Mei Chan Chong

Introduction: Nurses play a vital role in healthcare services, but various challenges make them consider leaving the profession, leading to nursing shortages both nationally and globally. However, studies exploring the factors influencing this intention remain very limited. This study aimed to investigate factors associated with nurses' turnover intentions, focusing on work environment and burnout. Methods: This study employed a cross-sectional design involving 252 nurses in Indonesia who had been working for at least six months, selected using non-probability sampling. Data were collected using a sociodemographic form, the Practice Environment Scale of the Nursing Work Index (PES-NWI), the Copenhagen Burnout Inventory (CBI), and the Turnover Intention Scale (TIS-6). Statistical analysis was conducted using the Chi-square test and logistic regression analysis, with α = 0.05. Results: 41.3% of participants intended to leave the nursing profession. Factors significantly associated with the turnover intentions were age: <30 (AOR=6.851; 95% CI=1.908-24.601; p=0.003) and 30-40 (AOR=3.017; 95% CI=1.214-7.499; p=0.017); region of origin: Java (AOR=4.276; 95% CI=1.296-14.107; p=0.017); highest education: bachelor’s (AOR=3.391; 95% CI=1.413-8.139; p=0.006); work experience: 2-4 years (AOR=8.828; 95% CI=1.792-43.477; p=0.007) and ≥5 years (AOR=6.806; 95% CI=1.047-44.224; p=0.045); work environment: poor (AOR=5.032; 95% CI=1.133-22.344; p=0.034); and burnout: moderate (AOR=3.064; 95% CI=1.304-7.198; p=0.01) and severe (AOR=12.741; 95% CI=3.940-41.198; p<0.001). Conclusion: This study underscores the importance of targeted retention strategies that address nurses’ diverse needs throughout their careers. Initiatives should focus on enhancing supportive work environments and addressing the various challenges nurses face at different career stages.

Aims: To examine longitudinal associations among maternal health literacy, psychological empowerment and health‐promoting behaviours across pregnancy among rural pregnant women. Design: Prospective cohort study. Methods: Between 1 May 2023 and 15 January 2024, 694 rural pregnant women were assessed at 12, 24 and 32 gestational weeks (T1, T2 and T3). Descriptive, correlation and cross‐lagged panel analyses were used. Results: Significant reciprocal cross‐lagged associations were observed among maternal health literacy, psychological empowerment and health‐promoting behaviours across pregnancy. Maternal health literacy at T1 significantly predicted psychological empowerment at T2 ( β = 0.183, B = 0.056, 95% CI [0.036, 0.075], p < 0.001), and psychological empowerment at T2 predicted health‐promoting behaviours at T3 ( β = 0.256, B = 0.373, 95% CI [0.246, 0.500], p < 0.001). Longitudinal indirect pathway analysis showed that maternal health literacy at T1 was indirectly associated with health‐promoting behaviours at T3 through psychological empowerment at T2 ( β = 0.047, B = 0.021, 95% CI [0.010, 0.031], p < 0.001). Conclusion: Maternal health literacy, psychological empowerment, and health‐promoting behaviours were longitudinally and reciprocally associated across pregnancy. Psychological empowerment also carried the longitudinal indirect association between earlier maternal health literacy and later health‐promoting behaviours. Early gestation may represent an intervention window. Implications for the Profession and/or Patient Care: Integrating literacy‐sensitive and empowerment‐based interventions into antenatal care may help rural pregnant women support sustained health‐promoting behaviours throughout pregnancy. Impact: Clarifies the longitudinal role of maternal health literacy. Demonstrates a significant indirect longitudinal role of psychological empowerment. Supports early‐stage capability‐based interventions within rural maternal healthcare. Reporting Method: This study is consistent with the STROBE statement for cohort studies. Patient or Public Contribution: This study did not include patient or public involvement in its design, conduct or reporting.

Introduction: The success of cervical cancer treatment is not solely determined by medical procedures but is also influenced by individual and external factors such as patient knowledge, family support, peer group involvement, and the role of health professionals. These factors enhance treatment adherence and patient participation during therapy. Objective: This study aimed to analyze the multifactorial roles of individual and external factors in the success of cervical cancer treatment. Methods: A quantitative, cross-sectional study was conducted in 2024 at XX General Hospital, Semarang, involving 135 cervical cancer patients. Data were collected from the cervical cancer patients using a validated and authorized questionnaire; independent variables included knowledge, family support, peer groups, and health professionals. The dependent variable was treatment success, defined as patients receiving at least one session of cancer treatment, including chemotherapy, surgery, radiotherapy, or chemoradiation, measured through self-reported confirmation of treatment received. Data were analyzed through univariate, bivariate (Somers'd test), and multivariate analyses using ordinal logistic regression. Results: Most patients had good knowledge (58.5%), good family support (57%), strong peer group support (58.5%), and adequate support from health professionals (53.3%). A total of 58.3% of respondents reported high treatment success. Bivariate analysis revealed strong, statistically significant associations between each independent variable and treatment success (P-value<.001; r=.881–.968). Multivariate analysis indicated that the four variables simultaneously influenced 81.5% of treatment success variation (R² = .815). Conclusion: Knowledge, family involvement, peer support, and health services, particularly by nurses, significantly contribute to the success of cervical cancer treatment in women. Integrating educational and social support interventions is essential for improving treatment outcomes, as these interventions enhance patients' adherence to therapy, promote self management, reduce treatment-related anxiety, and facilitate the early detection of complications, ultimately leading to better quality of life and overall treatment effectiveness. Keywords: cervical cancer; family support; knowledge; peer group

Background: The uneven distribution of nurses across Indonesia’s remote regions remains a major obstacle to achieving universal health coverage and Sustainable Development Goals. Recruitment and retention policies for remote areas are often based on assumptions about what nurses value, while empirical evidence remains limited. This study aimed to examine the job attributes influencing nurses’ preferences for working in remote and very remote areas in Indonesia. Methods: A discrete choice experiment (DCE) was conducted among 243 nurses with at least one year of experience in remote healthcare facilities in East Nusa Tenggara, Papua, and West Papua. Job attributes and levels were identified through literature reviews and focus group discussions (FGDs). Six attributes were included: work location, employment status, supporting facilities, basic living facilities, student financial aid, and monthly net income. Preferences were estimated using a conditional logit model, with willingness-to-accept (WTA) estimates supporting policy interpretation. Results: Basic living facilities were the most influential factor in shaping nurses’ job preferences. Positions offering reliable access to clean water, electricity, and internet services were significantly more likely to be chosen than those without such facilities (odds ratio [OR] = 2.06; 95% CI: 1.82–2.33). Jobs in very remote areas were also preferred over rural postings (OR = 1.76; 95% CI: 1.52–2.04). In contrast, civil servant employment was less preferred than contract-based positions (OR = 0.56; 95% CI: 0.49–0.64), and direct provision of housing and transportation did not significantly influence job choice (OR = 1.07; 95% CI: 0.94–1.22). A higher monthly income increased the likelihood of selecting a remote posting. Conclusion: Nurses’ preferences for remote postings in Indonesia are driven mainly by living conditions, employment security, and location, rather than financial incentives alone. Policies should prioritize basic infrastructure improvements and stable employment arrangements.

Anaemia during pregnancy continues to be a major public health concern worldwide, affecting a substantial proportion of expectant mothers and contributing to adverse maternal and neonatal outcomes. This scoping review explores the role of antenatal education in reducing the risk of anemia by examining the types of educational strategies used, their reported outcomes, and existing gaps in current practice. The review was guided by the Arksey and O’Malley framework and reported in line with PRISMA-ScR recommendations. Relevant experimental studies published between 2000 and 2024 were identified from four electronic databases. Following a rigorous screening process, 11 studies were included. Overall, the findings suggest that antenatal education delivered through approaches such as community-based counseling, digital communication, visual or art-based methods, and home visits can improve maternal knowledge, increase adherence to iron and folic acid supplementation, and raise hemoglobin levels. However, the effectiveness of these interventions appears to vary depending on contextual factors, including cultural background, literacy levels, and the extent to which behavioural theories are applied. In conclusion, while antenatal education shows clear potential in reducing anaemia risk, future interventions should place greater emphasis on theory-driven design, cultural relevance, and long-term evaluation. Digital platforms, in particular, may offer practical opportunities to enhance accessibility and engagement, especially in resource-limited settings.

Aim: To synthesize qualitative evidence on midwives’ experiences and perceptions regarding the use of digital health technologies in clinical maternity care. Background: Although digital health technologies are rapidly transforming maternity care, there is limited understanding of how midwives experience both the benefits and challenges of these tools in real‐world maternity care. Methods: Eight major databases were systematically searched for qualitative studies published between January 2015 and May 2025. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Mixed Methods Appraisal Tool. Findings were synthesized through a structured three‐phase aggregation process. Results: This review synthesized evidence from 20 primary studies reflecting midwives’ experiences. Three major themes emerged: (1) Agentic Adaptation in Digital Practice, (2) Structural Underenablement in Implementation, and (3) Reflective Becoming of an e‐Midwife. These themes were further divided into eight subthemes. Discussion: This review suggests that digital health is reshaping midwifery practice in complex and uneven ways. Although it may enhance service delivery, it also reconfigures professional roles and relational work, generating new tensions in maternity care. Conclusion: Digital transformation in midwifery is not solely a matter of technological adoption but of how digital systems are aligned with the professional, organizational, and relational foundations of maternity care. Implications for nursing: Midwives require structured, practice‐oriented digital health education that extends beyond basic technical skills to include ethical awareness, data interpretation, and digitally mediated communication. Implications for Nursing Policy: Policy frameworks should clearly define accountability, governance, and quality standards for digital maternity care while ensuring meaningful midwifery involvement in system design and evaluation. Investment in infrastructure, digital leadership, and privacy safeguards is essential for equitable and sustainable integration.

Patients with cancer who are also parents of minor children often express significant concerns related to their parenting role. This cross-sectional study aimed to understand parenting concerns in young breast cancer patients and their spouses, focusing on the perspective of dyadic coping. A total of 296 Chinese young breast cancer couples were recruited via convenience sampling, from April 2023 to December 2023. Participants completed the general information questionnaire, Dyadic Coping Inventory, and Parenting Concerns Questionnaire. Dyadic data were analyzed using the Actor-Partner Interdependence Model. The parenting concern scores of young breast cancer patients and their spouses were (3.57 ± 0.56) and (3.26 ± 0.92) respectively, both indicating a moderate to high score; There were statistically differences in parenting concern between young breast cancer patients and their spouses (t = 4.810, p < 0.001). The dyadic coping scores of young breast cancer patients and their spouses were (118.23 ± 20.32) and (118.24 ± 19.47) respectively, and both were at a moderate score. Interdependence model analysis showed that the dyadic coping of both patients and their spouses negatively associated with their own parenting concerns (p < 0.05); Spouse’s supportive coping positively associated with the patient’s parenting concern (p < 0.05), while there was no statistical difference in the patient’s object effect (p > 0.05). The mean score of parenting concerns of young breast cancer patients and their spouses was affected by the score of dyadic coping. Health care workers should regard patients and their spouses as a whole and formulate mutually supportive coping strategies with family as the center, so as to increase positive coping behavior and enhance their family’s ability to cope with breast cancer while raising underage children.