TESIS
OLEH:
AL’ANA
NIM . 166070300111053
i
2018
iii
TESIS
Oleh :
Al’Ana
NIM. 166070300111053
Menyetujui
Komisi Pembimbing
Ketua Anggota
Prof. Dr.dr. Noorhamdani AS, Sp.MK Ns. Lilik Supriati, S.Kep, M.Kep
NIP. 195011101980021001 NIP.
ii
TESIS
Oleh :
Al’Ana
NIM. 166070300111053
Menyetujui
Komisi Pembimbing
Ketua Anggota
Prof. Dr.dr. Noorhamdani AS, Sp.MK Ns. Lilik Supriati, S.Kep., M.Kep
NIP.
Dr.195011101980021001
Ahsan, S.Kp. M.Kes NIP.
Komisi Penguji,
Ketua Anggota
Prof. Dr. dr. Yuyun Yueniwati P.W., M.Kes., Sp.Rad (K) Dr. Titin Andri Wihastuti, S. Kp., M. Kes.
NIP. 196810311996012001 NIP. 197702262003122001
iii
PERNYATAAN ORISINALITAS TESIS
pengetahuan saya, di dalam Naskah TESIS ini tidak terdapat karya ilmiah yang
pernah diajukan oleh orang lain untuk memperoleh gelar akademik di suatu
Perguruan Tinggi, dan tidak terdapat karya atau pendapat yang pernah ditulis
atau diterbitkan oleh orang lain, kecuali yang secara dikutip dalam naskah ini dan
unsur-unsur PLAGIASI, saya bersedia tesis ini digugurkan dan gelar akademik
yang telah saya peroleh (MAGISTER) dibatalkan, serta diproses sesuai dengan
Mahasiswa
Nama : Al’Ana
NIM : 166070300111053
PS : Magister Keperawatan
Prog : Pascasarjana
Fak : Kedokteran UB
iv
IDENTITAS TIM PENGUJI TESIS
JUDUL TESIS:
NIM : 166070300111053
Komisi Pembimbing:
Dosen Penguji 1 : Prof. Dr. dr. Yuyun Yueniwati P. W., M.Kes., Sp.Rad (K)
Tanggal Ujian :
SK Penguji :
v
KATA PENGANTAR
Puji syukur penulis panjatkan kehadiran Allah SWT. atas segala Rahmat
dan Karunia-Nya sehingga penulis dapat menyelesaikan tesis yang berbagai
pihak, untuk itu pada kesempatan ini penulis berjudul “Analisis Faktor Yang
Mempengaruhi Outcome Pada Pasien Cedera Kepala Berdasarkan Pendekatan
Teori Need For Help Ernestine Wiedenbach di IGD RSUD Bangil Kabupaten
Pasuruan”
Penyelesaian naskah tesis ini tidak lepas dari bantuan dan bimbingan dari
vi
Sangat disadari bahwa dengan kekurangan dan keterbatasan yang
penyusunannya, oleh karena itu penulis mengharapkan saran dan kritik yang
membangun agar tesis ini lebih baik lagi. Semoga tesis ini dapat bermanfaat bagi
Malang,
Penulis
vii
RINGKASAN
Al’Ana, NIM 166070300111053. Program Studi Magister Keperawatan,
Fakuas Kedokteran, Universitas Brawijaya. Analisis Faktor Yang
Mempengaruhi Outcome Pasien Cedera Kepala Berdasarkan Pendekatan
Teori Need For Help Ernestine Wiedenbach Di RSUD Bangil Kabupaten
Pasuruan. Komisi Pembimbing Ketua : Noorhamdani, Anggota :Lilik
Supriati
viii
Kesimpulan penelitian ini adalah ada hubungan antara usia, skor GCS, ,
tekanan darah sistolik, frekuensi pernapasan, frekuensi nadi, dan trauma organ
lain dan jenis transportasi terhadap outcome pasien cedera kepala. Jenis
kelamin, mekanisme cedera dan lama prehospital tidak ada hubungan dengan
outcome pasien cedera kepala. Skor ISS merupakan faktor yang paling
berpengaruh terhadap outcome pasien cedera kepala.
Keterbatasan dalam penelitian ini adalah pada Kelemahan teori need for
help Wiedenbach yaitu pemberian bantuan kepada klien berdasarkan
penggunaan persepsi klien terhadap kebutuhannya. Pada kasus cedera kepala
klien tidak mampu mengungkapkan persepsinya secara jelas terutama pasien
cedera kepala berat sehingga pengkajian dilakukan kepada keluarga/pengantar.
ix
Summary
Data were analyzed using the Spearman correlation test which showed an
association of age factors at p value = 0.020 <α = 0.05, GCS score p value = 0,000
<α = 0.05, respiratory frequency factor p value = 0.033 <α = 0.05 the pulse factor
is p value = 0.031 <α = 0.05, and the ISS score factor is p value = 0,000 <α =
0.05, so that H0 is rejected or there is a relationship between age, GCS score, RR,
pulse and ISS score with outcome of head injury patients. Furthermore, the data
were analyzed using the chi square test which showed a correlation between
systolic blood pressure factor p value = 0.001 <α = 0.05, transportation type factor
p value = 0.043 <α = 0.05 with the head injury patient outcome, so that H0 was
rejected or there was a significant relationship between systolic blood pressure
scores and the type of transportation with the outcome of head injury patients. The
results of the chi square analysis did not show a significant relationship between
the mechanism of injury p value = 0.649> α = 0.05. Besides the data analyzed
using logistic regression which shows the dominant factor that influences the
outcome of head injury patients is the ISS score p value = 0,000 <α = 0.05 with a
correlation strength of -0,664.
The conclusion of this study was that there was a relationship between
age, GCS score, systolic blood pressure, respiratory frequency, pulse frequency,
x
and other organ trauma and type of transportation to the outcome of head injury
patients. Gender, mechanism of injury and prehospital duration were not related to
the outcome of head injury patients. The ISS score is the most influential factor in
the outcome of head injury patients.
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ABSTRAK
xii
ABSTRACT
Head injury is the major cause of morbidity and mortality in individuals aged
under 45 years. The focus of the management of head-injured patients is to prevent
and limit the possibility of secondary brain injuries which strongly affect the
outcome of patients. Patients with head injury are in emergency conditions and must
be immediately and precisely treated to obtain better outcome. This research was
conducted to analyze the factors that relate with the outcome of patents with head
injury based on the approach namely the need for help theory proposed by
Wiedenbach in the Emergency Unit of Public Regional Hospital (RSUD) of Bangil,
Pasuruan District. This research employed a quantitative approach using cross
sectional method, involving 53 respondents who were selected using the purposive
sampling method. Data were analyzed using the Spearman correlation test which
showed an association of age factors at p value = 0.020 <α = 0.05, GCS score p value
= 0,000 <α = 0.05, respiratory frequency factor p value = 0.033 <α = 0.05 the pulse
factor is p value = 0.031 <α = 0.05, and the ISS score factor is p value = 0,000 <α =
0.05, so that H0 is rejected or there is a relationship between age, GCS score, RR,
pulse and ISS score with outcome of head injury patients. Furthermore, the data were
analyzed using the chi square test which showed a correlation between systolic blood
pressure factor p value = 0.001 <α = 0.05, transportation type factor p value = 0.043
<α = 0.05 with the head injury patient outcome, so that H0 was rejected or there was
a significant relationship between systolic blood pressure scores and the type of
transportation with the outcome of head injury patients. The results of the chi square
analysis did not show a significant relationship between the mechanism of injury p
value = 0.649> α = 0.05. Besides the data analyzed using logistic regression which
shows the dominant factor that influences the outcome of head injury patients is the
ISS score p value = 0,000 <α = 0.05 with a correlation strength of -0,664.
Key Words: Head Injury, Factors Influencing Patients’ Outcome, Nurse, Need
For Help, Ernestine Wiedenbach
xiii
DAFTAR ISI
BAB 1 PENDAHULUAN............................................................................. 1
BAB 6 PEMBAHASAN
xx
DAFTAR TABEL
DAFTAR GAMBAR
Gambar 2.1 Kerangka Teori Analisis Faktor yang Mempengaruhi
DAFTAR LAMPIRAN
Lampiran 1: Lembar Penjelasan Penelitian....................................................
Lampiran 2: Lembar Persetujuan Responden................................................
Lampiran 3: Observasi Penelitian..................................................................
Lampiran 4: Panduan Pengukuran Kategori Trauma Skor dengan RTS........
Lampiran 5: Panduan Pengukuran Kategori Trauma Skor dengan ISS..........
Lampiran 6: Panduan Penghitungan TRISS....................................................
Lampiran 7: Hasil Uji Univariat, Bivariat dan Multivariat..................................
Lampiran 8: Surat Permohonan Kelaikan Etik (Ethical Clearance)................
Lampiran 9: Surat Kelaikan Etik (Ethical Clearance)......................................
Lampiran 10: Surat Permohonan Ijin Studi Pendahuluan..............................
Lampiran 11: Surat Keterangan Telah Melakukan Studi Pendahuluan..........
Lampiran 12: Surat Permohonan ijin Uji Validitas dan Reliabilitas.................
Lampiran 13: Surat Permohonan Ijin Penelitian.............................................
Lampiran 14: Surat Balasan Ijin Penelitian....................................................
Lampiran 15: Surat Keterangan Telah Melakukan Penelitian ........................
Lampiran 16: Surat Keterangan Bebas Plagiasi............................................
Lampiran 17: Manuskrip................................................................................
Lampiran 18: Lembar Konsultasi Tesis..........................................................
DAFTAR SINGKATAN
AIS : Abbreviated Injury Scale
AUC : Area Under the Curve
CKB : Cedera Kepala Berat
CKR : Cedera Kepala Ringan
CKS : Cedera Kepala Sedang
CT Scan : Computerized Tomography Scanner
EDH : Epidural Hematom
FIM : Functional Independence Measure
GCS : Glasgow Coma Scale
ICH : Intracerebral Hematom
IGD : Instalasi Gawat Darurat
ISS : Injury Severity Score
MRI : Magnetic Resonance Imaging
MTOS : Major Trauma Outcome Study
N : Nadi
NaCl : Natrium Klorida
NPV : Negative Predictive Value
O2 : Oksigen
PaCO2 : Tekanan karbondioksida
PaO2 : Tekanan Oksigen
PPV : Positive Predictive Value
Ps : Probability of Survival
RL : Ringer Laktat
RR : Respiratory Rate
RS : Rumah Sakit
RSUD : Rumah Sakit Umum Daerah
RTS : Revised Trauma Score
S : Suhu
SAH : Sub Arachnoid Hematom
SBP : Sistolik Blood Pressure
SDH : Sub Dural Hematom
TD : Tekanan Darah
THT : Telinga Hidung Tenggorokan
TIA : Transient Ischemic Attack
TIK : Tekanan Intra Kranial
Tn : Tuan
TRISS : Trauma and Injury Severity Score (TRISS).
WHO : World Health Organization