Regency, Bengkulu Province, Indonesia, between May and August 2025 using in-depth interviews and focus group discussions. A total of 30 participants (18 pregnant women and 12 healthcare providers, consisting of six midwives and six nutritionists) were recruited using purposive sampling through antenatal care services. Data were collected using semi-structured interview guides and analyzed using inductive thematic analysis following Braun and Clarke's approach. Results:Three themes emerged from the thematic analysis: (1) understanding anemia beyond symptoms, (2) challenges in maintaining consistent iron-folic acid supplementation, and (3) perceived structural constraints in antenatal counseling. Pregnant women demonstrated limited understanding of anemia beyond physical symptoms, which was compounded by low educational levels prevalent in the sample. Barriers to consistent supplementation included forgetfulness, side effects, and uncertainty about proper tablet intake. Healthcare providers reported that high patient volumes and limited consultation time constrained their ability to deliver comprehensive counseling and follow-up support. Conclusion:The findings demonstrate that the routine provision of iron-folic acid supplements alone are insufficient to support consistent adherence. Strengthening continuous and practical support within antenatal care through nursing- and midwifery-led education and follow-up is essential to improve anemia prevention in rural maternal health services. Strategies should be tailored to address low health literacy, daily behavioral barriers, and structural service constraints to achieve meaningful improvements in maternal anemia prevention.
Background:Self-management-based health coaching is increasingly applied in chronic disease management; however, conceptual ambiguity persists regarding its defining characteristics and theoretical boundaries. A clear and consistent conceptualization is essential to strengthen its application in nursing research and practice. Objective:This study aimed to clarify the concept of self-management-based health coaching in chronic disease care. Method:A concept analysis was conducted using Walker and Avant's framework. A systematic literature search was conducted across multiple databases (PubMed, ScienceDirect, and Google Scholar) for studies published between January 2000 and June 2025, resulting in 49 articles included in the analysis. Conceptual elements were extracted and synthesized using iterative content analysis and constant comparison. Results:The analysis identified seven core attributes (health-focused, partnership and collaboration, client-centered, goal-oriented, process-driven, enlightening, and empowering) that reflect a collaborative, client-centered, and process-oriented approach that facilitates insight and empowerment in behavior change. Antecedents included individual readiness and supportive contextual conditions, while consequences encompassed psychological, behavioral, and clinical outcomes. Model and additional cases further illustrated the concept's application and boundaries. Conclusion:This study provides a clearer conceptual understanding of self-management-based health coaching and highlights its relevance for guiding theory-informed research and practice in chronic disease management. However, further empirical and theoretical work is needed to refine and validate the concept across diverse contexts.
Background: Family-Centered Early Intervention (FCEI) is increasingly recognized as a framework for promoting child development and family empowerment. However, its application in nursing practice may be limited by the lack of a clear distinction between FCEI, Family-Centered Care (FCC), and Patient- and Family-Centered Care (PFCC). Objective: To clarify the concept of FCEI and distinguish it from FCC and PFCC by identifying its defining attributes, antecedents, consequences, and empirical referents. Methods: Walker and Avant’s eight-step concept analysis method was applied. A comprehensive search was conducted across five databases (PubMed, CINAHL, Scopus, ERIC, and Taylor & Francis) for studies published between January 2010 and September 2025. After screening, 49 of 1,958 identified records were included. Results: Seven defining attributes distinguished FCEI from FCC and PFCC: family capacity building, caregiver-mediated intervention (coaching), natural environment-based delivery, routines-based intervention, timeliness and early action, orientation toward developmental and functional outcomes, and an enabling system. These attributes position families as the primary agents of developmental change and situate intervention within everyday routines and natural environments. Antecedents included developmental screening, coordinated service systems, and provider coaching competencies, while consequences encompassed improved child developmental outcomes, greater parental self-efficacy, enhanced family quality of life, and stronger service coordination. Conclusion: FCEI is a distinct developmental intervention framework that extends family-centered principles beyond clinical care toward caregiver coaching, family capacity building, and developmental support in everyday contexts. Integrating FCEI into pediatric and community nursing may strengthen early identification, family empowerment, and coordinated developmental care, particularly in low- and middle-income countries.
Background: Female reproductive health vulnerabilities are influenced by socio-demographic factors and domestic power imbalances. In Indonesia, investigating how relational empowerment affects sexual health outcomes remains a critical public health necessity. Objective: This study aimed to evaluate the association between sexual autonomy, socio-demographic determinants, and self-reported sexually transmitted infection (STI) symptoms among coupled women in Indonesia. Methods: A secondary analysis was conducted using nationally representative data from the 2017 Indonesia Demographic and Health Survey (IDHS). The analytical sample comprised 28,264 currently married or cohabiting coupled women. A composite index for sexual autonomy was constructed based on standardized sexual negotiation indicators. Survey-weighted binary logistic regression analysis was conducted to calculate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results: The multivariate analysis demonstrated a significant association between sexual autonomy and self-reported STIs. Women with high sexual autonomy had 1.51 times higher odds of reporting STI symptoms than those with low sexual autonomy (AOR = 1.51; 95% CI: 1.23-1.84). Rather than indicating greater biological risk, this association suggest a symptom disclosure effect related to greater health awareness. In contrast, structural vulnerabilities independently reduced protective capacity; lower decision-making autonomy (AOR = 1.14), primary education (AOR = 1.29), and a strong justification of intimate partner violence (AOR = 2.08) were all significantly associated with higher odds of experiencing and reporting STIs. Conclusion: The association between high individual sexual autonomy and elevated STI symptom reporting highlights a health disclosure mechanism rather than biological disease incidence. Among coupled Indonesian women, reproductive health outcomes are deeply shaped by gender power relations. Public health and community nursing interventions should therefore prioritize addressing structural domestic coercion, normalizing the rejection of violence, and creating safe environments that support health transparency.
Background:Nurse-led interventions play a vital role in cervical cancer care across the disease trajectory but are often underappreciated despite their impact on patient-reported outcomes. Objective:This review aimed to map current nurse-led interventions for women with cervical cancer across the disease trajectory, identify key design gaps, reporting, and evaluation to guide practice and research. Methods:The scoping review was guided by Arksey and O'Malley's framework for conducting scoping studies. The included studies were published between 2015 and 2025 and were identified through searches of MEDLINE, Scopus, Embase, CINAHL, and ScienceDirect. The final database search was conducted on 31 December 2025. The studies were empirical studies on nurse-led interventions targeting management of cervical cancer patients. The primary results were organized by themes using a line-by-line coding method. Results:Of the 1,220 studies identified, twenty-two met the inclusion criteria. Most studies used quasi-experimental designs, with few randomized, mixed-methods, or qualitative studies. The nurse-led interventions emphasized health education and psychological support, and improved sexual function, mental health, disease knowledge, quality of life, self-efficacy, personal confidence, and body image. Important elements of cervical cancer care such as cost of care, financial burden, palliative and end-of-life care, and cancer recurrence were mostly not addressed by any intervention. Conclusion:The included studies frequently reported positive outcomes associated with nurse-led interventions such as improved patients' sexual function, quality of life, mental health, emotional well-being, family functioning, symptom burden, self-management, knowledge, and satisfaction with care. Registry:PROSPERO [CRD420261277487].
Background: Evidence-based practice (EBP) is a vital approach to achieve Quality Improvement (QI) in healthcare services by ensuring that nursing care is grounded in the best available evidence. However, the integration of EBP into nursing in Vietnam is often lacking, presenting a significant challenge for both healthcare leaders and individual practitioners. Objectives: This qualitative study aimed to understand the workplace culture regarding EBP implementation among Vietnamese nurses, exploring the shared beliefs, values, and contextual factors that influence EBP within a tertiary hospital setting, with a particular focus on the Intensive Care Unit and other relevant departments. Method: A focused ethnographic approach was employed. Data were collected over 14 months (from late May 2024 to early July 2025) through participant observation and in-depth interviews with 30 registered nurses from various units (Nursing Department, Intensive Care Unit, Emergency Room, Neurological Department, Internal Medicine Department, and Geriatrics Department). Data analysis followed ethnographic analytic principles to identify key themes. Results: The findings revealed a complex interplay of individual, organizational, and systemic factors. Five key themes emerged: 1) Informal and experiential learning with limited research involvement; 2) Culture of task- and procedure-centered nursing practice; 3) Compliance culture; 4) Developing professional identity; and 5) Misconceptions of EBP and low-evidence conceptualization. Nurses favored experiential and peer-based learning over systematic scientific evidence. Structural constraints, including insurance policies and rigid hierarchies, further hindered EBP implementation. Conclusion: The study recommends multi-level strategies that involve policy reform, hospital management support, and enhanced nursing education to foster an environment conducive to EBP, thereby improving nursing autonomy and the quality of patient care.
Background: Parents’ inability to generate meaning in events related to their child, especially a chronic illness, leads to uncertainty. This could negatively impact the management and outcome of their child and family well-being. Nevertheless, there is no available tool to measure parental uncertainty in Indonesia. Objective: The study aimed to evaluate the validity and reliability of the Indonesian version of the Parent’s Perception of Uncertainty Scale (PPUS) using an exploratory approach. Methods: This was a psychometric properties study conducted in 2020 among parents of children with genetic conditions, i.e., congenital adrenal hyperplasia (CAH), type 1 diabetes mellitus (T1DM), and Down syndrome (DS), recruited from pediatric endocrinology clinics in secondary and tertiary hospitals, and a genetic research center in Semarang, Central Java, Indonesia. The original PPUS was translated and back-translated into Indonesian and English. Principal Axis Factoring (PAF) was performed to measure its validity and reliability. IBM SPSS version 26 and JASP version 0.18 were utilized to perform descriptive and parallel analysis, respectively. Partitioning Around Medoids (PAM) was analyzed using RStudio version 2026.05.0 on R version 4.6.0. Results: A total of 259 parents (105 fathers and 154 mothers) of 170 children with CAH, T1DM, and DS completed the questionnaire. Samples were adequate (KMO = 0.857), and factor analysis was feasible (Bartlett p < 0.01). The Indonesian version of PPUS comprised 24 items forming three subscales, i.e., Ambiguity, Unpredictability, and Lack of Clarity (α = 0.839). Conclusion: Despite requiring further refinement in a homogeneous sample, the Indonesian PPUS demonstrated potential use in research on parental uncertainty and proposing future nursing interventions aimed at improving family-centered care.
Background: For Muslim patients, performing the five daily prayers (Solah) is a non-negotiable pillar of faith and a vital source of spiritual solace during illness. In Malaysia, the Ibadah-Friendly Hospital (IFH) framework was established to support this need within holistic care. However, adherence remains low, particularly among patients with physical limitations, such as orthopaedic conditions, suggesting a significant gap between policy and lived experience. Objective: This study aimed to explore in-depth the lived experiences, perceptions, and multifaceted barriers faced by hospitalised Muslim orthopaedic patients in fulfilling their obligatory prayers. Methods: A qualitative descriptive case study design was employed. Purposive sampling was used to recruit 16 Muslim patients from the orthopaedic wards of a tertiary hospital on the East Coast of Malaysia. Data were gathered via semi-structured, in-depth interviews and non-participant observations between July 2023 and February 2024. Thematic analysis was conducted using the Framework Method, facilitated by the Atlas.ti software. Trustworthiness was ensured through researcher reflexivity, audit trails, and team debriefing. Results: Three primary themes emerged from the data: (1) Negotiating Obligation and Leniency, where patients held a common misconception that religious concessions (rukhsah) permitted complete postponement rather than adaptation of prayer; (2) The Embodied Struggle of Purity and Piety, capturing profound distress over ritual impurity from medical devices (catheters, diapers) and practical hurdles with inadequate ablution facilities and missing prayer attire; and (3) The Silent Gap in Supportive Care, highlighting a systemic failure where patients perceived nurses as too busy for spiritual support, experienced gender-related discomfort, and found existing IFH facilities (e.g., prayer kits) inaccessible or unknown. Conclusion: The barriers are complex, intertwining knowledge gaps, embodied distress, and systemic shortcomings. Moving beyond infrastructural provisions, a patient-centred approach is urgently needed. This includes proactive nursing assessment of spiritual needs, tailored patient education on rukhsah, gender-sensitive assistance protocols, and training that empowers nurses to provide holistic, culturally competent care that truly supports patients’ spiritual well-being.
Background:Aspiration pneumonia is a major cause of morbidity and mortality in hospitalized adults, yet limited evidence exists from the Eastern region of Saudi Arabia. Objective:To identify clinical correlates of disease severity in patients with confirmed aspiration pneumonia. Methods:A retrospective cross-sectional study was conducted using medical records of adult patients diagnosed with aspiration pneumonia across two major hospitals in Eastern Saudi Arabia (January 2018 - December 2023). A total of 294 eligible records were reviewed. Demographic, clinical, functional, and respiratory data were extracted. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with greater clinical severity, defined by respiratory compromise and treatment intensity. Results:The mean age was 63.6 years (SD 24.1); 55.1% were male, and 54.8% were fully dependent. Dysphagia or esophageal dysfunction was common, and nearly half required nasogastric feeding. In the primary multivariable model, lower oxygen saturation (aOR = 0.92, 95% CI 0.85-0.99, p = 0.035), lower Glasgow Coma Scale score (aOR = 0.81, 95% CI 0.68-0.96, p = 0.017), dysphagia/esophageal dysfunction (aOR = 2.72, 95% CI 1.15-6.40, p = 0.022), mechanical ventilation (aOR = 3.42, 95% CI 1.51-7.74, p = 0.003), and broad-spectrum antibiotic use (aOR = 2.36, 95% CI 1.07-5.18, p = 0.033) were independently associated with greater severity. An exploratory analysis of oral hygiene was limited by sample size. Conclusions:Aspiration pneumonia in Eastern Saudi Arabia predominantly affects older, dependent adults with swallowing impairment. Independent correlates of greater severity include dysphagia, reduced consciousness, hypoxemia, and mechanical ventilation. These findings support routine dysphagia screening, structured oral care, airway protection strategies, and rehabilitative nursing interventions in chronic care pathways for at-risk patients.
This corrigendum corrects clerical errors regarding the study timeline, IRB approval dates, the instrument permission date, and adolescent age classifications in the original article (DOI: https://doi.org/10.33546/bnj.3744), which resulted from an inadvertent mistake in converting Buddhist Era (BE) dates to the Gregorian calendar. The authors confirm that these administrative corrections do not affect the methodology, data analysis, results, or conclusions of the original study and sincerely apologize for any inconvenience caused.
Background: Older adults with colorectal cancer who undergo chemotherapy are at high risk of functional status decline. Various demographic and physiological factors influence functional status. However, based on the Theory of Unpleasant Symptoms, few studies have examined the relationships among physiological, psychological, and situational factors, symptom experience, and functional status in older adults with colorectal cancer undergoing chemotherapy. Objective: This study aimed to describe functional status and investigate its associated factors among older adults with colorectal cancer undergoing chemotherapy in Thailand. Methods: A cross-sectional study was conducted among 128 older adults with colorectal cancer receiving chemotherapy. Participants were recruited from a cancer hospital in Northeastern Thailand using multi-stage sampling, followed by systematic random sampling with a random digit table. Data were collected between October 2024 and July 2025 using standardized instruments. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation coefficients, and multiple regression analysis. Results: The findings revealed that participants’ functional status was moderate. Pearson’s correlation coefficient analysis showed that body mass index and social support were positively associated with functional status. Fatigue, depression, and the number of chemotherapy cycles were negatively associated with functional status. Multiple regression analysis showed that fatigue was the strongest factor negatively associated with functional status (β = -0.375, p < 0.001), followed by depression (β = -0.329, p < 0.001). On the other hand, body mass index (BMI) (β = 0.188, p < 0.05) was positively associated with functional status. The model was statistically significant (R2 = 0.409, F(3,124) = 28.590, p < 0.001), which explaining 40.90% of the variance in functional status. Conclusion: These findings suggest that nurses should implement early screening and proactive nursing interventions to reduce fatigue and depression. Such interventions may include optimizing nutritional status at each chemotherapy cycle and providing family support to help this population preserve functional status.
Background: Resourcefulness is the capacity to confront life’s obstacles by utilizing coping skills, adapting to new circumstances, and seeking assistance from the environment. Therefore, the geriatric field continues to emphasize the importance of older adults’ resourcefulness. The Indonesian version of the Resourcefulness Scale© (I-RS) has just been translated; it is essential to conduct this research and report the findings for its application in Indonesia. Objective: This study intended to develop the Bahasa Indonesian version of the Resourcefulness Scale© and to test its reliability and validity in older adults. Methods: The questionnaire was initially created in English and then translated by two linguistic experts. Subsequently, meaning and cultural analysis were performed by psychiatric nursing specialists. Following this, a back-translation was executed, and the Indonesian version was used for data collection. Data was collected with 331 older adults residing in 11 nursing homes from 2023 to 2024. Correlational analysis and Confirmatory Factor Analysis (CFA) were conducted using Structural Equation Modeling (SEM) in LISREL 8.8 to examine the validity of the I-RS. Reliability was assessed using Cronbach’s Alpha and Split-half reliability. Results: The internal consistency of the Indonesian version of the instrument is acceptable with Cronbach’s Alpha .79 and Split-half reliability .75. According to the results of SEM, Chi square = 253.13, the Root means square error of approximation (RMSEA = 0.04), the adjusted goodness of fit index (AGFI = 0.90), Normed Fit Index (NFI = 0.92), Parsimony Normed Fit Index (PNFI = 0.76) and Comparative fit Index (CFI = 0.97) were all accepted. Two factors, such as personal and social resourcefulness, were identified through factor analysis using SEM. A positive and significant relationship was found between resourcefulness and spiritual health (r = 0.45, p < 0.001). Conclusion: These results confirmed the use of the Indonesian version of the Resourcefulness scale (I-RS), indicating that it has acceptable reliability and validity. This instrument is potentially useful for measuring older adults’ resourcefulness in geriatric nursing in Indonesia, across both clinical and community settings.
Despite substantial theoretical advancement, nursing knowledge continues to be framed by epistemological classifications rather than ontological clarification. The question of what nursing knowledge is, as a mode of existence, remains unanswered, despite existing frameworks that emphasize patterns, types, or domains of knowing. This paper argues that nursing knowledge is best understood as a relational ontology, a performative enactment emerging through practice rather than a collection of categorized components. Nursing knowledge is conceptualized as a unitary process manifested through embodied presence, interpretive meaning-making, and technologically mediated action. This paper illuminates how these aspects do not function as distinct domains but as a single, inseparable mode of being in clinical judgment and caring practices within digitally mediated contexts.
Background: The Depression, Anxiety, and Stress Scale (DASS-21) is widely used to assess mental health symptoms; however, its dimensionality in working populations, particularly healthcare workers, remains under debate. Objective: This study aimed to examine the dimensional structure of the DASS-21 among Chilean healthcare workers to evaluate its suitability as a screening measure of psychological distress in occupational contexts exposed to crises, emergencies, or disasters. Methods: A cross-sectional survey was conducted in 2021 using a non-probabilistic convenience sample of 239 healthcare workers from a hospital in northern Chile. Confirmatory factor analyses were conducted to test four competing models (unidimensional, three correlated factors, second order, and bifactor) using structural equation modeling. Model fit was evaluated using RMSEA, CFI, and TLI, complemented by auxiliary bifactor indices (ECV, ωH, ωHS, PUC, ARPB). Results: All models showed acceptable fit (RMSEA = 0.038–0.065; CFI = 0.974–0.992; TLI = 0.971–0.990). Although the bifactor model demonstrated the best global fit, auxiliary indices supported the dominance of a general factor (ECV = 0.87; ωH = 0.94), with limited reliable variance attributable to the specific factors (ωHS ≤ 0.16). Measurement invariance across sex was supported. Conclusions: In this non-clinical sample characterized by low symptom severity, the DASS-21 operates primarily as an essentially unidimensional measure of psychological distress. From a nursing practice perspective, the total score may be used as a parsimonious screening indicator to support early detection, monitoring, and preventive mental health strategies among healthcare workers.
Background: Uncontrolled hypertension leads to a number of complications. To achieve effective self-management, adults with uncontrolled hypertension need health literacy to promote and maintain good health. Transformative learning is a key adult learning paradigm that supports perspective transformation, self-management, and blood pressure control. Objective: This study aimed to evaluate the effects of a Transformative Learning Theory-Based Health Literacy Enhancement Program on self-management behaviors and blood pressure among adults with uncontrolled hypertension. Methods: This cluster-randomized controlled trial was conducted at two sub-district health-promoting hospitals in northeastern Thailand. Hospitals were randomly allocated to either the experimental or control group to prevent treatment contamination. A total of 58 participants (n = 29 per group) were consecutively recruited. Data were collected between February and June 2025 using a validated Self-Management Behavior Scale and digital BP monitoring. Data were analyzed using independent- and dependent-samples t-tests and repeated-measures ANOVA, and ANCOVA was used to compare groups while controlling for baseline values. Results: At 8 and 12 weeks after the program, the experimental group had significantly higher self-management scores than the control group (t = 2.117, p = 0.039; t = 3.416, p = 0.001, respectively) and than their own baseline (F = 31.958, p < 0.001). Regarding clinical outcomes, ANCOVA revealed a significant main effect of the program on mean arterial pressure (MAP) at both 8 weeks (F(1, 55) = 9.014, p = 0.004, hp2 = 0.141) and 12 weeks (F(1, 55) = 9.133, p = 0.004, hp2 = 0.142). The adjusted mean MAP for the experimental group was significantly lower than the control group at the final follow-up (108.90 vs. 111.37 mmHg). A significant reduction was noted for systolic blood pressure (p = 0.028) but not diastolic blood pressure. Conclusion: The study highlights the effectiveness of the program for improving self-management behaviors and systolic blood pressure. Nurses can integrate adult learning theories into health education to enhance outcomes for hypertensive patients in primary care. Trial Registry Number: Thai Clinical Trial Registry (TCTR20250202009)
Background: Health promotion in correctional settings faces challenges due to limited healthcare access and restricted environments. Nurses are primary healthcare providers in correctional institutions; however, evidence on nurse-led capacity-building programs for inmate health volunteers remains limited. Developing the capacity of Prison Public Health Volunteer Leaders (PPHVs) through a holistic healthcare approach can enhance their self-reliance. Objective: This study aimed to collaboratively develop, implement, and evaluate a holistic health care program to strengthen the capacity of PPHVs at the Central Correctional Institution for Young Offenders in Pathum Thani Province, Thailand. Methods: This study employed a Participatory Action Research (PAR) design. A total of 100 well-behaved inmates were purposively selected as PPHVs and actively engaged as co-participants throughout the PAR process. The intervention was collaboratively designed and implemented over five weeks, comprising ten participatory training sessions that addressed physical, mental, social, and environmental health dimensions. Quantitative data were collected using validated questionnaires assessing knowledge, attitudes, health practice skills, data management skills, and overall capacity at baseline, post-intervention, and at 1-month follow-up. Data were analyzed using repeated measures analysis of variance (ANOVA). Results: The findings revealed statistically significant improvements (p <0.001) in participants’ knowledge (F = 778.41, ηp² = 0.887), attitudes (F = 889.09, ηp² = 0.900), health practice skills (F = 1241.89, ηp² = 0.917), data management skills (F = 546.81, ηp² = 0.847), and overall capacity (F = 727.48, ηp² = 0.880). These outcomes indicate substantial enhancement in PPHVs’ ability to perform health promotion and data management roles proficiently. Conclusion: The holistic health care program significantly improved PPHVs’ capacity, suggesting promise for strengthening inmate health volunteer programs in correctional settings. These findings have significant implications for nursing practice in designing capacity-building programs, nursing education in preparing nurses for correctional care, and nursing policy in developing standards for correctional nursing in Thailand. Trial Registry Number: Thai Clinical Trials Registry (TCTR20260115003)
