International Journal of Nursing and Health Services (IJNHS)

System Quality, Service Quality, and Electronic Medical Record Adoption: User Satisfaction as Mediator in Regional Hospital Outpatient Care

Synthia Sari Toha — 2026-06-29

Background: Electronic medical record (EMR) adoption is essential for improving documentation accuracy, information accessibility, service efficiency, and patient safety. In outpatient care, EMR adoption is particularly important because healthcare professionals work in a high-volume and time-sensitive service environment. Objective: This study aimed to examine the effects of system quality and service quality on EMR adoption, with user satisfaction as a mediating variable, among healthcare professionals in a regional hospital outpatient department. Method: A quantitative cross-sectional analytical study was conducted among 97 Care Provider Professionals in the outpatient department of Dr. Dradjat Prawiranegara Regional Hospital, Serang. Respondents were selected using purposive sampling. Data were collected using a structured questionnaire and analyzed using Structural Equation Modeling-Partial Least Squares (SEM-PLS). Result: User satisfaction had a positive and significant effect on EMR adoption (? = 0.600; t = 4.075; p < 0.001). System quality significantly influenced user satisfaction (? = 0.202; t = 2.805; p = 0.005) and EMR adoption (? = 0.506; t = 5.573; p < 0.001). Service quality significantly influenced user satisfaction (? = 0.770; t = 12.540; p < 0.001), but its direct effect on EMR adoption was not significant (? = -0.164; t = 0.966; p = 0.334). The model explained 83.3% of the variance in user satisfaction and 78.4% of the variance in EMR adoption. Conclusion: EMR adoption in outpatient care is primarily influenced by system quality and user satisfaction. Service quality contributes to EMR adoption indirectly by improving user satisfaction rather than through a direct pathway. Recommendation: Hospitals should strengthen EMR system reliability, responsive technical support, user-centered training, and routine user satisfaction monitoring to sustain EMR adoption.

Leadership Commitment, Open Organizational Culture, and Learning Organization Among Nurses: Happiness at Work as a Mediator

Evi Maris Sahara — 2026-06-29

Background: Hospital nurses must continuously adapt to changes in healthcare technology, patient-safety standards, and service-quality expectations. A learning organization is therefore essential, yet the psychological mechanism that links leadership commitment and open organizational culture with organizational learning among hospital nurses remains insufficiently explained. Objective: This study analyzed the associations of perceived leadership commitment and open organizational culture with learning organization, with happiness at work as a mediating variable among nurses at An-Nisa Hospital, Tangerang. Method: An explanatory cross-sectional study was conducted among 225 staff nurses selected using purposive sampling. Data were collected using a validated 45-item questionnaire with a four-point Likert scale. Instrument validity, reliability, descriptive statistics, and structural model testing were analyzed using SPSS 25 and SmartPLS 3. Direct and indirect effects were evaluated using Structural Equation Modeling-Partial Least Squares. Result: Perceived leadership commitment and open organizational culture explained 54.8% of the variance in happiness at work. The final model explained 69.3% of the variance in learning organization and demonstrated acceptable model fit (SRMR = 0.055). Happiness at work had the strongest association with learning organization (? = 0.574, p < 0.001), followed by open organizational culture (? = 0.251, p = 0.004) and perceived leadership commitment (? = 0.104, p = 0.048). Happiness at work partially mediated the association of perceived leadership commitment (? = 0.127, p < 0.001) and open organizational culture (? = 0.351, p < 0.001) with learning organization. Conclusion: Nurses’ happiness at work is a central psychological pathway through which leadership commitment and open organizational culture are translated into organizational learning. Recommendation: Hospital managers should strengthen fair leadership practices, transparent communication, shared organizational values, and nurse well-being programs to support clinical learning. Further longitudinal and multi-site studies are recommended to confirm temporal relationships and improve generalizability.

Association of Body Image, Eating Behavior, and Physical Activity with Wasting among Adolescents

Deby Andriani — 2026-06-29

Background: A learning organization is therefore essential, yet the psychological mechanism that links leadership commitment and open organizational culture with organizational learning among hospital nurses remains insufficiently explained. Objective: This study analyzed the associations of perceived leadership commitment and open organizational culture with learning organization, with happiness at work as a mediating variable among nurses at An-Nisa Hospital, Tangerang. Method: An explanatory cross-sectional study was conducted among 225 staff nurses selected using purposive sampling. Data were collected using a validated 45-item questionnaire with a four-point Likert scale. Direct and indirect effects were evaluated using Structural Equation Modeling-Partial Least Squares. Result: Perceived leadership commitment and open organizational culture explained 54.8% of the variance in happiness at work. The final model explained 69.3% of the variance in learning organization and demonstrated acceptable model fit (SRMR = 0.055). Happiness at work had the strongest association with learning organization (? = 0.574, p < 0.001), followed by open organizational culture (? = 0.251, p = 0.004) and perceived leadership commitment (? = 0.104, p = 0.048). Happiness at work partially mediated the association of perceived leadership commitment (? = 0.127, p < 0.001) and open organizational culture (? = 0.351, p < 0.001) with learning organization. Conclusion: Nurses’ happiness at work is a central psychological pathway through which leadership commitment and open organizational culture are translated into organizational learning. Recommendation: Hospital managers should strengthen fair leadership practices, transparent communication, shared organizational values, and nurse well-being programs to support clinical learning.

Keywords: happiness at work; leadership commitment; learning organization; nurses; organizational culture

Midwives' Electronic Medical Record Use: Perceived Ease, Competence, and the Mediating Role of Usefulness in a Regional Hospital

Apri Ranti Nasir — 2026-06-29

Background: Electronic Medical Record (EMR) implementation is a key element of hospital digital transformation. In midwifery services, EMR use is particularly important because midwives are responsible for timely, accurate, and continuous maternal and neonatal documentation. Objective: This study examined the effects of perceived ease of use and midwife competence on EMR use, with perceived usefulness as a mediating variable. Method: A quantitative cross-sectional analytical study was conducted among 103 midwives at Dr. Dradjat Prawiranegara Regional Hospital, Serang, Banten. Total sampling was used. Data were collected using a structured questionnaire and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). Result: Midwife competence showed the strongest direct effect on EMR use (beta = 0.437; p < 0.001), followed by perceived ease of use (beta = 0.329; p < 0.001) and perceived usefulness (beta = 0.217; p = 0.002). Perceived ease of use significantly influenced perceived usefulness (beta = 0.267; p = 0.001), and midwife competence also significantly influenced perceived usefulness (beta = 0.615; p < 0.001). Perceived usefulness mediated the effects of perceived ease of use (indirect beta = 0.058; p = 0.019) and midwife competence (indirect beta = 0.133; p = 0.005) on EMR use. The model explained 71.6% of the variance in perceived usefulness and 84.8% of the variance in EMR use. Conclusion: EMR use among midwives is shaped not only by system usability but also by professional competence and the degree to which the system is perceived as useful for daily clinical documentation. Hospitals should strengthen workflow-based EMR training, system usability, and clinical data utilization to improve sustainable EMR use.