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Rapid global environmental changes, especially due to advances in technology and information, have had a significant impact on various sectors of life, including the health sector. In the context of modern health services, hospitals are no longer just places of healing, but also institutions that are required to provide high-quality services, based on patient safety, and are able to adapt to the dynamics of community needs. This change requires a transformation in human resource management, especially related to the interpersonal and psychosocial competencies of nurses as the spearhead of medical services.Purposes:​ to analyze the effect of effective communication and Assertive Attitude on Nurses' Work Productivity in hospitals, with Work Fatigue as a mediating variable.Methods: This type of research is quantitative, using statistical figures to measure the influence of independent variables on dependent variables. The research design is a cross-sectional study.Results: The results of this study indicate that effective communication, assertiveness, and job fatigue collectively significantly influence nurses' work productivity. Communication and assertiveness positively contribute to job fatigue, which in turn affects productivity. Job fatigue is also shown to be a significant mediator in the relationship between communication and assertiveness on work productivity .Conclusion : The importance of strengthening effective communication as a strategy to increase productivity. Organizations need to design communication systems that support openness, transparency, and clarity of information and culture-based assertiveness training, so that employees can express their opinions appropriately without causing resistance in the team.

The growing number of alleged medical malpractice cases in Indonesia, particularly physicians’ misdiagnosis resulting in patient death, underscores the need for stronger legal certainty and accountability in healthcare services. Physicians are professionally obligated to conduct diagnosis and medical treatment in accordance with professional standards, service standards, and standard operating procedures; however, negligence may occur and lead to severe harm. This study aims to analyze the legal provisions governing physicians’ liability for misdiagnosis causing patient death and to examine the forms of legal responsibility that may be imposed. The research applies a normative juridical method using a case approach and literature review, relying on primary legal materials such as the Indonesian Civil Code, the Criminal Code, the Medical Practice Law, the Hospital Law, and Law Number 17 of 2023 on Health, supported by secondary and tertiary sources. The findings indicate that physicians may be held liable under civil, criminal, and administrative law if the essential elements of medical negligence are proven, namely duty of care, breach of duty, harm (including death), and a causal relationship between the misdiagnosis and the fatal outcome. Moreover, liability may extend to hospitals under the doctrines of vicarious liability, hospital liability, and strict liability. This study implies the importance of strengthening professional competence, reinforcing disciplinary mechanisms, and ensuring balanced legal protection for both patients and healthcare professionals within Indonesia’s health law framework.

Injuries represent a common health issue associated with physical activity in both recreational and competitive sports settings. Appropriate initial management is essential to prevent complications and to facilitate optimal recovery. This study aims to describe the management of minor sports injuries at the Surisina Primary Health Center based on observational findings Sports and structured interviews with healthcare professionals. The study employed direct observation and structured interviews involving physicians and nurses at Surisina Primary Health Center on November 24, 2025. The findings indicate that sports injury management at the primary healthcare level involves a systematic initial assessment, comprehensive physical examination, and the implementation of simple immobilization techniques tailored to the type and severity of injury. Common injuries treated include sprains, muscle cramps, contusions, lacerations, ankle injuries, and minor fractures. Despite limitations in the availability of immobilization equipment, healthcare services were delivered effectively, supported by adequate patient education on injury care, warning signs, and activity recommendations during recovery. This study demonstrates the critical role of primary health centers in providing initial sports injury management and serving as practical learning sites for students in physical education and health programs.  

The availability of human resources (HR) in hospitals is a key factor in ensuring quality healthcare services. A type C general hospital in Medan faces challenges in terms of limited health personnel in several service units. The Workload Indicators of Staffing Need (WISN) method by WHO is applied to calculate staffing requirements based on actual workload. This study aimed to analyze the workload and HR needs of a type C general hospital in Medan using the WISN method. A quantitative descriptive study with a WISN approach. Data were obtained from hospital management reports including patient visits, bed occupancy rate (BOR), and staff distribution across main units. Analysis was carried out by calculating available working time, workload standards, allowance standards, and HR needs per unit. The analysis indicated shortages of personnel in several units: inpatient nurses (−20), anesthetists (−2), pharmacists (−1), laboratory analysts (−5), radiographers (−5), and medical records staff (−6). Some units had surplus staff, such as maternity (+8). The type C general hospital in Medan continues to face HR shortages in critical service units. Workload-based HR planning using the WISN method is crucial to support effective recruitment and staff redistribution.

Hospitals often face difficulties in determining patient treatment priorities due to limited medical resources and the uncertainty of patient conditions. Conventional prioritization methods tend to rely on subjective judgment, which can lead to inconsistent decisions and delays in treatment. This study aims to apply fuzzy logic in a decision support system to determine patient priority levels more objectively and systematically. The proposed method utilizes a fuzzy inference system that processes several criteria, including the severity of symptoms, vital signs, patient age, and waiting time. These criteria are represented as fuzzy sets and evaluated using a set of inference rules to generate priority classifications. The results indicate that the fuzzy logic–based system is able to classify patient priorities more consistently and transparently compared to manual assessment. The system provides clear priority categories that can support medical staff in making faster and more accurate decisions. The findings imply that the implementation of fuzzy logic in hospital decision support systems can improve the quality of healthcare services, enhance fairness in patient handling, and optimize the allocation of medical resources, particularly in emergency and high-demand situations.

Malpractice in dental health services has become a complex legal issue as public awareness of service quality and patient rights continues to increase. The enactment of Law Number 17 of 2023 on Health introduces important changes in regulating the legal accountability of medical personnel, including dentists, particularly in relation to criminal liability for malpractice. This study analyzes the forms of dental malpractice and the criminal responsibility of dentists under the new Health Law. The research uses an empirical legal method with sociological and statutory approaches. Data were obtained through interviews and a review of relevant legislation, legal doctrines, and court decisions. The results show that dental malpractice can arise from negligence, failure to comply with professional standards, violations of standard operating procedures, and the absence or disregard of informed consent. Law Number 17 of 2023 stipulates that criminal liability for dentists can only be applied after a recommendation from the Professional Discipline Board, ensuring a clear distinction between inherent medical risks and professional misconduct. This framework is designed to provide balanced legal protection for both patients and dentists while strengthening legal certainty in malpractice case resolution. Consequently, dentists must understand professional standards and criminal liability mechanisms to practice responsibly and professionally.

Health services at the Puskesmas (Community Health Center) are an important sector directly related to the community. However, there are still various challenges in patient data management and handling complaints that can hinder service efficiency. One of the efforts to improve service quality is by developing a complaint information system that can efficiently manage and record patient complaints. This study aims to develop a complaint information system for services at the Puskesmas Waimangura using the Prototype method. This method was chosen because of its ability to produce system prototypes that can be immediately tested and developed according to user needs. The system is designed to allow patients to submit complaints related to the services received, as well as enabling Puskesmas staff to follow up on and record each complaint systematically. With the implementation of this system, it is expected to increase efficiency in managing complaint data, speed up problem resolution processes, and improve accuracy in recording patient and complaint data. The results of prototype testing show that this system simplifies the complaint process and provides convenience for staff in following up on patient complaints. The implementation of this information system is expected to improve the quality of services at Puskesmas Waimangura and accelerate responses to issues faced by patients.

Anxiety among family member in the Intensive Care Unit (ICU) is a common psychological issue. This situation arises from the uncertainty about the patient’s condition. Effective therapeutic communication by nurses is one of the key strategies to help reduce anxiety. This study was conducted from June 4 to July 20, 2025. This study aims to analyze the relationship between nurses’ therapeutic communication and the anxiety levels of family members in the ICU of RSUD Meuraxa, Banda Aceh. This research employed a quantitative, correlational design. The population consisted of 66 family members of ICU patients, with a sample of 57 respondents selected using a purposive sampling technique. The results showed that most families received therapeutic communication at a moderate level (50.9%) and a good level (49.1%). The anxiety levels experienced by the families were mostly moderate (54.4%) and mild (45.6%). The analysis revealed a p-value of 0.003, indicating a statistically significant relationship between nurses’ therapeutic communication and the anxiety levels of family member. These findings prove that therapeutic communication given by nurses plays a vital role in influencing the anxiety levels of patients’ families in the ICU. Therefore, the hospital management is encouraged to improve nurses’ therapeutic communication skills and establish supportive communication policies to enhance services and reduce anxiety among the family members in the ICU.

Background: Hypertension remains a major public health problem, particularly in primary health care settings. The coexistence of diabetes mellitus may contribute to increased hypertension severity; however, evidence from primary care data in Indonesia remains limited. Objective: This study aimed to examine the association between diabetes mellitus and hypertension severity among patients attending a primary health care center in Indonesia. Methods: A cross-sectional study was conducted using secondary data obtained from medical records at a primary health care center in 2025. A total of 84 patients with hypertension were included using total sampling. Hypertension severity was classified into stage 1 and stage 2. Bivariate analysis was performed using the Chi-square test or Fisher’s exact test as appropriate, with statistical significance set at p < 0.05. Data were analyzed using SPSS version 26. Results: Of the 84 participants, 33.3% had diabetes mellitus. Stage 2 hypertension was more prevalent than stage 1 hypertension. Diabetes mellitus was significantly associated with hypertension severity (p = 0.029), with a higher proportion of patients with diabetes mellitus presenting with stage 2 hypertension. Conclusion: Diabetes mellitus was significantly associated with greater hypertension severity in a primary health care setting. These findings highlight the importance of integrated management of diabetes mellitus in patients with hypertension at the prizary care level.

Hypertension and diabetes mellitus are two highly prevalent non-communicable diseases that often coexist as comorbidities, significantly increasing the risk of cardiovascular complications. The coexistence of these conditions accelerates the onset of atherosclerosis, diabetic nephropathy, and kidney failure, thereby requiring more comprehensive clinical management. One of the key parameters in diabetes management is fasting blood glucose (FBG), which reflects the balance of glucose metabolism after a fasting period. Chronic hyperglycemia is known to contribute to endothelial dysfunction, increased peripheral vascular resistance, and activation of the sympathetic nervous system and renin-angiotensin-aldosterone system, ultimately leading to elevated blood pressure. This study employed a systematic literature review approach, analyzing articles published between 2021 and 2025. Narrative synthesis was conducted across various study designs, including cross-sectional, cohort, and meta-analysis studies. The findings indicate that most studies support a significant association between FBG levels and blood pressure, although some reported varying results. Cohort studies provide stronger evidence that elevated FBG increases the risk of new-onset hypertension. Age, treatment adherence, and lifestyle factors were also identified as confounding variables influencing outcomes. Overall, the evidence highlights that glycemic control through FBG monitoring is essential in managing hypertension among diabetic patients. Multidisciplinary strategies, patient education, and strengthening of primary healthcare services are required to reduce cardiovascular risks. Longitudinal studies are recommended to deepen the understanding of the relationship between FBG and blood pressure and to reinforce the scientific basis for evidence-based clinical interventions.

Chronic liver disease is a significant health problem and places a significant burden on healthcare services. Deaths from complications of chronic liver disease (cirrhosis and cancer) account for approximately 3.5% of all deaths worldwide each year. Hepatocellular carcinoma (HCC) is a primary liver tumor, accounting for 90% of all liver tumors. Due to limitations in liver transplantation, liver resection is considered the treatment of choice for HCC patients with a single tumor and sufficient liver function reserve. Liver resection and transplantation are the only curative treatment options available for HCC patients. Surgical procedures require anesthesia. General anesthesia is the preferred method for liver tumor resection. There are five main classes of anesthetic agents: intravenous (IV) anesthetics, inhalational anesthetics, IV sedatives, synthetic opioids, and neuromuscular blocking agents. Estimated health risks depend on the extent or severity of liver disease, the nature and timing of surgery, the type of anesthesia, and other comorbidities.

Pulmonary tuberculosis (TB) remains a major public health problem in Indonesia. Despite the implementation of national TB control programs through the Directly Observed Treatment Shortcourse (DOTS) strategy, treatment success continues to face significant challenges, particularly related to patient adherence to anti-tuberculosis drug (ATD) therapy. Non-adherence to TB treatment can lead to treatment failure, disease relapse, and the development of drug-resistant tuberculosis, thereby increasing the overall burden of the disease.Treatment adherence in TB patients is influenced not only by medical factors but also by social and behavioral determinants. Family support plays a crucial role in encouraging patients to comply with treatment regimens by providing motivation, reminding medication schedules, and offering emotional support throughout the long duration of therapy. Patients who receive adequate family support tend to demonstrate higher levels of treatment adherence compared to those with limited support.In addition, the use of herbal medicine as a preventive and supportive health measure is common among the Indonesian population. Herbal medicine is often utilized to enhance immune function, reduce medication side effects, and improve patient comfort during TB treatment. However, the use of herbal remedies without proper medical guidance may lead to misconceptions regarding standard TB therapy.Therefore, it is important to examine the relationship between family support and the use of herbal medicine as preventive measures with treatment adherence among pulmonary TB patients in primary healthcare settings. Such evidence is expected to support a comprehensive family medicine approach and strengthen TB control programs in primary care services.

Aortic dissection is a cardiovascular emergency characterized by a tear in the aortic intima layer and the formation of a false lumen, posing risks of fatal complications such as rupture and organ malperfusion. Stanford type B dissections may be managed conservatively; however, complicated cases require intervention. Thoracic Endovascular Aortic Repair (TEVAR) has emerged as the preferred modality, offering lower perioperative morbidity and mortality compared to open surgery. To report the first TEVAR procedure performed in Manado on a patient with Stanford type B aortic dissection, highlighting the technical approach, operative challenges, and clinical outcomes. A 62-year-old male with a history of hypertension and chronic chest pain was referred following a CT angiography that revealed a Stanford type B aortic dissection with an entry site in the proximal descending aorta. TEVAR was performed with stent-graft placement in zone 2 and a chimney graft to preserve perfusion of the left subclavian artery (LSA). Intraoperative aortography confirmed false lumen exclusion without endoleak. The patient showed significant clinical improvement and recovered without postoperative complications. The procedure was technically and clinically successful, with no major complications. Postoperative evaluation confirmed stable stent position and maintained LSA perfusion. This case demonstrates that TEVAR can be safely implemented in non-tertiary regional hospitals with thorough preparation. The first TEVAR procedure in Manado illustrates that this technique can be an effective solution for complicated type B aortic dissections. This experience marks a milestone in the development of endovascular services in resource-limited settings and may serve as a reference for similar institutions in Indonesia.

Acute pain is a complex phenomenon frequently experienced by post-surgical patients. If not properly managed, it can hinder the recovery process and increase the risk of chronic complications. This study aims to conduct an in-depth analysis of the concept of acute pain in surgical patients from a nursing perspective to improve the quality of care. The method used was a narrative literature review, analyzing various research articles and clinical protocols related to surgical pain management. The study findings indicate that acute post-surgical pain involves sensory and emotional dimensions influenced by the type of surgical procedure, individual pain threshold, and the effectiveness of pharmacological and non-pharmacological interventions. Furthermore, the role of nurses in conducting accurate pain assessments and patient education is a key factor in successful pain management. The implications of this study emphasize the importance of implementing integrated multimodality pain management protocols and improving nurses' competency in conducting intensive monitoring. Optimizing pain management is expected to accelerate patient mobilization, shorten hospital stays, and increase patient satisfaction with nursing services.

Ibnu Sina Yarsi Islamic Hospital Padang Panjang plays a crucial role in providing medical services to the community. However, challenges such as inadequate facilities, limited service space, and insufficient healthcare personnel have led to long queue times and schedule mismatches, adversely affecting patient satisfaction. This study analyzes strategies to improve service quality at the hospital using a qualitative descriptive approach with data collected through observation, interviews, and documentation involving management, medical staff, and patients. Data validity was ensured by triangulation, and analysis followed the Miles and Huberman interactive model. The findings reveal that strategies focusing on human resource development programs, performance-based budget management, and consistent application of standard operating procedures (SOP) have been implemented effectively. Despite this, limitations in human resources, budget, and physical infrastructure hinder optimal results. Strengthening internal capacity and resource optimization are necessary to achieve sustainable improvements in service quality.

Since 2022, the application of the Internet of Things (IoT) in the healthcare sector has grown significantly, marked by the increasing adoption of wearable technology, artificial intelligence (AI), machine learning (ML), and blockchain integration. Research highlights India and China as leading contributors in this domain. IoT enables real-time monitoring of chronic diseases, tracking of patient vital signs, and detection of health protocol compliance. Integrated systems such as Monit4Healthy and RADAR-IoT support personalized medical recommendations and cross-platform interoperability. However, key challenges persist, including patient data privacy and security, system interoperability issues, data fragmentation, and barriers to user acceptance due to cost, digital literacy, and device comfort. Proposed solutions include blockchain for secure data sharing, adaptive congestion control for network performance, and user training to improve technology adoption. Therefore, successful IoT deployment in healthcare requires a comprehensive approach that addresses technological, social, ethical, and sustainability aspects to achieve an effective and inclusive transformation of health services.

In this paper, we study the use of linear programming for the performance enhancement of fortified queues systems in which resources are unreliable in terms of variation and a case study on Marjan Hospital is considered. The quality management maturity level in the hospital was measured by an integrated inspection tool; senior management was found to be concerned for quality of service improvement and implementation of modern technology systems. Strengths and weaknesses in that activity are shown, and it is evidenced the need of boosting the quality of service activities and promoting the coordination between the different areas. From the findings, the study recommends the use of linear programming technique,Orgers should as well enhance proper training and development and Acquisition of modern day technology for effective performance improvement and quality of service. The study demonstrates that the adoption of linear programming techniques could be a viable solution to optimize resource allocation and enhance performance in the hospital's queue systems. Additionally, the research underscores the importance of investing in staff training and development programs, as well as the acquisition of state-of-the-art technology, to further improve service delivery and ensure sustainable quality improvement in the long term.

This study aims to explore the communication styles and experiences of healthcare workers in enhancing public service communication skills at Petir Community Health Center (Puskesmas Petir) in Tangerang City. Effective communication is a crucial factor in the quality of healthcare services for patients; however, various challenges such as time constraints, differences in patients’ backgrounds, and work pressure often hinder optimal interactions. This research employs a qualitative approach with a case study method, involving in-depth interviews, participatory observations, and document analysis to uncover the experiences, perceptions, and practices of healthcare workers in communicating with patients and the community. The findings indicate that communication skills are improved through internal training, peer mentoring, and the adaptation of communication strategies to match patient characteristics. Additionally, personal motivation, managerial support, and a conducive work environment play significant roles in the successful implementation of communication strategies. The results of this study provide an in-depth understanding of public service communication practices within the community health center context and serve as a basis for recommendations in developing training programs and policies to enhance the quality of interactions between healthcare workers and the community.

Depression is one of the mental health problems that often arise in patients with chronic diseases, such as diabetes mellitus, hypertension, and chronic kidney failure. This condition not only impacts the patient's quality of life, but also affects the treatment process and the burden on the family. However, mental health literacy in the community is still low, so targeted preventive and curative efforts are needed. The Community Service Program (PKM) aims to improve people's mental health through educational interventions with scientific booklet media that are easy to understand and apply. The activity method is carried out in a participatory manner, including the preparation stage, socialization, educational implementation, and evaluation. Education is provided to the community with a focus on preventing depression through a healthy lifestyle, stress management skills, and early intervention efforts by seeking professional support. Evaluation is carried out through pre-post tests, observations, and group discussions. The results of the activity showed an increase in public knowledge about depression, a change in attitudes to be more open in expressing feelings, as well as practical skills in relaxation, maintaining sleep patterns, and building social support. Participants also better understand the importance of seeking professional help when depressive symptoms are getting worse. The conclusion of this PKM is that the scientific booklet has proven to be effective as a preventive and curative educational intervention medium, and can be an innovative strategy in improving the mental health of people affected by chronic diseases.

Tuberculosis (TB) remains one of the leading infectious diseases causing morbidity and mortality in Indonesia. Limited public health literacy regarding TB symptoms, prevention, and treatment adherence contributes to delayed diagnosis and poor treatment outcomes. This community service program aimed to improve public understanding and awareness of TB through interactive educational activities conducted at the Outpatient Unit and TB Clinic of UPT Puskesmas DTP Saketi, Pandeglang Regency. The activities involved 30 participants, including TB patients and their families. Interactive counseling sessions, audiovisual media presentations, and group discussions were used to engage participants actively. Evaluation results showed a 35% increase in participants’ knowledge scores, greater awareness of the importance of completing treatment, and improved communication between patients and healthcare workers. The implementation of interactive education proved effective in enhancing TB health literacy and supporting national TB elimination efforts at the primary healthcare level.