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Schizophrenia is a severe mental disorder often accompanied by auditory hallucinations and has a significant impact on patients’ psychosocial functioning. This condition can reduce medication adherence, thereby increasing the risk of relapse. In this context, the role of caregivers is crucial in supporting treatment success. This study aims to describe psychiatric nursing care for patients with auditory hallucinations in improving medication adherence through caregiver involvement. The method used is a case study with a nursing process approach, including assessment, nursing diagnosis, planning, implementation, and evaluation. Interventions focus on hallucination management, psychoeducation, and caregiver involvement in care. The results show an increase in patients’ and families’ knowledge regarding the illness and its treatment, improved medication adherence, and enhanced patient ability to control responses to auditory hallucinations. Caregiver involvement has been shown to assist in supervision and providing support to patients. Therefore, comprehensive psychiatric nursing care through hallucination management, psychoeducation, and caregiver involvement is effective in improving medication adherence and controlling symptoms in patients with auditory hallucinations.

The development of digital technology in the Society 5.0 era presents both challenges and opportunities in history teaching, particularly regarding teachers’ ability to integrate technology and adapt to changes in students’ learning styles. This study aims to analyse the challenges faced by teachers and the strategies employed in digital-based history teaching. The method used is a Systematic Literature Review (SLR) employing the PRISMA approach, involving the stages of identification, screening, eligibility assessment, and inclusion of scientific articles published between 2020 and 2025. From the selection process, 25 relevant articles were identified for qualitative descriptive analysis. The findings indicate that teachers’ digital literacy levels remain at a moderate level and are unevenly distributed, thereby affecting the sub-optimal integration of technology into teaching. Furthermore, changes in students’ learning styles which are increasingly technology-oriented require more interactive and contextual pedagogical innovations. On the other hand, the use of digital media has proven capable of enhancing student motivation and learning outcomes, although this is still hindered by limitations in infrastructure and teachers’ technical competencies. The abundance of historical information on the internet also poses challenges regarding the validity of sources, thus necessitating the strengthening of digital literacy and critical thinking. The implications of this research underscore the importance of the ongoing development of teachers’ digital skills, the improvement of educational facilities, and the implementation of innovative teaching models to ensure that history teaching becomes more relevant and effective, and is capable of fostering critical thinking skills in pupils in the digital age.

Breast tumors are classified into two types, namely benign and malignant tumors, the latter commonly referred to as breast cancer. Breast cancer is one of the major health problems affecting women worldwide, including in Indonesia. According to WHO data in 2022, there were 2.3 million breast cancer cases with 685,000 deaths globally, while in Indonesia, 396,914 cases and 234,511 deaths were reported. The high incidence rate is exacerbated by low public awareness in recognizing early symptoms and performing early detection, resulting in 60–70% of cases being diagnosed at an advanced stage, supported by findings that 65.6% of female students still have a low level of knowledge. Female students were selected as research subjects because they are in a vulnerable reproductive age group and have an important role in increasing awareness of early detection, yet they still have limited knowledge. Based on this, this study aims to design a web-based early detection system for breast tumor risk using the Forward Chaining method, which functions as a tool to identify early symptoms, assess risk levels, and provide information on prevention and initial management. This study employed the method with the Expert System Development Life Cycle (ESDLC) model, consisting of the stages of assessment, knowledge acquisition, design, testing, and documentation, along with the Forward Chaining inference method.

The results of the study show that pricing strategy contributes dominantly to increasing sales, but the lack of digital promotion causes limited market reach. Micro, Small, and Medium Enterprises (MSMEs) play a crucial role in driving national economic development and providing employment. However, in facing an increasingly competitive market, MSMEs need to implement efficient marketing strategies to ensure sustainability and sustainable growth. This community service activity aims to provide knowledge and assistance to Indonesian Es Teh MSMEs regarding the implementation of flexible marketing strategies, both through digital and traditional channels. The activity took place at the Es Teh Kampung Solo outlet in Kramatwatu Square. The methods used included counseling, training, and assessment of marketing strategy implementation, with a primary focus on optimizing social media as an interactive and competitive digital promotional tool. The results of this activity demonstrated a significant increase in MSMEs' understanding of strategic marketing planning, promotional innovation, and the use of digital platforms to expand market reach. Thus, it is hoped that digital-based marketing strategies can strengthen the competitiveness and sustainability of MSMEs. This activity is expected to contribute to increasing the competitiveness and sales volume of the Kampung Solo Es Teh MSME in a sustainable manner through the implementation of a modern marketing approach that is responsive to technological changes.

Laparotomy is a major surgical procedure associated with a high risk of acute postoperative pain. According to Gan (2017), if pain is not properly managed, it can progress to chronic pain. (Toro et al., 2018) reported that severe pain on the first postoperative day is still commonly found in laparotomy patients, while (Small & Laycock, 2020) indicated that moderate to severe pain within the first 24 hours following major surgery remains a significant clinical issue. This study aims to evaluate the effectiveness of pharmacological pain management following laparotomy under general anesthesia, specifically to identify the types of opioid analgesics used, analyze their effectiveness in reducing pain intensity, identify side effects, and examine administration techniques and routes. This study employed a Systematic Literature Review (SLR) method following the PRISMA guidelines. Literature searches were conducted in the PubMed, ScienceDirect, and SpringerLink databases covering the years 2015–2026. The included studies comprised randomized controlled trials (RCTs), cohort studies, and retrospective studies addressing opioid pharmacological pain management in adult patients following laparotomy under general anesthesia. Study quality assessment was performed using the Joanna Briggs Institute (JBI) instrument. A total of 11 studies met the inclusion criteria. The results of the systematic literature review indicate that opioids are effective in reducing postoperative pain following laparotomy under general anesthesia. The most commonly used opioids are morphine, fentanyl, and oxycodone. Of all the opioids reviewed, oxycodone provided the best pain control, while intrathecal morphine was most effective in reducing the need for supplemental opioids during the early postoperative period. Other opioids, such as extended-release dinalbuphine sebacate and tegileridine, are also effective, but the number of studies is still limited. The most common side effects are nausea, vomiting, pruritus, sedation, and dizziness. Pharmacological pain management using opioids is effective in reducing the intensity of postoperative pain following laparotomy under general anesthesia. Morphine, fentanyl, and oxycodone are the most commonly used opioids. Oxycodone and intrathecal morphine have shown good results in improving pain control and reducing the need for supplemental opioids. The selection of opioid type, dosage, and administration technique must be tailored to the patient’s clinical condition to achieve optimal analgesia with minimal side effects.

Group-based learning in the classroom plays a vital role in enhancing social interaction, individual responsibility, as well as students' critical thinking and collaborative skills. However, its implementation often faces challenges such as the dominance of certain members, social loafing, low participation, and interpersonal conflicts that hinder group effectiveness. This study aims to comprehensively examine the dynamics of learning groups by integrating four key aspects: the concept of group dynamics based on the Tuckman model, the characteristics of effective groups in cooperative learning, group formation techniques, and conflict management strategies. The research utilizes a qualitative approach with a literature study method, analyzing 25 sources including nationally accredited journals, academic books, and theses published between 2020 and 2024. Data analysis was conducted through reduction, thematic classification, content analysis, and conceptual synthesis. The results indicate that effective group dynamics can be achieved through the Tuckman stages, the application of the five elements of cooperative learning, the selection of appropriate group formation techniques with risk mitigation, and the implementation of the Thomas-Kilmann conflict management styles.The scientific contribution of this research is the development of an integrative model based on these four aspects, which serves as a conceptual framework to strengthen collaborative learning practices in the classroom. Practical implications include the formation of ideal groups consisting of 4–5 students, the establishment of initial group contracts, the use of dual assessment rubrics (individual and group), and peer evaluation mechanisms to enhance accountability and reflection.

Hypertension is one of the most common chronic diseases among the elderly and is often accompanied by insomnia. This condition can increase anxiety and reduce quality of life. Progressive Muscle Relaxation (PMR) is an effective non-pharmacological therapy to lower blood pressure and improve sleep quality. This paper describes nursing care for elderly patients with hypertension and insomnia through PMR application at RSUD Embung Fatimah Batam City in 2025. A case study approach was used through the nursing process, including assessment, nursing diagnosis, intervention, implementation, and evaluation. The main nursing diagnosis was sleep pattern disturbance related to physical discomfort and anxiety. Interventions included education and PMR exercises for six consecutive days. Results showed blood pressure decreased from 180/100 mmHg to 130/80 mmHg, sleep quality improved from difficulty sleeping to 6–7 hours per night, and anxiety levels reduced. Progressive muscle relaxation therapy proved effective as an independent nursing intervention to reduce blood pressure and improve sleep quality in elderly patients with hypertension and insomnia. Nurses should use this therapy as a routine non-pharmacological intervention in gerontological nursing practice.

Sweet orange peel (Citrus x aurantium L.) is an agricultural by-product rich in bioactive compounds including flavonoids, phenolics, terpenoids, and vitamin C with antioxidant and moisturizing potential. This study aimed to formulate and evaluate a body lotion using 15% ethanol extract of sweet orange peel obtained by maceration with 96% ethanol. Evaluations included organoleptic, homogeneity, pH, adhesion, spreadability, viscosity, irritation, cycling test, cream type, and DPPH antioxidant activity assessments. The preparation was semisolid, yellow, with a characteristic herbal aroma, homogeneous, pH 8, adhesion time of 4.10 seconds, spreadability of 9.9–11.1 cm, and acceptable viscosity. The preparation caused no skin irritation, remained stable through six cycling test cycles, and formed an oil-in-water (O/W) emulsion. Antioxidant activity showed an IC₅₀ of 284.6 ppm (weak category) compared to vitamin C as positive control (IC₅₀ 4.2 ppm). It was concluded that ethanol extract of sweet orange peel can be formulated into a stable and safe body lotion, though further optimization is needed to enhance its antioxidant activity.

Frozen  shoulder or adhesive capsulitis is a chronic condition that causes pain and limited movement in the shoulder joint. Intervention in the early phase (freezing stage) is crucial to prevent more severe functional disabilities, especially in the elderly population. This case study was conducted on a 60-year-old female patient with complaints of pain and stiffness in the right shoulder for one month. Clinical assessment was conducted using the Numeric Rating Scale (NRS) for pain, Manual Muscle Testing (MMT) for muscle strength, goniometry for joint range of motion, and the Shoulder Pain and Disability Index (SPADI) for functional ability. The therapy program was administered in three intervention sessions. After undergoing three therapy sessions, there was a significant reduction in pain intensity, where movement pain decreased from a score of 7 to 5 and pressure pain from 5 to 2. Muscle strength improved from a value of 3 to 4 on the MMT scale. Additionally, the total SPADI score decreased from 66.1% to 50%, indicating an improvement in the patient's functional capacity in daily activities. The multimodal physiotherapy approach has proven effective in reducing pain, increasing muscle strength, and improving shoulder function in elderly patients with early-stage frozen  shoulder. The combination of electro-physical modalities and manual therapy provides more comprehensive clinical outcomes compared to single interventions.

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.

Perimenopause is an important phase in a woman's life characterized by extensive hormonal changes as the ovaries gradually lose their function. During this period, the body experiences significant hormonal fluctuations, particularly a decrease in estrogen and progesterone production, which can cause various physical discomforts such as fatigue. One way to overcome fatigue is through low-impact exercise. This exercise is a light, safe activity that can improve physical fitness and enhance the body's endurance, thereby potentially reducing fatigue levels in perimenopausal women. This study used a descriptive method with a case study approach conducted on two perimenopausal women, Mrs. T and Mrs. N. The results of the nursing care showed that after six sessions of low-impact exercise over two weeks, the fatigue levels of both respondents decreased, as evidenced by their Fatigue Assessment Scale (FAS) scores. Mrs. S's FAS score decreased from 28 to 23, while Mrs. N's decreased from 30 to 27. The symptoms experienced by Mrs. T decreased on the third day and further decreased on the sixth day. For Mrs. N, symptoms decreased on the third day and further decreased on the fifth day. The results of this study indicate that low-impact exercise is effective as an intervention for fatigue issues in perimenopausal women.

The prevalence of non-communicable degenerative diseases in Indonesia continues to rise, particularly affecting adolescents and productive age populations due to unhealthy lifestyle patterns and free radical exposure. Purple sweet potato leaves (Ipomoea batatas L.), a locally abundant resource often regarded merely as agricultural by-product, contain significant bioactive compounds including polyphenols, flavonoids, anthocyanins, and terpenoids demonstrating potent antioxidant properties with IC50 values of 47.99 ppm. This study employs a qualitative descriptive literature review approach, analyzing 28 scientific publications spanning 2018-2025 sourced from Google Scholar and PubMed databases to examine the potential of purple sweet potato leaves as effervescent tablet raw material for degenerative disease prevention. Findings reveal that bioactive constituents effectively neutralize free radicals, prevent lipid peroxidation, and protect cellular structures from oxidative damage linked to diabetes, cancer, and cardiovascular disorders. The effervescent tablet formulation provides strategic advantages including enhanced solubility, accelerated absorption rates due to elimination of disintegration processes, pleasant carbonation sensation masking unpleasant active ingredient taste, and superior gastrointestinal tolerance. This innovation offers promising prospects for degenerative disease prevention through local food resource utilization, though experimental validation regarding optimal formulation, effective dosage determination, and clinical efficacy assessment remains necessary for practical implementation.

This research investigates transparency and accountability in the management of state-owned assets (BMN) at the East Java Regional Police's Logistics Bureau as a step toward enhancing effective, adaptive, and integrity-focused governance in police logistics. The research context arises from the growing public call for transparency and accountability in managing state assets, in line with policies for bureaucratic reform and digitalization in the police logistics framework. This study utilized a qualitative descriptive approach involving in-depth interviews, observations in the field, and analysis of documents. The results show that adopting a unified digital system has enhanced the efficiency of asset management, sped up inventory operations, and reduced the risks of asset misuse. Nonetheless, obstacles persist, such as restricted human resource capacity, data alignment problems, and inadequate performance-based assessments. The conversation emphasizes that effective asset management relies on the implementation of adaptive governance, motivation for public service, and precise performance assessment systems. The research indicates that the integration of digital innovation, professional skills, and a robust commitment to public accountability is crucial for creating transparent and sustainable governance in police logistics

High-dimensional clinical data exhibit complex and non-linear relationships among patient attributes, where outcomes are often influenced by feature interactions rather than isolated variables. However, many existing machine learning models prioritize predictive performance while providing limited interpretability and insufficient insight into interaction structures. This study aims to address this limitation by developing an interpretable and robust framework for feature interaction mining in clinical data. We propose a hybrid tree–neural modeling framework that explicitly captures and ranks feature interactions while maintaining stable predictive performance. Tree-based ensemble models are employed to identify non-linear interaction patterns, while neural representations enhance learning flexibility and generalization. The framework integrates interaction importance analysis, cross-validation–based stability assessment, and evaluation across multiple data splits to ensure robustness and interpretability. Experiments conducted on a real-world high-dimensional clinical dataset demonstrate that the proposed approach achieves consistent predictive performance, with AUC values ranging from 0.628 to 0.641 across five cross-validation folds (mean AUC ≈ 0.633). Performance remains stable under varying train–test splits, indicating strong generalizability. Interaction analysis reveals that a small number of dominant feature interactions—such as age combined with length of hospital stay and medication count combined with diagnostic information—consistently contribute to model predictions, appearing in over 80% of validation folds. Ablation studies further confirm that removing interaction-aware components leads to noticeable performance degradation, highlighting their importance.  In conclusion, this study demonstrates that explicit feature interaction modeling enhances interpretability, stability, and generalization in clinical prediction tasks. The proposed hybrid framework provides a reliable foundation for developing trustworthy and transparent clinical decision-support systems

This research benchmarks multiple machine learning (ML) algorithms for large-scale loan default prediction using a real-world dataset of 255,000 borrower records, where default cases represent only ~9–12% of total observations. The study addresses the persistent gap in comparative analyses of ML models that balance predictive accuracy, interpretability, and computational efficiency for credit risk assessment. Six algorithmic families were evaluated Logistic Regression, Random Forest, XGBoost, LightGBM, CatBoost, Artificial Neural Networks (ANN), and Stacked Ensemble—using standardized preprocessing, hybrid imbalance handling (SMOTE, class weighting, under-sampling), and comprehensive evaluation metrics (AUC, F1, Recall, Precision, PR-AUC, and Brier Score). Empirical results show Logistic Regression achieved the highest AUC of 0.732, outperforming nonlinear models under the baseline configuration, while LightGBM attained perfect recall (1.0) but low precision (0.116), indicating over-prediction of defaults. Gradient boosting models demonstrated robust calibration (Brier ≈ 0.114–0.116) and the best computational efficiency, with LightGBM showing the fastest training and lowest memory use. CatBoost exhibited strong recall but the slowest computation, and ANN underperformed on tabular data (AUC ≈ 0.56). The Stacked Ensemble delivered balanced results with AUC = 0.664 and improved overall stability. These findings confirm that boosting-based models, particularly LightGBM and CatBoost, offer superior scalability and calibration, whereas Logistic Regression remains a valuable interpretable baseline. The study concludes that effective default prediction requires integrating rebalancing, calibration, and threshold optimization to enhance recall and operational deployment reliability in large-scale credit ecosystems.

The postpartum period is a crucial phase for mothers to recover after childbirth. One of the common problems is perineal wounds, caused either by episiotomy or spontaneous rupture, which require proper care to prevent infection and accelerate healing. This case study aimed to provide midwifery care for Mrs. M, 28 years old, P3A0H3, with a second-degree perineal wound at PMB Bd. Silvi Ayu, S.Keb. The SOAP approach was applied through assessment, diagnosis, intervention, implementation, and evaluation over five days (June 12–16, 2025). Interventions included education on perineal hygiene, encouragement of nutritious food intake, light mobilization, and perineal wound care using boiled binahong leaves. The results showed decreased pain, reduced edema, a dry wound, and complete healing on the fifth day, with the REEDA score decreasing from 11 to 0. The discussion emphasized that flavonoids, saponins, and ascorbic acid in binahong leaves contribute to tissue regeneration and faster healing. Limitations of this study included the short monitoring period, limited sample, and reliance on maternal compliance. In conclusion, binahong leaf decoction was found to be effective, practical, and able to enhance maternal independence in wound care. This study is expected to serve as a reference for midwifery practice and as a basis for further research with a wider scope.

The development of rural economies based on locally superior commodities is an integral part of inclusive and sustainable development strategies. Sumberdem located in Wonosari Subdistrict, Malang Regency, possesses significant potential for the development of coffee-based ecotourism. However, this potential remains largely underutilized due to several structural and institutional constraints. Key challenges include inadequate supporting infrastructure, limited capacity of local human resources, and the absence of downstream processing for coffee products. This community engagement program implemented an adaptive approach known as the Lumintu model, rooted in the Participatory Rural Appraisal (PRA) framework. Field assessments revealed critical limitations such as poor road access to plantation areas, insufficient agricultural irrigation, and weak digital connectivity. Moreover, the capacity of village institutions—such as the Village-Owned Enterprises (BUMDesa) and coffee farmer groups—remained low, resulting in local coffee products with limited added value. The initial implementation of the program has shown promising results, particularly in strengthening institutional capacity through training on tourism business management and high–value coffee processing. Furthermore, product diversification through the development of coffee-based agrotourism and digital marketing innovations has been successfully introduced. Overall, this community engagement initiative has provided a concrete solution to rural development challenges in Sumberdem Village. Moving forward, the village is expected to strengthen its position as a sustainable coffee ecotourism destination and improve the long-term economic well-being of its residents. The proposed development model also holds the potential for adaptation and replication in other rural areas with similar characteristics, thereby supporting the broader achievement of the Sustainable Development Goals (SDGs).

This study explores the impact of interactive games on the English vocabulary mastery of grade XI Animal Nursing students at the Kupang State Agricultural Vocational School. Given the low level of vocabulary mastery in vocational high school students, the study aims to investigate how using Gamestolearnenglish.com, an interactive game-based platform, can enhance vocabulary skills. A quasi-experimental design with pre- and post-treatment assessments was implemented. The results showed a significant improvement in students' vocabulary mastery, with the average score rising from 73.70 to 83.52, an increase of 9.82 points. The Shapiro-Wilk test confirmed the normality of the data, and a paired-sample t-test revealed a significant difference between the pre- and post-assessment (p = 0.000). This suggests that the use of interactive games significantly contributes to the enhancement of students' ability to recognize, understand, spell, and use vocabulary. These findings highlight the effectiveness of game-based learning in improving English vocabulary skills among vocational high school students, particularly in agricultural fields.

Flexible work arrangements (FWAs) have gained increasing attention in contemporary organizations as a strategy to enhance employee-related outcomes in dynamic work environments. This study aims to synthesize empirical evidence on the relationship between flexible work arrangements and employee outcomes through a Systematic Literature Review (SLR) guided by the PRISMA framework. A structured literature search initially identified 200 records, of which 117 peer-reviewed journal articles were retained after excluding non-journal publications. Following full-text screening and eligibility assessment, 45 empirical studies were included in the final analysis. The review reveals that flexible work arrangements are generally associated with positive employee outcomes, particularly job satisfaction, employee well-being, work–life balance, engagement, and performance, although the strength and direction of these relationships vary across organizational contexts and implementation practices. The findings highlight key research trends and methodological gaps, offering valuable insights for future research and practical implications for organizations seeking to effectively implement flexible work arrangements.A

Asthma is a chronic inflammatory disease of the airways characterized by reversible bronchoconstriction, mucus hypersecretion, and bronchial hyperresponsiveness. This condition causes shortness of breath, coughing, wheezing, and increased respiratory rate which impacts increased respiratory muscle work. One of the non-pharmacological interventions that can be applied in nursing practice is diaphragmatic breathing relaxation to help improve breathing patterns and increase respiratory muscle relaxation. Objective: To analyze the application of diaphragmatic breathing relaxation in improving respiratory muscle relaxation in asthma patients in the inpatient ward. Method: The study used a case study design with an Evidence Based Practice (EBP) approach. The research subjects were three asthma patients who experienced increased respiratory frequency. The intervention was carried out for three days in the form of structured diaphragmatic breathing exercises. Data were collected through nursing assessment, observation of respiratory frequency before and after the intervention, and evaluation of patient responses. Results: Before the intervention, all respondents experienced tachypnea with the use of accessory respiratory muscles. After three days of diaphragmatic breathing relaxation, the respiratory rates of all three respondents returned to normal (12–20 breaths/minute), respiratory muscle tension decreased, and the patients appeared more relaxed. Conclusion: Diaphragmatic breathing relaxation is effective in increasing respiratory muscle relaxation and stabilizing respiratory rate in asthmatic patients. This intervention can be used as part of non-pharmacological nursing care for patients with respiratory system disorders.