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 Background: Perineal pain due to episiotomy is a common complaint experienced by postpartum mothers and can affect patient comfort, mobility, and recovery. Nonpharmacological pain management is needed to help reduce discomfort with minimal risk of side effects. Objective: This study aimed to determine the effectiveness of applying cold compresses using ice packs in reducing perineal pain intensity in postpartum mothers with episiotomy. Methods: The study used a descriptive case study design in three vaginal postpartum patients with episiotomy who were treated in the postpartum ward. The intervention involved applying cold compresses using ice packs to the perineal area for 10–15 minutes, as per nursing procedures. Pain was measured using the Numeric Rating Scale (NRS) before and after the intervention. Findings: The results showed a decrease in pain intensity in all patients after the application of cold compresses. Patient P1 experienced a decrease in pain score from 5 to 4, patient P2 from 6 to 5, and patient P3 from 5 to 4, with an average decrease of 1 point. Implications: Cold compresses using ice packs have the potential to be an effective non-pharmacological nursing intervention to help reduce perineal pain and improve the comfort of postpartum mothers with episiotomies during the care period.

The emergence of Large-Format Printing (LFP) technology has transformed global visual communication by enabling the production of large-scale, high-quality printed materials, significantly influencing Nigeria’s graphic design industry. This study aims to examine the impact of LFP on graphic design practice (GDP) in 21st-century Nigeria and propose strategies for sustainable development while addressing emerging challenges. A mixed-method approach was employed, with a primary qualitative focus through interviews and participant observation, supported by quantitative data collected using a Likert-scale questionnaire to assess designers’ perceptions of LFP’s influence. The findings reveal a dual impact. On the positive side, LFP has enhanced design scale, print quality, creative flexibility, and production efficiency, effectively overcoming the limitations of earlier methods such as letterpress printing, manual clamp offset printing, and hand-painted signboards. However, several challenges persist, including the oversaturation of practitioners, increased design piracy, and issues of color inconsistency, which undermine quality outcomes. These challenges highlight gaps in professional standards and regulation within the industry. The study concludes that while LFP has driven innovation and growth in Nigeria’s graphic design sector, its optimal benefits are constrained by the proliferation of unaccredited freelance designers. Therefore, the study recommends the implementation of targeted training programs and stricter professional accreditation systems through relevant regulatory bodies to ensure sustainable development and maximize the transformative potential of LFP technology.

This research is motivated by the vital role of clean water services and the need to optimize operational revenue at BLUD UPT Water Supply Management in Batam City. The study aims to analyze the influence of willingness to pay, ability to pay, and payment awareness on BLUD revenue achievement. A quantitative associative approach was employed, involving a population of 29,047 customers. A sample of 100 respondents was determined using the Slovin formula, and data were analyzed via multiple linear regression using SPSS software. The results indicate that, simultaneously, all three independent variables significantly affect revenue achievement with an F-value of 56.825 and a significance of 0.000. Partially, willingness to pay (t=8.279), ability to pay (t=11.020), and payment awareness (t=10.435) also exert a significant influence. These findings imply that higher community payment behavior directly increases institutional revenue. It is recommended that BLUD improves service quality and payment socialization to ensure sustainable revenue achievement.

The postpartum period is a vulnerable phase often accompanied by lactation problems, particularly ineffective breastfeeding and discomfort due to breast engorgement. These conditions may reduce maternal comfort, inhibit the let-down reflex, and increase the risk of failure in exclusive breastfeeding. Therefore, safe, practical, and comprehensive non-pharmacological nursing interventions are needed. This Final Nursing Project aims to describe the implementation of cabbage leaf compresses combined with breastfeeding education to improve maternal comfort and enhance breast milk flow in postpartum mothers. This study employed a case study method using a nursing care approach involving two postpartum mothers who experienced ineffective breastfeeding and discomfort due to breast engorgement. The interventions were provided for three days and included cabbage leaf compresses and education on breastfeeding techniques. Evaluation focused on breastfeeding ability, pain level, breast condition, maternal comfort, and milk production. The results showed improvement in breastfeeding ability, indicated by the mothers’ ability to correctly demonstrate proper positioning and latch-on techniques. Infants appeared calmer during feeding, and the duration of breastfeeding increased to approximately 10 minutes per breast. Pain scores decreased from 5 to 0–3, breast tension was reduced, and maternal comfort improved. It can be concluded that the application of cabbage leaf compresses combined with breastfeeding education is effective in improving breast milk flow and maternal comfort in postpartum mothers and can be recommended as an independent nursing intervention in maternity practice.

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.

This study examines the environmental advocacy strategies carried out by WALHI Jambi in addressing the pollution of the Batanghari River caused by illegal gold mining activities. This issue reflects ongoing environmental degradation and weak policy enforcement in managing natural resources. The study aims to analyze advocacy practices in terms of raising public awareness, community organizing, and influencing policy. A qualitative approach with a case study method was employed, with data collected through in-depth interviews, observation, and document analysis. The findings show that WALHI Jambi has undertaken various advocacy efforts, including media campaigns, public actions, community assistance, and engagement in policy forums. However, these efforts remain not fully optimal. Public awareness initiatives are still limited to information dissemination, community organizing has not yet developed into a strong collective movement, and policy influence is constrained by the absence of systematic instruments such as formal documentation, litigation, and structured coalitions. This study contributes to the understanding of environmental advocacy practices and highlights the need for strengthening advocacy strategies to achieve more effective policy influence and sustainable environmental governance.

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.

Post section caesarea (SC) and method of operative female sterilization (MOW) are surgical procedures that may cause various problems, such as pain, limited mobility, decreased muscle strength, and risk of postoperative complications. Physiotherapy management through exercise therapy is an important intervention to accelerate the recovery process. Objective this study aimed to determine the effectiveness of exercise therapy in improving the functional condition of patients post SC and MOW in Annisa Ward 32 A at PKU Muhammadiyah Karanganyar Hospital. Method: used was a case report on a 33-year-old female patient following SC and MOW procedures. The physiotherapy interventions included deep breathing exercises, active range of motion exercises of the extremities, light abdominal muscle contractions, gradual early mobilization, as well as breast massage and oxytocin stimulation. The results showed a reduction in pain from a scale of 4–5 to 2–3 based on the Numeric Rating Scale (NRS), improvement in mobility such as independent position changes, and increased activity tolerance, including sitting and walking with minimal assistance. In addition, the patient showed increased confidence in performing daily functional activities. Conclusion: exercise therapy has a positive effect on improving mobility, reducing pain, and accelerating functional recovery in post SC and MOW patients. Therefore, exercise therapy is recommended as an essential component of postoperative physiotherapy management to improve patients' quality of life.

This study aims to analyze the extent of the effect of honey bee pollen supplementation on increasing appetite and body weight in anemic children. The type of research used in this study is an experimental study with a pre- and post-test one-group design. The research sample consisted of 52 anemic fourth- and fifth-grade elementary school students. The average total food intake (Yellow Rice) showed a significant result (P=0.000), increasing from 241.40±94.334 g to 354.94±122.57 g after the final measurement of ad libitum appetite. The average body weight also showed a significant result (P=0.00), with a mean of 23.59±5.29 kg at pre-test and rising to 24.65±5.58 kg at post-test. The Z-Score calculation for weight-for-age based on the WHO NCHS reference showed a non-significant result: P=0.0180 (0.01±0.04) at pre-test and 0.03±0.08 at post-test. Based on the 24-hour recall analysis over two days, a significant result was obtained (P=0.000), with total energy intake of elementary school students increasing from an average of 1,594±420.17 kcal before intervention to 2,070.2±491.77 kcal after two months of intervention. After statistical testing (Paired T-Test), a P-value of 0.00 (<0.05) was obtained. It can be concluded that the administration of honey bee pollen for 8 weeks at a dose of 25 grams per day significantly increased appetite and body weight in anemic elementary school children.

Background: The management of hemorrhagic shock in obstetrics typically involves aggressive fluid resuscitation, often leading to iatrogenic fluid overload and pulmonary edema. Implementing a timely fluid de-escalation (deresuscitation) strategy is critical to facilitate ventilator weaning and achieve early extubation. Case Illustration: A 31-year-old female (G5P3A1) was admitted to the ICU following emergency Re-Cesarean Section due to Grade IV hemorrhagic shock caused by postpartum hemorrhage (PPH) and placenta previa totalis. Intraoperative aggressive resuscitation triggered iatrogenic fluid overload, manifesting as bilateral pulmonary edema and severe gas exchange impairment (initial AaDO2 of 459 mmHg and lactate level of 2.8 mmol/L). Management and Results: Following initial hemodynamic stabilization, an active fluid de-escalation strategy was initiated on Post-Operative Day 1 (POD 1) using continuous furosemide infusion at 10 mg/hour targeting a negative fluid balance. The patient achieved a negative fluid balance of -1485 mL within 24 hours, accompanied by a significant increase in urine output (7.8 mL/kg/hour). This approach successfully reduced the AaDO2 to 162 mmHg and improved lactate clearance to 1.8 mmol/L without compromising hemodynamic stability. The patient was successfully extubated within 18 hours of ICU admission. Conclusion: Early transition from resuscitation to fluid de-escalation, guided by perfusion targets (lactate) and oxygenation markers (AaDO2), is safe in critical obstetric cases. This strategy effectively resolves pulmonary edema and accelerates early extubation.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an obligate intracellular bacterium that affects the skin, peripheral nerves, upper respiratory mucosa, and eyes. Type 2 diabetes mellitus (T2DM) is a comorbidity that can worsen the course of leprosy. The female patient, Mrs. D, aged 55 years came to the emergency room of Cut Meutia Hospital with the main complaint of red bumps accompanied by pain on the face, hands, chest, and back since 3 days ago and additional complaints such as fever, joint pain, and numbness and loss of feeling in the legs, weakness, frequent thirst, and frequent urination. Dermatologic status is obtained in the facial region in the form of erythema nodules with firm boundaries with numular size, multiple. Laboratory examination showed anemia and leukocytosis. The therapy given was MDT MB package, ferrous sulfate 1x325 mg and PRC transfusion 3 kolf. Complaints arose acutely after the patient resumed taking MDT (multidrug therapy) leprosy drugs which had previously been stopped for more than 3 months. Based on the time of onset of symptoms, history of leprosy treatment, and the manifestation of systemic inflammatory lesions with signs of neurotropism, it can be suspected that the patient is experiencing a type 2 leprosy reaction or Erythema Nodosum Leprosum (ENL).

Lumbar flexibility refers to the maximum capacity of the muscles in the lumbar spine to move freely. Impairment in functional movement may lead to restricted mobility, which can be influenced by disruption of biomotor components, particularly lumbar spinal flexibility. Flexibility may be affected by both internal and external factors, including age and duration of sitting during work. This study aimed to analyze the relationship between sitting duration and age with lumbar flexibility using the Modified Schober Test among employees of PT Bank Syariah Indonesia, Lhokseumawe City. This study applied a cross-sectional design and was conducted in December 2023 in the prayer room area of the PT Bank Syariah Indonesia branch office. Sampling was carried out using a total sampling technique involving 46 respondents. Data collection was performed by measuring lumbar flexibility using the Modified Schober Test method. The results showed that the highest proportion of respondents had limited lumbar flexibility, accounting for 24 respondents (52.2%). The majority of respondents had a sitting duration of 7–9 hours, totaling 26 respondents (56.5%), while the largest age group was 26–35 years, consisting of 23 respondents (50%). Spearman-Rank correlation analysis demonstrated a relationship between sitting duration and lumbar flexibility measured by the Modified Schober Test (r = 0.662). In addition, the relationship between age and lumbar flexibility also showed a correlation based on the Spearman-Rank test (r = -0.321). The study concluded that longer sitting duration and increasing age were associated with greater limitation in lumbar flexibility among employees of PT Bank Syariah Indonesia, Lhokseumawe City.

Background: Anxiety can affect physiological functions in patients prior to surgery, including increased heart rate and respiration, changes in blood pressure and temperature, relaxation of smooth muscles in the bladder, cold and clammy skin, and dry mouth, which may reduce the patient’s energy level. Psychologically, anxiety can lead to increased postoperative pain, delayed wound healing, increased physical disability, and decreased quality of life. One effective non-pharmacological intervention to reduce anxiety is Benson relaxation therapy. Objective: This study aimed to determine the effect of benson relaxation therapy on reducing anxiety levels in pre operative. Methods: This study used a case study design involving one preoperative patient with anxiety symptoms in the Teratai Ward of Prof. Dr. Margono Soekarjo Hospital, Purwokerto. Benson relaxation therapy was administered for 3 days, twice daily, with a duration of 15 minutes per session. Anxiety levels were measured using the Zung Self-Rating Anxiety Scale (ZSAS) before and after the intervention. Results: The patient showed a decrease in anxiety score from 55 (moderate anxiety) to 40 (mild anxiety) after receiving Benson relaxation therapy. Subjectively, the patient reported feeling calmer, more accepting, and motivated. Objectively, there was a reduction in heart rate and physical signs of anxiety. Conclusion: Benson relaxation therapy is effective in reducing anxiety levels in preoperative patients. This intervention can be used as a non-pharmacological alternative to support psychological recovery of pre-operative patients.

Introduction: Carpal Tunnel Syndrome (CTS) is the most common neuropathy caused by compression and tension of the median nerve in the carpal tunnel of the wrist. The most common symptoms of CTS include pain and paresthesia (tingling) with or without numbness in the me dian nerve area of ​​the wrist. Method: The method used was a case study on a 72-year-old male patient diagnosed with bilateral CTS who experienced pain (NRS 7/10), tingling, numbness, and limitations in hand movement and functional activity. Physiotherapy interventions provided included Ultrasound therapy (US), Transcutaneous Electrical Nerve Stimulation (TENS), nerve mobilization, and structured exercise therapy in the form of stretching and median nerve gliding. Evaluation was carried out using the Numeric Rating Scale (NRS) for pain and the Boston Carpal Tunnel Questionnaire (BCTQ) for functional activity. Result: The results showed a significant reduction in pain, with motion pain decreasing from a scale of 7 to 3 and pressure pain from 5 to 1 after three therapy sessions. Furthermore, there was an increase in functional activity, as indicated by a decrease in BCTQ scores, namely the Symptom Severity Scale (SSS) from 4 to 2 and the Functional Status Scale (FSS) from 4 to 2. This indicates a gradual improvement from the moderate-severe category to approaching mild. Conclusion: A multimodal physiotherapy approach is effective in reducing pain, reducing paresthesias, and improving hand function in CTS patients. Combining various therapeutic modalities has been shown to be more optimal than single therapies because it can address various pathological aspects simultaneously. Therefore, comprehensive, evidence-based physiotherapy interventions are highly recommended in the conservative management of CTS.

Background: Knee osteoarthritis is a degenerative joint disease that often occurs in the geriatric population and causes pain, limited movement, and decreased function. In advanced conditions, management is carried out with Total Knee Replacement (TKR). However, post-surgery patients still experience functional limitations so that physiotherapy intervention is needed. Objective: To determine the effectiveness of static bicycle and quadriceps strengthening exercises on pain, range of motion, muscle strength, functional mobility, and quality of life in post-TKR patients. Methods: This study used a case study design in one patient with post-TKR dextra et causa bilateral knee osteoarthritis. The intervention was given for 3 weeks with a frequency of 2 times per week. Evaluation was carried out using the Numeric Rating Scale (NRS), goniometer, Manual Muscle Testing (MMT), Timed Up and Go Test (TUG), and the Knee Osteoarthritis Outcome Score (KOOS). Results: Results showed a decrease in motion pain from NRS 6 to 4 and stationary pain from 3 to 2. Knee range of motion increased from 75° to 90° of flexion and from -5° to 0° of extension. Muscle strength increased from MMT 3 to 4 in the quadriceps muscle. Functional mobility also improved, with TUG time decreasing from 22 seconds to 18 seconds. However, the KOOS score remained relatively unchanged at 38.84. Conclusion: Static bicycle and quadriceps strengthening exercises were effective in reducing pain, increasing ROM, muscle strength, and functional mobility in post-TKR patients. However, the improvement in quality of life as measured by the KOOS was not significant, requiring a longer rehabilitation period.

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.

Background: Carpal Tunnel Syndrome (CTS) is a condition caused by compression of the median nerve at the wrist, resulting in pain, paresthesia, and decreased hand function. This condition is commonly experienced by individuals who perform repetitive wrist activities. Objective: To determine the effectiveness of a combination of neural mobilization exercises and electrotherapy modalities in improving hand function, increasing muscle strength, and reducing pain in a patient with Carpal Tunnel Syndrome. Methods: This study used a case report design involving a 57-year-old female patient (Mrs. Q) who presented with pain and sensory disturbances in the right hand. The intervention was administered for four weeks and consisted of ultrasound therapy, Transcutaneous Electrical Nerve Stimulation (TENS), grip strengthening exercises, and nerve gliding exercises. Outcome measures included pain intensity assessed using the Numeric Rating Scale (NRS), muscle strength evaluated using Manual Muscle Testing (MMT), and functional ability measured using the Wrist Hand Disability Index (WHDI). Results: The evaluation showed a reduction in pain intensity, with resting pain at 0/10, tenderness at 4/10, and movement pain at 4/10. Muscle strength improved from grade 3 to grade 4 based on MMT. Functional ability also improved, as indicated by a 20% reduction in the WHDI score. The combination of these interventions proved effective as a conservative management approach for Carpal Tunnel Syndrome. Conclusion: The administration of ultrasound, TENS, grip strengthening exercises, and nerve gliding exercises over four therapy sessions in Mrs. Q resulted in decreased pain, increased muscle strength, and improved hand functional ability.

The phenomenon of cyberbullying and the spread of hoaxes among students has posed a significant threat to the ethics of the younger generation. Consequently, the education sector must take prudent action. The purpose of this study is to examine how the integration of digital ethics into the Islamic Religious Education (PAI) curriculum serves as an effort to prevent and address online behavioral violations. This research was conducted qualitatively using a desk study. Data were collected through documentary research of educational literature, Islamic moral values, and curriculum policies. In this analysis, a content analysis method was used to examine how Islamic concepts relate to the ethics of modern digital communication. The research indicates that the current PAI curriculum requires strengthening digital transaction materials through internalizing the principles of tabayyun (religious conduct) to combat hoaxes and the principles of akhlaqul karimah (good character) to reduce cyberbullying. PAI should not be limited to theoretical literature; instead, it should develop into a practical guide that helps people improve their digital lives. To create a safe and secure internet environment, the PAI curriculum must be aligned with critical digital literacy and the strengthening of religious character. It is hoped that this integration will provide students with a strong spiritual foundation to face the challenges of future technological disruption.

The Free Nutritious Meal Program (MBG) is a strategic initiative by the Indonesian government to address the long-standing issues of malnutrition and stunting, which have significantly hindered human resource (HR) development in Indonesia. The program aims to improve children's nutrition and reduce stunting by providing free nutritious meals, particularly in areas with limited access to healthy food. This study aims to analyze the legal framework of MBG, its effectiveness in achieving its goals, and its impact on national development. Using a qualitative approach, the study analyzes the implementation of MBG through document analysis, interviews with relevant stakeholders, and field observations. The findings highlight challenges within the program, including imbalanced food distribution, inadequate infrastructure in remote areas, and suboptimal food quality control, which resulted in several food poisoning incidents in 2025. Nevertheless, the program has a positive economic impact by empowering micro, small, and medium enterprises (MSMEs) involved in food supply. The study suggests strengthening the monitoring system, improving budget management, and better coordination between government sectors and communities to maximize the success of MBG. It also emphasizes the importance of nutrition education campaigns to support the program's goals. Overall, MBG is a crucial step toward creating a healthier and more productive generation, supporting the achievement of Indonesia's Golden Generation by 2045..