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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.

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.

Thalassemia is a chronic genetic disease that requires long-term treatment and affects children's quality of life physically, psychologically, socially, and academically due to chronic anemia and regular blood transfusion needs. This study aimed to determine factors influencing the quality of life of children with thalassemia at Rumah Sakit Anak dan Bunda Harapan Kita. A descriptive design with a cross sectional approach was used, involving 41 respondents through total sampling. Data were collected using the Pediatric Quality of Life Inventory (PedsQL 4.0 Generic Core Scale) and respondent characteristics including age, gender, socioeconomic status, parental education, and frequency of blood transfusions. Data were analyzed using univariate and bivariate analysis with the Chi-Square test. The results showed most respondents were under ten years old, female, from families with socioeconomic status below the minimum wage, had parents with high school or higher education, and received blood transfusions every three weeks. Bivariate analysis indicated only the frequency of blood transfusions was significantly associated with quality of life, while other variables were not. Thus, transfusion frequency is the main factor influencing quality of life in children with thalassemia.

This study is intended to analyze the implementation of the value for money approach in assessing financial performance at RSUD Kota Tangerang during the period of 2022–2024. The research employs a descriptive quantitative approach using secondary data derived from budget realization reports. This analysis carried out using three main ratios: economy, efficiency, and effectiveness. The findings show that the hospital’s financial performance is categorized as economical, as reflected by economy ratios under 100% throughout the observed year. In terms of effectiveness, performance was considered effective in 2022 and 2023 but declined in 2024, indicating that the revenue target was not fully achieved. Meanwhile, efficiency performance remains suboptimal, as efficiency ratios exceed 100%, suggesting that the costs incurred are higher than the revenue generated. Overall, the hospital demonstrates the ability to manage its budget economically and achieve revenue targets, but still faces challenges in improving resource efficiency. Therefore, efforts are needed to optimize cost management and enhance service productivity to achieve a balance among economy, efficiency, and effectiveness in line with the value for money principles.

This regulation, which requires all healthcare facilities to implement EMR by December 31, 2023, stemmed from the emergence of Health Ministerial Regulation No. 24 of 2022. Santosa Hospital, Bandung Kopo, has implemented EMR, but no research has been conducted on it. This study aimed to determine the effect of EMR implementation on service quality in the emergency unit at Santosa Hospital, Bandung Kopo. The research methods used were descriptive verification analysis and multiple linear regression analysis. Data collection used a questionnaire distributed to all emergency unit staff. The results of the descriptive analysis were generally considered very good. The results of the verification analysis, both partially, showed a negative and insignificant effect on system quality and service quality, while information quality and use statistics showed a positive and significant effect. Simultaneously, these positive and significant effects were proven, and the researchers recommend maintaining and further improving them.

Meningitis is a serious infectious disease that can be prevented through vaccination; however, the vaccination process often causes anxiety in patients, especially during the pre-procedure phase. Uncontrolled anxiety can affect patient readiness and comfort. Therapeutic communication by nurses is one intervention that has the potential to reduce this level of anxiety. This study aims to determine the relationship between nurses’ therapeutic communication and the anxiety levels of patients prior to meningitis vaccination at Pambalah Batung Amuntai Regional General Hospital. This study used a quantitative analytic design with a cross-sectional approach. The sample consisted of 107 respondents selected using a convenience sampling technique. Data on therapeutic communication were collected using an observation sheet, while anxiety levels were measured using the DASS questionnaire (anxiety subscale). Data analysis was conducted using univariate and bivariate methods with the Chi-Square test at a significance level of 0.05. The results showed that most therapeutic communication was in the good category, and patient anxiety levels were predominantly in the normal category. Statistical test results indicated a significant relationship between nurses’ therapeutic communication and patient anxiety levels (p = 0.000 < 0.05). The better the therapeutic communication provided, the lower the patient’s anxiety level. In conclusion, nurses’ therapeutic communication plays an important role in reducing patient anxiety prior to meningitis vaccination and needs to be optimized in nursing practice.

Turbinate hypertrophy is a condition characterized by abnormal enlargement of the nasal turbinate mucosa, which can lead to chronic nasal obstruction and decreased quality of life. This condition is associated with inflammatory processes in which eosinophils play a role as part of the immune response. This study aimed to determine the relationship between eosinophil levels and the degree of turbinate hypertrophy based on blood examination in hospitalized patients. This research used an observational analytic design with a cross-sectional approach involving 40 patients diagnosed with turbinate hypertrophy at Cut Meutia General Hospital, North Aceh. Data were obtained from medical records, including patient characteristics, eosinophil levels, and the degree of turbinate hypertrophy. The results showed that most patients were aged 17–25 years, predominantly female, and commonly had non-allergic underlying conditions. The majority of patients had normal eosinophil levels (80%), while most cases were classified as grade III turbinate hypertrophy (65%). Statistical analysis using Fisher’s Exact Test demonstrated no significant relationship between eosinophil levels and the degree of turbinate hypertrophy (p>0.05). These findings suggest that eosinophil levels may not be a reliable indicator in assessing the severity of turbinate hypertrophy, particularly in patients with non-allergic conditions. This study highlights the need to consider other contributing factors in the evaluation and management of turbinate hypertrophy to improve diagnostic accuracy and treatment outcomes.

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.

The implementation of Hospital Management Information Systems (HMIS) has become a strategic imperative to enhance operational efficiency amidst the ongoing global digital health transformation era. This study aims to analyze the determinants of successful HMIS implementation and its impact on service efficiency and patient outcome quality. Employing a narrative review approach with thematic synthesis of literature from PubMed, Scopus, and ScienceDirect databases between 2016-2026, the study evaluates the relationship between technology investment and organizational performance. The synthesis results indicate that while HMIS significantly reduces administrative burdens and medication errors, a "digital paradox" exists where technical efficiency may disrupt interpersonal interactions between healthcare providers and patients if systems are not user-centered. Key success factors include data interoperability (HL7/FHIR standards), human resource readiness, and governance policy support. This study concludes that a patient-centered efficiency model is the fundamental basis for ensuring technology investments yield sustainable added value within the healthcare delivery system.

This study examines the importance of legal protection for healthcare workers in medical services, particularly in the Central Surgical Installation of the Regional General Hospital of Mataram City, which involves high medical risks. The background of this research is based on the increasing potential for medical disputes and the vulnerability of healthcare workers to legal claims due to discrepancies between medical outcomes and patient expectations. The objective of this study is to analyze the implementation of legal protection and identify the challenges faced in practice. The research employs a descriptive method with a qualitative approach, utilizing interviews, observations, and documentation studies. The findings indicate that legal protection has been implemented through standard operating procedures, informed consent, and internal hospital policies in accordance with applicable laws and regulations. However, its implementation remains suboptimal due to several constraints, including limited legal awareness among healthcare workers, inadequate legal assistance systems, and increasing public demands. The study implies the need to enhance legal education for healthcare workers and strengthen the role of hospitals in providing effective legal protection to support professional and safe healthcare services.

Tuberculosis (TB) remains a significant health issue in Indonesia, with the number of cases not showing a decline. Pediatric pulmonary tuberculosis is one of the leading causes of morbidity and mortality. In 2018, the number of TB cases in Aceh reached 41,595, with Aceh Utara having the highest number at 4,819 cases, followed by Bireuen with 3,636 cases, while Sabang recorded the lowest at 272 cases. The primary risk factor for pulmonary tuberculosis in children is a history of contact with adult TB patients, as children's immune systems are still weak, allowing the bacteria to enter their bodies easily. This study aims to examine the history of TB contact in children at the Pediatric Clinic of Cut Meutia General Hospital. The research used a descriptive observational design, with 105 respondents, and data was collected from medical records. The results showed that the majority of respondents were toddlers (47.6%), most were male (54.3%), and 58.1% had good nutritional status. A significant percentage of respondents (77.1%) had a history of contact with TB patients, and 83.8% did not receive BCG vaccination. These findings highlight that contact with TB patients is a key factor in the transmission to children.

Work motivation is one of the important factors influencing time management and nurses’ performance in providing nursing care. Good time management enables nurses to complete tasks in a timely, efficient, and effective manner. This study was conducted to determine the relationship between work motivation and time management among staff nurses at ML Hospital in 2025. This research used a quantitative approach with a cross-sectional design. A total of 40 staff nurses were selected using a total sampling technique. The instruments used were questionnaires on work motivation and time management. Data were analyzed using the Spearman Rank statistical test with a significance level of < 0.05. The results showed that most respondents had good work motivation (62.5%), while the majority demonstrated a moderate level of time management (75%). The Spearman Rank test yielded a p-value of 0.005, indicating a significant relationship between work motivation and time management among staff nurses. In conclusion, there is a significant relationship between nurses’ work motivation and time management, in which higher work motivation is associated with better time management. It is recommended that hospitals enhance nurses’ motivation through managerial support and a positive work environment.

Hospitals often face difficulties in determining patient treatment priorities due to limited medical resources and the uncertainty of patient conditions. Conventional prioritization methods tend to rely on subjective judgment, which can lead to inconsistent decisions and delays in treatment. This study aims to apply fuzzy logic in a decision support system to determine patient priority levels more objectively and systematically. The proposed method utilizes a fuzzy inference system that processes several criteria, including the severity of symptoms, vital signs, patient age, and waiting time. These criteria are represented as fuzzy sets and evaluated using a set of inference rules to generate priority classifications. The results indicate that the fuzzy logic–based system is able to classify patient priorities more consistently and transparently compared to manual assessment. The system provides clear priority categories that can support medical staff in making faster and more accurate decisions. The findings imply that the implementation of fuzzy logic in hospital decision support systems can improve the quality of healthcare services, enhance fairness in patient handling, and optimize the allocation of medical resources, particularly in emergency and high-demand situations.

Expressive feelings therapy is a form of mental health nursing modality therapy that aims to help individuals express their thoughts and emotions openly without violating the rights of others. This study aims to explore the effectiveness of cognitive therapy focused on “expressing feelings” in improving emotional expression abilities among female patients in the recovery phase at the Anggrek Ward of the Aceh Government Mental Hospital. This descriptive qualitative study was conducted through group therapy activities with structured stages, using media such as emotion expression picture cards and a spin-the-bottle game as interaction stimuli. The population consisted of 18 patient in the Anggrek ward, with a sample of 12 patients who were cooperative, psychologically stable, able to communicate bidirectionally, and willing to participate in group therapy. The results showed that participants experienced an improvement in their ability to express emotions such as happiness, sadness, anger, and anxiety more openly, accompanied by increased social interaction and reduced emotional tension. The therapy also encouraged greater self-confidence and a sense of emotional relief. These findings support that expressive feelings therapy can be incorporated as part of routine nursing interventions for patients who experience difficulties in emotional regulation. It is recommended that further research be conducted over a longer duration and with a broader scope to strengthen the validity of the findings.

Penelitian ini membahas kekuatan hukum akta perjanjian kerja sama yang dibuat di bawah tangan antara Rumah Sakit Bethesda Yogyakarta dan Yakes Telkom Area Jawa Tengah–DIY. Perjanjian ini menimbulkan persoalan hukum ketika terjadi wanprestasi berupa keterlambatan penagihan sebesar Rp5.962.000 pada periode Juni–Agustus 2023. Permasalahan yang dikaji meliputi: (1) kekuatan hukum akta bawah tangan dalam perspektif hukum perdata, (2) efektivitas pembuktian akta bawah tangan dibandingkan akta otentik serta implikasinya terhadap penyelesaian sengketa dan (3) perlindungan hukum bagi pihak yang dirugikan. Metode yang digunakan adalah penelitian hukum normatif dengan pendekatan perundang-undangan, konseptual, dan kasus. Data diperoleh dari bahan hukum primer, sekunder, dan tersier, kemudian dianalisis secara kualitatif. Hasil penelitian menunjukkan bahwa akta bawah tangan sah menurut Pasal 1320 KUH Perdata, namun memiliki kelemahan pembuktian karena mudah disangkal dan tidak memiliki kekuatan eksekutorial. Perlindungan hukum tetap tersedia bagi pihak yang dirugikan, tetapi prosesnya lebih kompleks di pengadilan. Kesimpulan penelitian ini menegaskan pentingnya penggunaan akta otentik melalui notaris agar perjanjian kerja sama memperoleh kekuatan pembuktian sempurna, kepastian hukum, serta perlindungan lebih kuat bagi para pihak

Managing Regional Public Service Agency (Badan Layanan Umum Daerah/BLUD) hospitals requires planning and budgeting processes that are accountable, measurable, and aligned with service performance. In practice, BLUD planning is still constrained by fragmented applications (hospital information system/SIMRS, finance, human resources, e-office, and procurement), duplicate data entry, approval delays, and limited monitoring of process compliance. This study aims to analyze requirements and design a web-based BLUD planning information system using an Enterprise Application Integration (EAI) approach through middleware to improve cross-system interoperability, data consistency, and the timeliness of executive reporting. The study adopts the Design Science Research (DSR) framework, comprising problem identification, definition of solution objectives, artifact design and development, demonstration, evaluation, and communication/report writing. The proposed system includes a unit-based budget proposal module and item management, a role-based approval workflow (RBAC) with SLA tracking, a budget ceiling (pagu) master to benchmark proposals, audit trails and report exports, and an executive dashboard integrating budget perspectives, service indicators (e.g., bed occupancy rate/BOR and patient visits), and process compliance. It also provides an integration design via middleware (ESB/message broker) supported by a canonical data model (CDM) and traceable logging (trace_id/correlation_id). Evaluation using black-box testing and API contract testing indicates that the main planning workflow operates as intended and the integration interfaces are consistently defined, providing a foundation for staged implementation and further performance evaluation.

Informed consent constitutes a fundamental legal and ethical requirement in healthcare services, ensuring that every medical action is performed with the patient’s full awareness and voluntary approval. In Indonesia, the obligation to obtain informed consent is firmly regulated under the Health Law No. 17 of 2023, the Minister of Health Regulation on Medical Consent, and provisions on medical records. This paper examines the essential role of informed consent as a protective instrument for both patients and healthcare providers within the clinical and legal framework. Informed consent guarantees patients’ rights to information, autonomy, and decision-making, while providing legal safeguards for medical practitioners by documenting the process of explanation, acceptance, or refusal of medical treatment. Proper documentation within medical records ensures accountability, continuity of care, and serves as crucial evidence when medical disputes arise. Medical disputes often stem from dissatisfaction, communication gaps, or misunderstandings about risks inherent in medical procedures. Therefore, informed consent functions not merely as an administrative requirement but as a mechanism for preventing conflict, clarifying responsibilities, and distinguishing unavoidable medical risks from professional negligence. By strengthening the implementation of informed consent, healthcare providers can enhance transparency, improve service quality, and reduce the likelihood of medical litigation.  

Diabetes mellitus is the second leading cause of death worldwide after cardiovascular disease. This condition causes physical and psychological burdens. Quality of life is influenced by various aspects, including the ongoing special needs of diabetes mellitus patients. Family support is a form of assistance provided by family members to provide physical and psychological comfort when someone is ill. This study aims to determine the relationship between family support and quality of life of diabetes mellitus patients at Santa Elisabeth Hospital Medan in 2024. This type of research is quantitative with a correlational design and a cross-sectional approach. The sampling technique used purposive sampling with a sample size of 80 respondents. Inclusion criteria included patients who had been diagnosed with diabetes mellitus for more than one year, were accompanied by their family, and were able to communicate in Indonesian. Data collection was conducted using the HDFSS questionnaire and the DQOL questionnaire. The results showed high family support and a high quality of life for diabetes mellitus patients. The Spearman statistical test produced a p-value of 0.048 and a correlation of 0.222. Thus, there is a positive relationship between family support and quality of life for diabetes mellitus patients. This means that the higher the family support, the better the patient's quality of life. Based on the results of this study, hospitals are advised to provide education regarding the importance of family support in influencing the quality of life of diabetes mellitus patients.

Healthcare Associated Infections (HAIs) are serious occurrences and problems that are often found in all hospital facilities. HAIs cause extended hospitalization, permanent disability, increased treatment costs, and death. Hand Hygiene has an important role in the prevention and control of HAIs. This study aims to see the compliance of nurses' hand hygiene and nurses' knowledge of healthcare associated infections (HAIs) in the intensive care unit of Santa Elisabeth Hospital Medan in 2024. The type of research design used was descriptive with a sampling technique using a total of 31 respondents. Based on the results of the study, it was found that most nurses were obedient in carrying out hand hygiene (83.9%) and knowledge that is about the prevention of HAIs was found to be a large number of nurses who had high knowledge (67.7%). It is hoped that nurses maintain compliance in performing hand hygiene so that HAIs do not occur.

Background: Cardiac catheterization is the most widely used diagnostic and hemodynamic intervention procedure in the world for the treatment of coronary heart disease (CHD). Cardiac catheterization can cause anxiety in patients who will undergo it. Objective: To analyze the factors that influence the anxiety of patients who will undergo cardiac catheterization. Method: This study is a descriptive analytical study with a cross-sectional approach conducted at Murni Teguh Memorial Hospital Medan. The study population was 40 people, and all of them were used as samples (total sampling). The research instrument was a questionnaire. Data analysis was carried out univariately and bivariately using the Chi-Square test with a significance level of 95% (= 0.05). Results: This study shows that there is a significant influence between knowledge, family support, past experience, and education level on the anxiety of patients who will undergo cardiac catheterization at Murni Teguh Hospital Medan. This is proven by the chi square test with p values for each knowledge (p = 0.000); family support (p = 0.002); past experience (p = 0.003); and education (p=0.003) which are all less than 0.005. Conclusion: Cardiac catheterization patient anxiety is influenced by knowledge, family support, past experience, and education level. Suggestion: It is recommended that further researchers increase the number of samples and independent variables, considering that many factors influence patient anxiety before cardiac catheterization/angiography