Synergistic Interaction between Older Age and an Abnormal Ankle-Brachial Index in Relation to Diabetic Peripheral Neuropathy

Yani Sofiani; Rizki Nugraha Agung; Yana Adharani; Iyar Siswandi; Yohanes Andy Rias

doi:10.14710/nmjn.v16i2.78381

DOI: https://doi.org/10.14710/nmjn.v16i2.78381

Synergistic Interaction between Older Age and an Abnormal Ankle-Brachial Index in Relation to Diabetic Peripheral Neuropathy

*Yani Sofiani

- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Indonesia

Rizki Nugraha Agung - Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Indonesia

Yana Adharani - Department of Informatics Engineering, Faculty of Engineering, Universitas Muhammadiyah Jakarta, Indonesia

Iyar Siswandi - Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Indonesia

Yohanes Andy Rias

- Faculty of Health, College of Nursing, Institut Ilmu Kesehatan Bhakti Wiyata Kediri, Indonesia

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

BibTex Citation Data :

@article{NMJN78381,
    author = {Yani Sofiani and Rizki Nugraha Agung and Yana Adharani and Iyar Siswandi and Yohanes Andy Rias},
    title = {Synergistic Interaction between Older Age and an Abnormal Ankle-Brachial Index in Relation to Diabetic Peripheral Neuropathy},
    journal = {Nurse Media Journal of Nursing},
  volume = {16},
    number = {2},
    year = {2026},
    keywords = {Ankle-brachial index; diabetic peripheral neuropathy; Indonesia; older age; type 2 diabetes mellitus},
    abstract = {  A Sequential Explanatory Mixed Methods Evaluation of a Clinical Nursing Practice Guideline for Intracranial Pressure Management          Background:  Increased intracranial pressure (IICP) is a life-threatening complication of traumatic brain injury (TBI). Previous studies in Thailand have not evaluated the effectiveness of a structured clinical nursing practice guideline (CNPG) in improving nurses’ knowledge, skills, and confidence, highlighting the need for a rigorously developed and evaluated CNPG.   Purpose:  This study aimed to evaluate the effectiveness of a CNPG in improving nurses’ knowledge, skills, and confidence in managing IICP among patients with TBI and to explore nurses’ perceptions of its feasibility, optimality, and benefits.   Methods:  A sequential explanatory mixed methods design was employed. The quantitative phase used a pre–post design and was conducted from February to September 2024. The intervention involved implementing an IICP CNPG among 45 registered nurses in two neurological wards at a tertiary hospital in eastern Thailand. Data were collected using four validated instruments: the Nurses’ Knowledge on IICP Questionnaire, Clinical Skills Observation Checklist, Self-Confidence Scale for IICP Care, and Nurses’ Perception of CNPG Questionnaire. In the qualitative phase, 20 nurses participated in two focus group discussions, which were analyzed using conventional content analysis.   Results:  Nurses showed statistically significant improvements in knowledge, clinical skills, and self-confidence following CNPG implementation (all p < .001). Perceptions of the CNPG in terms of feasibility, optimality, and benefits significantly exceeded the standard benchmark (all p < .001). Eight qualitative themes were identified, highlighting the roles of evidence-based knowledge, repeated training, structured protocols, interprofessional collaboration, and refresher training in enhancing the consistency, confidence, and quality of IICP care.   Conclusion:  The CNPG was feasible, effective, and well accepted among nurses, leading to significant improvements in knowledge, clinical skills, and self-confidence in IICP management. Future research should examine its long-term impact and effectiveness across diverse clinical settings.                  Background:  Diabetic peripheral neuropathy (DPN) is associated with older age and an abnormal ankle-brachial index (ABI). However, no previous study has investigated the synergistic interaction between older age and an abnormal ABI in relation to DPN.   Purpose:  This study aimed to investigate the independent associations and synergistic interaction of older age and an abnormal ABI in relation to DPN.   Methods:  This analytical cross-sectional study included 416 individuals with type 2 diabetes mellitus in Jakarta, Indonesia. Older age was defined as age >64 years. DPN was assessed using a combination of sensory testing with a 10-g Semmes-Weinstein monofilament and vibration testing with a 128-Hz tuning fork, with the diagnosis validated by a physician. ABI was assessed using continuous-wave Doppler ultrasound. Chi-square tests, independent t-tests, and multivariable logistic regression were performed with a significance level of p < .05.   Results:  DPN was identified in 34.9% (n = 145) of participants. Older age (adjusted odds ratio [AOR] = 1.74) and an abnormal ABI (AOR = 2.04) were independently associated with DPN. Older participants with an abnormal ABI were 4.03 times more likely to have DPN than adult participants with a normal ABI (p < .001). A positive synergistic interaction between older age and an abnormal ABI in relation to DPN was identified (AOR = 4.03; relative excess risk due to interaction [RERI] = 2.20; attributable proportion [AP] = 0.55; synergy index [SI] = 3.65).   Conclusion:  Older age and an abnormal ABI were independently associated with DPN, with their co-occurrence showing a positive synergistic interaction in relation to DPN. Further longitudinal studies with larger samples and relevant clinical factors are needed to confirm these findings.    },
   issn = {2406-8799},  doi = {10.14710/nmjn.v16i2.78381},
    url = {https://ejournal.undip.ac.id/index.php/medianers/article/view/78381}
}

Citation Format:

Abstract

A Sequential Explanatory Mixed Methods Evaluation of a Clinical Nursing Practice Guideline for Intracranial Pressure Management

Background: Increased intracranial pressure (IICP) is a life-threatening complication of traumatic brain injury (TBI). Previous studies in Thailand have not evaluated the effectiveness of a structured clinical nursing practice guideline (CNPG) in improving nurses’ knowledge, skills, and confidence, highlighting the need for a rigorously developed and evaluated CNPG.

Purpose: This study aimed to evaluate the effectiveness of a CNPG in improving nurses’ knowledge, skills, and confidence in managing IICP among patients with TBI and to explore nurses’ perceptions of its feasibility, optimality, and benefits.

Methods: A sequential explanatory mixed methods design was employed. The quantitative phase used a pre–post design and was conducted from February to September 2024. The intervention involved implementing an IICP CNPG among 45 registered nurses in two neurological wards at a tertiary hospital in eastern Thailand. Data were collected using four validated instruments: the Nurses’ Knowledge on IICP Questionnaire, Clinical Skills Observation Checklist, Self-Confidence Scale for IICP Care, and Nurses’ Perception of CNPG Questionnaire. In the qualitative phase, 20 nurses participated in two focus group discussions, which were analyzed using conventional content analysis.

Results: Nurses showed statistically significant improvements in knowledge, clinical skills, and self-confidence following CNPG implementation (all p < .001). Perceptions of the CNPG in terms of feasibility, optimality, and benefits significantly exceeded the standard benchmark (all p < .001). Eight qualitative themes were identified, highlighting the roles of evidence-based knowledge, repeated training, structured protocols, interprofessional collaboration, and refresher training in enhancing the consistency, confidence, and quality of IICP care.

Conclusion: The CNPG was feasible, effective, and well accepted among nurses, leading to significant improvements in knowledge, clinical skills, and self-confidence in IICP management. Future research should examine its long-term impact and effectiveness across diverse clinical settings.

Background: Diabetic peripheral neuropathy (DPN) is associated with older age and an abnormal ankle-brachial index (ABI). However, no previous study has investigated the synergistic interaction between older age and an abnormal ABI in relation to DPN.

Purpose: This study aimed to investigate the independent associations and synergistic interaction of older age and an abnormal ABI in relation to DPN.

Methods: This analytical cross-sectional study included 416 individuals with type 2 diabetes mellitus in Jakarta, Indonesia. Older age was defined as age >64 years. DPN was assessed using a combination of sensory testing with a 10-g Semmes-Weinstein monofilament and vibration testing with a 128-Hz tuning fork, with the diagnosis validated by a physician. ABI was assessed using continuous-wave Doppler ultrasound. Chi-square tests, independent t-tests, and multivariable logistic regression were performed with a significance level of p < .05.

Results: DPN was identified in 34.9% (n = 145) of participants. Older age (adjusted odds ratio [AOR] = 1.74) and an abnormal ABI (AOR = 2.04) were independently associated with DPN. Older participants with an abnormal ABI were 4.03 times more likely to have DPN than adult participants with a normal ABI (p < .001). A positive synergistic interaction between older age and an abnormal ABI in relation to DPN was identified (AOR = 4.03; relative excess risk due to interaction [RERI] = 2.20; attributable proportion [AP] = 0.55; synergy index [SI] = 3.65).

Conclusion: Older age and an abnormal ABI were independently associated with DPN, with their co-occurrence showing a positive synergistic interaction in relation to DPN. Further longitudinal studies with larger samples and relevant clinical factors are needed to confirm these findings.

Fulltext Email colleagues

Keywords: Ankle-brachial index; diabetic peripheral neuropathy; Indonesia; older age; type 2 diabetes mellitus

Article Metrics:

Article Info

Section: Articles

Language : EN

In Vol 16, No 2 (2026): (August 2026) [In Progress]

Most cited articles

Motivation among Indonesian Nurses in Pursuing Continuing Professional Education and Its Relationship to Their Competencies Nurses’ Patient Safety Competencies in Aceh Province, Indonesia Eating Behavior of Autistic Children Effects of Islamic Spiritual Mindfulness on Stress among Nursing Students Improving Self-Efficacy and Physical Self-Reliance of Patients with Pulmonary Tuberculosis through Mindfulness More cited articles

Alves-Cabratosa, L., Comas-Cufí, M., Ponjoan, A., García-Gil, M., Martí-Lluch, R., Blanch, J., Elosúa-Bayes, M., Parramon, D., Camós, L., Guzmán, L., & Ramos, R. (2020). Levels of ankle–brachial index and the risk of diabetes mellitus complications. BMJ Open Diabetes Research & Care, 8. https://doi.org/10.1136/bmjdrc-2019-000977
American Diabetes Association. (2023). Standards of care in diabetes—2023 abridged for primary care providers. Clinical Diabetes, 41(1), 41-43. https://doi.org/10.2337/cd23-as01
Baum, P., Toyka, K. V., Blüher, M., Kosacka, J., & Nowicki, M. (2021). Inflammatory mechanisms in the pathophysiology of diabetic peripheral neuropathy (DN)—new aspects. International Journal of Molecular Sciences, 22(19), 10835. https://www.mdpi.com/1422-0067/22/19/10835
Chang, K.-C., Pai, Y.-W., Lin, C.-H., Lee, I. T., & Chang, M.-H. (2024). Glycemic variability’s impact on painful diabetic peripheral neuropathy in type 2 diabetes patients. Scientific Reports, 14(1), 22276. https://doi.org/10.1038/s41598-024-73472-y
Chattopadhyay, S., Goswami, S., Sengupta, N., & Baidya, A. (2024). Can the 128-Hz tuning fork be an alternative to the biothesiometer for diabetic peripheral neuropathy screening? A cross-sectional study in a tertiary hospital in East India. BMJ Open, 14(6), e082193. https://doi.org/10.1136/bmjopen-2023-082193
Chen, T., Xiao, S., Chen, Z., Yang, Y., Yang, B., & Liu, N. (2024). Risk factors for peripheral artery disease and diabetic peripheral neuropathy among patients with type 2 diabetes. Diabetes Research and Clinical Practice, 207, 111079. https://doi.org/https://doi.org/10.1016/j.diabres.2023.111079
Cheng, Y., Cao, W., Zhang, J., Wang, J., Liu, X., Wu, Q., & Lin, Q. (2022). Determinants of diabetic peripheral neuropathy and their clinical significance: A retrospective cohort study. Frontiers in Endocrinology, 13(6), 1-8. https://doi.org/10.3389/fendo.2022.934020
Ching, S. M., Lee, K. W., Yusof Khan, A. H. K., Devaraj, N. K., Cheong, A. T., Yap, S. F., Hoo, F. K., Wan Sulaiman, W. A., Loh, W. C., & Chong, S. H. (2024). Prevalence and factors associated with peripheral neuropathy in a setting of retail pharmacies in Malaysia–A cross-sectional study. PloS One, 19(10), e0307093. https://doi.org/10.3389/10.1371/journal.pone.0307093
Cosentino, F., Grant, P. J., Aboyans, V., Bailey, C. J., Ceriello, A., Delgado, V., Federici, M., Filippatos, G., Grobbee, D. E., Hansen, T. B., Huikuri, H. V., Johansson, I., Jüni, P., Lettino, M., Marx, N., Mellbin, L. G., Östgren, C. J., Rocca, B., Roffi, M., . . . Group, E. S. D. (2020). 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The task force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). European Heart Journal, 41(2), 255-323. https://doi.org/10.1093/eurheartj/ehz486
Dominguez, L., Veronese, N., Marrone, E., Di Palermo, C., Iommi, C., Ruggirello, R., Caffarelli, C., Gonnelli, S., & Barbagallo, M. (2024). Vitamin D and Risk of Incident Type 2 Diabetes in Older Age: An updated systematic review and meta-analysis. Nutrients, 16. https://doi.org/10.3390/nu16111561
Emara, S. M., Fahmy, S. F., AbdelSalam, M. M., & Wakeel, L. M. E. (2025). Effect of high-dose N-acetyl cysteine on the clinical outcome of patients with diabetic peripheral neuropathy: A randomized controlled study. Diabetology & Metabolic Syndrome, 17(1), 79. https://doi.org/10.1186/s13098-025-01624-9
Fadlilah, S., Amelia, V. L., Tuppal, C. P., Chang, H.-C., Chang, C. W., Lin, C. L., & Tsai, H. T. (2025). Significant impacts of the body-mass index, blood pressure, blood glucose, and ankle-brachial index on peripheral neuropathy risk in indonesian with type 2 diabetes: A cross-sectional study. Biological Research For Nursing, 27(4), 558-569. https://doi.org/10.1177/10998004251336795
Gholami, F., Khaki, R., Mirzaei, B., & Howatson, G. (2021). Resistance training improves nerve conduction and arterial stiffness in older age with diabetic distal symmetrical polyneuropathy: A randomized controlled trial. Experimental Gerontology, 153. https://doi.org/10.1016/j.exger.2021.111481
Grech, V., & Eldawlatly, A. A. (2024). STROBE, CONSORT, PRISMA, MOOSE, STARD, SPIRIT, and other guidelines–overview and application. Saudi Journal of Anaesthesia, 18(1), 137-141. https://doi.org/10.4103/sja.sja_545_23
Hicks, C. W., Wang, D., Windham, B. G., Matsushita, K., & Selvin, E. (2021). Prevalence of peripheral neuropathy defined by monofilament insensitivity in middle-aged and older age in two US cohorts. Scientific Reports, 11(1), 19159. https://doi.org/10.1038/s41598-021-98565-w
Huang, L., Shen, X., Huang, L., Yan, S., & Wu, P. (2021). Identification of independent risk factors for diabetic neuropathy progression in patients with type 2 diabetes mellitus. Journal of International Medical Research, 49(9), 1-10. https://doi.org/10.1177/03000605211044366
Jakubiak, G., Pawlas, N., Cieślar, G., & Stanek, A. (2020). Chronic lower extremity ischemia and its association with the frailty syndrome in patients with diabetes. International Journal of Environmental Research and Public Health, 17. https://doi.org/10.3390/ijerph17249339
Kim, G. R., Choi, D. W., Nam, C. M., Jang, S. I., & Park, E. C. (2020). Synergistic association of high-sensitivity C-reactive protein and body mass index with insulin resistance in non-diabetic adults. Scientific Reports, 10(1), 18417. https://doi.org/10.1038/s41598-020-75390-1
Koumelli, A., Konstantinou, K., Sakalidis, A., Pappelis, K., Mantzouranis, E., Chrysohoou, C., Nihoyannopoulos, P., Tousoulis, D., & Tsioufis, K. (2025). Prediction of all-cause mortality and cardiovascular outcomes using ambulatory arterial stiffness and ankle-brachial indices in patients with acute myocardial infarction: A prospective cohort study. Journal of Clinical Medicine, 14. https://doi.org/10.3390/jcm14134627
Kurniasari, M. D., Karwur, F. F., Rayanti, R. E., Dharmana, E., Rias, Y. A., Chou, K. R., & Tsai, H.-T. (2021). Second-hand smoke and its synergistic effect with a body-mass index of > 24.9 kg/m2 increase the risk of gout arthritis in Indonesia. International Journal of Environmental Research and Public Health, 18(8), 4324. https://doi.org/10.3390/ijerph18084324
Kyriazos, T., & Poga, M. (2023). Dealing with multicollinearity in factor analysis: the problem, detections, and solutions. Open Journal of Statistics, 13(3), 404-424. https://doi.org/10.4236/ojs.2023.133020
Li, L., Yang, Y., Bai, J., Zhang, Y., Yang, H., Zhang, Y., & Lv, H. (2022). Impaired Vascular Endothelial Function is Associated with Peripheral Neuropathy in Patients with Type 2 Diabetes. Diabetes, Metabolic Syndrome and Obesity, 15(null), 1437-1449. https://doi.org/10.2147/DMSO.S352316
Maiga, Y., Diallo, S., Konipo, F. d. N., Sangho, O., Sangaré, M., Diallo, S. H., Mahamadou, S., Péréon, Y., Giumelli, B., & Coulibaly, A. (2020). Diabetic polyneuropathy with/out neuropathic pain in Mali: A cross-sectional study in two reference diabetes treatment centers in Bamako (Mali), Western Africa. PloS One, 15(11), e0241387. https://doi.org/10.1371/journal.pone.0241387
Malik, R. A., Andag-Silva, A., Dejthevaporn, C., Hakim, M., Koh, J. S., Pinzon, R., Sukor, N., & Wong, K. S. (2020). Diagnosing peripheral neuropathy in South-East Asia: A focus on diabetic neuropathy. Journal of Diabetes Investigation, 11(5), 1097-1103. https://doi.org/https://doi.org/10.1111/jdi.13269
Negussie, Y. M., & Bekele, N. T. (2024). Diabetic peripheral neuropathy among adult type 2 diabetes patients in Adama, Ethiopia: Health facility-based study. Scientific Reports, 14(1), 3844-3853. https://doi.org/10.1038/s41598-024-53951-y
Owolabi, L. F., Alghamdi, M., Adamu, B., Taura, M. G., Jibo, A., Almansour, M., Alaklabi, S. N., Alghamdi, M. A., Alotaibi, Y. A., Imam, I. A., Abdelrazak, R., Rafaat, A., & Aliyu, M. H. (2022). Magnitude of diabetic peripheral neuropathy in Saudi Arabia: A systematic review and meta-analysis. BMC Endocrine Disorders, 22(1), 266. https://doi.org/10.1186/s12902-022-01167-4
Papanas, N. (2020). Diabetic Neuropathy Collection: Progress in Diagnosis and Screening. Diabetes Therapy, 11(4), 761-764. https://doi.org/10.1007/s13300-020-00776-3
Perveen, W., Ahsan, H., Rameen, S., Fayyaz, S., Zaif, A., Paracha, M. A., Nuhmani, S., Khan, M., & Alghadir, A. H. (2024). Prevalence of peripheral neuropathy, amputation, and quality of life in patients with diabetes mellitus. Scientific Reports, 14(1), 14430. https://doi.org/10.1038/s41598-024-65495-2
Pfannkuche, A., Alhajjar, A., Ming, A., Walter, I., Piehler, C., & Mertens, P. R. (2020). Prevalence and risk factors of diabetic peripheral neuropathy in a diabetics cohort: Register initiative “diabetes and nerves”. Endocrine and Metabolic Science, 1 (1), 100053. https://doi.org/10.1016/j.endmts.2020.100053
Rias, Y. A., Abiddin, A. H., Huda, N., Handayani, S., Sirait, H. S., Pien, L.-C., Weng, S.-F., & Tsai, H.-T. (2021). Psychometric testing of the bahasa version of the brief illness perception questionnaire among indonesians with type 2 diabetes mellitus. International Journal of Environmental Research and Public Health, 18(18), 9601. https://www.mdpi.com/1660-4601/18/18/9601
Rias, Y. A., Gordon, C. J., Niu, S. F., Wiratama, B. S., Chang, C. W., & Tsai, H. T. (2020). Secondhand smoke correlates with elevated neutrophil-lymphocyte ratio and has a synergistic effect with physical inactivity on increasing susceptibility to type 2 diabetes mellitus: a community-based case control study. International Journal of Environmental Research and Public Health, 17(16), 5696. https://www.mdpi.com/1660-4601/17/16/5696
Rias, Y. A., Sofiani, Y., Yunitri, N., Rayasari, F., & Hernani, E. (2024). Effect of combined ankle exercise and self foot massage on ankle-brachial index and diabetic peripheral neuropathy symptoms. Riset Informasi Kesehatan, 13(2), 223-237. https://doi.org/10.30644/rik.v13i2.908
Savelieff, M. G., Elafros, M. A., Viswanathan, V., Jensen, T. S., Bennett, D. L., & Feldman, E. L. (2025). The global and regional burden of diabetic peripheral neuropathy. Nature Reviews Neurology, 21(1), 17-31. https://doi.org/10.1038/s41582-024-01041-y
Wang, C., Pai, Y.-W., Lin, C.-H., Lee, I. T., Chen, H.-H., & Chang, M.-H. (2024). Diabetic peripheral neuropathy: Age-stratified glycemic control. Frontiers in Endocrinology, 15. https://doi.org/10.3389/fendo.2024.1377923
Wang, W., Ji, Q., Ran, X., Li, C., Kuang, H., Yu, X., Fang, H., Yang, J., Liu, J., Xue, Y., Feng, B., Lei, M., & Zhu, D. (2023). Prevalence and risk factors of diabetic peripheral neuropathy: A population-based cross-sectional study in China. Diabetes/Metabolism Research and Reviews, 39(8), e3702. https://doi.org/10.1002/dmrr.3702
Wang, Y., Liu, P., Shang, C., Wang, Y., Yuan, M., Zhao, G., & Sun, L. (2025). Association of brachial‐ankle pulse wave velocity with subclinical diabetic peripheral neuropathy in patients with type 2 diabetes mellitus. Journal of Diabetes Investigation, 16, 874-883. https://doi.org/10.1111/jdi.70008
Zheng, H., Sun, W., Zhang, Q., Zhang, Y., Ji, L., Liu, X., ... & Zhang, S. (2021). Proinflammatory cytokines predict the incidence of diabetic peripheral neuropathy over 5 years in Chinese type 2 diabetes patients: a prospective cohort study. EClinicalMedicine, 31, 1-6. https://doi.org/10.1016/j.eclinm.2020.100649
Zhu, B., Quinn, L., & Fritschi, C. (2018). Relationship and variation of diabetes related symptoms, sleep disturbance and sleep‐related impairment in age with type 2 diabetes. Journal of Advanced Nursing, 74(3), 689-697. https://doi.org/10.1111/jan.13482
Zhu, J., Hu, Z., Luo, Y., Liu, Y., Luo, W., Du, X., Luo, Z., Hu, J., & Peng, S. (2024). Diabetic peripheral neuropathy: Pathogenetic mechanisms and treatment [review]. Frontiers in Endocrinology, (14). https://doi.org/10.3389/fendo.2023.1265372

Last update:

No citation recorded.

Last update:

No citation recorded.

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Journal Author(s) Rights

In order for the Department of Nursing, Faculty of Medicine, Universitas Diponegoro to publish and disseminate research articles, we need non-exclusive publishing rights (transferred from the author(s) to the publisher). This is determined by a publishing agreement between the author(s) and the Department of Nursing, Faculty of Medicine, Universitas Diponegoro. This agreement involves the transfer or licensing of the copyright for publishing to the publisher, while authors still retain significant rights to use and share their own published articles. The Department of Nursing, Faculty of Medicine, Universitas Diponegoro supports the need for authors to share, disseminate, and maximize the impact of their research through these rights in any databases.

As the author(s), you have rights to a wide range of uses of your article, including use by your employing institution or company. These author rights can be exercised without the need to obtain specific permission. Authors publishing in the Nurse Media Journal of Nursing have extensive rights to use their works for teaching and scholarly purposes without needing to seek permission, including (but not limited to):

use for classroom teaching by the author or the author’s institution and presentation at a meeting or conference, including distributing copies to attendees;
use for internal training by the author’s company;
distribution to colleagues for their research use;
use in a subsequent compilation of the author’s works;
inclusion in a thesis or dissertation;
reuse of portions or extracts from the article in other works (with full acknowledgment of the final article);
preparation of derivative works (other than for commercial purposes) (with full acknowledgment of the final article);
voluntary posting on open websites operated by the author or the author’s institution for scholarly purposes;

following the open access license of the Creative Commons CC BY-SA License.

Authors, readers, and third parties can copy and redistribute the material in any medium or format, as well as remix, transform, and build upon the material for any purpose, even commercially, but they must give appropriate credit (including the name of the creator and attribution parties, detailed information about the authors, a copyright notice, an open access license notice, a disclaimer notice, and a link to the material), provide a link to the license, and indicate if changes were made. The publisher will indicate any modification of the material (if any) and retain an indication of previous modifications using a CrossMark Policy and information about Erratum-Corrigendum notifications.

Authors, readers, and third parties can read, print, and download, redistribute or republish the article (e.g., display it in a repository), translate the article, download it for text and data mining purposes, reuse portions or extracts from the article in other works, sell or reuse it for commercial purposes, remix, transform, or build upon the material. They must distribute their contributions under the same license as the original Creative Commons Attribution-ShareAlike (CC BY-SA).

Copyright Transfer Agreement for Publishing (Publishing Right)

The Authors submitting a manuscript do so on the understanding that if accepted for publication, non-exclusive right for publishing (publishing right) of the article shall be assigned/transferred to Publisher of the Nurse Media Journal of Nursing (Department of Nursing, Faculty of Medicine, Universitas Diponegoro).

Upon acceptance of an article, authors will be asked to complete a 'Copyright Transfer Agreement for Publishing (CTAP)'. An e-mail will be sent to the Corresponding Author confirming receipt of the manuscript together with a 'Copyright Transfer Agreement for Publishing' form by online version of this agreement.

Nurse Media Journal of Nursing and Department of Nursing, Faculty of Medicine, Universitas Diponegoro, the Editors and the Editorial Board make every effort to ensure that no wrong or misleading data, opinions or statements be published in the journal. In any way, the contents of the articles and advertisements published in the Nurse Media Journal of Nursing are sole and exclusive responsibility of their respective authors and advertisers.

Please note that even though we ask for a transfer of copyright for publishing (CTAP), our journal Author(s) retain (or are granted back) significant scholarly rights as mentioned before.

The Copyright Transfer Agreement for Publishing (CTAP) Form can be downloaded here: [Copyright Transfer Agreement for Publishing (CTAP) Form NMJN 2024]

The copyright form should be signed electronically and send to the Editorial Office in the form of original e-mail below:

Dr. Sri Padma Sari (Editor-in-Chief)
Editorial Office of Nurse Media Journal of Nursing
Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Jl. Prof. Soedarto, Tembalang, Semarang, Central Java, Indonesia 50275
Telp.: +62-24-76480919; Fax.: +62-24-76486849
E-mail: media_ners@live.undip.ac.id

(This policy statements has been updated at 24th January 2024)

Synergistic Interaction between Older Age and an Abnormal Ankle-Brachial Index in Relation to Diabetic Peripheral Neuropathy

Journal Author(s) Rights

Copyright Transfer Agreement for Publishing (Publishing Right)

OFFICE INFORMATION