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Stroke is an acute neurological condition caused by decreased blood flow to the brain. Nervous system dysfunction occurs suddenly (within seconds) or rapidly (within hours) and the symptoms and signs correspond to the local area of ​​the brain affected. Objective: To conduct an analysis of managed cases with a medical diagnosis of non-hemorrhagic stroke with jigsaw puzzle pairing exercise therapy to increase upper extremity muscle strength Methods: This research is a quasi-experimental design with pre and post test. This type of research is a research design that is used to look for causal relationships with research involvement. The sample used in this study were 6 patients with a critical sample of patients who had non-hemorrhagic stroke who were treated at Prof. Hospital. Dr. Aloei Saboe Gorontalo City. Results: The results of the study showed that changes in muscle strength were only present in Mr. I.T obtained an increase on the evaluation of the third day of implementation where there was an increase in muscle strength to 5/4, which means there was an increase using the MMAS (Modified Muscle Assessment Scale) it was found that the client was only able to lift the top part of the puzzle and put it back. (The patient reaches forward at arm's length, lifts the top of the puzzle, releases it back to the part of the table that is closest to the patient's body). Conclusion: Based on the research conducted, it was found that 6 respondents from the results of the assessment had measuring results that had been carried out after the Jigsaw Puzzle installation exercise, it was found that there was a change in the range of motion of the client's fingers while for the client's muscle strength and fine motor movements there had been no change. Stroke attack can cause permanent physical disability.

Introduction : Pain in labor is pain due to uterine contractions which can lead to increased activity of the sympathetic nervous system, changes in blood pressure, heart rate, breathing, and if not treated it will increase feelings of worry, tension, fear and stress. Warm and cold water compress therapy is a non-pharmacological method to meet the need for comfort and to treat pain. Objective : to determine the effectiveness of giving warm and cold compresses to reduce pain in active phase 1 infartu mothers at RSIA Siti Khadidjah Aisyiyah, Gorontalo city. Research Methods : One group of subjects will be used in this study with a pre-experimental research design with a one-group pre-post test strategy to determine cause and effect. Before the intervention, the subject group was monitored, and then after the intervention. Mothers who were in the early phase of the active phase of physiological labor in the VK room of RSIA Siti Khadijah Aisyiyah, Gorontalo City, were used as research subjects. Research Results : The results of this study found acute pain in the four patients, it was found that 2 patients were given warm water compresses, the pain level decreased to a pain scale of 4 (moderate) and in the administration of cold water compresses to 2 patients, the pain level decreased to a pain scale of 6 and 5 (currently). Conclusion : the conclusion of this study is seen from the level of pain that has decreased when given warm water or cold water compresses. Hot and cold compress therapy is a non-pharmacological method to treat pain.

Background: One of the non-pharmacological intervention techniques that can be used is the guided imagery relaxation technique. When doing Guided Imagery Relaxation it produces endorphins. Endohrpin is a neurohormone associated with pleasant sensations so it is expected to lower blood pressure. This study aims to determine the effect of Guided Imagery Relaxation on reducing blood pressure in hypertensive patients. Method: This type of research is Quasy Experiment with a one group pretest posttest design. The sampling technique used purposive sampling with the population that will be taken in this study is the community of the Cikalongkulon Cianjur Health Center in people with hypertension aged 45-70 years who do not experience complications and do not regularly take hypertension medication. The number of samples is 16 respondents. Statistical analysis using the Wilcoxon Signed Rank T-Test. Results: From the results of the Wilcoxon Signed Rank T-Test analysis, it shows that there is a significant effect between Guided Imagery Relaxation and a decrease in blood pressure in the Working Area of ​​the Cikalongkulon Health Center, Cianjur p-value 0.002 (<0.05). Conclusion: From this study it shows that there is an effect of guided imagery relaxation on reducing blood pressure in the Working Area of ​​the Cikalongkulon Health Center.

Inguinal hernia is a condition of protrusion of all or part of an organ through the locus minoris in the abdominal wall. The incidence of inguinal hernia is quite high, in the world there are approximately 20 million hernia repairs done every year. Hernia repair surgery is considered good if it does not experience recidivism, there are no complications, costs are not too expensive, and patients can immediately carry out their work routines. The incidence of residive hernia is influenced by many factors, including factors from the surgeon, namely the knowledge and skills of the surgeon, the selection of surgical techniques and meshes used, mesh fixation techniques, mesh size, lateral and medial hernia bag management, sliding hernias, lipomas in the inguinal canal, operating time, types of anesthesia, postoperative complications This study aims to determine the incidence of inguinal hernia and recidival inguinal hernia, Surgical techniques used and risk factors associated with recidivist inguinal hernia. This study used a cohort retrospective research design, sampling was carried out in total sampling on inguinal hernia patients who had undergone surgery in 10 government and private hospitals in North Aceh Regency and Lhokseumawe City as many as 1109 patients in the period 2018 to 2021. The results of this study found that the most hernia sufferers found in peripheral hospitals in Aceh were mostly under 60 years old with the most gender being men. The most common risk factors for inguinal hernia are people who are obese, have a history of heavy physical activity, have a history of chronic cough and have a history of constipation. Surgical techniques that are widely used in hernia management are surgical techniques using mesh graft and most patients with ingunal hernias do not experience recidivism.  

Colorectal carcinoma, a malignant neoplasm originating from the epithelial cells of the large intestine or rectum, poses a significant health problem worldwide. The estimated global incidence of colorectal cancer was 2.17 million cases in 2019. Meanwhile, in Indonesia, colorectal cancer ranks fifth among the most common cancer cases with a mortality rate of 9.5%. Demographic characteristics, including age, gender, ethnicity, and geographic location, have been extensively studied in relation to colorectal carcinoma. Understanding the patterns of differentiation and demographic characteristics associated with this disease is crucial for the diagnosis, treatment, and overall prognosis of patients. This study is a descriptive observational study that examines the demographic characteristics and differentiation of colorectal carcinoma patients. The study sample consists of a subset of the research population at Ciawi Regional General Hospital who underwent surgery from June 2021 to May 2023. A total of 21 respondents met the inclusion criteria, with a mean age of 54 years, and were predominantly female (57.1%). The results of this study indicate that poorly differentiated colorectal carcinoma generally occurs at a younger age compared to well and moderately differentiated cases. In terms of gender, females are more likely to experience colorectal carcinoma compared to males. Further research is needed to uncover the interactions between tumor biology, demographics, and clinical outcomes, with the ultimate goal of improving the prognosis and survival rates for individuals with colorectal carcinoma.    

Background: Stroke is one of the main health problems for the community because stroke can cause damage to the brain that appears suddenly, progressively, and quickly due to non-traumatic brain blood circulation disorders. Purpose: To conduct an analysis of managed cases with a medical diagnosis of hemorrhagic stroke with innovative mobilization therapy (Passive ROM) and tactile stimulation for upper limb recovery in the HCU Room of Prof. Dr. H. Aloei Saboe City of Gorontalo Methods: This research is a quasi-experimental design with pre and post test. To determine the effect of providing innovative mobilization therapy (Passive ROM) and tactile stimulation to hemorrhagic stroke patients in the HCU Room of Prof. Dr. H. Aloei Saboe City of Gorontalo. The sample used in this study were 5 patients with the sample criteria being patients who had hemorrhagic strokes who were treated in the HCU Room at Prof. Hospital. Dr. H. Aloei Saboe Gorontalo City, patients who experience hemiparesa, patients have awareness of compos mentis. Results: Implementation of innovation in Mrs.FK On the first day the Ara test score was 0 until the third day there was no increase in the Ara test value which was still 0. Mr. RA on the first day the Ara test value was 1, on the third day the Ara test value increased enough to be 2. On Mr. UT on the first day the Ara test value was 0, on the third day the Ara Test value was 1. Mr. AH on the first day the Ara test value was 0, on the third day the Ara Test value was still 0. Mr. MH on the first day the Ara test value was 1, on the third day the Ara Test value increased to 2. Conclusion: Based on the research conducted, it was found that 5 respondents from the results of the study had the same complaint, namely experiencing weakness/hemiparesis of the upper extremities. The client's upper extremity muscle strength is 1/5, 3/4, 2/4, 4/2, 4/5, when the motor function test is carried out by holding the researcher's hand the client is unable to grip,

Childbirth is a series of events when a baby is released from the mother's womb, followed by the release of the placenta and fetal membranes from the mother's body (Fitriana and Nurwiyandani, 2018). Experimental research method with a design that is Control group pre test-Post test. The population in this study were all primigravid postpartum patients without complications during the first active phase in the working area of ​​the Halilulik Health Center, Naitimu Village, West Tasifeto District, East Nusa Tenggara, Using a purposive sampling technique, a sample of 16 people was obtained with a distribution of 8 people for the back rubbing massage treatment using the Power Massager (group 1) and 8 people for the back rubbing massage treatment using the hands (group 2). The results showed that the back rubbing massage treatment using a power massager obtained an average decrease in pain of 2.375, while the treatment of back rubbing massage using hands obtained an average decrease in pain of 1.250, obtained P count of 0.0013 P <0.05, So it can be concluded that back rubbing massage using a power massager is more effective than using hands in reducing pain in primigravida in parturient patients in the active phase 1. In conclusion, back rubbing massage using a power massager is more effective in reducing pain in primigravid patients in labor in the first active phase.

Outpatient services are an important part of health services provided by hospitals. However, some BPJS hospitals experience obstacles in providing efficient and quality outpatient services, such as long queues, long waiting times, and lack of a good management system. the application of Lean Management to the outpatient services of BPJS patients in hospitals can help hospitals improve operational performance, so as to increase public trust in BPJS Health. This study aims to analyze the application of Lean Management to the outpatient services of BPJS patients in hospitals. This research uses a literature study method or Systematic Literature Review using the Google Scholar search engine and journal databases, such as Researchgate. The results showed that most outpatient service activities for BPJS patients still have patient waiting times below the established service standards. In analyzing the flow that patients go through, each activity is identified into two groups, namely Value Added (VA) as an activity that is considered necessary and profitable and Non Value Added (NVA) as an activity that is considered unnecessary. Based on the percentage of waste in the form of the largest waiting time can be described, namely, 35.1% in the registration process, 30.2% in the poly examination process, and 20.7% in the process of receiving drugs in the pharmaceutical installation

Background: Self-efficacy is the perception of the ability to consider and implement behavior patterns as self-regulation that is obtained through motivation and determining achievement of expectations. Good self-efficacy is needed not only for healthy people but also for sick people, especially people with chronic illnesses. Decreased self-efficacy can occur in people with chronic illnesses. We know that people with chronic diseases have long treatment programs, even for a lifetime, such as taking medication and sometimes this feels boring or boring. Consuming drugs or running a continuous treatment program can lead to boredom so that it is possible to want to stop taking medication. This is the background for wanting to know what actions can be taken to increase self-efficacy in people with chronic diseases. Self-efficacy increases if there is effort in dealing with existing obstacles. Interventions can be provided by health workers in increasing self-efficacy in people with chronic diseases. Objective: This study aims to describe the effect of Beapreasi therapy on self-efficacy in patients with chronic diseases at the Bergas Health Center, Semarang Regency. Methods: The research design used was descriptive and was carried out on 6 respondents, all of whom became the experimental group or all of whom became respondents. The method used to determine respondents is a purposive sampling technique. All respondents were assessed for self-efficacy using a self-efficacy scale questionnaire which was measured 2 times, namely before and after being given Beapreasi therapy. Results: The study showed that the mean value of the self-efficacy scale in the experimental group before the intervention was 81.79 and the value of the efficacy scale in the experimental group after the intervention was 89.36. this shows that there is an increase in the value on the self-efficacy scale and there is a difference in the mean value on the self-efficacy scale in the experimental group before giving the intervention with after giving the intervention with a p value of 0.00, p value <0.05 so that there is a significant/significant effect of giving reward therapy on improvement self-efficacy. Conclusion: Beapreasi therapeutic intervention can be used to maintain self-efficacy or increase self-efficacy in patients with chronic diseases, with the hope that patients will remain enthusiastic in carrying out their care and life. Beapreasi therapy can be used as a nurse's independent intervention in accompanying the care of patients with chronic diseases who require lifelong treatment and this is in an effort to increase self-efficacy in sufferers of chronic diseases.  

Bacground Sectio caesarea is a procedure that involves cutting the uterine and abdominal walls to deliver a fetus. This study aims to determine the application of hand-held relaxation techniques to reducing the pain scale of post-section caesarea patients at RSIA Sitti Khadijah Aisyiyah, Gorontalo City. Method : The method used is descriptive analytic with a case study approach on 4 Post sectio caesarea patients with pain at RSIA Sitti Khadijah Aisyiyah Gorontalo City which includes nursing assessment, nursing diagnosis, nursing intervention, nursing implementation and nursing evaluation. The process of applying this finger-held relaxation technique is carried out for 1 day. Measurement of the pain scale was carried out before and after the hand-held relaxation technique was carried out and using a Numeric Rating Scale (NRS) pain scale measuring instrument. Result : So the results obtained before and after the relaxation technique was carried out, the pain intensity decreased. This case study shows that after finger grip relaxation was performed in patients I, II, III, and IV who experienced postoperative sectio caesarea pain, the result was a change in the pain scale from a moderate pain scale to a mild pain scale. Conslusion : There is a significant effect of the application of finger grip relaxation techniques in post op section caesarean patients for changes in pain levels.

Lean is a concept and technique for systems that optimizes patient benefit by decreasing waste and waiting time. The literature review approach is used in this study to acquire research data, with internet searches serving as a supplementary tool while looking for relevant papers. According to the study findings, mean hospital length of stay (LOS) fell by 24% throughout the intervention period in 259 patients with PMV (131 pre-intervention; 128 post-intervention) (29 vs. 22 days, p 0.001). This demonstrates that clinical redesign based on Lean Six Sigma decreases LOS in intensive care units. Other studies show that utilizing Lean Six Sigma has resulted in a 57% reduction in length of stay and an 88% reduction in the identification of non-value added tasks. Lean management in hospitals is a step toward greater service efficiency that has been shown to outperform Total Quality Management (TQM) and Plan, Do, Check, Action (PDCA) improvements. Customers and their families gain from shorter wait times, as do healthcare employees (medical, emergency, and non-medical) and hospital administration. The use of the lean six sigma approach in conjunction with the DMAIC cycle effects LOS reduction, indicating that lean six sigma can reduce LOS in hospitals.

TB is an infectious disease that is easily transmitted caused by the bacterium Mycobacterium tuberculosis. This bacterium can attack several organs in the body but most of these bacteria attack the lungs. The most common transmission is through droplet infection by TB patients. Efforts to convey information on media selection are very important and need to be considered because the correct selection and delivery will provide maximum results in increasing knowledge, attitudes and intentions. This type of research is qualitative research using a qualitative approach. The delivery of learning material at the Kebonsari Health Center uses online, namely like looking through social media. Based on the results of the research and also the results of the interviews conducted by the researchers, it was shown that the delivery of TB material using promotional media, print media, such as leaflets and posters, was effectively used and contributed to rehabilitation patients at the Kebonsari Health Center in Surabaya. Because patients think that the delivery of material uses a new leaflet for them and patients pay more attention to the material presented.

Anxiety is the most common feeling experienced by pediatric patients who experience hospitalization, anxiety that is often felt by children such as crying, fear of the environment and new people. The number of stressors experienced by children when undergoing hospitalization can have a negative impact on the child's development. This aim is to determine the effect of coloring play therapy on the anxiety level of preschool-aged children who experience hospitalization at the Banda Aceh Mother and Child Hospital. This study used a quantitative research design with a sample size approach of 5 respondents. The sampling technique used is purposive sampling. Data collection instruments were carried out before and after carrying out coloring play therapy using observation sheets with a percentage calculation assessment scale. The results showed that before being given coloring play therapy, there were 2 respondents who experienced moderate anxiety (40%) and 3 child respondents who experienced severe anxiety (60%). And after being given coloring play therapy there were 4 child respondents who experienced mild anxiety (80%) and 1 person who was in the moderate category (20%). It is suggested that the results of this study can be used as a reference for coloring play therapy in preschool-age child patients who experience hospitalization anxiety in the children's room at the Banda Aceh mother and child hospital in 2021.

Perianal fistula is a condition where a cavity forms in the area around the rectum and fills with pus. Perianal fistula is an anorectal disorder that arises due to obstruction of the anal crypts. If left untreated perianal fistula can lead to serious complications such as perineal gangrene and sepsis. A large number of perianal abscesses will recur within a year or two, especially if predisposing factors are present. This study aims to determine patient characteristics and management of perianal fistula patients at Cut Meutia General Hospital in 2018-2021. This is a retrospective descriptive study using secondary data from perianal fistula patients at Cut Meutia General Hospital. The results of the study were 11 patients diagnosed with perianal fistula based on medical record data that met the inclusion and exclusion criteria. Based on the age range criteria, the most patients with perianal fistulas were in the age group range of 20 - 40 and 41-60 years, each of which was 5 patients (45.45%), male patients were the most, namely 9 patients (81.18%), based on the operation of perianal fistula patients who underwent surgery the most using LIFT procedures were 7 patients (63.63%), and based on the history of recurrence, the most patients who experienced new/primary cases of perianal fistula were as many as 9 patients (81.8%).

Congestive heart failure (CHF) is a clinical syndrome (a collection of signs and symptoms) characterized by dyspnea and fatigue (at rest or during activity) due to abnormalities in the structure and function of the heart. CHF can be caused by diseases that cause reduced ventricular filling (diastolic dysfunction) and/or myocardial contraction (systolic dysfunction). The purpose of this study is so that the authors are able to perform Nursing Care for Decreased Cardiac Output in Congestive Heart Failure (CHF) Patients. used is a case study, this research is descriptive in the form of a case report which is a nursing analysis. This research was conducted from 26 December 2022 - 07 January 2023, with a total sample of 3 respondents. The case data showed that the three patients had a history of hypertension, 1 patient with a history of Diabetes Mellitus, 2 patients had a Medical Diagnosis of Congestive Heart Failure (CHF) and 1 patient had a Medical Diagnosis of Hypertensive Heart Disease (HHD). The three patients had the same cardiac EKG, namely Arrhythmia, 2 patients had results of Photo Thorax Cardiomegaly and All patients had a weak general condition with Composmentis awareness. With the appointment of a nursing diagnosis of Decreased Cardiac Output. The three patients had a history of the same disease, namely hypertension and 1 patient had diabetes mellitus and used the nursing diagnosis of decreased cardiac output.

Introduction: Head injury is a traumatic disorder of brain function that does not result in a disconnection of brain continuity and can occur with or without interstitial hemorrhage of the brain substance. Purpose:Acute pain is one of the nursing problems experienced by patients with head injuries. To analyze the application of finger hold therapy interventions in reducing pain in patients with mild head injuries. Research methods: is Pre Experimental, which is a design with a One group pre test post test design approach, when this study was carried out from December 21, 2022 to January 23, 2023, with a sample of 6 patients. Research Results: The frequency of patients who experienced moderate pain levels before treatment was 4 patients (66.7.7%), and severe pain levels were 2 patients (33.3%) while the distribution of psien frequency who experienced mild pain levels after treatment was 3 respondents (50.0%), moderate pain levels were 1 patient (16.7%) and berst pain levels were 2 patients (33.3%). This shows that there is no change in pain levels in patients with severe pain scales, because finger hold terap cannot be applied to patients with severe pain levels.Conclusion :This study showed that there is an effect of finger hold therapy in reducing pain in patients with mild head injuries

A 52 year old male patient with complaints of weakness in the body. Initially the patient was brought to the Health Center with complaints of weakness since 3 days. Weakness is felt suddenly throughout the body and feels continuously. Complaints of weakness are also accompanied by a feeling of dizziness in the head. The patient also complained of frequent urination at night, urinating more than 10 times in one night. The patient also constantly feels thirsty, but his appetite has decreased since the last 2 years or so. The patient feels a loss of weight. In addition, the patient also complained of a wound on his left leg which had not healed since 1 year ago. Primary data were obtained through anamnesis and physical examination by conducting home visits, filling out family folders, and filling out patient files. The assessment was carried out based on the initial holistic diagnosis, process and end of the visit both quantitatively and qualitatively. Patients and families are given education about diabetes mellitus including the symptoms and complications that will arise, education about the patient's motivation to take medication regularly as well as educating and teaching patients about foot care and diabetes exercise. An approach with family doctor intervention is able to improve habits that are influential in the treatment of diabetes mellitus.

The quality of service at hospitals must always be improved to provide the best service to people in Indonesia. In accordance with Permenkes Number 82 of 2013 it states that every hospital is required to implement and develop a Hospital Management Information System (SIMRS). The Hospital Management Information System (SIMRS) is very important to do to support the efficiency of the management process in hospitals starting from information to patients, data, data processing and all activities in the hospital. By implementing a Hospital Management Information System, it is necessary to know how it is applied in improving the quality of health services in Indonesia. This research was conducted with literature reviews and journal searches using Google Scholar. The research results show that the implementation of the Hospital Management Information System (SIMRS) can improve the quality of health services because it facilitates the management activities of health service institutions.

Nephrotic syndrome is a collection of symptoms characterized by massive proteinuria, hypoalbuminemia, edema and hypercholesterolemia. Snakehead fish contains important nutrients such as protein, omega-3 fatty acids, vitamins and minerals. Protein is the main building material in the body and is needed for albumin synthesis. Adequate protein consumption can provide the essential amino acids needed for albumin production in the body, thereby increasing albumin levels in the blood. The purpose of this study was to explain that snakehead fish extract has an effect on increasing albumin levels in patients with nephrotic syndrome based on a literature review. The research method uses a literature review study. The results of the study based on some of the literature that has been reviewed found that snakehead fish extract has an effect on increasing albumin levels in patients with nephrotic syndrome.

Background: Most respiratory disorders are caused by problems or diseases of the respiratory system, including the lungs. Inability of the lungs to expand (elasticity), as well as structural (anatomical) and functional airway obstructions that prevent the creation of breathable airflow, are signs of impaired lung function. Restriction and blockage are two types of lung function problems.Purpose: To analyze the application of the tripod position and pursed lip breathing technique to the increase in oxygen saturation in congested patients in the emergency room at PROF Hospital. Dr. SABOE TONGUE.Methods: Case report, which is a narrative report. The case study in this paper examines the use of a tripod position and pursed lip breathing technique to increase oxygen saturation in shortness of breath patients. Patients with asthma, lung cancer, TB, and COPD constitute the study population. Four patients with asthma, lung cancer, tuberculosis, and COPD were sampled for the study.Results: After the nurse's intervention was carried out, which was related to airway management in the fourth patient, the overall evaluation results were obtained, then the intervention was continued in the patient's treatment room.Conclusion: Based on the description above, people with respiratory problems often experience decreased functional daily activities, decreased concentration, and mood swings. As a result, if the condition of shortness of breath is allowed to continue unnoticed it will reduce oxygen saturation which in turn can cause cyanosis in patients who experience recurrent infections.