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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 completeness of nursing care documentation serves as a primary indicator of hospital service quality and remains a critical component of patient safety, clinical communication, and legal accountability. Despite its importance, empirical evidence from various healthcare facilities indicates that nursing records are frequently suboptimal, incomplete, or inconsistent. This study aims to analyze the complex interrelationships between burnout and coaching on the completeness of nursing care documentation, specifically examining the role of nursing competence as a mediating (intervening) variable at the Dr. Chasbullah Abdulmadjid General Hospital in Bekasi City. Utilizing a quantitative research framework with a cross-sectional design, this study sampled practicing nurses stationed across inpatient and intensive care units. Primary data were gathered through a validated, structured questionnaire designed to measure psychological burnout, the frequency of clinical coaching, perceived professional competence, and the objective completeness of documentation. The data were subjected to rigorous analysis using Structural Equation Modeling–Partial Least Squares (SEM-PLS) to test the hypothesized pathways within the conceptual model. The results demonstrated that burnout exerts a significant negative influence on both nursing competence and the quality of documentation, suggesting that emotional exhaustion hinders professional performance. Conversely, systematic coaching was found to have a significant positive impact, directly improving both competence levels and documentation adherence. Critically, the analysis confirmed that nursing competence acts as a vital intervening variable; it effectively mediates and strengthens the influence of both burnout reduction and coaching interventions on the overall completeness of nursing care records. This study concludes that proactive burnout management and the institutionalization of structured coaching programs are essential strategic priorities. By addressing these factors, hospital management can enhance individual nurse competence, thereby ensuring high-quality, comprehensive nursing documentation that supports patient safety and institutional integrity.

Effective communication is essential for teamwork effectiveness in healthcare, particularly in inpatient units where patient care requires coordination among multiple professionals. Internal data from Hospital X showed that more than 50% of medical incidents in the last two years were related to miscommunication among healthcare workers. In addition, the 2024 employee satisfaction survey reported that workplace communication satisfaction was only 62%, below the hospital target of 75%. This study aimed to examine the influence of effective communication on teamwork effectiveness with interprofessional collaboration as an intervening variable at Hospital X.This study used a quantitative cross-sectional design involving 226 healthcare workers, including doctors, nurses, and medical support staff. Data were analyzed using the Three-Box Method and PLS-SEM. The findings revealed that effective communication significantly influenced teamwork effectiveness both directly and indirectly through interprofessional collaboration. Interprofessional collaboration also acted as a significant mediating variable between communication and teamwork effectiveness. These results indicate that communication is a key foundation for strengthening collaboration and improving teamwork in hospitals. Therefore, hospitals should enhance communication training and interprofessional collaboration programs to improve healthcare quality and patient safety

The optimal therapeutic impact of local vaginal drug delivery systems is strongly influenced by the physical characteristics balance of Solid Vaginal Suppositories. A comprehensive review regarding the comparison of mechanical profiles, specifically melting time and crushing strength parameters, from various base classifications constitutes the primary objective of this literature research. The implementation of a Literature Review study design was executed through the extraction of empirical data from twelve experimental journals published within the last ten years. Excessively rapid phase transformation characteristics at physiological basal temperatures and low compression resistance were consistently demonstrated by lipophilic bases such as Oleum Cacao. The risk of structural deformation during the distribution process is highly susceptible to unmodified lipid preparations. High surface elasticity accompanied by a delay in molecular hydration duration reaching 120 minutes was recorded in the utilization of Glycerinated Gelatin Base. Structural rigidity exceeding 4 kgF and disintegration time efficiency under 60 minutes were optimally demonstrated by Polyethylene Glycol (PEG) Base. An enhancement in mechanical resistance against external shocks during the storage period is offered by the thorough modification of the synthetic polymer ratios. Therefore, the determination of the PEG base as the most optimal material is recommended to maintain the quality stability of pharmaceutical products. Compendial regulation standards regarding the physical strength testing of pharmaceutical preparations must be obeyed by every institution to ensure long-term treatment effectiveness. Thus, the alignment between active substance release duration and physical preparation endurance can be realized for absolute patient comfort.

Hospitals play a strategic role in improving public health through professional, safe, and high-quality healthcare services. In modern healthcare organizations, service quality is not only determined by medical facilities and technology but also by the quality of human resources, particularly healthcare workers who directly interact with patients. This study aims to analyze the influence of authentic leadership on healthcare workers’ performance and hospital service quality. The study employed a quantitative explanatory research design involving 120 healthcare workers in a hospital setting. Data were collected using questionnaires and analyzed through multiple linear regression analysis. The findings demonstrate that authentic leadership has a positive and significant effect on healthcare workers’ performance, with a regression coefficient value of 0.648 and a significance level of 0.000. Furthermore, authentic leadership indirectly influences hospital service quality through healthcare workers’ performance, with an indirect effect value of 0.521. These findings indicate that leaders who demonstrate honesty, transparency, integrity, and interpersonal support are able to create a healthy work environment that enhances healthcare workers’ motivation, responsibility, and professionalism. Consequently, improved employee performance contributes to better hospital service quality, particularly in responsiveness, empathy, and communication with patients. This study highlights that authentic leadership is an effective leadership approach for strengthening healthcare human resources and improving hospital service quality in contemporary healthcare organizations.

Background: Acute respiratory infection (ARI) remains a major public health concern, particularly in primary care settings. Lifestyle factors such as dietary patterns and physical activity are increasingly recognized as potential contributors to respiratory health. Objective: This study aimed to examine the association between dietary patterns, physical activity, and ARI among primary care patients in East Halmahera, Indonesia. Methods: A cross-sectional study was conducted at a primary health care facility in East Halmahera, Indonesia, from January to February 2026, involving 106 respondents selected using a total sampling technique. Data were collected using structured questionnaires and medical records. Variables included sociodemographic characteristics, dietary patterns, physical activity, and ARI status. Data were analyzed using descriptive statistics and Chi-square tests with a significance level of p < 0.05. Results: The prevalence of ARI among respondents was 77.4%. Bivariate analysis showed that dietary patterns (p = 0.006) and physical activity (p = 0.015) were significantly associated with ARI. In contrast, age, gender, marital status, education level, employment status, smoking, and alcohol consumption were not significantly associated with ARI (p > 0.05). Conclusion: Dietary patterns and physical activity were significantly associated with ARI among primary care patients in East Halmahera. These findings highlight the importance of lifestyle-related factors in addressing respiratory infections at the primary care level.  

Dengue Hemorrhagic Fever (DHF) remains a major public health problem in Indonesia, particularly in densely populated areas. Control efforts require accurate data and spatial analysis to understand disease distribution patterns. Geographic Information System (GIS) is an effective tool for visualizing case distribution and supporting surveillance and planning of control programs at the primary healthcare level. This study aims to describe the spatial distribution of Dengue cases based on medical record data and produce a geographic distribution map to support Dengue control efforts at the Puskesmas level. This study used a quantitative descriptive design with secondary data from medical records at Karangsari Health Center. The sample consisted of 255 DHF patients in 2025, selected using a total sampling technique. Data were processed through editing, geocoding patient addresses, and spatial analysis using QGIS software.The results showed 255 Dengue  cases in 2025 with fluctuating monthly trends, peaking in April and lowest in December. Case distribution was uneven and tended to cluster. High-risk areas accounted for 15.7%–21.2%, moderate-risk areas 9.8%–15.7%, and low-risk areas 7.1%–9.8%. Megu Cilik Village had the highest proportion of cases, while other villages were categorized as moderate and low risk. This pattern indicates that Dengue incidence is influenced by environmental conditions, vector density, host factors, rainfall, and Aedes aegypti presence. GIS provides clearer spatial visualization, helping identify high-risk areas and supporting targeted public health interventions.

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

Critically ill patients are individuals with unstable health conditions who require close monitoring of hemodynamic parameters. The high mortality rate among critically ill patients treated in intensive care units reaches 36.5% of 33,148 patients. Hemodynamic instability in critically ill patients can be influenced by underlying diseases, medical interventions, as well as physical and psychological stress responses during treatment. Therefore, in addition to pharmacological therapy, non-pharmacological interventions such as Asmaul Husna dhikr therapy are needed, as they can provide a relaxation effect and help stabilize hemodynamic parameters in critically ill patients. To determine the outcomes of the implementation of Asmaul Husna dhikr therapy. This study used a descriptive case study method involving two critically ill patients with unstable non-invasive hemodynamic parameters. Changes in non-invasive hemodynamic parameters were observed in both respondents after the implementation of Asmaul Husna dhikr therapy. In respondent 1, the hemodynamic status was initially categorized as increased and became stable after the intervention. Similarly, in respondent 2, the hemodynamic status changed from increased before the intervention to stable after the intervention. The implementation of Asmaul Husna dhikr therapy can be used as a complementary therapy to help stabilize hemodynamic parameters in critically ill patients.

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.

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.

The premium healthcare industry in urban areas is experiencing increasing competition along with the increase in healthcare facilities and the increasing public demand for fast, comfortable, and quality medical services. In this context, Columbia Asia Pulomas Hospital is implementing an expansion strategy by increasing facility capacity, modernizing services, and adding a Center of Excellence (COE) as a service differentiation. This study aims to analyze customer retention strategies within the Balanced Scorecard (BSC) framework, focusing on the relationship between customer perspectives, internal processes, learning and growth, and their application to the financial perspective. The research method uses a document-based policy and strategy analysis approach, field findings, and a synthesis of Balanced Scorecard theory and patient experience.The analysis shows that customer retention during the expansion phase is influenced not only by clinical quality, but also by the assurance of doctor time in practice, speed of service, physical comfort, and digitization of queues and administration. The addition of a COE has been shown to increase the perception of service value and expand market share through service specialist differentiation. Within the BSC framework, the customer perspective serves as a leading indicator for achieving the financial perspective, where increased patient retention contributes to increased revenue, ROI growth, and long-term financial expectations. The research implications emphasize that strategies for strengthening human resources, modernizing internal processes, and service innovation are important foundations in ensuring successful hospital expansion and enhancing competitive advantage.

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.

Prolonged outpatient waiting time remains a major challenge in public hospitals and reflects inefficiencies in service process management. Internal medicine clinics are characterised by high service complexity and patient volume, making them particularly vulnerable to process waste that contributes to extended waiting times. Objective: This study aimed to develop an outpatient service flow model based on the Lean Hospital approach to reduce waiting time in the internal medicine clinic of RSUD Balaraja. Methods: A qualitative case study design was employed. Data were collected through direct observation of outpatient service processes, document review, and Focus Group Discussions (FGD) with relevant stakeholders. Process analysis was conducted using Value Stream Mapping (VSM) to identify value-added and non–value-added activities, while Fishbone Diagram analysis was applied to explore the root causes of process inefficiencies. All findings were integrated to develop a future-state outpatient service flow model. Results: The findings indicate that prolonged outpatient waiting time is primarily influenced by inefficient service flow design, repetitive administrative processes, and weak coordination among service units. The proposed service flow model demonstrates a more streamlined, integrated, and patient-centred process, with potential reductions in waiting time through systematic waste elimination and process improvement. Conclusion: The Lean Hospital approach provides an effective framework for developing outpatient service flow models in public hospitals. The proposed model offers a practical basis for improving outpatient service efficiency in complex clinical settings such as internal medicine clinics.

Supraventricular tachycardia (SVT) is one of the most common arrhythmias in the pediatric population, often resulting from re-entry mechanisms involving accessory pathways or dual atrioventricular nodal physiology. Although generally well tolerated in children with structurally normal hearts, its management can be challenging, particularly in recurrent or persistent cases. This study is a case report describing a pediatric patient with hemodynamically stable SVT treated at Dr. Wahidin Sudirohusodo Hospital. Data were collected retrospectively from medical records, including history taking, physical examination, and supporting investigations such as serial electrocardiography (ECG), laboratory tests, chest radiography, and transthoracic echocardiography. Management was conducted according to current clinical guidelines, including vagal maneuvers, pharmacological therapy with beta-blockers and antiarrhythmic agents (amiodarone), and monitoring of treatment response based on clinical evaluation and ECG, along with identification and treatment of underlying triggers. We report a case of a 10-year-old female presenting with suspected SVT and pericarditis, who experienced episodes of narrow QRS complex tachycardia that were successfully converted to sinus rhythm following amiodarone administration. Echocardiographic evaluation revealed mild to moderate tricuspid regurgitation with preserved ventricular function. Laboratory and radiological findings suggested an underlying inflammatory process, which was considered a triggering factor. This case highlights the importance of a comprehensive approach in the diagnosis and management of pediatric SVT, including addressing underlying conditions and ensuring continuous monitoring to prevent recurrence.

Hypertension is a non-communicable disease often referred to as a silent killer because it generally does not present noticeable symptoms. Several risk factors contribute to the development of hypertension, including high body mass index (BMI) and low levels of physical activity. However, data regarding the association between BMI, physical activity, and hypertension at Pakuan Baru Public Health Center, Jambi City, remain limited. Therefore, this study aimed to determine the relationship between body mass index and physical activity with hypertension among adults at Pakuan Baru Public Health Center, Jambi City. This study employed a quantitative approach with a cross-sectional design. The research was conducted at Pakuan Baru Public Health Center, Jambi City, from November 19 to December 6, 2025. The study population consisted of all adult patients with hypertension at Pakuan Baru Public Health Center, totaling 2,797 individuals. A sample of 93 respondents was selected using an accidental sampling technique. Data were collected using observation sheets through measurements of height and weight to calculate BMI, as well as the Global Physical Activity Questionnaire (GPAQ). Data analysis was performed using univariate and bivariate analyses with the chi-square statistical test. The univariate analysis showed that 27 respondents (29.0%) were classified as severely obese, 42 respondents (45.2%) had a low level of physical activity, and 28 respondents (30.1%) were categorized as having stage 2 hypertension at Pakuan Baru Public Health Center, Jambi City. The bivariate analysis revealed a significant relationship between body mass index and physical activity with blood pressure among patients with hypertension (p = 0.000). It is expected that healthcare providers at Pakuan Baru Public Health Center will continue to provide education regarding the importance of controlling body mass index and engaging in regular physical activity, as these factors contribute to increased blood pressure among patients with hypertension.

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).

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.