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All Journal Jurnal Kedokteran STM (Sains dan Teknologi Medik)
Zaim Anshari
Fakultas Kedokteran, Universitas Islam Sumatera Utara, Indonesia
Biochemistry, Genetics & Molecular Biology Education Immunology & microbiology Medicine & Pharmacology Public Health

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PERSEPSI PASIEN TERHADAP EDUKASI PRAOPERATIF PADA TINDAKAN BEDAH ELEKTIF: SEBUAH STUDI KUALITATIF: PATIENT PERCEPTIONS OF PREOPERATIVE EDUCATION IN ELECTIVE SURGERY: A QUALITATIVE STUDY Handi Efendi; Zaim Anshari
Jurnal Kedokteran STM (Sains dan Teknologi Medik) Vol. 9 No. 2 (2026): Juli 2026
Publisher : Fakultas Kedokteran Universitas Islam Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30743/stm.v9i2.1337

Abstract

Preoperative education in elective surgery is a crucial nursing intervention to reduce anxiety and enhance patient readiness. However, patients' perceptions of the education they receive are often not adequately explored. This study aims to explore patient perceptions of preoperative education for elective surgery at Dr. Pirngadi Regional Hospital, Medan. This study employed a qualitative approach with a descriptive phenomenological design. Eight participants were selected through purposive sampling based on inclusion criteria. Data were collected through semi-structured in-depth interviews until saturation was reached. Data analysis used Braun and Clarke's thematic analysis. Three main themes were identified: (1) a gap between expectations and reality of information, where education was procedural, limited, and rushed; (2) the vital role of family support in building readiness, yet not formally accommodated; (3) preferences for contextual and empathetic educational methods, including visual aids, polite and local language, and staged delivery. Patients' perceptions indicate that preoperative education at Dr. Pirngadi Regional Hospital, Medan, remains not patient- and family-centered. Hospitals need to develop multimodal education standard procedures, involve families, and enhance nurses' empathetic communication to improve the quality of the perioperative experience. AbstrakEdukasi praoperatif pada tindakan bedah elektif merupakan intervensi keperawatan penting untuk mengurangi kecemasan dan meningkatkan kesiapan pasien. Namun, persepsi pasien terhadap edukasi yang diterima seringkali tidak tergali secara memadai. Penelitian ini bertujuan untuk mengeksplorasi persepsi pasien terhadap edukasi praoperatif pada tindakan bedah elektif di RSUD Dr. Pirngadi Medan. Metode: Penelitian ini menggunakan pendekatan kualitatif dengan desain fenomenologi deskriptif. Partisipan berjumlah 8 orang yang dipilih secara purposive sampling sesuai kriteria inklusi. Pengumpulan data dilakukan melalui wawancara mendalam semi-terstruktur hingga mencapai titik jenuh. Analisis data menggunakan analisis tematik Braun dan Clarke. Ditemukan tiga tema utama: (1) kesenjangan antara harapan dan realitas informasi, di mana edukasi bersifat prosedural, terbatas, dan terburu-buru; (2) peran vital dukungan keluarga dalam membangun kesiapan, namun belum diakomodasi secara formal; (3) preferensi metode edukasi yang kontekstual dan empatik, meliputi media visual, bahasa santun dan lokal, serta penyampaian bertahap. Persepsi pasien menunjukkan bahwa edukasi praoperatif di RSUD Dr. Pirngadi Medan masih belum berpusat pada pasien dan keluarga. Rumah sakit perlu menyusun standar prosedur edukasi multimodal, melibatkan keluarga, serta meningkatkan komunikasi empatik perawat untuk meningkatkan kualitas pengalaman perioperatif.
MONITORING TERAPI CAIRAN PADA KASUS EMERGENSI: TINJAUAN KOMPREHENSIF PENDEKATAN DINAMIS TERKINI: FLUID THERAPY MONITORING IN EMERGENCY CASES: A COMPREHENSIVE REVIEW OF THE LATEST DYNAMIC APPROACH Agus Sumedi; Zaim Anshari
Jurnal Kedokteran STM (Sains dan Teknologi Medik) Vol. 9 No. 2 (2026): Juli 2026
Publisher : Fakultas Kedokteran Universitas Islam Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30743/stm.v9i2.1342

Abstract

Fluid therapy is a cornerstone of resuscitation in emergency patients, but conventional approaches based on static parameters such as central venous pressure and isolated clinical signs have proven insensitive and frequently trigger fluid overload, which directly correlates with increased mortality and multi-organ failure. This article aims to comprehensively review the evolution of fluid therapy monitoring strategies, focusing on dynamic parameters and Point-of-Care Ultrasound (POCUS) in emergency departments and intensive care units based on current clinical evidence. A narrative review was conducted on 26 reputable scientific literatures (Scopus Q1/Q2 and international guidelines) published between 2018–2026 regarding the accuracy of dynamic parameters, functional tests, and ultrasonography in predicting fluid responsiveness. The results demonstrate that determining fluid responsiveness using dynamic parameters—such as Pulse Pressure Variation (PPV) and Stroke Volume Variation (SVV) with an accuracy >13%—is far superior to static parameters. For spontaneously breathing patients, the Passive Leg Raising (PLR) test proves safe and reversible. Integration of POCUS through evaluation of Inferior Vena Cava collapsibility and Carotid Artery Flow Time provides real-time visualization of circulatory volume status at the bedside. Implementation of a phase-based resuscitation protocol (the ROSE concept) guided by dynamic parameters, along with a post-resuscitation restrictive strategy, has been shown to reduce the incidence of acute kidney injury and the duration of mechanical ventilation. In conclusion, fluid monitoring based on dynamic parameters and POCUS is strongly recommended to replace conventional linear resuscitation dogma in order to reduce morbidity and mortality in emergency patients. AbstrakTerapi cairan merupakan pilar utama resusitasi pasien emergensi, namun pendekatan konvensional berbasis parameter statis seperti tekanan vena sentral dan tanda klinis terisolasi terbukti tidak sensitif dan sering memicu fluid overload yang berkorelasi langsung dengan peningkatan mortalitas serta kegagalan multi-organ. Artikel ini bertujuan menelaah secara komprehensif evolusi strategi monitoring terapi cairan dengan fokus pada parameter dinamis dan Point-of-Care Ultrasound (POCUS) di instalasi gawat darurat dan ruang intensif berdasarkan bukti klinis literatur terkini. Metode yang digunakan secara komprehensif terhadap 26 literatur ilmiah bereputasi (Scopus Q1/Q2 dan panduan internasional) kurun waktu 2018–2026 terkait akurasi parameter dinamis, uji fungsional, dan ultrasonografi dalam memprediksi responsivitas cairan. Hasil tinjauan menunjukkan bahwa penentuan responsivitas cairan menggunakan parameter dinamis seperti Pulse Pressure Variation (PPV) dan Stroke Volume Variation (SVV) dengan akurasi >13% jauh lebih unggul dibanding parameter statis. Bagi pasien bernapas spontan, uji Passive Leg Raising (PLR) terbukti aman dan reversibel. Integrasi POCUS melalui evaluasi kolapsibilitas Vena Cava Inferior serta parameter Carotid Artery Flow Time memberikan visualisasi status volume sirkulasi secara real-time di tempat tidur pasien. Implementasi protokol resusitasi berbasis fase (konsep ROSE) yang dipandu parameter dinamis serta strategi restriktif pasca-resusitasi terbukti menurunkan kejadian cedera ginjal akut dan durasi ventilasi mekanik. Sebagai kesimpulan, monitoring cairan berbasis parameter dinamis dan POCUS sangat direkomendasikan untuk menggantikan dogma resusitasi linier konvensional demi menurunkan morbiditas dan mortalitas pasien emergensi.
ANALISIS KENDALA AKSES LAYANAN KESEHATAN PADA MASYARAKAT SEBAGAI DASAR PERUMUSAN KEBIJAKAN PELAYANAN: ANALYSIS OF CONSTRAINTS TO ACCESS TO HEALTH SERVICES IN THE COMMUNITY AS A BASIS FOR FORMULATING SERVICE POLICIES Marlina Elfa Lubis; Zaim Anshari
Jurnal Kedokteran STM (Sains dan Teknologi Medik) Vol. 9 No. 2 (2026): Juli 2026
Publisher : Fakultas Kedokteran Universitas Islam Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30743/stm.v9i2.1349

Abstract

Access to healthcare services remains a major challenge in achieving equitable health outcomes in Indonesia, despite the implementation of the National Health Insurance (JKN) program. This study aimed to analyze the barriers to healthcare access experienced by communities as a basis for formulating responsive healthcare service policies. A qualitative descriptive approach was employed, involving six informants selected purposively from JKN participants who had experience accessing healthcare services. Data were collected through in-depth semi-structured interviews and analyzed using data reduction, data display, and conclusion-drawing techniques. Source triangulation was applied to ensure data validity. The findings revealed four major barriers to healthcare access: geographical, economic, administrative, and health literacy barriers. Geographical and transportation issues, including long distances to healthcare facilities, inadequate road conditions, limited transportation options, and mobility constraints among older adults, emerged as the most prominent challenges. Economic burdens related to transportation costs, complex referral procedures, lengthy waiting times, and limited understanding of healthcare procedures further hindered healthcare utilization. These interconnected barriers contribute to persistent inequalities in healthcare access. The study concludes that healthcare policies should be context-specific and evidence-based, focusing on improving transportation infrastructure, simplifying administrative procedures, strengthening community-based health education, and providing greater support for vulnerable populations. Such efforts are essential to promote equitable and accessible healthcare services for all communities. AbstrakAkses terhadap layanan kesehatan masih menjadi tantangan utama dalam mewujudkan pemerataan derajat kesehatan masyarakat di Indonesia meskipun Program Jaminan Kesehatan Nasional (JKN) telah diterapkan. Penelitian ini bertujuan untuk menganalisis kendala akses layanan kesehatan yang dialami masyarakat sebagai dasar perumusan kebijakan pelayanan kesehatan yang responsif. Penelitian menggunakan pendekatan kualitatif dengan desain deskriptif. Informan penelitian berjumlah enam orang yang dipilih secara purposive, yaitu masyarakat peserta JKN yang pernah mengakses layanan kesehatan. Data dikumpulkan melalui wawancara mendalam menggunakan pedoman semi-terstruktur dan dianalisis melalui tahapan reduksi data, penyajian data, serta penarikan kesimpulan. Keabsahan data dijamin melalui triangulasi sumber. Hasil penelitian menunjukkan adanya empat kendala utama dalam akses layanan kesehatan, yaitu kendala geografis, ekonomi, administratif, dan literasi kesehatan. Kendala geografis dan transportasi berupa jarak fasilitas kesehatan yang jauh, kondisi jalan yang kurang memadai, keterbatasan sarana transportasi, serta keterbatasan mobilitas pada kelompok lansia menjadi hambatan yang paling dominan. Selain itu, biaya transportasi, prosedur administrasi yang kompleks, antrean pelayanan yang panjang, serta rendahnya pemahaman masyarakat mengenai prosedur dan hak pelayanan kesehatan turut memengaruhi pemanfaatan layanan kesehatan. Berbagai kendala tersebut saling berkaitan dan memperkuat ketimpangan akses layanan kesehatan. Oleh karena itu, diperlukan kebijakan yang kontekstual dan berbasis kebutuhan masyarakat melalui peningkatan infrastruktur transportasi, penyederhanaan prosedur pelayanan, penguatan edukasi kesehatan berbasis komunitas, serta perhatian khusus terhadap kelompok rentan. Upaya tersebut penting untuk mewujudkan pelayanan kesehatan yang lebih adil, merata, dan mudah diakses oleh seluruh masyarakat.
Co-Authors Agus Sumedi Handi Efendi Marlina Elfa Lubis