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Stroke is a neurological disorder caused by impaired blood flow to the brain, resulting in brain tissue damage and various functional impairments. One of the common problems experienced by stroke patients is sleep disturbance, which may be influenced by neurological deficits, limited physical mobility, pain, and post-stroke anxiety. Persistent sleep disturbances can delay the recovery process and reduce patients’ quality of life. The long-term use of sleeping medications may lead to adverse effects; therefore, safe and easily applicable complementary therapies are needed. This study aimed to determine the effectiveness of peppermint oil aromatherapy in improving sleep quality among stroke patients in the working area of Barebbo Community Health Center, Bone Regency. The method used was the implementation of complementary therapy through the administration of peppermint oil aromatherapy to stroke patients experiencing sleep disturbances. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) before and after the intervention. The assessment results showed that before the intervention, patients experienced poor sleep quality, characterized by difficulty initiating sleep, frequent nighttime awakenings, insufficient sleep duration, and daytime fatigue. After receiving peppermint oil aromatherapy, patients demonstrated increased comfort, reduced anxiety, improved ability to initiate sleep, and better overall sleep quality compared to their condition before the intervention. Therefore, peppermint oil aromatherapy was found to be effective in improving sleep quality among stroke patients and can be used as a complementary non-pharmacological intervention in nursing care.

Aerobic capacity, commonly measured by maximal oxygen uptake (VO₂max), is a key indicator of physical fitness and athletic performance, particularly in endurance sports. Recent attention has focused on the role of respiratory muscle function in supporting exercise performance, as respiratory muscle fatigue during high-intensity or prolonged activity may reduce ventilatory efficiency and exercise tolerance. This literature review aims to examine current evidence regarding the effects of Respiratory Muscle Training (RMT), including Inspiratory Muscle Training (IMT), on aerobic capacity in athletes. Relevant studies were identified through electronic databases such as PubMed, Scopus, and Google Scholar using keywords related to respiratory muscle training, VO₂max, and athletes. The reviewed studies generally reported improvements in inspiratory muscle strength, reduced respiratory muscle fatigue, and enhanced ventilatory efficiency following RMT interventions. These physiological adaptations may contribute to better exercise tolerance and overall athletic performance. However, evidence regarding direct improvements in VO₂max remains inconsistent across studies. The findings suggest that RMT can be used as a complementary strategy alongside conventional training programs to support aerobic performance. In addition, improved respiratory muscle function may provide benefits in health promotion and rehabilitation by reducing dyspnea and increasing exercise tolerance. Further well-designed studies are needed to clarify the extent of RMT’s contribution to improving VO₂max in athletic populations.

Aerobic capacity, commonly measured by maximal oxygen uptake (VO₂max), is a key indicator of physical fitness and athletic performance, particularly in endurance sports. Recent attention has focused on the role of respiratory muscle function in supporting exercise performance, as respiratory muscle fatigue during high-intensity or prolonged activity may reduce ventilatory efficiency and exercise tolerance. This literature review aims to examine current evidence regarding the effects of Respiratory Muscle Training (RMT), including Inspiratory Muscle Training (IMT), on aerobic capacity in athletes. Relevant studies were identified through electronic databases such as PubMed, Scopus, and Google Scholar using keywords related to respiratory muscle training, VO₂max, and athletes. The reviewed studies generally reported improvements in inspiratory muscle strength, reduced respiratory muscle fatigue, and enhanced ventilatory efficiency following RMT interventions. These physiological adaptations may contribute to better exercise tolerance and overall athletic performance. However, evidence regarding direct improvements in VO₂max remains inconsistent across studies. The findings suggest that RMT can be used as a complementary strategy alongside conventional training programs to support aerobic performance. In addition, improved respiratory muscle function may provide benefits in health promotion and rehabilitation by reducing dyspnea and increasing exercise tolerance. Further well-designed studies are needed to clarify the extent of RMT’s contribution to improving VO₂max in athletic populations.

Diabetes mellitus (DM) is a chronic metabolic disease characterized by elevated blood glucose levels due to insufficient insulin production or ineffective insulin utilization. The prevalence of DM in Indonesia reached 11.7% in the 2023 National Health Survey, with Brebes Regency recording 568 DM cases in 2025 and increasing to 157 cases in Tonjong Village in January 2026. This case study aims to describe comprehensive nursing care for Ny. M, a 52-year-old patient diagnosed with endocrine system disorder (diabetes mellitus), in the family of Tn. I at Karang Anyar Village, Tonjong District, Brebes Regency. The method used was a case study with data collection through interview, observation, physical examination, blood glucose measurement, and literature review conducted on December 26–28, 2025. The assessment found subjective data: the patient frequently felt fatigue, tingling in both legs, excessive thirst, and increased urination frequency. Objective data: pale and fatigued face, blood pressure 150/100 mmHg, pulse 95x/min, respiration 22x/min, temperature 36.7°C, and random blood glucose (RBG) 155 mg/dl. Two nursing diagnoses were established: blood glucose instability and readiness for enhanced knowledge. Interventions implemented included hyperglycemia management (monitoring blood glucose, dietary education, complementary herbal therapy with ginger and honey), and health education regarding DM complications. Evaluation results showed that after 2 days of nursing visits, fatigue decreased, blood glucose improved (RBG 130 mg/dl), and the patient's knowledge about DM complications was resolved.

Background: Congestive Heart Failure (CHF) is a condition characterized by the inability of the heart to pump blood optimally, resulting in the accumulation of fluid in the lungs and other organs. This condition frequently causes ineffective airway clearance due to hypersecretion of the airway. Objective: This study aims to describe the comprehensive nursing care provided to Ny. R with Cardiovascular System Disorder: Congestive Heart Failure (CHF) with the main nursing problem of ineffective airway clearance at the Melati Ward of RSUD Banyumas. Method: This study used a descriptive method through a case study approach. Data were collected through interviews, physical examination, observation, and documentation. Results: Two nursing diagnoses were identified: (1) ineffective airway clearance related to airway hypersecretion, and (2) activity intolerance related to an imbalance between oxygen supply and demand. Nursing interventions included airway management and energy management. After two days of implementation (January 27–28, 2026), the first diagnosis was resolved and the second was partially resolved, with continued interventions recommended including monitoring of physical and emotional fatigue, advising bed rest, and monitoring vital signs. Conclusion: Comprehensive nursing care with appropriate interventions can effectively address ineffective airway clearance in CHF patients.

This study aims to analyze the effect of homework load and extended study hours on students’ learning stress levels. The background of this research is based on increasing academic demands that may affect students’ psychological conditions. This study employs a qualitative approach with data collected through observation and interviews. The results indicate that excessive homework load and prolonged study duration significantly contribute to higher levels of learning stress. Students tend to experience physical and mental fatigue, decreased motivation, and difficulty managing time between study and rest. In addition, pressure to achieve high academic performance further exacerbates stress levels. Other factors such as lack of environmental support and less varied teaching methods also influence students’ stress. Furthermore, students often report feelings of anxiety and emotional exhaustion when academic tasks accumulate without adequate rest periods. This condition not only affects their psychological well-being but also reduces concentration and learning effectiveness in the classroom. Therefore, balanced learning load management, appropriate task distribution, and more effective and humanistic teaching strategies are needed to reduce learning stress and improve the quality of education. Schools and educators are encouraged to consider students’ cognitive capacity and mental health in designing assignments and study schedules to create a more supportive learning environment.

Introduction: Congestive Heart Failure (CHF) is a complex clinical syndrome caused by the inability of the heart to pump blood adequately to meet the body's metabolic demands. This condition may result in dyspnea, edema, activity intolerance, fatigue, and reduced quality of life. Comprehensive nursing care is essential to address patients' needs and improve health outcomes. Methods: This study employed a descriptive case study approach. Data were collected through interviews, observation, physical examination, and medical record review. Nursing care was provided using the nursing process, including assessment, nursing diagnosis, planning, implementation, and evaluation. Results: The assessment of Mrs. T identified four nursing diagnoses: ineffective breathing pattern, hypervolemia, activity intolerance, and knowledge deficit. Nursing interventions included semi-Fowler positioning, fluid balance monitoring, passive Range of Motion (ROM) exercises, and health education. Following two days of nursing implementation, three nursing diagnoses were resolved, namely ineffective breathing pattern, activity intolerance, and knowledge deficit. Hypervolemia was partially resolved due to persistent fluid imbalance. Discussion: The findings indicate that the application of systematic nursing care can improve several clinical problems experienced by CHF patients. However, fluid balance management remains a challenge, highlighting the importance of patient adherence to fluid restriction and continuous monitoring to prevent worsening symptoms.

Congestive Heart Failure (CHF) is a condition in which the heart is unable to pump blood adequately to meet the metabolic needs of the body. CHF is one of the most prevalent cardiovascular disorders globally, nationally, and locally, contributing to significant morbidity and mortality. This study aims to describe a comprehensive nursing care process applied to a patient (Mr. R) diagnosed with CHF at the Mawar 1 Ward of RSUD dr. Soeselo, Tegal Regency. This study used a descriptive case study design. Data were collected through interviews, physical examination, observation, and medical record documentation on February 9–11, 2026. Three nursing diagnoses were identified: ineffective airway clearance related to airway hypersecretion, fatigue related to physiological conditions (chronic disease), and knowledge deficit related to insufficient information exposure. Nursing interventions applied included airway management (semi-Fowler positioning, oxygen therapy, effective coughing technique), energy management (range-of-motion exercise, gradual activity), and health education about CHF. After 2×24 hours of nursing care, all three nursing diagnoses were resolved: airway clearance improved (SpO₂ increased from 91% to 95%, respiratory rate decreased from 28 to 23 times/minute), fatigue decreased, and patient knowledge about CHF improved. Systematic nursing care significantly improved the patient's condition in CHF management.

Diabetes Mellitus Type II is a chronic metabolic disease characterized by elevated blood glucose levels due to insulin resistance and impaired insulin secretion. Globally, the number of people with diabetes in 2024 is estimated to reach 800 million, with more than 95% being Type II Diabetes Mellitus. At RSUD Prof. M. Yamin, SH Pariaman in 2025, there were 189 recorded cases of Type II Diabetes Mellitus without complications. The purpose of this scientific paper is to provide nursing care to a patient with Type II Diabetes Mellitus in the Internal Medicine Ward of RSUD Prof. M. Yamin, SH Pariaman. The method used is a case study with a nursing process approach, including observation, interviews, physical examination, and data collection from medical records. This study was conducted in the internal ward for 5 days, from February 6, 2026 to February 10, 2026, with the subject Mrs. N. The assessment results identified nine nursing problems: unstable blood glucose levels, acute pain, impaired skin/tissue integrity, ineffective peripheral perfusion, impaired physical mobility, sleep pattern disturbance, fatigue, risk of infection, and risk of nutritional deficit. The evaluation after 5 days of nursing care showed that five diagnoses were resolved, namely unstable blood glucose levels, ineffective peripheral perfusion, fatigue, risk of infection, and risk of nutritional deficit. Meanwhile, the other four diagnoses were not fully resolved but showed improvement. It is expected that the patient and family will maintain adherence to a healthy lifestyle, therapy, diet, and regular follow-up in order to prevent complications.

Education is the main driver of a nation's progress, which is not only related to intellectual intelligence, but also the formation of student character. Unfortunately, currently the world of education is facing serious problems, such as declining interest in learning and increasingly complex external factors in the digital era. This study aims to explore in depth the impact of learning motivation on student academic achievement, identifying obstacles that hinder this achievement. The method used in the current study is a literature study with a qualitative approach. Data were collected through theoretical studies and analysis of various relevant scientific sources, including research journals and textbooks, which were then combined to develop a comprehensive argument. The findings of this study indicate that learning motivation is the main factor that encourages student persistence and consistency in achieving the best learning. Academic success is defined as the result of a complex interaction between internal and external factors, where the existence of a supporting ecosystem such as good learning facilities, a supportive environment, and effective communication between lecturers and students plays a very important role. On the other hand, phenomena such as digital fatigue, low independence, and excessive workload are identified as significant barriers that can reduce academic performance. This analysis concludes that there is synergy in strengthening psychological aspects and creating an adaptable learning environment to maintain the stability of academic achievement amidst global demands.

This study aims to explore the phenomenon of using a second Instagram account among Generation Z as a strategy for impression management and privacy protection. Amidst the dominance of a culture of show-off and hegemonic aesthetic standards on primary accounts, Generation Z tends to experience aesthetic fatigue and social pressure due to scrutiny from diverse audiences (context collapse). Using Erving Goffman's Dramaturgy theory, this study examines how individuals construct distinct identities on the front stage and back stage. The research method used is descriptive qualitative. Data were collected through in-depth interviews with five Generation Z informants who have multiple accounts, as well as passive participant observation of their digital activities. The sampling technique used was purposive sampling, while data analysis followed the Miles and Huberman model, which includes data reduction, data presentation, and drawing conclusions. The results show that the primary account functions as a highly curated front stage to maintain professional and social reputations. Conversely, the second account functions as a back stage that allows Generation Z to engage in emotional catharsis, honest self-disclosure, and identity experimentation through unique names (pseudonyms). The use of a second account is a strategic response to reclaim personal authority over their life narratives from the pressure of algorithms and public judgment. The study concludes that second accounts are not just a technological trend, but rather a self-defense mechanism for Generation Z to maintain authentic space and maintain mental health amidst massive digital transparency.

Nurse workload is the total number or volume of tasks that must be completed by nurses during their professional practice in hospitals, including both physical and mental responsibilities in providing nursing care to patients. Meanwhile, nurse burnout is a condition of emotional and mental fatigue experienced by nurses due to prolonged work pressure and the high intensity of emotional demands in the hospital environment. However, workload problems are still commonly found in hospitals, with one of the main contributing factors being work stress caused by excessive job demands and continuous pressure during work activities. The population in this study were outpatient, inpatient and emergency nurses at Ibnu Sina Islamic Hospital, Bukittinggi in 2025 This study used a quantitative method with a cross-sectional approach, analyzing the relationship between one variable and another. This study had 130 samples consisting of outpatient nurses, inpatient nurses, and emergency room nurses. Sampling was carried out using a total sampling technique. The results of this study indicate a significant relationship between workload and burnout at a significance level of 0.00 (≤ 0.05). There is a significant relationship between workload and nurse fatigue at Ibnu Sina Islamic Hospital Bukittinggi in 2025.

Abstract. This study aims to describe students’ motivation toward online learning at Universitas Negeri Medan and to identify the underlying reasons for such motivation. The research employed a descriptive qualitative design, utilizing the ARCS (Attention, Relevance, Confidence, Satisfaction) motivational model and Expectancy-Value Theory as the theoretical frameworks. Data were collected through an online questionnaire distributed to 34 English Education students and semi-structured interviews with 5 purposively selected participants. The results indicated that all four components of the ARCS model were in the moderate category, with mean scores of 3.16 for Attention, 3.29 for Relevance, 3.20 for Confidence and 3.20 for Satisfaction. While students appreciated the flexibility and accessibility of online materials (high utility value), they frequently experienced boredom and mental fatigue due to limited social interaction and the "artificial" nature of screen based learning (high cost and low intrinsic value). The study concludes that students remain motivated primarily due to professional aspirations rather than engaging instructional designs. These findings suggest that educators should implement more interactive strategies to enhance student engagement in digital environments.

This study aims to examine the impact of academic burnout on students’ mental health in the context of hybrid learning through a literature review approach. The rapid transformation of learning systems in higher education, particularly the integration of online and offline methods, has increased academic demands and adaptation challenges for students. This condition potentially triggers academic burnout, which is characterized by emotional exhaustion, depersonalization, and decreased academic achievement. This research employs a literature review method by analyzing relevant scientific articles published between 2019-2025 obtained from indexed national journals and open-access sources. The findings indicate that academic burnout is still commonly experienced by students, generally at a moderate level, and has a significant impact on mental health, including increased stress, emotional fatigue, and decreased academic performance. The study also identifies several influencing factors, including internal factors such as self-efficacy and hardiness, as well as external factors such as social support, learning environment, and academic workload. Furthermore, technological developments, particularly Artificial Intelligence, have the potential to be utilized as an early detection and prevention tool for academic burnout. This study implies the importance of developing adaptive learning strategies and psychological interventions to support students’ well-being in hybrid learning environments.

Industrial hygiene management plays a critical role in protecting worker health by controlling exposure to hazardous factors in the workplace. However, many work environments still show suboptimal implementation, leading to increased risks of occupational diseases. This study aims to analyze the implementation of industrial hygiene management systems in improving worker health based on a literature review approach. The method used is a literature review by collecting and analyzing scientific articles from national databases published between 2021 and 2026. A total of ten relevant articles were selected through a systematic screening process based on predefined inclusion criteria. The findings indicate that workplace hazards such as physical, chemical, and ergonomic factors are significantly associated with various health problems, including respiratory disorders, musculoskeletal issues, and work-related fatigue. The implementation of industrial hygiene management systems, including hazard identification, risk control measures, use of personal protective equipment, and environmental monitoring, has been shown to reduce health risks among workers. However, the effectiveness of implementation is influenced by factors such as worker compliance, management commitment, and availability of facilities. These results highlight the importance of a comprehensive and systematic approach to industrial hygiene in maintaining worker health and preventing occupational diseases. Therefore, strengthening the implementation of industrial hygiene management systems is essential to create a safe and healthy working environment and to support sustainable occupational health practices.

Irregular sleep patterns are a common issue experienced by university students and are often considered a normal part of academic life. However, such conditions can have negative effects on students’ learning concentration and cognitive function. Poor sleep patterns are generally influenced by various factors, including high academic workload, habitual late-night activities, poor time management, and excessive use of electronic devices at night. This study aims to examine the relationship between sleep patterns and students’ learning concentration, identify factors contributing to irregular sleep patterns, and analyze constraints as well as propose solutions to improve sleep quality in order to enhance learning concentration. The method used in this scientific paper is a literature review, which involves examining relevant scientific sources such as research journals and academic literature related to sleep patterns and students’ learning concentration. The results of the review indicate that students with poor sleep patterns tend to experience physical fatigue, decreased immune function, cognitive impairment, and difficulties in maintaining focus and concentration during the learning process. In the long term, these conditions have the potential to reduce academic achievement and learning motivation. Therefore, it can be concluded that effective time management, limiting the use of electronic devices before bedtime, creating a conducive sleep environment, and support from universities through health education play an important role in improving students’ sleep patterns. With regular and high-quality sleep, students’ learning concentration is expected to improve, allowing the learning process and academic achievement to proceed optimally.

This case report examines the effectiveness of a combined pulmonary rehabilitation and musculoskeletal physiotherapy program for a 26-year-old male post-pulmonary tuberculosis patient with lumbar tuberculous spondylitis. The patient, who had completed anti-tuberculosis treatment, presented with low back pain, shortness of breath, fatigue, and limited mobility. Spirometry indicated severe restrictive ventilatory impairment (FVC 1.28 L, 32% of predicted), and lower extremity muscle strength was reduced (MMT 2-3/5). The patient used a TLSO brace and walking aid. Over a three-week physiotherapy program, the patient participated in breathing exercises, spinal mobilization, muscle strengthening, functional exercises, and education on brace use. Evaluation occurred at the first, second, and third weeks. After treatment, pain intensity decreased from VAS 6 to VAS 3, FVC improved to 1.72 L, chest expansion increased, muscle strength improved to MMT 4/5, and performance on the Five-Times Sit-to-Stand Test showed progress. The Functional Independence Measure (FIM) score increased from 98 to 115, reflecting improved functional independence. These findings suggest that the combination of pulmonary and musculoskeletal physiotherapy effectively improved respiratory function, muscle strength, and the patient’s overall functional capacity.

This study analyzes visual signs in the Charlie Chaplin animations Safari at The Park and The King in The Ring using Charles Sanders Peirce’s semiotic framework, focusing on icons, indexes, and symbols. Film and animation communicate meaning through visual elements such as gestures, facial expressions, movements, and character interactions, making them rich for semiotic analysis. Using a descriptive qualitative method, the research identified and categorized visual signs in both animations. Results show that icons, which resemble real-world objects, dominate by establishing story settings natural safari environments in one animation and competitive boxing arenas in the other. Indexes reveal cause-and-effect relationships, demonstrating how gestures, expressions, and actions convey danger, fatigue, or emotional shifts. Symbols convey conventional or cultural meanings, such as Charlie Chaplin’s bowler hat and cane representing his comedic identity, a championship belt symbolizing victory, or a rose indicating affection. While both animations use the same types of signs, the intensity and focus vary with the narrative context: Safari at The Park emphasizes situational and natural elements, whereas The King in The Ring highlights competition and emotional reactions. This study confirms that Peirce’s triadic model effectively explains how meaning is constructed in animation through dynamic visual communication.

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

Heart failure is a clinical syndrome characterized by shortness of breath and fatigue resulting from structural or functional abnormalities of the heart.  Acute Decompensated Heart Failure (ADHF), also known as decompensated heart failure, is a condition of worsening chronic heart failure that can occur acutely, subacutely, or insidiously, with symptoms progressively worsening over several days or weeks. A 1-year-old male patient presented to the Dermatology Clinic at Cut Meutia General Hospital with the chief complaint of A 60-year-old female patient was brought to the Cut Meutia Emergency Department with the complaint of shortness of breath that had worsened 1 day prior to admission; the shortness of breath worsened during light activity and when the patient was lying down. She also complained of swelling in both legs for one week prior to admission, which had progressively worsened. On examination, skin turgor was slow to return in the left and right lower extremities; palpation of the neck revealed jugular vein distension. Inspection showed a normal chest contour; auscultation of the lungs revealed rhonchi. Cardiac percussion revealed enlargement of the upper, left, and right borders of the heart, as well as the cardiac border at the level of the waist. Auscultation revealed a murmur at the fourth intercostal space on the left side. Examination of the lower extremities revealed pitting edema on both the left and right sides.  Supportive X-ray examination revealed severe cardiomegaly. An ECG revealed sinus rhythm, an irregular rate of 80 beats per minute, LAD axis, P wave not identifiable, PR interval 0.20 seconds, QRS complex 0.6 seconds, inverted T waves in I and AVL, LVH (+), RVH (-), PVCs, AF, and lateral ischemia. Echocardiography revealed severe aortic stenosis due to RHD and an LVEF of 21%. The patient has been prescribed furosemide, warfarin, bisoprolol, and spironolactone.