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An alignment between two or more aspect in hospitals could have an impact on efficiency. The results of a preliminary study at 9 regional general hospitals showed an inefficient 66.67% in 2015-2016, and there was a decrease in efficiency 33.33% of the inefficient hospital. The purpose of this paper is to analyze the contribution of alignment between the costs of quality improvement activities and quality achievements on efficiency in hospital. This study is an observational analytic research with survey method. The population of this study is general hospitals (government and private) class B and C in East Java of 150 units with a sample of 30 hospitals. Respondents for the alignment assessment are 432 people, while for the efficiency measurement are 118 people. Analysis to determine the contribution of alignment on efficiency using linear regression statistical test. The results showed that most hospitals were in an align between the cost of quality improvement activities with quality achievement of 70%, most of the hospitals were in the efficient of 60%, and the contribution of alignment between the costs of quality improvement activities and quality achievement on efficiency (RoS /CoS ratio) of 4.1% with a value of R² = 0.041.

An alignment between two or more things in an organization (including hospitals) could have an impact on the organization performance. The alignment between two aspects (eg between processes and outputs) in the health sector, especially in the hospital is necessary. The alignment between processes and outputs is needed such as the alignment between the costs of quality improvement programs (processes) and the quality achievements (outputs). This alignment could be deployed as an evaluation parameter for the cost control and the quality control carried out in the hospital. The purpose of this paper is to systematically review evidence of the assessment instrument for the alignment between the cost and the quality or the alignment of other aspects. This study was a systematic review of articles on the assessment instruments for the alignment between the cost and the quality or the alignment of other aspects. The inclusion criteria that were used were the assessment or the measurement instrument of the alignment, the assessment or the measurement instrument, the alignment between the cost and the quality, or other alignments. The initial identification process based on the search found 774.139 articles.

The prevalence of chronic pain ranges from 30-50% in patients with cancer undergoing active therapy. Kynurenic acid, xanthurenic acid, and quinolinic acid are significant biomarkers for assessing pain objectively. This study aims to investigate the scientific evidence of the effect of serum kynurenic acid levels on the severity and duration of chronic cancer pain. It is a cross-sectional study with 80 subjects consisting of 19 male and 61 female patients in the palliative outpatient clinic of Dr Soetomo Hospital. The pain assessment was performed using the NRS, and the biochemical analysis of serum kynurenic acid was assessed using the ELISA method. Of the total of 80 subjects, 26 patients had pelvic organ cancer (33.7%), 24 patients had respiratory organ cancer (30.1%), 17 patients had breast cancer (21.7%), 9 patients had abdominal organ cancer (9.6%), 3 patients had malignant melanoma (3.6%), and 1 patient had sternal bone cancer (1.2%). Kynurenic acid significantly correlated with the severity of pain (p = 0.043), with (r) of -0.218. However, kynurenic acid showed no significant correlation with the duration of pain (p = 0.052). Kynurenic acid affected the severity of pain but did not affect the duration of pain in chronic cancer pain patients.

https://tianjindaxuexuebao.com/details.php?id=DOI:10.17605/OSF.IO/CHJZP

Organizational Citizenship Behavior (OCB) owned by a person as an organization member is an extra role behavior, formed when a person feels the benefits of the organization for himself. People become committed, loyal to behave outside the obligation, as an inseparable part of the organization. OCB appears to employees who commit, positive perception of the organization, feel satisfaction if giving something exceeds the standard (Borman & Motowidlo, 1993). Someone behaves extra role, will do anything for the organization voluntarily and happily. Growing love, having all your heart, desperately defending his organization, is a form of Organizational Pride. Pride relates to feelings of commitment, intention, behavior, and shows cooperation with the organization (loyalty, staying as a member of the organization) (Tyler & Blader, 2000). -tulisan merah belum di translate-. The research aims to prove the influence of OCB on the Lecturer's Organizational Pride. Explanatory observational research with cross-sectional approach. Respondents were 105 lecturers. The independent variable is OCB (Altruism, Conscientiousness, Sportsmanship, Courtesy, Civic virtue). The dependent variable is Organizational Pride. Data analysis using linear regression test, α = 0,05. The results of the study prove that OCB influences Organizational Pride (p = 0.001; b = 0.573). It shows that OCB has a role in encouraging Lecturer Organization Pride. The conclusion is that the higher the OCB will ultimately increase the Organizational Pride. Necessary activities to maintain and improve OCB and pride owned by lecturers (individual or institutionalized) sustainable, continuous training methods Small Group Discussion. Thus, strengthening the internalization of love, belongingness, commitment and loyalty to the organization. In the end it is able to optimize the performance of lecturer tridharma.

Objective To identify the factors which affect the cost difference in appendicitis cases. Method This was an observational analytic research with cross-sectional study design. This research involved 40 medical records of patients who were diagnosed with appendicitis in Jombang Islamic Hospital from January-December 2018. The patients were selected using stratified random sampling. The data were analysed using linear regression. Results This research showed that length of stay (β = 0.290; p = 0.005) and schedule for the surgery (β = 0.265; p = 0.010) had a significant impact on the cost differences in the JKN patient with appendicitis. An increase in the length of stay and the delay of the surgery schedule will increase the cost difference. Conclusion The hospital should monitor the surgeon's compliance with the length of stay of appendicitis cases. The schedule for the surgery also needs to be followed to prevent the delay from reducing the cost difference in Jombang Islamic Hospital.

This study aims to overview and identify how medical record is executed by specialists in undertaking their medical tasks. This study involves specialists at Dr. M. Soewandhie hospital. Based on th...

Surabaya is one of the cities with low coverage of exclusive breastfeeding in East Java. The average rate of babies who got exclusive breastfeeding in Surabaya from 2012 to 2015 was 63.13% (target 80%). Decision about whether to breastfeed or not is a challenge for every mother, especially for working mothers. This research aimed to identify breastfeeding behavior among working mothers and housewives. This was descriptive observational research with prospective cohort study design. The sample size was 79 mothers in the eastern part of Surabaya chosen by purposive sampling technique. Result showed that 56.6% of housewives have low knowledge on breastfeeding. Both working mothers (100%) and housewives (90.6%) already give colostrum right after baby born. However, There were 54.7% of housewives and 46.2% of working mothers already give formula milk during the first month after baby born. There were not much difference between working mothers and housewives in knowledge, feeding colostrum and skin to skin contact aspects. But, working mothers mostly give formula milk during the first month of baby born than housewives. This research has been approved by the Health Research Ethics Committee of Faculty of Public Health Universitas Airlangga Number 396-KEPK on 20 June 2016.

The implementation of risk management is an essential function in an organization to control risk. Basedon the preliminary research that has been carried out, only 4.2% of FLHF in East Java implemented thecomplete risk management process, starting from establishing context to evaluating risks. Modificationsof risk management cycle implementation are made by reviewing the opinion of Carroll (2001) and ISO31000:2009. This research aims to analyze the influence between the stages of implementing modified riskmanagement based at 95 FLHF in East Java. The results show that each stage of the capitation mechanismrisk management has a strong significant influence on each other. The results provide recommendation thatFLHF should improve the understanding and awareness of the risks and expected to be able to apply riskmanagement cycle as a whole.

Incidencesregarding patient safety still occur,and not all are reported to the Hospital Patient SafetyCommittee. The aim studyto analyze the employee relationship influences the work unit staff’s intention inimplementingthe patient safety program—the study was conducted bythe quantitative design of observationalanalytics and through a cross-sectional staff approach. The research sites includedSidoarjo Regional Hospital,Anwar Medika Sidoarjo Hospital, and Ahmad Yani Surabaya Islamic Hospital. The research collects dataduring May–July 2019. The variables consist of employee relationship as the independent variable andintention as the dependent variable. The results show that the development stage’s employee relationshipwas broadly establishing (46.51%), whereas, for the relationship stage, it was a majority of trusts (72.09%).The source intention stage was mostly personal intention(62.79%), and at the intention level, most of thedistal intention was 84.88%. The leadership type affects theworking unit staff’s discretionto implementpatient safety programs in hospitals, with employee relationships as a variable mediator.The study concludedthat the employee relationships had a significant influence on the working unit staff’s intention in hospitalsto carry out patient safety programs. However,employee relationships affect the work unit staff’s intentionto carry out the patient safety program.

Background: Exposure to ultraviolet A & B (UVA-UVB) plays a role in the survival of human life, but it may cause negative effects, such as immunosuppression and skin cancer. The effect of solar UVA-UVB exposure on apoptosis (Bax/Bcl-2 ratio) of peripheral blood cutaneous lymphocyte antigen (CLA)+ T-lymphocyte; the immune competent cells in the skin, has not been investigated. Apoptosis of peripheral blood CLA+ Tlymphocyte affects its function; which serves as the skin's resistance and is involved in infectious diseases, skin inflammation, and malignancies. This study observed the effect of solar UVA-UVB to apoptosis (Bax/Bcl2 ratio) of peripheral blood CLA+ T-lymphocytes. Methods: An observational cohort study of 37 male outdoor workers (caddies on the golf course) and 33 indoor workers in Surabaya, aged 20-45 years, with skin phototype IV/V. Measurement of solar UVA-UVB doses received by the subjects was conducted for 2, 4, and 8 weeks. Examination of Bax and Bcl-2 of peripheral blood CLA+ T-lymphocyte was conducted at the beginning of the study, after 4 and 8 weeks. Results: The average dose of solar UVA-UVB for 8 weeks received by outdoor workers was 12450.51±3948.81 (J/m2 ) and that by indoor workers was 1793.97±1518.46 (J/m2 ). Exposure to solar UVAUVB leads to the increase of apoptosis (Bax/Bcl-2 ratio) of peripheral blood CLA+ T-lymphocytes (p=0.003). Conclusion: Cumulative exposure to solar UVA-UVB radiation in high-dose or received within 8 weeks resulted in the increase in apoptosis of peripheral blood CLA+ T-lymphocytes. Keywords : solar UVA-UVB, CLA + T Lymphocyte, Bax, Bcl-2, apoptotic .

Midwife’s performance at Primary Health Care (PHC) still not optimal, slacken the effort of reducing maternal death. Unavailability of doctor at PHC placed greater responsibility on midwife, thus improving midwife’s performance is crucial. Midwife’s performance influenced by ability, motivation, and supervision. Cross- ethnic supervision combined with line manager supervision, fit in the development of dialogue focused supervisory relationship (DFSR) in midwifery supervision. This study aimed to analyse the effect of DFSR on midwife’s performance, and the relationship between cross-ethnic supervision and DFSR. This research used crosssectional design. Using random sampling techniques, 113 pairs of midwives -supervisors working in PHC at Kupang city and Kupang district were obtained. Data analysed using regression analysis. The findings were: (1) quality of DFSR affecting midwife’s performance improvement, with quality of dialogue give strongest influence, (2) good quality supervisory relationship decrease midwife’s performance, and (3) cross-ethnic supervision didn’t have significant relationship towards DFSR. The development of DFSR as a new construct and evident of the relationship between DFSR and midwife’s performance is a novel in this study. To enrich this finding, future research should use longitudinal design and with different type of respondent. Study in exploring factor in cross-ethnic supervision that may influence DFSR also suggested. Keywords: Midwife’s performance, Dialogue focused supervisory relationship, Cross-ethnic supervision

Inpatient services at the X Hospital consists of Intensive Care Units and Inpatient Units. In 2014, a nurse at the unit as a whole experienced a shortfall of 66.67% from 9 rooms there. This shortage triggered theincreasing of nurse workload. This study aimed to find out the objective workload on nurses in Intensive Care Units and Inpatient Units. This research is quantitative descriptive with cross-sectional design. The sample used is total sampling, as many as 174 nurses. Data obtained using activity sheets time and motion study indirectly (self-assessment). Results from this study show the objective workload in the Intensive Care Unit on the morningshift have a heavy workload category, afternoon shift and the night shift has a moderate workload category, while at Inpatient Unit on the morning shift and afternoon shift has a heavy workload category, and shift night has amoderate workload category. The conclusion of this study is objective workload in the Intensive Care Unit has a moderate workload category, while the objective workload in the Inpatient Unit has a heavy workload category.Keywords: nurse,objective workload, time and motion study

Many mistakes are often made in the laboratory such as: confusing results of specimen examination, wrong process of laboratory services and many problems appearing during services can result in patient's error. The knowledge management can be a systematically way to capture and communicate knowledge to the laboratory technicians in order to minimize errors made in the laboratory. The purpose of this study is to prove that by implementation of patient's safety using management strategy of knowledge about patient's safety can increase the performance of laboratory personnel. The study is carried out pre-experimentally by using a pre-post design in a group without a control group comprising 55 respondents. Prior to giving implementation about knowledge of patient's safety, the study subjects were tested by a pre-test about: the personnel's potentials (mindset, attitude, awareness and knowledge), quality of work and performance of the personnel. Knowledge management was implemented in several stages, starting from dispersion of knowledge by making: modules, stages of setting up a team, distribution of knowledge by training and executing patient's safety and acquainting knowledge by routine team meetings, recording, reporting and evaluation of patient's safety. The increase of potentials, work process quality and personnel performance was post-tested to show a change and implementation effect of knowledge management about patient's safety. The result showed a significant change in the personnel potentials post implication of knowledge management (p

Objective: To evaluate the diagnostic value of Non Contrast Helical Computed Tomography (NCHCT) scanning as the first choice diagnostic modality for detecting urolithiasis cases in Soetomo General Hospital Surabaya and evaluate the feasibility as alternative to Intravenous Urography (IVU). Material & Methods: Seventeen patients with clinical manifestation of suspected urolithiasis underwent NCHCT and IVU to evaluate suspected urolithiasis. Reformatted three-dimensional CT was performed in all patients. The images were correlated with findings from surgical procedure (ureteroscopy, percutaneous nephrolithotomy, and open surgery). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were determined for NCHCT and IVU. Results: The diagnosis of urolithiasis was defined as unequivocal evidence of urolithiasis on either NCHCT or IVU. Sixteen of seventeen patients evaluated were diagnosed with urolithiasis. NCHCT established the diagnosis in 16 of 17 patients while IVU was positive in 11 of 17 patients. IVU was negative in 6 of the 17 cases. The sensitivity, specificity and accuracy of NCHCT was 100%, 100%, and 100% respectively (p = 0.05) and the sensitivity, specificity, and accuracy of IVU was 68%, 100% and 70% respectively (p = 0.35). There was no statistically significant difference between IVU and NCHCT using Fisher’s exact test. Conclusions: NCHCT accurately diagnosed urolithiasis in patients with suspected urolithiasis. Considering that NCHCT is more effective and efficient than IVU as diagnostic modality in determining the presence of urolithiasis, it may be considered to replace IVU as the first line diagnostic tool for urolithiasis in Soetomo General Hospital Surabaya. Keywords: Non Contrast Helical CT Scan, Intravenous Urography, Urolithiasis.

Objective: To prove that ureteric jet examination using Color Doppler Ultrasonography (CDU) can be used as a diagnostic tool to predict success of retrograde Double J Stent insertion in uterine cervicis carcinoma patients with hydronephrosis. Materials and Methods: This observational analytic study took 32 samples since May until October 2013. Before, the ureteric jet were counted for 5 minutes using CDU , then continued on the same day with cystoscopy and retrograde DJ Stent insertion. The analysis was using Chi-Square and also Coefficient Contingency test. Results: In both Chi-Square and Coefficient Contingency test, it is proven a significant correlation between success of retrograde DJ Stent insertion and Blood Urea Nitrogen (BUN), creatinine value, grade of hydronephrosis and also ureteric jet examination using CDU, with probability value (p < 0,005). The normal of BUN, creatinine level and the lower grading of hydronephrosis, the more likely successful DJ Stent insertion. Successfulness of DJ Stent insertion is also greater in a positive ureteric jet samples on examination using CDU , with sensitivity value 90,9% and specificity 89,5%, positive predictor value 83,3%, negative predictor value 95% and accuracy value 0,9. Conclusion: Ureteric jet frequency examination using CDU can be used as a success predictor of retrograde DJ Stent insertion in hydronephrosis uterine cervicis carcinoma patients with sensitivity value 90,9% and specificity 89,5%. Keywords: Ureteric jet, Color Doppler Ultrasonography, Double J Stent, Uterine Cervicis Carcinoma

Objective: To compare the successful of the identification of the ureteral orifice at cervical cancer patients who received phenazopyridine orally and to analyze the correlation between hydronephrosis and successful rate for retrograde stenting. Material & Method: This was a comparative experimental study, using phenazopyridine hcl orally prior to cystoscopy to identify the ureteral orifice on cervical cancer patients and to perform retrograde stenting on spotted ureteral orifice. Forty samples provided consent to enroll in this study. Mean age was 49.2 ± 5.16 years. Thirty-four out of 40 samples was confirmed as squamous cell carcinoma type. Results: Chi-square test demonstrated no significant differentiation in finding ureteral orifice between treatment and control group on stage 3B (p = 0.408). However, result shown conversely on stage 4A (p = 0.046). There was no significant disparity in conducting retrograde stenting between treatment and control group on stage 2B and 3B (p = 0.221 and p = 0.197). There was no significant correlation between hydronephrosis gradation and retrograde stenting on control group (p = 0.144). Conclusion: Administration of phenazopyridine HCL orally in cervical cancer patients increase success for ureteral orifice identification and retrograde stenting, but not statistically significant. There is no correlation between hydronephrosis with a success retrograde stenting. Keywords: Cervical cancer, hydronephrosis, phenazopyridine hcl, ureteral orifice, retrograde stenting. Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

Objective: The objective of this study was to evaluate the implementation of diuretic Doppler Ultrasound (DDU) to differentiate the obstructed and non-obstructed kidney. Material & Method: From 28 patients, we gathered data of 48 kidneys in accordance with the inclusion criteria. We evaluated the Doppler Ultrasound Resistive Index (RI) before and after administration of diuretic, using the renogram as the comparison. The result of renogram was categorized into total obstruction (n = 19), partial obstruction (n = 18), and non-obstructive dilatation (n = 3). The statistical analysis was performed using Anova test followed by Tukey HSD test. We also performed diagnostic test, the total and partial obstruction were categorized within obstructed group (n = 37) whereas normal and non-obstructed dilated kidney categorized as non-obstructed group (n = 11). Results: Average change of RI (ΔRI) was 0,542 ± 0,0457 for total obstruction, 0,0428 ± 0,0439 for partial obstruction, 0,0275 ± 0,0392 for normal kidney, -0,0300 ± 0,0361 for non obstructed dilated kidney. The result of normality and homogeneity test indicated the data were normally distributed. One-way Anova test revealed significant differences of ΔRI between groups. The subsequent Tukey HSD test indicated that there were significant differences in total and partial obstruction groups, compared to non-obstructive dilated kidney group. Based on ΔRI cut-off point (0,035) the diagnostic characteristics were 88,5% sensitivity and 72,3% specificity. Conclusion: RI of Diuretic Doppler Ultrasound is a valuable examination to evaluate obstructed and non-obstructed kidney. The cut-off point of 0,035 indicated probability of obstructive kidney. Keywords: Resistive index, renogram, obstructive kidney, non-obstructive kidney.

Objective: To evaluate erectile function before and after transrectal ultrasound (TRUS) guided prostate biopsy using International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score (EHS) instrument. Material & Method: We conducted a study on 17 BPH LUTS patients who underwent TRUS guided prostate biopsy from January to April 2011 in Urological Minimal Invasive Installation (IIU) Dr. Soetomo Hospital. Out of 17 patients, three patients had mild ED, while 14 other patients had normal erectile function before the procedure. After TRUS guided prostate biopsy, we performed erectile function assessment using the IIEF-5 and EHS at weeks I, II, and IV. Results: Pathological examination of all specimens from prostate biopsy results revealed BPH. There were 2 patients with hematuria and 1 patient with rectal bleeding shortly after the biopsy, which resolved spontaneously less than 24 hours. Based on the IIEF-5 there were 4 patients (23,5%) with decreased erectile function in the evaluation of first week after prostate biopsy, and it reduced to 2 patients (11,7%) whose erectile function was still decreasing in the evaluation week II, while in fourth week evaluation there was 1 patient (5,9%) with decreased erectile function. Based on EHS data obtained, there were 5 patients (29,4%) with decreased scores in evaluations week II, and in the evaluation of week IV there were no patients having erectile function problems compared with EHS data before prostate biopsy. Conclusion: TRUS guided prostate biopsy can have temporary effect on erectile function. Keywords: Erectile dysfunction, prostate biopsy, international index of erectile function-5, erection hardness score. Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

Political changes in health policy, pertaining to the regional autonomy in lndonesia, have caused changes in the structural and funetional components in the health field at Provincial and District level. The role of District Health Office becomes very essential in manage the health program and resources, including health human resources. Since the variability of resources between inter-regional health system is veryenormous, and same problems are existed, thus government should develop the system atie scenario of human resources management system. The scenario needs support from a leader that has visionary and transformationalleadership as well as entrepreneur and professionalism mindset to tackling the health problems in the regional area. In conclusion, despite the important role of District Health Office in managing the health human resources as the anticipation of the impact ofdecentralization, the health workers should also take the opportunities and challenge to provide program and health services that suffice the needs and demands of society Key words: health human resource, policy, leadership, decentralization ABSTRAK Perubahan politik dalam kebijakan kesehatan, khususnya terkait dengan otonomi daerah di lndonesia, menyebabkan perubahan pada komponen struktural dan fungsional pada level Provinsi dan Kabupaten/Kota. Peran Dinas Kesehatan Kabupaten dan Kota menjadi sangat vital dalam mengelola program sekaligus dalam pengelolaan sumber daya, termasuk SDM kesehatan. Karena variabilitas sistem kesehatan antardaerah yang sangat besar serta adanya berbagai kendala yang harus dihadapi dalam penyelenggaraan desentralisasi, maka pemerintah daerah harus mengembangkan sistem pengelolaan SDM yang secara sistematis. Selain itu, diperlukan kepemimpinan yang visioner dan transformasional sekaligus ber-mindset profesional dan berjiwa enterprenuer yang dapat mendorong implementasi desentralisasi kesehatan. Dapat disimpulkan bahwa peran Dinas Kabupaten atau Kota cukup besar dalam melakukan penataan SDM Kesehatan, sebagai upaya mengantisipasi dampak dari kebijakan desentralisasi. Selain itu, SDM Kesehatan juga harus mampu memanfaatkan peluang di era desentralisasi dan pasar bebas sehingga dapat menyediakan program dan pelayanan kesehatan yang sesuai dengan kebutuhan dan tuntutan masyarakat. Kata kunci: SDM kesehatan, kebijakan, kepemimpinan, desentralisasi

Nurses wishes to pursued them from doctors as a profession. The realization was through conducting nursing law. The implementation of this nursing law need circumstantial policy analysis to comprehend its consequences. This policy analysis studied the 19th device of nursing law. Several questions should be answered in the policy review of nursing law device such as kinds of policy problem which will be entered, value of changing, important actors which involved, approaches that will be used, kinds of resistance which possible emerge and trades off which predicted has possibility goes into effect. Conclusion of this article is that this nursing law device represent policy which relative new anticipating other profession which have established. This policy device was less detailed, less clear about boundaries and some section become weaknessess to this policy. There are resistant to effort application of this device, especially from nurses which can not fulfill the law's criterion on nursing practices. Key words: policy analysis, nursing practice, nursing law device

Objective: To determine whether the administration of tamsulosin, as adjunctive medical therapy, increases the efficacy of one session of extracorporeal shock wave lithotripsy (ESWL) to treat renal stones. Material & Method: A prospective randomized placebo controlled study enrolled 21 patients. They underwent a single ESWL session to treat solitary radiopaque renal stones 4 to 20 mm in diameter. After ESWL, the study group (11) received 0,4 mg tamsulosin daily and the control group (10) received placebo until stone clearance or a maximum period of 8 weeks. The primary endpoint was stone-free rate and parameters were stone size and clearance time. Results: The overall stone-free rate was better in the study group than in the control group (90,9% vs. 60,0%). The clearance time after 2, 4, 6 and 8 weeks was greater in the study group than in the control group (36,4%; 63,6%; 72,7% and 90,9% vs 30,0%; 50,0%; and 60,0% respectively) but statistically insignificant. Conclusion: Clinically, the results of our study have demonstrated that tamsulosin therapy, as an adjunctive medical therapy after ESWL, is more effective than lithotripsy alone for the treatment of patients with renal stones. Keywords: ESWL, tamsulosin, medical expulsive therapy, renal stones.

Workload Indicators of Staffing Need (WISN) was a method for calculating the number of health worker in Public Health Center. However, the result from previous studies show that this method had some weakness. Public Health Center in Pacarkeling Surabaya had problem in the shortage of health worker. Previously, Workload Indicators of Staffing Need was applied to assess the health worker. This study identified the weakness of WISN by company to the objective workload. This was an observational study by using total population of medical, midwifery, and nursing staff in Pacarkeling Surabaya Public Health Center. WISN calculation method was performed to get the final result. They were the number of staff needs and the value of ratio. This ratio compared with the result of objective workload calculating to show the weakness of WISN method. WISN method is not appropriate when applied in Public Health Center. There were some weakness in the WISN method that made this method was less accurate. It is because health worker don’t carry out their job based on main duty, the method using data from previous years and don’t pay attention to labor of productivity. Keyword: weakness of WISN, the number of health worker, Public Health Center