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This study examines the effectiveness of the GOOL (Dukcapil Go Online) service in accelerating the issuance of birth certificates at the Population and Civil Registration Office of Probolinggo City. GOOL is a digital-based civil administration service innovation that allows residents to process civil documents without visiting the office in person. This study employed a descriptive qualitative method, with data collected through in-depth interviews, observation, and documentation. Effectiveness indicators were based on Campbell's (2014) theory, covering: program success, goal achievement, community satisfaction, and overall objective attainment. The findings indicate that the GOOL service is generally effective in expediting birth certificate issuance. Supporting factors include collaboration with healthcare facilities (Indonesian Midwives Association and hospitals), an integrated 3-in-1 service program, and adequate technological infrastructure. Inhibiting factors include technical difficulties during document uploads, unstable internet connections, and limited digital literacy among some residents.

Patient satisfaction is a key indicator of health service quality in the National Health Insurance era. Outpatient services for BPJS members still face problems regarding waiting time, communication, and facilities. This study aimed to analyze factors affecting BPJS patient satisfaction with outpatient service quality at Malahayati Islamic Hospital Medan in 2026. A cross-sectional analytic design was applied to 150 respondents selected through consecutive sampling. Data were collected using a validated questionnaire (r>0.361; α=0.876) and analyzed by Chi-square and multiple logistic regression. Results showed that waiting time (p<0.001), staff competence (p<0.001), staff attitude (p<0.001), drug availability (p=0.032), facility comfort (p<0.001), administrative ease (p=0.003), and information clarity (p=0.008) were significantly associated with satisfaction. Multivariate analysis revealed waiting time as the most dominant factor (OR=5.42; 95% CI: 2.31–12.71), followed by staff competence (OR=4.18), facility comfort (OR=2.87), and staff attitude (OR=2.42), with Nagelkerke R²=0.512. Hospital management should optimize service flow and adopt digital queuing systems to enhance patient satisfaction.

The development of Artificial Intelligence (AI) has driven significant transformation in hospital management, particularly in operational efficiency, service quality, and patient safety. This study aims to analyze the implementation of AI in hospital management based on recent scientific evidence from 2020 to 2026. The method used was a systematic review guided by the PRISMA 2020 framework. Literature was retrieved from PubMed, ScienceDirect, SpringerLink, Google Scholar, and ProQuest. From 360 identified articles, a stepwise selection process was conducted, resulting in 15 articles that met the inclusion criteria. The findings indicate that AI contributes to improved operational efficiency through patient flow optimization, operating room management, workforce scheduling, and electronic medical record management. AI also enhances service quality through predictive data analytics and supports patient safety through risk detection and early warning systems. In conclusion, AI has strong strategic potential to support modern hospital management. However, its implementation still faces several challenges, including human resource readiness, data security, algorithmic bias, system interoperability, and investment requirements. Therefore, AI implementation should be carried out in a planned, ethical manner and evaluated from a health economics perspective.

The implementation of Electronic Medical Records (EMR) has become an essential part of digital transformation in the healthcare sector, aiming to improve the quality, effectiveness, efficiency, and continuity of healthcare services. In Indonesia, the implementation of EMR is supported by the Regulation of the Minister of Health Number 24 of 2022, which mandates healthcare facilities to adopt electronic medical records. However, the implementation process is often challenged by various technical and non-technical factors that may affect its success. This study aims to analyze the success factors and barriers to EMR implementation in hospitals through a literature review approach. The research method used was a literature review by examining and analyzing 11 scientific articles obtained from Google Scholar and other relevant scientific sources. The findings indicate that the success of EMR implementation is influenced by three main aspects, namely human, organizational, and technological factors. Supporting factors include management commitment, user readiness, continuous training, availability of information technology infrastructure, system quality, and organizational support. Meanwhile, common barriers include limited digital literacy among healthcare workers, insufficient information technology personnel, unstable internet connectivity, system errors, inadequate facilities and infrastructure, budget limitations, and the absence of specific standard operating procedures. Furthermore, EMR implementation provides significant benefits, such as improving service efficiency, facilitating access to patient information, enhancing documentation quality, supporting communication among healthcare professionals, and increasing patient safety. Therefore, successful EMR implementation requires synergy between human resources, organizational readiness, and technological infrastructure to achieve optimal healthcare service delivery.

Background: Breastfeeding is a valuable experience for both mother and infant, enhancing cognitive development, immunity, and emotional bonding. However, exclusive breastfeeding coverage remains suboptimal, partly due to inadequate breastfeeding technique skills among mothers. Objective: This study aims to analyze the differences in breastfeeding technique skills among pregnant women before and after a video-based educational intervention at the Gema Santi Nusa Penida Regional General Hospital, Klungkung Regency. Methods: This study utilized a pre-experimental design with a one-group pretest-posttest approach. The population consisted of 160 pregnant women visiting the Gema Santi Nusa Penida Regional General Hospital from March to April 2025. A sample of 32 pregnant women was determined using a comparative analysis sample size formula and selected via purposive sampling. Primary data were collected through observation using a validated and reliable breastfeeding technique skill checklist (calculated $r = 0.411 - 0.758 > 0.349$; Cronbach's alpha $= 0.757 > 0.6$). Results: The Shapiro-Wilk test indicated that the data were normally distributed, with values of 0.325 (pre-test) and 0.127 (post-test) $> 0.05$. The mean score for breastfeeding technique skills was 42.28 before the intervention and increased to 70.46 afterwards. The paired t-test demonstrated a significant difference in breastfeeding technique skills before and after the educational intervention ($p = 0.000 < 0.05$). Conclusion: Video media is highly effective in improving breastfeeding technique skills. Future initiatives should focus on developing more comprehensive video content to further enhance educational efficacy.

Nursing care in hospitals is still below the established standard of 80%, thus reflecting suboptimal nurse performance. This condition is thought to be influenced by factors such as rewards, workload, length of service and supervision. This study aims to analyze the relationship between rewards, workload, length of service, and supervision with nurse performance in the Inpatient Unit of Ratu Zalecha Martapura Regional Hospital. This study used a quantitative method with an observational analytical design using a cross-sectional approach. The study sample consisted of 152 nurses selected using cluster proportional random sampling technique. Data were collected using a questionnaire and analyzed using the chi-square test and multiple logistic regression. The results showed a significant relationship between rewards and nurse performance (p-value=<0.001), workload and nurse performance (p<0.001), and supervision and nurse performance (p-value=<0.001). Length of service did not show a significant relationship with nurse performance (p-value=0,968). Multivariate analysis showed that supervision was the most dominant factor related to nurse performance. Thus, compensation, workload, and supervision are related to nurse performance, while length of service is not related to nurse performance in the Inpatient Unit of Ratu Zalecha Regional Hospital, Martapura. The hospital is expected to improve supervision, workload management, and training and recognition for nurses to improve the quality of nursing services.

Background: Chronic Kidney Disease (CKD) patients undergoing long-term hemodialysis often experience anxiety due to therapy dependency, changes in health conditions, and uncertainty regarding the disease. Unresolved anxiety can reduce quality of life, comfort, and patient adherence to treatment. Therefore, non-pharmacological interventions are needed that are safe, easy to implement, and aligned with the patient's spiritual values. Mantram Tri Sandya has the potential to provide relaxation and psychological calm, thus helping to reduce anxiety. However, scientific evidence regarding the effectiveness of this therapy in hemodialysis patients is still limited, making this research crucial.  Purpose: The aim of this research is to determine the effect of the Tri Sandya mantra on reducing anxiety levels in CKD patients who are undergoing hemodialysis at the Buleleng Regency Regional Hospital. Methods: Pre-Experimental One Group Pre-Test & Post-Test research design with the Wilcoxon Signed Rank Test conducted at the Buleleng Regency Regional General Hospital. Data were collected using the HARS (Hamilton Anxiety Rating Scale) questionnaire sheet with Purposive Sampling technique with a sample size of 88 people. Results: The results obtained from this study were that there was a decrease in anxiety levels when given Mantra Tri Sandya therapy to CKD patients who were undergoing hemodialysis with a P value <0.001 (p<0.05). Conclusion: There is a significant effect of administering the Tri Sandy mantra on reducing anxiety levels in CKD patients who are undergoing hemodialysis at the Buleleng Regency Regional Hospital.

Anemia during pregnancy remains a common health problem and may lead to adverse outcomes for both mother and fetus. Hemoglobin and erythrocyte indices examination are important to identify anemia and describe erythrocyte morphology in pregnant women. This study aimed to describe hemoglobin levels and erythrocyte indices among anemic pregnant women at Sentosa Maternity Hospital. This research used a descriptive design with secondary data obtained from hematological examination results of pregnant women who underwent laboratory testing at Sentosa Maternity Hospital from January to December 2023. Data were analyzed descriptively and presented in frequency distribution tables. The results showed that out of 58 pregnant women undergoing hematological examination, 28 women (48%) were anemic with a mean hemoglobin level of 10.2 g/dL, while 30 women (52%) had normal hemoglobin levels with a mean of 12.8 g/dL. Based on erythrocyte indices, most anemic pregnant women had microcytic hypochromic anemia, accounting for 19 women (67%) with mean MCV of 72.3 fL, MCH of 29.8 pg, and MCHC of 33.9 g/dL, whereas 9 women (33%) had normocytic normochromic anemia with mean MCV of 83.4 fL, MCH of 29.6 pg, and MCHC of 33.4 g/dL. It can be concluded that nearly half of the examined pregnant women experienced anemia, with microcytic hypochromic anemia being the most dominant type.

This study aims to determine the effect of assertive leadership and self-actualization on the performance of nurses at Dr. Soekardjo Regional General Hospital in Tasikmalaya. The research design used in this study is a quantitative approach using a survey method. Research subjects: All 40 nurses working in the Melati ward were included as respondents. Research data were collected through the distribution of questionnaires to all respondents. The collected data were analyzed using a series of multiple linear regression tests, along with instrument validation and hypothesis testing. The results of the data analysis yielded the regression equation Y = 0.743 + 0.482X1 + 0.521X2 + e. Furthermore, the analysis indicated that assertive leadership positively contributes to improved nursing performance. Additionally, self-actualization also plays a role in supporting performance improvement. Simultaneously, both variables exert a significant influence on nursing performance. The coefficient of determination of 68.2% indicates that 68.2% of the variation in nurses’ performance can be explained by the two independent variables—assertive leadership and self-actualization—while the remainder is influenced by other factors outside the research model. These findings suggest that strengthening a more assertive and clear leadership style and fostering nurses’ self-actualization can serve as strategies for improving the quality of nursing care.

Background: Cesarean section (CS) is a mode of delivery frequently used in women with high-risk pregnancies. Over the past two decades, the rate of CS has increased significantly worldwide. Although CS can be a life-saving intervention when performed based on appropriate medical indications, it may also result in adverse outcomes for both mothers and infants and increase the clinical and economic burden on healthcare systems. Limiting CS rates can be achieved through the control of modifiable risk factors. Purpose: This study aimed to describe the factors contributing to the occurrence of cesarean section. Method: This study employed a descriptive cross-sectional design and was conducted at Singasana Regional General Hospital, Tabanan Regency, from February to May 2025. The study sample consisted of 259 women who underwent cesarean delivery during the period 2020–2024. Data were collected through a review of medical records using a checklist instrument. Univariate analysis was performed to describe maternal characteristics and indications for cesarean section. Result: Most cesarean deliveries occurred in women aged 20–35 years (77.99%) and in multiparous women (48.65%). The most dominant maternal factor was a previous cesarean section (37.6%), while the most common fetal factor was fetal distress (42.7%). Conclusion: Maternal age of 20–35 years, multiparity, a history of previous cesarean section, and fetal distress were the dominant factors associated with cesarean delivery. These findings highlight the importance of early antenatal risk screening and optimal labor management to reduce unnecessary cesarean sections and improve maternal and neonatal safety.

- Background: The rate of cesarean section (CS) deliveries continues to increase in Indonesia. Bali Province ranks first nationally, with a cesarean delivery rate of 53.2%. Cesarean section results in surgical wounds that cause pain in postpartum mothers. One non-pharmacological intervention to reduce pain is early mobilization through video media. Objective: This study aimed to determine the differences in pain intensity among post-cesarean mothers before and after receiving early mobilization through video media. Methods: This study employed a quantitative approach with a pre-experimental one-group pretest-posttest design. The study population consisted of post-cesarean mothers at Singasana Regional General Hospital. A total of 26 respondents who met the inclusion and exclusion criteria were recruited. Pain intensity was measured using the Numeric Rating Scale (NRS) before and after the intervention. The intervention consisted of early mobilization delivered through a 3-minute and 23-second video, accompanied by healthcare personnel. Data were analyzed using the Wilcoxon test. Results: Most respondents were aged 20–35 years, multiparous, had completed senior high school, and were employed. The median pain intensity decreased from 5.00 before the intervention to 3.00 after the intervention. The Wilcoxon test showed a p-value of 0.000 (p < 0.05), indicating a significant difference in pain intensity before and after the intervention. Conclusion: Early mobilization through video media was effective in reducing pain intensity among post-cesarean mothers. Video media can be utilized as an educational tool to support the implementation of early mobilization in healthcare settings..

In order to raise the standard of healthcare services in the contemporary period, digital transformation in hospital management has become a phenomena. The purpose of this study is to investigate the adoption, advantages, difficulties, and success aspects of digital transformation in healthcare facilities. A literature review employing a narrative review system was the methodology. 14 papers that met the inclusion requirements were found using data sources from Google Scholar, PubMed, and ScienceDirect databases with publication years ranging from 2020 to 2025. To determine the primary study themes, data analysis was carried out utilising a thematic synthesis approach. According to the study's findings, digital transformation can enhance operational effectiveness, service quality, and patient safety by using technology including electronic health records (EHR), telemedicine, and hospital management information systems. However, there are still a number of obstacles to its adoption, such as inadequate infrastructure, inadequate human resource competency, expensive investment costs, and data security threats. Significant barriers also include a lack of system integration and opposition to change. Government policies and regulatory assistance have an impact on the success of digital transformation in hospital administration.

This study aimed to analyze the influence of workload and burnout on nurses’ sleep quality while controlling for age, gender, and education as potential confounding variables. A quantitative analytic study with a cross-sectional design was conducted among 156 nurses working in a private hospital in Depok City. Data were collected using a workload questionnaire, the Maslach Burnout Inventory (MBI), and the Pittsburgh Sleep Quality Index (PSQI). The data were analyzed using Chi-Square tests and multiple logistic regression. The findings showed that both workload and burnout had significant effects on sleep quality (p < 0.05), with burnout identified as the most dominant factor. Age and gender were also significantly associated with sleep quality, whereas education did not show a statistically significant effect. The regression model demonstrated excellent fit, indicated by a McFadden pseudo R² value of 0.908. These results suggest that occupational factors, particularly burnout, play an important role in determining nurses’ sleep quality. Therefore, effective stress reduction and workload management strategies are needed to support nurses’ well-being and improve sleep quality.

Mental health disorders remain a significant public health concern in Indonesia due to their increasing prevalence and substantial impact on individuals, families, and communities. These disorders can impair a person's ability to think clearly, regulate emotions, behave appropriately, and interact effectively with others. Among the various symptoms experienced by individuals with mental disorders, hallucinations are one of the most common and challenging because they can interfere with daily functioning and increase the risk of relapse if not properly managed. Families play a crucial role in supporting patients through appropriate care, supervision, and adherence to treatment. Therefore, improving family knowledge about hallucination management is essential to enhance patient outcomes. This community service activity aimed to strengthen the knowledge of families and patients regarding the care and management of hallucinations at the Abepura Mental Hospital (RSK Abepura). The activity was conducted through direct mental health education and counseling sessions involving interactive lectures, discussions, and question-and-answer sessions. A total of 63 participants, consisting of patients and their family members visiting the hospital, took part in the program. The evaluation demonstrated that approximately 75% of participants actively engaged in the educational sessions, showed high enthusiasm, and were able to correctly answer the evaluation questions, indicating an improvement in their understanding of hallucination management. These findings suggest that mental health education is an effective strategy for enhancing family knowledge and supporting better care for patients with hallucinations.

Type 2 diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia due to impaired insulin secretion, insulin resistance, or a combination of both. HbA1c levels are used as an indicator of long-term glycemic control in patients with type 2 diabetes mellitus. Insulin therapy is one of the treatment options given to help achieve glycemic control targets. The purpose of this study was to determine the difference in HbA1c levels of type 2 diabetes mellitus patients with insulin and non-insulin therapy at PKU Muhammadiyah Gamping Hospital. This research method used a descriptive study with a cross-sectional approach. The subjects in this study were 80 type 2 diabetes mellitus patients who had used insulin and non-insulin therapy for less than 1 year, using Purposive Sampling techniques and data analysis using SPSS with Chi-Square and Mann-Whitney tests. This study has obtained ethical approval from PKU Muhammadiyah Gamping Hospital. This study shows that the characteristics of gender and age of type 2 DM patients with insulin and non-insulin therapy are dominated by women at 60.0% and 43.3%, while elderly patients at 60.0% and 53.3%. Of the 50 patients using insulin, 45 patients (90.0%) had controlled HbA1c and 5 patients (10.0%) were uncontrolled. Meanwhile, all non-insulin patients, 30 patients (100%), had uncontrolled HbA1c. Based on this study, there is a significant difference in HbA1c levels between type 2 diabetes mellitus patients with insulin and non-insulin therapy with a p-value <0.001. Patients using insulin therapy tend to have better glycemic control than patients not using insulin therapy.

Type 2 diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia due to impaired insulin secretion, insulin resistance, or a combination of both. HbA1c levels are used as an indicator of long-term glycemic control in patients with type 2 diabetes mellitus. Insulin therapy is one of the treatment options given to help achieve glycemic control targets. The purpose of this study was to determine the difference in HbA1c levels of type 2 diabetes mellitus patients with insulin and non-insulin therapy at PKU Muhammadiyah Gamping Hospital. This research method used a descriptive study with a cross-sectional approach. The subjects in this study were 80 type 2 diabetes mellitus patients who had used insulin and non-insulin therapy for less than 1 year, using Purposive Sampling techniques and data analysis using SPSS with Chi-Square and Mann-Whitney tests. This study has obtained ethical approval from PKU Muhammadiyah Gamping Hospital. This study shows that the characteristics of gender and age of type 2 DM patients with insulin and non-insulin therapy are dominated by women at 60.0% and 43.3%, while elderly patients at 60.0% and 53.3%. Of the 50 patients using insulin, 45 patients (90.0%) had controlled HbA1c and 5 patients (10.0%) were uncontrolled. Meanwhile, all non-insulin patients, 30 patients (100%), had uncontrolled HbA1c. Based on this study, there is a significant difference in HbA1c levels between type 2 diabetes mellitus patients with insulin and non-insulin therapy with a p-value <0.001. Patients using insulin therapy tend to have better glycemic control than patients not using insulin therapy.

This study aims to overhaul the conventional understanding of tourism through a missiological lens, by positioning social interactions at the Parbubu Tarutung Soda Water Tourism Object as the locus of Missio Dei (God's Mission) manifestation. Amidst the tendency of modern humans to be trapped in egocentrism, alienation, and minimal openness due to secular routines, God is present with a mission to transform human relations. Using a qualitative descriptive-theological method, this study analyzes three axes of social interaction (inter-tourists, tourists-managers, and tourists-local communities). The results of field research indicate that although the pattern of interaction between visitors is still minimalist and egocentric-group due to a purely physical recreation orientation, there is a strong spiritual modality in the service aspect (hospitality) of the managers that reflects the restoration of the image of God (Imago Dei). The absence of social conflict and the presence of sincere hospitality are identified not merely as business strategies, but as real implications of the work of the Holy Spirit who precedes the church (prevenient grace) in destroying human egoism. This study concludes that tourism can be an eschatological means by which social interactions are transformed into encounters that bring about God's Shalom, meaning that tourism can be a way to bring about God's peace through authentic encounters between tourists, rather than simply ordinary tourist transactions. The author recommends the reconstruction of public spaces in this destination as inclusive communal spaces that facilitate reconciliation and social transformation.

Patient trust is a crucial variable in hospital management, determining clinical success, treatment adherence, and institutional loyalty. In the increasingly competitive and digitalized modern healthcare landscape, hospitals face unique challenges stemming from the inherent characteristics of healthcare services. This article presents a systematic literature review exploring the determinants of patient trust through the lens of hospital service characteristics: intangibility, inseparability, variability, and perishability. This study followed the PRISMA protocol and analyzed 150 articles published between 2010 and 2026 from Scopus, Web of Science, and Google Scholar databases. The review results indicate that assurance and empathy are the most significant service quality dimensions in mitigating perceived risk due to intangibility. Meanwhile, the quality of therapeutic communication is a key factor in managing inseparability, and standardization of operational procedures is necessary to address variability. The study also identifies the role of digital technology and the physical environment as "tangible evidence" that strengthens hospital credibility. The managerial implications of this research emphasize the need for organizational culture transformation oriented toward humanitarian values ​​and transparency to rebuild public trust that has eroded in the post-pandemic era.

Thalassemia is an inherited hemolytic anemia caused by genetic abnormalities in chromosomes 11 and 16 that impair globin chain production, leading to insufficient hemoglobin and red blood cells. This study aims to describe nursing care for An. W with thalassemia at the Anggrek 2 Ward of RSUD dr. Soeselo, Tegal Regency. The method used was a descriptive approach through anamnesis, documentation, observation, and literature review. Nursing care was carried out over two days (January 13–14, 2026). Physical examination results on January 12, 2026 showed a pale face, anemic conjunctiva, weakness, CRT >3 seconds, decreased skin turgor, weak peripheral pulse, cold extremities, and laboratory hemoglobin of 5.9 g/dL, with vital signs of pulse 111x/minute, temperature 36.7°C, and respiration 22x/minute. Two nursing diagnoses were established: ineffective peripheral perfusion related to decreased hemoglobin concentration (D.0009), and activity intolerance related to weakness (D.0056). Nursing interventions included circulatory care (I.02079) and energy management (I.05178). Nursing implementation was carried out according to plan. Evaluation on January 14, 2026 showed that both nursing diagnoses were resolved; the patient's hemoglobin improved to 10.7 g/dL after two blood transfusions, and the patient was declared fit for discharge. It is recommended that hospitals establish support groups for thalassemia patients to provide adequate emotional and social support.

Preeclampsia is one of the leading causes of maternal mortality and may result in various complications during pregnancy and childbirth. In Tegal Regency, preeclampsia contributed to 27% of maternal deaths in 2024; therefore, studies on childbirth characteristics among mothers with this condition are needed. This study aimed to identify the characteristics of childbirth events in mothers with preeclampsia at Dr. Soeselo Slawi Regional Hospital, Tegal Regency. A descriptive design with a retrospective approach was used by reviewing the medical records of 202 mothers who delivered with preeclampsia during 2025. Data were analyzed univariately and presented as frequency distributions and percentages. The results showed that most mothers underwent operative delivery (62.38%), while spontaneous and induced labor accounted for 37.13% and 0.50%, respectively. Most deliveries occurred at preterm gestational age (62.38%), followed by term (36.14%) and postterm (1.49%) deliveries. Maternal and obstetric complications included bleeding (6.93%), fetal distress (4.95%), eclampsia (1.49%), and HELLP syndrome (0.99%). Most neonates had normal birth weight (82.18%) and did not require NICU care (95.05%), although low birth weight (17.82%) and NICU admission (4.95%) were still identified. The maternal clinical condition was dominated by blood pressure of 140–159/90–109 mmHg (75.74%). Proteinuria was found in 46.53% of respondents, with moderate proteinuria (+2) as the predominant category (38.30%). In conclusion, childbirth among mothers with preeclampsia was dominated by operative and preterm deliveries. These findings emphasize the importance of early detection and optimal management of preeclampsia to reduce maternal and neonatal complications and improve the quality of maternal-infant health services overall.