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The ICU is one of the largest clinical cost centers in hospitals due to its high demand for human resources, medical equipment, and operational costs. This situation emphasizes that intensive care unit efficiency is a multidimensional issue that cannot be assessed solely from a single aspect. This study aims to analyze the efficiency of the intensive care unit at Ciremai Hospital, Cirebon City, using the Data Envelopment Analysis (DEA) model to determine resource optimization. Analytical quantitative study with a cross-sectional design. The population in this study consisted of personnel in the ICU of Ciremai Hospital from 2023 to 2025, with total sampling applied. The input variables included the number of physicians, nurses, beds, monitors, and ventilators, while the output variables consisted of BOR, LOS, and recovered patients. The ICU input variables remained stable during the study period, while output variables fluctuated with a declining trend in BOR and LOS. The results of the Data Envelopment Analysis (DEA) indicated that all study periods achieved an efficiency score of 1.00 (efficient), with a slack value of 0.00 across all input variables.

Pressure ulcers are a common complication in patients with impaired consciousness due to prolonged immobilization. This condition can increase morbidity and prolong the length of stay, thus requiring effective preventive interventions such as progressive mobilization. To determine the outcomes of implementing progressive mobilization on the incidence of pressure ulcers in patients with impaired consciousness at the Anggrek 2 High Care Unit (HCU) of Dr. Moewardi General Hospital. This study employed a case study design involving two participants with impaired consciousness. The intervention, consisting of progressive mobilization, was conducted over 3 days with monitoring of skin condition and pressure ulcer risk. Findings: Following the implementation of progressive mobilization, both participants showed improvement in skin condition and a reduction in the risk of pressure ulcers, as evidenced by the absence of progression to more severe wounds and an increase in skin integrity. The application of progressive mobilization is effective in preventing and reducing the risk of pressure ulcers in patients with impaired consciousness. This intervention can serve as a safe and planned nursing intervention in the intensive care unit.

Thalassemia is a chronic genetic disease that requires long-term treatment and affects children's quality of life physically, psychologically, socially, and academically due to chronic anemia and regular blood transfusion needs. This study aimed to determine factors influencing the quality of life of children with thalassemia at Rumah Sakit Anak dan Bunda Harapan Kita. A descriptive design with a cross sectional approach was used, involving 41 respondents through total sampling. Data were collected using the Pediatric Quality of Life Inventory (PedsQL 4.0 Generic Core Scale) and respondent characteristics including age, gender, socioeconomic status, parental education, and frequency of blood transfusions. Data were analyzed using univariate and bivariate analysis with the Chi-Square test. The results showed most respondents were under ten years old, female, from families with socioeconomic status below the minimum wage, had parents with high school or higher education, and received blood transfusions every three weeks. Bivariate analysis indicated only the frequency of blood transfusions was significantly associated with quality of life, while other variables were not. Thus, transfusion frequency is the main factor influencing quality of life in children with thalassemia.

This case report examines the effectiveness of a combined pulmonary rehabilitation and musculoskeletal physiotherapy program for a 26-year-old male post-pulmonary tuberculosis patient with lumbar tuberculous spondylitis. The patient, who had completed anti-tuberculosis treatment, presented with low back pain, shortness of breath, fatigue, and limited mobility. Spirometry indicated severe restrictive ventilatory impairment (FVC 1.28 L, 32% of predicted), and lower extremity muscle strength was reduced (MMT 2-3/5). The patient used a TLSO brace and walking aid. Over a three-week physiotherapy program, the patient participated in breathing exercises, spinal mobilization, muscle strengthening, functional exercises, and education on brace use. Evaluation occurred at the first, second, and third weeks. After treatment, pain intensity decreased from VAS 6 to VAS 3, FVC improved to 1.72 L, chest expansion increased, muscle strength improved to MMT 4/5, and performance on the Five-Times Sit-to-Stand Test showed progress. The Functional Independence Measure (FIM) score increased from 98 to 115, reflecting improved functional independence. These findings suggest that the combination of pulmonary and musculoskeletal physiotherapy effectively improved respiratory function, muscle strength, and the patient’s overall functional capacity.

Burnout among nurses is a serious problem that can reduce the quality of nursing services and the well being of nurses. Work motivation and self efficacy are psychological factors that play an important role in reducing burnout. The aim is to minimize the occurrence of burnout among nurses in their performance.The purpose of this study is to determine the significance of the relationship between work motivation and self efficacy with the level of burnout among nurses. This research is quantitative in nature with a cross-sectional approach. Data collection was conducted using questionnaires administered to 98 respondents from the total population. The instruments used included a work motivation questionnaire (ERG), a general self-efficacy scale (GSES), and a Maslach Burnout Inventory (MBI). The data collected was processed using Spearman's test and ordinal logistic regression. Results researchers found that respondents who reported high work motivation numbered 89 respondents with a percentage of (90.8%), self-efficacy among nurses also showed a high category in 90 respondents with a percentage of (91.8%), and the majority of burnout levels were in the low category range of 65 respondents with a percentage of (66.4). Statistical tests showed a relationship between work motivation and burnout levels with a p-value of 0.000 (a = -0.358), and showed that there was a relationship between self-efficacy and burnout levels with a p-value of 0.013 (a = -0.250). Furthermore, multivariate statistics found that work motivation was the dominant factor influencing burnout with a p-value of 0.012 (E = -2.030). Conclusion there is a significant relationship between work motivation and self-efficacy with the level of burnout among nurses. Nurses with high work motivation and self-efficacy tend to have lower levels of burnout. Work motivation is a dominant factor in influencing burnout.

This regulation, which requires all healthcare facilities to implement EMR by December 31, 2023, stemmed from the emergence of Health Ministerial Regulation No. 24 of 2022. Santosa Hospital, Bandung Kopo, has implemented EMR, but no research has been conducted on it. This study aimed to determine the effect of EMR implementation on service quality in the emergency unit at Santosa Hospital, Bandung Kopo. The research methods used were descriptive verification analysis and multiple linear regression analysis. Data collection used a questionnaire distributed to all emergency unit staff. The results of the descriptive analysis were generally considered very good. The results of the verification analysis, both partially, showed a negative and insignificant effect on system quality and service quality, while information quality and use statistics showed a positive and significant effect. Simultaneously, these positive and significant effects were proven, and the researchers recommend maintaining and further improving them.

Meningitis is a serious infectious disease that can be prevented through vaccination; however, the vaccination process often causes anxiety in patients, especially during the pre-procedure phase. Uncontrolled anxiety can affect patient readiness and comfort. Therapeutic communication by nurses is one intervention that has the potential to reduce this level of anxiety. This study aims to determine the relationship between nurses’ therapeutic communication and the anxiety levels of patients prior to meningitis vaccination at Pambalah Batung Amuntai Regional General Hospital. This study used a quantitative analytic design with a cross-sectional approach. The sample consisted of 107 respondents selected using a convenience sampling technique. Data on therapeutic communication were collected using an observation sheet, while anxiety levels were measured using the DASS questionnaire (anxiety subscale). Data analysis was conducted using univariate and bivariate methods with the Chi-Square test at a significance level of 0.05. The results showed that most therapeutic communication was in the good category, and patient anxiety levels were predominantly in the normal category. Statistical test results indicated a significant relationship between nurses’ therapeutic communication and patient anxiety levels (p = 0.000 < 0.05). The better the therapeutic communication provided, the lower the patient’s anxiety level. In conclusion, nurses’ therapeutic communication plays an important role in reducing patient anxiety prior to meningitis vaccination and needs to be optimized in nursing practice.

Turbinate hypertrophy is a condition characterized by abnormal enlargement of the nasal turbinate mucosa, which can lead to chronic nasal obstruction and decreased quality of life. This condition is associated with inflammatory processes in which eosinophils play a role as part of the immune response. This study aimed to determine the relationship between eosinophil levels and the degree of turbinate hypertrophy based on blood examination in hospitalized patients. This research used an observational analytic design with a cross-sectional approach involving 40 patients diagnosed with turbinate hypertrophy at Cut Meutia General Hospital, North Aceh. Data were obtained from medical records, including patient characteristics, eosinophil levels, and the degree of turbinate hypertrophy. The results showed that most patients were aged 17–25 years, predominantly female, and commonly had non-allergic underlying conditions. The majority of patients had normal eosinophil levels (80%), while most cases were classified as grade III turbinate hypertrophy (65%). Statistical analysis using Fisher’s Exact Test demonstrated no significant relationship between eosinophil levels and the degree of turbinate hypertrophy (p>0.05). These findings suggest that eosinophil levels may not be a reliable indicator in assessing the severity of turbinate hypertrophy, particularly in patients with non-allergic conditions. This study highlights the need to consider other contributing factors in the evaluation and management of turbinate hypertrophy to improve diagnostic accuracy and treatment outcomes.

Sectio caesarea is a common surgical procedure to deliver a baby when normal delivery is not possible or risky. Postoperatively, patients often experience acute pain that can interfere with the recovery process. The benson relaxation technique is a nonpharmacological method that has been shown to be effective in reducing pain through a relaxation and patient confidence approach. This study uses a case study approach on Mrs. T, a post-sectio caesarea patient at Harapan Bunda Hospital, Batam City. Nursing care is carried out comprehensively for three days, including assessment, diagnosis, intervention, implementation, and evaluation. The main intervention was the administration of benzone relaxation techniques for 10–15 minutes every day. After three days of applying the Benson relaxation technique, Mrs. T's pain intensity decreased from a scale of 6 (moderate pain) to a scale of 2 (mild pain). Patients show increased comfort, ability to be active, and decreased expressions of pain such as grimacing. These results support previous findings that benzon relaxation is effective as a nonpharmacological therapy in reducing postoperative pain. This technique can be a safe and easy-to-apply alternative in nursing practice, especially for post-sectio caesarean patients.

The implementation of Hospital Management Information Systems (HMIS) has become a strategic imperative to enhance operational efficiency amidst the ongoing global digital health transformation era. This study aims to analyze the determinants of successful HMIS implementation and its impact on service efficiency and patient outcome quality. Employing a narrative review approach with thematic synthesis of literature from PubMed, Scopus, and ScienceDirect databases between 2016-2026, the study evaluates the relationship between technology investment and organizational performance. The synthesis results indicate that while HMIS significantly reduces administrative burdens and medication errors, a "digital paradox" exists where technical efficiency may disrupt interpersonal interactions between healthcare providers and patients if systems are not user-centered. Key success factors include data interoperability (HL7/FHIR standards), human resource readiness, and governance policy support. This study concludes that a patient-centered efficiency model is the fundamental basis for ensuring technology investments yield sustainable added value within the healthcare delivery system.

This study aims to analyze The Responsibility of the Regional General Hospital (RSUD) TC. Hilers Maumere regarding the practice of burning medical waste and to examine its conformity with the provisions of Law Number 17 of 2023 concerning Health and other regulations related to hazardous waste management. Medical waste management is an important issue because improper handling may cause environmental pollution and pose serious risks to public health. This research employs an empirical legal research method with a descriptive approach, examining how the law operates in society through field data collection and analysis of relevant legal regulations.The results show that RSUD TC. Hilers Maumere implements a waste management system that includes the separation of household waste, liquid waste, and hazardous and toxic waste (B3). Medical waste is categorized and packaged according to its type, weighed, temporarily stored in medical waste storage facilities, and then destroyed using an incinerator or transported by authorized third parties. However, the practice of burning medical waste must be strictly supervised to prevent environmental impacts and potential legal violations. Therefore, stronger supervision, compliance with medical waste management standards, and the implementation of firm legal responsibility are necessary to protect public health and environmental sustainability.

Tuberculosis (TB) remains a significant health issue in Indonesia, with the number of cases not showing a decline. Pediatric pulmonary tuberculosis is one of the leading causes of morbidity and mortality. In 2018, the number of TB cases in Aceh reached 41,595, with Aceh Utara having the highest number at 4,819 cases, followed by Bireuen with 3,636 cases, while Sabang recorded the lowest at 272 cases. The primary risk factor for pulmonary tuberculosis in children is a history of contact with adult TB patients, as children's immune systems are still weak, allowing the bacteria to enter their bodies easily. This study aims to examine the history of TB contact in children at the Pediatric Clinic of Cut Meutia General Hospital. The research used a descriptive observational design, with 105 respondents, and data was collected from medical records. The results showed that the majority of respondents were toddlers (47.6%), most were male (54.3%), and 58.1% had good nutritional status. A significant percentage of respondents (77.1%) had a history of contact with TB patients, and 83.8% did not receive BCG vaccination. These findings highlight that contact with TB patients is a key factor in the transmission to children.

This study is motivated by the increasing complexity of financing coordination between the National Health Insurance (BPJS Kesehatan) and supplementary health insurance providers under the Coordination of Benefits (KAPJ) scheme, which creates potential claim disputes and administrative risks for hospitals. Although Minister of Health Decree No. HK.01.07/MENKES/1117/2025 regulates payment allocation and membership verification mechanisms, it does not explicitly recognize pre-admission confirmation as a preventive legal protection instrument. This research aims to analyze the normative position of pre-admission confirmation within the KAPJ framework, conceptualize it as a preventive legal protection mechanism, and formulate a proportional implementation model. The study employs a normative juridical method using statutory and conceptual approaches through literature review of relevant regulations and scholarly works. The findings indicate that pre-admission confirmation possesses implicit normative legitimacy through membership verification obligations and system integration requirements, and functions as a risk allocation mechanism that clarifies payment responsibilities prior to service delivery. Its implementation enhances legal certainty, reduces fraud potential, and minimizes claim disputes, provided that access to emergency medical services remains guaranteed.

Knee osteoarthritis is a degenerative joint disease that commonly affects older adults and causes pain and functional limitations. Age, obesity, a sedentary lifestyle, and comorbidities influence disease severity and response to medical rehabilitation. This study aimed to describe the characteristics of geriatric patients with knee osteoarthritis receiving medical rehabilitation therapy at Ibnu Sina Hospital, Makassar, in 2024. This was a quantitative descriptive study with a cross-sectional design. The results showed that most geriatric patients with knee osteoarthritis undergoing medical rehabilitation at Ibnu Sina Hospital in 2024 were in the 60–70 year age group and were predominantly female. The majority of patients had a body mass index in the overweight to obese category. Most patients had no history of smoking but had one or more comorbidities, particularly hypertension and diabetes mellitus. Medical rehabilitation therapy was generally provided as a combination of several modalities. In conclusion, geriatric patients with knee osteoarthritis receiving medical rehabilitation were predominantly aged 60–70 years, female, overweight or obese, and had comorbidities. These findings highlight the importance of individualized and multidisciplinary rehabilitation approaches based on patient characteristics

The use of radiation-based medical equipment such as CT Scan poses potential risks of radiation leakage that may endanger patients, medical personnel, and the surrounding environment if not properly managed. This study aims to analyze radiation safety policies in anticipating radiation leakage in the CT Scan unit of Royal Prima General Hospital Medan, covering policy frameworks, physical protection measures, implementation challenges, and supervision and evaluation systems. This research employed a qualitative approach with a case study design. Data were collected through in-depth interviews, observations, and document reviews related to radiation safety policies. The results indicate that radiation safety policies at Royal Prima General Hospital Medan have referred to BAPETEN regulations and international standards, particularly in the structural protection of the CT Scan room, which has been proven effective in maintaining radiation exposure levels below the permissible limits. However, policy implementation still faces several obstacles, including budget limitations, non-compliance of some medical staff with the use of personal protective equipment, and suboptimal discipline in adhering to standard operating procedures. Supervision and evaluation have been conducted internally by certified Radiation Protection Officers and externally through periodic inspections by BAPETEN, yet further strengthening is required in terms of staff behavior and safety culture. In conclusion, radiation safety policies have been technically effective, but continuous improvement in compliance, supervision, and safety culture among medical personnel is essential to sustainably minimize the risk of radiation leakage.

Work motivation is one of the important factors influencing time management and nurses’ performance in providing nursing care. Good time management enables nurses to complete tasks in a timely, efficient, and effective manner. This study was conducted to determine the relationship between work motivation and time management among staff nurses at ML Hospital in 2025. This research used a quantitative approach with a cross-sectional design. A total of 40 staff nurses were selected using a total sampling technique. The instruments used were questionnaires on work motivation and time management. Data were analyzed using the Spearman Rank statistical test with a significance level of < 0.05. The results showed that most respondents had good work motivation (62.5%), while the majority demonstrated a moderate level of time management (75%). The Spearman Rank test yielded a p-value of 0.005, indicating a significant relationship between work motivation and time management among staff nurses. In conclusion, there is a significant relationship between nurses’ work motivation and time management, in which higher work motivation is associated with better time management. It is recommended that hospitals enhance nurses’ motivation through managerial support and a positive work environment.

The prevalence of diabetic ulcers in Indonesia reaches 12-15% of all sufferers. This condition has an impact on the patient's psychological condition in the form of anxiety due to wounds that are difficult to heal, changes in body image, and concerns about the possibility of amputation. One of the nonpharmacological interventions that can help overcome anxiety is the slow deep breathing technique. The purpose of writing this scientific paper is to carry out Nursing Care for Mrs. M with Diagnosis of Diabetic Ulcers using the application of slow deep breathing intervention in reducing anxiety at Az-Zahra Hospital. The writing method is a nursing care process that includes the stages of study, nursing diagnosis, planning, implementation, and evaluation. The subject of care was Mrs. M, a patient with diabetic ulcers in the inpatient room of Az-Zahra Hospital. Data collection was carried out through interviews, observations, documentation studies, and physical examinations, and using a medical-surgical nursing care assessment format. The ethical principles applied use the principles of Nursing Ethics. The results of nursing care showed that after three days of slow deep breathing intervention, patients reported feeling calmer, sleeping better, and anxiety levels decreased from moderate to mild based on observation results and anxiety scales used. This suggests that slow deep breathing interventions are effective in helping to reduce anxiety in patients with diabetic ulcers. It is hoped that patients and families can continue these breathing exercises independently as part of stress management efforts and quality of life improvement.  

Background: Normal labor is influenced by Power, His, maternal strength, external pelvic passage, pelvic shape, pelvic width, and perineal elasticity, which affect labor.Objective: To determine the effect of perineal massage and peanut ball on labor progress.Method: This study used a quasi-experimental design with two groups and a posttest only. The sample consisted of 30 mothers in labor, divided into two groups: 15 respondents received perineal massage and 15 respondents received perineal massage and used a peanut ball. Data were analyzed using an Independent T-Test. Results: The study showed that the average duration of the first stage of active labor in the perineal massage group was 6.87 hours, while in the combination group of perineal massage and peanut ball it was 5.20 hours. Statistical testing showed a value of p = 0.012 (p < 0.05), indicating a significant difference between the two groups. Conclusion: Perineal massage and peanut balls are effective in accelerating labor as non-pharmacological midwifery interventions in labor management.

Patient safety is often viewed exclusively as the responsibility of clinical personnel. However, administrative errors occurring during the admission process and documentation stages constitute major contributors to medical risk. This study aims to explore the strategic role of administrative staff in strengthening patient safety culture and mitigating medical risks through effective communication coordination. A narrative literature review was conducted extensively using the Scopus, PubMed, and Web of Science databases, covering publications from 2014 to 2024. Data were analyzed using a thematic synthesis approach. The findings identify four main themes: administrative staff as information gatekeepers, the role of health information technologies (HIS/EMR) in bridging communication gaps, collaboration barriers arising from hierarchical structures, and the need for an Interprofessional Shared Governance framework. Administrative accuracy in the early phases of care is proven to be critical in preventing latent errors with potentially fatal consequences. Strengthening patient safety culture requires the integration of administrative staff through cross-departmental training, standardized communication protocols, and non-punitive incident reporting systems. Administrative staff are not merely bureaucratic support personnel but are key actors within the modern hospital patient safety ecosystem.

Leadership management plays a crucial role in developing nursing career paths in hospitals. An effective career path system not only enhances nurses' competence and professionalism but also contributes to job satisfaction and retention. However, scientific evidence regarding the influence of leadership management on nurses' career paths remains scattered and shows varying findings. This systematic review aims to synthesize scientific evidence related to the influence of leadership management on nursing career path development in hospitals. This study used a systematic review design following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A literature search was conducted through PubMed and Google Scholar for articles published between 2015 and 2024. Articles were selected based on inclusion and exclusion criteria, resulting in 13 articles for analysis. Data synthesis was conducted using a thematic synthesis approach. The review identified five main themes: leadership style, managerial support, organizational systems and policies, the impact of career paths, and barriers to implementation. Transformational and participatory leadership has been reported to have a positive influence on nurses' career development. Managerial support through coaching, mentoring, and ongoing training strengthens career readiness, increases job satisfaction, and reduces nurse turnover intentions. Leadership management has a significant influence on nursing career development in hospitals. Integrating effective leadership with a clear and transparent career development system is necessary to enhance professionalism, job satisfaction, and the sustainability of the nursing workforce.