Critical Medical and Surgical Nursing Journal

Application of Deep Diaphragmatic Breathing in Cases of Acute Decompensated Heart Failure with Ineffective Breathing Patterns in Surabaya Hospitals

Mohammad Rizal Diansya — 2025-09-28

Introduction: Acute Decompensated Heart Failure (ADHF) is a sudden worsening of heart failure symptoms. In 2019, WHO reported 17.9 million deaths worldwide from heart disease, with ADHF affecting 1.5% of Indonesia’s population. Shortness of breath is the most common symptom, occurring in 80% of hospitalized ADHF patients. Deep Diaphragmatic Breathing can help improve breathing by strengthening the diaphragm. This case study aimed to evaluate the effectiveness of Deep Diaphragmatic Breathing in improving respiratory status in patients with Acute Decompensated Heart Failure (ADHF).

Objective: This research used a descriptive case study design with a single case study approach 7 days, assessing and evaluating the effects of Deep Diaphragmatic Breathing exercises to reduces ineffective breathing patterns in Acute Decompensated Heart Failure. Data collection through interviews, observation, measurement, physical examination, and medical records.

Case: A 46-year-old patient with Acute Decompensated Heart Failure (ADHF) was admitted with shortness of breath, nausea, vomiting, and loss of appetite for one day. On examination, the patient was conscious (GCS 456), BP 95/66 mmHg, temperature 36.2°C, pulse 68/min, RR 22/min, SpO₂ 98% (with nasal cannula), weight 60 kg, and height 167 cm. The main complaint was dyspnea, especially when lying down, with wheezing and irregular breathing. Blood test (B2) showed weak palpable pulse, warm moist extremities, and transient chest pain. Nursing care included respiratory monitoring, deep diaphragmatic breathing, and positioning in Fowler or semi-Fowler. By day 6, breathing improved (RR 18/min, SpO₂ 99%) without oxygen support.

Conclusion: Deep Diaphragmatic Breathing reduced ineffective breathing patterns in ADHF patients. Future research should involve larger sample sizes and explore long-term outcomes to strengthen evidence for its clinical application.

The Superiority of Demonstration Over Video in Improving High School Students’ Skills in Closed Fracture Management

Mareta Nawang Saputri — 2025-09-28

Introduction: The number of fracture injuries caused by accidents is rising globally, with closed fractures being a common type. The school environment poses a high risk for such injuries, often due to falls, sports activities, or accidents. Prompt and proper treatment is essential. Therefore, it is important for students to be trained in handling closed fractures, particularly in using splint bandages correctly. This study aimed to analyze the difference in students’ skills in handling closed fractures after receiving education via videos versus demonstrations.

Methods: This research used a quasi-experimental design with a posttest-only control group. The independent variable was the instructional method (video or demonstration), while the dependent variable was the students’ skills in handling closed fractures. The study involved first-grade high school students in Boyolali, Indonesia. A total of 88 students were selected through simple random sampling and divided equally into two groups: 44 in the intervention group (demonstration) and 44 in the control group (video). The Mann-Whitney test was used for bivariate analysis.

Results: After the intervention, the demonstration group achieved a maximum score of 98 and a minimum of 64, while the video group scored a maximum of 79 and a minimum of 52. The Mann-Whitney test revealed a significant difference in skill levels between the two groups, with a p-value of 0.000 (p < 0.05).

Conclusion: There is a significant difference in the effectiveness of video and demonstration methods on students' skills in handling closed fractures. The demonstration method proved to be more effective, as it provides students with direct, hands-on experience that enhances understanding and skill application. Future research should examine long-term skill retention and include larger, more diverse samples to enhance generalizability.

Effectiveness of Simulation-Based Health Education on Adolescents’ Basic Life Support Knowledge and Skills

Lale Wisnu Andrayani — 2025-09-28

Introduction: Sudden cardiac arrest is a medical emergency that requires immediate intervention in the form of Basic Life Support (BLS). Adolescent knowledge and skills in performing BLS are crucial, especially in areas with limited access to emergency services. This research to assess the effect of simulation-based health education on adolescents' knowledge and skills in performing BLS at Junior High School.

Methods: This study used a pre-experimental design with a One-Group Pretest-Posttest approach. A total of 52 students were randomly selected using simple random sampling. Data were collected through questionnaires and skills checklists, and analyzed using the Wilcoxon Signed Rank Test. In this study, the independent variable is the simulation-based health education provided to adolescents, which serves as the intervention aimed at improving their preparedness in emergency situations. The dependent variables are the adolescents’ knowledge and skills in performing Basic Life Support (BLS).

Results: Prior to the intervention, all participants (100%) had low knowledge and skills in BLS. After the intervention, 83% of participants had good knowledge, and 56% were skilled in performing BLS. Statistical analysis revealed a significant improvement in both knowledge and skills (p=0.000).

Conclusion: Simulation-based health education significantly improved adolescents' knowledge and skills in BLS. Future research is recommended to involve larger and more diverse populations, such as students from different educational levels (elementary, high school, or university) or adolescents from rural and urban areas, to compare the effectiveness of simulation-based health education across settings.

The Effectiveness of Spiritual Emotional Transcedence Care (SET Care ) On Stress Levels of Pulmonary Tuberculosis Patients: A Quasi-Experimental Study

Hartono Hartono — 2025-09-28

Introduction: Tuberculosis (TB) is a chronic infectious disease that can affect various organs and often leads to psychological stress. Spiritual Emotional Transcendence Care (SET Care), which integrates the SEFT approach with self-transcendence theory, is a relaxation technique aimed at reducing stress in TB patients.

Methods: This quasi-experimental study used a non-randomized pretest-posttest control group design. A total of 20 pulmonary TB patients were selected through purposive sampling and divided into treatment (n=10) and control (n=10) groups. Stress levels were measured using a modified DASS-42 stress subscale. Data were analyzed using the Wilcoxon signed-rank test and the Mann-Whitney U test with a significance level of p ≤ 0.05.

Results: Demographic data showed equal gender distribution (50% male, 50% female), with most participants aged 44–55 years and educated up to senior high school. A significant reduction in stress levels was found in the treatment group after the intervention (p = 0.004), while the control group showed no significant change (p = 0.655). The Mann-Whitney U test confirmed a significant difference in post-test scores between groups (p = 0.000).

Conclusions: SET Care effectively reduces stress in pulmonary TB patients and can be considered a complementary nursing intervention. Its integration into nursing practice supports holistic care by addressing emotional and spiritual well-being, potentially enhancing treatment adherence and patient outcomes.

The Effect of Abdominal Stretching Exercise Therapy on Dysmenorrhea Pain Intensity in Adolescent Girls

Gita Marini — 2025-09-28

Introduction: Adolescence is referred to as a transitional period towards adulthood or puberty which is marked by the occurrence of the first menstruation (menarche). Menstruation experienced by adolescent girls mostly causes pain called dysmenorrhea, although this is normal due to the production of prostaglandins. Prostaglandins will stimulate the smooth muscles of the uterine wall to contract. The higher the prostaglandin levels, the stronger the contractions will be, and the pain will also be stronger. This study aims to analyze the effect of abdominal stretching exercise therapy on the intensity of dysmenorrhea pain in adolescent girls.

Methods: The research design used was quantitative with a quasi-experimental research design, namely pre-post test with control group design. The population in this study were junior high school students, sampling using purpose sampling technique with a total sample of 66 respondents (33 intervention groups and 33 control groups) taken according to the inclusion and exclusion criteria. The independent variable of the study was the abdominal stretching exercise technique and the dependent variable was the intensity of dysmenorrhea pain. Abdominal stretching exercise therapy was given using standard operating procedures and pain intensity was measured using the Visual Analog Scale (VAS).

Results: The research data were statistically tested using the Wilcoxon test with a significance level of p<0.05. The results of the study showed that there was a significant effect of abdominal stretching exercise techniques on the intensity of dysmenorrhea pain with a value of p=0.000 (p<0.05).

Conclusion: Abdominal stretching exercise intervention is effective to be applied in solving pain problems in adolescent girls who experience dysmenorrhea. Future research should explore the long-term effects and sustainability of abdominal stretching exercises in managing dysmenorrhea among adolescent girls, including variations in frequency, intensity, and duration of the intervention.

The Effectiveness of Nutritional Therapy in Patient with Chronic Obstructive Lung Disease: A Systematic Review of Randomized Controlled Trials

Hasanudin Hasanudin — 2025-09-28

Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and is often complicated by malnutrition and muscle wasting, which adversely affect prognosis. Although nutritional therapy has been recommended as part of comprehensive COPD care, the effectiveness of recent interventions has not been systematically evaluated. This systematic review aimed to evaluate the impact of nutritional therapy on clinical, functional, and patient-centered outcomes in individuals with COPD.

Methods: Following the PRISMA guidelines, we searched Scopus, PubMed, EBSCO, and Nature for randomized controlled trials (RCTs) published between January 2020 and June 2025. Eligible studies included adult patients with COPD who received nutritional interventions. The risk of bias was assessed using the Cochrane RoB 2 tool. From 252 screened records, 13 RCTs involving 2,962 participants were included. Given the heterogeneity across interventions and outcomes, the findings were synthesized narratively.

Results: The interventions included oral nutritional supplements, high-energy formulas, individualized dietary counseling, vitamin D, ω-3 fatty acids, and multi-nutrient combinations. Seven studies reported significant improvements in quality of life, six demonstrated gains in weight and nutritional status, and three showed increased muscle strength. Two trials observed enhanced physical activity, whereas both vitamin D studies found no overall protective effect against exacerbations, except in patients with severe deficiencies. The risk of bias was low in eight studies and raised concerns in five. Overall, the strength of evidence was moderate, limited by heterogeneity, and inconsistent outcome reporting.

Conclusion: Nutritional therapy improves nutritional status and selected clinical outcomes in patients with COPD. Standardized, adequately powered RCTs are warranted to establish optimal protocols and to confirm long-term benefits.

Back Matter

Muhammad Fikri Alfaruq — 2025-09-28

Front Matter

Muhammad Fikri Alfaruq — 2025-09-28