Untitled - Repository STIKES Aisyiyah

Transcription

1st International Nursing Conference
PROCEEDING BOOK
“Building Transcultural Nursing in Education and
Practice to facing Asean Community 2015”
SCHEDULE
1st INTERNATIONAL NURSING CONFERENCE (INC)
OCTOBER, 22nd–23rd 2014
Day 2nd , Thursday, October 22nd, 2014
(1st International Nursing Conference – Day 1st)
TIME
TOPIC
07.15–08.15
Registration
08.15–08.50
Opening Ceremony
Reading the Holy Qur‟an
08.50–09.50
Greeting‟st
1. Speech from SC
2. President AIPNEMA
3. Keynote Speech Major Bandung City
- Beating the “Gong”
- Photo Session
09.50–10.00
Coffee Break
10.00–11.30
Expert Panel Presentation
1. Implementation of transcultural nursing
in academy
2. Implementation of tanscultural nursing
in academy and clinical setting:
Thailand Perspective
3. AINEC–AIPNI
Reward‟s Announcement and Handover
the Souvenir for SC, Speaker, and
Moderator
11.30–12.55
Pray and Lunch
12.55–17.00
Poster exhibition
SPEAKER
Panitia
1. Moh. Afandi, S.Kep., Ners.,
MAN
2. H. Edy Soesanto, S.Kp.,
M.Kes.
3. Ridwan Kamil
Panitia
- Prof. Junko
- Prof. Khannitta, RN., PhD
- Muhammad Hadi, SKM.,
M.Kep., Dr.(Cand.)
Moderator: Kusman Ibrahim,
S.Kp., MNS., Ph.D
Secretary: Warsiti, M.Kep.,
Sp.Mat.
Ass. Prof. Dr. Somporn
Rungruangkulkit
Dr. Nichapatrphuttikhamin
Oral dan poster presentation
17.00–17.30
Joint research program: joint research team
Report session
Discussion
Wrapping
Ass. Prof. Dr. Somporn
Rungruangkulkit
Dr. Nichapatrphuttikhamin
GALA DINNER
19.00–19.15
19.15–19.20
19.20–19.30
19.30–20.00
20.00–20.10
20.10–20.15
20.25–20.30
20.30–20.50
20.50–21.00
21.00–21.30
21.30–21.45
21.45–22.00
-
Traditional dance
Opening Gala Dinner
Greeting by the chairman of committees
Dinner and acustickecapi suling
Dance‟s performance
Introducing participants by MC
Acustic live music (fazah performance)
Angklung Performance
Organ Performance
MOU / lembar joint research
Traditional song
Performance participants and Closing
Day 3rd , Wednesday, October 23rd , 2014
(1st International Nursing Conference – Day 2nd )
TIME
TOPIC
08.30–10.45 Opening dan Panel Expert
in academy and clinicalsetting: Taiwan
Perspective
Malaysia Perspective
Indonesian Perspective
Reward‟s Announcement and Handover
the Souvenir for SC, speaker and
moderator
SPEAKER
- Dr. Paris
- Prof. Zabidah, RN., PhD
- Dr. Titi
Moderator: Moh. Afandi, S.Kp,
MAN
Secretary: Angga W., S. Kep.,
Ners.
11.00–11.15 Closing
11.15–11.15 Pray and Lunch
City Tour
Panitia
OPENING SPEECH
Proceeding is published related to the activities that have been
organized by The Association of Muhammadiyah Aisyiyah Nurse
Education (AIPNEMA) in collaboration with Institute of Health
Sciences „Aisyiyah Bandung (STIKes ‘Aisyiyah Bandung), that is an
international seminar (first national nursing conference) as the
Annual meeting of the Association of Muhammadiyah Aisyiyah
Nurse Education (AIPNEMA) .
This international seminar will be held at Horizon Hotel Bandung on
22-23 October 2014. The theme of this international seminar is
“Building Transtructural Nursing in Education and Practice to Facing ASEAN Community 2015”.
This activity held in scientific forum includes of working paper presentation, discussion and
poster. Seminar is conducted parallelly by using presentation and discussion method by
researchers from domestic and foreign universities. It is expected to motivate lecturer to publish
the result of research in proceeding or national and international journal.
We thank all of participants in this activity. We hope this proceeding give benefit for all readers.
Bandung, October 2014
H. Edy Soesanto, S.Kp., M.Kep
President of AIPNEMA
FROM THE COMMITTEE
Thanks to Allah S.W.T who has been giving us blessing and mercies.
Let's say thank to Muhammad SAW as our own prophet. Because of
his strugle now we are walking on the right way. As one of the efforts
for
coordination
and
consultation
of
the
Association
of
Muhammadiyah Aisyiyah Nurse Education (AIPNEMA), Annual
Meeting of AIPNEMA conducted annually. This year, STIKes
Aisyiyah Bandung welcomes its occasion in Bandung city and we
also like to thank you for the trust that given by AIPNEMA to organize
these activities.
At this time Annual Meeting of AIPNEMA was held in conjunction with the First International
Nursing Conference with the theme "Building Transtructural in Nursing Education and Practice
to Facing the ASEAN Community 2015". It is our hope, that through these activities can
contribute to the world of education, especially in the institutional environment of Persyarikatan
Muhammadiyah - 'Aisyiyah, in addition to strengthen the relationship among nursing institutions
both within and outside the country.
Finally, we would like to thank all participants in this activity and we also apologize for any
shortcomings that may occur during this activity.
Tia Setiawati, S.Kp., M.Kep., Ns.Sp.Kep.An
Chair of Institute of Health Sciences „Aisyiyah Bandung
(Sekolah Tinggi Ilmu Kesehatan „Aisyiyah Bandung)
FROM THE COMMITTEE
Assalamu‟alaikum Warohmatullohi Wabarokaatuh.
Thanks to Alloh SWT who has been given us bleesing and mercies.
Transcultural nursing is a theory based humanistic discipline,
desaigned to serve individuals, organizations, communities, and
societies. Human care/caring is defined within the context of culture.
Culturally competent care can only occur when culture care values
are known and serve as the foundation for meaningful care.
Collaboration between health care providers is needed to minimize the gap and improv health
care services. In order to deliver better care to clients, nurses need to build interest. This
cooperation will then give assurance in understanding clients and consideration of humanized
care.
The objectives of this event are to identify evidence based best practice that promote
trancultural nursing, demonstrate research based models or promoting culturally competence
care, describe transcultural nursing partnerships that promote cultural competence, and apply
transcultural nursing theories to local, national and international health care issues. The target
of this event are the academics, the researchers, and nursing service practicioners.
STIKes Aisyiyah is very proud to present this event and hope that it will give a lot of benefits for
all the participants. We would like to thank for the speaker for spending the time in order to give
us a new knowledge and sharing the experience and also we would like to thank for all the
participants for your presence and participations.
We also would like to give the highest appreciation and honour for the institutions and company
for their support so that this event can be presented now.
The last but not least we wish that this event can be useful for all.
Be enjoy in Bandung.
Nandang Jamiat Nugraha, S.Kp., M.Kep., Ns, Sp.Kep.Kom
Chair of Organizing Committee INC
Implementation of Transcultural Nursing in academy and Clinical Setting:
Malaysian Perspective
This paper outlines the cross cultural insights that emerged concerning language, culture, and
social context in respect of the issue of transcultural nursing in Malaysia. It highlights the
cultural and religious safety in academy and clinical practices in the nursing curriculum and in
the clinical setting. The nursing academy has to be mindful of creating a curriculum that is
responsive to the diverse needs of the communities, while the clinicians are always conscious
of the cultural diversity in the clients and communities they serves. Through obliging to this
requirement the nurses felt the sense of cultural humility and an appreciation of the sources and
values of their own culture. Thus the tensions inherent in a multicultural practice are minimized
in the Malaysian health settings. The implementation of transcultural nursing in academy and
clinical practice in the Malaysian perspectives will be discussed.
Brief CV: Zabidah Putit
Associate Profesor Dr Zabidah Putit, is the Head of the Nursing Department, UNIMAS,
Malaysia. She obtained her PhD from University of Bristol UK, MHSc (Hons) in New Zealand,
BNSc (Hons) in UM, while midwifery and nursing in Nursing college, Kuching.
She has been in nursing since 1983. Besides in Malaysia, she also has nursing experiences in
Bristol Royal Infirmary Hospital and teaching in the School of Policy studies, University of
Bristol, UK in 2005 – 2008. Her research interests are domestic violence, behavioral sciences
and nursing, and have been presenting her related research projects both nationally and
internationally.
AP Dr Zabidah is an author of five books;(1) Perempuan Di(Se)Balik dinding kaca, (2)Domestic
Violence: Towards a better exit, (3) Sarawak Women Treading the path of post-independence
years (4) Sarawak women in Politics and (5) Sarawak women in Volunteerism (Invited writer).
Besides, her works has also been published in Journals. She reviewed manuscript for journals
and books for publication. She has been external examiners of various nursing programme of
higher education in Malaysia.
She is currently the President of Malaysian Nursing Council, Public Institution of Higher
Learning. Throughout her service, she received several awards. Beyond academia, AP Dr
Zabidah is known to be actively engaged in the public community services and was recognized
by the State government of Sarawak and thus was honored to be offered as member for
Women and Family Council Sarawak since January 2011.
BRIEF CURRICULUM VITAE
Name:
Junko Tashiro, RN, PHN, MW, MA, PhD
Affiliation:
Professor, Nursing in Health Care & Social Service, Global Health Nursing
St. Luke‟s International University, Professor (1999-present)
Specialty:
Global Health Nursing (Public Health Nursing, Human Resource in Nursing)
Research Area:
Development of International Collaborative Working Model for Strengthening Community
Nursing in Developing Countries.
Development of Web-based Educational Program for International Collaboration to Improve
Health for All.
Service Learning at College or School of Nursing.
Adolescent Health Focusing on Health Promoting Lifestyle Behaviors and Risk Behaviors in
Japan.
Education:
Ph.D., Nursing Sciences, Graduate College,
University of Illinois at Chicago, Illinois, USA, 1996
M.A., Sociology, Graduate College, Master Program,
Rikkyo University (St. Paul University), Tokyo, Japan, 1975
B.S., Nursing, St. Luke‟s College of Nursing, Tokyo, Japan, 1972
Professional Experience:
Professor, St. Luke‟s College of Nursing, teaching Nursing Research, Nursing Theory, and
Global Health Nursing Doctoral and Master Students, 1999 to present.
Associate Director of WHO Collaborating Center for Nursing in PHC at St. Luke‟s College of
Nursing.
Professor, College of Nursing and Medical Technology (Associate Degree Program),
University of Tsukuba, 1996-1998, Teaching Fundamental Nursing, and Community
Nursing.
Associate Professor. St. Mary Junior College of Nursing, teaching Maternal and Child Health
and Nursing, 1985-1991.
Lecturer, College of Nursing and Medical Technology, University of Tsukuba, teaching
Pediatric Nursing. 1980-1984.
Head Nurse, Hospital, University of Tsukuba, 1975- 1980.
Social Activity (Current):
Board of Director (Associate Director), Japan Academy of Nursing Science, 2011-2013.
Subject Editor of Japan Journal of Nursing Science, 2011-present.
Chair of Preparatory Committee for Council of National Representative (CNR) and
International Council of Nurses (ICN) Conference in 2007.
Board of Director, East Asian Forum of Nursing Scholar, 2002 - 2006.
Representative of WPRO, Global Network, WHO Collaborating Center for Nursing &
Midwifery 2002-2006.
Director and Board of Director, St. Luke‟s Society of Nursing Research, 2002-2005.
Others (Major one only):
Expert of Japanese International Cooperation Agency (JICA), Pakistan Nursing Education
Project, Cooperation of Mid-level Pediatric Nursing Education, 1988-1990, and its after
care 2002.
Short Term Expert of JICA for Kenya Medical Training College Project.
Current Work
(Publication)
Tashiro,J.,Shinpuku,Y.,Naruse,K.,Maftuhah,& Matsutani,M.,(2012)
Concept analysis of reflection in nursing professional development.,Japan. Journal of
Nursing Science. Doi:10.111/j.1742-7942.2012.00222.x
Kishi, R; McElmurry, B. J.; Vonderheid, S; Alfeld, S; McFarlin, B; Tashiro, J. (2010).
Health care for women international 32:Japanese women‟s experiences from pregnancy
through early postpartum period.,Routledge.,1,57-71 doi:10.1.1080/07399331003728634
Tashiro,J.,William Holzemer(Ed.) (2010).
Chapter 7. Defining the research problem in improving health through nursing research.
The International council for nurses; Wiley-blackwell.,69-76.
Naruse, K.; Tashiro, J.; Sakyo, Y.; Ichikawa, W.; Karani, A. (2008). Stakeholders‟ perception of
the desired Master‟s program for Kenya in community health nursing: Areas of
competency. Areas of competency. Japan Journal of Nursing Science No.5. 61-67.
Tashiro, J., Nagamatsu, Y., Omori, J. Hishinuma, M., Matsutani, M., Oikawa, I. & others. (2007).
Webjyou deno herusu borantia gakusyu to borantia gakusei gakusyu shien puroguram kaihatu:
kaihatukatei [Development of an e-learning program for the community and supporting
student health volunteer: Process of the Development]. 11 109-115.
Tashiro, J., Nagamatsu, Y. (2007). Syushikatei kokusaikangogaku kaikou no kei to gakubu
ikkkan no ko-su tennkai. [Starting a Master Course and Consistent Development of
Baccalaureate Course in International Nursing at St. Luke‟s College of Nursing]. ,3111-115
Tashiro, J., Nagamatsu, Y., Omori, J. Hishinuma, M., Matsutani, M., Oikawa, I. & others. (2007).
Beikoku ni okeru sa-bisu ra-ningu no rinen to torikumi. [ Concept and implementation of
service learning at the two universities- Report of Observation Surveys-. ,368-73
(Current Presentation )
Tashiro, J; Mafutuhah; Mizutani, M; Karuyadi; Matsutani, M. (2013) Strategies for stregthening
Nursing and Midwifery percecived by stakeholders in Indonesia. At ICN 25 th Quadrennial
Congress (C032c). May 18 -23, 2013, Melbourne, Australia.
Mizutani, M.; Tashiro, J.; Mafutuhah. (2013). Perceived health, health concerns and health
lifestyle of middle-aged Muslim farmers in a rural district of West Java, Indonesia- A pilot
study. At 3rd World Academy of Nursing Science Conference. Oct, 16-18, 2013. At Soul,
Korea
CURICULUM VITAE
Nama
Tempat/Tgl Lahir
Alamat Rumah
Email
: MUHAMMAD HADI
: Lamongan, 1 Mei 1971
: Jl.Budi Mulia I RT.003/06, Pademangan Barat
Jakarta Utara
: hadi_bintang001@yahoo.co.id
RIWAYAT PENDIDIKAN;
1. SDN di Lamongan – Jawa Timur
2. SMPN di Lamongan – Jawa Timur
3. SMA N2 di Lamongan – Jawa Timur
4. AKPER RSIJ Jakarta
5. S1– Universitas Indonesia
6. S2 – Universitas Indonesia
7. S3 – Universitas Indonesia
RIWAYAT PEKERJAAN:
1. Dekan FIK UMJ s.d. sekarang
RIWAYAT ORGANISASI;
1. Ketua PPNI Jakarta Pusat 2001 s.d. 2012
2. Ketua Bidang Hukum dan Pemberdayaan Politik – Pimpinan Pusat Persatuan Perawat
Nasional Indonesia 2005 s.d. 2010
3. Wakil Ketua ICMI Jakarta Utara 2006 s.d. sekarang
4. Pengurus Pusat Asosiasi Institusi Pendidikan Ners Muhammadiyah seluruh Indonesia
2007 s.d. sekarang
5. Pengurus Pusat Ikatan Ners Kardiovaskuler Indonesia 2006 s.d sekarang
6. Sekjend Asosiasi Institusi Pendidikan Ners Indonesia (AIPNI) 2009 s.d. 2013
7. Task Force Lembaga Akreditasi Mandiri PT Kesehatan (LAM PT Kes)
8. Asessor BAN PT s.d. sekarang
9. Ketua Bid Hukum Pengurus Himpunan Perawat Manager Indonesia 2013 s.d.
sekarang
10. Ketua Umum AIPNI 2013-2017
Jakarta, 2013
Muhammad Hadi
CURRICULUM VITAE
I. Data Perorangan
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Nama
Jenis Kelamin
Tempat, tanggal lahir
NIP
Agama
Status Perkawinan
Pendidikan Terakhir
Kantor
Pangkat / Golongan
Alamat Kantor
Telepon
Faximile
Email
Web
11. Alamat rumah
Nomor HP
E-mail
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
Dr. Ir. Paristiyanti Nurwardani, MP.
Perempuan
Sukabumi, 7 Mei 1963
19630507 1990 02 2 001
Islam
Menikah, satu orang putri
S-3 (Doktor)
SEAMEO SEAMOLEC Jakarta
Pembina Tingkat 1/ Golongan IV b
021-21-7422184
021-7422276
secretariat@seamolec.org
www.seamolec.org
Jalan Perwira No. 3A Cianjur - Jawa Barat
+62 87884782750
paristiyantin@yahoo.com
II. Riwayat Pendidikan
No
1
2
3
Tingkat
Nama Pendidikan
Doktor (S-3)
Magister
Sarjana
Universitas Brawijaya
Universitas Brawijaya
IPB-Institut Pertanian Bogor
Ijasah/Tanda
Lulus/ Tahun
2006
1996
1987
Tempat
Malang
Malang
Bogor
III. Riwayat Pekerjaan
No
Jabatan
1
Deputy Director
2
Atase Pendidikan
Nama Institusi
SEAMEO
SEAMOLEC
Kedutaan Besar
Republik Indonesia
di Manila, Filipina
Tempat/Waktu/Pengalaman
Jakarta, 2014-sekarang
Manila-Filipina/
Desember 2010- September 2014
Indonesia-Filipina
- Mengembangkan MoU Government
to Government Collaboration on
Basic Education.
Higher Education
Vocational Education
Indonesia-Palau Republic
Mengembangkan MoU Government to
Government Collaboration on
Education.
Indonesia-Marshall Island
Mengembangkan MoU Government to
Government Collaboration on
Education
Mengembangkan 268 (dua ratus
enam puluh delapan) University to
University Collaboration
Mengembangkan 21 (dua puluh satu)
Sister School Indonesia-Filipina
Mengembangkan 100 Beasiswa
Pemerintah Indonesia untuk Guru
Madrasah Mindanao, Filipina
Mengembangkan 500 Beasiswa
Miskin untuk siswa WNI miskin di
Mindanao, Filipina
Menembangkan Indo-Phil Journal
Mengembangan 2 (dua) SMP
Terbuka di Mindanau, Filipina
3
4
5
6
7
8
9
10
11
Konsultan Program
BERMUTU (Better
Education through
Reform Management
Universal Teacher
Upgrading) Kerjasama
Bank DuniaPemerintah BelandaPemerintah Indonesia
Manager of Indonesian
German Institute di
PPPPTK Pertanian
Dekan Fakutas Sain
Widyaiswara PPPTK
Pertanian Cianjur
Dekan Fakultas
Pertanian
Quality AssuranceDocument
Coordinnator
Marketing Manager
Divisi Agribisnis
Pembantu Dekan 1
Fakultas Pertanian
Kepala Departemen
Agronomi
World Bank dan
Direktorat Bindiklat
Jakarta
Mengembangkan Sekolah Indonesia
General Santos, Mindanao, Filipina
Jakarta
2009-2010
Mengembangkan CPD guru di 75
Kabupaten/Kota dan 16 Provinsi
PPPPTK Pertanian
Cianjur,
2008-2010
Universitas
Suryakanca Cianjur
PPPPTK Pertanian
2014-sekarang
Universitas
Suryakancana
PPPPTK Pertanian
PPPPTK Pertanian
Universitas
Suryakancana
PPPPTK Pertanian
Cianjur, Jawa Barat
1990-2010
Cianjur
2005- 2014
Cianju
2002-2003
Cianjur
1999-2001
Cianjur
2001-2004
Cianjur
1996-1999
IV. Diklat, Kursus, Pelatihan Dalam dan Luar Negeri
No
Jenis Pelatihan
1
4
5
6
7
8
Environmental policy, objectives
targets and programs
Identification environmental aspect
Environmental Management
Manual
Communication and Plan
ISO 14001 action plant
ISO 14001 documentation
Awareness ISO 14001
ISO Leadership
9
10
11
12
3-D-Microscopy
TOT KTSP
International Management Training
Biotechnology Course
13
14
15
16
17
18
19
20
ISO 14001
Lead Auditor
Biotechnology Management
Advanced Biotechnology
Professional Training
ISO 17025
Consultancy Skill
Creative Decision Making
Management Training
21
Management Training
22
Management Training
23
24
25
26
27
28
29
30
Laboratory safety
ISO 9001 :2000
Terampil Mengaudit
Statistic Process Control
Marketing Plan
Bio-farming
Pelatihan Instruktur
AKTA
31
32
33
34
Bahasa Inggris
Pra Pasca
Fasilitator Nasional untuk ME
Fasilitator Pengembangan Kur.
SLTP Keterampilan
Fasiltator Nasional untuk SLTP
Keterampilan
Fasilitator Kur. SLTP
Micro Entreprise Training
2
3
35
36
37
Jakarta
Lama
Pelatihan
2 hari
Jakarta
Jakarta
2 hari
2 hari
2008
2008
Jakarta
Jakarta
Jakarta
Jakarta
ISO leadership-Austria di
Semarang
Canada
Jakarta
Germany
Martin Luther UniversityGermany
InWent-Germany
InWent-Germany
Martin Luther University
Germany
2 hari
2 hari
3 hari
1 hari
5 hari
2008
2008
2008
2008
2008
21 hari
6 hari
20 hari
3 bulan
2008
2005
2005
2005
4 hari
12 hari
5 hari
7 bulan
2 bulan
6 hari
6 hari
2 hari
2004
2004
2004
20032004
2004
2003
2003
2003
2 hari
2003
2 hari
2003
5 hari
14 hari
4 hari
3 hari
4 Hari
4 hari
2 bulan
5 bulan
Tempat Pelatihan
Jakarta
Jakarta
Thailand German Institute
Bangkok
Singapore German
Institute Singapore
Malaysia German Institute
Kuala Lumpur
Germany
VEDCA
VEDCA
VEDCA
Hotel Wijaya
VEDCA
PPPG Pertanian
IKIP Jakarta
Tahun
2009
LIA Jakarta
Univ. Brawijaya
PPPG Pertanian
PPPG Pertanian
5 bulan
3 bulan
1 minggu
10 hari
2003
2003
2003
2003
2003
2003
1990
1990/
1991
1992
1994
1996
1997
PPPG Pertanian
10 hari
1997
Hotel Utami
VTET Brunei Darussalam
7 hari
1 bulan
1997
1999
V. Tanda Penghargaan /Jasa
No
1
2
Penghargaan
Keterangan
Tanda kehormatan
Cumlaude
Satyalancana Karya Satya 10 Tahun
Lulusan Terbaik pertama di Pascasarjana
Universitas Brawijaya Tahun 1996
VI. Kegiatan Lain
a. Pengabdian Masyarakat
No
Jenis Kegiatan
1
2
Sekretaris Aisyiyah
Pembinaan Industri Pupuk Organik
3
3
Wakil ketua PD Aisyiyah
Pembina Perhimpunan Pertanian
Organic
Tempat
Tahun
Cianjur
Singkawang-Kalimantan
Barat
Cianjur, Jawa Barat
Cianjur, Jawa Barat
2007– 2009
2008-sekarang
1992-2006
1999
b. Seminar/Simposium
No
Seminar
1
2
3
4
5
6
7
Teaching Factory
Usaha Kecil dan Manengah
Success story Unit Produksi Bio-Product
Prospek UKM di Jawa Barat
Teaching Factory
Unit Produksi SMK
Kurikulum Berbasis Kompetensi
Pada Pendidikan Tinggi
Sistim Mutu Perguruan Tinggi
Akreditasi Perguruan Tinggi
Asesmen Institusi untuk Lembaga Perguruan
tinggi
Business Plan IGI
Management Training
Balance Scored Card
Management Facilities
Sistem Audit padaPerguruan Tinggi
Sistem Akreditasi Perguruan Tinggi
Prospek Chitosan untuk Pelpis Benih
Study Chitosan untuk “ Coating Fruit”
Prospek Mycorhiza sebagai pengikat Unsur
Fosfor
Prospek Trochoderma sebagai dekomposer
Pemenfaatan Gigaspora pada Gramineae
Lingkungan Hidup Sedunia
Fitopatologi
Potensi dan Kendala Sistem Pertanian Organisk
Pemanfaatan Mikoriza
Pencegahan Efek Rumah Kaca
Prospek Agribisnis pada Milenium ke Tiga
Pemasaran Produk Agribisnis
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Tempat
Tahun
Semarang
Cianjur
Salatiga
Cianjur
Jakarta
Jakarta
Kopertis-Bandung
2008
2008
2008
2008
2007
2006
2005
Kopertis-Bandung
Bandung
Bandung
2005
2004
2003
Hotel Jayakarta Bandung
TGI - Bangkok
SGI- Singapura
MGI- Kuala Lumpur
Bandung
Bandung
Malang
Malang
Malang
2003
2003
2003
2003
2002
2002
2001
2001
2001
Malang
Malang
PPPG Pertanian Cianjur
Univ. Brawijaya Malang
Hotel Mulia Jakarta
Hotel Atlit Jakarta
2001
2001
2000
2000
2000
2000
2000
2000
2000
c. Karya Ilmiah
No
Topik/Judul Penelitian
1
2
3
Pendidikan Jarak Jauh-Flora sebagai sumber Belajar
Pendidikan Jarak Jauh-Lahan sebagai Belajar
Pertanian Organik
Cianjur
Cianjur
Cianjur
4
Bio-pestisida
5
Bio-insektisida
6
Bio-fertilizer
7
Implementasi KBK pada program studi Pemanfaatan
Sumberdaya Perikanan
Peluang Penerapan Sistem Mutu Internasional pada
Fakultas Pertanian Universitas Suryakancana
Implementasi KBK pada program studi Budidaya
Pertanian
Using Chitosan to Elicit Beta 1,3 Glucanase on Chili
Fruit
Khitosan Sebagai Bahan Pengendali Penyakit
Antraknosa pada Buah Cabai
Biorodenticide Production
Study Pemanfaatan Chitosan untuk Pengendalian
Penyakit Busuk de Barry pada Buah Tomat
Penyakit Busuk Buah pada Cabe
Penyakit Busuk Buah pada Cabe Rawit
Pengujian daya simpan benih okra
Pengujian varietas benih okra
Cianjur dan
Singkawang
Cianjur dan
Singkawang
Cianjur dan
Singkawang
Pelabuhan Ratusukabumi
Cianjur
8
9
10
11
12
13
14
15
16
17
Tempat
Tahun
2009
2009
2000sekarang
1996sekarang
1996sekarang
1996sekarang
2005
2004
Cianjur
2003
Germany
2005
Cianjur-Germany
2005
Cianjur
Balithor- Cipanas
2004
2003
Balithor- Cipanas
2003
Balithor- Cipanas
2003
PPPG Pertanian
PPPG Pertania
1998
199
d. Organisasi Profesi
No
Jenis Kegiatan
Tempat
1
2
Association of Bio-agro-input in Indonesia (ABI)
Indonesia German Institut
Jakarta
Jakarta
3
International Bio-Pesticide Manufacturing Association
Perancis
4
Perhimpunan Anggrek Indonesia
Malang
5
PGRI
Cianjur
6
Perehimpunan Hortikultura Indonesia
Bogor
7
Perhimpunan Entomologi Indonesia
Bogor
8
Perhimpunan Fitopatologi Indonesia
Bogor
Tahun
2008
2002sekarang
2005Sekarang
2000sekarang
1995Sekarang
1990sekarang
1987Sekarang
1987Sekarang
e. Kemampuan Berbahasa Asing
No
Bahasa Asing yang dikuasai
1.
2
Inggris
Jerman
Keterangan
Aktif
Pasif
Demikian Data Riwayat Hidup ini dibuat, untuk dipergunakan sebagaimana mestinya.
Cianjur, 7 Maret 2014
Dr. Ir. Paristiyanti Nurwardani, MP.
TABLE OF CONTENT
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Evidence Based on Nutrition Education as an Effective Nursing Intervention to
Improve Nutritional Status of Children with Malnutrition
Indarwati, Ferika ……………………………………………………....………………
Structure and Relations of Health Behavior for Middle-Aged Muslim Women with
Hypertension in Rural West Java, Indonesia : A Pilot Study
Mayumi Mizutani, Junko Tashiro, Maftuhah, Heri Sugiarto, Lily Yulaikhah,
Riyanto Carbun ...……………………………………………………....………………
1-6
7
The Effect of Spiritual Quantum Touch to the Pain When Turning to the Left and
Right Position in Post Surgery Patients at RSUD Serang 2014
Ani Haryani, F. Sri Susilaningsih, Aat Sriati …………………………………………
9 - 13
The Learning Model of Reproductive Health through a Peer Group with a Culture
of Early Marriage in the Traditional Boarding School, Jember
Awatiful Azza, Cipto Susilo ……………………………………………………....……
15 - 22
The Description of Component Antenatal Care Examination in the 3rd Trimester
Pregnant Women in Public Health Center Wonosari I Gunung Kidul in Yogyakarta
Disa Grapella …………...……………………………………………………....………
23-28
The Influence of Psychoeducation toward Family’s Caring Ability and
Schizophrenia Patient’s Independence Level in Pontianak
Dewin Safitri, Wahyu Kirana, Sarwito Rachmad Barmawi …………...……………
29 - 32
Perception Differences between Nurse and Acute Coronary Syndrome Patient
toward Spiritual Needs in Cardiac Intensive Care Unit at Hasan Sadikin Hospital
Hana Ariyani, Suryani, Aan Nuraeni …………...……………………………………
33 - 40
The Influence of Family Support on Hiv Patients’ Compliance to Take Therapy
Program in VCT Clinic Kebumen State Hospital
Herniyatun, Dita Try Ubaya Sakti, Sarwono …………...……………………………
41 - 45
The Effectiveness of Assertiveness Training Therapy to the Assertive
Communication Skill of the Nursing Practice Students to the Inpatients Nurses
Ike Mardiati Agustin, Novy Helena CD, Ice Yulia Wardani …………...…………
47 - 55
The Key-Determinant Factors of Depression Level in Eldery Patients
Shintha Silaswati, Muftadi, Rizqika Nurlis Manda Putri …………...……………
57 - 66
i
11.
The Effect of Educative Blog About Diabetes Mellitus (DM) to Fasting Blood
Glucose on Diabetic in Public Health Center Wirobrajan
Maya, Erfin Firmawati …………...…………………………………………………….
67 - 72
12.
Self Regulation and Anxiety on Home Visit and Clinical Visit (A Cohort Study in
Postpartum Mother)
Giari Rahmilasari1, Avip Syaefullah, Vita Murniati Tarawan …………...………… 73 - 81
13.
Positive Deviance in a Group of Children Nutritious Good Nutrition in Rural Poor
Families in Banyu Biru and Kedunggudel Widodaren Ngawi East Java
Yuli Isnaeni …………...……………………………………………………....…………
83 - 90
Oxytocin Massage in Increasing Breast Milk Production of Postpartum Mother in
Mergangsan Public Health Service Center of Yogyakarta in 2014
Warsiti, Lilis Wijayanti …………...……………………………………………………
91 - 97
14.
15.
Motivation, Adaptation, and the Family Roles: A Qualitative Case Study of Chronic
Renal Failure
Tassyah Devina Rayani, Yoyok Bekti Prasetyo, Nurlailatul Masruroh, Edi
Purwanto …………...……………………………………………………....…………… 99 - 104
16.
The Perceptions of Nurse Students to the Learning Environment University of
Muhammadiyah Semarang Based on Dundee Ready Education Environment
Measure (DREEM)
Tri Nurhidayati, Desy Ariyana, Fatkul Mubin …………...………………………… 105 - 111
17.
Meaning of Spirituality in Patients with Stage III Cervical Cancer in Gynecology
Inpatient Ward Hospital Dr Hasan Sadikin Bandung, Indonesia
Inggriane Puspita Dewi …………...……………………………………………………113 - 118
18.
Range of Motion (ROM) Effect to Reduce of Pain and to Increase the Activity of
Daily Living (ADL) in Elderly with Mobilization Disorder Due to Rheumatic in
Pasirgunung Selatan Depok City
Nandang Jamiat …………...……………………………………………………....…… 119 - 123
19.
Effect of Head Up and Supine Position of Hemodynamic Changes on Patients
with Heart Failure in the High Care General Hospital Center Dr Hasan Sadikin,
Bandung
Popy Irawati …………...……………………………………………………....………… 125 - 130
20.
The Association between Support, Coping Strategy, Family Burden, Health
Status of Elderly and the Incident of Elderly Abuse Depok, West Java
Etty Rekawati, Achir. Yani S. Hamid, Junaiti Sahar, Sudijanto Kamso,
Widyatuti …………...……………………………………………………....…………… 131 - 139
ii
21
Application of Kolcaba’s Comfort Theory in Handling Risk of Fluid and Electrolyte
Imbalance on Post-Operative Children at BCH Ward of RSUPN Dr. Cipto
Mangunkusumo
Fauziah Rudhiati, Nani Nurhaeni, Siti Chodidjah …………...…………………… 141 - 145
22.
Description Level Knowledge of Diet DM On DM Sufferer in Region Work of
Wirobrajan Public Health Center Yogyakarta
Isra Nur Utari S. Potabuga, Erfin Firmawati …………...…………………………… 147 - 151
23.
Acupuncture for Nausea Vomiting in Pregnancy
Imtihanul Munjiah …………...……………………………………………………....… 153 - 158
24.
The Difference in Oxygen Saturation Value (SpO2) with Suction Time in Patient
with Endotracheal Tube in ICU RSUD Ulin Banjarmasin 2014
Solikin, Zaqyyah Huzaifah …………...…………………………………………………159 - 164
25.
The Experience of Student Nurses in Communication During the Cross-Cultural
Learning Program
Nur Lailatul Masruroh, Reni Ilmiasih …………...…………………………………… 165 - 172
26.
Factors Related to the Relapse Incident in Children with Acute Leukemia
Limpoblastik at Pediatric Outpatient Unit Dr. Cipto Mangunkusumo National
Hospital, Jakarta 2014
Nyimas Heny Purwati, Lestari …………...……………………………………………173 - 177
27.
Prevalence and Risk Factors of Latent Tuberculosis Infection Among Pulmonary
TB Close-Contacts in Bandung, West Java, Indonesia
Reynie P. Raya, Raspati Cundarani, Merrin Rutherford, Karen Hornby,
Rovina Ruslami, Bachti Alisjahbana,
Philip Hill,
Dick Menzies,
Ab. Schaap …………...……………………………………………………....………… 179 - 188
28.
Gymnastics Effectiveness in Reducing Dismenorhea Adolesenct in Class XI
Social Mojolaban 1 High School District Sukoharjo
Datik Kurniawati, Sri Mintarsih …………...………………………………………… 189 - 194
29.
Differences in the Mean and Limit of Agreement of the Result Visual Estimation,
Nomograms and Formulas Ross Laboratories in Patients in the Intensive Care
Unit of Dr. Hasan Sadikin Hospital Bandung
Yani Trihandayani, Tri Wahyu Murni, Kusman Ibrahim …………...……………… 195 - 208
30.
The Methods to Overcoming Malnutrition Problem in Bandarlampung
Gunawan Irianto …………...……………………………………………………....…… 209 - 213
31.
The Description of Self Care by Maternal Postpartum Do A Postnatal Care
Aspects
Sri Ayu Rahayu, Sri Sumaryani …………...………………………………………… 215 - 220
iii
32.
The Description of Smoking Dependence on Senior High School Students in
Yogyakarta
Ayu Purwasih, Sutantri …………...…………………………………………………… 221 - 227
33.
The Relationship between Spiritual Care Knowledge with Nurse’s Attitude in
Fulfilling the Clients Spiritual Needs at Rajawali Hospital Bandung
Sajodin, Istianah, Ariandini D. …………...…………………………………………… 229 - 237
34.
Health-Related Disaster Mitigation Management in Ciamis Regency Supported by
Application of Information Technology
Etika Emaliyawati, Ayu Prawesti, Iyus Yoses, Kusman Ibrahim …………...……
239
35.
Systematic Review Spiritualities and Spiritual Influence of Nursing Cancer
Patients
Triana Dewi Safariah …………...……………………………………………………. 241 - 247
36.
Caring Experience the Mothers Who’s Premature Babies with Different Culture
Dewi Mustikaningsih …………...……………………………………………………. 249 - 254
37.
Social Capital Approach to Improving Sustainability Awareness in Prevention
Dengue Hemorrhagic Fever (DHF)
Nur Mukarromah, Soedjajadi Keman, Rahmad Hargono …………...…………… 255 - 260
38.
The Utilization of Jargon in Nursing Learning Process of HIV-AIDS in Stikes
‘Aisyiyah Bandung
Perla Yualita …………...……………………………………………………....……… 261 - 269
39.
The Effect of Yoga Therapy on the Level of Insomnia Among Elderlies at Budhi
Dharma Nursing Home in Ponggalan Umbulharjo Yogyakarta
Suratini, Suhesti…………...……………………………………………………....…… 271 - 277
40.
Dimensions of Cultural Organizations that Influence Caring Behavior in PKU
Muhammadiyah Hospital Temanggung
Lutfi Fauzy Asriyanto, Puguh Widiyanto, Sodik Kamal …………...……………… 279 - 284
41.
The Effectiveness of Hip Exercises to Decrease Low Back Pain in the Elderly in
the Kalirejo Village, Salaman District, Magelang Regency
Sigit Priyanto, Erfiana …………...…………………………………………………… 285 - 290
iv
1st INC-AIPNEMA 2014:
EVIDENCE BASED ON NUTRITION EDUCATION AS AN EFFECTIVE NURSING
INTERVENTION TO IMPROVE NUTRITIONAL STATUS OF CHILDREN WITH
MALNUTRITION
Indarwati, Ferika
School of Nursing, Universitas Muhammadiyah Yogyakarta, Indonesia
E-mail: ferika.sonumy@gmail.com
ABSTRACT
Introduction: Malnutrition in children has been a significant issue for many decades in
developing country. Indonesia as one of the developing countries in South East Asia faced
the same problem. According to the National Economic and Social Survey 2005 Central
Bureau of Statistics Indonesia, the percentage of children under five by nutritional status are
8.80% severely malnourished, 19.24% lack of nourishment, 68.48% moderately nourished
and only 3.48% well nourished. Furthermore UNICEF in 2006 also reported that the
prevalence of underweight children in Indonesia is 28 % and it is contribute 4.2 % of total
underweight children in the world. In Indonesia, protocols and programs were established
particularly in dietary management to treat children who suffer from malnutrition however
these programs still can not thoroughly solve the problem.
Methods: A Literature review was conducted to find the effectiveness of nutrition education
to prevent malnutrition in developing countries. Six data bases were searched and finally 15
articles were found. All studies included in this literature review were analysed for strengths
and weaknesses using the relevant appraisal tools. The qualitative studies were critically
appraised by a Critical Appraisal Skills Program (CASP) tool. Quantitative studies were
analysed with Health Care Practice Research and Development Unit (HCPRDU). After critical
appraisal, the articles were analysed to define the level of evidence using National Health
and Medical Research Council (NHMRC) levels of evidence and grades for recommendation
(2009).
Result: The results showed that an intensive nutrition education can significantly improves
the nutritional status of children with malnutrition. The evidence obtained from the articles
indicates that these evidence support the use of nutritional education intervention as a
treatment to improve child growth and development especially children with malnutrition.
Conclusion: Even though this evidence is only at level II based on the hierarchy of evidence
and not at the highest level of the hierarchy of evidence, this finding still can be used to
support the nursing practice and can be trusted to guide practice in most situation according
to NHMRC(2009). The implementation of the evidence should be integrated with other
government programs and need a strong effort of each element that involved in malnutrition
management in Indonesia so that the effectiveness of this program can be achieved.
Keywords: Malnutrition, Nutrition Education.
1
Introduction
Malnutrition in children has been a
significant issue for many decades in developing
country particularly in southern Asia and subSaharan Africa. Indonesia as one of the
developing countries in South East Asia faced
the same problem. According to the National
Economic and Social Survey 2005 Central
Bureau of Statistics Indonesia, the percentage
of children under five by nutritional status are
8.80% severely malnourished, 19.24% lack of
nourishment, 68.48% moderately nourished and
only 3.48% well nourished (Central Bureau of
Statistics Indonesia, 2005). Furthermore
UNICEF also reported that the prevalence of
underweight children in Indonesia is 28% and it
is contribute 4.2% of total underweight children
in the world (UNICEF, State of the world’s
children, 2006).
In addition, more than 50% of the 10-11
million children under 5 years of age, die each
year because of malnutrition. Not only causing
mortality of children under five years this
condition also contribute to children growth and
development. Around 200 million children under
5 years also suffer from developmental delays,
most of them come from developing countries
(Grantham-McGregor et al., 2007 cited in Avan
& Kirkwood, 2010, p: 102).
After searching the databases and found
articles that answering my research question “In
children under five years with severe
malnutrition in developing countries, are
combination treatments: standard treatment +
intensive nutrition education more effective than
standard treatment only in treating children with
severe malnutrition (weight-for-height >70% or
ànormal Z score based on the National Centre
for Health Statistics (NCHS) median)?”, in this
paper I would like to discuss the contribution of
evidence that I found in the treatment of
malnutrition. The discussion will involve a brief
description of each article, level of evidence,
applicability and contribution of each article in
my clinical practice.
The Literature Review
A. A brief description of each article
1.
Title : Intensive nutrition education with
or without supplementary feeding
improves the nutritional status of
moderately-malnourished children in
Bangladesh.
Brief description : This study was a
quantitative study with prospective
randomised controlled trial approach; the
aims of the study were: to test the
effectiveness of a specific nutrition
education to reduce malnutrition and to
change mothers’ behaviour related to
feeding practice, care giving and health
seeking practices in Bangladesh. The
result of the study showed that an
intensive nutrition education significantly
improves the status of moderatelymalnourished children with or without
supplementary feeding (Roy et al, 2005,
pp. 320-329).
Developing country like Indonesia has been
strugling for many years to eradicate
malnutrition. The government has been
colaborate with International Organisations like
World Health Organisation (WHO) espescially
UNICEF and other Non Government
Organisations to overcome malnutrition.
Protocol and program were established
particularly in dietary management to treat
children who suffer from malnutrition however
these program still can not thoroughly solve the
problem. Indonesia for example still at the fourth
place in the world according to UNICEF statistics
2006 as a country with children with malnutrition.
That is why finding an evidence based clinical
treatment for children with malnutrition in
developing countries should be found and apply
it to the clinical and community setting in
Indonesia.
2
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Article 1
2.
Article 2
Title : Prevention of malnutrition among
young children in rural Bangladesh by a
food-health-care
educational
Building Transcultural Nursing in Education and Practice to Facing Asean Community 2015
Evidence Based on Nutrition Education as an Effective Nursing Intervention to Improve Nutritional Status of
Children with Malnutrition
in China. The intervention group received
educational messages and home visits
and the control group received standard
treatment. After 1 year, infants in the
intervention group gained more weight
rather than the control group (Shi.J,et al,
2009, p.556).
intervention: A randomized, controlled
trial.
Brief description : This study conducted
by Roy, SK et al in 2007. The researchers
conducted a community-based,
randomised control trial in Bangladesh.
The objective of this study is to explore
the efficacy of a nutrition education
package to prevent malnutrition among
young children. The intervention group
had a significant weight increase than the
control group and this intervention also
successfully prevented growth flattering
and malnutrition among young children
(Roy et al, 2007, p. 375) .
5. Article 5
Title : Using the theory of planned
behaviour to examine the effectiveness
of an educational intervention on infant
feeding in China.
Brief description : A quantitative cluster
randomised controlled trial was
conducted in Laishui, China. The aims
of this study were to determine the
effectiveness of an educational
intervention on infant feeding and
mothers’ psychosocial mediating factors
based on the theory of planned
behaviour (TPB), and to predict the
influence of mediating factors on
mothers’ intention and feeding practices.
485 families (251 intervention and 234
control groups) were evaluated after 11
months intervention. The results showed
that mothers’ psychosocial variables will
affect infant feeding behaviour and child
growth and development (Zhang. J et al,
2009, p. 529)
3. Article 3
Title : Effectiveness of an educational
intervention delivered through the health
services to improve nutrition in young
children: a cluster-randomised controlled
trial.
Brief description : This study was
conducted in Peru. The researchers did
a quantitative experimental study with a
cluster-randomised controlled trial of an
educational intervention in a poor peri
urban area. This study enrolled 187
infants from intervention area and 190
from control area. After 6 months the
result showed that the activation of
nutrition education conducted by health
professionals can decrease the number
of children with stunted growth in
childhood areas (Penny. M.E et al, 2005,
p.1863).
6. Article 6
4. Article 4
Title : Effectiveness of an educational
intervention on complementary feeding
practices and growth in rural China: a
cluster randomised controlled trial.
Brief description : The researchers did
a quantitative study with cluster
randomised controlled trial. This study
involved 599 infants age 2-4 months from
eight townships in Laishui, a rural area
1st INC-AIPNEMA 2014
Title : An evaluation of a community
dietetics
intervention
on
the
management of malnutrition for
healthcare professionals.
Brief description : The researchers
conducted a quantitative experimental
study involving health care professionals
in midlands, the Republic of Ireland in
2006 and 2007. This study involved 87
health care professionals that provide
services for patients at risk of
malnutrition. The researchers used pre
and post test design to assess nutritional
knowledge of the participant before and
after the intervention. In conclusion, the
|
Bandung, October 22nd–23rd 2014
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3
Based on NHMRC levels of evidence
this study included in level IV because
this study employed pre-post test
design, without controlled group.
researchers found that an educational
program increased health care
professionals’ nutritional knowledge and
improved the management of patients
with malnutrition in the community
(Kennelly. S, 2010, p. 567).
B.
Over all, the evidence from all of the
articles included in level II based on
NHMRC levels of evidence because the
evidence that I found consist of more than
one studies applying quantitative
randomised controlled trial designs. The
evidence obtained from the articles that I
found in databases indicates that these
evidence support the use of nutritional
education intervention as a treatment to
improve children growth and development
especially children with malnutrition.
Level of evidence
All of the studies that I found from
searching the databases are quantitative
studies so that I will use the National
Health and Medical Research Council
(NHMRC) levels of evidence and grades
for recommendation (2009) according to
type of research question to analyse the
level of evidence of each article.
Level Type of evidence (Intervention)
I
A systematic review of all relevant
randomised controlled trials.
II
A randomised controlled trial (RCT).
III-1 A pseudo-randomised controlled trials
(alternate allocation or some other
method), or loss of benefits of
randomisation.
III-2 A comparative studies with concurrent
controls and allocation not randomised
(cohort studies), case-control studies,
or interrupted time series with a
control group.
III-3 A comparative studies with historical
control, two or more single-arm
studies, or interrupted time series
without a parallel control group.
IV
Case series, either post-test or pretest and post-test.
(NHMRC, Levels of evidence according
to type of research question, 2009).
1. Article 1 to 5
Based on the guideline all of these
articles included in level II because
these studies employed a randomised
controlled trial design.
2. Article 6
4
|
C.
Limitation of the evidence
Limitation of the evidence that I found
from searching databases was that I
cannot find a systematic review of level II
studies. It means this evidence is not at
grade A for recommendation according to
NHMRC grades of recommendations
(2009). The evidence that I found was at
level B, it is not the best evidence but the
body of evidence can be trusted to guide
practice in most situation (NHMRC, 2009,
p. 8).
D.
Discussion of Applicability and
contribution
After analysing the level of evidence
of each article, in this section I will discuss
the applicability and contribution of this
evidence into my area of practice. The
discussion will include assessing the
quality of the studies, are the findings
applicable or relevant to my setting and
what do the results means to my patients.
The first and second studies were
done by Roy, SK et al in (2005) and
(2007), First study employed a
randomised controlled trial approach; the
aims of the study were: to test the
Evidence Based on Nutrition Education as an Effective Nursing Intervention to Improve Nutritional Status of
Children with Malnutrition
0.4) can affect the reliability of the study
(Contento et al, 2002, pp. 2-25). The
limitations of the second study are about
20 % of participants dropped out and the
study has inability to blind the participants,
these limitations can cause possible bias
in this study.
effectiveness of a specific nutrition
education to reduce malnutrition and to
change mothers’ behaviour related to
feeding practice, care giving and health
seeking practices in Bangladesh. This
study was well conducted. The result of
the study was highly significant with p
value <0.0001. The result showed that an
intensive nutrition education significantly
improves the status of moderatelymalnourished children with or without
supplementary feeding (Roy.S.K et al,
2005, pp. 324-326).
The last article conducted in
midlands, the Republic of Ireland in 2006
and 2007. The researchers used pre and
post test design to assess nutritional
knowledge of the participants before and
after the intervention. The results were
highly significant with p value < 0.001
(Kennelly. S et al, 2010, p. 570). However,
this study was not a randomised controlled
trial, and only conducted in nursing homes
area. That is why the validity and
generalisation of this study need to be
reviewed again.
Second articles aimed to explore the
efficacy of a nutrition education package
to prevent malnutrition among young
children. The intervention group had a
higher weight gain than the control group
(1.81 vs 1.39 kg, p<0.001). It means that
the result was significant enough to prove
that educational intervention can prevent
malnutrition in children ( Roy. S.K et al,
2007, pp. 378-381).
Overall, all of the findings from these
studies are applicable to be implemented
in my practice area. All of the studies were
conducted in developing countries which
are similar to Indonesia, cost effective and
the resources to support this educational
program are available in Indonesia.
However, I’m still not sure about the
effectiveness of the intervention because
I still cannot find a systematic review for
this intervention. A systematic review is
the highest level of evidence according to
NHMRC (2009). Furthermore, this
intervention cannot be effective if
delivered alone, there must be
collaboration among government or policy
maker, health professionals and other
institutions, conducting integrated
programs to eradicate malnutrition in
Indonesia.
Third study was conducted in Peru.
The strength of this study are randomised
controlled trial design, the sample size
more than enough to ensure sufficient
power to test the hypotheses, and the
results are significant with p value of each
hypothesis < 0.05 (Penny.M.E et al, 2005,
p. 1867). However there are some
weaknesses, this study cannot be blinded,
which can led to bias. The respondents
have heterogeneity in their prior
knowledge and socioeconomic status that
can affect the results.
The fourth and fifth studies conducted
in China. Both of the studies have the
strengths: significant results with p value
< 0.05, randomised controlled design,
standardised evaluation procedures and
carefully designed data analysis. On the
other hand, these studies also have
limitations. First study was conducted in
one rural China area; it means we have
to be careful when generalising the
findings to greater area, and a poor
internal consistency (Cronbach’s alphas
Conclusion
In conclusion, most of the evidence that I
found used randomised controlled trial design
in their studies. Even though this evidence is
only at level II based on the hierarchy of
evidence and not at the highest level of the
hierarchy of evidence, this finding still can be
|
|
5
used to support my practice and can be trusted
to guide practice in most situation (NHMRC,
2009, p. 8). The implementation of the evidence
that I found should be integrated with
government program and need a strong effort
of each element that involved in malnutrition
management in Indonesia so that the
effectiveness of this program can be achieved.
Reference
Avan. B & Kirkwood. B, 2010, Role of
neighbourhoods in child growth and
development: does ‘place’ matter?. Social
science & medicine, vol 71, pp: 102 – 109,
Elsevier, viewed 20 March 2011, (online
ProQuest).
Central Bureau of Statistics Indonesia, 2009,
Precentage of children under five by
nutritional status 2005, viewed 27 March
2011,
diunduh
melalui:
< w w w. d d s . b p s . g o . i d / e n g / t a b _ s u b /
view.php?tabel=18daftar=1&id_subyek=30&notab=4>.
Contento. I.R, Randell.J.S, Basch. C.E, 2002,
Review and analysis of evaluation
measures used in nutrition education
intervention research, Journal of Nutrition
education, vol 34, pp. 2-25,viewed 18 May
2011, (online ProQuest).
Kennelly. S, Kennedy. N.P, Rughoobur. G.F,
Slattery. C.G, & Sugrue. S, 2010, An
evaluation of a community dietetics
intervention on the management of
malnutrition for healthcare professionals,
Journal of human nutrition and dietetics, vol
23, pp. 567-574,viewed 27 March 2011,
(online CINAHL).
NHMRC, 2009, NHMRC levels of evidence and
grades for recommendations for developers
of guidelines, viewed 12 May 2011, online
www.nhmrc.gov.au.
trial, The lancet, vol 365, pp. 1863-1872,
viewed 20 March 2011, (online Proquest).
Roy. S.K, Fuchs. G.J, Mahmud. Z, Ara. G, Islam.
S, Shafique. S, Akter. S.S, Chakraborty. B,
2007, Intensive nutrition education with or
without supplementary feeding improves
the nutritional status of moderatelymalnourished children in Bangladesh,
Journal Health Population Nutrition, volume
4, pp. 320-330, viewed 27 March 2011,
(online CINALH).
Roy. S.K, Jolly. S.P, Shafique. S, Fuchs. G.J,
Mahmud. Z, Chakraborty. B, Roy. S, 2005,
Prevention of malnutrition among young
children in rural Bangladesh by a foodhealth-care educational intervention: A
randomized, controlled trial, Food and
Nutrition Bulletin, vol. 28, no. 4, The United
Nations University, pp. 375-383, viewed 27
March 2011, (online CINALH).
Shi. L, Zhang. J, Wang. Y, Caulfield. L.E, Guyer.
B, 2009, Effectiveness of an educational
intervention on complementary feeding
practices and growth in rural China: a
cluster randomised controlled trial, Public
health nutrition, vol 13, ed 4, pp. 556-565,
viewed 20 March 2011, (online Science
direct).
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viewed 28 March 2011, www.unicef.org/about/
execboard/files/global_framework for action 1.0
- Dec 2006 pdf.
Zhang. J, Shi. J, Chen. D, Wang. J, Wang. Y,
2009, Using the theory of planned behaviour to
examine effectiveness of an educational
intervention on infant feeding in China, Journal
of preventive medicine, vol 49, pp. 529-534,
viewed, 20 March 2011, (on line Science direct).
Penny. E.M, Creed-Kanashiro. H.M, Robert.
R.C, Narro. M.R, Caulfield. LE, Black. R.E,
2005, Effectiveness of an educational
intervention delivered through the health
services to improve nutrition in young
children: a cluster-randomised controlled
6
|
STRUCTURE AND RELATIONS OF HEALTH BEHAVIOR FOR MIDDLE-AGED MUSLIM
WOMEN WITH HYPERTENSION IN RURAL WEST JAVA, INDONESIA:
A PILOT STUDY
Mayumi Mizutani1, Junko Tashiro2, Maftuhah3, Heri Sugiarto4,
Lily Yulaikhah4, Riyanto Carbun4
1
Doctoral Program in Nursing, St. Luke’s International University, Tokyo, Japan
2
St. Luke’s International University, Tokyo, Japan
3
Syarif Hidayatullah State Islamic University, Jakarta, Indonesia
4
Indramayu College of Health Science, Indramayu, Indonesia
E-mail: 12DN010u5Q-ts@slcn.ac.jp
ABSTRACT
Introduction: In order to prevent and control hypertension, it is important to promote healthy
behaviors of people. However, there is limited knowledge of health behaviors of people with
hypertension in Indonesia. The purpose of this study was to describe the structure and
relations of health behaviors of middle-aged Muslim women with hypertension in rural West
Java in order to promote health behaviors of people in culturally appropriate way.
Methods: A 76-item Health Behavior Questionnaire was developed based on nine categories
of health behaviors, which were derived from a qualitative study and literature review.
Frequency of each behavior (item) was analyzed on a four-point Likert scale. A face-to-face
questionnaire was conducted with 102 middle-aged Muslim women with hypertension in
rural West Java. The data were analyzed by factor analysis and reliability analysis.
Results: 12 factors with 31-item were extracted by principal factor method with promax
rotation based on eigenvalues greater than 1.0. These factors are: 1) Islamic spiritual practice;
2) caring for other people; 3) seeking health information; 4) seeking health care; 5) resting;
6) relaxing; 7) reducing salt; 8) eating fried food; 9) eating fruits and vegetables; 10) eating
meat; 11) activity for family; and 12) stress management. The cumulative contribution of
these factors was 59.5% of the total variance. Factor loading ranged from .917 to .402.
Cronbach’s alpha was .724 for the global (total) health behavior questionnaire (scale). Factor
of caring for other people showed weak and medium correlations (r=.409~280) with six
other factors. Factor of Islamic spiritual practice showed weak correlations (r=.309~.240)
with five other factors.
Conclusion: The structure of health behaviors for middle-aged Muslim women with
hypertension in rural West Java was similar to the categories of health behaviors, which
were derived from the qualitative study. Since some of their health behaviors was related to
caring for other people and Islamic spiritual practice, it is necessary to support these behaviors
in order to promote their health behaviors. Further study is needed with a larger sample to
examine the structure of their healthy behaviors.
Keywords: health behavior, hypertension, Indonesia, Muslim.
7
THE EFFECT OF SPIRITUAL QUANTUM TOUCH TO THE PAIN WHEN TURNING TO
THE LEFT AND RIGHT POSITION IN POST SURGERY PATIENTS
AT RSUD SERANG 2014
Ani Haryani1, F. Sri Susilaningsih2, Aat Sriati2
1
Nursing Program, STIKes Faletehan, Serang
2
Post Graduate Nursing Program, Padjadjaran University, Bandung
E-mail: aniharyani3376@gmail.com
ABSTRACT
Introduction: Post-major surgery patients have risk for complications that threatening their
condition. Early mobilization is one procedure to prevent the complication, but mobilization
leads to increased pain. Spiritual Quantum touch (SSQ) is a biofield energy-based
complementary intervention has been widely used. The purpose of this study was to determine
the effect of SSQ to the pain when turning to the left and right position in post-surgery
patients.
Methods: The research design was pre-experimental one group pretest-post test design.
The number of samples was 18 peoples obtained through purposive sampling. The intensity
of pain was measured using the Numeric Rating Scale (0-10). Wilcoxon test was used for
analysis the differences of pain intensity at pre and post test measurements.
Results: The results showed a median value of pain intensity at rest was 5, turning without
SSQ was 8, turning after SSQ1 is 5.5 and turning after SSQ 2 was 5. There was a significant
decrease in pain intensity when turning after SSQ1 (p = 0.001) and SSQ 2(p=0,041).
Conclusion: SSQ can be an alternative for nurses in the critical care nursing in nonpharmacological pain management to improve mobilization. Further research is needed
using a larger sample and various cases.
Keywords: Biofield, Mobilization, Post-surgery Pain, Spiritual Quantum Touch
Introduction
Despite the advantages of mobilization and
immobilization adverse effects in patients after
surgery has been widely emphasized in postsurgery patient care guidelines, but it is not
without obstacles. The results of the study on
74 patients showed an average ICU time change
of position was 7.7 h (5-12 hours) and only 2.7%
of patients were positioned every 2 hours. Lack
of manpower and nurse time, hemodynamic
instability, patients who are intolerant and pain
are impediments to change position so it cannot
be done every two hours4.
The development of medical technology
has driven the increasing operating procedure.
The use of anesthetics and organ manipulation
in major surgery causes postoperative recovery
process is more complex. 1 . The risks of
malfunctioning of the body which can be life
threatening including respiratory and circulation
problems. These risks are also exacerbated by
the state of immobilization. The mobilization is
important in the management of post-surgery
to prevent complications. Early mobilization
increases whole organ function. Mobilization has
a significant effect on recovery and prevent postsurgery complications. 2,3
The results of the study in 5,957 ICU
patients showed that changes position as the
most painful procedure (mean 4.93; SD 3.09,
scale 0-10). The other research in 1680 post9
surgery patients also showed that 4.2% of
patients
experienced
severe
pain
postoperatively at rest and increased to 26.9%
while moving5. Pain can activate stress response
by activating the sympathetic nervous system,
triggering an imbalance of hemodynamic and
poor wound healing 6,7 . Farmacologic
management as first choice in pain management
remains less favorable consequences8,9. Nurse
challenged to reduce pain at change.
The strong association pain with emotional
can be an opportunity for develop psychological
approach to decrease pain. Psychological
approaches offer greater benefits because can
increase personal control10. One of the nonpharmacological interventions in the nursing
services that have been developed is a touch
therapy that uses the biofield therapy approach.
Biofield is the electromagnetic wave surrounds
the body, believed the unity of various
combinations of the electromagnetic field of the
body ions and play a role in integrating the entire
body system.
There was an evidence that biofield
significantly increasing alpha wave in the frontal
and central areas of cerebral cortex after 4
minutes of therapy as the basis of the
physiological process in reducing pain
intensity11. Biofield energy received by large
somatosensory fibers as not pain stimulus that
activating inhibitory interneurons, which in turn
will close the pain gate. Closing of the gates
strengthens the biofield transmission to the brain
and changing beta into alpha waves and release
beta-endorphin and dynorphin 11-12.
of 18 patients were obtained using purposive
sampling. The research was conducted from
March to July 2014 in an intensive care RSUD
Serang hospital. Pain was measured by
Numeric Rating Scale (0-10). first SSQ therapy
was conducted 20 minutes.
Results
Almost all respondents (94.40%) were
female. Most of the respondents (83.3%) are in
the ages of 18-40 years and a half of the
respondents came from Sundanese cultural
background. Half of the respondents were
patients with post sectio Caesarea (50%), the
type of anesthesia used is general and spinal
anesthesia and most have programs providing
analgesic every 12 hours. According to the day
of post-surgery care, most respondents are
patients who have been treated for 24-48 hours
of surgery. Almost all respondents is the first
experience of patients with surgery.
The intensity of pain was not significantly
different in the various measurement positions
based on the characteristics of the respondents
(p value>0.05 by Mann Whitney and Kruscall
Walis test). Changes in pain intensity when
turning before and after the intervention are
shown in chart 1.
In Indonesia, a growing therapeutic touch
is Spiritual Quantum Touch (SSQ). SSQ is
defined as the art of healing with the touch of a
hand that is based on love and pray
accompanied with a sincere heart, thus allowing
the healing to happen 13. The study aims to
determine the effect of Spiritual Quantum Touch
to pain intensity when change the position on
postoperative patients in intensive care.
Methods
The study was designed to use the preexperimental one-group pretest-post test. A total
10
| Building Transcultural Nursing in Education and Practice to facing Asean Community 2015
The Effect of Spiritual Quantum Touch to the Pain When Turning to the Left and Right Position in Post Surgery
Patients at RSUD Serang 2014
Chart 1.The difference in the intensity of post-surgery pain in the supine position/ rest, turning
and turning before the intervention SSQ and after SSQ intervention in post-surgery
patients in RSUD Serang Hospital 2014 (n = 18)
Discussion
The results showed that the intensity of
post-surgery pain in patients at rest was
increase. Value of pain intensity in this study
was higher than the results of previous research.
Dominique research found that the average of
post-surgery pain in the first 24 hours was 2.7
at rest and 4.9 while moving. This difference is
caused by the difference in assessment time.
in this study pain assessed three hours after
administration of analgesics so the peak effect
of analgesic has been reduced. Dominique pain
assessment studies conducted periodically for
24 hours with appropriate analgesic
administration program14.
The time measurements difference in the
range providing analgesic pain will greatly affect
the value of the intensity of pain. Patients with
opioid titration and administration of non- opioid
analgesics still got the benefits of analgesia, so
the intensity of the pain will be reduced.
Measurement of pain intensity in this study was
3 hours after 30 mg kethorolac administration,
so the peak effects was passed.
Most of the patients get non-opioid
analgesic after leaving the recovery room.
Administration of non-opioid analgesic
completed the titration, the analgesic program
continued with the non opioid analgesic every 8
hours or 12 hours. The majority of respondents
have analgesic program every 12 hours, they
have risk to experience moderate to severe pain
in the 10 hours and fall on persistent acute pain
that lead to chronic post surgery pain and
delayed wound healing. 15-16
Based on the assessment of pain intensity
on turning without SSQ intervention, the results
showed an increase in pain intensity from
moderate category to severe category. This
result is consistent with the results of the Puntillo
research, also showed a change in position as
a painful procedure. The increase in the intensity
of pain in turning will also be potential barriers
in the early mobilization procedures. Severe
intensity of pain can trigger stress responses
that lead to disruption of the patient’s
|
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11
hemodynamic and affect the patient emotional,
perceived spread of the touch of the hand
so the patient may be experiencing emotional
distress.
therapist, feeling like the flow of a low electrical
power that makes relaxed and calm feeling. Ten
In contrast to the results of the assessment
of the eighteen respondents (56%) reported
sleep more soundly after undergoing therapy.
in turning without SSQ, the assessment results
in turning after the 1st SSQ intervention lower
and significantly different. Similarly on the third
measurement turning with 2nd SSQ intervention
occurs a significant reduction in pain intensity,
so that the intensity of pain assessment after
the 2nd SSQ intervention.
Based on observations during the process of
therapy, the majority of respondents (67%) fall
asleep during the treatment process even on
respondents who reported very high pain
intensity (9-10).
Conclusion
The reduction in pain intensity after SSQ
SSQ as complementary intervention biofield
intervention can be affected by the emotional
and spiritual approaches of the SSQ procedure.
energy-based proven to reduce the intensity of
pain during turning left and right on the analgesic
Developing communication to establish a
trusting relationship before doing therapy so that
effect has been reduced, so that the turning left
and right mobilization can still be done safely.
patients with consciousness is willing to follow
therapy. Spiritual approach is built by referring
References
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to feel peaceful, safe and light in the face of
suffering. Trusting relationship also allows the
nurse to be able to minimize distress to the
procedures that causes pain. 17-19
Clinically, the results of this study are very
helpful for patients after surgery in the early
stages of mobilization intervention. The
researchers interviewed the five respondents
who experienced good progress in mobilizing
ability. Respondents revealed that the SSQ
intervention greatly enhances their ability to
mobilize, because the most difficult to
mobilization is the time to start, because the pain
is very strong, but after often moved the pain is
decrease.
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13
THE LEARNING MODEL OF REPRODUCTIVE HEALTH THROUGH A PEER GROUP
WITH A CULTURE OF EARLY MARRIAGE IN THE
TRADITIONAL BOARDING SCHOOL, JEMBER
1
Awatiful Azza1, Cipto Susilo1
Faculty of Health Sciences, Muhammadiyah University of Jember
E-mail: awatiful.azza@yahoo.com
ABSTRACT
Introduction: Legally marital in Indonesia have been regulated in the Marriage Law No. 1
of 1974. The data reveal the impact of early marriage give asymmetrical gender relations
and lead to a lack of access of women to various things such as food, health, education and
skills that directly lead to poverty. Early marriage often leads to a loss in terms of both health
and development for the women, was also an issue of human rights violations that are
widely ignored and is usually associated with social and physical that will bring harm to
young women and their offspring.
Methods: The purpose of this study was to explore the ability of young women in the traditional
boarding to rise and increase self-awareness about the health rerpoduction through peer
group. This study used a pre-experimental approach to assessing changes in knowledge
about early marriage, with the questionnaire data collection. This research was conducted
in the traditional boarding Wirowongso, Jember. Total sample of 30 female students
Results: The results of this study showed that 65% of female students have never received
information on health reproductive and female organs as well as the impact when early
marriage. Analysis using the Spearman Rho on the peer group learning showed 0:00, there
is the influence of peer learning model with an understanding of the students about early
marriage. Female students need to gain an understanding of health reproduction not only
through religious education, but also need understanding of the social impact.
Keywords: early marriage, reproductive health learning, peer group.
average age of marriage was 19.1 years. In East
Java, South Kalimantan, Jambi, and West Java,
the incidence of early marriage consecutive
39.4%, 35.5%, 30.6%, and 36%. Even in some
rural areas, marriage is often done immediately
after the first menstrual period. The number of
girls at the age of child marriage rate, indicating
that the empowerment of law enforcement in a
legal marriage is still low.
Introduction
Married at the age of 18 years is a reality
that must be faced by most children around the
world, especially developing countries. Although
the Declaration of Human Rights in 1954 to
explicitly oppose child marriage, but ironically,
the practice of early marriage is still going on in
various parts of the world and it reflects the
protection of human rights are neglected
younger age groups. Implementation Act often
ineffective and broken by the customs and
traditions that govern the social norms of a
community group.
Early marriage very closely with the
exploitative culture to children, which makes the
child powerless against the will of the adults,
either parents who want the marriage, as well
as those who marry. Some of the forms of
exploitation include is exploiting children in the
name of economic or material, because of
The number of cases of early marriage in
Indonesia reached 50 million people with an
15
prestige or self-esteem could marry his son with
people who are considered respected
regardless of whether her prospective husband
is married or not, whether her daughter is ready
physically, mentally and socially or yet. There
are exploiting children as mentally hedonists,
seeking pleasure in many things including
polygamy with children under age. Some are
due to mental disorders, pedophili. Another
reason even exploiting children in the name of
religion, although many religious leaders have
emphatically stated that early marriage is not a
religion, especially if claimed as part of the sunna
of the Prophet SAW.
Early marriage is a social phenomenon that
is influenced by the culture they profess, which
is produced by the action if the local community
that are thought to be still deeply entrenched in
the public trust. Many effects are caused by early
marriage socially, psychology, and health,
especially reproductive health. This is very
important because it affects the quality of the
reproductive health of the fetus is produced, and
also affect the level of health of the mother,
because the progress of a nation can be
indicated with maternal mortality.
This condition requires alternative solutions
to women who do early marriages can access
knowledge about reproductive health. The
learning model of reproductive health through
peer group systematically arranged and as a
strategy for health development is an attempt
to build a young generation resources as well
as to raise awareness of their potential in an
effort to improve the reproductive health status.
1.1 Problem Formulation
According to Elizabeth (2010) stated
that traditionally youth are regarded as
“storm and stress” is an emotional time
when tension rises as a result of physical
changes and glands. These conditions can
be concluded that the physical and
emotional adolescence not yet mature
enough to be able to undergo a marriage
bond.
Early marriage often results in a loss
in terms of both health and development.
16
The data showed that the women will be
more at risk due to early marriage, early
marriage besides also an issue of human
rights violations that are widely overlooked
and is usually associated with social and
physical that will bring harm to young
women and their offspring. Doing a
wedding without the readiness and careful
consideration of one side can indicate
appreciative attitude toward the meaning
of marriage and even further to an abuse
of the sanctity of marriage.
According to the United Nations
Development of Economic and Social
Affairs (UNDESA), Indonesia is the country
with the 37th highest number of early
marriages in the world. To the level of
ASEAN, Indonesia ranks second only to
Cambodia. Therefore important to have an
understanding of provisioning and
reproductive health for adolescents so that
women are able to make decisions about
marriage
1.2 Specific Objectives
The risk of reproductive health
problems can be influenced by many
interrelated factors such as the cleanliness
of the reproductive organs, sexual
intercourse too early, access to health
education, sexual violence,. These
conditions place the most vulnerable young
women in their reproductive systems face
health problems.
This study aims to explore the ability
of young women to rise up and increase
self-awareness about the health
reproduction through peer group. Specific
objectives to be achieved in this study are:
a. Identify the knowledge and perceptions
of female students about the impact of
early marriage for reproductive health
before being given treatment
b. Identify the knowledge and perceptions
of female students about the impact of
The Learning Model of Reproductive Health through a Peer Group with a Culture of Early Marriage in the
Traditional Boarding School, Jember
Darussa’adah Jember with 30 sample, the
manager of a traditional boarding school
with a number of 10 people.
early marriage for reproductive health
after being given treatment
c.
Analyzing the learning model of
reproductive health through a peer
group with a culture of early marriage
in the traditional boarding school
districts Jember
d.
The data collected in this study include
primary data and secondary data. Primary
data is obtained directly as a source of data
that is through observation, questionnaires
and interviews were conducted to the young
women. This study also requires secondary
data. Secondary data was obtained from
community leaders, managers boarding
school through Focus Group Discussion
(FGD), in addition to the researchers also
need other sources of relevant policies and
programs related to adolescent
reproductive health.
Methods
a.
Research Design
This study aims to prove whether a
healthy reproductive learning through peer
group can increase the knowledge of
students of about the negative impact of
early marriage for their reproductive health.
Therefore, the design of this research study
using experimental pre - post test design.
Female students will be assessed
before being given his knowledge of
reproductive health and further learning will
be re-evaluated after a given learning
knowledge of reproductive health through
peer group.
b.
c.
e.
Data Processing Techniques
Processing of data obtained
theoretically and from the field will be
analyzed quantitatively by Spearman Rho.
However, to complete this study will be
presented qualitative data to clarify the
meaning of quantitative data.
Location Research and Research Time
This study was conducted in a
traditional boarding school Darussa’adah
daughter who was in the village
Wirowongso, Jember. Range to achieve
the goal of this research is done in stages,
researchers focus more on formulating an
appropriate model in teaching reproductive
health of young women in traditional
boarding school. These activities are carried
out through discussions and interviews with
managers of traditional boarding schools,
self-assessment as well as explore the
potential for teenage girls at the boarding
school to determine the learning model that
best fits the reproductive health for young
women in traditional boarding school.
Data Collection Techniques
Results
a.
Identify the needs learning of female
students at the boarding school
traditional about Reproductive Health.
Table 1. The needs Learning of female
students about reproductive health
The needs learning of
female students about
reproductive health
Anatomy of the
reproductive organs
Pregnancy
Menstruation
Gynecology
Total
amount
%
10
33,30%
9
4
7
30
30,00%
13,30%
23,40%
100%
Population and Sample
The study involved young women who
are in a traditional boarding school
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17
Based on these data the majority of
students want to get learning about the
anatomy of the reproductive organs. Until
now, traditional boarding school is a nonformal education based on religion, not
related to the learning curriculum about
reproductive health. Some of the issues
about health reproduction discussed in the
book Fath al-Qarib about menstruation and
childbirth blood.
b.
Meanwhile, learning of sexual
problems is usually called jima ‘is more
focused on Islamic law which only focuses
on the procedures jima’ according to
religious or legal sanctions for violations.
While the development of information
access in a variety of media outside the
boarding school very quickly, it must be
balanced with the knowledge that the
strengthening of female students to
understand the limits of reproductive health
risks.
The formulation of the model of learning
through peer group about reproductive
health.
Peer tutoring is a group of students who
have completed the learning materials,
provide assistance to students who have
difficulty in understanding the lessons
learned material. Help learning by peers can
eliminate the awkwardness.Communication
with peers group more easily understood.
besides, no reluctance, low self-esteem,
shame, and so on, so it is expected that
students who do not understand do not
hesitate to reveal the difficulties faced.
The learning model is very suitable to
be applied in boarding school. The peer
group model’s which tested in boarding
Darussa’adah wirowongso Jember district
are as follows :
Female student
Female student
Peer tutoring
Female student
Female student
Figure 1.
Model of learning reproductive health through peer tutoring in Boarding school
Darussa’adah Jember
In the process of reproductive health education in boarding schools, cleric is not the only source
that can be used as a guide by students. This means that students must be self-sufficient, independent
and not rely on reproductive health education materials from the cleric alone. By utilizing a variety
of learning resources available students trying to actively seek learning resources related to
reproductive health education materials. Peer tutoring learning method can improve the
understanding of the students about their own reproductive health and more responsible.
18
c.
Analysis of students knowledge before and after being given a healthy reproductive learning
through peer group
Table 1. Correlations: before and after learning of reproductive health in Boarding school
Darussa’adah
Knowledge before Knowledge after
Correlation
1.000
.627**
Coefficient
Knowledge before
.
.000
Sig. (2-tailed)
30
30
N
Spearman's rho
Correlation
.627**
1.000
Coefficient
Knowledge after
.000
.
Sig. (2-tailed)
30
30
N
**. Correlation is significant at the 0.01 level (2-tailed).
Results using Spearman’s rho test
showed 0.00 where < value is smaller than
0.05 so it can be concluded that there is
influence on the understanding female
students of learning about reproductive
healthy and the impact of early marriage
for reproductive health
Discussion
a.
Impact of Early Marriage Against
Reproductive Health.
Married women under the age of 20
years have a risk to the reproductive organs
because at this stage, immature
reproductive organs to perform its function.
Womb (uterus) new ready to perform its
function after the age of above 20 years up
to 35 years of age, because at this time of
hormonal function through a period of
maximum. At the age of 14-18 years, the
development of the muscles of the uterus
has not been good enough and the strength
of contraction of the uterus so that if there
is a pregnancy can rupture (tear). At the
age of 14-19 years, the hormonal system
is not stable, unstable pregnancy becomes
easy bleeding and there was a miscarriage
or fetal death. Too early gestational age of
delivery prolong the active reproductive age
range.
Pregnancy at a very young age is
apparently correlated with maternal
mortality and morbidity. Mentioned that girls
aged 10-14 are five times higher risk of
dying during pregnancy or childbirth
compared to age group 20-24 years, while
the risk was more than doubled in the age
group 15-19 years. Anatomy of the child’s
body is not ready to process pregnancy and
birth, so that there can be complications
such as obstructed labor and obstetric
fistula. UNFPA data from 2003, showed
15% -30% of the delivery at an early age is
accompanied by chronic complications,
namely obstetric fistula, this condition can
also occur as a result of sexual intercourse
at an early age.
Early marriage is also closely
associated with high fertility, pregnancy with
a short distance, also the occurrence of
unwanted pregnancies. Younger age at first
sexual intercourse also increases the risk
of transmission of sexually transmitted
diseases and HIV infection. Many
teenagers who quit school early to get
married when they are tied up in the
institution of marriage, they often do not
understand basic reproductive health,
including the risk of HIV infection. Largest
HIV infections acquired as a direct
transmission from an infected partner who
had sex before. Furthermore, the age
difference is too much may cause the child
hardly ask for safer sex due to the
dominance of the pair. Weddings young age
is also a risk factor for cervical carcinoma.
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19
Limitation of motion as a wife and a lack of
support to health services due to hit the
husband permit conditions, economic
constraints, the barrier is certainly
contributing to increased morbidity and
mortality in pregnant teenagers.
b.
Factors that support Early Marriage
Phenomenon.
1.
child of both parties who have
become husband and wife, as well
as the sustainable development
efforts of both sides the parents,
where these efforts is a branch of
the business that need each other
and complement each other.
3.
Environmental Factors
The reason his parents soon
marries a young age is to immediately
unite familial bond between relatives of
the bridegroom and the bride’s relatives
that they want together. The desire of
the bond will bring benefits to both
parties, that is where the bridegroom
after the marriage-law living in the
house as well as boys can be utilized
as an aid to the labor law.
In the hold of a marriage, here women
do not measure what age she can be
married. It is based on a criterion that
is if he has reached a certain level of
physical development. The fact is
because the common law does not
recognize a sharp boundary between
someone who is already mature and
capable illegal or not.
4.
Economic Factors
The reason parents marry off their
children at a young age seen from the
economic factors are as follows:
a)
b)
20
To simply meet the need or lack of
financing life his parents,
especially the parents of the bride.
Because of the wedding of her
children in this young age, will
receive donations in the form of
goods, materials, or the number of
companion money that can be
used subsequently to cover the
cost of the needs of everyday life
for some time.
To ensure the preservation or
expansion of the parents of the
bridegroom and the bride’s parents
for the convening of their marriage
at a young age is so that later the
Religious factors
Religion to regulate all aspects of
human life throughout the ages. God
Almighty created man is also
accompanied with religious guidelines,
it is to keep humans are not ruined in
sin, and in addition it is also equipped
by reason as a tool to think and make
sense of all the problems it faces, one
aspect of which is governed by religion
is the institution of marriage.
In addition, to maintain harmony
and peace among relatives and to
prevent the marriage with another
person who is not approved by parents
or relatives who are concerned with the
implementation of the marriage.
2.
Social factors
5.
Educational factors
Low level of education makes young
people do not know the negative effects
of child marriage. So they get married
without giving them enough, so they do
not know about the negative effects for
reproductive health.
6.
Cultural factors
Cultural factors also take a big
influence, because this culture is
rooted. In local culture trust if not
immediately marry his daughter, it
would be a shame because they did
not sell the family in its environment.
Or if there are people who are
financially considered very capable and
propose their children, regardless of
age or marital status, most parents
accept the proposal because they
thought the future would be brighter for
the child, and of course that is expected
to reduce the burden of the parents
c.
The Learning Model of Reproductive
Health Through Peer group in a
traditional boarding school in reducing
the number of early marriages
Boarding school life are familiar with the
character of social media is good enough
to develop a method of learning through
peer group. The learning with peer group is
an independent group formed on the basis
of awareness of the importance of the
learning process in life, especially for
adolescents in terms of biological,
psychological, and sociology have special
needs. In general, adolescent phase is a
phase of self that often can not be controlled
by the environment.
provisions, the expected teenagers capable
to take decision right about reproductive
rights in making a decision about marriage
Conclusions
a.
Boarding School is a non-formal education
has a big influence in helping to improve
the intelligence of the nation.
b.
There is the influence of reproductive health
learning through peer groups in improving
students’ knowledge of the impact of early
marriage on reproductive health
References
Adolescent Reproductive Health Working Group
(2002); Facilitators Guide For My Puberty.
Dhaka, Bangladesh
Anita, Atashendartini dan Saparinah.
(2006).Implementation of Article 12 of Law
No. 7 of 1984 Care Pregnancy, Childbirth
and Postpartum. Yogyakarta : Surviva
Paski, Nitiprayan.
The formation of a study group is a
collection of adolescent peer knowledge
sharing through dialogue and discussion
about anything related to life. Iriyanti (2003)
suggested that adolescents have a
tendency to form groups and interact with
they friends, so will try to break away from
dependence on parents or family.
Azza, A. (2009). Burden of Women with HIV /
AIDS in a gender perspective. Faculty of
Health Sciences, Muhammadiyah
University of Jember
Some teens join to form a peer group.
In addition to the formation of peer groups,
are considered the same age the teenagers
also noticed other similarities, such as
hobbies, socioeconomic status, family
background, school equation, residence,
religion, and also race (Desmita, 2009).
Desmita. (2009). Peer group models as a
learning medium. Jakarta: Rineka Cipta
Peer group has a very important role
in adolescent adjustment and preparation
for life in the future, and also affect the
outlook and behavior. Through adequate
Convention Watch.(2007). Rights of women
Legal Instrument to Achieve Gender
Equality. Jakarta: Yayasan Obor Indonesia.
Dian. (2010). Boarding school in the perspective
of Indonesian Islamic education. thesis :
STAIN Jember not publication.
Iriyanti.(2003). The development of Adolescent
Psychology. Jakarta : EGC
Nurhasanah (2006). Patterns Boarding School
Education: Study Against boarding school
at the city of Pekanbaru. Faculty of Tarbiyah
and Teaching UIN Suska Riau
Mas’udi, & Masdar. (2007). Islam and women’s
reproductive rights: In the empowerment.
Bandung : Mizan.
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21
Sarwono dan Suprihatin. (2000). Learning
Method Peer group Tutor improve Learning
Outcomes-Based Self-Regulation. Makara,
Social Humanities, Vol. 14, No. 2,
Desember 2010: 91-97
Savitri. (2003). Socializing women’s
reproductive health. USU digital library
22
THE DESCRIPTION OF COMPONENT ANTENATAL CARE EXAMINATION IN THE 3rd
TRIMESTER PREGNANT WOMEN IN PUBLIC HEALTH CENTER WONOSARI I
GUNUNG KIDUL IN YOGYAKARTA
Disa Grapella
Universitas Muhammadiyah Yogyakarta
E-mail: disa.grapella@gmail.com
ABSTRACT
Introduction: In Indonesia, Maternal Mortality Rate (MMR) is still quite high. Poor quality of
health care Antenatal Care (ANC) is an obstacle to reduce the MMR. ANC service utilization
is still low in some areas, this is caused by various factors such as low education mother.
Involving families in care during pregnancy is very important to improve the welfare of the
mother and fetus. Known description of ANC examination were do in the third trimester
pregnant women public helath center Wonosari I, Gunung Kidul in Yogyakarta.
Methods: This study used a non-eksperimental type of research that is descriptive quantitative
and purposive sampling technique. Total sample of 30 respondents who are 3rd trimester
pregnant women, pregnant women with minimum elementary school education last, pregnant
women with Javanese culture, and pregnant women who can Indonesian.
Result: In doing anamnesis, weight measurements, blood pressure checks, and
measurement of TFU 100% of pregnant women have been conducted. As many as 23
(76.6%) of pregnant women consume iron tablet. Most pregnant women have been
immunized TT1, as many as 28 (93.3%) of pregnant women, while TT2 immunization by 22
(73.3%), immunization TT3 13 (43.3%), immunization TT4 only 5 (16.7%) pregnant women,
and immunization TT5 only 2 (6.7%). Laboratory tests were conducted with 22 pregnant
women (73.3%) while the last component of the ANC including counseling as many as 24
(80%) of pregnant women has been do.
Keywords: Antenatal Care Examination, Pregnant, Maternal Mortality Rate.
Introduction
hypertensive disorders, infection and
hemorrhage (Indriyani, 2013). Indirect causes
Based on Indonesia Demographic Health
Survey (2012), Maternal Mortality Ratio (Ratio)
of maternal death include anemia, chronic
energy deficiency (CED), and the state of the
reached 359 per 100,000 live births. This is an
increase compared to the Maternal Mortality
“four too” (too young / old, often, and a lot),
maternal mortality is also characterized by non-
Rate (MMR) in 2007, as many as 228 per
100,000 live births. There are various causes
technical matters are categorized as basic
causes, such as the low status of women,
of maternal deaths due to pregnancy which
consists of the direct and indirect causes, but
helplessness, and low educational level
(Saifuddin, 2006).
generally there are three main causes of
23
Indonesian Health Ministry recommends
components Antenatal Care quality services,
namely (1) measurement of height and weight,
(2) measurement of blood pressure, (3) iron
tablets, (4) immunization Tetanus Toxoid (TT),
(5) abdominal examination, (6) testing of blood
and urine samples, (7) informasi about the signs
of pregnancy complications. According to
research Rahmani and Brekke (2013) low
utilization of antenatal and obstetric Care
because of to the limited knowledge of maternal
and child health, financial problems,
transportation difficulties, especially for poor
rural women and uneducated, and low family
support.
study is shown by the frequency distribution
Based on preliminary surveys on the date
December 11, 2013 at the Health Office in
Yogyakarta, obtained Maternal Mortality Rate
(MMR) in 2012 in Gunung Kidul as many as 107
per 100,000 live births, Sleman district as many
as 87.6 per 100,000 live births, Kulon Progo as
87.34 per 100,000 live births, the city of
Yogyakarta as many as 87.3 per 100,000 live
births and Bantul area as many as 52.2 per
100,000 live births. Ministry of Health expressed
K4 coverage of pregnant women visit
Yogyakarta Province in 2012 amounted to
93.31% where it is already more than the
government’s target, which is 90%, but of the
five districts/cities in the province, three of which
have achieve the target, which is Sleman
92.67%, 90.68%, Kulon Progo, Yogyakarta City
and 90.34%, as well as two districts that have
not reached the targetwhich is, Gunung Kidul
87.35%, 85.52% and Bantul.
Village, Siraman Village many as 9 people,
Duwet Village 2 and Wareng Village by 4 people.
Based on these explanations can be
concluded that the Maternal Mortality Rate
(MMR) which is the highest in DIY is in Gunung
Kidul, which is 107 per 100,000 live births and
maternal kujungan K4 coverage in Gunung Kidul
is still low, 87.35%, in this case researchers
became interested in researching focus
description of of ANC examination were do in
the third trimester pregnant women.
Results
Methods
This study used a descriptive quantitative
approach using the observation sheet
table. The population in this study is the third
trimester pregnant women were included in the
work area as much as 98 health centers I
Wonosari pregnant women. The sample in this
study is a three trimester pregnant women.
Researchers using purposive sampling
technique where the number of samples in this
study only 30 respondents.
Researchers take five villages of the
districts Wonosari I, the Village Karangrejek
many as 9 people, as many as 6 people Pulutan
The five villages and has the characteristics of
respondents almost the same region, as well
village distance is not too far compared to other
villages. Samples taken from the population
must also meet the inclusion and exclusion
criteria. The criteria for inclusion: third trimester
pregnant women, pregnant women with at least
elementary school education last, pregnant
women with Javanese culture, and pregnant
women who can Indonesian. Exclusion criteria:
pregnant women experience abortion events
during the study, pregnant women who do not
follow the research process, and pregnant
women who come out of the course of study.
Tabel 1. Distribution Component Antenatal
Care Examination
ANC Component
Anamnesa
Yes
No
Measurement of
Weight
Yes
No
Frequency Percent
instruments. The study was carried out from
February-April 2014 Analysis of the data in this
24
30
0
100
0
30
0
100
0
The Description of Component Antenatal Care Examination in the 3rd Trimester Pregnant Women in
Public Health Center Wonosari I Gunung Kidul in Yogyakarta
ANC Component
Frequency Percent
Measurement of
Blood Pressure
Yes
30
100
No
0
0
Measurement High
Fundus Uteri
Yes
30
100
No
0
0
Consume Iron Tablet
Yes
23 76.6
No
7 23.3
Imunization TT1
Yes
28 93.3
No
2 6.7
Imunization TT2
Yes
22 73.3
No
8 26.7
Imunization TT3
Yes
13 43.3
No
17 56.7
Imunization TT4
Yes
5 16.7
No
25 83.3
Imunization TT5
Yes
2 6.7
No
28 93.3
Laboratorium Test
Yes
22 73.3
No
8 26.7
Conseling
Yes
24
80
No
6
20
Amount
30
100
Tabel 1. Showed In doing anamnesis,
weight measurements, blood pressure checks,
and measurement of TFU 100% of pregnant
women have been conducted. As many as 23
(76.6%) of pregnant women consume iron
tablet. Most pregnant women have been
immunized TT1, as many as 28 (93.3%) of
pregnant women, while TT2 immunization by 22
(73.3%), immunization TT3 13 (43.3%),
immunization TT4 only 5 (16.7%) pregnant
women, and immunization TT5 only 2 (6.7%).
Laboratory tests were conducted with 22
pregnant women (73.3%) while the last
component of the ANC including counseling as
many as 24 (80%) of pregnant women has been
do.
Discussion
According Siswosudarmo & Emilia (2008)
Antenatal Care is care that is do / given to a
pregnant woman until the time of delivery.
Pregnancy can be divided into three periods of
roughly the same interval (less than 13 weeks,
or 3 months), which is known as the first
trimester, II, III. This division should not be used
to indicate the age of the pregnancy, but only to
show the conditions / diseases that commonly
occur in a given period. Sarwono cit Indriyani
(2013) suggested minimum standard of
antenatal care is called “7T”, which is balanced
body weight and height, blood pressure
measuring, measuring fundal height, Tetanus
Toxoid immunization (TT) complete, giving iron
tablets for a minimum of 90 tablets pregnant,
tests against sexually transmitted diseases, and
colloquium in order counseling referral. During
pregnancy the mother and fetus circumstances
should always be monitored if there are
deviations from the normal state, can be
detected early and given proper treatment.
Based on Table 1, showed that 100% of
pregnant women has been doing anamnesis,
weight measurements, blood pressure checks,
and measurement of TFU. Sofian (2013)
suggested that it may be investigated when
history is made up of the identity of the patient
such as name, age, religion, occupation,
education, address, marital status and so on.
According Mufdlilah (2009) range of healthy and
safe reproductive age is 20-35 years. Menstrual
history that explains how the history of the first
menstruation, when the first day of the last
menstrual period (LMP), when the mother does
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25
not remember HPHT, ask about other things
tetanus. Based on the Expanded Programme
such as fetal movement or feeling nauseous.
Primigravida feel fetal movement at 18 weeks
on Immunization (EPI) and the Maternal and
Child Health Care (MCH) is recommended to
gestation, whereas at 16 weeks multigravida
(Hutahaean, 2013). Pregnancy history consists
give Tetanus Toxoid immunization twice during
pregnancy.
of the use of contraception, childbirth, and
childbirth before, kind of birth, number of children
Only 23 (76.6%) of pregnant women who
living/dead, how his weight, who help, is there
any illness during pregnancy, birth just months/
no (Siswosudarmo & Emilia, 2008). Is there a
history of previous miscarriage, pregnancy
problems/previous delivery such as prematurity,
birth defects, and hemorrhage (Mufdlilah, 2009).
Complaints experienced by the mother as
appetite, sleep, micturition, defecation, pain
during pregnancy, bleeding, and so forth (Sofian,
2013).
consume tablets Fe, whereas iron tablets is
essential for fetal development. According to
investigators pregnant women do not like taking
tablets Fe because it will give the effect of
nausea. This is supported by the opinions
Mufdlilah (2009) who explains that giving vitamin
iron begins to give one tablet a day as soon as
possible after the nausea passes. Each tablet
contains FeSO4 mg (60 mg of iron) and 500ìg
folic acid, minimum 90 tablets each. Iron tablets
Obstetric Examination according Manuaba
should not drink tea or coffee together, because
disturbing the absorption, the husband / family
Indriyani cit (2013) consists of: gestational age,
fundal height (SFH), Fetal Heart Rate (FHR) for
pregnancies of more than twelve weeks,
should always be involved for the mother of
taking iron tablets to assure that the iron really
drunk.
measurements outside the pelvis. According
Hutahaean (2013), a pelvic examination in
Research Azizah & Nurhidayati (2012)
pregnant women especially primigravida
needed to assess the situation and shape of
pelvic disorders or whether there are
circumstances that can cause delivery
complications. As for the TT immunization are
still many who do not complete. Immunization
TT1 as many as 28 (93.3%), TT2 immunization
by 22 (73.3%), immunization TT3 13 (43.3%),
immunization TT4 only 5 (16.7%), and
immunization TT5 only 2 (6.7%). According to
the researchers this is due to maternal age
varied so that the majority of pregnant women
have done to TT2 immunization, and the
government also recommends minimum
pregnant women given TT2 minimum until
immunization. It is also supported by the
Indonesian Demographic Health Survey (2012)
Tetanus Toxoid immunization given during
conducted in health centers with sample
Yogyakarta is a three trimester pregnant women
explained that there is a relationship incidence
of anemia in pregnant women three trimesters
with the midwife’s role in giving iron tablet during
pregnancy examination. Midwives can be a
facilitator or liaison with relevant parties
regarding the provision of blood booster tablets,
but it can also be a motivator midwife for regular
checkups at the nearest health facility.
Other factors that can affect pregnant
women consume iron tablet is in support of her
husband. Based on research Novyta & Anjarwati
(2009) explains that there is a significant
relationship between the level of husband’s
support in consume iron tablet with anemia. That
is, the higher the possibility of husbands’
support, the lower the incidence of anemia.
pregnancy to protect the newborn from neonatal
26
The Description of Component Antenatal Care Examination in the 3rd Trimester Pregnant Women in
Public Health Center Wonosari I Gunung Kidul in Yogyakarta
Based on table 1 laboratory examination
done by 22 pregnant women (73.3%). According
Sofian (2013) maternal urine and blood should
be checked at least twice during pregnancy,
once at the beginning and once again when the
end of pregnancy. The first visit was also made
to the examination of blood hemoglobin
concentration, hematocrit, and white blood cell
count (Hutahaean, 2013).
Acknowledgement
We are very thankful to the sub district health
centre of Gunung Kidul, Wonosari for allowing us
to conduct this study. We are also indebted to the
village midwives of the Public Health Community
for helping us to collect the baseline data. Finally,
we would extend a special thanks to all the
respondents for their useful information and
While the last component of the ANC
cooperation. We hope this study will make a
positive impact on their lives in the future. This
including counseling as many as 24 (80%) of
pregnant women has been do. According to
work was supported by School of Nursing
Muhammadiyah University, Yogyakarta. We are
researchers, women who do not do counseling
can result from several factors, including the
also grateful to the College for its generous
financial support and scholarly guidance.
factors of health care providers / midwives.
Pregnant women want the service provider
References
concerned, giving clear information and
education related to pregnancy. When pregnant
women are not satisfied with the service
provided, it is likely they will visit a lot of other
health services. The pregnant woman wants to
receive care in systems that offers a clean,
friendly area for children, an efficient schedule,
and minimal waiting time (Walsh, 2008).
Other factors that can affect pregnant
women in ANC examination is the perception of
high risk pregnant women about pregnancy. The
better perception of high risk pregnant women
about pregnancy, then the chances are high for
pregnant women dutifully perform the greater
Antenatal Care (Listianingrum and Sugiyanto,
2008).
Conclusion
Based on the results of research and
discussion, it can be concluded that most of the
components of the ANC examination of pregnant
women in the region of the first health centers
Wonosari incomplete.
Azizah, N., Nurhidayati, E., (2012). Hubungan
Peran Bidan dalam Pemberian Tablet Fe
dan Penyuluhan Gizi dengan Kejadian
Anemia Ibu Hamil Trimester III. Jurnal
Kebidanan dan Keperawatan, Vol.8 No.1,
Juni 2012:34-40. Yogyakarta.
Badan Pusat Statistik. (2012). Survei Demografi
dan Kesehatan Indonesia. Access of 30
Oktober
2013.
Available
www.datastatistik-indonesia.com.
at:
Dinkes D.I. Yogyakarta (2013). Profil Kesehatan
Daerah Istimewa Yogyakarta. Yogyakarta.
Hutahaean, Serri. (2013). Perawatan Antenatal.
Jakarta: Salemba Medika.
Indriyani, D. (2013). Aplikasi Konsep dan Teori
Keperawatan Maternitas Postpartum
dengan Kematian Janin. Yogyakarta: ArRuzz Media.
Indriyani, D. (2013). Keperawatan Maternitas
Pada Area Perawatan
Yogyakarta: Graha Ilmu.
Antenatal.
Listianingrum & Sugiyanto (2008). Hubungan
Persepsi Ibu Hamil tentang ResikoTinggi
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Kehamilan dengan Kepatuhan Melakukan
Antenatal Care di Wilayah Puskesmas
Sanden Bantul. Jurnal Kebidanan dan
Keperawatan Vol 4. Nomor 2, Desember
2008 (hal. 109-118).
Mufdlilah. (2009). Antenatal Care Fokused.
Yogyakarta: Nuha Medika
Novyta, R. N., Anjarwati., (2009). Hubungan
Dukungan Suami tentang Konsumsi Tablet
Fe dengan Kejadian Anemia pada Ibu Hamil
Trimester III di Puskesmas Mergangsan
Yogyakarta. Jurnal Kebidanan dan
Keperawatan, Vol.5, No.2, Desember
2009:102-112. Yogyakarta.
Profil Dinas Kesehatan Kabupaten Gunung
Kidul
(2013).
Ibu.Yogyakarta.
Angka
Kematian
Saifuddin, A.B. (2006). Buku Acuan Nasional
Pelayanan Kesehatan Maternal dan
Neonatal. Jakarta : Yayasan Bina Pustaka
Sarwono Prawirohardjo.
SDKI.
2012.
Adult
and
Maternal
Mortality.Jakarta.
SDKI. 2012. Reproductive Health. Jakarta.
Siswosudarmo, R., & Emilia, O. (2008). Obstetri
Fisiologi. Yogyakarta: Pustaka Cendikia,
2008.
Sofian, A. (2013). Rustam Mochtar Sinopsis
Obstetri. Jakarta: EGC.
Walsh, L.V.(2008). Buku Ajar Kebidanan
Komunitas. Jakarta:EGC.
28
THE INFLUENCE OF PSYCHOEDUCATION TOWARD FAMILY’S CARING
ABILITY AND SCHIZOPHRENIA PATIENT’S INDEPENDENCE LEVEL IN
PONTIANAK
Dewin Safitri1, Wahyu Kirana2, Sarwito Rachmad Barmawi3
Program Sudi S1 Keperawatan STIKes Yarsi Pontianak, Indonesia
E-mail: dewin_safitri@yahoo.com
ABSTRACT
Introduction: Schizofrenia is a syndrome with various causes. Family as the main
nurse of patient needs some treatments to improve their knowledge and ability in
caring for the patient. Psychoeducation is the education delivering for the family to
improve their understanding and ability in caring for their family members who have
mental illness (schizophrenia). Patients who get support and good response will have
motivation to get their independence. The aim of this research is to find out the
influence of psychoeducation toward family’s caring ability and schizophrenia patient’s
independence level.
Method: The type of the research used is quasi experiment with pre and post test
without control group. The sample consists of 30 respondents that determined by
using purposive sampling technique. The data was collected by using questioner
and observation sheets, and analyzed by the marginal homogeneity test.
Result: The research finding showed that there is a significant influence in family’s
caring ability before and after psychoeducation treated, cognitive ability (p=0.002),
affective ability (p=0.033), psychomotor ability (p=0.012), and there is a significant
influence of schizophrenia patient’s independence level before and after
psychoeducation treated, observed by researcher (p=0.020), observed by family
(p=0.005).
Conclusion: Based on the research, it can be concluded that psychoeducation is
effective to improve family’s caring ability and schizophrenia patient’s independence
level.
Keywords: Family psychoeducation, schizophrenia, caring ability, indepenence level.
29
Introduction
caregivers of client require treatment to improve
The inability of a person to overcome
sources of stress can lead to mental emotional
disorder that often leads to the occurrence of
mental disorders. One of the types of severe
mental disorder is schizophrenia. Schizophrenia
is a group of psychotic reactions that affect the
various functions of the individual, including the
functions of thinking and communication,
receive and interpret reality, to feel and show
emotions, and behave irrationally. Until now the
treatment of patients with schizophrenia has not
been satisfactory, this is especially true
indeveloping countries, due to families and
communities ignorancy against these types of
mental disorders (Stuart & Laraia, 2005).
their knowledge and skills in caring client
(Gunadarsa, 2004).
In addition to medical treatment, the client
is also need others aid that encourage and
motivate him/her to be independent. So,
acceptance and social support from the family
are very needed. Psychoeducation therapy is
intended so that schizophrenia patients can
adapting to their surrounding social environment
and can caring for thier self independently and
also not become the burden for the family and
society (Mohr, 2006).
Family psychoeducation terapy is one form
Mental disorders including schizophrenia be
come a serious problem. At this time the number
of family therapy mental health care by providing
information and education through therapeutic
of patients with schizophrenia have increased.
Data from the WHO, in 2011 3/1000
communication. Psychoeducation program is an
approach that is both educational and
schizophrenia affects the adult population and
in 2012 increased to 7/1000 of the adult
population, especially the 15-35 year age
pragmatic. Based on research, family
psychoeducation proven effective for family with
grouped. The prevalence of schizophrenia in
Indonesiais 0.3 to 1% and usually occurs at the
age of 18 to 45 years but there is also 11 to 12year-old has been suffering from schizophrenia.
Data from the number of outpatient visits were
obtained from the results of preliminary studies
in the Rumah Sakit Jiwa Daerah Sungai
Bangkong Pontianak City in 2013 also
increased. In September there are 794 visits,
825 visits in October, 841 visits in November
and 853 visits in Desember (Arif, 2006).
Schizophrenia not only cause suffering for
the individual, but also for people who are
nearby. Usually the family is most affected by
the presence of schizophrenia in their families.
Family is very important factor in the healing
process of clients who get mental illness,
including schizophrenia. Family conditions that
theraputic and support client are very helpful for
the client’s healing. Family as the primary
30
social isolation client, family with drug client and
family with depression client. Referring to this,
the authors focus on family psychoeducation
conducted with clients schizophrenia. The
author expects that by family psychoeducation
that treat in familiy with clients schizophrenia,
the family’s caring ability for schizophrenia client
can be increased and also can increase the
independence of schizophrenia client (Carson,
2000 in Stuart & Laraia, 2005).
Methods
The type of the research used is quasi
experiment with pre and post test without control
group. The sample consists of 30 respondents
that have fulfilled the inclusion and exclusion
criteria and it is determined by using purposive
sampling technique. The data was collected by
using questioner and observation sheets, then
the data was analyzed with the marginal
homogeneity test.
The Influence of Psychoeducation toward Family’s Caring Ability and Schizophrenia Patient’s Independence
Level in Pontianak
Result
much as 20% and after psychoeducation
The research finding showed that there is
a significant influence in family’s caring ability
before and after psychoeducation treated,
cognitive ability (p=0.002), affective ability
(p=0.033), psychomotor ability (p=0.012), and
there is a significant influence of schizophrenia
patient’s independence level before and after
increased to 40%, 36.7% families have
considerable ability before and after
psychoeducation, psychoeducation increased to
43.3% while families have less ability prior to
psychoeducation is as much as 43.3% and after
psychoeducation decreased to 16.7%.
Psychomotor ability enhancement is
psychoeducation treated, observed by
researcher (p=0.020), observed by family
probably related to learning theory that explains
people learn not only from direct experience but
(p=0.005).
from imitation, and modeling. In accordance with
the statement from Notoatmodjo(2007) that the
Discussion
Family psychoeducation therapy can
improve cognitive abilities because it contains
elements to increase family knowledge about
the disease, teach techniques that can help
families to know the symptoms of deviant
behavior, and also increased support for the
family members themselves. The purpose of this
educational program are to improve the
achievement of family knowledge about the
disease, teach families how teaching techniques
to help their families in an effort to protect his
family by knowing the symptoms of behavioral
behavioris the result of cognitive factors and the
environment, it is meaning that a person is able
to have certain skills when there is a positive
braids and stimulation that observed and the
characteristics of a person.
At the independence level of schizophrenic
patients, the results showed before
psychoeducation, patients independent on the
total care level was 56.7% and after
psychoeducation decreased to 33.3%, patients
independent on the partial care level before
psychoeducation was 23.3% and after
and supportive family strength.
psychoeducation increased to 40.0%, while the
patients independent on self care level before
The affective ability is an learning outcomes
that related to attitudes and values of a
psychoeducation was 20.0% and after
psychoeducation increased to 26.7%. This
person.This ability is interrelated with the
knowledge and psychomotor achievement of
shows that berfore psychoeducation, clients has
been unable to achieve their independence,
learning goals. Affective ability emphasis on
attitudes, feelings, emotions and moral
while after psychoeducation, clients are able to
achieve their independence including physical
characteristics that required in social life. In this
research, most of the families have sufficient
careand daily activities.
affectiveabilities. This shows that the family
already has a consciousness to accept the
conditions ofhis family members who suffer from
schizophrenia and has a willingness to care the
Although there was an in crease after the
intervention in this research, but the average is
still on moderate independence. It can be
caused due to necessary acculturation longer
to change the behavior and needed consistency
assistance to clients and families in order to have
family member.
In psychomotor ability, families have good
good behavior can persist and increase.
ability to care berofe psychoeducation is as
|
|
31
Conclusion
Based on this research, psychoeducation
Notoatmodjo, Soekidjo. (2007). Promosi
Kesehatan dan Ilmu Perilaku. Jakarta : PT
Rineka Cipta
influenced family’s caring ability including
cognitive ability, affective ability, psychomotor
Stuart, G. W., & Laraia M. (2005). Principles and
ability and also influenced the independence of
schizophrenia patients.
Practice of Psychiatric Nursing, (8th ed.). St.
Louis : Mosby
Acknowledgement
I would like to express my deepest
appreciation to all those who provided me the
possibility to complete this research. A special
gratitude I give to my family for all of their
support. Furthermore I would also like to
acknowledge with much appreciation to the chief
of STIKES YARSI and also my supervisor
Ns.Wahyu Kirana.,M.Kep,Sp.Jiwa, who gave me
so many advises. Her enthusiasm,
encouragement, and faith in me throughout have
been extremely helpful. She was avalaible for
my questions and she was positive and gave
generously of her time and vast knowledge. She
always knew where to look for the answer to
obtacles while leading me to the right source,
theory and perspective.
Sudaryono. (2012). Dasar-dasar Evaluasi
Pembelajaran. Yogyakarta : Graha Ilmu
References
Arif, Iman Setiadi. (2006). Skizofrenia
memahami dinamika keluarga pasien.
Bandung : Refika Aditama.
Gunarsa, Singgih. (2004). Dari anak sampai
usia lanjut. Jakarta : EGC
Hawari, D. (2001). Pendekatan holistik pada
gangguan jiwa skizofrenia. Jakarta : EGC
Keliat, Budi Anna. (2010). Manajemen
keperawatan jiwa komunitas desa siaga/
CMHN (intermediate course). Jakarta : EGC
Mohr, W. K. (2006). Psychiatric mental health
nursing (6th ed). Philadelphia : Lippincott
William & Wilkins.
32
PERCEPTION DIFFERENCES BETWEEN NURSE AND ACUTE CORONARY
SYNDROME PATIENT TOWARD SPIRITUAL NEEDS IN CARDIAC INTENSIVE CARE
UNIT AT HASAN SADIKIN HOSPITAL
Hana Ariyani, Suryani, Aan Nuraeni
Universitas Padjadjaran Bandung
E-mail: hanaariyani@yahoo.co.id, ynsuryani@yahoo.com, an_1612@yahoo.com
ABSTRACT
Introduction: This research is motivated by the high incidence of Acute Coronary Syndrome
(ACS) disease. The patient with ACS experience some psychological and spiritual beside
physical problem. Nurses have an important role to meet the spiritual needs of the patient to
enable them reach the Spiritual Well Being (SWB). If SWB is not achieved then the physical,
psychological and social aspect of patient can not function optimally. One of the factors that
influence the spiritual needs fulfillment is perception.
Method: This research examined the comparison of ACS spiritual needs perception between
nurse and patient in Cardiac Intensive Care Unit of Dr Hasan Sadikin Hospital. The perception
of ACS spiritual needs was assessed by spiritual needs perception questionnaire. Participants
of this research were 19 nurses and 26 patients using total sampling method for nurse
population and concecutive sampling for patient population. Data analysis used independent
sample t test.
Result: The result showed that nurse’s total score mean was 85,4 with deviation standard
was 13,1 and patient’s total score mean was 88,2 with deviation standard 13,5. T test analysis
0,666 and p value 0,509. It showed that there’s no differences ACS spiritual needs perception
between nurse and patient in Cardiac Intensive Care Unit of Dr Hasan Sadikin Hospital.
Keywords: Acute Coronary Syndrome, Nurse, Patient, Perception, Spiritual Needs.
Introduction
In Indonesia, the sum of deaths from noncommunicable diseases was 1.064 million
Cardiovascular disease is a noncommunicable disease that can cause
people. From these figures, the cause of death
was dominated by cardiovascular disease (30
significant mortality. According to the data from
the World Health Organization (WHO) in 2008
%) (WHO , 2011). According to the number of
heart patients hospitalized in 2007 from
36 million of the 57 million deaths that occur in
this world are caused by non-communicable
Direktorat Jendral Pelayanan Medik data in
2008 showed that Acute Coronary Syndrome
diseases, at first rank , heart disease , and then
stroke and diabetes later.
(ACS) is a disease in a great number, there were
33
67,800 outpatients and 22,454 inpatient
(Depkes, 2009). At Doctor Hasan Sadikin
Hospital (RSHS) Bandung which is the highest
referral hospital in West Java was also noted
that the case of the SKA as the most dominant
cardiac disorder. It can be seen from a record
number of patients treated in Cardiac Intensive
Care Unit (CICU) from January to November
2013 which showed that the total number of ACS
was 53.5 % or 282 cases from the total number
of cardiac disorder. The ACS type based on the
most as follows: Coronary Artery Diseases ST
Elevation Miocardial Infarct (STEMI CAD) as
many as 219 people, Coronary Artery Disease
Non- ST Elevation Miocardial Infarct (CAD
NonSTEMI) as many as 44 people and Unstable
Angina Pectoris (UAP) as many as 19 people .
SKA
begins
with
the
rupture
of
atherosclerotic plaque in the coronary arteries,
which stimulates platelet aggregation and
thrombus formation that will inhibit the coronary
arteries which provide the heart muscle
perfusion (Overbaugh, 2009) . At the time of
severely blocked coronary artery, the patient
usually feels the pressure in the chest area
accompanied by chest pain, shortness of breath
and fatigue (Arora et al., 2010). According to
opinion from Kanel et al. (2011) on the acute
conditions patients would experience anxiety
because of the fear of death and sense of
helplessness. In the opinion of Timmins and
Kelly (2008) that patients with cardiac disorder
will experience the hospitalization so that they
will experience a new and unfamiliar
environment, in this situation it will lead to
isolation feeling and alienation form daily life. In
these circumstances the patient will experience
spiritual distress ( Carpenito - Moyet, 2006) .
One of the ways to overcome this problem
is by providing spiritual care in the spiritual
beliefs of patients (Smeltzer et al . , 2010). In
fact from the preliminary study that spiritual care
was not actually given in the CICU because
nurses were more focused on the patient’s
physiological problems. This is in accordance
with the opinion of Edwards et al. (2010) that
one of the factors that impede the fulfillment of
spiritual needs is the limited time, cultural
differences and beliefs, and the lack of special
education about spiritual care .
Spiritual care is benefit to the patient
because it can reduce the ACS patient’s
psychological problems such as depression and
anxiety and improve patient ‘s ability to cope
with both of them (El Noor, 2012). In practice,
spiritual care has not actually given to the
patient, because the nurse thought that spiritual
care is only limited in helping patients in worship
activities, involving family and religious leaders,
as well as giving spirit (Romadona , 2012) . The
nurse’s perception was difference with the
patient’s perception. Patient’s perception of the
spiritual needs broader than just maintain a
relationship with God and fellow human beings.
In Nuraeni study (2012) which explores the
meaning of spirituality produce several themes:
accept the disease as a reprimand or trials; life
become more better; resignation to God;
worship or communication with God; hope;
request for forgiveness; gratitude; attention, love
and affection from others and the success of
the family; provide benefits for others; and hobby
or activity in nature. This research is supported
by the opinion from Galek et al. (2005) that the
spiritual needs of patients who experienced a
hospitalization were consists of multiple
dimensions, namely: Love/belonging/respect;
Divine; Positivity/gratitude/hope/peace;
meaning and purpose; morality and ethics;
appreciation of beauty; resolution / death.
support form which appropriate to the needs and
34
Perception Differences between Nurse and Acute Coronary Syndrome Patient toward Spiritual Needs in
Cardiac Intensive Care Unit at Hasan Sadikin Hospital
needs so that nurses can meet the spiritual
According to the differences in perception
above, the researcher found that it is necessary
needs of patients in accordance with patient’s
expectations .
to examine the perceptions of nurses and ACS
patients toward the spiritual needs in CICU.
Methods
According to Pareek (1996) this perception is
very important to study because the end result
In this study, the entire population of the
nurses who have been working in the CICU
of a perception process is an action in the form
of behavior (in Sobur, 2003). So the researchers
Doctor Hasan Sadikin Hospital Bandung totaly
19 people, and all ACS patients were treated in
assume that by examining differences in nurses
and ACS patients perceptions towards the
the CICU Doctor Hasan Sadikin Hospital
Bandung, as many as 27 people. The sample
spiritual needs, it will be known what is needed
by the patient but not yet filled by the nurses.
group of nurses in this study were taken using
a total sampling method that was 19 people.
The results of this study may provide information
to nurses about the things that are needed by
ACS patient sample group in this study were
taken using a non probability sampling method
the patient in meeting the patient’s spiritual
that is concecutive sampling. In this sampling
method, the respondents of the study were who
meet the inclusion krieria during the period JuneJuly 2014 that as many as 26 people.
Results
Tabel 1. The frequency distribution of respondents in the CICU Doctor Hasan Sadikin Hospital
Bandung based on religious background, ethnicity and age.
No
1
2
3
Characteristic
Religion
Islam
Kristen
Ethnicity
Sundanese
Batak
Javanese
Age
18-40
40-60
>60
Nurse (n=19)
Sum
Percentage
Patient (n=26)
Sum
Percentage
17
2
89%
11%
26
0
100%
0%
16
2
1
84%
11%
5%
26
0
0
100%
0%
0%
15
4
0
79%
21%
0%
1
17
8
4%
65%
31%
Tabel 2. Perception’s Differences of nurses and ACS patients toward the spiritual needs in the
CICU Doctor Hasan Sadikin Hospital Bandung 2014.
Nurse
Mean
85,4
Patient
SD
13,1
Mean
88,2
SD
13,5
t
0,666
|
p value
0,509
|
35
Discussion
Based on the table 2 above, we see the
perception’s differences between nurses and
ACS patients toward spiritual needs with p value
of 0.509. The p value greater than 0.05, then
Ha is rejected, so it can be concluded that
generally there is no difference between nurse
and ACS patient’s perceptions toward the
spiritual needs in CICU Doctor Hasan Sadikin
Hospital Bandung. This is consistent with the
results of comparative research on the
perception of the spiritual needs conducted by
Emblen and Lois (1993) using qualitative
research methods to the nurse, patient and
religious leaders. The results showed some
several themes namely: religion, values ,
relationships, transcendental, affective feelings,
and communication .
The common perception seems to be
influenced by culture. In table 1 shows that
almost all respondents both nurses and patients
coming from the Sundanese, only 3 nurses who
comes from the Javanese and Batak. In
Sundanese culture, religiosity was very
important because it is an identity a Sundanese
people (Rahmawati, 2012). The results of this
study are not accordance with the opinion of
Cancer Research United Kingdom (2014) that
one of the factors that affect the spiritual needs
nurses seem not all provide spiritual care to
patients. The nurse looks more priority treatment
to the patient’s physical problems, such as giving
medications, feeding, observe vital signs, and
so on. Results of interviews with patients as well
as that two of the three patients stated that
nurses have not fully provide spiritual care.
Nurses sometimes remind the time of prayer,
facilitating patient to worship, bring the family,
but rarely to spend time with a patient to pray
together, to invite discussion about life after
death, help the patient explore feelings about
the meaning of life and so on.
The difference between the results of the
research with the assumptions of previous
studies probably influenced by other factors. At
first the researchers refer to the opinion of Sobur
(2003) and Purnawati (2010) that perception is
influenced by the behavior. Unlike the case with
the results of this study, it seems that the factors
influencing the behavior of spiritual needs of
patients by nurses is not influenced by
perception, because the results showed no
difference in perception between nurses and
ACS patients toward spiritual needs. According
to the analysis the researchers, there seems to
be another factor that can affect the ACS
patient’s unfulfilled spiritual needs.
In Green (1980) stated that not only
was culture, in this research shows that there
is no perception differences although there is a
perception that affect the person’s behavior, but
other factors are also as a contributing factors.
variety in ethnicity, maybe due to an imbalance
number of samples from each ethnicity.
According to the researcher analysis, in this
case nurses perceptions are good, but there is
The results of this study are not in
no supporting factors in the work environment,
where nurses are required to work extra. This
accordance with the initial assumption of
researchers in stating that there is a difference
in perception between nurses and ACS patients
toward spiritual needs. This assumption is
based on observations from the room for one
week and interviews of three patients. The
results of previous observations showed that
36
is in accordance with the opinion of Robbins and
Judge (2008) that one of the factors that
influence a person’s behavior is the work
situation. Average nursing services in a shift of
about 3-4 people capacity when the number of
patients able to achieve 8 people with average
using the ventilator in each of his shift 2.
According to Gillies (1986) ideally the ratio
between nurses and patients in the intensive
care 1:1 if using a ventilator, and 1:2 if without
using of a ventilator. According to researchers
analysis it is the factor that affects the behavior
of the patient’s spiritual needs fullfilment.
dominant stimulus is received by individual. In
patient respondents, the dominant stimulus
becomes concerned was that their illness, while
nurses in healthy physical condition, so that
patients have the perception that the “respectful
care of bodily needs “ is needed .
Other data that may support why this item
Opinions of Robins and Judge (2008) and
Green (1980) above is reinforced by the results
is needed by the patient is of length of stay. Most
patients were in treatment period of 1-3 days ,
of research Tzu Lee et al . (2014) and Edwadrs
et al . (2010) that the work environment or
which is an acute-phase period . In this phase
the patient is still in a state of helpless and need
situation and time constraints become an
obstacle for nurses in meeting the spiritual
assistance to meet their physical needs. This is
consistent with the illness behavior theory that
needs of the patient. Not only the work situation
and time, according to Tzu Lee et al. (2013) and
one person’s reaction to the ill condition is
inability to perform the self-care independently.
Edwars et al. (2010) there is one other factor
that inhibits the provision of spiritual care, it was
If left unchecked, then the patient will feel
hopeless and helpless, so that the sick person’s
education continuing education that is specific
to the field of spiritual care to patients. According
condition are expecting their physical needs are
met in a good way (Young , 2004).
to the nurse, from all nurses who served in the
CICU room, only one person trained become
The next item that shows the difference is
“to give and receive love”. It was very important
during hospital visits . According to Strain (1979)
warois.
Among the results of the analysis showed
generally no differences in perception between
nurses and ACS patients toward spiritual needs,
there are two items that showed statistically
difference, the item were”For respectful care of
your bodily needs” and the item “Give or receive
love”. Both of these items are on the dimensions
of “ Love/belonging/respect “. If seen from the
mean, it appears that the mean value of the
patient is much higher than the mean value of
nurses. This indicates that the second item is
much needed by patients compared with nurses.
According to the researchers analysis this
is most likely due to the perception of the
respondents are influenced by attention.
According Hugenberg and Bodenhausen (2009)
that perception is influenced also by the
attention. “Attention” is attention to the a
that one of the sick person’s response is fear of
losing the love from the people around them.
Under these conditions it is important for nurses
to meet the needs of “love and belonging” for
the patient being treated. The form of
intervention that can be done by nurses to meet
the item “give or receive love” which is as
follows: to establish a good relationship with the
patient, empathy, present at the time and the
patient needs to understand the feelings/patient
complaints such as pain, anxiety and so on (
Emakpor and Nyback , 2010).
Conclusion
Based on the research that has been done
by using descriptive comparative study of two
groups: nurses and patients, which amounted
to 19 people and 26 people, it can be concluded
that in general there is no difference in
|
|
37
perception between nurses and ACS patients
toward spiritual needs in CICU Doctor Hasan
Departemen Kesehatan. (2009). Profil
kesehatan Indonesia 2008. Jakarta:
Sadikin Hospital Bandung. However, there are
two items on the dimensions of “Love/belonging/
Departemen Kesehatan Republik
Indonesia. Retrieved 24 Maret 2014, from
respect” that shows the difference. Both of the
item are the “respectful care of your bodily
http://www.litbang.depkes.go.id/sites/
download/profil/profil_kesind/
needs” and “to give/receive love”
Profil_Kesehatan_Indonesia_2008.pdf
According to the assumptions of
researchers, this common perception occurs
because most of the background of the two
groups respondents ws same, which is derived
from the same ethnic and religious groups.
However, there is little difference in the
perception of the dimension of “Love/belonging/
respect” because it can be affected by factors
of concern/attention. According to the perception
of the patient, both of these items is more
needed than what is perceived by nurses. This
happens because the patient has a physical
disorder, whereas nurses do not experience it.
In such conditions, patients are usually more
focused on themself and tend to demands their
physical needs met by others in a good way and
need more attention and affection people that
they love.
Acknowledgements
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10.1111/ j.1467- 566.2004.00376.x/full
40
THE INFLUENCE OF FAMILY SUPPORT ON HIV PATIENTS’ COMPLIANCE TO TAKE
THERAPY PROGRAM IN VCT CLINIC KEBUMEN STATE HOSPITAL
Herniyatun, Dita Try Ubaya Sakti, Sarwono
Bachelor of Nursing Study Program Muhammadiyah Health Science Institute of Gombong
E-mail: herni_yatun76@yahoo.com
ABSTRACT
Introduction: Anti Retroviral therapy is a kind of therapy given to HIV patients by taking the
medicine for whole lifespan. Data taken in VCT Clinic of Kebumen State Hospital show that
the number of HIV patients who have ever had therapy were 128 persons. 57 of them show
COMPLIANCE to take therapy and the rest were not obedient. High COMPLIANCE is not
only for a day, but for lifetime. COMPLIANCE can be gained from the closest persons like
family. to find out the influence of family support on HIV patients’ compliance to take therapy
program in VCT Clinic, Kebumen State Hospital.
Method: the method of this research is cross sectional study. The samples consist of 50
HIV patients. Data analyses of this research are frequency distribution, Chi-square statistic
for bivariate analysis, and logistic regression for multivariate one.
Results: there are significant influence of the following supports on HIV patient compliance
to take therapy program: information (p=0.001), consideration (p=0.000), instrumental (p =
0.001), and emotional (p = 0.000). The emotional support is the dominant variable influencing
HIV patients’ compliance to take therapy program with exp B value 16,032. Therefore, much
more better emotional family support is needed to increase HIV patients’ compliance to take
therapy program.
Keywords: family support, compliance, ARV therapy.
Introduction
(ARV). The drug does not kill the HIV virus, but
it can slow down the growth of the virus. Time
slow the growth of the virus, as well as HIV
HIV is a health problem that threatens
Indonesia and many countries around the world.
Currently no country is free from HIV problem
disease (NAM, 2012).
(Zein, 2006). Treatment programs, Voluntary
Counseling and Testing (VCT) through the
In HIV-positive, individuals with immune
systems will decline and it takes several years
provision of antiretroviral therapy or called ARV,
means treating HIV infection with multiple drugs.
until the discovery of the symptoms of advanced
stage and then the patients is diagnosed as
Because HIV is a retrovirus, these drugs are
commonly referred to as an antiretroviral drug
AIDS patients. It depends on the physical and
41
psychological condition. When someone has
been infected as HIV patient, he/she will show
changes in the character of life, psychosocial
stress, depression, feeling a lack of social
support, and behavioral changes. HIV patients
face their own conditions without the support of
friends and family which then will give impact of
anxiety, depression, guilt and suicidal thoughts
or behavior. It not only affects the patient, but
Results
The results of the family support are: in the
informational support category, 46.0% of the
respondents have good category, 22% of the
respondents have fair category, 32% of the
respondents have less category. In the support
assessment category, 66.0% of the respondents
have good category, 12% of the respondents
also can affect the family or the closest people.
have fair category, and 22% of he respondents
have less category. In the instrumental category,
High compliance is not a one day issue,
but it is for a lifetime. Therefore, it is necessary
58.0% of the respondents have good category,
20% have good category, 22% have less
for HIV patients to have support and
encouragement, even though the patients have
category. In the emotional support, 68.0% of the
respondents have good category, 8% of the
been very obedient for many years. Support can
be obtained from the nearest parties like family.
respondents have fair category, 24% have less
category. Based on this table, it can be seen
In some cases, it takes time for the family to
process information about the HIV status of
that 39 respondents (78.0%) categorized as
compliant in undergoing treatment and 11
family members and adjust to the changes that
occur in HIV patients. Family support is defined
by Gottlieb (1983) in Zainudin (2002) as verbal
respondents (22.0%) categorized as noncompliant in undergoing treatment.
information, objectives, tangible assistance or
behavior given by people who are familiar with
the subject in the social environment and the
presence or in the form of things that can provide
emotional benefits or influence on the
acceptance behavior.
Methods
This study used a cross-sectional study
design, which aims to examine the correlation
between the dependent variable with the
independent variables at the same time or time
point approach. Several variables at the same
time (Notoadmodjo, 2010). The populations
consist of 128 HIV patients undergoing
treatment in VCT clinic Kebumen Hospital. The
The results indicate that there is influence
of informational support to HIV patients
compliance in undergoing treatment (p = 0.001),
support for an assessment to the HIV patients
instrumental support to the HIV patients
and emotional support to HIV patients
compliance in undergoing treatment (p = 0.000).
Emotional support is the most influential factor
to HIV patients compliance in undergoing
treatment with a B value of emotional support
exp 16,032 (fixed to 16), which means that it is
expected to provide more family emotional
support to increase HIV patients compliance in
undergoing treatment
samples consist of 50 respondents taken by
using purposive sampling technique. The
samples can represent the characteristics of the
population (Nursalam, 2003).
42
The Influence of Family Support on Hiv Patients’ Compliance to Take Therapy Program in VCT Clinic
Kebumen State Hospital
Discussion
Family Informational support influences the
HIV patients’ compliance in undergoing
treatment. The families can help in terms of
providing advice, information and advice that
can be used to reveal problems. This
informational support may suppress the
emergence of a stressor because the provided
information can give peace as HIV patients
become more understanding about the disease.
This will lead to awareness for the HIV patients
to always take medicine regularly.
Some studies show that compliance has
declined, even in people who are very obedient.
This phenomenon is called saturation or
saturation pill therapy. HIV patients feel tired and
useless to take medication because the drug
does not provide a cure for them so that they
have the feeling of depression, suicidal, and a
sense of surrender. In this case the family
emotional support is needed more so that
patients will not experience saturation in taking
medication. High compliance is not a one day
issue, but it is for a lifetime. Therefore, it is
If there is no special attention or positive
necessary for HIV patients to have support and
encouragement, even though the patients have
rewards to someone with HIV, the selfconfidence and self-esteem will be disrupted.
been very obedient for many years. Compliance
can be very difficult and would require support
Patients will withdraw themselves from the
environment so that it will interfere with social
to HIV patients become accustomed to the
changes caused in his life.
function. This will affect HIV patients when taking
medication since they feel worthless or vain to
Conclusion
take medication in the absence of a positive
appreciation of his family.
There is influence of informational support
to HIV patients compliance in undergoing
Family plays a major role in the instrumental
treatment (p = 0.001), support for an
assessment to the HIV patients compliance in
support. The support is provided directly by
facilitating by providing what patients’ need, such
as transportation, or delivering the patient when
to go for treatment. This can be seen from how
the families know the health status of the
patients and their willingness to provide support
in a program of treatment, as evidenced by the
presence of the family who would deliver or
accompany treatment to the VCT. With the
support of this instrument, HIV patients become
easier with no obstacles in undergoing the
treatment, taking the drug regularly with no
delay. Emotional support to do the family can
be attention received from him, in which HIV
can issue complaints about perceived disease
during their treatment program.
undergoing treatment (p = 0.000), instrumental
support to the HIV patients compliance in
undergoing treatment (p = 0.001), and emotional
support to HIV patients compliance in
undergoing treatment (p = 0.000). Emotional
support is the most influential factor to HIV
patients compliance in undergoing treatment
with a B value of emotional support exp 16,032
(fixed to 16), which means that it is expected to
provide more family emotional support to
increase HIV patients compliance in undergoing
treatment
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45
THE EFFECTIVENESS OF ASSERTIVENESS TRAINING THERAPY TO THE
ASSERTIVE COMMUNICATION SKILL OF THE NURSING PRACTICE STUDENTS TO
THE INPATIENTS NURSES
Ike Mardiati Agustin¹, Novy Helena CD², Ice Yulia Wardani³
¹ STIKES Muhammadiyah Gombong
E-mail: ikeagustin83@gmail.com
ABSTRACT
Introduction: Students of nursing clinical practice is part of a professional nurse who is
required to communicate well, effectively and assertively both when they are in the room
and when they are talking to clients or patients.
Method: The goal of this research is to gain an overview of the influence of Assertiveness
training (AT) therapy to the assertive communication skills for nursing clinical practice students
to the nurses in inpatient ward. The samples consist of 60 respondents with 30 respondents
in intervention group and 30 respondents in control group.
Results: The results show that students with assertive communication skills increased the
AT significantly by 2.27 (4,54%) with a p value <0.05. This therapy is recommended in a
therapy to increase assertive communications for nursing clinical practice students.
Keywords: students practice, assertive communication skills, assertiveness training therapy.
Introduction
and develop. Therefore, a nurse on demand and
Humans are social creatures that need
is able to improve his knowledge about the
dynamics of communication, appreciation of the
interaction with others. In human interaction
requires communication. Nurses are social
advantages and disadvantages of self and
sensitivity to the needs of others (Hamid, 2000).
beings who always interact with others that the
patient or the health professions fellow peers.
Research conducted by Begley and
Glacken (2004) on assertive communication
skills of students, stating that the average
student has the ability not assertive, they tend
to be passive and aggressive in communicating
that causes low levels of student assertiveness,
in this study said that after a workout assertive
communication ability of students to be more
assertive at the end of the study period.
Good communication and effective nurse can
facilitate the achievement of the quality of
nursing services that can meet the patient or
customer satisfaction (Supratman, 2009).
Professional nurses always tried to behave
therapeutic, meaning that every interaction that
made an impact therapy allows clients to grow
47
Based on the above explanation, we need
a technique or attitude in communicating that
could predispose a person is able to
communicate what they want, feeling and
thinking to others, through assertiveness that
can be trained through assertiveness training
therapy (Nursalim,2005).
Research conducted Daulima and
Mustikasari (2002) states that students practice
experience mild anxiety level. Anxiety that may
lead a person to behave aggressively is to give
a response before the other person stops
talking, speak with a loud tone, or a passive one
that is in doubt, speak softly, giving approval
regardless of his own feelings (Nursalim,2005).
Assertive is defined as the ability to be able
to express emotions, maintain and defend the
truth of interaction with others in an honest,
responsible and free from anxiety (Willis and
Daisley, 1995). Efforts to improve the ability of
a person to be more assertive communication
can be done through training assertiveness
therapy. Assertive communication is the
communication that drives a person to develop
optimally, both physically and psychologically,
it contains a message that is clear, positive,
open, trustworthy and non-judgmental
(Ramadhani, 2008).
This study will be conducted in hospitals
Kebumen which is owned by the Government
General Hospital, as the hospital type C plus
with vision as a health referral center and
community pride Kebumen, in line with the vision
of the district general hospital Kebumen is used
as one of the practitioner land for students, both
students of nursing, midwifery and medicine.
Data known to students of nursing practice using
Kebumen District Hospital as a practice within
the last three months between January to March
2014 totaled 100 students who come from a
48
variety of practice nursing education institutions
(hospitals TRAINING Kab.Kebumen, 2014).
Based on the preliminary study results of
observations on 10 students undertaking clinical
practice of nursing in the hospital using the
observation sheet assertiveness therapy training
modules obtained 55% of students passive in
communicating that students tend not to dare
to ask, anxious and afraid to express their needs
and desires when practices, 30 % which is less
likely to communicate politely aggressive in
communicating demonstrate behaviors that
challenge, talk slowly and loudly, blaming a
friend practice when asked, and only 15% are
able to communicate assertively with a relaxed
attitude, willing to listen to other people talk. The
results of the discussion will be undertaken in
10 nurses in the inpatient nurse in the room to
get the data that students who tend to complain
of passive communication so as to make room
nurse confused about how to facilitate targets
Student competence.
The results of the observations and
discussions show that it takes a form of activity
that can improve the communication skills of
students one of them through communication
training. Training can be given through
assertiveness training so that one can learn to
communicate all needs oneself or someone else
with better. Therefore the author was interested
to conduct a research on how the influence of
assertiveness training on assertive
communication skills of nursing students clinical
practice.
Methods
This study used a quasi-intervention
method (Quasi-experimental) with pre-post test
design with control group assertiveness training
with therapeutic intervention. This study
measures the ability of assertive communication
The Effectiveness of Assertiveness Training Therapy to the Assertive Communication Skill of the Nursing
Practice Students to the Inpatients Nurses
student nursing clinical practice before and after
people (55%). The results of statistical tests, the
assertivenesstraining.
students showed gender equality with (p value>
0.05).
Respondents involved in this study a
number of 60 people, with 30 people as the
control group and 30 as the intervention group.
The sampling used was simple random
sampling that the sampling in such a way that
each unit of the base (people) have the same
opportunity to be taken as a sample (Polit &
Hungler, 2006).
Measuring equality characteristics in the
control group and the intervention used
Correlation test, equivalence test for assertive
communication skills using the paired-t test.
While the analysis of differences in assertive
communication skills before and after the
intervention using the Mann-Whitney U-test
because the data are numerical and not normally
distributed.
Results
Assertive communication skills of clinical
practice of nursing students in the intervention
group had a mean score of 35.83 (71.66%) with
a standard deviation of 5.547 and the value of
communication skills of students in the control
group had an average of 20.60 (41.2%) with
standard deviation value of 9.933. Statistical
analysis showed the assertive communication
skills of students is not equivalent or not
homogeneous (p value <0.05).
Based on the above table assertive
communication skills of students in the
intervention group after getting AT unknown
mean values were 38.1 (76.2%) this means
an increase in communications capability by an
Average student nursing clinical practice
average of 2.27 (4.54%). Assertive
communication skills of students in the control
20,03 years old with the youngest 19 years old
and the oldest 23 years of age. The test results
group after group intervention known to get AT
average rating of 21.2 (42.4%) this means an
showed that the age of the student equality
intervention and control groups are not
increase of 0.63 (1.26%).
equivalent to (p value <0.05).
Gender characteristics of students in both
groups were women amounts to at most 33
Statistical test results showed that there was
a therapeutic effect on the ability of AT assertive
communication where value (p value <0.05) in
both the intervention group and the control
group.
Tabel 1.1 Pengaruh AT terhadap Kemampuan Komunikasi Asertif Mahasiswa Sebelum dan
Sesudah Mendapatkan AT di Ruang Inap RSUD Kabupaten Kebumen Bulan Mei - Juni
2014 (n=60)
Kelompok
Intervensi
Kontrol
Mean
Mean
Sebelum Sesudah
35,80
38,10
20,60
21,20
Selisih
Mean
2,27
0,63
SD
Selisih
0,828
0,718
t
p value
15,000
4,829
0,001
0,001
Differences in assertive communication skills of students in both groups were performed using
Mann-Whitney analysis of U-Test. Tests have been selected because the data is numeric and the data
are not normally distributed, and consist of 2 groups. The results of the analysis can be seen in table 1.2
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|
49
Tabel 1.2 Perbedaan Kemampuan Komunikasi Asertif pada Kelompok Intervensi setelah
Mendapatkan Terapi Assertivenes Training dan kemampuan komunikasi asertif pada
Kelompok Kontrol setelah Kelompok Intervensi mendapatkan AT (n=60)
Variable
Intervensi (post test)
Kontrol (post test)
n
Mean
SD
SE
t
p value
30
38,10
5,68
1,04
15,000
0,001
30
21,23
9,84
1,80
4,829
Based on Table 1.2 shows the ability of
that the female gender is the most includes 33
assertive communication between the group of
students who received assertiveness training
people (55%) compared to male sex. Explained
that women are able to feel and express
with the group who did not receive therapy
training assertivenes different from (p value
emotions and desires than boys, because more
men are taught to adapt to difficult situations
<0.05).
and stressful than using emotions and feelings
(Mubayidh, 2006). This can affect the admission
Discussion
Based on the results, that the average age
of 20.03 years students practice with the
youngest 19 and the oldest 23 years old, and
these results can be seen that the students
belonging to the developmental phase of young
adulthood. At this stage of development of an
individual young adult is able to perform an
intimate interaction with others (Keliat, et al,
2011). Age is a characteristic studied
communications relating to a person’s ability to
establish relationships with others because of
the age of a person closely related to the
experience of growing skills in dealing with
various kinds of stressors, the ability to utilize
sources of support and skills in coping
mechanisms (Goleman, 1998). The research
associated with increasing age also increase the
person’s maturity, psychological maturity
showed maturity, seen from the behavior of an
increasingly discerning, capable of rational
thinking, emotional control, and is considerate
of others (Nurjanah, 2008).
Another characteristic of this study were
gender, based on the survey results revealed
50
to a treatment for behavior change.
Assertive communication skills students in
the intervention group needs before getting
Assertiveness Training has an average score
of 35.83 average values show that the
communication ability of students still need to
be improved. After getting treatment increased
assertiveness training assertive communication
skills average or an increase of 38.10 (4.54%)
have increased three scores, This is consistent
with the results of the study Deltsidou, (2008)
who found that the level of assertiveness in the
semester students end slightly increased after
participating in learning about assertive behavior
is often also called assertive communication
skills.
Assertive communication skills essential
shared by all nurses and students as a qualified
health practitioner at all levels of health care
delivery. Many studies support the use of
assertive communication skills in the delivery
of clinical care. Although nurses assertive
behavior has been investigated in many
situations, the empirical evidence is still
inadequate with respect to frequency and use
assertive communication skills by nurses and
midwives in clinical care so that it will have an
impact on the study process of clinical practice
in the hospital on the student (Timmins &
McCabe , 2005).
benefits of what will be gained during the training
assertiveness therapy (Will & Daisley, 1995).
Assertive behavior should be encouraged
through learning methods. Student nurses
Assertive communication skills of students
should receive this training during the study,
therapists have an important role in the
in the control group before the intervention
therapy group assertiveness training average
improvement and achievement assertivenes
training curriculum for students (Deltsidou,
value of 20.60 indicates that the communication
ability of students is still below the average
2008). Results of research conducted by Begley
and Glacken (2004) states that students who
standard assessment scores. This group of
students communication skills at the end of the
are involved in activities assertiveness skills
training will be more effective than having the
measurement after the intervention AT
mandapatkan average to 21.2 (42.4%), this
communication skills to nursing students who
are not trained for the study.
means an increase of 0.63 (1.26%). Improved
communication skills that experienced by the
The results showed significant differences
control group of students who are not given the
AT is not too significant, but this may occur could
be caused by the possibility of students learn to
communicate assertively with the modeled room
nurses, peers and fellow students practice
(Shukri & Zulkarnain, 2008)
The results showed the therapeutic effect
of the training assertivenes assertive
communication skills of nursing students clinical
practice with p <0.05. Hypothesis which says
there is no treatment effect assertivenes training
on assertive communication skills of students
rejected. The big difference in the ability of
assertive communication between the student
before or after this intervention proves that this
approach, which assertivenes therapy training
to improve communication skills assertive
students have a different effect or influence
Assertive communication requires selfawareness of the student’s attitude for
communicating with clients, clinical instructor,
and the peer group. Without self-awareness, not
be followed by a change in attitude and behavior.
Aspects of attitude may change if there is a
cognitive understanding of the purpose and
in assertive communication skills therapy
students were given the AT with the control
group with p <0.05. Hypothesis which says there
are no significant differences in assertive
communication skills to students who get the
AT AT is not getting rejected. Group therapy
Assertiveness Training support students to
understand and respond to any emotional
response that is raised as a result of client unmet
client needs (Townsend, 2014). Assertiveness
training, self training students receive the
emotions themselves, accept client emotions,
thinking about how to respond to emotions with
active clients. Students will understand that in a
way that is aggressive or passive every time we
face a client complaint, will not have a positive
impact on the relationship nurses (student) with
client (Gotman & DeClaire, 2008).
Spread differential assertive communication
skills in the group receiving group therapy
training Assertiveness significantly higher than
the group who did not receive therapy group
assertiveness training. At the beginning of the
intervention, assertive communication skills
before therapy is not the same / heterogeneous
|
|
51
between the two groups, but after receiving the
intervention showed a significant difference in
The difference in the ability of assertive
communication between groups of students who
the rise of the assertive communication skills in
the control group. The lack of a heterogeneous
get assertiveness therapy training with the group
who did not receive therapy training
condition assertive communication skills of
students between the intervention group with the
assertiveness significantly different .
control group is due, before the intervention, the
researchers did not test the homogeneity
according to plan. Homogeneity test was not
done because of the limited number of samples.
although researchers knew that the
homogeneity test is very important to improve
Acknowledgment
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55
THE KEY-DETERMINANT FACTORS OF DEPRESSION LEVEL
IN ELDERY PATIENTS
Shintha Silaswati, Muftadi, Rizqika Nurlis Manda Putri
STIKes Bani Saleh Bekasi
E-mail: elin_rabin@yahoo.com
ABSTRACT
Introduction: Eldery is a condition of person who reached an age more than 60 years. The
existance of eldery is considered as family and surrounding community burden with changes
both physical and psychology make an eldery as vulnerable groups to make problems
complicated especially depression. Assessment on the factors that affect the level of
depression in the elderly patients are very important. The aims of the study was to know the
factors that affect the level of depression in the eldery patients. The study was conducted at
the Budi Dharma Geriatric Home in Bekasi.
Method: The research method were descriptive design with Cross-Sectional approaches.
The number of samples was 86 eldery patients in the Budi Dharma Geriatric Home in Bekasi.
To analysis the data, we applied univariate and bivariate methods (Chi Square with ñ value<
0,05).
Results: The result of the research revealed that elderly patients with the mild levels of
depression were 58,1%, while with the severe levels of depression were 41,9%. The bivariate
analysis indicated that only geriatric nursing syndrome influence the depression level of the
patients (ñ value < 0,05). Whereas, other factors such as sex ratio, ages, daily activity,
social support and history of the health have no influence with the level of depression (ñ
value > 0,05). The results suggested that it will be necessary to implement a valid and
reliable and comprehensive geriatric nursing syndrome measurement with increase the
number of population and larger samples.
Keywords: Depression, Elderly, Nursing Home, Geriatric Nursing Syndrome.
57
Introduction
The increase of life expectancy has an
impact on the increasing number of population
on the aged over 60 years. The presence of
elderly is always negative, as a burden in the
family and in the surrounding community. It
leads to a perception that when we get older,
we will be more experience with health
problems. (Nugroho, 2008). According to the
World Health Organization (WHO), within the
last few years, starting in 2010, the elderly
population had reached 350 million people, 20%
of elderly person lived with depression. In 2011,
among 250 million elderly people, 19% of them
lived with depression. In 2012, the number of
elderly population had reached 680 million
people and 32% live with depression. According
to the Ministry of Social Affairs of the Republic
of Indonesia, the number of elderly in Indonesia
physical and psycho-social (Rachmawati, 2008).
Depression phenomenon also occurs in geriatric
home. Syamsuddin (2006) stated that most of
elderly people want to live and loved with and
by their family, as well as to have a good
attention and a care from them. However, in
reality, most of elderly people do not have a good
care from their family due to some factors, e.g.
no children/family, their children passed away,
daily activities of their family, no attention to their
parents and other reasons. Those factors cannot
be well accepted by the elderly people (Ollyvia,
2012).
This study was conducted in Bekasi. The
geriatric home is owned by the Ministry of Social
Affairs. Based on the initial survey conducted
by the authors at Tresna Whreda Budi Dharma
Geriatric Home Bekasi the elderly people who
increases every year. In 2008, among 9.5 million
elderly people, 20% lived with depression. In
live in this geriatric home were abandoned by
their family and through an observation, there
were some elderly who show symptoms of
2009, among 11.3 million people, 18% lived with
depression. Among 19.5 million elderly, 32%
depression. Based on this phenomenon, this
study will examine the level of depression in the
lived with depression in 2011 (Isaac, 2013).
According to the data which is released by
elderly and the factors that influence in
TresnaWhreda Budi Dharma Geriatric Home
government, there are 264,080 of 2,888,548
elderly which have their condition neglected in
Bekasi, to identify the factors that caused
depression in the elderly in TresnaWhreda
West Java. The majority of the elderly are
abandoned and living in a poor economic
Bekasi Geriatric Home in 2014.
condition. The phenomenon was revealed in
Rapat Kerja Daerah (Rakerda) or Regional
Methods
Work Meeting, Lembaga Lanjut Usia Indonesia
(LLUI) or Institute for Indonesian Elderly in Dinas
using descriptive design intended to examine a
phenomenon based on empirical facts in the
Kesehatan Jawa Barat. Head of Social Service
of West Java, Aip Rivai, stated that 1,580 elderly
field with the cross sectional approaches. In data
processing, the authors used an 86 respondents
have been accommodated in Social Institution,
Geriatric Home Tresna Wreda which are owned
of the TresnaWhreda Budi Dharma Geriatric
Home Bekasi that fit to the criteria. The research
by government and private (Pelita, 2014).
period was conducted in between 1 February
to 21 April 2014.
The elderly people are vulnerable with their
This type of research was a quantitative
health problems especially the level of
depression caused by various changes both in
58
Results
Table 1.
Distribution of respondents by gender in the level of depression in the elderly
population in Budi Dharma Geriatric Home Bekasi. Year 2014 (n = 86)
Gender
Male
Female
Total
Level of Depression
Moderate to
Mild to Moderate
Psychotic
n
%
n
%
15
50,00%
15
50,00%
35
62,50%
21
37,50%
50
58,10%
36
41,90%
Amount
n
30
56
86
pvalue
%
100%
100%
100%
0,373
95%
CI
0,245
1,472
OR
0,6
Based on the Table 1, the result of the moderate to psychotic depression level by gender revealed
that the percentage of male is higher than female with 50% of 15 male respondents and 37.5% of 21
female respondents. The results obtained (Chi-square = 0.373; p value> 0.05) indicated that there is
insignificant impact by gender for the level of depression in Budi Dharma Geriatric Home Bekasi, and
95% CI = 0.245 to 1.472 with OR = 0.600. It means that the female respondents have 0,600 times
higher risk for moderate to psychotic depression compared to male respondents.
Table 2.
Distribution of respondents by age in the level of depression in the elderly population
in Budi Dharma Geriatric Home Bekasi Year 2014 (n = 86)
Level of Depression
Age
60-74yo
? 75 yo
Total
Mild to Moderate
n
33
17
50
%
64,70%
48,60%
58,10%
Moderate to
Psychotic
n
%
18
35,30%
18
51,40%
36
41,90%
Amount
n
51
35
86
pvalue
%
100%
100%
100%
0,205
95%
CI
0,808
4,666
OR
1,941
Based on Table 2, the result of moderate to psychotic depression level by age 60-74 year old
displayed 35.3% of 18 respondents and 51.4% of 18 respondents by age above 75. Statistical results
obtained 0.355 (p value> 0.05) and concluded that there is no significant impact by age for the level of
depression in Budi Dharma Geriatric Home Bekasi, and 95% CI = 0.808 to 4.666 with OR = 1.941, it
means that the respondents aged above 75 year old have 1.941 times higher risk compare to 60-74
year old respondents.
|
|
59
Table 3.
Distribution of respondents based on daily activities in the level of depression in the
elderly population in Budi Dharma Geriatric Home Bekasi Year 2014 (n = 86)
Level of Depression
Daily Activities
Mild to
moderate
dependency
Moderate to
complex needs
dependency
Total
Mild to Moderate
n
39
%
61,90%
Moderate to
Psychotic
n
%
24
38,10%
Amount
n
63
pvalue
95%
CI
OR
0,355
0,677
1,773
%
100%
11
47,80%
12
52,20%
23
100%
50
58,10%
36
41,90%
86
100%
4,645
Based on Table 3, the result of moderate to psychotic depression level by daily activities shows
38.1% of 24 respondents with mild to moderate dependency and 52.2% of 12 respondents with moderate
to complex needs dependency. Statistical results obtained 0.355 (p value> 0.05) and can be concluded
that there is no significant impact by age for the level of depression in Budi Dharma Geriatric Home
Bekasi, and 95% CI = 0.808 to 4.666 with OR = 1.941. It means that the respondents aged above 75
year old have 1.941 times higher risk compared to 60-74 year old respondents.
Tabel 4.
Distribution of respondents based on nursing geriatric syndromes in the level of
depression in the elderly population in Budi Dharma Geriatric Home Bekasi Year 2014
(n = 86)
Geriatric
Nursing
Syndrom
2 types of
disorders
> 2 types of
disorders
Total
Level of Depression
Amount
pvalue
95%
CI
OR
0,001
1,994
5,25
n
30
%
78,90%
Moderate to
Psychotic
n
%
8
21,10%
20
41,70%
28
58,30%
48
100%
-
50
58,10%
36
41,90%
86
100%
13,825
Mild to Moderate
n
38
%
100%
Based on the Table 4, the result of moderate to psychotic depression level by nursing geriatric
syndromes showed that 21.1% of 8 respondents with less than 2 kinds of disorders and 58.3% of 28
respondents with more than 2 kinds of disorders. Statistical results obtained 0.001 (p value < 0.05) and
concluded that there is no significant impact by age for the level of depression in PSTW Budi Dharma
Bekasi, and 95% CI = 1.994 to 13.825 with OR = 5.250. It means that the respondents with more than
2 kinds of disorders have 5.250 times higher risk compared toless than 2 kinds of disorders.
60
Table 5.
Distribution of respondents by level of social support in depression level in the elderly
population in Budi Dharma Geriatric Home Bekasi Year 2014 (n = 86)
Level of Depression
Social Support
Supporting
Not supporting
Total
Mild to Moderate
n
24
26
50
%
70,60%
50,00%
58,10%
Moderate to
Psychotic
n
%
10
29,40%
26
50,00%
36
41,90%
Amount
n
34
52
86
pvalue
%
100%
100%
100%
0,095
95%
CI
0,96
6
OR
2,4
Based on the Table 5, the result of moderate to psychotic depression level by social support resulted
29.4% of 10 respondents with social support and 50.0% of 26 respondents without social support.
Statistical results obtained 0.095 (p value > 0.05) and can be concluded that there is no significant
impact by social support in Budi Dharma Geriatric Home Bekasi, and 95% CI = 0.960 to 6.000 with OR
= 2.400, it means that the respondents without social support have 2.400 times higher risk compared
torespondents with social support.
Table 6.
Distribution of respondents based on the history of patient on the level of depression
in the elderly population in Budi Dharma Geriatric Home Bekasi Year 2014 (n = 86)
Level of Depression
History of
Patient
? 2 types of
diseases
> 2 types of
diseases
Total
Amount
pvalue
95%
CI
OR
0,291
0,706
2,019
n
42
%
61,80%
Moderate to
Psychotic
n
%
26
38,20%
8
44,40%
10
55,60%
18
100%
-
50
58,10%
36
41,90%
86
100%
5,773
Mild to Moderate
n
68
%
100%
Total 50 58.1% 36 41.9% 86 100% Based on Table 6, the result of moderate to psychotic depression
level by type of diseases shows 38.2% of 26 respondents who have less than 2 types of diseases and
55.6% of 10 respondents who have more than 2 types of diseases. Statistical results obtained 0.291 (p
value > 0.05) and concluded that there is no significant impact by type of diseases in Budi Dharma
Geriatric Home Bekasi, and 95% CI = 0.706 to 5.773 with OR = 2.019. It means that the respondents
with more than 2 types of diseases have 2.019 times higher risk compared to respondents with less
than 2 type of diseases.
|
|
61
Discussion
Based on the results of the bivariate
analysis in this study, the p value> 0.05 is 0.373,
it can be concluded that there is no significant
influence by gender in the level of depression.
The results of this study are consistent with the
results of Ratna (2013) that concluded that there
is no relevancy between the gender with
depression in the elderly in UPTD Rumah
Sejahtera Geunaseh Sayang Ulee Kareng
Banda Acehin 2013. The p value> 0.05 is
obtained 0.205, it can be concluded that there
is no significant impact by age in the level of
depression. The results of this study are
consistent with the results of the study Ollyvia
(2012) that stated that there is no relevancy
between age and levels of depression in elderly
in Geriatric Home Tresna Whreda Budi Mulia 4
South Jakarta. Theory of Nevid (2003) stated
that the age of the depression can become
chronic if the depression appears for the first
time at the age of above 60 year old. Based on
the results of a study of elderly patients with
depression in a period of 6 years depression
treatment, approximately 80% of the patients did
Whreda Mulia Dharma Geriatric Home
Kabupaten Kubu Raya” The value> 0.05 is
obtained 0.129 which stated that no relevancy
with the activity patterns of stress level. of the
elderly in Nursing Home Tresna Whreda Mulia
Dharma Botanical District. Theory of Sugiarto
(2005) stated Activities of Daily Living (ADL) is
a routine activity undertaken by humans. The
ability of daily activities decreases at our old age,
the decrease in the function of the body organs
due to the aging process experienced by the
elderly. Daily activities are such as bathing,
dressing, toileting, transferring, continence,
feeding and up down the stairs. These
assessments are helpful to know type of
activities that the elderly people do every day,
and are being independence in performing daily
activities. The daily activities of elderly with
moderate-severe dependence have 1,773 times
higher risk compared with respondents who selfdependence, because the condition of having
moderate-severe dependence can not perform
daily activities optimally as the elderly who are
severely ill, this makes elderly people need
assistance in performing daily activities.
not recover but continue have depression due
to the decrease in the function of the organs of
There is no significant impact between the
daily activities in the level of depression. The p
the body, as well as the increasing age e” 75
years that a person would also have a 1.941
value> 0.05 is obtained 0.355. The results of
this study are consistent with the results of
times greater risk for moderate to severe
depression due to old age will tend to decline in
Diamond, et al (2013), the title “Relationship
Activity Patterns of Basic Needs Fulfillment With
memory (often forgotten), sleep disorder, and
decreased physical conditions and weak.
Stress Levels of Elderly In Nursing Home Tresna
Whreda Mulia Dharma Kubu Raya District” The
The p value> 0.05 is obtained 0,355t in this
study and can be concluded that there is a
significant difference between the activities of
daily life in the level of depression. The results
of this study are consistent with the results of
the study Diamond, et al (2013), the title
“Relationship Activity Patterns of Basic Needs
Fulfillment With Elderly Stress Levels In Tresna
62
value> 0.05 is obtained 0.129 which stated that
there is no relevancy with the activity patterns
of stress level of the elderly in Nursing Home
Tresna Whreda Mulia Dharma Botanical District.
Based on the results of the bivariate
analysis in this study, the p value> 0.05 is
obtained 0.095, it can be concluded that there
is no significant impact of social support in
depression levels. The results of this study are
hormones, enzymes, and substances that are
not in line with the results of the Goddess (2011),
the title “The Relationship Between Social
required for immunity.
Support With Depression Levels In Geriatric
Home Whreda In Jakarta (Quantitative Study of
Conclusions
This study shows that there is only nursing
Two Institutions In Whreda)” The value <0.05 is
obtained 0.000, which stated that there is the
geriatric syndromes (GNS) has the impact on
the depression level of elderly (p value <0.05 is
influence of the support social to the elderly. The
theory is supported by Hestie (2008) entitled
0.001) . as follows:
“The Relationship Between Social Support With
Depression In Elderly” The value <0.05 is
obtained 0.002 which statesd that there is
irrelevant between social support and
1.
There is no significant impact by gender
in the level of depression of the elderly (p
value> 0.05 is 0.373).
2.
depression in the elderly. The difference of the
results obtained the differences of instrument
There is no significant impact by age in
the level of depression of the elderly (p
value> 0.05 is 0.205).
and research location.
3.
There is no significant relevancy between
the level of depression and medical history . The
p value> 0.05 is obtained 0.291, it can be
concluded that the results of this study are
consistent with the results of Ayu (2011) entitled
daily activities and depresion level of the
elderly (p value> 0.05 is 0.355).
4.
5.
diseases and illness. One of the factors that can
trigger depression is a physical health condition.
The cause of the disease in the elderly generally
comes from within the body (endogenous), as
social support and depression level of the
conditionand depression condition of the elderly
in nursing home. According to Maryam, et al
(2008), elderly people are seen and considered
as the biological degeneration along with various
There is a significant relevancy between
nursing geriatric syndrom and depression
level of the; statistical result was obtained
0.001 (p value <0.05)
“Genesis And Depression In Elderly Level Comparative Study In Nursing Home and
Community” . The value> 0.05 is obtained 0.626
which stated that there is no relevancy of health
6.
medical history and depression level ofthe
Acknowledgment
For Tresna Whreda Budi Dharma Geriatric
well as someone who was getting older it has>
2 types of disease and tend to have 2,019 times
Home Bekasi nursing is expected to minimize
depression in old age through early detection
higher risk for moderate to severe depression.
This is caused by old age and the function of
and to improve activities that have been
programmed to fill the daily activities of the
various organs of the body has been decreasing
due to damage to the cells and the aging
elderly and make a changing schedule to further
avoid boredom activities.
process, resulting in the production of
|
|
63
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66
THE EFFECT OF EDUCATIVE BLOG ABOUT DIABETES MELLITUS (DM) TO
FASTING BLOOD GLUCOSE ON DIABETIC IN PUBLIC HEALTH CENTER
WIROBRAJAN
Maya1, Erfin Firmawati2,
Universitas Muhammadiyah Yogyakarta, Indonesia
E-mail: maya_nurse@yahoo.com
ABSTRACT
Introduction: Diabetes Mellitus is the important causes of morbidity and mortality in the
world that needed long time care. If diabetic did not control and not true to treat her illness,
it can cause complications. One treatment of DM is health education that can given used
internet acces and it can changes behavior of diabetic more positive and can control blood
glucose to prevent compication of DM. To know effect of educative blog about diabetes
melitus (DM) toward fasting blood glucose on diabetic in public health center Wirobrajan.
Methods: This research used quasi experiment with two group pretest-postest and control
group design. Sampling technique used purposive sampling with 48 diabetic respondents.
Data collection researcher do check blood glucose, while data analys is used Paired Wilcoxon
Signed Rank test dan Mann-Whitney U.
Result: The results showed that there are not significant different between intervention and
control group after given educative blog about DM toward fasting blood glucose level with p
value 0.63 (p>0.05).
Conclusions: Educative blog about DM did not affect to blood glucose.
Keywords: blood glucose,diabetes mellitus, educative blog.
Introduction
According to the World Health Organization
(WHO)3 in 2007th Indonesia was ranked 4 with
Diabetes Mellitus is an important causes of
morbidity, mortality, and disability in the world
highest number of diabetic in the world, as many
as 8.4 million people with diabetes in 2000th and
that needed long-term care and DM is a problem
that many happened in developing countries,
is predicted can increase 21.3 million in 2030th.
including Indonesia (Suyono, 2007)1.
Number of diabetic in Indonesia is high,
because dietary behavior of diabetic is low, of
Based on reports the International Diabetes
98 respondents was 60.1% of respondents did
not obedient to do diet (Widyastuti, 2012)4.
Federeation (IDF) 2 in 2013th, the number of
diabetic in the world as many as 282 million
people and can increase to 592 million in 2035th.
67
Beside of that, diabetic in Indonesia high
Blog is a media that easier to accessed
because life style and obesity (Suyono, 2007).
through gadgets like mobile phones, which is
currently many used by public. Almost all
Diabetes is a chronic disease that must
controlled, therefore people with diabetes should
always maintain blood glucose within normal
limits (Waspadji, 2009)5. If blood glucose levels
of diabetic not controlled and handled properly,
it can causes many kind complications such as
hyperglycemia, diabetic ketoacidosis, diabetic
foot complications, diabetic retinopathy, and
erectile dysfunction (International Diabetes
Federation/IDF, 2013)6. According study by
7
Indonesian people used gadgets and as many
as 95% just to access social media (Merdeka,
2013)13. Gadgets like mobile phones currently
available with a variety of features that can be
directly connected to the internet, so that
patients can consult whenever and not limits
hours of work practice medical team (Gloriane
& Ayub, 2009)14.
Therefore, the researchers tried to examine
Maarifuddin and Burhanudin (2013) of 20
respondent, 16 respondent had level blood
the influence of an educativeblog about DM
toward blood glucose levels type 2 diabetes
glucose is bad with average of blood glucose >
140 mg/dl.
patients in the territory work Public Health
Centers of Wirobrajan.
Efforts to prevent the serious condition and
complications of diabetes, therefore treatment
Methods
of diabetes mellitus in Indonesia standardized
into 4 pillars include meal planning, physical
exercise, medicine, and education participation
(Association of Indonesian Endocrine/
PERKENI, 2006)8. Education is one of the the
program that can improve knowledge of
diabetic, dietary behavior more better and blood
sugar levels is controlled (Soegondo, 2009)9.
According to the Departemen kesehatan RI
(DEPKES RI)10 (2008) effort to delivery health
promotion messages can given with indirectly
through media such as gadgets delivered with
accessing the Internet which is now highly
developed, such as blog. Health education
through web access used gadgets have a
positive impact such as increased knowledge,
changes in dietary behavior, physical activity and
blood glucose control, as well as decreased
levels of cholesterol and triglycerides (Hyu,
Parsons, Mamdani, Levobic, Shah et al, 2012)11;
McMahon, Gomes, Hohne Jye Hu, Levine &
This study used a quantitative research
method with Quasi exsperiment design with
pretest-posttest control group. The population
in this study were all patients with type 2
diabetes who are at the Public Health Center of
Wirobrajan. Sampling technique used purposive
sampling, researcher include respondents
based on inclusion and exclusion criteria and
the researchers obtained 48 respondents were
divided into 24 intervention group and 24 control
group.
The variable in this study is blood glucose
levels of patients with type 2 diabetes in Public
Health Center of Wirobrajan region. Blood
glucose levels were measured at pre-test and
post-test used glukotest. Results of the
measurement is categorized by scale ratio when
scores on blood glucose is reduce that showed
blood glucose levels is normal. The research
instrument was a glukotest to measure blood
glucose levels.
Conclin , 2005)12.
68
The Effect of Educative Blog About Diabetes Mellitus (DM) to Fasting Blood Glucose on Diabetic
in Public Health Center Wirobrajan
The statistical test that used to determine differences blood glucose levels before and after given
educative blogs about DM on one group pretest-posttest intervention and control are used Wilcoxon
Signed Rank Test and, to compare results of the measurement blood glucose levels in the two groups
during the post-test group used Mann-whiney U.
Results
1.
The effect of an educational blog about DM toward fasting blood glucose levels in type 2
diabetes patients at Public Health Center of Wirobrajan.
a. Difference test to one group
The difference results of the pretest-posttest levels Fasting Blood Glucose (FBG)
Table 1. Comparison Value of Different Levels pretest-posttest FBG on Intervention and
Control Group in Public Health Center of Wirobrajan (N = 40)
Pretest
MR
SR
9,65
96,5
8,54
102,5
Intervensi (n=20)
Control (n=20)
Postest
MR
SR
10,39
93,5
11,42
68,5
Z
0,6
7,41
p
0,95
0,46
Table 1 shows the increase value of Mean Rank blood glucose on the intervention group and
the control group, Mean Rank intervention group at pre-test= 9.56 and at post-test = 10.39 and
the value of Mean Rank control group at pretest = 8.54 and posttest = 11.42. Based on the
analysis of data with the Wilcoxon Signed Rank test both the intervention and control groups
showed no significant difference in blood glucose levels with value p> 0.05.
b. Different test to two groups
The difference in the results of fasting blood glucose level between the intervention group and
the control group
Table 2. Comparison of Different Value fasting blood glucose level between intervention
and control groups in the Public Health Center of Wirobrajan (N = 40)
FBG
Pretest
Postest
Intervensi (n=20)
MR
SR
22,92
458,5
23,92
478,5
Kontrol (n=20)
MR
SR
18,08
361,5
17,08
341,5
U
P
151,5
131,5
0,19
0,63
Based on Table 2, it showed the value of Mean Rank at pretest in the intervention group=22.92
while the control group=18.08 and after the test used the Mann-Whitney U test obtained p 0.19
(p > 0.05). At the posttest Mean Rank values in the intervention group=23.92, while in the
control group=17.08 and after the test used the Mann-Whitney U test obtained p 0.63 (p>
0.05). It can be concluded that there is no significant effect of educational blogs about diabetes
on blood glucose levels of respondents.
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69
Discussion
The results from different test between the
two groups pretest-pretest obtained p 0.19 (p>
0.05) and the posttest-posttest p 0.63 (p> 0.05).
It can be concluded that there is no influence of
educational blogs on blood glucose levels then
H0 is rejected.
In addition to adherence to diet, physical
activity such as exercise can also affect blood
glucose levels diabetic patients who are not
controlled by the researcher at this time. Studies
conducted by Dewi (2013)17 shows that the
practice of sports that are less able to cause
fasting blood glucose levels are not normal, this
There is not significant effect on blood
is in line with research conducted by Achmad
(2011)18 that regular exercise associated with
glucose levels may be causes to limited time,
researcher used 2 weeks to do reseach, so that
success in the management of patients with
diabetes mellitus type 2 diabetes such as
the blood glucose levels of the respondents have
not been fully controlled and can be viewed by
uncontrolled blood glucose levels.
the data pretest and posttest in both groups
average fasting blood glucose level of
respondents >126 mg/dl. This is supported by
studies conducted by McMahon et al., (2005)12
who showed that a decrease in glucose levels
in patients with diabetes control is low during
Stress factors also affect the patient’s blood
glucose levels, which are not controlled by the
researcher. Based on studies conducted by Putri
(2009)19 that there is a relationship of stress with
uncontrolled blood glucose levels and an
increase in the blood glucose levels of
In addition, there are several things that can
respondents. Research conducted by Nugroho
and Purwanti (2010)20 said blood glucose levels
in patients who are experiencing stress tend to
affect blood sugar levels such as medication
adherence antihipoglikemi (OHO) which are not
rise. In addition, obesity factors can also affect
the blood glucose levels are not controlled by
controlled by the researcher. Studies conducted
by Mihardja (2009) 15 reported that the
researchers, according to Ilyas (2007)21 obesity
causes insulin receptors on target cells
adherence to the diabetes medication blood
glucose levels of diabetic can be controlled,
throughout the body less sensitive and thus
reduced the amount of insulin in the blood can
Mihardja also delivered one of the causes of
uncontrolled blood glucose level is the amount
not be exploited and cause glucose levels in
blood is high.
of food consumed by diabetic which include
errors in dosage amount of food that will be
Conclusion
the 1-year study.
consumed.
Obedience of diabetic to management of
eating such as the amount of the meal, type and
schedule can also affect the blood glucose levels
of DM patients. Studies conducted by Widyastuti
There is no effect of educative blog about
DM toward blood glucose levels in type 2
diabetes patients in Public Health Center of
Wirobrajan.
Acknowledgment
16
(2012) say that almost all respondents of the
study after the analysis does not adhere to the
diet and this could potentially affect the balance
of blood glucose levels of respondents.
70
We are very thankful to the health centre of
Wirobrajan, for allowing us to conduct this study
and we would extend a special thanks to all the
respondents for their useful information and
The Effect of Educative Blog About Diabetes Mellitus (DM) to Fasting Blood Glucose on Diabetic
in Public Health Center Wirobrajan
cooperation. We hope this study will make a
evaluating a web based self management
positive impact on their lives in the future. This
work was supported by School of Nursing
site for patient with type 2 diabetessystematic website development. Journal
Muhammadiyah University, Yogyakarta. We are
also grateful to the College for its generous
of BMC Medical Information & Decision
Making. 1472-6947/12/57.
McMahon, G.T., Gomes, H.E., Hohne, S.H., Jye
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Achmad, Y. (2011). Hubungan antara 4 pilar
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tipe 2 dengan kadar glukosa darah di
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Jakarata: FKUI.
72
SELF REGULATION AND ANXIETY ON HOME VISIT AND CLINICAL VISIT (A
COHORT STUDY IN POSTPARTUM MOTHER)
Giari Rahmilasari1, Avip Syaefullah2, Vita Murniati Tarawan3
1
STIKES Aisyiyah Bandung, Indonesia
2,3
Universitas Padjadjaran, Bandung, Indonesia
E-mail: ummahatgia@gmail.com
ABSTRACT
Introduction: Literature rivews on postpartum care show that home visit, could enhance
knowledge and self regulation ability during postpartum period, also reduce anxiety and
depression among post partum women. The ability of postpartum women on self regulation
assumed be able to reduced maternal and infant morbidity and mortality rate.
Methods: To prove that assumption, a prospective cohort study with observational technique
was done. STAI was used to measure anxiety and questionnaire made by Miller, Brown and
Lawendowsky (1999) was used to measured self regulation.
Results: show no difference between maternal anxiety who receive home visitation and
who visit the clinic p=0.480 (p > 0.05). This could happen because all of the respondents
used Jampersal. However, there are significant differences between self-regulation mothers
receiving home visit with those who visit a clinic that is p=0.048 (p < 0.05). The difference in
time of visit (3rd day, 6th day, and 14th day), there is no significant difference between the
anxiety with home visits and clinic visits, all in all it shows p value> 0.05 (p = 0.725 , p = 803
, and p=0.677), whereas on self-regulation, there are significant differences in self-regulation
on the 14th day where p value = 0.042 (p < 0.05). There is no correlation between anxiety
with home visits and clinic visits, and there is no relationship between self-regulation with
home visits and clinic visits, all with p value > 0.05. Multivariate analysis finds that mothers
having high anxiety are 1.27 times at risk on lower regulation.
Conclusion: home visits at least on the 6th day or on the 14th day is necessary, as it is
known that on the 6th day anxiety occurs its highest, and self- regulation abilities show their
lowest, while on the 14th day home visits can affect the ability of self-regulation.
Keywords: anxiety, clinic visits, home visit, postpartum, self- regulation.
73
Introduction
Physiological changes during postpartum
period have impacts on psychological changes
due to the fact that puerperium is a stressful
transitional period4. The first one to three days
after delivery is the time when women are in
the phase of dependency on others in terms of
getting comfort, rest, and nutrition. This period
is the appropriate time for health care workers
to provide guidance and learning on postpartum
care, because these women usually feel unable
to control the situation and have the eagerness
to learn and apply every advice from others to
meet their needs and their baby’s needs.5. .
anxiety level between postpartum women who
received home visit and those who did clinical
visits as well as to reveal the correlation between
self-regulation and anxiety in women who
received home visits and those who did clinical
visits.
Methods
This study observed postpartum women on
the third, sixth, and 14th days after
delivery. Respondents were postpartum women
who gave birth in Puskesmas with in-patient
service (Puskesmas DTP) in Bandung City who
met the inclusion, exclusion and minimum
sample size criteria and willing to participate in
Postpartum women who stay at home can
learn and make adjustments safely and
the study after receiving information followed by
informed consent signing.
comfortably, enable them to control their
emotional state. On the contrary, postpartum
The questionnaires used wereSelf
women who stay in the hospital can easily feel
anxious and vulnerable, which may lead to
postpartum blues or to a more severe condition,
namely postpartum depression3, 6. It is presumed
that by prevention through self-regulation may
overcome the anxiety among postpartum
Regulation Quetionnaire (SRQ) and State Trait
Anxiety Inventory STAI). Only the anxiety part
of the STAI questionnaire was used, i.e. using
20 adjectives (r = 0.96). Translation into
Indonesian was performed using back
translation method, interpretation was based on
women14.
the average assessment in the study with a
common division of anxiety based on normal
Early postpartum discharge, which is
currently the policy of the health care facilities,
distribution28. The self-regulation questionnaire
used was Self Regulation Questionnaire (SRQ)
requires a good follow-up care, as a key to
improved service satisfaction during the
based on Miller & Brown, 199145.
postpartum period18. The follow-up care can be
given at home (home visit) and in the clinic
(clinical visit). Several studies reveal that the
home visit in populations at risk, has not been
able to ease the burden of health and social
problems; therefore home visit to all postpartum
women is expected to reach clients with special
needs who may not seek help out of the house 19.
3
.
Thus, the purpose of this study was to
The validity testing of the questionaires was
conducted in two stages, direct validity
(professional /expert judgment) with expert
consultation (DR. Intaglia Harsanti., S.Psi., MSI),
and derivative validity testing (statistical testing).
The results of the validity testing on the anxiety
questionnaire (STAI ) produced 10 items on
anxiety statements with R = 0.866 and r = 0.484
to 0.806. For the self-regulation questionnaire,
16 items were stated as good items (valid) with
R = 0.914 and r = 0.308 to 0.80661.
measure the difference in self-regulation and
74
Self Regulation and Anxiety on Home Visit and Clinical Visit (A Cohort Study in Postpartum Mother)
Results
The following table describes the frequency distribution of the respondent characteristics:
Tabel 1.
Frequency Distribution of Respondents
Home
Visit
n = 21
5
13
3
7
11
3
%
p
<25
25-35
> 35
Primiparous
Multiparous
Grandmultiparous
Clinical
Visit
n = 20
10
9
1
12
7
1
n = 41
15
22
4
19
18
4
36.6
53.7
9.7
46.3
43.9
9.8
0,185
Elementary school
3
4
7
17.07
Junior High School
Senior High
School
8
6
14
34.14
8
8
16
39.02
Higher Education
1
3
4
9.75
Characteristics
Age
Parity
Education
Total
0.204
0.704
Chi Square test
Table 1 illustrates that the number of respondents who did clinical visit and home visit tend to be
distributed evenly, i.e. 20 people did clinical visits and 21 people did home visit with a total respondents
were 41 people. Most of the respondents aged 25-35 years old (53.7%), Almost half of them were
primiparous women (46.3%) with 39.02% were high school graduates.
Anxiety and Self-Regulation of Women who Received Home Visit and Clinical Visit
The difference in the anxiety and self-regulation scores in postpartum women is listed in table 2
below:
Table 2.
Differences in Anxiety based on the Place of Service Delivery
(Home visit and clinical visit)
Mean
Visit classification
Day 3
Day 6
Day 14
Clinical Visit Home Visits
29,05
29,45
29,6
29,714
29,857
28,952
P value
0.480
Wilk's Lambda test (General Linear Model)
Women who received home visits were able to reduce their anxiety on day 14, which is better
than women who did clinical visits.
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75
Table 3.
Differences in Self-Regulation
data was controlled by methods of service
based on the Place of Service
Delivery
provided:
(Home visit and clinical visit)
Mean
Visit
Clinical Home
classification
p Value
Visit
Visit
Day 3
60.150 64.667 0,003 *
Day 6
35,25 32,429
Day 14
34,7 42,619
Table 4.
Relationship between Anxiety
and Self-Regulation
The results showed no association between
anxiety and self-regulation (p> 0.005). The
relationship and the probabiity of anxiety can
actually be observed by controlling other
Time of Visit
Wilk's Lambda test (General Linear Model)
Table 3 shows that there are differences in
self-regulation between women who received
home visits and clinical visits, with a significant
value of p = 0.003 (p <0.05). The mean scores
indicate that women who received home visits
had higher scores. The same is true for day 14. It
is clear that women who received home visits
could regulate themselves better on day 14.
Relationship between Anxiety and SelfRegulation
Day 3
Day 6
Day 14
Pearson Test
R
p value
0, 268 0, 091
-0.1 67 0, 296
-0.0 30 0, 853
variables. The following is the end result of
modeling of the relationship between visit and
self-regulation after controlling the age,
education, and parity (adjusted association) (see
table 5)
The following table shows the relationship
between anxiety and self-regulation after the
Table 5.
Relationship between Self Regulation and Anxiety, Age, Education and Parity
Regulation
Highmedium
Visit
home
Age Group
<25
25-35
> 35
Education
Elementary School
Junior high school
Senior high school
Higher education
Parity
Primiparous (1)
Multiparous (2-3)
Grandmultiparous (> 3)
76
Anxiety
day 3
Crude OR (P value)
Anxiety
6th day
Anxiety
day 14
0.95 (0.945)
1.6 (0.492)
1.36 (0.624)
1.97 (0.280)
0.9 (0.867)
1.1 (0,879)
1.8 (0.387)
~ (0,999)
1.65 (0.458)
1.14 (0.906)
1.37 (0.638)
1.14 (0.906)
0.417 (0.355)
0.96 (0.986)
~ (0,999)
0.3 (0,213)
1.25 (0.809)
~ (0,999)
0.417 (0.355)
0.750 (-, 753)
~ (0,999)
1.71 (0.626)
0.8 (0.840)
1.71 (0.626)
0.636 (0.626)
1.39 (0,619)
3.33 (0.33)
Table 6.
Final model of the relationship between Anxiety and Self-regulation with Age,
Education, and Parity Controlled
Variables
Regulation
Anxiety
Day 6
adjOR
95% CI
1.81
Anxiety
day 14
adjOR
95% CI
(0.351 to 9.36)
1.20
(0.281 to 513)
Logistic Regression Test
On day 6 and 14, women who have high regulation had the possibility to have higher anxiety
compared to women with lower self-regulation at home after visit, age, education, and parity variables
were controlled.
Table 7.
Final Model of Relationship between Service Method (Visit) and Self-regulation with
age, education, and parity controlled
Regulation
Variables
day 3
adjOR
95% CI
Visit
3.03 (0.26)
0.43-21
Logistic Regression Test
Regulation
day 6
adjOR
95% CI
0.18 (0.54)
0.03-1.03
Regulation
day 14
adjOR
95% CI
1.86 (0.41)
0.42-8,15
On day 3 and 14, women who visited
have higher anxiety (1.97 times) compared to
clinics had 3.03 times higher risk to have low
regulation compared to women who received
women who visited clinic. On day 14, the home
visited women have 1.1 times higher possibility
home visit after the age, education, and parity
variables were controlled.
to be anxious compared to those who went on
clinical visits. The older the women, the more
Discussion
anxious they are compared to women with
younger age. The parity data also show the the
In general, delivery, even if it is a normal/
spontaneous delivery, can be stressful for
women who undergo the process. This is
observed especially on day 6, when the anxiety
and self-regulation in home visits and clinical
visits reach the lowest score. This is due to an
increase in anxiety on day 5 and 10 after4. The
transition period lasts for 1-14 days, with a peak
on day 566.
higher the parity, the more anxious the
postpartum women are.
Financial concerns as the most frequently
found concerns among postpartum women (in
addition to appearance after childbirth, and
household chores as the things that mostly
contribute to postpartum women anxiety) 68 are
no longer found in this study because all
respondents were participants of the
On day 6, women with medium to high
regulation have a 1.6 times higher possibility to
Jamkesmas, which was applied in Indonesia
until December 31, 2013.
have high anxiety, and 1.36 times possibility to
have high anxiety on day 14. On the third day,
Another factor that most frequently affect
women who received home visits, will probably
the one-month postpartum period is the
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77
resilience factor, namely mastery, social
Self-regulation is formed through seven
support, and marital satisfaction. The mastery
and social support factors may be better in home
stages: receiving relevant information,
evaluating information, triggering a change,
visits because women will be able to receive
information better in a place that is considered
looking for options, formulating a plan,
implementing the plan, evaluating the
comfortable (home)70.
effectiveness of the plan43,There is a possibility
that all of those stages can be formed better in
Another reason that may explain the slightly
different anxiety between home visit and clinical
visit is that several things are very much related
to the provision of care, i.e. performance of the
midwife who provide care, the ability to listen,
empathy, problem-solving techniques, and all
interpersonal skills, and not only the reliability
of medical treatment71. A significant difference
was found in self-regulation (p = 0.003),
indicating that the visit can contribute to a
decrease in self-regulation. This is possible
because on the third day the women are still
generally dependent on the people around her
to meet her needs (taking in phase); therefore
the women are not able to regulate themselves
properly.
Rubin in his theory stated that there are
three phases in the postpartum period: “Taking
in phase, Taking hold phase, and Letting go
phase” or are also called the dependence phase
(at this time women tend to be passive in their
environment), the transition phase (women
become more sensitive and in desperate need
of support), and responsibility take over phase
(at this time women already feel comfortable)
. The results of this study indicate that during
70
the first phase (day 3) the regulation is low for
clinical visit and home visit groups. In the second
phase (day 6), the self-regulation is lower than
the previous phase in home visit and clinical visit
groups while in the third phase (day 14 ) women
who received home visits are able to regulate
themselves better than the women who visited
clinic70.
a home visit scheme. In accordance with the
results of previous studies, women who received
home visit of care workers are able to improve
the overall quality of newborn parenting ability54,
and postpartum women who receive home visits
shwo a significant increase in the knowledge
on exclusive breastfeeding, pregnancy spacing
(contraceptives), danger signs in postpartum
period, and danger signs for newborns 21 .
Therefore, women who received home visits are
able to absorb information better, leading to a
good self-regulation.
Difficulties and challenges faced by
postpartum women were written in a nursing
journal entitled Negotiating Motherhood: The
Difficulties and Challenges of Rural First Time
Mothers in Parung, West Java. This study noted
that although postpartum women complain of
lack of sleep and fatigue, but due to the
traditional society culture that emphasizes on
the dua roles of postpartum women (being a
mother who takes care of the children, and
become wife who takes care of the husband and
housework), all women try to meet the
expectation of the dua role. This leads to
“sacrifice”, a discourse that a good mother is
“patient” and “compassionate” and always puts
the needs of the children and husband over her
own needs or interests, both in terms of
personal, sexual, educational, and economic
needs90.
This study found another finding, which is
that the majority of the respondents in this study
lived with their parents, both by going back to
78
the parents’ home or inviting the parents to stay
at the respondents’ house. It is clear that the
women try to anticipate their dual role after
childbirth that they choose to live close to the
parents who are considered to be able to help
them performing the role. This enables women
to deal with their anxiety better so that in this
study, there is insignificant difference in anxiety
in this study ( p> 0.05).
Correlation between self-regulation of
anxiety after the age, education, and parity are
controlled show that women with high anxiety
has 1,27 times higher risk to have lower
regulation. This is consistent with the theory that
one of the factors that can limit self-regulation
is mood disorders44.
Conclusion
There is no significant difference in anxiety
between postpartum women who received
home visits and who did clinical visits. Thre is a
significant different in self-regulation between
postpartum women who received home visits
and who did clinical visits. Thre is no significant
correlation between anxiety and self-regulation
both in home visit group and in clinical visit
group.
bringing the total number of respondents in this
study amounted to 41 people, leading to the
inability to generalize the results for all
postpartum women. Another limitation is that the
questionnaire was ”self-reported”, allowing
respondents not to express their true
feelings. As stated by Oates, 1998 and Rilley,
1995 women do not express their fears
openly 52, leading the possibility of bias in the
answers given in the questionnaire.
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Acknowledgement
Waldenstrom U, Professor, Turnbull D, Senior
This study has limitations including the
limitation of the ability of local midwives to visit
patients. Therefore, the sampling in this study
was defined by distance, which is the
respondents who live in areas far from the health
care center (Puskesmas) were selected to be
the respondents for home visit group and those
who live near the Puskesmas were selected to
be the respondents for clinical visit group. This
may create bias. Secondly, the limited number
of respondents due to limited time available for
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81
POSITIVE DEVIANCE IN A GROUP OF CHILDREN NUTRITIOUS GOOD NUTRITION
IN RURAL POOR FAMILIES IN BANYU BIRU AND KEDUNGGUDEL WIDODAREN
NGAWI EAST JAVA
Yuli Isnaeni
STIKES ‘Aisyiyah Yogyakarta, Indonesia
E-mail: yuli2ishal@yahoo.com
ABSTRACT
Introduction: Assumption of malnutrition occur in poor households, not entirely true (Jogja
Daily, Thursday, February 6, 2014). Parenting influence on the incidence of malnutrition that
not all children who grow up in poor families grow unhealthy. This study aims to explore in
depth pratek positive deviant behavior or positive deviance in groups of infants from poor
families well-nourished, which includes aspects of feeding (feeding), child care (carrying),
the search for health care (health seeking) passage and hygiene (hyiene ).
Methods: The research design was a qualitative study with an ethnographic approach, the
subjects of this study were mothers of well-nourished infants from poor families and families
in the village capable of Banyu Biru and Kedunggudel Widodaren Ngawi, totaling 10 people.
Data collection was performed using the technique of focus group discussions (FGDs) and
in-depth interviews. Data processing is done with qualitative data analysis.
Results: Some solutions to address the nutritional problems already exist within the
community, just need to be known observed positive deviation form practiced covering any
aspect. Positive deviance practiced by mothers of poor families with well-nourished infants
in this study include breastfeeding from birth and complementary feeding from 6 months
which made instant and local materials, the frequency of eating 5 times a day is given as
you play and add to the chili vegetable soup, side dish and vegetables come from around
the house or rice field. Mother familiarize bath up to 3 times, rinse with lukewarm water
when brushing your teeth and putting on footwear while playing. Mother carrying child while
working in the fields, and supervise children playing, the use of games owned sister or
brother of the same age. When sick mother gave special attention and use of traditional
medicine for mild pain.
Conclusion: Positive deviance is obtained quickly provide solutions, affordable family, do
not need to rely on outside resources to practice new behaviors, much more cost effective,
participatory, and original, because the solution is already in place and Culturally acceptable
Keywords: positive deviance, the poor family, malnutrition child.
83
Introduction
Under-nutrition in children under five
groups is a serious problem for thenation,
because this toddler group is an asset of human
resources in the future (Isnaeni,201). According
Soekirman (2000), the incidence of malnutrition
inchildren under five in Indonesia is
still quite high, reaching 18.6%. MOH (2004)
states that in 2003 there were 27.5%
(5 million) under five are malnourished, as much
as 19.2% (3.5 million) experienced
malnutrition and 8.3% (1.5 millionchildren under
five) malnourished.
Ngawi is one of the ten regions in East
Java, which has a fairly high rate of malnutrition
(Ayunin & Sutikno, 2008, in digilib.its.ac.id
accessed on February 9, 2014), ie, there were
68 infants with poor nutritional status, where
as 420 other less nutritional status
(PR Ngawi, blogspot accessed February 9,
2014). The incidence of malnutrition in PHC
Widodaren relatively high, compared to other
health centers around Ngawi West
(PHC Profile, Walikukun Widodaren, 2013).
Fatma (2014) mention that the
perception of malnutrition cases occur in poor
households, not entirely true (Jogja Daily,
Thursday,
February
6,
2014).
Parenting influence on the incidence
of malnutrition that not all children who grow up
in poor families grow unhealthy. Conversely,
children whose parents have sufficient
income even more, there are many suffering
from malnutrition, this happens because of child
care, feeding and child pearwatan submitted to
caregivers who have limited knowledge of the
importance of the provision of nutritious food.
The results of a preliminary study in
the region Widodaren, mother of 5
them also have a toddler malnutrition or
underweight and of 5 family of children with
poor category, but 3 of them have young
children who grow up healthy and have good
nutritional status or obese (FGD, January 29,
2014). Category of poor mothers who
mentioned that during this parenting
alone all her children, providing meals and
invited to playon the sidelines of
busy work, the reason to save the mother
breastfeed the child. This family also used to
cook vegetables from around the house. This
behavior is a form of positive deviance behavior.
Positive aspects of this behavior needs
to be investigated, in order to be
foundand used as a parenting wisdom
possessed by the people themselves. There
are four patterns of parenting role in preventing
malnutrition in children under five, namely
feeding (feeding), child care (carrying), the
search for health care (health seeking) passage
and hygiene (hyiene) (Save the Children, 2003),
which became responsibilities of community
nurses.
A series of community nurses have a
role in this at-risk population that ischildren
under five, of whom act as educators and
program planners toincrease the health status
of children under five (Stanhope and Lancaster,
2004). As educators, nurses are expected
to increase the knowledge, the ability and
willingness of parents of children under
five who are malnourished by feeding
pattern is true in daily life. Positive deviant
behavior this poor familyneed to be explored
and its findings can be used as a toddler
parenting goodfor the poor and middle to the
top. Based on the above, the researcher is
interested in conducting research to identify
the Positive Deviance in a group of well-
toddlers middle class and above, 2 of
84
Positive Deviance in a Group of Children Nutritious Good Nutrition in Rural Poor Families in Banyu Biru and
Kedunggudel Widodaren Ngawi East Java
nourished infants from
poor
families
not afford the well-nourished children and 5
people from affluent families with children
less nourished. Age of the participants
in Puskesmas Widodaren NgawiEast Java.
Methods
This study aims to explore in depth pratek
varied between 21-40 years, having the number
of children 1-4 and children aged between 10
positive deviant behavior or positive deviance
in groups of infants from poor families well-
months - 5 years. The level of education of
participants, among primary school-PT,
nourished, which
includesaspects
of
feeding (feeding), child care (carrying), the
7 housewives but at certain times of workers in
the fields weeding grass orleaves of sugarcane
search for health care (health seeking) passage
and hygiene (hyiene ).
and the rest Ngrasak entrepreneur and teacher.
Results of Data Analysis Research Themes .
The research design was a qualitative study
This section describes the themes that
emerged based on the participants’
with an ethnographic approach, which aims
to investigate the behavior of positive deviations
answers when the Focus Group Discussion
(FGD), as follows:
(positivedeviance) on the poor but wellnourished children under five living in the village
1.
of Banyu Biru and Kedong Güdel Ngawi
East Java.
Behavior feed poor families with wellnourished toddlers.
a.
Exclusive breastfeeding and
breastfeeding.
The subjects of this study were mothers
of well-nourished infants from poor
families and families in the village capable of
Banyu Biru and Kedong Güdel Widodaren
Exclusive breastfeeding mothers in
the group was not able to start from
birth orbreast-fed the
next two days, while the first group
Ngawi, totaling 10 people. Data collection was
performed using the technique of focus group
of women or wealthy familiesare
able to start breastfeeding after 2-
discussions (FGDs) and in-depth interviews.
Data processing is done with stage 1).
3 days, according to a statement the
participants:
Write FGD transcripts, 2). Compile
andcategorize the data, 3). Looking for a
pattern or theme, with a view to understand the
meaning of the –tema theme, 4). Doing
... ”Bu midwife immediately put my
son in the chest, he said to to want
interpretation orinterpretation to give meaning to
the analysis, explaining the pattern or category,
to breastfeed..., but not yet out...”
(P.1) and (P.4)
find the relationship between various concepts
and 5). Data analysisis inductive / qualitative
... ”Once breastfeeding has not
come out first, then given just 2
tablespoonsmilk in the first day, after
basis of the facts found in the field
and thenconstructed a hypothesis or theory.
that yes... ASI continues...” (P.3)
Results
... ”I am off to breastfeed after 2.5
years, when breastfeeding
Participants in this study were 10 mothers
with toddlers, 5 people from families who can
Ekslusifnya 6months...” (P.1)
|
|
85
... ”Yes... the
benefits
of
breastfeeding to 6 months, after that
the milk bottles until now ...” (P.6)
b.
processing, while the family is able
to preferinstant food.
a.
... ”Sometimes my kids eat up to
5 times, disposable dishes tempeh,
Complementary Feeding
Mother ’s poor start
giving complementary
tofu and vegetable Santen... love
him...” (P.1)... If his father to eat, like
foods (complementary feeding) the
age of 6 months with a combination
disuapin want... a mouthful of two
bribes... if I eat, yes... while I suapi...
of instant and local, while
the mother ’sfamily is
able
if you want.” (P.5)
to provide complementary
feeding at 6 months, although the
The mother of the family was able
to express the following statement:
PASI has given birth to some instant
food alone. Contained in the
... ”If I, not my schedule... yes... if he
asked me give, because love does
notwant to be forced-forced ...” (P.7)
followingexpression:
.... ”I started giving complementary
foods, since my children aged 6
...”About eating my maid affairs,
rarely fed my child ... once a
months...” (P.5)
week ... even in those rare ... I
think my son eat 2-3 times a
... ”My children from the age of eight
day ..” (p.10)
patang (4 x 35 days) or 4 months...”
(P.1)
... ”Since the
baby
is bottle-
fed ... kalau eat solid anyway since
the age of 6 months ..” (p.10)
.... ”Type XX given additional
food, alternating with bananas...
2.
Frequency of eating children up
to 5 times a day
b.
Ways mother feed the child outside
the home while playing with friends
Mothers of poor families more often
outside the home while giving
and the team” (P2)
(feeding) children, while families are
able to feed more in the house.
... ”If I intervene, XX and YY for
1.5 months ..” (P 8)
.... ”Menyuapin while
Pattern Toddler Feeding
Feeding patterns up to 5 times a
day, special tips for children to eat by
playing, or disuapin while the
streets ...” (P.5)
... ”While watching TV at home
alone...” (P.7)
adding sambal (chili) and local food
86
c.
How to increase children’s appetite
... ”I was shopping at markets or
by adding chili to the fry vegetables.
stalls practical nuggets, sausage
noodle satu... never take vegetables
A mother of a poor family in
the vegetables add chilli to increase
around the house... troublesome...”
(P8)
appetite,while the family’s mother
was able to not mention specific
efforts to improve the child’s
appetite.
... ”My son wants sauce, if not life
gravy sauce... not exhausted
d.
3.
Behavioral Health Keeping Yourself
Toddler
a.
Bathe the child every time his dirty
Santen, I love chili 2 seed, his son
wants tuh, no problem... (Meaning
Mother bathing more than 2 times
no abdominal painor pungency)...”
(P. 3)
... ”Kids like to play in mud, then
... ”I let it go... yaa... nanti when
after I finished playing immediately
washed... could be 3 times or
hungry will eat ...” (p.10)
more when dirty ...” (P.1)
a day.
While the toddler of the family can
afford, simply bathed 2 times a
Food processing (side dishes and
day.
vegetables) are from around the
house or rice field.
...”Yes ordinary bath 2 times,
morning and afternoon soap alone
child health..”
Types of side dishes and vegetables
taken from the environment around
the house or rice field around a
b.
The habit of always brushing your
family residence, while the family
was able to choose an instant.
teeth with boiled water
Brushing the teeth is still
supported by the
mother, at
... ”Father looking for catfish in the
field... otherwise yes... wader.. for
least 2 times a day anduse boiled
water, as mentioned in the following
side dish” (P.3)
expression:
...”Vegetable cassava leaves and
’elung’ (leaves of sweet potato or
...”Grab a glass, rinse with water
sweet potato) and ’gori’ (jackfruit)..”
(P.5)
mateng tell, if it’s okay ketelan..”
(P.4)
... ”Some times cook ’potato ireng’
or ’potato kleci’ ... or simply boiled
also been good ... just.” (P.4)
|
|
87
c.
The habit of always wearing
... ”Children are
footwear while playing.
of ... playing the maid during the
day, I work ...”(P.7)
... ”Kids playing in the front yard,
sometimes beyond... playing-dirty
c.
care
Tool used games former plaything
playing using sandals...” (P.3)
of his brother
The habit of wearing sandals is
Simple play thing owned and used
rarely performed in the family is able
to:
to belong to an older brother or
sister who is the same age
...”Remove your sandals when
belong, while the family was always
able to buy new toys,according to a
playing on mud yaa...” (P.5)
4.
taken
statement as follows:
Parenting Behavior
... ”Tool used games ... his brother’s
bike, still good ...” (P.1)
a.
... ”No cars, the remains of his
Take along a child while working
brother ...” (P.4)
Mother and child while working to
Family able to state:... ”... I bought a
bring into the fields, while the family
was able, toddlers cared for by
new bike. But sometimes playing
games,.. ... ”(P.6)
attendants all day.
... ”...If the rice fields. I take
it, that work just weed ... ”(P.5)
... ”Yes ... There who keep at home,
my maid...., I came home from work
b.
Health maintenance and help-seeking
behavior when a child is sick.
Maintenance is done by the mother’s
at 15:00"
own health with simple treatments using
traditional medicines.
A watchful eye on the condition
a.
Simple maintenance and use of
of danger when playing
traditional medicine
Mother families are not able to
do very strict supervision, while my
If a child is sick, the mother to give
more attention and use of traditional
family was able to nurture carried by
the maid:
medicine:
... ”My house by the roadside, at
concerned, usually eat eel dishes...”
(P.5)
06.00 am ready to take care of
children.... I could not careless if the
child is awake... all the attention to
him...” (p.2)
88
5.
... ”If a child is sick, the food is
... ”Midwife rarely check... if
diarrhea, use of salt... or guava
leaves...” (P.1)
... ”In love onions and vegetable
field. The practice of adding chili, especially
oil packaging, attached .. (P.4)
capcasain content can improve health, kills
cancer cells and stabilize cholesterol
But there is if his sick mother
immediately brought to the doctor
and midwife, it looks like the
following statement: ”... to bring the
child
to
the
pediatrician
immediately...” (p.10)
b.
(Rusman, 2014) and the spicy taste can
improve children’s appetite. Mother familiarize
bath up to 3 times, rinse with lukewarm
water when brushing your teeth and putting
on footwear while playing. Bath, keeps the
body clean and comfortable so nap more
Mothers bring their own children to
posyandu
soundly, rinse withlukewarm water using a more
secure and custom footwear prevent worm
All mothers of poor families always
diseases. Mother carrying child while working in
the fields, and supervisechildren playing, the
bring their children to the
neighborhood health center,
use of games owned sister or brother of the
same age.Age of the children is the golden
unless there is an event that can not
be left behind while thefamily’s
period, needed love and attention and
stimulation (Noorastuti, 2012). When sick
mother was never able to bring their
own children to a neighborhood
mother gave special attention and use of
traditional medicine for mild pain. Guava leaf
health center.
decoction can inhibit the growth of Escherichia
coli and stphylococcus aureus that are anti-
... ”I own that brought the child to
the neighborhood health center, get
to knowthe scales ..” (P.4)
... ”I could never work... posyandu...”
(P.6)
diarrhea; primarily caused by infection
(Father Mother, 2014).
Some of the advantages of positive
deviance method is obtained quickly provide
solutions, affordable family, do not need to
rely on outside resources to practice new
Discussion
Positive deviance is used to describe a
state of positive deviation related to health,
growth and development, parenting in particular
children with other children within the same
community or family. Some solutions to address
thenutritional problems already exist within the
community, just need to be known observed
positive deviation form practiced covering any aspect.
This study found a toddler feeding
practices of poor families that eat 5 times a
day frequency is given while playing and
add the chili vegetable soup, side dishes and
vegetables come from around the house or rice
behaviors, much more cost effective,
participatory, and original,because the solution
is already in place and could Culturally
accepted. In Indonesia, positive deviance
studies have been carried out by Jauhari, et al
(2000) in Jakarta, Bogor and Lombok, the
results showed maternal interaction with
children aged 6-17 months was positively
related to the nutritional state of children.
Children who always strived to consume
food, get a response whenchattering, always
got a smile from the mother, better nutritional
statecompared with their peers who received
less parental attention.
|
|
89
Conclusion
Positive behavior practiced by mothers of
poor families with well-nourished infants in this
study
include
breast
feeding from
birth and complementary
feeding from
6 months which made
instant and local
materials, the frequency of eating 5 times a
day is given as you play and add to
the chili vegetable soup, side dish and
vegetables come from around the house or rice
field.Mother familiarize bath up to 3 times, rinse
with lukewarm water when brushing your
teeth and putting on footwear while playing.
Mother carrying child while working in the
fields, and supervise children playing, the use of
games owned sister or brother of the same
age. When sick mother gave special
attention anduse of traditional medicine for
mild pain.
90
OXYTOCIN MASSAGE IN INCREASING BREAST MILK PRODUCTION OF
POSTPARTUM MOTHER IN MERGANGSAN PUBLIC HEALTH SERVICE CENTER OF
YOGYAKARTA IN 2014
Warsiti1, Lilis Wijayanti2
STIKES Aisyiyah Yogyakarta,Indonesia
E-mail: Stikesaisyiyah.warsiti@gmail.com
ABSTRACT
Introduction: Breast feeding and breast milk play important role in children health
development and significantly affect the decrease of children death rate which becomes the
4th MDG’s target. Breast milk is a kind of food which suffices all baby’s physical, psychological,
social and spiritual needs. WHO, in Health Department (2012), mentions that in 2012, breast
milk scope in many countries was still less than 80%. In Indonesia, exclusive breast milk
scope is only 32% and is on the 10th rank among 18 countries which join The Association of
Southeast Asian Nations and Regional Committee for South-East Asia. The research aims
at revealing the influence of oxytocin massage on breast milk production of postpartum
mother in Mergangsan Public Health Service Center in 2014.
Methods: The research uses Quasi Experiment method with Static Group Comparison.
The samples are 30 postpartum mothers with purposive sampling technique which comprises
of 15 experiment group respondents and 15 control group respondents.
Result: Data analysis uses Chi Square test. The research reveals that oxytocin massage
increases breast milk production of postpartum mother effectively which is shown in the
value of p=0.032
Conclusions: oxytocin massage increases breast milk production of postpartum mother
effectively
Keywords: breast milk production, oxytocin massage.
91
Introduction
There are many factors which influence
Breast feeding and breast milk play
exclusive breast milk feeding such as the myth
important role in children health development
or society’s perception, breast milk blocking after
and significantly affect the decrease of children
delivery/the small amount of breast milk, baby’s
death rate which becomes the 4th MDG’s target.
problem in sucking breast milk, mother’s
Breast milk is a kind of food which suffices all
problems with her nipples, working mother and
baby’s physical, psychological, social and
the influence of promotion on breast milk
spiritual needs. WHO, in Health Department
substitute (Mardiyaningsih, 2010).
(2012), mentions that in 2012, breast milk scope
in many countries was still less than 80%. In
Indonesia, exclusive breast milk scope is only
32% and is on the 10th rank among 18 countries
which join The Association of Southeast Asian
Nations and Regional Committee for South-East
Asia
The fact shows that the slight breast milk
production and ejection in the first days after
delivery becomes a problem in early breast
feeding. According to Cox (2006), mother who
is unable to breast feed in the first days is caused
by mother’s anxiety and fear on the limited
breast milk production and also mother’s limited
The government has enacted Government
knowledge on breast feeding process
Policy No 33 (2012) about Exclusive
(Mardiyaningsih, 2010). Mother’s anxiety and
Breastfeeding. In the policy, the government
fear decreases oxytocin hormone production,
states that every baby born must feed exclusive
thus breast milk is unable to come out directly
breast milk in which breast milk is given to the
after delivery and eventually, mother decides to
baby after delivery for 6 months without adding
give milk substitute to her baby (Putri, 2010).
and/or replacing breast milk with any other food
or beverages (Kemenkes, 2012).
Oxytocin massage is one of the solutions
to solve the breast milk disfluency. Oxytocin
According to SDKI survey result in 2012,
massage is a massage on the whole backbone
exclusive breast milk scope in Indonesia is only
(vertebrae) and is an effort to stimulate oxytocin
27,1%. This number is considered as very low
hormone after delivery (Biancuzzo, 2003;
since the exclusive breast milk feeding scope
Indiyani, 2006; Yohmi & Roesli, 2009 in
is 80% (Riskesdas, 2012). In Yogyakarta
Mardiyaningsih, 2010).
Province, exclusive breast milk percentage in
Methods
2011 is 49,5% in which Bantul District is 63,5%,
Kulon Progo is 58,0%,Gunung Kidul 44,8% and
This research uses Quasi Eksperimen
Sleman 42,3%, while Yogyakarta is 46,4%
Static Group Comparison method in which
(Dinkes DIY, 2013).
experiment group receives intervention
(oxytocin massage) which is followed by
92
measurement or observation (breast milk
comprises of 15 respondents as the experiment
production)the observation result is then
group and 15 respondents as control group.
controlled or compared to observation result in
Oxytocin massage intervention is done 2 times
control group which receives no intervention.
in a day for 3 days which is done by family.
The samples are all postpartum mother who
data analysis uses Chi Square test.
were treated in delivery ward in Mergangsan
Result
Publich Health Service Center of Yogyakarta.
1.
The samples were taken by using purposive
Respondent Characteristics
sample technique. There are 30 samples which
Table 1. Respondent Characteristics based on Age, Parity and LILA in Mergangsan
Public Health Service Center of Yogyakarta in 2014
No
1
2
3
1
2
1
2
Characteristics
Age
< 20 years old
20 - 35 years old
> 35 years old
Total
Parity
Primipara
Multipara
Total
LILA
23,5 – 26,5 cm
>26,5 cm
Total
Based on table 1, it is revealed that
Group
Experiment
Control
f
(%)
f
(%)
2
10
3
15
13,30%
66,70%
20,00%
100%
1
12
2
15
6,70%
80,00%
13,30%
100%
6
9
15
40,00%
60,00%
100%
4
11
15
26,70%
73,30%
100%
15
0
15
100%
0%
100%
12
3
15
80,00%
20,00%
100%
2.
Breast feed production in Postpartum
the respondent characteristics in both
Mother in Control Group
groups have the same scope tendency/
Table 2. Frequency Distribution of
Postpartum Mother based on Breast
homogeny in the characteristics of age,
Milk Production in Control Group in
Mergangsan Public Health Service
parity and upper arm circumference (LILA)
which is more in healthy reproductive age
Center of Yogyakarta in 2014
(20-35 years old), multi-parity and LILA in
normal number.
No
1
2
Breast Milk
Production
Sufficient
Insufficient
Total
|
Frequency
Percentage
11
4
15
73,30%
26,70%
100%
|
93
Based on table 2, it is revealed that
Statistic test result using Chi-Square
from 15 postpartum mother respondent in
test shows p value = 0,032 (p value <
control group, there are 11 respondents
0,05). This result indicates that there is
(73,3%) who are included to have
influence of Oxytocin Massage on Breast
sufficient breast milk.
Milk Production in Postpartum Mothers in
Mergangsan Public Health Service Center
of Yogyakarta in 2014.
3.
Breast Milk Production in Postpartum
Mother in Experiment Group
According to the research result, it is
revealed that from 15 respondents who
are given oxytocin massage intervention,
all of them (100%) belong to sufficient
category of breast milk production. Based
on the observation, it is revealed that the
baby’s weight increase in the 15th day is
400 gram compared to baby born weight.
4.
The Influence of Oxytocin Massage on
Breast Milk Production in Postpartum
Mothers in Mergangsan Public Health
Service Center of Yogyakarta in 2014
Table 3. The Influence of Oxytocin
Massage on Breast Milk Production in
Discussion
The results shows that breast milk
production in postpartum mothers who are not
given oxytocin massage intervention in which
of 15 respondents who have enough milk
production there are 11 respondents (73.3%)
and respondents whose breast milk production
was not quite much are 4 respondents (26.7%)
with an average baby weight gain on the 15th
day is 200 grams
Based on the characteristics of the
respondents, from 11 people who have enough
breast milk production, multipara, are 9
respondents (81.8%). The success of lactating
mothers on the earlier lactation makes mothers
more confident to succeed in the current
Postpartum Mothers in Mergangsan
Publich Health Service Center of
lactation. The confidence stimulates the
Yogyakarta in 2014
hormone oxytocin so that breast milk can be
Group
Experiment
Control
N
15
15
Value
Asymp. Sig
(2-sided)
4,615
0,032
released smoothly (Mardiyaningsih, 2010).
According to Arini (2012) it is 35 years old
mothers or more closely related to anemia of
nutrition that can affect milk production
compared to younger mothers (20-35 years old),
over 35 years old women will face many
obstacles such as limited breast milk production
and fatigue (Lester, 2012). This age range,
94
including in young adults, in which this period,
into the blood. This Oxytocin causes the cells
the growth of the body function is at optimum
around the alveoli to contract miopitelium and
level. With the optimal body function, the mother
stimulate the breast milk to flow from the alveoli
can breastfeed their babies with few obstacles
to duktuli towards sinus and then is sucked by
bodily functions.
the baby’s through nipples. The smoother breast
Based on the size of MUAC, the majority of
respondents in control group have LILA size in
the range of 23.5 - 26,5cm and of the 12
respondents with upper arm circumference size
in the range of 23.5 - 26,5cm most of them, that
are 8 respondents (66.67%) show improvement
in average body weight of 200 grams and the
milk release the more breast milk production.
As stated by Mardiyaningsih (2010) that by
giving oxytocin massage, mother will feel
relaxed, more comfortable and fatigue will
disappear after childbirth and also by giving
oxytocin massage it will stimulate the oxytocin
hormone and breast milk is easily released.
respondent with MUAC> 26.5 cm average, the
This result is in accordance with the results
baby’s weight increase is by 300 grams
of Rusdiarti’s (2014) research entitled “The
compared to birth weight. This shows that with
Effect of Oxytocin Massage in Postpartum
better nutritional status, the more the production
Mothers on Breastfeeding Release in Jember”.
of breast milk is produced. However, this study
Based on the calculations using SPSS it reveals
does not assess the nutritional scope or
p value 0.000 <á 0.05 or (5%) which means that
mothers’ nutritional intake scope during 2 weeks
there is the influence of oxytocin on breast milk
of postpartum.
release in postpartum mother.
The results shows that milk production in
In addition to the factors of oxytocin
mothers postpartum massage intervention
massage in this study, breast milk production in
oxytocin all of them (100%) have adequate
the experimental group is sufficient because of
breast milk production and the statistic test
other factors related to the characteristics of the
results using Chi-Square test reveals p value =
respondents. Based on the parity status of the
0.032 (p value <0.05)
multipara (60%), the average weight gain in
The result of this study indicates that by
giving oxytocin massage it facilitates more
breast milk production in postpartum mothers.
Oxytocin massage performed on the mother’s
back
gives
comfort
to
the
infants in multipara respondents is 400 grams,
whereas in primipara is only 300 grams. This
result suggests that breast milk production in
multipara is more than in primipara.
mother.
Age and nutritional status of the mother can
Physiologically, it stimulates oxytocin reflex or
affect breast milk production. The results of the
let down reflex to secrete the oxytocin hormone
study in most of the experiment respondents
|
|
95
aged between 20-35 years old are 10
respondents (66.7%). The growth body function
of mothers aged 20-35 years old is at the optimal
level. This result is reinforced by the results of
Purnama’s research (2013) showing that breast
milk is influenced by mother’s age with most
maternal age are in the age range of 20-35 years
old (Purnama, 2013) .
Based on the size of MUAC, in the
experimental group, all respondents (100%)
References
Bappenas (2011) Laporan Pencapaian Tujuan
Pembangunan Milenium di Indonesia.
Tersedia
dalam
:
<http://
www.bappenas.go.id/files/1913/5229/9628/
laporan-pencapaian-tujuan-pembangunanm i l e n i u m - d i - i n d o n e s i a 2011__20130517105523__3790__0.pdf>
[Diakses 01 Februari 2014]
have LILA size in the range of 23.5 to 26.5 cm.
Dinkes DIY. (2013) Profil Kesehatan Propinsi
D.I. Yogyakarta. Yogyakarta : Dinkes DIY
This means that the nutritional status of all
Dinkes Kota Yogyakarta (2013) Profil Kesehatan
respondents in both experimental groups is in a
good condition. This is in line with Nugroho
Kota Yogyakarta. Yogyakarta : Dinkes Kota
Yogyakarta
(2011) which states that nutrition in breast
Kemenkes (2012) Peraturan Pemerintah
feeding mothers is closely associated with
Republik Indonesia Nomor 33 Tahun 2012
Tentang Pemberian Air Susu Ibu Eksklusif.
Jakarta : Kemenkes RI
breast milk production, which is needed for the
growth and development of infants.
Conclusion
The research result shows that of 15
respondent groups postpartum mothers who are
Lestari. A. 2012. Motivasi Ibu bekerja dalam
Memberikan ASI Eksklusif di PT. Dewhirst
Men’s Wear Indonesia. Students e-journals
vol 1, No 1 (2012). Bandung : FIK
Universitas Padjajaran
given oxytocin massage, all of them (100%)
have sufficient breast milk production. There is
Mardiyaningsih, E. (2010) Efektifitas Kombinasi
influence of oxytocin massage on the increase
Teknik Marmet Dan Pijat Oxytocin Terhadap
Produksi ASI Ibu Post Seksio Sesarea Di
breast milk release process with p value = 0.032
(p value <0.05).
Rumah Sakit Wilayah Jawa Tengah. Tesis,
Purnama, R. 2013. Efektivitas Antara Pijat
Oxytocin dan Breast Care terhadap
Produksi ASI pada Ibu Post Partum dengan
Sectio Caesarea di RSUD Banyumas.
Skripsi. Universitas Jenderal Soedirman
Fakultas Kedokteran Dan Ilmu-Ilmu
Kesehatan
Purwokerto
96
Jurusan
Keperawatan
Putri, T. (2010) Mengapa ASI Tak Langsung
Keluar. Tersedia dalam : <http://
kesehatan.kompas.com/read/2010/01/07/
1
2
2
0
4
0
6
0
/
Mengapa.ASI.Tak.Langsung.Keluar>
[Diakses 24 Januari 2014]
Riskesdas (2011) Data Cakupan ASI. Tersedia
dalam : <http://www.riskesdas.go.id>
[Diakses 24 Januari 2014]
Survey Demografi dan Kesehatan Indonesia
(2012)
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97
MOTIVATION, ADAPTATION, AND THE FAMILY ROLES: A QUALITATIVE CASE
STUDY OF CHRONIC RENAL FAILURE
Tassyah Devina Rayani1, Yoyok Bekti Prasetyo2, Nurlailatul Masruroh3, Edi
Purwanto4
School of Nursing, Faculty of Health Sciences, University of Muhammadiyah Malang
E-mail: yoyok@umm.ac.id
Introduction: Chronic renal failure is a progressive destruction of the kidney structure which
happen continuously. Common problem for CRF patient is generalized weakness and edema.
The treatment is requiring hemodialysis and rigorous treatment with the support of family.
The purpose of this study was to determine how to treat the patient with CRF using a family
approach.
Methods: This study was a qualitative research using a case study approach. Sample of
this study were patients who were diagnosed with a chronic renal failure for 7 years and had
been doing hemodialysis for approximately ± 2604 times. The data were gathered using
interview, observation, documentation, and data analysis.
Result: The results of this study identified three themes, namely 1) Treatment of chronic
renal failure with hemodialysis, 2) Treatment of chronic renal failure at home, 3) Client’s
motivation with chronic renal failure.
Conclusions: Treatment of chronic renal failure with hemodialysis should be done by patients
to improve their quality of life. In addition, treatment of chronic renal failure at home is
believed to maintain the stability of the patient’s condition. High motivation to patients is
believed to improve the quality of life.
Keywords: chronic renal failure, family roles.
99
Introduction
According to Corwin (2009), Chronic renal
failure is a progressive destruction of the kidney
structure which happen continuously. In
During the process of data collection,
researchers recruited families as clients (.
Through this approach, the researcher obtained
the data needed to conduct research.
addition, according to Baradero (2008), CRF is
Based on the interviews results with the
a progressive deviation of kidney function which
respondents with chronic renal failure patients,
cannot be recovered, where there is a failure
Mr. S (61 years), the respondents suffered from
on body’s ability to maintain metabolic balance
chronic kidney disease for 7 years and he also
and fluid and electrolyte which is resulting in
claimed to have had a kidney stone operation
uremia. Chronic renal failure is a terminal
in 2007 and had performed hemodialysis or
disease when there is a decreasing kidney
dialysis for 7 years (± 2604 times hemodialysis).
function in regulating the metabolic balance of
Based on the interviews with the respondents’
fluid and electrolytes in the body.
family, the family is very active in providing care
The United States Renal Date System
(USRDS)’s report in 2007 showed an increasing
in the population of patients with chronic renal
failure in the United States compared to previous
years, where the prevalence of chronic renal
failure patients reach 1,569 people per million
population (Butar & Siregar, 2007). While the
number of patients with kidney failure in
Indonesia is relatively high, reaching 300,000
people. However, not all patients can be handled
to the respondent. One of them is the family
plays an active role in controlling the types of
foods which can be consumed, limiting fluid
intake, and providing insight to the respondent
for not doing heavy activity, and controlling
medicine administration for the respondent. In
addition, the family also plays an active role in
providing motivation to respondents because the
family believes that the great spirit can improve
the quality of life of the respondents.
by the medical personnel. Approximately 25,000
Based on the above discussion, it can be
new patients who can be treated, which means
concluded that there are still several patients
that there are 80% of patients were completely
(80%) with chronic renal failure in Indonesia who
untouched by the proper treatment (Susalit,
have not received treatment. The important role
2012).
of the family in providing care to patients with
This study uses a systems approach to
nursing homes. Family nursing approach
consists of four types of approaches. They are
a family context, the family as a client, family as
a system and the family as a social component.
chronic renal failure is believed to help people
to improve their health status. Therefore, the
researchers wanted to explore more about how
to deliver a proper care which is given by the
family to a chronic renal failure patient to improve
the quality of life of patients.
100 | Building Transcultural Nursing in Education and Practice to facing Asean Community 2015
Motivation, Adaptation, and the Family Roles: A Qualitative Case Study of Chronic Renal Failure
Methods
“... I don’t want to. If the speed is too
fast, my heart could not bear with it “(W /
The design of this study is a qualitative
Tn.S / 09/07/14).
study using case study approach. This research
was conducted in Mr. S’s family in PHC Dinoyo
“... I do understand because I have been
Malang.
diagnosed this disease for 7 years” (W /
Tn.S / 09/07/14).
Results
1.
Theme I : Treatment of chronic renal
2.
Theme II : Treatment of chronic renal
failure at home
failure with hemodialysis
Hemodialysis is one way that can be
done to improve kidney function in patients
with chronic renal failure. However, there
are some hemodialysis machine that can
cause discomfort to the patient.
Treatment of chronic renal failure at
home is also important. The role of the
family in providing care to family members
who suffer from chronic kidney disease is
very important for the provision of
treatment of chronic renal failure at home.
“... I will discontinue the treatment if I
feel pain. I’m not strong “(W / Tn.S / 09/
07/14).
“... I should not do heavy chores, my
mother also reminds me. She usually
control my diet, what should I eat and I
“... I was not strong. I felt dizzy “(W /
should not eat. I should not drink plenty
Tn.S / 09/07/14).
of water “(W / Tn.S / 09/07/14).
“... I will discontinue the treatment one
“... when I collapsed, my mother will
hour before it finish” (W / Tn.S / 09/07/
refer me to the hospital to do
14).
hemodialysis. “(W / Tn.S / 09/07/14).
“I always watch over my father. He
In addition, experience in
performing hemodialysis patients can
should not work too hard. He also
also improve patients’ knowledge
cannot eat carelessly “(W / Ny.S / 17/07/
associated with hemodialysis.
14).
“... I have a similar body weight before
“... he should not drink plenty of water”
(W / Ny.S / 17/07/14).
and after the procedure “(W / Tn.S / 09/
07/14).
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101
3.
Theme III : clients’ motivation with chronic
renal failure
Motivation is very important in
promoting the spirit of the client’s life. The
high motivation of the patient could
increase the patients’ quality of life.
“I love my grandchildren very much.
Sometimes I asked my son to bring
them to my house to cheer me up “(W /
Tn.S / 09/07/14).
After undergoing hemodialysis, the patients will
feel more relaxed. These changes are due to
toxic substances in the blood has been
removed; also fluid in the patient’s body has
been secreted (Supriyadi, Wagiyo, & Widowati,
2011).
Based on the theory above, there are
similarities between the theory and the
participants’ condition. Participants (Mr .S) also
experience things described in theories such as
breathlessness and chest pain and tightness of
“He loves his grandchildren. They
chest pain which are complication of chronic
usually come over his house. He wants
kidney disease. However, after performing
to keep alive to see his grandchildren
hemodialysis, chest tightness and pain is
grows “(W / Ny.S / 17/09/14).
reduced. This proves that hemodialysis is very
important to be done to reduce the complications
Discussion
Treatment of chronic renal failure with
in patients.
Treatment of chronic renal failure at home.
hemodialysis.
It is not easy for people with kidney failure
According to Corwin (2009) Hemodialysis
is a process which is used on acutely ill patient
and require dialysis therapy short-term (a few
days to a few weeks) or patients with terminal
stage renal disease (ESRD: end-stage renal
disease) who require treatment for a long period
or permanent therapy. Hemodialysis process
takes approximately 4-5 hours and generally
lead to physical stress, the patient will feel
fatigue, headache, and cold sweat due to
decreased blood pressure. Patients with chronic
renal failure will feel discomfort, tightness,
edema, chest pain, nausea or even vomiting,
and muscle cramps which is resulting in severe
who undergo a strict diet and perform a healthy
lifestyle. Weight loss, weakness (fatigue) and
loss of muscle mass in chronic renal failure
patients are often diagnosed as malnourished,
but the disorder is a consequence of metabolic
processes that occur in chronic renal failure, not
because of lack of nutrition (Kuhlmann, 2007).
The diet in patients with kidney disease focused
on controlling the intake of energy, protein, fluid,
electrolytes sodium, potassium, calcium, and
phosphorus contained in everyday foods (Uyun
& Brahmantio, 2011). Based on the theory
described, there are similarities between the
theories with participants. Mr. S with the help of
pain (Supriyadi, Wagiyo, & Widowati, 2011).
Motivation, Adaptation, and the Family Roles: A Qualitative Case Study of Chronic Renal Failure
his wife (Ny. S) also controls the intake of dietary
chronic renal failure. Performing routine
and fluid restrictions daily. This is one way of
hemodialysis is important in order to improve
participating family in providing care to
the quality of life of patients. Treatment of chronic
participants who suffer from chronic renal failure.
renal failure at home can be done by controlling
Motivation of client with chronic renal failure.
the dietary intake of patients, limiting the amount
of liquids, and limit heavy chores. It is believed
Assessing sources, coping strategies, and
to maintain in order to stabilize the condition of
family processes provide a foundation to help
the patient. High motivation is needed by
families adapt and achieve a higher degree of
patients with chronic renal failure which is mainly
well-being. Achieve a higher degree of well-
sourced from partner, family and friends. The
being is the purpose or reason for the existence
high motivation given by the family will also
of family nursing practice. Strengthening and
increase the patients’ spirit in improving their
encouraging response and adequate adaptive
quality of life.
capacity, and reduce the actual and potential
stressors from within and outside the family is
Acknowledgments
part of the broad purpose and scope of this
dr. Bayu Tjahjawibawa Head of Puskesmas
(Friedman, 2010). The spirit of life for patients
Dinoyo Malang and Elief Yuniarti, S.Kep., Ns
with chronic renal failure is very important to
as a community nurse who has provided
carry out routine hemodialysis. The spirit of life
opportunities for researchers to conduct this
derived from the support of a spouse, family,
research as well as assisting during the research
friends and caregivers of hemodialysis. Support
process.
is very important is the support of a partner, if
the support weakened, the patient could rapidly
decreased physically and psychologically
(Raziansyah, Widyawati, & Utarini, 2012).
References
Baradero, Mary., Wilfrid, Mary., & Dayrit. (2008).
Klien Gangguan Ginjal). Jakarta : EGC.
Based on the theory described there are
similarities between the data of the theory with
the data obtained from the participants.
Participants (Mr. S) considered his family as the
biggest motivation when suffering chronic renal
failure and undergoing hemodialysis.
Butar, Agustina., & Siregar, Cholina Trisa.
(2007). Karakteristik Pasien dan Kualitas
Hidup Pasien Gagal Ginjal Kronik yang
Menjalani Terapi Hemodialisa. Vol. 2, No.3.
Corwin, Elizabeth J. (2009). Buku Saku
Patofisiologi. Jakarta : EGC
Conclusion
Haemodialysis is a therapy to replace renal
function which must be done by patients with
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103
Friedman, Marilyn M. (2010). Buku Ajar
Saryono. (2010). Metodologi Penelitian Kualitatif
Keperawatan Keluarga : Riset, Teori, &
dalam Bidang Kesehatan. Yogyakarta :
Praktik. Jakarta : EGC.
Nuha Medika.
Gilliss, C.L., Rose . D. B., Hallburrg, J. C., &
Soemantri,S. (2012). Panduan Lengkap
Martinson, I. M. (1989). The Family and
Mencegah dan Mengobati Serangan
Chronic illness. In C. L. Gilliss, B. L. Higley.
Jantung, Stroke, dan Gagal Ginjal.
B. M. Roberts, & I. M. Martinson (Eds.),
Yogyakarta : Araska.
Toward a Science of Family Nursing (pp.
287-299). Menlo Park. CA: Addison-Wesley.
Supriyadi., Wagiyo., & Widowati, Sekar ratih.
(2011). Tingkat kualitas Hidup Pasien gagal
Kamaluddin, Ridlwan., & Rahayu, Eva. (2009).
Ginjal Kronik Terapi Hemodialisis. Jurnal
Analisis Faktor-Faktor yang Mempengaruhi
Kesehatan Masyarakat, Vol. 6, No.2, 107-
Kepatuhan Asupan Cairan pada Pasien
112.
Gagal Ginjal Kronik dengan Hemodialisa di
RSUD Prof. Dr. Margono Soekarjo
Purwokerto.
Jurnal
Sugiyono. (2010). Metode Penelitian Pendidikan
Pendekatan Kuantitatif, Kualitatif dan R&D.
Keperawatan
Bandung : Alfabeta.
Soedirman, Vol. 4, No.1, Maret 2009.
Uyun, Shofawatul., & Hartati, Sri. (2011).
Penentuan Komposisi Bahan Pangan
Metodologi Penelitian Keperawatan
Untuk Diet Penyakit Ginjal dan saluran
Pedoman Skripsi, Tesis, Dastrument
Kemih dengan Alogaritma Genetika. Jurnal
Penelitian Keperawatan. Jakarta : Salemba
Ilmu Gizi, Vol. 3, No. 2.
Medika.
O’Callaghan, Chris. (2006). At a Glance Sistem
Wright. L,M., & Leahey,M. (2004). Nurses and
Families : A Guide In Family Assessment
Ginjal, Edisi Kedua. Jakarta : Erlangga.
and
Dalam. Jakarta : FKUI.
Raziansyah., Widyawati., & Utarini, Adi. (2012).
(3 rd
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Philadelphia:Davis.
Perhimpunan Dokter Spesialis Penyakit Dalam
Indonesia. (2005). Buku Ajar Ilmu Penyakit
Intervention
Yin,
Robert.
K.
(2004).
Case
Study
Research,Design and Methods, Third
Edition. Sage Publications, Inc. California.
Pengalaman dan Harapan Pasien yang
Menjalani Hemodialisis di RSUD Ratu
Zalecha Martapura. Jurnal Manajemen
Pelayanan Kesehatan, Vol.15, No.2.
THE PERCEPTIONS OF NURSE STUDENTS TO THE LEARNING ENVIRONMENT
UNIVERSITY OF MUHAMMADIYAH SEMARANG BASED ON DUNDEE READY
EDUCATION ENVIRONMENT MEASURE (DREEM)
Tri Nurhidayati, Desy Ariyana, Fatkul Mubin
Universitas Muhammadiyah Semarang
E-mail: trinurhidayatitrapsila@yahoo.com
ABSTRACT
Introduction: Learning environment is a major consideration of nurse professional program
to reform and improve the quality as an educational institution by providing a useful service.
This study aimed to evaluate the learning environment in the Nurse Program of Nursing and
Health faculty, Muhammadiyah University of Semarang.
Methods: The method used in this study was descriptive. The data collection used Dundee
Ready Education Environment (DREEM) instrument.
Results: The characteristics of respondents were as follows: female in majority, living in a
boarding house, unmarried, and unemployed. Nurse student perceptions of the learning
activities were above average (32.15), the advisory lecturers were good (39.19), the learning
achievement were good (31.24), learning atmosphere was good (42.32), and social problems
were fair (19:38).
Conclusions: The perceptions of Nurse Students on the learning activities was above
average, advisory lecturers were good, learning achievments were good, learning atmosphere
was comfortable, and social problems were fair. The management of Nurse Internship
programme of Unimus should improve the learning activities especially student-focused
activities by changing learning methods.
Keywords: DREE, perception, learning environment
Introduction
students. This provides the atmosphere and
Learning environment is a major
consideration of nurse professional program to
characteristics of educational institutions,
something which is suggested and affirmed as
reform and improve the quality as an
educational institutionby providing a useful
well as concerning the patterns of life that are
expressed and perceived. The students’
service. The learning environment is the overall
environment of an educational institution that
perceptions of the learning environment is very
useful as a basis for modifying and improving
is important for education providers and
the quality of learning. A Perception is a set of
processes that causes an individual to become
105
aware of his environment, and then interprets
in following clinical education, marital status,
the results of the information obtained.
Meanwhile, according to Robbins, a perception
place of residence, career choices, and student
learning achievement in the form of a
is a process by which an individual organizes
and interprets her/his sensory impressions to
cummulative achievement index during the
study (Emilia, 2008).
give meanings to their environment. Kreitner and
Knickl said that a perception is more a mental
Environment is also a part of marker factors.
and cognitive process that makes an individual
able to interpret and understand the surrounding
The learning environment in hospital is a unique
social context with special conditions for
environment (Sari, 2008).
practical learning and learning resources,
practical opportunities, and application of the
Students as learnurse who seek knowledge,
learn and interact in a educational institution will
knowledge and evaluation. The specific level of
independence (autonomy), good supervision
make an interpretation of the environment.
Meanwhile, as social beings, students need
and social supports, reasonable workload, role
clarity, variation in clinical experiences and
perceptions to adapt in continuing the life
(Sarwono, 2008). One of the most important
attentions to teaching and learning are the
learning conditions expected (Emilia, 2008,
perceptions is a perception of students toward
the learning environment (Sari, 2008, Kossioni.
Lokahetty. et al, 2010, Khan et al, 2010).
et al, 2012).
A process variable is described as an
Different perceptions of the learning
interaction between student characteristics and
attributes of clinical learning environment. This
environment are influenced by gender and
ethnic stereotypes, giving rise to variations in
interaction will result in a unique way in dealing
with the learning environment in the hospital and
interests, perceptions, expectations and reasons
for choosing a career. Gender that includes
in dealing with the burden of learning as well as
the possibility of stress. The success of students
men’s and women’s perspectives has a strong
influence in perceiving something. In addition,
in meeting the learning burden will affect the
approach and success of student’ learning
interest arises because of the presence of
motivation. Academic assessment and
demonstrated with the real achievement and the
perceptions of the achievements (Pinnock. et
achievement are strong motivators (Baldo. et
al, 2010).
al, 2011). Continuous changes of professional
learning strategy result in a need for a study on
In the Biggs’ model, learning is influenced
the evaluation of professional learning
environments to investigate the impact of the
by personal and environment variables, and
stress is considered as a barrier variable due to
the interaction between the students and the
environment/context.
The marker factors (presage according to
the Biggs’ term) when students are in learning
learning environment.
Objectives of the study determine Nurse
students’ perceptions of learning environment
based on DREEM in Muhammadiyah University
of Semarang.
environments include personal and
environmental/contextual variables. The
personal variables are gender, the time needed
The Perceptions of Nurse Students to the Learning Environment University of Muhammadiyah Semarang
Based on Dundee Ready Education Environment Measure (DREEM)
Methods
Table1.
Characteristics of respondents of
Nurse Students of Unimus in July
2013
The method used in this study was a
descriptive with survey . The population of this
study was Nurse Students of Muhammadiyah
Characteristic
University of Semarang. The sample were 102
students. The data collection used Dundee
Gender
Ready Education Environment (DREEM)
instrument. DREEM instrument had been
Recidency
translated and modified for the use of
professional learning situation. This instrument
Marital Status
consisted of 50 statements with 5 alternative
answers (5 Likert scale) that consisted of
Employment
Status
aspects of learning activities, lecturer, academic
achievement, learning atmosphere, and social
issues. The scores of positive question items
were strongly agree with a score of 4, agree
with a score of 3, doubtful with a score of 2,
disagree with a score of 1 and strongly disagree
with a score of 0. Nine of 50 items were negative
statements (4, 8, 9, 17, 25, 35, 39, 48, 50). The
interpretations of the scores on the negative
Not work
good, 151-200 for very good.
Results
1.
Characteristics of Respondents
Data that met the criteria were 86
respondents. The percentage of the respondent
characteristics
63
13
72
15
70
Based on Table 1, the majority of the
respondent’ characteristics was female, living
in a boarding house, married and unemployed
2.
Student perceptions described into 5 subscale scores and 1 total score of DREEM
Table 2.
Perceptions of Nurse Students of
statement were 0 for strongly agree, 1for
disagree, 2 fordoubtful, 3 for disagree, and 4
for strongly disagree. The overall interpretations
were 0-50 for poor, 51-100 for fair, 101-150 for
Male
Female
Own his/her
self house
Boarding
Married
Not married
Work
Total /
Percentage
22
63
22
Unimus by5 sub-scale in July 2013
Perception of
students
Learning activities
Educator
Academic
achievement
Learning atmosphere
Social problems
Total score
Value
32.15
39.19
31.24
42.32
19.38
164.28
Average
score
2.68
3.56
3.90
3.53
2.77
Based on Table2, learning environment had
the best score while the smallest score was
social problems.
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107
3.
Perceptions of Nurse Students of Unimus
based on statement items
Table 3.
Unimus on the statement item of
learning activities in July 2013
Learning activity item
I am encouraged to participate
in class (1)
The teaching is often stimulating
(7)
The teaching students is
student centres (16)
The teaching is sufficiently
concerned to develop my
competence(16)
The teaching is well focused
(20)
The teaching is sufficiently
concerned to develop my
confidence(22)
The teaching time is put to good
use (24)
I am clear about the learning
objectives of the course(38)
The teaching encourages me to
be an active learner (44)
Long-term learning is
emphasized over short-term
(4)7
Average
score
4.18
3.66
3.46
4.19
3.94
4.02
3.78
3.72
3.93
3.64
Tabel 4.
Perceptions of Nurse Student of
Unimus on the statement item of
educator in July 2013
Educator item
The teaching is student-centred
(2)
The teachers are patient with
patients (6)
The teachers ridicule the
students (8)
The teachers are authoritarian
(9)
The teachers have good
communications skills with
patients (18)
The teachers are good at
providing feedback to students
(29)
The teachers provide
constructive criticism here (32)
The teachers give clear
examples (37)
The teachers get angry in class
(39)
The teachers are well prepared
for their class (40)
The students irritate the
teachers (50)
Average
score
4.6
3.52
3.09
2.89
3.69
3.61
3.79
3.45
3.02
3.52
3.73
Based on Table 4, the highest score was
from the statement item No 2 ie lecturers have
Based on Table 3, the statement item no.
16 which is the practice of the profession
enough knowledge, while the statement item No
9 had the lowest score, ie lecturer is
helpeing to develop the competency received
the highest score, while the statement item No.
authoritarian.
13 which is student-focused learning activities
received the lowest score.
The findings were in line with Murdochetal
(2007) that learning activities affected the
learning atmosphere.
Tabel 5.
Tabel 6. Perceptions of Nurse Students of
Unimus on academic statement
item in July 2013
Unimus about the statement item of
learning atmosphere in July 2013
Average
score
I am confident about my passing
4.28
this year (10)
I feel I am being well prepared
3.98
for my profession (21)
Last year’s work has been a
3.93
good preparation for this year’s
work (26)
I am able to memorize all I need
3.41
(27)
I have learned a lot about
4.12
empathy in my profession (31)
My problem-solving skills are
3.92
being well developed here (41)
Much of what I have to learn
4.05
seems relevant to a career in
medicine (45)
Academical item
Learning atmosphere items
from the statement item No 10, ie, students are
confident that this year they get good grades,
whereas item No 41had the lowest score, ie,
problem solving skills.
The atmospheres is relaxed
during the ward teaching (11)
This school is well time-tabled
(12)
The atmosphere is relaxed
during the lectures (23)
There are opportunities for me
to develop inter-personal skills
(30)
I feel comfortable in class
socially (33)
The atmosphere is relaxed
during seminars/tutorials (34)
I find the experience
disappointing (35)
I am able to concentrate well
(36)
The enjoyment outweighs the
stress of studying medicine (42)
The atmosphere motivates me
as a learner (43)
I feel able to ask the questions I
want (49)
Average
score
3.34
3.67
3.26
3.96
3.86
3.56
3.71
3.54
3.05
3.68
4.0
from the statement item No 49, ie, getting the
opportunity to performa skill, whereas the
statement item No 42 had the lowest value, ie,
happiness to follow practices.
The findings were in line with a study by
Wilkinson (2006) and a study by Murdoch et.al
(2007) that practical experiences were more
powerful and had many factors like happiness
to follow the practices so that it required CI
character, friends in the group (Chan, 2002).
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109
Tabel 7. Perceptionsof Nurse Students of
Unimus about the statement item of
social problems in Juli 2013
Item of Social Problems
There is a support system for
students who get stressed(3)
I am too tired to enjoy this
course (4)
I am rarely bored on this course
(14)
I have good friends in this
school (15)
I seldom feel lonely (28)
My accommodation is pleasant
(46)
Average
score
2.69
improve the learning
atmosphere,
particularly the happiness during the
practice by giving facilities for counseling,
and improve the social interaction of
students, especially students who are too
tired during the practice by organizing the
stages and coordinating with CI of the
2.51
Hospital so that students do not solely
follow the routine activities of the Hospital,
3.01
but they are more emphasized to achieve
their competence.
4.27
Acknowledgements
3.49
3.49
Based on Table 7, the statement item No15
had the highest score, ie, having good friends,
Researchers would like to thank all
participants of the internship nurse programme
University of Muhammadiyah Semarang and
staff for assistance with piloting the
questionnaires.
whereas the statement item No 4 had the lowest
score, ie, students are too tired to follow practice.
References
This finding was in line with a study by Nolan
and Ryan (2006) stating that manystudents
Baldo, Hassan, M., Sharaf-Eldin, A.O., Abdullah,
D.I, (2010), Medical Education Measuring
the medical educational environment at
experienced stress due to too much workload.
Conclusions
1.
Perceptions of Nurse Students about the
learning activities were in upper average,
the supervising lecturers were good, the
learning achievements were good, the
learning environment were comfortable,
and the social problems were enough.
2.
The management of Nurse internship
programme of Unimus should improve the
learning activities, especiallystudentfocused activities by changing learning
Methods, improve educators, especially
the authoritarian attitude by training them
with positive feedback, improve academic
achievement, especially the problem
Alzaeim Alazhari University, Khartoum
Medical Journal Vol 03, No 03
Emilia, O, (2008). Kompetensi Dokter dan
Lingkungan Belajar Klinik. Yogyakarta:
Gadjah Mada University Press.
Fraenkel, J. & Wallen, N., (2009).How to Design
and Evaluate Research in Education. San
Fransisco: McGraw-Hill Higher Education.
Khan, A.S., Akturk, Z., Al Megbil, T., (2010)
Evaluation of the learning environment for
diploma in family medicine with the Dundee
Ready Education Environment (DREEM)
inventory, Journal Education Evaluation for
health profession vol 7 No 2
solving skills by applying clinical PBL,
Kossioni, A.E., Varela, R., Ekonomu, I., Lyrakos,
G., Dimoliatis, I.D. K., ( 2012), Students’
perceptions of the educational environment
in a Greek Dental school, as measured by
DREEM, European Journal of Dental
Education vol 16
Lokuhetty, M., Warakulasuriya, S., Perera, R.,
De Silva, H., Wijesinghe, H., ( 2010)
Students perception of the educational
environment in a medical faculty with an
innovative curriculum in Sri Lanka, South
East Asian Journal of Medical Education vol
4 no 1
Pinnock, R., Shulruf, B., Hawken, S., Hennis,
U., Jones, R., (2011) Student’s and
teacher’s perceptions of the clinical learning
environment in years 4 and 5 at the
University of Auckland, Journal of the New
Zealand Medical Association Vol 124 No
1334
Sari, D.N., 2008, Tingkat Persepsi Mahasiswa
Program Studi Pendidikan Dokter FK UGM
Terhadap Situasi Pembelajaran Studi
Berdasarkan DREEM: Kajian Berdasarkan
Persepsi Mahasiswa Angkatan 2007
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Belajar, Jurnal Pendidikan Kedokteran dan
Profesi Kesehatan Indonesia vol 3 No4
Sarwono, S. W. (2008) Teori teori psikologi
sosial, Edisi revisi. Jakarta: PT. Raga
Grafindo Persada.
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MEANING OF SPIRITUALITY IN PATIENTS WITH STAGE III CERVICAL CANCER IN
GYNECOLOGY INPATIENT WARD HOSPITAL DR HASAN SADIKIN BANDUNG,
INDONESIA
Inggriane Puspita Dewi
Nurse Bachelor Programme, Aisyiyah School of Healthy Bandung
E-mail: ine.stikes12@gmail.com
ABSTRACT
Introduction: Professional nurses view the humans as a whole including biopsychosocial
and spiritual aspects. Clients with cervical cancer have physiological effects, psychological,
social and spiritual. The purpose of this research is to gain a deep meaning of spirituality
patients with stage III cervical cancer.
Methods: This research is a qualitative research method case study, in which researchers
are trying to determine the meaning of spirituality in patients with stage III cervical cancer.
The total sample of eight people who come by purposive sampling technique.
Result: The results of this study found six theme of spirituality stage III Cervical Cancer
patients, namely 1) belief in the spiritual source, 2) how to meet spiritual needs, 3) the
meaning of pain, 4) social support on patient spiritual, 5) the meaning giving and receiving
affection, 6) hope and strength.
Conclusions: The pain and suffering of the patients gave a spiritual experience, the meaning
of God as a spiritual source, how to meet spiritual needs, the meaning of pain, the meaning
of love and hope and strength can vary influenced by the patient’s previous life experiences
and spiritual understanding of the patient. Besides pain also cause feelings of despair, so
that social support in the spiritual power stage III Cancer Patients is urgently needed, that
there is a deal with a sick patient and considered as a test or trial or regard the disease as a
form of God’s injustice toward him.
Keywords: cervical cancer, spirituality.
113
Introduction
Cancer is a chronic and progressive
disease, with the side effects of cancer treatment
can cause physiological,psychological and
spiritual effects. Physiological impact of
emerging as pain , weakness , impaired skin
integrity , nutrition less than the requirement ,
the risk of secondary infection often experienced
by sufferers , anxiety reactions appeared that
described the feelings of fear and guilt as a result
of actions in the past , grieving , body image
disturbance , as well as the issue of spiritual
distress1 .
This study aims to explore the meaning of
spirituality in patients who develop cervical
cancer stage III
Methods
This research using the Methods of
qualitative research to the type of case study ,
the researchers explore the spiritual meaning
in the case of patients with stage III disease
Cervical Cancer through in depht interview .
Researchers are looking for a purposive sample
( non- probability ) . Called non probability
because the study does not aim to generalize
The crisis in the face of chronic illness ,
the findings of the research . There is no
standard criteria regarding how the number of
suffering and death can cause spiritual distress2
. The characteristics of spiritual distress
respondents to be interviewed , but the number
is usually less than ten people1 The subject of
according to NANDA cited by Taylor , including
one or more of the following signs : difficulty in
this research will be taken from patients with
cervical cancer who were treated in the
defining the meaning of life and death , having
trouble sleeping or nightmares , reveal the
gynecology ward ( 17 C ) RS DR . Hasan Sadikin
. The number of informants were taken in this
values and beliefs conflict with his situation ,
inability to seek spiritual source and fulfillment
study was 8 people who meet the inclusion
criteria for women with stage III cervical cancer
of their needs , seek spiritual help , ask about
the meaning of pain and suffering , angry with
aged between 30 to 50 years , able to
communicate and express their feelings and be
God , not sure of his religion , irregularities or
mood disorders evidenced by crying , anger ,
willing to cooperate in this research .
withdrawal , suicide attempts , anxiety , feelings
of helplessness or apathy3.
People who suffer from chronic illnesses
often suffer as a result of lifestyle changes they
experienced . Feeling lonely in the face of these
circumstances can be a thing that is a threat ,
causing fear , anxiety and despair . A person
may be feeling lost his purpose in life and feel
no longer useful4.
Advanced cancer who require chronic long
time in the treatment . Progress of treatment or
Results
Characteristics of respondents in this study
is 8 respondents consisted of women aged
between 35 till 48 years old , all are married,
Moslems , with 3 widows , the rest still have a
husband . Experienced by respondents varied
wedding , even one time there were 3 times .
Highest educational background is a junior high
school.
The results showed some spiritual themes
obtained based on in-depth interviews.
cure of cancer clients one of which is determined
by the immune system. Where the immune
system is affected by one’s spiritual condition5 .
Meaning of Spirituality in Patients with Stage III Cervical Cancer in Gynecology Inpatient Ward Hospital
Dr Hasan Sadikin Bandung, Indonesia
Tabel 1. Respondents Spiritual Themes with Cervical Cancer Stage III
Spiritual Resources
The way to meet the spiritual
needs
Meaning of pain and suffering
Meaning of Pain and Suffering
THEMES
Source of Spiritual
Psychological feeling towards
Allah SWT that appears when
first diagnosed with cancer
Belief in Allah involvement in
answering his prayer
Perceptions of affection Allah
SWT
The habit of the respondents to
improve the spiritual ( faith )
The influence of pain on the
worship of the client as well as
the feeling that accompanies
Manner and purpose of prayer
annoying thing at this time due
to illness
The habit of the respondents to
improve the spiritual ( faith )
Spiritual source is Allah SWT
Sad , frightened , grieving feeling
unfairly
Believed that Allah SWT grant
her prayer
1. Allah SWT loves His servant
2 Desperate to Allah SWT
Prayer, du’a and dzikr
Fixed obligations except during
menstruation
The influence of the ill client
Not perform worship
Worship and feelings that
Feelings impure , dirty
accompany
Sense of sin
How to: pray the prayer or dzikr
Manner and purpose of prayer Purpose pray motivation to
recover
Fatigue
Annoying thing at this time due
Pain
to illness
Sleep disorders
Rest
It is normal people do to reduce
Crying or screaming
the suffering caused by illness
Begging to end his suffering
The scary thing from the current Fear of death
Lonely
state of the respondents
Chalenge,
Lessons from pain
Feeling sick as a bad luck
Angry
Sad
Feelings accompanying pain
Guilty
Shame
Do not want to be a burden to
Motivation to recover
others , Responsibility for the
The role taken by the husband ,
Changes in the role after feeling
son or brother , feeling
ill and accompanying
embarrassed , sad , worthless
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115
Results
How to meet the spiritual source and
spiritual needs
Spiritual source is a need for basic beliefs
or basic trust , are useful to raise awareness of
something higher than his power1 Source of
spiritual respondents in this study is Allah SWT,
according to the belief in Islam . Respondents
spiritual source is not separated from the role
of parents is crucial in a child’s spiritual
development . Parents eighth respondents in
this study are Muslims2.
Hospital as part of the psychological impact
of life issues such as sadness , anger , despair
and fear . This is experienced by the eighth
respondent , as the first reaction when
diagnosed with the disease3. Spiritual feelings
that accompany the psychological condition of
the respondents experienced when it looks
different . Six of the eight respondents perceive
that God as the source of spiritual still gives his
love even though he was in a state hospital . If
further examination , it is not apart from the
frequent ritual or religious messages that the
respondents obtained either from family or
Meaning of pain and suffering
All respondents claimed that before being
diagnosed with cancer , have symptoms of
vaginal discharge more than usual , while the
perceived symptoms appear different time
ranging from 4 months to 1.5 years before
diagnosis appeared . Feelings of pain being felt
as a result of bleeding often experience fatigue
, so that the activity day - the day began to fail ,
this is where they feel the helplessness , so there
is a feeling that accompanies illness such as
anger , guilt and shame as a result of inability to
express his helplessness .
Other factors that influence the behavior of
pain is pain threshold of the patient1 . Two people
with the same disease stage III cervical cancer
, has a different pain behavior, People will feel
more pain and suffering of others while the other
person does not feel pain . This is due to their
different perceptions of pain . Pain behavior
would be different result is that there is a deal
with a sick patient and consider the trials of life
as those that regard illness as a cause of
suffering to be unfortunate fate .
Feelings ( Suffering ) is located in the area
spiritual activities which respondents follow , in
addition to coping strategies that respondents
of a person’s emotions , but when one is used
to keep the religious message in his mind then
mechanism open to receive suggestions or
advice from others . Of the eight respondents ,
he will perceive suffering as a test of life or
something because the will of God as revealed
two responen stated that he was not loved by
his Lord with life events or problems that
four respondents that pain is a difficult life .In
contrast to one of the respondents who saw the
happened . These respondents had a bitter life
events in his view is divorced by three husbands
suffering and pain as the fate of the poor , what
respondents perceived by NANDA ( 2012) ,
because they can not give offspring while
respondents lainny . Life experience is positive
belong to the spiritual pain ( spiritual pain) due
to the loss of the meaning of the love of God ,
or negative can affect a person’s spirituality .
The opposite is also influenced by how one
so that he was sick as a matter of understanding
which makes an ugly fate.
defines a spiritual experience4 .
Meaning of Spirituality in Patients with Stage III Cervical Cancer in Gynecology Inpatient Ward Hospital
Dr Hasan Sadikin Bandung, Indonesia
responsibilities in accordance with its role as
Social support
Inability or limitations which is owned by a
person with cancer will alter the stability of the
family that has been running well1. A mother who
before the illness , but when the sick role is partly
or entirely taken by the family as a form of
affection ( affective ) against the respondent .
takes care of the usual role and take full
responsibility for household affairs , when
Support that is moral and material can help
boost the spirit of life which the respondent is
suffering from cancer with weakness due to
frequent bleeding should share the role with his
one of the basic spiritual needs . One form of
support is expected respondent is prayer , visit
family .
, entertainment as well as the place to share
stories . This will run smoothly when supported
For families who have open communication
among members of this role change will be easy
to adjust , it can be seen from either the child or
the family support that replaces the role of the
mother’s husband when sick .
Other basic needs is the need for the
spiritual life of society is filled with religious
values 2. From here we see that not every
individual involved in the activity or active in the
community , so when ill and had to undergo
treatment , clients immediate neighborhood
medical team and care services can be a great
social support for these clients .
Harmonious social life or religious nature
of the shape of the respondents get community
activities such as lectures , speeches , even
posyandu . Basically, these activities provide
spiritual support to the respondent through
counsel , moral and spiritual needs of the
respondents to distribute horizontally .
by good communication patterns between
patients and families2.
Hope And Strength
Respondent four perceive that God as the
source of hope , if seen his background , the
respondent is recitation activists who have moral
sport tresponden more than others , so the
message - often spiritual message he received
from his sermons made him able to place as a
source of spiritual strength and hope to recover.
But for the majority of respondents perceive
the support of the family that became the
foundation for achieving strength and hope in
continuing life . It is not independent of the need
for enhanced spiritual that is horizontal , where
harmony and harmony with fellow human beings
to drive to believe that he deserves to struggle
to get healing .
Support expected respondents apart from
family is from health care workers who become
Giving And Receiving Love
One of the important functions of the family
is the place to get warmth , support, love and
acceptance . Through meeting the needs of the
individual was able to have the ability to relate
intimately with members of his family 1 .
Expression of love and warmth shown by the
fifth respondent to perform the duties and
immediate neighborhood of the respondents at
the time of illness and treated . Empathy , mental
and behavioral suport friendly and willing to
respond to complaints - complaints respondents
are therapeutic action in helping respondents
to address and hopefully , settle the problems
they face3.
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117
Agustian AG. Rahasia sukses membangkitkan
Conclusions
The pain and suffering of the patients gave
ESQ power: sebuah inner journey melalui
al-ihsan. 10 ed. Jakarta: Arga; 2006.
a spiritual experience , the meaning of God as
a spiritual source , how to meet spiritual needs
Craven. Fundamentals of nursing : Human
, the meaning of pain , the meaning of love and
hope and strength can vary influenced by the
health and function. Philadelphia: Lippincot
William and Wilkins; 2000.
patient’s previous life experiences and spiritual
understanding of the patient . Besides pain also
cause feelings of despair , so that social support
in the spiritual power stage III cancer patients is
urgently needed.
Büssing A. Spirituality as a Resource to Rely on
in Chronic Illness: The SpREUK
Questionnaire. religions. 2010:9-17.
Kozier B, Erb G, Berman A, Syider SJ.
Fundamentals of Nursing : Concept,
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RANGE OF MOTION (ROM) EFFECT TO REDUCE OF PAIN AND TO INCREASE THE
ACTIVITY OF DAILY LIVING (ADL) IN ELDERLY WITH MOBILIZATION DISORDER
DUE TO RHEUMATIC IN PASIRGUNUNG SELATAN DEPOK CITY
Nandang Jamiat
Nurse Bachelor Programme, ‘Aisyiyah School of Healthy Bandung
E-mail: ndgjem@yahoo.com
ABSTRACT
Introduction: Elderly Aggregate are at risk and vulnerable groups with the condition of the
disease, due to lack of access to services and support. The limitation is exacerbated by the
disruption mobilization. It is necessary to foster family care elderly health, especially in the
prevention of disorder and disability mobilization. One of the efforts of family nursing care is
to provide motion exercises/Range of Motion (ROM). The purpose of the study was to
determine the effect of ROM to a decrease in pain and an increase in self-efficacy in older
adults with impaired mobilization.
Methods: The research method using the Wilcoxon test.
Result: The results showed a decrease in pain level: 80% down, 10% fixed and 10%
increased rate of pain. In addition, an increase in the numbers on the Barthel Index at 60%
family, 30% fixed and 10% declined.
Conclusions: There is a ROM effect on reducing the level of pain and improvement of selfefficacy in older adults with impaired mobilization due to arthritis. Is necessary to the
continuous preventive and promotive ability of nurses to elderly optimum.
Keywords: disorders mobilization, range of motion, pain.
Introduction
aspects of the life of the elderly, both individually
and in relation to family and community.
Development of health has succeeded in
reducing infant mortality, and maternal morbidity
Individually due to increasing age aging process
occurs that causes a variety of problems both
and result in improved community nutrition so
that an increasing number of elderly in
physical, biological / medical, mental, social or
economic.
Indonesia. The resulting positive impact is the
increased life expectancy (life expectancy),
According to Stanhope and Lancaster
which in turn will lead to an increase in the
number and proportion of elderly population.
(2004), the elderly are a group at increased risk
for the disorder biology / health. Elderly are at
This demographic change will affect many
risk (at risk) because at the elderly there are
119
health risk factors that influence the occurrence
Problem Formulation : How does the ROM
of disease or unhealthy namely : Biologic risk
age (age risk and biology), Social risk (social
influence the reduction of pain and the increase
of ADL in the elderly with mobilization disorder
risk), Economic risk (economic risk), life - style
risk (risk lifestyle), life - event risk (the risk of
due to arthritis ?
events in the life) . Age risk and biologic risk
factor are suitable with the theory of
consequences. According to Miller (2004 ), The
theory postulates that the elderly experience the
General objectives: To identify the effect of
ROM in reducing of pain and increasing of ADL
in the elderly with mobilization disorder due to
arthritis ?
consequences of the functional consequences
due to age-related changes and additional risk
Specific Objectives : 1 ) identify the effect
of ROM on reducing pain in older adults with
factors. The combination of age-related changes
and risk factors can interfere with the body’s
mobilization disorder due to arthritis ; and 2 )
identify the effect ROM to increased ADL at the
biological functional ability .
elderly with mobilization disorder due to
rheumatic?
One of the affected system is the
musculoskeletal system (skeletal muscle). The
Framework concepts. Elderly with
limitations of movement and the reduction of
the use of joint movement can aggravate these
mobilization disorderneeds to get help from
community nurses / family . The assistance
conditions (Miller, 2004) . The decreased of
musculoskeletal ability may decrease physical
activity and exercise , so it will affect the elderly
provided should be done with due regard to the
level of intervention and intervention strategies.
in performing activities in daily life (activity daily
living or ADL ) ( Westerterp & Meijer , 2001 in
Miller , 2004) . Mobilization disorder will cause
the elderly become susceptible to health
problems . Vulnerable population is easier to
get the health problems . The vulnerability
occurs as a result of the interaction of internal
and external factors that cause a person to
become vulnerable to poor health ( Stanhope &
Lancaster , 2004) .
One of the interventions is to provide ROM
exercises. The goal is that it can decrease the
pain scale based on the Wong / Baker Faces
Rating Scale ( Loretz , 2005), and enhance the
ability of self-activity in the Barthel Index scale.
Methods
Research with quantitative approach
conducted on a sample size of 10 clients by
using a pre - post comparison analysis. If the
Treatment of Rheumatic disorders due to
unknown is the mean ( interval scale data / ratios
or numerical ), and the nature of the research is
mobilization can be carried out by community
nurses . Community nurses can perform
research with paired samples ( before and after
) it can be obtained a sample of 7 clients .
promotive and preventive efforts at mobilization
disorders . One of the treatment that can be
Researchers took a sample of 10 clients in order
to avoid dropouts. Measurement of pain relief
performed in the elderly with rheumatic
disorders is to provide exercises Range Of
as the output as a result of family nursing
intervention provided, as well as an increase in
Motion ( ROM ) or commonly called joint motion
exercises ( Tseng , CN . , Chen CCH . , And lin
ADL as measured using the Barthel index used
to measure the degree of independence of the
, LC , 2006)
client, an analysis of the comparative analysis
Range of Motion (ROM) Effect to Reduce of Pain and to Increase the Activity of Daily Living (ADL) in Elderly
with Mobilization Disorder Due to Rheumatic in Pasirgunung Selatan Depok City
of pre - post ( before and after intervention )
using T test pairs ( if the data were normally
distributed ) or using the Wilcoxon test ( if the
data is not normally distributed ). Testing
normality done analytically by using the Shapiro
Wilks test .
Results
Results nursing care performed on the
entire family assisted obtained the following
results : A decrease in the level of pain : 80 %
Discussion
Practice domain has modest degree of skill
levels to levels that are difficult skills (complex).
Someone needs practice and skill- application
process which consistently achieved to seize
the complex skill level . Based on this theory, it
is appropriate to authors organized a ROM
exercise in elderly with mobilization disorder
due to arthritis.
Based on the results of family nursing care,
decreased , 10 % remained, and 10 % increased
rate of pain. In addition, an increase in the
we can conclude that most of the elderly get in
pain which caused by arthritis. Pain is felt among
numbers on the Barthel Index at 60 % family ,
30 % remained and 10 % declined. Statistically
other neck and back pain, shoulder pain, buttock
pain and leg pain ( Miller, 2004). These
based testing using the Wilcoxon test ( because
the data are not normally distributed based on
complaints are common complaints. The pain
usually increases with movement and slightly
the Shapiro Wilks test ) results obtained p - value
= 0.023 . where this value indicates that there
decreases with rest. Some particular
movements sometimes cause more pain than
is a significance reduction in pain after the
intervention ( from 3.2 ± 0.63 to 2.4 ± 0.84 ). So
the other movements. to measure pain we can
use the scale 0-5 from the Wong / Baker Faces
is the case with ADL improvement obtained by
using the Wilcoxon test p - value = 0.018 which
Rating Scale ( Loretz , 2005).
indicates that an increase in ADL after the
intervention ( from 84 ± to 90 ± 6:14 8:16 ).
Pain
Statistic
Mean (SD)
Median
Min – Max
p-value Normality
P-value wilcoxon
Before
3.2 (0.6)
3.0
2.0 - 4.0
0.012
0.023
After
2.4 (0.8)
2.0
1.0 - 4.0
0.172
ADL
Statistic
Mean (SD)
Median
Min – Max
P-value Normality
P-value Wilcoxon
Before
84 (6.15)
85.00
75 - 90
0.046
0.018
After
90 (8.16)
90.00
75 – 100
0.169
ROM exercises is the exercise which is
given to elderly who are at risk or experience
the limited mobilization. Range of Motion
Exercise is one type of physical exercise,
physical fitness component that can be trained
is the elasticity (flexibility ) which is the ability to
move muscles and joints in the entire movement.
Physical exercise can be done to increase and
improve flexibility. The benefits of this ROM
exercises are ; optimize the motion of muscles
and joints ; improve physical fitness ; reduce
the risk of injury to muscles and joints ; reduce
muscle tension and pain ( Perry & Potter , 2002).
In this study, it can be proved that the range
of joint movement or range of motion ( ROM )
can affect the reduction in pain with p-value
under 0.5 or 5%. The existence of the
respondents who experienced an increase in
pain due to other comorbidities is high
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121
cholesterol. When do the ROM, the respondent
form of handling and care of the elderly with
performs very limited. In addition to pain, the
respondent was also decreased ADL. This is
mobilization disorder due to arthritis as the ROM
can be an alternative solution .
due to the pain that is felt due to increased
cholesterol values . Movement to perform daily
Refferences
activities be limited .
Friedman , Bowden , and Jones (2003 )
states that the family should be involved in
providing assistance to the family members who
are sick ( health problems ) as efforts to
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J.A,
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Spradley
B.W.
(2005).Community
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implement family health tasks . Families also
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Amendola, MG. (2011). Empowerment :
Healthcare Professional’s and Community
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had been trained to monitor the treatment
Member’s Contributions. Diunduh dari
www.ebsco/journal of cultural diversity pada
program in elderly impaired mobilization due to
arthritis. Cadres and families should continue
tanggal 18 April 2012)
to cooperate in improving the ability of elderly
optimal
Conclusions
1)
2)
A decrease in the level of pain : 80 %
decreased , and 10 % remained .
An increase in numbers in the Barthel Index
at 60 % of families , and 30 % remained .
This shows an increase in the ability of
elderly independent in carrying out daily
activities / day ( ADL )
3)
The influence ROM movement towards
decreased levels of pain in older adults
with physical mobilization disorder due to
arthritis
4)
The influence of the increase in ADL ROM
movement elderly with
physical
mobilization disorder due to arthritis
Health department is expected to provide
guidance program on a regular basis and
planned cadre. Coaching or training in question
is an attempt to help the elderly to remain optimal
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123
EFFECT OF HEAD UP AND SUPINE POSITION OF HEMODYNAMIC CHANGES ON
PATIENTS WITH HEART FAILURE IN
THE HIGH CARE GENERAL HOSPITAL CENTER DR HASAN SADIKIN, BANDUNG
Popy Irawati
Institute of Health ‘Aisyiyah Bandung, Indonesia
E-mail: popyners@gmail.com
ABSTRACT
Intoduction: In critical condition, position is one of nursing procedures that influence patient
in changing his hemodynamic condition. Patient with critical cardiac failure usually positioned
sitting to alleviate respiratory of the patient. Position changing influence hemodynamic
parameters include blood pressure, heart rate, respiratory rate and oxygen saturation.
Objectives: This study is aimed to identify the hemodynamic changes on head up position
and supine changes on among patient with cardiac failure.
Method: Used in this study was one group pretest-posttest control group design with
consecutive and complete random sampling. Twenty five (25) respondents with cardiac
failure was included in this study, consist of 11 male and 14 female; range of age was 17-75
years. Intervention was introduced to the respondents starting with position head up 600,
head up 300 continue to supine within 2 minutes, and then measuring hemodynamic
parameters include blood pressure, heart rate, respiratory rate and oxygen saturation on
each of the position. Data collected from the study was analyzed using ANOVA.
Result: Results of the analysis show on position, head up 600 and head up 300and supine,to
all hemodynamic parameters changes (blood pressure, heart rate, respiratory rate and oxygen
saturation) there was no significant result.
Conclusion, there is no significant difference between supine and head up towards
hemodynamic in patients with cardiac failure. Therefore, recommended that head up and
supine positions can be doing in patients with cardiac failure with nurses attentions.
Keywords: cardiac failure, hemodynamic changes, head-up position, supine position.
125
Introduction
Heart failure is the leading cause of morbidity and mortality of heart patients (Mariyono & Santoso,
2007; Woods, Froelicher, Motzer, & Bridges, 2010). In the critical state of the patient with heart failure
requiring pharmacologic management of both pharmacological and non, with the aim to relieve symptoms
and improve quality of life.Pada severe acute heart failure is an emergency condition that requires
appropriate management includes knowing the causes, improved hemodynamics, pulmonary congestion
and eliminate improvement of tissue oxygenation. Placing the patient in a sitting position with a high
concentration of oxygen administration is the first act that can be given to patients with heart failure
(Mariyono & Santoso, 2007).
The position is one factor that must be considered in maintaining adequate systemic circulation as
it can affect the hemodynamic system including the venous system. (Gelman, 2008). According to
some theories, changes in body position can affect non-invasive hemodynamic changes including,
blood pressure, heart rate, oxygen saturation and respiratory rate (Kozier, ERB, Berman, & Synder,
2004).
The sitting position often makes the patient uncomfortable if done in a long period of time, most
patients with acute heart failure will experience severe shortness of more than 2 hours, causing muscle
strain which adds to the discomfort. This study investigates the influence of the position of the lower 30
and supine position on the hemodynamics of blood pressure, pulse, respiration and oxygen saturation
in patients with heart failure.
Methods
The method used in this study was one group pretest-posttest control group design with random
consecutive sampling as technique. This study was conducted on 25 respondents with heart failure
consisting of 11 men and 14 women with ages between 17-75 years. Research techniques, are used to
make changes ranging from head-up position 60 degree and subsequent supine head-up 30 degree
with 2-minute intervals, then measuring hemodynamic consisting of blood pressure, heart rate, respiratory
rate and oxygen saturation at each position. Data were analyzed using ANOVA.
Results
Table Effect of Head-up and supine position on Hemodynamics in patients with heart failure (n = 25)
Parameter
Head Up 60
Head Up 30
Supine
*p value
Sistol
126.48 ± 22.69 127.32 ± 24.47 124.08 ± 23.37
0.880
Diastol
82.32 ± 15.03
83.28±15.45
82.32 ±16.94
0.970
MAP
96.52 ± 16.67
97.60 ± 17.49
96.00 ± 18.67
0.948
Denyut jantung
96.40 ± 19.72
94.96 ± 17.19
95.32 ± 18.61
0.949
Frekuensi pernapasan
25.28 ± 4.646
25.16 ± 6.18
26.76 ±5.79
0.659
Saturasi Oksigen
97.08 ± 2.48
97.20 ±2.09
97.08 ± 2.19
0.775
Effect of Head Up and Supine Position of Hemodynamic Changes on Patients with Heart Failure in
the High Care General Hospital Center Dr Hasan Sadikin, Bandung
From the table above for systolic, diastolic,
The lack of effect of position on blood
and MAP, if we look at the maximum of the range
of values obtained supine values lower than
pressure can be caused due to the small sample
in this study was not due to confunding . it could
the value of the other two positions, ie 60 degree
head-up and head-up position 30 degree. This
be caused by pharmacological therapy with
which therapy given to respondents affected
value is included in Stage 1 hypertension
category while the minimum range was still
blood pressure. Among them, the first ACE
(angiotensin converting enzyme inhibitors) as
within the normal range is between 100 - 120
The p-value> 0.05 then the change in systolic,
much as 52% of respondents using this
medication, ACE I, works to inhibit the enzyme
diastolic, and MAP wasn’t significant. On the
heart rate, the maximum value of the range it
that inhibits the angiotensin II increases
aldosterone expenditure which can cause
was found that the head-up position 600 is the
value in the high category tachycardia, while the
vasoconstriction of the blood vessels so that
blood pressure can be maintained. Other drugs
minimum range that has a normal value>70x/
mnt. Allthaugh Therefore, changes in heart rate
that affect the blood pressure are a beta blocker
that work to suppress the sympathetic system
were not significant.
or systems andrenergik a state of hyperactivity
(Andrew & Raymond, 2005). Other causes that
For respiratory frequency, obtained from the
maximum range that the supine position was
the highest position, the range was a range that
is included in the category of tachypnea, but the
change was not statistically significant. Similarly,
the oxygen saturation, the minimum of the range
it was found that the supine position is the lowest
can lead to a lack of response to changes in the
position of the blood vessels is age. Most
respondents were in their middle and older
adulthood. According Setianto (2007), the blood
vessel walls become more rigid with age, due
to increased collagen connective tissue in the
position, the range was still within normal limits.
tunica media and adventitia of medium and large
arteries. As a result, increased vascular
Discussion
resistance and become flexible. Calculations
showed that statistically there was no difference
From the results of research, there was no
difference in blood pressure in the head-up
in heart rate in the supine position and the headup. But when seen from the maximum range
position 60 degree, 30 degree and supine , both
in systole, diastole or MAP. When viewed from
even at the starting position, including the
category of tachycardia, seen a decrease of 2
the mean value and range of values in the
blood pressure has almost the same value at
to 4 x / min in the head-up position 30 and
supine.Therefore changing this position does
every position, but even so when seen from the
minimum range of the MAP had a tendency to
not worsen the condition of patients at risk for
heart rate parameters. As in blood pressure,
decrease 1-3 mmHg.
there was no influence on the position of the
heart rate can be caused by several small cause
In terms of blood pressure values , the
maximum value was still higher than normal and
included in stage 1 hypertension, it was caused
due to a history of the disease in as many as
24% of respondents were hypertensive.
number of sample was one of the most
important. Furthermore pharmacological therapy
that is affecting both the sympathetic autonomic
nerves and the sympathetic nerves. Inotropic
(+) or digitalis affects heart rate, 78% of
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127
respondents use the digitalis digoxin which has
In oxygen saturation can be concluded
the effect of strengthening the contraction of the
heart and lowers the heart rate. Treatment is
there was no difference in oxygen saturation in
head-up position and supine. It can be seen in
aimed at controlling the rhythm and heart rate
so that the response to changes in heart rate
mean oxygen saturation values , although there
was a trend decline in value there is only a
due to the change in position is reduced. Other
drugs which affect the heart rhythm and rate are
difference of less than 1.Sehingga, nurses can
change position and still maintain the oxygen
beta-blockers and anti-arrhythmia.
saturation in the third that position. Oxygen
saturation at e” 95% of all respondents then
Other causes that can affect the position
effect is age, a decline in beta-adrenergic
response to stimulation due to increasing age,
the result is a decreased heart rate and
contractility are limited in the face of the load. In
addition to the degenerative processes of the
nervous system, including sympathetic and
parasympathetic nerves to make the reflex
when the blood flow to the heart rate and a stable
heart rhythm controlled, oxygen-containing
blood circulation is not obstructed so that the
change in position does not cause an excessive
increase in oxygen demand. This is supported
by respondents that used oxygen therapy using
a nasal cannula.
becomes slower. From the results of this study
concluded there was no difference in changes
This study has limitations, among others,
this study has a small sample size because in
in respiratory rate and supine head-up position.
However, if the average seen in the initial
position has a respiratory rate above normal
this study does not take into account
confounding variables. There is not yet studies
on the same subject with the study so it is difficult
values . With the changes into the supine
position there is a tendency of increased
to compare study with previous research.
respiratory rate, so that the ± 5.79 standard
deviations it is feared the supine position,
breathing frequency increases> 30 x / min.
Therefore, for nurses who will change positions,
they need to considered initial respiratory rate
did change in position.
In patients with heart failure patient’s
Conclusions
Statistically, there was no hemodynamic
changes in the head-up and supine positions in
patients with heart failure.
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THE ASSOCIATION BETWEEN SUPPORT, COPING STRATEGY, FAMILY BURDEN,
HEALTH STATUS OF ELDERLY AND THE INCIDENT OF ELDERLY ABUSE
DEPOK, WEST JAVA
Etty Rekawati1, Achir. Yani S. Hamid2, Junaiti Sahar3, Sudijanto Kamso4, Widyatuti5
FIK UI Depok, Indonesia
E-mail: rekawati@ui.ac.id
ABSTRACT
Introduction: The elderly person generally represents a high risk group. They often
experience a drop of functions that lead to the inability to meet their daily needs independently,
thus they do require family support. The object of this study, is to identify the relationship
between support, coping strategies, family burden, health status and the incidence of abuse.
Method: The method of this study used a cross sectional study involving a sample selected
by proportional cluster sampling. Data analysis is elaborated in the frequency distribution
and a correlative, distribution format.
Result: The result of this study concluded that more than 50% of participants were able to
provide valuable informational support (55.5%), valuable instrumental support (56.3%),
valuable appraisal support (54.1%), and valuable emotional support (50.3%). The majority
of families, that were involved in this study, used coping strategy seeking spiritual
support (66.7%). Most of caregivers didn’t feel burdened in taking care of elderly parents
(89.6%). Most of the elderly persons were perceived to be in poor health and physical condition
(48.1%) and psychosocially (45.2%). The numbers of those abused, are as follows physical
abuse (24.2%), psychological abuse (74.8%), financial abuse (45.2%), and neglect (43.7%).
Bivariate analyses showed that appraisal support was associated with elderly abuse
(p=0.019); emotional support was associated with elderly abuse (p=0.007); coping strategies
Acquiring Social Support was associated with elderly abuse (p=0.032); psychosocial health
was associated with elderly abuse (p=0,048).
Keywords: elderly, abuse, family support, family coping strategies, family burdens, the health
status of the elderly.
131
Introduction
It is estimated that the elderly population
has been consistently increasing. Based on
United Nations report (2005), Demography
Institution of Economic Faculty University of
Indonesia (2009), and Statistics Indonesia
(2009) that the elderly population, particularly
those over the age of 60 years, in developed
Functional Consequences Theory by Miller
(2004), health impairment in elderly persons
occurred because of their biological alteration.
Health impairment will be significantly severe if
it is accompanied and complicated because of
an unhealthy diet and lifestyle during their
younger and developing years.
Their natural family is the closest
countries, has been estimated to increase from
20% in 2004 to 32% in 2050. In developing
environment and the main support for elderly
persons and as such, they are expected to
countries, the number of older adults, over the
age of 60 years is also estimated to significantly
accommodate them and to take on the task to
enable them to improve their health, comfort,
increase from 8% in 2005 to 20% in 20152050. This estimation has been proven in
and well-being (Friedman, 2003). However, it
was found that not every elderly person received
regards to the number of elderly people aged
above 65 years in Southeast Asia 13.146 million
appropriate attention and support from their
family.
people in 1980; 17.147 million people in 1990;
24.893 million in 2000; 59.316 million people
(estimated) in 2025. The final estimation is
strengthened by the national survey report by
Statistics Indonesia (2010) that revealed data
that the number of Indonesian citizens accounts
for a total of 237.5 million people with the number
of elderly people ranging from 59-75 years,
accounted for 23.992 million.
Elderly abuse in the family is best described
as the inability to care for them adequately in
their physical, psychological, spiritual and social
health. (National Centre on Elder Abuse USA,
2005). The early stages of abuse or neglect can
emanate from a families strain and exhaustion
in meeting their needs and thus they become
more of an exhausting burden for the family, as
World Health Organization (2002) estimated
a whole. The phenomenological study of Asniar
(2007) about the families experience in taking
that the number of the elderly in Indonesia could
reach 11.34% by 2020 or specifically, 28.8
care of a post stroke victim at home, concluded
that the experiences were assorted and as such,
million individuals. This percentage is predicted
to exceed the number of toddlers at an estimated
the caregivers perceived a twofold burden in
taking care the elderly who may have developed
6.9 %. Even though, the percentage of the
elderly population in Indonesia is relatively small
a health impairment. The family deemed it as a
stressful circumstance.
compared to the elderly people in some other
countries, the actual number is high and they
The nursing model that was developed by
represent the fourth position after China, India,
and the United States of America. (National
Commission for Older Persons Indonesia,
2010).
Elderly persons are at risk and potentially
Sahar (2002) has established that a Family
Carer’s Training Program brought about positive
impacts towards the health status of the elderly
which was directly proportional to their ability in
taking care of the elderly. In other words, a family
with this education became competent
exposed to various diseases. Based on the
The Association between Support, Coping Strategy, Family Burden, Health Status of Elderly and
the Incident of Elderly Abuse Depok, West Java
caregivers in their respective home and could
of physical abuse stood at 16%; financial abuse
affect the health status of the elderly.
24%; 44% of elderly experienced psychological
abuse; none experienced neglect.
The National Centre of Elder Abuse, USA
(2005) stated that elderly neglect is one
Based on Caplan, 1976, (in Friedman,
description of elderly abuse. From 1986 until
1996, there was an increase in the number of
2003), it was noted that the family provided the
function to give social support as information
instances of elderly abuse. According to
(Duckhorn, 1997), it was reported that the figure
seekers and givers; provided emotional support
that helped maintain emotional control; gave
of the elderly abused was 117,000 in 1986;
128,000 in 1987; 140,000 in 1988; 211,000 in
direct support in supporting financial
assistance and taking care of elderly
1990; 213,000 in 1991; 227,000 in 1993;
241,000 in 1994; 286,000 in 1995; 293.000 in
parents. Limited supportive resources in any
given family can be the main reason of elderly
1996. The WHO (2012) elaborated that the
abuse of women was prevalent in older adults
abuse (Miller, 2004). The study that was
conducted by Ramlah (2011) stated that there
than men. In 1995, 7.4% of women experienced
abuse and the incidence of abuse was gradually
was relationship between informational support,
instrumental support, appraisal support,
increasing. In 2010, it stood at 9.2% and it has
been predicted that it could reach 13% by
emotional support and the incidence of elderly
neglect.
2025. Duckhorn (1997) also elaborates that the
type of abuse in elderly, are as follows 14.6%
physical abuse, 12.4% financial abuse, 7.8%
Emotional support is a main factor that
could lead to a higher incidence of elderly
emotional abuse, 0.4% sexual abuse, 55.1%
neglect, 4.1% is unknown abuse, 6.2% are other
aspects, abuse.
In a previous study that had been
undertaken by Rekawati (2010), about a Trial
Test of Detection Model on Elderly Abuse in
Family that had been executed in the Ciracas
Region, East Jakarta, found familial, elderly
abuse with the following results: 56% of elderly
are women; 76% of family caregivers were
ethnic Sundanese; 20% were from Betawi; 4%
were from Javanese; and 100% of elderly were
moslem; 60% of elderly still had a living spouse;
40% of them are widows, widowers or
unmarried. Also 72% of the elderly are
uneducated, 20% had graduated from
elementary school, 8% had graduated from high
school. Further 60% stated that they had health
complaints ranging from mild to severe, while
40% of them had no complaints. The incidence
neglect. Therefore, all the above mentioned
aspects of support, provided by a natural family
can effectively prevent abuse in the first instance
and will lead to an overall improvement in the
level of health.
Based on the above explanation, the
researcher of this study was interested in being
aware of the various factors related to the
incidents of elderly abuse, specifically as follows:
identifying the characteristics of the elderly and
their family; support, coping strategies, the
family burden, elderly health status and the
number of familial elderly abuse incidents;
identify the association between family support
and elderly abuse in the home; identify the
association between family coping strategies
and the number of elderly abuse incidents in
the home; identify the association between the
family burden in taking care of the elderly and
the number of elderly abuse incidents in the
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133
home; identify the association between the
impaired person, where the family member is
health status of the elderly and the incidents of
elderly abuse in the home.
viewed as the person whose support is always
available to help if needed.
Literature Review
Friedman (2013) explained that the
characteristic of a family is an open system that
consists of family member that respectively has
interdependent characteristics, interactive, and
Several studies related to family support in
elderly persons have also been undertaken.
Siswanu (2010) did research titled, “The
association of family support and participation
of elderly parents in Calisthenics Exercise for
mutual.
Elderly in Perumahan Sinar Waluyo, Semarang”
This had a result that was described as the
The family has a filter that is used to select
input and output information. The respective role
relationship between family support and the
participation of the elderly in elderly calisthenics
of family members will be different depending
on such factors as social, cultural and economic
exercises. The result of the Continuity Correction
Test with significancy= 0.030 and á = 0,05.
reality.
The existence of a family as part of the
larger system, i.e. the total number of residents
in the home. The family as an open system
(permeable limit) where there is an exchange
between the system and the organization of
respective family members, or the structure that
will influence the function of the other family
The result of the study that was conducted
by Handayani (2009), concluded that family
support will contribute to a declining of anxiety
for the elderly residents in nursing homes. Jafar
(2010) carried out a phenomenology study
regarding the experience of the elderly that
receive social support in nursing homes. Panti
Sosial Tresna Wredha Abiyoso, in D.I.
members. All the while, the developmental task
of a family with elderly parents is to modify their
Yogyakarta, concluded that support received for
the elderly during their stay in nursing homes
environment to fulfill the specific needs in the
elderly and focus on fully providing physical
can be divided into resources and types of
support. The resources of support can be gained
needs, promote comfort and support, maintain
relationships between the family and other
from family, nursing home workers, and any
other allied concerns. Support can be best
residents and embed the feeling of an
understanding of life and crisis management.
decried as social integration, emotional support,
financial support, informational support, and
service support.
Family support is commonly accepted as
the emotional support in the form of sympathy
and best decried as the evidence of love,
The meaning of family support for the
elderly provides them with inner happiness.
attention and ability to listen to the complaints
of others. Several researchers viewed family
Elderly persons deem family support as a
positive content. They expect to have family
support as real instrumental support and
emotional or informational support (House dan
support when they are in a nursing home and
this maintains a good relationship through
Khan, 1985 dalam Friedman, 2003). Cited from
Friedman (2003), family support was attitude,
having regular interaction, giving appraisal for
them and preparing them during their final
action, and family acceptance towards the
stages of life.
Based on several mentioned researches, it
nursing homes, Panti Sosial Tresna Wredha
implies that family support can dramatically
influence their health status. However, the fact
Kecamatan Peusangan Kabupaten Bireuen
Nanggroe Aceh Darussalam, proved that the
remains that not every elderly person optimally
enjoys support from their family and this could
stress level in the elderly who lived in nursing
homes was higher than those that lived with their
be construed as abuse.
families.
The Family Crisis Oriented Personal
Evaluation Scales (F-COPES) (Mc. Cubbin,
Coping strategy problems are often used by
the elderly in nursing homes. Religious coping
1981) was devised to identify coping strategies
used by families in overcoming problems. F-
strategies were more often used by the elderly
in family situations and there is no difference in
COPES depicts a coping dimension based on
a pile-up factor, family resources and a
seeking social support and coping strategies
between two elderly people who lived either in
perception of problems.
a nursing home and those that lived with their
family.
Five types of coping strategies in F-COPES
Scale are as follows:
1)
Acquiring Social Support Strategy
(ASSS) is to measure the ability of a family
in utilizing support from friends, neighbors,
and the extended family
2)
Reframing Strategy (RS) is to assess the
ability of families to redefine stress
Based on the International Council of
Nursing (2001), elderly abuse in families was
interpreted as a families inability to take
adequate care of them physically,
psychologically and socially. Elderly abuse
consists of four type, are as follows:
1)
physical power that causes injury to the
body, physical pain, and disablement and
circumstances and how to overcome
them
3)
4)
Seeking Spiritual Support Strategy
characterized by the existence of bruises,
fissure from fractured bones, the evidence
(SSSS) is to measure the ability of a family
through spiritual support
of abuse, open wound, dislocation, deep
wound, bleeding, broken spectacles and
Mobilising Family to Acquire and Accept
reports from elderly persons that they are
being hit, kicked, or any other
Help Strategy (MFS) is to comprehend the
ability of families in utilizing community
mistreatment
2)
resources
5)
physical abuse, is defined as using
Psychological abuse can be defined in the
Passive Appraisal Strategy (PAS) is to
emergence of hurt feeling, feeling
pressured and pushed and displaying fear
assess the ability of families in accepting
problems with minimal reactions.
in speaking and attitude. Generally, this
is characterized in being irritable and
withdrawal from interaction,
The study of Hamdiana (2009) that
analyzed the difference of stress levels and
coping strategies in the elderly that lived
3)
Neglect may be defined as the ignorance
or failure in fulfilling one’s basic needs and
together with family compared to those in
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135
4)
is characterized by dehydration,
family caregivers were the children of elderly
malnutrition and a deficit self-hygiene.
persons.
Financial exploitation may be defined as
the misappropriation of financial, property
The result of this study showed the following
data:
or the use of their assets without their
agreement and is characterized by the
sudden loss.
Methods
This research used simple descriptive
design with cross sectional study. The
participants were 135 older adults who lived with
their family. Samples were taken by sampling
probability technique with multistage cluster
sampling. Inclusive criteria of elderly person was
those equal or over the age of 60 years old,
lived with family, minimal graduate from
elementary school, and could communicate
More than half of the participants gave good
informational and instrumental appraisal, and
emotional support for their elderly parents. The
most coping strategy used by families in taking
care of the elderly is seeking spiritual
support (66,7%). Most families stated that they
had no burden in taking care of their elderly
(89,6%). Most of the elderly were physically
healthy (51.9%), while the remainder were
unhealthy psychosocially (45.2%). The
incidence of elderly abuse was shown in the
following table:
Table 1.
The incidence of elderly abuse in
verbally, effectively. Whereas, inclusive criteria
for family are caregiver who lived with family,
families Kelurahan Harjamukti
Kecamatan Cimanggis Depok,
minimal graduate from junior high school, and
are able to effectively communicate.
July 2013 (n=135)
Results
No
1
Characteristic of Elderly and Family
The result of this research revealed the
following data:
Most characteristics of elderly persons were
those within the range, aged 60-69 years old
(51,1%); more than half are women (55,6%),
where most of them had low income under the
regional minimum wage (91,9%); more than half
are Betawi ethnics (57%). Characteristics of
2
3
4
family, more than half of the family caregivers
were aged 20-39 years old (58,5%) and most
were women (88,1%). Most of the surveyed
participants had low family income, below the
regional minimum wage (76,3%). Most families
were from Betawi ethnics (61,5%) and most of
5
The type of
abuse
Abuse
• No
• Yes
Total
Physical Abuse
• No
• Yes
Total
Financial Abuse
• No
• Yes
Total
Psychological
Abuse
• No
• Yes
Total
Neglect
• No
• Yes
Total
Total
Percentage
(%)
68
67
135
50,4
49,6
100
102
33
135
75,6
24,4
100
74
61
135
54,8
45,2
100
34
101
135
25,2
74,8
100
76
59
135
56,3
43,7
100
The highest number of elderly abuse is
Bivariate results showed that there is a
relationship between appraisal support and
elderly abuse (p=0.019); emotional support and
psychological abuse (74,8%).
The relationship between support, coping
strategies, family burden in taking care of
the elderly, health status of elderly and the
incidence of elderly abuse.
elderly abuse (p=0.007); coping strategy
Acquiring Social Support and elderly abuse
(p=0.032); elderly psychosocial health and
elderly abuse (p=0.048).
Recapitulative analysis bivariate between
support, coping strategy, and family burden in
Statistical Modelling of Research
taking care, health status and the incidence of
elderly abuse can be seen in table 2.
Statistical modelling on this research began
with the multivariate analysis with a double
Table 2.
logistic al regression test that was aimed to
estimate the validity of the relation between
Recapitulation of p value score
between support, coping
strategy, family burden, and
health status of elderly towards
physical,
psychological,
financial abuse, and neglect.
Kelurahan
Harjamukti
Kecamatan Cimanggis Depok
July 2013 (n=135)
support, coping strategies, the family burden,
elderly health status and was effectively
correlated with the incident of elderly abuse in
the home and the influence of such variables,
as age, gender, income, ethnics, and the
relationship between elderly persons and family.
The result of the final modelling is shown in
Table 3.
Independent Variable
Family support:
• Informational support
• Instrumental support
• Appraisal support
• Emotional support
Family coping strategy
• Acquiring Social Support
• Reframing
• Seeking Spiritual Support
• Mobilizing family to acquire
and accept help
• Passive Appraisal
• Family burden
Elderly health status
• Physical health
• Psychosocial health
Dependent
Variable
(Abuse)
Table 3.
The result of the final modelling
multivariable test that is
correlated with the incidence of
0.102
0.102
0.019*
0.007*
0.032*
0.807
0.543
0.782
0.933
0.553
elderly
abuse
Harjamukti
Kelurahan
Kecamatan
Cimanggis Depok July 2013
(n=135)
No
Variabel
1 Informational
support
2 Acquiring
Social
Constanta
B
1.197
P value
0.001
OR
3.309
0.833
0.024
2.301
-0.940
0.003
0.391
0.345
0.048*
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137
Modelling was obtained through logistic
persons who have high dependency. The value
equation:
applying in society was the children had
responsibility in taking care of their parents, like
Y  constants  1x1   2x2
-0.940 + 1.197 (informational support) +
what their parents did in their childhood. This
point boosted the residents to state that they
0.833 (coping strategy Acquiring Social
Support Strategy)
did not feel burdened in taking care of older
adults.
Information support is a variable that is
The conformable study executed by Muraki,
dominant when correlated with elderly abuse in
the home because it had the biggest OR, that is
at all (2007) that did investigation related to the
association between patients with stroke and
3.309.
dementia and the burden of family caregiver in
Japan population. The conclusion of this study
Discussion
showed that the burden of family caregiver was
high for the patients with stroke and even higher
Y=
The study of Hamid (1993) and this study
used similar instrument, F-COPE. Although the
criteria or the target of respondent between
those studies are different, yet F-COPE
instrument were still able to identify coping
for patients with dementia in general population.
It implicated that complication of functional
alteration in elderly persons might increase the
burden of family caregiver.
strategy used by family. This point showed that
F-COPE instrument could be applied to assess
Kim & Cheong Seok (2003) stated that
reciprocal support between older adults and their
coping strategy of family in every condition.
Therefore, F-COPE instrument, specifically that
family caregiver would bring positive impact,
especially in life satisfaction. The family who
was developed already by Mc Cubbin could be
applied for assessing Indonesia residents.
received reciprocal support between family
caregivers and older adults were more likely to
Based on Swasono (1989) every culture
reach life satisfaction than the family caregiver
that provided support for their older parents, but
had determined old stage as well as its role and
social function with various values, perception,
and measurement. However, there was a
universal view that older adults were those who
were able to collect wise and wisdom. Therefore,
older adults population was deemed as an
individual that has strength, certain skills, and
with their huge experiences, they deserve to be
respected. For conventional residents, that
generally consist of large family, entering old
stage was something that does not need to be
worried. They would have good social
warranties: their children and relatives. The
children in this society, felt responsible of taking
care their older parents, especially the elderly
did not perceived support from their older
parents. Similar evidence also stated by Merz
& Consedine (2009) that positive emotional
support in older adults could improve health
status of older adults. This statement was
conformable with this study that reciprocal family
support could increase the health status of older
adults. This evidence was proven from the
results of questionnaire that there were families
that limit the activities of older adults and there
were older adults that feel desperate. Based on
the result of chi-square analysis in the first step
of this study, it was found that there was no
relationship between the physical health of
elderly persons and the incidents of elderly
abuse, yet there was a relationship between
psychosocial health and the incidents of elderly
abuse.
Conclusions
•
There was a relationship between family
support and the incident of elderly abuse.
•
There was relationship between family
coping strategies and elderly abuse.
•
There was no correlation between family
burden and the incidence of elderly abuse
•
There was a relationship between the health
status and the incidence of elderly abuse
References
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139
APPLICATION OF KOLCABA’S COMFORT THEORY IN HANDLING RISK OF FLUID
AND ELECTROLYTE IMBALANCE ON POST-OPERATIVE CHILDREN AT BCH WARD
OF RSUPN DR. CIPTO MANGUNKUSUMO
Fauziah Rudhiati1, Nani Nurhaeni2, Siti Chodidjah2
1
Pediatric Nursing, Nursing Science Study Program (S-2), STIKes Jenderal Achmad
Yani, Cimahi, Indonesia
2
Pediatric Nursing, Faculty of Nursing Science, Indonesia University, Depok, Indonesia
E-mail: faru202002@yahoo.com
ABSTRACT
Nausea vomiting is comfort disorder which is experienced by most of post-operative children.
Nausea vomiting can cause fluid imbalance is risk that can happen to almost all children
who have undergone surgery. Fluid and electrolyte imbalance of post surgery could result
worsening on children condition which was in the end obstructed recovery process of surgical
wounds. The aim of the final scientific writing was to give description of application of Comfort
Theory concept in nursing care on post-operative children who had needs over fluid and
electrolyte. The usage of comfort theory could improve nurse’s awareness over clients needs
of comfort of every aspect physical, psycho-spiritual, environment, and socio-cultural
complained by clients nor result of nurse analysis through theory application that had been
applied by nurse could discover changes of comfort level before and after nursing intervention
was applied. It is suggested implementation of comfort theory application can be maintained
at hospital of nursing care.
Keywords: Comfort theory, fluid, and electrolyte post operative.
Introduction
because
of
non
infectious
disease.
(Hockenberry, 2010).
In 2010, number of children in Indonesia
suffered for non infectious disease age 1-4
years old was 4,03%, age 5-14 years old was
Stress effect because of hospitalization and
level of morbidity because of non infectious
8,29%, and increased to group of age 15-24
years old which amounted 12,55% (Kemenkes,
disease can be minimized by fulfilling children
basic needs. One of the important basic needs
2012). For several non infectious diseases
surgery is required for medication, therefore,
to be noticed of children clients with surgery
case was the fulfillment of fluid and electrolyte,
hospitalization on children is unavoidable.
Hospitalization on children and parents could
for children usually had to do fasting before
surgery. The other reason was children were
be one of stress triggers and in the end should
impact on children physical condition before or
vulnerable to dehydration (Nair & Balachandran,
2004).
after surgery and increased level of morbidity
141
Effort of fluid fulfillment on children clients
malformation of closed colostomy, hirschsprung
with surgery before and after surgery was a way
to increase client’s and family’s comforts
disease, and anorectal malformation of PSA
manufacturers and repaired colostomy. Although
(Kolcaba&Kolcaba, 1991; Kolcaba, 2001;Wilson
&Kolcaba, 2004). It is expected with focus on
it had different medical diagnosis, the similarities
of five cases were they experienced abdominal
nursing care over comfort, clients and family
could achieve health and welfare status that
surgery and had general anesthesia procedure.
were expected. More broadly if health and
welfare of children with surgery case could be
achieved, so level of morbidity of children with
non infectious disease could be suppressed.
Therefore, trial of implementation of comfort
theory concept which is initiated by Kolcaba in
practice of nursing care on children with surgery
case should be carried out in order to develop
and increase the quality of pediatric surgical
nursing care.
Methods
Method used in writing this final scientific
works was case study. In which writers
presented description in details concerning
application of Katherine Kolcaba’s comfort
theory on nursing care of post-operative
children.
Surgery can cause fluid and electrolyte
imbalance through mechanism of stress, pain,
immunology, and anesthesia intervention which
stimulated ADH secretion, so that fluid and
electrolyte retention happened 48 hours post
surgery (Ganong, 2003 in Kim van Wissen &
Breton, 2004). General anesthesia intervention
on procedure of abdominal surgery could also
provoke nausea and vomiting (Rose& Watcha,
1999; Pierre& Whelan, 2012). Therefore, even
varied in surgical procedure, the five cases in
point had risk to experience fluid and electrolyte
imbalance. Discussion of Kolcaba’s comfort
theory application on the five control cases
based on nursing process: those were
assessment, nursing diagnosis, nursing
intervention and evaluation.
Assessment : range of client age on control
Results
cases lied on babies to school age, therefore,
when starting assessment, pediatric nursing
After application of comfort theory was done
on five cases of post-operative children, there
residence used communication technique in
appropriate with children development. Non
was increase of comfort related to fluid and
electrolyte imbalance risk. From five cases, four
verbal communication technique for instance
caressing, smiling, a lot more carrying applied
of which experienced increase of comfort from
lowest level or relief to level of medium comfort
to child F since the client was not able to
communicate verbally. Egocentric respond on
or ease. Whereas the other one had already
been in level of medium comfort or ease and
children NP, MA, and A were still dominant. By
which, pediatric nursing residence underwent
could be maintained until end of the treatment.
an approach by letting a child to touch and to
use inspection tools. Focus of assessment was
Discussion
focusing on assessment of client’s hydration
status those were physical aspect, only level of
There were five control cases that would
be discussed. Those consisted of invagination/
intussusception, apendicitis, anorectal
comfort of every case was different. According
to Ball, Blinder, & Blinder (2008) age had effect
on fluid composition in the body, in this case
Application of Kolcaba’s Comfort Theory in Handling Risk of Fluid and Electrolyte Imbalance on
Post-Operative Children at BCH Ward of RSUPN Dr. Cipto Mangunkusumo
child F, girl, 5 months old who suffered
comfort level, which meant the need of disorder
invagination was client who was most vulnerable
over fluid imbalance.
fulfillment should be immediately settled.
When observation was done there were 2
Risk of fluid imbalance was also
experienced by NP, girl, 36 months old who was
clients with weight problems. First, child F
experienced body weight decrease for 2,5 %
discovered suffering for down syndrome and
post surgery of laparatomy + anastomosis.
within 3 days. Child F suffered defecation of
slime mixed with blood and greenish vomit and
When the client went back to Bch ward after
underwent 1 day care at PICU, client’s
also hesitated to drink. Post surgery of
laparatomy resection ileo-colon ascenden +
consciousness had not entirely back to normal,
for client was on drug effect of midazolam drug
anastomosis ielo-colica child F was being fasted
and pt on NGT to stream gastric fluid. Client
1 cc/hour with aim client could rest and
decreased risk of detached stitches of post
obtained fluid therapy on intravenous such as
N 5 + KCl (10 mEq/L) for 26,3 ml/hour and
surgery. However, as result, client was being
fasted and drinking process was delayed.
aminofusin therapy 5% 3 ml/hour. In taxonomic
structure, this condition occurred in ease
Therefore, client was given therapy N5 + KCL
(10 mEq/L) as much as 38 ml/hour and AF 5%
physical aspect column, since based on nurse
analysis client required strict supervision and
as much as 8 ml/hour. Client seemed
experiencing nausea, and green fluid flew as
monitoring of fluid, so that client’s needs of body
fluid could be fulfilled precisely. Client needs
based on nurse analysis were included in ease
much as 15 cc from NGT during observation.
Her lips looked dry.
comfort level.
Nursing intervention: what was done for
fluid imbalance was sort of standard comfort
Child A, age 16 months old, suffered for
prolapsed colostomy with body weight 8,2 Kg.
intervention which were monitoring fluid intake
and output, measuring fluid balance, measuring
Description body weight could also be
description of amount of fluid in the body,
fluid intake per day, monitoring symptoms of
dehydration or electrolyte imbalance, monitoring
therefore, child A also had risk to experience
fluid imbalance. Besides body weight condition
vital sign such as breathing frequency, pulse,
temperature and observing laboratory test
that could increase fluid imbalance, prolapsed
colostomy on child A could also gain evaporation
concerning fluids as Hb, Ht, Ur/Cr, blood
electrolyte Na/K/Cl. To overcome nausea and
of body fluid.
vomiting occurred post surgery, acupressure
was sought on point pericardium 6, on which
On the case of child RA, boy, age 8 years
old who suffered for chronic appendicitis had
experienced bloody defecations since 1 month
before hospitalized. On March 25 laboratory test
could obstruct nausea/vomiting stimulation of
client post surgery.
Intervention to overcome pain which was
was taken, it showed Hb was low 10,9 g/dL and
hematocrit value was in normal level 35,1 %.
standard comfort intervention was doing pain
scale assessment and collaborated giving
Child RA looked pale, akral cold, complained
headache. According to taxonomic structure of
analgesic therapy as pain reliever. However, we
could also do intervention of coaching nursing,
Kolcaba physical needs of RA lied on relief
that was teaching mother hw to do technique of
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143
distraction as it was taught to mother of child F.
awareness in monitoring fluid output and intake
Distraction techniques were singing, caressing,
giving toys to clients age 15 months old, 24
of children client post surgery.
months old, and 36 months old oar giving non
nutritive sucking technique to baby clients age
5 months old. Besides those, imaginary
guidance technique on clients age 8 years old
could also be used. Comfort food for the soul
was a nursing intervention to give comfort
without clients asked for it, for instance giving
child F damp cloth to wet their lips, light
Application of Kolcaba’s comfort theory was
proven increasing nurse awareness over the
importance of fluid monitoring after surgery was
undergone, however, the effectiveness had not
been proven yet, therefore, advanced
application over more cases with compared
group need to be held, so its effectiveness be
more visible.
massaging at extremity time, or on clients’ back.
References
Evaluation: according to Kolcaba’s comfort
theory, evaluation of nursing intervention which
Ball, J., Blinder, R., & Blinder, RM.
(2008).Pediatric nursing:Caring for children.
had been implemented could be done through
taxonomic structure, by which progress could
be seen before and after interventions.
Generally evaluation of comfort level of fluid and
electrolyte imbalance over four cases, those
were cases 1, 2, 3, and 4, they met progress.
Indicators used by writers in determining
changes of comfort level of fluid and electrolyte
imbalance of every client could be seen on the
success of accomplishment of planning result
criterions of nursing intervention. If fluid and
electrolyte imbalance problem occurs actually,
comfort level category is relief. After nursing
intervention was done and result of criterions
set could be accomplished, so nursing problems
of fluid and electrolyte imbalance were managed
and level of comfort was shifted into ease.
Conclusions
Application of Kolcaba’s comfort theory in
handling risk of fluid and electrolyte imbalance
on post-operative children is a novelty that has
not been applied before. Change that could be
more felt by the implementation of comfort
theory in nursing care of risk fluid and electrolyte
imbalance was the improvement of nurse
California: Prentice Hall.
Ganong, W.F. (2003). Review of medical
physiology. 20thed. New York: Appleton &
Lange.
Hockenberry, M.J., & Wilson, D. (2009).Wong’s
essentials of pediatric nursing.(8thed). St.
Louis: Mosby Elseiver
Kolcaba, K. (2001). Evolution of the mid range
theory of comfort for outcome
research.Nursing Outlook, 49(2), 86-92.
Kolcaba, KY., &Kolcaba, RJ. (1991). An analysis
of the concept of comfort. Journal of
Advance Nursing, 16, 1301-1310.
Nair, SG.,&Balachandran, R. (2004).
Perioperative fluid and electrolyte
management in paediatric patients.Indian
J. Anaesth, 48(5), 355-364.
Pierre, S., & Whelan, R. (2012).Nausea and
vomiting after surgery.Continuing Education
in Anaesthesia, Critical Care & Pain
Advance, 2012.
Application of Kolcaba’s Comfort Theory in Handling Risk of Fluid and Electrolyte Imbalance on
Post-Operative Children at BCH Ward of RSUPN Dr. Cipto Mangunkusumo
Rose, JB., &Watcha, MF. (1999). Postoperative
nausea and vomiting in paediatric
patient.British Journal of Anaesthesia,
83(1), 104-117.
Wilson, L., &Kolcaba, K. (2004).Practical
application of comfort theory in the
perianesthesia setting.Journal of
Perianesthesia Nursing, 19(3), 164-173.
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145
DESCRIPTION LEVEL KNOWLEDGE OF DIET DM ON DM SUFFERER IN REGION
WORK OF WIROBRAJAN PUBLIC HEALTH CENTER YOGYAKARTA
1
2
Isra Nur Utari S. Potabuga , Erfin Firmawati
1
Student of School of Nursing, Universitas Muhammadiyah Yogyakarta, Indonesia
2
Lecturer of Medical Surgical, School of Nursing, Universitas Muhammadiyah
Yogyakarta, Indonesia
E-mail: cheery_nara@yahoo.com
ABSTRACT
Introduction: Diabetes Mellitus (DM) was often known as “The great imitator” because the
disease can affect and attack all organs and cause complaints variety greatly. Diabetes
Mellitus Sufferer in Indonesia is predicted to increase the amount of 8,4 million in 2000 to
around 21,3 million in 2030. Knowledge of diet DM is very important to increase intellectual
behavior that can be associated with the level of knowledge. The purpose of this study was
to know description level knowledge of diet DM on DM sufferer in region work of Wirobrajan
Public Health Center Yogyakarta.
Method: Design of this research used a non-experimental with descriptive analytic. This
research used Purposive Technique Sampling and obtained 40 respondents. This research
start from May until June 2014 and used questionnaire. Data analysis used the frequency
distirubution table.
Result: The result showed description level knowledge of diet DM there are 7 respondents
good category (17,5%), 13 respondents enough category (32,5%) and 20 respondents less
category (50%).
Conclusion: Based on the research it can be concluded that most respondents are have
less knowledge of diet DM. I suggest for Wirobrajan Public Health Center to give health
education and counseling to increase knowledge to be good.
Keywords: Diabetes Mellitus, Diet, Knowledge.
147
Introduction
Diabetes mellitus (DM) is often known as “the
great imitator” because the disease can attack all
organs of the body and cause a variety of
complaints with signs and symptoms vary greatly.
Along with the changing times and increasing
public welfare in the developing countries cause
to lifestyle changes that leads to unhealthy lifestyle.
It is the result diabetic from year to year continues
to increase and to current the DM is a chronic
disease that is classified as a world health
problem.
In epidemiology, the International Diabetes
Federation (IDF) in 2013 estimated that the
increase in the number of diabetic in the world
from 382 million in 2013 to 592 million in 2035.
Indonesia has now ranks fourth highest diabetes
prevalence after the United States, China, and
India (Association of Indonesian Hospital / PERSI,
2011), whereas according to the World Health
Organization (WHO) in 2007 predicted increase
the number of diabetic in Indonesia from 8.4 million
in 2000 to around 21.3 million in 2030. Data from
the Wirobrajan Public Health Center in January
2014, in 2013 patients that diabetes control in 1624
a number of visits with an average of 135 visits
Knowledge about diet DM is very important for
people with diabetes to improving intellectual
behavior that can be attributed to the level of
knowledge, understanding, analysis and
synthesis. Therefore, the researchers wanted to
know description level knowledge of diet DM on
DM sufferer in region work of Wirobrajan Public
Health Center Yogyakarta.
Methods
This research used a research “Nonexperiment” is descriptive analytic with using the
cross sectional design. The population in this
study were all patients with type 2 DM living in
region work of Wirobrajan Public Health Center
Yogyakarta. This study obtained data about total
population in 2013 in Wirobrajan Public Health
Center Yogyakarta as many as 186 patients. The
sampling technique used in this study is using
the purposive sampling. Location of the research
conducted in Wirobrajan Public Health Center
Yogyakarta. This research was carried out for 2
months from May to June 2014.
The research instrument used by the
researchers in this study is a demographic data
questionnaire and DM dietary knowledge
per month.
questionnaire. Data collection was conducted
in two phases, the first phase is the preparation
The incidence of diabetes is still high caused
by many factors such as genetics, obesity and
phase and the second phase of implementation.
Validity test is done to test the truth or validity of
demographics (Suyono, 2013). Another cause can
be caused by lack of movement, overeating,
a questionnaire about knowledge of diet DM
using the Content Validity Index (CVI).
pregnancy, and deficiency of insulin hormone
production (Subekti, 2013). Management efforts
Calculation of dietary knowledge questionnaire
instrument reliability DM using the Kuder
to prevent the impact of DM complications
consisted of four pillars which include education,
Richardson formula (KR-20) because it
produces a dichotomy scores (1 and 0). Data
medical nutrition therapy, physical exercise, and
pharmacological management (Indonesian
analysis used the univariate analysis. Univariate
analysis of the data to analyze the demographic
Society of Endocrinology, 2006). The success of
the diet DM is supported by many factors, one of
characteristics of the data to be displayed with
frequencies and percentages include age,
which is the knowledge of patients about diet DM.
gender, education, income, information,
Description Level Knowledge of Diet DM On DM Sufferer in Region Work of Wirobrajan Public Health Center
Yogyakarta
employment and drug use. The data is displayed
using a frequency distribution table.
Based on Table 1 above shows the average
age of people with diabetes 45-59 years (95%).
Characteristics of respondents by sex, most of
Results
the female by 75%. Characteristics of
respondents by education, the majority (52.5%)
Tabel 1.
description of DM at Wirobrajan Public
had high school. Characteristics of respondents
by job most of the respondents had a job as a
Health Center (N = 40)
housewife (55%). Characteristics of
respondents by income have the most income
No
1.
2.
3.
Demographic
Characteristics
Age
30 – 44
45 – 59
Total
Sex
Man
Woman
Total
Education
Elementary
Junior High School
Senior High School
Bachelor
Total
Occuption
4.
Civil servants
Private
Employees
Entrepreneurs
Housewife
Retirement
Total
Income
5.
< 1,2 million
1,2–2,5 million
2,5 – 5 million
Total
6.
Got Information
Yes
No
Total
Source: Primary Data, 2014
Total (N=40)
F
%
2
38
40
5
95
100
is around 1.2 to 2.5 million of 67.5%.
Characteristics of respondents based on got
information about dietary DM by 90% of
respondents ever received the information.
Tabel 2.
10
30
40
25
75
100
Frequency Distribution of Knowledge of
Diet DM on diabetic in Wirobrajan Public
Health Center Yogyakarta (N = 40)
0
16
21
0
40
52,5
3
40
7,5
100
2
2
2
11
22
1
40
5
5
5
27,5
55
2,5
100
Knowledge
Categories
Good
Enough
Less
Total
Number Percentage
(n)
(%)
7
17,5
13
32,5
20
50
40
100
Based on Table 2 appears that the level
knowledge of diet DM on diabetic with good
category 7 respondents (17.5%), enough
category 13 respondents (32.5%), and less
category 20 respondents (50%).
Discussion
11
27
2
40
27,5
67,5
5
100
36
4
40
90
10
100
Based on Table 1 the characteristics of the
average age of the respondents DM at
Wirobrajan Public Health Center is 45-59 years.
This is in accordance with the IDF Diabetes Atlas
(2013) which states the majority of 382 million
people with diabetes aged between 40 and 59
years. Judging from the characteristics of the
respondents in this study gender domination by
women by 30 respondents at 75%. The results
are consistent by Sari (2013) states that the
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149
number of respondents who suffered most with
most have knowledge of diet DM were less by
type 2 diabetes are female.
20 respondents (50%). I suggest Wirobrajan
Public Health Center to giving health education
Educational characteristics of DM patients
at Wirobrajan public health center most have a
history of high school education was 52.5%.
According to research Wulp, et al (2012) which
states that people with type 2 diabetes are
largely secondary education. Based on the
characteristics of DM patients at Wirobrajan
Public Health Center have the majority of income
is in the range 1.2 to 2.5 million with a
percentage of 67.5%, it can be concluded that
the average respondent has income above the
Regional Minimum Wage. Characteristics of
obtaining information on the dietary DM DM
patients in health centers by 90% of respondents
Wirobrajan obtain information about the dietary
DM. Availability of information can increase
one’s knowledge which will be able to change
one’s lifestyle towards more positive
(Notoatmodjo, 2010).
and counseling about knowledge of diet DM to
increase the diabetic knowledge to be good.
Acknowledgment
We are very thankful to Wirobrajan Public
health centre, for allowing us to conduct this study.
We are also indebted to doctor and nurse helping
us to collect the baseline data. Finally, we would
extend a special thanks to all the respondents for
their useful information and cooperation. We hope
this study will make a positive impact on their lives
in the future. This work was supported by School
of Nursing Muhammadiyah University, Yogyakarta.
We are also grateful to the College for its generous
Refferences
Based on Table 2 the results of statistical
Perhimpunan Dokter Spesialis Penyakit Dalam
Indonesia. (2013). Mengenal Diabetes
Melitus (DM). Diakses 4 November 2013,
analysis showed that the frequency distribution
of dietary DM knowledge 50% in DM patients
dari
http://www.pbpapdi.org/
papdi.php?pb=detil_berita&kd_berita=20
categorized as having less knowledge. The
things that can affect the level of knowledge of
World Health Organization. (2007). Global
diet DM as education, information, culture, and
socio-economic experiences (Notoatmodjo,
Health Observatory. Diakses 27 Januari
2014, dari http://www.who.int/topics/
2007). According to research conducted by
Purwanto (2011), states that in order to increase
diabetes_mellitus/en/
the knowledge of people with diabetes required
the participation of health professionals to
provide appropriate information through health
education for how to diet diabetes mellitus (p =
0.00).
Conclusions
Based on the research results of description
Perkumpulan Endokrinologi Indonesia. (2006).
Konsesus Pengelolaan
Diabetes
Mellitus. Jakarta
Perhimpunan Rumah Sakit Seluruh Indonesia.
(2011). RI Rangking Keempat Jumlah
Penderita Diabetes Terbanyak Dunia,
Diakses 4 November
www.pdpersi.co.id/
level knowledge of diet DM on DM sufferer in
region work of Wirobrajan Public Health Center
Yogyakarta, can be concluded that diabetic the
2014, dari http://
Description Level Knowledge of Diet DM On DM Sufferer in Region Work of Wirobrajan Public Health Center
Yogyakarta
Suyono,
S.
(2013).
Kecenderungan
Peningkatan Jumlah Penyandang
Diabetes. Jakarta. Badan penerbit FKUI
Subekti. (2013). Apa itu Diabetes : Patofisiologi,
Gejala dan Tanda. Jakarta. Badan penerbit
FKUI
Internasional Diabetes Federation. (2013).
Diabetes Atlas. Diakses 18 Januari 2014,
dari http://www.idf.org/diabetesatlas
Sari, D.P. (2013). Upaya Penanganan Dan
Perilaku Pasien Penderita Diabetes Mellitus
Tipe 2 Di Puskesmas Maccini Sawah Kota
Makassar Tahun 2013. Skripsi Strata Satu.
Universitas Hasanudin, Makassar.
Wulp, I., Leeuw, J., Gorter, K.J., Rutten, G.
(2012). Effectiveness of peer-led selfmanagement coaching for patients recently
diagnosed with Type 2 diabetes mellitus in
primary care: a randomized controlled trial.
Diabetic Medicine
Notoatmodjo, S. (2010). Promosi Kesehatan
dan Ilmu Perilaku. Jakarta : Rineka Cipta.
Purwanto,
N.H.
(2011).
Hubungan
Pengetahuan Tentang Diet Diabetes
Mellitus Dengan Kepatuhan Pelaksanaan
Diet Pada Penderita Diabetes Mellitus.
Jurnal Keperawatan
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151
ACUPUNCTURE FOR NAUSEA VOMITING IN PREGNANCY
Imtihanul Munjiah
Lecturer School of Health ‘Aisyiyah Bandung
Master of Midwifery Student Padjadjaran University
E-mail: astar.iim@gmail.com
ABSTRACT
Introduction: Nausea and vomiting are experienced by approximately 50-90% of women.
These symptoms become more severe in hundred of thousand pregnancies. One of the
non-pharmacological treatments that is cheap and safe is acupuncture. Several studies
have shown acupuncture to be effective in treating nausea and vomiting in pregnancy. Most
of the cases were treated by sticking needles into meridian points Pericardium 6 (Neiguan).
Stimulatory effect at that point believed to increase the release of beta-endorphin and ACTH
in the pituitary throughout the chemoreceptor trigger zone (CTZ) inhibits the vomiting center.
Methods: This study is a review of the literature which is based on a systematic search of
computerized databases in the form of journal articles and researches.
Results: The mechanism of acupuncture to prevent nausea and vomiting associated with
sympathetic nerve stimulus in the center by the hypothalamus resulting in the inhibition of
gastrointestinal peristalsis. Acupuncture does not cause significant side effects, so it is quite
appropriate to be used as an alternative medicine in the health care system. The study
states that women who experience nausea and vomiting in pregnancy less than 14 weeks
and getting acupuncture therapy at the point Pericardium 6 reported nausea decreased in
the second week of the experiment, the study concluded that acupuncture is an effective
treatment for women who experience nausea and vomiting in early pregnancy Some studies
show that acupuncture is more effective than acupressure to prevent nausea and vomiting.
Keywords: Acupuncture, nausea, vomiting.
Introduction
vomiting disappeared at 14 weeks gestation,
and 90% disappeared at the age of 22
minggu.1,2,3 Pregnancy symptoms become more
Nausea and vomiting experienced by
approximately 50-90% of women. Nausea and
severe in hundred of thousand pregnancies.
Approximately 35% of women who experience
vomiting occur in 60-80% and 40-60%
multigravida primigravida. Approximately 25%
nausea and vomiting during pregnancy lost jobs
/ activities with family.4
only experience nausea without vomiting. Fifty
percent of women who experience nausea and
153
There are two ways that are often used to
The study states that women who
relieve nausea, the pharmacological and nonpharmacological. Non-pharmacological
experience emesis gravidarum in gestational
age less than 14 weeks and getting acupuncture
Methods are not harmful to the mother and the
fetus, does not have the effect of allergic or other
therapy at the point Pericardium 6 reported
nausea decreased in the second week of the
negative effects. There are several kinds of nonpharmacological techniques to reduce nausea
experiment, the study concluded that
acupuncture is an effective treatment for women
and vomiting among other ginger therapy,
acupressure, aromatherapy, and acupuncture.
who experience nausea and vomiting in early
pregnancy.8
Acupuncture is a complementary medicine
technique that is often done and it is consider
Methods
non-pharmacological treatment that is cheap
and safe.
This study is a literature review (Literature
Review) is trying to identify about acupuncture
Acupuncture point or acupoint is a collection
therapy, especially against Emesis Gravidarum.
Sources to conduct this literature review
of various nerve endings of skin and muscle that
can be stimulated by a variety of Methods, such
as acupuncture needles. Stimulation of
acupuncture points can be activated three
centers, namely the spinal cord, midbrain and
pituitary. It releases neurochemicals such as
endorphins, serotonin and norepinephrine that
is able to block pain messages and pressing
the vomiting center. In addition, stimulation of
acupuncture points can also cause the release
of adenocorticotropin hormone (ACTH) from the
pituitary. ACTH stimulates the adrenals to
produce cortisol which is antiemetik.5,6
includes studies systematic search of
computerized databases (Cochrane Google and
Google Scholar) in the form of journal articles
and research, with the total of 13 sources.
Discussion
Principles of Acupuncture
Acupuncture is a method that uses fine
needles to stimulate energy channels that run
beneath the surface of the skin. It affects the
body’s energy balance changes and work to
Nause and vomiting in pregnancy can be
restore health. Acupuncture is a treatment
method by means of a special needle into
treated with acupuncture. Therapy needed
varies according to the individual and the
specific points on the skin are called points
akupunktur.9 Basics of Traditional Chinese
severity of nausea, there were only done one
time treatment of nausea and vomiting
Medicine (TCM) is the theory of Yin Yang and
the Five Elements are made up of elements of
disappeared, the average treatment required is
three times. Most of the cases were treated by
Wood, Fire, Earth, Metal and Water. Yin Yang
balance in view of modern medicine is defined
sticking needles into meridian points
Pericardium 6 (Neiguan). Stimulatory effect at
as the unity of humoral homeostasis, namely
the immune system, the nervous and endocrine
that point believed to increase the release of
beta-endorphin and ACTH in the pituitary
systems. The picture of the area Yang in the
body is the head and neck area, where the
throughout the chemoreceptor trigger zone
(CTZ) inhibit the vomiting center (Tarcin et al,
medical world is the center of all the activity of
motion, both consciously and autonomously,
1992).5,7
Yang is fast and short activities. Yin is slow with
a long duration of activity, Yin is the front area
nerves that affect organ viscera
of the body that is relatively soft and close to
the viscera organs. The theory of the five
(gastrointestinal tract) resulting in
inhibition of movement of the
elements explain the abnormality of one element
can easily affect the other elements, the more
gastrointestinal tract and reduced
secretion. Sympathetic nerves also affect
severe the disorder, the more other elements
sickness.10
the adrenal medulla and norepinephrine
release epinepfrin that enhance the effects
Mechanism of Acupuncture for Nausea
of the sympathetic nerve, thus inhibiting
gastrointestinal motility stronger (Guyton
Vomiting
and Hall, 1996).
Acupuncture is effective at certain points on
the surface of the body, called acupuncture
points. The acupuncture points show a small
2.
in LCS potentially with entiemetik action
on ì-receptors, â-endorphin also cause
nerve bundles that penetrate into the fascia.
Three thousand and nine acupuncture points
desensitization, CTZ and vomiting center
in the medulla oblongata.
located very close to the nerve, while another
286 acupuncture points are located very close
to the blood vessels around the small nerves
are called nerve vasorum.
3.
Acupuncture
also
increases
Adenokortikotropik hormone (ACTH).
Acupuncture stimulates the hypothalamus
produces ACTH, ACTH stimulates the
Basic knowledge of medical acupuncture
is neuroscience, namely the insertion of
acupuncture points can stimulate certain nerves
adrenal gland
s
to
produce
endogenous corticosteroids. These
which are beneficial to health, and the effects
of stimulation can also cause vasodilation of
blood vessels so blood flows more smoothly,
and can regulate the endocrine system. The
Acupuncture at the point Pericardium 6
can stimulate the formation of â-endorphin
endogenous corticosteroids are antiemetics.
4.
Acupuncture norepinefrinergik cause
needles are inserted at acupuncture points will
cause a warm feeling to the patient and the skin
nerve fibers activated. Then causes the
release of norepinephrine sympathetic
appears reddish. At longer excitation can
stimulate the formation of endogenous atagonis
effects (Guyton and Hall, 2005) .10
opioid peptides, such as oktapeptid
cholecystokinin (CCK-8) by the hypothalamus
which serves to inhibit gastric motility.
The mechanism of prevention of nausea
and vomiting can be explained by the fact that:
1.
Acupuncture Point for Nausea Vomiting
Acupuncture at the point Pericardium 6
(Neiguan) has been used in various clinical
environments and a lot of research has been
done on the effect of stimulation of Pericardium
6 point on nausea and vomiting, nausea,
Acupuncture can inhibit gastric acid
secretion and inhibits gastric movement.
vomiting either physiological or nausea and
vomiting in pregnancy is due to the movement
Acupuncture stimulates the hypothalamus
to activate the autonomic nervous system,
or due to idiopathic etiology such as surgery,
chemotherapy radiotherapy and nausea or
particularly the sympathetic efferent
vomiting on the way. 11
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155
Acupuncture point Pericardium 6 is
Development Conference concluded that the
separated from the other point is a good strategy
for nausea and vomiting due to any etiology.
stimulus at the point Pericardium 6 can prevent
nausea and vomiting in pregnancy,
Point Pericardium 6 (Neiguan) located in the
inner wrist 2 cun to the top of the wrist. It can be
chemotherapy, post surgery, and motioninduced nausea and vomiting. Clinical research
measured with 3 fingers of one hand is placed
on the woman and the other wrist. Stimulatory
on acupuncture shows the effect of different
Methods of stimulating acupuncture point
effect that point has not been able to fully
understand, but stimulation at that point believed
Pericardium 6. Several studies have shown that
acupuncture is more effective than acupressure
to increase the release of beta-endorphin and
ACTH in the pituitary throughout the
to prevent nausea and vomiting.10
chemoreceptor trigger zone (CTZ) inhibit the
vomiting center.5
The mechanism of acupuncture to prevent
nausea and vomiting associated with
Stimulation of acupuncture points can
sympathetic nerve stimulus in the center
(central) by the hypothalamus resulting in the
activate three centers, namely the spinal cord,
midbrain and pituitary to release neurochemicals
inhibition of gastrointestinal peristalsis.
Acupuncture does not cause significant side
such as endorphins, serotonin and norepinehrin
were able to block the pain messages. In
effects, so it is quite appropriate to be used as
an alternative medicine in the health care
addition, stimulation of acupuncture points can
also cause the release of adenocorticotropin
hormone (ACTH) from the pituitary. ACTH
system.
stimulates the adrenals to produce cortisol. 5
Carlson and his colleagues conducted a
randomized single-blind cross check with the
placebo control group in 33 women with
hyperemesis gravidarum in Sweden (2000).
They compared the effects of acupuncture or
Pericardium 6 deep needling Superficial
(placebo). The woman asked to see the impact
of therapy on both nausea and vomiting by using
a visual analogue scale and the results showed
in the group receiving acupuncture group
received deep than placebo therapy. Stated that
in conjunction with conventional management,
hyperemesis can be alleviated more quickly by
using acupuncture, as well as reduce
hospitalization time. 5
A number of clinical studies on acupuncture
antiemetic effects that have been conducted,
mostly using point Pericardium 6. Consensus
Figure 1. Pericardium 6
Point Pericardium 6 (Neiguan), located 2
cun above the wrist. The way of matchmaking
perpendicular depth from 0.5 to 0.9 cun.
Acupuncture needles will be inserted at the point
Pericardium 6 according to the patient’s
complaints. These needles will be left for 5
minutes and then stimulated with twisted
around. With this excitation is expected taste
sensation like an electric shock needle up to
the middle finger. When it seemed to the middle
finger means the treatment given start reacting.
Neda Ebrahimi, et al. Optimal Management of
Five minutes later stimulated again in the same
way, and then left to stand for five minutes. And
Nausea of
vomiting of Pregnancy.
International Journal of Women’s Health.
so on until about 30 minutes for each therapy.12
A study that therapeutic effect of acupuncture
[Review]. 2010 August 2, 2010: 241-8.
on vomiting very quickly, as within a few minutes
of stimulation and therapeutic effects of more
than eight hours after the treatment is done.13
For pregnant women who experience
nausea and vomiting mild complaint are usually
disappear after one time of therapy. However, if
nausea vomiting are worse, they will have to
get few treatments. They do not need to do the
therapy every day, two days will be enough or
Kevin Gunawan, et al. Diagnosis and
Management of Hyperemesis Gravidarum.
Indon J Med Assoc. 2011 11 November
2011; Vol 61 No 11: 458-64.
Mariena Feejo S, et al. High Prevalence of
Severe Nause and vomiting of Prenancy
and Hyperemesis Gravidarum Effectived
Among Relatives of Individuals. Eur J
Obstet Gynecol Reprod Biol. 2008; 141 (1):
13-7.
if the complaints of nausea and vomit came to
be unbearable, they have to come for
BKPT Makassar. Acupressure effectiveness
acupuncture therapy. Pregnant woman with
minor complaints, they usually just need to be
Complaints Against Nausea Vomiting In
Pregnancy First Trimester In 2013, Napier
acupuncture by usinge a needle on pericardium
6 on the right and left of their hands. Good
response body only requires a single therapy.
City, 2013.
As for those who do not have goog respon, they
need to come back for more therapy. 12
Zhao ZQ. Neural Mechanism Underlying
Acupunture Analgesia. Progress in
Neurobiology. 2008; 85: 355-75.
Conclusions
Philip B. Hyperemesis Gravidarum Literature
Nausea and vomiting in pregnancy can be
Review. Wilconsin Medical Journal. 2003;
Volume 102 No. 3.
treated with pharmacological and nonpharmacological techniques. One of the non-
Smith C, Crowter C, J B. Acupuncture to Treat
pharmacological techniques that is safe
acupuncture techniques. Pericardium 6
Nausea and vomiting in Early Pregnancy:
A Randomized Controlled Trial. 2002 Mar,
(Neiguan) is proven to be effective in the
management of nausea and vomiting during
29: 1-9.
pregnancy.
Kurniawan H. Role of Acupuncture in Obstetrics.
In 2010.
Refferences
Anais Lacasse, et al. Epidemiology of Nausea
Anggarda Kristianti Utomo, et al. Comparison
Between Acupuncture PC6 And
and vomiting of Pregnancy: Prevalence,
Severity, Determinants, and the Importance
Ondansetron in Preventing Nausea and
Vomiting Incidence of Post-Surgical
of Race / Athnicity. BMC Pregnancy and
Childbirth. [Reseach article]. 2009 2 July
Orthopedics. Indonesian Medicine. 2009; I
No. 1: 25-31.
2009: 1-9.
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157
Dundee JW, McMillan C. Positive Evidence for
P6 Acupuncture antiemetics. Postgraduate
Medicine Journal. 1991; 67 (Review Article):
417-22.
Kristianto F. Acupuncture Overcome Nausea
Vomiting. 2012; Available from:
threspuspa.wordpress.com.
Christer P.O. Carlsson, et al. Manual
Acupuncture Reduces Hyperemesis
Gravidarum: A Placebo-Controlled,
Randomized, Single-Blind, Crossover
Study. Journal Of Pain And Sympton
Management. [Original Article]. 2000 in
October 2000; Vo 20, No. 4273-9.
THE DIFFERENCE IN OXYGEN SATURATION VALUE (SPO2) WITH SUCTION TIME
IN PATIENT WITH ENDOTRACHEAL TUBE IN ICU RSUD ULIN BANJARMASIN 2014
Solikin, Zaqyyah Huzaifah
Magister Of Nursing Program Banjarmasin Muhammadiyah Health College
E-mail: rosikinsolikin@yahoo.co.id
ABSTRACT
Introduction: Endotracheal Tube which is already attached need special attention to keep
the hygiene from secretion accumulation so the airways clearance still good and the procedure
that often been done is suctioning. Suction procedure should be done as quick as possible
to avoid hypoxia complication, there are some recommendation for suction duration that is
10 seconds maximum and 10-15 seconds. This study aimed to determine differences in
oxygen saturation value (SpO2) with suction time less than 10 seconds and more than 10
seconds-15 seconds in patient with endotracheal tube.
Methods: This study is an experimental with 15 respondents and every sampel was applied
twice suction intervention and oxygen saturation measurement using pulse oxymetri. This
study is done in ICU RSUD Ulin Banjarmasin.
Results: The result showed a significant differences in oxygen saturation value with suction
time less than 10 seconds and more than 10 seconds-15 seconds (p=0.005, p=0.001).
Conclusion: Conclusions of this study is suction with 10 seconds maximum duration will
decrease the oxygen saturation value more less. For the further research hopefully could
have more respondent than before and for the observation should be done in severe times
or in some days in order to know the fluctuation of oxygen saturation value.
Keyword: Oxygen saturation, suction endotracheal.
Introduction
in lungs (desaturation oxygen), hyposemia
happened as it is symbolized with the reduction
Endotracheal suction is the intervention
of oxygen saturaction. One of the efforts which
can be done is by putting attention of the
which often carried out by nurse and it has vital
benefits for patient to release secret from upper
suctioning of endotracheal secretion (Higgins,
2005). It is important to pay attention to the
side of respiration for patient who has lower
conscious and low cough reflect (Dougherty and
suction’s period of time to reduce the side
effects.
Lister in Hinggis, 2005). In secretion’s
suctioning, it isn’t only secret but also oxygen
159
Based on Higgins’ (2005) that suction’s
out the differences of oxygen saturation’s value
procedure should be done immediately, because
in the treatment, suction can also suction
based on the period of time by using statistical
test of Wilcoxon Test with the meaningful level
oxygen/gas out and could cause collapse to
alveoli. In order to minimize the suction of
á = 0,05.
oxygen with the suction secretion and the
possibility of the reduction of oxygen level, it is
important to do the procedure immediately in
maximum 10 seconds to one time suction time.
Results
1.
The characteristic of respondents based
on sex and age.
Perseden (2009) showed his support in the
Table 1
Respondents Distribution Based on Sex
result of systematic observation and meta
analysis which gave recommendation to be used
and Age in ICU RSUD Ulin Banjarmasin,
May–July 2014 (n=15)
as guideline for nurse to do endotracheal suction
for adult on the period of time no less than 10
seconds.
The idea of other reference about the time
period of suction attracted researcher to find out
the differences of saturation’s value of oxygen
(SpO2) based on the time period of less or same
as 10 seconds and more than 10-15 seconds
for patient with endotracheal tube in ICU RSUD
Ulin Banjarmasin.
Characteristics
1. Sex
a. Male
b. Female
Total
2. Age
a. Less than
32 years
b. More than
32 years
Total
Methods
This research is experimental Pre-Post test
control design. The stage was started by giving
pre test, post the treatment, the researcher did
the post test. In this research, the treatment
given was twice; the first was to measure the
saturation’s value. Post that, the next thing to
do was giving suction in period of time less or
equal to 10 seconds. Then, the value of oxygen
saturations was measured. The second
treatment was carried out by measuring the
oxygen saturation as the beginning, and then
the suction was held for more than 10-15
seconds.
The sample of this research was 15 adult
patients with ETT in ICU RSUD Ulin
Banjarmasin. Bivariate analysis was used to find
N
Percentage
(%)
9
6
15
60
40
100
2
13,3
13
15
86,7
100
The Difference in Oxygen Saturation Value (SpO2) with Suction Time in Patient with Endotracheal Tube in ICU
RSUD Ulin Banjarmasin 2014
2.
Oxygen saturation (SpO2) pre and post suction with the period of time less or equal to 10 seconds.
Table 2 Oxygen Saturation’s Value (SpO2) Pre and Post Suction with the Period of Time
less or Equal to 10 Seconds In ICU RSUD Ulin Banjarmasin, May–July 2014 (n=15)
Variables
Mean
SD
MinMax
95% CI
SpO2
Pre and Post Suction with Time Less or Equal to 10 seconds
Pre
Post
3.
99,53
97,33
0,834
3,395
98-100
88-100
99,53-100,00
95,45-99,21
Oxygen saturation (SpO2) Pre and Post suction with time 10–15 seconds.
Table 3 Oxygen Saturation’s Value (SpO2) Pre and Post Suction with Time 10–15
Seconds. In ICU RSUD Ulin Banjarmasin, May–July 2014 (n=15)
Variables
Mean
SD
MinMax
95% CI
SpO2
Pre and Post Suction With Time More Than 10–15 Seconds
Pre
Post
4.
99,73
95,2
0,594
4,144
98-100
81-98
99,40-100,06
92,91-97,49
Oxygen saturation (SpO2) based on the time period of Suction
Table 4 Oxygen Saturation’s Value (SpO2) Pre and Post Suction Based on the Time
Period of Suction In ICU RSUD Ulin Banjarmasin, May–July 2014 (n=15)
Variable
Oxygen Saturation Value (SpO2)
suction less or equal Pre
to 10 seconds
Post
Pre
suction more than
10–15 seconds
Post
Mean
SD
95% CI
p value
99,53
97,33
99,73
95,20
0,834
3,395
0,594
4,144
99,07-100,00
95,45-99,21
99,40-100,06
92,91-97,49
0,005
|
0,001
|
161
Discussions
The result shows that the youngest
respondent is 18 years old and the oldest is 63
years old, while the most respondents are male.
The result of the research is in the same
line with Martin (2005) who stated that younger
client needs shorter treatment and the client has
higher level of survival, while the older one has
higher level of dependency toward ventilator.
Respondents’ ages are same with the patients’
age in Intensive Care Unit (ICU) (Smeltzer,
2009).
becomes mean 95.20. However, by analyzing
the amount of saturation oxygen post the suction
more than 10-15 seconds, we can recommend
that the suction to patient with endotracheal tube
should use suction maximum 10 seconds.
The result is in the same line with Higgins
(2005) which states that suction’s procedure
should be carried out immediately in short period
of time to minimize the oxygen suction with
secret and may cause the reduction of oxygen’s
level. Suction’s procedure should be should be
carried out immediately in short period of time.
Sex characteristic in this research is same
Sujatmi (2010) also carries research about the
effectiveness of long suction toward oxygen’s
with the previous research by Sujatmi (2010)
who states that the male respondents are more
saturation perifer to stroke’s patient in ICU
station RSUD Kebumen. This research is aimed
than female respondents. This matter is not in
the same page with Martin (2005) who sates
to find out the differences of effectiveness of 1015 seconds suction toward oxygen perifer. The
that the failure in respiration happens more in
female, because physiologically, the compliance
result shows that 10 seconds suction is more
effective than 15 seconds suction.
ability of male’s lung is higher than female.
Smeltzer (2009) states that age factor and
sex give effect to lung’s ventilation function. The
reduction of ventilation happens as the growth
of age, in normal condition around 50 years old,
where the alveoli start to lose its elasticity.
Conclusions
There is difference of oxygen saturation pre
and post the suction less or equal to 10 seconds
with p value 0.005 (p<0.05) with mean of oxygen
saturation’s value pre suction is less or equal to
Statistical test result by using wilcoxon test
10 seconds is 99.53% with deviation standard
of 0.834 and post treatment the mean of oxygen
gets p value 0.005 for suction less or equal to
10 seconds and p value 0.001 for suction more
saturation becomes 97.33% with deviation
standard of 3.395. meanwhile, for suction more
than 10-15 seconds which means that p value
< á (0.05), means that Ho is rejected. Therefore,
than 10-15 seconds shows difference that p
value 0.001 (p<0.05) with mean of oxygen
we can take the conclusion that there is
difference in oxygen saturation’s value toward
saturation’s value pre suction is less or equal to
10 seconds is 99.73% with deviation standard
the suction’s period of time less or equal to 10
seconds and more than 10-15 seconds.
of 0.594 and post treatment the mean of oxygen
saturation becomes 95.20% with deviation
standard of 4.144.
After suction given less or equal to 10
second and 10-15 seconds, there is reduction
of oxygen saturation’s value which is mean
99.53 becomes mean 97.33, and mean 99.73
The practice of nurse can be developed
based on the existing researches, because for
the practical nurse, the result can be applied
for endotracheal suction treatment and for
The Difference in Oxygen Saturation Value (SpO2) with Suction Time in Patient with Endotracheal Tube in ICU
RSUD Ulin Banjarmasin 2014
manager of nursing in hospital to set the
Maggiore, S. M, et al. (2013). Decreasing the
procedure of operational standard that the
maximum time for section is 10 seconds so that
Adverse Effects of Endotracheal
Suctioning During Mechanical Ventilation
the quality of nursing services can be improved.
by Changing Practice. Respir Care
2013;58(10):1588 –1597.
References
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Agustinar. (2010). Saturasi oksigen pada
Endotracheal suctioning in hypoxemic
patients. Reanimation Volume 20, 12-18.
pasien terpasang ventilator di ICU
(Intensive Care Unit) Rumah Sakit
Roemani Muhammadiyah Semarang.
http://jtptunismus-gdl-agustinaar-7020-2-
inspiratory muscle strength training to
facilitate ventilator weaning. http://
bab1.pdf (Accessed in 11 Desember
2013).
chestjournal.chestpubs.org/content/122/1/
192. full. html. (Accessed in 22 February
American Association for Respiratory Care.
(2010). Endotracheal Suctioning of
Mechanically Ventilated Patients With
2014).
NSW Intensive Care Coordination and
Monitoring Unit. (2010). Suctioning an
Artificial Airways 2010. http://
rcjournal.com/cpgs/pdf/06.10.0758.
(Accessed in 22 Februari 2014).
Augustyn,B. (2007). Ventilator-Associated
Pneumonia Risk Factors and
Preventions. http://aacn.org/WD/CETests/
Media/C0742.pdf. (Accessed in 7 October
2013).
Clark AP, Winslow EH, Tyler DO, White KM.
Effects of endotracheal suctioning on
mixed venous oxygen saturation and
heart rate in critically ill adults. http://
www.ncbi.nlm.nih.gov/pubmed/2211166
(Accessed in 28 Desember 2013).
Higgin, D. (2005). Tracheal Suction. http: //
nursingtimes.net/. (Accessed in 22
February 2014).
Higgins, Dan. (2005). Tracheal Suction VOL:
101, ISSUE: 08, PAGE NO: 36.
<http.wwwTracheal suction. _ Practice _
Nursing Times.htm> (Accessed in 22
January 2014).
Martin, A.D., Davenport, P.D., Franceschi,
A.C.& Harman. (2005). E. Use of
adult with a tracheal tube. http://
final_suction_guideline_desember_4.pdf.
(Accessed in 28 November 2013).
Pedersen. Nielsen, Rosendahl M. Hjermind.
Egerod. (2009). Endotracheal Suctioning
of the Adult Intubated Patient — What Is
the Evidence?. Intensive Crit Care Nurs.
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November 2013).
Pritchard M, Flenady V, Woodgate P.
Preoxygenation for tracheal suctioning in
intubated, ventilated newborn infants.
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Ruben, D. Restrepo., Brown Joel II.,Yohanes
M Hughes. (2010). American Association
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(Tracheostomies & Endotracheal Tubes).
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2013).
Smeltzer & Bare. (2009). Keperawatan
Medikal Bedah. Jakarta: EGC.
Smeltzer, S. C., & Bare, B. G. (2004). Brunner
& Suddarth’s Textbook of Medical
Surgical Nursing 10th edition. lippincott
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Sujatmi, Sri. (2010). Efektifitas Lama Waktu
Suction 10 dan 15 Detik Terhadap Kadar
Saturasi Oksigen (O2) Perifer pada
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Tesis. STIKES Muhammadiyah
Gombong.
1ST INC-AIPNEMA 2014:
THE EXPERIENCE OF STUDENT NURSES IN COMMUNICATION DURING THE
CROSS-CULTURAL LEARNING PROGRAM
Nur Lailatul Masruroh1, Reni Ilmiasih1
1
Nursing Study Program-Health Science Faculty, University of Muhammadiyah Malang
E-mail: faranurlailatul@yahoo.com
ABSTRACT
Introduction: ASEAN Community is getting closer, therefore an important ability that should
be prepared in facing this era is cross-cultural communication ability. Communication is a
very essensial aspect of cross-cultural care nursing practice. Nurses will meet some obstacles
in the situations where they do not communicate the same languange as their patients, and
it will lead to the poor quality of nursing care. The purpose of the study is to explore the
student nurses‘ experiences in communication during the cross-cultural learning program.
Methods: The design is qualitative descriptive exploratory study. Semi structured interviews
were conducted with eight students nurses from Indonesia and Thailand who participated in
the cross-cultural nursing practice program. The data were analyzed thematically.
Results: There are three themes that emerge as the findings of the study, these are: the
barriers of communication, the strategies of communication and factors affecting
communication. Students nurses have made creative startegies to communicate with the
patients who have different background of culture. It is important for every school of nursing
to ensure that the prospective of nurses has been equipped with sufficient knowledge and
skill of cross-culture communication. It is in order to give high quality of nursing care for the
patients with the different cultural and guarantee the readiness of nurses in facing the
challenge of ASEAN Community.
Keywords: communication, cross-culture learning program, student nurses.
Introduction
nursing practice . The ability to overcome the
challenges of understanding a new culture
allows the nurse be able to provide a higher
ASEAN Community that will be launch
in 2015 will bring the impact to the health care
delivery system, it is including nursing. Nurses
quality of nursing care through an improved
nurse-client relationship and achieve the goal
will face particular challenges when take care
for the patients from a different cultural
of improved nursing practice (Hitchcock,1999).
It is essessensial for every nurse to be able to
background (Potter & Perry, 2008).
Understanding cultural differences is both an
adapt their nursing care strategies to respond
to the culture need of their patients.
opportunity and a challenge to professional
165
The definition of culture is the shared
beliefs, values, ideas, language, communication
and norm of a group of people (Papadopoulos
I., 2006). The common problem of nurses and
other healthcare professionals is lacking the
knowledge and skills to respond to the needs of
patient from a different cultural background to
their own (Berlin et al , 2006; Gerrish et al, 1996),
and the major barrier in the cross-culture care
is communication difficulties ( Cioffi R.N, 2003).
Communication is a fundamental part of
nursingIt involves sharing information, caring
conversations and social interactions .
Communication is a significant factor with regard
to patient satisfaction and the quality nursing
care (Potter & Perry, 2008). Patients’ emphasize
that nurses should take time to communicate
since it is through communication that nurses
get to know patients, identify their needs and
inform them. When communication is poor
patients are dissatisfied with their care (Attree
M., 2001).
Accordingly, the ability to develop the
skill to communication effectively is something
important in the cross-culture care. Therefore,
it is important to explore deeply the phenomena
that will be the focus of investigation within the
study which entitled the experiences of student
nurses in communication during the crossculturalal learning .
about the research issue (Straus A. & Corbin J.,
1998).
Participants for this research were
purposefully selected because they all had
particular experience of the topic which the
researcher is trying to explore and who following
requirement of inclusion criteria (Holloway &
Wheeler, 2010). Semi-structured interviews
were conducted with 8 student nurses, four
student nurses were from Indonesia and the rest
were from Thailand. All of students spoke
English as the daily conversation among them
during the program. However, normally each of
student was used to spoke in their national
language as the everyday language among
students who have the same nationality. As an
additional information, especially for the
Indonesian students were come from different
background of ethnic. It is important to be
noticed since each of ethnic in Indonesia is
typically using different local languages.
The participants were from nursing study
program of a famous University in Thailand and
also a Private University in East Java, Indonesia
and had undertaken the students exchange
program and conducted a nursing parctice in a
general hospital in Malang City, East Java
Province of Indonesia. The general information
of the participants are shown in Table 1.
Methods
The overall objective of this study is to
explore the student nurses‘ experiences in
communication during the cross-cultural
learning program. Descriptive exploratory
qualitative was used to investigate the topics
under investigation. The present research
design will help to explore the dimensions of
the problem because there is limited knowledge
The Experience of Student Nurses in Communication During the Cross-Cultural Learning Program
Table 1 Description of participants by initial, gender, age, race/ ethnic and nationality
Initial
UB
NP
AJ
BR
RN
TM
C
YA
Gender
Age
F
F
F
F
F
F
M
M
22
21
21
21
22
22
24
23
Year of
Study
3th Year
3th Year
3th Year
3th Year
4th Year
4th Year
4th Year
4th Year
The interviewing process were conducted
in English and it took place and time based on
the agreement of both interviewer and
participants during the cross-cultural learning
program. The researcher asked the same main
questions, that is: “would you please tell me
about your experiences in communication during
undertake the cross-cultural learning program!”.
The data were collected by a written open
question and also in depth Interviews. The result
Ethnic
Thai
Thai
Thai
Thai
Lombok
Sumbawa
Central Java
Bima
Nationality
Thailand
Thailand
Thailand
Thailand
Indonesia
Indonesia
Indonesia
Indonesia
started with the words used by participant to
prevent researcher from imposing her own
framework and ideas from the data. Most of
codes were generated from the data are chunks
of the data that represented the main idea of
each participant‘s statement. Subsequently, to
find supporting evidence and identify the similar
meanings which are linked to the same
phenomenon, the following step was grouping
the codes together which reflect every different
of interviews were audio-tape recorded and
labeled with the number or code, date and an
significant idea (Holloway & Wheeler, 2010).
anonymous name to protect the identity of each
participant. All the answers of participants were
Next, the researcher focused on the most
frequent codes, sorted and compared amounts
transcribed after each of collecting data process,
and the data deleted afterwards. The data
of data from these focused codes to generate
categories and themes (Charmaz, 2006). In
collection process was ended when the
saturation of the data is achieved. It was
formulating the themes and sub themes,
researcher integrated quotations from the
achieved in the sixth participant. However, the
collecting data process was continued until two
transcript of the interview to describe the
experience explicitly. At this stage, the
more participants in order to ensure that there
is no new information anymore (Holloway &
researcher identified several themes that
appeared as a result of exhaustive analysis of
Wheeler, 2010).
the data.
In order to have a deep understanding of
the data, the researcher read through the
Two activities were taken to develop
credibility in this study. Firstly, the researcher
transcribed interviews three times. Next, the
researcher established initial code (open
established initially familiarity with the culture
of participants before the first data collection take
source) on the data (Holloway & Wheeler, 2010).
In this step, the researcher wrote a brief, and
place. Secondly, the researcher gave an
opportunity to refuse to participate in the study
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to ensure that the data collection process involve
of communication. A student nurse explained
only those who are indeed willing to participate
and prepared the data objectively (Shenton,
the obstacles she had:
2004). Meanwhile, transferability ascertains with
thick description, and dependability and
confirmability are achieved with collected the
data using semi-structured interviews on
competent participants who are knowledgeable
and answering essentially the same questions
(Shenton, 2004). Next, audit trail is performed
to ensure confirmability by writing the detailed
process of how researcher achieved the
conclusions (Holloway & Wheeler, 2010).
Results
The student nurses‘ experiences in
communication during the cross-cultural
learning programpresented through three
themes that emerged from the data. Those are:
the barriers of communication, the strategies of
communication and factors affecting
communication.
The barriers of communication
The barriers in the language lead to the
problems for nurses and patients. Problems
ware not only felt by the Thai student nurses,
but also the student nurses from Indonesia since
in general they come from different ethnic
background with the patients. Despite, the
difficulties that has been felt by Indonesian
Students did not as hard as perceived by Thai
students. Participants expressed concern that
they felt uncomfortable in providing limited
information when they have to explain the
procedure to the patient who has East Javanese
background. In fact, they feel that they generally
communicate the technical aspects of what the
procedure requires, an explanation of the
“We couldn’t speak fluently, it didn’t feel
right but I don`t know what to say...the
patient didn’t get my point why I needed
to change the wound dressing with the
new one and I didn’t really concern to
explain it either. It was more that I just
did my job and… I just change it …”
Another situations were emerged from the
experience of participants who felt that an
important thing of the caring relationship was
disappeared:
“There is something that missing
during the nursing care... when I get in
contact with the patient, It’s not
organized very well…it`s difficult to say
something nice to make them happy
and close …when you don’t have a way
to communicate…communication is
essential for good nursing care...”
The strategies of communication
There are many strategies that participants
used to developed communication with patients
in situations where they did not understand the
common spoken language. All of participants
from Thailand concluded opinion on how
important the existence of their Indonesian
friends who became a partner during nursing
practice. The Indonesian student nurses always
facilitated the language barrier of the Thai
students. Meanwhile, in such situations,
Indonesian students also need a help from the
nurses to translate the local language when
they faced patients who did not understand the
national language.
reasons why the procedure needs frequently
have been eliminated because of the limitation
“Fortunatelly, my Indonesian partner
of communication when there was no common
always help me to translate Bahasa into
English...It suports me a lot during
spoken language.
“...we know that 70% of communication
is body language so why don`t we use
communication with the patient..”
The national language of Indonesian is
Bahasa, however the most daily conversation
it; it is a good tool for communication..
we can use body language instead and
of the people are using the local language in
line with their ethnicity background. In general,
a smile…”
the patients background ethnicity are East
Javanese, which typically tend to more rugged
compared to the common Java language which
is derived from the other Javanese ethnicity.
Therefore, several participants described
situations in which they had made an intentional
effort to facilitate communication. For example,
they had learnt a few words in the patient’s
language, and it also including the Indonesian
students.
“I learnt how to say greeting, sorry and
Factors affecting communication
It was clear that there were other factors
which affect communication in cross-cultural
learning program. Participants varied in their
attitude towards overcoming communication
difficulties. Participants who were from Thai
background generally emphasized the benifits
of adopting a positive attitude towards
addressing communication problems.
“If you take your time and are interested
in the patient then you can understand
them”
thank you in Javanese language...my
friend also told me how to call someone
Most participants emphasized on how
by the gender and seniority in the
Javanese manner...in such moment..it
important to understand the different cultural
norms and traditions. It supports them to
help me a lot”
appreciate that people behave differently and
have different world views. Cultural knowledge
Meanwhile, the Indonesian student nurses
also learn how to speak in the high level of Java
language. It is the common rule prevailing during
speaking to someone older or respected.
gave them more confidence in tackling
unfamiliar situations which in turn led to
improved communication.
“You have a different attitude, you have
learnt how to handle…different
“ I have been stay more than 3 years
in this town...but I still need time to
situations. You have learnt how to think
in a different way...”
understand the high level of Java
Language..it is completely different with
mine...when you don`t know how to
speak properly, people will accuse you
Most of participants suggested that their
experience within the cross-cultural learning
as an impolite..”
program had made them culturally aware and
had helped them to see the individual and not
Participants also emphasized the
advantages of using body language as a means
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169
just the cultural group they belonged to. It also
needs and were anxious about causing offence
helped them be comfortable with meeting
patients from different cultural backgrounds.
through their line of questioning. Medical
students in the UK report similar challenges in
“I have so much experience due to my
cross-cultural care encounters (Kai et al, 2001).
The current study points to the limitations of the
background. Somehow it comes
automatically and then…you cross a
line, in the end you don’t see cultural
differences but individual ones”
student nurses in communication skills but
suggests a willingness to learn more.
Gerrish et al (2001) have identified how
Discussion
nurses can work towards ensuring effective and
sensitive communication in cross-cultural care
The results reported in this study are from
an exploratory study of student nurses
encounters. Drawing upon Kim’s (1992) work
they propose that there may be generic
experiences in communication during the crosscultural learning program. In accordance with
communication skills which can be learned and
which prepare individuals to be optimally flexible
In agreement with the literatures (Leininger M,
McFarland MR, 2002; Culley L , 2001;
and adapt at meeting the challenges of crosscultural communication, irrespective of the
Papadopoulos I., 2006). Student nurses
identified that effective communication was
specific cultures involved in the exchange. They
call this ‘intercultural communicative
fundamental to providing quality nursing care.
However, they experienced the difficulties when
competence’. They also emphasize the need to
develop ‘cultural communicative competence’
whereby individuals acquire specific knowledge
trying to communicate with patients when they
did not speak the same language. Other authors
have identified the anxiety nurses experience
when they are unable to communicate effectively
with patients (Bradby H, 2001; Kai et al, 2007)
and this observation is endorsed by student
nurses in the current study. Kai et al (2007)
identified the professional uncertainty and
disempowerment that qualified nurses and other
healthcare professionals experience in crosscultural care encounters due to a perceived
ignorance of cultural differences.
Student nurses in the current study
identified how cultural knowledge acquired
through their cross-cultural learning nursing
program had helped to equip them with an
understanding of cultural diversity that could
inform their interactions with patients from
different cultural backgrounds. However, they
lacked skills and confidence in applying
knowledge to practice when assessing patients’
about the patient’s cultural background that
might have a bearing on nursing care. Nurses
should avoid stereotypes but need sufficient
knowledge to know what might be relevant in
the cross-cultural care encounter. The findings
from the current study highlight the need for
student nurses to develop these two dimensions
of communicative competence.
Conclusions
The implications of the findings of this study
could be the reference in developing the nursing
curriculum that emphasizes on enhancing the
ability of cross-culture communication skill and
knowledge. Many challenges in the crossculture communication that have been faced by
students nurses during the program, especially
when they do not use the same language with
the patient. Although they use many strategies
to facilitate communication they find themselves
in situations where they are unable to
Practice (Culley L, Dyson S, eds.),
communicate effectively and this leads to
dissatisfaction with the caring experience. They
Palgrave, Basingstoke, 109–27.
also lack skills and confidence in cross-cultural
communication. Even in situations where
students felt satisfied that they were able to
communicate, it does not mean that the patient
was satisfied with the interaction. In the light of
these findings, is important that nursing
programs enable student nurses to become
competent in communicating in cross-cultural
learning program and that the clinical learning
environment provides them with the opportunity
Cioffi R.N (2003). Communicating with culturally
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Acknowledgements
Nurs; 33: 566–74.
Alhamdulillahirobbil ‘Aalamiin, my greatest
gratitude for Allah S.W.T, the God who blesses
me a beautiful life. Next, I also would like to
express my grateful thank to the Dean of Health
Science Faculty and all of the University Leaders
of University of Muhammadiyah Malang for the
great supports
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FACTORS RELATED TO THE RELAPSE INCIDENT
IN CHILDREN WITH ACUTE LEUKEMIA LIMPOBLASTIK AT PEDIATRIC OUTPATIENT
UNIT DR. CIPTA MANGUNKUSUMO NATIONAL HOSPITAL, JAKARTA 2014
Nyimas Heny Purwati1, Lestari2
Fakultas Ilmu Keperawatan Universitas Muhammadiyah Jakarta
E-mail: psik_fkk_umj@yahoo.co.id
ABSTRACT
Introduction: Relapse in acute lymphoblastic leukemia reappeared in the blood compartment,
bone marrow, central nervous system or testis after achieving complete remission. The
purpose of this study was to determine the factors associated with the relapse incidence in
children with acute lymphoblastic leukemia at pediatric outpatient unit Dr. Cipto
Mangunkusumo National Hospital.
Methods: The design of this study used a descriptive cross-sectional design with a sample
of 49 respondents. In analyzing the data the researcher using frequency distribution univariate
analysis for age, gender, treatment adherence, treatment evaluation, as well as risk
stratification and Bivariate analysis to determine the relationship between two variables,
namely the relationship between age, gender, compliance, and risk stratification with events
relapse of acute lymphoblastic leukemia in children.
Results: The results showed that there was no relationship between age and the incidence
of relapse in children with LLA (p value = 0.062), there was no relationship between sex with
the incidence of relapse in children with LLA (p value = 1.000), there was no relationship
between compliance with the incidence of relapse in children with LLA (p value = 1.000), no
correlation between the incidence of relapse risk stratification in children with LLA (p value =
0.000).
Keywords: Children, Lymphoblastic Acute Leukemia, Relapses.
Introduction
proliferation of white blood cells, with the
manifestation of the presence of abnormal cells
in the peripheral blood, (Permono, et al, 2010).
Children classified as individuals aged from
0 to 18 years, which is in the process of growth
and development and is influenced by healthy
and diseased conditions. Blood cancer
Acute lymphoblastic leukemia (ALL) is type
of childhood cancer are most common and are
responsible for 80% of cases of childhood
(leukemia) is a malignant disease of blood cells
derived from bone marrow, characterized by a
leukemia incidence is highest in children aged
173
between 3 and 5 years. The impact on children
on age, sex, degree of stratification of the
and family issues are diagnosed leukemia
include psychological preparedness, funding,
disease and compliance.
treatment time, concerns cannot recover as well
as complications of the disease or treatment.
Results
The research results, revealed that most
The success of the acute lymphoblastic
leukemia therapy in children is influenced by the
age incidence is 1 to 10 years of the 40 children
(81.6%). Based on sex, more men than women,
child’s own factors and environmental factors
that include parents, socioeconomic, treatment
which is 28% and 57.1%, respectively. Based
on the level of compliance in the treatment
adherence.
showed mostly compliant treatment is 35 people
(71.5%). Results of univariate analysis showed
Based on the results of interviews with 10
parents, whose children were relapsed, the data
obtained that the occurrence of relapse in
children caused by non-compliance to treatment
resulting in delays in treatment as a result of
mismatches schedule for health insurance that
there were 14 children (28.6%) of respondents
who experienced relapse, and 17 children
(34.7%) had high-risk stratification.
1.
is not applicable, other factors are also caused
by the condition child decreased as a result of
Relation between ages with relapse
Incidence in children with LLA.
Based on the results of the study,
indicated that the incidence of relapse in
children with LLA generally occurs in
such disobedience.
Based on this background, researchers
interested in conducting research on the factors
associated with the incidence of relapse in
children aged 1-10 years is 22.5%
compared with patients aged> 10 years
(55.5%). The statistical test also showed
children with acute lymphoblastic leukemia
(ALL) at pediatric outpatient unit DR. Cipta
that there was no significant relationship
between age and the incidence of relapse
Mangunkusumo Hospitals include factors such
as child’s age, sex, risk stratification and
with p value = 0.062
adherence to chemotherapy.
2.
Relation between sex with relapse
Methods
The proportion of LLA patients who
This research was conducted by using
relapse equally between boys and girls
(28.6%). The statistical test also showed
cross sectional survey and held in Pediatric
Outpatient Unit Dr.Cipto mangunkusumo
no association between the sexes with an
incidence of relapse with p value = 1.000.
National Hospital in January 2014 through
February 2014. Population observed in this
study are all pediatric patients with acute
lymphoblastic leukemia in Pediatric Outpatient
Unit Dr.Cipto mangunkusumo National Hospital
the total sample of 49 respondents. The
collection of the data used in this study are a
questionnaire checklist sheet is based on data
3.
Relation between compliance with
relapse Incidence in children with LLA.
The research result Indicates that the
proportion of children with LLA equally
among children undergoing treatment
obedient and disobedient children, which
Factors Related to the Relapse Incident in Children with Acute Leukemia Limpoblastik at Pediatric Outpatient
Unit Dr. Cipto Mangunkusumo National Hospital, Jakarta 2014
4.
is 28.6% with p value = 1.000. Thus it can
study are consistent with the consensus
be concluded that there was no significant
relationship between compliance with the
of the conference The Rome and NCI in
the 1990s that set which is age limit 1-
incidence of relapse in children with LLA.
<10 years and leukocyte count of 50,000
/uL as a determining factor. This study is
Relation between stratification with
also in line with the opinion of Wong (2009)
that children at the time of diagnosis
Research results show that the
incidence of relapse commonly occurs in
between the ages of 2 years and 9 years
consistently showed a better prognosis
children with high risk stratification, which
is 64.7%. The analysis also showed no
than children who were diagnosed before
the age of 2 years or after 10 years.
significant relationship between the
incidence of relapse risk stratification in
2.
Relation between sex with relapse
children with LLA (p = 0.000). OR values
showed children with high risk stratification
The proportion of LLA patients whose
has 17.7 times greater chance for relapse
compared with patients with normal risk
relapse, equally between male patients
and female (28.6%). Value of OR = 1,
stratification.
indicating no difference in the relapse
tendency of boys and girls. The statistical
Discussion
test showed no relationship between the
sexes with an incidence of relapse (p =
From
the
49
respondents,
characteristics of children are generally male sex
as much as 28 (57.1%). Based on the literature
1.000). The study is not in accordance with
the opinion of Cecily (2003) that cases of
where ALL is more common in boys than girls.
This type of leukemia is 25% of all cancers
childhood leukemia incidence is highest
in children aged between 3 and 5 years,
affecting children under the age of 15 years.
Most often occurs in children between the ages
girls showed better prognosis than boys
of 3-10, but sometimes occurs in adulthood by
the age of 30-50 years.
1.
Relation between ages with relapse
The incidence of relapse in children
with LLA are generally occurs in children
aged> 10 years, which is about 5 people
(55.6%) compared with patients aged
between 1-10 years which is 9 people
(22.5%). From the statistical test showed
that there was no relationship between
age and the incidence of relapse in
children with LLA (p value = 0.062). This
3.
Relation between compliance with
The results of the analysis of
compliance with the incidence of relapse
in children with LLA showed the same
proportion of patients who relapse
between adhere and non-adherent
patients. There are 4 of the 14 patients
(28.6%) who did not adhere to treatment
has relapse. And there are 10 of 35
patients (28.6%) who adhere patients
experienced a relapse/ poor prognosis.
The statistical test showed no statistical
relationship between compliance with the
incidence of relapse in children with LLA
|
|
175
(p = 1.000). This study is not accordance
There is no significant relationship
with the Permono (2010) opinion that the
level of LLA patient’s life expectancy is
between age and the incidence of
relapse in children with LLA in Dr.
determined by two things: finding cancer
at an early stage as well as patient
Ciptomangunkusumo
Hosiptal Jakarta.
compliance in treatment.
4.
2.
3.
National
Relation between stratification risk
with relapse Incidence in children with
between sex with the incidence of
relapse in children with LLA in Dr.
LLA.
Ciptomangunkusumo
Hospital Jakarta.
Results of the analysis of risk
stratification with the incidence of relapse
in children with LLA shows the proportion
4.
National
between the incidence of relapse
of patients who relapse is greater in
patients with high risk stratification
treatment adherence in children with
LLA in Dr. Ciptomangunkusumo
compared with patients with normal risk
stratification. From the 17 high-risk
National Hospital Jakarta.
patients, 11 (64.7%) of them relapsed,
whereas 32 patients from the risk of
regular, only 3 (9.4%) patients who
relapse. The analysis also showed no
5.
There is a significant relationship
between the incidence of relapse risk
stratification in children with LLA in
RSUPN Dr. Ciptomangunkusumo
Jakarta
statistical relationship between the
incidence of relapse risk stratification in
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greater than the risk stratification of
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patients with normal. (CI: 3.762 to 83.495).
This study was accordance with the
Jurnal Of Jakarta.Jurnal 0f cancer
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177
PREVALENCE AND RISK FACTORS OF LATENT TUBERCULOSIS INFECTION
AMONG PULMONARY TB CLOSE-CONTACTS
IN BANDUNG, WEST JAVA, INDONESIA
Reynie P. Raya1, Raspati Cundarani2, Merrin Rutherford3, Karen Hornby4,
Rovina Ruslami2, Bachti Alisjahbana2, Philip Hill3, Dick Menzies4, Ab. Schaap5
1
‘Aisyiyah Bandung School of Health Sciences
2
TB-HIV Research Centre, Faculty of Medicine Universitas Padjadjaran Bandung
3
5
Center for International Health, Otago University, Dunedin, New Zealand
4
McGill International TB Center, McGill University, Canada
TB Center, London School of Hygiene and Tropical Medicine, United Kingdom
E-mail: reynie.praya@gmail.com
ABSTRACT
Introduction: Screening and treatment of latent tuberculosis infection (LTBI) in a high
tuberculosis (TB) incidence areas is not yet a priority. This study was aimed to identify
prevalence and risk indicators of LTBI among adults in close contact with pulmonary TB
patients.
Methods: Between April 2011 and January 2012, we performed a cross-sectional survey
among adults in close-contact to pulmonary TB patients at a lung clinic in Bandung, Indonesia.
Adult close contact was defined as a person of 18 years and older, who spend more than
four hours per week at least one week with a pulmonary TB patient. LTBI was determined by
positive skin testing, without any abnormality on chest X-Ray. Risk factors for LTBI were
evaluated using univariate and multivariate logistic regression analyses.
Results: In total we included 293 close contacts, of which 56% was identified as having
LTBI. Based on the univariate logistic regression analysis, some economical factors were a
risk factor for developing LTBI. Risk factors identified by previous studies did not significantly
affect LTBI in our study, such as age, living in the same house with index case, index case
bacterial load and treatment delay and high risk working place.
Conclusion: More than half of LBTI infection occurred among close contacts and socioeconomic status in the first and fourth quintile was a risk factor to LTBI. It is suggested to
start prioritizing screening and giving prophylaxis to people in close contact with pulmonary
TB patients.
Keywords: adult close-contacts, latent tuberculosis infection, pulmonary tuberculosis.
179
Introduction
Estimated is that around one third of the
global population is infected with Mycobacterium
tuberculosis (Mtb) (1). Most people will have a
latent tuberculosis infection (LTBI), which means
they are infected, but asymptomatic. Among
them 5 to 10% will develop tuberculosis disease
(TB) during their lifetime, the rest remain
asymptomatic (2). Each year an estimated 8.8
million people get active TB, of which 1.1 million
die due to the disease (1).
LTBI is diagnosed by Mantoux test,
where purified protein derivative (PPD)
intracutaneous is inserted on the lower arm. If
the diameter of the induration is 10 milimiter or
more the result is considered positive. Chest Xray examination are done to exclude active TB
(3). TB is an airborne disease and therefore
transmission is more common among close
contacts of TB patients (4). HIV and other
diseases that impair immunity are major risk
factors for developing TB (5). Other risk factors
for developing TB are among others malnutrition,
being in close contact with a TB patient, a history
of TB and socio-economic status (SES) (5, 7).
However, there are also risk factors unique for
each population, such as time of employment
for health care workers, homelessness for drug
users, foreigners in countries with low
tuberculosis incidence (6, 7, 8).
risk group were age, the amount of contact with
TB patients, educational level and body mass
index (BMI) (9, 10). In children the LTBI
prevalence was 31% in Laos and 24 – 79% in
South East Asia and particularly 41% among
children in Indonesia (11, 12, 13). The risk
factors in children are contact with sputum
positive patients and the bacterium load of the
patients. Also the house environment is
important, such as the number of people living
in a house, number of rooms and number of
windows.
Indonesia has one the highest TB load
worldwide, therefore it is important to know LTBI
prevalence as well as identify people at risk for
LTBI and treating them before they have active
TB. Therefore, we aim to determine the risk
factors of LTBI among close contacts of
pulmonary TB patients. Some studies has been
done on LTBI, some of the results said that it is
more common among the close contacts of
pulmonary TB patients In Indonesia, there was
not yet any study on the risk factors of LTBI
among close contacts of pulmonary TB patients.
Therefore this study will give additional
information and it can also give additional
information for screening program in Indonesia.
Primary objective of this study is to measure
the prevalence of LTBI in close contacts of
pulmonary TB patients. And specific objective
is to explore risk factors of LTBI in close contacts
of pulmonary TB patients.
Most studies have been done in high
income countries with low TB incidence,
whereas Asia has a high TB incidence. In Asia
only few studies have looked at LTBI prevalence
Methods
Study population and design
A cross-sectional survey was conducted
and risk factors, concentrating mostly children
and health workers. In China the LTBI
among close contacts of pulmonary TB patients
who visited a lung clinic in April 2011 until
prevalence among health care workers was
56%, whereas this prevalence varied from 47 to
January 2012. This study received ethical
clearance from both the ethical committee of
66% in Viet Nam. Risk factors for LTBI in this
McGill University of Canada and Ethical
Prevalence and Risk Factors of Latent Tuberculosis Infection Among Pulmonary TB Close-Contacts in
Bandung, West Java, Indonesia
Committee of Faculty of Medicine, Universitas
to the DOTS clinic for further examination and
Padjadjaran, Bandung, Indonesia. As for this
project, ethical clearance was also sought from
treatment. All participants received an
appropriate compensation for transport.
LSHTM ethical committee. For this study we
selected adults (e”18 years) in close contact to
Statistical analyses
a pulmonary TB patients (index case) more than
4 hours per week more than a week. Index case
One of the variables used in the
statistical analyses is the wealth index. This
was identified as new cases of pulmonary TB
patients who has positive sputum smear and
wealth index was calculated with Principal
Component Analysis (PCA). Basically, a
visited Bandung lung clinic for medication. Index
cases then interviewed for determining people
collection of household assets which indicate
wealth was reduced to one variable. In our study,
who live in the same household with them and/
or who spend more than 4 hours per week
the household assets used were ownership of
the house, availability of electricity, type of toilet
around them. Participants were excluded if they
had TB (pulmonary and/or extra pulmonary TB),
used, flooring material, ceiling, cooking fuel, wall
material, roof material, source of drink water,
were pregnant, using hormonal contraceptive
or planning to get pregnant within 6 months.
cooking fuel, radio, television, VCD/DVD player,
telephone/cell phone, refrigerator, bicycle, motor
Data collection
cycle and car and/or truck. The sum of the factor
calculated by PCA was categorized to 5 quintiles
After informed consent, participants
received a Mantoux test; 100μl tubercule purified
of wealth index. However, several of these
indicators are not representative of wealth in
protein derivative (PPD) is injected under the
skin on the lower arm. After 48 to 72 hours the
Indonesia now. Therefore we dropped having a
television, electricity, telephone/cellphone and
test was read by a study nurse with a specific
Mantoux test scale and the induration was
cooking fuel, because almost all respondents
have a television (94%), electricity (99%) and
reported. An induration of 10mm or more is
considered positive, in which case the
telephone/cellphone (88%). In addition, 87%
uses gas for cooking, since the Indonesian
participant has LTBI. When a participant could
not come to the clinic for the Mantoux test, the
government subsidized gas.
study nurse would do the test at their home. All
participants with an induration of 10mm and
more received a chest X-ray to exclude active
TB. In additions, all respondents were
interviewed to determine characteristics for this
study, such as demographic factors, socioeconomic status, health status, and factors
related to TB and LTBI.
All
respondents
with
LTBI
In this study we used descriptive
statistics to characterise our study population,
which include percentages, means and standard
deviations. To determine the relationship
between each independent variable and LTBI,
we used univariate logistic regression analyses.
Bases on prior knowledge, variables were
selected for multivariate logistic regression and
adjusted odds ratio (OR) were calculated.
are
randomised for LTBI treatment (either 4 month
rifampin or 9 months isoniazid). In addition,
patients with a positive chest X-ray were referred
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181
Results
Descriptive analysis
A total of 293 close contacts were included in this study. More than half of the respondents (54%)
was male, 85% aged more than 24 years, 75% married, 61% working and 54% finished primary education.
We found a prevalence of LTBI of 56% (164 participants). Figure 1 shows the prevalence of LTBI in the
different classes of wealth index.
Figure 1. Percentage of LTBI based on wealth index
Percentage of LTBI and Non-LTBI
100,0%
90,0%
80,0%
70,0%
60,0%
LTBI
50,0%
Non-LTBI
40,0%
30,0%
20,0%
10,0%
0,0%
Low est
Second
Third
Fourth
Highest
Wealth Index
More than half of the LTBI was contracted by male (54.3%), mostly in productive age, married
(75.6%), unemployed (31.1%) and finished senior high school (37.8%) and more than half (64.8%) was
in the first quintile of the wealth index. Analyses show that people with LTBI do not different in sociodemographics characteristics than those who without LTBI. Complete information can be seen in the
table below:
Table 1. Socio-demographic characteristics of LTBI respondents (n=164)
Characteristics
Total
Sex
Male
Female
Age (years)
15 – 24
25 – 34
35 – 44
45 – 54
? 55
293
LTBI
n (%)
164 (56.0)
151
142
89 (58.9)
75 (52.8)
0.291
25
33
34
42
30
0.200
N
45
71
59
75
43
(55.6)
(46.5)
(57.6)
(56.0)
(69.8)
p value*
Characteristics
LTBI
n (%)
N
Marital status
Married
Single
Divorced/Widowed
Occupation
Unemployed
Private company employe
Government employee
Self-employed
Labour
Private school teachers
Students
Retirement
Seller
Education
Un-educated
Primary Education
Higher Education
Wealth index
1st quintile
2nd quintile
3rd quintile
4th quintile
5th quintile
209
65
19
88
32
3
46
79
4
8
5
28
7
150
136
54
63
61
57
58
p value*
124 (59.3)
29 (44.6)
11 (58.0)
51
17
1
23
44
3
4
2
19
0.112
(57.9)
(53.1)
(33.3)
(50.0)
(55.7)
(75.0)
(50.0)
(40.0)
(67.9)
0.823
3 (42.9)
89 (59.3)
72 (52.9)
0.431
35
30
36
36
27
0.135
(64.8)
(47.6)
(59.0)
(63.2)
(46.6)
Univariate analysis
Univariate analysis of logistic regression was used to assess possible risk factors that of LTBI
among the close contacts. We chose these factors based on prior knowledge of TB, such as history of
immunosuppressant condition, BCG vaccination, smoking habit and HIV status. In addition, other variables
of house conditions and relation with index case were also been analysed.
Table 2 gives an overview of variables and there relation to LTBI. The analyses show that none of
these variables are significantly related to LTBI.
|
|
183
Table 2. Health condition and history of LTBI respondents (n=164)
Variable
Immunosuppresion condition
Asthma
Diabetes
BCG vaccination history
Vaccinated
BCG scar
Smoking habit
Current
Ex-smoker
Never
HIV status
Positive
Negative
Unknown
Body Mass Index
Underweight
Normal
Overweight/obese
LTBI
n (%)
N
OR (95%CI)
p value*
15
8
9 (60.0)
5 (62.5)
1.19 (0.41 – 3.43)
1.32 (0.31 – 5.63)
0.746
0.704
169
130
94 (55.6)
69 (53.1)
1.03 (0.65 – 1.65)
1.23 (0.78 – 1.96)
0.888
0.373
136
19
138
79 (58.1)
11 (57.9)
74 (53.6)
1.00
0.99 (0.38 – 2.62)
0.83 (0.52 – 1.34)
0.987
0.457
1
14
278
0 (0)
9 (64.3)
155 (55.8)
1.43 (0.47 – 4.37)
1.00
48
167
78
31 (64.6)
90 (53.9)
43 (55.1)
1.00
0.95 (0.55 – 1.63)
1.48 (0.71 – 3.11)
0.532
0.856
0.296
SES was measured by wealth index, but for the univariate analysis each of variables was assess
(table 3).
Table 3. Housing characteristics of LTBI respondents (n=164)
Housing Characteristics
House ownership
Private
Non-private (parents’, relatives’,
rental, company’s)
Electricity
Yes
No
Toilet
Private
Public
Flooring material
Ceramics
Cement
Wood/bamboo
LTBI
n (%)
N
OR (95%CI)
p value*
97
196
52 (53.6)
112 (57.1)
0.87 (0.60 – 1.28)
0.567
290
3
163 (56.2)
1 (33.3)
0.39 (0.03 – 4.34)
0.428
241
52
137 (59.0)
27 (51.9)
0.82 (0.45 – 1.50)
0.518
217
59
17
128 (78.1)
27 (45.8)
9 (52.9)
1.00
0.59 (0.33 – 1.05)
0.78 (0.29 – 2.11)
0.071
0.627
Housing Characteristics
Ceiling material
Wood/bamboo
Concrete
Asbestos/eternite
None
Cooking fuel
Gas
Non-gas
Wealth index
1st quintile
2nd quintile
3rd quintile
4th quintile
5th quintile
LTBI
n (%)
N
OR (95%CI)
p value*
184
15
77
17
104
12
35
13
(56.5)
(80.0)
(45.5)
(76.5)
0.40 (0.13 – 1.27)
1.23 (0.23 – 6.67)
0.26 (0.08 – 0.86)
1.00
0.121
0.121
0.810
255
38
146 (57.3)
8 (21.0)
1.00
1.49 (0.75 – 2.95)
0.254
2.11 (0.99 – 4.52)
1.04 (0.51 – 2.13)
1.65 (0.80 – 3.41)
1.97 (0.93 – 4.15)
1.00
0.054
0.906
0.174
0.075
54
63
61
57
58
Several variables were related to the index
case, such as the relationship with index case,
35
30
36
36
27
(64.8)
(47.6)
(59.0)
(63.2)
(46.6)
sputum smear. Around 45% (132 out of 293)
index case had positive 3 bacterial load and only
8% was scanty. Number of LTBI was increase
shared bedroom, index case’s bacterial load and
time of starting treatment. Most index cases
in scanty to positive 1, 48% and 59.5%.
However, in positive 2 and 3, the percentage
were family members, in 25.9% the spouse and
in 55.6% another direct family member. Others
was quite similar, 55.8% and 55.3%. The time
for an index case to seek treatment at a lung
(18.4%) include extended family members,
housemates, and colleagues.
clinic was more than 3 weeks after first
symptoms in the majority of the cases (78.8%).
Most of respondents did not shared
bedroom with their index case (70.3%). Index
As shown in table 4 none of these variables are
significantly associated with the prevalence of
case bacterial load was categorized from
number of Mycobacterium tuberculosis found in
LTBI among case contacts.
Table 4. Variables that related with index case (n=293)
Variable
Relationship with index case
Spouse
Nuclear family member
Others
Shared bedroom
Yes
No
N
LTBI
n (%)
OR (95%CI)
76 41 (59.0) 1.00
163 96 (58.9) 1.22 (0.71 – 2.11)
54 27 (50.0) 0.85 (0.42 – 1.72)
87 48 (55.2) 1.05 (0.63 – 1.73)
206116 (56.3)
|
p value*
0.472
0.657
0.858
|
185
Variable
N
Index case’s bacterial load
Scanty
Positive 1
Positive 2
Positive 3
First time visit lung clinic
? 3 weeks
> 3 weeks
LTBI
n (%)
25
84
52
132
12 (48.0)
50 (59.5)
29 (55.8)
73 (55.3)
OR (95%CI)
1.00
1.59 (0.65 – 3.91)
1.37 (0.52 – 3.56)
1.34 (0.57 – 3.17)
62 32 (51.6) 1.00 (0.99 – 1.00)
231132 (57.1)
p value*
0.309
0.523
0.503
0.490
Multivariate analysis
Based on prior knowledge on LTBI we selected some variables for multivariate logistic regression
analysis. Table 5 shows the variables we considered and the corresponding adjusted Odds Ratios.
These results show that after adjustment, only wealth index is a risk factor for LTBI.
Table 5. Multivariate logistic regression
Variable
OR(95%CI)
p value
Wealth index
1st quintile
2nd quintile
3rd quintile
4th quintile
5th quintile
1.00
2.29 (1.05 – 4.98)
1.79 (0.85 – 3.78)
1.21 (0.58 – 2.54)
2.36 (1.06 – 5.26)
0.037*
0.129
0.614
0.036*
BMI
Underweight
Normal
Overweight
1.00
0.86 (0.49 – 1.52)
1.41 (0.65 – 3.02)
0.609
0.383
1.14 (0.67 – 1.92)
0.635
1.00
1.65 (0.65 – 4.17)
1.83 (0.68 – 5.01)
1.47 (0.60 – 3.57)
0.288
0.242
0.399
1.00 (0.99 – 1.00)
0.345
Sleeping arrangements
In the same bedroom
Index case bacterial load
Scanty
Positive 1
Positive 2
Positive 3
First time visit lung clinic (days)
Mean±SD: 89.8±98.6
Our study was a cross-sectional study and
Discussion
The majority of case contacts of pulmonary
TB patients have LTBI, namely 56%. In addition,
we could not clearly identify factors that
increased the risk of LTBI in this group.
therefore appropriate to determine the
prevalence of LTBI. However, this lacks strength
in identifying risk factors for LTBI, since some
case contact could already have LTBI prior to
the index case getting TB.
This study is the first to look at the
prevalence of LTBI and risk factors among adult
case contacts in Indonesia. Previous studies in
Conclusions
In conclusion, LTBI is very common among
Asia have focused on different risk groups, such
as children in close contact to TB patients and
case contacts of pulmonary TB patients, but we
could not identify risk factors of LTBI in this
health workers. It is difficult to compare the LTBI
prevalence we reported to other studies, since
group. Therefore, we would recommend
prophylactic treatment to all close case contacts.
the prevalence of LTBI differs between countries
and risk groups. For example, a systematic
In addition, further research is needed to
determine risk factors for LTBI in Indonesia.
review showed that the LTBI prevalence varied
between 50.5%% in Africa, 48.6 in Asia and
Acknowledgment
65.5% in Americas. (14). In some populations
the prevalence of LTBI is much higher, for
example 61.1% of hospital workers in Hanoi
have LTBI (10). In other groups, such as
We would like to thank TB clinic authorities
where this study was taken place which without
their permission this study will not be possible.
pregnant women in Tanzania and drugs users
in Houston, Texas, the prevalence was lower
We also would like to express our gratitude to
all of the TB clinis’s staff for their continuous
and generous help so that this study could be
ranging from 26.2% to 45% (14, 15).
done well.
Previous studies have shown that close
contact with TB patient, low SES, smoking,
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house hold environment, such as number of
people living in the house, sleeping in the same
World Health Organisation. Global
Tuberculosis control, Geneva: World
room with TB patient and number of window and
treatment delays risk factors for LTBI. However,
in our study we could not identify any of these
variables as risk factor for LTBI. A possible
explanation is that the tuberculosis burden in
Indonesia is so high, that everyone gets exposed
to Mtb and therefore other factors do not
increase the risk of exposure. Also our study
population might be biased because people with
severe TB infection might not make it to the clinic
Health Organisation. 2010.
Pienaar E, Fluitt AM, Whitney SE, et.al. A
model Tuberculosis transmission and
intervention strategies in an urban
residential area. Computational Biology
and Chemistry. 2010:34:86-89.
Nguyen D and Menzies D. Diagnosis and
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Canadian Journal of CME. 2009; 89-97
and people with mild symptoms might get
treatment at primary health facilities.
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GYMNASTICS EFFECTIVINESS IN REDUCING DISMENORHEA ADOLESENCT IN
CLASS XI SOCIAL MOJOLABAN 1 HIGH SCHOOL DISTRICT SUKOHARJO
Datik Kurniawati, Sri Mintarsih
STIKes PKU Muhammadiyah,Surakarta
E-mail: datikkurniawati119@gmail.com, mintarsihmimin11@yahoo.co.id
ABSTRACT
Introduction: Dismenorhea cramp lower abdoment is a great and very sore just before or
during menstruation. Preliminary studies conducted by researchers at Mojolaban 1 High
School Sukoharjo on 54 respondents, as many as 41 people (75%) of whom had dismenorhea
and sometimes forced to leave school hours, while 13 people (25%) did not experience
menstrual pain. One of the management dismenorhea is with physical exercise, one of
them with gymnastics. Dismenorhea Gymnastics is one of the relaxation techniques.
Dismenorhea many gymnastic movements targeting the lower abdominal muscles that close
to the uterus. To determine the effectiveness of exercise in reducing Dismenorhea in
adolescent girls.
Methods: This study used a pre-experimental design with pre-post-test design types in one
group (one group pre-post test design). The population in this study were all young women
sitting in class XI social Mojolaban 1 High School Sukoharjo which includes 3 classes by the
number of girls students 76 people. This study uses a sampling technique Non-Probability
Sampling with purposive sampling. The study sample as many as 38 students of class XI
social Mojolaban 1 High School Sukoharjo.
Results: Data analysis is done to give the results that dismenorhea gymnastics performed
with intensity < 3x effective in reducing dismenorhea with probability value of 0,046 at 5%
significance level and gymnastics dismenorhea performed with intensity > 3x is also effective
in reducing dismenorhea with probability value of 0,014 at the 5% significance level.
Conclusion: Gymnastics dismenorhea performed with intensity > 3 times more effective
than dismenorhea gymnastics performed with intensity < 3x, where the probability value of
0,046 > 0,014 at the 5% significance level.
Keywords: Events Dismenorhea, Gymnastics Dismenorhea.
189
Introduction
3.
High
Dysmenorrheal is great cramp in the lower
It is very great pain. It makes someone
abdomen and very sore just before or during
menstruation (Benson, 2009). Dysmenorrheal
can’t do everything. They need rest. The
treatment is given in high intensity. If it is
is a painful cramps during menstruation. It is
just a symptom not disease. Menstrual pain
possible, operation can be done because
it disturbs every menstruation.
raise from the contraction of myometrium
disritmic that displays one or more symptoms
from mild to severe pain in the lower abdomen,
buttocks and spasmodic pain on the medium
side of thigh (Baziat, 2008).
Prawirohardjo (2007) mentions that there
are 2 dysmenorrheal, namely:
1.
Primary dysmenorrheal
It is called essential, intrinsic, or idiopathic
dysmenorrheal. Primary dysmenorrheal is
menstrual pain encountered without real
abnormalities in the genital tool
2.
Many theories have been advanced to
explain the cause of primary dysmenorrheal, but
the pathophysiology hasn’t been understood
clearly. Apparently, there are some factors
causes the primary dysmenorrheal such as
psychological, constitution, obstruction of
cervical canal and endocrine factors
(Prawiroharjo, 2007)
The most common symptoms are cramp in
the lower abdomen and other symptoms like
sweating, tachy cardia, headache, nausea,
vomiting, diarrhea, and shaking (Benson, 2009).
The great symptom of dysmenorrheal are
Secondary Dysmenorrheal
nousea/vomiting, pale/weakness, headache/
migraine, irritable of colon and bladder (Adrews,
It is called extrinsic dysmenorrheal that is
got from acquired. Secondary
2009)
dysmenorrheal is caused by gynecologic
disorder like salpyngytis, chronicle,
endometriosis, adenomyosis uteri, uterine
services stenosis and others.
Manuaba (2010) divides the intensity of
Dysmenorrheal gymnastic is one of
relaxation techniques. Sport or physical exercise
can produce endorphin hormone. This hormone
can act as a natural tranquilizer that is produced
by the brain. It can give a comfort sense and
dysmenorrheal in the three types:
able to reduce the pain during contractions.
Sport can increase the endorphin levels four
1.
to five time in the blood. More exercise done,
the higher level of
endorphin. By exercise,
Low
Moment and it can recover quickly. The
pain will go way itself without medicine.
The pain doesn’t disturb the daily activity.
2.
Medium
someone will come out the endorphin and
captured by receptor in the hypothalamus and
limbic system that control the emotion (Harry,
2005)
The pain needs medicine to relieve the
pain. The pain can be controlled. We don’t
need leaving our activity.
Gymnastics Effectiveness in Reducing Dismenorhea Adolesenct in Class XI Social Mojolaban 1 High School
District Sukoharjo
The Implementation Time Gymnastics
Dysmenorrheal
Results
1.
Respondents Based on Age
Regular exercise can reduce stress and
fatigue. Indirectly, it also reduces pain. The
Table 1 Distribution Calculation Result of
simple exercise and regular physical activity
such as walking, running, cycling, or swimming
Respondent Age
at the time before and during menstruation can
make the blood flow in the muscles around the
Age
f
%
17 s / d 18 years old
25
65.8
15 s / d 16 years old
13
34.2
Total
38
100
Source: processed primary data, 2014
uterus to be smooth, so that the pain can be
overcome or reduced. The exercise at least 30
minutes a week with a frequency of 3-5 times
(Proverawati and Misaroh, 2009).
From the data, it can be seen that the
age of 15 s / d 16 years old is as many as
Methods
13 respondents or 34.2% and the age of
17 s / d 18 years old is as many as 25
This study used a pre-experimental design
with pre-post-test design types in one group (one
respondents or 65.8%. It can be
concluded that the majority of respondents
group pre-post test design). The type of one
group pre-post test design was chosen by the
age 17 s / d 18 years old is as many as 25
respondents or 65.8%.
researcher based on the purpose of study, the
ability of the researcher and the data are
available. So the design is the most
appropriately used in this research. The
characteristics type of this research is revealing
a causal relationship by engaging a group of
subject. The group of subjects are observed
before doing intervention. Then the researchers
observe more after intervention (Nursalam,
2013).
The Characteristics Distribution of
2.
Invariant Analysis
a. Dysmenorrheal Gymnastics Intensity for Girls
Table 2 The Results of Distribution Calculation
for Dysmenorrheal Gymnastics Intensity for
Girls
Age
f
%
Done <3x
14
36.8
Done> 3x
24
63.2
Total
38
100
The distribution based on the intensity of
dysmenorrheal gymnastic for girls. Exactly, the
girls are at SMA N 1 Mojolaban Sukoharjo, XI
IPS. It can be seen that the category of <3x is
as many as 14 respondents or 36.8% and the
category of > 3x is as many as 24 respondents
or 63.2%. So we can conclude that the majority
of teenagers do the category of done> 3x. Those
are 24 respondents or 63.2%.
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191
b. The Condition of Girls Before Gymnastics
Dysmenorrheal Trained
3.
Bivariant Analysis
Table 5 The comparison between the
Table 3 The Results of Distribution Calculation
for The Condition of Girls Before Gymnastics
condition of girls before gymnastics
dysmenorrheal trained and after gymnastics
dysmenorrheal trained at SMA N 1 Mojolaban
Sukoharjo Class XI IPS
Category
f
%
Mild pain
12
31.6
Severe pain
26
68.4
Total
38
100
It can be seen that the distribution based
on the condition of girls before gymnastics
Sukoharjo, XI IPS are the category of severe
pain are 26 respondents or 658.4%, and mild
p-value, the
significant
Gymnastics
dysmenorrhea <3x
0.046 <0.05
Notification
H0 is rejected and Ha
accepted, gymnastics
dismenorhea ineffective
in reducing dismenorhea
Gymnastics
H0 is rejected and Ha
dysmenorrhea > 3x accepted, gymnastics
0.014 <0.05
dismenorhea effective in
reducing dismenorhea
pain are 12 respondents or 31.6%. It can be
concluded that the majority are in severe pain
Based on the test results in table 4.7 by
using Wilcoxon (Z) analysis can be seen that
category. Those are 26 respondents or 68.4%.
the result of dysmenorrheal gymnastics done
less than 3 times (<3x) is 0.046 <0.05. Whereas
c. The Condition of Girls After Gymnastics
the result of gymnastics dysmenorrheal done
more than 3 times (>3x) is 0,003 <0,05. So, it
Table 4 The Results of Distribution
Calculation for The Condition of Girls After
can be said that dysmenorrheal gymnastic can
reduce dysmenorrhea at the girls of SMA N 1
Gymnastics Dysmenorrheal Trained
Mojolaban Sukoharjo XI IPS. It is more effective
if it is done more than 3 times (>3x).
Category
f
%
Mild pain
22
57.9
Severe pain
16
42.1
Total
38
100
It can be seen that the distribution based
on the condition of girls after gymnastics
Sukoharjo, XI IPS are the category of severe
pain are 16 respondents or 42.1%, and mild pain
are 22 respondents or 57.9%. It can be
concluded that the majority are in mild pain
category. Those are 22 respondents or 57.9%.
Discussion
Based on the results of test by using
Wilcoxon (Z) analysis can be seen that that the
result of dysmenorrheal gymnastics is done less
than 3 times (<3x) is 0.046 <0.05. Whereas the
result of gymnastics dysmenorrheal is done
more than 3 times (>3x) is 0,003 <0,05. So, it
can be said that dysmenorrheal gymnastic can
reduce dysmenorrhea at the girls of SMA N 1
Mojolaban Sukoharjo XI IPS. It is more effective
if it is done more than 3 times (>3x)
According Anurogo and Wulandari (2009)
Based on the experience of dysmenorrhea
suffer, usually they perform some steps to
Gymnastics Effectiveness in Reducing Dismenorhea Adolesenct in Class XI Social Mojolaban 1 High School
District Sukoharjo
reduce menstrual pain, but not until in severe
4.
conditions is avoid stress. The body will react
when it is stress. These stress factors can
reduce resistance to pain. The first sign that
shows stress is the tighten of body muscles
because of stress hormones. The condition will
cause the increasing of blood pressure, heart
rate, body temperature, and respiration. The
body will produce more the adrenaline,
Dysmenorrhea gymnastic is done more
than 3x (>3x) is effective to reduce
dysmenorrhea by p is as many as 0.014
5.
Dysmenorrheal gymnastic more effective
can reduce dysmenorrhea, if it is done
more than 3 times (>3x) where the value
of p is 0.046>0.014 by the significant 5%
Acknowledgments
estrogen, progesterone and prostaglandins
hormone during the stress. Estrogens may
The girls are expected to do gymnastics
cause more increasing of uterine contractions.
Whereas progesterone inhibits contraction. The
dysmenorhea
before
menstruation
independently so that the level of dysmenorrhea
increasing of the contraction can cause the pain.
Moreover, the hormone adrenaline also
can be reduced. The researchers are expected
control the factors that can influence the degree
increases. The condition can cause the tighten
of body including the muscles of the uterus. It
of dysmenorrhea, e.g psychological,
constitutional, and activity. They can do
can make pain when
(Prawirohardjo, 2009).
dymenorrhea gymnastics every morning and or
evening in order to the result can be maximal.
menstruation
Conclusions
References
1.
The intensity of dysmenorrhea gymnastic
at the girls of SMA N 1 Mojolaban
Andrews, Gilly. 2009. Buku Ajar Kesehatan
Reproduksi Wanita Edisi 2. Alih Bahasa Sari
Sukoharjo, class XI IPS, majority
performed > 3x is as many as 24
Kurnianingsih. Jakarta : Penerbit Buku
Kedokteran EGC
respondents (63.2%).
2.
Anurogo, dr. D dan Wulandari, A. 2011. Cara
The condition of girls before gymnastics
dysmenorrhea trained at SMA N 1
Mojolaban Sukoharjo, XI IPS are majority
in severe pain category. Those are 26
respondents or 68.4%. Whereas, the
condition of girls after gymnastics
dysmenorrheal trained are majority in mild
pain category. Those are 22 respondents
Jitu Mengatasi Nyeri Haid. Yogyakarta :
ANDI.
Baziat, Ali. 2008. Endokrinologi Ginekologi Edisi
2. Jakarta : Media Aesculapius FKUI
Benson, Ralph. 2008. Buku Saku Obstetri dan
Ginekologi. Alih Bahasa Susani Wijaya.
Jakarta : Buku Kedokteran EGC
or 57.9%.
Bobak Lowdermik Jensen. 2004. Buku Ajar
3.
Dysmenorrhea gymnastic is done less
than 3x (<3x) is effective to reduce
dysmenorrhea by p is as many as 0.046
Keperawatan Maternitas Edisi 4. Jakarta :
Penerbit Buku Kedokteran EGC
Harry, W. 2005. Hubungan Kemampuan Aerobik
dan Kondisi Psikologis pada Pelajar Lakilaki SMU Negeri 1 Prabumulih. Fakultas
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Kedokteran Universitas Sriwijaya. http://
klikharry. files.wordpress.com/2007/02/
1.doc%20+%20endorphin%20+%20dalam%20+%20tubuh.
Akses October, 5, 2013. Jam 19:25
Manuaba, dkk. 2010. Buku Ajar Penuntun Kuliah
Ginekologi. Jakarta : Trans Info Media
Manuaba, Ida Bagus Gde. 2004. Penuntun
Kepaniteraan Klinik Obstetri dan
Ginekologi. Jakarta : Penerbit Buku
Kedokteran EGC
Nursalam. 2013. Metodologi Penelitian Ilmu
Keperawatan Edisi 3. Jakarta : Salemba
Medika
Prawirohardjo, S. 2007. Ilmu Kandungan.
Jakarta : Yayasan Bina Pustaka
Prawirohardjo, S. 2009. Ilmu Kandungan. Edisi
2. Jakarta: Yayasan Bina Pustaka
Proverawati, A dan Misaroh, S. 2009. Menarche
Menstruasi Pertama Penuh Makna.
Yogyakarta: Nuha Medika.
DIFFERENCES IN THE MEAN AND LIMIT OF AGREEMENT OF THE RESULT VISUAL
ESTIMATION, NOMOGRAMS AND FORMULAS ROSS LABORATORIES IN PATIENTS
IN THE INTENSIVE CARE UNIT OF
DR. HASAN SADIKIN HOSPITAL BANDUNG
Yani Trihandayani, Tri Wahyu Murni, Kusman Ibrahim
Fakultas Ilmu Keperawatan Universitas Padjadjaran,Bandung
E-mail: yantrhy21@yahoo.co.id
ABSTRACT
Introduction: Patients were treated in intensive care unit is usually in state of reduce
consciousness or with some limitations, so often encountered in critically ill patients will be
problems related to fulfillment of nutrients, oxygen, or other besic needs. Weight assessment
in critically ill patients is often done by visual, using some formula or with anthropometric
measurrements. Many studies have suggested that visual estimation of body weight in the
determination of many inaccuracy, which can cause problem assosiated with the used of
the data that weight can aggravate the condition and increase length os time the patient’s
care. The purpose of this study was to analyze differences in the mean and limit of agreement
of the result visual estimation, nomograms and formulas Ross Laboratories in patients in
the intensive care unit of dr. Hasan Sadikin Hospital.
Methods: This study is an observasional, cross sectional analytic. Sampling technique with
consecutive sampling as many as 19 patients and 19 helathy people as a control group.
Weight determination is done by visual observation and anthropometric measurrements for
later results incorporated into nomograms and formula Ross Laboratories.
Results: Statistical test results obtained by measuring the mean weight probability 0.032 is
smaller than á = 0.05 it can be conclude that there are significant differences in body weight
between measurrement method visually, nomograms and formula Ross Laboratories.
Conformance test results obtained by the Bland Altman Plots third methode of determining
the weight has a p value > á = 0.05, which means there is no match between the
measurrements in patients with healthy people as a control group.
Conclusion: Determination of the weight formula Ross Laboratories is quite applicated for
use in patients without fracture extremity complications and nomogram for patientd if there
are fracture extremity. Further research is needed to determine the effect of weight
determination by formula Ross Laboratories in meeting the nutritional needs of patients in
intensive care.
Keywords: Determination of body weight, formulas Ross laboratories, intensive care patients,
nomograms, visual estimation
195
Introduction
Characteristics of patients treated in an
in adult patients in hospitals, especially in the
emergency department (Anglemyer et.al, 2004).
intensive care generally varies as major
postoperative patients, emergency patients due
Based on the results of preliminary studies
conducted at the time of doing a residency at
to major trauma, sepsis or respiratory failure.
The effects of injury or serious illness of the
the Hospital researcher Dr. Hasan Sadikin, the
determination of estimates of body weight in
energy metabolism, protein, carbohydrate and
fat will affect the nutritional needs of the critically
patients with decreased consciousness or
limitations in providing information on the actual
ill patients (Escallon, 2003). In addition, patients
treated in an intensive care unit is usually in a
weight being treated in an intensive care carried
out by different Methods, some use a formula
state with some limitations, such as limitation of
motion and loss of consciousness.
or perform anthropometric measurements, but
most still do by asking the patient’s family
Assessment is important in the scope of
nursing critical areas one of which is the
assessment of body weight, because the weight
of data will be widely used for the determination
of some requirements, such as nutritional needs,
dosage requirements of drugs, resuscitation
process, determining tidal volume respiration
and hemodynamic assessment. However,
because most critically ill patients in a state of
reduced consciousness and with some
limitations, so that the weight measurements for
the evaluation of every day is hard to do. With
regard to the above health practitioners are often
in charge did not know for sure how much weight
the patient, so the patient’s weight is often
determined by visual estimation by a health care
practitioner. And do not rule out the possibility
that the weight estimation is done by a health
practitioner can vary between one another.
According to Leary, et al (2000) visually
estimated weight carried by health practitioners
to determine the approximate weight of the
patient in mind that these Methods are less
accurate when compared to actual patient body
weight (Chittawatanarat et.al, 2012), and no
study about the accuracy of the ability of health
care workers in estimating the patient’s weight
members or by visual estimation by looking at
the patient in a lying position with regard to the
patient’s height standard bed length from head
to toe, which is performed by a doctor or nurse
and are usually not determined but based on
the opinion of 2 or 3 people. Evaluation of the
patient’s weight during hospitalization in the
room is not done every day, when seen from
the documentation contained in the patient
observation sheet, the determination of the
patient’s weight did not change from the start to
go up a few days patients were hospitalized in
the infirmary. The nurse in the room was saying
requires an effective and fast way for the
determination of the patient’s weight that will
support to fulfill the nutritional needs of the
patient. Based on the results of a survey
conducted on 15 nurses with experience of
working in different clinics to perform a visual
estimate of the individual’s body weight was only
3 people who can correctly determine the weight
according to the actual weight of the
respondents.
The accuracy in the determination of the
patient’s weight by health practitioners is very
important, so hopefully there will be no errors in
some ways related to the estimation of body
weight, such as errors in drug administration,
determining the nutritional needs of the patient
Differences in the Mean and Limit of Agreement of the Result Visual Estimation, Nomograms and Formulas
Ross Laboratories in Patients in the Intensive Care Unit of Dr. Hasan Sadikin Hospital Bandung
or other things that may worsen the patient’s
to the actual weight figures, made
condition. Looking at the above explanation is
necessary instruments weight estimation
researchers to find out more about the mean
difference and the weight determination of the
especially for patients with loss of
consciousness or with some limitations that do
suitability of the results visually, nomograms and
formulas according to Ross Laboratories in
not allow the patient to weight measurement.
patients in intensive care department of dr.
Hasan Sadikin hospital.
There are several Methods for estimating
body weight in patients with loss of
consciousness or with some limitations for
measuring the weight in such a simple direct
visual estimates by looking at the patient in a
supine position without physical contact with the
patient, the nomogram (Lorenz et.al, 2007) ,
calculation using the formula from Ross
Laboratories (Lin et.al, 2008), anthropometric
measurements (Chittawatanarat et.al, 2012) and
guide measure weight based on height (Dudek,
1993 in Bare, 2006).
Based on research conducted by Darnis et
al (2012) concluded that the determination of
weight through anthropometric measurements
primarily through measurement height and
circumference of the upper arm. But according
to the results of other studies of Lorenz et.al
(2008) says that before making a visual
estimation of weight is recommended to
determine the nomogram weight through
anthropometric measurements using meterline
Methodology
This research is a quantitative nonexperimental designs are correlative. Aiming to
identify the suitability of the results of the
determination of visual weight, nomograms and
formulas Ross Laboratories. The study design
is cross-sectional (cross-sectional), which is
used for measurements and observations were
made simultaneously using visual measuring
tools, nomograms and formulas Ross
Laboratories.
The population in this study were all patients
who undergo intensive treatment in the NCCU
(Neurosurgical Critical Care Unit) and the CICU
(Cardiac Intensive Care Unit) Hospital Dr. Hasan
Sadikin, in the span of time during January 2014
sampling method used was consecutive
sampling, determination of the sample using the
following criteria:
1)
Willing to be a respondent.
body in a short time. Lin et al Besides (2009)
also have shown the accuracy of the use of Ross
2)
Adult patients aged 20-65 years
Laboratories formula in determining weight in
the emergency department, especially in male
3)
Patient days - 1 to day 3 treatment
patients.
That the opinions of the three previous
researchers and based on the test results
between the use of weight estimation formula
using the formula calculation of Ross
Laboratories, when compared with the use of a
nomogram done on researchers apparently use
basic
In this study, the sample size is 19 for a
group of people sick and 19 healthy people to
the group, so that the total sample amounted to
38 patients. The research instrument used
observation sheet, measuring devices meterline
in units of centimeters (cm) and weight scales
tool in kilograms (kg).
the nomogram to estimate body weight is closer
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197
Analysis of the data used is the frequency
of determining the suitability of test weight used
distribution for the data characteristics of the
respondents, and to determine the mean of the
to test the numerical data Bland Altman plots.
In Bland Altman Plots This test determined the
three different measuring devices used repeated
ANOVA test when normal distribution of the data
95% confidence limit of the standard deviation
is 1.96 and the results will be considered
followed by a paired t test corrected test
(Bonferroni). While to determine the suitability
appropriate if p value <á = 0.05 (Ho is rejected).
This study will be conducted in the intensive care
of the results (limit of agreement) third method
unit (CICU, NCCU) Hospital dr. Hasan Sadikin.
Results
1.
Table 1.1. Frequency Distribution Characteristics of Respondents Patient characteristics
of the respondents (n = 19) healthy people (n = 19).
Characteristic of
The
Respondents
Age (Year)
Mean
SD
Minimum
Maximum
Male
Gender Female
Freq
9
10
Patient (n = 19)
40,79
12,895
20
65
%
47,4
52,6
Helthy people
(n=19)
25,21
6,312
20
48
%
Freq
7
36,8
12
63,2
Referring to table 1.1 above can be interpreted that the average age of this group of patients
was 40.79 years, while in the group of healthy individuals was 25.21 years. Gender female
respondents mostly either in the patient group and the healthy group.
2.
The mean patient weight based method for determining intensive visual weight, nomograms and
formulas Ross Laboratories
The mean weight of patients based on visual determination, nomograms and formulas Ross
Laboratories conducted using data value total weight of each study subject.
Table 1.2. Distribution Average Patient Intensive Weight Loss Weight Determination
Method Based Visually, nomogram and formula Ross Laboratories
Intensive Patients
Group
Mean
Std. Deviation
Minimum
Maximum
Determination Body Weight Method
Ross
laboratories
Visual
Nomogram
formula
58.63
62.42
52.56
9.494
13.116
10.992
42
42
35
80
98
75
Based on table 1.2 above can be explained that the intensive group patients, mean body
weight measurement results by researchers with the nomogram method showed the most weight
is 62.42 kg body weight compared with the results of measurements of visual Methods and formulas
Ross Laboratories.
3.
The difference in mean body weight of patients based on visual determination method, nomograms
and formulas Ross Laboratories
The difference in the average weight of the patient based on the method of determining the
weight visually, nomograms and formulas Ross Laboratories conducted using data averaged
measurement results of each method, as illustrated in Table 1.3 below:
Table 1.3. Analysis of Mean Differences Based on the Patient’s Weight Determination
Method Visually, nomogram and formula Ross Laboratories
Measurement Methods
Visual
Nomogram
Ross laboratories
Mean
58.63
62.42
52.56
Std.
Deviation
9.494
13.116
10.992
95% Confidence
Interval for Mean
Lower
Bound
54.06
56.10
47.26
Upper
Bound
63.21
68.74
57.85
p
.032
See table 4.3 above can be explained that the test results obtained by statistical probability
value 0.032, smaller than á = 0.05 which means that there is a significant difference in body
weight between the Methods of measuring visual weight, nomograms and formulas Ross
Laboratories. Further analysis with the Least Square Differences (LSD) proves that the method of
measurement is significantly different measurement Methods of the nomogram with the formula
Ross Laboratories.
4.
Analysis of Results of Conformity Determination Weight Visually, nomogram and formula Ross
Laboratories in Patients in Intensive Care hospital room dr. Hasan Sadikin.
Table 1.4 Analysis of Results of Conformity Determination Weight Visually, nomogram and
formula Ross Laboratories
Method
Visual – Nomogram
Visual – Ross laboratories
Normogram - Ross
laboratories
Mean
-3,8
6,1
9,9
Std.
Deviation
8,42
8,24
8,39
95 % Confidence
Interval
Lower
limit
-20,3
-10,1
-6,56
|
Upper
limit
12,7
22,2
26,3
p
0,065
0,0048
0,0001
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199
Based on the data in Table 1.4 above can be explained that only the comparison between the
Methods of visual and nomograms that have p-value > á = 0.05, which means that Ho is accepted
or in other words there is no agreement between the two Methods of measurement. But for the
other comparison Methods are still within the limits of results of conformity.
Table 1.5 Analysis of Results of Conformity Determination Methods Weight Visually,
nomogram and formula Ross Laboratories with Actual Weight Healthy People.
Methode
Visual healthy people – BB
aktual
Nomogram sehat– BB
aktual
Ross laboratories sehat –
BB aktual
Mean
Std.
Deviation
95 % Confidence
Interval
p
1,5
4,98
Lower
limit
-8,2
Upper
limit
11,3
0,198
1,1
3,71
-6,2
8,4
0,21
-4,5
6,35
-17
7,9
0,006
Based on data in Table 1.5 above can be explained that only the method of Ross Laboratories
formula that has a value of p < á = 0.05 when the actual weight is associated with healthy people,
so it can be interpreted that Ho is rejected or in other words there is a match between Ross
formula method laboratories in determining the weight to actual weight. As for the Methods of the
nomogram and visually when connected with the actual weight healthy person has a p-value
greater than á = 0.05, which means there is no fit.
Table 1.6 Analysis of Results of Conformity Determination Methods Weight Visually,
nomogram and formula Ross Laboratories In Patients In Intensive Care Room and
Healthy People Group .
Method
Mean
Std.
Deviation
95 % Confidence
Interval
p
Visual patients – Visual
healthy people
Nomogram patients –
Nomogram healthy people
2,7
11,63
Lower
limit
-20,1
Upper
limit
25,5
0,3185
6,9
19,26
-30,8
44,7
0,1333
Ross laboratories patients
– Ross laboratories
healthy people
2,7
13,6
-23,9
29,4
0,3936
Based on data in Table 1.6 above can be explained that all the weight determination method
has a value of p> á = 0.05 when linked from measurements in patients in intensive care and in a
group of healthy people, so it can be interpreted that Ho is accepted or in other words there is no
fit.
Discussion
12-24 hours of the first, in this phase of
1.
metabolism will decrease because the
focus of attention drawn to the efforts of
Weight visually, nomograms and
formulas Ross Laboratories patients in
the intensive care department of dr.
Hasan Sadikin.
the body to survive. The purpose of this
stress response is to restore blood
The results of a descriptive analysis,
perfusion into the tissues of the body,
maintaining adequate oxygenation and
the mean body weight measurement
results with the visual method was 58.63
stop the bleeding. After the ebb phase will
be followed by an acute phase or phase
kg, 62.42 kg and the formula nomogram
Ross Laboratories 52.56 kg. Here looks
flow. This phase is the period when the
body mobilizes nutrients to meet the
just mean nomogram method of
measurement results that have a mean
metabolic needs are high due to stress.
Increased levels of glucocorticoid
value of the large, this can be explained
because at the time of execution of the
hormones, catecholamines and glucagon
are also referred to as stress hormones
body circumference measurements of
many factors that can affect the results of
will lead to hypermetabolism. The final
phase is the phase of adaptation, in which
such measurements are one example
when measuring the waist circumference
the levels of stress hormones and glucose
levels will decrease and your metabolism
at the umbilicus should be aligned with
patients are not aware that the state will
back to normal. This occurred after 7 days,
after the metabolic rate returns to normal,
do abdominal breathing can affect the
measurement results, especially for the
adequate nutritional therapy will result in
a positive nitrogen balance (protein
determination of weight nomogram.
Because the measurement with the
anabolism) and weight gain. While weight
loss in adults would normally occur
nomogram method one is to use the data
waistlines, so there will likely produce
between 60-70 days of total starvation
state, and will occur more rapidly in
more value than it should be so that the
determination of the average weight
malnourished patients and patients
hypermetabolism due to stress as well as
nomograms have more weight when
compared with other measurement
in patients with severe or critical illness
(Best, 2008). So that monitoring body
Methods.
weight is very important, to know early
malnutrition on someone.
Weight assessment is widely used to
provide health care to patients, including
the critically ill patients, as necessary to
perform the assessment of nutritional
status (Fulbrook, 2007). In conditions of
severe metabolic illness is a severe stress
for the body. Response body changes that
occur over time, the first phase of the body
is experienced ebb phase which lasts for
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201
2.
Different mean weight determination
weight kekauratan visually estimated at
results visually, nomograms and
formulas Ross Laboratories in patients
three pharmacy students, with the
conclusion that the visual determination
in the intensive care department of dr.
Hasan Sadikin.
of the weight should not be done alone
given the differences of each of these
Different test analysis using ANOVA
measures, so there must be at least 3
people to perform visual estimation of
obtained results indicate a difference in
mean weight loss between the
weight to support its accuracy.
measurement of visual Methods,
nomograms and formulas Ross
The ability of health care workers who
are lacking in estimating visual weight is
Laboratories. Further analysis showed
that the weight measurement method
found by researchers today, one of which
is, as stated by Hall et.al (2004) which
showed no difference is the method of
measuring the nomogram by Ross
states that health workers have the ability
to determine weight less visually . Another
Laboratories, while the weight
measurement results using a visual
opinion was also expressed by Corbo et.al
(2005) which states that doctors and
method showed a difference.
nurses are only able to estimate the weight
of patients approaching 10% correct on
The
difference
in
weight
measurement results especially with
visual Methods due to the characteristics
of the measuring it self. In this study the
researchers themselves do the
measurements are less have the
experience to care for patients in the
hospital directly every day because the job
of researcher is in the field of education.
Based on the explanation above it can
be concluded that the experience and
length of service in caring for the patient
will affect the results of the determination
of the weight determination of weight
especially visually. This is consistent with
the proposed Breuer et.al (2010) which
states that the visual estimation of body
weight should be done by experienced
personnel (such as nutritionists) who
frequently perform weight estimate to
determine nutritional needs. Goutelle et.al
(2009) is also consistent with the above
statement that conducts research on
the actual weight patients, approximately
50% and the ability of doctors to estimate
the patient’s weight was not supported by
experience or specialization that they do.
Further studies conducted by Kahn et.al
(2007) stated that health workers are able
to estimate the patient’s weight closer to
5% actual weight, there are only about
33%.
Most estimates are conducted by
health officials in determining the patient’s
weight is limited by visual estimation, but
today it is known that the method is less
accurate compared to the actual weight
(Leary, et.al, 2000). Besides those two
things have the time limited by health
workers, especially in emergency care
units who require immediate management
action and make health workers choose
the simplest way is by visual estimates in
determining the weight of the patient at
hand (Anglemyer, et .al, 2004).
3.
Suitability weight determination results
Laboratories using anthropometric data of
visually, nomograms and formulas
Ross Laboratories
the body ie upper middle arm
circumference and height / length of the
Analysis of Bland Altman plots
knee, which is then inserted into the
formula which has been determined by
showed that only the method of Ross
Laboratories formula that has a value of
p <á = 0.05 when associated with actual
weight in the group of healthy people, so
it can be interpreted that Ho is rejected or
in other words there is a match between
the formula method Ross Laboratories in
determining the healthy weight with actual
weight. As for the Methods of the
nomogram and visually when connected
with the actual weight healthy person has
a p-value greater than á = 0.05, which
means there is no fit. Based on the
analysis of the Bland Altman Plots are the
Ross Laboratories . According to Lin et.al
(2008) method for determining the weight
Ross Laboratories formula is designed for
non-emergency conditions, but trying to
do the study in the emergency room,
which is determined by the body
anthropometric measurements using
gauges meterline and the result is the
existence of strong conformance between
the determination of weight formula Ross
laboratories with actual weight on
respondents.
Inaccuracies weight determination
most appropriate visual Methods that have
a greater probability value when compared
with the nomogram method.
method has been widely depicted visually
in several publications as well as on
research conducted by Martin, et al (1994)
Ross Laboratories suitability of the
retrospectively compared the patient’s
weight after cardiac arrest visually
use of the formula with the results of actual
weight in the group of healthy individuals
is supported by a statement from Lin et.al
(2008) which has proved the accuracy of
Ross Laboratories use this formula to
determine body weight in patients in the
emergency department. However, Lin et
al (2008) also said that Ross Laboratories
formula is more accurate in determining
body weight in men than in women, it also
performed by paramedics apparently differ
by more than 10% of the weight The actual
weight patients. Additionally Coe, et al
(1999) also compared the visual weight
estimation performed by an experienced
physician compared with actual weight in
38 patients, and the result is more than
10% is not accurate or does not
correspond to the actual patient weight.
appears to have been anticipated by Ross
Laboratories distinguishing formula weight
Lack of accuracy of the nomogram
method is supported by research
determination for men and women .
conducted by Darnis et.al (2012) which
states that the determination of weight by
Correspondence between Ross
Laboratories formula in determining
weight with the actual weight can be
ascertained due to the method of
using anthropometric measurements were
inaccurate in adult patients who were
hospitalized.
determining the formula weight Ross
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203
Based on the results of the suitability
analysis with Bland Altman plots for
method of determining the weight visually,
Laboratories determining outcome in
patients with body weight in healthy
people it will get the p value for the three
Methods of measurement> of á = 0.05,
which means is the discrepancy between
the results of measurements in patients
and in the group of healthy people. This
can be explained comparison of the three
Methods performed on the different
characteristics of the two groups, where
one of them is a healthy person without
any limitations and other groups are sick
with some limitations that differ from one
another. So it is very possible once the
discrepancy of the measurement results,
4.
Nursing Implications
Patients with critical conditions
require comprehensive nursing care that
starts from assessment through evaluation
of nursing actions that have been
performed. One of them requires
assessment of data accuracy assessment
result is weight, since the weight of data
will be used for the determination of the
need for the patient’s body, such as used
in memenentukan calorie needs, the dose
of medication, fluids, oxygen and other
body needs, which if we do not appropriate
in determining the need for either a
deficiency or excess of the needs of the
body should then be able to have an
impact on the health of patients and
duration of patient care.
it should be the method of comparing
measurements performed on the same
Based on that in assessing the weight
of nurses should be careful and use the
group characteristics and should there be
a default value that can be ascertained
method of determining the weight which
can obtain data that is approaching weight
the level of accuracy to measure the
suitability of the results of the method of
actual weight of the patient. If until now
still using the method of weight
determining the weight. In order to know
the accuracy of the suitability of the results
determination in critically ill patients
because of several limitations visually, it
for all three Methods of weight
determination performed on patients
should only be done by a healthcare
practitioner who has a long work
admitted to the intensive care room, which
should be used as a standard of
experience in the field and not be alone
but minimum 3 people, this is due to the
assessment is the result of the size of the
weight on the scale bed patients, who had
experience and long work in caring for the
patient will affect the person’s ability to
previously performed calibration accuracy
level. So it will be more objective in
perform visual estimation of body weight.
concluding the weight determination
method which is most suitable for use
The results of this study also says that
the method of weight estimation formula
approaches that produce the actual weight
patients.
Ross Laboratories has the most
appropriate measurement results with
actual weight in the group of healthy
people, so it is expected for the future can
be considered as a method of estimation
of body weight in patients with loss of
consciousness or with limited movement.
We should be more careful in the use of
visual Methods for the determination of
weight especially for health practitioners
who are new and have not had a lot of
experience, so that we can avoid the bad
Conclusions
Based on the results of research and
discussion, several conclusions can be
presented as below:
1.
There were differences in mean weight
determination method results visually,
effects that can occur due to a mismatch
in determining the health of the patient’s
Laboratories in patients in the intensive
body weight, as a matter of necessity
nutrition, the problems caused by medical
care department of dr. Hasan Sadikin
error, an error in the fulfillment of the needs
of oxygen that can worsen the patient’s
condition and the long extended patient
care.
2.
There is no method of determining the
suitability of the results of visual weight,
Laboratories between the group of
patients with a group of healthy people.
5.
Limitations of Research
In this study there are some
limitations of which is the number of
samples taken is not much and only from
space CICU and NCCU with a variety of
Advice that can be given for the hospital
is to provide facilities to all intensive care beds
that use a weight scale (bed scale) in order to
evaluate weight loss in patients who are not
diagnoses that do not cover the entire
space for intensive care in adult patients
aware and with limited motion in particular, and
can apply method of determining the weight
formula Ross laboratories for patients without
in particular. Also in this study only
measured by one person, while according
limitation of motion and limb fracture nomogram
for patients with fractures of the extremities when
to the results of research Goutelle et.al
(2009) to estimate a visual weight at least
the scale is not yet available beds. For Academic
is to provide information in the learning theory
there should be 3 meters to support its
accuracy.
of weight measurement method in patients with
loss of consciousness or with limited movement
Data collection was primarily for the
and train skills of students on related material.
For further research, this study can be used as
determination of weight nomogram in this
study, researchers used the observation
sheet photocopied so can cause errors in
determining the points that will affect the
results of the approximate weight, other
than that in measuring high / knee length
baseline data for further research on the factors
that influence the determination of the weight
discrepancy results visually, nomograms and
formulas Ross Laboratories with sample size
more.
is used to estimate the weight of data the
bodies formula Ross laboratories
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THE METHODE TO OVERCOMING MALNUTRITION PROBLEM IN
BANDARLAMPUNG
Gunawan Irianto
STIKes Muhammadiyah Pringsewu, Lampung
E-mail: iguana_2011@yahoo.com
ABSTRACT
Introduction: Based on the report of Bandar Lampung city Health Department in 2012,
obtained the discovery of 24 cases of malnutrition with numbers Case fatality rate (CFR)
increased compared to 2011 is 3.1%. There needs to be an effort that is able to resolve the
problem by empowering potential that exists in society, in this case through the Positive
Deviance approach, which makes high-risk communities or families (poor families) but have
an infant or toddler with a good nutritional status as a pilot model problems and solutions
nutrition in the community. The purpose of this study was to identify risk factors and provide
an alternative solution nutritional problems in the community through Positive Deviance
approach.
Methods: The study design was a pre Experiments with Static Group Comparison approach
/ Post Test Only Control Group Design. The population in this study is a family with an infant
and toddler nutrition problems in the area of patient Puskesmas Pinang Jaya and Bandar
Lampung Banyan Kingdom. Samples were 30 people through taking total sampling
techniques. Assistance in this research for 12 days to see the application of the knowledge
and behavior of Positive Deviance in the experimental group. In this study identified risk
factors for nutritional problems in the community in Bandar Lampung is the intake of food,
infectious diseases and food security, while through a statistical test with independent t-test
obtained a significant difference in weight gain in the treatment group compared with the
control group (p value: 0.00 <0.05).
Results: Based on these results, it is suggested that the program can be used as the main
program in resolving health problems, and of course the support and cooperation of all
stakeholders is needed so that this method can work better and comprehensive.
Keywords: Nutrition Issues, Risk Factors, Positive Deviance.
209
Introduction :
The high number of children malnutrition is
still the biggest nutritional problem in Indonesia,
particularly in Bandarlampung. Based on the
report of Bandar Lampung city Health
Department in 2012, obtained the discovery of
24 cases with numbers Case fatality rate (CFR)
increased compared to 2011 is 3.1%. Similarly,
another indicator of nutritional problems, such
as the number children under the red line (BGM)
Therefore, the need for further studies and
solutions to address the nutritional problems in
this community. The alternative solution is to
improve the nutritional status of children with
potential resource base family (community). The
approach taken in this solution is seen in the
case of positive deviance in society Nutrition
Problem (Positive Deviance) as a cornerstone
in addressing nutritional problems in the
community.
of 448 children (0.57%) with the big 3 are the
Palapa Public Health Centre (2.09%), Pinang
The selection is based on the
characteristics of the research community,
Jaya (1.84%) and Segala Mider Public Health
Center (1.42%).
especially the poor and the percentage of
children under the Red line, in this case the
Malnutrition problems is influenced by many
working area Pinang Jaya health center is the
region that has the characteristics of the poverty
factors that affect each other in complex
ways. At the household level, nutritional status
is influenced by the ability of households,
providing food in sufficient quantity and type,
rate is quite high and the lowest percentage of
BGM to two (1.84%) in Bandar Lampung.
Methods
maternal nutrition and child care are influenced
by educational and behavioral factors, and
health status of household members (UNICEF,
This study is a survey and once the pre
experiment, the research conducted by
1998, in Pujiadi, 2000)
collecting data to see the lifestyle of the people,
especially their nutritional patterns and look for
Starting in 1998, efforts to combat
malnutrition cases enhanced through
patterns of positive then implement the positive
pattern in people who experience nutritional
networking, referrals and free treatment at the
health center or hospital. Feeding (PMT) and the
problems. This study uses the approach Static
Group Comparison / Post Test Only Control
effort - that is another rescue attempt. Food aid
such as rice for the poor (Raskin) was also given
Group Design is research experiment by adding
a control group for comparison with the
by other sectors of society to avoid the threat of
starvation. But all these efforts also can not
treatment groups.
seem to resolve the problem and improve the
nutritional status of the community again,
especially toddlers. Toddlers with poor
nutritional status are getting help can be cured,
but the case - the case of emerging and
sometimes
more
so
impressed
countermeasures undertaken not mean much,
because Malnutrition rate can not be reduced
The population in this study is a family who
have children with nutritional problems and a
society with low economic status of the working
area and PHC Banyan Pinang Jaya Jaya
(Control). The sample of this study were 30
people with the sampling technique is the total
sampling. Comparisons between treatment and
control groups is 1: 1. Criteria inkklusi
significantly.
respondent is a family who has a baby or toddler
suffering from malnutrition and lack included in
with BGM and who showed no weight gain 2
consecutive months.
this trial. The trial results showed, within six
months of the implementation of the activities
Results
contained 30% malnutrition children have can
be lowered to 10.9%. The same thing also
Based on the measurement of changes in
body weight during the 12 days of assistance,
appears that 20.9% of children can be improved
nutritional status into good nutrition. (Aryastami,
then
analyzed
using
statistical
tests (independent t-test) the significance
2006)
changes before and after treatment, which is in
accordance with the table below:
Positive Deviance approach to try to
empower the community as strictly teach the
Table
mother to manage resources very limited,
instilling discipline parenting, get used to living
Changes in Body Weight Problems in
Children With Nutrition Methods Through
clean, stimulating upbringing and development
of early and teach you how to feed the child. All
Positive Deviance in Bandar Lampung in
2013 (N = 30)
of these processes in the frame of family
resource potential. In this study, in order to
Variables
Treatment
Group
Controls
N
15
Mean
0.360
SD
0.512
SE
0.132
15
-0.320
0.417
0,107
P Value
0.00
ensure a change in behavior made assistance
to families with nutrition problems conducted by
nutritionist of the Pinang Jaya Public health
centre regularly and carefully for 12 (twelve)
days.
In the table shown weight changes in the
treatment group increased by an average of
Improving the nutritional status in the
0.360 kg, whereas the control group had an
average weight of 0,320 kg. P-value results in
community can be done without having to wait
for an established economic variables, are
the table above is 0.00, so we can conclude the
existence of a significant difference on average
indispensable analysis of systematic and
measurable aspects of the management and
changes in body weight in the group treated with
the method of Positive Deviance and control
alleviation of malnutrition awareness and
empowerment course itself (Soekirman, 2001).
group.
Conclusions
Discussion
This result is consistent with the application
Research to improve the nutritional
problems in the community in Bandar Lampung
of the Positive Deviance methodes in Makassar,
Jeneponto and Takalar which also increase a
with the Positive Deviance approach it can be
concluded that the risk factors in the emergence
child’s weight gain is achieved in just 12
days (Plan International and Media Nutrition
of community nutrition problems can be caused
by lack of food intake, an infection disease and
Napier, 2004).
inadequate food security, while the factor of
parental knowledge about nutrition and health
A trial with the Positive Deviance approach
has also been implemented in Cianjur, West
Java. A total of 150 children under five are
care is good enough. There are signifikatan
improvement on body weight in infants and
toddlers who were respondents in this study (p
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211
value: 0.00 <0.05), through the process of
Hastono, P. Sutanto, 2001. Modul Analisa Data.
sharing knowledge and experience of Positive
Deviance and assistance from local health
Fakultas Kesehatan MasyarakatUniversitas Indonesia. Depok. Jawa Barat.
authorities.
Aacknowledgment
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213
THE DESCRIPTION OF SELF CARE BY MATERNAL POSTPARTUM DO A
POSTNATAL CARE ASPECTS
Sri Ayu Rahayu1, Sri Sumaryani2
1
2
Student School of Nursing Universitas Muhammadiyah, Yogyakarta
Lecturer at Maternity Nursing, School Universitas Muhammadiyah, Yogyakarta
E-mail: aiu_yuai93@yahoo.co.id, yanipsikumy@gmail.com
ABSTRACT
Introduction: Postpartum period is a critical period for the mother. In Indonesia, the maternal
mortality rate usually occurs in the first 24 hours postpartum period, it is often associated
with the incidence of puerperal complications such as puerperal infection and bleeding. The
purpose of postnatal self-care in addition to prevent morbidity and mortality is to provide
comfort on a mother and raising healthy postnatal maternal behavior thus achieved a better
quality of life. Objective: To know the description of postnatal self-care aspects do by maternal
postpartum.
Method: This research uses a Non experiment design which uses the descriptive quantitatif
method and use 15 samples taken with purposive sampling technique.
Result: On this research showed 15 total respondents that as many as 14 person (93.3%)
was doing personal hygiene aspect, 8 person (53.3%) who do perineum care aspect, there
are 4 person (26.7%) were doing after pains management aspect, there are 9 person (60,0%)
was doing defecation management aspect, 5 person (33.3%) were doing fulfillment nutrition
management aspect and as many as 6 person (40.0%) were doing early ambulation aspect.
Conclusion: It can be concluded that the self-care for aspects of postnatal care by maternal
postpartum has not been done completely.
Keywords: Self Care, Postnatal Care, Maternal.
Introduction
causes of the high maternal mortality rate is 28%
hemorrhage, eclampsia 24%, 11%, followed by
infection incidence of postnatal complications,
Maternal Mortality rate (MMR) becomes
very important indicator in measure the degree
prolonged labor and abortion (Indonesia Health
Profile 2011)[6].
of maternal health in Indonesia. Indonesia
Demographic Health Survey (IDHS) 2007 MMR
analysis was 228/100,000 live births, it
increased significantly when seen MMR in 2012
Postnatal period is the most vulnerable time
for mothers to experience various complications
amounted to 359/100,000 live births [1]. The
after give birth, so it needs sufficient knowledge
215
about postnatal care as part of efforts to prevent
mother experience unwanted event.
Method
This study is included in this type of
Postnatal care provide a very large effect
in unknown and was done entirely by the mother
research Non-Experiment with descriptive
quantitative method. The population in this study
who was in the period after giving birth. The
World Health Organizations (WHO)[15] in his
is a third trimester pregnant women were
included in the work area Wonosari 1 public
book, entitled Opportunities for Africa’s
Newborns (2011) mentions that the impact
health Centre, Gunung Kidul Yogyakarta as
many as 45 pregnant women. Researchers
occurred in the mother if it does not gain
knowledge about the treatment of postnatal is
conducted sampling in this study with purposive
sampling. The number of samples that met the
the mother can experience events like bleeding
mostly happens in a 24 hour period after
inclusion criteria by 15 third trimester pregnant
women. The inclusion criteria is the last of
childbirth attended by occurrences of infections
that usually occur in parturition six weeks
education minimum were primary school,
Indonesian native speaker, the PBD (Prediction
postnatal period and lack of knowledge capital
in detecting pregnancy complications quickly so
Born Day) is February-March 2014, mother who
normal delivery.
that the reference to health facilities was also
experiencing delays (Wulandari & Ambarwati,
2012)[16].
The study was start from February-March
2014. The research of variable consist of a
These problems can be addressed and
single variable that is a description of self care
by postnatal mothers do a postnatal care. Data
prevented if every mother get appropriate care
during intranatal and postnatal. Self-care in
analysis used Univariate analysis to search the
proportion of single variables were then
postnatal are needed because at the time of
parturition women will undergo a lot of changes
analyzed using a statistical test frequency
distribution table.
in him, either physical or psychological.
Postpartum self-care is not only important to
reduce maternal mortality and morbidity, but also
important to strengthen and improve healthy
behaviors in the care of the mother postnatal.
Healthy behavior begins when the postpartum
and needed to ensure that good mothers get a
good health care (United States Agency of
International Development, 2007)[14].
Based on the description, then
researchers interested in conducting research
that would like to describe as a self-care of
maternal postpartum do postnatal care aspects.
The Description of Self Care by Maternal Postpartum Do A Postnatal Care Aspects
Results
Discussion
Tabel 1. Distribution Self Care do a Postnatal
Care
Postnatal Care
Aspect
Personal Hygiene
• Yes
• No
Perineum Care
• Yes
• No
After Pain Management
• Yes
• No
Defecation Management
• Yes
• No
Nutrition Management
• Yes
• No
Early Ambulation
• Yes
• No
Total
According to Reeder., et al, (2012) stated
that postnatal care was meant for the mother to
be in optimal comfort, rest and activity are
N
%
14
1
93,3
6,7
balanced, experienced a recovery of body
functions, to prevent or minimize complications
after delivery and to develop knowledge and
skills for self-care mothers[11]. Farrer (2008)
mentions that there are some aspects of the
general care is an important concern for
8
7
53,3
46,7
4
11
26,7
73,3
management, defecation management, nutrition
management, and early ambulation[4].
9
6
60
40
From the research results in Table 1 indicate
that for personal hygiene aspects there are 14
5
10
33,3
66,7
6
9
15
40
60
100
postnatal mothers, among them are: personal
hygiene, perineum care, after pain
people (93.3%) was doing general care.
Researchers assume that basically for self-care
such as bathing twice a day, changing pads
twice a day and breast hygiene is an important
thing becomes a habit that must to be aware.
This is because the impact of good personal
hygiene affects the health of the mother and
child as well. This is according to research
Table 1. showed 15 total respondents that
as many as 14 person (93.3%) was doing
personal hygiene aspect, 8 person (53.3%) who
do perineum care aspect, there are 4 person
(26.7%) were doing after pains management
aspect, there are 9 person (60,0%) was doing
defecation management aspect, as many as 5
person (33.3%) were doing fulfillment nutrition
management aspect and as many as 6 person
(40.0%) were doing early ambulation aspect.
conducted by Puji., et al, (2007) which stated
that the practice of good breast self care based
on the existence of a great knowledge, attitudes
that support and high motivation by postnatal
mother[10].
For aspects of the perineum care there are
8 people (83.3%) who did well perineum care.
According to Reeder., et al, (2012) said that
good perineum care techniques include
replacing and disposing of perineum pads every
4-6 hours, and wash and dry the lochia with a
clean cloth or water flow[11]. In this study the
researchers assume that the perineum care well
done caused by any external factors that affect
the knowledge of the mother, such as the
existence of guidance from health workers. This
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217
is according with research conducted by Suryati
foods such as vegetables and fruits and also
(2013) which states that high levels of maternal
knowledge gain speed the healing of wounds
given a laxative. This is according with research
conducted by Fathurrohman., et al, (2012) which
of perineum is fast, this knowledge is obtained
from Antenatal Care program followed by
states that puerperal women who experience
postpartum obstipation usually occurs during the
postnatal mother from since checked the
pregnancy. Because at the time of postpartum
2 days basically considered normal and if more
than 2 days, the health workers give a laxative[5].
maternal was given education by health workers
actively on exclusive breastfeeding, how to care
However, there were 6 people (40,0%) were not
doing so good management with defecation.
for a baby, how to treat breast and nipples as
well as do a good treatment of the perineum
Researchers assume that this state is influenced
by the habits of the postnatal mother who do
and true healing of the perineum wound in order
to get a quick[12].
not pay attention to diet, this is in agree with
research conducted by Mardiatun (2013) which
Based on Table 1 shows that for the after
states that sustainable obstipation by postnatal
mother caused by disobedience in consuming
pains aspects of management who are doing
there are 4 person (26.7%). In this case the
researchers assume that the pain felt by
postnatal mother are considered as normal and
vegetables and fruit as well as the lack of activity
of the mother in early mobilization like get out
of bed or walking[9].
some postnatal mother of the observed think
this is not a serious thing. This is in agree with
research conducted by Dhaher., Et al, (2008)
Based on the table. 1 showed that there
were 5 people (33.3%) who did postnatal
maternal nutrition management is good.
which says that the factors that affect each
postnatal women do not seek treatment because
Researchers assume that this situation is
influenced by internal factors such as family
they already feel well and in good health after
delivery so no need to do postnatal care such
support in the fulfillment of that less nutrients
affects postnatal maternal nutrition management
as managing pain that is felt after giving birth[3].
Meanwhile, according to Farrer (2008) stated
and external factors such as family economic
circumstances wholly insufficient to meet the
the after pains management is something that
often happens in the seventh and tenth postnatal
nutritional needs of the mother postnatally.
Assume research is supported by research
day and it is very disturbing comfort by postnatal
mothers[4].
conducted by Kumboyono., et al, (2012) who
stated that family support can affect the physical
For aspects of defecation management that
and psychological recovery postnatal mothers
in taking care of themselves[7]. In addition, the
are actually doing the treatment as much as 9
person (60.0%). Doing defecation either have
adequate fluid intake and eating fibrous foods
(Reeder., et al, 2012)[11]. From the results of
Table 1. researchers assume that the self care
in conducting management defecation is
study of Tittaley et al., (2010) also explained that
the economic circumstances of family is unable
to meet postnatal care within the first month after
birth[13].
Aspects of early ambulation are 6 people
influenced by the presence of continued
intervention given the form of education of health
(40.0%) who is doing the actions well care.
Based on these results the researchers assume
workers to consume plenty of water and fibrous
that this state of self influenced by his own
The Description of Self Care by Maternal Postpartum Do A Postnatal Care Aspects
mother. The desire to perform early ambulation
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www.biomedcentral.com/1471-2393/8/26
It can be concluded that the self-care for
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This study was supported by School of Nursing
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Tingkat Kemandirian dalam Merawat Diri
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thanks for all the support and the guidance.
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dr.Soepraoen Malang. Karya Tulis Ilmiah,
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Newborns. Diakses pada 12 November
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publications/oanfullreport.pdf
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Asuhan Kebidanan Nifas. Jogjakarta:
Mitra Cendekia Press
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Wanita, Bayi, & Keluarga (Ed. 18) (Y.
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Kurnianingsih, N.B. Subekti & D. Yulianti,
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tentang Perawatan luka perineum dan
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Titaley, C.R., Hunter, C.L., Heywood, P., &
Dibley, M.J. (2010). Why Don’t Some
Women Attend Antenatal And Postnatal
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THE DESCRIPTION OF SMOKING DEPENDENCE ON SENIOR HIGH SCHOOL
STUDENTS IN YOGYAKARTA
Ayu Purwasih1, Sutantri2
1
2
Student of School Nursing Muhammadiyah University, Yogyakarta, Indonesia
Lecturer at Community Nursing, Muhammadiyah University, Yogyakarta, Indonesia
E-mail: ayupurwasihpjs@yahoo.com
ABSTRACT
Introduction: In 2010 there were an estimated 6 million people in the world die (including
190,260 people in Indonesia) as a cause of tobacco disease. Indonesia every years have
an increase in smoking uptake among adolescents. This trend is particularly alarming because
of smoking in adolescent ages are have a lot of risk for health, the health risks of smoking in
adolescents is much worse than adults who smoke because the adolescents still at the age
of growth and possibility to stop smoking will be lower. Indonesia has a many legal basis to
support the control of tobacco consumption, but in international areas Indonesian has not
shown a strong commitment to tobacco control, because it has not signed the Framework
Convention on Tobacco Control (FCTC). So that, cause complicate efforts made in tobacco
control and provide a great opportunity for the tobacco industry to freely expand their market.
Considering that, to know description of smoking dependence among Senior High School
Students in Yogyakarta is important. This study was to know description of smoking
dependence among Senior High School Students in Yogyakarta.
Method: This study was a non-experimental design with descriptive analytic approach. Used
total sampling method. Analyzed of the data presented in a frequency distribution table.
Total sample of 34 respondents. This research start from April until Mei 2014. Data collection
tecnique used questioner.
Results: From the results obtained there is shows that as many as 31 respondents in the
category of very low dependence (91.1 %), 2 respondents in the category of low dependence
(5.9 %), 1 respondent in the category of high dependence (2.9%) and no one respondents
who included into the category of medium and very high dependence.
Conclusion: Based on the research it can be concluded that most respondents are have
very low dependence with a percentage of the total 91,2% as many as 31 respondents. This
shows that the majority of respondents have not been addicted to cigarettes. School provide
or give more education and regulation related smoking is very important to maintain the
respondents remain in the category of very low dependence.
Keyword: Smoking, Smoking dependence, Cigarettes.
221
Introduction
The data of Riskesdas in 2010 showed that
In 2010 there were an estimated 6 million
people in the world die (including 190,260
people in Indonesia) as a result of tobacco
diseases (1). Smoking is a public health problem
in Indonesia and is one of the major risk factors
of chronic diseases such as lung cancer, upper
respiratory tract cancers, heart disease, stroke,
bronchitis, emphysema, etc., which can even
lead to death (2). And an estimated 10 million
deaths will occur in 2020 if it is not promptly
receive appropriate treatment (3). Not only that
cigarettes also cause economic damage in
many countries (4).
the age of first smoking at the age of 5-9 years
of 1.7%, at the age of 10-14 years
sebesar17,5%, at the age of 15-19 years was
43.5%, at the age of 20-24 year by 14.6%, at
the age of 25-29 years was 4.3% at the age of
3.9% e”30 year (10). This shows that the age of
first smoking is most common in the 15-19 age
teens. According to the above data there is an
increase in the age of starting to smoke among
adolescents. This trend is particularly worrying
because of smoking in adolescence are
particularly at risk for health, the health risks of
smoking in adolescents is much worse than with
adults who smoke as a teenager still at the age
Based on data from the Tobacco Atlas, the
prevalence of smoking among teens in 2005 is
of growth and possibility to quit smoking will be
lower. Cigarettes not only cause health problems
still very high at 38% in men and 5.3% in women
(5)
. In 2012 the prevalence of smoking has
in the physical but also the emotional problems
decreased to 23.9% in men and 1.9% in women
. Meanwhile, according to the Global Adult
(6)
Tobacco Survey Indonesia (7) shows the
prevalence of smokers aged 15 years and above
is very high among other smokers men 67.4%
and women 2.7%(3).
According to Eriksen
(6)
, the prevalence of
smoking among adolescents in Indonesia at the
age of 13-15 years is equal to 23.9% in men
and 1.9% in women, it shows that male smokers
12 times higher than for smokers women. The
statement shows that men prefer to smoke than
women in Indonesia. According to cultural norms
that embrace in Indonesia, assume that women
who smoke are behaviors that do not fit with
the culture of Indonesia (8). Many factors play a
role in the increase in the number of smokers
teenage boys, the tobacco industry advertising
that illustrates that an individual smoker is
successful and has a glamorous lifestyle or even
symbolizes masculinity (9).
(11).
Indonesia has a legal basis to support
tobacco control are included in the Health Law
No. 36/2009 on the safeguarding of Tobacco
Products as addictive substances for health.
Under the health legislation has also made
government regulation, rule with the Ministry of
Health and Ministry of the Interior, and Local
regulations in some provinces that include
smoking area (12). Although many tobaccorelated regulations that have been made but
in international areas Indonesia has not shown
a strong commitment to tobacco control,
because it has not signed the Framework
Convention on Tobacco Control (FCTC), so that
cause complicate efforts made in controlling
cigarette and provides a great opportunity the
tobacco industry to freely expand their markets.
As for other factors that come into effect on
the high level of prevalence of smoking in
Indonesia that is associated with the cultural
norms in Indonesia. Smoking is considered to
be a reasonable thing for the people in
The Description of Smoking Dependence on Senior High School Students in Yogyakarta
Indonesia. There are even any activities or social
different values as respondent’s answer. The
events in the community there will always be
smoking as the main feature. Moreover, the
results interpretation of questionnaire fagerstrom
will categorized into 5 categories: score 0-2 =
majority of people in Indonesia have a habit of
eating don’t eat that matters can smoke even
very low dependence, 3-4 = low dependence,
5= medium dependence, 6-7 = high
smoke is considered symbolic of one’s
masculinity (9).
dependence, 8-10 = very high dependence.
Fagerstrom assessment questionnaire form an
Consider the dangers of smoking for the
ordinal scale.
health of adolescents, the lack of attention from
the Government on the control of tobacco, as
Analysis of the data in this research used
descriptive analytic with Univariate analysis (to
well as the high prevalence of smoking in
teenagers in Indonesia, the researchers want
know the description of the smoking
dependence of students). The Data is displayed
to know and are interested in researching the
description of smoking dependence in students
using a frequency distribution table.
at one senior high school in Yogyakarta.
Result
Tabel 1.
Methods
Distribution frequency
characteristics of respondents
according to ages, class, gender
This research is a type of non-experimental
research that is descriptive analytic with cross
sectional design research. The population in this
research are all of students in class X and XI
are numbered 221 students and students who
smoke there are as many as 34 students.
Sampling method in this research are the total
sampling. Total sampling is a technique of
determination of the sample by way of making
the population being sampled (13). The samples
used in the study was 34 students who smoke.
This research was conducted in one of the
senior high school in Yogyakarta. This research
was carried out in April-May 2014. The variables
used in this study is a single variable that is
description of the dependence of smoking on
students in one senior high school in Yogyakarta.
The research instrument used to measure
smoking dependence is fagerstrom
questionnaire. Fagerstrom questionnaire
consists of questions that lead to smoking
(n=34)
Characteristics of
Respondents
Ages
14 years
15 years
16 years
17 years
Class
X
XI
Gender
Male
Female
Total
n
%
2
4
21
7
5,88
11,76
61,76
20,6
17
17
50
50
34
0
34
100
0
100
Based on the results of this research noted
that the characteristics of the age of respondents
is mostly age of respondents in 16 years of as
many as 21 people 61,76%. Meanwhile, the
respondents at least 14 years of age is as much
as 2 people (5.88%).
dependency, including frequency of smoking
and number of cigarettes smoked per day. The
questionnaire consisted of 6 questions with
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223
Tabel 2. Distribution frequency smoking
dependence respondents on high school
students in Yogyakarta (n = 34)
Behavior category
Very low
dependence
Low dependence
Medium dependence
High dependence
Very high
dependence
Total
Total Persentage
(n)
(%)
31
91,2
2
-
5,9
-
1
-
2,9
-
34
100
Based on Table 2 above shows that as
many as 31 respondents in the category of very
low dependence (91.1 %), 2 respondents in the
category of low dependence (5.9 %), 1
respondent in the category of high dependence
(2.9%) and no one respondents who included
into the category of medium and very high
dependence.
Discussion
1. Characteristics of respondents
Based on these results it is known that
most of the characteristics of the
respondent’s age is 16 years old
respondents (61,76%) as many as 21
people. Meanwhile, the respondents were
at least 14 years of age there is 2 people
(5,88%). Based on a survey of 854 men
and 800 women aged between 11 to 18
years will be undertaken in Ellisras, South
Africa found that the increasing age of the
higher levels of cigarette consumption due
to exposure to cigarette advertising is very
high from a variety of media such as
television, video, movies and billboards
(Monyeki et al, 2013) (15). In addition, age
greatly affect how respondents take a
decision in terms of consuming cigarettes
or not, because of the increasing age of
the person’s experience and knowledge
is increasing (Notoadmodjo, 2003) (17).
The results based on the
characteristics of the class is balanced
number of respondents are 17 people
came from class X and 17 people from
class XI. The results of research based
on gender characteristics obtained all
respondents were male. The number of
smokers the most current from among
men, reaching 61%. Based on the Global
Adult Tobacco Survey Indonesia (GATS,
2011) showed the prevalence of smokers
aged 15 years and above is very high
among other smokers men 67.4% and
women 2.7% (MOH, 2012).
This is due to their association and
the pressures of the environment. In
addition, many factors play a role in the
increasing number of teenage male
smokers, such as advertising industry of
cigarettes that smokers describe that is
an individual who has a successful and
glamorous lifestyle or even symbolic of
virility (Aula, 2010), besides smoking is
also considered a lifestyle trend and
simply keeping track of the world (16). This
is substantiated by the fact that the culture
in Indonesia considers reasonable if the
man smokes, not be a taboo thing if a man
smokes on the contrary a man will be
considered weak or not manly if dare not
smoking (Aula, 2013).
It is also supported by research
Monyeki et al (2013) are conducted at
Ellisras, South Africa that people who
smoke are perceived as being relaxed,
interesting, cool and rich. Plus more
adolescents at this age (11 to 18 years)
not too young respondents and intensity
very quickly receive the information
obtained and applying it to real life
of smoking respondents were not frequent
or permanent.
(Aditama, 2004) (18).
2.
This is supported by nursing models
Description of the smoking
dependence students in one of senior
Orem, Orem which states that there are
three principles of self-care with attention
high school in Yogyakarta
to the client’s level of dependence of the
system wholly compensatory, partly
Based on Table 2 above shows that
as many as 31 respondents in the
category of very low dependence (91.1
%), this is caused by the dependence of
smoking students affected by age of
smoking initiation and intensity of how
often they smoke, where the
characteristics of the low age of the
students in this study was 14 years and
smoking intensity respondent is not too
often because of their activity that is done
in schools where the majority of the time
school students are not allowed to smoke
or smoking is prohibited so as to make
the time to be reduced cigarette
compensatory system and supportive
educative system. Where in this study is
based on the principle of supportive
educative nursing system that can provide
assistance in decision-making and control
of behavior by providing guidance, support
and teaching (Asmadi, 2013) (19).
Researchers assume that the
dependency of smoking students in the
category of very low dependence because
students are getting the help and support
either directly or indirectly, to choose their
behavior of smoking or not smoking.
Also due to the students level of
consumption. This resulted in the students’
level of smoking dependence are in the
smoking dependence is already low
coupled using standard research criteria
very low dependence category.
for inclusion respondent last smoked a
maximum of 1 month, whereas according
This assumption is supported by
research Monyeki et al ( 2013 ) that
smoking dependence will be difficult to
change a person if the person is
consuming cigarettes ranging from too
young an age that is 10 to 12 years. This
study is strengthened by the opinion of
Leventhal and Cleary (1980 ) which states
that there are at least 2 years of time that
must pass to become a smoker with the
use of a fixed first tried cigarettes. It can
be concluded that the dependence of
smoking students are mostly included in
the very low dependence category
because the age of smoking initiation was
Benowitz (2010) (20) a person against
nicotine dependence will decrease or
disappear if done stops smoking for 7
days, so that when measured not show a
significant value of smoking dependence
on the respondent.
Conclusions
Based on the research it can be concluded
that most respondents are have very low
dependence with a percentage of the total
91,2% as many as 31 respondents. This shows
that the majority of respondents have not been
addicted to cigarettes. School provide or give
more education and regulation related smoking
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225
is very important to maintain the respondents
remain in the category of very low dependence.
Acknowledgment
We are very thankful to the headmaster of
senior high shcool in Yogyakarta for allowing us to
conduct this study. We are also thankful to the
teachers who help us to collect the data in senior
high school. Finally, we would extend a special
Mackay, J., Eriksen, M. (2005). Tobacco Atlas.
Geneva: World Health Organization.
Eriksen, M., Mackay, J., Ross, H. (2012). The
Tobacco Atlas. Fourth Ed. Atlanta, GA:
American Cancer Society; New York, NY:
World Lung Fondation. Diakses pada
www.tobaccoatlas.org/more.
thanks to all the respondents for their useful
information and cooperation. We hope this study
GATS (Global Adult Tobacco Survey). (2011).
Global Adult Tobacco Survey: Indonesia
will make a positive impact on their lives in the
future. This work was supported by School of
Report 2011. Diakses pada tanggal 4
Desember 2013 dari http://
Nursing Muhammadiyah University Yogyakarta.
We are also grateful to the College for its generous
www.searo.who.int/entity/
noncommunicable_diseases/data/
ino_gats_report_2011.pdf
References
GATS (Global Adult Tobacco Survey). (2011).
Global Adult Tobacco Survey: Indonesia
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ino_gats_report_2011.pdf
Sirait, A.M. 2003: Perilaku Merokok, Research
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(2012). Kemenkes Luncurkan Hasil
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report on the global tobacco epidemic
warning about the dangers of tobacco.
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Ng, N., Weinehall, L., Ohman, A. (2007). If I
don’t smoke, I’m not a real man’ —
Indonesian teenage boy’s views about
smoking. Health Education Research,
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atau Tidak Sama Sekali). Yogyakarta:
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laporan_riskesdas_2010.pdf.
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Persoalan Rokok di Indonesia. Diakses
pada tanggal 4 November 2013 dari http:/
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Nursalam. (2008). Konsep dan penerapan
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Motshwane, M. (2013). Advertisement
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THE RELATIONSHIP BETWEEN SPIRITUAL CARE KNOWLEDGE WITH NURSE’S
ATTITUDE IN FULFILLING THE CLIENTS SPIRITUAL NEEDS AT RAJAWALI
HOSPITAL BANDUNG
Sajodin1, Istianah2, Ariandini D.3
1
STIKes ‘Aisyiyah Bandung
2
STIKes Rajawali Bandung
3
Rumah Sakit Rajawali Bandung
E-mail: sajodin@yahoo.com
ABSTRACT
Introduction: Spiritual care is a treatment which fulfill human needs when facing trauma,
diseased or sadness and nursing care cannot apart from spiritual aspect where nurse meets
clients’ spiritual needs comprehensively. Nursing care which given by nurse must be based
on knowledge to give more positive impact which is support attitude in every clients’ needs
compliance including fulfilling clients’ spiritual client. The aim of this study to find the
relationship between spiritual care knowledge with nurse’s attitude in fulfilling spiritual needs
of adult clients.
Method: The design of this research using correlation descriptive method with cross sectional
approach. Respondents totaled 31 nurses. The process of data collection is done by filling
out the questionnaire. Correlation test used was chy-square. Data collection May 2013.
Results: The results using the chi square test showed p = 0.200 which is greater than the pvalue p = 0.005, these means statistically that the relationship between nurses’ knowledge
about spiritual care toward nurses’ attitude to meet the spiritual needs of adult clients in
Rajawali Bandung is have not meaningful relationship.
Conclusion: This result that there is no relation significantly between spiritual care knowledge
with nurse’s attitude in fulfilling spiritual needs of adult clients.
Keyword: attitude of nurses, spiritual care, spiritual needs.
229
Introduction
The knowledge and insight in the world of
respond to the needs of clients in terms of
spiritual fulfillment.
health experience gained from the development
of the disease process, treatment and
Videback (2008) states that the beliefs and
spiritual care can assist clients in coping with
management of care (Mc Sherry, 2005) . with
these developments, there is a recognition of
stress and illness then find meaning and
purpose in the situation and can offer a strong
spirituality in health, recent research has shown
that spiritual beliefs can improve quality of life
source of support. It turns out that the spiritual
needs can affect the state of the client. Thus,
and accelerate the process of healing client
(Noble and Colin, 2010).
each nurse is important to understand the
context of spiritual care, to be able to assist
Lundberg and Pet (2009) stated in his
research that there are five themes related to
clients in meeting the spiritual needs.
Spiritual is a concept that can be applied to
the provision of spiritual care include providing
mental support, facilitate the religious rituals and
all human beings. Spiritual is also an integral
aspect and universal to all human beings.
cultural beliefs, communicate with the client and
the client’s family, assessing the spiritual needs
Everyone has a spiritual dimension and this
dimension integrate, motivate, move, and affect
of the clients and show respect, and to facilitate
family participation in nursing care .but, Landro
all aspects human of life. This reason
researchers want to know the extent to which
find in General Internal Medicine between 3.000
inpatient University of Chicago Medical care
nurses knowledge and attitudes about spiritual
care nurses in meeting the spiritual needs of
Center the last three years , 41% spiritual issues
and client service care that spiritual discussions
the clients, and to investigate the relationship
between the two.
became more satisfied with the overall (Landro,
2011).
Based on the results of preliminary studies
Utami and Supratman (2009) in his research
in Rajawali Bandung Hospital in 2013 the
number of nurses in the room as much as 54
nurse states that less attention to the spiritual
needs of the clients because of the knowledge
adult clients. The measurement results of five
nurses, three nurse obtained with good
and attitude of nurses is lacking. This lack of
knowledge is due to several factors, including
knowledge of spiritual care and two nurses
less. Meanwhile, the attitude of nurses showed
lack of training or seminars on spirituality in
nursing and also may be due to lack of material
that two nurses support of spiritual fulfillment
and three nurses was not conducive to spiritual
received nurse in the learning process.
Meanwhile, Narayasami and Owens (2001),
fulfillment, this shows that nurses are less
supportive of spiritual fulfillment adult clients.
Callister et al (2004) in Lundberg and Petcharat
(2009) found that there is a gap between the
From the description of the statement, the
researcher interested in conducting research on
idea of the spiritual and the nurse’s role related
to the spiritual care because nurses have the
“The Relationship Between Spiritual Knowledge
Attitude Care whit Nurses Meeting the Spiritual
knowledge and experience that is lacking in
doing spiritual care . So the nurse being less
Needs Klien adult in Rajawali Hospital
Bandung”. The purpose of this study that is
know the relationship between the knowledge
The Relationship between Spiritual Care Knowledge with Nurse’s Attitude in Fulfilling the Clients Spiritual
Needs at Rajawali Hospital Bandung
of spiritual care by nurses attitude in meeting
From the calculation of sample size
the spiritual needs of clients in the Rajawali
Hospital Bandung .
obtained a total sample of 31 people. Thus, the
sample size in this study as many as 31 people.
Methods
Research Design
In this study, data collection was conducted
by distributing questionnaires were distributed
The design of this research uses
descriptive correlation method using cross
sectional approach in which the involvement of
researchers are observational (nonexperimental) or the collection of data at once
at some point (time point approach) and
to all nurses who have agreed to be the
respondent, where a questionnaire filled
themselves by respondents previously
described by researchers on how to fill.
In this research, using two questionnaires,
conducted at Rajawali Bandung Hospital in May
is a sectional 2013.Cross the design of all types
the first questionnaire about spiritual knowledge
care and nurse questionnaire on attitudes of
of research that the variables of measurement
done once, at one time, and no follow-up
nurses in meeting the spiritual needs of adult
clients. Questionnaires knowledge about
(Sastroasmoro and Sofyan, 2010).
spiritual care nurses using structured such
statement is based on the theory of spiritual
In this study, researchers looked for a
relationship between knowledge about spiritual
care nurse with an attitude of nurses in meeting
the spiritual needs of adult clients in the Rajawali
Bandung Hospital by measuring instantaneous.
Of course, not all of the subjects to be examined
on the same day or the time, but these variables
can be measured according to the state or status
at the time of observation, so the cross-sectional
design was no follow-up yet.
answer is right or wrong according to the
respondents, while the attitude questionnaire
statements are prepared using the scale likert
so that respondents taskbar statement
according to the code given is very positive to
very negative which includes strongly agree,
undecided, disagree, and strongly disagree.
Research Procedure
Population and sample
Population in research that is all nurses
who served in the adult inpatient unit that is in
the Suhud room , Suhadi Space, And Space
Chodijah as many as 54 nurses. This research
is a descriptive categorical, formula sample size
used in this study are:
Z 2.P.q
N
d2
care, which consists of positive statements and
negative statements in which respondents only
The procedure aims to facilitate research
investigators in performing the stages of
research, while the research procedures, among
others:
The preparation phase:
Defining the research problem,
Conducting preliminary studies, Develop
research proposals according to the
guidelines, Develop questionnaires as a
research instrument, Doing research
proposal exam.
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231
The implementation stage:
Getting permission to test the validity
of the Mitra Anugerah Lestari Hospital and
get permission to conduct research at the
Rajawali Bandung Hospital , Doing
informed concent (to obtain the consent
of the respondents), To collect the data,
Perform data processing and data
analysis, conclusion.
The final phase:
Preparation of research reports,
presentation of research results.
Processing and Data Analysis
Researchers perform data processing
actions after collecting data on the respondents.
Data processing consists of editing, coding, data
respondents, frequency distribution of spiritual
care nurses knowledge, attitudes and
distribution of nurses in meeting the spiritual
needs of adult clients. In the bivariate analysis
of the research results show the relationship
between knowledge about spiritual care nurse
with an attitude of nurses in meeting the spiritual
needs of adult clients in Rajawali Bandung
Hospital.
Here will be presented the results of the
study “The relationship of knowledge about
spiritual care nurse with an attitude of nurses in
meeting the spiritual needs of adult clients in
hospitals Rajawali Bandung Hospital”, with as
many as 31 respondents ie respondent nurses
who care for adult clients in Rajawali bandung
Hospital.
Univariate analysis
movement / data entry, and data cleaning
Age Frequency Distribution of Respondents
The location and time of the research
This research was conducted at the
Rajawali Bandung Hospital, especially in the
inpatient adult clients in May 2013. Rajawali
Bandung Hospita have four adult inpatient unit
that Suhud space, Suhadi space, Chodijah
space and space of Rafei.
Results
The results of the study, entitled
“Relationship of knowledge about spiritual care
nurse with an attitude of nurses in meeting the
spiritual needs of adult clients in Rajawali
Bandung Hospital” is divided into two parts,
namely the univariate and bivariate analysis. In
the univariate analysis were divided into five
research is the result of research on the
frequency distribution of the age of respondents,
frequency distribution of respondents latest
Table 1 Frequency Distribution of
Respondents Age Rajawali London Hospital.
No
Age Respondent
Freq.
%
1
20 Year – 24 Year
2
6,5
2
30 Year – 34 Year
2
6,5
3
35 Year - 39 Year
11
35,5
4
>40 Year
16
51,6
31
100
Number
Based on Table 1 shows that the age of the
respondents who are spanned 20 years-24
years of 6.5%, the range of patients 30 years of
age-34 years of 6.5%, age range 35 years-39
years of 35.5% and most respondents aged>
40 years at 51.6%.
education, tenure frequency distribution of
Frequency Distribution of Knowledge About
Last Education Distribution of Respondents
Spiritual Care Nurses
Table 2 Distribution of respondents Last
Education Eagles London Hospital
No
Last Education
Table 4 Frequency Distribution Nursing
Knowledge About Spiritual Care in the
Freq.
%
Rajawali Bandung Hospital
1
D3 Nursing
30
96,8
No
2
S1 Nursing, Ners
1
3,2
1
31
100
2
Number
Pengetahuan
Perawat Tentang
Freq.
%
Good
17
54,8
Less than
14
45,2
31
100
Number
Based on Table 2 shows that most respondents
to the latest D3 Nursing education at 96.8% and
respondents with recent education nurses
nursing S1 by 3.2%.
Work Period Distribution of Respondents
1
Work Period
<5 Year
Freq.
%
2
6,5
2
5 Year – 10 Year
4
12,9
3
>10 Year
25
80,6
31
100
Number
respondents had a good knowledge of spiritual
care by 54.8%, while 45.2% had knowledge of
spiritual care less.
Table 3 Distribution of Respondents Working
Period Eagles London Hospital
No
Based on Table 4 shows that most
Frequency Distribution of Attitude Nurses In
Adult Clients Meet Spiritual Needs
Table 5 Frequency Distribution of Attitude
Nurses In Adult Clients Meet Spiritual Needs
In the Nurse
Attitude Meet
No
years as much as 80.6%, as much as 12.9%
have tenure ranges between 5 years to 10 years
and as much as 6.5% have a service life of less
than 5 years.
%
1
Support
15
48,4
2
Does Not Support
16
51,6
31
100
Number
Based on Table 3 shows that most
respondents have a service life of more than 10
Freq.
Based on Table 5 show that most
respondents did not support having an attitude
in meeting the spiritual needs of adult clients of
51.6% and a supportive attitude shown by
48.4% of respondents
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233
Bivariate analysis
Table 6 Distribution of the sample according to the nurse’s knowledge of spiritual care by nurses
attitude in meeting the spiritual needs of adult clients at Rajawali Bandung Hospital
Nurses in Adulth Clients Meet
Spiritual Needs
Nurse Knowledge About
Spiritual Care
Good
Supports
Total
Not Support
P Value
N
%
N
%
N
%
10
58,8
7
41,2
17
100
0,2
Less than
5
35,7
The results based on Table 6 shows that
the nurse’s knowledge of both the attitude of
spiritual care support nurses in meeting the
spiritual needs of adult clients by 10
respondents, while seven respondents had a
good knowledge of spiritual care by nurses
attitudes is not support in meeting the spiritual
needs of adult clients. Nurses knowledge about
spiritual care less attitude to support nurses in
meeting the spiritual needs of adult clients by 5
respondents, while 9 respondents had
knowledge about spiritual care nurses lack the
attitude of nurses do not support in meeting the
spiritual needs of adult clients. The results of
the statistical test using the chi-square p value
of 0.200 obtained is greater than alpha (0.05),
this means that there is no significant
relationship between the knowledge of spiritual
care nurse with an attitude of nurses in meeting
the spiritual needs of adult clients in Rajawali
Bandung Hospital.
Discussion
The results using the chi square test
showed p = 0.200 which is greater than the pvalue p = 0.005, which means statistical
research on the relationship between knowledge
9
64,3
14
100
about spiritual care nurse with an attitude of
nurses in meeting the spiritual needs of adult
clients in the Rajawali bandung hospital no
relationship meaningful.
However, the results of this study differ from
research and Supratman Utami (2009) which
states that there is a significant relationship
between the knowledge of nurses in meeting
the spiritual needs of patients with the attitude
of nurses. Knowledge nurses are less impacting
nurses less attitude in meeting the spiritual
needs of the clients. Dhamani, Pauline and
Joanne (2011) states that nurses in Tanzania to
understand, and show a desire to do the spiritual
practices and participate in spiritual practice.
Many factors affect the attitudes of nurses
in meeting the spiritual needs of adult clients
not only of knowledge but also the views and
beliefs can affect. As was Anwar (in A and
Goddess M Henry, 2010) mentioned that in
shaping attitudes, there are three components:
a cognitive component, affective component and
conative components; cognitive component
includes knowledge, beliefs and views; cognitive
component includes feelings of a person
towards something and conative components
include a tendency to behave. This is supported
____________________. Pengantar konsep
by the results of the study of Wu and Lih-Ying
(2011) states that there is a significant
dasar keperawatan. 2nd ed. Jakarta:
Salemba Medika; 2007.
relationship between the notion of the spiritual
with spiritual care.
____________________. Riset keperawatan
Conclusions
dan teknik penulisan ilmiah. Jakarta:
Salemba Medika; 2008.
After doing research about relationship of
knowledge about spiritual care nurse with an
Kinasih KD, Aries Wahyuningsih. Peran
pendamingan spiritual terhadap motivasi
attitude of nurses in meeting the spiritual needs
of adult clients in Rajawali Bandung Hospital in
kesembuhan pada pasien lanjut usia.
Kediri: STIKES RS Baptis Kediri: [online]
May of 2013 with a sample of 30 people, it can
be concluded that there is no significant
2012 Juli [cited 15 Februari 2013]; 5 (1):
1-10. Available from URL: http://
relationship between the knowledge of spiritual
care by nurses attitudes of nurses in meeting
cpanel.petra.ac.id/ejournal/index.php/
stikes/article/view/18464/18278
the spiritual needs of adult clients Rajawali
Bandung Hospital.
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237
HEALTH-RELATED DISASTER MITIGATION MANAGEMENT IN CIAMIS REGENCY
SUPPORTED BY APPLICATION OF INFORMATION TECHNOLOGY
Etika Emaliyawati, Ayu Prawesti, Iyus Yoses, Kusman Ibrahim
Fakultas Ilmu Keperawatan Universitas Padjadjaran Bandung
E-mail: eemaliyawati@yahoo.com
ABSTRACT
Introduction: West Java region is vulnerable to earthquakes, flood, dan landslides. Disasters
cannot be predicted and when occurred all elements of disaster handling must be ready
including health elements. Ciamis regency is the fifth most vulnerable region to disaster in
West Java. The objective of this study is to develop a health information system related to
disaster including health services and facilities required before and during disaster to support
victims handling coordination starting from disaster location, evacuation and transportation
of the victims to health service location that depend on the victims condition, health facility
infrastructure, logistics required, distance and time travel to health service location, as well
as human resource in the health service location.
Method: This study is an operational research where the Methods used identify tools to
supply data into the information system, editing and querying, visualization of background
map (health service) and then compiling into kml/kmz files that were displayed in Google
Earth.
Results: The result was a health information system related to disaster called “SIMBARAN”
(Padjadjaran Disaster Information System), which provide health service information in Ciamis
Regency including 38 Community Health Centers, 1 Regency Hospital, and 2 Private
Hosputals. The Hospitals are able to handle patients with red triage label, 4 Community
Health Center are able to handle patients with yellow triage labels, 34 Community Health
Center are able to handle patients with green triage labels. The data displayed include
facilities and capacity in handling disaster victim, human resource and capacity to handle
cases and referenced facilities such as ambulance.
Conclusion: The project has succeeded in developing health information system related to
handling disaster victims, but the system need to be further developed through collaboration
with related agencies such as National Disaster Management Agency (BNPB), Geospatial
Information Agency (BIG), and National Institute of Aeronatics and Space (LAPAN) in order
to integrate the system to other aspects such as disaster early warning system.
Keywords: Health, Disaster Mitigation, Information Technology, Simbaran.
239
SYSTEMATIC REVIEW SPRIRITUALITAS AND SPIRITUAL INFLUENCE OF NURSING
CANCER PATIENTS
Triana Dewi Safariah
STIKes ‘Aisyiyah Bandung, Indonesia
E-mail: triana.dsafariah@gmail.com
ABSTRACT
Research on the effect of spirituality on spiritual nursing has been reviewed in cancer patients.
These studies showed in terminal illness disease, especially cancer, that spiritual nursing
as part of nursing interventions becomes an absolute, at least spiritual intervention can give
you the confidence and happiness in the face of death. Several studies were conducted
following confirms that the importance of spiritual intervention for advanced cancer patients
spiritual needs cannot be met by religious communities or the medical system. Spiritual
support is very closely related to the good quality of life (QOL). For example, patients with
lung cancer has a serious breakdown in the psychological and social aspects of QOL. Mental
condition of depression, negative paradigm of the Meaning Of Illness (MOI) as well as suffering
from cancer at a young age is 37% of QOL. Another thing that lowers the quality of life is the
amount of 35% of patients experienced depressed mood and 75% depressed with the family
diagnosis suffering from cancer as well as depressed due to decreased sexual function.
Approximately 67% of reported irregularities conditions of his life. On the study of the
spirituality influence in QOL, patterns of religiosity and spirituality have a portion relationship
with QOL which is it has different patterns between cancer patients from different cultures.
Psychological effect on patients diagnosed with cancer again demonstrated the good quality
of life and improved mood and decreased stress compared to patients who were first
diagnosed with cancer. As a professional nursing in nursing spiritual intervention, a nurse
assigned to provide communications that gives hope to patients. Patients with high support
and is able to control themselves have high hope and are able to change the judgement.
The experience of the nurses who had cancer confirms that patients need compassion and
openness of the medical team as a therapeutic intervention.
Keywords: Spriritualitas, Spiritual, Cancer Patients.
241
Introduction
Cancer is a degenerative disease that is
feared because of its prevalence continues to
increase. This disease originated from genetic
material damage is defined as a malignant
growth or tumor cells are characterized by
uncontrolled growth and spread of abnormal
cells in the body. Based on data from the WHO
in 2005, estimated global cancer as a cause of
death for 7.6 million people in the world
(Dwipoyono, 2009).
Due to the high mortality rate, the cancer
patients had high levels of stress and suffered
a mental collapse. This shock resulted in
distrust, fear, uncertainty, loneliness and
isolation constant and loss of self-control. This
suggests the occurrence of a spiritual imbalance
in patients. Someone who is in the diagnosis of
cancer will lead to emptiness and despair of self,
where both of these things can only be released
with the attitude of acceptance, connectedness
and forgiveness(Doris DC,2003).
in the adjuvant therapy (therapy that helps) to
feel the symptoms of breast cancer for 2 years
after therapy. Discomfort is a common symptom
of fatigue, difficulty concentrating, pain, skin
irritation, depression and anxiety (Juanita,
2004). The struggle of Breast cancer women to
find the meaning of life is not diminished with
the passage of time, but should be aided by the
support of a friendship and redefine the values
that are important in their lives (Doris DC, 2003).
The following studies have focused on the
influence of spiritual nursing in the care of cancer
patients
Spiritual and Nursing Spiritual
Patients with terminal illnesses such as
cancer will get a palliative care (care to reduce,
relieve pain). Palliative care is holistic, providing
multidimensional services. Organization WHO
defines palliative care is a treatment approach
that improves the quality of life of patients and
families of patients while the patient is
Several studies conducted in women with
threatened by the disease either at diagnosis
or after initial indications. Many nursing authors
breast cancer after several years at diagnosis
to identify the characteristics of a spiritual
state that spirituality is part of a holistic service
dimensions and when the nurse meets the
imbalance. Spiritual imbalance manifested in
despair and depression, grief unreasonable
spiritual needs of patients, then this is the most
fundamental part of holistic nursing (Esther Mok
length and loss of imagination. Besides, it also
happens the fear of recurrence and sudden
et al., 2009).
death (Doris DC, 2003).
Patients in the palliative care get special
The cancer patients was reported, showed
attention in balance with the cost, energy and
attention to the personal and social needs. On
a phenomenon symptoms of discomfort
(symptom distress). These symptoms lead to
the way to the terminal condition, inner
confrontation occurred in the patient on the face
physical and mental suffering because of the
unpleasant, unusual, disturbing the comfort and
of death that makes the patient must do
reflection. Therefore be important for the spiritual
productivity. Some symptoms show different
variations in different patients. Patients in the
nursing terminal patients, but nurses find it
difficult to define it.
early diagnosis of breast cancer shows
symptoms of discomfort in the form of emotional
There are fundamental differences between
distress, fatigue and insomnia. Some patients
the spiritual and religious. Religions talk about
Systematic Review Spiritualities and Spiritual Influence of Nursing Cancer Patients
the system, the social institutions in which they
Spirituality and Nursing Spiritual for Cancer
have confidence, worship rituals and traditions.
Characterized religion has the boundary but the
Patient
spiritual has without limit (Edwards et al., 2010).
Spiritual in some studies often has identified
with some spiritual aspects such as the meaning
and purpose of life, worship or vision. Spiritual
concepts implemented in many ways such as
welfare (well-being), and health awareness
According to some Chinese-Hong Kong
terminal patients in the Esther Mok study,
spirituality is an abstract concept and a unique
personal beliefs that give strength and relate to
the meaning of life. More themes are about the
meaning of life which includes interrelationships,
(Meraviglia, 2005).
various linkages, self-reflection and
responsibility fulfillment of the obligation. In
Based on an analysis of the concept,
spiritual is defined as a unique experience of
spiritualview, the death is believed to be a
process of life to go to the silence and peace of
soul expression and dynamic reflection of the
belief in God, connectedness to the Divine that
mind. Spiritual well-being is achieved by having
faith and knowing the possibilities in life and after
integrates sense, physical and mental
(Meraviglia, 2005).
death. According to Esther Mok, patients do not
expect to get spiritual care institutions (hospitals)
The oncology nurses have a unique
position, where they are fully involved in the
physiological and psychological well-being of the
patient to help survive and healing with all their
but when the nurse provide interpersonal
spiritual care,the patients admitted it that give
strength and support.
Once
the
importance
of
spiritual
experience and the impact received in life (Betty
R, 2002)Spiritual nursing and attention to the
intervention, Tracy et al. (2006) stated that the
spiritual needs of advanced cancer patients can
existence of self are in the domain of oncology
nurses. Spiritual nursing intervention defined as
not be met by religious communities or the
medical system where spiritual support is very
the provision in the domain of spirituality and
has long been a focus of ChaplainsHospital.
closely related to the good quality of life (QOL).
Tracy also stated that religious individuals are
Spiritual care has been accepted as the focus
of nursing practice. North America has two
often long-lived.
diagnoses of nursing spiritual which in the face
of difficulty and in seeking the welfare of life
(well-being). Nursing enter 20 indicators for
spirituality and classification of nursing
interventions enter four (4) specific interventions
such as spiritual-religius care, worship, spiritual
support, spiritual growth facilities, facilities
forgiveness, and two (2) interventions in spiritual
care is bibilitoterapi with sacred text and the
presence (Amy Rex S , 2006).
According Meraviglia (2005) from a study
of breast cancer patients, the meaning of life
(meaning life) was positively related to
psychological responses and negatively
associated with physical responses. Worship is
done is positively related to psychological wellbeing. Wisdom of life is used as a mediation
between the perceived effects of the body from
cancer with psychological well-being. Meraviglia
also detect breast cancer patients, that those
who have a good worship and feel so close to
God are those with low education and low
income.
|
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243
Has been investigated against 100 people
In the study the influence of spirituality on
who participated in breast cancer by Juanita
(2004), the relationship of symptom distress
QOL, WL Jung et al. (2009) reported that the
pattern of religiosity and spirituality have a
with psikospiritual welfare. This study reported
that no relationship was found between age and
relationship with QOL in part, which have
different patterns between cancer patients from
symptom distress, but age is inversely related
to the welfare psychospiritual. Juanita stated that
different cultures (Korean American and
Korean). However, more social support mediate
age and symptom distress accounted for 23.1%
of the difference in welfare psychospiritual. Due
the spirit of the Korean American citizens than
native Korea. Psychological influences on QOL
to cancer, according to Doris DC, after being
declared cancer patients and support groups
was also investigated by Hae-Chung Yang et
al. (2007) who reported psychological
following the self-transcendence, the patient is
able to support other people who have cancer
relationship with QOL for patients for cancer
recurrence. Patients diagnosed with cancer
and do advocacy work, especially breast cancer.
again no improvement in physical condition and
function. However, quality of life and mood was
Effect of Spirituality In Quality of Life (QOL)
Quality of life (QOL) is a tool that describes
improved and stress was decreased. Compared
with patients who were first diagnosed , the
the multidimensional phenomenon that affects
the experience of patients in the disease. Linda
recurrence patients have lower levels of anxietyconfusion despite physical function is
Sarna (2004) examined QOL of lung cancer
patients, especially women and relate it to the
worsewere made QOL improvement of quality
of life is slower, and high symptom distress.
concept of Meaning Of Ilness (MOI). Patients
with lung cancer had a serious breakdown in
Then, Hae-Chung Yang also pointed out that
under the age of 54 years has been slow to
the psychological and social aspects of QOL.
Mental conditions (mood) that depression,
restore quality of life.
negative paradigm of the MOI, as well as
suffering from the disease at a young age is 37%
Necessity of Alternative Medicine And
Information That Improves Hope
of the QOL. These data correlate with the
physical dimensions of poverty, psychological
From cancer, Doris DC states that occur in
the patient’s spiritual imbalance. This imbalance
and social aspects of QOL.
spur all participants to seek out the information,
seeking support from others, searching for the
Linda reported that participants had a
negative impression on the MOI by 36%.
Another thing that lowers the quality of life is
the number of 35% of patients were depressed
mood and 75% depressed families affected by
the diagnosis of cancer as well as depressed
due to decreased sexual function. Then about
67% reported irregularities conditions of life in
which approximately 31% suffer from obstructive
lung disease.
source of pious and reach the inner depths of
the value of life.
Necessity of Alternative Medicine And
Information to Improves Hope
In order to seek out of information
resources, Suzane (2005) states that there are
5 things related to the patient’s experience in
seeking out of information resources, especially
through the internet:
1.
2.
Patients receive and filter the internet for
and the nurse cause trouble. Nurses should
support purposes in order to find hope and
new treatment options
change clinical environment by building a
system that involved nurses and patients to
while doing the above, patients selfmanage fear by controlling information
3.
Looking for a friend as a partner in the
search for information where the internet
information is second choice
4.
5.
Making the internet information as a direct
improve care.
In addition, as aprofessional in spiritual
nursing,the nurse must give hope to patient on
communication to help. Anne (2007) states,
women have difficulty and trauma of the
diagnosis of ovarian cancer. Patients with high
support and the ability to control yourself, have
supervisor
hope and are able to change the verdict.
Therefore, healthcare providers and nursing
One constitutive pattern was searching for
information on the Internet that makes
communication spiritual influence for change in
view of the verdict of death.
cancer as a “friend” of life instead of death
judgement.
The Importance of Spirituality In Nursing
Terminal
But Paula Klem et al. (2001) showed that a
group of internet information search more
To understand more about the influence of
depressed compared with traditional search.
Therefore, before providing intervention via the
spirituality and spiritual nursing for patients,
Edward A et al. (2009) states that;
Internet, it is necessary to first evaluate the
intervention.
•
Spirituality focuses on connectedness, not
only limited meaning and embodied in a
friendship.
Implications In Nursing Actions
Some nurses have in the diagnosis of
cancer, according to Carol P et al. (2003).
Nurses have been about 50 years old. This study
reported a change in the way in providing
•
Spirituality is a broader term that is not
just religion.
•
Work within the framework of existing
nursing spiritual encouragement. This is
achieved in the physical care by focusing
nursing interventions on the terminal. Their
experiences as professionals and patients
on attendance, walking together, listening,
connecting, engaging and open with each
revealed fivethemes such as role ambiguity,
deepening the level of compassion for the
patient, provider self-disclosure as a therapeutic
intervention, be an advocate for change and
other.
•
where it is possible to respond to the
spiritual needs.
volunteerism.
Survival from cancer is an important factor
for nurses in clinical practice. Experience as a
patient confirms that patients need love and
need for openness of medical team as a
Strong relationships supported patients,
•
Involvement of home care nurse in
spiritual care are less utilized.
therapeutic intervention. Ambiguity of the patient
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245
•
•
Establishment of a spiritual relationship in
Cancer in Palliative Care Setting, Clinical
the provision of spiritual care creates its
own needs and if this relationship is
Journal of Oncology Nursing, Volume 12,
Number 4, 575 – 581. http://
damaged can result in pressure.
www.ions.org.il/img/fck/file/pdf/
meyda_nurses/pain_paliativecare.pdf
Barriers to spiritual care include lack of
time, cultural or educational, institutional
factors and professionalism.
Conclusion
1.
The understanding of spirituality needs of
patients should be the basis for nursing
intervention.
2.
In the face of a terminal illness disease,
especially cancer, then it becomes an
absolute spiritual nursing as part of
nursing interventions, at least Nursing
spiritual care can give you the confidence
and happiness in the face of death.
3.
It is important for nurses to improve the
Carol Picard, Joan Agretelis, Rosanna F.
DeMarco, 2003, Nurse Experiences as
Cancer Survivors: Part II—Professional,
Oncology Nursing Forum, Vol 31, No.3,
537 – 542. http://www.ncbi.nlm.nih.gov/
pubmed/15146219
Doris DC., David LK., 2003, Resolution of
Spiritual Disequilibrium by Women Newly
Diagnosed With Breast Cancer, Oncology
Nursing Forum, Vol 31, No.2, 24 – 31.
http://ons.metapress.com/content/
e80687q677404626/
Dwipoyono, Bambang, 2009, Kebijakan
Pengendalian Penyakit Kanker (Serviks)
quality of the spiritual self as well as
communication and information to build
di Indonesia, Indonesian Journal of
Cancer, Vol.III, 3, Juli – September, 109 –
expectations especially to patients, their
families and communities
116. http://indonesianjournalofcancer.org/
images/stories/2009/
IJoC_2009_3_109.pdf
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CARING EXPERIENCE THE MOTHERS WHO’S PREMATURE BABIES
WITH DIFFERENT CULTURE
Dewi Mustikaningsih
STIKes ‘Aisyiyah Bandung
E-mail: aning_klw@ymail.com
ABSTRACT
Introduction: Characteristics of premature babies are infants of gestational age less than
37 weeks with a birth weight less than 2500 grams. Mothers who have had premature
babies often care based on the origin habits and was not ready psychologically, there is a
sense of fear, stress and anxiety, which can interfere with the relationship between a mother
and her baby.
Methods: Qualitative research phenomenological with Colaizzi method, to determine the
experience of mothers caring for premature babies, 5 participants that mothers who have
had premature babies weighting 1500 to 2500 grams in the village of Bandung Cipagalo.
Results: Mothers who care for premature babies in the tribe of the Javanis two and Sundanis
three. Mothers who have a habit of premature babies caring by maternal region of origin,
with the result of the mother who comes from Javanis, babies given honey bees, honey
mixed with mashed banana, milk out yellowish should not be given to babies because it is
considered a disease , before the baby can swallow baby honey bees by means of smeared
on the tongue. While the caring of premature babies by the mother of the Sundanis, baby in
wrapped in cloth with fabric so warm, use a hot water bottle placed on either side of the
baby, the baby wiped with warm water, use a 15 watt lamp with a distance of 20 cm, there is
the use of bottled water heat and light, there is also a drying her baby every morning, the
baby was left enclosed space wearing warm clothes and diapers and baby in wrapping the
stomach. In addition it also causes premature birth is obtained, the feeling of a mother first
saw the baby, mother preparing baby care, baby care information about the mother, the
health of newborns, baby’s growth and development as well as the support of her husband
and family care for premature babies.
Conclusion: Mothers who have premature babies at home taking care of her baby based
on the original custom baby’s mother. Health workers are expected to socialize again about
the care of premature babies in the proper care of premature babies like a kangaroo method
care.
Keywords: Experience, mothers, premature babies.
249
Introduction
Premature infants have a characteristic
temperature is unstable and tends to
hypothermia is a temperature less than 36,5oC.
Cold stress can increase mortality and hinder
growth, while hiperthermia and fluctuating
temperatures can cause apnea (Monintja,
1997). The incidence of premature infants in
Indonesia is still relatively high at 14% (Depkes
RI, 1998). In Subdivision School of Medicine
baby, other than that some still have the habit
of bathing the newborn, warmed by means of a
piece of cloth or a light warmed the coals, and
rubbed the baby’s body to be warm, there are
also the hot water bottle or approximated with
kerosene lamps lights and some of the Methods
proposed community kussu the marsupial
animals that exist in the region that is similar
animal kangaroo (Pratomo, 1998).
In West Java, the research reported in the
Perinatology IKA RSCM during 1998 obtained
early neonatal mortality rate in the group of
district Leuwiliang Bogor, which generally
mothers who have premature or low birth weight
infants with a birth weight less than 1000 grams,
1000-1499 grams and 1500-2499 grams each -
infants treatment with wrapping baby with a cloth
to keep warm wrapping called, using a hot water
amounting to 75%, 41.9% and 6.6%. The
condition of the infant at birth is neonatal
bottle placed on either side of the baby, the baby
wiped with warm water, some use the lights to
mortality caused by handling of the case is not
appropriate. Based on years of research
the power of 25 watts at a distance of 25 cm as
well as doing a combination of a hot water bottle
Perinasia 1992/1993 on the care of premature
infants reported that the customs of traditional
birth attendants in the Sumatra region is bathed
and light, there is also a drying her baby every
morning with ten minutes old, baby left closed
ro wear warm clothes and diapers in guarding
with water leaves baby cikarau, cikumpal or
sidingin. There is also a baby is given a drink of
against wet . The duration of treatment with the
administration of a hot water bottle or a light one
egg beaten with palm sugar, canned milk was
given and left alone. In NTB no smearing baby
to two months (Sutomo, 2003). The way to keep
the babies warm body temperature is the
shaman habits with hibiscus leaves, leaf
beluntas, palm leaves and turmeric and baby
kangaroo method, warm room, heated bottles,
radiant warmer, a heated water bed and
covered and placed in a basket. In the area of
Maros, South Sulawesi premature infants
incubator. In terms of effectiveness, safety and
hygiene together with the kangaroo method
warmed, dried, and covered in coconut oil and
then wipe with a lighted lamp (Wiknjosastro et
incubator type 3 is the most advanced, yet costdiffer greatly. Kangaroo method at no charge
al, 1992). Care of premature infants in Maluku
Bandaneira done by rubbing the baby’s body
except the love of his parents. Emotional
relationship with the baby’s mother began
with oil to prevent it from freezing, and
eucalyptus oil given the baby’s stomach tied with
pregnancy. Emotional bonds called attachment
or bonding is a process of relationship with the
octopus (Meutia, 1998). In the middle of the
Moluccas result that 52.1% of pregnant women
baby’s parents. Neonate is totally dependent
physically and emotionally to take care of him
found premature babies do not need to be
bathed, 87.5% should be breastfed, 91.7% and
(Tessier, 1998). Infants with early contact with
his mother cry less, smile more often and use
57.9% carried may not be refused if the mother’s
skin care made direct contact with the skin
more than breastfed infants in contact with his
mother late or inadequate (De Chateau, 1977).
Date RW 10 Cipagalo Bandung that there
participants and researchers about the time of
are 5 babies born with less than a month and
based on sharing experiences to mothers who
the interview, the researcher will conduct
interviews with participants in accordance with
have premature babies are not ready
psychologically and burdened by fear, stress
the time and place mutually agreed. Participants
fill out questions in the questionnaire
and anxiety, which can interfere with the
relationship between a mother and her baby.
demographic data sheet in accordance with the
instructions of each piece. In conducting the
Method
interview, the researcher recorded the interviews
using a voice recording of handpone and digital
The design of this qualitative study with a
phenomenological approach to determine how
video. After completion of the interview, the
researcher made a transcript of the interview,
mothers experience a premature baby and the
extent of readiness of mothers who have had
and if there are things that are less obvious,
interviews will be conducted if the has been
premature babies in the care of her baby at
home. The population is mothers who own and
completed the saturation is achieved, in the
sense that the interviews were conducted with
care for premature babies at home. 5 the
number of samples, because the sample size
participants who otherwise would not be found
more things new one. The method used is the
phenomenological qualitative research is usually
10 people or less (Polit, DF, Hungler, BP, 2001,
method of Colaizzi. The analysis is used to
describe the process in detail which consisted
hlm.215). Samples were taken by using
purposive sampling, sample inclusion criteria
of reading all of the procedures for obtaining
their feelings, to review any interviews and
were mothers of premature infants by 34 weeks
of age weighing 1500 to 2500 grams, are willing
express the meaning of each significant
statement, the meaning of which has been
to be interviewed or be a participant and can
speak Indonesian. The research was conducted
formulated to organize into a group theme,
comparing these groups back to the procedure
in the Village of Bandung Cipagalo on 1 - 28
November 2011 instrument used in this study is
original to noting deviations among the various
groups, with a waiver to avoid the date or themes
divided into two parts. First is the demographic
data questionnaire, which contains a statement
that are not appropriate, integrate the results
into a broad explanation of the phenomenon,
of the general data of participants in the data
collection sheet (questionnaire) in the form of
formulating broad explanation of the
phenomenon that is being investigated as a
maternal age, religion, ethnicity, education last,
and number of children. The second is an
statements identified as specific as possible and
ask the participants about these findings so far
interview guide containing questions about the
mother ’s experience includes caring for
perhaps as a final validation step. (Polit, DF,
Hungler, BP, 2001, hlm.393).
premature babies at home with a number of
questions about the 12. Researchers
Results and Discussion
approached prospective participants by
contacting prospective participants to make an
Causes of premature birth is maternal
factors such as fatigue. Maternal factors that
appointment and for approval as the study
sample. Following the approach to potential
cause preterm birth among other trauma during
pregnancy, such as physical (falling) and
participants and achieved agreement among
psychological (stress), maternal age at
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251
pregnancy of less than 20 years or more than
Dissatisfaction with the results of the baby, this
35 years, women who have previously given
birth more than 4 and child malnutrition
experience becomes stress and fear as well as
long-term problems. (Sherr, 1995)
(Berhman, Kliegman, & Arvin, 2002, page 562).
In addition, premature rupture of membranes
Preparation of the mother to care for
and infection. The cause of preterm birth is
multiple pregnancy fetal factors, hydramnios,
premature rupture of membranes, congenital
defects, infections (eg. Ruberella, syphilis,
toxoplasmosis), maternal and fetal blood
incompatibility (Rh factor, a goal. ABO blood)
(Berhman, Kliegman, & Arvin, 2002, page 562).
Based on these results demonstrate the lack of
knowledge of antenatal mothers. where the
expected mothers during antenatal care to know
the danger signs so that further tests can be
done to prevent complications that occur during
premature babies at home by preparing a box
of baby bed covered with lamp of learning, room
thermometer, make klentik oils for bathing and
there is also a tool for the preparation wipe bath
warm. Care for premature infants in the main
house are seeking a neutral ambient
temperature. To prevent the harmful effects of
hypothermia due to low ambient temperature or
chilled efforts should be made to take care of a
baby in a temperature neutral environment, the
temperature required for the oxygen
consumption and caloric expenditure is minimal.
pregnancy, including premature birth.
This lock state can be achieved when the baby’s
core temperature (the temperature of the body
Feelings first saw the baby was feeling sad
to see a premature baby because the baby is
small and confused because the baby was born
without dressing) can be retained 36.6o -37.5oC
degrees Celsius. Temperature neutral
environment can be achieved through a variety
but they were sad because the state of the baby
does not like a normal baby. Premature babies
of ways, namely by means of an incubator. But
if there is no incubator, infant environment can
have a baby that looks thin, as if consisting only
of skin and bones and no fat. Care of premature
be warmed by putting a hot water bottle in the
baby’s right and left side. Hot water bottle
infants in the baby should be placed in a bed
box that was given to help the light to warm the
wrapped in a cloth before it is placed or a towel
and placed beside the cart, not to touch or get
baby’s survival. Mothers who have had
premature babies fear and lack of information,
too close to the baby’s body. Fill the bottle is
replaced every hour or when it is not hot. Other
sometimes there are mothers who do not want
to see the baby is premature for the first time.
participants who have no care for the way the
baby is attached to the mother with the kangaroo
Rejection is a natural and commonly found in
the first few days because of anxiety and fear.
method. This method can be practiced when
there is no accompanying pathological
She also could not worry that premature babies
love. Anxiety and stress can relieve happy
problems, good suction reflexes, coordination
of sucking and swallowing reflexes both parents
together. (Glover, B., & Hodson, C., 1998,
hlm.37). Premature babies cause a variety of
agreed and the preparation of the mother, the
baby, the baby, infant observation, how
high difficulty, because every baby will be
different results. Experience preterm birth based
breastfeeding and maternal and infant hygiene
(Alisjahbana, 1998 ). If there is a power tool to
on the definition, it is too early to conclude, often
panic, and high medical intervention.
give a warm environment is done by placing an
incandescent bulb close baskets or cots on three
sides and placed such that it can be turned off
month. Premature infants are particularly
and on separately. Information about the care
of the premature baby nurse, a friend who has
vulnerable to infection because the immune
system is not developed optimally. Wong, 2000,
a premature baby, books, magazines and the
internet. The nurse is an individual who can
said that premature babies are vulnerable to
infection due to incomplete immunity so easily
explain in primary prevention and crisis
management as well as facilitating adaptation,
disturbed health.
learning and growth so that the individual can
see the benefit of his experience and can face
a crisis that may occur in the future using the
skills they learned. (Caplan, 2002). Based on
the observations of researchers in the field and
based on the results of the interview participants
received information from health workers are still
lacking. Involvement in breast-feeding mothers
Growth and development of premature
infants is different when viewed with the
development of the book is always dibatas
bottom curve but does not pass through the
normal curve. Wong, 2000, said that the
development of premature infants is different
from that of term infants 2 months hampered
backward when compared with term infants.
only, these mothers are confused and do not
understand how to care for premature babies
Husband and family support to mothers who
care for premature infants is a husband and wife
after they return home later.
help families participate in caring for the baby
such as making milk alternately, buy books on
Implementation of premature infant care at
home is done by the mother herself and her
husband after returning home, the mother can
give a touch of love in a way similar to a
kangaroo carrying her child as a replacement
incubator and warmer tool. In this way improved
the condition of premature babies, babies feel
premature babies, delivering control to the
doctor, clinic consultation to infant growth and
advise the wife. Wong, 2000, saying that as a
family support system is needed by mothers who
have premature babies.
Conclusions and Recomendations
comfortable and calm. (Anderson, 1991).
Mothers experience caring for premature
Home care of premature infants are breastfed and there is time to use milk premature
babies at home include the causes of premature
birth, maternal feeling to see the baby first, the
breast milk has not come out through the spoon
when it has not been able to suck a pacifier or
preparation of the mother to care for premature
babies at home, information about the care of
not to breastfeed, bath with swabbed, virgin
coconut oil on doing while in baby massage and
premature babies, premature baby care
implementation in home care of premature
placed on the mother’s chest skin so warm and
given vitamins for the brain. This is consistent
babies, premature baby health condition, growth
and development of premature infants as well
with the statements of participants who say the
treatment of premature infants is used to warm
as her husband and family support to mothers
who care for premature babies at home.
the warm bottles and baby oil. (Surasmi, A.,
Hand, S., & Kusuma, HN, 2003, pp 15).
Pediatric nurse to provide health education to
parents who have a premature baby on the
The health condition of premature babies
proper techniques in caring for premature babies
at home.
in the hospital often each week and once a
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253
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SOCIAL CAPITAL APPROACH TO IMPROVING SUSTAINABILITY AWARENESS IN
PREVENTION DENGUE HEMORRHAGIC FEVER (DHF)
Nur Mukarromah1, Soedjajadi Keman2, Rahmad Hargono3
1
2,3
Fakultas Ilmu Kesehatan Universitas Muhammadiyah Surabaya
Fakultas Kesehatan Masyarakat Universitas Airlangga Surabaya
E-mail: mukarromah_n@yahoo.co.id
ABSTRACT
Introduction: Increasing the incidence of DHF early needed the behavior change through
the improving sustainability awareness independently with social capital approach. The
purpose of this research was to find a indicator of social capital to increase public awareness
sustainability of the prevention of DHF in Sidoarjo.
Methods: The design used was a cross sectional with analysis unit for family members who
were at the public health centre of Tanggulangin and the public health centre of Buduran
with the sample of 296 people. The sampling method was multistage random sampling. The
instrument used was a questionnaire that has been tested for validity and reliability. The
data collection was analyzed by using Mann Whitney, logistic regression and SEM.
Results: The results showed that social capital in both locations there were no differences,
for sustainability awareness there were significant difference with p-value 0.000 <á =0.05.
8 of the 12 indicators of social capital, the most influential on the sustainability awareness
were values, sense of identity, norms, trusts systems, cooperation, attitudes, perceptions,
and expectations. Strengthening social capital in improving community sustainability
awareness was very important renewal approach. Social capital could move society in
Sidoarjo district, in preventing and combating the incidence of dengue hemorrhagic fever
properly.
Keywords: social capital, sustainability awareness, dengue hemorrhagic fever.
Introduction
now very urgent. The success and failure of the
PSN has been launched by the government are
often carried out only when it is a case of DHF
Social capital strengthening in community
awareness improvement through sustainability
even until death.
awareness could be considered as a renewal
approach that was very important. Development
Coleman (1998) in his book titled Social
of knowledge and attitudes about public
awareness, with the approach of social capital
Capital in the Creation of Human Capital states
that the sustainability of any social transaction
as a key factor in community development, is
is determined by the presence and maintenance
255
of trust or the mandate of the parties involved.
Buduran. The criteria for samples are heads of
The purpose of this research was to find a model
of social capital approach in an effort to increase
families who have family members been
diagnosed with dengue fever as well as reside
public awareness sustainability of the prevention
of DHF in Sidoarjo
in the region at least one year. The sample total
of 296 people was divided into two groups of
Some of the key indicators that can be used
samples with a multistage random sampling
method. Data were collected through
as a measure of social capital among others
(Spellerber, 1997; Suharto, 2005), namely: 1)
Feelings of identity; 2) Feelings have or vice
versa, feeling aliens; 3) trust system and
ideology; 4) The value and purpose; 5) Fear; 6)
attitude towards other members of society; 7)
Perceptions of access to services, resources
and facilities (employment, income, education,
housing, health, transport, social protection); 8)
Opinion about the government’s performance
earlier; 9) Confidence in institutions and the
general public; 10) The level of trust; 11)
satisfaction in life to be achieved in the future;
and 12) Hope to be achieved in the future.
Methods
The study design used was analytic
observational with cross-sectional design
because data collect in snapshoot. Data
collection was carried out on two groups of
samples. Stage first was the identification and
analysis of factors that serve as indicators on
questionnaire, observation and interview. Data
analyzed by statistical descriptive and analytic.
Statistical descriptive showed frequency
distribution of age, occupation and education.
Statistical analytic showed by result of MannWhitney test, simple logistic regression, and
confirmatory analysis of SEM.
Result and Discussion
Indicators of social capital in Tanggulangin
district or Buduran sub-district then they were
compared by using the Mann-Whitney test.
Some indicators that there were differences
between the two research areas were the sense
of identity with a p-value of 0.006, trust systems
with p-value of 0.000, participation with a pvalue (0.023), attitude with a p-value (0.000). In
general, social capital research in both regions
were no differences. Sustainability awareness
in both regions was a significant difference with
p-value of 0.000.
social capital in the community. Stage second
was comparing of social capital indicators that
The analysis of the results of the indicators
of social capital influenced on sustainability
exist in endemic areas the incidence of dengue
hemorrhagic fever, which is free of the dengue
awareness in Tanggulangin district and Buduran
sub-district used simple logistic regression test.
fever. Stage third was developing an approach
model of social capital to improve the
Logistic regression test showed that values was
the factor influenced sustainability awareness
sustainability awareness on the prevention of
DHF in Sidoarjo region.
with p-value of 0.002. Odds ratio values showed
results concluded that people with values less
The populations are all community who
lived in Sidoarjo region. Especially the
individuals who lived at Tanggulangin which is
outbreak district of dengue hemorrhagic fever.
Another area that is free of dengue fever is
likely to have good sustainability awareness both
of 6.1 (95% CI: 2.04 to 18.3) times compared
with those who have less value. In Buduran sub
district for logistic regression appeared there
was significantrelationships between the values
of the sustainability awareness and p-value of
sustainability awareness both of 0.12 times
0.011. OR calculations could be concluded that
the value would be less likely to have good
compared with those who had less satisfaction.
Buduran subdistrict showed p-value of 0.011,
sustainability awareness both of 0.03 (95% CI:
0.009 to 0.12) times compared with someone
which meant there was a significant correlation
between satisfaction and good sustainability
who had a good value. While that had a quite
greater value likely had good sustainability
awareness.
awareness both of 0.21 times compared with
those who had less value.
In this study there were 12 variables
expected to affect the sustainable awareness,
Another significant indicator was the
i.e. values, sense of identity, norms, trust
systems, collaboration, participation, fears,
cooperation with the p-value of 0.000. Odds ratio
calculations showed that people with less
attitudes, perceptions, opinions, satisfaction and
hope. Overall the most influential indicators after
cooperation will likely have good sustainability
awareness both of 0.25 (95% CI: 0.8 to 0.78)
bivariate analysis one by one independent
variable (the variable that was supposed to
times compared with those who had good
cooperation. While the cooperation had
influence) with dependent variable (sustainable
awareness) are presented in Table 5.33. From
sufficient opportunity to have good sustainability
awareness both of 1.53 times compared with
the result of the table 5.33 there were eightvalue variables p <0.25, i.e. the values, sense
those who have less cooperation. Buduran Sub
district showed p-value of 0.012 <á = 0.05, which
meant there was a significant relationship
of identity, norms, trust systems, cooperation,
attitudes, perceptions, and expectations.
between cooperation with sustainability
awareness. OR envisaged that with the
cooperation of people who were less likely to
have good sustainability awareness both of 7.75
(95% CI: 2.45 to 24.5) times compared with
those who had a good cooperation. While the
cooperation had sufficient opportunity to have
good sustainability awareness both of 3.0 times
compared with those who had less cooperation.
The next indicator of social capital
significant was satisfaction with the p-value of
0.003 which mean that there was a significant
relationship between satisfactions and good
sustainability awareness in the Tanggulangin
district. Odds ratio showed people with less
Conclusions
New scientific findings of this dissertation
research were structural equation model of
social capital was the trust factor and the norm
that were fit model to describe the social capital
in Sidoarjo district. Community sustainability
awareness could be improved through social
capital with the main factors of trust and norms.
Indicators that could measure social capital were
the sense of identity, trust systems,
expectations, fears, norms, values, attitudes,
perceptions, and opinions.
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THE UTILIZATION OF JARGON IN NURSING LEARNING PROCESS OF HIV-AIDS IN
STIKES ‘AISYIYAH BANDUNG
Perla Yualita
STIKes ‘Aisyiyah Bandung, Indonesia
E-mail: perlayualita3@gmail.com
ABSTRACT
Introduction: The jargon (terminology) of HIV-AIDS nursing process need to be introduced
to prospective nurses since attending college. This is to make it easier when they plunge
into the world of work.
Methods: in reviewing the jargon on HIV-AIDS nursing process using qualitative analysis.
The Methods used in studying the use of jargon nursing process of HIV-AIDS in the learning
process is a quantitative analysis.
Result: The results of the study: 202 were obtained jargon nursing process of HIV-AIDS are
typically used within the scope of the HIV-AIDS. Results show jargons of 202 HIV-AIDS
nursing process, as many as 37% of jargon nursing process of HIV-AIDS has been known
from the learning process, and as many as 67% of jargon nursing process of HIV-AIDS is
not known.
Conclusion: There is jargon typical in every sphere of the nursing process, one of which is
in the process of HIV-AIDS nursing jargon found 202 HIV-AIDS nursing process. List the
results of these studies add vocabulary helpful to prospective nurses in the nursing process
jargon of HIV-AIDS considering 67% of new HIV-AIDS is known from the study.
Keywords: Jargon, HIV-AIDS Nursing Process, Learning Process.
Introduction
specifically shows the striking development of
AIDS cases in Thailand. In 1983 the newly
The number of people living with HIV-AIDS
discovered one or two cases of AIDS, but only
within seven years, ie in 1990, has reached
in the world are growing each day. The WHO
report states, spreading the disease began in
300,000 cases (Amir, 2008: 12).
1980 until further after 2000 would have grown
extraordinarily in Asia, surpassing the case in
So even in Indonesia, according to the
Center for Public Communication, Secretariat
America and Europe. In fact, Asia is expected
to be the continent with the second largest
General of the Ministry of Health conducted by
the Disease Control and Environmental Health
number of AIDS cases after Africa. Observations
261
(PP & PL) MOH. (http: // www.depkes.go.id/) the
7) the application of planning, prioritization and
cumulative number of AIDS cases in Indonesia
until September 30, 2009 as many as 18 442
implementation of programs based data.
cases. During the period July - September 2009
AIDS cases increased by 743 cases in 32
provinces in Indonesia. The number of AIDS
cases in 2009 (January to September) of 2332
cases. Transmission of AIDS cases occur
through heterosexual highest (49.7%), through
No exception students of STIKes Aisyiyah
Bandung as prospective nurses since entering
college need to be equipped knowledge about
HIV-AIDS. Starting from the Introduction of
terminology (jargon), symptoms, reached the
stage of treatment.
injecting drug users / IDUs (40.7%), and
homosexual (3.4%). The proportion of patients
On the basis of such thought, the
researchers were interested in conducting
found most frequently in the age group of 20-29
years (49.57%), followed by age group 30-39
research with the title: “ The Utilization Of
Jargon in Nursing Learning Process Of Hiv-
years (29.84%), and the age group 40-49 years
(8.71%). Meanwhile, a report by Province, more
Aids in Stikes ‘Aisyiyah Bandung .”
AIDS cases in West Java, East Java, Jakarta,
Papua, Bali, West Kalimantan, Central Java,
Identification of the Problem Research
North Sumatra, Riau, Riau Islands. The number
of people with AIDS who died around 3,708
1.
with the jargon of the nursing process in
detail with HIV-AIDS.
people (20.1%). Based on the search, from the
amount of 18 442 AIDS cases in Indonesia
known percentages by gender, with 74% male
(13 654 people), 25.5% of Women (4701
people) and 0.5% (87) cases of unknown
gender.
Nurses as one of the medical personnel
who can also help to treat the diseases need to
be given a lot of knowledge about HIV-AIDS.
This is in line with the HIV-AIDS treatment
strategies expressed by HIV-AIDS Commission
of Indonesia (2014), namely: 1) to improve and
expand the coverage of the whole prevention,
2) improve and expand the scope of care,
support and treatment, 3) reduce the negative
impact of the epidemic by improving access to
social mitigation programs, 4) strengthening
partnerships, and public health systems, 5)
Treatment of HIV-AIDS disease continues
to grow, but student nurses are not familiar
2.
Learning the jargon of the HIV-AIDS
nursing process has not been detailed.
Problem Formulation Research
1.
Whatever jargon used in the nursing
process of HIV-AIDS?
2.
How does the use of jargon nursing
process of HIV-AIDS in the lesson?
Objective
1.
To find out what the jargon used in the
nursing process of HIV-AIDS.
2.
To determine the utilization of jargon in
the nursing process of HIV-AIDS in the
learning process.
improve the coordination between the
stakeholders and the mobilization of resources
at all levels, 6) develop structural interventions,
The Utilization of Jargon in Nursing Learning Process of HIV-AIDS in Stikes ‘Aisyiyah Bandung
Benefits Research
approach to problem solving that enables
1.
nurses to organize and deliver nursing
care. The nursing process contains
Scientific Aspects
a. In terms of science, research results are
expected to increase and expand their
elements of critical thinking that allows
nurses to make judgments and take action
repertoire of science jargon nursing
process, especially HIV-AIDS.
based on the reason. The nursing process
is the framework and structure creative
b. The results are expected to be useful as a
organization to provide nursing care,
nursing process but also flexible enough
source of information about the use of
jargon nursing process to therapeutic
communication for patients, especially
patients with HIV-AIDS.
2.
to be used in all spheres of nursing.
3.
HIV-AIDS
HIV-AIDS stands for Human
Immunodeficiency Virus-Acquired
Immunod Deficiency Syndrome). The HIV
Practical Aspects
a. In practical terms, the results of this study
can be used as a starting point to explore
virus was discovered around 1983 by Lug
Montaigneur a French microbiologist. In
the jargon used within the scope of the
HIV-AIDS.
1984, a microbiologist from the United
States, Robert Gallo, also announced the
b. The results of this study can be used as
same discovery. AIDS is a collection of
symptoms of a disease that causes the
input for the development of the scope of
the particular nursing terminology study
body difficult to fight the infectious
diseases. Itself immune deficiency caused
of HIV-AIDS.
by the HIV virus. These viruses attack and
destroy the human immune system that
Theory Platform
depress immunity.
1.
Jargon
Basically, HIV is a type of obligate
parasites, the virus that can live only in
Meaning of “jargon” in the Big
Indonesian Dictionary (KBBI) is a special
vocabulary used in the field of life (a
living cells or media. The virus is like to
live and breed in the body fluid containing
particular environment). As according to
Hartmann and Stork (Alwasilah, 1993: 51)
white blood cells. In the process, the virus
was then attacked one of the types of
which is jargon is a set of terms and
phrases used by a social group or groups
of workers, but not used and often not
understood by the speech community as
a whole.
2.
white blood cells which served to ward off
infection (Amir, 2008: 4).
4.
Learning
According to the Big Indonesian
Dictionary (2008: 23), learning is a
Nursing Process
The nursing process according to
Potter and Perry (2005: 137) is an
process, manner, or the act of making
living beings learn. Learning, which is an
activity undertaken by teachers in a way
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263
that learners behavior change for the
people and students of level Diploma III-3 of
better. According to the flow of cognitive,
learning is the way teachers provide
Nursing (2014-2015) as many as 55 people.
opportunities for learners to think in order
to know and understand what is being
studied (Darsono, 2000: 24).
Definition of Terms Definitions of terms in
this study are as follows.
1.
Jargon is terminology / phrase often used
by nurses in implementing the nursing
process in HIV-AIDS patients in both the
learning process and practices in the
Research Instruments
The instrument used in this study were
interview guides, observation, literature studies,
and questionnaires.
In this study, the author uses several
techniques to collect data, namely: observation,
interview, the study of literature, and
questionnaire.
hospital.
Processing Techniques and Data Analysis
2.
3.
HIV-AIDS Nursing Process is the nursing
care given to patients with HIV-AIDS.
Processing and data analysis technique,
The process of learning in STIKes
which is a technique used to process, compile,
interpret and analyze the data in order to answer
Aisyiyah Bandung is the opportunity given
to the students Tk. Prodi III-3 Nursing D
the research questions and write a conclusion.
After the researchers obtained the data, the
TA. 2014/2015 to learn the terminology
within the scope of the HIV-AIDS which
can be measured by assessment.
researchers conducted data processing. The
data referred to in this study is the result of
Methods
interviews, observations, literature studies, and
questionnaires that researchers get the following
The method used in reviewing the jargon
steps: data collection, grouping, making a list of
terminology questionnaire HIV-AIDS nursing
of HIV-AIDS is a qualitative analysis carried out
with data collection techniques: interviews,
process, spread questionnaire, processing and
data analysis, and assessment.
observation, and study of the literature to obtain
the expected data. The use of jargon to examine
HIV-AIDS in the learning process through the
use of quantitative analysis: the creation of a
questionnaire list jargon nursing process of HIVAIDS, distributing questionnaires to students,
processing and analysis of data, as well as
assessment.
Sources of Data Research
Sources of data in this study is the nursing
faculty who deals with HIV-AIDS as many as 3
NO.
1
2
3
4
5
6
7
8
9
10
NAME
AIDS
ACUTE RETROVIRAL SYNDROME
ADJUVANT
AFFECTED COMMUNITY
AIDS BIBLIOGRAPHY
AIDS CLINICAL TRIALS GROUP
(ACTG)
AIDS DEMENTIA COMPLEX
AIDS EDUCATION AND TRAINING
CENTERS (AETC)
AIDS KNOWLEDGE BASE
AIDS RESEARCH ADVISORY
COMMITTEE
NO.
NAME
11 AIDS SERVICE ORGANIZATION
(ASO)
12 AIDSDRUGS
13 AIDSLINE
14 AIDS-RELATED CANCERS
15 AIDS-RELATED COMPLEX (ARC)
16 AIDSTRIALS
17 ALKALINE PHOSPHATASE
18 ALOPECIA
19 ANAMNESTIC RESPONSE
20 ANAPHYLACTIC SHOCK
21 ANERGY
22 ANTIBODY-DEPENDENT CELLMEDIATED CYTOTOXICITY (ADCC)
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
ANTIRETROVIRAL
ANTIRETROVIRAL AGENTS
ANTIVIRAL
APOPTOSIS
ART
ARV
ASSEMBLY AND BUDDING
ATTENUATED
AUTOIMMUNIZATION
AUTOINOCULABLE
AUTOLOGOUS
AZT
B LYMPHOCYTES (B CELLS)
BACULOVIRUS
BCI
BINDING ANTIBODY
BODY FLUIDS
BRANCHED DNA ASSAY
CASE MANAGEMENT
CD NOMENCLATURE
CD4 (T4) or CD4+ CELLS
CD8 (T8) CELLS
CDC NATIONAL AIDS
CLEARINGHOUSE
CELL-MEDIATED IMMUNITY (CMI)
CENTERS FOR DISEASE
CONTROL AND PREVENTION
(CDC)
NO.
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
NAME
CENTRAL NERVOUS SYSTEM
(CNS) DAMAGE
CERVICAL DYSPLASIA
CLADE
CLINICAL LATENCY
COMMUNITY PROGRAMS FOR
CLINICAL RESEARCH ON AIDS
(CPCRA)
CONCORDE STUDY
CORE PROTEIN
CORRELATES OF
IMMUNITY/CORRELATES OF
PORTECTION
CPCRA
CST
CYTOKINES
CYTOMEGALOVIRUS (CMV)
RETINITIS
CYTOMEGALOVIRUS (CMV)
CYTOTOXIC T LYMPHOCYTE (CTL)
D4T
DATRI
DDC
DDI
DEMENTIA
DENDRITIC CELLS
DERMATITIS
DIARRHEA
DIVISION OF AIDS TREATMENT
RESEARCH INITIATIVE (DATRI)
ENV
ENVELOPE
EPIDEMIOLOGIC SURVEILLANCE
EXPRESSION SYSTEM
FOLLICULAR DENDRITIC CELLS
(FDCs)
FOOD AND DRUG
ADMINISTRATION (FDA)
GFATM
GP120
GP160
GP41
HAIRY LEUKOPLAKIA
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|
265
NO.
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
NAME
HEALTH RESOURCES AND
SERVICES ADMINISTRATION
(HRSA)
HELPER/SUPPRESSOR RATIO
HEMATOCRIT
HISTOPLASMOSIS
HIV
HIV DISEASE
HIV-negatif, HIV-positif, Home based detoxification,
Homoseksual,
HOST FACTORS:
HSTV
HUMAN IMMUNODEFICIENCY VIRUS
TYPE 1 (HIV-1):
HUMAN IMMUNODEFICIENCY VIRUS
TYPE 2 (HIV-2):
HUMAN LEUKOCYTE ANITGENS
(HLA):
HUMAN PAPILLOMA VIRUS (HPV):
HUMORAL IMMUNITY:
IDU
IEC
Intravena (Intravenous, IV)
Incinerator
Infeksi Oportunistik (Opportunistic
Infection)
Informed concent
3TC
IMMUNE THROMBOCYTOPENIC
PURPURA (ITP)
IMMUNITY
IMMUNOCOMPETENT
IMMUNODEFICIENCY
IMMUNOSUPPRESSION
IMS
INFECTION
INTEGRASE
INTEGRATION
INTERLEUKIN-2 (IL-2)
ISOLATE
NEEDLE
KAPOSI'S SARCOMA
Universal Precautions
NO.
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
NAME
KILLER T CELLS
KPA
KPAD
LAI
LAV
LENTIVIRUS
LONG TERMINAL REPEAT
SEQUENCE (LTR)
LONG-TERM NONPROGRESSORS
LYMPHADENOPATHY SYNDROME
(LAS)
Lymphadenitis
LYMPHOID INTERSTITIAL
PNEUMONITIS (LIP)
MACROPHAGE
MARPs
Masif
Meningitis
MN
MUTATION
NAC
NATIONAL CANCER INSTITUTE
(NCI)
NATIONAL INSTITUTE OF CHILD
HEALTH AND HUMAN
DEVELOPMENT (NICHD)
NATIONAL LIBRARY OF MEDICINE
(NLM)
NATURAL KILLER CELLS
NEF
NEUROLOGICAL COMPLICATIONS
OF AIDS
NEUROPATHY
NEUTRALIZING DOMAIN
Odha
OI
Oral Candidiasis
Outreach, Penjangkauan dan
pendampingan
p24
Harm Reduction
Supply Reduction
Demand Reduction
PENTAMIDINE
Perjasun
NO.
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
NAME
PLASMAPHERESIS
PLHIV
PMS
PMTCT
PNEUMOCYSTIS CARINII
PNEUMONIA (PCP)
POLYMERASE CHAIN REACTION
(PCR)
Prevalence
Prophylaxis
REGULATORY T CELLS
RETROVIRUS
REV
REVERSE TRANSCRIPTASE
RIBONUCLEIC ACID (RNA)
RYAN WHITE CARE ACT
Semprit (Syringe)
Septikemia (Septicemia)
SEROPREVALENCE
SEXUALLY TRANSMITTED
DISEASE (STD)
SF-2
SHIV
Silikona (silicone)
SIMIAN IMMUNODEFICIENCY VIRUS
(SIV)
SIV
STI
SUBUNIT HIV VACCINE
SUPERANTIGEN
SUPPRESSOR T CELLS
SURROGATE MARKER
Surveilans Sentinel (sentinel
surveillance)
SYNCYTIA
T LYMPHOCYTE PROLIFERATION
ASSAY
TB : Tuberculosis
Shooting Gallery
TERRY BEIRN COMMUNITY
PROGRAMS FOR CLINICAL
RESEARCH ON AIDS (CPCRA):
Tes HIV
THERAPEUTIC HIV VACCINE
olerasi (Tolerance)
TOXOPLASMOSIS
NO.
194
195
196
197
198
199
200
201
202
NAME
TRANSMISSION
UNGASS
V3 LOOP
VACCINIA
VCT
VIRAL CORE
VIRAL ENVELOPE
Viral Load
WASTING SYNDROME
Results
From the results of the collection and
processing of data obtained some terminology
in the nursing process of HIV-AIDS is as follows.
From the questionnaire results of the HIVAIDS jargon list to 55 students of level III-3 D
Nursing Academic Year 2014/2015 only 37% of
jargon that has been known, while 67% have
not been known. This suggests that the
Introduction of the nursing process jargon HIVAIDS should be given in more detail to the
students in order to increase student vocabulary
knowledge and scope of HIV-AIDS. It is useful
as a preparation when they plunge into the world
of work.
Conclusions
1.
Jargon HIV-AIDS nursing process as a
characteristic widely obtained from HIVAIDS nursing process is different from the
treatment of other diseases. From the
results of the study found as many as 202
jargon nursing process of HIV-AIDS.
2.
Utilization jargon nursing process is used
as an HIV-AIDS knowledge and
vocabulary enrichment of students,
especially in the area of HIV-AIDS. This
is evident from the responses of students
who considered jargon nursing process of
HIV-AIDS is important, but only 37% knew
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267
of a given list of jargon. As many as 67%
Documentation Standards. Philadelphia:
of the nursing process jargon HIV-AIDS
is known from the study. Utilization
F.A. Davis Company.
implemented through the creation of a
glossary of terms, spread to the students,
and the assessment can be made either
at the time the student supplies the
practice in the hospital or at work later.
References
Amir, Syafruddin. 2008. HIV/AIDS dalam
Solusi Islam. Bandung: Idea Spektrum
Lintasmedia.
Arikunto, S. 2002. Prosedur Penelitian: Suatu
Pendekatan Praktek.. Jakarta: Rineka
Cipta.
Asmadi. 2008. Konsep Dasar Keperawatan.
Jakarta: EGC.
Brown, H. D. 1994. Teaching by Principles An
Interactive Approach to Language
Francisco State University.
Departemen Kesehatan. — [Online]. Tersedia:
http://www.depkes.go.id/
index.php?vw=2&id=449 [1 Juli 2014]
Direktorat Tenaga Kependidikan Direktorat
Jenderal Peningkatan Mutu Pendidik
dan Tenaga Kependidikan Departemen
Pendidikan Nasional. 2008. Pendekatan,
Jenis, dan Metode Penelitian Pendidikan
.[Online].Tersedia:http://
lpmpjogja.diknas.go.id.[ 13 Desember
2009]
Ditjen PP & PL Kemenkes RI. —.[Online]
Tersedia: http://www.spiritia.or.id/Stats/
StatCurr.php?lang=id&gg=1 [ 1 Juli 2014]
Fischbach, F.T. 1991. Documenting Care
Communication, the Nursing Process and
Fraenkel dan Wallen. 2007. How to Design
and Evaluate Research in Education.San
Fransisco: Mc Graw-Hill
Komisi Penanggulangan AIDS Indonesia
(KPAI). 2014. Strategi dan Program.
[Online] Tersedia: http://
www.aidsindonesia.or.id/contents/13/69/#sthash.BlR4lfdl.dpuf [10 Maret 2014].
Kompas.Com. 2014. Fakta HIV-AIDS ini Wajib
Diketahui Remaja. [Online] Tersedia:http:/
/health.kompas.com/read/2014/01/24/
0944493/Fakta.HIV/AIDS.Ini
.Wajib.Diketahui.Remaja. [20 Maret
2014].
Potter dan Perry. 2005. Fundamental
Keperawatan Konsep, Proses, dan
Praktik. Ed. 4. Jakarta: EGC.
Pusat Komunikasi Publik, Sekretariat Jenderal
Departemen Kesehatan. 2014. Jumlah
Kumulatif Penderita AIDS di Indonesia
18.442 Kasus. [Online]. Tersedia: http://
www.depkes.go.id/
index.php?vw=2&id=449 [20 Maret 2014]
Sander, D. Glossary of HIV-AIDS. [Online].
Tersedia: (david.sander@virology.net ) [1
Juli 2014].
Sugiyono. 2009. Metode Penelitian Kuantitatif
Kualitatif dan R&D. Bandung:Alfabeta.
Tim Penyusun Kamus Besar Bahasa
Indonesia. 2008. Kamus Besar Bahasa
Indonesia Pusat Bahasa Edisi Ke Empat.
Jakarta : PT. Gramedia.
Tn. Tt. Strategi dan Program.[Online]
Tersedia: http://www. aidsindonesia.or.id/
contents/13/69/Strategi-dan-Program#sthash.BlR4lfdl.dpbs
Tn. 2011. Istilah-Istilah yang Sering Dipakai
dalam Aksi Respon terhadap HIV-AIDS.
[Online]. Tersedia: http://
www.odhaberhaksehat.org/2011/istilahistilah-yang-sering-dipakai-dalam-aksirespon-terhadap-hiv-aids/ [ 1 Juli 2014].
Tn. Tt. Glossary. [Online]. Tersedia: http://
aids-ina.org/modules
.php?name=Glossary&op=terms&ltr=D [1
Juli 2014].
Unggul, E. 2009. Pengantar Metodologi
Penelitian. [Online]. Tersedia : http : //
www. poltektegal. ac. id / files / download
/ Erni.../ Peng_Metopen.pdf. [ 13
Desember 2009].
Yusuf,M. Daftar Istilah Seputar HIV-AIDS.
[Online}. Tersedia: http: http://
yayasanmahakasih.wordpress.com/
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THE EFFECT OF YOGA THERAPY ON THE LEVEL OF INSOMNIA AMONG
ELDERLIES AT BUDHI DHARMA NURSING HOME IN PONGGALAN UMBULHARJO
YOGYAKARTA
Suratini1, Suhesti2
1
Lecturer of School of Nursing ‘Aisyiyah Health Sciences College of Yogyakarta
2
Student of School of Nursing ‘Aisyiyah Health Sciences College of Yogyakarta
E-mail: anisa_tini@yahoo.com
ABSTRACT
Introduction: Aging is a natural process which is unavoidable. Most old agers are at risk of
having sleeping disorders due to many factors such as social changes, the increasing use
of medicines, the death of the spouse, and diseases. The example of insomnia among old
agers are excessive sleepiness during the day, atensi and memory disorder, frequent fall,
and decreasing the quality of life. A non pharmacological therapy that can be done to overcome
insomnia is called yoga therapy.The objective this study was the effect of yoga therapy on
the level of insomnia among old agers at Budhi Dharma Nursing Home in Ponggalan
Umbulharjo Yogyakarta.
Methods: This research was designed with pre experiment, one group pretest-posttest.
The subjects of the research consisted of elderlies with insomnia at Budhi Dharma Nursing
Home in Ponggalan Umbulharjo Yogyakarta with as many as 11 respondents using total
sampling technic. The statistic test was using Wilcoxon Match Pairs Test.
Result: Analysis showed that pretest and posttest with Wilcoxon Match Pairs Test was z
value – 2.944 with significance value (p) 0,003, which means that Ha is accepted and Ho is
rejected. So, it can be concluded that yoga therapy had effect on the level of insomnia
among elderlies at Budhi Dharma Nursing Home in Ponggalan Umbulharjo Yogyakarta.
Conclusion: Suggestion it is recommended that Budhi Dharma Nursing Home in Ponggalan
Umbulharjo Yogyakarta should conduct weekly sport activities with the purpose of giving
therapy for the elderlies who have insomnia.
Keywords: Yoga Therapy, Insomnia, Elderlies
271
Introduction
Indonesia is a country that entered the
era of structured population aging (aging
population structured) because the number
of people aged 60 years and over about
7.18%. The number of senior citizens in
Indonesia in 2006 amounted to
approximately 19 million, with a life
expectancy of 66.2 years. In 2010 the
estimated population of the elderly in
Indonesia will reach 23.9 million or 9.77%
with a life expectancy of about 67.4 years.
Ten years later or in 2020 the estimated
population of the elderly in Indonesia
reached 28.8 million, with a life expectancy
of 71.1 years. (ANA, 2007).
Currently cases of insomnia or lack of
sleep is a sleep disorder that most
complained. In the United States 35% of the
total population experiencing insomnia
disorders are quite serious. The high
incidence of insomnia here due to
inadequate treatment of insomnia (Hadriani,
2010). In 2004, Indonesia’s population
amounts to 238.452 million there were
28,053 million Indonesian people are
affected by insomnia or approximately
11.7%. This data is based on indications in
general do not take into account genetic
factors, cultural, environmental, social, racial
(Bararah, 2010).
There are some serious impact of sleep
disorders in the elderly such as excessive
daytime sleepiness, impaired attention and
memory, mood depression, frequent falls,
improper use of mortgages, and decreased
quality of life. Mortality, heart disease and
cancer rate was higher in the old man slept
more than 9 hours or less than 6 hours per
day when compared with the old man sleep
between 7-8 hours per day (Amir, 2007).
Actually there are more effective ways
to get rid of insomnia without involving drugs.
Zammit, Diriktur Sevelt Sleep Disorder
Institute has introduced a therapy that can
help relieve insomnia and help you sleep
better. The trick with techniques that can
reduce stress, such as yoga, meditation or
relaxation. Yoga is more relaxed and able
to refresh the mind, body and soul is very
effective for people suffering from insomnia.
Most people experience insomnia is caused
by stress, anxiety, depression and
unpleasant memories (Subandi, 2008).
Yoga is one of the six Hindu
philosophical teachings about meditation
activity in which a person focuses the mind
to control the senses and the body as a
whole, with the aim to achieve unification
with the Creator. Yoga refreshes and soothes
the mind, body, and soul. Yoga is also a
physical and mental disorders, including
insomnia. Practice yoga before bed will
“squeeze” all the tension and makes the
body become quite tired and easy to sleep
(Sindhu, 2008).
After preliminary studies in the UPT
Panti Wredha Budhi Dharma Yogyakarta
Ponggalan Umbulharjo the data obtained in
the homes of elderly who were 53 elderly
which consists of 36% male and 64%
female. From the results of interviews with
44 elderly get the data 75% of the elderly
have trouble sleeping and woke up in the
middle of the night. In the parlor there were
9 elderly are isolated and should not be
interviewed. The problem of insomnia
complaints by the elderly in nursing homes
UPT Budhi Dharma Yogyakarta Ponggalan
The Effect of Yoga Therapy on the Level of Insomnia Among Elderlies at Budhi Dharma Nursing Home in
Ponggalan Umbulharjo Yogyakarta
Umbulharjo for disturbing the rest meraka.
To overcome this problem, the elderly just
try to close my eyes and hope to be able to
sleep again.
Analysis of the data in this study using
statistical parametric test Wilcoxon Match
Pairs Test. Analysis of the results of the
decision made by hypothesis testing based
Methods
on the significance level of p = 0.05. When
The research design used in this study
the count value of p is smaller than the
was pre-experimental with pretest posttest
significance level (p <0.05) then Ho is
one group design is design that does not
rejected and Ha accepted.
have a comparison group (controls), but at
Results and Discussion
least we have made
the first observation
(pretest) which allows to test the changes
that occurred after the experiment (program)
(Notoatmodjo, 2012).
The population in this study had a
controlled criteria on confounding variables
such as physical illness, emotional stress,
medications, food intake, calories and the
environment obtained with a number of 11
elderly respondents. Sampling technique in
This research was conducted in UPT
Panti Wredha Budhi Dharma Yogyakarta
Ponggalan Umbulharjo. At home there are
53 seniors.
a. Characteristics of respondents by sex
Characteristics of respondents in
this study include gender ie male and
female. Image characteristics of
respondents can be seen in the image
below:
this study with a total sampling ie sampling
technique by taking all members of the
Female
64%
population as respondents or samples
Male
36%
(Sugiyono, 2009).
The tools used to collect data in this
study
is
Insomnia
Rating
Scale
Figure 1 : Characteristics of
respondents by sex.
questionnaire in order to determine the score
of insomnia in order to value objectively. The
questionnaire consists of eight questions
In Figure 1 explains that the
comprising the length of sleep, dreams, the
characteristics of the respondents by
gender is female gender of 7 people (64%)
quality of sleep, go to sleep, wake up at night
and 4 men (36%).
the day, time to sleep after waking, early
morning waking, and feeling refreshed when
waking up in the morning.
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273
b.
Characteristics of respondents
Based on Table 1 Data obtained
according to age
before given yoga therapy that results
from the pretest to the highest level that
Characteristics of respondents in
this study include the age of the
respondents. Image characteristics of
respondents can be seen in the image
insomnia is insomnia (82%).
d.
The level of insomnia after yoga therapy
The level of insomnia in the elderly
below:
was measured after administration of
therapeutic yoga. The level of insomnia
71-80 year
36%
in the elderly after yoga therapy can be
seen in the following table:
60-70 year
64%
Table 2 Level of insomnia after
yoga therapy in the elderly in
nursing homes UPT Budhi
Figure 2 Characteristics of
Dharma Ponggalan Umbulharjo
Yogyakarta in January 2014.
respondents by age.
In Figure 2 explains that the
Tingkat insomnia
characteristics of respondents by age of
respondents aged 60-70 years were 7
Lightweight Insomnia
Total
people (64%), while the 71-80 year age
of 4 people (36%).
c.
Based on the data obtained after 4.2
table given yoga therapy that results from
The level of insomnia before given yoga
therapy
the posttest to the highest level of mild
insomnia is insomnia (100%).
The level of insomnia in the elderly
measured before therapy yoga. The level
of insomnia in the elderly before yoga
therapy can be seen in the following table:
Table 1 Level of insomnia before
yoga therapy in the elderly in
Post Test
Jumlah
%
11
100
11
100
e.
Hypothesis test the effect of yoga therapy
on the level of insomnia in the elderly in
nursing homes UPT Budhi Dharma
Yogyakarta Ponggalan Umbulharjo
Table 3 Results of hypothesis
nursing homes UPT Budhi
Dharma Ponggalan Umbulhajo
testing the effects of yoga therapy
on the level of insomnia in the
Yogyakarta in January 2014.
elderly in nursing homes UPT
Budhi Dharma Yogyakarta
Pre test
Jumlah
%
Lightweight Insomnia
1
9
Medium Insomnia
9
82
Weight Insomnia
1
9
Total
11
100
Source: Primary data 2014
Insomnia Level
Ponggalan Umbulharjo Asymp.
Variabel
Z
Sig.
(2-tailed)
Level insomnia after
-2.944
0,003
yoga terapi
Level insomnia
before yoga terapi
Based on Table 3 it can be seen that
of only a lack of exercise. Lack of exercise is
the Wilcoxon z value obtained at -2944
with a significance value (p) 0.003. To
one of the factors is difficult to sleep. As
happened in UPT Panti Wredha Budhi Dharma
determine the hypothesis is accepted or
rejected then the value of significance (p)
Ponggalan Umbulharjo Yogyakarta, for sporting
activities only done once a week. Therefore for
compared to the error level of 5% (0.05).
If p is greater than 0.05, then the
sports activities is still lacking met for the elderly
in the home.
hypothesis is rejected and if p is smaller
than 0.05, then the hypothesis is
According Sumedi (2010) in his study says
accepted. From the results, p-value less
than 0.05 (p <0.05), so the hypothesis is
accepted. It can be concluded that there
is a therapeutic effect of yoga on the level
of insomnia in the elderly in nursing homes
UPT Budhi Dharma Ponggalan
Discussion
The rate of insomnia before given yoga
therapy for the elderly In Table 1 it can be seen
most of the elderly in nursing homes UPT Budhi
that insomnia occurs due to muscle tension,
when a stress it will experience some muscle
tension. Active sympathetic nervous makes
people can not relax or relaxed so it can not
bring a sense of sleepiness. Based on the
results of the study respondents said that after
following the implementation of the elderly fit
exercisers regularly, calmer mind is not agitated
or stressed, easier concentration, feeling happy,
and sleep more soundly than usual as well as
easy to initiate sleep.
It is therefore very necessary exercise to
Dharma Yogyakarta Ponggalan Umbulharjo
insomnia are as many as 9 people (82%). Seen
keep the body healthy and strong, especially in
the elderly are much less daily physical activity
in Figure 4.1 shows that most respondents who
had insomnia were female (64%) compared to
with exercise, the heart will continue to work
properly trained, will smooth blood circulation.
36% men. The greater the number of women
who experience insomnia necessarily prove that
Insomnia after a given level of yoga therapy
insomnia is experienced by many women or
gender factors affecting the level of insomnia.
for the elderly In Table 2 it can be seen that after
yoga therapy, 10 (91%) experienced a decrease
According Ernawati (2010) anxiety and
in the level of mild insomnia insomnia becomes
level. From the results of this study indicate that
lifestyle factors thought to be one of the causes
of insomnia. As the opinion Ernawati (2010)
yoga therapy is effective in reducing the level of
insomnia in the elderly. According to Khalsa
according to the research that the sex 95
respondents (42%) of the total sample were
(2004) to more effectively cope with insomnia
is with yoga. Researchers explained that people
men, because men have lower levels of anxiety
than women. Additionally Ernawati mention that
with insomnia have high levels of cortisol, and
stress hormones. In addition, the researchers
women are more worried about the inability
compared with men, men are more active,
reasoned that yoga can reduce stress levels by
learning to manage concentration, thus allowing
exploratory, while women are more sensitive.
easy insomniacs to sleep well at night.
In addition to anxiety there are several other
In this study still found 9% of respondents
factors that affect insomnia in the elderly is one
who did not experience a decrease in the level
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275
of insomnia despite following the yoga exercise
interrupted momentarily squeezed. Under these
for 7 days caused a good sleep patterns
because the respondent is often too long nap.
conditions the brain will automatically ordered
more blood gets shed body being stopped
According to the research results Amir (2007)
can take the form of poor sleep disorders sleep
earlier. Once we normalize the position of the
body as usual, blood (including calcium content
hygiene and specific sleep disorders. Poor sleep
hygiene can be caused by excessive
is important to relax the nerve cells) will be
“ejected” and more flowing around the thyroid
expectations on sleep or sleep schedule. As a
result, the elderly often spend time in bed or
gland. From this process will bring a new
balance in the body so it felt more comfortable
intermittent asleep during the day.
and helps the body relax and fall asleep
(Subandi, 2008).
In addition, respondents always use a bright
light while sleeping at night. According to
For the elderly enough sleep is very
biologist Joan Roberts, said that in a state that
really dark body produces melatonin, a hormone
important, if need considerably less sleep will
impact excessive daytime sleepiness, memory
in the immune system is able to fight and prevent
a variety of diseases including breast cancer and
impairment, frequent falls, and decreased
quality of life. As described QS nature. Ar-Rum:
prostate cancer. In contrast, the state of sleep
with the lights on at night, no matter how small
23 and QS. An-Naba: 9 explained that: “And
among the signs of His power is at a time when
light causes the production of the hormone
melatonin stalled. In addition, Joan Roberts
discovered this secret after conducting
night and sleep during the day, and your seeking
of His bounty in part. Verily in that are signs for
a people who listen. “(QS. Ar-Rum: 23) “And We
experiments on animals. When the animals were
given artificial light at night, melatonin decreased
made your sleep for rest.” (QS. An-Naba: 9)
and weakened immune systems. Therefore, in
addition to saving energy by turning off lights
when you sleep is a natural way to improve
health (Ernawati, 2010).
The system can be likened to the human
body as a machine that needs a break to be
able to work again with a more optimal, as well
as the human body needs a break, and break
Effect of Yoga Therapy Level Against
the best is sleep, because in addition to eating
and drinking are basic human needs, sleep is
Insomnia In Elderly In Nursing Unit Wredha
Budhi Dharma Yogyakarta Ponggalan
also a starting point for the emergence of a new
energy to the human body.
Umbulharjo In Table 4.3 it can be seen the
results obtained Wilcoxon z value of -2944 with
Conclusions
a significance value (p) 0,003 so it can be
concluded that there is a therapeutic effect of
1 The rate of insomnia before yoga therapy,
the majority of respondents experiencing
yoga on the level of insomnia in the elderly.
When yoga is possible to move the two glands
insomnia levels are 9 people (82%), mild
insomnia 1 person (9%), and severe insomnia
(thyroid and endocrine) that regulate the body’s
calcium metabolism. By training the neck
1 person (9%). Level 2 insomnia after yoga
therapy, most of the respondents experienced
movements, such as the movement of the neck
muscles sequeezing (like squeeze) for a few
a decrease in the level of mild insomnia
insomnia 10 people (91%) and 1 (9%) did not
moments the muscles around the blood flow is
experience a decline. 3 The difference in the
level of insomnia before and after yoga therapy
in the elderly in nursing homes UPT Budhi
Dharma Yogyakarta Ponggalan Umbulharjo
obtained results of 9 people and 1 person
insomnia is severe insomnia, insomnia fell into
Sindhu.(2008). Hidup Sehat dan Seimbang
dengan Yoga. Bandung. Qanita.
Subandi.(2008). Yoga Insomnia. Jakarta. PT
Elex Media Komputindo.
mild insomnia. While mild insomnia 1 person
who does not decline. 4. influential yoga therapy
Sugiyono.(2009). Statistika untuk Penelitian.
Bandung. Alfabeta.
to lower levels of insomnia in the elderly in
nursing homes UPT Budhi Dharma Ponggalan
Sumedi.T, Wahyudi & Kuswanti.A.(2010).
Pengaruh Senam Lansia Terhadap
Penurunan Skala Insomnia Pada Lanjut
References
Usia di Panti Wredha Dewanata Cilacap
dalam http://www.jos.unsoed.ac.id
Amir, N.(2007). Gangguan Tidur Pada Lanjut
Usia Diagnosis dan Penatalaksanaannya
dalam http://www.kalbe.co.id diakses
diakses tanggal 30 Januari 2014.
tanggal 8 Oktober 2013.
Bararah, V.F.(2010). 28 Juta Orang Indonesia
Terkena Insomnia dalam http://
www.health.detik.com diakses tanggal 2
Desember 2013.
Ernawati.(2010). Faktor-faktor Yang
Berhubungan Dengan Terjadinya
Insomnia Pada Lanjut Usia di Desa
Gayam Kecamatan Sukoharjo Kabupaten
Sukoharjo dalam http://
www.publikasiilmiah.ums.ac.id diakses
tanggal 30 Januari 2014.
Hermana.(2007). Penduduk Lanjut Usia di
Indonesia dan Masalah
Kesejahteraannya dalam http://
kemsos.go.id diakses 26 September
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Khalsa.(2004). Treatment of Chronic Insomnia
with Yoga: A Preliminary Study with
Sleep-Wake Diaries dalam http://
www.link.springer.com diakses tanggal 9
Oktober 2013.
Notoatmodjo, S.(2012). Metodologi Penelitian
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277
DIMENSIONS OF CULTURAL ORGANIZATIONS THAT INFLUENCE
CARING BEHAVIOR IN PKU MUHAMMADIYAH HOSPITAL TEMANGGUNG
Lutfi Fauzy Asriyanto1, Puguh Widiyanto2, Sodik Kamal2
1
2
PKU Muhammadiyah Hospital in Temanggung
Faculty of Health Science University of Muhammadiyah Magelang
E-mail: ompuguh@gmail.com
ABSTRACT
Introduction: The quality of health services becomes important for a health institution, as a
special impact on the image, profits, productivity, and liability. One of the keys of the quality
of health services provided by nurses lies in aspects of attention, empathy, and caring (caring).
Based on preliminary studies in PKU Muhammadiyah Hospital in Temanggung, it can be
concluded that the behavior of nursing care can not be said to be optimal, although the
management of the hospital has established a commitment to quality service through its
quality policy. AIMS: to determine the factors that affect the dimensions of organizational
culture with caring behavior of nurses.
Methodology: The study design used was a cross sectional analytic method in 50 nurses.
Bivariate data analysis using Pearson and Spearman correlation test.
Result: with the result there is no relationship between the dimensions of involvement,
consistency, adjustment, and mission with the nurse caring behavior. Suggestions for the
management of the hospital to take care of inserting items into the standard of care and
nurse performance appraisal.
Keywords: Caring Behavior, Nurses, Organizational Culture.
Introduction
to organizational culture ever undertaken by
Zees (2011) at the Prof. DR. H. Aloei Saboe
Caring behavior as part of a nurse’s
performance is strongly influenced by the values
Hospital Gorontalo city, with a result of a
significant relationship between marital status,
that exist within an organization. It is based on
the concept that caring behavior is an
communication, training, reward, decision
making, and management by nurses caring
interpersonal characteristics that can not be
passed down through genetics, but can be
behavior.
learned through cultural education as a
profession (Tomey and Alligood, 2006).
Organizational culture has as strong
influence on the behavior and performance of
Research on nurse caring behavior in relation
members of the organization. Strong culture can
279
be an advantage for the organization, because
Nurse
caring
behavior
in
PKU
it can create common goals, motivations
members, as well as control structure to form
Muhammadiyah Hospital Waterford can not be
said to be optimal, although the management
the required behavior in order to improve the
performance and achievements of the
of the hospital has established a commitment
to quality service through quality policy SOFT
organization (Kreitner and Kinicki, 2010; within
Zees, 2011).
and FAST. Accordingly, the need to study more
about the factors that influence nurses caring
Organizational culture can be said to be
behavior, in particular organizational culture
variables. Therefore, the formulated research
strong if each person in it to understand and
believe in goals, priorities, and practices of the
organization, which will affect the way of thinking
and good behaving (Vesper, 1993; within
Bateman and Snell, 2008). The concept shows
that the higher the level of acceptance of
members of the core values of the organization
and the greater the commitment, the
organizational culture will be stronger, and so
did the opposite happens.
questions: whether the cultural dimensions of
organizational factors that influence nurses
caring behavior in the PKU Muhammadiyah
Hospital Temanggung?
Methods
This study used a quantitative design cross
sectional analytic method, which aims to analyze
the dimensions of organizational culture factors
that influence nurses caring behavior. The
The quality of health care becomes an
absolute thing, because it specifically affects the
samples in this study were nurses in the
inpatient unit PKU Muhammadiyah Hospital in
health care institution in terms of image, profits,
productivity, and liability (Herjanto). One of the
as many as 50 nurses. The study was conducted
in April-August 2014 data were taken using a
keys to quality of health care lies in aspects of
attention, empathy, and caring of nurse (Nahrawi
questionnaire. Data were analyzed using
Pearson and Spearman correlation test.
and Ichsan, 2008). Concern (caring) is the
essence of nursing practice that aims to help
Results
clients recover from his illness (Potter and Perry;
within Widiharti, Sunaryo, and Purwaningsih,
Characteristics of the respondents by
gender split is almost balanced by the
2011).
percentage (46% male: 54% female). In the
meantime, if viewed based on marital status,
Caring behavior is reflected in the activities
of nurses when providing nursing care to clients.
This behavior is part of a nurse’s performance
is influenced by the organization of the system
variables, in particular organizational culture.
Bijaya (2006), the Zees (2011), suggests there
is a strong and significant correlation between
organizational culture with the performance of
the majority (84%) of respondents in the married
category. age characteristics showed that the
average age of nurses is 30 years, and the
average tenure is 7.5 years working nurses. The
results of the bivariate analysis can be seen in
the following table:
a nurse.
Dimensions of Cultural Organizations that Influence Caring Behavior in
PKU Muhammadiyah Hospital Temanggung
The relationship between the dimensions of organizational culture with Nurse Caring
Behaviors in PKU Muhammadiyah Hospital Temanggung; July 2014 (n=50)
Variables
Dimension of Iinvolvement
Consistency Dimension
Dimensions of Adjustment
Dimensions of Mission
* Significant at the α = 0,05
Nurse Caring Behaviors
n
p*
r
50
0,539
0,089
50
0,665
-0,063
50
0,749
0,046
50
0,485
0,101
The results of the bivariate analysis above
involvement of management strategies can be
shows that of the four dimensions of
organizational
culture
(involvement,
effective for organizational performance, as well
as strategies for creating employees a better
consistency, adjustment and the mission) was
not statistically associated with the nurse caring
working environment.
behavior.
The results of this study contrast with
statements Hersey and Blanchard, in Safaria
and Yunastiwi (2013), performance is a function
Discussion
This section discusses the results of the
analysis of the relationship dimensions of
organizational culture, including involvement,
consistency, adjustment, and mission, the nurse
caring behavior.
The relationship between involvement with
Denison, in Fey and Denison (2003) and
Herminingsih (2011), states that the involvement
is voluntary, bottom-up involvement, as well as
structured have a positive impact on
organizational effectiveness. This concept
suggests that the level of engagement and high
participation creates the sense of property
(sense of ownership)and responsibilities. From
this awareness arises a greater commitment to
the organization and will need a little more strict
control of the leaders (Denison, 2000; within
of motivation and ability. Thus, in completing a
task or job, one must have a degree of
willingness and a certain level of ability. Ammir
Ali (2007), in Safaria and Yunastiwi (2013), also
suggested that foster a high level of job
involvement on employees can be effective for
improving performance, and encourage
employees to be more positive.
The relationship between Consistency with
Consistency is the degree of agreement of
members of the organization to the basic
assumptions and core values of the organization
(Sobirin, 2007). An organization that is
consistent and well integrated to show the
effectiveness of good performance. This
indicates that the organization has a strong
culture, which significantly influence the attitudes
Doloksaribu, 2001).
and behavior of members in the ability to reach
an agreement, coordinated action, and work on
Walton Research and Lawler (in Denison,
1990, and Doloksaribu, 2001) suggests the
common framework of values and guidelines
that have been agreed upon (Pascale, 1984;
within Ferryansyah, 2013).
|
|
281
Some authors (Frost, Moore, Louis,
Research Kotter (in Fey and Denison,
Londberg, and Martin, 1985; Martin and Shiel,
1983, etc.) in Denison (1990) and Doloksaribu
2000;, and Doloksaribu, 2001) lead to the
conclusion that the organization of the cultural
(2001) noted the importance of beliefs and
shared values (shared beliefs and values) for
values that promote innovation, risk taking,
entrepreneurship, and leadership more
effectiveness organization.
successfully adapt to external influences than
other organizations that do not have it.
Indicators dimensional consistency are core
values, agreement, and coordination and
In contrast to the above concept, the
integration (Fey and Denison, 2000; within
Doloksaribu, 2001). In the context of the
employees perceive that the risk of decisionmaking and creative efforts developed at work
organization, coordination and integration
between the unit / part is often a difficult thing to
often gets the challenge of leadership. On the
other hand, the nurse caring behavior shown is
implement. This is what happens at PKU
Muhammadiyah Hospital in Temanggung, where
not bad, and even tend to be either, so the
statistical test shows there is no relationship
constraints in cooperation with other parts of the
hospital is still quite high. The employee also
between the dimensions of the adjustment to
the nurse caring behavior.
considers that the activity perception among
employees about new ways of working is not
often done. In addition, the core values are used
as guidelines in attitude and behavior has not
been fully understood and applied properly, even
though it be disseminated to employees through
the distribution of the manual.
The relationship between adjustment to
The relationship between the mission of
the caring behavior of nurses
The mission is the cultural dimension that
shows the organization’s core purpose, which
makes members of the organization remains
steadfast and focused on what is considered
important by the organization (Sobirin, 2007).
the nurse caring behavior
Living the mission will provide two major
influence on the functioning of the organization,
Adjustment is the organization’s ability to
respond to external changes to the way
namely: 1).Determine the benefits and meaning
by way of defining social roles, social goals, and
organizations conduct internal organizational
changes (Sobirin, 2007). The state refers to an
objectives of external organizations, as well as
defining the role of individuals with regard to the
organization that is oriented to the customer,
take risks and learn from mistakes, and have
role in the organization; 2). Provide clarity of
direction or rules (Denison, 1989; within
the ability and experience in creating change
(Fey and Denison, 2003; within Herminingsih,
Ferryansyah, 2013).
2011).
Vision describes the aspirations of the
Culture that can help organizations
organization and would like nothing, while the
mission describes the organization of doing
anticipate and adjust to a changing environment,
will are associated with good performance in the
business, customer service, and expertise
needs to be developed to achieve the vision of
long term (Fey and Denison, 2000; within
Doloksaribu, 2001).
the organization (Denison, 1989; within
Ferryansyah, 2013). The mission of the
organization can result in members, the non-
Dimensions of Cultural Organizations that Influence Caring Behavior in
PKU Muhammadiyah Hospital Temanggung
economic reasons, are willing to invest the effort
Kewirausahaan “Optimal”, Vol. 5, No. 1.
for the good of the organization, because of the
expectations of the organization (Fey and
Jakarta
Denison, 2003; within Herminingsih, 2011).
Denison Research shows that organizations are
lacking in implementing the mission will result
in members do not understand the results to be
achieved, as well as long-term goals that are
set are not clear.
Conclusions
Doloksaribu (2001). Pengaruh Budaya
Organisasi terhadap Kinerja Manajerial
(Studi Kasus pada Kanca BRI di Wilayah
Jawa Barat, Jawa Tengah, dan
Yogayakarta serta Jawa Timur).
Semarang Downloaded: http://
eprints.undip.ac.id/9060/1/
2001MM977.pdf
In statistics obtained shows that the
relationship between the dimensions of
Safaria, S., Yunastiwi, A.S. (2013). Pengaruh
Keterlibatan Kerja terhadap Kinerja
organizational cultures (involvement,
consistency, adjustment, and mission) with a
Pegawai pada PT. Seascape Surveys
Indonesia. e-Journal Manajemen dan
nurse caring behavior. Nonetheless, referring to
the literature review and related research
Bisnis, Vol. 1, No. 3
journal, obtained evidence that the dimensions
of organizational culture has a huge influence
on the effectiveness of the performance of
members and accomplishments of the
organization.
Mosby Elsevier; St. Louis, Missouri
Bateman, Thomas S. dan Snell, Scott A.
(2008). Manajemen Kepemimpinan dan
Kolaborasi dalam Dunia yang Kompetitif.
Salemba Empat; Jakarta
Ferryansyah, M.F, (2013). Pengaruh budaya
organisasi dan Komitmen Organisasi
Watson, Jean. (2002). Assessing and
Measuring Caring in Nursing and Health
Science : Second Edition. Springer
Publishing; New York.
Widiharti, Sunaryo dan Purwaningsih. (2011).
terhadap Kinerja Karyawan (Studi Kasus
pada PPPA Darul Qur’an). Jakarta:
Skripsi%20Muham
mad%20Fadli%20Ferryansyah.pdf
dalam Kehidupan Organisasi). UPP STIM
YKPN; Yogyakarta
Tomey, Ann M. and Alligood, Martha R.
(2006). Nursing Theorists and Their Work.
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dspace/bitstream/123456789/23849/1/
Sobirin, Achmad. (2007). Budaya Organisasi
(Pengertian, Makna, dan Aplikasinya
Pengembangan Strategi Peningkatan
Mutu Pelayanan Keperawatan
Berdasarkan Analisis Porsi Perilaku
Caring Perawat dengan Jendela
Pelanggan. Jurnal Ners Vol. 6 No. 1 April
2011
Herminingsih, Anik. (2011). Pengaruh
Kepemimpinan Transformasional
terhadap Budaya Organisasi. Jurnal
Ilmiah Ekonomi Manajemen dan
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283
Zees, R.F., (2011). Analisis Faktor Budaya
Organisasi yang Berhubungan dengan
Perilaku Caring Perawat Pelaksana di
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Saboe Kota Gorontalo. Depok diunduh
http://lib.ui.ac.id/file?file=digital/20282247T%20Rini%20Fahriani%20Zees.pdf
THE EFFECTIVENESS OF HIP EXERCISES TO DECREASE LOW BACK PAIN IN THE
ELDERLY IN THE KALIREJO VILLAGE, SALAMAN DISTRICT, MAGELANG
REGENCY
Sigit Priyanto1) and Erfiana2)
1
University of Muhammadiyah Magelang
Address: Nglerep, Deyangan, Mertoyudan, Magelang
E-mail: masigit_fikes@yahoo.com
Hp 081328505262
ABSTRACT
Background : The elderly lessen their physical activities after pension, although their daily
activity need many muscles. Even elderly with chronic health disorder or just suffering
symptom of aging process admit to do physical exercise in hip. Low back pain is pain feeling
in bone lumbal sakral and sakroiliakal area.
Purpose : to determine the effectiveness of hip exercise to decrease low back pain in the
elderly in the Kalirejo Village, Salaman District, Magelang Regency.
Methods: this research use quasi-experiment. The population in this study were elderly
aged 55-65 years with a number of 86 people in the Kalirejo Village, Salaman District,
Magelang Regency. Sampling with proportional random sampling with a sample of 51 elderly.
The statistical test used the Wilcoxon test with a 95% degree of confidence or a=0.05.
Results : The level of low back pain in the elderly in Kalirejo Village, Salaman District,
Magelang Regency as much as 56% had moderate pain scale, 44% had severe pain scale,
after being given a hip exercise, as much as 56% of elderly have mild pain scale, 44% of
elderly had moderate pain scale. Wilcoxon test results obtained by the analysis of the value
of the level of low back pain in elderly with p value = 0.000, it means there is an effectiveness
of hip exercises to decrease low back pain in the elderly.
Conclusion: hypothesis that showed the effectiveness of hip exercises to decrease low
back pain in the elderly, are accepted and proven.
Suggestion: the results of this study are expected to improve the quality of health services
in dealing with low back pain.
Keywords : hip exercise, low back pain, the elderly.
285
Introduction and Objective
Elderly is not a disease, but an advanced
stage of a process of life that is characterized
by the body’s ability to adapt to environmental
stress. The decline in the ability of various
organs, functions and systems of the body it is
in men and 13.6% in women. National Safety
Council also reports that occupational sick
highest frequency of occurrence is pain/ back
pain, which is 22% of the 1.7 million cases
(Tarwaka, et al, 2010).
According to research conducted by
natural/ physiological. The decrease was due
to a reduced number of cells and the ability of
Melissa Aprilia (2009) to the field of construction
workers on the construction project and
the body. In general, the signs of aging begin to
appear since the age of 45 years and will cause
Recreation Facilities Sports Boker (Boker GOR)
Ciracas results obtained from 38 samples of
problems at the age of about 60 years
(Bandiyah, 2009). The cause of the problems
94.7% of workers experience musculoskeletal
complaints in several parts of his body and lower
that occur in the elderly is the skin, mobility,
elimination, vision, hearing, cardiovascular,
back (18 , 8%), right shoulder (17.4%), and leg
(15.2%). An estimated 40% of the population of
respiratory, pain, depression, dementia, and
elderly hematologic abnormalities. Pain is one
Central Java aged over 65 years had suffered
from lower back pain and its prevalence in men
that is often felt by the elderly for example, pain
in the legs, lower back pain.
and in women 18.2% 13.6% (Tjokorda and
Maliawan, 2009).
Lower back pain or Low Back Pain (LBP) is
a manifestation of pathological circumstances
Lower back pain has not been a clear
impact in people’s lives, where the pain is
experienced by the tissue or organ that is part
of the waist or in the lumbar region. Lower back
causing disturbance or disability on the lives of
people all day. Causes of low back pain varies,
pain is a complaint which is closely related to
age. Usually the pain is being felt in their second
with most cases caused by tension in the
muscles and soft tissues of the spine. Physical
decade of age and found a high incidence in
the fifth decade (and against & Sidhartha, 2008).
causes include osteoathritis, rheumatoid
arthritis, degeneration of the discus between the
A person aged 40 years and above require
knowledge of information about the activities of
vertebrae (disc herniation), vertebral fracture,
or muscle spasms. Lower back pain can be
sports or physical fitness (Setiabudhi &
Hardywinoto, 2005).
classified into three types based on the duration
of pain, the acute (within 4 weeks), subacute
In Indonesia, the incidence of lower back
(4-12 weeks), and chronic (12 weeks upper).
Diseases of lower back pain can be treated with
pain is definitely not known, but the NPB
estimated prevalence rate varies between 7.6%37%. NPB problems in workers generally
begins in young adulthood with a peak
prevalence in the age group 45-60 years with
little difference by sex (Widiayanti, at all, 2009).
exercises such as stretching the hips. If simple
stretches every day can set the spine to recovery
at a cost that is not much of the kind described
in a journal published in Journal Watch General
Magazine, 2012.
Research Community Oriented Program for
Controle of Rheumatic Disease (COPORD)
Efforts should be made to address lower
back pain is the use of pharmacological therapy
Indonesia shows back pain prevalence of 18.2%
and
non-pharmacological
therapy.
The Effectiveness of Hip Exercises to Decrease Low Back Pain in the Elderly in the Kalirejo Village,
Salaman District, Magelang Regency
Pharmacological therapy aims to relieve pain
no complications such as scoliosis, and can read
such as analgesics. Non-pharmacological
therapy aims to reduce pain so that no potential
and write. Collecting data using a Visual
Analogue Scale (VAS) that the degree of pain
to cause effects for patients. The benefits of nonpharmacological therapy in addition to reducing
are numbered 0-10, figure 0 indicates no pain
and severe pain the 10 states. Pain assessment
pain also have the nature of a simple, effective,
and without harmful effects (Lowdermilk & Perry,
performed on people suffering from lower back
pain by circling the one number that has been
2004). Approach to non-pharmacological
therapy can provide lower back pain relief in the
specified (Sudoyo et al, 2006). Observation
sheet gymnastics hip developed from research
elderly. Non-pharmacological therapy to address
low back pain including relaxation, massage,
by Padila (2013). Statistical analysis using the
Wilcoxon signed rank test and Mann Whitney.
warm compresses, acupuncture and gymnastics
hip.
Results
One of the non-pharmacological therapy
Top of Form
that aims to reduce lower back pain is hip gym.
Gymnastics is an exercise pelvic floor muscles
Here are effective hip exercises for lower
back pain relief in the elderly in Kalirejo Sub
back to reduce lower back pain. Gymnastics
aims hips can help improve blood circulation and
Salaman, Magelang regency, the median value
obtained from the pretest was 6.00 and the
strengthen the back muscles and prevent
osteoporosis and curvature of the body.
Moreover, it can increase muscle strength waist,
average is 6.68 with a standard deviation of
1.600, and for the posttest median is 3.00, the
thigh and also overcomes the limitations of joint
movement (Padila, 2013). Gymnastics hip can
be done at least 3 times in one week to get the
results back floor muscle exercises (Hirsch, et
al. 2008).
average is 3:48 with the standard deviation of
1.636, p value = 0.000. The test results of the
difference between the intervention and control
groups by Mann Whitney test showed that Sig
(2-tailed) showed the value of p = 0.000, with
mean 38.92 and the mean control interventions
by the 13:58.
Methods
Research is a quantitative study using a
quasi experimental design using the design of
Discussion
Gymnastics is an exercise hip first be
pre-test and post-test control group design,
which design do the two groups were observed
introduced and used to restore strength,
endurance and flexibility of the back muscles,
before and after treatment. The samples used
were 51 respondents, consisting of 25 people
which aims to reduce the pressure on the facet
of the body and stretch the lumbar region as
in the intervention group and 26 in the control
group. The intervention group performed in three
well as correcting the wrong body. Dreger,
quoted by Suharjana (2007) states that the hip
hamlets while the control group was conducted
in four villages Kalirejo village, subdistrict of
exercise training program encompassing the
dose of exercise, frequency of exercise, exercise
Magelang regency Salaman. Inclusion criteria
were 55-65 years, not taking medication within
time, and other principles of training. Hip
exercises require a relatively long time to get
the last 1 month, experiencing lower back pain
optimal results. Results hip exercises can be
|
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287
done in one or two weeks, it would be optimal
Muscles to perform its function in pairs therefore
to do three or four weeks.
upon agonist muscle groups in the state to
contract the antagonist muscle to the contrary
Hip exercises designed to reduce back pain
by strengthening the muscles that flex the
lumbo-sacralspine, especially the abdominal
muscles and stretch your muscles and muscle
groups gluteusmaximus ektensor lower back.
Stiffness in the lower back area is usually caused
in a relaxed state. When this does not occur as
a result of both the muscles will attract each
other and will inhibit the movement. Similarly,
when trying to straighten the arm biceps should
be in a relaxed state.
by too much lactic acid accumulates in the
muscle (Wolf, 2004). Along the degeneration of
Types of training programs commonly given
to patients with complaints of low back pain in
the nucleus protruding disc that accompanied
the formation of lime and inflammation of the
hospitals and other health services are usually
gentle exercise or careful, which is done in a
synovial capsule, lordosis increases, causing
narrowing of the intervertebral foramen and the
“passive” means that body movements in the
exercise carried out by the therapist. According
resulting emphasis. This emphasis allows the
loss of motor function, sensory, and reflex. Nerve
to William gymnastics hip more emphasis on
contracting the back muscles so happy under
root compression rate of mild pain is felt in the
buttocks, to the nerve root compression levels
these muscles become relaxed and become
more powerful. This can reduce the pain in the
greater felt in the hamstrings and lower back
and leg nerve root pressure broader level felt in
the legs.
muscle due to weak muscles in the area and
can also increase the scope of the movement
(Keenenth, 2009).
Hip exercises a rehabilitation program to
The benefits of aerobic exercise hip is not
improve the strength of your back and
abdominal muscles, as well as stretching
just for the elderly, lower back pain, but this
exercise is also aimed at people who do not
exercises to increase flexibility, but also reduce
weight. Fitness exercise to prevent recurrence
suffer from lower back pain. Hip exercises
should be done every day, not just when the
must be careful on the dorsal flexion exercise
are double knee-to-chest strecth, pelvic tilt
pain alone. From the above, it is necessary to
do physical exercise despite his advanced age,
exercise, lower trunk rotation stretch, curl up
exercise, trunk flexion stretch, alternate arm-leg
this exercise can also be helpful for elderly pre
anticipation of back pain that occur because of
extension exercise, bone lumbar extension,
alternate leg extension and harmstring stretch
hip exercises can improve flexibility and
endurance lower back muscles. Because of
while standing (Anonymous, 2008).
lower back pain can not be accepted as an aging
process, this condition is a chronic problem that
Flexibility exercises lower back muscles by
doing pelvic exercises are examples of
exercises to improve muscle strength belt.
Heartbeat that this exercise can strengthen the
muscles which in turn can reduce pain due to
muscle weakness. This is related to reduced
requires a change in the daily activities that
aging is not a problem. Keep in mind that people
with depression often reduces lower back as
little as possible during the sitting, standing and
lying in everyday life.
muscle work in pairs to carry out its functions.
The Effectiveness of Hip Exercises to Decrease Low Back Pain in the Elderly in the Kalirejo Village,
Salaman District, Magelang Regency
Markam S. (2000). Penuntun Neurologi. Edisi
Conclusion
Gymnastics is effective in lowering the hips
lower back pain in the elderly, with a p value =
0.000.
Kedua. Jakarta: Binarupa Aksara.
Maryam, R. Siti, dkk. (2008). Mengenal Usia
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LIST OF NAMES ASSOSIASI INSTITUSI PENDIDIKAN NERS
MUHAMMADIYAH ‘AISYIYAH
(AIPNEMA) AND CO-HOST INC
Sponsored By :

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