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PENGALAMAN KERJA PERAWAT DALAM MERAWAT PASIEN DI RUANG ICU RSUD. Dr. PIRNGADI KOTA MEDAN Anwari, Putri; Fitrini, Fitriani; Ramud, Suci Munawarah; Hasibuan, Eva Kartika; Purba, Bunga Theresia
Jurnal Ilmiah Keperawatan Vol 1 No 2 (2018): JURNAL MUTIARA NERS
Publisher : Program Studi Ners UNIVERSITAS SARI MUTIARA INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (471.476 KB)

Intensive Care Unit (ICU) is the last gate of hospital patients, especially patients who use ventilator and ICU need 24 hour monitoring. Nurses working in the Intensive Care Unit must be fast and precise, continuous work, high workload, less modern tools and family conditions can stress the consequences of nurse work and other health teams are not fluent and empathy for patients is decreasing, so that nursing care is given partially implemented and addressed on physical issues. This study aims to explore the work of nurses in caring for patients in the ICU. This research was conducted at ICU Pirngadi General Medan. The type of research used was qualitative with phenomenology approach, the participants in this study were nurses ICU which amounted to 4 people. Technique of taking participant in this study by way of purposive sampling. The results in this study have six themes, namely physical, nursing care, psychology, environment, facilities and expectations. The conclusion in this research is nurses tend to experience various problems in work so that nurses become less maximal in work it will affect service in ICU less maximal. Suggestion in this research is expected to nurse to maximal and discipline in work and to hospital service to pay more attention nurses work load by increasing knowledge and held training, addition of award to create maximum service.

PENGALAMAN KERJA PERAWAT DALAM MERAWAT PASIEN DI RUANG ICU RSUD. Dr. PIRNGADI KOTA MEDAN Putri Anwari; Fitriani Fitrini; Suci Munawarah Ramud; Eva Kartika Hasibuan; Bunga Theresia Purba
Jurnal Ilmiah Keperawatan Vol 1 No 2 (2018): JURNAL MUTIARA NERS
Publisher : Program Studi Ners UNIVERSITAS SARI MUTIARA INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (471.476 KB)

Intensive Care Unit (ICU) is the last gate of hospital patients, especially patients who use ventilator and ICU need 24 hour monitoring. Nurses working in the Intensive Care Unit must be fast and precise, continuous work, high workload, less modern tools and family conditions can stress the consequences of nurse work and other health teams are not fluent and empathy for patients is decreasing, so that nursing care is given partially implemented and addressed on physical issues. This study aims to explore the work of nurses in caring for patients in the ICU. This research was conducted at ICU Pirngadi General Medan. The type of research used was qualitative with phenomenology approach, the participants in this study were nurses ICU which amounted to 4 people. Technique of taking participant in this study by way of purposive sampling. The results in this study have six themes, namely physical, nursing care, psychology, environment, facilities and expectations. The conclusion in this research is nurses tend to experience various problems in work so that nurses become less maximal in work it will affect service in ICU less maximal. Suggestion in this research is expected to nurse to maximal and discipline in work and to hospital service to pay more attention nurses work load by increasing knowledge and held training, addition of award to create maximum service.

PELAKSANAAN MENTORSHIP OLEH PERAWAT PENYAKIT JANTUNG TERPADU DI RSUP H. ADAM MALIK MEDAN Eva Kartika Hasibuan; Nurmaini Nurmaini; Sri Eka Wahyuni
Jurnal Online Keperawatan Indonesia Vol 1 No 2 (2018): JURNAL ONLINE KEPERAWATAN INDONESIA
Publisher : UNIVERSITAS SARI MUTIARA INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (252.96 KB)

Mentoring is mutually beneficial between someone who has the advantage in experience and someone who does not. Informal mentoring is done spontaneously with the span of time according to the menteeâ€™s need; it does not need preparation (impromptu) for mentoring process, it occurs voluntarily, and it is established according to mutual confidence building between a mentor and a mentee. The objective of the research was to dig up nursesâ€™ experience in implementing mentorship in RSUP H. Adam Malik, Medan. The research was qualitative with descriptive phenomenological method. The data were gathered by conducting in-depth interviews and field recording. The samples were 9 nurses as the respondents, taken by using purposive sampling technique with inclusive criteria: nurses with the rank of PK 2 and PK 3 in career, ward heads, and the team heads in PJT (Integrated Heart Disease) Room. The result of the interviews was analyzed by using NVivo Version 11.0 (trial) software program. The result of the research showed that there were 2 themes, 4 sub-themes, and 10 categories. The themes were getting hope in implementing mentorship, and getting obstacles in implementing mentorship. It is recommended the hospital management make specific standard and format and specific schedule and time so that there will be uniformity in implementing mentorship. It is also recommended that the next researchers dig up their researches profoundly so that there will more themes with more respondents in order that the result of the research will be better

HUBUNGAN JENJANG KARIR DENGAN KEPUASAN KERJA PERAWAT Eva Kartika Hasibuan; Masri Saragih; Erwin Silitonga
Jurnal Online Keperawatan Indonesia Vol 4 No 2 (2021): Jurnal Online Keperawatan Indonesia
Publisher : UNIVERSITAS SARI MUTIARA INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51544/keperawatan.v4i2.2442

Job satisfaction is an employee's attitude towards work related to work situations, cooperation between employees, rewards received at work, and matters relating to physical and psychological factors. In Indonesia, there are 55.8% of nurses in government hospitals experiencing low job satisfaction. There are several factors that influence job satisfaction including salary earned, organizational culture, relationships with coworkers, supervision, and career development. Career level is one of the efforts to realize nurse job satisfaction. Nursing career level is the implementation of several career plans that have been determined to provide nurses with positions/levels that are in accordance with the education, abilities, skills and competencies of nurses. The purpose of this study was to find out the career level relationship with Job Satisfaction of nurses at Sari Mutiara General Hospital Lubuk Pakam. The research design used is descriptive correlation with cross sectional design. The population in this study were all nurses at Sari Mutiara General Hospital Lubuk Pakam. The sample in this study amounted to 56 people obtained by using total sampling. The data collection tool uses a questionnaire sheet. The statistical test used was the chi square test. The results showed the majority of respondents had a high career level 69,6% and respondents’ performance satisfaction was satisfied as much as 67,8%. Based on the results of the Chi-Square statistical test value = 0,017 (p <0,05) which means that there is arelationship of career level with the satisfaction of nurse performance at Sari Mutiara General Hospital Lubuk Pakam It is recommended for nurses to improve their skills through training and education facilitated by hospitals.

HUBUNGAN KEPEMIMPINAN EFEKTIF KEPALA RUANGAN DENGAN KINERJA PERAWAT DALAM MELAKUKAN ASUHAN KEPERAWATAN DI RSU SARI MUTIARA LUBUK PAKAM Eva Kartika Hasibuan; Masri Saragih
Indonesian Trust Health Journal Vol 2 No 1 (2019): Indonesian Trust Health Journal
Publisher : STIKes Murni Teguh

Effective leadership is required by the head of the room to create a good performance on nurses to achieve the purpose of the room is provide good and quality health serviceThis study aims to determine the effective leadership of head room with the performance of nurses in nursing care at RSU. Sari Mutiara Lubuk Pakam. Researchers used descriptive research method correlation with cross-sectional approach. The population in this study nurse who was on duty in the inpatient unit RSU. Sari Mutiara Lubuk Pakam totaling 55 people. The sample in this study used a total sampling technique with 55 respondents. The data collection technique using a questionnaire given to respondents. The results of this study are analyzed in univariate effective leadership of head room (81.8%) with sufficient performance of nurses (50.9%). After bivariate analysis with chi-square test showed that there is a relationship effective leadership of head room with the performance of nurses (p-value = 0.003). This study recommends that the head of the room more attention to implementation of the tasks of nursing care by nurses, as well as providing support in working order, the better the performance of nurses. Kepemimpinan efektif diperlukan oleh kepala ruangan dalam menciptakan kinerja yang baik pada perawat pelaksana untuk mencapai tujuan ruangan yaitu memberikan pelayanan kesehatan yang baik dan berkualitas. Penelitian ini bertujuan untuk mengetahui kepemimpinan efektif kepala ruangan dengan kinerja perawat dalam melakukan asuhan keperawatan di RSU. Sari Mutiara Lubuk Pakam. Peneliti menggunakan metode penelitian deskriptif korelasi dengan pendekatan cross-sectional. Populasi dalam penelitian ini seluruh perawat pelaksana yang sedang bertugas RSU Sari Mutiara Lubuk Pakam berjumlah 55 responden. Sampel dalam penelitian ini menggunakan teknik total sampling dengan jumlah responden sebanyak 55. Teknik pengumpulan data menggunakan kuisioner yang diberikan kepada responden. Uji statistik yang digunakan dalam penelitian ini adalah uji chi-square. Hasil penelitian ini dianalisis secara univariat yaitu kepemimpinan kepala ruangan efektif (81,8%) dengan kinerja perawat cukup (50,9%). Setelah dilakukan analisis bivariat dengan uji chi-square didapatkan hasil yaitu ada hubungan kepemimpinan efektif kepala ruangan dengan kinerja perawat (p-value=0,003). Penelitian ini merekomendasikan agar kepala ruangan lebih memperhatikan pelaksanaan tugas asuhan keperawatan oleh perawat, serta memberikan dukungan dalam bekerja agar kinerja perawat semakin baik.

LAMANYA PERAWATAN PASIEN SKIZOFRENIA RAWAT JALAN DENGAN TINGKAT STRES KELUARGA Jek Amidos Pardede; Eva Kartika Hasibuan
Indonesian Trust Health Journal Vol 3 No 1 (2020): Indonesian Trust Health Journal
Publisher : STIKes Murni Teguh

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37104/ithj.v3i1.49

Schizophrenia is one form of chronic mental disorder, which causes serious persistent brain disease that results in psychotic behavior, concrete thinking, and difficulty in obtaining information. Prolonged treatment in schizophrenia patients will generally cause stress to families related to the high burden they bear.The purpose of this research is to know the relationship between the duration of treatment schizophrenia patients with the level of family stress.The design of this research is a descriptive correlation with the Cross-Sectional approach. The population of this study amounted to 181 people and samples of this study as many as 64 respondents.Sampling techniques with accidental sampling. The collection of data using questionnaires with test Chi-Square p = < 0.005. The results of this study showed that there is a connection between the duration of treatment schizophrenia patients with a level of family stress in the hospital psychiatric clinic Prof.Dr. Muhammad Ildrem Medan. From 64 respondents there were 43 respondents experiencing moderate stress (67.2%), 11 respondents experiencing severe stress (17.2%), and 10 respondents experiencing mild stress (15.6%).The results of this study indicate there is a significant relationship between the length of treatment with the level of family stress with P=0.035 or P=0.05.This research is expected that families are able to anticipate their stressements by giving support to schizophrenia patients. Abstrak Skizofrenia merupakan salah satu bentuk gangguan jiwa kronik, yang menyebabkan penyakit otak persisten serius yang mengakibatkan prilaku psikotik, pemikiran konkret, dan kesulitan dalam memperoleh informasi. Perawatan yang lama pada pasien skizofrenia umumnya akan menimbulkan stress kepada keluarga terkait tingginya beban yang mereka tanggung. Tujuan penelitian ini untuk mengetahui hubungan antara lamanya perawatan pasien skizofrenia rawat jalan dengan tingkat stress keluarga. Desain penelitian ini adalah deskriptif korelasi dengan pendekatan Cross-Sectional. Populasi penelitian ini berjumlah 181 orang dan sampel penelitian ini sebanyak 64 responden. Tehnik pengambilan sampel dengan accidental sampling. Pengumpulan data mengunakan kuesioner dengan menggunakan uji Chi-Square p= <0,05. Hasil penelitian ini menunjukan adanya hubungan antara lamanya perawatan pasien skizofrenia rawat jalan dengan tingkat stress keluarga di Poliklinik Rumah Sakit Jiwa Prof. Dr. M. Ildrem Medan. Dari 64 responden terdapat 43 responden mengalami stress sedang (67,2%), 11 responden mengalami stress berat (17,2%), dan 10 responden mengalami stress ringan (15,6%). Hasil penelitian ini menunjukan ada hubungan signifikan antara lamanya perawatan dengan tingkat stress keluarga dengan p=0,035 atau p=0,05. Penelitian ini diharapkan keluarga mampu mengantisipasi stresnya dengan memberi dukungan pada pasien skizofrenia.

HUBUNGAN PEMBERIAN INSENTIF DENGAN KINERJA PERAWAT DALAM PENDOKUMENTASIAN ASUHAN KEPERAWATAN Masri Saragih; Rosetty Sipayung; Eva Kartika Hasibuan
Indonesian Trust Health Journal Vol 3 No 1 (2020): Indonesian Trust Health Journal
Publisher : STIKes Murni Teguh

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37104/ithj.v3i1.50

The problem that often arises in the implementation of nursing care is that many nurses have not done a complete documentation of nursing care. The provision of incentives is one of the factors that influence the performance of nurses in documentation. This study aimed to identify the relationship between incentives and nurses' performance in documenting nursing care at Sari Mutiara Lubuk Pakam Hospital. The research design used a description of the correlation with the cross sectional approach. The population in the study were 56 nurses in the inpatient room. There were 56 respondents as total sampling for the sampling technique. Data collection tools used questionnaire sheets and observation sheets. The statistical test used the chi square test. The results of the univariate analysis for the incentive variable the majority of incentives were classified as high as 69,6% and the performance of nurses in the complete documentation was 67.8%. From the results of the bivariate analysis showed that there was a relationship between the provision of incentives and the performance of nurses in documenting nursing care (p = 0.017; p <0.05). It is hoped that nurses will be able to complete documentation not only because of a high incentive, but it is a nurse's responsibility that must be carried out. Abstrak Masalah yang sering muncul dalam pelaksanaan asuhan keperawatan adalah banyak perawat yang belum melakukan pendokumentasian asuhan keperawatan secara lengkap. Pemberian insentif merupakan salah satu faktor yang mempengaruhi kinerja perawat dalam pendokumentasian. Penelitian ini bertujuan untuk mengidentifikasi hubungan pemberian insentif dengan kinerja perawat dalam pendokumentasian asuhan keperawatan di Rumah Sakit Umum Sari Mutiara Lubuk Pakam. Desain penelitian yang digunakan adalah deskripsi korelasi dengan pendekatan cross sectional. Populasi dalam penelitian adalah seluruh perawat di ruang rawat inap sebanyak 56 orang. Teknik pengambilan sampel total sampling sehingga sampel sebanyak 56 responden. Alat pengumpulan data menggunakan lembar kuesioner dan lembar observasi. Uji statistik yang digunakan uji chi square. Hasil dari analisa univariat untuk variabel pemberian insentif mayoritas pemberian insentif tergolong tinggi sebanyak 69,6% dan kinerja perawat dalam pendokumentasian lengkap 67,8%. Dari hasil analisa bivariat yang digunakan menunjukkan bahwa ada hubungan pemberian insentif dengan kinerja perawat dalam pendokumentasian asuhan keperawatan (p=0,017 ; p<0,05). Diharapkan agar perawat mampu melakukan pendokumentasian yang lengkap bukan hanya karena adanya suatu insentif yang tinggi, tetapi menjadi suatu tanggung jawab perawat yang harus dilaksanakan.

HUBUNGAN QUALITY OF NURSING WORK LIFE DENGAN PRODUKTIVITAS PERAWAT DI RSU BETHESDA GUNUNGSITOLI Adventy Riang Bevy Gulo; Masri Saragih; Eva Kartika Hasibuan; Santi Gitasari Lombu
Indonesian Trust Health Journal Vol 5 No 1 (2022): Indonesian Trust Health Journal
Publisher : STIKes Murni Teguh

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37104/ithj.v5i1.91

Nursing services are very important in hospitals and health institutions, so efforts are needed to improve health services and nursing services together to improve the quality of hospital services. One effort that needs to be done is to increase the Quality of Nursing Work Life (QNWL) in hospitals.Improving the quality of work life is carried out by means of a better way of working where employees and other members gain insight to improve the quality of work effectively so as to increase the productivity of nurses. The purpose of this study was to determine the relationship between the quality of nursing work life and the productivity of nurses at Bethesda General Hospital Gunungsitoliin. The method in this research is descriptive correlation using cross sectional design. The population in this study were 43 nurses who worked at Bethesda General Hospital Gunungsitoli. The sample in this study were 43 nurses. Total sampling sampling technique. The tool used is a questionnaire sheet, the data were analyzed using the chi-square test. The results of the univariate analysis of the frequency distribution show that the majority of nurses with a high quality of nursing work life were 76.7%, and the frequency distribution of nurse productivity in the good category is 65.1%.So that the bivariate analysis show that there is a relationship between the quality of nursing work life and the productivity of nurses at Bethesda General Hospital Gunungsitoli (p value = 0.002). Suggestions from this study are expected to be input for nursing staff and hospitals to improve the quality of nursing work life in an effort to increase the productivity of nurses to improve the quality of health services that are better and quality and can be used as consideration for reference in further research. Abstrak Pelayanan keperawatan menjadi sangat penting di rumah sakit dan instansi kesehatan, sehingga perlu upaya peningkatan pelayanan kesehatan dan pelayanan keperawatan secara bersama-sama untuk peningkatan kualitas pelayanan rumah sakit. Salah satu upaya yang perlu dilakukan yaitu peningkatan quality of nursing work life (QNWL) di rumah sakit. Peningkatan kualitas kehidupan kerja dilakuakan dengan cara kerja yang lebih baik dimana karyawan serta anggota lainnya mendapatkan wawasan untuk meningkatkan kualitas kerja secara efektif sehingga meningkatkan produktivitas perawat. Tujuan penelitian ini adalah untuk mengetahui hubungan quality of nursing work life dengan produktivitas perawat di RSU Bethesda Gunungsitoli. Metode dalam penelitian ini yaitu deskriptif korelasi dengan menggunakan desain cross sectional. Populasi dalam penelitian ini yaitu seluruh perawat yang bekerja di RSU Bethesda Gunungsitoli sebanyak 43 perawat. Sampel dalam penelitian ini sebanyak 43 perawat. Teknik pengampilan sampel total sampling. Alat yang digunakan yaitu lembar kuesioner, data dianalisis dengan menggunakan uji chi-square. Hasil analisa univariat distribusi frekuensi bahwa mayoritas perawat dengan quality of nursing work life tinggi yaitu sebanyak 76,7 %, dan distribusi frekuensi produktivitas perawat dengan kategori baik sebanyak 65,1%. Sehingga analisa bivariat menunjukkan ada hubungan antara hubungan quality of nursing work life dengan produktivitas perawat di RSU Bethesda Gunungsitoli (p value = 0,002). Saran dari penelitian ini yaitu diharapkan menjadi bahan masukan bagi tenaga keperawatan serta rumah sakit untuk meningkatkan quality of nursing work life dalam upaya meningkatkan produktivitas perawat untuk meningkatkan kualitas pelayanan kesehatan yang lebih baik dan bermutu serta dapat dijadikan sebagai bahan pertimbangan untuk dijadikan referensi dalam penelitian selanjutnya.

Dukungan Caregiver Dengan Frekuensi Kekambuhan Pasien Skizofrenia Jek Amidos Pardede; Eva Kartika Hasibuan
Idea Nursing Journal Vol 10, No 2 (2019): Idea Nursing Journal
Publisher : Fakultas Keperawatan-Universitas Syiah Kuala

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52199/inj.v10i2.17161

Skizofrenia merupakan penyakit gangguan jiwa berat yang setiap tahunnya mengalami peningkatan secara global. Pasien skizofrenia sering mengalami kekambuhan. Frekuensi kekambuhan dinilai dari banyaknya jumlah kekambuhan yang dialami pasien dalam kurun waktu tertentu, dengan gejala-gejala yang biasanya dialami dan ditujukan pasien pada episode skizofrenia akut. Dukungan caregiver menjadi salah satu peran khusus bagi pengasuh pasien skizofrenia saat menjalani perawatan dan pengobatan. Tujuan penelitian untuk mengetahui hubungan dukungan caregiver dengan frekuensi kekambuhan pasien skizofrenia rawat jalan di Poliklinik Rumah Sakit Jiwa Prof.Dr.M.Ildrem Medan. Desain penelitian ini adalah deskriptif korelatif dengan menggunakan pendekatan Cross-Sectional. Populasi dalam penelitian ini adalah caregiver pasien skizofrenia sebanyak 4.615 orang dengan teknik pengambilan sampel menggunakan purposive sampling sebanyak 79 orang dan menggunakan kriteria inklusi. Hasil penelitian didapat bahwa dukungan caregiver responden mayoritas kurang 51.9% dan frekuensi kekambuhan mayoritas 2 kali sebanyak 35.4%. Dari hasil uji statistic Chi-Square didapatkan bahwa terdapat hubungan dukungan caregiver dengan frekuensi kekambuhan pasien skizofrenia rawat jalan di Poliklinik Rumah Sakit Jiwa Prof.Dr.M.Ildrem Medan (p=0.007 ; p0.05). Jika dukungan caregiver kurang maka frekuensi kekambuhan mengalami peningkatan, oleh karena itu diharapkan kepada caregiver lebih memberikan informasi dan motivasi kepada pasien yang menderita skizofrenia dalam menjalankan pengobatan dapat ditingkatkan. Kata Kunci: Dukungan Caregiver, Frekuensi Kekambuhan, Skizofrenia Abstract Schizophrenia is a disease of severe mental disorder that annually experiences an increase globally. Schizophrenia patients often experience relapse. Frequency of recurrence is assessed by the number of recurrence of the patient in a given period of time, with symptoms commonly experienced and addressed by patients in acute schizophrenia episodes. Caregiver Support became one of the special roles for caregivers schizophrenia while undergoing treatment and treatment. Research objectives to know caregiver support relationship with frequency of recurrence schizophrenia patients outpatient in the clinic of psychiatric hospital Prof. Dr. M. Ildrem Medan. The design of this research is descriptive corelative by using the Cross-Sectional approach. The population in this study is caregiver in schizophrenia patients with 4,615 sampling techniques using a sample purposive of 79 people and using inclusion criteria. The results of the study gained that support caregiver majority respondents were less than 51.9% and the frequency of recurrence majority 2 times as much as 35.4%. From the test results statistic Chi-Square is found that there is a caregiver support relationship with frequency of recurrence schizophrenia patients outpatient in the hospital psychiatric clinic Prof. Dr. M. Ildrem Medan (p = 0.007; p 0.05). If caregiver support less then frequency of recurrence is increased, therefore it is expected to caregiver more information and motivation to patients who suffer schizophrenia in carrying out treatment can be improved.Keyword: Caregivers Support, Frequency of Recurrence, Schizophrenia

The effect of dual role conflicts on nurse performance at private general hospitals in Medan and Deli Serdang Eva Kartika Hasibuan; Lasma Rina Efrina Sinurat
Malahayati International Journal of Nursing and Health Science Vol 4, No 1 (2021)
Publisher : Program Studi Ilmu Keperawata Fakultas Kedokteran Universitas Malahayati Bandar Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/minh.v4i1.4693

Background: Hospital human resources and hospital organizations become one unit. This requires a female nurse to have a high commitment because she must be able to place her position as a woman employed and her responsibilities as a housewife. Career women who uphold the profession will be more likely to experience conflict.Purpose: To determine whether there is an effect of dual role conflict on performing nurses at the Medan City Private General Hospital and Deli Serdang.Method: This study uses a correlational design and cross-sectional. The sampling technique used total sampling. The population was married female nurses and had children who worked at the Medan Advent General Hospital and Sari Mutiara Lubuk Pakam General Hospital, the nurses at Intensive Care Unit, inpatient and outpatient wards of 94 respondents.Results: The finding was 67% has a dual role category and 74.5% nurse performance in a good category, and by chi-square statistical test showed that there was a significant effect between multiple roles on performance as a nurse as a housewife with p-value = 0.045 (p<0.05).Conclusion: Even though dual role conflict is happening in female nurses, that a nurse can still perform well even though she has a high dual role by remaining wise in managing time as effectively as possible so that she can still harmonize employed and housewife, and keep the nursing care services at the hospital provided remain optimal.

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