Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal)
Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal): A Journal of Values, Issues, Experience, and Collaboration has been a leading platform for healthcare thought leaders and innovators since its establishment in 2013. Published in collaboration with DPW PPNI Jawa Barat, the journal is dedicated to advancing nursing and healthcare knowledge through evidence-based research and practice. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal) is a peer-reviewed journal published by STIKep PPNI Jawa Barat, quarterly publication released in January, April, July, and October each year. Each issue offers valuable insights into contemporary topics and challenges relevant to nursing professions across diverse practice settings. By fostering collaboration and sharing innovative ideas, the journal serves as a vital resource for nurses, educators, researchers, and policymakers committed to improving nursing outcomes. The dynamic and ever-evolving nature of global healthcare continues to present new challenges and raise critical questions. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal) invites researchers, academics, practitioners, managers, and policymakers from diverse countries and backgrounds to submit papers that explore these pressing issues and advance the body of knowledge in nursing and clinical practice. Beginning July 2021, the journal will be published in English. Manuscript submissions can be made online through our website: http://journal.stikep-ppnijabar.ac.id. We look forward to receiving your contributions and fostering meaningful dialogue in the field of nursing and healthcare. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal) has been nationally accredited based on the Decree of Minister of Research, Technology and Higher Education Number : 152/E/KPT/2023 with SINTA Score 4. JKK has p-ISSN: 2354-8428, e-ISSN: 2598-8727, and DOI: https://doi.org/10.33755/jkk Average article statistics (from early 2020 to present) 7 s.d 14 Days to First Editorial Decision 30 Days to Accept 75% Acceptance Rate 25% Rejection Rate
Evaluating the Effectiveness of Benson Relaxation on Dysmenorrhea Pain Intensity: A Pre-Experimental Study Among Indonesian Female University Students
Background: Dysmenorrhea is a prevalent menstrual disorder among young women that can impair daily functioning and quality of life. Although pharmacological treatments are commonly used, they may cause side effects, leading to increased interest in non-pharmacological approaches such as Benson relaxation. Objective: This study aimed to evaluate the effectiveness of Benson relaxation in reducing dysmenorrhea pain intensity among female university students. Methods: A quantitative pre-experimental study with a one-group pretest–posttest design was conducted involving 35 female students selected through purposive sampling. Participants received a 15-minute Benson relaxation session in a quiet and comfortable environment. Pain intensity was measured before and after the intervention using the Numeric Rating Scale (NRS). Data were analyzed using the Wilcoxon Signed-Rank Test. Results: The findings showed a statistically significant reduction in dysmenorrhea pain intensity following the intervention (Z = -5.257; p < 0.001). The median pain score decreased from 6 to 3. Before the intervention, most participants experienced moderate and severe pain, whereas after the intervention, pain levels shifted to mild and moderate categories. Conclusion: Benson relaxation is an effective, simple, and low-cost non-pharmacological intervention for reducing dysmenorrhea pain intensity. It can be applied in nursing practice and self-care, although further research using controlled designs is recommended
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Self-Efficacy as a Behavioral Enabler of Self-Care in Chronic Heart Failure
Background: Chronic heart failure (CHF) is a major health problem associated with morbidity, repeated hospitalization, and long-term self-management demands. Although self-care is essential for symptom control and prevention of deterioration, many patients have difficulty maintaining effective daily management. Self-efficacy is considered an important psychological factor that may support self-care behavior.. Objective: This study aimed to examine the relationship between self-efficacy and self-care among patients with chronic heart failure and to contextualize the role of self-efficacy in supporting self-management behavior. Methods: A cross-sectional study was conducted involving 74 patients with CHF. Data were collected using the Self-Care of Heart Failure Index (SCHFI) v.6.2 and the General Self-Efficacy (GSE) Scale. Data were analyzed using descriptive statistics, Pearson’s correlation, independent t-test, and multiple linear regression. Results: Most participants were male (70.3%), with a mean age of 52.01 ± 13.46 years. The mean self-efficacy score was 35.00 ± 3.75, and the mean self-care score was 69.66 ± 3.80. Self-efficacy was positively correlated with self-care (r = 0.343, p = 0.003) and remained a significant predictor in multivariate analysis (β = 0.31, p = 0.004). Conclusion: Self-efficacy was positively associated with self-care among patients with chronic heart failure, but the modest strength of the relationship suggests that self-care is shaped by multiple interacting factors. These findings support the view that self-efficacy functions as a behavioral enabler rather than a standalone determinant of self-care. Interventions aimed at improving CHF self-management should therefore combine confidence-building strategies with broader educational, clinical, and contextual support
The Effect of Facial Expression Gymnastics and Oral Motoric Exercise in Supporting Communication in Stroke Patients: A Literature Review
Background: Stroke is a neurological disorder that frequently leads to facial muscle weakness, dysarthria, articulation impairment, and reduced communication ability. Rehabilitative interventions such as facial expression exercises and oral motor exercises are commonly used to stimulate orofacial muscles and support recovery of communication functions. Objective: This literature review aims to analyze the effects of facial expression exercises and oral motor exercises on communication abilities in stroke patients. Methods: A literature search was conducted across PubMed, Scopus, ScienceDirect, CINAHL, and Google Scholar for studies published between 2000 and 2025. Articles were selected based on predefined inclusion criteria, and twelve relevant studies were analyzed using a narrative synthesis approach. Results: The findings indicate that facial expression exercises and oral motor exercises are associated with improvements in facial muscle strength, lip and tongue coordination, articulation clarity, and speech intelligibility. Some studies also report improvements in swallowing function; however, these outcomes are distinct from communication measures. Technology-assisted interventions, including speech therapy applications, show potential as complementary tools, although the evidence remains limited. Conclusion: Orofacial exercises appear to be safe and feasible interventions that may contribute to improved communication outcomes in stroke patients. However, the strength of evidence varies across studies, and further high-quality research is needed before recommending widespread or routine implementation.
Patient Safety Culture in Hospital Settings for Quality Improvement: A Cross-Sectional Assessment
Background: Patient safety culture is a critical component of healthcare quality and plays an essential role in reducing medical errors. Understanding healthcare professionals’ perceptions of patient safety is important for identifying strengths and areas requiring improvement within hospital systems. Objective: This study aimed to assess patient safety culture among hospital staff in a single private hospital to support quality improvement initiatives. Methods: A quantitative cross-sectional study was conducted among 217 hospital staff working in both clinical and non-clinical units in a single private hospital. Data were collected using the Hospital Survey on Patient Safety Culture. Data were analysed using descriptive statistics to calculate frequencies, percentages, and percent positive responses for each dimension. Results: The findings showed moderate variation across patient safety culture dimensions. The highest positive response was observed in response to error (73.5%), followed by handoffs and information exchange (68.7%). Other dimensions, including communication about error (64%), staffing and work pace (63.5%), communication openness (63%), teamwork (62%), and overall patient safety rating (62%), also reflected moderate perceptions. However, reporting patient safety events had the lowest positive response (43%), indicating a potential gap in incident reporting practices. Conclusion: Overall, patient safety culture in this setting demonstrates moderate positive perceptions across several dimensions. However, the relatively low score in incident reporting suggests that this area may require further attention. These findings highlight the need for continued evaluation of reporting practices to better understand underlying barriers and support ongoing quality improvement efforts
Mobile Health Interventions for Postpartum Maternal Health: An Umbrella Review
Background: The postpartum period is a critical phase involving physical recovery, emotional adaptation, and social transition, which may affect maternal wellbeing. Limited access to continuous postnatal care can increase the risk of depression, inadequate self-care, and delayed recovery. Mobile health (mHealth) interventions have emerged as a potential solution to support continuity of care through remote monitoring, digital education, and ongoing support. Objective: This review aimed to synthesize evidence on the role of mobile health interventions in improving maternal health outcomes during the postpartum period. Methods: An umbrella review was conducted following the PRISMA 2020 framework. Relevant studies published between 2019 and 2025 were identified from PubMed, Scopus, CINAHL, and ScienceDirect. Eligibility was determined using the PICO framework, focusing on postpartum women receiving mHealth interventions compared to standard care. Five review-level studies were included and analyzed using descriptive and thematic synthesis. Results: mHealth interventions showed potential benefits in improving maternal self-efficacy, self-care engagement, physical activity, and overall wellbeing. They were also associated with reduced postpartum depression symptoms and improved adherence to follow-up care. Conclusion: Mobile health interventions may contribute positively to both psychological and physical health outcomes in postpartum women. However, the available evidence remains limited an indirect. Further high-quality primary studies are needed to establish effectiveness and inform clinical implementation.
Inhaled Lavender Aromatherapy for Preoperative Anxiety: A Systematic Review of Randomized Controlled Trials
Background: Preoperative anxiety is common among patients undergoing surgery and may adversely affect perioperative outcomes, including hemodynamic instability, increased anesthetic requirements, and delayed recovery. Lavender aromatherapy has been widely used as a complementary non-pharmacological intervention; however, its effectiveness in preoperative care remains variably reported across studies. Objective: This review aimed to synthesize evidence from randomized controlled trials (RCTs) on the effectiveness of inhaled lavender aromatherapy in reducing preoperative anxiety among adult surgical patients. Methods: A structured review of RCTs was conducted using Scopus, PubMed, and ScienceDirect. Studies published within the last 10 years were searched using combinations of terms related to lavender aromatherapy, inhalation, and preoperative anxiety. Eligibility criteria were defined using the PICOS framework. After duplicate removal, title and abstract screening, and full-text assessment, 11 RCTs were included in the final qualitative synthesis. Due to heterogeneity in surgical populations, intervention protocols, comparators, and anxiety measurement tools, findings were synthesized narratively. Results: Eleven RCTs met the inclusion criteria. Most studies reported reductions in preoperative anxiety following inhaled lavender aromatherapy compared with standard care, no-aroma control, or placebo. Several trials also reported additional benefits, such as improved hemodynamic parameters, reduced cortisol levels, and lower anesthetic requirements. However, the findings were not entirely consistent, as some studies found lavender to be comparable to other non-pharmacological interventions or not significantly different from placebo. Conclusion: Inhaled lavender aromatherapy appears to be a promising complementary intervention for reducing preoperative anxiety in adult surgical patients. Nevertheless, the evidence remains heterogeneous, and effectiveness may vary according to clinical context, comparator type, and intervention protocol. Further high-quality trials using standardized administration methods and outcome measures are needed to clarify its clinical role.
The Relationship Between Resilience and Nurses’ Mental Health: A Systematic Review
Background: Nurses face chronic work-related stress burdens that lead to mental health problems such as depression, anxiety, stress, burnout, and sleep disorders, while suboptimal resilience levels may increase nurses’ mental health vulnerability. Objective: This systematic review aimed to synthesize recent evidence on the relationship between resilience and mental health outcomes among nurses. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A structured search was conducted in Scopus, PubMed, ScienceDirect, and Web of Science to identify articles published in English between 2021 and 2025. Original quantitative studies that examined the association between resilience and mental health outcomes among nurses were included. Two reviewers independently screened the records, assessed eligibility, and resolved disagreements through discussion. Methodological quality was appraised using the Joanna Briggs Institute Critical Appraisal Checklist. Due to heterogeneity in study measures and outcomes, findings were synthesized narratively. Results: A total of 1319 records were identified, of which 10 studies met the inclusion criteria. Resilience was consistently associated with lower levels of depression, anxiety, psychological distress, burnout, and fatigue among nurses. Higher resilience was also associated with better psychological well-being, professional quality of life, occupational adaptation, and job satisfaction. Several studies suggested that resilience functioned as a mediating factor in the relationship between occupational stressors and mental health outcomes, while burnout also emerged as an important mediator. Conclusion: Resilience is consistently associated with more favorable mental health outcomes among nurses. However, the available evidence is limited to cross-sectional research, preventing causal inference. Strengthening resilience may represent a promising strategy to support nurses’ mental health, but future longitudinal and intervention studies are needed
Impact of Android-Based Reproductive Health Education on Knowledge Improvement Among Adolescent Girls in Takalar, Indonesia: A Quasi-Experimental Study in a Senior High School
Background: Adolescent girls are particularly vulnerable to reproductive health problems due to limited knowledge and inadequate access to reliable information. Innovative educational strategies are needed to improve their understanding of reproductive health. Objective: This study aimed to evaluate the effectiveness of Android-based reproductive health education in improving knowledge among adolescent girls. Methods: A quasi-experimental study with a pretest–posttest control group design was conducted among 100 female students at a senior high school in Takalar, Indonesia. Participants were divided into an intervention group (n = 50) and a control group (n = 50). The intervention group received reproductive health education through an Android-based application, while the control group continued routine school activities. Knowledge was assessed using a structured questionnaire administered before and after the intervention. Data were analyzed using descriptive statistics and the Mann–Whitney U test. Results: The intervention group showed a substantial increase in mean knowledge scores from pre-test to post-test (11.52 ± 3.04 to 17.54 ± 2.29), while the control group demonstrated only a slight change (12.86 ± 3.74 to 13.24 ± 4.22), indicating greater short-term knowledge improvement in the intervention group. Conclusion: Android-based reproductive health education effectively improves knowledge among adolescent girls and represents a promising digital approach for school-based health promotion
SMART-HTN Pocketbook Education and Improved Medication Adherence and Blood Pressure Control in Primary Care
Background: Hypertension remains a major global health problem contributing significantly to cardiovascular morbidity and mortality. Poor medication adherence is a key factor leading to uncontrolled blood pressure, particularly in primary care settings. The SMART-HTN pocketbook is a structured educational tool integrating medication adherence, lifestyle modification, and self-monitoring strategies for hypertension management. Objective: This study aimed to evaluate the effectiveness of SMART-HTN pocketbook-based education on medication adherence and blood pressure control among hypertensive patients in primary care. Methods: A quasi-experimental pretest–posttest control group study was conducted involving 60 hypertensive patients (30 intervention and 30 control). The intervention group received structured education using the SMART-HTN pocketbook combined with follow-up reinforcement for eight weeks, while the control group received standard care. Medication adherence was measured using the Morisky Medication Adherence Scale (MMAS-8), and blood pressure was assessed using a calibrated digital sphygmomanometer. Data were analyzed using paired and independent t-tests. Results: Baseline characteristics were comparable between groups (p > 0.05). After eight weeks, the intervention group demonstrated a significant increase in medication adherence scores (mean difference = +2.3 points; p < 0.001) compared to the control group. In addition, systolic blood pressure decreased by 13.3 mmHg and diastolic blood pressure decreased by 8.3 mmHg in the intervention group, both significantly greater than the control group (p < 0.001). Conclusion: SMART-HTN pocketbook-based education was associated with improved medication adherence and better blood pressure control among hypertensive patients in primary care. This structured and low-cost intervention shows promise as a scalable strategy for hypertension management in resource-limited settings
Glycemic Control, Complications, and Sleep Quality in Type 2 Diabetes Mellitus: A Multivariate Analysis Using Logistic Regression
Background: Diabetes mellitus is a silent killer, meaning it kills people slowly. This disease can cause complications for sufferers, including reduced sleep quality due to factors that increase blood sugar levels, the emergence of other complications, psychological factors such as anxiety and stress, and providing family support for those with diabetes mellitus. Objective: The aim is to influence of sleep quality in patients with type 2 diabetes mellitus in Meuraxa Regional General Hospital, Banda Aceh City Methods: This study was a descriptive correlation study with a cross-sectional design. The population was 369 people, with a purposive sampling technique, resulting in a sample size of 79 individuals. A questionnaire was used as the data collection instrument. This study was conducted at Meuraxa Hospital, Banda Aceh City, and data analysis used the chi-square test. Results: The results of the study showed that 50 respondents (73.5%) had poor sleep quality compared to 18 respondents (26.5%). Based on the chi-square statistical test, the test used was Fisher's exact test on exact sig (2-sided) with a p-value of 0.005 (p < 0.05) and the results of the study showed that 51 respondents (83.6%) had poor sleep quality compared to 10 respondents (16.4%) who had good sleep quality. Based on the chi-square statistical test results, the test used was continuity correction on asymp sig (2-sided) with a p-value of 0.000 (p < 0.05). Conclusions: Type 2 diabetes mellitus can significantly affect a person's sleep quality and conversely, poor sleep quality can maintain the condition of type 2 diabetes mellitus
The Role of Clinical Instructors in Preventing Adverse Events Among Nursing Students
Background: Patient safety is a fundamental aspect of healthcare delivery and a major concern in nursing education, particularly during students’ clinical practice, which carries a high risk of adverse events. Nursing students are in a transitional phase from theoretical learning to real clinical practice and therefore require adequate supervision to prevent clinical errors that may compromise patient safety. Objective: This study explored how clinical instructors perceive and enact their role in preventing adverse events during students’ clinical practice. Methods: A qualitative study with a descriptive phenomenological approach was conducted. Data were collected through in-depth semi-structured interviews with five clinical instructors who supervised nursing students across various hospital care units. The data were analyzed using thematic analysis to identify patterns of meaning related to clinical supervision and patient safety practices. Results: The analysis revealed that clinical instructors operate not only as supervisors but also as safety gatekeepers. Their role extends across several domains, including direct supervision, assessment of student readiness, real-time correction of unsafe practices, and modeling of professional behavior. Adverse events were largely viewed as preventable, but only when supervision was consistent and context-aware. Organizational factors, particularly workload and collaboration, shaped how effectively instructors could perform this role. Conclusion: Clinical instructors occupy a critical position at the intersection of education and patient safety. Strengthening their role requires not only individual competence but also institutional support and realistic workload structures.
Usability of the CERDASIA Application (Check the Development, Nutrition, Children and Mental Health of Indonesian Adolescents) at the Sukawarna Community Health Center
Background: Early childhood growth and development monitoring and adolescent mental health are important components of promotive and preventive efforts in primary health care. However, conventional methods are often ineffective in reaching parents and adolescents sustainably. The use of digital technology is an innovative alternative to improve access to information and the quality of health services. Objective: This study aims to evaluate the usability of the CERDASIA (Cek Pengembangan, Gizi, dan Kesehatan Anak Remaja Indonesia) application as a supporting medium for monitoring child growth and development and adolescent mental health. Method: This study used a descriptive design with a cross-sectional approach. Respondents consisted of parents of children aged 0–5 years and adolescents in the Sukawarna Community Health Center (Puskesmas) working area. Usability evaluation was conducted using the System Usability Scale (SUS) and a time completion test to assess ease of use, efficiency, and user experience. Data were analyzed descriptively. Results: The average SUS score showed a good usability category, indicating that the CERDASIA application is easy to use, has clear navigation, and is able to increase user satisfaction. Conclusion: The CERDASIA application has good usability and has the potential to become a nursing technology innovation in supporting child growth and development monitoring and adolescent mental health
Factors Associated with Disaster Response Self-Efficacy among Nursing Students in Indonesia
Background: Disaster preparedness is a critical competency for nursing students, as they are expected to respond effectively in emergency and disaster situations. However, the level of disaster response self-efficacy (DRSE) and its associated factors among nursing students in Indonesia remain unclear. This study aimed to identify factors associated with DRSE among nursing students. Design: A cross-sectional design was used. Methods: This study involved 234 students from a university in North Sulawesi Province, Indonesia, selected through convenience sampling. Data were collected in May 2023 using the Disaster Response Self-Efficacy Scale (DRSES) and analyzed using descriptive statistics, independent t-test, Pearson correlation, and multiple linear regression. Results: The mean DRSES score was 3.31 (SD=0.66). Age was positively correlated with self-efficacy (r=0.188, p=0.004). Significant differences were also found for academic level (t=-4.974, p<0.001), disaster experience (t=-2.613, p=0.010), disaster organization involvement (t=-2.231, p=0.027), disaster training (t=-2.883, p=0.004), and disaster course participation (t=-3.320, p=0.001). Academic level emerged as the only significant determinant of DRSE (β=0.293, 95% CI [0.166 to 0.626], p<0.001). The overall model was statistically significant (p<0.001), explaining 15.6% of the variance. Conclusions: DRSE among nursing students was moderate, with academic level as the primary determinant. The findings underscore the need for curriculum enhancement through structured disaster education, simulation-based training, and experiential learning to better prepare nursing students for real-world disaster response
Digital Technology Platforms for Community-Based Hypertension Management: A Bibliometric Analysis
Background: Hypertension remains a major global health challenge requiring effective and sustainable long-term management. The rapid advancement of digital health technologies has introduced new opportunities to enhance blood pressure control, patient adherence, and community-based care delivery. Objective: This study aimed to analyze global research trends on digital technology platforms for community-based hypertension management using a bibliometric approach, and to identify key research themes, collaboration patterns, and emerging gaps. Methods: A bibliometric analysis was conducted using data retrieved from the Dimensions.ai database for publications between 2021 and 2025. Study selection followed PRISMA guidelines with predefined inclusion and exclusion criteria. Data were analyzed using VOSviewer to visualize keyword co-occurrence, collaboration networks, and thematic evolution through network, overlay, and density mapping. Results: Of 14,455 identified records, 3,371 articles met the inclusion criteria. The analysis identified 161 key items grouped into five thematic clusters, with a total link strength of 19,847. Findings demonstrate a clear shift in research focus from conventional clinical treatment approaches toward the integration of digital health technologies, including telemonitoring, self-management systems, patient engagement tools, and artificial intelligence in community-based hypertension care. Conclusions: Digital technology platforms are increasingly central to community-based hypertension management, particularly in improving blood pressure control, medication adherence, and healthcare accessibility. However, critical gaps remain regarding long-term effectiveness, interoperability, and data privacy. Future research should prioritize sustainable implementation and integration within health systems to maximize clinical and public health impact
Digital Queueing Innovation and Outpatient Service Quality: Integrating Technology Acceptance and SERVQUAL at a Military Hospital in Indonesia
Background: Long waiting times in outpatient services often reduce service quality. Digital solutions such as online queue systems, including Mobile JKN, are increasingly used to improve efficiency, but their impact on overall service quality remains unclear. Objective: This study aims to examine how effective an online queue system is in improving service quality at Dustira Hospital. Methods: A quantitative approach with a cross-sectional design was applied. Participants were selected through purposive sampling, resulting in a total of 379 respondents. Data were collected using structured questionnaires with Likert-scale responses to assess both the performance of the online queue system and perceived service quality. The independent variable refers to the effectiveness of the online queue system, evaluated using the Technology Acceptance Model (TAM), which includes perceived usefulness, perceived ease of use, behavioral intention, and actual system utilization. The dependent variable is service quality, measured through SERVQUAL dimensions: tangibles, reliability, responsiveness, assurance, and empathy. Data analysis consisted of univariate statistics, Chi-square testing for bivariate analysis, and logistic regression for multivariate analysis. Results: Most respondents were adults aged 18–59 years, male, and had completed secondary education. Bivariate analysis showed a significant association between online queue system effectiveness and perceived service quality (p < 0.05). In the multivariate model, perceived ease of use emerged as the only significant predictor of service quality (p < 0.05; OR = 1.874), indicating that patients who perceived the system as easier to use were more likely to report better service quality. Conclusion: The implementation of an online queue system contributes positively to service quality at Dustira Hospital. Greater ease in system usage is associated with better perceived service quality among patients.
Protocol-Guided Suctioning for Safe Airway Management in Hemorrhagic Stroke Patients with External Ventricular Drainage: A Case Study
Background: Ineffective airway clearance is a frequent nursing diagnosis in critically ill patients, particularly those with hemorrhagic stroke who experience decreased consciousness and impaired cough reflex. Accumulation of airway secretions increases the risk of hypoxia, aspiration, and respiratory complications, necessitating comprehensive airway management in the intensive care unit (ICU). Objective: This study aims to describe the implementation of suction-based nursing care in managing ineffective airway clearance in a patient with hemorrhagic stroke following external ventricular drainage (EVD). Methods: A single-patient case study was conducted in the ICU. Data were collected through comprehensive nursing assessment, direct observation, physical examination, and review of medical records. Nursing interventions were implemented based on clinical guidelines, including airway monitoring, positioning, oxygen therapy, and suction procedures. Data were analyzed descriptively to evaluate changes in clinical indicators over a five-day observation period. Results: Following structured airway management, progressive improvement in respiratory parameters was observed. Oxygen saturation (SpO₂) increased from 94% at baseline to 98% by Day 5, while respiratory rate decreased from 30 to 18 breaths per minute. Secretion volume reduced from approximately 25–30 ml/day to 8–10 ml/day, accompanied by changes in consistency from thick and viscous to thin and clear. Auscultation findings improved from bilateral rhonchi with gurgling to clear vesicular breath sounds. No adverse events or signs of neurological instability were observed during suction procedures. Conclusion: This case study demonstrates that structured, suction-based nursing care may effectively improve airway clearance and respiratory status in critically ill hemorrhagic stroke patients. Early and carefully monitored airway interventions can support oxygenation and reduce secretion burden without compromising patient safety in the ICU
The Endotracheal Suctioning and Oxygen Saturation in an Intensive Care Patient with Ischemic Stroke and Decreased Consciousness: A Descriptive Case Study
Background: Patients with ischemic stroke and decreased consciousness are at high risk of ineffective airway clearance due to impaired cough reflex and accumulation of airway secretions. This condition may lead to hypoxemia and further neurological deterioration, requiring appropriate airway management in intensive care settings. Objective: To describe the implementation of endotracheal suctioning as part of nursing care in an intensive care patient with ischemic stroke and decreased consciousness, with particular attention to oxygen saturation and clinical airway status. Methods: A descriptive single-patient case study was conducted in the general intensive care unit. Data were collected through direct observation, physical examination, bedside monitoring, and medical record review. The nursing care process included assessment, diagnosis, planning, implementation, and evaluation. Endotracheal suctioning was performed according to clinical indications and unit protocol, and oxygen saturation was observed before and after suctioning over a five-day period. Results: At baseline, the patient presented with decreased consciousness, retained airway secretions, bilateral rhonchi, weak cough reflex, tachypnea, and oxygen saturation of 92%. Across the five-day observation period, suctioning was followed by short-term improvement in oxygen saturation, with post-procedure values reaching 97–98%, accompanied by reduced secretion burden and clearer breath sounds. By the end of observation, respiratory status was more stable and suctioning was required less frequently. Conclusion: In this case, endotracheal suctioning performed on the basis of clinical indications was associated with improvement in short-term oxygen saturation and airway clearance indicators. These observations should be interpreted within the broader context of comprehensive intensive care and should not be taken as evidence of independent treatment effect. Further studies with stronger designs are needed to evaluate the contribution of suctioning in neurocritical patients
Implementation Barries and Service Outcome of Telehealth Information in the Health Services: A Systematic Review
Background: Digital transformation in the field of health services is increasingly experiencing novelty that can support the services provided to the community Telehealth technology in the form of telemedicine is an effort to use information technology that can help patients, health workers and health institutions to share information easily, quickly and safely. Research related to telehealth (remote healthcare services) is crucial to optimize the potential of technology in healthcare systems, especially after the COVID-19 pandemic, which has accelerated digital adoption. In addition to the many benefits, telehealth programs must be faced with the readiness of human resources, financing, facilities and infrastructure as well as clear legal aspects. Aims: The purpose of this literature review is to describe the use of telemedicine in the health profession in improving professional health services. Methods: The research design uses Literature Review, based on a summary of several studies related to the research topic Telehealth approach used was a literature review. Articles on the use of Telehealth technology were searched using topics and keywords related to "Telehealth", "Telemedicine", "Health Service" and "effectiveness". Relevant research was searched using the Boelean formula and filtered for articles published between 2019 and 2025, including PUBMED, CINAHL, and Google Scholar. "Telehealth", "Telemedicine", "Health Service" and "effectiveness". Then from the results of the literature search, the journal is open access, full article, accessible, and downloadable. The author obtained 8 articles that fit the inclusion criteria used in this method, namely: articles using English and Indonesian. Results: Based on the articles collected, the use of Telehealth programs can increase the effectiveness of health services. However, telehealth also has disadvantages, namely the dependence on a stable internet connection and high device capabilities (technological literacy). In addition, health workers cannot perform the direct examinations necessary for an accurate diagnosis. Conclusion:. The use of telehealth needs to be further developed and researched, to determine the frequency and efficiency of its utilization, in order to support health services, especially in the field of palliative care
Passive Range of Motion Intervention to Improve Physical Mobility in a Hemorrhagic Stroke Patient After External Ventricular Drainage: A Case Study
Background: Hemorrhagic stroke is a life-threatening neurological disorder that often leads to significant motor impairment due to intracranial bleeding, elevated intracranial pressure, and disrupted neuromuscular function. Patients in intensive care settings are highly susceptible to complications related to prolonged immobility, including joint stiffness, muscle weakness, atrophy, contractures, impaired circulation, and pressure injuries. Passive Range of Motion (ROM) exercises are commonly applied as a nursing intervention for patients who are unable to perform voluntary movement, aiming to preserve joint mobility and prevent musculoskeletal deterioration. Objective: This case study aimed to describe the implementation of nursing care in a hemorrhagic stroke patient with impaired physical mobility following External Ventricular Drainage (EVD), with a focus on the application and evaluation of passive ROM exercises in the General Intensive Care Unit (GICU). Methods: A descriptive case study design was employed involving a female patient with hemorrhagic stroke who underwent EVD placement. Data were collected through comprehensive nursing assessment, direct observation, interviews, and medical record review. Passive ROM exercises were administered twice daily for 10–15 minutes using controlled movements of the upper and lower extremities. Neurological status, hemodynamic stability, and EVD function were continuously monitored. Results: Over a five-day period, gradual improvement was observed. Muscle strength increased by one grade, joint mobility improved by approximately 10 degrees, and the Glasgow Coma Scale reached 12. No complications related to the intervention or EVD were identified. Conclusion: Passive ROM may be safely incorporated into nursing care for hemorrhagic stroke patients with EVD and may help maintain joint function and reduce immobility-related complications, although outcomes are influenced by multiple clinical factors.
Needs Assessment for Ergonomic Patient Repositioning Device Among Bedridden Patients: A Literature Review
Background: Pressure ulcers remain a prevalent and preventable complication among bedridden patients, with manual repositioning every two hours established as the clinical standard of prevention. This practice places substantial physical demands on nurses and informal caregivers, contributing to high rates of work-related musculoskeletal disorders, including low back pain, among those performing repetitive turning tasks. Despite the availability of various assistive devices, most have been developed without systematic assessment of the combined needs of both patients and caregivers as dual users. Objective: This review aimed to identify clinical, ergonomic, and functional needs for a patient repositioning device among bedridden patients and their caregivers through synthesis of existing literature. Methods: A literature review was conducted using Scopus, PubMed, and EBSCO, covering publications from 2016 to 2024. Articles published in English addressing repositioning practices, assistive device design or evaluation, caregiver ergonomics, or pressure injury prevention in immobile patients were included. Studies unrelated to repositioning function or device ergonomics were excluded. Eight articles met the inclusion criteria and were included in the final synthesis. Results: Three primary need domains were consistently identified across the reviewed literature. First, bedridden patients require effective pressure redistribution to prevent tissue injury during prolonged immobility. Second, caregivers need a reduction in biomechanical workload during repositioning, particularly in lumbar and shoulder loading. Third, the device must offer usability features that enable safe, consistent positioning without requiring multiple personnel or specialized training. Current assistive devices inadequately address all three domains simultaneously, with most designs optimizing for one dimension at the expense of others. Conclusion: Bedridden patients and their caregivers present distinct yet interdependent needs that must be jointly addressed in ergonomic repositioning device development. A dual-user design framework integrating pressure redistribution, biomechanical efficiency, and practical usability represents a critical direction for future nursing research and device innovation.