Nurse empowerment needs in diabetes self-management

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"documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2021;31 Supl 3:531-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Experiences and coping of cancer patients undergoing radiotherapy: A qualitative study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "531" "paginaFinal" => "534" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lingga Curnia Dewi, Ika Nur Pratiwi, Lailatun Nimah, Graeme Drummond Smith" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Lingga Curnia" "apellidos" => "Dewi" ] 1 => array:2 [ "nombre" => "Ika Nur" "apellidos" => "Pratiwi" ] 2 => array:2 [ "nombre" => "Lailatun" "apellidos" => "Nimah" ] 3 => array:2 [ "nombre" => "Graeme Drummond" "apellidos" => "Smith" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862121001339?idApp=UINPBA00004N" "url" => "/11308621/00000031000000S3/v1_202111050750/S1130862121001339/v1_202111050750/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S1130862121001352" "issn" => "11308621" "doi" => "10.1016/j.enfcli.2020.10.039" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "1853" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2021;31 Supl 3:521-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Nurses and physicians’ perceptions on the Electronic Health Record implementation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "521" "paginaFinal" => "525" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yuni Kartika, Nurwestu Rusetiyanti, Ariani Arista Putri Pertiwi" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Yuni" "apellidos" => "Kartika" ] 1 => array:2 [ "nombre" => "Nurwestu" "apellidos" => "Rusetiyanti" ] 2 => array:2 [ "nombre" => "Ariani Arista Putri" "apellidos" => "Pertiwi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862121001352?idApp=UINPBA00004N" "url" => "/11308621/00000031000000S3/v1_202111050750/S1130862121001352/v1_202111050750/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Nurse empowerment needs in diabetes self-management" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "526" "paginaFinal" => "530" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Yanuar Primanda, Lisa Herviani" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Yanuar" "apellidos" => "Primanda" "email" => array:1 [ 0 => "yanuarprimanda@umy.ac.id" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Lisa" "apellidos" => "Herviani" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "School of Nursing, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionDiabetes mellitus (DM) is one of serious chronic diseases with high prevalence worldwide. Based on World Health Organization (2016), the prevalence of DM in Indonesia was 7%, and 6% of the total death in Indonesia was attributable to DM.<a class="elsevierStyleCrossRef" href="#bib0155">1</a> In Bantul, Yogyakarta, DM was the third common reason for people to go to general hospital, accounting for 7130 visits in 2018.<a class="elsevierStyleCrossRef" href="#bib0160">2</a> DM leads to serious complication and high mortality rate if not treated comprehensively.Self-management is one of the vital aspects in diabetes care where patients develop capability to manage their symptom, treatment, physical and psychological consequences as well as life style modification as a result of their disease.<a class="elsevierStyleCrossRef" href="#bib0165">3</a> As health care provider, nurses play important role in facilitating diabetes self-management education and support. Not only providing physical care and education, nurses also have role to ensure that patients are on the right track regarding their diabetes care with good communication and problem solving skill.<a class="elsevierStyleCrossRef" href="#bib0170">4</a>Primary care nurses in Indonesia must have good knowledge and skill to provide diabetes care.<a class="elsevierStyleCrossRef" href="#bib0175">5</a> In general, one of the nurse's roles is to become an educator or counsellor to empower patients. A study among 52 practice nurses in a regional/rural setting in New South Wales Australia in 2014 found that nurse's knowledge on diabetes care was low, thus requiring empowerment especially on dietary knowledge and medication management.<a class="elsevierStyleCrossRef" href="#bib0180">6</a> Several factors contribute to the nurses’ roles in supporting diabetes self-management including knowledge, motivation and self-efficacy.<a class="elsevierStyleCrossRef" href="#bib0185">7</a> Therefore, a study to investigate the empowerment needs among nurses in primary health centre is needed.The objective of this study was to identify the empowerment needs of primary health nurses in Bantul Yogyakarta Indonesia to facilitate patients’ diabetes self-management.MethodThis was a descriptive analytic study with a cross sectional approach. The nurses from nine, out of 27, different primary health centres in Bantul were selected. The primary health centres were selected based on their high number of patients with DM. Fifty-one out of 58 nurses were selected as the research participants through a cluster sampling technique. The inclusion criteria were nurses who worked in primary health centre with minimal education level of Diploma 3 in Nursing.The data in this study were collected by using the demographic questionnaire and Nurse Empowerment Needs Questionnaire. The Nurse Empowerment Needs Questionnaire consisted of six aspects including knowledge, motivation, self-efficacy, skills, communication and work satisfaction related to facilitation of patients ‘diabetes-self management with a total of 52 questions. There were 14 questions to measure nurses’ knowledge with correct, incorrect and doubt response rates. Those who chose the correct answer based on the answer key received 1 score. Nurses’ motivation was measured with 5-Likert scale questions of which the score ranged from strongly disagree=1, disagree=2, agree=3, and strongly agree=4. The semantic scale questions (10) ranging from 1-10 with 1 means very not confident and 10 absolutely very confident were used to measure nurses’ self-efficacy. The six multiple choices questions were used to measure nurses’ skill. Nurses’ communication was measured with 8-Likert scale questions of which the score ranged from never=1, rarely=2, occasionally=3 and always=4. Nurses’ work satisfaction was measured by using 9-Likert scale of which the score ranged from very dissatisfied=1, dissatisfied=2, satisfied=3, and very satisfied=4. The scores in each aspect were summed and categorised as good (X>Quartile 3), moderate (Quartile 1≤X≤Quartile 3), and poor (X<Quartile 1).The validity of the Nurse Empowerment Needs Questionnaire was tested by using Content Validity Index.<a class="elsevierStyleCrossRef" href="#bib0190">8</a> Three experts from School of Nursing, Faculty of Medicine and Health Sciences validated the questionnaire with score 0.83. Then, the validity of the questionnaire was tested to 20 respondents who had similar inclusion criteria but not included as the research participants.The aspects of motivation, self-efficacy, communication and work satisfaction were tested by using Pearson Product Moment Correlation, while Point Biserial was used to test the aspect of skills and knowledge. The result of the validity test showed that the questionnaire was valid for each aspect including motivation (r=0.462–0.680), self-efficacy (r=0.602–0.922), communication (r=0.526–0.861), work satisfaction (r=0.673–0.952), knowledge (r=0.468–0.582) and skill (r=0.448–0.651).The Cronbach Alpha test was used to test the reliability of the questionnaire for motivation, self-efficacy, communication, and work satisfaction aspects, while Kuder–Richardson 20 (KR 20) was used for knowledge and skill aspects. The results showed that the questionnaire was reliable for motivation (r=0.67), self-efficacy (0.92), communication (r=0.90), work satisfaction (0.95), knowledge (0.89) and skill (0.64). The data in this study were analysed by using descriptive statistics.The study was approved by the research ethic committee from the Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta with the approval letter no. 586/EP-FKIK-UMY/XI/2018. Ethical principles were implemented in this study including respondent self-determination, autonomy, confidentiality, and justice.ResultMost of the respondents were female (88.2%) and completed Diploma 3 in Nursing (96.1%) with an average age and years of services of 38.57 years and 12.87 years respectively. About 25% of them participated in DM management training and DM wound care was the most frequent training taken by these nurses (76.9%), <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that almost 60% of the nurses had moderate level of self-efficacy, communication, and work satisfaction. Similarly, most of them also had moderate level of knowledge, skill, and motivation (80.4%, 86.3% and 92.2% respectively).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionKnowledge is one of the essential parts for nurses as an educator. Interestingly, about 80% of nurses have moderate level of knowledge and only less than 10% have good knowledge levels. This result could be due to the level of education and trainings taken by nurses. Most of the nurses in this study graduated from Diploma 3 in Nursing and only a quarter of the nurses participated in DM management training. Additionally, none of them received diabetes educator certification by Indonesian Diabetes Educator Association (PEDI).In Indonesian context, based on Indonesian Nursing Act No. 38 of 2014, nurses who graduate from Diploma 3 in Nursing are considered as vocational nurses, while those who graduate from Ners degree (4 years in academic and 1 year in clinical stage) and Ners specialist degree are considered as professional nurses.<a class="elsevierStyleCrossRef" href="#bib0195">9</a> Vocational nurses are responsible for fulfilling patients’ basic needs and health problems under the direct or indirect supervision of professional nurses, whereas professional nurses are responsible for not only fulfilling basic needs but also accommodating patients ‘advanced health problems and needs both independently and collaboratively with other health care professionals.<a class="elsevierStyleCrossRef" href="#bib0200">10</a> Level of education is related to nurses’ knowledge, where a higher level of education enables nurses to receive more information and to process it easily.<a class="elsevierStyleCrossRef" href="#bib0205">11</a> In fact, 77.56% of nurses in Indonesia are Diploma 3 graduates including those who work in primary health centres.<a class="elsevierStyleCrossRef" href="#bib0210">12</a> Regarding the fact that nurses in primary health centres play central roles to facilitate patients with diabetes to deal with their day to day diabetes self-management, it is imperative for them to have sufficient knowledge related to diabetes self-management.In terms of diabetes self-management, the US standard of diabetes self-management education and support (DSMES) emphasizes the importance of diabetes educator certification for health care providers including nurses as the DSMES team who provide supports for diabetic patients.<a class="elsevierStyleCrossRef" href="#bib0215">13</a> Thus, they can effectively contribute to support the patients based on the level of diabetes educator, ranging from transmitting knowledge about essential skills for safe self-management up to providing higher level of counselling, regimen adjustment and therapeutic problem solving. Indonesian Endocrinologist Association (PERKENI) recommends the necessity of education in diabetes management, however there is no specific recommendation regarding the role of DSMES and diabetic educator.<a class="elsevierStyleCrossRef" href="#bib0220">14</a> Although diabetes educator certification for health care providers including nurses, physicians, nutritionists, and pharmacists which is conducted by Indonesian Diabetes Educator Association (PEDI) is available, the number of diabetes educators is still insufficient compared to the total health care providers in Indonesia. Therefore, it is essential for government to facilitate the improvement of education level and diabetes educator certification among nurses as well as to ensure that each primary health centre has diabetes educator to improve the quality of health services for diabetic patients.This study found that most of the nurses had moderate level of motivation to provide diabetes self-management to the patients. Motivation in this study covered both internal (pride in providing support, awareness of responsibility and self-enthusiasm) and external (praise and show off) motivation. Most of the nurses in this study scored high in internal motivation but not for external motivation. This result could be due to the cultural belief among nurses where they should provide healthcare based on their internal motivation rather than external motivation. In healthcare context, intrinsic motivation is defined as “self-gratification” in which health care providers are pleased in providing healthcare and services at the workplace instead of working for external rewards. Furthermore, nurses are expected to progress and develop in their career based on internal motivation.<a class="elsevierStyleCrossRef" href="#bib0225">15</a> However, the study among 730 nurses in acute hospital showed that nurses who have high intrinsic and extrinsic motivation have better perceived health and employment outcomes compared to those with high internal motivation only who reported higher job burnout.<a class="elsevierStyleCrossRef" href="#bib0230">16</a>Self-efficacy is people's belief regarding their ability to perform certain activities related to their responsibility or task that integrate cognitive, motivational, affective, and selection processes.<a class="elsevierStyleCrossRef" href="#bib0235">17</a> Nurses’ self-efficacy is correlated with their ability to affect diabetic patients’ self-efficacy and health behaviours,<a class="elsevierStyleCrossRef" href="#bib0240">18</a> weight management practices,<a class="elsevierStyleCrossRef" href="#bib0245">19</a> professional commitment and job satisfaction among diabetic medical care personnel.<a class="elsevierStyleCrossRef" href="#bib0250">20</a> More than fifty percents of the primary health nurses in this study had moderate level of self-efficacy, while almost one fourth of them had poor self-efficacy. Low formal education level and participation in diabetes management training that hinder the mastery experience of nurses in providing diabetes self-management education and support to their patients might influence this result. There was a significant difference of nurses’ self-efficacy between those who had diploma and bachelor degree.<a class="elsevierStyleCrossRef" href="#bib0255">21</a> Despite attending higher education level, attending specific training related to patients’ specific conditions can also increase self-efficacy because nurses may have to deal with conditions that could be rarely found in educational setting.<a class="elsevierStyleCrossRef" href="#bib0260">22</a> However, a study among Indonesian nurses found that there was no significant difference of self-efficacy mean score based on educational levels that might be caused by poor allocation of nurses’ assignments.<a class="elsevierStyleCrossRef" href="#bib0265">23</a>Nurses’ communication skill is one essential aspect in supporting diabetic patients’ health. The current study revealed that less than a quarter of primary health care nurses had good communication. The low scores of nurses’ communication was about the adequacy of time and speed of information delivery. A study among 151 nurses in educational hospital found that lack of time was the most important barrier in nurse-patient communication.<a class="elsevierStyleCrossRef" href="#bib0270">24</a> Nurse-patient communication in primary care related to diabetes management is initiated with completion of extensive checklist, physical examination, referral to other health care professionals, distribution of written materials, and spending longer time than consultation with other health care professional. Additionally, they highlighted the mismatch of nurses and patient's expectation related to the topic of education although both patients and nurses expressed overwhelmed feeling of information volume.<a class="elsevierStyleCrossRef" href="#bib0275">25</a> In nurse-patient communication to improve diabetes self-management, it is also important to pay attention to language. Nurses should use language that is neutral, non-judgmental, and based on facts, actions, or physiology/biology; free from stigma; strengths-based, respectful, inclusive and imparts hope; fosters collaboration between patients and providers; and person-centered.<a class="elsevierStyleCrossRef" href="#bib0280">26</a>This study showed that the nurses’ skill was mostly in moderate level. The skill in this research was related to insulin injection procedure, pulse measurement, foot exercise, and blood glucose testing skills. Most of the nurses had low score on insulin injection skill. This might be because most of the nurses in primary health centres have limited interaction with patients who are prescribed insulin injection since the insulin is provided by pharmacists to the patients in pharmacy counter which is separated from nurse station. Additionally, most of the diabetic patients usually start insulin injection in hospital setting, not in primary care setting, therefore, nurses rarely perform that skill. Unlike in the United Kingdom, a report showed that among 622 patients requiring insulin administration in primary care, only 20.3% of them asked other healthcare providers apart from the community nurses to administer insulin.<a class="elsevierStyleCrossRef" href="#bib0285">27</a> The data indicated that primary care nurses often provide insulin injection to the patients. Poor knowledge and skills on insulin administration are some barriers for health care professionals to start insulin administration among type 2 DM patients.<a class="elsevierStyleCrossRef" href="#bib0290">28</a>Work satisfaction contributes to better quality of patient care.<a class="elsevierStyleCrossRef" href="#bib0295">29</a> Only about 20% of the nurses in this study were satisfied with their work. In this study, the score of nurses’ self-confidences in providing support on patients’ diabetes self-management and perceived time adequacy were low. Self-confidence was significantly correlated with job satisfaction among diabetic medical care personnel. Age, years of service in the medical or nursing field, the actual number of years caring for patients with diabetes, self-efficacy, and professional commitment explained the variance of job satisfaction.<a class="elsevierStyleCrossRef" href="#bib0250">20</a> Other study found that role ambiguity leads to dissatisfaction in providing diabetes care to patients.<a class="elsevierStyleCrossRef" href="#bib0300">30</a> Therefore, it is necessary to concern on those various factors that contribute to nurses’ work satisfaction to facilitate better patients’ outcome.ConclusionNurses’ knowledge, motivation, self-efficacy, communication, skill and work satisfaction need to be empowered. Nurses in primary health centre play pivotal roles in supporting patients’ self-management, thus greater attention should be paid to empower nurses by increasing the formal education level of primary nurses to meet the international standard of diabetic educators, providing specific training for nurses based on their needs and creating policy that supports nurses’ professional development. With a high number of nursing workforces, empowering nurses can contribute to significant outcome to facilitate better health status in Indonesia.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1605814" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1437181" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Method" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Result" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack565919" "titulo" => "Acknowledgement" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-10-08" "fechaAceptado" => "2020-10-13" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1437181" "palabras" => array:3 [ 0 => "Diabetes empowerment" 1 => "Self-management ability" 2 => "Type 2 diabetes" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveNurses play pivotal roles in facilitating diabetes self-management. The objective of this study was to describe the empowerment needs among nurses in primary health centres to facilitate diabetes self-management among peoples with type 2 diabetes mellitus. MethodThis was a descriptive study with a cross-sectional approach. Fifty-one primary health nurses from nine primary health centres in Bantul Yogyakarta were selected using a cluster sampling technique. The data were collected using the Nurse Empowerment Needs Questionnaire. The data were analysed using descriptive statistics. ResultsThe average age of the nurses was 38.6 years with 12.9 years of services, mostly women, and graduated from three years of nursing education (88.2% and 92.2% respectively). Out of 51 nurses, only 13 nurses (25.2%) participated in diabetes management training especially diabetic wound care training (10 nurses). Most of the nurses had a moderate level of knowledge (80.4%), motivation (92.2%), self-efficacy (56.9%), communication (58.8%), skills (86.3%), and work satisfaction (58.8%) in facilitating diabetes self-management. ConclusionNurses in primary health centres need to be empowered to improve their performance in facilitating diabetes self-management. It is important to have certified diabetes educators in each primary health centre in Indonesia." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "Peer-review under responsibility of the scientific committee of the 3rd International Joint Conference on Nursing Science (IJCNS). Full-text and the content of it is under responsibility of authors of the article." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Min–max \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.57 (9.46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21–58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Years of services (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.87 (9.48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Formal education</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diploma 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diploma 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ners \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Participation in DM management training \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topic of DM management training (N=13)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wound care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medical/Drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Exercise \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Foot care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Foot exercise \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complementary therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2739164.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic characteristics of the respondents (N=51)." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency (f) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Knowledge</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good (X>11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate (7≤X≤11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor (X<7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Motivation</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good (X>15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate (12≤X≤15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor (X<12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Self-efficacy</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good (X>81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate (65≤X≤81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor (X<65) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Communication</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good (X>31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate (24≤X≤31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor (X<24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Skill</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good (X>5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate (3≤X≤5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor (X<3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Work satisfaction</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good (X>27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate (26≤X≤27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor (X<26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2739165.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Description of nurse empowerment needs in diabetes self-management (N=51)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "World Health Organization – diabetes country profiles [Internet]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "World Health Organization" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2016" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0160" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health profile of Bantul District 2019 [Internet]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Health Department of Bantul District" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "fecha" => "2019" "paginaInicial" => "1" "paginaFinal" => "47" "editorial" => "Bantul" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0165" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Self-management approaches for people with chronic conditions: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. 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Ng" 1 => "P.S.M. Lai" 2 => "Y.K. Lee" 3 => "S.A. Azmi" 4 => "C.H. Teo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijcp.12691" "Revista" => array:7 [ "tituloSerie" => "Int J Clin Pract" "fecha" => "2015" "volumen" => "69" "numero" => "October" "paginaInicial" => "1050" "paginaFinal" => "1070" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26147376" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0295" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of job satisfaction on quality of care among nurses on the Public Hospital of Lahore, Pakistan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Farman" 1 => "R. Kousar" 2 => "M. Hussain" 3 => "A. Waqas" 4 => "S.A. Gilani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Saudi J Med Pharm Sci" "fecha" => "2017" "volumen" => "3" "paginaInicial" => "511" "paginaFinal" => "519" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0300" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of nurses in diabetes care in Kuwait: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Alshammari" 1 => "G. Adams" 2 => "R. Windle" 3 => "D. Bowskill" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Diabetes Metab [Internet]" "fecha" => "2019" "volumen" => "10" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack565919" "titulo" => "Acknowledgement" "texto" => "We thank Universitas Muhammadiyah Yogyakarta, Indonesia for the research funding and publication (No. 194/SK-LP3M/XII/2018)." 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Original Article

Nurse empowerment needs in diabetes self-management

Yanuar Primanda

Corresponding author

yanuarprimanda@umy.ac.id

Corresponding author.

, Lisa Herviani

School of Nursing, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetes mellitus &#40;DM&#41; is one of serious chronic diseases with high prevalence worldwide&#46; Based on World Health Organization &#40;2016&#41;&#44; the prevalence of DM in Indonesia was 7&#37;&#44; and 6&#37; of the total death in Indonesia was attributable to DM&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> In Bantul&#44; Yogyakarta&#44; DM was the third common reason for people to go to general hospital&#44; accounting for 7130 visits in 2018&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> DM leads to serious complication and high mortality rate if not treated comprehensively&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Self-management is one of the vital aspects in diabetes care where patients develop capability to manage their symptom&#44; treatment&#44; physical and psychological consequences as well as life style modification as a result of their disease&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> As health care provider&#44; nurses play important role in facilitating diabetes self-management education and support&#46; Not only providing physical care and education&#44; nurses also have role to ensure that patients are on the right track regarding their diabetes care with good communication and problem solving skill&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Primary care nurses in Indonesia must have good knowledge and skill to provide diabetes care&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> In general&#44; one of the nurse&#39;s roles is to become an educator or counsellor to empower patients&#46; A study among 52 practice nurses in a regional&#47;rural setting in New South Wales Australia in 2014 found that nurse&#39;s knowledge on diabetes care was low&#44; thus requiring empowerment especially on dietary knowledge and medication management&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> Several factors contribute to the nurses&#8217; roles in supporting diabetes self-management including knowledge&#44; motivation and self-efficacy&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Therefore&#44; a study to investigate the empowerment needs among nurses in primary health centre is needed&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this study was to identify the empowerment needs of primary health nurses in Bantul Yogyakarta Indonesia to facilitate patients&#8217; diabetes self-management&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a descriptive analytic study with a cross sectional approach&#46; The nurses from nine&#44; out of 27&#44; different primary health centres in Bantul were selected&#46; The primary health centres were selected based on their high number of patients with DM&#46; Fifty-one out of 58 nurses were selected as the research participants through a cluster sampling technique&#46; The inclusion criteria were nurses who worked in primary health centre with minimal education level of Diploma 3 in Nursing&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The data in this study were collected by using the demographic questionnaire and Nurse Empowerment Needs Questionnaire&#46; The Nurse Empowerment Needs Questionnaire consisted of six aspects including knowledge&#44; motivation&#44; self-efficacy&#44; skills&#44; communication and work satisfaction related to facilitation of patients &#8216;diabetes-self management with a total of 52 questions&#46; There were 14 questions to measure nurses&#8217; knowledge with correct&#44; incorrect and doubt response rates&#46; Those who chose the correct answer based on the answer key received 1 score&#46; Nurses&#8217; motivation was measured with 5-Likert scale questions of which the score ranged from strongly disagree<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; disagree<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44; agree<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44; and strongly agree<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46; The semantic scale questions &#40;10&#41; ranging from 1-10 with 1 means very not confident and 10 absolutely very confident were used to measure nurses&#8217; self-efficacy&#46; The six multiple choices questions were used to measure nurses&#8217; skill&#46; Nurses&#8217; communication was measured with 8-Likert scale questions of which the score ranged from never<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; rarely<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44; occasionally<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3 and always<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46; Nurses&#8217; work satisfaction was measured by using 9-Likert scale of which the score ranged from very dissatisfied<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; dissatisfied<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44; satisfied<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44; and very satisfied<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46; The scores in each aspect were summed and categorised as good &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Quartile 3&#41;&#44; moderate &#40;Quartile 1<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>Quartile 3&#41;&#44; and poor &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>Quartile 1&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The validity of the Nurse Empowerment Needs Questionnaire was tested by using Content Validity Index&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> Three experts from School of Nursing&#44; Faculty of Medicine and Health Sciences validated the questionnaire with score 0&#46;83&#46; Then&#44; the validity of the questionnaire was tested to 20 respondents who had similar inclusion criteria but not included as the research participants&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The aspects of motivation&#44; self-efficacy&#44; communication and work satisfaction were tested by using Pearson Product Moment Correlation&#44; while Point Biserial was used to test the aspect of skills and knowledge&#46; The result of the validity test showed that the questionnaire was valid for each aspect including motivation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;462&#8211;0&#46;680&#41;&#44; self-efficacy &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;602&#8211;0&#46;922&#41;&#44; communication &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;526&#8211;0&#46;861&#41;&#44; work satisfaction &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;673&#8211;0&#46;952&#41;&#44; knowledge &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;468&#8211;0&#46;582&#41; and skill &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;448&#8211;0&#46;651&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The Cronbach Alpha test was used to test the reliability of the questionnaire for motivation&#44; self-efficacy&#44; communication&#44; and work satisfaction aspects&#44; while Kuder&#8211;Richardson 20 &#40;KR 20&#41; was used for knowledge and skill aspects&#46; The results showed that the questionnaire was reliable for motivation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;67&#41;&#44; self-efficacy &#40;0&#46;92&#41;&#44; communication &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;90&#41;&#44; work satisfaction &#40;0&#46;95&#41;&#44; knowledge &#40;0&#46;89&#41; and skill &#40;0&#46;64&#41;&#46; The data in this study were analysed by using descriptive statistics&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The study was approved by the research ethic committee from the Faculty of Medicine and Health Sciences&#44; Universitas Muhammadiyah Yogyakarta with the approval letter no&#46; 586&#47;EP-FKIK-UMY&#47;XI&#47;2018&#46; Ethical principles were implemented in this study including respondent self-determination&#44; autonomy&#44; confidentiality&#44; and justice&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Result</span><p id="par0055" class="elsevierStylePara elsevierViewall">Most of the respondents were female &#40;88&#46;2&#37;&#41; and completed Diploma 3 in Nursing &#40;96&#46;1&#37;&#41; with an average age and years of services of 38&#46;57 years and 12&#46;87 years respectively&#46; About 25&#37; of them participated in DM management training and DM wound care was the most frequent training taken by these nurses &#40;76&#46;9&#37;&#41;&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that almost 60&#37; of the nurses had moderate level of self-efficacy&#44; communication&#44; and work satisfaction&#46; Similarly&#44; most of them also had moderate level of knowledge&#44; skill&#44; and motivation &#40;80&#46;4&#37;&#44; 86&#46;3&#37; and 92&#46;2&#37; respectively&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Knowledge is one of the essential parts for nurses as an educator&#46; Interestingly&#44; about 80&#37; of nurses have moderate level of knowledge and only less than 10&#37; have good knowledge levels&#46; This result could be due to the level of education and trainings taken by nurses&#46; Most of the nurses in this study graduated from Diploma 3 in Nursing and only a quarter of the nurses participated in DM management training&#46; Additionally&#44; none of them received diabetes educator certification by Indonesian Diabetes Educator Association &#40;PEDI&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In Indonesian context&#44; based on Indonesian Nursing Act No&#46; 38 of 2014&#44; nurses who graduate from Diploma 3 in Nursing are considered as vocational nurses&#44; while those who graduate from Ners degree &#40;4 years in academic and 1 year in clinical stage&#41; and Ners specialist degree are considered as professional nurses&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> Vocational nurses are responsible for fulfilling patients&#8217; basic needs and health problems under the direct or indirect supervision of professional nurses&#44; whereas professional nurses are responsible for not only fulfilling basic needs but also accommodating patients &#8216;advanced health problems and needs both independently and collaboratively with other health care professionals&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Level of education is related to nurses&#8217; knowledge&#44; where a higher level of education enables nurses to receive more information and to process it easily&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> In fact&#44; 77&#46;56&#37; of nurses in Indonesia are Diploma 3 graduates including those who work in primary health centres&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Regarding the fact that nurses in primary health centres play central roles to facilitate patients with diabetes to deal with their day to day diabetes self-management&#44; it is imperative for them to have sufficient knowledge related to diabetes self-management&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In terms of diabetes self-management&#44; the US standard of diabetes self-management education and support &#40;DSMES&#41; emphasizes the importance of diabetes educator certification for health care providers including nurses as the DSMES team who provide supports for diabetic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> Thus&#44; they can effectively contribute to support the patients based on the level of diabetes educator&#44; ranging from transmitting knowledge about essential skills for safe self-management up to providing higher level of counselling&#44; regimen adjustment and therapeutic problem solving&#46; Indonesian Endocrinologist Association &#40;PERKENI&#41; recommends the necessity of education in diabetes management&#44; however there is no specific recommendation regarding the role of DSMES and diabetic educator&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> Although diabetes educator certification for health care providers including nurses&#44; physicians&#44; nutritionists&#44; and pharmacists which is conducted by Indonesian Diabetes Educator Association &#40;PEDI&#41; is available&#44; the number of diabetes educators is still insufficient compared to the total health care providers in Indonesia&#46; Therefore&#44; it is essential for government to facilitate the improvement of education level and diabetes educator certification among nurses as well as to ensure that each primary health centre has diabetes educator to improve the quality of health services for diabetic patients&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This study found that most of the nurses had moderate level of motivation to provide diabetes self-management to the patients&#46; Motivation in this study covered both internal &#40;pride in providing support&#44; awareness of responsibility and self-enthusiasm&#41; and external &#40;praise and show off&#41; motivation&#46; Most of the nurses in this study scored high in internal motivation but not for external motivation&#46; This result could be due to the cultural belief among nurses where they should provide healthcare based on their internal motivation rather than external motivation&#46; In healthcare context&#44; intrinsic motivation is defined as &#8220;self-gratification&#8221; in which health care providers are pleased in providing healthcare and services at the workplace instead of working for external rewards&#46; Furthermore&#44; nurses are expected to progress and develop in their career based on internal motivation&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> However&#44; the study among 730 nurses in acute hospital showed that nurses who have high intrinsic and extrinsic motivation have better perceived health and employment outcomes compared to those with high internal motivation only who reported higher job burnout&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Self-efficacy is people&#39;s belief regarding their ability to perform certain activities related to their responsibility or task that integrate cognitive&#44; motivational&#44; affective&#44; and selection processes&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Nurses&#8217; self-efficacy is correlated with their ability to affect diabetic patients&#8217; self-efficacy and health behaviours&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> weight management practices&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> professional commitment and job satisfaction among diabetic medical care personnel&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> More than fifty percents of the primary health nurses in this study had moderate level of self-efficacy&#44; while almost one fourth of them had poor self-efficacy&#46; Low formal education level and participation in diabetes management training that hinder the mastery experience of nurses in providing diabetes self-management education and support to their patients might influence this result&#46; There was a significant difference of nurses&#8217; self-efficacy between those who had diploma and bachelor degree&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Despite attending higher education level&#44; attending specific training related to patients&#8217; specific conditions can also increase self-efficacy because nurses may have to deal with conditions that could be rarely found in educational setting&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> However&#44; a study among Indonesian nurses found that there was no significant difference of self-efficacy mean score based on educational levels that might be caused by poor allocation of nurses&#8217; assignments&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Nurses&#8217; communication skill is one essential aspect in supporting diabetic patients&#8217; health&#46; The current study revealed that less than a quarter of primary health care nurses had good communication&#46; The low scores of nurses&#8217; communication was about the adequacy of time and speed of information delivery&#46; A study among 151 nurses in educational hospital found that lack of time was the most important barrier in nurse-patient communication&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Nurse-patient communication in primary care related to diabetes management is initiated with completion of extensive checklist&#44; physical examination&#44; referral to other health care professionals&#44; distribution of written materials&#44; and spending longer time than consultation with other health care professional&#46; Additionally&#44; they highlighted the mismatch of nurses and patient&#39;s expectation related to the topic of education although both patients and nurses expressed overwhelmed feeling of information volume&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> In nurse-patient communication to improve diabetes self-management&#44; it is also important to pay attention to language&#46; Nurses should use language that is neutral&#44; non-judgmental&#44; and based on facts&#44; actions&#44; or physiology&#47;biology&#59; free from stigma&#59; strengths-based&#44; respectful&#44; inclusive and imparts hope&#59; fosters collaboration between patients and providers&#59; and person-centered&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">This study showed that the nurses&#8217; skill was mostly in moderate level&#46; The skill in this research was related to insulin injection procedure&#44; pulse measurement&#44; foot exercise&#44; and blood glucose testing skills&#46; Most of the nurses had low score on insulin injection skill&#46; This might be because most of the nurses in primary health centres have limited interaction with patients who are prescribed insulin injection since the insulin is provided by pharmacists to the patients in pharmacy counter which is separated from nurse station&#46; Additionally&#44; most of the diabetic patients usually start insulin injection in hospital setting&#44; not in primary care setting&#44; therefore&#44; nurses rarely perform that skill&#46; Unlike in the United Kingdom&#44; a report showed that among 622 patients requiring insulin administration in primary care&#44; only 20&#46;3&#37; of them asked other healthcare providers apart from the community nurses to administer insulin&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> The data indicated that primary care nurses often provide insulin injection to the patients&#46; Poor knowledge and skills on insulin administration are some barriers for health care professionals to start insulin administration among type 2 DM patients&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Work satisfaction contributes to better quality of patient care&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> Only about 20&#37; of the nurses in this study were satisfied with their work&#46; In this study&#44; the score of nurses&#8217; self-confidences in providing support on patients&#8217; diabetes self-management and perceived time adequacy were low&#46; Self-confidence was significantly correlated with job satisfaction among diabetic medical care personnel&#46; Age&#44; years of service in the medical or nursing field&#44; the actual number of years caring for patients with diabetes&#44; self-efficacy&#44; and professional commitment explained the variance of job satisfaction&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Other study found that role ambiguity leads to dissatisfaction in providing diabetes care to patients&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> Therefore&#44; it is necessary to concern on those various factors that contribute to nurses&#8217; work satisfaction to facilitate better patients&#8217; outcome&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nurses&#8217; knowledge&#44; motivation&#44; self-efficacy&#44; communication&#44; skill and work satisfaction need to be empowered&#46; Nurses in primary health centre play pivotal roles in supporting patients&#8217; self-management&#44; thus greater attention should be paid to empower nurses by increasing the formal education level of primary nurses to meet the international standard of diabetic educators&#44; providing specific training for nurses based on their needs and creating policy that supports nurses&#8217; professional development&#46; With a high number of nursing workforces&#44; empowering nurses can contribute to significant outcome to facilitate better health status in Indonesia&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2020-10-08"
    "fechaAceptado" => "2020-10-13"
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            2 => "Type 2 diabetes"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nurses play pivotal roles in facilitating diabetes self-management&#46; The objective of this study was to describe the empowerment needs among nurses in primary health centres to facilitate diabetes self-management among peoples with type 2 diabetes mellitus&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a descriptive study with a cross-sectional approach&#46; Fifty-one primary health nurses from nine primary health centres in Bantul Yogyakarta were selected using a cluster sampling technique&#46; The data were collected using the Nurse Empowerment Needs Questionnaire&#46; The data were analysed using descriptive statistics&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The average age of the nurses was 38&#46;6 years with 12&#46;9 years of services&#44; mostly women&#44; and graduated from three years of nursing education &#40;88&#46;2&#37; and 92&#46;2&#37; respectively&#41;&#46; Out of 51 nurses&#44; only 13 nurses &#40;25&#46;2&#37;&#41; participated in diabetes management training especially diabetic wound care training &#40;10 nurses&#41;&#46; Most of the nurses had a moderate level of knowledge &#40;80&#46;4&#37;&#41;&#44; motivation &#40;92&#46;2&#37;&#41;&#44; self-efficacy &#40;56&#46;9&#37;&#41;&#44; communication &#40;58&#46;8&#37;&#41;&#44; skills &#40;86&#46;3&#37;&#41;&#44; and work satisfaction &#40;58&#46;8&#37;&#41; in facilitating diabetes self-management&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nurses in primary health centres need to be empowered to improve their performance in facilitating diabetes self-management&#46; It is important to have certified diabetes educators in each primary health centre in Indonesia&#46;</p></span>"
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                  \t\t\t\t">38&#46;57 &#40;9&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21&#8211;58&nbsp;\t\t\t\t\t\t\n
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                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency &#40;<span class="elsevierStyleItalic">f</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Knowledge</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Good &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate &#40;7<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Poor &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Motivation</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Good &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate &#40;12<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Poor &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Self-efficacy</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Good &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate &#40;65<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Poor &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Communication</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Good &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate &#40;24<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Poor &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Skill</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Good &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate &#40;3<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Poor &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Work satisfaction</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Good &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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