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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.

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.

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).

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.

Dysmenorrhea or menstrual pain, is a common health issue among adolescent girls, often disrupting daily activities and quality of life. Effective management of dysmenorrhea is strongly influenced by the level of knowledge and attitudes of adolescent girls toward this condition. This literature review aims to analyze the relationship between knowledge and attitudes regarding the management of menstrual pain among adolescent girls. Various studies indicate that while adequate knowledge about dysmenorrhea is important, the correlation between knowledge and attitude is not always significant. Some research finds that good knowledge does not necessarily translate into a positive attitude towards pain management, as other factors such as stress, anxiety, and reluctance to take action also play a role. However, there are studies that show a positive relationship between increased knowledge and better attitudes toward dysmenorrhea management,  although the strength of this association is very weak. Most adolescents tend to choose non-pharmacological management, such as rest and warm compresses, but many still ignore menstrual pain due to a lack of knowledge and information. Therefore, educational interventions and counseling in schools are essential to improve knowledge and foster positive attitudes in managing dysmenorrhea among adolescent girls. These efforts are expected to help adolescent girls manage menstrual pain more effectively and enhance their quality of life.

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.

Herpes zoster is a skin infection caused by the reactivation of the varicella-zoster virus, characterized by unilateral skin lesions corresponding to dermatome distribution and complaints of pain or itching. This disease is more common in adults and the elderly, especially in individuals with reduced immunity due to stress or work overload. A case was reported of a 40-year-old woman who worked as a nurse and came to a primary health care facility complaining of itching and red spots on her right breast area that had spread to the surrounding area two weeks before the examination and had worsened in the last few days. Physical examination revealed unilateral red skin lesions in a dermatomal pattern without crossing the midline of the body, consistent with the early phase of herpes zoster. Management was comprehensive, including medication, patient education about the disease and skin care, prevention of complications, and family support. A holistic approach is necessary to improve the success of therapy and the patient's quality of life.

Developmental Dysplasia of the Hip (DDH) in children often results in joint stiffness, muscle weakness, limited range of motion, and gait impairment following surgical management and immobilization. Early physiotherapy intervention is essential to restore hip function and walking ability. This study aimed to evaluate the effectiveness of active exercise on functional walking in outpatient children aged 3–5 years after DDH surgery. A case study design was conducted on three female patients who completed a five-week rehabilitation program consisting of ten active exercise sessions, including hip strengthening, mobility training, and balance exercises, combined with a home program. Outcome measures included hip range of motion, Manual Muscle Testing, and Modified McKay and Harris Hip Score assessed at baseline, mid-intervention, and post-intervention. The results showed improvements in hip range of motion, particularly in flexion, extension, abduction, adduction, and external rotation, while internal rotation improved but did not reach normal values. Muscle strength increased from grade 1–2 to grade 3 in most hip muscle groups. Functional walking scores improved from poor to good and excellent, with patients achieving independent, symmetrical gait without pain. These findings indicate that active exercise is an effective rehabilitation approach to reduce impairments and enhance functional walking in children after DDH surgery. The study highlights the importance of structured physiotherapy and caregiver involvement to optimize recovery and participation in daily activities.

Musculoskeletal Disorders (MSDs) are disorders of the skeletal muscles that can range from very mild to very painful. Repeated static loads over a long period of time can cause damage to joints, ligaments, and tendons. Musculoskeletal disorders can occur due to several factors, including occupational factors, individual factors, psychosocial factors, and environmental factors. This study aims to analyze the relationship between age, length of service, and smoking habits with musculoskeletal disorders in furniture craftsmen. This study used an observational analytical study with a cross-sectional design. The sample used a total population of 51 workers. Data collection techniques were observation and filling out the Nordic Body Map (NBM) questionnaire. Data analysis used the Somers'd. The results of the analysis showed that there was a relationship between age (p value = 0.015), length of service (p value = 0.001), and smoking habits (p value = 0.000) with the incidence of Musculoskeletal Disorders (MSDs).

Background: Comprehensive midwifery care is essential for early detection of complications and reducing maternal and infant mortality rates. In Sleman Regency, despite high access to health services, continuous monitoring remains crucial for ensuring maternal and fetal safety. Objective: To provide comprehensive midwifery care for Mrs. M at Klinik Pratama Shaqi, Sleman, from the third trimester of pregnancy through the postpartum and neonatal periods. Methods: This is a descriptive qualitative study using a case study approach based on Varney's seven-step midwifery management and SOAP documentation. Findings: During pregnancy (37 weeks 6 days), the mother experienced physiological complaints of back pain and shortness of breath, managed through posture education and pregnancy exercises. Labor proceeded normally and spontaneously on October 6, 2024, utilizing "gentle birth" practices such as endorphin massage to reduce pain. A second-degree perineal tear occurred and was treated according to procedure. The baby was born healthy, weighing 3100 grams, with successful Early Initiation of Breastfeeding (EIB). During the postpartum and neonatal periods, uterine involution was normal, breast milk production was adequate, and the infant's growth met standards with no danger signs. Implications: Continuous assistance improves the mother's physical and psychological readiness and ensures a healthy neonatal transition.

Empowering pregnant women in their third trimester through Respectful Maternity Care-based childbirth preparation counseling is a relevant promotive and preventive strategy for improving maternal health. This counseling not only provides knowledge about the signs of labor, stages of labor, pain management options, and birth planning, but also equips mothers with an understanding of their rights in midwifery care. Childbirth preparation education often focuses solely on clinical aspects and fails to fully address the psychosocial aspects and the rights of mothers as service recipients. This has the potential to lead to an unpleasant childbirth experience and even contribute to disrespect and abuse during labor. This counseling can equip mothers with an understanding of their rights in midwifery care. With an empathetic, participatory, and woman-centered approach, pregnant women are expected to be able to recognize their needs, convey their preferences, and communicate effectively with health workers. The purpose of this counseling is to improve pregnant women's knowledge before and after being empowered in their third trimester through Respectful Maternity Care-based childbirth preparation counseling.