Proceeding Inc Ners Unair 2017 PDF

COVER
1
The Proceeding of 8th International Nursing Conference:
Education, Practice and Research Development In Nursing
Fakultas Keperawatan Universitas Airlangga
Hak Cipta © 2017,

Fakultas Keperawatan Universitas
Airlangga Surabaya
Kampus C Mulyorejo Surabaya
60115
Telp. : (031)5913754, 5913257
Faks. : (031)5913752
Website : http:/ners.inair.ac.id
Email : dekan@fkp.unair.ac.id
Hak cipta dilindungi undang-undang. Dilarang memperbanyak sebagian atau seluruh isi buku
ini dalam bentuk apa pun, baik secara elektronis maupun mekanis, termasuk tidak terbatas pada
memfotokopi, merekam, atau dengan menggunakan system penyimpanan lainnya, tanpa izin
tertulis dari Penerbit.
UNDANG-UNDANG NOMOR 19 TAHUN 2002 TENTANG HAK CIPTA

1. Barangsiapa dengan sengaja dan tanpa hak mengumumkan atau memperbanyak sutu
Ciptaan atau memberi izin untuk itu, dipidana dengan pidana penjara paling lama 7
(tujuh) tahun dan/atau denda paling banyak Rp. 5.000.000.000,00 (lima miliar
rupiah)
2. Barangsiapa dengan sengaja menyiarkan, memamerkan, mengedarkan, atau menjual
kepada umum suatu Ciptaan atau barang hasil pelanggaran Hak Cipta atau Hak Terkait
sebagaimana dimaksud diatas, dipidana dengan pidana penjara paling lama 5 (lima)
tahun dan/atau denda paling banyak Rp 500.000.000,00 (lima ratus juta rupiah).
Penerbit: Fakultas Keperawatan Universitas Airlangga
The Proceeding of 8th International Nursing Conference:

Education, Practice and Research Development In Nursing
412 hlm, 21 x 29,7 cm
ISSN: 1413536244
ii
DAFTAR ISI
DAFTAR ISI........................................................................................................................... iii

GREETING FROM STEERING COMMITTEE ............................................................... vi
OPENING REMARK FROM THE DEAN OF FACULTY NURSING ..........................vii
OPENING SPEECH FROM THE RECTOR OF UNIVERSITAS AIRLANGGA ......... ix
STEERING COMMITTEE ................................................................................................... xi
TIME SCHEDULE .............................................................................................................. xiii
Pain Assessment Of Critical Pain Observation Tool For Mechanically Ventilated Adults
In Icu: A Systematic Review ............................................................................................... 1
Dominant Factors Affecting Nurse Performance In General Wards: A Systematic Review
.............................................................................................................................................. 8
Analysis Of The Influence Of Mgso4 Injection On Pre Eclampsia Delivery In Pre-
Referral Jombang Hospital Towards Prevalence Eclampsia Incident ............................... 14
Systematic Review Lifestyle Interventions In Patients With Type 2 Diabetes ................. 21
Effectiveness Of Honey In Treatment Of Diabetic Foot Ulcer: A Systematic Review..... 26
Cadre Skills Towards Rolling Massage ............................................................................. 34
Early Detection Of Breast Cancer By Breast Self-Examination (Bse) In Adult Women (A
Systematic Review) ........................................................................................................... 38
Effectiveness Of The Improvement Of Chinese Traditional Medicine Pulmonary Function
And Quality Of Life Of Patients Copd .............................................................................. 43
Non-Pharmacological Intervention To Increase Quality Of Sleep On The Elderly: A
Systematic Review ............................................................................................................. 47
Systematic Review Of Factor That Affect Implementation Of The Patient Safety Culture
In The Hospital .................................................................................................................. 54
A Systematic Review On The Effectiveness Of Auricular Accupressure For Pain .......... 60
Improve Family Readiness To Treat Post Deprived Mental Disorders By Family
Psychoeducation ................................................................................................................ 65
Risks Factors Of Client Outcome With Head Injury ......................................................... 73
A Systematic Review: Factors Affecting Turnover Intention Of Nurse In Hospital ......... 78
Factors Affecting Medication Errors By Nurse In Hospital .............................................. 85
Oral Hygiene Of Cerebrovascular Accident Patients: A Systematic Review .................... 91
Therapeutic Effect Of Audio Murottal For Recovery Time Of Post General Anesthetic
Patient ................................................................................................................................ 96
Effectiveness Of Music As Intervention For Perioperative Anxiety: A Systematic Review
.......................................................................................................................................... 102
Optimalization Of Family Role As Self Management Program Support At Type 2
Diabetes............................................................................................................................ 110
Analysis On The Efficacy Of Aroma Therapy To Relieve Post Operative Nausea And
Vomiting: A Systematic Review ....................................................................................... 115
iii
8th International Nursing Conference “Education, Practice And Research Development In Nursing”
Factors That Affect Mother’s Behavior In The Treatment Of Diarrhea In 0 – 5 Years Old
Children............................................................................................................................ 120
Exercise Improved Sleep Quality In The Elderly ............................................................ 127
The Relationships Between Nurse’s Caring With Clien’s Comfort Islamic Perspectife . 132
A Systematic Review Of Cognitive Behavior Therapy (Cbt) And Insomnia .................. 140
relationship Between The Supervision Of The Head Room With Nurse’s Performance: A
Systematic Review ........................................................................................................... 147
Factors Associated With Hallucinations: A Systematic Review Of Mental Health
Research ........................................................................................................................... 153
Systematic Review Effectivity Of Banana (Musa) As Anti-Diabetic Agent On Mice.... 161
Characteristics Of Parents’caring In The Development Of Children Under Five Years . 164
Effectiveness Hypnosis Relaxation Techniques For Patients With Hypertension .......... 169
Relationship Between Waist-Hip Ratio (Whr) And Total Cholesterol Levels Of
Employees In Stikes Bina Sehat Ppni Mojokerto ............................................................ 173
Relations With Nutritional Status In The Event Early Menarche Grader V And Vi In Sdn
1 Kemayoran Surabaya .................................................................................................... 178
Treadmill Exercise For Increasing Walking Function After Stroke ................................ 183
The Effectiveness Of Music To Reduce Stress And Anxiety: A Systematic Review ..... 189
Effectiveness Cognitive Behavior Therapy Of Changes In Behavior In Adults With
Clients Attention Deficit Hyperactivity Disorder: Systematic Review ........................... 193
The Implemention Of Pregnancy Mother Class And Mother Knowledge About
Dangerous Sign Of Pregnant And Labour In Wilayah Kerja Puskesmas Palang Kabupaten
Tuban ............................................................................................................................... 198
Analyzing Of Motivation In Learning Foreign Language Faced By Nursing Students .. 206
The Effect Of Kangaroo Method On The Adequacy Of Enough Month Aged Baby At
Blega Oloh Polindes At Blega District Blega Oloh Kecamatan Blega ........................... 212
The Effect Of Anticipatory Guidance To Mothers' Behavior In Caring Of Low Birth
Weight Babies .................................................................................................................. 218
Effectiveness Of Interprofesional Education (Ipe) Program On Students Perception Of
Teamwork ........................................................................................................................ 224
Effectiveness Of Education Program Interprofesional (Ipe) Health Status Of Family ... 230
Perspective Depression In Some Groups In Society: Systematic Review ....................... 236
The Effect Of Spiritual Emotional Freedom Technique To Increase Self Esteem Of
Schizophrenia In Mental Hospital Surakarta ................................................................... 242
Knowledge And Attitudes In Cardiopulmonary Resuscitation (Cpr) Of Family Members
Of Sudden Cardiac Arrest (Sca) In The Icvcu Of The Rsud Dr. Moewardi Surakarta 2016
.......................................................................................................................................... 248
Emergency Condition And Vulnerability And Mitigation Efforts To Form Safe
Community In The Teritory Of Puskesmas Ceper Klaten ............................................... 254
iv
The Strategy Of Community Nursing Intervension Through Health Cadre Contribution,
Healthy Life Style Perception, And Anak Kandang*) Empowerment In An Effort To
Break The H5n1 Virus Transmittal Chain ......................................................................... 261
The Assesment Of Cognitive Impairment For Stroke Patient ......................................... 268
Etiology Factors Analysis That Influence To Congestive Heart Failure Incident In Icvcu
Dr. Moewardi Hospital Surakarta .................................................................................... 273
Application Problem Based Learning In Labor Care On The Improvement Of Motivation
And Achievement Midwifery Students ........................................................................... 279
Gastroenteritis Acute Handling And Acute Diarrhea In Children: Systematic Review .. 285
Analysis Of Infant Characteristics Postpartum Mother Role In Improving The Adaptation
Of Mother......................................................................................................................... 290
The Effect Of Demonstration Method On The Ability To Care For Non-Ulcer Diabetic
Foot Of Patients With Type 2 Diabetes Mellitus (Dm) ................................................... 296
Determinants Of Anemia In Adolescent Girl .................................................................. 302
The Differences Of Newborn Weight Infant Toward Soil Transmitted Helminthes
Infection In Pregnancy ..................................................................................................... 305
Factors Of Health Information And Support Increase In Compliance With Tablet Fe
Consume Pregnant Women In The Labor Health East District Lombok Terara 2015 .... 310
Effect Of Cooperative Play To Sibling Rivalry Direct Reaction In Children Ages 8-12
Years In Sdn Blega 03 Bangkalan ................................................................................... 316
The Effect Of Zink Supplementation For Growth Development In Children ................. 322
A Literature Review; Effectiveness Of Warm Footbath On Sleep Quality In Elderly .... 330
Intervention To Reduce Anxiety In Nursing Students: A Systematic Review ................ 334
Poisoning Due To Pesticide Spraying Viewed From Personal Hygiene And Long
Exposure To Onion Farmers In Sumberjo Nganjuk ........................................................ 340
Analysis Of The Main Indicators Of Nutrition Aware Family (Kadarzi) On The
Occurrence Of Malnutrition In Children Under Five Years In The Work Area Health
Centers Northern Territory Of Kediri .............................................................................. 347
Effort To Improve The Ability Of Nurse In Applying The Patient Centered Care (Pcc) In
Hospital ............................................................................................................................ 353
The Quality Of Patient Satisfaction With Service Inside Of Health Care Of A Systematic
Review ............................................................................................................................. 358
The Effect Of Murottal Alquran On The Sleep Quality Of Children (1-5 Years Old) .... 376
Family Environment And Public (Social), Independence Elderly, The Achievement Of
Welfare Of Elderly........................................................................................................... 385
Effectiveness Exercises Of Self-Acceptence: Relaxation And Dzikir For Reduction Of
Blood Glucose Degree To The Patient Of Diabetes Mellitus Type 2.............................. 389
The Self-Concept Of Chronic Renal Failure Patients Who Undergoing Hemodialysis In
Dr Soeradji Tirtonegoro Hospital .................................................................................... 394
The Effect of Leboyer Method Toward Anxiety Decrease on Maternity Mothers..........401
v
GREETING FROM STEERING COMMITTEE
Assalamualaikum Warahmatullahi Wabarakatuh
Honorable Rector of Universitas Airlangga

Honorable Dean of Faculty of Nursing, Universitas Airlangga
Honorable Dirjen Sumber Daya Iptek Dikti
Honorable Head of Co-Host Institutions
Distinguished Speakers and all Participants
Praise the presence of God Almighty, for his mercy so that Faculty of Nursing Airlangga
University can organized: The 8th International Nursing Conference on the theme of
“Education, Practice And Research Development In Nursing”. Welcome in Surabaya, City of
Heroes Indonesia.
This international nursing conference is conducted in cooperation with 6 nursing schools

throughout the nation. These institutions including, Poltekkes Kementerian Kesehatan
Surakarta, STIKES Ngudia Husada Bangkalan, STIKES Pemerintah Kabupaten Jombang,
STIKES Maharani Malang, Poltekkes Kementerian Kesehatan Surabaya, and STIKES YARSI
Mataram. The Faculty of Nursing Universitas Airlangga once more aims to elaborate with the
aforementioned institutions and international universities through holding an international
nursing conference. The international universities include: Flinders University* (Australia), La
trobe University (Australia), University of Collegue Cork (Irlandia), University of Malaya
(Malaysia), and Kaohshiung Medical University (Taiwan). We also invited Prof. dr. Ali Gufron
Mukti, M.Sc., Ph. D. Dirjen Sumber Daya Iptek Dikti, as a keynote speaker.
Proceeding of this International Nursing Conference will be publish at Atlantis Press. The
selected papers will be submit at Journal Ners or index by Conference Proceeding Citation
Index, Thomson Reuters.
Participants of this conference are lecturers, nurses, students both from clinical and educational
setting, regional and overseas area.
Finally, I would like to thanks to all speakers, participants, and sponsors so that this conference
can be held successfully.
Please enjoy the international conference, I hope we all have a wonderful time at the conference.
Wassalamualaikum Warahmatullahi Wabarakatuh
Steering Committee
vi
OPENING REMARK
FROM THE DEAN OF FACULTY NURSING
Assalamualaikum Warahmatullahi Wabarakatuh
Honorable Rector of Universitas Airlangga

Distinguished speakers and all Participants
First of all, I would like to praises and thanks to God for the blessing and giving us the grace to
be here in a good health and can hold this conference together. Secondly, it is a great privilege
and honor for us to welcome every one and thank you very much for your participation and
support for the 8th International Nursing “Education, Practice and Research Development in
Nursing”.
Research and education into practice is very important to enhance nursing competencies with
nurse colleagues in the international sphere. Indonesia face problems such low frequency of
nursing conference, number of researches, also international publications. This problem can
hinder quality improvement of nursing services.
The demand of health care services including nursing care will increase continously not only
the quality but also the affordability and the service coverage. Facing this society's demands,
particularly in the field of nursing, we should make a change in various aspects such as in
nursing education, nursing practice and nursing research. The science of nursing has philosophy
and nursing paradigm that underlying the various aspects to improve professional in education,
practice, and nursing research. As a science, nursing can grow continously through research
and education.
The interaction among education, practice, and nursing research are interrelated and affect the
development of science in nursing. Nursing practice has interactions with nursing education
and research. Practice can be used as a source of nursing phenomena that occurs, so it can
become a nursing model in accordance with the theory developed in education and has been
proven through nursing research. In addition, nursing research become a substance of the
development of nursing science, because of through nursing research may prove the theory
which developed in education so it is useful and can be practiced in the health service. So, it
can be concluded that education, nursing practice and research have interaction each other that
cannot be separated.
Along with Universitas Airlangga vision to become a world class university and enter top World
University Ranking, Faculty of Nursing, participates actively in reaching the vision. To achieve
World Class University ranking, faculty needs to meet the standards of World’s top Universities
such as Academic reputation, employer reputation, publication, faculty standard ratio,
international students and exchange. International Nursing Conference is one of the few
strategies that have been implemented by the faculty to increase Publication standard.
Finally, I would like to thanks to all speakers, participants, and sponsorships that helped the
success of this event. I hope that this conference having good contribution in increasing the
quality of nursing and nursing care.
Please enjoy the international conference. I hope, we all have a wonderful time at the
conference.
vii
Wassalamualaikum Warahmatullahi Wabarakatuh
Prof. Dr. Nursalam, M.Nurs (Hons)

Dean, Faculty of Nursing
Universitas Airlangga
viii
OPENING SPEECH
FROM THE RECTOR OF UNIVERSITAS AIRLANGGA
Assalamu’alaikum wa-rahmatullahi wa-barakatuh.
May the peace, mercy and blessings of Allah be upon you.
Alhamdulillah! Praise be to Allah, The Almighty for giving us the opportunity to gather
here in “THE 8TH INTERNATIONAL NURSING CONFERENCE & WORKSHOP“. Let us
also send shalawat and salam to our Prophet Muhammad SAW (Praise Be Upon
Him): Allaahumma shalli ‘alaa Muhammad wa ‘alaa aali Muhammad. May Allah give mercy
and blessings upon Him.
Ladies and gentlemen,

Nursing is a dynamic science and profession. It can be seen from the relentless efforts
made to optimize either the scientific or practical aspects of Nursing. These efforts towards
excellence are absolutely needed.
Innovations in providing nursing care are possible to be introduced through education,
practice and research. In this regard, we believe that those innovations are from “new concepts”
formulated in the field of Nursing to provide the best service. If we can do this, there will be
more benefits we can get such as gaining reputation for nursing profession and the education
institution.

Higher education of Nursing has a strategic role towards excellent healthcare service.
Therefore, the education format should be ready anticipating any developments. This readiness
is needed to accelerate the realization of “Healthy Global Citizen”.
So, let us exploit these changes around us, and consider this improving healthcare
service as our success towards welfare. Let us always be consistent to improve quality in the
field of Nursing. This field of science is expected to respond and voice concern about all aspects
of healthcare service development in any communities.
At this point, the organization of “THE 8TH INTERNATIONAL NURSING
CONFERENCE & WORKSHOP“ and “The Education, Practice and Research Development
in Nursing” as the theme is important. We cannot deny that through education, practice and
research implemented seriously, we will get valuable findings for Nursing science
development.
In education, students’ questions can start new discourses towards Nursing science
development. In its practice, various problems and solutions found in the field will broaden the
scientific scope of Nursing. In research, through this activity we are developing the science in
a well-planned and scientific manner.
Therefore, let us use this wonderful occasion to present research findings, either from
the education, practice and research. We believe that this event will take on the challenges in
providing quality healthcare service in the society.

Finally, I would like to express my gratitude to the committee, all nursing education
institutions, either domestic or overseas, for participating in this event, and other people
contributing to make this event a success. May everything run well and every objective
achieved. Have a great conference and workshop. Good luck!
ix
Wassalamu’alaikum wa-rahmatullahi wa-barakatuh.
Rector of Universitas Airlangga,

Prof. Dr. Moh. Nasih, SE., MT., Ak., CMA.
NIP. 196508061992031002
x
STEERING COMMITTEE
Patron : Rector of Universitas Airlangga

Advisor : 1. Prof. Dr. Nursalam, M.Nurs (Hons)
Dean of Faculty of Nursing,Universitas Airlangga
2. Head of STIKES Ngudia Husada Bangkalan
3. Head of STIKES Pemerintah Kabupaten Jombang
4. Head of STIKES Maharani Malang
5. Head of Nursing Programme Poltekkes Kementerian Kesehatan
Surabaya
6. Head of STIKES Surya Mitra Husada Kediri
7. Head of Nursing Programme Poltekkes Kementerian Kesehatan
Surakarta
8. Head of STIKES YARSI Mataram
Steering Committee : 1. Dr. Kusnanto, S.Kp.,M.Kes.
Vice Dean 1 of Faculty of Nursing Universitas Airlangga
2. Eka Mishbahatul Mar’ah Has.,S.Kep., Ns., M.Kep.
Vice Dean 2 of Faculty of Nursing, Universitas Airlangga
Steering Chairman : Dr. Ah. Yusuf, S.Kp., M.Kes.
Vice Dean 3 of Faculty of Nursing, Universitas Airlangga
Organizing Committee
Chairman : Elida Ulfiana, S.Kep. Ns.M.Kep
Secretaries : 1. Rista Fauziningtyas, S.Kep. Ns.M.Kep
2. Ika Nur Pratiwi, S.Kep. Ns.M.Kep
Administer : 1. Aria Aulia, S.Kep. Ns.M.Kep
2. Kristiawati, S.Kep. Ns.M.Kep
3. Lingga Curnia Dewi S.Kep. Ns.M.Kep
Treasurer : 1. Praba Diyan R, S.Kep. Ns.M.Kep
2. Tsuwuaibatul Islamiah S.Kep., Ns.
Reviewer : 1. Prof Dr Nursalam, M.Nurs (Hons)
2. Dr Kusnanto, S.Kp.M.Kes
3. Dr Joni Haryanto, S.Kp.M.Kes
4. Dr Tintin Soekartini, S.Kp.M.Kes
5. Dr. Esti Yunitasari, S.Kep. Ns.M.Kep
6. Fery Effendi, S.Kep. Ns. M.Sc
7. Eka Misbahatul, S.Kep. Ns.M.Kep
8. Laily Hidayati, S.Kep. Ns.M.Kep
Editor : 1. Iqlima Kurniawati, S.Kep.Ns.M.Kep
2. Sylvia Dwi Wahyuni, S.Kep. Ns.M.Kep
3. Ira Suarilah, S.Kp. M.Sc
4. Lailatun Ni’mah, S.Kep. Ns. M. Kep
5. Gading Ekapuja Aurizki S.Kep. Ns.
Event Team : 1. Tiyas Kusumaningrum. S.Kep. Ns.M.Kep
2. Deni Yasmara, S.Kep. Ns.M.Kep. Sp. Kep.MB
3. Khoridatul Bahiyah, S.Kep. Ns.M.Kep, Sp.Kep.J
4. Nadia Rohmatul Laili S.Kep. Ns.M.Kep
Public Relation : 1. Setho Hadisuyatmana, S.Kep. Ns.M.S
2. Retnayu Pradanie, S.Kep. Ns.M.Kep
3. Hakim Zulkarnain S.Kep. Ns
Publication & : 1. Candra Panji A, S.Kep. Ns.M.Kep
xi
Documentary 2. Rr. Dian Tristiana, S.Kep. Ns.M.Kep
3. Dimas Dwi Arbi, S.Kom
Sponsorship : 1. Erna Dwi W, S.Kep. Ns.M.Kep
2. Ilya Krisnana, S.Kep. Ns.M.Kep
Accomoation Team : 1. Dr Makhfudli, S.Kep. Ns.M.Ked. Trop.
2. Kenang DH
3. Achmad Efendik
4. Lutfi Rachman
Logistic Team : 1. Dr Hanik Endang N, S.Kep. Ns.M.Kep
2. Suyatik
Equipment Team : 1. Rahmad Affandi
2. Moch Anwari, S.Pd
3. Sigit
4. Sodiqin
xii
TIME SCHEDULE
8TH INTERNATIONAL NURSING CONFERENCE
“EDUCATION, PRACTICE AND RESEARCH DEVELOPMENT IN NURSING”
Surabaya, 8-9 April 2017
DAY 1, SATURDAY 8th April 2017

TIME ACTIVITY VENUE
07.00 - 07.45 Open Registration Committee
07.45 – 08.00 Opening Remarks MC:
- Indonesia Raya: National Anthem Nadia & Hakim
- Hymn Airlangga NEVO
08.00 – 09.00 Keynote Speaker MC
Prof. dr. Ali Ghufron Mukti, M.Sc., Ph.D.
(Ministry of Research and Higher Education
Republic Indonesia)
Kahuripan 300
“The Policy on Nurses and Health Worker
Management
Research-Based Development”
Building,
09.00 – 09.10 Certificate Conferment & Giving Souvenir Dean/Rector
Unair Kampus
09.10 – 09.50 - Welcoming Show (Traditional Dance): Tari Dance Team
C
Jejer
- Speech from Steering Committee Prof Nur, Bu
- Speech from Dean of The Faculty of Nursing, Elida, Rektor,
- Speech from Rector Universitas Airlangga
- Opening ceremony: Hit the Gong Pak Mahfud
- Pray
09.50 – 10.00 Coffee Break and Opening Poster Presentation MC
Plenary Session I
10.00 - 10.20 Speaker 1 Moderator:
Dr. Chong Mei Chan RR Dian T,
University of Malaya S.Kep., Ns.,
“Geriatric Nursing Care: Trends and Issues” M.Kep
10.20–10.40 Speaker 2
Ya-Ping Yang, Ph.D Notulen:
Kaohsiung Medical University Sylvia Dwi
“Alternative therapies for People with Dementia” Wahyuni Kahuripan 300
10.40 – 11.10 Speaker 3 Management
Dr. Joni Haryanto, S.Kp., M.Si Operator: Building,
Universitas Airlangga Candra Panji A Unair Kampus
“Spiritual Ceki Card Game to Increase Cognitive C
Function and Reduction of Frontotemporal
Dementia Symptoms on Elderly”
11.10 – 11.30 Plenary Discussion
Certificate Conferment Chairman/Vice
Dean
11.30 – 12.30 Poster Presentation 1 Committee
Lunch Break Committee
Plenary Session II
12.30 – 12.50 Speaker 4 Moderator: Kahuripan 300
xiii
TIME ACTIVITY VENUE
Pauline Hill, RN, Dipp.App.Sc(Nsg), BN(Ed), Ika Nur Pratiwi, Management
MEd(St), PhD S.Kep., Ns., Build,
Flinders University M.Kep Unair Kampus
“Practice Development: Supporting Students at C
The Bed Side” Notulen:
12.50 – 13.10 Speaker 5 Iqlima Dwi K
Sonia Reisenhofer, RN, BN, Postgrad Dip,
(Emergency Nursing), MCN Operator:
La Trobe University Deni Yasmara
“Mental Health & Gender Issues: Trends in
Research and Practice”
13.10 – 13.30 Speaker 6
Dr. Esty Yunitasari, S.Kp., M.Kes
“Optimization of Family Support in Improving
Resilience of Cervical Cancer Client Post Radical
Hysterectomy+Bilateral Salpingooophorectomy
which is Getting Chemotherapy”
13.30 – 13.50 Speaker 7
Dr. Sestu Retno DA, S.Kp., M.Kes.
Stikes Pemkab Jombang
“Role Provider in Increasing Early Initiation of
Breastfeeding Coverage to Mother Post Sectio
Cesarea in Indonesia”
13.50 – 14.30 Plenary Discussion Moderator
Certificate Conferment Vice Dean
14.30 – 15.00 Coffee Break and Prayer Committee
Plenary Session III
15.00 – 15.20 Speaker 8 Moderator:
Proffesor Eileen Savage BNS., MSc, PhD. Setho Hadi S,
University College Cork, Irlandia S.Kep., Ns.,
“Enabling Primary Care Services toward M.NS
Integrated Care for Chronic Disease Prevention (CommHlth&PC
and Management” )
15.20 – 15.35 Speaker 9
Ferry Effendi, S.Kep., Ns., M.Sc., PhD. Notulen:
Universitas Airlangga Lailatun Ni’mah
“Indonesian Nurses Migration under Bilateral
Agreement: Policy Issues and Responses” Operator:
15.35 – 15.50 Speaker 10 Candra Panji A
Dr. Siti Nur Kholifah, M.Kep., Sp.Kom.
Poltekes Kemenkes Surabaya
“Interpersonal Interaction with Family-Nurse in
Improving The Performance of Public Health
Nurse”
15.50 – 16.05 Speaker 11
Eva Agustina Yalestyorini, S.Kep., Ns., M.Kep
STIKES Surya Mitra Husada
xiv
TIME ACTIVITY VENUE
“Relationship between Dietary Habits and
Menstrual Pattern with Anemia of Adolescent”
16.30 – 16.45 Closing Day 1 MC
DAY 2, SUNDAY 9th April 2017

TIME ACTIVITY VENUE
07.00 – 08.00 Open Registration Committee Kahuripan 300
08.00 – 08.30 Opening Ceremony : NEVO Choir MC Management
Performance (Gebyar-Gebyar & Heal the Word) Nadia & Hakim Build,
NEVO Unair Kampus C
Plenary Session IV
Bill Mc.Guiness, RN, Dip T, B Ed, MNS, Ph.D, Ira Suarilah,
FAWMA S.Kep., Ns.,
La Trobe University M.Sc
“Pressure Ulcer Updates”
08.45 – 09.00 Speaker 13 Notulen:
Prof. Dr. Nursalam, M.Nurs (Hons) Lingga Curnia
Universitas Airlangga Dewi
“Family Experience In Caring For HIV Positive-
Indonesian Migrant Workers: A Operator:
Phenomenological Study” RR Dian T Kahuripan 300
09.00 – 09.15 Speaker 14 Management
Ninuk Dian Kurniawati, S.Kep., Ns., MANP Building,
Universitas Airlangga Unair Kampus C
“Mind-Body-Spiritual Nursing Care in Intensive
Care Unit”
09.15 – 09.30 Speaker 15
Dr. Kusnanto, S.Kp., M.Kes
“The Effect of Implementation of Theory of
Reasoned Action against Clients with Type 2
Diabetic Mellitus Diet Adherence and Physical
Activity”
10.00 – 10.15 Coffee Break Committee
Plenary Session V
Dr. Linda Sweet Tiyas
Kahuripan 300
Flinders University Kusumaningrum,
Management
“Enhancing Clinical Learning- Before, During, S.Kep., Ns.,
Building,
After” M.Kep
Unair Kampus C
10.40 – 11.00 Speaker 17
Dr. Kristen Graham Notulen:
xv
TIME ACTIVITY VENUE
Flinders University Aria Aulia N
“Using Simulation to Enhance Student
Learning” Operator:
11.00 – 11.30 Plenary Discussion RR Dian T

11.30 – 12.00 Doorprize Session I MC
12.00 – 13.00 Lunch Break Committee
13.00 – 14.00 Oral Presentation 1 (30 oral) Committee Kahuripan Room
16.00 – 16.30 Doorprize Session 2 + announce best oral and MC Kahuripan Room
poster presentator
16.30 – 17.00 Closing Remark MC Kahuripan Room
300
xvi
PAIN ASSESSMENT OF CRITICAL PAIN OBSERVATION TOOL FOR
MECHANICALLY VENTILATED ADULTS IN ICU: A SYSTEMATIC REVIEW
Nur Hidayati, Yani Erniyawati, Senja Setiaka

Faculty of Nursing, Universitas Airlangga
Email: deyyacutez@gmail.com
ABSTRACT
Introduction: Critical care pain observation tool (CPOT) is one of the behavior pain scale
frequently used to detect pain in a critical patients with non verbal method. Objectives: To
assess validity, specificity, and sensitivity of CPOT in detecting pain to critical adult patients
in ICU unable to communicate his pain. Method: Article searching from database; Google
scholar, Ebscho, ScienceDirect, Elseiver, Medline, CINAHL, SpingerLink, and Proquest
ranging from 2006 to 2016. Results: There are 16 reviewed international journals; 11 articles
dealing with CPOT, 3 CPOT & BPS articles, 1 CPOT & NVPS-R article, and 1 CPOT &
FLACC & PINR article. Conclusions: This systematic review is less strong to recommend the
use of CPOT universally. However, in general CPOT can be used to measure pain scale in
mechanically ventilated adult patients in ICU either conscious or unconscious. Further study is
needed by using RCT and more accurate criteria for validity.
Keywords: critical-care pain observation tool, critically ill adults, intensive care unit
INTRODUCTION et.al., 2016). Assessment of pain in

Critically ill patients frequently critically ill patients on intubation and
complain of pain and being in an sedation who are unable to communicate
uncomfortable state during their care in their needs verbally is still a challenge.
ICU. Approximately 50% of patients Unfortunately, measurement of acute pain
complain of pain ranging from moderate to is frequently inaccurate, so management to
severe, either during rest or routine relieve pain is also inadequate. No pain
procedures (Rijkenberg, et.al., 2015). The assessment tools universally accepted are
pain is caused by a number of factors; used in all intensive care units (Linde, et.al.,
pathological conditions, surgical 2013). Therefore more accurate pain
procedures, medical procedures, and assessment tools are needed and the validity
nursing interventions such as; repositioning and reliability must be tested. CPOT is
and suctioning (Varquez, et.al., 2011). Pain observational rating scale designed by
is subjective. Self report is the main Gellinas, et.al. (2006) to measure pain in
standard used to assess pain, but self report patients treated in ICU unable to
cannot be readily obtained (Bourbonnais, communicate it verbally. CPOT has 4
et.al., 2016). Many patients treated in ICU indicators; facial expression, body
find it difficult to verbalize the pain because movement, muscle tension, and compliance
they are mechanically ventilated, are with ventilator (for intubated patients) or
sedated/ under analgesia, or suffer from vocalization (for extubated patients).
altered LOC (Stites, 2013). Inadequate pain CPOT is used due to limitation of tool
management can result in impaired behavioral pain assessment (BPS & the post
physiological and psychological condition anesthesia care unit behavioral pain rating
such as unstable hemodynamic and scale) in which BPS consist of 3
delirium (Li, et.al., 2014). components; facial expression, upper limb
Assessment is the first important movement, and compliance with
stage in pain management (Bourbonnais, ventilation, while in CPOT muscle tension
1
category is added both BPS and CPOT are FLACC, PINR, NVPS-R, and sensitivity
used to assessed body movement, but outcomes and specificity of using CPOT in
additional muscle tension needs peer measuring pain scale. The searching
evaluation (Linde, et.al., 2013). obtained 37 full text articles subsequently
The Objectives of this paper is to strickly selected. It then produced 16
review validity, specificity, and sensitivity journals articles which were critically
of CPOT in measuring pain scale in reviewed.
critically ill adult patients in ICU on
ventilator either conscious or unconscious, Study Selection Criteria
intubated or nonintubated. The articles are confined to the use
of CPOT in critically ill adults treated in
METHOD ICU published in English in the past 10
Literature Search years (2006-2016). The article searching is
A systematic review was initiated not specified on certain designs due to the
with article search in electronic databases lack of available study. From 16 articles, 11
including Google Scholar, Ebsco, articles measured CPOT, 3 articles
ScienceDirect, Elseiver, Medline, compared CPOT & BPS, 1 article compared
CINAHL, SpingerLink and ProQuest. The CPOT & NVPS-R, and 1 article compared
PICO framework was used including CPOT & FLACC & PINR. The selected
critically ill adult population, critical care sample was patients treated in ICU. Study
pain observation tool intervention, on medical files and or nurses were
compared with behavioral pain scale (BPS, excluded.
Search electronic database: Google Scholar, Ebscho, ScienceDirect, Medline,

CINAHL, Elseiver, SpingerLink, & ProQuest (2006 – 2016)
Keywords:
critical-care pain
observation tool,
critically ill adults,
intensive care unit
Eligible articles
(n = 37)
full text articles
excludes, with
Full text article
reasons
included
(n = 21)
(n = 16)
Figure 1. Search algorithm
Level Of Evidence
The strength of the study is measured based
on level of evidence Wood & Haber (2010)
divided into 7 levels.
2
exposure), during turning (exposure), and
20 minutes after (post exposure). The
patient’s self – report of pain was taken
while the patients were on intubation and
extubation. The result reveal that pre
exposure CPOT has 47.2% sensitivity and
82.9% specificity; exposure 86%
sensitivity, 78 % specificity, and 84.5%
accuracy; while post exposure sensitivity
and specificity is 63% and 97.4%
respectively.
Varquez, et.al. (2011) used
prospective descriptive study to compare
Figure 2. Level of Evidence based on CPOT with patients’ physiological
Wood & Haber (2010) responses before, during, and post
repositioning on 96 critically ill patients
RESULTS which included medical cases (21) and
Study Design surgical cases (75). The measurement
Articles reviewed include; 2 revealed facial expression is an indicator
observational – prospective study, 1 which significantly increased compared
prospective observational cohort, 2 with baseline condition (without stimuli),
descriptive-correlational design, 1 non followed by body movement, compliance
randomized prospective study, 7 repeated with ventilator, and muscle tension. Total
measures design, and 3 descriptive design. mean in CPOT during turning on surgical
According to the level of evidence, 16 patients = 2.02, medical patients = 1.80.
articles are in 4-6 levels from 7 level of CPOT cutoff score > 3 with sensitivity =
evidence, level 4 (12 articles) & level 6 (4 66.7% and specificity = 83.3%
articles). Li, et.al. (2014) used repeated –
measures design on 63 conscious and
Characteristic of Participant ventilated critically ill patients able to hear
Studies reviewed were derived from and understand Chinese and who were
7 countries; Canada (7 studies), Korea (1 stable. Pain scale measurement with CPOT
study), China (2 studies), Spain (1 study), was done during rest, pre and post turning
USA (3 studies), Netherland (1 study), and and NIBP. The results revealed CPOT cut
Italy (1 study). All studies were carried out off score (> 2) with 80.8 – 89.4% sensitivity
in critically ill adults (age ≥16 years old and and 73.3 – 81.8 % specificity.
≥18 years old) including; General ICU (all Joffe, et.al. (2016) used repeated
cases), Cardiac ICU (Cardiac surgery), measures within subject prospective design
Medical ICU, Neurosciences ICU (Brain to measure reliability and validity CPOT on
injury, stroke, aneurysm, & TBI), and 79 critically ill patients with brain injury
Neurosurgical ICU (traumatic or (stroke, aneurysm, tumor, TBI, etc).
neurosurgery, vascular, brain surgery). Measurement was done pre & post 2
procedures (non painful/ gentle touch &
Sensitivity and Specificity painful procedure/ turning). Self report of
Gelinas, et.al. (2009) used repeated pain was obtained by having the patients
– measure design to evaluate sensitivity & give verbal affirmation (Yes/No) or nod by
specificity CPOT on 105 intubated using Faces Pain Thermometer scale 0-10.
critically ill patients post cardiac surgery Measurement reveals CPOT cut off score =
able to hear and see. Pain scale 2 with 90% sensitivity and 67% sensitivity.
measurement was done during rest (pre
3
Severgnini, et.al. (2016) used observational because it also increase during nonpainful
– prospective study on 101 critically ill procedure (Rijkenberg, et.al., 2014).
patients conscious ventilated patients (41),
unconscious ventilated patients (60). This Criterion validity
study measured pain by using CPOT & BPS There is a significant relationship
1 minute before, during, and 20 minutes between patient’s self-report of pain and
after procedures (turning, suctioning, CPOT score; in patient’s self-report pain
medications, repositioning, & catheter CPOT score is 1.62 – 3.65; in patient’s
management). The measurement revealed denying pain CPOT score is 0.49-2.11. In
that BPS was more specific (91.7%) than addition, there is moderate positive
CPOT (70.8%), but BPS was less sensitive correlation between self – report of pain and
(62.7%) compared with CPOT (76.5%). CPOT during turning (0.64, rs=0.48, p
Combination of both tools produced better <0.01) (Gelinas, et.al., 2006; Gelinas, 2009;
sensitivity value (80.4%). Benites, et.al., 2014; Severgnini, et.al.,
It concluded that specificity of 2016; & Joffe, et.al., 2016).
CPOT during the painful procedure was Criterion validity between CPOT &
between 67 – 97.4% and sensitifity 66.7 - FLACC is 0.87-0.92, but FLACC is less
90 %. While BPS revealed 91.7% appropriately used on ill adults (Buttes,
specificity and 62.7% sensitivity. et.al., 2014). Criterion validity of CPOT &
Sensitivity of CPOT was lower during the NVPS-R is significantly higher during
pre exposure (47.2%) and post exposure turning than NIBP (CPOT p=0.019, NVPS-
63%, but it had higher specificity than pre R p=0.025), but NVPS-R has weaker inter-
exposure 82.9% & post exposure 97.4% rater & concurrent validity than CPOT
(Gelinas, et.al., 2006). (Vranic, et.al., 2013). CPOT & PINR have
lower correlation (0.50-0.69) than CPOT &
Validity BPS (r=0.951) (Liu & Herr, 2015).
Discriminant validity
Score of CPOT during nociceptive DISCUSSION
procedure (mean score=1.93, SD 1.41) is This review shows that CPOT score
higher than non nociceptive procedure increased during painful procedure and
(mean score 0.27, SD 0.64) or (t= -9.01 to – immediately decreased within short time
15.96, p< 0.001) (Gelinas, et.al., 2006; (about 10-20 minutes) (Rijkenberg, et.al.,
Varquez, et.al., 2011; & Benites, et.al., 2015). It became the basis that CPOT
2014). There was no significant difference increases during painful procedure and it is
of discriminant validation of CPOT before assumed that the change of score results
and after gentle touch (Wilcoxon = - 1.00, from manipulation turning or ETT/TT
p=0.32), but the score is higher during suctioning procedure increases pain while
turning than preturning (Wilcoxon= -7.06, rest, oral care, gentle touch, NIBP
p<0.01) (Joffe, et.al., 2016). measurement are less painful procedure
This review shows that CPOT and (Severgnini, et.al., 2016).
BPS are both reliable and valid with good CPOT is used on mechanically
criterion and discriminant validity to ventilated patients conscious or
measure pain on either intubated or non unconscious that are unable to
intubated patients supported by criterion communicate their pain without
validity score of BPS is rs=0.56, p<0.0001 neuromuscular disorder. According to
and Spearman correlation of CPOT and Severgnini, et.al. (2016) CPOT is more
BPS (r=0.951, p<0.001) (Liu & Herr, 2015 complete than BPS because muscular
& Severgnini, et.al., 2016). However, movement of arms and legs are not
discriminant validation of BPS is less strong measured in BPS. Facial expression and
ventilator compliance are measured in both
4
tools. CPOT is more sensitive than BPS, but be used in ICU viewed from sensitivity,
is less specific than BPS. According to Liu validity, and nurses’ recommendation as
& Herr (2015) both CPOT and BPS are long as no more accurate tool is invented.
valid and reliable to measure pain on
intubated or non intubated patients because Limitations
CPOT and BPS increased significantly This systematic review is within
during painful procedure, in which both level 5 to 7 level of evidence with most
have strong correlation (Spearman articles (n=16) reviewed within level 4-6. it
correlation analysis r=0.951, p<0.001). is therefore, less stronger to refer to. The
CPOT & BPS significantly increased as study sample sizes of 23 – 257 critically ill
well (2 digits) between rest and turning adults (11 studies n<100 & 5 studies n>100)
(Rijkenberg, et.al., 2014). CPOT & BPS without randomising is considered not
shows good criterion validity (BPS rs=0.56, strong therefore cannot be generalized.
p<0.0001; CPOT rs=0.48, p<0.0001). CPOT measurement is subjective to
Severgnini, et.al. (2016) found that operator (nurses) and is not objective
combination of CPOT & BPS procedures (Severgnini, et.al., 2016). The ability of
better sensitivity (80.4%) in measuring nurses in understanding the measuring
pain. technique and how to determine the score
Although CPOT has lower affects CPOT score. Therefore, the need
specificity than BPS (Severgnini, et.al., training about CPOT before being applied
2016), CPOT is more reliable than other (Linde, et.al., 2013). Muscle tension cannot
tools. Discriminant validation of BPS is less be measured on patients physically unable
supportive because score also increased to respond such as quadriplegia, paraplegia,
during nonpainful procedure (Rijkenberg, or neuromuscular disorder (Stites, 2013).
et.al., 2014). FLACC is less appropriately Delirium condition can be a confounding
used in adults, this tool is more appropiately factor resulting in bias of CPOT results
used in infants (Stites, 2013 & Buttes, et.al., (Rijkenberg, et.al., 2015). Specificity of
2014). CPOT & NVPS-R increased during CPOT during painful procedure is lower
turning instead of NIBP, but the inter-rater than during nonpainful procedure
and concurrent validity is weaker than (Severgnini, et.al., 2016).
CPOT (Vranic, et.al., 2013). CPOT & PINR
have lower correlation (0.50-0.69) than CONCLUSIONS
other tools (Buttes, et.al., 2014). In general, CPOT can be used to
Regarding criterion validity, CPOT measure pain on mechanically ventilated ill
has moderate positive correlation with adults (conscious or unconscious) in ICU
patient’s self – report of pain during turning for all cases. CPOT has positive correlation
(0.64, p<0.01) in which CPOT score during with self reported pain, is more sensitive
patient’s reporting pain 1.62-3.65 and than other tools, but less specific than BPS.
patient’s denying pain 0.49-2.11 (Gelinas, This systematic review is not strong enough
2006; Gellinas & Arbour, 2009; Benites, to recommend the universal use of CPOT.
et.a., 2014; & Joffe, et.al., 2016). From However, CPOT is still recommended to be
nurses’ point of view, >90% nurses support used in ICU as long as no better tool is
the use of CPOT due to its clarity, available. There is a need for further
understand ability, and easiness to fill in. research with high quality RCT and a more
More than 70% nurses agree that CPOT is objective and accurate validity standard.
helpful in nursing clinical practice and is
recommended to be routinely used (Gelinas, REFERENCES
2010). CPOT can be measured within short Benites, C.E., Kapoustina, O., & Gelinas.
time and need minimum training (Linde, C. (2014). Validation of the Use Of
et.al., 2013). CPOT is still recommended to The Critical – Care Pain
5
Observation Tool (CPOT) with Injured Critically Ill Adults. Journal
Brain Surgery Patients in The Of Critical Care, 36, pp. 76-80.
Neurosurgical Intensive Care Unit. Lee, K., HyunSoo, Suh, Y., & Seo, W.
Intensive And Critical Care (2013). Patterns and Clinical
Nursing, 30, 257-265. Correlates of Pain Among Brain
Bourbonnais, F.F., Tucker, S.M., & Injury Patients in Critical Care
Kischel, D. (2016). Intensive Care Assessed With the Critical Care
Nurses’ Assessment Of Pain In Pain Observation Tool. Pain
Patients Who Are Mechanically Management Nursing, 14 (4), pp.
Ventilated: How a Pilot Study 259-267.
Helped to Influence Practice. The Li, Q., Wan, X., Gu, C., Yu, Y., Huang, W.,
Canadian Journal Of Critical Care Li, S., & Zhang, Y. (2014). Pain
Nursing, 27 (3), 24-29. Assessment Using The Critical –
Buttes, P., Keal, G., Cronin, S.N., Stocks, Care Pain Observation Tool in
L., & Stout, C. (2014). Validation Chinese Critically Ill Ventilated
Of The Critical – Care Pain Adults. Journal Of Pain and
Observation Tool In Adult Critically Symptom Management, 48(5), pp.
Ill Patients. Dimensions Of Critical 975-982.
Care Nursing, 33(2), 78-81. Linde, S.M., Badger, J.M., Machan, J.T.,
Gelinas, C., et.al. (2006). Validation of The Beaudry J., Brucker, A., Martin, K.,
Critical-Care Pain Observation Tool Opaluch-Bushy, N.B., & Navedo
in Adult Patients. American Journal Roy, R.D. (2013). Reevaluation of
of Critical Care, 15(4), 420-427. The Critical-Care Pain Observation
Gelinas, Celine. (2010). Nurse’s Tool in Intubated Adults After
Evaluations of The Feasibility and Cardiac Surgery. American Journal
The Clinical Utility Of The Critical- Of Critical Care, 22(6), pp. 491-
Care Pain Observation Tool. Pain 497.
Management Nursing, 11(2), 115- Liu, Y., & Herr, K. (2015). Evaluation Of
125. Two Observational Pain
Gelinas, C. & Arbour, C. (2009). Assessment Tools in Chinese
Behavioral and Physiologic Critically Ill Patients. Pain
Indicators During a Nociceptive Medicine, 16, pp. 1622-1628.
Procedure in Conscious and Rijkenberg, S., Stilma, W., Endeman, H.,
Unconscious Mechanically Bosman, R.J., & Oudemans-van S.,
Ventilated Adults: Similar or H.M. (2015). Pain Measurement in
Different?. Journal Of Critical Mechanically Ventilated Critically
Care, 24(4), p.628.e7-628e17. Ill Patients: Behavioral Pain Scale
Gelinas, C., Harel, F., Fillion, L., Puntillo, Versus Critical – Care Pain
K.A., & Johnston, C.C. (2009). Observation Tool. Journal Of
Sensitivity and Specificity of The Critical Care, 30(1), pp. 167-172.
Critical-Care Pain Observation Tool Severgnini, P., Pelosi, P., Contino, E.,
For The Detection of Pain in Serafinelli, E., Novario, R., &
Intubated Adults After Cardiac Chiaranda, M. (2016). Accuracy Of
Surgery. Journal of Pain and Critical Care Pain Observation Tool
Symptom Management, 37(1), 58- and Behavioral Pain Scale To
67. Assess Pain In critically Ill
Joffe, A.M., McNulty, B., Boitor, M., Conscious and Unconscious
Marsh, R., & Gelinas, C. (2016). Patients: Prospective, Observational
Validation of The Critical – Care Study. Journal Of Intensive Care,
Pain Observation Tool in Brain- 4(68), 2-8.
6
Stites, Mindy. (2013). Observational Pain A., & Canzian, S. (2013). Validation
Scales in Critically Ill Adults. and Evaluation of Two
Critical Care Nurses, 33(3), 68-78. Observational Pain Assessment
Varquez, M., Pardavila, M.I., Lucia, M., Tools in a Trauma and
Aguado, Y., Margall, M.A., & Neurosurgical Intensive Care Unit.
Asiain M.C. (2011). Pain Pain Res Manag, 18(6), e107-e114.
Assessment In Turning Procedures Wood, G. L. & Haber, Judith. (2010).
for Patients With Invasive Nursing Research – Methods and
Mechanical Ventilation. Nursing in Critical Appraisal for Evidence-
Critical Care, 16(4), 178-185. Based Practice. 7th ed. Elseiver.
Vranic, J.T., Gelinas, C., Li, Y., Pollmann- China.
Mudryj, M.A., Innis, J., McFarlan,
7
DOMINANT FACTORS AFFECTING NURSE PERFORMANCE IN GENERAL
WARDS: A SYSTEMATIC REVIEW
Achmad Masfi, Aulia Rahman, Sarifudin

Faculty of Nursing Universitas Airlangga
Email: auliarahmanfattan@gmail.com
ABSTRACT
Introduction: The main problem of nurse performance in nursing services is the lack of highly
educated nurses, inadequate capacity, many nurses were rude (less friendly to the patient). The
purpose of this study was to determine the dominant factors affecting nurse performance in
general wards. Methods:This study was used a systematic review design. A literature search
conducted through several major databases such as ProQuest, ScienceDirect, Eldoxea, Medline,
and Google Scholar by entering keywords Nurse Performance, Job Satisfaction of Nurse,
Factors Effecting Performance of Nurse. Researcher found only 15 articles with a sample of
study were 2017 nurses in general wards of hospital. The inclusion criteria was 1) Case Control
/Cross Sectional design 2) Sampling taken with random sampling technique 3) Non Experiment
4) The number of samples > 50 respondents. Results: The result showed from the 15 articles,
there are three factors that are often used by researcher as a variable to determine the factors
affecting nurse performance in general wards of hospital namely motivation as much as 7
researchs, salary as much as 6 research, leadership as much as 5 research. These factors become
dominant factors in this study to determine the effect on the nurse performance in general wards
of hospital.
Keywords: Nurse Performance, Job Satisfaction, Performance
INTRODUCTION educational factors affecting nurse

The main problem of nurse performance.
performance in nursing services is the lack According to Jeles (2009) nurse
of highly educated nurses, inadequate performance is an act done by a nurse within
capacity, many nurses were rude and less an organization according to their authority
friendly to the patient. The problems were and responsibilities, not violate the laws,
not just about the attitude to the patient, but rules and norms and ethics, which is a good
also the high rates of nursing workload, performance will give satisfaction to the
unclear rules and regulations of the nurse service user. The activities of a nurse is to
(Aditama, 2003). Consumers still feel a lot collect data about the health of the patient
of deficiencies from nurse performance, (assessment), make a diagnosis according to
such as competitiveness and competency the science of nursing, set nursing goals,
that can not meet the demand for healthcare implement nursing actions and evaluation.
services (Department of Health RI, 2001 in Many researchers doing research about the
Sasono, 2016). factors affecting nurse performance with
The previous study showed the different variables and results. Their
differences in the results of the factors research has many differences from sample
affecting nurse performance. Mulyaningsih size and place of research is influenced by
(2013) in her research showed the various factors.
demographic and educational factors did Based on the background above,
not affect nurse performance, while researcher conducted a systematic review
Rahmatina, et al. (2015) and Nurbaya research about " Dominant Factors
(2012) in their study mentioned that
8
Affecting Nurse Performance in General incentives (0,037) to the improved nurse
Wards”. performance (Nurbaya, 2012). Sasono, et al.
(2015) mentioned that one of demographic
METHODS factors such as age has an influence on the
Systematic review is one of the nurse performance.
research methods that use a review, study,
structured evaluation, classifying and Identification of factors affecting nurse
categorizing of evidence based had done performance in general wards of hospital
before. The steps and strategies for the There was 15 articles has been
systematic review were highly planned and chosen as a sample of research and 53
structured so that this method is different variable found as the factors affecting nurse
from the methods which just used to show performance. Researchers only used 27
the literature study (Tutik, 2013). variables as the factors affecting nurse
A literature search conducted performance in general wards of hospital
through several major databases such as namely 1) motivation, 2) supervision, 3)
ProQuest, ScienceDirect, Eldoxea, awards, 4) competency, 5) Adversity
Medline, and Google Scholar by entering Quotient (AQ), 6) Quality Management
keywords Nurse Performance, Job (TQM) , 7) training, 8) education, 9) age,
Satisfaction of Nurse, Factors Effecting 10) gender, 11) working period, 12) job
Performance of Nurse. Data were collected satisfaction, 13) leadership, 14) work
at Airlangga University in Surabaya and culture, 15) career development, 16)
1254 articles have been found. Then the compensation, 17) salary, 18) discipline,
number of the article is minimized by the 19) workloads, 20) intensive, 21) facilities,
year 2012 - 2016. This aims to maintain the 22) nurse status, 23) type of hospital, 24)
currency of writing based on the latest experience, 25) time management, 26)
research results, found 567 articles by sociodemographic, 27) environment.
researcher. Researcher found only 15
articles with a sample of study were 2017 Identification of dominant factors
nurses in general wards of hospital. The affecting nurse performance in general
inclusion criteria was 1) Case Control wards of hospital
/Cross Sectional design 2) Sampling taken Researcher analyzed the dominant
with random sampling technique 3) Non factors affecting nurse performance in
Experiment 4) The number of samples > 50 general wards of hospital from 27 existing
respondents. variables. Researcher identify, classify
The result showed from the 15 same variable, and analyze the factors
articles, there are three factors that are often which is more used from 15 samples in
used by researcher as a variable to order to examining the factors affecting
determine the factors affecting nurse nurse performance in general wards of
performance. The purpose of this study was hospital (Table 3).
to determine and analyze the dominant Table 3 shows from 15 studies,
factors affecting nurse performance in variables which is significant with the nurse
general wards of hospital. performance in general wards of hospital
were 40 variables. Researchers conducted
RESULTS AND DISCUSSION the identification and clustering the same
Statistical analysis showed nurse variables and 19 variables was found: 1)
performance were not good by 37.6%. motivation, 2) supervision, 3) awards, 4)
Bivariate analysis showed a significant Adversity Quotient (AQ), 5) leadership, 6)
relationship between the reward factor (p = training, 7) education, 8) job satisfaction, 9)
0.000), leadership (p = 0.000), education work culture, 10) career development, 11)
and training (p = 0.037) and the providing discipline, working period, 12) workloads,
9
13) facilities, 14) nurse status, 15) age, 16) Motivation could push a nurse to
time management 17) experience, 18) behave according to the goals that would be
environment, 19) job satisfaction. achieved. Motivation can also make a nurse
Analysis showed from 15 articles, to predict the behavior of what have to do in
there was three factors are often used by the future. In this case the behavior of the
researchers as variable to determine the nurses will either come from that nurse with
factors affecting nurse performance in good motivation. So if a nurse has a good
general wards of hospital namely motivation to achieve its goals, their
motivation as much as 7 researchs, salary performance will increase. Thus, the more
as much as 6 researchs, leadership as much motivation of individual nurses increase,
as 5 researchs. . These factors become the more nurse performance of individuals,
dominant factors in this study to determine groups and the hospital improve.
the effect on the nurse performance in
general wards of hospital. Salary/incentive factor
There was 6 of 15 articles that use
Motivation factor salary as a factor affecting nurse
There was 7 of 15 articles that use performance in general wards of hospital.
motivation as a factor affecting nurse Those article include article from Surya
performance in general wards of hospital. Darma Putra, et al (2014), Nurbayak, et al
Those articles include article from Fergie (2012), Inriyani Mathius, et al (2014),
Mandagi M., et al (2015), Endah main Sasono Mardiono, et al ( 2015), Nebiat
Woro, et al (2013), Sri Sugiyanti (2013), Negussie, et al (2013), Agezegn Asegid, et
Inriyani Matthew, et al (2014), Sasono al (2015).
Mardiono, et al (2015), Tesfaye (2015), Salary is one of the factors which
Agezegn Asegid, et al (2015). can affect the nurse performance in general
Motivation affects nurse wards of hospital. this is consistent with
performance in general wards of hospital, research by Lande (2006), which showed
this is consistent with research by that the relationship between incentive and
Indrawaty and Rattu (2012) which nurse performance when performing
mentioned that there was a significant nursing care in general wards. There was so
relationship between motivation and nurse many nurses in general wards of Elim
performance in Irina general wards of Rantepao Toraja Hospital are not satisfied
Binangkang Datoe Kotamobagu City with their incentive which related to their
Hospital. Mahendra and Brahmasari (2015) poor performance in performing nursing
in their research also mentined that there care.
was a significant relationship between work Similarly with research by Sitohang
motivation and nurse performance in the (2006) which mentioned that the low
general wards of Menur Psychiatric performance of nurses to do works it is
Hospital Surabaya. Research by because of low incentives earned. It can be
Muttaqillah, et al (2015) mentioned that the seen from the nurses who always think to
motivation from nurses to BLUD RSJA get another job outside the hospital.
have a positive effect in improving nurse Emerging paradigm is the incentive will
performance. automatically be always accompanied by
Motivation in the workplace can be the increase in productivity/ performance.
defined as an individual's degree of Incentive or salary is one of the factors that
willingness to exert and maintain effort affect the level of performance, and there
towards organizational goals. Work are other factors may also affect
motivation is an internal process and person performance such as conducive
receive certain stimuli from the environment (attitude and behavior of
environment (Bennetts, et al 1999). supervisor) and the environmental
10
characteristics of nurse organization in the the work productivity of organization
work can also solve the problem and members although there are leader
management policies (Muhammad, 2003). commitments that states are less good, but
A good salary is a system that is able to the fact remains significantly affect the
ensure the satisfaction of the organization performance of nurses. Thus, if the pattern
members. An organization acquire, of leadership in improving performance are
maintain and employ a number of people less or no good, then the performance will
with a positive attitude and behavior, and decrease because leadership is a key in
also those people work productively for the determining the employee performance,
benefit of the organization. If the including the nurse performance in general
organization members was not satisfied wards of hospital.
with their compensation, the impact on the
organization will be very negative. This CONCLUSION
means that if these grievances are not Factors that are often used by
resolved properly, it is natural that the researchers to determine the effect of the
organization member want more incentive. nurse performance can be divided into
There was 5 of 15 articles that use internal and external factors. Internal
leadership as a factor affecting nurse factors including age, gender, education,
performance in general wards of hospital. experience, time management skills, and
Those article include article from Sri discipline. While external factors including
Sugiyanti (2013), Rahmatina Aulia, et al motivation, leadership, salary, training,
(2014), Nurbayak, et al (2012), Sasono facilities, nurse status, workload, Adversity
Mardiono, et al (2015) , Agezegn Asegid, et Quotient (AQ), and environment. The
al (2015). dominant factor affecting nurse
Leadership is a factor affecting performance nurses in general wards of
nurse performance in general wards of hospital are external factors such as
hospital. This is consistent with research by motivation, salary, and leadership.
Ermina Rusilawati (2009) which concluded
that the factors affecting the employee REFERENCE
perfomance at zainab Women and Adhar Arifuddin, dkk. Hubungan Disiplin
Children's Hospital Pekanbaru, one of the dan Beban Kerja terhadap Kinerja
variable is leadership, with coefficient value Perawat di Rawat Inap RSUD
0. 390. It means leadership positively Undata Palu. Healthy Tadulako
affects employee performance. The results Journal. Di akses tanggal 10
of this study consistent with Andreas’s oktober jam 20.00
opinion (2005: 15) which explains that in Aditama, 2003, Administrasi rumah sakit,
the literature of management and Jakarta, Penerbit. Salemba
organization, organizational culture and Agezegn Asegid,dkk. Factors Influencing
leadership is seen as the two main variables Job Satifaction and Anticipated
that affecting both the poor and the good Turnover Among Nurse in Sidema
performance of employees. Strong and Zone Public Health Facilities, South
adaptive organizational culture and also Ethiopia. Hindawi Publishing
transformational leadership are two key Corporation Nursing Research and
variables which related to determine the Practice Volume 2014. Di akses
level of employee performance. Both of this tanggal 10 oktober jam 20.00
evidence showed the influence of leadership Bennett,S and Franco LM, Public Health
on employee performance improvement. Worker Motivation and Health
Organizational commitment is a situation Sectoreform: A.Conceptual
where an employee in favor of an Framewprk. Major Apllied
organization policies which aim to maintain Research 5, Technical Paper 1.
11
Bethesda, MD: Partnership for Yogyakarta,
Health Reform Project, Abt http://wwwlarde,roket,mail 3 mei
Associates Inc. January 1999 2002
Endah Woro utama,dkk. Pengaruh Matthew,dkk. Understanding Clinnical
Adversity Quotient terhadap Expertise: Nurse Education,
Kinerja Perawat dengan Motivasi Experience, and The Hospital
Kerja sebagai Variabel Mediasi Context. Published in final edited
(Studi di RSUD ”Ngudi Waluyo” form as:Res Nurs Health. 2010
Wlingi). Jurnal Aplikasi August ; 33(4): 276–287.
Manajemen Vol.11 Nomor 11 maret doi:10.1002/nur.20388. Di akses
2013. Di akses tanggal 10 oktober tanggal 10 oktober jam 20.00
jam 20.00 Mulyaningsih. Peningkatan Kinerja
Finasari, Dian Maya. Pengaruh Penerapan Perawat dalam Penerapan MAKP
Konsep Total Quality Management dengan Supervisi oleh Kepala
(TQM), KepuasanKerja dan Rungan di RSJD Surakarta.
Disiplin Kerja Terhadap Kinerja GASTER Vol. 10 No. 1 Februari
Karyawan Pada PT. Sampoerna 2013. Di akses tanggal 10 oktober
Printpack Sukoharjo, Benefit, Vol 9 jam 20.00
No. 3, 2006 Mulyono,2013. Faktor-faktor yang
Fergie M. Mandagi, dkk. Analisa Faktor – Berpengaruh terhadap Kinerja
faktor yang berhubungan dengan Pperawat di Rumah Sakit Tingkat
Kinerja Perawat dalam penerapan III Ambon, Jurnal AKK, Universitas
Asuhan Keperawatan di RSUD Makasar
Bethesda GMIM Tomohon. Jurnal Muttaqillah, Lubis AR, Majid
e-Biomedik (eBm), Volume 3, MSA.Pengaruh Stress Kerja dan
Nomor 3, September-Desember Motivasi Kerja terhadap Kinerja
2015. Di akses tanggal 10 oktober Perawat Serta Implikasinya pada
jam 20.00 Kinerja Badan Layanan Umum
Hariyanti, Tutik Sri.2013. Mengenal Daerah Rumah Sakit Jiwa (BLUD
Systematic Review Theory dan study RSJ) Aceh. Jurnal Manajemen
kasus. Depok: Universitas Pascasarjana Universitas Syiah
Indonesia. Kuala. 2015;4(1):144-53. Di akses
IIyas Y. Kinerja, Teori, Penilaiandan tanggal 10 oktober jam 20.00
Penelitian, Pusat Kajian Ekonomi Mr. Mohammad Qteat. Factors Effecting
Kesehatan. Jakarta: FKM UI;2002 Time Management and Nurse’s
Indrawati DP, Rattu AJM. Faktor-faktor Performance in Hebron Hospital.
yang Berhubungan dengan Kinerja Journal of Education and Practice
Perawat di Instalasi Rawat Inap Vol.5, No.35, 2014. Di akses
Rumah Sakit Datoe Binangkang tanggal 10 oktober jam 20.00
Kota Kotamobagu. JIKMU. Nebiat Negussie,dkk. Relationship Between
2012;2(1):44-52. Leadership Styles of Nurese
Inriyani Mathius,dkk.2014. Faktor-faktor Managers Nurses’s Job Satifaction
yang Berhunungan dengan Kinerja in Jimma University Specialized
Perawat di Rawat Inap RS Hospital. Ethiop J Health Sci.Vol.
Bhayangkara Makasar. RS 25, No. 3 March 2013. Di
Bhayangkara Makassar. Di akses akses tanggal 10 oktober jam 20.00
tanggal 10 oktober jam 20.00 Nurbayak,dkk. Faktor-faktor yang
Lande 2006, yang menunjukkan adanya Berhubungan dengan Kinerja
hubungan antara imbalan dengan Perawat di Bagian Unit Rawat Inap
kinerja perawat.Statistik Deskriptif. RS Umum Daya Makasar. Bagian
12
Administrasi dan Kebijakan kompensasi,pengembangan karir.
Kesehatan, Fakultas Kesehatan Kepuasan kerja terhadap kinerja
Masyarakat, UNHAS, Makassar. Di perawat Badan Layanan Umum RSJ
akses tanggal 10 oktober jam 20.00 Aceh. Jurnal Manajemen
Rahmatina, Aulia,dkk. Pengaruh Pascasarjana Universitas Syiah
Pendidikan dan Pelatihan Kuala. Volume 3, No. 2, Mei 2014.
Kepuasan kerja dan Kepemimpinan Di akses tanggal 10 oktober jam
terhadap Kinerja Perawat di Rawat 20.00
Inap RSUD Kab.Siak. Di akses Tesfaye, dkk. Motivasi and Factors
tanggal 10 oktober jam 20.00 Affecting It Among Health
Ricky 2001, imbalan jasa adalah salah satu Professionals in The Public
faktor yang mempengaruhi tinggi Hospital, Central Ethiopia. Ethiop J
rendahnya kinerja, Health Sci.Vol. 25, No. 3 July 2015.
http://www,erlangga,co.id,Tanggal Di akses tanggal 10 oktober jam
12 maret 2004 20.00.
Ridwan LF. Pengaruh Motivasi Intrinsik
dan Motivasi Ekstrinsik Terhadap
Kinerja Perawat Suatu Kajian
Literatur. Bandung: Universitas
Padjajaran; 2013.
Robbins,2003,Pengaruh Motivasi
kepemimpinan dalam kinerja
perawat.http:// www.uniska-
bjm.ac.id 13 november 2013.
Sasono Mardiono, dkk. Faktor-faktor yang
Mempengaruhi kinerja perawat
dalam Pelayanan Keperawatan di
RS Muhammadiyah Palembang
Jurnal Kesehatan Bina Husada,
volume 11 No 4, Januari 2016. Di
akses tanggal 10 oktober jam 20.00
Sengkey JF, Kandou GD, Tilaar CR.2011.
Hubungan antara Karakteristik
Individu dan Motivasi Kinerja
Perawat di Instalasi Rawat Darurat
Medik Badan Layanan Umum
RSUP Prof. Dr. R. D. Kandou
Manado. JIKMU. 2011;1(3):148-
54.
Sri Sugiyanti. Pengaruh Total Quality
Management (TQM) dan Motivasi
Kerja terhadap kinerja perawat
pada ruang rawat INAP (Study
Kasus RSUD Ranap RS Tugurejo
Semarang). JURNAL EKONOMI –
MANAJEMEN – AKUNTANSI No.
35 / Th.XX / Oktober 2013. Di akses
tanggal 10 oktober jam 20.00
Surya Darma Putra,dkk. Pengetahui
pengaruh budaya organisasi,
13
ANALYSIS OF THE INFLUENCE OF MGSO4 INJECTION ON PRE ECLAMPSIA
DELIVERY IN PRE-REFERRAL JOMBANG HOSPITAL TOWARDS
PREVALENCE ECLAMPSIA INCIDENT
Niken Grah Prihartanti, Rini Hayu Lestari

Department of Midwifery,STIKES Pemkab Jombang, Indonesia
Email: nikengrah01@gmail.com
ABSTRACT
Introduction: Eclampsia become one of the major causes of maternal mortality in Indonesia.
Number of patients in hospitals Preeklampsi weight Jombang in 2015 as many as 78 people,
while in January to May 2016 has reached 74 people. In order to prevent eclampsia, MgSO4
must be given immediately after the diagnosis of severe preeclampsia. Nevertheless, based on
the study still found pendahululan pre-referral health facilities that do not provide MgSO4
therapy on maternal pre eclampsia. Method: This research is an analytic study using a
retrospective cohort design. Based on estimates of the samples, it takes 74 mothers of the total
population 119 mothers. Sampling was done by simple random sampling. Test analysis to see
the effect of MgSO4 on maternity severe preeclampsia to eclampsia, used chi square test and
Fisher's exact test. While the chances of exposure to risk factors was assessed using the Relative
Risk (RR). Result: The results of the analysis proved that χ2 = 1.014; p = 0.000, which means
there is the effect of MgSO4 in a reference to the prevalence of pre-eclampsia. Further analysis
of the results obtained by the value of relative risk (RR) of 1.03 is the meaning contained 1.03
times greater risk of eclampsia occur in the group not given pre-referral MgSO4 in place
compared to mothers who were given MgSO4. Conclusion: The results of this study can be
used as a reference to create the target program in place pre-referral health services associated
with handling severe preeclampsia so as to reduce maternal mortality and infant.
Keywords: MgSO4, Weight Preeclampsia, Eclampsia
INTRODUCTION were 17 people aged ≥35 years and 8 (DHO

Maternal mortality is still a major Jombang, 2014). From the data obtained
problem in Indonesia, the number of cases from previous studies which refers to the
continues to increase each year. Indonesia's district hospital medical records. Jombang
maternal mortality remains dominated by number of patients Preeklampsi weight
three major causes of death are hemorrhage, during 2015 as many as 78 people, while in
hypertension in pregnancy, and infection. 2016 (January-May) as many as 74 people.
The proportions of the three causes of death In case preeklampsi that if not immediately
have changed, as bleeding and infection get treatment will be eclampsia, or seizures
tended to decrease while the proportion of that cause damage to organs such as heart
hypertension in pregnancy is increasing. In failure, renal failure, impaired liver function,
2011 the main causes of maternal mortality blood clotting disorders, HELLP syndrome,
in East Java is perdarahan. But in 2012 and and even death in the mother and baby, or
in 2013 shifted to preeclampsia / eclampsia. both (Rukiyah, 2010). Additionally, effect on
More than 25% of maternal deaths in babies born asphyxiated due to early
Indonesia in 2013 caused by hypertension delivery (Ballington, 2010).
in pregnancy (MOH RI, 2014). If the Currently the administration of
maternal mortality disaggregated by age MgSO4 in every hospital has become the
group, the maternal mortality age <20 years standard of care for the management of
amounted to one person, aged 20-34 years patient weight Preeclampsia / Eclampsia
especially in hospitals JOMBANG which
14
serves as a referral hospital in Jombang. In Test data analysis to see the effect of
order to prevent eclampsia, then MgSO4 risk factors on maternal MgSO4 granting
must be given immediately after the pre eclampsia in a reference to the incidence
diagnosis of severe preeclampsia, although of pre eclampsia, using chi square test and
still in the pre-referral health facility Fisher's exact test. While the chances of
exposure to risk factors assessed on the size
METHODS
of the association used are the Relative Risk
This research is an analytic study
(RR).
using a retrospective cohort design, the
effect of MgSO4 in a pre reference to an RESULT
incident in the incidence of eclampsia Overview Characteristics of
PONEK Jombang General Hospital in Respondents Mother Maternity Hospital
January-June 2016. In a retrospective PONEK PEB in Jombang. Can be explained
cohort study, exposure and disease have in Table 1 that the frequency of respondents
occurred in the past before the start of the by age of mother in hospital PONEK
study , so that these variables were Jombang, the study group respondents
measured through historical records / mostly aged 20-35 years as many as 22
medical records of patients. mothers (59.5%) and in the control group
Conducted a retrospective cohort most of the respondents aged> 35 years of
study using the study group (a group of the 19 mothers (51.4%). Based on the
people who were exposed to the risk factor) history of the respondents parity, maternal
and the control group (a group of people study group is largely a primipara mothers
who are not exposed to a risk factor). In this that as many as 26 mothers (70.3%) and in
study, MgSO4 is a risk factor and eklmpsia the control group mothers PEB frequency
as the effects of exposure that has happened with parity primiparas as many as 33
in the lampau.Populasi in this study are all mothers (89.2%). Results of research
mothers who were referred to hospitals characteristics respondents based on
PONEK Jombang on indications pre gestational age, maternal study group as a
eclampsia in January-June 2016 as many as whole is as much as 37 mothers (100%) are
119 mothers. From the results obtained women with gestational age> 30 weeks and
sample calculation formula the sample size the control group respondents mothers with
is 29 respondents for each - each group, gestational age> 30 weeks, of 35 mothers or
taking into account the drop out cases by 94.6 %. Based on the incidence of
20%, then set the number of samples for eclampsia incidence, the study group as a
each group of 37 mothers, so the overall whole 100% or as much as 37 mothers did
sample in this study amounted to 74 not experience eclampsia. While in control
mothers. Sampling was done by simple kelmpok there is one mother who suffered
random sampling by taking into account eclampsia which amounted to 2.7% of the
criteria for inclusion and exclusion as total number of respondents in the control
follows: group.
a.The inclusion criteria
Mother maternity referred by health
care and diagnosed severe preeklampsi.
b. Criteria for exclusion:
Mother maternity referred to
PONEK and terdiagnnosis eclampsia due to
the complications of pre eclampsia in place
of reference.
15
Table 1. Characteristics of Respondents Mother Table 2 Characteristics of Respondents
Maternity Hospital PONEK PEB in Jombang Based Genesis Eclampsia Pre Eclampsia in
during the month of January-June 2016 PONEK Hospital Jombang during the
The study Control month of January-June 2016
variable group group Eclampsia Not Eclampsia
n % n % Variable
n % n %
age Mothers
<20 years 2 5,4% 1 2,7% age Mothers
20-35 years 13 35,1% 19 51,4% <20 years 0 0,0% 3 100,0%
> 35 years 22 59,5% 17 45,9% 20-35 years 0 0,0% 32 100%
parity > 35 years 1 2,6% 38 97,4%
1 time 26 70,3% 33 89,2% parity
> 1 times 11 29,7% 4 10,8% > 1 times 0 0,0% 15 100%
Age Pregnancy 1 time 1 1,7% 58 98,3%
37 100% 35 94,6% age pregnancy
> 30 weeks
0 0,0% 2 5,4% > 30 weeks 1 1,4% 71 98,6%
<30 weeks <30 weeks 0 0,0% 2 100%
Eclampsia
yes 0 0,0% 1 2,7% Eclampsia Based Health History and
no 37 100% 36 97,3% Management of Pre Eclampsia in
PONEK Hospital Jombang
According to table 2 can be
Table 3 explains that respondents
explained that as a whole (100%) of the
with poor general condition suffered
respondents were aged <20 years and in the
eclampsia by 25% or as much as one
reproductive age range (20-35 years) do not
mother. The results of this study explaining
suffer eclampsia. While respondents
also that mothers who suffered eclampsia
experienced eclampsia were age> 35 years
are mothers with examination results in a
that is a number one respondent (2.6%).
referral hospital PONEK Jombang had
Based on the characteristics of the history of
systolic blood pressure> 160mmHg as
parity, respondents who experienced
much as 1.9%, and diastolic <110mmHg as
eclampsia are mothers with parity
much as 2.9%. Whereas in urine protein test
primiparity that as many as one mother
results showed that mothers who suffered
(1.7%) of 59 women primipara. The results
eclampsia merpakan mother with urine
of this study also mentions that the
protein> +3 as much as 23.3% and there
respondents had eclampsia is the mother
oedeme.
PEB with a gestational age> 30 weeks, or
by 1.4%.
Table 3 Genesis Eclampsia Based Health History and Management of Pre Eclampsia in
PONEK Hospital Jombang during the month of January-June 2016
Not p value
Eclampsia Eclampsi
Variable a (chi
n % n % square)
General
Situation
Good 0 0,0% 70 100% 0,054*
Poor 1 25% 3 75%
Blood pressure
16
(systolic)
≥160mmHg 1 1,9% 51 98,1% 1,000*
<160mmHg 0 0,0% 22 100%
Blood pressure
(Diastolic)
≥110mmHg 0 0,0% 39 100% 0,473*
<110mmHg 1 2,9% 34 97,1%
Protein urine
≥ +3 1 23,3% 42 97,7% 1,000*
< +3 0 0,0% 31 100%
Oedeme
Negative 0 0,0% 28 100% 1,000*
positive 1 2,2% 45 97,8%
* Fisher exact test
Analysis of Effect of MgSO4 On Mother Hospital Jombang PONEK Prevalence Of

Maternity PEB In The Prevalence Of Genesis Eclampsia 2016
Genesis Reference Pre Eclampsia Exposure Risk Output
Based on the results of the analysis Factors
Total
are shown in Table 4, the chi square test in in a pre- Not
Eclampsia
get χ2 value count = 1,014> χ2 table; p = referral eclampsia
0.000 <α (0.05) it can be concluded that Securities
there is a difference in the outcome effects Granted
37 0 37
of giving birth mothers with MgSO4 the MgSO4
PEB. As for knowing Relative Risk (RR) in Not given
36 1 37
this study can be known through Table 5. MgSO4
Total 73 1
Table 4 Prevalence of Mother Maternity
PEB Treated With Pre-Referral MgSO4 In Relative Risk (cumulative incidence
place during the month of January-June ratio=CIR): 1,03
2016
DISCUSSION
Characteristics of Respondents
Not
Eclampsia Mother Maternity PEB Experiencing
Variable Eclampsia
Eclampsia In PONEK Hospital Jombang
n % n %
This study suggested that the proportion of
Granted respondents who experienced eclampsia
MgSO4 were age> 35 years that is a number one
Yes 0 0,0% 37 100% respondent (2.6%) of the total number of
No 1 2,7% 36 97,3% respondents ie 74 mothers who referred to
χ2 = the PEB PONEK Hospital Jombang. It is
1,014 ; possible mothers aged between 20-34 years
p= is the lowest age contributor to maternal and
0,000 infant mortality, while older mothers are at
great risk. Meaning, mothers aged> 35
Table 5 Relative Risk (RR) Research years have a tendency to experience
Giving Mother Maternity MgSO4 In complications of pre-eclampsia. This is
Preeclampsia Weight In The Pre-Referral consistent with previous studies which
17
stated that the mother's age is one factor that The results of this study also
contributes to the occurrence of eclampsia. mentions that the respondents had
A woman of reproductive age is 20-35 years eclampsia is the mother PEB with a
old, and is the safest period to deal with gestational age> 30 weeks, or by 1.4%. This
pregnancy and childbirth because at that age is supported by the theory that eclampsia as
the risk of complications during pregnancy a result of the shape vasopspasme and
are lower. Age above 35 years of age is endothelial activation when the pregnancy
mentioned as the risk of complications over 20 weeks.
during pregnancy. Because at the age above
35 years degenerative process occurs which Genesis Eclampsia Based Health History
results in structural and functional changes and Management of Pre Eclampsia in
in peripheral blood vessels are responsible PONEK Hospital Jombang
for changes in blood pressure. This The results of this study revealed
condition resulted in pre-eclampsia that the prevalence of eclampsia in women
susceptible even to occur in patients with giving birth with a diagnosis of PEB
pre-eclampsia eclampsia. referred to PONEK Hospital Jombang,
Based on the characteristics of the experienced by the mother in a bad state that
history of parity, the percentage of as many as 1 person or 25%. The test results
respondents who experienced a data of analysis obtained p value> α, it means
eclampsia are mothers with maternal parity that there are no differences in the general
primi the risk is that as many as one mother state of the group who suffered eclampsia
(1.7%) of the 59 women primi. In and eclampsia group that did not
primigravidas have a tendency to be experience. Poor general state of the
complications of pre-eclampsia are two- complications of preeclampsia is a
fold greater (JNPK-KR, 2009). condition that has great potential to
Preeclampsia is more common in first eclampsia.
pregnancies compared with subsequent In addition, the results of this study
pregnancies. This is because the first also explains that birth mothers who
pregnancy blocking the formation of suffered eclampsia PEB is mother to
antibodies against the antigen placenta was ≥160mmHg systole blood pressure and
not perfect, more perfect in subsequent diastolic blood pressure <110 mmHg. The
pregnancies. In theory, primigravidas more test results of analysis obtained p value> α,
at risk of developing pre-eclampsia than it means that there is no significant
multigravida for pre eclampsia usually difference on blood pressure in those who
occurs in women who first exposed suffered eclampsia and eclampsia group
chorionic villi. This happens because the that did not experience. The incidence of
woman immunologic mechanism of eclampsia is not only caused by a single
blocking antibody formation performed by cause, but many factors. In terms of systolic
HLA-G (human leucocyte antigen-G) and diastolic blood pressure, eclampsia
against the antigen placenta has not been events experienced by many mothers who
completely formed, so that the implantation have a systolic blood pressure ≥160 mmHg
process trophoblastic tissue to be disrupted in the amount of 1.9% and diastolic blood
maternal decidua. Primigravidas also pressure <110 mmHg of 2.9%. The results
vulnerable to stress in the face of labor that of this study are consistent with the theory
will stimulate the body to release cortisol. that generally eclampsia preceded by an
The effects of cortisol is to increase the increase in systolic blood pressure
sympathetic response, resulting in cardiac (Wiknjosastro, 2006). Unlike the theories
output and blood pressure will also increase expressed by Cunningham (2006) stated
(Yie et al, 2008). that although hypertension as a prerequisite
for diagnosing pre-eclampsia, blood
18
pressure can not always be used as an MgSO4 on maternal pre eclampsia in a pre-
indicator to determine the degree of referral.
severity. Eclampsia is generally preceded The results of further analysis can be
by severe headache or visual disturbances. determined the value of relative risk (RR) of
Based on the results of urine protein 1.03 which meaning is there a risk 1.03
investigations, it was found that mothers times more likely to occur eclampsia in
who suffered eclampsia is the mother with mothers PEB group who were not given in
the results of urine protein ≥ 23.3% + 3 and the pre-referral MgSO4 compared with
accompanied oedeme as much as 2.2%. The groups of women who were given PEB
test results of analysis obtained p value> α, MgSO4, the results are consistent with
it means that there is no significant several other major research results that
difference in the results of urine protein and prove the superiority of MgSO4 to prevent
oedeme in the group experiencing eclampsia in patients with severe pre-
eclampsia with the group that did not eclampsia. One of them is listed in reference
experience eclampsia. books neonatal Basic Emergency obstetric
Exploration results to proportion the care (2007) which states that magnesium
difference measurement of blood pressure, MgSO4 is the choice of drugs intended to
urine protein and oedeme that takes place in prevent and cope with seizures in pre-
a pre-referral by reference, as in the eclampsia.
recording of blood pressure may occur bias Another thing that terkaji on HSIL
that blood pressure readings recorded in a MgSO4 exploration of the preparations
referral after being given anti-hypertensive used in hospitals PONEK Jombang and
therapy. So as there is possibility of effect on the therapeutic effect of drugs is a
respondents who earlier had come systole storage area in accordance with prescribed
≥160mmHg blood pressure and diastolic standards. According Hutomo (2008),
>110 mmHg but because it has been given MgSO4 good storage stored at room
anti-hypertensive therapy, in this study temperature which is 250-300C.
belong to the respondent with blood pressure Temperature conditions that do not fit the
<160mmHg. Moreover, the fact that states standard can result in damage to the drug, so
that the difference in the proportion of the the drug will lose efficacy when used.
results of urine protein in a pre-referral and
the referral is caused due to the instruments CONCLUSIONS AND
used to use an expired user so that the RECOMMENDATIONS
interpretation of data will be returned into Conclusion
unequal between examination in a pre-referral The incidence of eclampsia
and in place reference. experienced by mothers with eclampsia Pre
MgSO4 weight is not given in the pre-
Effect of MgSO4 On Mother Maternity referral as much as one mother or by 2.7%.
PEB In The Prevalence Of Genesis Based on that number, a mother who
Reference Pre Eclampsia suffered eclampsia is in the range of age>
Based on the frequency distribution 35 years (2.6%), parity primiparous (1.7%),
of the incidence of eclampsia, found that gestational age> 30 weeks (1.4%), with a
patients with pre-eclampsia are not getting history of poor general state of health
MgSO4 and experienced a 2.7% incidence (25%), had a systolic blood pressure ≥160
of eclampsia. Conversely, patients with pre- mmHg (1.9%) and diastolic blood pressure
eclampsia who got none MgSO4, who <110 mmHg (2.9%), urine protein ≥ +
experienced eclampsia or equal to 0% of the 3 (23.3%) and accompanied oedeme
total number of respondents. The results of (2.2%).
the analysis proved that χ2 = 1.014; p There is the effect of MgSO4 on
=0.000, which means there is the effect of maternity Pre Eclampsia in a pre-referral
19
hospitals PONEK Jombang on the Cunningham, F.et al. 2006. Obstetri
incidence of eclampsia. Evidenced through William.Jakarta: EGC 4.Jombang
the analysis of research that proves that χ2 Health Department. 2014. Health
=1.014; p = 0.000, which means there is the Profile Jombang.
effect of MgSO4 on maternal pre eclampsia East Java Health Office. 2013. The Health
in a pre-referral. The results of further Profile of East Java.
analysis can be determined the value of JNPK-KR. 2009. Normal Delivery Care and
relative risk (RR) of 1.03 which meaning is Breastfeeding initiation
there a risk for eclampsia occurs 1.03 times Dini.Jakarta: JNPK-KR
greater in the group of Pre Eclampsia Nugroho Typhoon, dr. 2012. Pathology
mothers who were not given in the pre- Midwifery. Yogyakarta: Medika
Nuha.
referral MgSO4 compared with groups of Nursalam, 2013. Methodology of Nursing
women Pre Eclampsia weight by MgSO4. Research. Jakarta: Salemba Medika
Acute Pangemanan.2002.Komplikasi In
Recommendations Preeclampsia.
a. For research site http://digilib.unsri.ac.id/accesed on
The results of this study are December 7, 2016
expected to provide evaluation in midwifery Rukiyah & Yulianti. 2010. Midwifery Care
services, especially for pre eclampsia IV (Pathology Midwifery). Jakarta:
incidence in PONEK Hospital Jombang. News.
Setiyaningrum, Ary. 2013. Emergency
b. For Institutions Maternity Care (Midwifery Care
This study is expected to add a pathology). Jakarta: In Media.
reference so that it can be used as reading Sukarni & Sudarti, 2014. Pathology
material as well as an overview for further Pregnancy, Childbirth, Postpartum
research. The results of this study can be and High Risk Neonates.
used as reference data for the deepening of Yigyakarta: Nuha Medika
subjects related to the incidence of pre- Wiknjosastro, Hanifa. 2006. Ilmu
eclampsia. Kebidanan. Jakarta: Yayasan Bina
Library Sarwono Prawirohardjo.
c. For Health Department
Expected to be used as input to
create a program built on primary health
care in the work area associated with the
handling of pre eclampsia right.
d. For Further Research

This research is expected to become
a reference further research by taking
several other factors that contribute to
science, especially in the field of obstetrics.
REFERENCE
Ambarwati, et al. 2010. On Mother
Maternity Midwifery Care. Jakarta:
Salemba Medika
Billington & Mandy. 2010.
KegawatandalamKehamilan-Labor.
Jakarta: EGC.
20
SYSTEMATIC REVIEW
LIFESTYLE INTERVENTIONS IN PATIENTS WITH TYPE 2 DIABETES
Annisa Nur Nazmi, Tuty Alawiyah, Diny Kusumawardhani, Arum Dwi

Faculty of Nursing, Airlangga University
Email: annisanazmi91@gmail.com
ABSTRACT
Introductions: Diabetes mellitus (DM) is a group of diseases with the characteristics of blood
glucose levels are high because of the destruction of the body's ability to produce or properly
use insulin (American Diabetes Association (ADA), 2012). Preventive Diabetes Research
Programme (DPP), said that a lifestyle intervention can reduce the incidence of type 2 diabetes
by 58% where more than half of the DPP of participants had a family history of DM (Knowler
et al, 2002). Research conducted by Brekke et al in 2005 showed that lifestyle interventions
such as diet and exercise can lower cholesterol and fasting blood sugar in people with a family
history of type 2 diabetes that are expected to reduce the risk of diabetes. Methods: The method
used in this Systematic review began with the selection of topics, then determined keyword to
search journal using English through Several databases, Among others, Google Scholar,
Ebscho, ProQuest, Science Direct and Journal of Nursing Science. This search was restricted
from 2006 until 2016. English keywords used were "Lifestyle Intervention, Diabetes type 2,
Physical Activity, Health Education and Dietary.” From all journals that match the theme and
the criteria for inclusion were 15 journals. Results: This review resulted in the effectiveness of
lifestyle interventions in reducing the incidence of Type 2 Diabetes. Conclusion: Lifestyle
estimated proved effective against the incidence of type 2 diabetes through weight loss, physical
activity programs as well as reducing the consumption of fatty foods.
Keywords: Lifestyle Intervention, Diabetes Type 2, Physical Activity, Health Education
INTRODUCTION diagnosed with DM (International Diabetes

Diabetes mellitus (DM) is a group of Federation (IDF), 2011).
diseases with the characteristics of blood Results of preventive studies in
glucose levels are high because of the individuals with diabetes provide evidence
destruction of the body's ability to produce that the risk of type 2 diabetes can be
or properly use insulin (American Diabetes prevented or at least could be delayed by
Association (ADA), 2012). lifestyle changes (Heideman et al, 2011).
Changes in lifestyle that lead to Preventive Diabetes Research Programme
obesity and lack of activity makes the (DPP), said that a lifestyle intervention can
number of people with diabetes continue to reduce the incidence of type 2 diabetes by
increase. In the last decade the number of 58% where more than half of the DPP
people with diabetes in the world has participants had a family history of DM
increased two-fold. In 2000 an estimated (Knowler et al, 2002). Research conducted
171 million people worldwide suffer from Brekke et al in 2005 showed that lifestyle
Diabetes, and in 2011 rose to more than 346 interventions such as diet and exercise can
million people (World Health Organization lower cholesterol and fasting blood sugar in
(WHO), 2012). For the year 2030 have also people with a family history of type 2
predicted the number of people with diabetes that are expected to reduce the risk
diabetes will continue to increase by two- of diabetes. The high prevalence of diabetes
fold to 552 million. This means for every is closely related to the behavior of people
ten seconds there are three people in a preventive action. DM prevention
21
efforts conducted through three stages of after initiating insulin therapy (Rachel
prevention, including primary, secondary, Barratt, et.al.2008). The purpose of this
and tertiary prevention. research was that lifestyle interventions
Primary prevention aimed at performed by nutritionist for weight loss in
individuals who do not suffer from diabetes patients who are new to insulin therapy.
but are at risk for diabetes mellitus. DM This study was a Randomized Control Trial
primary prevention through lifestyle with research subjects of 50 patients with
modifications includes appropriate diet, type2 diabetes and a new 4 weeks one for
physical activity, weight loss, and stop using insulin therapy. In this study there
smoking (PERKENI, 2011). were two groups: a control group had given
standard treatment and intervention group
METHODS who received lifestyle or lifestyle changes.
The method used in this Systematic The control group experienced a significant
review began with the selection of topics, increase while the intervention group had a
then determined keyword to search journal slight decrease: BMI (P, 0 • 001), waist
using English through several databases, circumference (P, 0 • 001) and percentage
among others, Google Scholar, Ebscho, of body fat (P, 0 • 001) both groups had a
ProQuest, Science Direct and Journal of significant reduction in HbA1c, but only
Nursing Science. This search was restricted small changes in blood lipids. It showed that
from 2006 until 2016. English keywords with lifestyle intervention in the
used were "Lifestyle Intervention, Diabetes intervention group showed significant
Type 2, Physical Activity, Health Education results in terms of reducing the patient's
and Dietary.” body mass index. In the control group who
Journal selected for review based on received standard treatment increased blood
studies carried out in accordance with the pressure, which is one indicator of
inclusion criteria. A systematic inclusion cardiovascular disorders.
criterion in this review was the Lifestyle Research of Jaana Lindstrom (2010)
Intervention in patients with type 2 diabetes. and Timo Saaristo, md.et, al. (2010)
Search using keywords found 2267 English conducted a study on type 2 diabetes
Journals. From all journals that match the prevention program in Finland. Practical
theme and the criteria for inclusion were 15 implementation of prevention of type 2
journals and all of them were in English diabetes using three types of prevention
language journals. Fifteen of the journal programs as an example: the Finnish
were then observed and performed critical National Diabetes Prevention Program
appraisal. Then, Systematic Review was (FIN-D2D), which includes risk screening
done in accordance with the results of and consultation in primary health care. The
Critical Appraisal that have been conducted risk factors related to lifestyle that is most
before. important for this type2 diabetes is obesity,
In the 15 journals that met the sedentary lifestyle and a diet of high
inclusion criteria, Randomized Control saturated fat, carbohydrate energy and total
Trial design was used as many as 12 energy and lower fiber content. Beneficial
journals, 2 journals used cross sectional changes in the composition of food, mainly
design and one journal used queasy design related to the intake of total and saturated fat
experiments. has happened in Finland during the last
decade. This research was conducted at 352
RESULTS study subjects were selected randomly and
A randomized controlled trial in then divided into two groups, a control
investigating the effect of an intensive group who received standard care and
lifestyle intervention standard of care in lifestyle intervention group was delivered
adults with type 2 diabetes immediately mainly by nutritionist’s studies through
22
counseling sessions and accompanied by Subsequent research by Sanna m. Salmela,
physician investigators. Using the results of MS.et al. (2012) aimed to provide lifestyle
DPS (Diabetes Prevention Study) as a counseling interventions for the prevention
benchmark for the results of one year, the of type2 diabetes in 3620 subjects of
goal of achieving good nutrition, physical research in Finland. The results in this study
activity and weight loss results were more 36% of men and 52% of women felt the
modest. Weight loss average of 20.8 (SD need for lifestyle counseling for prevention
4.5) kg at 1 year follow-up was statistically of type 2 diabetes with p <0.001.
significant (P <0.002) and continued in 3 Research conducted by Jorien
years (21.0 (S5,6) kg, P <0.003). By Veldwijk et al (2013) was Randomized
lifestyle intervention, the morbidity and Control Trial aimed in evaluating the level
mortality of cardiovascular co-morbidities of participation of respondents with type 2
incidence decreased. diabetes on lifestyle intervention program in
Research of Misa Adachi et al the Netherlands as well as to calculate the
(2010) aimed to conduct intensive participant's willingness to pay (WTP)
education on lifestyle improvements lifestyle intervention program in the form of
associated with type2 diabetes and carried counseling. This study was conducted on
out by a registered dietitian at the clinic. 1,250 Dutch adults aged 35-65 years with
This research was conducted at 10 research type2 diabetes who are not suffering from
subjects in the intervention group and 10 serious complications related to diabetes
subjects in the control group which were (cardiovascular disease, nephropathy,
selected randomly, subjects were men and retinopathy, and neuropathy) and registered
women from 20 to 79 years old who have care groups. Total of five treatment groups
HbA1c concentration of 6.1% or more and located in five different provinces of the
receive treatment by doctors. Netherlands. The treatment group
The intervention group will receive distributed a total of 1,250 questionnaires
intensive education on lifestyle changes for all eligible patients in their treatment
associated with type2 diabetes by a group, 391 (31.3%) of completed and
registered dietitian at the clinic. The final included in the analysis. 391 questionnaires
goal was a change from baseline of HbA1c (31%) returned and included in the analysis.
at 6 months. Data on health behavior and The relative importance of the program
related issues would be collected attributes (ie, eating, physical activity,
continuously for a period of 6 months. schedule, structure consultation, an
There were some limitations in the study expected result and costs incurred program)
design. First, the success of this program is was determined by using a program.
dependent on the skills of nutritionists. To According to estimates drawn attributes,
overcome this problem, researchers have willingly incurred costs and the level of
developed a training process that is patient participation. The same result also
registered nutritionist before embarking on occurred in research Mireya Gamiochipia,
a randomized study. et.al (2016) conducted on 199 respondents
Therefore, education in 95 were assigned to the control group and
implementing this program is important. In 104 to the intervention group using
addition, the assessment sheet to help treatment group was proposed interventions
standardize the priority ranked according to of intensive lifestyle (IIEV), and the control
the advice by nutritionists. Second, only was collaborative education intervention
patients were blinded by a group. To avoid (COED). The results of this study showed
bias selection, the researchers asked the significant weight loss achieved by both
doctor to recruit all patients in turn. groups, with a greater loss in the
Furthermore, this study used HbA1c as the intervention group.
primary outcome.
23
Values lower baseline HbA1c on a program lifestyle modification. Not only that, it is
of intensive educational interventions from also found that weight loss is also one
time to time. Weight loss: of the participants predictor factor of reduced risk in diabetes
26.1% on the basis IIEV group lost 5% and mellitus type 2. The preventive program
13.6% of participants COED groups (x 2 = through increasing physical activity and
5.443, p = 0.0019). physical exercise aim at weight loss, it has
been applied in the US and is a proven
DISCUSSION program which much more makes effective
The research reviewed in this cost. The routine activities may provide the
Systematic Review used Control Trials following advantages: lower levels of blood
Randomized study, cross sectional and glucose, lower basal insulin levels, improve
queasy experiment. From the 15 studies that insulin sensitivity, lowers HbA1c, increase
examined prove that lifestyle interventions energy consumption, improve the strength
can reduce the incidence of diabetes type 2. and flexibility of the body as well as lower
Based on the positive results obtained from the risk of cardiovascular disease. Lifestyle
this lifestyle intervention then it is has shown to play a role on the incidence of
recommended in practical treatment of type2 diabetes with obesity. This study also
patients with risk factors for diabetes can be shows that there is a correlation between
prevented or not lead to type 2 diabetes. obesity and lifestyle and there is a
Nurses can make modifications for some relationship of obesity with the incidence of
interventions that can be done in order to pre-diabetes.
prevent the incidence of type 2 diabetes, one
of them by lifestyle interventions that can be REFERENCE
provided through education or counseling. Adachi, M., Yamaoka, K., Watanabe, M.,
Lifestyle interventions in reducing new Nishikawa, M., Hida, E., &
cases of diabetes mellitus type 2, in the Kobayashi, I. (2010). Effects of
group with a good lifestyle, the incidence of lifestyle education program for type
diabetes was fewer compared to the group 2 diabetes patients in clinics : study
who has a poor lifestyle. design of a cluster randomized trial.
BMC Public Health, 10(1), 742.
CONCLUSION AND SUGGESTION Ähäsarja, K. A. T. I. A. V, & Anhala, M. A.
In patients with type2 diabetes, they J. V. (2012). Perceiving Need for
have their bad lifestyle, excess weight, lack Lifestyle Counseling Findings from
of physical exercise, poor diet and the use Finnish individuals at high risk of
of cigarettes and alcohol. Some of the type 2 diabetes, (November 2011),
factors that affect the sensitivity and insulin 10–12.
resistance on the diabetes type 2 are obesity, Al-eitan, L. N., Nassar, A. M., Saadeh, N.
lifestyle, diet and genetics. A., & Almomani, B. A. (2016).
At 15 journals conducted systematic Evaluation of Glycemic Control ,
review shows that lifestyle changes can Lifestyle and Clinical
prevent the development of diabetes Characteristics in Patients with
mellitus type 2. The physical activity is less Type 2 Diabetes Treated at King
risky to the incidence of pre-diabetes or Abdullah University Hospital in
diabetes type 2. This is in line with existing Jordan. Canadian Journal of
research, a normal condition and has an Diabetes, 40(6), 496–502.
impaired glucose tolerance / DM shows the Aras, R. Y. (2014). Life Style Interventions
lifestyle-related physical activity is very to Prevent and Control Type 2, 5(2),
clearly related to their insulin sensitivity. 126–131.
Various evidences have been found that Barratt, R., Frost, G., Millward, D. J., &
type 2 diabetes can be prevented with Truby, H. (2008). A randomised
24
controlled trial investigating the Lau, C. J., Pisinger, C., Lotte, L.,
effect of an intensive lifestyle Husemoen, N., Kart, R., Linneberg,
intervention v . standard care in A., … Glümer, C. (2016). Effect of
adults with type 2 diabetes general health screening and
immediately after initiating insulin lifestyle counselling on incidence of
therapy British Journal of Nutrition, diabetes in general population :
1025–1031. Inter99 randomised trial. Preventive
Davies, M. J., Gray, L. J., Troughton, J., Medicine, 91, 172–179.
Gray, A., Tuomilehto, J., Farooqi, Lindstro, J., Absetz, P., Hemio, K., &
A.,Diabetes, P. (2016). A Peltonen, M. (2010). Reducing the
community based primary risk of type 2 diabetes with nutrition
prevention programme for type 2 and physical activity – efficacy and
diabetes integrating identi fi cation implementation of lifestyle
and lifestyle intervention for interventions in Finland, 13(8),
prevention : the Let ’ s Prevent 993–999.
Diabetes cluster randomised Saengtipbovorn, S., & Taneepanichskul, S.
controlled trial . Preventive (2014). Effectiveness of lifestyle
Medicine, 84, 48–56. change plus dental care ( LCDC )
Depkes. 2007. Pedoman Pengukuran dan program on improving glycemic and
Pemeriksaan. Riset Kesehatan periodontal status in the elderly with
Dasar 2007. Badan Penelitian dan type 2 diabetes, 1–11.
Pengembangan Kesehatan. Jakarta. Siddiqui, F., Kurbasic, A., Lindblad, U.,
7-19 Nilsson, P. M., & Bennet, L. (2016).
Dutton, G. R., & Lewis, C. E. (2015). Effects of a culturally adapted
ScienceDirect The Look AHEAD lifestyle intervention on cardio-
Trial : Implications for Lifestyle metabolic outcomes: a randomized
Intervention in Type 2 Diabetes controlled trial in Iraqi immigrants
Mellitus, 8, 4–10. to Sweden at high risk for Type 2
Eltonen, M. A. P. (2010). Lifestyle diabetes. Metabolism, 66, 1–13.
Intervention for Prevention of Type Tandra H. 2008. Segala sesuatu yang harus
2 Diabetes in Primary Health Care, Anda ketahui tentang Diabetes. PT
33(10). Gramedia Pustaka Umum. Jakarta.
Gamiochipi, M., Cruz, M., Kumate, J., Veldwijk, J., Lambooij, M. S., Gils, P. F.
Wacher, N. H., & Study, D. (2016). Van, Struijs, J. N., Smit, H. A., &
Patient Education and Counseling Wit, G. A. De. (2013). Type 2
Effect of an intensive metabolic diabetes patients ’ preferences and
control lifestyle intervention in willingness to pay for lifestyle
type-2 diabetes patients, 99, 1184– programs : a discrete choice
1189. experiment, 1–9.
Katula, J. A., Kirk, J. K., Pedley, C. F.,
Savoca, M. R., Effoe, V. S., Bell, R.
A., … Diabetes, L. (2017). The
Lifestyle Intervention for the
Treatment of Diabetes study ( LIFT
Diabetes ): Design and baseline
characteristics for a randomized
translational trial to improve control
of cardiovascular disease risk
factors. Contemporary Clinical
Trials, 53, 89–99.
25
EFFECTIVENESS OF HONEY IN TREATMENT OF DIABETIC FOOT ULCER: A
SYSTEMATIC REVIEW
Muhammad Saleh Nuwa, Galih Noor Alivian, Julvainda Eka Priya Utama, Anita
Fatarona
Email: musa.nuwa@gmail.com
ABSTRACT
Introduction: Honey has been known for thousand years for its effects on wound healing
process. Honey has antibacterial characteristics, stimulates the release of cytokines, and
stimulates cellular growth, so that it can facilitate wound healing process. Diabetic Foot Ulcer
(DFU) is one type of wounds which is its wound healing process still becomes problem. The
purpose of this systematic review was to determine the effectiveness of honey in healing
diabetic foot ulcers. Method: The process of searching articles conducted on 7 database to
answer the purpose of this review. There was 7 of 10 articles discuss about wound care with
honey using RCT design. 5 of 10 articles was high quality articles with medium level of
recommendations, 2 articles were medium quality articles with medium level, and 3 articles
used cohort design with a high quality medium level. Result: Several articles have been
reviewed and it is known that honey is a good alternative choice in wound care of DFU.
Conclusion: Meanwhile, to conclude that honey is one of the best alternatives in wound care
requires a lot of randomized clinical study which compares honey with a variety of existing
topical agents.
Keywords: Honey, diabetic foot ulcer, wound care
INTRODUCTION per 1,000 patients with diabetic ulcers

Diabetic Foot Ulcer (DFU) is one of (World Health Organization, 2016).
the long-term complications of diabetes Meanwhile, according to the report
mellitus with risk of death by 25%. from RISKESDA (2013), the prevalence of
Approximately 15% of individuals with diabetes which diagnosed by doctors was
diabetes mellitus will suffer from diabetic 2.1%. Those prevalence is higher than in
foot ulcers (Deribe, 2014). Centre for RISKESDA (2007) which is about 1.1%.
Disease Control and Prevention reported There are some provinces which have
that in 2003 about 11.6% of people in higher prevalence than the national average,
United States suffer from DFU, and in the that is Central Sulawesi (3.7%), North
same year in UK found about 7.4% of Sulawesi (3.6%), South Sulawesi (3.4%)
patients suffering from the same disease. and East Nusa Tenggara 3.3%. The
This amount will continue to increase along prevalence of diabetes tends to be higher in
with unhealthy lifestyle of people (Zubair, women than in men and is more common in
2015). Another study mentioned that about urban communities ( DEPKES RI, 2013).
38% of all amputations in United States was Unlike in Western countries, in Indonesia
related to DM disease (Dinker R Pai, 2013). there are only a few studies about the
Data from WHO showed the rate of prevalence and factors associated with
amputations in patient with diabetes usually DFU. The main complications of DM in
10 to 20 times that from non-diabetic Indonesia is neuropathy (13% - 78%), micro
patients. Over the last decade, rate of vascular complications (16% - 53%) and
amputations increased by 1.5 to 3.5 events DFU (7,3% - 24%) (Yusuf et al., 2016).
26
A patient with DFU tend to or raw materials of honey, C: Topical agents
experience symptoms including pain, other than honey, O: effectiveness in DFU
limited mobility, pruritus, sleep healing, T: duration of wound healing). So
disturbances, leakage and malodor of that, the formulation of this research
exudate in the wound, and there are some questions was “How is the effectiveness of
psychological effects such as emotions, honey in treatment of diabetic foot wound
embarrassment, frustration and self-esteem (Diabetic Foot Ulcer) in patients with DFU?
becomes reduced. (Harding et al., 2016). Furthermore, the database used in
Many studies have been done to prevent this study was CINAHL Ebsco, Sage
further complication of DFU, one of which Journal, Science Direct, Google Scholar,
is good wound care. One of the topical agent and Proquest which is limited to articles in
which is known over the centuries as topical English published from 2000 to 2016.
medication for variety of wounds, including Searches were conducted in September until
the methods of modern wound care is honey November 2016. Keywords to search
(Vandamme, Heyneman, Hoeksema, literature included wound care, diabetic foot
Verbelen, & Monstrey, 2013). ulcers, honey, wound care with honey,
Honey has been known for diabetic wound, and honey in wound care.
thousands of years for its effect on wound Inclusion and exclusion criteria as
healing process (Lindberg, Andersson, determined before literature search started.
Palm, & Fagerström, 2015). Honey has Inclusion criteria were: (a) primary research
multiple effects on the wound. In vitro and articles about wound care using honey in
animal studies showed that honey has patients with DFU (b) full-text articles.
antibacterial characteristics, stimulates the Exclusion criteria were (a) articles which is
release of cytokines, and stimulates cellular not in English (b) articles which discuss
growth, so that it can facilitate wound about wound care besides DFU (c) articles
healing process (Jull, Walker, Parag, which is contain no abstract and (d) articles
Molan, & Rodgers, 2007). There are many which discuss about wound care in animal
studies that have studied about the effects of experiments. Articles were selected by the
honey in treating DFU but not many of researcher in terms of keywords which is
which using systematic review method. correspond to the search of electronic
This systematic review aimed to evaluate databases, and then researcher determine
objectively the effectiveness of honey in whether the inclusion criteria is reached,
wound care (Diabetic Foot Ulcer) in followed by a review of full-text version. A
patients with DFU using existing research total of 1679 articles found, 510 articles of
evidence. which discuss about wound care using
honey. Articles which is appropriate with
METHOD the inclusion criteria and were reviewed as
Article search many as 10 articles. Schematically, it can be
The first step in this scientific article shown in following PRISMA diagram
search was to formulate PICOT Framework (Preferred Reporting Items for Systematic
(P: patients who suffer from DFU, I: all Reviews and Meta-Analyses):
wound care interventions which use honey
27
Articles from the database: Articles based on keywords :
CINAHAL Ebsco, SAGE Journal, wound care, diabetic foot ulcer,
Google Scholar, Science Direct, and honey, wound care with honey,
ProQuest 2006-2016 (n = 1679) diabetic wound, and honey in wound
Articles that has been screened: Article based on exclusion criteria:

(n = 510) (n=500)
Article based on inclusion criteria: 10 articles selected

n = (10)
Figure 1. Article Meta-analysis
Quality and level assessment of articles method used and existing designs. There
Researcher conducted critical was high quality (80-100)%, medium
appraisal using tools from The Joanna quality (70-79)% and the low quality
Briggs Institute Critical Appraisal tools for articles <69%. Furthermore, researcher
use in JBI Systematic Reviews for all conducted the assessment of the quality and
articles that have been selected. All articles strength of recommendation using GRADE,
were assessed with tools which is the system which is used by the BMJ
appropriate with its research design (The (Atkins et al., 2004) (see Table 1). With
Joanna Briggs Institute, 2016). Then, score of 4 (high), 3 (moderate), 2 (low) and
resercher conducted an assessment of the 1 (very low).
quality of each article which depends on the
Table 1. Quality and level assessment of articles.

The Quality and Strength
Author/Country Research Design
of Recommendation
(Imran et al, 2015) Pakistan RCT 87 % & 3
(Agarwal et al, 2015) India RCT 78 % & 3
(Jan, Shah, et al, 2012) RCT 80 % & 3
Pakistan
(Kamaratos et al, 2014) Yunani RCT 87 % & 3
(Siavash, et al, 2015) Iran RCT 80 % & 3
(Manalelsayedez et al, 2012) RCT 83 % & 3
Mesir
(Shukrimi, et al, 2008) RCT 77 % & 3
Malaysia
(Abdelatif, et al, 2008) Mesir Prospective pilot 80 % & 3
study
(Moghazy et al., 2010) Mesir Observational 83 % & 3
study
(Henshaw et al., 2014) Prospective 85 % & 3
Australia feasibility study
28
RESULT while in control group using povidone
There was 7 of 10 articles discuss iodine about 33% of patients were healed
about wound care with honey using RCT and as about 17% be amputated.
design. 5 of 10 articles was high quality Furthermore, Kamarotos et al (2014) also
articles with medium level of investigated the effects of manuka honey-
recommendations, 2 articles was medium impregnated dressing (MHID) in healing of
quality articles with medium level, and 3 neuropathic diabetic foot ulcers (NDFU)
articles used cohort design with a high with sample size of 32 as intervention group
quality medium level. and the control group. The result is known
Imran et al (2015) investigated that wound healing of the MHID group was
about the effectiveness of honey in DFU 31 ± 4 days and the control group was 43 ±
patients chich is divided in 179 respondents 3 days with p value <0.05. There was no
as honey group and 169 respondents as significant difference in the percentage of
control group using normal saline in the wound healing in both groups (97% for
surgical unit of a hospital from February MHID and 90% for the control group).
2006 to February 2010. It is known that Research by Siavash Shokri et al
wound completely cured by honey in 136 (2015) about the effectiveness of honey (5%
respondents (75.97%) and 97 (57.39%) with Royal Jelly) in healing of DFU compared
normal saline. Wounds which is not with placebo (gel) in 25 patients who
significant heals with honey versus normal suffered from type II Diabetes Mellitus. The
saline was 32 (17.87%) versus 53 (31.36%), average length of wound healing was 23
(p = 0.001). Healing time: 18.00 (6-120) days for placebo group and 33 days for
days with honey and 29.00 (7-120) days groups using Royal Jelly (P = 0.7). The
with normal saline. The conclusion of this number of healed wound was 29 of 32
study was honey is effective topical agent in wounds (90.6%) in placebo group and 30
treatment of DFU. from 32 wounds in group using Royal Jelly
Agarwal et. Al (2015) compared the (93.8%) with p value = 0.6. This study
effects of honey with povidone iodine as an mentioned that 5% topical Royal Jelly
ingredient in the treatment of diabetic foot showed no advantages in using placebo for
ulcers in 36 patients who suffer from type II treatment of DFU.
Diabetes Mellitus with 2nd degree wounds. Manalelsayedez et al (2012)
It is known that the average of healing time investigated the effects of honey
with honey: 14.2 days (6-26) days, while in (Pedyphar® ointment) compared with
povidone iodine group: 15.5 days (9-37) alginate (Fibracol® gel) as a topical
days. Edema, pain and exudate of wounds treatment for Type II Wagner DFU. The
also became reduced in honey group. The result showed that (Pedyphar® ointment)
results of T-test showed that there was no has 12 ± 3 weeks of healing time while
significant difference between those two alginate (Fibracol® gel) has 16 ± 4 weeks
groups P> 0. 05. It can be concluded that of healing time and there was significant
honey is a alternative which more safe for difference statistically with p value = 0.001.
the treatment of DFU compared with The conclusion of this study was Honey
povidone iodine. (Pedyphar® ointment) more effective than
Jan et al, (2012) investigated about alginate (Fibracol gel) for the treatment of
the effectiveness of honey compared with type II Wagner DFU.
povidone iodine in Wagner's Grade I-IV Shukrimi et al (2008) investigated
patients with sample size of 50 patients as the effect of honey compared with povidone
intervention group and 50 others as control iodine as dressings in the treatment of DFU.
group. The result showed that all patients in The study was conducted in 30 patients who
intervention group were completely healed suffered from type II Diabetes Mellitus with
by 36% and about 14% were amputated, Wagner Grade II which is divided into 2
29
groups: intervention group using honey DFU. Wounds were followed up for up to 6
dressing and control group using povidine weeks. The results showed that the ulcer
iodine. Wounds with povidone iodine area was reduced with average of 41% in
dressing has an averageof healing time by propolis group compared with 16% in
15.4 days (9-36 days). In intervention group control group during first week (p < 0.001).
using honey, the average of healing time by By the third week, ulcer area became 63%
14.4 days (7-26 days). Researcher vs 44% (p < 0.05). By the fourth week, ulcer
concluded that honey could be safe area became 10% vs 2% (p < 0.001) and by
alternative in the treatment of Wagner the seventh week, ulcer area became 19% vs
Grade II in patients with DFU. 12% (p < 0.05). it can be concluded that
The next research was research propolis (honey bee) was a topical treatment
using cohort design. Abdelatif et al (2008) which is effective in treating patients with
investigated the efficacy and safety of DFU.
PEDYPHAR (ointment from honey) in
treating patients with DFU. 60 patients with DISCUSSION
Diabetes Mellitus were divided into 3 Honey has the effect of antibiotics,
groups based on the stage wound: group 1 antioxidants, anti-inflammatory, auto
(stage I and II), group 2 (stage III) and group debridement, stimulation of growth factors
3 (stage IV). The result showed that 96% of and good osmolarity in wound healing
the patients in group 1 and 2 have good (Chapman, 2009). Furthermore, all of the 10
response using PEDYPHAR ointment, and articles which has been reviewed by
wound healing occurs. All patients in group researcher contain the benefits of honey in
3 healed after surgical excision, the treatment of diabetic foot ulcers.
debridement of necrotic tissue, and According to (Kateel, Adhikari, Augustine,
conservative treatment using PEDYPHAR and Ullal, 2016) honey dressing is safer to
ointment. It can be concluded that used in the treatment of diabetic foot ulcers
PEDYPHAR ointment may be safe for the because honey accelerates wound healing,
treatment of local DFU. has the effect of anti-inflammatory and anti-
Moghazy et al (2010) investigated bacterial, and reduce the number of
the effectiveness of honey as topical amputations. It is also found in the article
treatment for diabetic foot ulcers. The study discussed by (Tian et al., 2014) which said
was conducted on 30 patients who is that the total time of treatment, the average
randomly selected. Criteria of the patients time of cleaning the ulcer, the number of
was patient with DFU all degrees of bacteria, and healing the wound area using
wounds, all ages and exclude DFU patients honey was better.
who were amputated. The results showed Total of 7 articles using RCT design
that 43% (13 patients) wounds completely concluded that wound care with honey was
healed for 1-2 months, partially healed in 13 more effective in treating DFU although
patients (43.3%), patients who experienced there was some articles that showed no
amputation as much as 2 patients (6.7%), significant effects. But honey showed its
and patients who expeienced skin graft as effect of healing faster than the others. The
much as 2 patients (6.7%). Researcher last three observational studies was very
mentioned that honey was an effective and strong research with medium level
efficient topical alternative for DFU. recommendations. Those studies concluded
Henshaw et al (2014) invetigated the that honey is more effective in wound care
effectiveness of propolis (honey bee) on of DFU for all degrees of wounds, have
patients with DFU. As many as 24 patients anti-inflammatory and anti-bacterial
with Diabetes Mellitus type I and II, all the characteristic, accelerate granulation,
degrees of wounds were getting treatment autolysis, and cost effective (Moghazy et
compared with 84 control patients with al., 2010). This is consistent with research
30
by (Tsang et al., 2015) which mentioned 8(1), 51–56.
that honey has many benefits such as anti- https://doi.org/10.1586/edm.12.66
inflammatory, anti-cancer, anti-ulcer, anti- Chapman, L. (2009). Use of honey on a
viral, anti-fungal, vasodilators, and many neuropathic ulcer. Journal of
more. By looking at a variety of evidence Community Nursing, 23(2).
that already exists and the benefits of honey, DEPKES RI. (2013). RISET KESEHATAN
it can be said that honey was a highly DASAR RISKESDAS 2013. Badan
effective topical to heal diabetic foot Penelitian dan Pengembangan
wounds (DFU). Kesehatan Kementerian Kesehatan
RI. JAKARTA: DEPKES RI.
CONCLUSION AND SUGGESTION Deribe, B. (2014). Prevalence and Factors
Several articles have been reviewed Influencing Diabetic Foot Ulcer
and it is known that honey is a good among Diabetic Patients Attending
alternative choice in wound care of DFU. Arbaminch Hospital, South
Meanwhile, to conclude that honey is one of Ethiopia. Journal of Diabetes &
the best alternatives in wound care requires Metabolism, 5(1), 1–7.
a lot of randomized clinical study which https://doi.org/10.4172/2155-
compares honey with a variety of existing 6156.1000322
topical agents. Dinker R Pai, S. S. (2013). Diabetic Foot
Ulcer – Diagnosis and Management.
REFERENCES Clinical Research on Foot & Ankle,
Abdelatif, M., Etmaan, M., & Yakoot, M. 1(3), 1–9.
(2008). Safety and effi cacy of a https://doi.org/10.4172/2329-
new honey ointment on diabetic 910X.1000120
foot ulcers: a prospective pilot Harding, K., Armstrong, D., Chadwick, P.,
study. Journal of Wound Care, Choudhry, E. R., Edmonds, M.,
17(3), 108–110. Loots, M., Rastogi, A. (2016).
Agarwal, S., Bhardwaj, V., Singh, A., Goel, LOCAL MANAGEMENT OF
S., Bharat, M., & Krishna, J. A. I. DIABETIC FOOT ULCERS
(2015). a Control Clinical Trial of Innovations in the management of
Honey-Impregnated and Povidone DFUs and the diabetic foot in
Iodine Dressings in the Treatment of remission Living with a DFU: the
Diabetic Foot Ulcers Among patient’s perspective Managing and
Northern Indian Subjects. treating DFUs. World Union of
International Wound Journal, 6(2), Wound Healing Societies. Retrieved
7–10. from www.wuwhs.net%0AHow
Atkins, D., Best, D., Briss, P. A., Eccles, Henshaw, F. R., Bolton, T., Nube, V.,Hood,
M., Falck-Ytter, Y., Flottorp, S., A.,Veldhoen, D., Pfrunder, L.,
GRADE Working Group. (2004). Twigg, S. M. (2014). Topical
Grading quality of evidence and application of the bee hive
strength of recommendations. BMJ protectant propolis is well tolerated
(Clinical Research Ed.), 328(7454), and improves human diabetic foot
1490. ulcer healing in a prospective
https://doi.org/10.1136/bmj.328.74 feasibility study. Journal of
54.1490 Diabetes and Its Complications, 28
Biglari, B., Swing, T., Büchler, A., Ferbert, (6), 850–857.
T., Simon, A., Schmidmaier, G., & https://doi.org/10.1016/j.jdiacomp.2
Moghaddam, A. (2013). Medical 014.07.012
honey in professional wound care. Imran, M., Hussain, M. B., & Baig, M.
Expert Review of Dermatology, (2015). A Randomized, Controlled
31
Clinical Trial of Honey- https://doi.org/10.1080/10376178.2
Impregnated Dressing for Treating 016.1171727
Diabetic Foot Ulcer. Journal of the Manalelsayedez, E., Fathey, R., Hasaballah,
College of Physicians and A., & Basal, A. (2012). Topical
Surgeons--Pakistan : JCPSP, Honey versus Alginate as Dressing
25(10), 721–5. for Management of Wagner Type 2
https://doi.org/10.2015/JCPSP.7217 Diabetic Foot Ulcers. Journal of
25 American Science, 8(9). Retrieved
Jan, W. A., Shah, H., Khan, M., Fayaz, M., from
& Ullah, N. (2012). Comparison of http://www.jofamericanscience.org.
concentional pyodine dressing with Moghazy, A. M., Shams, M. E., Adly, O.
honey dressing for the treatment of A., Abbas, A. H., El-Badawy, M.
diabetic foot ulcers. Journal of A., Elsakka, D. M., … Mohamed, B.
Postgraduate Medical Institute A. (2010). The clinical and cost
(Peshawar - Pakistan), 26(4), 402– effectiveness of bee honey dressing
407. in the treatment of diabetic foot
https://doi.org/10.5923/j.surgery.20 ulcers. Diabetes Research and
130203.05 Clinical Practice, 89(3), 276–281.
Jull, A., Walker, N., Parag, V., Molan, P., & https://doi.org/10.1016/j.diabres.20
Rodgers, A. (2007). Randomized 10.05.021
clinical trial of honey-impregnated Shukrimi, A., Sulaiman, A. R., Halim, A.
dressings for venous leg ulcers. Y., & Azril, A. (2008). A
British Journal of Surgery, 95(2), comparative study between honey
175–182. and povidone iodine as dressing
https://doi.org/10.1002/bjs.6059 solution for Wagner type II diabetic
Kamaratos, A. V, Tzirogiannis, K. N., foot ulcers. The Medical Journal of
Iraklianou, S. A., Panoutsopoulos, Malaysia, 63(1), 44–46. Retrieved
G. I., Kanellos, I. E., & Melidonis, from
A. I. (2014). Manuka honey- http://www.ncbi.nlm.nih.gov/pubm
impregnated dressings in the ed/18935732
treatment of neuropathic diabetic Siavash, M., Shokri, S., Haghighi, S.,
foot ulcers. International Wound Shahtalebi, M. A., & Farajzadehgan,
Journal, 11(3), 259–263. Z. (2015). The efficacy of topical
https://doi.org/10.1111/j.1742- royal jelly on healing of diabetic
481X.2012.01082.x foot ulcers: a double-blind placebo-
Kateel, R., Adhikari, P., Augustine, A. J., & controlled clinical trial.
Ullal, S. (2016). Topical honey for International Wound Journal, 12(2),
the treatment of diabetic foot ulcer: 137–142.
A systematic review. https://doi.org/10.1111/iwj.12063
Complementary Therapies in The Joanna Briggs Institute. (2016).
Clinical Practice, 24, 130–133. Checklist for Systematic Reviews
https://doi.org/10.1016/j.ctcp.2016. and Research Syntheses. The
06.003 Joanna Briggs Institute.
Lindberg, T., Andersson, O., Palm, M., & Tian, X., Yi, L.-J., Ma, L., Zhang, L., Song,
Fagerström, C. (2015). A systematic G.-M., & Wang, Y. (2014). Effects
review and meta-analysis of of honey dressing for the treatment
dressings used for wound healing: of DFUs: A systematic review.
the efficiency of honey compared to International Journal of Nursing
silver on burns. Contemporary Sciences, 1(2), 224–231.
Nurse, 51(2–3), 121–134. https://doi.org/10.1016/j.ijnss.2014.
32
05.013
Tsang, K.-K., Kwong, E. W.-Y., Woo, K.
Y., To, T. S.-S., Chung, J. W.-Y., &
Wong, T. K.-S. (2015). The Anti-
Inflammatory and Antibacterial
Action of Nanocrystalline Silver
and Manuka Honey on the
Molecular Alternation of Diabetic
Foot Ulcer: A Comprehensive
Literature Review. Evidence-Based
Complementary and Alternative
Medicine, 2015, 1–19.
https://doi.org/10.1155/2015/21828
3
Vandamme, L., Heyneman, A., Hoeksema,
H., Verbelen, J., & Monstrey, S.
(2013). Honey in modern wound
care: A systematic review. Burns,
39(8), 1514–1525.
https://doi.org/10.1016/j.burns.2013
.06.014
World Health Organization. (2016). Global
Report on Diabetes. WHO (Vol.
978). https://doi.org/ISBN 978 92 4
156525 7
Yusuf, S., Okuwa, M., Irwan, M., Rassa, S.,
Laitung, B., Thalib, A., Sugama, J.
(2016). Prevalence and Risk Factor
of Diabetic Foot Ulcers in a
Regional Hospital, Eastern
Indonesia. Open Journal of Nursing,
6(1), 1–10.
https://doi.org/10.4236/ojn.2016.61
001
Zubair, M. (2015). Diabetic Foot Ulcer: A
Review. American Journal of
Internal Medicine, 3(2), 28.
https://doi.org/10.11648/j.ajim.201
50302.11
33
CADRE SKILLS TOWARDS ROLLING MASSAGE
Devi Mediarti*, Rosnani*, Hidayat Arifin**

*Department of Nursing, Polytechnic of Health Palembang
**Faculty of Nursing, Universitas Airlangga
Email: hidayat.unair@gmail.com
ABSTRACT
Introduction: Breast milk is a source of nutrients that are needed by the baby. Breast milk production
can be increased by breast care, one of them with a rolling massage. Health cadres as the spearhead
of health services have an important role in improving knowledge for postpartum mothers in the
rolling massage. The aim of this study was to determine the effectiveness of rolling massage training
towards cadre skill at Puskesmas Multi Wahana Palembang 2016. Method: The study used pre-
experimental with pre-posttest only design and conduct at Puskesmas Multi Wahana Palembang on
October 2016. Total population was all cadres and obtained 38 samples by using total sampling.
Independent variable was rolling massage training and dependent variable was cadre skill. Instrument
used observation sheet and analysis with Wilcoxon Signed Rank Test. Result: The result showed
there was influence of rolling massage training towards cadre skill (p=0.000). Discussion: Rolling
massage training can have a positive impact on the smooth of breast milk, so for health cadres who
are trained in the rolling massage can disseminate to postpartum mothers. Other researchers can be
combining the rolling massage therapy with other therapies.
Keywords: Rolling Massage, Skills, Cadre
INTRODUCTION of breastfeeding is often considered a problem

Early human development includes on her children.
aspects of education, per capita income and Based on (SDKI 2012), the number of
health. This is shown by the results of the exclusive breastfeeding in Indonesia is still
Human Development Index (HDI). Based on low, about 32% of the total births. This
the results of these calculations, Indonesia condition was very contrary to what happened
have scored 67.0 which ranks 109 of 191 with formula feeding. It is known in the same
countries in the world (Perinasia 2010). Reality year, the babies that was born in health
in Indonesia's development is the lack of facilities were less to get breast milk
funding. Therefore, the investment should be exclusively. Problems that were arising from
prioritized in low-risk activities and the mother during breastfeeding can be started
sustainable benefits. One of the innovative before delivery (antenatal period), in the early
development efforts is with the health-nutrition postpartum period and postpartum further.
investments (exclusive breastfeeding) and Breastfeeding problems can also be caused due
education. to a special condition. In addition, mothers
One of the benefits of nutritional health often complain that baby often cries or refuses
investment (exclusive breastfeeding) is a breastfeeding. The condition often mean that
developmental, emotional and intellectual breast milk was not enough or breast milk was
growth of children. The failure of Exclusive not good, so it often leads to the decision to
breastfeeding due to a failure in the discontinue breastfeeding.
breastfeeding process may cause by the One of the factors that affect milk
emergence of several problems, both the production is breast care. It was known that
mother and the baby issue. In some mothers 86.7% of postpartum maternal breast milk
who do not understand this problem, the failure through smoothly after being given an
explanation and demonstration of the breast
34
care (Nontji & Andriyani 2006). Mother's RESULT
knowledge about breast care was still low, Table 1. Distribution of The Effectiveness of
because the mother has the knowledge of Rolling Massage Training Towards Cadre
family or friends. Family and friends were not Skills.
entirely gain a correct understanding of breast Pretest Posttest
Variable
care, therefore, it is required to help health N % N %
cadres provide health education about the Skilled 15 39.5 29 76.3
correct treatment of breast (Saryono & Unskilled 23 60.5 9 23.7
Pramitasari 2009). Total 38 100 38 100
Spearheading of health personnel in the Wilcoxon
early detection and the first service to Signed Rank p = 0.000
postpartum mothers is health cadres. Health Test
service activities carried out by health cadres
that perform routine activities in Posyandu. Table 1 explained that by giving
Health education regarding breast care is not intervention to health cadre about rolling
optimal due to the training of cadres has not massage can be increasing cadre skill on apply
varied. rolling massage
The realization of breast care with It can be seen from total presentation that was
rolling massage method required the increase between pretest (39,5%) and posttest
cooperation of family and health workers and (73,6%). Wilcoxon Signed Rank Test showed
health cadres. Health cadres as facilitators and that there was significant influence between
motivators to mothers in the postpartum breast pretest and posttest on rolling massage training
care need to have knowledge and skills about towards cadre skill (p = 0,000).
rolling massage. Therefore, it is necessary to
make study about the effectiveness of rolling DISCUSSION
massage training towards health cadres at The result that conducted by researcher
Pukesmas Multi Wahana Palembang 2016. showed there was influence about rolling
massage training towards cadre skills. It could
METHOD be due to the intervention that provided by
The study used pre-experimental with researchers. So, in terms of respondents'
pre-posttest only design and conduct at knowledge and skills will increase.
Puskesmas Multi Wahana Palembang on Interventions given by the researchers in the
October 2016. Total population was all cadres form of training and demonstrations.
and obtained 38 samples by using total Notoatmodjo (2010) explained that in the
sampling. process of health education occurs a reciprocal
Inclusion criteria in this study consists of: process between various factors, among
1) Minimal education was Senior High others: the subject of learning, teaching,
School. methods and techniques of learning, learning
2) Had never got rolling massage training aids, and the material or materials being
before. studied. The output is a result of the learning
3) Willing to follow the study process until process, namely in the form abilities and
finished. behavior change of subject learning.
Independent variable was rolling massage Demonstration method is a method of
training and dependent variable was cadre learning that presents a procedure or task, how
skill. Instrument used observation sheet and to use the tools, and how to interact with the
analysis with Wilcoxon Signed Rank Test. respondent. Demonstrations can be done
directly or through media such as videos or
movies. Respondents can hear and see the
procedure, steps, and explanations of
fundamental importance. In practical emphasis
35
on the purpose and subject as an important The result that conducted by researcher
subject that is the focus of attention (Nursalam has same result with study that conducted by
& Efendi 2011). So, the method of (Handayani & Purwandari 2014) which
demonstration can be effective in improving showed that the average score of health cadres
the understanding and the ability of the before given training and after in control
respondent skills in performing rolling groups was 12.55, whereas in treatment groups
massage. was 13.31 in the range of 10-40 score. Skilled
The media of learning is the one of the score after given training has increased, control
important factors that could influence the group was 14.52 and treatment group was
change of knowledge and skills after the 32.31 (p-value <0,001).
treatment to community health education to The study that conducted by
individuals, families, groups and the (Shihipatul 2015) showed that the rolling
community at large. The ability of someone to massage can greatly affect positive in
remember the important information that will improving the smoothness of breastfeeding in
rise higher when a person learns through mothers with post SC. This therapy can be
writing method (read), because by reading applied to babies with weak indicators of
some will remember as many as 72% lactation.
(Windiana 2012).
This argument supported by CONCLUSION AND SUGGESTION
Notoatmodjo (2010) that explained the Conclusion
method and tools that use based on the The training about rolling massage was
principle that knowledge that exist in every very effective given to health cadres at
human being received or captured by the five Puskesmas Mult Wahana to increase the skill
senses, the more senses used to receive of cadre on applying rolling massage.
something, it will be more clear understanding
is obtained. Suggestion
Another factor that can influence was Rolling massage training can have a
the level of education and knowledge about positive impact on the smooth of breast milk,
rolling massage. The majority of respondents' so for health cadres who are trained in the
education was High School and the majority of rolling massage can disseminate to postpartum
respondents also educated as Diploma Degree. mothers. Other researchers can be combining
In general, the higher the education a person the rolling massage therapy with other
more easily receive information. Education is therapies.
an attempt to develop the personality and
ability inside and outside the school and lasts REFERENCIES
age life (Wawan & Dewi 2010). Handayani, S. & Purwandari, K.P., 2014.
Education affects the learning process, Efektivitas Pelatihan Perawatan
the higher the education a person of the easier Payudara Metode Massage Rolling
person to receive the information. A person (Punggung) Terhadap Keterampilan
with higher education will tend to get the Kader Kesehatan di Wilayah Kerja
information, either from others or from the Puskesmas Baturetno. Seminar
media. The more information you enter the Nasional Uniba, 1(1), pp.18–24.
more so that the knowledge gained will be Nontji, W. & Andriyani, 2006. Pengaruh
easier to apply what they have gained through Metode Demonstrasi Cara Perawatan
skills. Knowledge is closely associated with Payudara Terhadap Kelancaran
education where hopefully someone with Pengeluaran ASI pada Ibu PostPartum
tertiary education, then that person will be di Ruang Perawatan Nifas RSIA Siti
more knowledgeable knowledge (Sunaryo Khodijah 1 Muhammadiyah Cabang
2004). Makasar. Universitas Hasanudin.
Notoatmodjo, 2010. Ilmu Perilaku Kesehatan,
36
Jakarta: Rineka Cipta.
Nursalam & Efendi, 2011. Pendidikan Dalam
Keperawatan, Jakarta: Salemba
Medika.
Perinasia, 2010. Bahan Bacaan Manajemen
Laktasi, Jakarta: Perinasia.
Saryono & Pramitasari, 2009. Perawatan
Payudara, Yogyakarta: Mitra Cendikia
Offset.
SDKI, 2012. Servey Demografi Kesehatan
Indonesia, Jakarta: BPS.
Shihipatul, M., 2015. Efektivitas Pijat
Oksitosin (Massage Rolling) dan
Perawatan payudara terhadap
Kelancaran Produksi Asi Pada Ibu Post
Sectio Caesarea di RSAD Wira Bhakti
Mataram Tahun 2015.
Sunaryo, 2004. Psikologi untuk Keperawatan,
Jakarta: EGC.
Wawan, A. & Dewi, M., 2010. Teori dan
Pengukuran Pengetahuan, Yogyakarta:
Nuha Medika.
Windiana, N., 2012. Upaya Meningkatkan
Perilaku Pencegahan Diare pada Siswa
Kelas 5 Melalui Pendidikan Kesehatan
denga Booklet (Pendekatan Health
Believe Model) di SDN Sukoiber dan
SDN Mentaos Kecamatan Gudo
Kabupaten Jombang. Universitas
Airlangga.
37
EARLY DETECTION OF BREAST CANCER BY BREAST SELF-EXAMINATION (BSE)
IN ADULT WOMEN (A SYSTEMATIC REVIEW)
Khoirun Nisa, Indrawati, Sylvi Harmiardillah, Nurul Khusnul Khotimah

Faculty Of Nursing Airlangga University
Email: anissugiono@ymail.com
ABSTRACT
Introduction: Breast cancer is a problem that occurs in adult women. The number of incidences in
Indonesia is the second most common cancer of women after cervical cancer, in 2010 listed 45% of
women suffered from abnormal breast lumps, both malignant and benign tumors Breast cancer can
occur at any time and asymptomatic, thus it requires the appropriate detection methods to find out.
Methods: The method used in this systematic review begins with PICO framework that is focused
on breast self-examination for the detection of early breast cancer by searching journals through
database Science direct, Ebscho, and Proquest. Results: 8 articles journals were selected and
assessed, generally the journals review provide increased knowledge about BSE also Breast Self-
Examination (BSE) provides benefits to detection early breast cancer. Conclusion: The article study
reviews showed that almost all of which breast self examination (BSE) is able to give a positive effect
in terms of both, knowledge and awareness of women about breast health. Breast cancer should be
detected early to improve the prognosis for immediate action. One of the ways to detect breast cancer
is by improving the knowledge and awareness of women to do breast self-examination as a tool for
detecting breast cancer with a safe and easy method.
Keywords: Breast Self-Examination, Early Detection, Breast Cancer
INTRODUCTION biopsy without surgery, breast clinic

Breast cancer is a serious health examinations and Breast Self-Examination
problem as the second leading cause of death (American Cancer Society, 2016).
in women. According to the American Cancer BSE is more widely used because it is
Society, (2016) approximately the chance that simple, easy and can be done by herself or with
a woman will die from breast cancer is about 1 a very low cost, non-invasive without the
in 37 (about 2.7%). Breast cancer incidence is requirement of special tools and materials, an
likely to increase consistently in the effective diagnostic method for breast cancer
developing countries in line with the adoption only takes five minutes to apply (Ayed et al.,
of unhealthy lifestyles such as smoking, 2015). BSE is an act involving a woman using
physical activity, consume foods that contain hand and eyesight systematically examine her
lots of high-energy, changes in childbirth and breasts to detect unusual lumps shape, or
breastfeeding and exogenous hormone intake changes on the skin, a visual examination is
(Ayed et al., 2015). sitting or lying down (Corbex, Burton, &
Breast cancer in Indonesia is the Sancho-Garnier, 2012).
second most common cancer of women after Breast self-examination requires self-
cervical cancer, in 2010 listed 45% of women awareness and habits linked to cancer
suffering from abnormal breast lumps, both screening (Masso-Calderón et al., 2016). It is
malignant and benign tumors (Santoso, 2009). expected after obtaining knowledge about BSE
Breast cancer can happen to any woman at any (Breast Self-Examination) women can detect
time and asymptomatic, and thus it requires breast cancer early, so there is no further stage
proper detection method to find out. Many and get faster handling of the medical team at
studies mention a few checks to detect early an early stage. The purpose of this systematic
breast cancer, mammography, ultrasound, review is provide an overview of the
38
advantages of Breast Self-Examination (BSE) sectional and one other articles using RCT
as an effective method to detect breast cancer design, first article using uncontrolled and one
early. The research question: How is the randomized trial article uses a descriptive
effectiveness of Breast Self-Examination study.
(BSE) for the early detection breast cancer in Four articles provide health education
adult women? intervention program on knowledge of the
breast, including BSE (Breast Self
METHODS Examination) both knowledge and practice
Article searching gained knowledge of respondents about breast
The method used in this systematic cancer and BSE increased significantly. Breast
review begins with PICO framework. This health promotion program increases
type of research Randomized Controlled Trial significantly the frequency of the practice of
(RCT), experimental design and descriptive BSE in the intervention group compared to the
study that examines the effectiveness of Breast control group by 26.8% and 9.7% the control
Self-Examination (BSE) for the detection of group (p <0.0001) (Secginli & Nahcivan,
early breast cancer incidence used as the study 2011). While the research conducted by
inclusion criteria in this research. Meanwhile Masso-Calderón et al (2016) showed an
the scientific articles which do not examine the increase in knowledge about BSE at intervals
effectiveness of Breast Self-Examination of 7 days evaluation of the respondents were
exclusion criteria included in the selection of able to practice BSE (Breast Self Examination)
topics, and then specify keywords to search the on a regular basis. Health education can also be
journal using English through several done through home visits. Plan home visits
databases, among others Science direct, improve the practice of BSE among
Ebscho, and Proquest. This search is limited to respondents significantly by 51.6% from 4.3%
journals from January 2006 to October 2016. prior to treatment (Kolutek, Avci, & Sevig,
Keywords used were breast self-examination, 2016).
early detection, breast cancer. Training BSE through methods of
lecture and video viewing for ± 50 minutes can
Data collection, quality assessment and improve respondents' knowledge about breast
biased articles cancer, including risk factors, treatment and
Principal investigator read the titles and screening for 13.2% and 68.1% on the session
abstracts as well as issue unsuitable research pre-test and 79.1% and 96.7% on the session
articles. The research articles then be scored by post-test (Hacihasanoǧlu & Gözüm, 2008).
other researchers to determine the quality of Promotion and health education not
the methodology and bias using the Quality only improves knowledge and skills practice of
Assessment Tool For Quantitative Study BSE to the respondent, but this program also
EPHPP (Effective Public Health Practice can detect breast abnormalities. As the
Project). There are three criteria for ratings or research conducted (Loh & Chew, 2011) with
rating overall (global ratting) of the tool used experimental design pre-post test
is strong, moderate and weak. From the search questionnaire pads breast cancer patients
results have found 24 journals and 8 journals showed 80% of cancer patients previously
that match the criteria. detect the presence of lumps in the breast even
though the respondents did not perform BSE
RESULTS technique correctly. Roth et al (2011) through
8 articles journals were selected and the study of descriptive also conduct surveys
assessed. Selected journal articles involving a using the NHIS (National Health Interview
total of 3614 participants with the smallest Survey) in patients with breast cancer reported
sample size of 153 and the largest sample size that 43% of cancer survivors detect the
was 1598. Most of the articles using good presence of abnormal lumps in the breast
experimental design pre-post test and cross
39
namely 25% with the technique of BSE and all respondents increased skills and
18% were found by accident. knowledge. This encourages respondents to be
Through health education program also more alert and aware of the importance of
showed that respondents' knowledge increased breast health. In addition to improve the
by 90.7% from the previous 0% accompanied knowledge and practice of the respondents are
by increased awareness about cancer breast by expected to be screened to detect any
43% and 53% after the demonstration BSE, abnormalities in the breast because breast
even from this study found 7 cases of breast cancer in adult women often occurred
abnormalities are detected after further asymptomatic. The Frequencies of Breast Self
investigation two of them are carcinomas and examination (BSE) is related to awareness and
the other is fibroadenoma (Gupta et al, 2009). perceived seriousness of breast cancer,
It is also supported by research of Dahlui, Ng, benefits and health motivation for adult
Al Sadat, Ismail, & Bulgiba (2011) by the woman (Registe & Porterfield, 2012).
method of questionnaire about the knowledge That awareness and behavior changes
of breast cancer and BSE obtained 98.7% of may be detected abnormalities of breast during
respondents alert against breast cancer, 84% of BSE or at some other time, so that through
them do BSE technique from 19% of health promotion and education about breast
respondents who do BSE found a lump in the health and technique BSE detect a lump in the
breast, amounting to 87% continue with the breast indirectly. This occurs due to increase
examination of CBE after detected to ensure the awareness of women about breast cancer so
the condition further. that encourages women to practice BSE
technique. A well-managed education can
The quality of the articles and bias increase the positive perception of BSE
The quality of research articles selected because it is easily practiced, does not need the
using assessment tools EPHPP. Five articles special equipments, nevertheless it have to be
categorized strong means through assessments taught how to do it (Hacihasanoǧlu & Gözüm,
EPHPP do not get of weak value in the variable 2008). Nevertheless, in some cases the self-
tools. Meanwhile, three other articles examination (BSE) technique showed no
categorized by reviewing EPHPP moderate significant effect in the screening. Several
means there is a maximum of one weak value factors such as education level, marital status
of the variable tools. and the ethical issues become complicated
There is no research article reported on factors (Loh & Chew, 2011). In a review
a study blinding technique. Respondents who conducted by Corbex, Burton, & Sancho-
drop out and refused the intervention were also Garnier (2012) showed that the late detection
reported in several study articles. Five articles of breast cancer still accrued in many cases,
reported that respondents who drop out of his especially in the phase III and IV. This bias
research while three other articles are not occurs because BSE technique needs the
mention if there were respondents drop out or capability and the right techniques and
not. Once of the articles even assessing the bias influenced by several factors which breast
in the study cancer patients are afraid to know the real
condition of their screening results (Simi,
DISCUSSION Yadollahie, & Habibzadeh, 2009).
Generally all been reviewed journals Screening technique using
provide results that Breast Self Examination mammography is believed to be more accurate
(BSE) provide benefits to women as the and frequently used in healthcare facilities.
detection of early breast cancer. From the However, the radiation risk, cost factor and it
results of these studies indicate that the BSE should be done in a health facility become
(Breast Self Examination) is still a little bit to special consideration for women to do breast
do, the knowledge and the practice is relatively self examination (BSE).
low. However, after the intervention of nearly
40
CONCLUSION AND https://doi.org/10.1016/j.breast.2012.0
RECOMMENDATION 1.002
Conclusion Dahlui, M., Ng, C. W., Al Sadat, N., Ismail, S.,
At the conclusion of the article research & Bulgiba, A. M. (2011). Is breast self
review shows that almost all of breast self examination (BSE) still relevant? A
examination (BSE) is able to give a positive study on bse performance among
effect in terms of both knowledge and female staff of University of Malaya.
awareness for women about breast health. Asian Pacific Journal of Cancer
Breast cancer should be detected early to Prevention, 12(2), 369–372.
improve the prognosis for immediate action. Gupta S.K. (2009). Impact of a Health
Education Intervention Program
Recommendation Regarding Breast Self Examination by
One way to detect breast cancer is to Women in a Semi-Urban Area of
improve the knowledge and awareness of Madhya Pradesh, India. Asian Pacific J
women to perform breast self-examination Cancer Prev, 10, 1113-1117
(BSE) as a tool for detecting breast cancer for Hacihasanoǧlu, R., & Gözüm, S. (2008). The
a safe and easy method. This systematic review effect of training on the knowledge
is needed further review especially with RCT levels and beliefs regarding breast self-
design and uses many more articles to show a examination on women attending a
more accurate result. public education centre. European
Journal of Oncology Nursing, 12(1),
REFERENCE 58–64.
Americans Cancer Society. (2016). Breast https://doi.org/10.1016/j.ejon.2007.06.
Cancer Early Detection and Diagnosis. 005
https://www.cancer.org/cancer/breast- Kolutek, R., Avci, I. A., & Sevig, U. (2016).
cancer/screening-tests-and-early- Effect of Planned Follow-up on
detection/american-cancer-society- Married Women’s Health Beliefs and
recommendations-for-the-early- Behaviors Concerning Breast and
detection-of-breast- Cervical Cancer Screenings. Journal of
cancer.html.Accessed 2nd march 2017 Cancer Education.
at 18.15WIB https://doi.org/10.1007/s13187-016-
American Cancer Society. (2016). Cancer 1114-2
Facts & Figures 2016. Cancer Facts & Loh, S. Y., & Chew, S. L. (2011). Awareness
Figures 2016, 1–9. and practice of breast self examination
https://doi.org/10.1097/01.NNR.00002 among malaysian women with breast
89503.22414.79 cancer. Asian Pacific Journal of Cancer
Ayed, A., Eqtait, F., Harazneh, L., Fashafsheh, Prevention : APJCP, 12(1), 199–202.
I., Nazzal, S., Talahmeh, B., … Retrieved from
Awawdeh, R. (2015). Breast Self- http://www.ncbi.nlm.nih.gov/pubmed/
Examination in Terms of Knowledge, 21517257
Attitude, and Practice among Nursing Masso-Calderón, A. M., Meneses-Echávez, J.
Students of Arab American University/ F., Correa-Bautista, J. E., Tovar-
Jenin. Journal of Education and Cifuentes, A., Alba-Ramírez, P. A., &
Practice, 6(4), 37–47. Charry-Ăngel, C. E. (2016). Effects of
Corbex, M., Burton, R., & Sancho-Garnier, H. an Educational Intervention on Breast
(2012). Breast cancer early detection Self-Examination, Breast Cancer
methods for low and middle income Prevention-Related Knowledge, and
countries, a review of the evidence. Healthy Lifestyles in Scholars from a
Breast, 21(4), 428–434. Low-Income Area in Bogota,
Colombia. Journal of Cancer
41
Education, 1–7.
https://doi.org/10.1007/s13187-016-
1133-z
Registe, M., & Porterfield, S. P. (2012). Health
Beliefs of African American Women
on Breast Self-Exam. The Journal for
Nurse Practitioners, 8(6), 446–451.
https://doi.org/10.1016/j.nurpra.2011.0
9.025
Roth, M. Y., Elmore, J. G., Yi-Frazier, J. P.,
Reisch, L. M., Oster, N. V, &
Miglioretti, D. L. (2011). Self-
detection remains a key method of
breast cancer detection for U.S.
women. Journal of Women’s Health
(2002), 20(8), 1135–9.
https://doi.org/10.1089/jwh.2010.2493
Santoso, Satmoko. (2009). Buku Pintar
Kanker. Yogyakarta: Power Books
Secginli, S., & Nahcivan, N. O. (2011). The
effectiveness of a nurse-delivered
breast health promotion program on
breast cancer screening behaviours in
non-adherent Turkish women: A
randomized controlled trial.
International Journal of Nursing
Studies, 48(1), 24–36.
https://doi.org/10.1016/j.ijnurstu.2010.
05.016
Simi, a, Yadollahie, M., & Habibzadeh, F.
(2009). Knowledge and attitudes of
breast self examination in a group of
women in Shiraz, southern Iran.
Postgraduate Medical Journal,
85(1004), 283–7.
https://doi.org/10.1136/pgmj.2008.072
678
42
EFFECTIVENESS OF THE IMPROVEMENT OF CHINESE TRADITIONAL
MEDICINE PULMONARY FUNCTION AND QUALITY OF LIFE OF PATIENTS
COPD
Made Mahaguna Putra, Henry Wiyono, Sismulyanto, Nikodemus Sili Beda

Email: md. mahagunaputra@gmail.com
ABSTRACT
Introduction: COPD (Chronic Obstructive Pulmonary Disease) with high prevalence,
morbidity, mortality, and economic burden of the world is a global health problem. Recent
research into the cause of death COPD will rank fourth in the world in 2030. The new therapy
and appropriate strategies are needed to increase the effectiveness in treating this deadly
disease. Several systematic reviews have been conducted, demonstrating the potential
effectiveness of Chinese herbal medicine in COPD. However, the effectiveness is still not
assured because of the low quality of research. Methods: The search strategy used in this study
are as follows: Chronic Obstructive Pulmonary Disease, [AND] Complementary [OR]
Alternative Medicine, [OR] Herbs, [OR] Alternative Treatment on search engines Proquest
journals and Scopus. Results: 15 studies of Chinese herbal medicines. 13 studies conducted in
humans with COPD and 2 studies in experimental animals with COPD. Conclusion:
Traditional Chinese medicine pills may be involved in reducing the expression of interleukin
(IL) -8, IL-6, IL-10, IL-1β and TNF-α, and set the levels of inflammatory cytokines. Traditional
Chinese Medicine is able to increase the quality of life of patients with COPD. At present,
quality of life becomes an indispensable indicator in the world
Keywords: Chronic obstructive pulmonary disease, traditional chinese medicine,

complementary therapy.
INTRODUCTION deadly disease. In recent years, much

Chronic Obstructive Pulmonary attention has been paid to developing
Disease (COPD) is defined as a slowly Chinese herbal medicine for the treatment
progressive condition characterized by of COPD (Li et al. 2015).
reversible airflow limitation and systemic Phosphodiesterase inhibitors become the
inflammation (Li et al. 2015). Prevalence main method in treating. New therapies and
COPD with high morbidity, mortality, and appropriate strategies are needed to
economic burden is a global health problem increase the effectiveness in treating this
world (Li et al. 2013). COPD in 1990 was deadly disease. In recent years, much
the sixth leading cause of death in the attention has been paid to developing
world, a recent study says COPD will Chinese herbal medicine for the treatment
become the leading cause of death in the of COPD (Li et al. 2015).
world ranking fourth in 2030 (Zheng et al. COPD is one of the major non-
2016). Therefore, designing strategies and communicable diseases are rarely reported
treatments for COPD are important (S. Li et due to lack of information. In the United
al. 2012). Drug therapy that include States the data in 2007 showed that the
bronchodilators, steroids and prevalence of COPD of 10.1% (SE 4.8) in
phosphodiesterase inhibitors become the males 11.8% (SE 7.9) and for women 8.5%
main method in treating. New therapies and (SE 5.8). While mortality ranked as the
appropriate strategies are needed to fourth most common cause is 18.6 per
increase the effectiveness in treating this 100,000 population in 1991 and the death
43
rate increased by 32.9% from 1979 to 1991. Questionnaire (SGRQ), and symptoms. The
While the prevalence of COPD in the search strategy used in this study are as
countries of Southeast Asia is estimated to follows: Chronic Obstructive Pulmonary
6.3% with the highest prevalence found in Disease, [AND] Complementary [OR]
Vietnam (6.7%) and China (6.5%) (Oemiati Alternative Medicine, [OR] Herbs, [OR]
2013). Estimates of the prevalence of Alternative Treatment on search engines
COPD in Indonesia in men aged> 30 years Proquest journals and Scopus
was 1.6% and 0.9% of women. Chronic
obstructive pulmonary disease is a RESULTS
progressive disease, destructive and Review conducted at 15 research
debilitation. Lung function will decline journals on Chinese herbal medicine. two
rapidly, if not properly controlled COPD studies (Lu et al. 2016) and (Chengyang et
and the first patients often experience al. 2015) used a sample of COPD rats given
exacerbations. Decline in lung function will Chinese herbal medicine. Based on these
cause a decrease in health status and quality two studies, traditional Chinese medicine
of life of patients with COPD. COPD can lower inflammatory responses and
patients will find it difficult to carry out improve the function paru.13 studies were
daily activities, not being able to do what conducted in patients with COPD.
you want, it can even become an invalid, Research (Wang et al. 2014), (Ng et al.
who just lay helpless in bed (Wijaya et al. 2012), and (S. Li et al. 2012) explains that
2012). the Chinese herbal drug therapy can
Several systematic reviews have improve lung function of COPD patients.
been conducted, demonstrating the Research (Dong et al. 2014), (Li et al.
potential effectiveness of Chinese herbal 2013), (J. Liu et al. 2014), (Ya-ling et al.
medicine in COPD. However, the 2012), (Li et al. 2016), (JS Li et al . 2012),
effectiveness is still not assured because of (Miao et al. 2016), and (Jiansheng et al.
the low quality of research. In this study, we 2016) describes the Chinese herbal
systematically explain the effectiveness of medicine can improve the quality of life of
herbal medicines in COPD using lung patients with COPD. Research (M. Liu et
function, quality of life and clinical al. 2014) and (Guo et al. 2014) describes the
symptoms as a measuring tool (Chen et al. Chinese herbal medicine can improve lung
2014). A systematic review would be function and quality of life of COPD
beneficial to current practices and patients in the intervention group
instructions to continue research with a new
method of treatment. The purpose of this CONCLUSION AND
study was to assess the positive effects of RECOMMENDATION
Chinese herbal medicine (TCM) plus Conclusion
conventional treatment in stable COPD Chinese herbal medicine can
adults (Haifeng et al. 2015). improve lung function and quality of life of
patients with COPD. Further research on a
METHODS large scale, design appropriate studies,
Giving TCM for the treatment of randomized trials of TCM for COPD would
stable COPD accepted for inclusion, be required to justify the effect that is
control group treated with conventional written in this study
medicine, all studies published openly and
research data was provided; The results Recommendation
have most influenced the process of COPD, Future experiments should be
such as exacerbations, lung function, six- conducted in Indonesia in order to
minute walk test (6MWD), dyspnea, quality determine the effects of traditional Chinese
of life (QOL), St. George's Respiratory medicine in Indonesian society and able to
44
adopt the traditional Chinese medicine Jiansheng, L. et al., 2016. Effect of
preparations. sequential treatment with TCM
syndrome differentiation on acute
REFERENCE exacerbation of chronic obstructive
Chen, H.Y. et al., 2014. A systematic pulmonary disease and AECOPD
review and meta-analysis of herbal risk window ଝ. Complementary
medicine on chronic obstructive Therapies in Medicine, 29, pp.109–
pulmonary diseases. Evidence- 115. Available at:
based Complementary and http://dx.doi.org/10.1016/j.ctim.20
Alternative Medicine, 2014, pp.1– 16.09.009.
10. Available at: Li, F.S.E.N. et al., 2016. trial of the
http://www.pubmedcentral.nih.gov/ Yiqigubiao pill for the treatment of
articlerender.fcgi?artid=3984792&t patients with chronic obstructive
ool=pmcentrez&rendertype=abstra pulmonary disease at a stable stage.
ct. , i, pp.2477–2488.
Chengyang, W. et al., 2015. Effect of Li, J. et al., 2015. Systems pharmacology-
Liuweibuqi capsule, a Chinese based dissection of mechanisms of
patent medicine , on the JAK1 / Chinese medicinal formula Bufei
STAT3 pathway and MMP9 / Yishen as an effective treatment for
TIMP1 in a chronic obstructive pul- chronic obstructive pulmonary
monary disease rat model. , 35(1), disease. , (June), pp.1–15. Available
pp.54–62. at:
Dong, L. et al., 2014. Effect of www.nature.com/scientificreports/.
Lianhuaqingwen Capsules on Li, J. et al., 2013. The effective evaluation
Airway Inflammation in Patients on symptoms and quality of life of
with Acute Exacerbation of Chronic chronic obstructive pulmonary
Obstructive Pulmonary Disease. , disease patients treated by
2014. comprehensive therapy based on
Guo, S. et al., 2014. Effect of bufei granule traditional Chinese medicine
on stable chronic obstructive
patterns ଝ. Complementary
pulmonary disease: a randomized,
double blinded, placebo-controlled, Therapies in Medicine, 21(6),
and multicenter clinical study. pp.595–602. Available at:
Journal of traditional Chinese http://dx.doi.org/10.1016/j.ctim.20
medicine = Chung i tsa chih ying 13.09.006.
wen pan / sponsored by All-China Li, J.S. et al., 2012. Bu-Fei Yi-Shen granule
Association of Traditional Chinese combined with acupoint sticking
Medicine, Academy of Traditional therapy in patients with stable
Chinese Medicine, 34(4), pp.437– chronic obstructive pulmonary
444. disease: A randomized, double-
Haifeng, W. et al., 2015. Effectiveness and blind, double-dummy, active-
safety of traditional Chinese controlled, 4-center study. Journal
medicine on stable chronic of Ethnopharmacology, 141(2),
obstructive pulmonary disease: A pp.584–591. Available at:
systematic review and meta- http://dx.doi.org/10.1016/j.jep.2011
analysis. Complementary Therapies .08.060.
in Medicine, 23(4), pp.603–611. Li, S. et al., 2012. Effects of comprehensive
Available at: therapy based on traditional
http://dx.doi.org/10.1016/j.ctim.20 Chinese medicine patterns in stable
15.06.015. chronic obstructive pulmonary
45
disease : a four- center , open-label , , Double- Blind , Randomized
randomized , controlled study. , (1), Controlled Trial. , 9(8).
pp.1–11. Wijaya, O. et al., 2012. Peningkatan
Liu, J., Gao, F. & Li, Z., 2014. Effect of Persentase Makrofag dan Neutrofil
Yiqibushenhuoxue decoction on pada Sputum Penderita Penyakit
chronic obstructive pulmonary Paru Obstruktif Kronik
disease measured by St . George ’ s Berhubungan dengan Tingginya
respiratory disease questionnaire Skor COPD Assessment Test ( CAT
scores and forced expiratory ). Jurnal Respirasi Indonesia, 32(4),
volume. Journal of Traditional pp.240–249.
Chinese Medicine, 34(4), pp.445– Ya-ling, Z. et al., 2012. The effects of
449. Available at: Chinese Yam-Epimedium mixture
http://dx.doi.org/10.1016/S0254- on respiratory function and quality
6272(15)30044-3. of life in patients with chronic
Liu, M. et al., 2014. Xuan Bai Cheng Qi obstructive pulmonary disease.
formula as an adjuvant treatment of Journal of Traditional Chinese
acute exacerbation of chronic Medicine, 32(2), pp.203–207.
obstructive pulmonary disease of Available at:
the syndrome type phlegm-heat http://dx.doi.org/10.1016/S0254-
obstructing the lungs : a. BMC 6272(13)60012-6.
Complementary and Alternative Zheng, F. et al., 2016. A multicenter
Medicine. randomized , double-blind ,
Lu, X. et al., 2016. Sequential Treatments placebo-controlled trial to evaluate
with Tongsai and Bufei Yishen the safety and efficacy of rhubarb in
Granules Reduce Inflammation and treating acute exacerbation of
Improve Pulmonary Function in chronic obstructive pulmonary
Acute Exacerbation-Risk Window disease of the syndrome type
of Chronic Obstructive Pulmonary phlegm-heat obstructing the lungs.
Disease in Rats, Journal of Traditional Chinese
Miao, L. et al., 2016. Sugarcane bagasse Medical Sciences, 3(2), pp.71–80.
dietary fiber as an adjuvant therapy Available at:
for stable chronic obstructive http://dx.doi.org/10.1016/j.jtcms.20
pulmonary disease : a four-center , 16.07.002.
randomized ,. Journal of Traditional
Chinese Medicine, 36(4), pp.418–
426. Available at:
http://dx.doi.org/10.1016/S0254-
6272(16)30057-7.
Ng, T.P. et al., 2012. Curcumins-Rich
Curry Diet and Pulmonary Function
in Asian Older Adults. , 7(12),
pp.1–8.
Oemiati, R., 2013. KajianEpidemiologis
Penyakit Paru. Media Litbangkes,
23(2), pp.82–88.
Wang, G. et al., 2014. Effects of Two
Chinese Herbal Formulae for the
Treatment of Moderate to Severe
Stable Chronic Obstructive
Pulmonary Disease : A Multicenter
46
NON-PHARMACOLOGICAL INTERVENTION TO INCREASE
QUALITY OF SLEEP ON THE ELDERLY: A SYSTEMATIC REVIEW
Irwina Angelia Silvanasari, Amita Audilla, Ifa Nofalia

Faculty of Nursing, Airlangga University
Email: irwina.angelia@gmail.com
ABSTRACT
Introduction: Sleep disorders are common health problems reported 39-75% of the elderly.
The presence of sleep disorders in the elderly can lead to poor sleep quality in the elderly.
Pharmacological action in treating sleep disorder continuously will produce unwanted side
effects. Non-pharmacological action lately becomes a crucial issue in the nursing environment
in overcoming sleep disorders. Method: The source of article used is obtained from a search
through the database Proquest, EBSCO, Google Scholar, Scopus, SAGE, and Science Direct.
Search restricted articles ranging from 2008 until 2016. After the articles obtained, then
research articles were extended of making systematic review. Result: Systematic review
resulted 11 of the 13 non-pharmacological intervention options that can be used to improve the
quality of sleep on elderly, in example of acupressure, SSBM, ling tien kung therapy, baduanjin
exercise, exercise training program, gymnastics for elderly, practice of progressive muscle
relaxation, tai chi, sittercise, aerobic exercise, and aquatic exercise. Conclusion: Non-
pharmacological Intervention is part of secondary prevention that can be done to improve sleep
quality on the elderly.
Keywords: non-pharmacological intervention, quality of sleep, elderly
INTRODUCTION that could cause poor sleep quality on the

Sleep disorders are common health elderly are the response to disease,
problems reported 39-75% of elderly (Blay, depression, anxiety, physical environment,
S.L., Baxter, U.S., Leite, G.F., 2008). This and lifestyle (Silvanasari, 2013).
is in line with the statement of Roland Guyton & Hall (2007) stated that
(2011) who says that the aging process individual sleep quality can be analyzed by
makes the elderly more susceptible to sleep electroencephalography (EEG). Buysse
disturbances, besides resulting in normal et.al. (1988) also suggests measuring
changes in sleep and rest patterns of the instrument to the quality of sleep by
elderly. The presence of sleep disorders on Pittsburgh Sleep Quality Index (PSQI).
the elderly can lead to poor sleep quality on PSQI provide a quantitative measure of the
the elderly (Su, T.P., Huang, S.R., Chou, P., quality of sleep that fast in identifying sleep
2004). Sagala (2011) stated that the quality quality is good or bad, and better than the
of sleep is the satisfaction of a person to gold standard of clinical and laboratory
sleep, so that someone does not show diagnosis. PSQI score <5 indicates a
feelings of fatigue, easily aroused and sensitive and specific measure of sleep
agitated, lethargic and apathetic, black quality is good on the individual. The
around on the eyes, swollen eyelids, red higher PSQI global score obtained the
conjunctiva, sore eyes, fragmented worse also the individual sleep quality (D.J.
attention, headache and frequent yawning Buysse, Reynolds C.F., T.H. Monk,
or drowsy. Sumedi, T., Wahyudi, Kuswati Berman S.R., and D.J. Kupfer, 1988).
A. (2010) revealed that the quality of Nurses, both in the clinical or
nighttime sleep on the elderly decreased to community, have an important role in
approximately 70-80% of the adult. Factors improving the quality of sleep on elderly.
47
Nurses can perform preventive measures in Language used the keywords of “intervensi
dealing with sleep disorders on the elderly, keperawatan”, “intervensi
which includes primary prevention, nonfarmakologik”, “kualitas tidur”,
secondary, and tertiary. Primary prevention “lansia”, dan “lanjut usia”.
is an attempt to avoid specific diseases or
health conditions. Health education about Journal Selection
good sleep hygiene can be done as primary Articles were selected for review
prevention form of poor sleep quality. based on studies carried out in accordance
Secondary prevention is early detection and with the inclusion criterion. The criterion
treatment of adverse health conditions, for inclusion in this systematic review is the
including non-pharmacological and application of non-pharmacological
pharmacological actions. Tertiary nursing intervention. The journal is a
prevention is done if certain conditions or primary research, research design can be
diseases may have caused damage to the using Random Controlled Trial (RCT) or
individual (Anderson & McFarlane, 2006; quasi-experiment, the participants were
Stanley & Beare, 2006). elderly people with sleep problems such as
Individuals with insomnia usually insomnia and poor sleep quality, as well as
get treatment to improve the quality of the measurement can be subjectively the
sleep, but the action of pharmacology in form of the Pittsburgh Sleep Quality Index
overcoming sleep disorders are constantly (PSQI) and the scale of insomnia and
certainly will produce side effects that are objective in such polysomnography or
not desired (Bertisch, Herzig, Winkelman, actigraph form.
Buettner, 2014; DeMartinis, Kamath, Titles and abstracts of the search
Winokur, 2009). Non-pharmacological results then screened by investigators,
action in treating sleep disorder lately could be included into the inclusion criteria
becomes a crucial issue in the nursing or not. Researchers read the full text of
environment (Su et al., 2013). Various paper that exists when researchers difficulty
studies of non-pharmacological in deciding the journal suitable or not with
intervention in an effort to improve sleep the existing inclusion criteria. Search using
quality on the elderly have been published, keywords above found 61 articles. Of the
such as acupressure, music therapy, entire articles, which met the inclusion
exercise, and so on. The purpose of this criteria were 17 articles.
study was to evaluate the effectiveness of
non-pharmacological interventions in RESULTS
improving sleep quality in the elderly. Characteristics
The results in reviewing 17 research
METHODS articles that met the inclusion criteria, got
The Journal Search Strategy 13 types of non-pharmacological
The approach used was the interventions, namely practice of
approach of systematic review that began progressive muscle relaxation, gymnastics
with the selection of a topic, then the for elderly, tai chi, aerobic exercise and
specified keywords to search journals resistance exercise, aquatic exercise,
(primary research) using English and baduanjin exercise, walking, exercise
Indonesian through several databases, training program, ling tien kung therapy,
among Proquest, EBSCO, Google Scholar, slow stroke back massage, music therapy,
Scopus, SAGE, and Science Direct. This sittercise, and acupressure. Four studies
search was restricted from 2008 until 2016. tested more than once, which were
Keywords in English used were "nursing progressive muscle relaxation exercises,
intervention", “non-pharmacology", "sleep elderly gymnastics, tai chi, and music
quality”, and "elderly". Indonesian therapy.
48
Setting of the 17 articles of research was in muscle relaxation, gymnastics for elderly,
the community (n = 13), laboratory (n = 2), tai chi, aerobic exercise and resistance
and home care (n = 1). The number of exercise, aquatic exercise, baduanjin
samples was ranging from the smallest of exercise, walking, exercise training
20 people to the largest number of 126 program, ling tien kung therapy, slow
people. Most interventions more directed to stroke back massage, music therapy,
an exercise activity given to the elderly with sittercise, and acupressure. The time
poor sleep quality or elderly people with required of each intervention also different,
sleep disorders. Most studies also did not ranging from 1-16 weeks. Frequency of
explain in detail how the procedures related intervention was also different which
to the interventions, the researchers simply ranges from every day made up until only
wrote down how long that given once in a week.
interventions. Non-pharmacological intervention
Measuring instruments used on the form of acupressure is applied for 5 minutes
rest of the articles in the form of an on each point, once to twice daily (before
objective measurement tool the break of day and night) for 4 weeks can
(polysomnography, actygraph) as many as improve sleep quality in older adults with
four researches and measurement tools that hypertension (LW Zheng, Chen Y., Chen
were subjective (PSQI, Korean sleep scale, F., P. Zhang, Wu LF, 2014). Slow-Stroke
and insomnia rating scale) of 13 studies. Back Massage (SSBM) for 3 minutes of
The parameters used appropriate criteria for bedtime can overcome sleep disorders and
inclusion that were to measure the quality dementia in the care homes (Harris M.,
of sleep, insomnia, and other sleep Richards K.C, V.T. Grando, 2012). In
disorders in the elderly. contrast to these two studies, two studies
The results on 17 research articles using music as an intervention would
were reviewed, there were seven research indicate no significant difference between
articles that used quasi-experiment, in the treatment group and the control group.
which the intervention given that sittercise, Giving music may be effective as
gymnastics elderly (n = 2), practice of promoting sleep (M.F. Chan, Chan E.A., E.
progressive muscle relaxation (n = 2), Mok, 2010; Lai H.L, et al, 2015).
acupressure, and ling tien kung therapy. Non-pharmacological intervention
Ten RCT research approached with the rest form of exercise is various in types. Kung
of intervention options that music therapy tien ling therapy can improve the quality of
(n = 2), aquatic exercise, aerobic exercise, sleep of elderly with treatment for 6 weeks.
baduanjin exercise, home-based walking, Chen M.C., H.E. Liu, Huang H.Y., Chiou
exercise training program, SSBM, and tai A.F. (2012) explains that baduanjin
chi (n = 2). When viewed in terms of the exercise can improve sleep quality of the
selection method, in accordance with the elderly after 12 weeks of intervention.
level of evidence, of course, research Exercise training program can also improve
method approached, RCT was more general the quality of sleep of elderly with heart
than the study design of quasi-experiment. failure (Suna, Jessica M., et. Al., 2015).
Giving elderly gymnastics for 1 week may
Non-pharmacological intervention effect improve the quality of sleep of elderly
on the sleep quality of elderly (Yurintika F., F. Sabrian, Dewi Y.I, 2015;
Non-pharmacological interventions Cahyono H.K., 2012). Progressive muscle
to improve sleep quality on the elderly were relaxation exercise can improve sleep
very various, which there were 13 kinds of quality and reduce the level of insomnia in
intervention options from 17 articles were the elderly (Sulidah, Yamin A., Susanti
obtained. Type of non-pharmacological R.D., 2016). Tai chi is done and given a
interventions were practice of progressive maximum of 40 minutes 3 times a week for
49
16 weeks can improve sleep quality in the improve sleep quality of the elderly based
elderly. Other studies have produced on measurements of actigraph data in 48
evidence if tai chi which is done every week hours.
for two months may improve sleep quality The results of this review are
in older adults with cognitive impairment certainly useful for nurses, both clinical and
(Irwin M.R, R. Olmstead, Motivala S.J., community nurses. Nurses can apply one of
2008; Chan, et al., 2016). Sittercise non-pharmacological intervention as a form
performed 3 times a week for 8 weeks of secondary prevention of poor quality
resulted in significant positive results on the sleep and sleep disorders on the elderly.
quality of sleep (Lee M: S, Kim S.R., Min Clinic nurses can do SSBM and
G.H., Cho B.J., 2015). Aerobic exercise is acupressure in order to improve the quality
done alone or in combination with of sleep of elderly, while the community
resistance exercise is effective in improving nurse can choose exercise to improve sleep
sleep quality in the elderly after 10 weeks quality of the elderly. Application of non-
(Bonardi, J.M.T., et.al., 2016). Unlike the pharmacological intervention can certainly
case with the exercise study, research prevent a worse condition in the elderly
conducted by Chen L.J, Fox K.R., P.W. Ku, with poor sleep quality as well as elderly
Chang Y.W. (2016) actually get results that people with sleep disorders.
aquatic exercise can only lead to significant These studies could not be fully
differences in sleep latency and sleep generalized. Bias might occur. It could be
efficiency, not on the overall parameters of due to measurement parameter was not
measuring the quality of sleep and study of homogeneous and the condition of the
home-based walking intervention is not study sample were also less homogeneous
even significant in improving the quality of (there are a few samples with pathological
sleep of elderly (Wenzel, Jennifer A. et. al., conditions such as tumor, hypertension, and
2013). cognitive impairment).
DISCUSSION CONCLUSION AND

This systematic review provides RECOMMENDATION
evidence-based picture of the effectiveness Conclusion
of non-pharmacological interventions Non-pharmacological intervention
related to the improving of sleep quality on is part of secondary prevention that can be
the elderly. The results of the reviews done to improve sleep quality on the
explain that there are 11 of the 13 choices elderly. Acupressure, SSBM, kung tien ling
of interventions that can be used to improve therapy, baduanjin exercise, exercise
the quality of sleep of elderly, such as training program, gymnastics elderly,
acupressure, SSBM, therapy of ling tien progressive muscle relaxation exercises, tai
kung, baduanjin exercise, exercise training chi, sittercise, aerobic exercise, and aquatic
program, gymnastics elderly, practice of exercise can be selected non-
progressive muscle relaxation, tai chi, pharmacological interventions in
sittercise, aerobic exercise, and aquatic improving sleep quality of the elderly.
exercise; although aquatic exercise itself SSBM intervention is considered effective
does not show significant results in overall if the terms of the duration of the
sleep quality measurement parameters. intervention.
Music therapy and home-based walking
intervention showed no significant results Recommendation
in improving the quality of sleep on elderly. Clinic nurses can do SSBM and
From the terms of the duration for the acupressure in order to improve the quality
intervention, intervention options of SSBM of sleep of elderly, while the community
conducted for 3 minutes bedtime can
50
nurse can choose exercise to improve sleep Kecamatan Ungaran Timur
quality of the elderly. Kabupaten Semarang.
http://perpusnwu.web.id/karyailmia
REFERENCE h/documents/3556.pdf, 28
Anderson, E.T., & McFarlane J. (2006). Desember 2016.
Buku Ajar Keperawatan Komunitas Chan, Aileen WK et. al. (2016). Tai chi
Teori dan Praktik. Edisi Ketiga. qigong as a means to improve night-
Jakarta: EGC. time sleep quality among older
Austaryani, Nessma Putri & Arif Widodo. adults with cognitive impairment: a
(2011). Pengaruh Terapi Relaksasi pilot randomized controlled trial.
Otot Progresif Terhadap Perubahan Clinical Interventions in Aging :11
Tingkat Insomnia Pada Lansia di 1277–1286.
Posyandu Lansia Desa Gonilan, Chan M.F., Chan E.A., Mok E. (2010).
Kartasura. Effects of music on depression and
https://publikasiilmiah.ums.ac.id/bi sleep quality in elderly people: A
tstream randomised controlled trial.
/handle/11617/3623/NESMA%20P Complementary Therapies in
UTRI- Medicine (2010) 18, 150-159.
ARIF%20WIDODO%20Fix.pdf? https://www.ncbi.nlm.nih.gov/pub
sequence=1, 28 Desember 2016. med/20688261, 1 Januari 2017.
Bertisch, S. M., Herzig, S. J.,Winkelman, Chen L.J, Fox K.R., Ku P.W., Chang Y.W.
J.W., Buettner, C. (2014). National (2016). Effects of Aquatic Exercise
use of prescription medications for on Sleep in Older Adults with Mild
insomnia: NHANES 1999-2010. Sleep Impairment: a Randomized
Sleep, 37, 343–349. Controlled Trial. International
Blay, S.L., Baxter, A.S., Leite, G.F. Society of Behavioral Medicine
(2008). Prevalence of self- (2016) 23:501–506.
reported sleep disturbance among Chen M.C., Liu H.E., Huang H.Y., Chiou
older adults and the association A.F. (2012). The effect of a
of disturbed sleep with service simple traditional exercise
demand and medical conditions. programme (Baduanjin exercise)
International psychogeriatrics 20 on sleep quality of older adults: A
(3), 582–595. randomized controlled trial.
Bonardi, J.M.T., et.al. (2016). Effect of International Journal of Nursing
different types of exercise on sleep Studies 49 (2012) 265–273.
quality of elderly subjects. Sleep DeMartinis, N. A., Kamath, J., Winokur, A.
Medicine 25 (2016) 122–129. (2009). New approaches for the
Buysse D.J., Reynolds C.F., Monk T.H., treatment of sleep disorders.
Berman S.R., dan Kupfer D.J. Advances in Pharmacology, 57,
(1988). The Pittsburgh Sleep 187–235.
Quality Index: a new instrument for Guyton & Hall. (2007). Buku Ajar Fisiologi
psychiatric practice and research. Kedokteran. Jakarta: EGC.
Psychiatri Research, 28, 193-213 Harris M., Richards K.C, Grando V.T.
[serial online]. (2012). The Effects of Slow-Stroke
http://xa.yimg.com/kq/groups/2079 Back Massage on Minutes of
5556/421574977/name/psqi+article Nighttime Sleep in Persons With
.pdf, 28 Desember 2016. Dementia and Sleep Disturbances in
Cahyono, Heri K. (2012). Pengaruh Senam the Nursing Home: a pilot study.
Lansia terhadap Kualitas Tidur pada Journal of Holistic Nursing.
Lansia di Desa Leyangan American Holistic Nurses
51
Association Volume 30 Number 4 /123456789/27941/4/Chapter%20II
December 2012 255-263. .pdf, 28 Desember 2016.
https://www.ncbi.nlm.nih.gov/pub Silvanasari, I.A. (2013). Faktor-faktor yang
med/23007716, 1 Januari 2017. berhubungan dengan kualitas tidur
Irwin M.R, Olmstead R., Motivala S.J. yang buruk pada lansia di Desa
(2008). Improving Sleep Quality in Wonojati Kecamatan Jenggawah
Older Adults with Moderate Sleep Kabupaten Jember. Program Studi
Complaints: A Randomized Ilmu Keperawatan. Universitas
Controlled Trial of Tai Chi Chih. Jember.
SLEEP 2008;31(7):1001-1008. Stanley, Mickey & Beare, P.G. (2006).
Lai H.L, Chang E.T, Li Y.M, Huang C.Y, Buku Ajar Keperawatan Gerontik.
Lee L.H, Wang H.M. (2015). Jakarta: EGC.
Effects of Music Videos on Sleep Su, C. P., Lai, H. L., Chang, E. T., Yiin, L.
Quality in Middle-Aged andOlder M., Peng, S. J., Chen, P.W. (2013).
AdultsWith Chronic Insomnia: A Effects of listening to non-
Randomized Controlled Trial. commercial music on quality of
Biological Research for Nursing. nocturnal sleep and relaxation
2015, Vol. 17 (3) 340-347. indices in patients in
https://www.ncbi.nlm.nih.gov/pub cardiovascular-thoracic intensive
med/25237150, 1 Januari 2017. care unit. Journal of Advanced
Lee M.S, Kim S.R., Min G.H., Cho B.J. Nursing, 69, 1377–1389.
(2015). Effects of sittercise on Su, T.P., Huang, S.R., Chou, P. (2004).
elderly subjects depression and Prevalence and risk factors of
sleep quality. The Journal of insomnia in community-dwelling
Physical Therapy Science, 28: Chinese elderly: a Taiwanese
1120-1123, 2016. urban area survey. Australian and
https://www.ncbi.nlm.nih.gov/pmc/ New Zealand Journal of
articles/PMC4868198/, 1 Januari Psychiatry 38 (9),706–713.
2017. Sulidah, Yamin A., Susanti R.D. (2016).
Muhammad H., Indarwati R., & Ulfiana E. Pengaruh Latihan Relaksasi Otot
(-). Ling Tien Kung Movement Progresif terhadap Kualitas Tidur
Therapy Improve Sleep Quality on Lansia. Volume 4 Nomor 1 April
Elderly. 2016.
http://journal.unair.ac.id/down Sumedi, T., Wahyudi, Kuswati A. (2010).
load- fullpapers- Pengaruh Senam Lansia terhadap
ijchn871669770cfull. pdf, 28 Penurunan Skala Insomnia pada
Desember 2016. Lansia di Panti Wredha Dewanata
Roland, Ngang. (2011). Sleep disturbance Cilacap. Jurnal Keperawatan
among elderly people in nursing Soedirman (The Soedirman Journal
home: A nonpharmacological of Nursing), Volume 5, No.1, Maret
approach. Human Ageing and 2010.
Elderly Services [serial online]. Suna, Jessica M et. al. (2015). The effect of
https://publications.theseus.fi/bitstr a supervised exercise training
eam/handle/10024/36268/Thesis. programme on sleep quality in
pdf? sequence=3, 28 Desember recently discharged heart failure
2016. patients. European Journal of
Sagala,V. P. (2011). Kualitas Tidur dan Cardiovascular Nursing, Vol. 14(3)
Faktor-faktor Gangguan Tidur 198 –205,
[serial online] http://journals.sagepub.com/doi/pdf
http://repository.usu.ac.id/bitstream
52
/10.1177/1474515114522563, 2
Januari 2017.
Wenzel, Jennifer A. et. al. (2013). Impact of
a Home-Based Walking
Intervention on Outcomes of Sleep
Quality, Emotional Distress, and
Fatigue in Patients Undergoing
Treatment for Solid Tumors. The
Oncologist, 18 : 476–484.
Yurintika,F., Sabrian F., Dewi Y.I. (2015).
Pengaruh Senam Lansia terhadap
Kualitas Tidur pada Lansia yang
Insomnia. JOM Vol 2 No 2,
Oktober 2015.
Zheng L.W, Chen Y., Chen F., Zhang P.,
Wu L.F. (2014). Effect of
acupressure on sleep quality of
middle-aged and elderly patients
with hypertension. International
Journal of Nursing Sciences I
(2014) 334-338.
http://www.sciencedirect.com/scien
ce/article/pii/S2352013214001057,
1 Januari 2017.
53
SYSTEMATIC REVIEW OF FACTOR THAT AFFECT IMPLEMENTATION OF
THE PATIENT SAFETY CULTURE IN THE HOSPITAL
Nuning Khurotul Af’ida, Nurul Jannah, Mokhamad Nurhadi

Nursing Faculty, Airlangga University, Surabaya
Email: nuning.khurotul.afida-2016@fkp.unair.ac.id
ABSTRACT
Introduction: Patient safety is a global issue of health care ini hospital. It require special
attention in the implementation. This study has purpose factors that affect implementation of
patient safety. Method: the Journal had searched towards multiple database: DOAJ, Sage,
Proquest, Medline, Google Scholar, Science Direct. It used limited time in January 2011 to
august 2016. From 1797 article, only 15 articles that suitable with the inclusion criteria. Results
: from the 15 literature had acquired factors that affect the implementation of patient safety
such as : economics aspect, leadership, culture, health care system, knowledge, attitudes, and
actions of profesionals, analysis of the situation and workplace conditions, the risk
management system, the duration of nurse’s working hours, mentoring program, nursing
supervision, and evaluation of the patient safety implementation. The instrument used to
measure the implementation of patient safety include questionnaires, checklists observation
form, and interview form. The instruments are often by the environmental practice scale of the
nursing work index (PES-NWI) and the hospital survey of patient safety culture. Discussion:
these factors can provide positive support in the hospital to implement management system and
excellent health services by optimalizing the implementation of patient safety to reduce the risk
malpractice or undesirable events. In the implementing patient safety expected to have good
cooperation and collaboration of hospital’s to be run optimally. It can provide a positive impact
on improving the quality of health service.
Keywords: patient safety, health, health worker
INTRODUCTION Safety is a global issue, it summarized in

Patient safety is a system to make five important issues related to hospital
patient care safer include risk assessment, such as patient safety, hospital safety,
identification and management of matters environment safety, building safety and
relating to the risk of the patient, reporting hospital business safety. It was important
and analysing of incident, the ability to to be implementation, but it must be
learn from the incident, and follow up recognized hospital activities be operated
implementation of solution to reduce risks there was patients. Patient safety is key
and to prevent injuries caused by errors due priority for implementation issues related to
to carry out an act that should be done the quality and image of hospitalization
(Ministry of Health 2011). The hospitals (MoH 2011). WHO (World Health
always tried to increase the level of patient Organization) (2014) collected hospital
safety. Patient safety incidents at the research in various countries such as
hospital will give negative impact on Denmark and Australia. It was found 3.2%
hospital, staff, and patient, because they are - 16.6%. That be triggered in different
recipient of the service. The impact was countries to conduct research and
decreased the level of public trust to the development of patient safety system (Moh
health service. Low quality of care provided 2011).
for patient safety was part of quality service The hospital has an important role
(Flynn, 2002 in cahyono 2008). to realize optimal level of public health.
54
Therefore, the hospitals are required to be health worker. The limited time in January
able to manage activities by emphasis 2011 to august 2016. From 1797 article,
responsibilities of health professionals, only 15 article that suitable inclusion
especially medical and nursing staff in criteria. It contain were 1) the study design
official dutty. Not always medical service RCT, 2) variable factors that affect patient
not often provided health profesionals safety goals, 3) samples of health workers
workers to get results as aepected by all in hospitals, and 4) parameter that assessed
people. Because of many accident of the intensity of the implementation of
malpractice cases, so must be applied to patient safety goal.
patient safety programs.
The phenomenon of patient safety RESULTS
incidents in Indonesia still happen until From the fifteen literature has
2015, it has been published in kompas daily acquired variety of factors that affect the
about patient safety incidents such as implementation of patient safety goals,
happened for patient. Martin (7th) died after there are economics aspect, leadership,
received wound care post accident in culture, health care systems, knowledge,
kefamenamu hospital. The other happened attitudes and professionals interventions,
for swelling and open wasted on the femur analysis of the situation and workplace
of that injected by nurse citama bogor conditions, the risk management system,
hospital, Mrs sutiah (43th) has urticarial the duration of nurses working, mentoring
swelling in in the leg blistered post programs, nursing supervision, and
operative hernia in Kasih Ibu hospital North evaluation of the implementation patient
Aceh nad other patient safety incidents. It safety. While the parameters used to
describe patient safety culture in hospitals measure the implementation of patient
that required special attention in the safety to get data from the instrument are
implementation. Though patient safety questionnaires, observation sheets and
based on priority in hospital, but in the fact sheets intervies checklist. The instrument
is not as comfortable as possible. are often used by environmental practice
Nurse is the important health scale of the Nursing Work Index (PES-
worker in the process of provided health NWI) and the hospital survey of patient
sevices to patients. Nurses tried to maintain safety culture.
and to improve the health client toward
provided health care information that is DISCUSSION
clear and easily understood by client nad Economic aspects
family, while they not cured at the hospital. Research Jackson (2009) showed
In the nursing intervention that do not the influence of the economics aspects of
suitable with Standar Operasional the implementation of patient safety goals.
Procedure get risk of decreasing In the fact patient of lower economic class
implementation of patient safety goals. got nosocomial infections because of bad
Based on this phenomenon, the authors are implementation of patient safety in
interested to analyzed factors that affect the hospital. The economics aspects impacted
implementation of the patient safety in care unit level includes the availability of
hospital. facilities, supporting facilities, health care
and patient comfort during hospitalized.
METHODS
A literature searching towards some Leadership
major databases such as PROQUEST, Research Kessler (2014) aims to
SCIENCEDIRECT, DOAJ,SAGEPUB, evaluate theories, models, and empirical
MEDLINE, and GOOGLE SCHOLAR by evidence on function, rules and
with input keywords patient safety, health, independence leadership, safety culture and
55
the patient safety in hospital. Result of the target document completeness of patient
research is the development framework safety and risk management (60%), medical
based on Evidence Based Nursing which technology (63.6%), human resources
define the relationship between leadership, (42%), medical information (40%).
safety culture, and patient safety. Evaluation nursing practice (20%), finance
Research setowati (2013) aims to (16%) and health research (33%). Djibo
determine the relationship effective study (2013) on the effect of risk
leadership from head room with the management in the implementation of
implementation of patient safety culture. patient safety showed the results : 60 %
The analysis showed negative relationship experienced health professionals provided
between effective leadership from head health service to patient during
room with the implementation of patient hospitalized, 65,7 % are exposed blood
safety culture. Effective leadership style products, 45% do hand hygiene procedures,
from head nurse such as: effective 25,7% frequently use medical equipment,
leadership, knowledge, self-awareness, 14.3% of health workers have not
communication, energy, passion, and take immunize hepatitis-B, and 37.1% had
action. attended training hand hygiene and patient
Leadership style had great influence safety.
on the implementation of patient safety The results of three studies showed
goals. A good leader will be a role model that the risk management system and health
for teamwork in implementation of patient services that appropriate can give a positive
safety, so it can improve the quality of influence of optimization in
health service. implementation of patient safety.
Completeness of facilities and staff training
Culture will facilitate the implementation of patient
Research bouafia (2015) aims to safety in hospital.
determine obediencs staff level towards
implementation of patient safety culture in Knowledge, attitudes, and actions
hospital education center Tunisia. The Research gebru (2013) aims to
results showed that 68.8% health worker identify knowledge, attitudes, and action in
had made the application of patient safety conducted injection by health worker
culture was low. The cultural factors are professionals. The results showed 161
very influence in the implementation of people (85%) have knowledge about of
patient safety, because of providers and injection unsafe or rsky, 135 people (71%)
users of health survice have a unique know the way of administration with a
character management. Management and single dose. Other data showed 149 (79%)
good cooperation are required by staff at the know the inaccuracies in delivery drug that
hospital. Effort to promote patient safety infection, whereas 50 (26%) of health
program to all people there in hospital workers professionals do not apply aseptic
technique, 80 (42%) did not receive training
Risk Management Systems and Health on injection. Proceduces safety 40% of
Service health workers experienced needle stick
World research 2015 showed that injury incident.
90% of health workers in Kinshasa knowed Research of Bernadetta (2015) aims
about risk management infection control, to determine the relationship knowledge of
while 89% health worker do not know nurses about patient safety in the
about patient safety. Oyourou OA research implementation Standart Operation
and Adeoti 2013 showed the percentage of Procedures of patient safety related
influence service management aspect such operating procedures in panti waluya
as : leadership development (64%), the sawahan malang hospital.
56
The results showed a significant Mentoring program
ralatioship between the knowledge of Research Nurmalia (2013) aims to
nurses at the panti waluya hospital with the determine the effect of implementation of a
implementation of patient safety in mentoring program patient safety culture in
hospital. Based on spearman correlation unit at one private hospital in Semarang.
statistic value of it have 0.420 with a The results show there is influence between
significance of 0.001 (P<0.05). 49 the cultural implication of the control group
responden (81.7%) have sufficient after the intervention group mentoring
knowledge, 68.3% are still lacking in program (p= 0.056, x2=4.5 α = 0.1) and RR
implementation standar operation 2.5. The analysis showed group that did not
procedures of patient safety. get the mentoring program will be at risk of
Knowledge, attitudes, and action decline in the implication of patient safety
are required by health workers who better culture at 2.5 times greater than the group
to avoid mistakes or malpractice in the receiving mentoring nursing program.
health services. The precision of action by Research suggests new methods of
staff will support the achievement of optimizing the implication of patient safety
optimizing the implementation of patient is by mentoring. The discussion involves
safety, so it can improve the quality of the principles and theory of four
health services. dimensions of openness, fairness,
Condition Work reporting, and learning implications for
Research of Kirwan (2012) aims to service and nursing education to develop
determine the relationship between the methods directives in accordance with the
work environment of nurses towards the needs of nurses in hospitals.
implementation of patient safety. The
results showed that the workload of nurses Nursing Supervision and Patient Safety
in each care unit and the education level of Evaluation
nurses in a work environment significantly Research Suparna (2015) aims to
influence the implementation of patient determine the evaluation of implication of
safety. The percentage of influence of the patient safety: the risk falls the emergency
workload (76%) and education (51%). room at the Panti Rini Kalasan Sleman
Positive work environment and workload Hospital. The results showed that the risk
calculation according to human resources falls by standard operating procedures,
and staff education level can support aspects of which carried 100%, that is
optimal implementation of patient safety. writing on documentation, while 50% falls
risk assessment, aspects of the mounting
Duration working hours nurse pins fall risk, obtained only 51% of its
We yinghui research (2013) aims to appropriateness. Research Rasdini (2015)
determine the effect of the working hours of show the relationship between supervision
nurses towards patient safety. The results of nursing services with the implication of
showed that working hours duration of ners patient safety in the Sanglah Denpasar,
per week divided into three groups, that are Government Hospital. The results show
<40 hours, 40-60 hours, and >60 hours. The that significant correlation between the
longer duration of the working hours of supervision of nursing services (normative,
nurses can improve for low implementation formative, and restorarif) with the
safety culture. The effectiveness of working application of patient safety by nurses (p =
hours can affect the quality of performance 0.000).
will support the implementation of patient Supervision of nursing and patient
safety maximally. safety evaluation had given a positive
impact on implementation of patient safety
in hospitals. Supervision of nursing is a
57
form of supervision and assistance in the application of patient safety to reduce the
intervention of nurses. Periodic evaluation risk of malpractice or undesirable events.
do to determine the achievement of The development of further research to
implementation of patient safety. If there is identify other factors that may affect the
not suitable aspect have done, better implementation of patient safety. In the
strategies that target the implementation of process of implementation of patient safety
patient safety can be optimized for is expected to have a good cooperation and
improving the quality of health care in collaboration of all elements of the hospital
hospitals. to be run optimally and provide a positive
impact on improving the quality of health
CONCLUSION AND services.
RECOMMENDATION
Conclusion REFERENCE
Systematic review has gotten from Agency For Health Care Research and
15 medical journals showed variety factors Quality. 2014. Hospital Survei on
that affect implication of patient safety in Patient Survey Culture. Agency For
hospitals. There were economic aspects, Health Care Research and Quality:
leadership, culture, health care systems, Page 1 – 5
knowledge, attitudes, and actions of Akobeng AK. Understanding systematic
professionals, analysis of the situation and reviews and meta-analysis. Arch
workplace conditions, the risk management Dis Child 2015;90:845-8.
system, the duration of working hours of Akobeng AK. Principles of evidence based
nurses, mentoring programs, supervision of medicine. Arch Dis Child
nursing, and evaluation implementation of 2015;90:837-40.
patient safety. While the parameters used to Anwar R. Meta analisis. Fakultas Kesehatan
measure the implementation of patient Universitas Padjajaran: Bandung;
safety to get data from the instrument 2005 [cited 2012 August 12].
questionnaires, observation sheets Available from: URL:
checklist, and interview. The type of HYPERLINK
instrument that was often used is The http://pustaka.unpad.ac.id/wp-
Environmental Practice Scale of the content/uploads/2012/05/meta_anal
Nursing Work Index (PES-NWI) and The isis.pdf
Hospital Survey of Patient Safety Culture. Arikunto, S. 2006. Prosedur penelitian:
The results from 15 journals Suatu Pendekatan Praktek. Edisi
indicated that patient safety in hospitals Revisi VI. Jakarta: Rineka Cipta.
required particular attention in its Burls A. What is critical appraisal? What
implementation. Optimization of the factors is…? series of evidence-based
that influence the effectiveness of medicine 2nd ed. Hayward Group
implementation of patient safety can Ltd, Hayward Medical
improve the quality of implementation Communications Division; 2010
patient safety as well as to improve the Feb [cited 2012 August 12].
quality of health care in hospitals. Supported by Sanofi Aventis.
Available from: URL:
Recommendation HYPERLINK
From the 15 studies examined many http://www.medicine.oc.ac.uk/band
factors that affect the implementation of olier/painres/download/whatis/wha
patient safety. All these factors are expected ts_critical_appraisal.pdf
to provide positive support in the hospital to Colla, J.B., Bracken, A,C., Kinney, L.M.
implement a management system and and Weeks, W.B. (2005).
excellent health services by maximizing the Measuring Patient Safety Climate:
58
a Review of Surveys. Qual. Saf. Perera R, Heneghan C. Interpreting meta-
Health. Care. 14; 364 – 366. analysis in systematic reviews.
Crombie IK, Davies HT. What is meta- Evid. Based Med. 2011;13:67-9.
analysis? What is…? series of Ried K. Interpreting and understanding
evidence-based medicine 2nd ed. meta-analysis graphs: A practical
Hayward Group Ltd, Hayward guide. Aust Fam Physician
Medical Communications Division; 2016;35(8):635-8.
2011 Feb [cited 2012 August 12]. Shaheen M. Evidence based medicine and
Supported by Sanofi Aventis. critical appraisal: Physicians’ mess.
Available from: URL: Egypt.mJ. Bronchol 2011;3(1):5-
HYPERLINK 10.
http://www.medicine.oc.ac.uk/band Varadhan KK, Neal KR, Lobo DN. Safety
olier/painres/download/whatis/met and efficacy of antibiotics
a_an.pdf compared with appendicectomy for
Depkes RI. 2011. Panduan Nasional treatment of uncomplicated acute
Keselamatan Pasien Rumah Sakit. appendicitis: Meta analysisof
Jakarta: Depkes RI randomized controlled trials. BMJ
Dept. of General Practice University of 2012;344:e2156
Glasgow. Critical appraisal
checklist for a systematic review
[cited 2012 August 12]. Available
from URL: HYPERLINK
http://www.gla.ac.uk/media_64047
_en.pdf
Flaherty RJ. A simple method for evaluating
the clinical literature. Fam Pract
Manag 2014;11(5):47-52.
Great Ormond Street Hospital NHS Trust for
Children. Critical appraisal of
journal article. United Kingdom:
NHS; 2011 [cited 2012 August 12].
Available from: URL:
HYPERLINK
http://www.ucl.ac.uk/ich/services/li
brary/training_material/critical-
appraisal
Institute of Health Science (Oxford).
Critical appraisal skill programme
(CASP), making sense of evidence:
10 questions to help you make sense
of reviews. England: Public Health
Resources Unit; 2016 [cited 2012
August 12]. Available from: URL:
HYPERLINK
http://www.sph.nhs.uk/sph-
files/S.Reviews Appraisal Tool.pdf
KARS. 2012. Kebijakan Standar Akreditasi
RS (Versi 2012) Dan Cara
Penilaiannya. Komisi Akreditasi
Rumah Sakit
59
A SYSTEMATIC REVIEW ON THE EFFECTIVENESS OF AURICULAR
ACCUPRESSURE FOR PAIN
I Ketut Andika Priastana, Bagus Sholeh Apriyanto, Wildan Akasyah,

I Gede Juanamasta, Hyan Oktodia Basuki
Email: priastanasembilan@gmail.com
ABSTRACT
Introduction: Pain is defined as a subjective sensory and emotional unpleasant associated with
actual or potential tissue damage, or can describe the condition of the damage. To control pain,
can be done using auricular acupressure. Methods: The design used in this study is a systematic
review, with a literature search or study using online reference databases and aggregators in
Pubmed, Proquest, Medline and Science Direct. Articles that met the study criteria were 15
articles. Results: This study showed that there is a significant influence of auricular acupressure
intervention to decreased pain. Pain derived include mild pain to severe pain. Pain can be
derived include chronic pain, neuropathic pain, post-operative pain, menstrual pain, pain due to
cancer. Conclusion: Auricular acupressure is very effective to decrease the level of pain. The
results of the overall article showed consistent results. There are several limitations of the study,
namely at the level of bias is still not too significant. Future studies are expected to use the
method of randomized controlled trials with sham group and the risk of bias is very small so
the results obtained from the auricular acupressure intervention has a high degree of validity.
Keywords: Systematic Review, Auricular acupressure, Pain
INTRODUCTION which explains that pain impulses regulated

Pain is an uncomfortable feeling and by the defense mechanisms along the
very individual that can’t be felt or shared central nervous system. Balance the activity
with others. Everyone will feel a reaction of sensory neurons and fibers descending
and a different perception. Pain related to from the brain control the defense process.
two aspects of psychological and Neuron-delta A and C releasing substance
physiological and are both affected by C release substance P to transmit impulses
certain factors such as: culture, age, through a defense mechanism. There are
environment and support systems, past also mechanoreceptors, the neurons beta-A
experience, anxiety and stress, as well as the thicker, faster which release the
placebo effect (Hinkle & Cheever, 2013). neurotransmitter inhibitor. If the dominant
According to the International Association input fibers derived from beta-A, it will shut
for the Study of Pain (IASP) in 1979, the down a defense mechanism. The resulting
pain was defined as a subjective sensory message will stimulate mechanoreceptors,
and emotional unpleasant associated with if the predominant input derived from Delta
actual or potential tissue damage, or can A fibers and C fibers, it will open up the
describe the condition of the damage defense and the client perceives the
(Tamsuri, 2007). sensation of pain. Even if the pain impulse
There are various theories that is delivered to the brain, there is a higher
attempt to describe how nocireceptor can cortical center in the brain that modifies
generate pain stimuli, but the gate control pain. The descendent nerve pathways
theory considered most relevant today release of endogenous opioids, such as
(Tamsuri, 2007). Gate control theory endorphins and dynorphin, a natural pain
proposed by Melzack and Wall in 1965, control that comes from the body. The
60
neuromodulators close defense mechanism parts (Oleson, 2013). This relationship has
by inhibiting the release of substance P. The been validated by a device called Functional
technique of distraction, music, counseling Magnetic Resonance Imaging (fMRI)
and a placebo was an attempt to release (Alimi et al., 2002). Treatment through
endorphins (Potter et al., 2016). acupoint on the ear can stimulate and cause
The incidence of pain in Indonesia a reflex reaction in the body to relieve the
is not yet clear, but in Europe almost 20% body in a state of pathology (Oleson, 2013).
of adults experience moderate to chronic Using a variety of literature databases, this
pain which could impact on performance, study aimed to evaluate the effectiveness of
social life, and emotional function (Breivik, auricular acupressure for pain.
2006). To control pain, WHO (2007)
recommends to use of an opioid analgesic METHODS
and nonopioid. The efficacy and safety of The design used in this study is a
opioids is still unclear, and most patients systematic review. Search literature or
who use opioid drugs experience side studies done as much as possible from a
effects that are not desirable, including variety of sources, both print and online. In
nausea, vomiting, sexual dysfunction, even this study, author use an online reference
the use in the long term will lead to databases and aggregators in Pubmed,
hypogonadism, osteoporosis, suppression Proquest, Medline and Science Direct. The
of the immune system, cognitive disorders key words are auricular acupressure and
and hyperalgesia (Gregorian et al., 2010; pain. The inclusion criteria were the authors
Raghavan et al., 2011; Ajo et al., 2016). In set is: 1) Quantitative study, both
addition, the use of drugs nonopioid, such observation or experimental; 2) Maximum
as NSAIDs can cause gastrointestinal and span of the study 10 years ago (2007); 3)
cardiovascular disorders (Conaghan, 2012). The subject of men and women (aged ≥ 13
To avoid the side effects of the drug, can be years) who are experiencing pain, both
done using non-pharmacological, such as acute or chronic; 4) The intervention
auricular acupressure. provided in the form auricular acupressure;
Auricular acupressure or often 5) Parameter study results is the degree of
called Auricular Acupressure Point (APA) pain.
is one form of auricular therapy which uses
botanical seeds (or pellets) attached to the RESULTS
acupoint on the ear to produce effects like This study looking for an online
acupuncture. Auricular acupressure reference databases and aggregators in
originated in China over 2000 years ago and Pubmed, Proquest, Medline and Science
then rebuilt by French Neurosurgeon, Dr. Direct by keywords such as auricular
Paul Nogier in 1957 (Oleson, 2013). A acupressure and pain, and showed as many
system with a standard nomenclature ear as 940 articles (113 of Pubmed, 473 of
zone has been set by the WHO. This system Proquest, 40 from Medline, 314 from
combines the auricular anatomy and effects, Science Direct). A total of 886 articles
and has been accepted internationally. duplicates are found, so that 54 articles were
Stimulation of specific points on the ear by screened. After screening with the review of
applying pressure with the thumb and abstracts, generated 21 articles.
forefinger affect different anatomical Furthermore, conducted review of full text
regions of the body, which can cause effects articles and that qualify is 15 articles.
of treatment (WHO, 1990). The theory Fifteen articles were reviewed,
underlying auricular therapy nerves found generally has a low risk of bias amounted to
in the outer ear correspond to particular 56.7% based on Cochrane's Risk of Bias
areas of the brain, and these areas have assessment tool. Low risk of bias present in
specific reflex relationship with other body all parts and dominate in the random
61
sequence generation, allocation 0.002 on the Visual Analog Scale for pain
concealment, the data is incomplete, and (VAS), and the value p = 0.001 in the
selective reporting. Bias unclear was found Menstrual Distress Questionnaire (MDQ)
to be 37.8% and dominate on the allocation (Yeh et al., 2013; Kim et al., 2015). In
concealment, blinding of participants and addition, pain that occurs in cancer patients
investigators, assessment of results, and was also lowered by 50% to 55% in severe
other potential threats to validity. High risk pain and in the range of 42% to 57% for
of bias is found only at 5.5% and only in moderate pain (Yeh et al., 2015; Yeh et al.,
part a random sequence generation, 2015; Yeh et al., 2016). Auricular
blinding of participants and investigators, acupressure shown to modulate pain in the
and assessment of results, as well as other body (Santoro et al., 2015).
potential threats to validity, as well as other
potential threats to validity. This indicates DISCUSSION
that the quality of these studies is good From the overall of these studies
enough. indicate auricular acupressure can be
Total of six studies using implemented in clinical practice, and have a
Randomized Control Trial design and other positive effect on pain reduction. It also
uses observational and experimental design. provides the option of alternative
Total overall respondents were 808 people. interventions to manage pain in clinical
The research was carried out in various practice and the results also showed a
countries including Taiwan, USA, China, significant degree.
Italy, and South Korea. Auricular In the management of pain, auricular
acupressure given to respondents with a acupressure also has benefits in terms of
range of one day to one month. Overall lower costs, fewer complications, simple,
from the study showed that significantly effective, and has a security level that is
decreased pain with auricular acupressure high enough because it is not an invasive
intervention. Pain derived include mild pain procedure (He et al., 2013; Yeh et al.,
to severe pain. Pain can be derived include 2014).
chronic pain, neuropathic pain, post- Application of auricular acupressure
operative pain, menstrual pain, pain due to can be integrated into nursing services. This
cancer. is consistent with the philosophy of caring
Acuricular acupressure can reduce in nursing that emphasizes the health of the
chronic pain in the range 41% to 66% (Yeh client. Moreover, in Indonesia the
et al., 2012; Yeh et al., 2014; Yeh et al., implementation of auricular acupressure as
2014; Yeh et al., 2015). In reducing a complementary and alternative has been
neuropathic pain, auricular acupressure supported by the law as the basis of legality
capable of achieving 43.3% (Liu et al., in providing auricular acupressure
2010). In post-surgery pain, auricular intervention.
acupressure effectively used in the span of
one hour to seven days postoperatively with CONCLUSION AND
assessment through the Visual Analog RECOMMENDATION
Scale for pain (VAS) of 27.58 ± 13.96 (Yeh Based on a review of the entire
et al., 2010; Chang et al., 2012; He et al., article showed that auricular acupressure is
2013). Auricular acupressure also can very effective to lowering the level of pain,
reduce menstrual pain but not significantly such as chronic pain, neuropathic pain,
(Wang et al., 2013). However, in another post-operative pain, menstrual pain, pain
study showed a significant result with a due to cancer. The results of the overall
value of VAS amounted to 5.66 until 2:38 articles showed consistent results.
with a value of p = 0:02 in the Short-Form
McGill Pain Questionnaire (SF-MPQ), p =
62
Recommendation Physicians. The Journal of Pain,
There are several limitations of the 11(11), 1095-1108.
study is the level of bias is still not too He, B.-J., Tong, P.J., Li, J., Jing, H.-T., Yao,
significant. Future studies are expected to X.-M. (2013). Auricular
use the method of randomized controlled acupressure for analgesia in
trials with sham group and the risk of bias perioperative period of total knee
is very small so the results obtained from arthroplasty. Pain Medicine, 14(10),
the auricular acupressure intervention has a 1608-13.
high degree of validity. Hinkle, J.L. & Cheever, K.H. (2013).
Brunner & Suddarth's Textbook of
REFERENCE Medical-Surgical Nursing. (13th
Ajo1, R., Segura, A., Inda, M., Planelles, ed.). Philadelphia: Linppincott
B., Martínez, L., Ferrández, G., William & Wilkins.
Sánchez, A., Margarit, C., Peiró, A. Huang, L.C. (2005). Auricular Medicine: A
(2016). Opioids Increase Sexual Complete Manual of Auricular
Dysfunction in Patients with Non- Diagnosis and Treatment. (1st ed).
Cancer Pain. The Journal of Sexual Orlando Florida: Auricular
Medicine, 13(9), 1377-1386. International Research & Training.
Alimi, D., Geissmann, A., Gardeur, D. Kim, N.Y., Kim, M.A., Choi, S.E. (2015).
(2002). Auricular acupuncture Effects of Auricular Acupressure on
stimulation measured on functional Menstrual Pain, Difficulties in Daily
magnetic resonance imaging. Life, Negative Feelings and
Medical Acupuncture, 13(2), 18-21. Autonomic Nervous Responses in
Breivik, H., Collett, B., Ventafridda, V., Female College Students. Journal of
Cohen, R., Gallacher, D. (2006). Korean Biological Nursing Science,
Survey of chronic pain in Europe: 17(2), 159-168.
prevalence, impact on daily life, and Liu, C.-W., Chen, C.-H., Huang, Y.-F.,
treatment. European Journal of Huang, M.-H. (2010). Auricular
Pain, 10(4), 287-333. Acupressure as A Treatment for
Chang, L.-H., Hsu, C.-H., Jong, G.-P., Ho, Neuropathic Pain in Patients with
S., Tsay, S.-H., Lin, K.-C. (2012). Spinal Cord Injury. European
Auricular Acupressure for Journal of Pain Supplements, 4(1),
Managing Postoperative Pain and 132.
Knee Motion in Patients with Total Oleson, T. (2013). Auriculotherapy
Knee Replacement: A Randomized Manual: Chinese and Western
Sham Control Study. Evidence- Systems of Ear Acupuncture. (4th
Based Complementary and ed). Edinburgh: Churchill
Alternative Medicine, 2012. Livingstone, Elsevier.
Conaghan, P.G. (2012). A turbulent decade Potter, P.A., Perry, A.G., Stockert, P., Hall,
for NSAIDs: update on current A. (2016). Fundamentals of
concepts of classification, Nursing. (9th ed.). St. Louis,
epidemiology, comparative Missouri: Elsevier.
efficacy, and toxicity. Raghavana, S., Harveyb, A.D., Humblea,
Rheumatology International, 32(6), S.R. (2011). New opioid side effects
1491-1502. and implications for long-term
Gregorian, R.S., Gasik, A., Kwong, W.J., therapy. Trends in Anaesthesia and
Voeller, S., Kavanagh, S. (2010). Critical Care, 1(1), 18-21.
Importance of Side Effects in Santoro, A., Nori, S.L., Lorusso, L.,
Opioid Treatment: A Trade-Off Secondulfo, C., Monda, M.,
Analysis with Patients and Viggiano, A. (2015). Auricular
63
Acupressure Can Modulate Pain Yeh, C.-H., Lin, W., Wood, L., Bovbjerg,
Threshold. Evidence-Based D., van Londen, G. (2016).
Complementary and Alternative Auricular point acupressure to
Medicine, 2015. manage aromatase inhibitor-
Tamsuri, A. (2007). Konsep dan induced arthralgia in
Penatalaksanaan Nyeri. Jakarta: postmenopausal breast cancer
EGC. survivors. The Journal of Pain,
Wang, Y.-J., Hsu, C.-C., Yeh, M.-L., Lin, 17(4), S114.
J.-G. (2013). Auricular Acupressure Yeh, C.-H., Morone, N.E., Chien, L.-C.,
to Improve Menstrual Pain and Cao, Y., Lu, H., Shen, J., Margolis,
Menstrual Distress and Heart Rate L., Bhatnagar, S., Hoffman, S.,
Variability for Primary Liang, Z., Glick, R.M., Suen, L.K.-
Dysmenorrhea in Youth with Stress. P. (2014). Auricular Point
Evidence-Based Complementary Acupressure to Manage Chronic
and Alternative Medicine, 2013. Low Back Pain in Older Adults: A
World Health Organization. (1990). WHO Randomized Controlled Pilot Study.
Report of The Working Group on Evidence-Based Complementary
Auricular Nomenclature. Lyon, and Alternative Medicine, 2014.
France: World Health Organization. Yeh, C.-H., Suen, L.K.-P., Chien, L.-C.,
World Health Organization. (2007). WHO Margolis, L., Liang, Z., Glick, R.M.,
Normative Guidelines on Pain Morone, N.E. (2015). Day-to-Day
Management. Geneva, Switzerland: Changes of Auricular Point
World Health Organization. Acupressure to Manage Chronic
Yeh, C.-H., Chien, L.-C., Chiang, Y.-C., Low Back Pain: A 29-day
Huang, L.-C. (2012). Auricular Randomized Controlled Study. Pain
Point Acupressure for Chronic Low Medicine, 16(10), 1857-69.
Back Pain: A Feasibility Study for Yeh, M.-L., Hung, Y.-L., Chen, H.-H.,
1-Week Treatment. Evidence-Based Wang, Y.-J. (2013). Auricular
Complementary and Alternative acupressure for pain relief in
Medicine, 2012. adolescents with dysmenorrhea: a
Yeh, C.-H., Chien, L.-C., Chiang, Y.-C., placebo-controlled study. The
Ren, D., Suen, L.K.-P. (2015). Journal of Alternative and
Auricular Point Acupressure as an Complementary Medicine, 19(4),
Adjunct Analgesic Treatment for 313–318.
Cancer Patients: A Feasibility Yeh, M.-L., Tsou, M.-Y., Lee, B.-Y., Chen,
Study. Pain Management Nursing, H.-H., Chung, Y.-C. (2010) Effects
16(3), 285-293. of Auricular Acupressure on Pain
Yeh, C.-H., Chien, L.-C., Glick, R.M., van Reduction in Patient-controlled
Londen, G., Bovbjerg, D. (2015). Analgesia After Lumbar Spine
Auricular point acupressure to Surgery. Acta Anaesthesiol Taiwan,
manage symptom clusters of pain, 48(2), 80-86.
fatigue, and disturbed sleep in breast
cancer patients. The Journal of Pain,
16(4), S110.
Yeh, C.-H., Chien, L.-C., Huang, L.-C.,
Suen, L.K.-P. (2014). Auricular
point acupressure for chronic pain: a
feasibility study of a 4-week
treatment protocol. Holistic Nursing
Practice, 28(3), 184-94.
64
IMPROVE FAMILY READINESS TO TREAT POST DEPRIVED MENTAL
DISORDERS BY FAMILY PSYCHOEDUCATION
Suhron Muhammad*, Januarti Luluk Fauziyah**

*Faculty of Nursing, STIKES Ngudia Husada Madura
**Faculty of Nursing, Universitas Airlangga
Email: dsuhron@yahoo.co.id
ABSTRACT
Introduction: Mental disorders are disturbances in thinking, volition, emotion, action. The set
of circumstances that are not normal, either related to the physical, and the mental. From the
results of the preliminary study found the low families readiness in caring for post ODGJ
healthy deprived in Pondok X Bangkalan. This study was to analyze the readiness of families
in caring for people with mental disorders after deprived before and after the family
psychoeducation in healthy Pondok X Bangkalan. Methods: The method used is Pre-
experimental approach to one-group pre-post test design, family psychoeducation therapy
independent variables and the dependent variable is family preparedness in caring for people
with mental disorders post-deprived. The population of as many as 32 families with mental
disorders in healthy Pondok X Bangkalan instrument in gathering data using questionnaires.
Result: The results of the data analysis are presented in a frequency distribution table.
Statistical test in the study using the Wilcoxon Sign Rank Test α = 0.05. Based on the results,
before being given a family readiness family psychoeducation with the results after a mean
21.6 and family psychoeducation with the results given mean of 29.1 using the Wilcoxon test
showed ρvalue = 0.001 <α = 0.05 that concluded there is a difference in the care of family
readiness people with mental disorders before and after the family psychoeducation.
Conclusion: Solutions that can be given to the family of this study are expected to be input for
the family members of patients who experience a mental disorder on the importance of
knowledge and information about mental illness on family preparedness in treating patients
with mental disorders.
Keywords: Mental Disorders, psychoeducation, Family Readiness, Knowledge
INTRODUCTION discrimination (Thornicroft et al, 2008 at

Family behavior in the handling of Lestari & Ward, 2014).
post-deprived ODGJ in reality there were Reactions of anxiety in caregivers
referred to the Mental Hospital or to stay ODGJ deprived will post a negative impact
with family. The family has some reason to on family preparedness in caring for
care ODGJ at home, the main factor is that patients. Friedman (2010), mentions that
people do not know that ODGJ treatable, the Meru-feed the family support system
family feel ashamed for having a family that can be empowered because of family
member with ODGJ and family do not have Meru-an important part of individuals who
to check ODGJ costs to health services can not dipisahkan.Sebagai family support
(Keliat, 2003). ODGJ often stigmatized system must be stable and can survive in
neighborhood. ODGJ public trust that is any condition with the hope to resolve the
caused by mystical or supernatural problem, since the family is the first service
occurrences, dangerous, can not work and provider and is of particular importance in
will never be cured, so that the stigma on patients ODGJ.
ODGJ include neglect, prejudice and
65
WHO (World Health Organization) said at 20 April 2016, the result of the 10 families
least one in four people experiencing who have patients of people with mental
mental problems in the world, an estimated disorders post-deprived, 8 respondents
450 million people worldwide who readiness lacking in caring for families
experience mental health disorders. experiencing mental illness with a value of
Mention the prevalence of mental disorders <50%. While two respondents
in the population of Indonesia as much as preparedness sufficient in caring for
0.17%, and the prevalence of mental families experiencing mental illness with a
disorders in East Java in severe mental value of 56-75%.
disorders (psychosis / schizophrenia) as The cause of deprivation can be
much as 0.22% and emotional mental divided into two factors, namely internal
disorder at 6.5%. The Ministry of Health family includes limited information and
estimates that the number of ODGJ knowledge about mental disorders cause
deprived throughout Indonesia reached families and communities deprived, and
over 18,000 lives. The proportion of external factors families include difficulty
families who have ODGJ psychosis and had accessing health care facilities by the
been deprived of 14.3%, or about 237 family and the support of the social
families of 1,655 families who have a post environment (Halida, 2015). Social impact
ODGJ deprived and most of the families in is very serious form of rejection, exclusion
rural areas (18.2%) (Riskesdas, 2013). and discrimination. Similarly, the economic
The percentage of families who impacts such as the loss of productive days
have ODGJ after deprived in East Java as to make a living for patients and families to
much as 16.3% (Riskesdas, 2013). Jember care for, as well as high maintenance costs
District Health Office in 2014 found that to be borne by the family and society
the amount of post ODGJ most deprived are (Yulia, 2009).
in Sub Ambulu as many as six people were Efforts to improve the readiness of
identified. Deprivation carried out by the families in caring for people with mental
public due to several reasons, namely the disorders is the provision of family
fear ODGJ community and family will psychoeducation therapy, readiness can be
commit suicide and wounding others, the done through health education.
inability of families caring for ODGJ, and Psychoeducation was able to reduce the
also because the government does not workload significantly and improve the
provide basic mental health services in the readiness of families in caring for people
community that are ODGJ (Halida 2015). with mental disorders. Family
According to the Ministry of Social psychoeducation is one form of mental
Affairs survey in 2008, from about 650 health treatment therapies families by
thousand people with severe mental providing information and education
disorders in Indonesia, at least 30 thousand through therapeutic communication.
deprived. The reason that the patient is Psychoeducation is a tool that is
deprived generally do not harm others and increasingly popular family therapy as a
inflict a disgrace to the family. Though strategy to reduce the risk factors associated
memasung was unlawful. It is set in the with the development of behavioral
Mental Health Act No. 18 of 2014. The symptoms. Psychoeducation provided to
Ministry of Health also ordered all heads of the family influence on the improvement of
regions to ban memasung residents with knowledge, attitude, readiness and
mental disorders. Now the government was independence of the family.
not kidding, by launching a "Major free Family psychoeducation is part of
deprived Indonesia 2016". the education or the provision of
Based on the results of preliminary information to the patient or family about
studies in healthy Pondok X Bangkalan on the disease in order to reduce the tendency
66
of clients to relapse and reduce the Table 2. Data Frequency Distribution of
influence of his illness in other family Respondents Based Work
members. In his application Work f %
psychoeducation is given to patients with Private 7 23,3
psychiatric disorders including family Entrepreneur 9 30
members and other interested persons to Farmer 14 46,7
care for these patients (Stuart & Laraia, Total 30 100
2005). Based on Table 2 shows that almost
Thus the researchers will conduct half of the respondents worked as a farmer
research with the title "The Effect Against as many as 14 people (46.7%).
Family psychoeducation Family Readiness
In Caring for People with Mental Disorders Table 3. Data Frequency Distribution of
(ODGJ) post healthy deprived in Pondok X Respondents by Sex
Bangkalan". Sex f %
Male 26 87
METHODS Female 4 13
In this study, using pre-
Total 30 100
experimental model of one-group pre-post
Based on Table 3 shows that nearly all
test design that reveals a causal relationship
respondents gender is male as many as 26
by engaging a group of subjects. The group
people (87%).
of subjects was observed before the
intervention, and then observed again after
Table 4. Data Distribution Frequency
the intervention. (Nursalam, 2013).
Before applying
The independent variable in this study is a
psychoeducation
family psychoeducation. The dependent
variable is the family readiness ODGJ care Readiness %
for post-deprived. Less Readiness 19(63,3%)
In this study population used is the Moderate Readiness 9 (30%)
family of the patient post-deprived ODGJ Good Readiness 2 (6,6%)
treated at Pondok healthy X Bangkalan. Based on Table 4 shows that the majority of
Samples very helping researchers to reduce respondents before given psychoeducation
bias research results, especially if the the level of readiness were 19 people
variables (control or confounder) that (63.3%).
turned out to have an influence on the
variables studied. Table 5. Data Distribution Frequency
When given psychoeducation
RESULTS Readiness %
Table 1. Data Frequency Distribution Less Readiness 3 (10%)
Based on Age of Respondents Moderate Readiness 16 (53,33%)
Age (year) f % Good Readiness 11 (36,665)
26 - 35 23 76,7 Based on Table 5 shows that the majority of
36 - 45 7 23,3 respondents Readiness after given
psychoeducation is to have sufficient
Total 30 100
readiness as many as 16 people (53.3%).
According to the table 1 in mind that nearly
half the age of the respondents was the
beginning of adult age 26-35 years as many
as 23 people (76.7%).
Table 6. Data distribution In Caring
Family Readiness ODGJ post
67
deprived before and after media (radio, television and access
given psychoeducation Internet).
Uji Wilcoxon ρ value 0,001 α 0,05 Lack of preparedness and
Negative Ranks 0 knowledge of the family in recognizing
Positive Ranks 28 health problems in the family led to the
Ties 2 weakening of the patient's recovery
Total 30 process. Patients with psychiatric disorders
According to the table 4.6 in mind need extra attention from family. But the
that based on the output test of normality, outcome, the family paid little attention to
obtained significance value of 0,036, it can the changes that occur in patients ODGJ.
be concluded that the data Readiness family The family did not know about the day /
before and after psychoeducation month / year change in behavior in patients
distribution is not normal. thus, the with mental disorders. By knowing the
Wilcoxon statistical tests performed, the changes in the patient, at least the family
result of 30 respondents experienced an can determine the severity of a penyait
increase in family preparedness in treating suffered by the patient. The level of concern
patients ODGJ post deprived before and are affecting families cure rate of patients,
after psychoeducation. ρ value 0,001 <α especially patients ODGJ. ODGJ patients
0.05 Ho is rejected, H1 is accepted, it can do not know that he was sick, so the
be concluded that there are differences in knowledge of the family in recognizing the
the level of readiness of families in caring family health problems is very important. If
for the post of deprived after ODGJ given the family does not know the early
in Pondok healthy family psychoeducation symptoms of patients ODGJ, it can be
X Bangkalan. concluded that the family did not know the
information about how to care for those
DISCUSSION patients with psychiatric disorders.
Overview In Caring Family Readiness According to the theory
deprived ODGJ Post Before awarded (Notoatmodjo, 2007) knowledge is to know
Family psychoeducation the results and this occurred after people
Based on Table 4 shows that the perform sensing on a specific object.
majority of respondents readiness before Sensing occurs through the human senses,
given psychoeducation is having Readiness the senses of sight, hearing, smell, taste and
less as many as 19 people (63.3%) with a touch. Most human knowledge is obtained
mean of 21.6. From the results of the through the eyes and ears.
questionnaire, it is known that the lack of Knowledge families identify an
readiness of families in caring for post- initial mental health effort in providing a
deprived ODGJ them on how to recognize climate conducive to family members.
a family medical issue. The data obtained Families in addition to improving and
from questionnaires lowest total score is 48. maintaining mental health of family
While the two of them have a good members, it can also be a source of
readiness in caring for people with mental problems for family members who
disorders. experienced psychiatric problems his
From interviews conducted found family (Latipun, 2015)
that nearly all patients' family of people This is according to research from
with mental illness say never obtain the body of the American Medical
information about mental illness, be it Association, in 2006 found that a lot of
counseling from health professionals, misunderstanding or misconceptions about
information through print media the family of mental disorders, family
(newspapers and magazines), electronic mengangggap that someone experiencing
mental disorders will never recover again.
68
But in fact, the American Medical Based on Table 4.5 shows that the majority
Association, 2006 suggested that people of respondents Readiness after given
who experience mental illness can recover psychoeducation is to have sufficient
and be able to resume their activities. readiness as many as 16 people (53.3%)
Another factor influencing the lack with a mean of 29.1 is obtained. While three
of readiness of families in caring for people of them have less readiness in caring for
with mental disorders is the age factor. people with mental disorders. Based on the
Based on the results of the age distribution analysis of questionnaires obtained the
of the families of patients with mental highest score 110 for questions about how
disorders after deprived note that the age of to get to know a family medical issue, and
the respondent mostly early adult age the question of health facilities in the
category 26-35 years as many as 23 vicinity.
respondents, or 76.7%. The more mature Improved Readiness family after
age, the higher a person's experience. being given a family psychoeducation
According to Mubarak (2007) with influenced by the provision of therapeutic
a person's age will be a change in the information. Provide information about
psychological aspect (mental). Physical mental disorders. Cognitive readiness to
growth in general there are four categories increase the family is able to know the
of change, that change in size, proportions causes, signs and symptoms of mental
change, loss of cici-old traits and the disorders, health facilities in the vicinity
emergence of new traits. This occurs due to such as utilizing health insurance.
the maturation of organ function. On the According Keliat (2006) Changes
psychological and mental aspects of a that occur after the given family
person's level of thinking is more mature psychoeducation influenced by the source
and adult. This is consistent with the theory of the information obtained. With
Cit Henry (2010) is getting enough age, increasing resources it also increased the
level of maturity and strength a person will knowledge in the family, so the family can
be more mature in thinking and working. better care for patients ODGJ again. ODGJ
Another factor influencing the lack of healing process is inseparable from the role
readiness of families in caring for people of the family. The family is an important
with mental disorders is the work factor. part in the treatment process ODGJ, family
Results distribution by job family of support is needed by ODGJ motivating for
patients with mental disorders deprived care and treatment, because the family is
showed that nearly half of the respondents considered the most know the condition of
worked as a farmer as many as 14 the patient.
respondents, or 46.7%. Nearly half of the Based on the theory Marsh (2000),
respondents worked as a farmer. quoted by Stuart & Laraia (2005) to
According to Mubarak et al (2007) increase readiness didaktif there are
there are seven factors that affect a person's elements that provide information about
knowledge, including the job. Work mental illness and mental health system in
environment can make someone gain this study is more focused on clients with
experience and knowledge, both directly mental disorders.
and indirectly. This is according to Henry This study is in line with research
(2010) which states that the work is wiyati (2010), with the result that as many
generally a time-consuming activity. as 57.7% of respondents have a high level
of knowledge in treating patients with
In Caring Family Readiness overview mental disorders. This shows the
Post ODGJ deprived After given importance of knowledge of the family's
psychoeducation Family healing process of patients.
69
Analyzing the Effect Against Family Lawrenece & Veronika (2002)
psycho education In Caring Family reveals an increase of 33% on the families
Readiness deprived ODGJ Post of mental patients after therapy is given
Based on the statistical test using psychoeducation family, because in
Wilcoxon test showed ρ value 0,000 <α psychoeducation family provides for an
0.05, so it can be concluded that there are increased positive relationship between
significant differences about the readiness family members, increasing the stability of
of the family in caring for people with the family, stress management family,
mental disorders after deprived before and Readiness cognitive family malalui
after the family psychoeducation in Pondok information.
Sehat Foundation Ya Bani Amrini Tanah Family psychoeducation lowered
Merah districts. From the results of the angkakekambuhan or re-hospitalization of
average value between before and after the 9 months to 18 months. According to Dyck,
family psychoeducation has risen from 21.6 et al (in Kembaren, 2011) found that a
to 29.1. family group psychoeducation program
Improved Readiness families getting more effective care for negative
affected by the provision of education and symptoms than the standard group. Health
information that is therapeutic by providing education programs have succeeded in
information about the task of the health of reducing the negative reactions and the
the family, namely by knowing the family saturation of the caregiver. Family health
health problems, determine appropriate education can increase a family's readiness
action for the family, caring for families for therapy contains elements improve
experiencing health problems, modify the family knowledge about the disease,
family environment to ensure a healthy teaches techniques that can help families to
family, and health facilities nearby for know the symptoms of deviant behavior as
families. Improved family readiness is well as increased support for the family
related to learning theories that explain that members themselves. The purpose of this
a person learns not only from direct educational program is to improve the
experience, but from peniruan.Usia also achievement of family knowledge about the
affect a person's readiness, because the disease, teaches families how teaching
higher the age the more the experience techniques to help their families in an effort
gained by the person. If earlier the family to protect his family by knowing the
had treated patients ODGJ, then it is very symptoms of behavioral and supportive
easy for a family to care for patients ODGJ family strength (Stuart & Laraia, 2005).
others. Family therapy, family
Family psychoeducation therapy psychoeducation significant increase
can improve cognitive readiness for therapy readiness. corresponding opinion from
contains elements for improving family Goldenberg (2014) that psychoeducation is
knowledge about the disease, teaches the treatment given to provide education to
techniques that can help families to know families to improve their skills, to be able to
the symptoms of deviant behavior, as well understand and improve coping due to a
as increased support for the family mental disorder that can cause problems
members themselves. The purpose of this with family
educational program is to improve the Based on well known that family
achievement of family knowledge about the preparedness in caring for people with
disease, teaches families how teaching mental disorders after deprived as much as
techniques to help their families in an effort 2 respondents (6.6%). This is because the
to protect his family by knowing the role of families and family motivation in
symptoms of behavioral and supportive caring for people with mental disorders
family strength (Stuart & Laraia, 2005). post-deprived.
70
The family is the unit that is closest to the This research is expected to be input for the
client and the client's primary care for institution to provide counseling to the
mental disorders. The family plays a role in families of patients with mental disorders.
determining how or care is needed at home.
Families are expected to understand, which 2. For Students
in turn can play an active role as a leading This research is expected to be input for the
advocate for patients. Improving Readiness students in dealing with mental patients, as
adjustment themselves and more vulnerable well as to develop Readiness cognitive,
to the effects of psychosocial stressors affective, and psychomotor families in
(Hartati, 2012). caring for people with mental disorders
Based on the known extant 5.2 post-deprived.
Readiness poor families in caring for
people with mental disorders be given the 3. For the Family
post of deprived after the family This study is expected to be input for the
psychoeducation. This is because the lack family members of patients who experience
of roles and motivations of the family in a mental disorder on the importance of
caring for people with mental disorders. knowledge and information about mental
Low role of the family is also fueled illness on family preparedness in treating
by the low motivation of the family as the patients with mental disorders.
driving force. Motivation is an important
factor affecting human behavior due to their 4. For researchers
motivation then man will try his best to This study is expected to be a source of
achieve the goal (Setiadi, 2008). reference about handling mental patients
Families should be able to give post-deprived using a family approach.
more attention and motivate family
members who are mentally handicapped REFERENCE
patients in the healing process. Family American Medical Association, 2006.
expected more patient in dealing with Code of Medical Ethics Council on
family members with mental disorders, and Ethical and Judicial Affairs
better play its role as a family, both formal Current Opinions with
and non-formal (masithoh, 2015). Annotations. 2006 –2007 Edition
Annotations prepared by the
CONCLUSION AND Southern Illinois University
RECOMMENDATION Schools of Medicine and Law.
Conclusion Badan Penelitian dan Pengembangan
1. Before applying psychoeducation, Kesehatan. (2010). Riset Kesehatan
family has Readiness lacking in treating Dasar (Riskesdas 2010). Diakses
patients after deprived ODGJ tanggal 2 April 2016.
2. When given psychoeducation, family www.litbang.depkes.go.id
has sufficient readiness in treating Badan Penelitian dan Pengembangan
patients after deprived ODGJ Kesehatan. (2013). Riset Kesehatan Dasar
There is a significant relationship between (Riskesdas 2013). Diakses tanggal
before and after the Readiness family 2 April 2016. www.depkes.go.id
psychoeducation in treating patients post Friedman, M. M. (2003). Buku Ajar
ODGJ deprived. Keperawatan Keluarga: Riset,
Teori, & Praktek. Ed. 5. Jakarta:
Recommendation EGC
1. For Institutions Goldenberg, I & Goldenberg H. (2004)
Family Therapy a overview. United
States, Thomson.
71
Halida, N. (2015). Pengalaman Keluarga Mubarok, dkk. (2007). Pengetahuan.
Dalam Pemenuhan Kebutuhan Diakses tanggal 4 Oktober 2016.
Perawatan Diri Pada Orang http://digilib.unimus.ac.id
Dengan Gangguan Jiwa (ODGJ) Notoatmodjo. (2007). Pengetahuan.
Dengan Pasung Di Kecamatan Diakses tanggal 4 Oktober 2016.
Ambulu Kabupaten Jember 2015. http://digilib.unimus.ac.id
Diakses tanggal 20 Maret 2016. Potter, P. A & Perry, A. G. (2005). Buku
http://digilib.unimus.ac.id Ajar Fundamental Keperawatan:
Hartati, J. (2012). Hubungan Tingkat Konsep, Proses dan Praktik.
Pengetahuan Dengan Perilaku Jakarta: EGC
Family Caregiver Dalam Merawat Stuart, G., & Laraia, M. (2005). The
Penderita Stroke Di Rumah Tahun Practise Of Psychiatric Nursing.
2012. Diakses tanggal 29 Juni Elsevier Mosby, St Louis Missouri
2016. http://repository.uinjkt.ac.id Washitho, A. P. (2015). Peran Keluarga
Keliat. (2003). Pemberdayaan Klien dan Terhadap Proses Penyembuhan
Keluarga Dalam Perawatan Klien Pasien Perilaku Kekerasan Di
Skizofrenia Dengan Perilaku Panti Asuhan Rehabilitas Mental
Kekerasan di Rumah Sakit Jiwa Jiwa Wisma Budi Makarti Boyolali.
Pusat Bogor: Desertasi, Jakarta: Diakses tanggal 20 Maret 2016.
FKM UI http://stikeskusumahusada.ac.id
Latipun. 2015. Psikologi Eksperimen. Wiyati, R. (2010). Pengaruh Psikoedukasi
Malang: UMM Press Keluarga Terhadap Kesiapan
Lawrence & Veronika (2002). Keluarga Dalam Merawat Klien
Understanding Families in Their in Isolasi Sosial. Diakses tanggal 20
Their Own Context: Schizophrenia Maret 2016. http://jos.unsoed.ac.id
And Structural Family Therapy in Yulia, W. (2009). Pengalaman Keluarga.
Beijing. Journal Of Family Diakses tanggal 20 Juni 2016.
Therapy 24: 233-257 http://eprints.lib.ui.ac.id
Lestari, P., Choiriyah, Z., & Mathafi.
(2014). Kecenderungan Atau Sikap
Keluarga Penderita Gangguan Jiwa
Terhadap Tindakan Pasung (Studi
Kasus di RSJ Amino Gondho
Hutomo Semarang). Jurnal
Keperawatan Jiwa. Vol 2 (1): 14-
23.
Lestari, W. L. & Wardhani, Y.F. (2014).
Stigma dan Penanganan Penderita
Gangguan Jiwa Berat pasca
pasung. Buletin Penelitian Sistem
Kesehatan. Vol 17 (2): 157:166.
Masithoh, A. R. (2015). Pengaruh
Psikoedukasi Keluarga Terhadap
Kesiapan Perawatan Kebersihan
Diri Pada Anak Retardasi Mental
Di SDLB Purwosari Kudus Tahun
2015. Diakses tanggal 20 Maret
2016. http://jos.unsoed.ac.id
72
RISKS FACTORS OF CLIENT OUTCOME WITH HEAD INJURY
Nurul Bariyyah, Rizky Meuthia Pratiwi, Hery Sasongko, Candra Adi Wirawan
Faculty of Nursing Airlangga University
Email: bariyyah.ym@gmail.com
ABSTRACT
Introduction: head injury is one of the causes of mortality and morbidity. Several studies
mention predictors over outcome. The objective of this systematic review is to explore and
synthesis factors which contribute to client outcome with head injury. Method: source of
articles used was obtained from the search through data base which includes Pro Quest,
PubMed, and EbscoHost. This search is confined from 2006 to 2016. Subsequently, the
journals were reviewed for systematic review. Result: there were 10 articles reviewed.
Significant risk factors of head injury include socio demographic factors such as old age, male
sex, low education level, clinical factor (GCS), injury due to road traffic accident, hypotension,
hypoxia, increased intracranial pressure, absence of pupillary reaction, hypo and
hyperglycemia, coagulopathy, hypo and hyperthermia, abnormal electrolyte level, episode of
coma, result of intracranial lesion CT scan. Conclusion: outcome predictor in a patient with
head injury will be useful in Triage criteria, prognosis of injury, care and discharge planning,
the use resources and patient and family counseling
Keyword: risk factor, outcome, head injury
INTRODUCTION client outcome with head injury, it can be

Head injury is the most cases in the used to develop management system and
world. Data center for disease control and Triage for clients with head injury so that it
prevention (CDC) based on the emergency can be reduce mortality and morbidity
visit, hospitalization, and mortality resulting from head injury. Therefore, the
resulting from 2001 to 2010 shows annual objective of this systematic review is to
increase. There were 823,7 per 100.000 evaluate articles for subsequently drawing
cases of head injury. Head injury is one of conclusion of factors that can be used to
the most causes of mortality and morbidity. predict client outcome based on evidence
Several studies explain significant factors based practice.
contributing to outcomes after head injury.
Demographic parameter such as sex or METHODS
clinical condition such as severity of injury, Methodology used in this
pupilary reflex, CT scan and laboratory systematic review as preceded by topic
results are taken into account as strong selection, then keyword was determined to
predictors of patient with head injury. search journals in English though some data
These factors can be used to evaluate base which includes PubMed and Pro
chances for client survival and can be the Quest, EbscoHost, Scopus. This search was
management guidelines (Xu et al, 2007 in confined from 2006 to 2016. the key words
Kim, 2011) were traumatic brain injury, OR head
This can be basis for correct and trauma OR head injury and predictor OR
immediate neurological criteria in factor OR prognosis. Articles selected for
emergency room. Moreover, prognosis can review ware based on studies conforming
be used as counseling for clients and inclusion criteria. Inclusion criteria in this
families in critical condition (Perel et al, systematic review were primary research
2006). By recognizing the factors affecting articles in English. The subjects were
73
humans without age limitation, sex, and hyperthermia, low hemoglobin,
ethnicity with severe head injury. Outcome coagulopathy, high lactate level, electrolyte
prediction was good during hospitalization imbalance, subarachnoid, epidural, or
or one year after head injury. Outcome subdural bleeding.
prediction at least consisted of two Few number of clients aging 65
variables. Exclusion criteria were case years old manage to survive after head
report, article review, and multiple injury. injury (Calvin, 2012). Therefore, it can be
Glasgow coma scale (GCS) consists of synthesized that all elderly clients with mild
three components: 1) eye response, 2) injury should undergo Triage in emergency
verbal response, and 3) motoric response. room for rapid and serial assessment.
Total GCS is one of the considerations for In general, severity of injury is one
predictor in this review. of the important factor of client outcome
The search by using the keyword post injury. GCS is a tool commonly used
above found ten articles that meet the in many studies. Some studies examine
inclusion criteria. Then the sixteen articles components of GCS such as motoric or
were reviewed, synthesized, and presented verbal response particularly with lesion.
in a table. For initial assessment, GCS may be slightly
neglected and sedative medication can
RESULTS affect results of GCS measurement
Upon screening, 10 journals particularly for patient with narrow gap
meeting inclusion and exclusion criteria between moderate and mild head injury.
were obtained. Most of the studies were Therefore, GCS must be done in serial
conducted in Europe and USA. Glasgow fashion although the client has been stable
Outcome Scale (GOS) measured within six and is evaluated with CT scan.
months or one year after head injury was Although GCS has limitation
found the most. Some variables are associated with a number of symptoms
discussed in the research articles. (Udekwu et al.2004, Davis et al.2005), it is
Significant predictor of the multivariate still recommended to be used as a method
analysis result is explained in synthesis in evaluating level of consciousness in a
articles. Table 1.1 shows summary client with head injury (Luk et al 1999,
predictor upon outcome of head injury after Udekwu et al.2004). insufficient oxygen
discharge. The elderly, severe injury, supply to the brain can directly contribute
absence of pupillary reaction, hypotension to unexpected incident; for example,
or hypertension, increased intracranial decreased blood flow to the brain causes a
pressure, hypoxia, hyperglycemia or number of pathophysiologic event post
hypoglycemia, hypothermia or head injury, including increased
hyperthermia, low hemoglobin, intracranial pressure, brain vasospasm or
coagulopathy, high lactate level, CT scan of systematic hypotension. Several studies
subarachnoid, epidural, or subdural found significant association between
bleeding were identified as factors affecting systematic secondary symptoms (hypoxia,
bad outcome (GOS) in the three studies. hypotension, and hypothermia) post head
injury and bad client outcome (Van Beek et
DISCUSSION al. 2007, Fabbri et al. 2008). Therefore, it is
This systematic review discussed important to stay alert in initial assessment
some studies examining factors although outcome has been monitored
contributing to client outcome with head (McHugh et al. 2007).
injury. Factors affecting bad outcome Mechanism of head injury is one
(Glasgow coma scale) which includes the factor associated with client outcome (Tien
elderly, severe injury, absence of pupillary et al, 2006). Mechanism of injury affects
reflex, blood pressure, hypothermia or consciousness before and after surgery.
74
Passengers who suffer from head injury due Knowing abnormality through surgical
to road traffic accident with high speed procedure in SAH or SDH cases is
vehicle do not develop lucid interval and is important for management of acute brain
in prolonged comatose after surgery than injury. In addition, study of clinical history
traumatic clients with low speed vehicle. and CT scan scoring is recommended for
This injury indicated as diffused head evaluation and improving prognosis for
injury. head injury.
Abnormal parameter of laboratory The scope of this study covers
study during admission is an important studies with two predictors. Therefore, it is
outcome predictor post head injury. likely that there will be some misses in the
Laboratory parameter is considered articles related to the use of multivariate to
objective, regularly measured, and very analyze individual predictor, and estimation
important. Abnormal value can be is not reported in the abstract. In some
corrected with treatment to cover non- articles reviewing GOS over outcome.
modifiable parameter such as age, and Some articles predict GOS for six months
radiology results (Van Beek et al. 2007). and the other seven articles predict GOS for
Although hyperglycemia or hypoglycemia, twelve months. This review does not divide
coagulophaty, anemia, acidosis, or predictors into two groups of articles
hyperthermia are important markers of because it may cause bias leading to study
severity, it is important to focus on of outcome that is only based on the six
incidence and abnormal correction months.
parameter. Studies evaluate further benefit, GOS take stable condition into
and initial parameter correction is account in six months post injury
suggested in randomizes clinical trial. (Hukkelhoven et al. 2006), so this
Classification of CT Marshal is a limitation is considered insignificant. This
strong prognosis tool to determine client review does not analyze bias even though
outcome with head injury. Classification of bias can affect accuracy of prediction of a
CT Marshal uses CT scan finding at study. Also, this review does not compare
mesencephalic level, middle line predictor based on countries that may be
movement, and the presence or absence of important in exploring accuracy of
localized lesion to categorize patients into prediction model in different location for
six different groups (Matoha. 2016). Most further studies.
studies show that clients with type I
diffused head injury have better outcome CONCLUSION AND
while group IV or V clients with lesion RECOMMENDATION
found in CT have worse outcome. There is Conclusion
strong association between classification of This systematic review discusses
CT Marshal with outcome. Later, studies factors contributing to outcome of patients
focus on combination of CT characteristic with head injury. Significant factors
and other predictors to increase prognosis associated with outcome include socio
value. demography such as age, male sex, level of
Intracranial lesion is associated with education; clinical factors such as GCS
prognosis of intracranial bleeding. score, injury due to road traffic accident,
Subarachnoid hemorrhage (SAH) having hypotension, hypoxia, increased
five fold risks to increase shows worse intracranial pressure, absence of pupillary
outcome (Fabbi et al. 2008) and is a clear reaction, hypo or hyperglycemia, anemia,
characteristic in outcome prediction (Maas coagulopathy, hypo or hyperthermia,
at al. 2007). This study explains additional abnormal electrolyte level, episode of
SAH prognosis value through CT scan comatose; high classification of CT
results as a predictor for brain damage.
75
marshal, intra cerebral lesion such as https://doi.org/10.1136/jnnp.2007.1
hemorrhage or subdural hematoma. 20162
Kim, Y.-J. (2011). A systematic review of
Recommendation factors contributing to outcomes in
This systematic review implicates patients with traumatic brain injury.
nursing practice. Based on the reviewed Journal of Clinical Nursing, 20(11–
studies. It shows that outcome predictor in 12), 1518–32.
a patient with head injury will be useful in https://doi.org/10.1111/j.1365-
Triage criteria, prognosis of injury, care and 2702.2010.03618.x
discharge planning, the use resources and Maas, A. I. R., Steyerberg, E. W., Butcher,
patient and family counseling. This study I., Dammers, R., Lu, J., Marmarou,
will be useful as objective guidelines for (2007). Prognostic Value of
health care professionals to evaluate criteria Computerized Tomography Scan
and traumatic patients to fulfill criteria of Characteristics in Traumatic Brain
physiologic standard. Injury: Results from the IMPACT
Study. Journal of Neurotrauma,
REFERENCE 24(2), 303–314.
Center for Disease Control and Prevention. https://doi.org/10.1089/neu.2006.0
(2016). Rates of TBI-related 033
Emergency Department Visits, Mak, C. H. K., Wong, S. K. H., Wong, G.
Hospitalizations, and Deaths — K., Ng, S., Wang, K. K. W., Lam, P.
United States, 2001–2010. Diakses K., & Poon, W. S. (2012).
pada tanggal 3 Oktober 2016, dari Traumatic Brain Injury in the
http://www.cdc.gov/traumaticbrain Elderly: Is it as Bad as we Think?
injury/data/rates.html. Current Translational Geriatrics and
Chi JH, Knudson MM, Vassar MJ, Gerontology Reports, 1(3), 171–
McCarthy MC, Shapiro MB, Mallet 178.
S, Holcroft JJ, Moncrief H, Noble J, https://doi.org/10.1007/s13670-
Wisner D, Kaups KL, Bennick LD, 012-0017-2
Manley GT. (2006). Prehospital Matoha, J. (n.d.). Hubungan antara skala
hypoxia affects outcome in patients skor FOUR dan CT Marshall
with traumatic brain injury: a dengan penilaian GCS pada
prospective multicenter study. J penderita cedera otak akibat trauma,
Trauma. Nov;61(5):1134-41. 192–196. Jurnal Biomedik (JBM),
Corrigan, J. D., & Deutschle, J. J. (2008). Volume 8, Nomor 3, November
The presence and impact of 2016, hlm.192-196
traumatic brain injury among clients McHugh, G. S., Engel, D. C., Butcher, I.,
in treatment for co-occurring mental Steyerberg, E. W., Lu, J.,
illness and substance abuse. Brain Mushkudiani, N., … Murray, G. D.
Injury: [BI], 22(3), 223–231. (2007). Prognostic Value of
https://doi.org/10.1080/026990508 Secondary Insults in Traumatic
01938967 Brain Injury: Results from The
Fabbri, A., Servadei, F., Marchesini, G., IMPACT Study. Journal of
Stein, S. C., & Vandelli, A. (2008). Neurotrauma, 24(2), 287–293.
Early predictors of unfavourable https://doi.org/10.1089/neu.2006.0
outcome in subjects with moderate 031
head injury in the emergency Murray, G. D., Butcher, I., McHugh, G. S.,
department. Journal of Neurology, Lu, J., Mushkudiani, N. A., Maas,
Neurosurgery, and Psychiatry, A. I., Steyerberg, E. W. (2007).
79(5), 567–573. Multivariable prognostic analysis in
76
traumatic brain injury: results from preliminary prospective
the IMPACT study. Journal of investigation of early outcome.
Neurotrauma, 24(2), 329–337. Brain Injury, 22(2), 183–191.
https://doi.org/10.1089/neu.2006.0 Tien HC, Tremblay LN, Rizoli SB, Gelberg
035 J, Chughtai T, Tikuisis P, Shek P,
Mushkudiani, N. A., Engel, D. C., Brenneman FD. (2006).
Steyerberg, E. W., Butcher, I., Lu, Association Between Alcohol and
J., Marmarou, A. Maas, A. I. R. Mortality in Patients With Severe
(2007). Prognostic Value of Traumatic Head Injury, 141.Zador,
Demographic Characteristics in Z., Sperrin, M., & King, A. T.
Traumatic Brain Injury: Results (2016). Predictors of Outcome in
from The IMPACT Study. Journal Traumatic Brain Injury : New
of Neurotrauma, 24(2), 259–269. Insight Using Receiver Operating
https://doi.org/10.1089/neu.2006.0 Curve Indices and Bayesian
028 Network Analysis, 1–19.
Oh, H. S., Seo, W. S., Lee, S., & Song, H. Steyerberg, E. W., Mushkudiani, N., Perel,
(2006). Comparisons of the P., Butcher, I., Lu, J., McHugh, G.
Prognostic Predictors of Traumatic S., … Maas, A. I. R. (2008).
Brain Injury According to Predicting outcome after traumatic
Admission Glasgow Coma Scale brain injury: Development and
Scores - Based on 1- and 6-month international validation of
Assessments, 36(4), 621–629. prognostic scores based on
O'Phelan K, McArthur DL, Chang CW, admission characteristics. PLoS
Green D, Hovda DA. (2008). The Medicine, 5(8), 1251–1261.
Impact of Substance Abuse on Van Beek, J. G. M., Mushkudiani, N. A.,
Mortality in Patients With Severe Steyerberg, E. W., Butcher, I.,
Traumatic Brain Injury. Mchugh, G. S., Lu, J., … Maas, A.
https://doi.org/10.1097/TA.0b013e I. R. (2007). Prognostic Value of
31817db0a5 Admission Laboratory Parameters
Park JE, Kim SH, Yoon SH, Cho KG, Kim in Traumatic Brain Injury: Results
SH. (2009) Risk Factors Predicting from the IMPACT Study. Journal of
Unfavorable Neurological Outcome Neurotrauma, 24(2), 315–328.
during the Early Period after https://doi.org/10.1089/neu.2006.0
Traumatic Brain Injury. J Korean 034
Neurosurg Soc. Feb;45(2):90-5.
doi: 10.3340/jkns.2009.45.2.90.
Epub 2009 Feb 27.
Salim, A., Hadjizacharia, P., DuBose, J.,
Brown, C., Inaba, K., Chan, L., &
Margulies, D. (2009). Persistent
hyperglycemia in severe traumatic
brain injury: an independent
predictor of outcome. Am Surge,
75(1), 25–29.
Slewa-Younan, S., Baguley, I. J.,
Heriseanu, R., Cameron, I. D.,
Pitsiavas, V., Mudaliar, Y., &
Nayyar, V. (2008). Do men and
women differ in their course
following traumatic brain injury? A
77
A SYSTEMATIC REVIEW: FACTORS AFFECTING TURNOVER INTENTION OF
NURSE IN HOSPITAL
Nurul Hikmatul Qowi *, Cinthya Surya Nevada*, Yuliartiningsih*,

I Gede Juanamasta**
*Faculty of Nursing, Universitas Airlangga
** STIKes WiraMedika Bali, Denpasar
Email: nurulqowi@gmail.com
ABSTRACT
Introduction: Nurse are the largest health care providers in hospitals, which amounts to 40%
- 60% of all available health workers. Nurses’ turnover intention rate is among the high rates.
Methods: This study was used systematic review method of 15 scientific articles from national
and international journals with limitations of publication time in 2010-2016. Total research
subjects were 27.674 (range 20-23076) which aims to see the factors affecting turnover
intention of nurses. Data was analyzed by using univariate analysis. Most research uses
literature from thesis, books, and articles from national and international journals. Instruments
used in this 13 of the 15 studies have tested the validity and reliability. Results: Factors
affecting turnover intention mentioned in this study wereworkrelated stress factors,
satisfaction, and other factors. Factors work related stress factor were organizational policy,
work, interpersonal relations, and environmental factors. Factors according to the satisfaction
factor werework satisfaction and flexibility of work schedules satisfaction. Other factors were
personal, spirituality, and burnout factors. Conclusion: It can be concluded that factors
affecting turnover intention of nurse most commonly researched were work related stress on
the organizational policy factors.
Keywords: turnover intention, nurse, hospital
INTRODUCTION (Aziz, 2009). High turnover intention in

Hospital is one of the health nurses will affects the sustainability of
services industry (Kusumaningrum, 2015). nursing care.
Society's demands for health services in The largest nurses’ turnover at the
global era will continue changing as society Wava Husada Hospital in 2010 amounted
continues to evolving and changing to 32% (Rachman&Dewanto, 2016). Based
(Nursalam, 2011). The development of on data from Santa Familia Medical Center,
human resources management becomes nurses' turnover rate in 2010 is 33.3%
faster with their demands for more attention which increased to 55.0% in 2012. This rate
to the policies that are applied to their work. is higher than the standard turnover by Leap
Problems in human resources of (1993) which only 10-11% a year (Lusiati,
organization is the employee turn-over that Supriyanto, and Stephen, 2013).
occurs within the organization Turnover intention can be identified
(Kusumaningrum, 2015). Turn-over by looking at the negative response of
intention is a process consists of a cognitive nurses to work and organization. Negative
component which involved in taking response can be seen from the nurse job
decision to leave the current job or dissatisfaction and low organizational
behavior-oriented to the future (Takase, commitment (Takase, 2010). Nursing
2010). Nurse are the largest health care manager would prevent the turnover as it
providers in hospitals, which amounts to gives a bad impact on nursing services. The
40% - 60% of all available health workers impact will occur due to the high turnover
78
intention is the economic impact, impact in searches narrowed based on inclusion
nursing care and patient outcomes (Hayes criteria, that is research about turnover
et al, 2013). High nurses’ turnover intention intention of nurse in hospitals, factors
will reduce productivity, and increase high- related to turnover intention of nurse, and
cost of hospital because the process of research that using primary data, so that
recruitment of new nursing staff, and also researcher got 15 articles that will be used
cause a reduction in patient services which as a reference. These 15 articles are
has an impact on patient disatisfaction. included within Journal of Management
One way that can be used is prevent Application (2 articles), Journal of Health
turnover intention through the reduction of Administration Indonesia (1 articles),
risk factors. Takase (2011) mentions that Proceedings PESAT (Psychology,
turnover intention is caused by the Economics, Literature, Architecture &
organization (organizational Civil Engineering) (1 article), Management
characteristics, organizational culture, of IKM (1 articles), International Journal of
interpersonal relations in organization), Bio-Science and Bio-Technology (1
work (role related stress, workload, articles), Indian Journal of Science and
financial reward, characteristics of work Technology (2 articles), International
environment, employee access to Journal of Nursing Studies (2 articles),
authority), employee (demographics, Asian Social Science (1 articles), Health
employee attitude) and external factors Policy (2 articles), International Journal of
(work-life balance, job opportunities Health Policy and Management (1 articles),
outside). These factors need to be revisited and Nurse Education Today (1 article).
related with significance of the research The purpose of this study was to
results in order to obtain reliable results. determine turnover intention of nurse in
The purpose of this systematic review was hospital. Data were collected through the
to identify factors affecting turnover study of scientific articles literature from
intention of nurse based on 15 scientific national and international journals. Data
articles from national or international were analyzed by using content analysis
journals. with sorting the results of study into
thematic categories based on common
METHODS characteristics. Then, each thematic
This study was used systematic category will be analyzed to determine the
review method. Source of research data is relationship patterns of dominant factors
derived from the literature from internet affecting turnover intention of nurse.
especially scientific articles published in
national and international journals. RESULTS
Determination of keywords is based on There was 7 of 15 scientific articles
PICOT framework (P: nurse at the hospital, written by students of management, both
I: -, C: -, O: turnover intention, T: 2011- from the master management, hospital
2016). The database used in this study was management, health management, and
Scopus, ScienceDirect, Google Scholar, business management. This showed that
and Google Scholar. Keywords to search factors affecting turnover intention is often
literature included "nurse", "turnover examined from management viewpoint,
intention", "hospital" and found in the namely human resources management. The
database of Google Scholar (3850 articles), number of samples used for the study was
ScienceDirect (436 articles), and Scopus 20-23076 people. All of those research
(205 articles). While search using keywords were used cross-sectional design. Research
"nurse", "turnover intention", "hospital" using cross-sectional approach provides
was found in Google Scholar database significant findings about the factors that
(1110 articles). Then, scope of the article led to turnover intention of nurses.
79
The instruments which used by possibility to resign from the workplace
researcher to identify factors related to (Budiono, 2014; Yeun 2016; Rubel, 2015;
turnover intention has been tested the Lee, 2016). Organizational commitment
validity and reliability before use, its value that can be seen is the involvement of nurse
about 73%. Instrument used to measure the in activities at the hospital, a nurse who has
turnover intention that according to Lee, a high loyalty to the hospital, have a good
Curral, Lawer, and Yeun Kim. The validity assessment on hospitals, and others.
and reliability of this instrument are Occupational factors also have a
measured, so that research results can be relationship in turnover intention.
credible. Occupational factors include affiliates of
According to the table 1, it is known work, work-life imbalanced, and too much
that factors affecting turnover intention are work (Rachman, 2016; De Gieter, 2011). 4
work related stress factors, satisfaction, and of 15 studies showed significance in
other factors. The work-related stress interpersonal factors (Rachman, 2016;
factors discussed in the study is work, Lusiati, 2013; Yeun, 2015; Rubel, 2015).
organizational policy, interpersonal Environmental factors were only
relationship, and environmental factor supported by one study with significant
(holiday). Work satisfaction and flexibility results (Yeun, 2015). Based on table 2,
of work schedules satisfaction include in organizational policy factor is the most
satisfaction factor. And other factors that widely discussed in the research, and has
influence the turnover intention are most significant value. Table 3 explains that
(spirituality, and personal factors). factor that are most widely discussed from
organizational policy factors are
DISCUSSION organizational commitment factor.
Several studies about turnover Results of those study consistent with
intention showed significant results in Hayes et al (2012) which mentioned that if
organizational policy, work, interpersonal there was a lot of work but lack of support,
relations, and environment factor. One of it will cause emotional problems that cause
the organizational policy is organizational stress and the stress will trigger turnover
commitment, the higher a person's intention (Takase, 2010).
commitment to the organization, the lower
Table 1. Factors affecting turnover intention.

Factors Affecting Turnover Intention
Work Related Stress Factors
Organiz Enviro Satisfa Other
Researcher, Year Interperson
Occupation a-tional n- c-tion Facto
al Relation
al Factor Policy mental Factor rs
Factor
Factor Actor
Dini √
Kusumaningrum,
2015
Mardiana, 2014 √
Tsu-Yin Wu, 2011 √
Alies, 2013 √ √
Sara de Gieter, √ √
2011
Lutfi Rahman, 2016 √ √
Sugeng Budiono, √ √
2014
80
Ali Mohammad √ √ √
Mosadeghrad,
2013
Young-Ran Yeun, √ √ √
2016
Eun Ja Yeun, 2015 √ √ √
Mohammad Rabiul √
Basher Rubel, 2015
KyuEun Lee, 2016 √
Claudia Leone, √
2015
ConstanzeLeinewe √ √
ber, 2016
Yu-Mei Chiang, √
2012
Table 2. Factors affecting turnover intention of nurse according to work related stress factors.
Work Related Result of Research Total
Stress Factor Sig Sample Not Sig. Sample
Organizational 10 287;102;89;296;243;270;150; 2 154;20 10
policy 278;2235;23.076
Occupational 5 154;20;296;314;243 0 5
Interpersonal 4 243;270;296;23.076 1 154 5
relation
Environmental 1 270 0 1
Table 3. Factors affecting turnover intention of nurse according to organizational policy

Result of Research Total
Organizational Policy
Sig. Sample Not Sig. Sample
Organizational 9 287;102;89;296;270; 2 154;20 11
commitment 150;278;2235;23.07
6
Organizational culture 1 243 0 1
Organizational justice 1 278 0 1
Table 4. Factors affecting turnover intention of nurse according to satisfaction factor.

Satisfaction
Work satisfaction 4 100;60;287; 1 20 5
102
Flexibility of work schedules 1 314 0 1
satisfaction
Tabel 5. Other factors affecting turnover intention of nurse.

Other Factors
Spirituality 1 89 0 1
Personal 1 20 2 154;270 3
81
Therefore, support is very important for intention is caused by the organization
employee to in improving work motivation, (organizational characteristics,
especially the support from organizational culture, interpersonal
supervisor/manager. relations in the organization), occupation
Table 4 shows satisfaction factors (role related stress, workload, financial
affecting turnover intention of nurse. There reward, characteristics of the work
were four studies which examined about environment, employee access to
work satisfaction with significant results authority), employee (demographics,
(Kusumaningrum, 2015; Budiono, 2014; attitudes of employee), external factors
Mosadeghrad, 2013). Flexibility of work (work-life balance, work opportunities
schedules satisfaction found in one study outside).
and have significant results (Leineweber,
2016). The higher nurse satisfaction, the CONCLUSION AND
lower nurse willingness to leave their RECOMMENDATION
workplace (Mosadeghrad, 2013). Conclusion
Assessment of nurse in their work is known Based on several explanations, it is
from the psychological response, if the known that factors affecting turnover
result were bad, then it will cause stress. intention consist of work related stress
This is usually called as a shock to the factors (organizational policy, occupation,
system. This can be followed by interpersonal relation, and environment),
dissatisfaction and lack of organizational satisfaction, and other factors (spirituality,
commitment (Takase, 2010). and personal). The most dominant factor
Several other factors affecting affecting turnover intention of nurse with
turnover intention of nurse were significant results is organizational
spirituality, and personal factors (Lusiati, commitment related on organizational
2013; Yin Wu et al, 2011; De Grieter 2011; policy factors.
Yeun, 2015). Spirituality had a positive
relationship with turnover intention Recommendation
(Boediono, 2014). Personal factors which Turnover intention is one of the
have significant value were age, years of factors affecting process of continuous
service, and self commitment (De Grieter, nursing care. High turnover intention of
2011). Takase (2010) mentioned about nurse will affect the work teams system in
personal factors that influence turnover certain unit. Therefore, manager of nursing
intention such as demographic factors, should increase efforts to reduce nurses’
value systems or external factors such as a turnover intention. The way to do is to
family and availability of another jobs. identify the signs and symptoms of the
Demographic factor was an important employee turnover intention. Turnover
factor in personal aspects. These intention can be identified by looking at the
demographic factors will determine negative response such as work
characteristics of individual who hashigh dissatisfaction of nurse and low
turnover intention. organizational commitment. Another way
Based on several explanations that can be used to prevent turnover
above, it is known that factors affecting intention through the reduction of risk
turnover intention consist of work related factors. Several factors affecting turnover
stress factors (organizational policy, intention is organization, occupation,
occupation, interpersonal relation, and interpersonal relation, and environment.
environment), satisfaction, and other
factors (spirituality and personal). This is
consistent with Takase (2011) that turnover
82
REFERENCE Journal of Nursing Studies 58
Aziz, AH. 2009. Pengantar Konsep Dasar (2016) 47–58
Keperawatan. Jakarta: Leone, C et al. 2015. Work environment
SalembaMedika issues and intention-to-leave in
Budiono, S., Noermijati, and Alamsyah, A. Portuguese nurses: A cross-
2014. Pengaruh Spiritualitas di sectional study. Health Policy 119
Tempat Kerja terhadap Turnover (2015) 1584–1592
intention Perawat melalui Lusiati, A., Supriyanto & Stefanus. 2013.
Komitmen Organisasional di Dampak Faktor Individu, Faktor
Rumah Sakit Islam Unisma Pekerjaan dan Faktor Organisasi
Malang. Jurnal Aplikasi Pada Kepuasan Kerja dan Intensi
Managemen. Vol. 12. No 4. Turnover Perawat. Jurnal
Desember 2014 Administrasi Kesehatan Indonesia
De Gieter, S., Hofmans, J., and Pepermans, Volume 1 Nomor 2 April-Juni 2013
R. 2011. Revisiting the impact of Mardiana, I., Vitayala, A., Hubeis,
job satisfaction and organizational &Panjaitan, NK. 2014.
commitment on nurse turnover HubunganKepuasanKerjadenganTu
intention: An individual differences rnover intentions pada Perawat
analysis. International Journal of Rumah Sakit Dhuafa. Manajemen
Nursing Studies 48 (2011) 1562– IKM, September 2014 (119-130)
1569. Vol. 9 No. 2 ISSN 2085-
Hayes et al. 2013. Nurse turnover: A 8418Diakses dari
literature review – An update. http://journal.ipb.ac.id/index.php/ju
International Journal of Nursing rnalmpi/pada 25 Desember 2016
Studies 49 (2012) 887–905 Mei Chiang, Y and Chang, Y. 2012. Stress,
Kusumaningrum, D &Harsanti, I. 2015. depression, and intention to leave
Kontribusi Kepuasan Kerja among nurses in different medical
Terhadap Intensi Turnover Pada units: Implications for healthcare
Perawat Instalasi Ruang Inap. management/nursing practice.
Prosiding PESAT (Psikologi, Health Policy 108 (2012) 149– 157
Ekonomi, Sastra, Mosadeghrad, AM. 2013. Occupational
Arsitektur&Teknik Sipil) Vol. 6, Stress and Turnover intention:
Oktober 2015 .ISSN: 1858-2559. Implications for Nursing
Lee, KE., Kim, JH., and Jong Kim, M. Management. International Journal
2016. Influence of Perceived of Health Policy and Management,
Organizational Justice on 2013, 1(2), 169–176
Empowerment, Organizational Nursalam. 2011. Manajemen Keperawatan
Commitment and Turnover Aplikasi dalam Praktik
intention in the Hospital Nurses. Keperawatan Profesional Edisi 3.
Indian Journal of Science and Jakarta: SalembaMedika
Technology, Vol 9(20), DOI: Rachman, L &Dewanto, A . 2016.
10.17485/ijst/2016/v9i20/94702, Pengaruh Employee Engagement
May 2016 terhadap Kepuasan Kerja dan
Leineweber, C et al 2016. Nurses’ practice Turnover intentionPerawat (Studi
environment and satisfaction with pada Rumah Sakit Wava
schedule flexibility is related to HusadaKepanjen Malang). Jurnal
intention to leave due to Aplikasi Managemen. volume 14.
dissatisfaction: A multi-country, Nomor 2. Juni 2016
multilevel study. International Rubel, MRB,. &Huing, DM. 2015.
Perceived Fairness of Performance
83
Appraisal, Promotion Opportunity
and Nurses Turnover intention: The
Role of Organizational
Commitment. Asian Social Science;
Vol. 11, No. 9; 2015
Takase, M. 2010. A concept analysis of
turnover intention: Implications for
nursing management. Collegian
(2010) 17, 3—12.
Yeun, EJ, & Jeon, M. 2015. Relationship
between Nursing Professionalism,
internal marketing, and turnover
intention among hospital nurses.
Indian Journal of Science and
Technology,Vol.8( 25).
Yeun, YR and Han, JW. 2016. Effect of
Nurses’ Organizational Culture,
Workplace Bullying and Work
Burnout on Turnover intention.
International Journal of Bio-
Science and Bio-Technology Vol.8,
No.1 (2016), pp.372-380
http://dx.doi.org/10.14257/ijbsbt.2
016.8.1.33
Yin Wu, T, Fox, DP, Stokes, C., and Adam,
C. 2011. Work-related stress and
intention to quit in newly graduated
nurses. Nurse Education Today 32
(2012) 669–674
84
FACTORS AFFECTING MEDICATION ERRORS BY NURSE IN HOSPITAL
Cinthya Surya Nevada*, Nurul Hikmatul Qowi *, Yuliartiningsih*,

I Gede Juanamasta**
* Faculty of Nursing, University of Airlangga
** STIKes Wira Medika Bali, Denpasar
Email: cint.s.nevada@gmail.com
ABSTRACT
Introduction: Medication error is one important indicator of patient safety and commonly
occurs in health care. Many things can cause medication error happens. The purpose of this
study was to determine the factors affecting medication errors made by nurses in hospital care.
Methods: The database used in this study was Google Scholar, ProQuest, Scopus, Science
Direct, PubMed, Medline, Springerlink and Elsevier with limitation of publication time in
2011-2016. Results: Based on journals which has been reviewed, there was two dominant
factors affecting medication error made by nurses. Those factors were individual factor such
as knowledge and environmental factor such as workload factor. Conclusion: Factors affecting
medication errors made by nurses are divided into internal factors and external factors.
Keywords: medication error, nurse, factor.
INTRODUCTION starting from prescribing, dispensing

Patient safety is an important aspect (preparation), and drug administration. An
of a health care. One indicator of patient error in one step in can cause errors in the
safety is drug administration safety which is next steps. The incidence of medication
expected no errors in it or commonly errors is related to practitioners, drug
known as medication errors. Medication products, environmental procedures, or
error has fatal effects for the patient. systems that involve those steps.
Therefore, medication errors become very William within Muladi (2012)
considered in health care. mentioned that the incidence of medication
Minister of Health Decree No. errors is quite varied. Institute of Medicine
1027/Menkes/SK/IX/2004, mentioned that (IOM) reported about 44000-98000 people
medication errors are an adverse event, due died and about 7,000 people a year in the
to the use of drugs during the treatment by United States die due to medication errors.
health workers, which previously could The incidence of medication errors between
have been prevented. Medication error is an 2-14% of patients with 1-2% which led to
event that can cause improper drug the loss of patients, most commonly due to
administration or harm to the patient while wrong prescription. While the incidence
the medication under supervision of health rate of medication errors in Indonesia was
workers or patients (NCC MERP, 2012). reported about 3-6.9% in hospitalized
The occurrence of medication errors patients. An error in prescription process
need to be analyzed more deeply because it varies between 0.03 to 16.9%. One of the
involves some health workers include researchers mentioned about 11% of
doctors as determinant of pharmaceutical medication errors in hospital associated
therapy of patient, pharmacist as provider with the error when administer a drug to the
of drugs, and nurse who involved in drug patient, either because of wrong dosage or
administration to the patient. In addition, wrong drugs. There is no accurate and
there is also several steps in the process of systematic data in Indonesia. Medication
drugs distribution to patient which is
85
errors are common but rarely end up with will be used as a reference. These 15
patient injury (Dwiprahasto, 2006). articles are included within journal of
Leape, et al (1995) has identified the application.
causes of medication errors include: lack of The purpose of this study was to
knowledge, especially doctors who are the determine factors affecting medication
cause of that incident (22%); inadequat error by nurse in hospital. Data were
information, 14% of the errors about the collected through the study of scientific
patient such as laboratory test; not articles literature from national and
following the SOP drug administration international journals. Data were analyzed
which is errors in determining dose (10%); by using content analysis with sorting the
forget (9%); errors in reading prescription results of study into thematic categories
such as unreadable writing, prescription based on common characteristics. Then,
interpretation, and abbreviation in each thematic category will be analyzed to
prescription; understanding verbal determine the relationship patterns of
commands incorrectly; labeling and dominant factors affecting medication
packaging; poor stock and storage of drugs; errors by nurse.
problems with standards and distribution;
poor assessment of tools using in RESULTS
administer drugs; work related stress; and Based on the univariate analysis
ignorance of the patient. results in article literature, it is known that
Collaboration between practicioners the research about factors affecting
of medication error prevention program is medication errors by nurse is commonly
required by a multidisciplinary team to investigated by researchers outside of
prevent medication errors because this Indonesia. There was 4 of 15 scientific
frequently occurs, but not revealed and articles which examine individual factors, 4
almost no effort to prevent it (Carlos, et al, articles examine environmental factors, and
2013). 7 articles examine both of those factors.
The number of samples used for the
METHODS study was 70-1300 people. Researcher used
This study was used systematic qualitative, descriptive, and cross-sectional
review method. Source of research data is design. This is due to the lack of research
derived from the literature from internet about factors affecting medication errors by
especially scientific articles published in nurse.
national and international journals. Topic The literature used in several
selection and determination of keyword scientific articles about 18-213 literature,
performed before researcher search online either from books, health bulletins, health
scientific articles. Determination of and non-health journals, thesis, or
keywords is based on PICOT framework dissertation. There are no literature using
(P: nurse, I: -, C: -, O: medication errors, T: Indonesian due to the lack of literature
2010-2016). The database used in this study about these topic in Indonesia. This is
was Google Scholar, ProQuest, Scopus, related to the lack of accurate data about
Science Direct, PubMed, Medline, medication errors in Indonesia. So the
Springerlink and Elsevier. Keywords to percentage of using international journal
search literature included "factor", literature is 100%. Most of English
“nurse”and "medication error". Then, scope literature use references from international
of the article searches narrowed based on journals. Factors affecting the lack of
inclusion criteria, that is research about references from international journals in
factors affecting medication errors by nurse Indonesian reference are limited number of
in hospital and research that using primary researchers in accessing international
data, so that researcher got 15 articles that journals.
86
The instruments which used by used partly derived from scientific articles
researcher to identify factors related to from various international journals. Only
medication errors has been tested the one study which use dissertation as a
validity and reliability before use, its value research base. Use of literature can be used
about 70%. One of the instruments which in measuring the quality of a study. One of
used to measure medication errors is good research criteria is the use of current
questionnaire of the Medication journals in large quantities as a basic for
Administration Errors Reporting (MAERs) research. Based on attachment table, most
according to Beharu et al. This instrument research uses many scientific articles from
is measurable, another study using a journals. This showed that scientific articles
modified questionnaire with validity and have a good quality viewed from the
reliability test so that results of research can literature utilization aspect. This study was
be credible. As many as 30% did not development of previous studies without
mention details of the questionnaire used. creating new findings within management
Based on the distribution of the field, especially the topic of medication
references, it is known that the literature errors.
Table 1. Distribution of factors affecting medication errors by nurse.

Factors Affecting Medication Error
Researcher
Internal External
Abdelbaset M. Saleh, 2014 1. Depression
2. Fatigue
3. Sleep circadian rhytm disturbance
Ya-Hui Lan, et al. 2014 Knowledge
Hung, 2011 Nursing skill Size of work unit
Tamayo Kazaoka,et al. 2011 1. The way to deliver information

2. Drugs demand by nurse leader approved
by clinical
3. Interpersonal communication
Akram Shahrokhi, et al. 2013) 1. Nurse less cautious Heavy workload of nurse
2. Errors in documentation of prescription
Seyyedeh Roghayeh Ehsani, et al. 2013 The use of patients nickname

Foad Rahimi, et al. 2015 Workload
Al-Shara, 2011 1. Wrong patient

2. Knowledge about patient
3. Nurse workload
Jones, 2010 Nurse did not perform the 5 Right principles 1. Doctor’s handwriting in prescription
chart
2. Verbal command is not clear
3. RN : Patient ratio
4. Lack of nurse staff
Zahra Esmaeli Abdar, et al, 2014 Fatigue 1. Staff : Patient ratio
2. Difficulty in read doctor’s prescription
3. Workload too heavy
4. Night shift
Berhanu Boru Bifftu, et al, Education status Over time
2016
Senafikish Amsalu Feleke, et al, 2015 Work experience Night shift

Bjoerg O Simonsen, et al, 2011 Knowledge:
1. Pharmacology
2. Drugs calculation
Kim Sears, et al, 2016 1. Nurse experience

2. Education
A. Drach-Zahavy, et al 2014 Integration and knowledge 1. Technology and storage
2. Workload
87
Several factors affecting medication error because what is needed is knowledge
by nurse in hospital include fatigue, related to drug or pharmacological better.
knowledge, depression and other factors. While, according to Chang-Hung Chiao,
the educayional background has no effect
DISCUSSION because things that really needed is better
Based on Table 1, researcher knowledge about drug or pharmacology.
divided the factors affecting medication Based on environmental or external
errors into two parts, that is individual factors, factor that most commonly
factors and environmental factors. researched is the workload factor. In
Based on Table 1, it is known that addition, other external factor is
the environmental factors become factor communication, errors in identifying
that most commonly researched and most patients, wrong drug storage, and night
affecting medication errors than individual shift. Communication factor which is
factors. Individual factors affecting defned in this article is interpersonal
medication errors is knowledge factor communication. According to Kazaoka, et
either related to the science of al. good communication within the team
pharmacology or drug dose calculations can reduce the workload of nurse so that
especially in pediatric and infant patient as influenced the medication errors.
which is consistent with Bjorg, et al. Other An error in identifying patients
individual factors are experience, which is defined here is that there is nurse
experience also have an influence on the who did not performed patient
incidence of medication errors. identification before drug administration.
According to Kim, et al. nurse who Nurse thinks that they already know the
have so much experience would be less patient because they ever taking care of
make mistakes because they already have those patients before. However, this may
much more knowledge about drugs. In cause an error if there is a change in drugs.
addition, fatigue and depression factors can Night shift also become an influential
cause a lack of concentration at work so that environmental factor, according to
medication errors will occures more easily. Senafikish, during night shift focus of
Less attention to the patient and less nurses within work tends to decrease so this
discipline also becomes cause of shift at high risk of medication error events.
medication errors. This frequently occurs
because nurse feels that administer drugs is CONCLUSION AND
a routine activity so that nurse considers it RECOMMENDATION
is easy job. In addition to those factors, Conclusion
difficulties in reading prescription are also Based on discussion above, it can be
commonly experienced by nurse. concluded that factors affecting medication
Writing of the drugs name, dosage errors by nurse were individual factor
amount, and abbreviations which is not included knowledge, experience, fatigue,
appropriate with standard commonly make depression, lack of attention and discipline,
the nurse becomes confused and can cause and difficulty in read doctor's prescription.
errors. There was a difference of opinion While environmental factors consist of
about educational background factors. nurses’ workload, communication, errors in
According to Kim, the educational patient identification, wrong drug storage,
background has effect on medication errors and night shift.
because it is related to the nurse knowledge.
The higher educational background will Recommendation
make nurse get more knowledge. Public expectations about excellent
Meanwhile, according to Chang-Hung health services in global era will continue to
Chiao, the background has no effect change as people continues to growing and
88
changing. In addition, the demands of Study of the Link Between the
accreditation which makes patient safety as Ward's Learning Practices and
spearheading of quality within nursing Medication Administration Errors.
services are also requires health services to International Journal of Nursing
maintain reputation of the institution. Studies-Elsevier, 488-457.
Similarly, in nursing service, people want Abdelbaset M. Saleh, N. J.-m. (2014).
qualified nursing care. Medication errors is Impact of Nurse' Circadian Rythym
one indicator that frequently occurs, but Sleep Disorder, Fatigue and
The occurrence of medication errors need Depression on medication
to be analyzed more deeply because it administration errors. Egyptian
involves some health workers include Journal of Chest Disease and
doctors as determinant of pharmaceutical Tuberculosis, 145-153.
therapy of patient, pharmacist as provider Akram Shahrokhi, F. E. (2013). Factor
of drugs, and nurse who involved in drug Effective on Medication Errors: A
administration to the patient. In addition, Nursing View. Jorunal Research in
there is also several steps in the process of Pharmacy Practice , 18-23.
drugs distribution to patient which is Al-Shara, M. (2011). Factor Contributing to
starting from prescribing, dispensing Medicatiob Errors in Jordan : A
(preparation), and drug administration. An Nursing Pespective. Iranian
errors in one step in can cause errors in the Journal of Nursing and Midwifery
next steps. The incidence of medication Research, 158-161.
errors is related to practitioners, drug Berhanu Boru Bifftu, B. A. (2016).
products, environmental procedures, or Medication Administration error
systems that involve those steps. Reporting and Associated Factors
commonly unnoticed, especially among Nurses Working at the
nursing in Indonesia. Considering the University of Gondar referral
importance of this case, it is expected that Hospital, Northwest Etiopia, 2015.
there is a change in nursing field within BMC Nursing, 15:43.
health care to provide relevant knowledge Bjoerg O Simonsen, I. J. (2011).
of pharmacology through in-house training Medication Knowledge , certainty
activities either from service providers or and Risk of Errors in Health Care: a
pharmaceutical companies. In addition, it is cross sectional study. BMC Health
also necessary for the manager of nursing to Services Research, 11:175.
improve efforts in reducing medication Foad Rahimi, S. A. (2015). Factor
errors made by nurse. Nurses can creating Influencing Medication Errors
discipline culture and identifying workload According to Nurses' Decision to do
so that medication errors can be reduced Self-Report. IJNCP-International
significantly. Data collection accurately Journal of Basic & Clinical
related to medication errors are also Pharmacology, 130-133.
expected to be implemented by health care Hung, C.-C. (2011). Relationship mong
providers as a benchmark for further Organizational Context, Structure
research services and utilities. and Medication Error Taiwanese
Nursing Units. ProQuest.
REFERENCE I, Dwipahasto. (2006). Intervensi Pelatihan
1027/MENKES/SK/IX/2004, S. K. (2004). untuk Meminimalkan Risiko
Standar Pelayanan Kefarmasian di Medication Error di Pusat
Apotek. Jakarta: Departemen Pelayanan Kesehatan Primer.
Kesehatan RI. Berkala Ilmu Kedokteran, XXXVIII.
A. Drach-Zahavy, A. S. (2014). (How) do Retrieved Januari 7, 2017, from
we learn from errors? A rospective http://i-lib.ugm.ac.id
89
Jones, L. A. (2010). Devastangtingly
Human: An Analysis of Registered
Nurse Medication Error Account.
Qualitative Health Research-
SAGE, 1327-1342.
Kim Sears, L. O.-P. (2016). The
Relationship Between Nursing
Experience and Education and the
Occurence of Reported Pediatric
Medication Errors. Journal of
Pediatric Nursing-Elsevier, e283-
e290.
L L Leape, B. D. (1995). System Analysis
of Adverse Drug Events. JAMA,
274:29-34.
Prevention, N. C. (2012, december 31).
Retrieved from
http://www.nccmerp.org
Senafikish Amsalu Feleke, M. A. (2015).
Medication Administration Error:
Magnitude and Associated Factors
among nurses in Ethiopia. BMC
Nursing, 14:53.
Seyyedeh Roghayeh Ehsani, M. A. (2013).
Medication Errors of Nurses in the
Emergency Department. Journal of
Medical and History of Medicine,
6:11.
Tamayo Kazaoka, K. O. (2007). Why
Nurse make Medication Errors: A
Simulation Study. Nurse Education
Today-Elsevier, 312-317.
Ya-Hui Lan, K.-W. K.-J.-F.-I. (2014).
Medication Errors in Pediatric
Nursing: Assessment of Nurses
Knowledge and Analysis of the
Cosequences of Errors. Nurse
Education Today-Elsevier, 821-
828.
Zahra Esmaeli Abdar, H. T. (2014).
Registered Nurses Pereption of
Medication Errors: A Cross
Sectional Study in Southeast of
Iran. International Journal of
Nuring Education; New Delhi 6.1,
19-23
90
ORAL HYGIENE OF CEREBROVASCULAR ACCIDENT PATIENTS:
A SYSTEMATIC REVIEW
Auliasari Siskaningrum, Zuliani, Nurul Khoirun Nisa, Trijati Puspita Lestari

Email: nurulnisa90.nn@gmail.com
ABSTRACT
Introduction: Stroke or Cerebral Vascular Accident (CVA) occurs because of the sudden death
of the brain cells from the inadequate bloodstream. CVA occupies the third place in the world
after cardiovascular diseases and cancer. CVA leads to the weakness or paralysis, consciousness
decrease, speech impairment and swallowing and reducing oral hygiene quality. The decrease
of oral cleanliness affects the microorganisms heaping, dental problems and pneumonia. The
inability of patients independently such as oral hygiene can also affect the psychological
condition that decreases the quality of life. Purpose to describe the conditions of patients with
clinical stroke and self-care of an oral hygiene that deals with quality of life. Method: searching
international scientific articles using PICO frameworks on some databases such as Proquest,
Ebscohost, Pubmed, ScienceDirect bounded from 2006 until 2016. The used Keyword is “oral
hygiene related quality of life”. The searching with the keyword above founded 1.154 articles.
Those articles are identified in accordance to the inclusion criteria, which got 11 articles. Search
results identified further to have critical appraisal to the stage of making systematic review.
Result: this review explains the oral hygiene activities on patients with stroke. Conclusions: a
good oral hygiene care give significant influence to the patients with stroke. It happened to the
decrease of microorganisms in the mouth, good health of teeth, and the increase of satisfaction
level of patients in nurses. These conditions are better when patients located within the
community who keep practicing the oral hygiene.
Keywords: oral hygiene, oral health, stroke, CVA, OHrQoL, microorganism
INTRODUCTION East Java is fourth rank for greatest

Stroke or cerebrovascular accident prevalence of CVA (Riskesdas, 2013).
(CVA) is neurological problem caused by Some of the CVA patient get well
cessation of artery blood flow in the brain and will be healthy if their accepted good
(Price & Wilson, 2006). CVA is caused by treatment but some of them also got
thrombosis, embolic, ischemia and disability and can't meet their daily need,
hemorrhagic (Smeltzer, 2002). The effects this making their quality life at the low level
of CVA are paralysis, debility, no sensation (Corsalini, 2009).
on the face, difficult to speaking, difficult to Based on Henderson nursing
swallow and disturbance of consciousness theory, oral hygiene is one of basic human
and oral hygiene (Lam, 2007). needs (Brady, 2011). Self-care deficit of
CVA is the third highest of the oral hygiene among CVA patients can
world's causes of death after cardiovascular result in Candida Albicans, carries and
disease and cancer (Corsalini, 2009). pneumonia. Pneumonia aspiration is one of
Indonesia is one of the highest prevalence infection disease and also one of
of CVA in Asia (Yohida, 2009). In complication after the patient got CVA. The
Indonesia, based on the data in 2013, 12,1 correlation between pneumonia aspiration
in 1.000 got CVA, and this number was and oral hygiene condition: carries,
higher than in 2007 at 8.2%. Moreover, periodontal disease and less oral hygiene
condition.
91
Inability of the patients to oral klorheksidin and oral hygiene intervention
hygiene, it makes a psychological effect among CVA patients (P<0.001), this mean
like decreased in Quality of Life (Brady, that the group who received oral hygiene
2011). The aim of this study was to review intervention twice time got reduction of
CVA patients condition and correlation dental caries and dental plague than group
between oral hygiene and quality of life given klorheksidin
among CVA patients. Klorheksidin is a mouthwash, it can
be used to keep oral health of CVA patients.
METHODS Kim et al (2014) mentioned that dental
The methodology of this reseach caries and dental plague can prevent with
was literature review. First, the reseacher used Klorheksidin.
found the resource focus on health Yoshida et al (2011) mentioned that
condition of CVA patients, especially on age was significantly correlated with oral
oral hygine. The effect of oral hygiene hygiene status (P<0.05). The oral hygiene
intervention, and the correlation between condition of CVA patients was lower than
quality live and oral hygine among CVA cardiovascular patients. This research also
patients. Then, the reseacher searched found no significant difference between
resources from journals and database such CVA ischemia and hemorrhagic.
as Ebsco, Pubmed, Pro Quest, Google Moreover, Corsalini et al (2009)
Scholar, Science Direct, and Journal Of said that there is correlation between
Nursing Science. The articles or resources denture condition and CVA patients who
were published from January 2006 until aged >60 years old. About 42.4% the CVA
October 2016. The keyword used were oral patients need to repair their denture, 27.3%
hygiene AND stroke”, “oral hygiene and need rebase and 30.3% got good condition.
CVA”, “oral health and stroke”, and “oral Denture condition of CVA patients should
hygiene related quality of life”. regularly be monitored after 1 month and
The total of articles were 1.154, between 3 to 4 months.
including 345 journals from Ebsco, 257 Previous research from Jang et al
from Pro Quest, 304 from Science Direct (2015) mentioned that there is correlation
and 248 from Pubmed. The reseacher only between oral hygiene and quality life
used literatures with criteria inclusion: the among CVA patients. Schimmel,et al
literature related with oral hygine among (2009) found that there is correlation
CVA patients and related with quality life, between oral hygine and quality of life
the condition of CVA patients and nursing (p<0.01). OHrQoL of intervention group in
intervention to CVA patients. hospital was decreased caused by physical
The exclusion criteria of literature limitations and pain.
are the literature that didn’t mentioned the Based on Groth et al (2013) study,
correlation between oral hygiene and OHrQoL will be increased after the patient
quality life among CVA patients, the get back from hospital and some of them
literature not relevant with the topic, and they live in community (P<0.05).
the literature floccus on experiment study. McMillan et al (2005) found that
Fifteen articles were used in this research. CVA patients have low fungtion of physical
Fifteen literatures had critical appraisal and activity, emotional role and menthal health
scoring, than used systematic review by domain. Median score of GOHAI was 52
used scoring and critical appraisal. and 54 in comparison group of CVA
patients. OHRQoL was significant
RESULTS different.
Based on Anne, et al (2013), she Based on Brady's reseach in 2011,
found that any significant different effect he reported that there is correlation between
among two groups who received oral hygine practices and knowlege, care
92
services and professionalism of the nurses CVA is one of degenerative disease
in hospital. Quality of oral hygine will more which need long-term of caring and it make
likely signicant with the higest of effect of basic human needs. Inability to
knowledge among the nurses and health perform oral hygiene also gives impact to
care professionals. Horne et al (2014) also psychological problem, such as hopeless,
had same argumenatation. helpless and low quality of life.
Brady et al (2011) compared oral Psychological problem. Based on three
hygiene practices among dentist and nurses, literatures were mentioned that there is
he found that there is no significant correlation between oral hygiene and
differences of microbioloycal test between quality of life among CVA patients.
those groups, but there is differences of
satisfaction among those groups. The CONCLUSION AND
nurses get challeges of good communicaton RECOMMENDATION
and good knowledge, so that they will give Conclusion
benefits for their patients, decreased Oral hygiene care was one of
complication and improveing health care standard intervention to CVA patients in
services. ICU room. Based on literature reviewed in
this study it can be concluded that there is a
DISCUSSION significant effect of oral hygiene care
Systematic review in this research among CVA patients. The effects will be
aimed to identify oral hygiene condition better than when they live at home or their
among CVA patients. At first, the community and keep to do their oral
researcher got many literatures related with hygiene.
the topic, but only some of them met criteria Oral hygiene is one of important
inclusion of this study. This mean that not intervention to CVA patient, it will give
many literatures or research which focus in good quality of life. Nurses, health care
this topic. Moreover, only small review or providers and hospital management should
research focus on oral hygiene or oral give attention of their intervention so it will
health with focus group among nursing, be prevented the complication and
health care provider and also CVA patients. improved quality care. Moreover, further
Oral hygiene and oral health is one of kind research about standard operational
needed to CVA patients, if it not proper it procedure (SOP) in the hospital so doing
will make impact to CVA patients. The research on oral hygiene was needed.
impact of inappropriate of oral hygiene to
CVA patients, such as many Recommendation
microorganism, carries, poor dental plague Nurses and health care provider
and decreased quality life and life should be give oral hygine to CVA patients
satisfaction. with good standart, so it will prevent
Four articles were described about pneumonia.
microorganism among CVA patients. They Nurses and health care provider
mentioned that CVA patients got an were expected to train their patients to do
increase of microorganisms. An increase of oral hygine at home, so they will gain good
microorganisms caused by poor of quality of life.
frequencies of oral hygiene. The nurses Further reseach on oral hygine
should give oral hygiene care to CVA among CVA patients is needed, especially
patients as one of basic human needs. in Standart operational procedure with
Other research had found that any proper and based on evidence based.
correlation between oral hygiene and
quality life and level of satisfaction among
CVA patients.
93
REFERENCE the intensive care unit. Yonsei Med
Badan Penelitian Dan Pengembangan J;55:240-246.
Kesehatan Kementerian Kesehatan Lam OL, McMillan AS, Li LSW, McGrath
Ri. (2013. ).Riset Kesehatan Dasar C. (2013). Predictors of oral health-
(RISKESDAS). (2013). Jakarta: related quality of life in patients
Badan Litbangkes, Depkes RI following stroke. J Rehabil
Brady M, Furlanetto D, Hunter RV, Lewis Med;46:520-526.
S, Milne V. (2012). Clinical and Lam OL, McMillan AS, Samaranayake LP,
cost effectiveness of enhanced oral Li LS, McGrath C.(2013).
healthcare in stroke care settings Randomized clinical trial of oral
(SOCLE II): A pilot, stepped wedge, health promotion interventions
cluster randomized, controlled trial among patients following stroke.
protocol . Cochrane Database Syst Arch Phys Med Rehabil;94:435-
Rev:CD003864. 443.
Brady MC, Stott DJ, Norrie J, et al. (2011). Lam OLT, McMillan AS, Samaranayake
Developing and evaluating the LP, Li LSW, McGrath C. (2013).
implementation of a complex Effect of oral hygiene interventions
intervention: Using mixed methods on opportunistic pathogens in
to inform the design of a patients after stroke. Am J Infect
randomised controlled trial of an Control;41: 149-154.
oral healthcare intervention after McGrath C, McMillan AS, Zhu HW, Li
stroke. Trials;12:168. LSW. (2009) .Agreement be-tween
Corsalini M, Rapone B, Grassi FR, Di patient and proxy assessments of
Venere D . (2009) . A study on oral oral health-related quality of life
rehabilitation in stroke patients: after stroke: An observational
Analysis of a group of 33 patients. longitudinal study. J Oral
Gerodontology;27:178-182. Rehabil:36:264-270.
Dai R, Lam OLT, Lo ECM, Li LSW, Wen McMillan AS, Leung KCM, Pow EHN,
Y, McGrath C. (2015). A systematic Wong MCM, Li LSW, Allen
review and meta-analysis of PF.(2006). Oral healtherelated
clinical, microbiological, and quality of life of stroke survivors on
behavioural aspects of oral health discharge from hospital after
among patients with stroke. J Dent : rehabilitation. J Oral
43:171-180. Rehabil;32:495-503.
Horne M, McCracken G,Walls A, Tyrrell Mori C, Hakuta C, Endo K, et al.(2012).
P.(2014). Organisation, practice The effects of professional oral
and experiences of mouth hygiene in health care on patients in the
stroke unit care: a mixed-methods subacute stage of emergent
stud. Journal of Clinical Nursing, neurosurgical disorders. Spec Care
24, 728–738, doi: Dent;32:259-264.
10.1111/jocn.12665 Price, S.A & Wilson, L.M. (2012).
Jang E-J, Kim E-K, Lee K-S, et al.(2015). Patofisiologi konsep klinis proses –
Oral health related quality of life proses penyakit. Jakarta: Volume 2.
and its related factors of stroke EGC
patients at home in Korea. Arch Schimmel M, Leemann B, Christou P, et al.
Gerontol Geriatr;61:523-528. (2011).Oral health-related quality
Kim E-K, Jang S-H, Choi Y-H, et al. of life in hospitalised stroke
(2014). Effect of an oral hygienic patients. Gerodontology;28:3-11.
care program for stroke patients in
94
Smeltzer, Suzanne C. 2002. Buku Ajar
Keperawatan Medikal Bedah.
Jakarta: EGC
Yoshida M, Murakami T, Yoshimura O,
Akagawa Y.(2012). The evaluation
of oral health in stroke patients.
Gerodontology. 2012;29:e489-493.
Zhu HW, McMillan AS, McGrath C, Li
LSW, Samaranayake LP. (2008).
Oral carriage of yeasts and
coliforms in stroke sufferers: A pro-
spective longitudinal study. Oral
Dis;14:60-66.
95
THERAPEUTIC EFFECT OF AUDIO MUROTTAL FOR RECOVERY TIME OF
POST GENERAL ANESTHETIC PATIENT
Rafika Rosyda, Sriyono, Deni Yasmara

Email: rafika.rosyda-2016@fkp.unair.ac.id
ABSTRACT
Introduction: The first hour post general anesthetic is the important time for patient because
in this time respiratory distress can occur although patient seems wake up. Accelerate the
recovery time is important to minimize the several complications. Post general anesthetic
recovery on adult monitored by Aldrete scores. It provides information when the patient can be
moved from the recovery room. This study was to determine an overview of the therapeutic
effect of murottal for recovery time of post general anesthetic patient. Method: A quasy-
experimental study with post only with control group design. Used consecutive sampling and
obtained 36 respondents (18 for exsperiment group, 18 for control group). Data collected by
observation and analyzed using independent t-test with level of significance 0.05. Result:
Recovery time of experimental group were between 15 – 40 minutes with average time 22.5
minutes. The recovery time of control group were between 25 – 60 minutes with average time
37.5 minutes, p-value=0.000. Patients in exspriment group had shorter recovery time than
patients in control group. Murottal therapy can accelerate recovery time of post general
anesthetic patients. Conclusion: Further research is needed to prove the usage of murottal as
complementary therapy for post general anesthetic patient.
Keywords: audio Murottal, Comlementary therapy, Quran, General anesthetic, Recovery time
INTRODUCTION spiritual therapies are used and often help

Prolonged post anesthetic recovery the healing process together with drugs or
time is the one of frequent post surgery other medical interventions (Hamid, 2009).
complication (Senapati, 2009). In the post One of treatment through spiritual aspect is
anesthetic recovery periode, patient is not listening or reading Quran, called murottal
fully concious, so obstruction in airway (Qadri, 2003; Ad-Dihami, 2005; Ma'mun,
may occur. This condition may lead 2012).
aspiration because of anesthetic agents. Based on the preliminary studied on
Accelerate recovery time become important 10th and 11th November 2014 showed that in
for post surgical patient to minimize several Rumah Sakit dr. H. Soewondo Kendal, the
complications. (Latief et al. (2002). fastest recovery time after general
The concept of death due to anesthesia was 32 minutes and the longest
prolonged of post anesthetic recovery time was 69 minutes (mean of 52 minutes),
is very difficult to evaluate, confusing and obtained from 24 adult patients with general
is not clearly known, though death is clearly anesthesia. Intervention provided was O2
defined. So the number is not known yet. therapy to accelerate the evaporation of the
Even though complications due to anesthetic agent. Although almost all
prolongation of the recovery time is still patients are Muslims, but handling through
common (Lobato et al., 2008). a spiritual approach to accelerate recovery
In terms, role of nurse to monitor the time after general anesthesia was never
patients conditions any time is necessary, done.
but the spiritual aspect as part of holistic
nursing care is often ignored. Today the
96
METHODS and body mass index were measured the day
The design of fhis study was quasy before surgery.
experimental with post only with control In the recovery room, exsperimental
group. Used consecutive sampling, and group recieved intervention according to
recruited 36 patiens (18 patients as standard operational prosedures, and
experiment group, and 18 as control group) recieved murottal surah Ar-Rahman for 12
in rumah sakit dr. H. Soewondo, Kendal. minutes via earphones. Control group only
Patient who recived almost same dosage of recieved intervention according to standard
ketamine as intravenous agent, isofluran, operational procedures. The time of each
and sevofluran as inhalation agents, group reached score 9 on aldrete score were
moslem, non alcoholic, ages between 26 to observed.
45 yeras old, normal body mass index, The scores which had collected had
classified as ASA 1 physical status, and had been alaized with independent t-test
less than 2 hours surgery are included in this (p=0.05).
study. Patients with other complications,
and had hearing disorder are taken out of RESULT
this study. 55.6% samples from experiment
The independent variable in this group recieved 45 mg ketamin, 88.9%
study was audio murottal, and the samples were young adult, and 44.4%
dependent variable was recovery time after samples had body mass index between 20 to
general anesthesia. 20.9. In the other hand, 61.1% samples from
All of candidates recieved hearing control group recieved 45 mg ketamin,
test to made sure samples had no hearing 77.8% samples were young adult, and
dissorder, the candidates’ weight, height, 33.3% samples had body mass index
between 20 to 20.9.
Table 1: The Correlation Between Dose Of Ketamin and Recovery Time Post General
Anesthesia on Experimental Group and Control Group in Rumah Sakit Dr. H.Soewondo Kendal
8th To 22nd December, 2014
Experiment group Control group
Dose of Mean Mean
Ketamin Recovery recovery α
n1 r p-value n2 r p-value
(mg) time time
(min) (min)
40 5 17.00 0.751 0.000 3 25.00 0.948 0.000 0.05
45 10 21.50 11 35.90
50 3 35.00 2 45.00
55 0 - 2 57.50
From table 1, mean recovery time obtained r=0.751 (r>0.400) and p-

post general anesthesia were directly value=0.000 (p<0.05). Result of pearson
proportional with dose of general anesthesia correlation between dose and recovery time
agent recieved by both experiment and in control group obtained r=0,948 (r>0.400)
control group. Experiment group had faster and p-value=0.000 (p<0.05). There’s a
recovery time compared with control group, significant correlation between dose and
though samples recieved the same doses. recovery time post general anesthetic on
Result of pearson correlation between dose both experiment and control group.
and recovery time in experiment group
97
Tabel 2: The Different of Recovery Time Post General Anesthetic Between Young Adult and
Late Adult on Experiment And Contol Group in Rumah Sakit Dr. H. Soewondo Kendal 8th to
22nd December 2014
Experiment group Control group
Mean Mean
Group of
Recovery Recovery α
ages n1 SD p-value n2 SD p-value
time time
(min) (min)
Young adult 16 20.63 5.43 0.001 14 35.57 5.69 0.000 0.05
Late adult 2 37.50 3.54 4 51.25 7.50
From table 2, mean post general anesthetic minutes. The comparative test between
recovery time from experiment group was recovery time on yong adult and late adult
faster than control group both young and obtained p-value = 0.001 (p<0.05) from
late adult. Young adult from experiment experimet group, and p-value=0.000
group recovered at 20.63 minutes, and (p<0.05) from control group. That’s mean
control group were 35.57 minutes. That was there was a significant difference between
slower on Late adult. Late adult from young and late adult in terms of post genaral
experimental group recovered 37.50 anesthetic recovery time.
minutes, and from control were 51.25
Table 3: The Corelation Between Body Mass Index dnd Post General Anesthetic Recovery
Time from Experiment And Control Group in Dr. H.Soewondo Hospital Kendal 8th To 22nd
December 2014
Experimet group Control group
Mean Mean
Body mass
Recovery Recovery α
index n1 r p-value n2 r p-value
time time
(min) (min)
18 – 18.9 1 15.00 0.291 0.241 1 25.00 0.626 0.005 0.05
19 – 19.9 4 18.00 5 34.00
20 – 20.9 8 21.25 6 34.17
21 – 21.9 5 26.00 5 41.00
22 – 22.9 0 - 1 60.00
From table 3, in the same range of body DISCUSSION

mass indexes, mean recovery times for Mean recovery time for experiment
experiment group were faster than control group was 22.5 minutes with fastest time
group. In the experment group, with were 15 minutes, and the slowest was 40
pearson correlation obtained r=0.291 minutes. for the control group, mean
(r<0.400) and p-value=0.241 (p>0.05). So, recovery time was 37.5 minutes with 25
there was no significant correlations minutes for the fastest and 60 minutes for
between body mass index and post the slowest.
anesthetic recovery time. From control This study used ketamin as
group, obtained r=0.626 (r>0.400) and p- anesthesia agent with dose of ketamin
value=0.005 (p<0.05), that’s mean there is between 40 to 55 mg. Post anesthetic
significant correlations between body mass recovery times were directly proportional
index and post general anesthetic recovery with dose of anesthetic agent recieved by
time. both experiment and control group.
98
Samples who recieved less doses of Person who have higher body mass index
ketamin recovered faster than who recieved scores are not always heavier, and vice
more. According to Fandsen & Pennington versa. So, body mass index is not affecting
(2013) that pharmacodynamic influenced the dose of anesthesia agent, except for ones
by drug factors and patient factors, one of who chatagorized as underweight and
drug factor is dose, dose of drug is directly obese, that may change the distribution of
proportional with effect of drug. drugs.
Samples from experiment and The result of this study showed that
control group sparated into two groups by there were significant differences between
age, that were young and late adult. Young experiment and control group’s recovery
adult samples from experiment group had time, it was mean murrotal affected patients
mean recovery time 20.63 minutes, this recovery time post general anesthesia. In
result was faster than late adult who had the same doses, and same age group,
mean recovery time 37.5 minutes. Young experiment group’s mean recovery time
adult from control group had mean recovery was faster tahn control group. In both
time 35.57 minutes, and late adult from group, body mass index belong to normal
control group had mean recovery time category, and experiment group recovered
51.25 minutes. that was mean post faster too.
anesthetic recovery times for young adult According to research by Upoyo,
were faster than late adult. This result was Ropi and Sitorus (2011) that stimulation by
accordance with Olson (2004) that one of playing murottal Quran has significant
factor affecting post anesthetic recovery influence in raising conciousness. Murottal
time is age. Olson said that the older patient sound will form impulses received by
had undergone changes in their body neurosensory subsequently forwarded to
fuctions which affecting drug’s half-life. the Reticular Activating System through
Brown et al. (2010) said that recover from ascending reticular formatio, then impulses
the effects of anesthesia is gradually along delivered to stimulate the reactivation of the
with the elimination of anesthetic agent cerebral cortex function.
from the body, either through the lungs, General anesthesia is work
kidneys or through the skin as sweat. functionally to depress brain function. This
Body fungtions have changed in condition is more akin to a coma than sleep
older person, this is affecting the drug’s (Brown et al., 2010). Brain activity is
half-life, and distribution of anesthesia influenced by the noise. The brain waves
agent. Elimination organs that changed will will follow the rhythm of the sound heard
affecting the elimination of anesthesia by the individual. Moreover, brain activity
agent, so recovery. can be easily changed because of noise than
Samples from experiment and its own control (Scott, 2000).
control, group had nomal body mass According to Wijaya in Indrajati &
indexes. Mean recovery time in experiment Sulistiani (2013) murottal is music with
group was faster than control group. Post intensity of 50 decibels (normal
anesthetic recovery times were directly conversation is 60 decibels). The music has
proportional with body mass index, a rhythm for reviewing stimulate and
although the results of correlation test regulate muscle response and can be
between BMI and post-anesthesia recovery beneficial to adjust the patients with
time for the experimental group did not neuromuscular disorders. (Selimen &
show any significant relationship. Andsoy, 2011).
Dose of drug is based on weight and Murottal audio stimulation of the
body surface area (Olson, 2004). Bosy mass Qur'an can be used as an alternative therapy
index obtained from the ratio of weight in that is even better than the other audio
kilograms and square of height in meters. therapy (Abdurrahman et al., 2008).
99
Physiologically, murottal will stimulate the so murottal can be used as additional
return of neurotransmitters in the cortex, therapy for patients after standard
thalamus and brain stem which were procedure under general anesthesia.
hampered because of the increased Further research also can be
sensitivity of GABAA receptors and investigated the murrotal and its effect for
inhibition of LGICs, and NMDA through anesthesia dissociation after ketamin
stimulation of the amygdala to the cerebral administration, or compare the
cortex and thalamus, which stimulates the effectiveness of murrotal and other voice
return of sensory, motor and autonomic therapy for post anesthetic recovery time.
fuctions. (Pleuvry, 2007; Brown et al.,
2010). REFERENCES
Research by Hardiyanto and Abdurahman, A., Perdana, S. & Andhika,
Soenarjo (2006) showed that there were S., 2008. Muratal Al Quran;
differences of blood pressure and heart rate Alternatif Suara Baru. In Seminar
before, during, and after anesthesia. Nasional Sains dan Teknologi.
According to research by Ghauri and Lampung, 2008. Universitas
Asman (2008), the murrotal Quran had an Lampung.
effect on the improvement of pulse for the Ad-Dihami, 2005. Menjaga Hati. Jakarta:
listener. This indicates that murrotal which Gema Insani.
is given post-anesthesia will improve the Asman, O., 2008. Quranic Healing For
function of pulse, then affect changes in Spiritual Aliment, Between
blood pressure, peripheral vascularity, Tradition, Religious Law and
respiratory rate, peripheral oxygen Contemporary Law. Medical Law
saturation, conciousness, and activity. Journal, pp.259-84.
The recovery time differences Brown, E.N., Lydic, R. & Schiff, N.D.,
between experimental group and the control 2010. General Anesthesia, Sleep,
group showed that murottal as and Coma. The New England
complementary therapy could be accelerate Journal of Medicine, 363(27),
the recovery time after general anesthesia, pp.2638-50.
that could reduce the complications besause Frandsen, G. & Pennington, S.S., 2013.
of lengthening recovery time. This is Abrams' Clinical Drug Therapy:
according to research by Hart (2009), that Rationales For Nursing. 10th ed.
complementary therapies can help patients Philadelphia: Lippincott Williams
post surgery as part of a therapy to reduce & Wilkins.
postoperative complications. Ghauri, A.H., 2008. Quranic Spiritual
Healing. [Online] Available at:
CONCLUSION AND http://www.meem40.pwp.blueyond
RECOMENDATION er.co.uk/Healing.html [Accessed 25
Conclusoin Desember 2014].
Mean recovery time post anesthetic Hardiyanto, I.T., 2006. Pengaruh Anestesi
patients who recieved intervention as Spinal terhadap Hemodinamik pada
standard operational procedures plus Penderita dengan Sectio Secarea.
murrotal recovered faster than who recieved Karya Tulis Ilmiah. Semarang:
olny intervention as hospital standard Universitas Diponegoro.
operational procedures. There was Indrajati, T. & Sulistiani, N., 2013.
therapeutic effect of murottal to the Pengaruh terapi Murottal terhadap
recovery time after general anesthesia. Denyut Nadi dan Frekuensi
Recomendation Pernapasan pada Bayi Prematur di
Further research is needed with RSUD Banyumas. Skripsi.
more samples and various type of surgery,
100
Purwokerto: Universitas Jendral
Soedirman.
Latief, S.A., Suryadi, K.A. & Dachlan,
M.R., 2010. Petunjuk Prakis
Anestesiologi. Jakarta: Fakuttas
Kedokteran Universitas Indonesia.
Lobato, E.B., Gravenstain, N. & Kirby,
R.R., 2008. Complication in
Anesthesiology. Philadelphia:
Lippincott Williams & Wilkins.
Ma'mun, M.R., 2012. Sehat dengan Obat
Herbal: Obat Herbal Solusi
Terbaik. [Online] Available at:
http://www.mitradjaya.com/sehat-
dengan-meditasi-baca-al-quran/
[Accessed 23 September 2014].
Olson, J., 2004. Belajar Mudah
Farmakologi. Jakarta: EGC.
Pleuvry, B.J., 2007. Mechanism of Action
of General Anesthetic Drugs.
Anesthesia and Intensive Care
Medicine, 9(4), pp.152-53.
Qadri, M.A., 2003. Quranic Theraphy Heal
Yourself. USA: Educational.
Scott, E., 2000. Music and Your Body: How
Music Affects Us and Why Music
Therapy Promotes Health. [Online]
Available at:
http://stress.about.com/od/tensionta
mers/a/music_therapy.htm
[Accessed 20 Desember 2014].
Selimen, D. & Andsoy, I.I., 2011. The
Importance of A Holistic Approch
During The Perioperative Period.
AORN Journal, 94(4), p.485.
Senapati, M.G., 2009. Buku Ajar Ilmu
Anestesia dan Reanimasi. Jakarta:
PT. Indeks.
Upoyo, A.S., Helwiyah, R. & Ria, S., 2011.
Pengaruh Stimulasi Murotal Al
Quran terhadap Nilai Glasgow
Coma Scale pada Pasien Stroke
Iskemik di RSUD Dr. R Goeteng
Aroenadibrata Purbalingga. IJAS, I.
101
EFFECTIVENESS OF MUSIC AS INTERVENTION FOR PERIOPERATIVE
ANXIETY: A SYSTEMATIC REVIEW
Sri Handayani, Putu Indraswari Aryanti, Sofiana Salim, Titik Agustiyaningsih

Email: srihandayaniadib@gmail.com
ABSTRACT
Introduction: Anxiety is a general problem experienced by patients who had surgery and
invasive procedures. The attempt to reduce anxiety level easily, safely and cheaply is through
music intervention. There are differences in results from different studies related to music
intervention to reduce patients’ anxiety of perioperative; thus deeper analysis needs to be
performed. Method: The search for literature from online databases and review or evaluation
to 17 research journals fulfilling inclusion and exclusion criteria have been carried out. Results:
Thirteen studies (76%) have shown that there is a significant effect of giving music as
intervention on anxiety level. Four research reports (24%) have indicated that there is no
statistically significant difference in anxiety level between experimental and control groups
with music as intervention. Conclusions: In general, music used as the intervention is regarded
effective to reduce patients’ anxiety in perioperative and invasive procedures.
Keywords: Music, Anxiety, Preoperative, Surgery, Adult
INTRODUCTION hyper-activity (Bringman et al, 2009 cited

Patients who have been hospitalized in Pittman & Kridli, 2011).
and have undergone surgery and other The challenge for preoperative
invasive procedures generally will nurses is developing non- pharmacologic
experience increasing anxiety. Anxiety is therapy as a safe, easy, cheap, and free from
emotional state which is a manifestation of effect side intervention. The relaxing effects
behavior accompanying patients who had of music observed not only reduces stress
surgery and this happens to 11%-80% adult and anxiety as psychological parameter but
patients with surgery (Stark Weather et al, also as physiologic parameters in the forms
2006 cited in Labraguedan McEnroe- of decreasing heart rate, breath or
Petitte, 2014). respiration rate, basal metabolismrate,
The factors contributing to oxygen intake, muscle tense, epinephrine
increasing anxiety of patients with surgery level, sweat gland activity and blood
are: Separation from the family, worry of pressure (Arslan et al, 2008).
complication, surgery results, pain post Out of 17 reviewed research reports,
surgery, physical impairment, financial there is a contradiction; therefore, this
problems, waiting for surgery, personal life systematic review seeks to evaluate the
difference, worry of malpractice, and effectiveness of giving music as therapy for
change of environment (Jawaid et al, 2007). adult patients who will have invasive and
The therapy for the anxiety can be surgery procedures.
pharmacologic and non- pharmacologic. The objective of this systematic
Pharmacologically, patients can be given review is to describe several variations in
anxiolytic medication such as approaches used to examine the
Benzodiazepines, but this may have other effectiveness of music as intervention to
side effects such as hemodynamic decrease anxiety of adult patients with
instability, long-term amnesia, agitation and invasive and surgery procedures.
Furthermore, the reviewer also examines
102
duration and the type of music used and is given to patients who have invasive and
description of pain level, heart rate, BP, and surgery procedures.
respiration rate of patients. After searching for related
literatures, finally 17 research articles
METHODS fulfilling inclusion have been found for this
Music in this context is the recorded systematic review.
music played through tape recorder or
compact disk (CD) player. Music as Inclusion Criteria
intervention is defined as the music played In this systematic review, for article
for patients during scheduled treatment and relevance, some inclusion criteria are set as
for intended outcomes. Specifically, music follows
Tabel 1. Judgment of Risk of Bias in the 17 Studies Included in A Effectiveness Of Music As

Intervention For Perioperative Anxiety, Based on the Cochrain Quality Criteria
Study Random Concealment Blinding Blinding Incomplete Selective Other
Generation of of of Outcome Outcome Sources
of Allocationb Participant Outcome Datae Reportingf of Biasg
Allocationa and Assessorsd
Personnelc
Mohammadi Unclear No No Yes Yes No Yes
et al, (2014)
Weeks & Yes Unclear Yes Yes Yes Unclear No
Nilsson,(2010)
Ni, et al, Yes Yes Yes Yes Yes Yes Yes
(2010)
Twiss, et al, Yes Yes Yes Unclear No Unclear Yes
(2006)
Ignacio, et al, Yes Yes Yes Unclear Yes Unclear No
(2012)
Demarco, et Yes Unclear No Unclear No Unclear Unclear
al, (2012)
Kushni et al, Yes Yes Unclear Unclear Yes Yes Yes
(2012)
Lee, et al, Yes Yes Yes Unclear No Unclear Unclear
(2011)
Lee, et al Yes Yes Yes Yes Yes Yes No
(2011)
Hook, et al, Unclear Unclear Unclear Yes Yes Yes No
(2008)
Moradipanah, No No No No Unclear Yes No
et al, (2009)
Reza, et al, Yes Yes Yes Yes Yes Unclear No
(2007)
McLeod No Unclear No No Yes Unclear Yes
(2011)
Arslan (2008) No No No No Yes Yes No
Cutshall et al, Yes Yes Yes No Yes Unclear No
(2011)
Nilsson, Yes Yes No Yes Yes Yes No
(2009)
Li, et al (2011) Yes Unclear No Yes No Yes Yes
a
Yesrated as: If sequence generated by referring to a good random technique; no: If sequence generated by
poorrandom technique; unclear: Insufficient information to permit judgment.
b
Yes refers to participants and investigators enrolling participants could not foresee assignments before
assigning subjects to groups;no: If participants or investigators enrolling participants could possibly foresee
assignments;unclear: Insufficient information to permit judgment.
103
c
Yes indicates blinding of participants and key study personnel ensured; no: blinding of key study participants
and personnel attempted;unclear: Insufficient information to permit judgment.
d
Yes implies blinding of outcome assessment ensured; no: Blinding of outcome assessment attempted, but likely
that the blinding could have been broken;unclear: Insufficient information to permit judgment.
e
Yes implies no missing outcome data or loss to follow-up <10%;no: loss to follow-up >10%; unclear:
Insufficient reporting of exclusions to permit judgment.
f
Yes implies the study protocol is available; no: not all of the study’s pre-specified primary outcomes have been
reported; unclear: Insufficient information to permit judgment
g
Yes implies the study appears to be free of other sources of bias; no: there is at least one important risk of bias;
unclear: Insufficient reporting of attrition/exclusions to permit judgment
1. The population of the study Out of 17 research, nine of them use

arehospitalized adult patients. STAI (State Trait test Anxiety Inventory) to
2. The intervention given is recorded measure the anxiety level either pre and post
music. intervention. STAI is a-twenty item
3. The control group is notgiven music or questionnaire which is widely used because
without any treatment. of good reliability and validity (Spielberger
4. The results of the research which are et al., 1970 cited in Twiss et al. 2006).
observed include: anxiety which can be Meanwhile, VAS (Visual Analogue
accompanied with: pain, vital Scale) or VASA (Visual Analogue Scale for
symptoms (blood pressure, heart beat, Anxiety) is used in 4 studies. A study by
breath), hemodynamic status and Hook et al. (2008) uses both STAI and
cortisole or catecholamine serum VAS.
levels. Numeric Rating Scale (NRS) is a
5. Method of research studies using scale of measurement using numbers to
Randomized Controlled Trial (RCT). measure anxiety and pain. Two studies
6. The studies are conducted in the last 10 employ NRS. They are those of Weeks&
years (2006-2016). Nilsson, 2010 and Nilsson, 2009.
7. Research reports are written in English. In addition to all of those instruments,
Depression Anxiety Stress Scale (DASS) is
Strategies of Journal searching another instrument used to measure
Most research articles are obtained depression state, anxiety and stress levelas
from online searching, making use of the used in a study of Moradipanah et al, 2009.
following databases: CINAHL, Medline,
PsycINFO, Pubmed, Ebschohost, Proquest, RESULTS
SAGE and Google Scholar. Based on Table 1.1, it is concluded
The key words are written using that 13 out of 17 (76%) of the reviewed
analysis of PICOT (Population, studies demonstrate that the patients who
Intervention, Comparison, Outcome, received music as intervention have
Time). The PICOT format is used to answer experienced decreasing anxiety shown by
research questions (Riva et al, 2012). statistically significant decreasing in the
From this method, several key scores of STAI. Mohammadi et al. (2014),
words are found as follows: P= Preoperative Ni et al, (2010), Lee et al, (2011) found that
or Surgery, Adult; I= Music or Music the patients who have pre surgery
Intervention; C= No Music Intervention; procedures experience decreasing scores in
O= Anxiety; T=2006-2016. STAI after listening to music.
Research Design Four out of 17 studies (24%)
All studies reviewed employ reported that there is no significant
experimental research design using RCT difference in anxiety level between patients
(Randomized Controlled Trial). given music as intervention and those who
did not receive music as intervention.
Instruments
104
Only 1 out of 17 studies evaluates procedures and surgery decrease systolic
the level of cortisol serum level and and diastolic blood pressures
patients’ catecholamine. Nilsson (2009) (Mohammadiet al, 2014; Ni et al, 2010; and
found that after the first 30 minute bed-rest, Kushnir et al, 2012).
there is significant difference in cortisole
level but it was not found any significant Heart rate
difference in cortisol level in the second 30 There are six out of17 studies (35%)
minute bed-rest. which examine the relationship between
music and heart rate. Five out of 6 studies
Pain (83%) reveal tendency of decreasing heart
Five out of 17 (29%) studies rate of patients listening to music before
examine the pain level. Two out of 5 (40%) surgery. Mohammadi et al (2014) found
studies reveal that pain level decreases that individuals listening to music for about
because of intervention and three out of 5 20 minutes will experience decreasing heart
(60%) studies demonstrate that there is no rate from 73 to 70 times per minute.
significant difference in pain level between Similarly, Kushnir et al, (2012) found that
those with intervention and those without there is decreasing heart rate of patients
intervention. from 82 to 80 who listen to music for about
Blood Pressure 40 minutes. Lee et al. (2011) also reveals
There are 3 studies examining the that by listening for about 10 minutes, the
effect of listening to music on blood patients’ heart rate decreases from 73 to 72
pressure. All those studies conclude that times per minute.
listening to music before invasive
Table 2. Evaluation of Music Intervention

Author Anxiet Pain BP H RR Music Duration Sample
y R
Arslan SD NM N N N Selection : 30’ M (32)
(2008) M M M Classic turkey, Waiting NM (32)
Turkey SD SD folk, Pop OR =64
Cutshall et SD SD N Selection: M(49)
al, (2011) SD NM M Summer, 2 x 20 ' NM(51)
US N N Autumn, Day 2 until =100
Demarco, M M N Bird and night day 4 M (14)
et al, M song 20’ NM (12)
(2012) Determined: =26
Israel composer by dr.
Joseph Nagler
Hook, et SD SD N N N Selection: 2 x before M(51)
al, (2008) M M M Western, & 3days NM (51)
Malaysia Melayu, China postop =102
Music
Ignacio, et NS NS N N N Music selection 30’ per M (12)
al, (2012) M M M various types day NM (9)
Singapura
Kushni et SD NM SD SD SD Selection: 40’ M (28)
al, (2012) pop,classical, NM (32)
Israel Music israel =60
105
Lee, et al, SD NM N SD N RelaxationMusi 10’ M (64)
(2011) M M c NM (76)
Taiwan Folk, pop =140
Lee, et al SD NM N NS N Relaxation 10’ Hp (48)
(2011) M M music Bc (66)
Taiwan folk songs, pop NM (53)
music
Li, et al SD NM NS NS N Selection: 2 x 30’ M (60)
(2011) M China classic, NM (60)
China Music world,
china relaxation
music
McLeod NS NM N N N Selection: During M (40)
(2011) UK M M M Light, classical, surgery NM (40)
relaxation,conte
mporary
Mohamma SD NM SD SD SD Selection: 20’ M (30)
di et al, non NM(30)
(2014)Iran classicalvocal, = 60
Natural sounds
Moradipan SD NM N N N Selection: 20’ -M (37)
ah, et al, M M M relaxation music -NM (37)
(2009) =74
Iran
Ni, et al, SD NM SD SD N Music option 20’ M (87)
(2010) M Pop china, Pop NM (87)
Taiwan Taiwan =174
Nilsson, NS NS N NS NS Determined: 30’ M (28)
(2009) M Soft relaxation NM(30)
Sweden music =58
Reza, et al, NS NS N N N Music Guitar Intraop in M(50)
(2007) M M M Player Spanyol OR NM (50)
Iran
Twiss, et SD NM N N N Selection: During M (42)
al, M M M ‘Prescriptive and after NM(44)
(2006)US music’ surgery
A
Weeks & SD NM N N N
Determined During the -NM(34)
Nilsson, M M M
-classical music procedur -FM (34)
(2010) US -sound -LS (30)
environment
BP=Blood Pressure HR=Heart Rate RR=Respiration Rate SD=Significantly Descending
NS=No Significant NM=Not Measure OR=Operating Room M=Music NM=Non Music
FM=Focused Music LS=Loudspeaker Hp=Headphone Bc=Broadcast
Nilsson (2009) demonstrates that by to music compared to the groups who did
listening music for about 30 minutes, the not listen to music.
heart rate decreases from 79 to 78 times per
minute. However, statistically, this does not Breath or Respiration Rate
give significant effect on groups who listen
106
There are three out of 17(18%) of There are 13 out of 17 (76%) studies
the reviewed studies which examine the which reveal that listening to music can
effect of music on breath. Two out of 3 reduce the patients’ anxiety in surgery and
(67%) of the studies reveal that the breath invasive procedures.
rate of patients listening to music decreases Three out of 17 studies examine the
(Mohammadi et al, 2014; Kushnir et al. effect of listening music on blood pressure.
2012). Nilsson (2009) found that breath rate All of them lend support that listening to
of patients who listen to music decreases music has significant effect on blood
from 18 to 15 times per minute; however, pressure.
this is not significant compared to the Six out of 17 studies examine the
control group. effect of music therapy on heart rate and 5
out of 6 studies demonstrate that patients
Types of music with music therapy have lower heart rate
Types of music include variety of than that of patients who did not listen to
genres. Twelve out of 17 (71%) research music.
articles report that patients chose their own The last, two out of three studies
music and listened to music during investigating the breath pattern of anxious
intervention. patients also show that the patients’ breath
Five out of 17 studies (29%) report rate decreases after listening to music.
that the researchers chose the music for the The contradictory findings on the
patients. And 2 studies did not report the effects of music on anxiety and vital signs
type of music but they use “prescriptive can be related to medication taken by
music series” by Twiss et al. (2006) and patients. The medication such as anti-
“therapy music composed by dr. Joseph hypertension, anti-arrhythmic and beta
Nagler”. The study is that of DeMarco et al. blockers taken by patients may change
(2012). One study by Nilsson (2009) did not patients physiologic response to anxiety and
identify the method of selecting music or music (Nilsson et al, 2009).
type of music used. Ignacio et al. (2012) who did
Most studies use classical music (6 research to 21 respondents recommend
studies or 35%) and relaxation music (5 further studies with larger sample size for
studies or 29%) as the intervention. more significant research findings.
Four out 17 (24%) studies use McLeod et al. (2011) and Reza et al.
different types of pop music such as (2007) state that giving music to patients is
Chinese pop, Taiwanese pop and western not effective during being anethetized up to
pop for their intervention wound handling in surgery room since
Five out of 17 (29%) of the studies patients lost their control when they are
offer culture based music as Turkish, given anaesthesia.
Jewish, Chinese pop, Taiwanese pop, Duration and type of music which is
western music and Malay music. One study unfamiliar to patients during
did not report the genre of music but givenanaesthesia might be the cause of
mentioned the musical instrument namely inconsistency of effects of music on anxiety
Spanish guitar (Reza et al, 2007). and vital signs (Reza et al, 2007). To
complement music, the play Spanish guitar
DISCUSSION seems unfavorable to Iranian respondents;
Patients who have surgery or thus, the intervention did not give effect on
invasive medical procedures in hospital reducing anxiety.
experience increasing anxiety. This leads to There are large variations in terms of
examination on the effectiveness of music participants and sample. Sample size ranges
intervention during preoperative treatment. from 21-174 participants. Ignacio et al.
(2012) recruited 21 patients of post
107
orthopedic surgery. Mean while DeMarco music relevant to patients’ culture and
(2012) did study to 26 patients of intra belief, i.e. the music which has spiritual and
cosmetic surgery. Both studies have low religious values such as holy Koran
generalizing power which might be caused recitation, gospel, prayer or God glorifying
by small sample size. for their recovery. The spiritual values are
Another issue concerning variability expected to reduce their anxiety more
of effects of listening music is duration of effectively.
intervention. There are some differences in
duration of music therapy, ranging from 10 REFERENCES
to 40 minutes, although majority of study Arslan, S., Ozer, N., Ozyurt, F. (2007).
set 20 minutes of listening to music as Effect of music on preoperative
intervention. Generally, the anxiety in men undergoing
researcherspresent the music to patients urogenital surgery. Research Paper
once a day, but the studies of Li et al. at The Turkish Surgical and
(2011), Cutshall et al. (2011), and Hook et Operating Room Nursing
al. (2008) presented music twice a day to Conggress: With International
patients. Participation, 4-8 September 2007,
With regard to the choice of music, Gaziantep, Turkey.
12 out of 17 studies report that the patients Cutshall, S. M., Anderson, P. G., Prinsen, S.
chose their own music; 5 studies do not K., Wentworth, L. J., Olney, T. L.,
mention type of music and the method of Messner, P. K., et al. (2011). Effect
music selection. Reza et.al (2007) in their of the combination of music and
study mention that the absence of music Nature Sounds on Pain and Anxiety
alternatives and unfamiliarity to music limit in cardiac Surgical Patient: A
their findings. Culture based music can be Randomized Study. Alternative
the reference as the alternatives because of Therapies, 17(4), 16-23.
differences in ages, ethnic groups, belief Demarco, J., Alexander, J. L., Nehrenz, G.,
and cultures. & Gallagher, L. (2012). The Benefit
of Music for the Reduction of Stress
Conclusion and Anxiety in Patients Undergoing
Most studies lend support that music Elective Cosmetic Surgery. Music
intervention is effective to reduce the and Medicine, 4(1), 44-48.
anxiety of preoperative patients and patients Hook, L., Songwathana, P., Petpichetchian,
with other invasive procedures. The W. (2008). Music Therapy with
effectiveness is indicated by statistically Female Surgical Patients: Effect on
significant decreasing STAI scores, blood Anxiety and Pain. Thai J Nurs Res,
pressure, heart beat, and breath of 12(4), 259-271.
preoperative patients. In general, music Ignacio, J. J., Fai, C. M., Hui, T. S., Marie,
intervention is safe, cheap and easy to T. L. M., Goy, R. (2012). Research
perform to manage the anxiety level of in brief- The effect of music pain,
preoperative patients. anxiety, and analgetic use on adult
undergoing an orthopaedic surgery:
Recommendation A pilot study. Singapore Nursing
Music intervention can be used as Journal, 39(4), 49-52.
routine treatment particularly to Jawaid, M., Mushtaq, A., Mukhtar, S.,
preoperative patients with high anxiety. Khan, Z. (2007). Preoperative
Because of limitations and anxiety before elective surgery.
differences in research findings, further Neuroscience, 12(2), 145-148.
studies need to be done by considering Kushnir, J., Friedman, A., Ehrenfeld, M.,
sample size, therapy dosage and types of Kushnir, T. (2012). Coping with
108
Preoperative Anxiety in Cesarean undergoing coronary
Section: Physiological, Cognitive, angiography.Eastern
and Emotional Effects of Listening Mediterranean Health Journal,
to Favorite Music. Journal 15(3),639-647.
Compilation BIRTH, 39 (2), 121- Ni, C. H., Tsai, W. H., Lee, L. M.,Kao, C.
127. C., Chen, Y. C. (2011). Minimising
Labrague, L. J., & Mcenroe-petitte, D. M. preoperative anxiety with music for
(2014). Influence of Music on day surgery patients - a randomized
Preoperative Anxiety and clinical trial.Journal of Clinical
Physiologic Parameters in Women Nursing, 21, 620-625.
Undergoing Gynecologic Surgery. Nillson, U. (2009). The effect of music
Clinical Nursing Research,1-17. intervention in stress response to
Lee, K. C., Chao, Y. H., Yiin, J. J., Chiang, cardiac surgery in a randomized
P. Y., Chao, Y. F. (2011). clinical trial.Heart & Lung, 38(3),
Effectiveness of different music- 201-207.
playing devices for reducing Pittman, S., & Kridli, S. (2011). Music
preoperative anxiety: A clinical intervention and preoperative
control study. International Journal anxiety: an integrative review.
of Norsing Studies, 48(2011), 1180- International Nursing Review,
1187. 58(2011), 157-163.
Lee, K. C., Chao, Y. H., Yiin, J. J., Hsieh, Reza, N., Ali, S. M., Saeed, K., Qasim, A.
H. Y., Dai, W. J., Chao, Y. F. A., Reza, T. H. (2007). The Impact
(2011). Evidence That Music of Music on Postoperative Pain and
Listening Reduces Preoperative Anxiety Following Cesarean
Patients’ Anxiety. Biological Section. M E J ANESTH, 19(3),
Research for Nursing, 000(00), 1-7. 573-586.
Li, X. M., Zhou, K. N., Yan, H., Wang, D. Riva, J. J., Malik, K. M. P., Burnie, S. J.,
L., Zhang, Y. P. (2011). Effects of Endicott, A. R., & Busse, J. W.
music therapy on anxiety of patients (2012). What is your research
with breast cancer after radical question ? An introduction to the
mastectomy: a randomized clinical PICOT format for
trial. Journal Of Advanced Nursing, clinicians.Journal Canadian
68(5), 1145-1155. Chiropr Assoc,56(3), 167–171.
McLeod, R. (2011). Evaluating the effect of Twiss, E., Seaver, J., McCaffrey, R. (2006).
music on patient anxiety during The effect of music listening on
minor plastic surgery. Journal of older adults undergoing
Perioperative Practice, 1-5 cardiovascular surgery. Journal
Mohammadi, A., Ajorpaz, N. M., Torabi, Compilation, 11(5), 224-231.
M., &Mirsane, A. (2014).Effects Of Weeks, B. P., & Nilsson, U. (2011). Music
Music Listening On Preoperative interventions in patients during
State Anxiety And Physiology coronary angiographic procedures:
Parameters in Patients Undergoing A randomized controlled study of
General Surgery : A Randomized effect on patients’ anxiety and well-
quasi Experimental Trial. Central being. European Journal of
European Journal of Nursing and Cardiovascular Nursing, 10(2011),
Midwifery,5(4), 156–160. 88-93
Moradipanah, F., Mohammadi, E.,
Mohammadil, A. Z. (2009). Effect
of music on anxiety, stress, and
depression levels in patients
109
OPTIMALIZATION OF FAMILY ROLE AS SELF MANAGEMENT PROGRAM
SUPPORT AT TYPE 2 DIABETES
Sih Ageng Lumadi *, Andi Surya Kurniawan**

* Program Studi S1 Keperawatan, STIKes Maharani Malang
** Program Studi Profesi Ners, STIKes Maharani Malang
Email: lumadi@ymail.com
ABSTRACT
Introduction: Diabetes Mellitus (DM) is a disease that currently affects many people in
Developing Countries. Indonesia was ranked 4th in the world in the prevalence of patients with
DM. One of the efforts of the Government to lower the prevalence of DM in Indonesia is to
strengthen the 5 Pillars of Management DM namely education, physical exercise, diet, drug
therapy and monitoring oriented to the management of a standalone (Self-Management) (Kent
et al. 2013). In doing this self-management, patients with DM (diabetes) need a good support
system of family as a companion namely diabetes in everyday life. Methods: The purpose of
this research to analyze the use of the Family DiabEducation (FDE) method to optimize the role
of the family as a supporting program of self management in patients with type 2 diabetes .The
method which used was pre experimental one group pretest posttest design, by identifying the
role of the family before and after ion the FDE intervention given. Conducted on 30 respondents
with quota sampling. Data were analyzed using the Wilcoxon signed rank α of 0.05. Results:
Results p = 0.00 which means there is a significant relationship between pre and post
intervention with FDE. Conclusion: This research is expected to help the Government in
approach and optimize the role of the family as a companion with diabetes. In addition, the
results of this study are expected to provide sustainable ideas to explore and make the role of
the family as the sixth pillar in the treatment of diabetes.
Keywords: Family, DM, Self Management, Family DiabEducation (FDE)
INTRODUCTION namely 0.8% in 2007 to 3.4% in 2013. The

Diabetes Mellitus (DM) is a disease provinces with the highest prevalence
that currently affects many people in declines in the provinces of West Papua,
Developing Countries. Indonesia was namely 1.4% in 2007 to 1.2% in 2013
ranked 4th in the world in the prevalence of (Ministry of Health 2014). One of the
patients with DM. The prevalence of DM in efforts of the Government to lower the
Indonesia based on interviews in 2013 was prevalence of DM in Indonesia is to
2.1%. This figure is higher than in 2007 strengthen the handling of DM 5 Pillar
(1.1%). A total of 31 provinces (93.9%) namely education, physical exercise, diet,
showing a rise in the prevalence of diabetes drug therapy and monitoring with Self-
is significant. The highest prevalence of Management (Kent et al. 2013).
diabetes at age ≥ 15 years according to the Self-management is the process
doctor's diagnosis / symptoms Basic Health whereby a person developed the ability to
Research in 2013 were in Central Sulawesi manage their condition. The success of
(3.7%). Then followed North Sulawesi Self-management includes knowledge of
(3.6%) and South Sulawesi (3.4%). While the conditions, how to seek treatment and
the lowest is in Lampung (0.8%), then what to do. This may include changes in
Bengkulu and West Kalimantan (1.0%). behavior and learning problem-solving
Provinces with the largest increase in skills and how to find a way out when things
prevalence is a province of South Sulawesi, get tough. A very important element as Self-
110
management approach that will condition focusing on solving concrete problems, and
information, education and training specific behaviors that help to adapt to the
(Diabetes UK 2009) existing disease. By providing information
Diabetes UK (2009) have identified to families about the disease and suggest
important elements that people with effective coping mechanisms, the psycho-
diabetes need access and whatever is education program can reduce the client
necessary to get at least the minimum tendency for relapse and was able to
service to ensure that they are supported in maintain the client's role in society (Stuart
organizing itself. Such elements include: 2009; Townsend 2009).
High Quality of information is established, Methods Family DiabEducation
access to education, Structured Plan addressed to families to be able to
Personal Care, Access to Health Care understand the problems experienced by a
Professional Employer When Necessary. In family member with diabetes, solve the
doing this self-management, patients with problems of the family that appear because
diabetes mellitus (diabetes) need a good of caring for a family member with
support system of family as a companion of diabetes, as well as take advantage of
Diabetes patient in everyday life. community facilities to help the family. So
Based on literature reviews that this method is expected to provide benefits
have been conducted by researchers, the in the family to have the ability to care for
role of the family so far has not appeared in clients and resolve problems that arise in the
a self-management. That may be one cause care of the clients and client’s self-
of the increasingly rising prevalence of DM management which is optimal from the
and DM complication rate was also high family (C. R. Kneisl, TWilson, & Rigoboff,
enough. Based on a preliminary study 2004; Diabetes UK, 2009).
conducted by researchers, the role of family Implementation of Family
as the nearest person with diabetes is still DiabEducation (FDE) consists of four
not running optimally. Problems found in sessions with each session consisting of the
research is very important to look for a orientation phase, working phase and
solution that is how to optimize the role of termination phase. The sequence of this
the family as Supporting Self-Management method is as follows modified from
Program in Patients with Type 2 Diabetes Psychiatric Nursing Therapy Module
(C. R. Kneisl, TWilson, & Rigoboff, 2004; (Anonymous 2014).
Diabetes UK, 2009).
Family DiabEducation (FDE) is a 1. Session 1: Assessment of Family Issues
modification Family psychoeducation (Identification of Problems)
intervention model that is focused on At this first session of nurses and
families with members suffering from family together to identify the problems
diabetes. Family psychoeducation itself is arising from the family of the member with
one element of a family health care diabetes. This session will involve all
programs by providing information and family members are affected and involved
education through therapeutic in the care of clients, especially the
communication. Psychoeducation program caregiver. Assessment separately between
is an approach that is education and the the problems perceived by the caregiver and
pragmatic (Stuart 2009) other family members. The assessment
In FDE, intervention in the family focuses on the problems in caring for sick
intended to strengthen the family system in clients and problems that arise in
behavior coddle, disease control, prevent themselves because caring for clients
diabetes complications and retain clients to (Stuart 2009).
optimize their role. The FDE method treats
the family as a resource, not as a stressor, by
111
2. Session II: Client Care with Diabetes METHODS
In this session focuses on education This research uses pre-experimental
about the problems experienced by the design with one group Pre-Post Test Design
client. Education given to the family approached Cohort (prospective). With this
associated with medical diagnosis and method, researchers will look at the
diagnosis of nursing and family care in effectiveness of the method of Family
clients with diabetes. Intervention by DiabEducation (FDE) to increase the role of
educating the families can help families the family as a support in the self-
facing illness stressor for clients with a management of type 2 diabetic. Patient
positive effect on the condition of the client. population in this research that people with
The positive impact psychoeducation diabetes are friendly check in Batu Baptist
program indirectly to the client that Hospital in April - September 2016 which
provides information about the client's use Quota sampling.
disease on the family and give advice on
proper care, will reduce the rate of Table 1. Demographic Characteristic of
complications and recurrence of the disease Participants
(Towsend 2009). Name Varriable Responden %
Sex Female 19 64
3. Session III: Troubleshooting: Age 41-50 years 11 37
Relationships and how to care Education Senior high 19 63
Stress is an imbalance condition that school
occurs when there is a gap desire of Occupation Business 14 46
individuals in the internal or external Relation Husband/wife 16 53
environment with the ability to deal with
those desires (Towsend 2009). The aim in The criteria for the study include:
this session is a family able to explain the (1) Willing to be a respondent, (2) Staying
constraints experienced in caring for clients, at home with diabetes patient, (3) One of the
how to overcome existing barriers, support respondents with diabetes family (closest to
of the family and how to care family diabetes patient)
member suffering from diabetes. Instruments in this study using
questionnaires identification of the role of
4. Session IV: Empowering Communities family developed by researcher.
to Help Families Researchers applying the method of
Community has a major influence in Family DiabEducation (FDE), by
the care of clients with diabetes. Health care encouraging families to speak up about the
providers, including nurses, have to pain of patients and encourage families to
undergo a leadership role in reviewing the express the positive and negative of a
adequacy and effectiveness of resources in diseased condition of the family. Having
the community and in recommending explore well, the researchers gave the
changes to improve access to and quality of intervention to teach a variety of skills to
health services. The aim in this session prevent complications which include leg
focuses on getting families are able to reveal exercises, healthy foot care, nail cutting,
obstacles in dealing with health foot wound care, setting nutrition for people
professionals and know how to overcome with diabetes, exercise and medication use.
barriers to collaborate and to discuss with
health workers from the clinic about the RESULTS
referral system, advocating and seeking The process of data collection in this
support in client care.
study began in June 2016 with a sampling
of the 30 people taking the family with
112
diabetes at Batu Baptist Hospital, 3rd floor close to the subject in which the support is
room. Batu. information, a certain behavior or a material
that can make people feel loved, cared for
and loved. In this study, researchers used
Table 2. Family Role Before Intervention
some general data as participant
Role Responden %
demographic characteristics which include
Number
age, gender, level of education, work,
Good 0 0 relationships with patients with diabetes
Average 24 80 mellitus.
Less 6 20 Of the general data, researchers
Total 30 100 conducted a bivariate analysis using
Pearson between the variables of age, sex,
Table 3. Family Role After Intervention education level, occupation, kinship with
Role Responden % pre-intervention and post-intervention.
Number From the test was no significant relationship
Good 20 67 between work with the family role post-
intervention and level of education and the
Average 10 33
role of family pre intervention. The level of
Less 0 0 education will determine whether or not a
Total 30 100 person is easy to absorb and understand the
knowledge they gained, the higher one's
education is generally getting better the
knowledge (Notoatmodjo 2007).
According to Tamara, E.,
Bayhakki., Nauli, F.A. (2014), Someone
who has a good level of education will be
more mature in the process of change itself
so it would be more receptive to outside
influences are positive, objective and open
to a variety of health-related information.
Intervention FDE (Family
DiabEducation) is a systematic step in
Figure 1. Foot Excercise empowering families. FDE family roles
In the data analysis using the before intervention after intervention
Wilcoxon signed ranks it was concluded compared with FDE found a significant
that there is a significant relationship relationship. This indicates that the FDE
between family roles Pre-intervention Post quite effective in increasing the role of the
intervention with ap value of 0.00 count less family. FDE method was modified and is
than 0.05. Thus, H0 is rejected and Ha derived from the method FPE (Family
accepted. psychoeducation) which is usually applied
to families of patients with mental
DISCUSSION disorders. This therapy is a therapy
Family support is a very important appropriate specialist to be given to families
factor in improving the health status of with a family member who suffered from
patients ranging from strategies to health problems both physical and mental
rehabilitation (Akohoue et al. 2015). Family illness (Anonymous 2014).
support is the attitude, actions and FDE method which is a
acceptance of family to sick patients. modification of this FPE be more effective
Support can come from others (parents, when applied in the right way, gradually
children, husband, wife or brother) that is and continuously. So with this principle, the
113
researchers recommend for families of solidarity and prevent complications and
patients with diabetes can get their own living a healthy life in order to avoid DM.
therapy sessions in order to be able to
support the health of people with diabetes. REFERENCE
Family club with diabetes need to be formed Akohoue, S.A. et al., 2015. Patients’,
so that they are not suffering from diabetes caregivers’, and providers’ perceived
and can prevent complications in his family. strategies for diabetes care. American
Journal of Health Behavior, 39(3),
CONCLUSION AND pp.433–440.
RECOMMENDATION Anonymous, 2014. Model Terapi
Conclusion Keperawatan Jiwa.
The role of the family before the C. R. Kneisl, TWilson, H.S. & Rigoboff,
intervention almost entirely in enough T.E., 2004. Contemporary Psychiatric
categories, namely 80% (24 respondents). Mental Health Nursing 1st ed., New
The role of the family after the intervention Jersey: Pearson Education, Inc.
of the majority in both categories is 67% (20 Diabetes UK, 2009. Improving supported
respondents). There is a significant self-management for people with
relationship between the role of the family diabetes. , (November).
before and after the intervention. Kent, D. et al., 2013. Reducing the risks of
In line with the Program JKS diabetes complications through
(Universal Health Insurance) where public diabetes self-management education
funding of mutual cooperation, the and support. Population health
necessary prevention strategies) management, 16(2), pp.74–81.
complications well as preventive measures Available at:
and Promotive using FDE so as not to be http://www.ncbi.nlm.nih.gov/pubmed/
found complications of Type II diabetes 23405872.
who spent the state budget for healing. If the Notoatmodjo, S., 2007. Promosi Kesehatan
role of the family is important, then it is dan Ilmu Perilaku, Jakarta: Rineka
conceivable in the future that the family was Cipta.
a pillar of the sixth in the handling of DM in Stuart, G.W., 2009. Principles and Practice
Indonesia. of Psychiatric Nursing 9th ed.,
St.Louis, Missouri: Mosby Elsevier.
Recommendation Towsend, M.C., 2009. Psychiatric Mental
Some suggestions that could result Health Nursing 6th ed., Philadelphia:
from this research that could be investigated F.A. Davis Company.
further adoption of FDE (Family
DiabEducation) in clients with diabetes
who have microvascular and macro
vascular complications, as well as the
effectiveness of FDE in preventing
complications of diabetes Type II. FDE is a
step that is easy to apply in enhancing the
role of the family so that it can be tested to
be SOP (Standard Operating Procedure) to
increase family involvement in the
treatment process. Besides the family
should be more involved in patient care, not
only as a driver to the health care facilities.
Families need to be given a forum to
increase awareness of the importance of
114
ANALYSIS ON THE EFFICACY OF AROMA THERAPY TO RELIEVE POST
OPERATIVE NAUSEA AND VOMITING: A SYSTEMATIC REVIEW
Diana Pefbrianti, Diana Hardiyanti

Email: diana.pefbrianti-2016@fkp.unair.ac.id
ABSTRACT
Introduction: Feeling of post-operative nausea and vomiting is one of the uncomfortable
reaction of an operation and all types of anesthetics despite administration of antiemetic. 20%-
30% patients feel nauseous and vomiting with moderate to severe scale accompanying general
anesthetics. Aroma therapy is known and used as an independent nursing intervention.
Aromatherapy is accepted as management for post-operative nausea and vomiting. There have
been a number of evidence based practices supporting the use of aroma therapy. The objective
of this study is to analyze the efficacy of aroma therapy to relieve post-operative nausea and
vomiting. Method: Search of journals was done electronically by using some database, i.e.,
SAGE, PROQUEST, MEDLINE, GOOGLE SCHOOLAR, SCIENCE DIRECT, SCOPUS, and
PICOS framework. Range of year is 14 years (2002-2016). From literature search, 15 articles
were selected from 1750 articles found, all of which have controlled group. There are fourteen
from fifteen articles comparing aroma therapy and other therapies. Therefore, it used two or
more groups to compare with. The rest sees the efficacy of peppermint, IPA, and placebo.
Results: Almost all journals found support the use of aroma therapy to relieve post-operative
nausea and vomiting. Conclusion: aromatherapy is the correct method to relieve post-operative
nausea and vomiting. To improve the next systematic review, the number and homogeneity of
aromatherapy needs to take into account and determining one the most efficacious
aromatherapy to reduce PONV.
Key words: aromatherapy, post-operative nausea and vomiting
INTRODUCTION meteclopramide and droperidol;

Frequently found complication nevertheless, those medicines result in
accompanying an operation is nausea and adverse effects such as anxiety, fatigue,
vomiting (Eberhart L Frank; Lange H; disorientation, extrapiramidal signs, cardiac
Kranke P; Wulf H, 2006) with prevalence problems, decreased blood pressure &
attaining 20% - 30 % (Arjumand drowsiness, so it requires close monitoring
Mccracken G; Houston P, 2008). Most (Masters SB & Terevor AJ, 2009).
patients undergoing risky operation Although those medicines have good
complained nausea and vomiting. efficacy, the adverse effects must be taken
According to Arjumand Mccracken G & into account, so non pharmacological
Houston P, 2008, 70 %-80 % post operative remedies can be the correct choice due to its
patients complained nausea and vomiting. affordability, fewer risks, and acceptability.
Then they felt uncomfortable sensation and Non pharmacological remedies commonly
stress. Inappropriate intervention may lead used to relieve nausea and vomiting include
to fluid and electrolyte imbalance, increased hypnosis, acupressure & acupuncture. Thus
blood pressure, surgical wound stenosis, aromatherapy can be given to patients with
risk for aspiration, airway track obstruction, post operative nausea and vomiting
bleeding, and lengthy care. (Montazer S et al, 2004).
Nausea and vomiting is usually Aromatherapy has been an effective
treated pharmacologically such as remedy to relieve nausea (Chiravalle P,
115
2005; Mamaril M, 2006; Merrit B.A, 2002). anesthetics, inpatients, or outpatients, and
Aroma therapy is made of oil or other those on aromatherapy treatments.
substances used by inhaling steam or Non surgical patients (medical,
applying oil on the skin to help relieve oncological) were excluded. Aromatherapy
physical and emotional symptoms (Price is used by inhaling it to relieve post
S.A & L.M. Wilson, 2006). operative nausea and vomiting. Instruments
Specifically, peppermint, IPA, or used as PONV parameter include: 4 articles
pasebo, ginger essence are efficacious to using VNRS (visual nausea rating scale), 2
reduce post operative nausea vomiting articles using VAS (visual analogy scale), 2
(Anderson L, 2004; Mohsen AH, 2015; articles using VDS (verbal description
Hunt R, 2012). Aromatherapy contains scale), 2 articles using DOS (description
analgesics and antiemetic (such as ordinal scale), 1 article using BARF, and 1
peppermint oil and ginger). There are a article using Likert scale.
number of studies conducted by using
QueaseEase (Hodge N, (2014); Mcilvoy L, RESULTS
(2015). Isopropyl alcohol is traditional Design reviewed is 11 randomised
antiemetic proven in the studies conducted control trial (RCT), 3 Quasy Experiment
by Cronin S, (2015); Hunt R, (2012); and 1 prospective exploratory study. All
Cotton J, (2007); Pellegrini J, 2009; journals reviewed explain efficacy of
Winston A, (2003); Merrit B, (2002). Bret aromatherapy to post operative nausea and
A. Merit (2002). Isopropyl alcohol is vomiting (PONV), 2 journals review
usually used to clean injection site. It is efficacy of each type of aroma therapy
rarely used to relieve post operative nausea (peppermint, IPA, or placebo). The other 13
vomiting. journals compare one type of aromatherapy
This review was carried out to analyse with one type of antiemetic.
aromatherapy effect on nausea and Aromatherapy is given by
vomiting commonly occurs in post inhalation. Studies were conducted in
operative patients. several countries which include USA (10
journals), Iran (1 journal), Australia (1
METHODS journal), Canada (1 journal), Carolina (1
Research design reviewed was not journal), and Korea (1 journal). All studies
confined on certain design due to limited were done on patients undergoing surgery
articles with RCT design. Journal search aging 4 as of 16 years old (1 journal), and
was done in several online database such as more than 18 years old (14 journals).
SAGE, PROQUEST, MEDLINE, A study conducted by Lynn A et al
GOOGLE, SCHOOLAR, SCIENCE (2004) on 33 surgical patients complaining
DIRECT, and SCOPUS by using keyword nausea and vomiting in PACU room
aromatherapy, POV, nausea and vomiting (Parianesthesia Care Unit) after measuring
in the range of 14 years (2002 – 2016). nausea and vomiting with VAS (visual
From 1750 articles obtained, there analogue scale), patients used aromatherapy
were only 15 full text articles meeting the with isopropyl alcohol, peppermint or
inclusion criteria. Inclusion criteria: 1) saline. Overall, scale of nausea decreased
intervention given was aromatherapy; 2) and patients were satisfied (86,9%).
samples were adults and children Cronin S (2015) studied 121
complaining PONV. Inclusion criteria of patients with post operative nausea
respondents studied in the reviewed randomized into controlled group and
journals: adults (14 journals) and children intervention group in which the controlled
(1 journal), surgical procedure with general group was given placebo and the
anesthetics, regional or sedation intervention group was given
aromatherapy. The result shows that
116
aromatherapy is more efficacious than (isopropyl alcohol) and ondancetron on
placebo (P < 0.001) female patients with laparoscopy surgery.
Mcilvoy L et al, (2015) studied 70 Nausea and vomiting scale was measured
patients undergoing abdominal surgery. with VNRS (verbal Numeric Rating Scale)
The patients were taught how to assess in which controlled group was given
nausea scale and were given QE ondancentron while intervention group was
(QuaeseEase) aromatherapy. 25 patients given aromatherapy (IPA). The study found
(36%) reported to have PDN (post that there was significant difference
discharge nausea). Cronin S, (2015) between the two groups. 91% nausea and
compared affectivity of CB (controlled vomiting of intervention group decreased. 5
breathing) with or without aromatherapy respondents of controlled group was given
(isopropyl alcohol) on patients with promethazine for additional medication and
laparoscopy surgery. Resuls of the study only 1 respondent from intervention group
shows that, from 82 patients (41 controlled (P = 0.064).
group with CB and 41 intervention group
with aromatherapy, both therapies are DISCUSSION
efficacious to relieve post operative nausea using EPHP (effective public health
and vomiting. practice project). The components include:
A study conducted by Lee J, (2016); design, sample, blinding technique, data
Winston A, 2003; Farooque D on patients collection, drop out respondent, bias factor,
complaining nausea and vomiting method of quality intervention given and an
performed measurement by using NRS. It opinion alysed in the journals.
obtained that nausea and vomiting scale in According to the analysis, 13
the intervention group (aromatherapy) was journals were categorised strong quality, 2
significantly lower than controlled group. A journals were categorised moderate quality.
study conducted by Hunt R, (2012) on The number of sample in this research was
patients complaining nausea and vomiting approximately 33 – 301 respondents aging
in PACU with 73 respondents using normal at least 18 years old, and 1 research aged
saline, 78 respondents using IPA 70%, 76 between 4 – 16 years old complaining post
patients using ginger oil, 44 respondents operative nausea and vomiting.
using mixture of ginger oil, mint, and In general, most journals reviewed found
capulaga. The result revealed that there was that aromatherapy is efficacious to relieve
significant change in the level of nausea for post operative nausea and vomiting. This
mixed aromatherapy (P < 0.001) and ginger review can cover research ranging from
(P < 0.76). Thus aromatherapy is isopropyl alcohol, ginger oil, QE,
efficacious as remedy for PON (Kimberd peppermint, to other aromatherapy
M, 2016; Merrit B, 2002; Pellegrini J, compared with placebo saline, ondansetron,
2009). prometazine, or others “antiemetic
Sites D et al, (2014) conducted a standard”. All aromatherapies were given
study by using CB group + aromatherapy through direct inhalation. Studies were
(papermint AR) with CB only. The result conducted on inpatients and outpatients.
revealed that CB is more efficacious to Variables measured covered efficacy of
relieve post operative nausea and vomiting aromatherapy which include duration of
(62%), but it will be more efficacious if it is relief, severity of nausea, frequency of
combined with AR. A study conducted by nausea and vomiting, the use of antiemetic,
Mohsen A, (2015); Hosseini FS, 2015 and patient satisfaction.
found that inhaling ginger aroma can relieve In several studies, aromatherapy
post operative nausea and vomiting. Study (IPA) is efficacious to subtitute or reduce
conducted by Cotton J et al, (2007) the use of antiemetic medication
compared the efficacy of aromatherapy (Kamalipour, 2002), and to briefly relieve
117
post operative nausea and vomiting for Treatment of PON. Journal of
pediatric patients. In two studies (Cotton J, Perianesthesia Nursing, 5, 389–397.
(2007); (Winston A, 2003), IPA briefly Eberhart L Frank, Lange H, Kranke P, Wulf
relieve 50% symptoms of ondansetron and H, S. A. (2006). A Systematic Review
prometazine (Pellegrini J, 2009). Some on The Recurrence of Post Operative
literatures recommend the use of nausea and Vomiting After A First
peppermint aroma therapy to relieve post Episode in The Recovery Room
operative nausea and vomiting (Chiravalle Implication for The Treatment of
P, 2005; Price S, 2006; Price, 2007). PONV And Related Clinical Trials.
Anderson L, (2004) Anderson found that Journal BMC Anesthesial, 6(14), 1–
peppermint aroma therapy is as efficacious 11.
as IPA or saline. Those aroma therapies do F, D. (n.d.). Combination Aromatherapy
not have adverse effects. Patients were and Acupressure for Treating Nausea
satisfied with the use of aroma therapy to and Vomiting. Gastroenterology,
relieve nausea and vomiting (Anderson L, Departement of Internal Medicine
2004; Cotton J, 2007; Pellegrini J, 2009; Brandon Regional Hospital.
Winston A, 2003). Hodge NS, Mccartby MS, P. R. (2014). A
Prospective Randomized Study of The
CONCLUSION AND Effectiveness of Aromatherapy for
RECOMMENDATION Relief of PONV. Journal of
In general, aromatherapy can be Perianesthesia Nursing, 29(1), 5–11.
used to relieve post operative nausea and Hosseini FS, H. M. (2015). Ginger Essence
vomiting. Nonetheless, further studies need Effect on Nausea and Vomiting After
to be carried out by specifying the similar Open and laparoscopic
aroma therapies. Nephrectomies. Nurs Midwifery Stud.,
4(2).
REFERENCE Hunt R, Dienemann J, Norton J, H. W. et al.
Anderson L, G. J. (2004). Aromatherapy (2012). Aromatherapy As Treatment
with Peppermint, IPA or plasebo is For Post Operative Nausea: A
Equally Effective in Reducing PON. Randomized Trial. Int J Anesth Analog
Journal of Perianesthesia Nursing, 1, Res Soc, 10(10), 1–8.
29–35. Kamalipour, Y. R. (2002). Global
Arjumand Mccracken G, Houston P, L. G. Communication (Belmont Ca).
(2008). Guidline for The Management Wadsworth.
of Post Operative nausea and Kimberd MB, Clarke SK, Chorney J, D’eon
Vomiting. Journal Obstet Gynaecol B, W. S. (2016). Aromatherapy for
Canada, 30(7), 600–607. The Treatment of PONV in Children:
Chiravalle P, M. R. (2005). Alternative A Pilot RCT. BMC Complementaryy
Therapy Application for PONV. and Alternative Medicine, 16, 450.
Holistic Nursing Practice, 5, 207–10. https://doi.org/10.1186/s12906-016-
Cotton JW, Rowell LR, Hood RR, P. J. 1441-1
(2007). A Comparison Analysis of IPA Lee JM, Kim HS, H. S. (2016). Effect of
and Ondancentron in The Treatment of Aromatherapy on PONV of Patients
PONV from Hospital Setting to The With Laparoscopic Hysterectomy. In
Home. American Assosiation of Nurse Asia-Pasific Proceedings of Applied
Anesthesist Journal, 1, 21. Science and Engineering for Better
Cronin SN, Forren JO, Roberts H, Thomas Human Life (pp. 114–117).
M, Williams S, W. M. (2015). Effects Mamaril ME, Windle PE, B. J. (2006).
of Controlled Breathing, Wish or Prevention And Management of
Without Aromatherapy, in The Postoperative Nausea and Vomiting: A
118
Look at Complementary Techniques. Vacchiano CA, P. J. (2003).
Journal of Perianesthesia Nursing, Comparison of Inhaled IPA and IV
21(6), 404–10. Ondancentron for Treatment of PON.
Masters SB, Terevor AJ, K. B. (2009). American Association of Nurse
Basic & Clinical Pharmacology. Anesthesiist Journal, 71(2), 127–32.
Mcilvoy L, Richmer L, Kramer D, Jackson
R, Shaffer L, Lawrence J, I. K. (2015).
The Efficacy of Aromatherapy in The
Treatment of PDN in Patients
Undergoing Outpatient Abdominal
Surgery. Journal of Perianesthesia
Nursing, 30(5), 383–388.
Merrit B.A, Okyere CP, J. D. (2002). IPA
Inhalation: Alternative Treatment of
PONV. Nursing Research, 51(2), 125.
Mohsen AH, F. S. (2015). Investigating The
Effect of Inhaling Ginger Essence on
Post Nephrectomy Nausea and
Vomiting. Complementary Therapies
in Medicine, 23, 827–831.
Montazer S, Pormehdi Z, Latifi M, A. M.
(2004). Evaluation Acupressure Effect
on Nausea and vomiting During and
After Cesarean Section Under Spinal
Anesthesia in Pregnant Woman
Reffered to Razi Hospital. Int J Pharm
Res, 3, 39.
Pellegrini J, Deloge J, Bemmett J, K. J.
(2009). Comparison of Inhalation of
IPA VS Promethazine in The
Treatment of PONV in Patients
Identified at High Risk for
Developing PON. American
Association of Nurse Anesthesiist
Journal, 77(4), 293–9.
Price S.A & L.M. Wilson. (2006).
Patofisiologi Konsep Klinis Proses-
Proses Penyakit (6th ed.). Jakarta:
EGC.
Sites DS, Johnson T, Miller JA, Torbush
PH, Hardin JS, Knowles SS, Nance J,
Fax TH, T. R. (2014). Controlled
Breathing With or Without
Peppermint Aromatherapy for
Postoperative Nausea and/or
Vomiting Symtom Relief: A
Randomized Controlled Trial. Journal
of Perianesthesia Nursing, 29(1), 12–
19.
Winston AW, Rinehatt RS, Riley GP,
119
FACTORS THAT AFFECT MOTHER’S BEHAVIOR IN THE TREATMENT OF
DIARRHEA IN 0 – 5 YEARS OLD CHILDREN
Imam Tri Sutrisno, Yuni Sufiyanti Arief, Elida Ulfiana

Email: trisutrisnoimam@gmail.com
ABSTRACT
Introduction: Dehydration and mortality caused by diarrhea in less than five years old children
can be prevented if nanny or mother gives rapid and accurate treatment. So, analyzing factors
that affect mother’s behavior in the treatment of less than five years old children diarrhea is
important. This study was to explore factors and analyze the dominant factor that affect
mother’s behavior in the treatment of less than five years old children diarrhea. Method:
Descriptive analytic study with crossectional approach with purposive sampling and 49
respondents. The independent variables were mother’s knowledge, environment and health
resources availability, and family support, and dependent variable was mother’s behavior in
the treatment of diarrhea. Data obtained by questionnaire and analyzed using Spearman Rank
test with α=0.05. Result: There was a correlation between mother’s knowledge and mother’s
behavior in the treatment of less than five years old children diarrhea with r=0.891 (>0.238).
There was no correlation between environment and mother’s behavior in the treatment of less
than five years old children diarrhea with r=0.209 (<0.238). There was a correlation between
family support and mother’s behavior in the treatment of less than five years old children
diarrhea with r=0.564 (>0.238). Discussion: The dominant factor that affects mother’s
behavior in the treatment of less than five years old children diarrhea is mother’s knowledge.
So, increase mother’s knowledge about treatment of children diarrhea is important thing in
Posyandu Ceria I Surabaya.
Keywords: Knowledge, environment, health resources availability, family support, mother’s

behavior, children diarrhea, diarrhea treatment
INTRODUCTION
Diarrhea is the second leading cause other complications that can refer to
of death in children under 5 years old. malnutrition or death (Apriningsih, 2009).
Globally each year there are approximately The occurrence of diarrhea in
2 billion cases of diarrhea with a mortality infants is influenced by the attitude of the
rate of 1.5 million per year. Each episode of mother or caregiver. Lawrence Green found
diarrhea will cause loss of nutrients the factors that shape the behavior of
children need to grow, so diarrhea is a mothers in dealing with children with
major cause of malnutrition in children diarrhea there are three factors.
(WHO, 2009). Predisposing factors: knowledge, attitudes,
Based on the characteristics of the beliefs, beliefs, values, etc; supporting
population, the toddler age group is the factor (enabling factor) which is manifested
highest group suffering from diarrhea. The in the physical environment, facilities or
incidence of diarrhea was highest among health facilities and factors (reinforcing
infants aged 12 to 23 months (Riskesdas, factor) which is manifested in the behavior
2013). Diarrhea in infants is more of health workers, community, family and
dangerous than in adults because toddlers others (Notoadmojo, 2010).
are more susceptible to dehydration and Surabaya was ranked number three
in East Java with 66.841 cases of diarrhea
120
(Profil Kesehatan Jawa Timur, 2008). The research was done during
Puskesmas Tambak Rejo is a health center routine IHC meeting December 9, 2014.
located in the city of Surabaya, where cases The researcher explained the purpose of the
of diarrhea in children under five were study to respondents. Then the researchers
found to be quite high, in 2012 amounting gave the consent form as a form of consent
to 1,125 cases (Buletin Penelitian Sistem to be the subject of research. Then the
Kesehatan, 2011). researchers distributed questionnaires, then
Prior to the level of treatment, to respondents filled out a questionnaire with
reduce the number of deaths from the directives of researchers.
malnutrition and diarrhea, it is important to Data were analyzed using Spearman
analyze the factors that influence maternal Rank with a significance level of 0.05.
behavior in the treatment of diarrhea in
children under five Posyandu Ceria I RESULT
Tambak Rejo Surabaya. Mothers brought their children
come to Posyandu Ceria I Surabaya
METHOD majority (51%) aged 30-40 years, the latest
This research is a descriptive education the majority (53.1%) education
analytic study with cross-sectional wide past high school, and most (75.5%) did not
approach. The sampling technique used work.
purposive sampling with inclusion criteria: Mothers who bring their children to
Mothers with children who have a history Posyandu Ceria I Surabaya nearly half
of previous diarrhea. (44.8%) have less knowledge, the vast
The independent variables in this majority (73.4%) have environmental and
study is the mother's knowledge, the resource availability of good health, the
environment and the availability of health majority (57.1%) with good family support.
resources, and family support, and the However, almost half (49.1%) had less
dependent variable was the mother's diarrhea-handling practices.
behavior in the treatment of diarrhea.
Tabel 1. Cross-tabulation between mother knowledge with children in the treatment of diarrhea
Posyandu Ceria I Surabaya, December 2014
No Knowladge Treatment Amount
Good Average Less
1 Good 9 1 0 10
2 Average 4 10 3 17
3 Less 0 1 21 22
Amount 13 12 24 49
r-count = 0.885 (> 0.238)
p-value = 0.000 (< 0.05)
According to the table 1 shows that count = 0.885 (> 0.238), p-value = 0.000
nearly half of mothers have less knowledge (<0.05). This means that there is a
and handling, and a small portion has a significant relationship between maternal
level of knowledge and good handling. knowledge of diarrhea with the treatment of
Spearman rank test results show that the r- diarrhea in children.
121
Tabel 2. Cross-tabulation between environment and the availability of health resources with
children in the treatment of diarrhea Posyandu Ceria I Surabaya, December 2014
No Environment and the Treatment Amount
availability of health Good Average Less
resources
1 Good 12 8 16 36
2 Average 1 4 7 12
3 Less 0 0 1 1
Average 13 12 24 49
r-count = 0.259 (< 0.238)
p-value = 0,072 (> 0.05)
Based on Table 2 shows most moms 0.259 (<0.238), p-value = 0.072 (> 0.05).
have a good home environment and can This means that there is no significant
obtain good healthcare resources, but the relationship between the environment and
mother is still lacking in any treatment of the availability of health resources and
diarrhea in children. The results of the treatment of diarrhea in children.
Spearman rank test-count obtained r =
Table 3. Cross-tabulation between the support of families with children in the treatment of
diarrhea Posyandu Ceria I Surabaya, December 2014
No Families Treatment Amount
support Good Average Less
1 Good 13 6 9 28
2 Average 0 6 12 18
3 Less 0 0 3 3
Amount 13 12 24 49
r-count = 0.559 (> 0.238)
p-value = 0.000 (< 0,05)
Based on Table 3 shows that most p-value = 0.000 (<0.05). This means that
mothers have good family support, but there is a significant relationship between
almost half are still lacking in dealing with family support with the treatment of
diarrhea in children. Spearman rank test diarrhea in children.
results obtained r-count = 0.559 (> 0238),
Table 4. Spearman test independent-dependent variabel

Cross-sectional r-count p-value
Knowladge factor – treatment 0.885 0.000
Environment and the availability of health
0.259 0.072
resources – treatment
Families support – treatment 0.559 0.000
Based on Table 4 show that the r- relationship with the handling of mother to
count on the knowledge test with the child when diarrhea. So, the most dominant
handling of cross between a mother has the factor affecting treatment of diarrhea in
largest value of the cross test the other in the children is mother knowledge factor.
amount of 0.885. This means that
knowledge variable has a very strong
122
DISSCUSION influence in identifying whether a mother
The results showed that there is a can make the decision to care for a child
strong relationship between knowledge of who has diarrhea correctly or not. But also
mothers with treatment of diarrhea in got two mothers who have the latest
children. It can be interpreted that the lower education scholars also have less
a person's knowledge, the lower the person knowledge. In this case the mother's
handling. There are 22 mothers have the knowledge that less can also be caused by
knowledge and the handling is still lacking other factors such as the experience factor
in treating diarrhea. If you look at the results mother in caring for the child when his
of the questionnaire, most mothers diarrhea. According to Henry (2010)
incorrectly answered questions on Question experience is one of the active components
3, 8 and 9 that discusses the causes and and left a strong impression in the form of a
treatment of diarrhea. It can be associated mother's behavior.
with the mother's knowledge about the The age factor also can influence the
process of diarrhea and diarrhea during behavior of the mother, in this study, the
treatment for his child's mother when her majority of mothers ages ranged between
child with diarrhea. 20-30 years. With increasing age a person
Many factors affect the mother's will be a change in the psychological aspect
lack of knowledge about diarrhea one of and the psychological (mental). Age can be
which is the mother's education level, age, attributed to the experience factor and the
occupation, interests, experience and factor of one's education. The more mature
culture (Mubarak, 2007). Knowledge is the age of a person the more the experience that
result of human senses, or results to know a has been obtained including the experience
person against an object through its senses of caring for children when diarrhea.
(eyes, nose, ears, and so on). By itself, the A person's experience gained from
sensing time to generate such knowledge an event that never experienced someone in
greatly influenced the intensity of attention interacting with the environment. But the
and perception of the object. Most people's mother's experience in caring for children
knowledge gained through the senses of with diarrhea may also be affected by the
hearing (ears), and the sense of sight (eyes) number of children held by the mother. The
(Notoatmodjo, 2010). result showed almost half of the
Education can be defined as the respondents were mothers with first child,
guidance given one person to another of a which means that the mother does not have
thing so they can understand. It is inevitable enough experience in caring for her son
that the higher one's education more easily when diarrhea. Thus, the lack of knowledge
the information they receive, and ultimately of the mother in caring for her son when the
the more knowledge he has. Conversely, if diarrhea can be influenced by his
one level of education is low, it will hinder experience is lacking. Mother's education
the development of one's attitude to level has a major influence on the
receiving information and new values experience possessed by the mother.
introduced. In this study, most of the According to Redman (1993) in Potter &
mother's last education is high school, Perry (2006) that higher education will
which means mothers get only 12 years of provide greater knowledge, resulting in the
compulsory education, and a small habit of maintaining better health. When
proportion (13.5%) of mothers with primary aware of health problems, those who are
education last. In fact, 12-year compulsory knowledgeable are likely to seek help as
education has not been able to establish the soon as possible to resolve the problem.
level of health of a person correctly Based on the results of the study
according to established procedures. In this showed that most mothers residing in a
research, educational factors have a major good environment and is able to utilize
123
available resources with good health, but family and others. Knowledge factor
the handling of a mother in caring for predisposing factors and therefore, this
diarrhea in children is still much less. So, factor has greater effect in shaping maternal
the better the environment and the behavior. So that environmental factors and
availability of health resources are not many availability of health care resources did not
affected the treatment of diarrhea in affect the handling of a mother in childhood
children. diarrhea.
In accordance with the Decree of the Based on the data obtained
Minister of Health No. 829 / Menkes / SK / distribution of most mothers get the support
VII / 1999 one parameter healthy of a well. So, we can conclude the better
environment is to have a clean water supply, family support gained by the mother the
sewerage, waste water disposal and landfill better the child's mother at the treatment of
facilities. In this study, most mothers have diarrhea.
had the requirements of a healthy home, The family is the smallest unit of
which has a clean water supply, at all home society, including heads of families and
mom has been using water from the taps, some people who get together and stay
latrines shaped goose neck with saptic tanks somewhere under one roof in a state of
as reservoirs, waste disposal facilities in the mutual dependence and mutual influence.
house flowed in gutters closed, means Indirectly very big influence of family
garbage disposal at home watertight and the factors in determining treatment will be
distance between home and dumping more made by the mother in caring for children
than 1 km. However, some of the mothers with diarrhea. Because the family has an
answered a questionnaire wrong with the important treatment in recognizing the
item number 2, which discusses the types of health problems of each member of the
latrines. Almost half of the mothers family, took the decision to do the right
answered yet have latrines shaped goose thing for families, providing care for family
neck and saptic tanks when they had been members who are ill or unable to help
used to shelter feces. This can be caused by herself because of disability or age too
mothers do not understand the concept of a young, maintain a home atmosphere that
swan-neck-shaped pit and they consider a benefit the health and development of the
squat toilet is not a swan's neck. personality of the family members, holds
In this study, environmental factors interrelationships between families and
and availability of health resources are not health institutions which are embodied in
related to the handling of mothers in dealing existing health facilities (Setiadi, 2008).
with diarrhea in children. Environment and Based on the results, eight mothers
the availability of health resources is an who have good family support, but the
enabling factor, these factors essentially handling of the child diarrhea is still
support or enable the realization of health lacking. It can be caused by several factors,
behavior or not, these factors also called according to Purnawan (2008) factors that
contributing factors. As stated by Lawrence affect family support is internal factors such
Green, there are three factors that shape a as stage of development, education or level
person's behavior, namely: 1) the of knowledge, emotional and spiritual. Poor
predisposing factors (predisposing factor) handling while a good family support can be
which is embodied in the knowledge, caused by the mother's age affects the
attitudes, beliefs, beliefs, values and so on. receipt of support from his family, in every
2) factor support (enabling factor) which is age range have an understanding of and
manifested in the physical environment, response to support different. For example,
facilities or health care facilities. 3) factors a young mother who was aged minimal
(reinforcing factor) which is manifested in experience in treating children tend to be
the behavior of health workers, community, more receptive to the opinions of how to
124
treat children with diarrhea who according factor. While family factors have a
to the family well and not necessarily in relationship but the relationship is weak.
accordance with the procedure of the Based on the results of mother's
mothers who have more mature age. knowledge about diarrhea in IHC Ceria I
Educational factors may also affect the Tambak Rejo Surabaya is still lacking, so it
mother receives support from his family should be necessary to hold health
where cognitive abilities will shape the education programs on diarrhea and
thinking person, including the ability to treatment to mothers in the region.
understand the factors associated with a
disease. Recommendation
Furthermore, other factors that can For a community nurse should do
affect family support are external factors about diarrhea counseling and treatment to
that include family practice, socioeconomic parents who have a toddler.
and family backgrounds. Thus, family For further research to develop a
support enough to affect the handling of research model by using different theories,
children with diarrhea, the family always or can develop more varied variables.
provide support to mothers in the form of
emotional support, information, and support REFERENCE
instrumental assessment that the mother can Adisasmito, W., 2007. Faktor Resiko Diare
take the decision to provide treatment to Pada Bayi dan Balita di Indonesia.
children in accordance with their needs. Depok: UI.
In this study, the dominant factor Adisasmito, W., 2007. Faktor Resiko Diare
affecting mothers in dealing with diarrhea pada Bayi dan Balita Indonesia.
in children is mother knowledge factor. Depok: Fakultas Kesehatan
There is a strong relationship between the Masyarakat Universitas Indonesia.
factors of knowledge with the treatment of Adisasmito, W., 2007. Sistem Kesehatan.
diarrhea in children. Jakarta: PT. Raja Grafindo Persada.
Factors knowledge more influential Arikunto, S., 2006. Prosedur Penelitian
in shaping the behavior of the mother in Suatu Pendekatan Praktik. Revisi
caring for her son when diarrhea. It is VI ed. Jakarta: Rineka Cipta.
supported by a statement from Notoatmodjo Arikunto, S., 2010. Prosedur Penelitian
(2010) that knowledge or cognitive domain Suatu Pendekatan Praktik. Jakarta:
is very important for the formation of a Rineka Cipta.
person's actions (overt behavior). Azwar, S., 2009. Sikap Manusia Teori dan
Penularannya. Yogyakarta: Pustaka
CONCLUSION AND Pelajar.
RECOMENDATION Cuevas, 2006. Risk Factors for
Conclusion Hospitalization of Children with
The lower the mother's knowledge, Diarhea in Shahrrekord, Iran.
the lower the handling of the mother in Shahrrekord.
caring for her son when diarrhea. The better Depkes RI, 2008. Millenium Development
the environment and the availability of Goal 2015. Jakarta.
health resources are not many berengaruh Depkes RI, 2009. Sistem Kesehatan
the mother's behavior in dealing with Nasional. Jakarta.
children with diarrhea. The better the family Dinas Kesehatan Provinsi Jawa Timur,
support gained by the mother, the better the 2008. Profil Kesehatan Jawa Timur.
handling of mother in caring for children Surabaya.
with diarrhea. The dominant factor Friedman, M.M., 2010. Buku Ajar
affecting the mother's behavior in dealing Keperawatan Keluarga: Riset,
with diarrhea in children is the knowledge Teori dan Praktek. Jakarta: EGC.
125
Juffrie M, e.a., 2010. Buku Ajar Suraatmaja, S., 2007. Kapita Selekta
Gastroenterologi - Hepatologi. 1st Gastroenterologi Anak. Jakarta:
ed. Jakarta: IDAI. Sagong Seto.
Keman, S., 2005. Kesehatan Perumahan Wawan A, D.M., 2010. Teori dan
dan Lingkungan Pemukiman. Pengukuran Pengetahuan.
Jurnal Kesehatan Lingkungan, II, Yogyakarta: Nuha Medika.
pp.29-42. WHO, 2009. Indikator Perbaikan
Kesehatan, D., 2013. Badan Penelitian dan Kesehatan Lingkungan anak.
Pengembangan Kesehatan. Jakarta. Translated by Apriningsih. Jakarta:
Kolopaking, M.S., 2002. Penatalaksanaan EGC
Muntah dan Diare Akut. In
Simposium Penatalaksanaan
Kedaruratan Bidang Ilmu Penyakit
Dalam II. Jakarta, 2002. Pusat
Informasi dan Penerbitan Bagian
Ilmu Penyakit Dalam FKUI.
Maramis, W.F., 2006. Ilmu Perilaku Dalam
Pelayanan Kesehatan. Surabaya:
Universitas Airlangga.
Mubarak I, C.R.S., 2007. Promosi
Kesehatan: Sebuah Pengantar
Proses Belajar Mengajar dalam
Pendidikan. yogyakarta: Graha
Ilmu.
Mubarak, W.I., 2012. Ilmu Kesehatan
Masyarakat Konsep dan Aplikasi
dalam Kebidanan. Jakarta: Salemba
Medika.
Ngastiyah, 2005. Perawatan Anak Sakit.
2nd ed. Jakarta: EGC.
Notoadmodjo, S., 2005. Metodologi
Penelitian Kesehatan. 3rd ed.
Jakarta: Rineka Cipta.
Notoadmodjo, S., 2010. Metodologi
Penelitian Kesehatan. Jakarta:
Rineka Cipta.
Notoadmodjo, S., 2010. Pendidikan dan
Perilaku Kesehatan. Jakarta: Rineka
Cipta.
Nursalam, 2008. Konsep Penerapan
Metodologi Penelitian Ilmu
Keperawatan. Jakarta: Salemba
Medika.
Setiadi, 2008. Konsep dan Keperawatan
Keluarga. Yogyakarta: Graha Ilmu.
Subagyo B, S.N., 2011. Buku Ajar
Gastroenterologi-Hepatologi. 2nd
ed. Jakarta: IDAI.
126
EXERCISE IMPROVED SLEEP QUALITY IN THE ELDERLY
Dyah Pitaloka, Desy Siswi, Fitri Firranda

Email: -
ABSTRACT
Introduction: The aging process makes the elderly more easily in a sleep disorder,
characterized by poor sleep quality. Exercise is one of the secondary prevention that can be
applied to improve sleep quality in the elderly. Exercise that is mentioned in the literature is
also an assortment of numbers, ranging from baduanjin exercise, exercise with music, aquatic
exercise, progressive muscle relaxation exercises, aerobic exercise, resistance exercise, elderly
gymnastics, yoga, exercise training programs, and tai chi. To evaluate the effectiveness of the
exercise described in the literature and concluded that the most effective exercise to improve
sleep quality in the elderly. Methods: The source article is used obtained from a search through
the database include Google Scholar, Scopus, SAGE, and Science Direct. This search is
restricted to starting from 2008 until 2016. After the articles obtained, then do research articles
to the extent of making literature review. Results: Exercise with music (brisk walking) is more
effective than aquatic exercise, aerobic exercise, resistance exercise, baduanjin exercise, and
tai chi. Conclusions: Exercise with music (brisk walking) most effective in improving sleep
quality of the elderly. Exercise with music (brisk walking) can be applied to the elderly who
have poor sleep quality, sleep disorders, and insomnia.
Keywords: exercise, sleep quality, elderly, older adults
INTRODUCTION prevention, secondary, and tertiary.

The increase in the elderly Primary prevention is an attempt to avoid
population is a result of the increase in life specific diseases or health conditions.
expectancy of the population (Prayitno, Primary prevention can be done with the
2002). The prevalence of sleep disorders in elderly sleep disorder is to do a good sleep
the elderly is high at around 67%. Elderly hygiene. Secondary prevention is early
often report having difficulty to fall asleep detection and treatment of adverse health
while in bed so do not rule out getting poor conditions, including nonfarmakologik and
sleep quality (Roland, 2011). pharmacologic action. Tertiary prevention
Nighttime sleep quality in the is done if certain conditions or diseases may
elderly decreased to approximately 70-80% have caused damage to the individual
of the adult (Sumedi, T., Wahyudi, Kuswati (Anderson & McFarlane, 2006; Stanley and
A. 2010). Quality of sleep is the subjective Beare, 2006). The third refers to the
characteristics and are often determined by prevention, secondary prevention is an
feeling energetic or not after waking important step for the early detection and
(Kozier 2008). treatment should be done so that the client
Decreased quality of life will make does not fall in a worse condition.
the elderly become dependent on others Community nurses in improving the
(Sulidah, Yamin, Susanti, 2016). Poor sleep quality of sleep of elderly is very important.
quality in the elderly can be avoided and This is in accordance with the statement of
dealt with through the three stages of the National Institutes of Health Consensus
prevention that includes primary Development Conference in 1990 which
127
states that a sleep disorder characterized by no control group. 6 articles research using
poor quality of sleep strike 50% of people randomized controlled trials (RCTs) and as
aged 65 years living at home. Elderly living much as 9 article quasy experiment
at home is certainly an area of nursing care research approach. Only 10 research
coverage (Maas, 2011). articles that use random sample selection,
Various nursing research related to while six other studies did not use a random
secondary prevention in improving sleep sample selection.
quality in the elderly has been published, The parameters used in the study
ranging from aromatherapy, acupressure, that we reviewed various, among other
light therapy, music therapy, exercise, and PSQI global score, insomnia rating scale,
so on. Exercise to improve the quality of objective sleep parameters that sleep
sleep is of various kinds, ranging from latency, sleep efficiency, TST, Waso,
aquatic exercise, progressive muscle activity counts, awaking awaking number
relaxation exercises, aerobic exercise, tai and length. The parameters used matches
chi, brisk walking, elderly gymnastics, the criteria for inclusion is to measure the
gymnastics, yoga, and so on. Exercise quality of sleep of elderly. This is consistent
interventions that are diverse in improving with the statement (Guyton & Hall, 2007)
the quality of sleep of elderly researcher to which states that the individual sleep
obtain information and concluded that the quality can be analyzed through an
most effective exercise is based on examination of electroencephalography
evidence based practice to improve the (EEG), which is a recording of brain
quality of sleep in the elderly. electrical current (objective sleep
parameters). Buysse et al (1988) also
METHOD suggests measuring instrument to the
Based on searches that have been quality of sleep, in addition to using EEG
done by keyword, found some articles recording, the Pittsburgh Sleep Quality
accordingly. From some articles were then Index (PSQI). PSQI is an effective
selected to be included in the systematic instrument in measuring the quality and
study of this review. Screening process of sleep patterns. PSQI provide a quantitative
the final article obtained 15 articles in measure of sleep quality were quick to
accordance with the purpose of writing a identify the sleep quality is good and bad,
systematic review. and better than the gold standard of clinical
The inclusion criteria used in this and laboratory diagnosis
systematic review are: the article is
restricted from years 2008-2017, the DISSCUSION
research article, thesis or dissertation The results of a review of 12
published, articles in English and research articles that use parameters PSQI
Indonesian, English used is "exercise" and scores for sleep quality in the elderly, there
"sleep quality" and "elderly", "older are 10 research articles that get results PSQI
adults". Indonesian to use the keyword score to less than 5 after exercise. PSQI
"exercise" and "sleep quality" and score <5 indicates a sensitive and specific
"elderly". measure of the quality of a good sleep in
individuals, whereas a score of PSQI> 5
RESULT indicates a sensitive and specific measure
The results of a review of 15 of poor sleep quality in individuals. The
research articles that get data from 15 higher the PSQI global score obtained the
articles which have been discovered and worse anyway that individual sleep quality
studied, 13 research articles using the (Buysse et al, 1988). The results of the
treatment group and the control group, reviews 10 research articles with a score of
while as many as three articles the study had PSQI <5 indicates that the quality of sleep
128
in older adults become better after the well-designed case-control and cohort
exercise intervention. There is one article of studies, evidence from systematic reviews
research to the contrary, where after a of descriptive and qualitative studies,
comparison between the intervention and evidence from a single descriptive or
control groups showed the elderly have qualitative studies, and the latest evidence
poor sleep quality in the intervention group from the opinion of authorities and / or
than the control group, but those results do reports of expert committees, of course, the
not differ significantly in both groups. research method approach, RCT more
The results of a review of 15 studies generalizable than the research quasy
that examined the article, there are 6 articles design with experiment. There are six
studies using quasy experiment, in which options exercise interventions were
the intervention is given gymnastic exercise examined using RCT approach can improve
elderly, progressive muscle relaxation the quality of sleep of elderly, namely
exercises, therapeutic Ling Tien Kung, aquatic exercise, aerobic exercise,
yoga and gymnastics. All of the studies resistance exercise, baduanjin exercise,
showed that exercise interventions exercise with music, and tai chi. Aquatic
provided can improve sleep quality of the exercise can only lead to a significant
elderly. The research method using the difference in sleep latency and sleep
experimental quasy certainly makes the efficiency, not on the overall sleep quality
limitations of the research results when measurement parameters. Baduanjin
compared to the selection method of using exercise can significantly increase total
a randomized controlled trial. sleep quality, Subjective sleep quality,
The results of a review of 15 sleep latency, sleep duration, sleep ef fi
research articles were reviewed, there are 7 ciency, and daytime dysfunction but can
article studies using the approach only be effective after a minimum 12-week
randomized controlled trial with the option intervention. Aerobic exercise is done alone
of intervention that aquatic exercise, or in combination with resistance exercise
aerobic exercise, resistance exercise, is effective in improving sleep quality in the
baduanjin exercise, exercise with music elderly after 10 weeks. Provision of
(brisk walking), exercise training program, exercise (exercise) in this case in the form
and tai chi, Sample selection is done of brisk walking combined with effective
randomly expected to be generalized to the music for 2 weeks of treatment can improve
population and suppress the occurrence of the sleep quality of insomnia. Tai Chi
bias in the study. 7 article research using the training consists of two sessions of 60
RCT method gives results that a given minutes each week for 8 weeks can
intervention exercise can improve sleep significantly affect the quality of sleep in
quality of the elderly. One study remainder the elderly. If the comparison of the
provide results that after a comparison effectiveness of the intervention period,
between the intervention and control exercise with music (brisk walking) most
groups, the elderly had poor sleep quality in effective in improving sleep quality of the
the intervention group than in the control elderly.
group, but those results do not differ
significantly in both groups. CONCLUSION AND
The choice of method, in RECOMENDATION
accordance with the level of evidence that Studies with these results cannot be
began with a top that is systematic review fully generalizable. Do not cover the
or meta-analysis, evidence Obtained from possibility of bias in some studies. It can be
well-designed RCTs, Evidence Obtained caused due to less homogeneous sample
from well-designed controlled trials given the many factors that can affect sleep
without randomization, evidence from quality in the elderly, for example, the
129
sample used is already experiencing a Buysse D.J., Reynolds C.F., Monk T.H.,
variety of pathological conditions such as Berman S.R., dan Kupfer D.J.
impaired cardiovascular and malignancies, (1988). The Pittsburgh Sleep
in addition to the diversity of samples of Quality Index: a new instrument for
different ages may also influence so that psychiatric practice and research.
these interventions not only be done in the Psychiatri Research, 28, 193-213
elderly, but can be done at a younger age. [serial online].
Another limitation is the different types of http://xa.yimg.com/kq/groups/2079
insomnia and other sleep disorders in the 5556/421574977/name/psqi+article
patient's natural. In this study, it is unknown .pdf, diakses tanggal 28 November
how much influence these factors the 2016
significance of the analysis results. Cahyono, Heri K. (2012). Pengaruh Senam
Shortages in some studies is the inability of Lansia terhadap Kualitas Tidur pada
researchers to control the results, timing of Lansia di Desa Leyangan
intervention, characteristics and screening Kecamatan Ungaran Timur
samples. Kabupaten Semarang.
http://perpusnwu.web.id/karyailmia
REFERENCE h/documents/3556.pdf, diakses
Amitara, B.D. (2015). Pengaruh Latihan tanggal 28 November 2016.
Senam Yoga terhadap Kualitas Chan, Aileen WK et. al. (2016). Tai chi
Tidur pada Lanjut Usia (Lansia). qigong as a means to improve night-
http://eprints.ums.ac.id/39107/ , time sleep quality among older
diakses tanggal 28 November 2016. adults with cognitive impairment: a
Anderson, E.T., & McFarlane J. (2006). pilot randomized controlled trial.
Buku Ajar Keperawatan Komunitas Clinical Interventions in Aging :11
Teori dan Praktik. Edisi Ketiga. 1277–1286.
Jakarta: EGC. Chen L.J, Fox K.R., Ku P.W., & Chang
Araujo & Ceolim. (2010). Sleep quality of Y.W. (2016). Effects of Aquatic
elders living in long-term care Exercise on Sleep in Older Adults
institusions [serial online]. with Mild Sleep Impairment: a
http://www.scielo.br/pdf/reeusp/v4 Randomized Controlled Trial.
4n3/en_10.pdf , diakses tanggal 28 International Society of Behavioral
November 2016. Medicine (2016) 23:501–506.
Austaryani, Nessma Putri & Arif Widodo. Chen M.C., Liu H.E., Huang H.Y., & Chiou
(2011). Pengaruh Terapi Relaksasi A.F. (2012). The effect of a
Otot Progresif Terhadap Perubahan simple traditional exercise
Tingkat Insomnia Pada Lansia di programme (Baduanjin exercise)
Posyandu Lansia Desa Gonilan, on sleep quality of older adults: A
Kartasura. randomized controlled trial.
https://publikasiilmiah.ums.ac.id/bi International Journal of Nursing
tstream Studies 49 (2012) 265–273.
/handle/11617/3623/NESMA%20P Erliana, Haroen, & Susanti. (2008).
UTRI- Perbedaan Tingkat Insomnia Lansia
ARIF%20WIDODO%20Fix.pdf? Sebelum dan Sesudah Latihan
sequence=1, diakses tanggal 28 Relaksasi Otot Progresif
November 2016. (Progressive Muscle Relaxation) Di
Bonardi, J.M.T., et.al. (2016). Effect of BPSTW Ciparay Bandung.
different types of exercise on sleep http://pustaka.unpad.ac.id/wp-
quality of elderly subjects. Sleep content/uploads/2009/07/perbedaan
Medicine 25 (2016) 122–129.
130
_tingkat_insomnia_lansia.pdf, /123456789/27941/4/Chapter%20II
diakses tanggal 28 November 2016. .pdf, diakses 28 November 2016.
Guyton & Hall. (2007). Buku Ajar Fisiologi Samsudrajat, A. (2011). Menuju Lanjut
Kedokteran. Jakarta: EGC. Usia Aktif sebagai Aset Bangsa
Huang C., Chang E.T, & Lai H.L. (2016). yang efektif. Peringatan Hari Lansia
Comparing the effects of music and Tahun 2011. Jakarta: Komnas
exercise with music for older adults Lansia.
with insomnia. Applied Nursing Silvanasari, I.A. (2013). Faktor-faktor yang
Research 32 (2016) 104–110. berhubungan dengan kualitas tidur
Irwin M.R, Olmstead R., Motivala S.J. yang buruk pada lansia di Desa
(2008). Improving Sleep Quality in Wonojati Kecamatan Jenggawah
Older Adults with Moderate Sleep Kabupaten Jember. Program Studi
Complaints: A Randomized Ilmu Keperawatan. Universitas
Controlled Trial of Tai Chi Chih. Jember
SLEEP 2008;31(7):1001-1008 Stanley, Mickey & Beare, P.G. (2006).
Maas, L. Meridean. (2011). Asuhan Buku Ajar Keperawatan Gerontik.
Keperawatan Geriatrik: Diagnosis Jakarta: EGC.
NANDA, Kriteria Hasil NOC, & Sulidah, Yamin A., Susanti R.D.
Intervensi NIC. Jakarta: EGC. (2016).Pengaruh Latihan Relaksasi
Muhammad H., Indarwati R., & Ulfiana E. Otot Progresif terhadap Kualitas
(-). Ling Tien Kung Movement Tidur Lansia. Volume 4 Nomor 1
Therapy Improve Sleep Quality on April 2016,
Elderly. Sumedi, T., Wahyudi, Kuswati A. (2010).
http://journal.unair.ac.id/down Pengaruh Senam Lansia terhadap
load- fullpapers- Penurunan Skala Insomnia pada
ijchn871669770cfull. pdf, diakses Lansia di Panti Wredha Dewanata
tanggal 28 November 2016. Cilacap. Jurnal Keperawatan
Prayitno, A. (2002). Gangguan pola tidur Soedirman (The Soedirman Journal
pada kelompok usia lanjut dan of Nursing), Volume 5, No.1, Maret
penatalaksanaannya. Jurnal 2010.
Kedokteran Trisakti, Vol. 21 No. 1 Suna, Jessica M et. al. (2015). The effect of
[serial a supervised exercise training
online].http://www.univmed.org/w programme on sleep quality in
p- recently discharged heart failure
content/uploads/2011/02/Prayitno.p patients. European Journal of
df, diakses 28 November 2016. Cardiovascular Nursing, Vol. 14(3)
Roland, Ngang. 2011. Sleep disturbance 198 –205
among elderly people in nursing Wenzel, Jennifer A. et. al. (2013). Impact of
home: A nonpharmacological a Home-Based Walking
approach. Human Ageing and Intervention on Outcomes of Sleep
Elderly Services [serial online]. Quality, Emotional Distress, and
https://publications.theseus.fi/bitstr Fatigue in Patients Undergoing
eam/handle/10024/36268/Thesis. Treatment for Solid Tumors. The
pdf? sequence=3 , diakses 28 Oncologist, 18 : 476–484.
November 2016. Yurintika,F., Sabrian F., Dewi Y.I. (2015).
Sagala,V. P. 2011. Kualitas Tidur dan Pengaruh Senam Lansia terhadap
Faktor-faktor Gangguan Tidur Kualitas Tidur pada Lansia yang
[serial online] Insomnia. JOM Vol 2 No 2, Oktober
http://repository.usu.ac.id/bitstream 2015.
131
THE RELATIONSHIPS BETWEEN NURSE’S CARING WITH CLIEN’S COMFORT
ISLAMIC PERSPECTIFE
Abu Bakar
Email: abu.bakar@fkp.unair.ac.id
ABSTRACT
Planning a global spiritual is set in quality and quantity the presence of a nurse, spiritual
director, as well as the closest; supports the healing relationship with increasing patient
expectations; presents a support system such as family, friends, social; provide an opportunity
to pray; appropriate dietary therapy religion; and support the religious ritual. The next nursing
process is the implementation of planning and systematically evaluate the nursing process of
spiritual. The application of the nursing process from the perspective of the spiritual needs of
patients is not straightforward because of success in providing spiritual care is gaining
understanding of the spiritual dimension of patients. Spirituality in its many clients perceived
the same as religious or religion. Islamic religious dimension to be explored from the patient
as the recipient askep. Assess the patient's religious practices is not enough to provide
information to nurses to understand the patient confidence to overcome the disease. Spiritual
nursing process can be carried out optimally when nurses have caring. Caring is the behavior
holistically provide assistance to individuals. Caring is the essence of nursing is known as
"human science and human care". This paper focuses on caring developed by caroline and
Watson were assessed from an Islamic perspective. Caring assessed from an Islamic
perspective will be tested to assess the psychological comfort of the patient. Psychological
comfort of patients in a comfortable assessed value from the Islamic perspective.
Keywords: caring, comfortable, Islamic, Quran, spiritual
Introduction
Indonesia's population is among the blessing of Allah to the characteristics of
most populous Muslim. Indonesia's professional, friendly, trustworthy,
population of mostly embraced Islam, constancy, patience, and Ikhlas (Sudalhar,
menjadiakan some institutions trying to 2011). Islamic nursing care is to provide
attract customers by providing the warranty nursing care to the Islamic principle that
will get services that Islamic. Hospitals that charity in performing nursing care, caring
offer Islamic services will establish a behavior but are required to be professional,
religious-based hospitals. Hospitals that and always provide guidance toward
offer Islamic services Dapa seen from the goodness (Fadilah, 2009). This situation
vision and mission of the hospital. Haji shows that the Islamic nursing should also
hospital Surabaya Islamic Hospital be supported by nurses caring behavior.
Surabaya, Surabaya Muhammadiyah Caring is the behavior holistically
Hospital, or Hospital Al-Irsyad Surabaya is provide assistance to individuals. Caring
an example of a faith-based hospital in East theory expressed Watson (2008) is at the
Java, especially in Surabaya. The hospital is core of nursing science known as "human
competing to provide services to Islam, science and human care". Nurse caring
especially in nursing services. behavior aims to meet the client's welfare
Islamic nursing is nursing service (Tonges & Ray, 2011). Welfare clients can
comes in the form of worship that is based generally be interpreted with perbagai
on the Qur'an and the Hadith to achieve the things, such as patient satisfaction (Rafii,
132
Hajinezhad, and Haghani, 2007). is still not Islamic ?. Caring supplied
Prosperous comfortable in theory is a whether also should make clients feel
condition that can be physically comfortable Islamic religion in Islamic?
uncomfortable, psychospiritual,
sociocultural and environmental. This Caring Theory of Caroline.
indicates that the client was in hospital- Caring is the behavior holistically
based Islamic should also feel comfortable. provide assistance to individuals. The
Nursing care in hospital-based theory of caring is the essence of nursing is
services carrying the Islamic religion. The known as "human science and human care"
application of the nursing process from the (Nursalam, 2014). Caring of Caroline is a
perspective of the spiritual needs of patients development that is based on five main
is not straightforward because of success in concepts process of caring from Watson
providing spiritual care is gaining namely Maintaining Belief (to maintain the
understanding of the spiritual dimension of trust), Knowing (knowing), Being with
patients (Perry & Potter, 2010). Islamic (being with), Doing for (doing), and
religious dimension to be explored from the Enabling (enable) (Watson, 2008 ). Watson
patient as the recipient askep. Assess the describes the keywords of caring is to
patient's religious practices is not enough to provide nursing care to clients with a full-
provide information to nurses to understand value sense of commitment and
the patient confidence to overcome the responsibility. Keywords described watson
disease (Perry & Potter, 2010). make some used as a basis for developing a caring from
inquiries. This situation raises questions, Caroline. The main concepts and
such as caring nurse who was in the hospital definitions caring of Caroline as follows
bebasis Islam is also should use the value of (Tonges & Ray, 2011):
the religion of Islam ?. Caring nurse today
Figure 2.2 Caring theoretical framework Caroline (Tonges & Ray, 2011)
1. Maintaining Belief / maintaining trust. the problem in front of him with the
Maintaining trust is based by the meaning / maintain and sustain the
capacity of a person's faith can be a period confidence value of a person's life.
of transition and have a meaningful life.
Basic trust someone and capacity to be able
to go through the process of transition and
133
2. Compassion / nursing affection. resulting in stressful, which can not be met
a) Knowing / know is trying to understand by traditional support systems. These needs
the events that they naturally have the include the need for a physical,
meaning in their lives. Nurses are psychospiritual, sociocultural or
expected to understand the experience of environmental. This need is monitored on
the patient's life to the exclusion of the an ongoing basis, through a statement
assumption of a nurse, but dig / expressed or not, refers to a disease process,
information of patients studied in detail, education and support, and counseling costs
focusing on one goal and a common and action plans (Tomey & Alligood,
perception of nursing between nurses 2014).
and patients.
b) Being with / being with a present near the 5. Comfort interventions / Interventions
patient as a whole with his emotions. comfort
Nurses are on the patient physically and Intervention comfort is the nurse
emotionally including sincere feelings. actions and methods that are specific to
meet the comfort needs of patients,
3. Competence / competency including physiological, social, cultural,
a) Doing for / do to is to commit an act in financial, psychological, spiritual,
such patients take this action if to environmental, and physical action plans
himself. Doing it also means taking (Tomey & Alligood, 2014).
action bersam for estimating what is
needed, comfort, maintaining the 6. Intervening variables / variable barrier
privacy and dignity of patients. Variable barrier are important
b) Enabling / enable an ease in meeting factors that affect the total comfort of the
patient and family care. Nurses empower patient. These factors include past
and facilitate patients for over a experience, age, attitude, emotional status,
transition period or capable of support system, prognosis, finance,
performing unusual acts done by education, cultural background, and all the
focusing on the action, inform, explain, elements in the barrier pasien.variabel
give support, validate feelings and give experience greatly influence the planning
feedback. and success of patient care intervention
(Tomey & Alligood, 2014).
4. Patient well being / welfare of the patient
is the ultimate goal of giving caring 7. Enhanced Comfort / increased comfort.
intervention models. Convenience is a situation that
dialamipasien of interventions comfortable
Comfort Theory of Kolcaba. experience. Comfortable can be defined as
Kolcaba theoretical model, of comfort an experience sudden, thorough experience
(comfortable) drawn on a concept that has a (holistic) which strengthens when one
strong relationship with nursing. Nurses reveals the need for three types of comfort
provide comfort to patients and their (relief / relief, peace / ease, and resignation
families through interventions with comfort / transcedence) in four states (physical,
measurements orientation (Tomey & psychospiritual, sosialkultural, and
Alligood, 2014). Comfortable theory of environment) (Tomey & Alligood, 2014).
Kolcaba have some main concepts
(Kolcaba, 2010c): 8. Health Seeking Behavior (HSBC) /
1. Health Care Needs / health care needs: health-seeking behavior.
Health care needs are defined as the need HSBC It is a broad category of the
for health care, as a need for comfort, output of the next-related health search
resulting from the situation of health care defined by the patient in consultation with a
134
nurse. HSBC may come from outside the
patient's behavior, behavior in the patient, 10. Best practice / good action.
or the desire to die peacefully (Kolcaba, The use of research results in health
2010c). care interventions into the best possible for
the patient and family to get the final result
9. Institutional Integrity / integrated of the good service (Tomey & Alligood,
institution. 2014).
Defined as service providers such as
companies, communities, schools, 11. Best policies / good policy.
hospitals, regions, sections, and the city has Institutional policy or regional
a complete quality, thorough, well-known, policies of protocols for procedures and
honest, ethical, and truly memeiliki quality. medical conditions can make it easier to
Agencies that have the quality of a good access and transfer of care is known as a
will to implement actions based on good policy (Tomey & Alligood, 2014).
evidence and good yangt policy (Tomey &
Alligood, 2014).
Explanation of the main concepts of the theory Comfort of Kolcaba, briefly described as
follows below:
Figure 2.3 Comfort Katherine Kolcaba theoretical framework (Kolcaba, 2010b)
Caring Islami Conscience), Commitment (commitment),

Caring Caroline almost the same and Comportment (authority) (Caranto,
concept of research conducted by 2015).
Hajinezhad and Azodi (2014) concerning Model Caroline caring, Behavior
Nurses Caring Behavior. Caring Behavior Nurses Caring and Caring Six C when
Nurses also developed from caring Watson viewed from the Muslim culture still exist
containing: Respectful deference that have not signed and represent the
(courteous and respectful), Human Muslim culture. Memasukka necessity of
presence (presence of a nurse), Positive Muslim culture in the caring because
connectness (positive relationship), according to Rafii, Hajinezhad, & Haghani
Knowledge and skills (knowledge and (2007) mentions the nurse caring highly
skills), Other's experience (behavior of associated with patient satisfaction and
caring others). The concept of Watson also patient religious culture. Caring Model
became the basis for constructing Caring focuses on caring interventions that take
caring Six C. Component six C from Roach, into account the culture of the patients
namely Compassion (Compassion), (Halligan, 2006). Most patients in Surabaya
Competence (Ability), Confidence culture is Islamic.
(Confidence), Conscience (Conscience /
135
Caring dimension according to surah Al Bayyinah 5 (2004) "And they only
Rafii, Hajinezhad, & Haghani (2007), ordered to worship Allah with Ikhlas obey
namely respect / honor, certainty / him solely because of (running) religion,
assurance, positive relationships, and also in order to perform prayer and give
professional, wholeheartedly. Caring islami alms; and that is the right religion (true) ".
according Abdurrouf, Nursalam, & Ikhsan impact in the next worship is
Purwaningsih (2013) includes the character to make nurses behave affection.
is professional, friendly, trustworthy, Compassion in Islam known as Mahabbah.
constancy, sincerity, and patience. Fadillah In accordance with the Qur'an Surah Al
(2009) mentions the character of Islamic Imran, 159 (2004) which states "And the
Nurses should ihsan in worship, grace of God you apply gentle towards
professional, and provide guidance toward them, in case you insist and be rude, they
goodness. Provide guidance to the good would distance themselves from all
characteristics not found in Islamic caring around". Affection is in accordance with
character by Abdurrouf, Nursalam, & the concept of Caroline Compassion
Purwaningsih, (2013). So the use of Islamic (affection). Behavior nurse affection is
caring characters still need to do the highly recommended in Islam.
assessment. Competence (competence) to the
Caroline concept in accordance concept of Caroline, where the concept was
with Islamic nurse character by Fadilah. also the same as Islam requires the nurse to
Maintaining the suitability of this concept be professional. Competence in Islam
namely Belief (to maintain the trust) which known as an expert. In accordance with the
is a person's capacity to deal with issues of Qur'an Surat an-Nahl 43 (2004), which
faith. Maintaining confidence in Islam can mentions "Then ask the person who has the
mean ikhsan in worship. In accordance with knowledge (the expert) if you do not
the Qur'an Surah Al Ahzab 29 (2004) which know". Surah in the Qur'an is also
states: "If you desire Allah and His confirmed by the hadith narrated by
messenger and the country Hereafter, Allah Bukhari, ie If a business handed to who are
provide a great reward for those who do not experts, so watch the destruction.
good (Ikhsan) among you". Ikhsan impact Competent nurse or professional behavior
on nurses are keeping the sincere intention is highly recommended in Islam. Simple
in working order. So maintain confidence in explanation contained in the following
the capacity of a person's faith means table.
Ikhlas. In accordance with the Holy Koran
Table 2.1 Caroline Caring concept in accordance with Islamic values.

No Caring Concepts Caroline Islamic values Information
1 Maintaining Belief Al Ikhlas Ikhlas as belief in
serving
2 Compassion Mahabbah nursing affection
3 Competence Mahir experts
136
Caroline concept that has the goal of grateful success, enjoying the process
welfare patient (Patient well being). (patient), and surrender all to God.
Welfare dimaksut patients who still have a Gymnastiar (2006) which states that
very broad sense so it needs to be assurance is a strong character and tireless
interpreted in the Islamic. Giving meaning (consistent).
to the concept of Islamic means adding The concept of mercy is needed
theories and concepts that are described in Wise, prioritize others, Helpful, and
the theory section comfort (comfort). Clement. In accordance with the disclosed
Maintaining confidence in the Gymnastiar (2006) that the communication
concept is not explained in detail Caroline and get along that well (affection) takes the
keeping techniques. The concept of love in attitude I'm no threat to you, I had fun, and
Caroline explained that there are two I'm useful to you. I'm not a threat is an act
techniques that determine (Knowing), and of wise and like putting someone else. Fun
being with (Being with). The concept of means of trustees, helpful and useful means
competent on Caroline explained that there to you. Izzan, (2010) nurse commendable
are two techniques that do for (Doing for) attitude among trustees, gentle, quiet, clean,
and enable (Enabling). Mechanical and keep it secret.
achievement concept at Caroline still less The concept of competence
powerful and less detail when passed back required trustful behavior, Critical
to the basic concept of Watson. Thinking, According to time, and Mandiri.
Watson concept known as 10 In accordance with the mentioned Herman
Carative factors, namely: 1) Establishment (2009) that the professional is working with
of humanistik- altruistic value system; 2) the scientific principle, carry out work with
To provide confidence and hope by an honest, responsible, succor, and
facilitating and improving nursing care; 3) collaboration. Widarti (2010) mention
Growing sensitivity to self and to others; 4) professional when working with intelligent
Build a trusting relationship; 5) Improve and appropriate knowledge. In accordance
and accept the expression of positive with the Holy Koran surah Al An'Mujadilah
feelings and negativ client; 6) Using the 11 (2004), "God will lift (degrees) those
creative problem solving process and who believe among you and those who
systematic; 7) Improvement of trans were given some degree of knowledge".
personalized learning; 8) Provide support,
protection and improvement of the Comfort Islami
environment or physical, mental, social, Convenient theory when viewed
and spiritual; 9) To assist the fulfillment of from the Muslim culture still exist that have
basic human needs; 10) Support for not signed and to represent the Muslim
spiritual power to pave the phenomenal- culture so that other theories need to
existential-spiritual dimension of mystery supplement. These factors will be very
and existential life and death of a person significant for the development of coronary
(Watson, 2008). heart patient's health indications to adjust
Concept 10 Carative factors from the dimensions of the Islamic comfortable.
Watson as the core of nursing guidelines Islamically healthy comfortable or is in a
need to be seen from the side of the Muslim state of well-being, full of gratitude for the
culture. Caroline concept and the concept of favor of God in the aspect of physical,
10 Carative factors from Watson in spiritual, and social. Prosperous gratefully
accordance with the Islamic concept, as means when recovering from illness as
follows. The concept of keeping the sincere usual, it is required to give thanks and
trust required patience, gratitude, and always do good. recovering from an illness,
consistent. In accordance with the disclosed but there is still residual symptoms or
Sentanu (2014) assurance capabilities are disabilities, it is obliged to be patient and
137
put their trust (handed over all affairs to Watson, J (2008) Nursing: The philosophy
Allah). Seriously ill or there is no hope for and science of caring. Revised
a cure, it is required to sincere and trusts edition. Association of American
(Izzan, 2010). Prosperous gratitude also University Presses. Colorado.
means keeping the faith of a patient so that Tonges, Mary & Ray, Joel (2011)
the required kind thought to God, be Translating Caring Theory Into
patient, grateful, air-seek forgiveness, and Practice: The Carolina Care Model.
put their trust (suryadi & Nasrullah, 2008). THE JOURNAL OF NURSING
Patience in accordance with the ADMINISTRATION. 374- 381 vol
Holy Koran 155- Al Baqarah verse 156 4 no 9.
which means "we ask and it will test you Rafii, Forough; hajinezhad, Mohammad
with something of fear, hunger, loss of Esmalel; & Haghani, Hamid (2007)
wealth, lives and fruits. And give glad Nurse caring in Iran and its
tidings to those who patiently, that those relationship with patient
who when afflicted with calamity, say satisfaction. Australian journal of
Innaa manufacture wa calamity ". Gratitude advanced nursing, vol 26, no 2.
in the holy book the Koran sura Ibrahim 7 Potter, P. A., & Perry, A. G. (2010).
"And (remember) when your Lord fundamental keperawatan (7th ed.).
proclaimed, 'If you are grateful, surely I will (Adriana Ferderika Nggie & Marina
add more (favors) unto you; but if you deny Albar, Penerjemah) Jakarta:
(my favor), then surely My punishment is Salemba Medika.
severe ". According to the book Ikhlas Al Nursalam. (2014). caring sebagai dasar
Koran Al Nasr 5 "And they were peningkatan mutu pelayanan
commanded to worship Allah with sincere keperawatan dan keselamatan
obey him solely because of (running) pasien. Surabaya: airlangga
religion, and also to perform prayer and university press.
give alms; and that is the right religion Tomey, A. M., & Alligood, M. R. (2014).
(true) ". This situation shows that Muslims Nursing Theorists and their work
needed a comfortable psychospiritual (8th ed.). Philadelphia: ELSEVIER
patience, gratitude, and sincere. Kolcaba, K. (2010b). Media. Dipetik Maret
9, 2015, dari Comfort line:
REFERENCE http://www.thecomfortline.com/res
Al Qur’an (2004) Departemen Agama ources/media.html
Republik Indonesia: Al Qur’an dan Kolcaba, K. (2010c). Introduction. Dipetik
terjemahnya. Bandung. PT Syaamil Maret 25, 2015, dari Comfort line:
Cipta Media http://www.thecomfortline.com/ho
Fadilah, H. (2009, September 29). Bekerja me/intro.html
Sebagai Ibadah Ihsan Dalam Hajinezhad, Mohammad Esmaiel & Azodi,
Pelayanan: Asuhan Keperawatan Parviz (2014) Nurse Caring
Islami. Dipetik April 1, 20015, dari Behaviors from Patients’ and
Rumah Sakit Islam Jakarta Nurses’ Perspective: A
Cempaka Putih: Comparative Study. European
http://www.rsi.co.id/artikel/artikel- Online Journal of Natural and
keperawatan/content/5-asuhan- Social Sciences. Vol.3, No.4 pp.
keperawatan-islami = seminar Harif 1010-1017.
Fadilah tanggal 29-09-2009 Caranto, Lowrence C. (2015) Coalescing
Sudalhar. (2011). Keperawatan Islami. the Theory of Roach and Other
Bojonegoro: CV Duta Ilmu Truth-. International Journal of
Indonesia. Nursing Science. volume 5. no 1.
halaman 1-4.
138
Halligan, P. (2006, Januari 1). Caring for keluarga pasien, dokter, dan
patients of Islamic perawat. Edisi 1. Jakarta.
denomination:critical care nurses’ Klinikalmahira.
experiences in Saudi Arabia. Hermawan, W. (2009, Juni 11). Pedoman
Journal of Clinical Nursing. journal pelayanan islam keperawatan dan
of clinical nursing, 1563 -1575. kebidanan di rumah sakit islam
Abdurrouf, M., Nursalam, & Purwaningsih. assyifa Sukabumi ahlak pribadi
(2013, April 01). Model caring perawat/ bidan. Dipetik April 1,
islami terhadap peningkatan 2015, dari wordpress:
kepuasan. Jurnal Ners, 8(1), 153- https://komitekeperawatanrsia.wor
164. dpress.com/2009/06/11/draft-
Fadilah, H. (2009, September 29). Bekerja pedoman-pelayanan-keperawatan-
Sebagai Ibadah Ihsan Dalam kebidanan-islami-rumah-sakit-
Pelayanan: Asuhan Keperawatan islam-assyifa-sukabumi/
Islami. Dipetik April 1, 20015, dari Widarti (2010) Implementasi nilai islam
Rumah Sakit Islam Jakarta dalam pelayanan kesehatan.
Cempaka Putih: Disampaikan pada symposium dan
http://www.rsi.co.id/artikel/artikel- seminar nasional FKIK UIN Syarif
keperawatan/content/5-asuhan- Hidayatullah Jakarta, 16 Agustus
keperawatan-islami = seminar Harif 2010.
Fadilah tanggal 29-09-2009 Suryadi & Nasrullah, R. (2008) Rahasia
Gymnastiar, Abdullah (2006) Jagalah Hati: ibadah orang sakit: sakit bukan
Step by step manajemen qolbu. berarti tidak ibadah. Madani prima.
Bandung. Khas MQ. Bandung.
Izzan, Ahmad (2010) Sakitku Ibadahku:
panduan ibadah bagi pasien,
139
A SYSTEMATIC REVIEW OF COGNITIVE BEHAVIOR THERAPY (CBT) AND
INSOMNIA
Maulana Rahmat Hidayatullah, Zulvana

Email: maulana.rahmat.hidayatullah-2016@fkp.unair.ac.id
ABSTRACT
Introduction: Insomnia is difficulty in maintaining sleep can be transient or persistent. One of the
non-pharmacological therapy that can be applied to reduce insomnia is CBT. CBT is a collection
of behavioral and cognitive techniques that are considered effective for treating insomnia. To
evaluate the effectiveness of CBT in reducing insomnia. Methods: The source article is used
obtained from a search through the database include Google Scholar, Science Direct, PubMed, and
ProQuest.This search is restricted to start from year 2003 to 2017. The article Inclusion criteria
were: 1) the study design RCT, 2) the treatment given is cognitive behavior therapy,3) samples
were from people who had insomnia, and 4) the parameters considered is the level of insomnia,
Once obtained, then do research articles to the extent of making systematic review. Results: CBT
proven effectively reduce insomnia. Conclusion: CBT is one of the non-pharmacological
therapies that can help reduce insomnia.
Keywords: CBT, insomnia, intervention insomnia
INTRODUCTION its effects on symptoms of insomnia are also

Treatment without medication for difficult to explain.
insomnia can be done using a variety of Cognitive-behavioral therapy (CBT)
techniques. McCurry, Logsdon, Teri, and therapy which considers that the basis of
Vitiello (2007) conducted a literature review psychological disorders is problematic client
on studies that use without drug treatment for cognition (Guevremont and Spiegler, 2010).
insomnia. Their search results show that only CBT interventions to be effective as present-
two techniques that have enough evidence to oriented, improve coping skills, focus on the
be considered effective, namely sleep-sleep problem, practical, and effective. It is
restriction and CBT multi-component associated with two things that need to be
compression. In addition to these two considered in dealing with psychological
techniques, other techniques have dubious problems, the psychological problems that
effectiveness. Stand-alone psychological often has been around a long time and the
techniques (such as relaxation, cognitive possibility of chronic disease. CBT
techniques, or psychoeducation sleep intervention to avoid both with the
hygiene alone) does not have a strong orientation on the present and focus on the
evidence for the effectiveness. Furthermore, problem (Spiegler & Guevremont, 2010).
there are also alternative techniques that do Psychological problem that has existed since
not have any scientific evidence, such as light long can trap therapists to continually look
therapy, walking, exercise, massage, and for root causes and spent many session.
weight training. However, alternative Although these searches can identify the root
techniques generally have a complex of the problem and satisfy the therapist, but
explanation of the mechanism of action and often the root of the problem is not related to
140
the problem at this time. Furthermore, the applied to research in general is three months
therapist must be sensitive enough to modify to twelve months. That is, the intervention
some aspects of therapy. given continuously and consistently every
Therefore, the aim of the systematic day. The duration of the intervention varies
review is to evaluate the articles for later in the study, ranging from 15-30 minutes or
concluded the best therapy is based on until the patient had had enough in therapy.
evidence-based practice for insomnia and There are 11 studies using the comparation
discuss considerations practice in the therapy. Meanwhile, another study using
application of nursing practice life through control group.
therapy in accordance with the nursing In a study entitled Internet-vs. group-
problems that exist in society and delivered cognitive behavioral therapy for
documenting research for improve insomnia insomnia: a randomized controlled non-
interventions and improve the outcome of inferiority trial showed an improvement in
patients, especially patients with insomnia. the severity of insomnia appears on both
treatments. Measuring tools (sleep diary data,
METHOD the responders, remitters, sleep medicine use,
The method used in this systematic depressive symptoms) also showed positive
review begins with the selection of topics, results. In the study, entitled A randomized-
and then determined the keywords to search controlled trial of an early minimal cognitive-
the journal using English and Indonesian behavioral therapy for insomnia comorbid
through several databases including Google with cancer showed that the average of all
Scholar, Science Direct, PubMed, and parameters showed significant gains from
ProQuest. The time limits are used is 2003 to pre- post treatment, but not for the control
2017. keywords English used were group. mCBT-also can significantly reduce
"insomnia", "CBT", "insomnia and CBT", symptoms of anxiety and depression, sleep
"intervention insomnia". Indonesian to use disorders are maladaptive, and belief about
the keyword "insomnia treatment", "CBT", sleep, and also gives a positive result for
"insomnia and CBT". Articles Inclusion cognitive function. In the journal, entitled
criteria were: 1) the study design RCT, 2) the Comparing and contrasting the therapeutic
treatment given is cognitive behaviortherapy, effects of cognitive-behavioral therapy for
3) samples were from people who had older adults suffering from insomnia with
insomnia, and 4) the parameters considered is objective short and long sleep duration
the level of insomnia. showed that CBT can improve sleep quality,
Parameter insomnia assessed using degrade easily awakened during sleep onset
instruments that vary widely. In general, and give sleep efficiency. Participants
studies using the insomnia severityindex, reported a decreasescore, Insomnia Severity
Sleep diary, Stress, Sleep medication, quality Index Flinders Fatigue Scale, Epworth
of life and others. Sleepiness Scale, Feeling and Daytime
From the 15 articles that have been Functioning Scale, Anxiety anticipatory
discovered and studied, all articles of Sleep Questionnaire, the Dysfunctional
research using approach randomized control Beliefs and Attitudes about Sleep Scale, and
trial. The parameters used in the study that we gains on the Sleep Self-Efficacy Scale. In the
reviewed is various such as insomnia severity journal, entitled A randomized controlled
was measured using the insomnia severity trial of cognitive-behavior therapy for
index, Sleep diary, Stress, Sleep medication, behavioral insomnia of childhood in school-
quality of life and others. When the study is aged children show that multi-component
141
CBT effective to improve sleep disorders, In a journal called Randomized
insomnia, and anxiety symptoms in school- Controlled Clinical Effectiveness Trial of
age children. In the journal, entitled Group Cognitive Behavior Therapy Compared With
cognitive behavioral therapy for insomnia: Treatment As Usual for Persistent Insomnia
Effects on sleep and depressive in Patients With Cancer showed that the
symptomatology in a sample with assessment of sleep and symptoms of
comorbidity showed that CBT-I is more depression and anxiety is done at the
efficient than the RT to lose weight insomnia beginning of the meeting, after the
and effective to reduce the symptoms of intervention and after 20 weeks. CBT group
depression. to get the good night's sleep post intervention
From the research results CBT of the intervention group receiving TAU
therapy and MBCR in the journal entitled standard (sleepefficiency of 0.63, interval;
The Comparative Impact Of Mindfulness- 95% (CI) from 0.34 to 0.92). There is no
Based Cancer Recovery (MBCR) And further difference in each group at the time of
Cognitive Behavior Therapy For Insomnia follow-up on the symptoms of anxiety and
(CBT-I) On Sleep And Mindfulness In depression. In the journal Auricular
Cancer Patients showed improvement in the Acupuncture and Cognitive Behavioral
severity of insomnia appears on both Therapy for Insomnia: A Randomized
treatment, decreased confidence in patients Controlled Study to compare Auricular
with insomnia sleep disturbances seen in the Acupuncture and Cognitive Behavioral
overall group of CBT-I and the MBCR and Therapy, AA groups obtain intervention by
there are no significant differences in the the NADA protocol)2 times a week for 4
CBT-I and MBCR in decreasing the severity weeks. All interventions carried out in health
of insomnia in post program and follow-up. facilities and performed by two therapists AA
In comparison ICBT and CBT-cntrl on experienced in mental health. CBT therapy
journal, entitled the Guided internet group basis, focus on cognitive rekstruktur
cognitive behavioral therapy for insomnia twice a week for 6 mnggu. This section
Compared to a control treatment A contains information about the physiology of
randomized trial showed that the results sleep, the difference in coping overcome
obtained by the decline seen in both treatment sleep problems, sleep deprivation, factors,
and control is ICBT but ICBT more active in stimulus control and relaxation techniques.
reducing sleeping disorders. Yet it can not be Each session is conducted for 90 minutes, led
concluded which is the most effective of the by three experienced psychologist associated
two. These results can be attributed to the CBT. There is an increase in sleep in patients
ability of therapy techniques who worked on in the intervention groups. CBT-I group in
the problem of insomnia and the severity of the ISI after the intervention and during
insomnia. But basically a lot of research that follow-up of 6 months and DBAs-16 after the
says CBT effective role in improving the intervention. Both groups showed significant
quality of sleep. Comparison of non- differences between groups post-intervention
pharmacological therapy and CBT CBT increase in ISI.
pharmacology showed an increase in the In the journal, entitled Effects of
quality and improve insomnia. The results of armodafinil and cognitive behavior therapy
this study indicate that non-pharmacological for insomnia on sleep continuity and daytime
therapy is more effective in tackling sleepiness in cancer survivors with treatment
insomnia. CBTI and placebo (CBTI + P); CBT-I and
armodafinil (CBT-I + A); armodafinil
142
(ARM); by using a measuring instrument night's sleep post intervention of the
sleep latency (SL), wake after sleep onset intervention group receiving TAU
(Waso) and total sleep time (TST) showed (standarsleep efficiency of 0.63, interval;
CBT-I shows a significant and durable 95% (CI) 0.34 to 0.92). There is no further
improvement in SL and Waso and additions difference in each group at the time of follow-
armodafinil do not improve daytime up on the symptoms of anxiety and
sleepiness. This intervention was carried out depression. In a journal entitled Cognitive
for seven weeks. It can be a measure of the Behavior Therapy and Pharmacotherapy for
success of CBT. In the journal Cognitive- Insomnia showed improved levels of
behavior therapy singly and combined with insomnia seen in the CBT group than in the
medication for persistent insomnia: Impact group of pharmacotherapy and CBT
on psychological and daytime functioning recommended as an early intervention are
using clinical evaluation of sleep / insomnia, taken in cases of chronic insomnia. The main
medical history and physical examination, outcome measures were sleep onset latency
and polysomnography (PSG), Sleep as measured by sleep diaries; secondary
medication, levels of anxiety, depression measures included sleep diary measures of
level, level the severity of insomnia in the sleep efficiency and total sleep time,
measurement of insomnia it obtained objective measures of sleep variables
significant results are fatigue, quality of life (Nightcap sleep monitor recorder), and
(mental component), anxiety, and depression measures of daytime functioning
obtained in CBT without the use of drugs. Studies with the above results can not
Unlike the CBT with medical treatment. In be fully generalizable. Do not cover the
the journal Evaluation of a Brief Treatment possibility of bias in some studies. It can be
Program of Cognitive Behavior Therapy for caused due to less homogeneous sample
Insomnia in Older Adults showed that the given the many factors that can influence the
treatment group receiving CBT-I reported an occurrence of insomnia.
improvement in time and quality of sleep.
Participants also reported a decrease of CONCLUSION AND
Insomnia Severity Index, Flinders Fatigue RECOMENDATION
Scale, Epworth Sleepiness Scale, Feeling and This systematic review has
Daytime Functioning Scale, Anxiety implications for nursing practice. Based on
anticipatory Sleep Questionnaire, the research that has examined showed that CBT
Dysfunctional Beliefs and Attitudes Scale is effective in lowering insomnia. With the
and increased Sleep Self-Efficacy Scale. results of this review, the nurse may apply
In the journal, entitled Physical CBT as a non-pharmacological therapy to
fitness exercise versus cognitive behavior reduce insomnia.
therapy on reducing the depressive symptoms CBT is a therapy that helps clients
among community-dwelling elderly adults: how to think and act so that clients feel better.
A randomized controlled trial shows the CBT focuses on the problems that exist at the
results of such an increase in physical fitness moment, and help the client to understand the
and quality of life improvement of social issues involved are so large and are broken
support resulting in decreased symptoms of down into small parts making it easier for
depression. In the journal, entitled Group clients to see how they relate to one another
cognitive behavioral treatment for insomnia and how the problem is affecting clients
in primary care: a randomized controlled trial (Royal College of Psychiatris 2005). Of the
showed that CBT group to get the good 15 studies that examined prove that CBT can
143
reduce the incidence of insomnia, another improving physical fitness, quality of life and
benefit that is found which can be involved in increased social support.
the repair time and quality of sleep as well as
Table 1. Manual therapies in the treatment of insomnia Intervention

Intervention Author Measure Insomnia Result
ICBT & GCBT Blom, et al., Insomnia Severity Index (ISI), Both treatment groups improved significantly, with
2015 Insomnia severity.
Mcbt-I Ivers, et al., Insomnia Interview Schedule, Insomnia Significantly greater reduction of anxiety and
2015 Severity Index,Sleep diary depression symptoms, maladaptive sleep habits,
Cbti Lovato, et al., One- week sleep diaries, actigraphy, and a Cbti produced robust and durable improvements in
2016 comprehensive battery of questionnaire quality of sleep, including reduced wake after sleep
were used to evaluate the efficacy of cbti onset and improved sleep efficienc
CBT and combined Paine and Sleep latency, wake after sleep onset, and Multi-component CBT can be effective for the
behavioural sleep medicine Gradisar, sleep efficienc sleep, insomnia, and anxiety symptoms of
techniques with anxiety 2011 Behavioural Insomnia of Childhood in school-aged
Treatment techniques children.
CBT for insomnia (CBT-I) and Tillfors et al., Beck Depression Inventory-Second -CBT-I was more efficient than RT in reducing
an active control (relaxation 2015 Edition (BDI-II), Insomnia Severity Index insomnia severity and equally effective in reducing
training: RT) (ISI), Work and Social Adjustment Scale depressive symptoms.
(WSAS), Sick leave and healthcare -CBT-I was associated with less functional
consumption, Sleep diary, Credibility and impairment, shorter sleep onset latency and wake
expectancy (CEQ). after sleep onset but both treatments had equal
improvements of sleep quality, early morning
awakenings and total sleep time.
-cognitive behavior therapy Espie et al., Primary outcomes were sleep diary CBT was associated with mean reductions in
(CBT) 2008 measures. Actigraphic sleep, health-related wakefulness of 55 minutes per night compared with
-treatment as usual (TAU) quality of life (QOL), psychopathology, no change in TAU.
and fatigue were secondary measures. CBT for insomnia may be both clinically effective
and feasible to deliver in real world practice.
-CBT Jacobs, et al., The main outcome measures were sleep- Young and middle-age patients with sleep-onset
-Pharmacotherapy 2004 onset latency as measured by sleep diaries; insomnia can derive significantly greater benefit
-Combination therapy secondary measures included sleep diary from CBT than pharmacotherapy and that CBT
measures of sleep efficiency and total should be considered a first- line intervention for
sleep time, objective measures of sleep chronic insomnia.
variables (Nightcap sleep monitor
recorder), and measures of daytime
functioning.
Comparing mindfulness-based Garland, et. Mindfulness, dysfunctional sleep beliefs, There were no significant differences between the
cancer recovery (MBCR) to Al., 2015 and insomnia severity clinical cutoffs. MBCR and CBT-I groups in the percent age of
cognitive behavior therapy for patients exceeding insomnia severity clinical
insomnia (CBT-I) cutoffs at post-program or follow-up.
To evaluate if internet- Viktor, et. ISI, sleep medication, sleep efficiency, ICBT-i was significantly more effective than the
delivered Cognitive Behavioral Al., sleep latency, and sleep quality control treatment in reducing ISI (Cohen's d ¼
Therapy for insomnia (ICBT-i) 2015 0.85), sleep medication, sleep efficiency, sleep
latency, and sleep quality at post-treatment.
Cbti Nicole Sleep diaries, actigraphy, and a Cbti produced robust and durable improvements in
Lovato et al comprehensive battery of questionnaires quality of sleep, including reduced wake after sleep
(2014) onset and improved sleep efficiency.
-Physical fitness exercise Tzu-Ting 6-min walk distance, quality of life, and Of such an increase in physical fitness and quality
approach (PFE) Huang et all, social support of life improvement of social support resulting in
-Interventions: cognitive 2015 decreased symptoms of depression.
behavioral therapy (CBT)
Approach
CBT & CBT plus medication Charles M. Medical history and physical examination, Significantly improve of fatiguequality of life,
Morin et al., and polysomnography (PSG) axiety, and depression
(2016)
CBT & TAU Cape, 2016 Asessment of sleep, anxiety, and CBT more improve the sleep efficiency
depression
-Auricular Acupuncture Bergdahl, et Insomnia Severity Index CBT-I and Auricular Acipuncture both
-Cognitive Behavioural al., 2016 (ISI),Dysfunctional Beliefs andattitudes significantly reduce insomnia severity and equally
Therapy about Sleep scale (DBAS-16), Epworth effective in reducing depressive symptoms
Sleepiness Scale (ESS), and Hospital
Anxiety anddepression scale (HAD)
-CBT-I dan plasebo (CBTI + Sheila N. Sleep latency CBT-I show the significantly increase of latency
P); Garland et (SL), wake after sleep onset (WASO), SL dan WASO.
-CBT-I dan armodafinil (CBT- all, 2015 total sleep time (TST). Adjusting of armodafinil doesn’t increase sleepy in
I + A); the noon.
-armodafinil (ARM);
144
REFERENCES (2016). Effects of armodafinil and
Bergdahl, L., Broman, J., Berman, A. H., cognitive behavior therapy for
Haglund, K., Knorring, L. Von, & insomnia on sleep continuity and
Markström, A. (2016). Auricular daytime sleepiness in cancer
Acupuncture and Cognitive survivors. Sleep Medicine, 20, 18–
Behavioural Therapy for Insomnia : 24.
A Randomised Controlled Study, https://doi.org/10.1016/j.sleep.2015
2016. .12.010
Blom, K., Tarkian, H., Wiklund, T., Garland, S. N., Rouleau, C. R., Campbell,
Danlycke, E., Forss, M., Lindefors, T., Samuels, C., & Carlson, L. E.
N., … Jernel, S. (2015). Behaviour (2015). ORIGINAL RESEARCH T
Research and Therapy Internet-vs . HE C OMPARATIVE I MPACT
group-delivered cognitive behavior OF M INDFULNESS -B ASED C
therapy for insomnia : A ANCER R ECOVERY ( MBCR )
randomized controlled non- AND C OGNITIVE B EHAVIOR
inferiority trial, 70. T HERAPY FOR I NSOMNIA (
https://doi.org/10.1016/j.brat.2015. CBT-I ) ON S LEEP AND M
05.002 INDFULNESS IN C ANCER P
Brodin, M., Kaldo, V., Jernel, S., & Mia, J. ATIENTS. Explore: The Journal of
(2015). Behaviour Research and Science and Healing, 11(6), 445–
Therapy Guided internet cognitive 454.
behavioral therapy for insomnia https://doi.org/10.1016/j.explore.20
compared to a control treatment e A 15.08.00
randomized trial *, 71, 90–100. Huang, T., Liu, C., Tsai, Y., & Chin, Y.
https://doi.org/10.1016/j.brat.2015. (2015). International Journal of
06.001 Nursing Studies Physical fitness
Cape, J., Leibowitz, J., Whittington, C., exercise versus cognitive behavior
Espie, C. A., & Pilling, S. (2016). therapy on reducing the depressive
Group cognitive behavioural symptoms among community-
treatment for insomnia in primary dwelling elderly adults : A
care : a randomized controlled trial, randomized controlled trial.
1015–1025. International Journal of Nursing
https://doi.org/10.1017/S00332917 Studies, 52(10), 1542–1552.
1500256 https://doi.org/10.1016/j.ijnurstu.20
Espie, C. A., Fleming, L., Cassidy, J., 15.05.013
Samuel, L., Taylor, L. M., White, C. Ivers, H. (2015). Behaviour Research and
A., … Paul, J. (2017). J OURNAL Therapy A randomized-controlled
OF C LINICAL O NCOLOGY trial of an early minimal cognitive-
Randomized Controlled Clinical behavioural therapy for insomnia
Effectiveness Trial of Cognitive comorbid with cancer *, 67.
Behavior Therapy Compared With https://doi.org/10.1016/j.brat.2015.
Treatment As Usual for Persistent 02.003
Insomnia in Patients With Cancer, Ivers, H. (2016). Behaviour Research and
26(28), 4651–4658. Therapy Cognitive-behavior
https://doi.org/10.1200/JCO.2007.1 therapy singly and combined with
3.9006 medication for persistent insomnia :
Garland, S. N., Roscoe, J. A., Heckler, C. Impact on psychological and
E., Barilla, H., Gehrman, P., daytime functioning nchez Ortu n ~
Findley, J. C., … Perlis, M. L. o d , Annie Valli e, 87, 109–116.
145
https://doi.org/10.1016/j.brat.2016. Adults. Psychology and Aging
09.002 Copyright, Vol. 22, No. 1, 18 –27
Jacobs, G. D., Pace-schott, E. F., Stickgold, DOI: 10.1037/0882-7974.22.1.18.
R., & Otto, M. W. (2017). Cognitive Paine, S., & Gradisar, M. (2011).
Behavior Therapy and Behaviour Research and Therapy A
Pharmacotherapy for Insomnia, randomised controlled trial of
164. cognitive-behaviour therapy for
Lovato, N., Lack, L., & Kennaway, D. J. behavioural insomnia of childhood
(2016). Comparing and contrasting in school-aged children. Behaviour
therapeutic effects of cognitive - Research and Therapy, 49(6–7),
behavior therapy for older adults 379–388.
suffering from insomnia with short https://doi.org/10.1016/j.brat.2011.
and long objective sleep duration. 03.008
Sleep Medicine, 22, 4–12. Spiegler, M. D., & Guevremont, D. C.
https://doi.org/10.1016/j.sleep.2016 (2010). Contemporary Behavior
.04.001 Therapy (5th ed.). USA: Wadsworth
Lovato, N., Lack, L., Wright, H., & Cengage Learning.
Kennaway, D. J. (n.d.). Evaluation Tillfors, M., Norell-clarke, A., & Jansson-
of a Brief Treatment Program of fr, M. (2015). Behaviour Research
Cognitive Behavior Therapy for and Therapy Group cognitive
Insomnia in Older Adults. behavioural therapy for insomnia :
McCurry, S.M., Logsdon, R.G., Teri, L., Effects on sleep and depressive
and Vitiello, M.V., L. Min-zhi., Su symptomatology in a sample with
Li., L. Bao-yun., T. Jin-jing., Chen- comorbidity, 74, 80–93.
Qing., L. Jian-xiong. (2007) https://doi.org/10.1016/j.brat.2015.
Evidence-Based Psychological 09.005
Treatments for Insomnia in Older
146
RELATIONSHIP BETWEEN THE SUPERVISION OF THE HEAD ROOM WITH
NURSE’S PERFORMANCE: A SYSTEMATIC REVIEW
Sofia Mayasari, Soliha, Berlian Yuli Saputri

Email: sofia.mayasari-2016@fkp.unair.ac.id
ABSTRACT
Introduction: A good quality nursing care is strongly influenced by performance of nurses at
work. Professional performance of nurse is a job performance based on PPNI standard. The
purpose of this study is to explain and describe the relationship between clinical supervision
and nurses’ performance. Method: The literature search conducted in some database major
such as DOAJ, Sage, Proquest, Medline, Google Scholar, Science Direct, PubMed, PIP. The
inclusion criteria are: 1) independent variable is nursing supervision, 2) the respondent is a
nurse, and 3) depedent variable is the performance of nurses. Literature contains of fifteen
journal articles selected from 54 journal articles. Fifteen studies in this study describe about
research on nurses' performance. Result: All research aims to determine the relationship of
clinical supervision with nurses' performance. Six articles examine the performance in
providing nursing care, four articles explain the performance of nurses in documentation of
nursing care, an article observes the performance of high vigilance drug safety, an article about
the implementation of the wound surgery care procedure, an article about the quality of drugs
intravenous provision, an article focuses on Prevention nosocomial infection, and an article
concerns on patient safety implementation. Thirteen studies showed there was relationship
between supervision and nurses performance and two studies showed there was no relationship.
Conclusion: The conclusion of this study indicate that clinical supervision activities are
effective in improving the performance of nurses. For further research, it needs to observe the
assessment of other components of performance. In addition, it needs to consider the number
and homogenous subjects (age, gender, education, length of employment) so it does not result
in bias.
Keywords: supervision, nurses’ performance
INTRODUCTON Assessment can be done at some

Supervision is a convinient process performances of nursing such as:
in completion of nursing tasks (Swansburg documentation, wound care, decision-
& Swansburg, 1999). Supervision is to making, the provision of high alert drugs,
plan, direct, guide, teach, observe, injection, ineos prevention, and patient
encourage, improve, trust, evaluate safety. One of controls carried out in
continuously in every nurse patiently, fair nursing management is supervision.
and wisely (Kron, 1987). Data were collected from some
Based on these definitions, it can be previous studies observing some hospitals
concluded that supervision is an effective such as Regional General Hospital (RSUD)
way to to achieve organizational goals. The and other type of hospitals. The results of
purpose of supervision is providing previous studies at RSUD Prof. Dr.
assitance to subordinates directly, so they Soekandar Mojosari stated that supervision
will be able to carry out tasks or jobs with for surgery wound care by the head room
good results (Suarli, 2009). has not good enough, implementation of
postsurgery wound care in accordance with
147
Standard Operating Procedures (SOPs) is criteria of the article were: 1) independent
influenced by several factors working variable is nursing supervision, 2) the
climate, supervision. From the data respondent is a nurse, and 3) dependent
obtained explains that there is a significant variable is nurses’ performance.
association between supervision with the The performance of nurses was
performance of nurses at RSUD Soprong, classified in some respects, which was the
West Papua (Margareth, 2016). Shinta performance in terms of high vigilance
(2012) concluded there is relationship (High Alert) to provision of drugs, mental
between the supervision of head room with disorder treatment, post-surgery wound
nursing care documentation in inpatient patient according to SPO, providing
RSUD Ungaran. intravena drug, nursing documentation,
Research conducted in inpatient of prevention of nosocomial infections, giving
Zainal Abidin Hospital in 2013 by Riana nursing care, implementing patient safety.
concluded that clinical supervision training Several designs used in this journal
effected on job satisfaction and nurses’ were one journal used Quasi study
performance. At journal Qalbia, 2013 also experimental, four journals used cross-
mentions that there is a significant sectional, Pre-experiment with pre-post test
relationship between motivation and group design, Pre experimental design with
nurses’ performance in implementing pre-post approach, only one group, and nine
patient safety at Universitas Hasanuddin correlational analytical research with cross
Hospital. Regarding to that statement, sectional approach. This study aims to
journal research conducted by Maylinda prove the relationship between supervision
2013 also shows there is a significant of head room and nurses’ performance.
relationship between a role of supervision The population in this study were all
of the head room as a planner, a director, a nurses in inpatient at several hospitals. The
coach, an observer, an assessor and nurses’ performance parameters used
performance in providing nursing care for questionnaire, 24 items of observation sheet
inpatient at RSI Ibn Sina Yarsi, Padang. nurses' performance using Gutmann scale,
Some studies abroad like journals in observational survey, questionnaire and
Iran and Sweden find out the relationship of check-list of assessment for nursing
clinical supervision and nurses’ documentation from Department of Health,
performance nurses (Hemant, 2005). Davis documentation evaluation instrument by
and Burke (2011) concluded that development team MPKP FIK UI - RSUPN
supervision is effective way to improve Dr. Cipto Mangunkusumo.
patient care. The positive side of
supervision is done well, true and obedient. RESULTS
Recommendation of several studies is to All researches aimed to determine
maintain the application of clinical the relationship of clinical supervision with
supervision of head room by sustainbility nurses' performance by identifying the
coaching, monitoring, and evaluation. kinds of performance of nurses. Six articles
examined the performance in provision of
METHODS nursing care, four articles assessed the
Literature were obtained from performance of nurses in implementation of
major databases such as DOAJ, Sage, nursing care documentation, an article
Proquest, Medline, Google Scholar, assessed the performance of high vigilance
Science Direct, PubMed, PIP. by entering drug safety, an article about the
keywords: supervision, nurse performance. implementation of procedur for surgery
The year limitation was no more than 10 wound care, an article about the quality of
years (2006 -2016). 15 out of 54 articles intravenous drug administration, an article
have fulfilled the criteria. The inclusion
148
on the Prevention Inos, and an article about performance of supervision and two studies
the implementation of patient safety. showed no there is no relation with the
It can be concluded, thirteen performance of nurse supervision.
researches showed there is relation with the
Table 1. identification article supervision relationship with the performance of nurses

Performance
No Awareness Nursing SOP quality of Documentation of prevention Patient
articles of drug care implementation in intravenous nursing care Inos safety
safety surgery wound drug
care
1 √
2 √
3 √
4 √
5 √
6 √
7 √
8 √
9 √
10 √
11 √
12 √
13 √
14 √
15 √
amount 1 6 1 1 4 1 1
DISCUSSION of nursing managers is expected to perform

Supervision is an important part of the function of guiding through good
nursing management. Management of supervision to guarantee the quality of
nursing care needs the ability in nursing care documentation.
supervision. Head room is a person in Shinta (2013) conducted on
charge so he/she should be able to be good research, good nursing supervision is able
supervisor to his/her nurse. Thus, it can to improve the completeness of the nursing
increase the quality nursing care given and care documentation up to three times better
performance of nurses.Supervision is really quality. So, the better supervision of the
needed to improve the working of nursing head room, the better completeness of the
care documentation. Interest of the leader nursing care documentation.
can be done by guidance and direction in Personal research (2009) showed
performing the task, the availability of that the factor of perception nurses
supervisor to listen and give suggestion for regarding supervision conducted by the
consideration, a broad-minded in receiving head room affects the performance of
staff complaints to resolve problems. nurses in documenting nursing care. Nurses
Monitoring which is implemented by direct who have a good perception of supervision
supervisor regularly may also encourage tend to perform better in nursing care
nurse to work better (Retyaningsih, et al. documentation so it needs to provide
2013). A good supervision supports the facility to develop the knowledge of nurses
environment to improve the quality of about supervision of head room and also to
nursing work so that the quality of enhance the ability of head room in
documentation could be better. The ability supervising nurse. Sugiharto (2012) stated
149
the supervision of nursing is a formal performance of high vigilance drug safety,
process and professional which is done by an article about the implementation of the
a supervisor or leader to support, guide, surgery wound care procedure, an article
direct, evaluate, and develop the knowledge about the quality of intravenous drug
and competence of nurses to complete the administration, an article on the Prevention
task with full responsibility in order to Inos, and an article about the
achieve goals of hospitals and patient implementation of patient safety. Thirteen
safety. studies showed there is relationship
Windhu, et al in 2011, showed there between supervision and performance of
was a significant relationship between nurses and two studies showed there is no
supervision of head room and nurses in the relationship between an effective clinical
implementation of standard operating supervision activities and improving the
procedures for postsurgery wound care. A performance of nurses in order to achieve
proper supervision significantly influences the maximum quality of nursing care.
powerful, positive pattern, where the better Monitoring by direct supervisor
supervision carried out by the head room regularly may also encourage nurses to
the more improving quality of wound care work better. Supervision of nursing should
by nurses. be done at least once a month.
Pitman (2011) explains that the
supervision is beneficial to improve quality
and allegiance in implementing nursing Recommendation
actions such as post-surgery wound care in 1. Carried out further studies on the
accordance with the SPO, to gain relationship between supervision and
knowledge, which is techniques of post- specific criteria e.g. age, education,
surgery wound care for consideration in length of employment etc.
making post-surgery wound care SPO. It 2. It needs to do research concerned about
improves the quality of service that aims to performance of nurses who focus on one
maintain the safety of the patient, that is to desired performance
prevent infection and other complications. 3. It is advisable for every hospital
The statement is also supported by a generally and the room, especially to
statement Royal College of Nurshing implement good clinical supervision on
(2003) in Clinical Supervision In The nurses or head room, either planned
Workplace. It mentions that supervision is supervision or unplanned supervision.
an importance and benefit to support
quality improvement, an opportunity to REFERENCE
learn new things, increasing the efficiency Azwar, A. (1996). Menj aga mut u
and effectiveness of the supervised person. pelayanan kesehatan: Aplikasi
prinsi p lingkaran pemecahan
CONCLUSION AND masalah. Jakarta: Pustaka Sinar
RECOMMENDATION Harapan.
Conclusion Andriani, Lembah. 2012. Kepuasan Kerja
Fifteen research in this study focus Perawat pada Aplikasi Metode Tim
on nurses' performance. All research aims Primer dalam Pelaksanaan
to determine the relationship of clinical Tindakan Asuhan Keperawatan
supervision with nurses' performance. Six (Studi Kuantitatif di Rumah Sakit
articles examine the performance in Dr. Saiful Anwar Malang). Jurnal
providing nursing care, four articles assess Aplikasi Manajemen, Vol.10 No.2,
the performance of nurses in the June 2012 : 419 – 424.
implementation of nursing care Atihuta, Jeles A, dkk. 2010. Analisis
documentation, an article assesses the Faktor yang Mempengaruhi
150
Kinerja Mutu Pelayanan di RSUD Analisis Data. Jakarta: Salemba
Dr. M. Haulussy Ambon. Medika
Universitas Hasanuddin Makassar : Hasibuan, M. (2003). Manajemen sumber
Makassar daya manusia. Jakarta: Bumi
Badi’ah (2008). Hubungan Motivasi Aksara.
Perawat dengan Kinerja Perawat Ilyas, Y. (2002). Kinerja: Teori, penilaian,
di Ruang Rawat Inap Rumah Sakit & penelitian. Jakarta: Badan
Daerah Panembahan Senopati penerbit Fakultas Kesehatan
Bantul Tahun 2008. Jurnal Masyarakat Universitas Indonesia.
Manajemen Pelayanan Kesehatan. Lupiah, Lauga. Dkk. 2009. Hubungan
12 : 74 – 82. Faktor-Faktor Motivasi dengan
Buheli, Kartin. 2012. Faktor – Faktor Yang Kinerja Perawat dalam
Mempengaruhi Kinerja Perawat Melaksanakan Asuhan
Dalam Penerapan Proses Keperawatan di Ruang Rawat Inap
Keperawatan di RSUD Toto RSUD Kefamenanu Kabupaten
Kabupaten Bone Balango. TTU. Jurnal Fakultas Kesehatan
Politeknik Kesehatan Kemenkes Masyarakat Universitas Udayana
Gorontalo : Makassar Bali : Bali
Emanuel, dkk. 2013. Hubungan antara Mulyono, M. Hadi dkk. 2012, Faktor Yang
supervisi kepala ruang dengan Berpengaruh Tehadap Kinerja
pendokumentasian asuhan Perawat di RS Tingkat III. 16.06.01
keperawatan di Rumah Sakit Umum Ambon. Jurnal AKK Vol 2 No. 1,
Daerah Ambarawa. Jurnal January 2013 : 18-26.
Managemen Keperawatan . Nainggolan, Mei Junita, 2010, Pengaruh
Volume 1, No. 1, May 2013; 1-6 Pelaksanaan Supervisi Kepala
Faizin, dkk. 2008. Hubungan Tingkat Ruangan Terhadap Kinerja
Pendidikan dan Lama Kerja Perawat Pelaksana Di Rumah Sakit
Perawat dengan Kinerja Perawat Islam Malahayati Medan, Skripsi,
di RSU Pandan Arang Kabupaten Universitas Sumatera Utara :
Boyolali. Jurnal Berita Ilmu Medan
Keperawatan ISSN 1979-2697, Notoatmodjo. Soekidjo. 2002.
Vol. 1 No.3, September 2008: 137- Metodologi Penelitian Kesehatan.
142 Jakarta : Penerbit Rineka Cipta
Fakhrizal. 2010. Pengaruh pelatihan dan Nursalam. 2011. Manajamen
supervisi terhadap kinerja perawat Keperawatan. Jakarta : Penerbit
pelaksana di ruang rawat inap Salemba Medika
RSUD DR. H. Yuliddin Away Nirwan dan Zamzami F. 1999. Motivasi
Tapaktuan Kabupaten Aceh Kerja Pegawai Dinas Kehutanan
Selatan. Tesis. Universitas Propinsi Daerah Istimewa Aceh.
Sumatera Utara Medan : Medan Jurnal Manajemen & Bisnis
Gillies, D.A. (2002). Nursing management: Riyadi, Sujono dan Kusnanto. Hari.
A system approach (3rd Ed.). Motivasi Kerja dan Karakteristik
Philadelphia: W.B. Saunders Individu Perawat di RSD Dr. H.
Company. Moh. Anwar Sumenep Madura
Hasibuan, Malayu S.P. 2008. Manajemen 2007. Jurnal. KMPK Universitas
Sumber Daya Manusia.Jakarta : Gadjah Mada : Yogyakarta
Penerbit Bumi Rosyidah. Haryono. Reni Oktafiani. 2008.
Hidayat, Aziz Alimul. 2008. Metode Hubungan Karakteristik Perawat
Penelitian Keperawatan dan Teknik dengan Kinerja Perawat dalam
Menangani ODHA di Rumah Sakit
151
PKU Muhammadiyah Yogyakarta, Siagian. Sondang. P 1989, Teori Motivasi
Jurnal Kesehatan Masyarakat dan Aplikasinya. Bumi Aksara,
Universitas Ahmad Dahlan Jakarta
Yogyakarta : Yogyakarta
Nurhaeni. (2001). Faktor-faktor
determinan yang berhubungan
dengan kinerja perawat pelaksana
di Rumah Sakit Jiwa Makasar
(Tesis Master, Tidak
dipublikasikan).
Fakultas Ilmu Keperawatan
Universitas Indonesia.Jakarta.
Panggabean, M.S. (2004). Manajemen
sumber daya manusia. Bogor:
Penerbit Ghalia. Indonesia
Persatuan Perawat Nasional Indonesia
(PPNI). (2004). Standar praktik
keperawatan. Jakarta: Pokja
standar praktik keperawatan.
Pitman, Steve. 2011. Handbook for Clinical
Supervisors: Nurshing Post-
Graduate Programmers. Dublin:
Royal College of Surgeons in
Ireland
Riwidikdo, Handoko. 2009. Statistik
Kesehatan. Jogjakarta: Mitra Cendekia
Royal College of Nurshing. 2003. Clinical
Supervision In The Workplace.
London: Royal College of Nurshing
S, Suarli. & Bachtiar. Y. 2012. Manajemen
Keperawatan Dengan Pendekatan
Praktisi. Jakarta: Erlangga Medical
Series
Sugiyono. 2013. Statistika untuk
Penelitian. Jakarta: Alfabeta
Siagian, S.P. (2005). Manajemen sumber
daya manusia. Jakarta: PT Bumi
Aksara.
Saydam. Gozali. 1996. Manajemen Sumber
Daya Manusia. Jakarta :
Djambatan.
Setiowati, Dwi. 2010. Hubungan
Kepemimpinan Efektif Head Nurse
dengan Penerapan Budaya
Keselamatan Pasien Oleh Perawat
Pelaksana di RSUPN Dr.
Ciptomangunkusumo. Tesis.
Universitas Indonesia : Jakarta
152
FACTORS ASSOCIATED WITH HALLUCINATIONS:
A SYSTEMATIC REVIEW OF MENTAL HEALTH RESEARCH
Dhia Diana Fitriani, Muhammad Luthfi

Email: fitriani.dhia93@gmail.com
ABSTRACT
Introduction :The world, approximately 450 millions people suffer from mental disorders.
Mental disorders have become serious problem in the world. There are at least one of four
people in this world experience mental disorder. Hallucinations are a symptom of mental
disorder. Impacts that can be caused by patients who have hallucinations are losing control of
themselves. In this situation patient may commit suicide, kills another person (homicide), even
damaging the environment. Avoiding such impacts requires knowledge of any factors
associated with hallucinations. The aim of this study is to see the extent of hallucinations in the
world especially factors associated with hallucinations. Methods: Searching journal articles
using multiple databases electronically with: Proquest, ScienceDirect, DOAJ, Sagepub,
Medline and Google Scholar. Time limit that used is a journal published from 2013 until 2017.
Result: The result of this Systematic Review is inequality technique (heterogenesis), but the
different is not overly influence (significant), because all factors included hallucinations
obviously, so the results are more varied. Conclusion: The findings of the study that examined
found that factors associated with hallucinations can be obtained from the individual itself and
environment.
Keywords: factor, Hallucination, Mental health
INTRODUCTION "Where is your soul?" Only a small part that

According to the World Health can show where his/her soul. This is
Organization (WHO), mental health is a because the soul is not the form of the
situation where a person is free from mental object, but a system of behavior, results of
disorders and have a positive attitude to thought, feeling, perception, and social
describe the maturity and personality. environmental influence. All of them are
Data from WHO in 2012 indicated manifestation of a person's psychological.
the number of people concerned about Therefore, to study mental health and
mental disorders globally, approximately nursing, study of the manifestations of soul
450 millions people suffer from mental related to material that can be observed in
disorders. People who experience mental the form of human behavior (Yusuf, dkk.,
illness most are live in developing 2015).
countries, as many as 8 out of 10 people Hallucinations are sensory
with mental disorders were not getting perception disturbance of an object in the
treatment (Kemenkes RI, 2012). absence of external stimuli, sensory
Soul is the human element that is perception disorder covers all the senses.
immaterial, but functions and Hallucinations are a symptom of mental
manifestations are related to the material. disorder that patients experience in sensory
Students who first learn the mental science perception changes, and sensation of a false
and mental health nursing often have form of sound, sight, taste touch, or smell.
trouble with things to learn, because the Patients feel the stimulus that did not exist
soul is abstract and intangible things. Every (Yusuf, dkk., 2015).
human being has a soul, but when asked,
153
Patients with mental disorders factor hallucination, 2) sample of at least 10
experience have a change in the orientation people, 3) parameters assessed are
of reality. One of manifestations that hallucination.
appear is hallucination make patient unable Hallucination parameters
to perform activity in daily life. To avoid assessed using instrument are vary widely.
such impacts requires knowledge of any One study using LaunaySlade
factors associated with hallucinations. The hallucinations Scale (LSHS-E), five studies
aim of this study is to see how far using the Positive and Negative Syndrome
hallucination developing in the world Scale (PANSS), Hallucination Scale (RHS),
especially factors associated with one study using the hallucinations and
hallucination. psychosis items of the Movement Disorder
Society, one study uses Revised psychosis
METHOD screening questionnaire (PSQ), and there
This study is a systematic review. are several studies that use multiple
Source of this research data is derived from instruments in a single study, as Psychotic
the literature obtained via internet in the Symptom Rating Scales (PSYRATS),
form of the results of studies conducted Hamilton Program for schizophrenia
around the world. Literature research Voices questionnaire, Delusions Severity
conducted in some major databases such as subscale of the PSYRATS, and Chicago
ProQuest, ScienceDirect, DOAJ, Hallucination Assessment Tool (CHAT).
SAGEPUB, MEDLINE, and GOOGLE The number of samples studied are
SCHOLAR by entering keywords factor, quite diverse ranging from 37-8580 people.
hallucination. The time limit which used is Most of the study design are using cross
a journal published from 2013 through sectional design followed by four cohort
2017. Of the 26.980 articles were obtained, studies, two surveys, and two randomized
15 articles that met the inclusion criteria. controlled trials.
The inclusion criteria of this study are 1)
Tabel 1. Selected characteristic of studies identified by review

Authors Number of sample Hallucination Measurement Design
Gaweda, 2013 Sample: 135 Revised Hallucination Scale (RHS) Cross Sectional
Sample : 87 Positive and Negative Syndrome Scale (PANSS) Cohort
Sheffield, 2013
Control : 27
Cross Sectional
Cohen, 2014
Sample : 198 The Structured Clinical Interview-PANSS
1. Positive and Negative Syndrome Scale Cross Sectional
(PANSS)
2. Scale for the Assessment of Positive Symptoms
Kern, 2014 Sample : 44 (SAPS)
3. Psychotic Symptom Rating Scales (PSYRATS)
4. Chicago Hallucination Assessment Tool
(CHAT)
1. Positive and Negative Syndrome Scale RCT
Sample : 51 (PANSS)
Tol, 2014
Control : 51 2. Psychotic Symptom Rating Scale
3. Hamilton Program for Schizophrenia Voices
Berg, 2015 Sample : 454 Positive and Negative Syndrome Scale (PANSS) Cross Sectional
Sample : 9,646 Extended LaunaySlade Hallucinations Scale Survey
Kompus, 2015
(LSHS-E)
Sample : 106 1. Selfreport Cardiff Anomalous Perceptions Scale Cohort
(CAPS)
Geddes, 2016
2. Positive and Negative Symptoms Scale
(PANSS)
Sample : 78 Interview Cohort
Ikeda, 2016 Sample after 3 years :
63
Misiak, 2016 Sample : 37 Positive and Negative Syndrome Scale (PANSS) RCT
154
Control : 57
Sample in 2000 : 8580 Psychosis screening questionnaire (PSQ) Survey
Sheaves., 2016
Sample in 2007 : 7403
Solesvik, 2016 Sample : 204 Positive and Negative Syndrome Scale (PANSS) Cross Sectional
Sample : 694 Auditory Vocal Hallucination Rating Scale Cohort
Steenhuis, 2016 Sample after 5 years :
337
Roncero, 2017 Sample : 767 Interview Cross Sectional
Sample : 371 Hallucinations and Psychosis item of the (MDS- Cross Sectional
Zhu,. 2017
UPDRS)
RESULTS AVH. Also, depression’s mood has also

Sheffield, et al. (2013) found that been shown to increase the risk of transition
patients with psychotic disorders who to psychosis in individuals with
experience auditory hallucinations reported hallucinations.
experiencing sexual harassment, physical Research by Misiak, et al. (2016)
and emotional heavier than patients who with a sample of 37 patients diagnosed with
never experienced auditory hallucinations. schizophrenia based on DSM-IV and ICD-
Sample in this study is 87 patients with 10. The Operational Criteria for Psychotic
psychotic disorders assessed with the Illness (OPCRIT) checklist is used to
Structured Clinical Interview for the DSM- validation diagnosis made, and the number
IV-TR (SCID) and interviewed by of control group is 57. Early Trauma
psychiatry. The number of control group are Inventory Self-Report-Short Form (ETISR-
27 healthy people (without a history of SF) is used for the assessment of the four
mental disorder or mental intervention types of childhood trauma: general trauma,
before). The patient group and the control physical punishment, emotional and sexual
group did not distinguish gender, ethnic or abuse that may occur under the age of 18
parents’s education. Patients are classified years old. The correlation between
into individuals groups who have or have frequency of AVH and significant sexual
not experienced certain symptoms in their event, DUI and depression PANSS factor
lifetime, based on data from the SCID scores (B = 0.234, t = 2.302, p = 0.024).
interview to explore the relationship This correlation is significant in women (r =
between trauma in childhood and certain 0.411, p = 0.008), but not in men (r = 0.122,
positive symptoms,. Participants were p = 0.380). Linear regression analysis
assessed for five types of hallucinations revealed that the number of categories AVH
(auditory, visual, tactile, gustatory, predicted by scores of sexual abuse in
olfactory) and 8 kinds of delusions women (B = 0.394, t = 2.501, p = 0.017) but
(reference, persecutory, grandiose, somatic, not in men (B = 0.123, t = 0.880, p = 0.383).
companies, control, thought broadcasting, Result showed that a history of childhood
and bizarre). trauma, especially sexual abuse, is
Kompus, et al. (2015) conducted a associated with a higher number of AVH in
survey research with a sample of 9.646 women but not in men.
young adults who were born between the The study by Zhu, et al. (2017)
years 1993-1995. The study included self- discuss the high prevalence of VHS (Visual
report young adult with two items assessing Hallucination) in patients with Parkinson
Auditory Verbal Hallucination (AVH). Disease, with cross sectional study design
AVH assessed with two items of the with 371 samples. Research shows high
extended LaunaySlade hallucinations Scale prevalence visual hallucinations in patients
(LSHS-E). Women in this group reported with Parkinson Disease.
higher levels of depression, it shows that Tol, et al. (2014) conducted a study
they have experience higher stress levels with a view of predisposing hallucination’s
that can explain they have more stress in the factors through the anatomical structure of
155
the brain with sample 51 patients (meets result of religious adolescents are more
DSM criteria for a diagnosis of likely to report AVH than adolescents
schizophrenia -iv) with the control group: without religiousity (O.R.¼2.6).
51 people (recruited through flyers and Participants reported their voices in this
advertisements do not merit a diagnosis of sample (16.3%), more than half reported
Axis-I lifetime. MRI data measured by positive noises.
Philips intera 3-tesla magnetic resonance Cohen, et al., (2014) conducted a
system. The results showed that the study with a sample: 198 people aged 55
abnormally low volume of the left inferior years old and older living in the community
frontal gyrus (IFG) and parahippocampal and was diagnosed with schizophrenia
gyrus associated with the presence of before age 45. Elder with schizophrenia
hallucinations (left parahippocampal gyrus auditory verbal hallucinations were lower
in this comparison (k = 836, Z = 3.93, MNI than had been reported earlier for younger
coordinates: [z = -21 y = 3 z = -29], people with schizophrenia. This study using
pFWE_ROI = 0.085). a cross sectional design with the result is
The study by Kern (2014) with presence of auditory verbal hallucinations
cross-sectional design. 44 participants (19 followed by the appearance of depression
men, 25 women) were studied. Only symptoms.
participants who met the diagnostic criteria Roncero, et al. (2017) by the number
for schizophrenia (as evidenced by the of participants were 767 patients were
diagnosis of SCID) or schizoaffective evaluated on CIP (cocaine-induced
disorder and had reported a history of psychosis) and included in the study, using
auditory hallucinations included in the data cross sectional design. Of the entire sample,
section. Participants were also given 6.6% reported CITSH at some point of their
questionnaires Positive and Negative lives, 48.4% had experienced some CIP
Syndrome Scale (PANSS), Scale for the apart CITSH, and 45% had no psychotic
Assessment of Positive Symptoms (SAPS), symptoms. The risk of overdose increases
and Chicago Hallucination Assessment 12.1 (OR) times the probability of having
Tool (CHAT). A series of t-tests were used CITSH than patients with CIP-without-
to identify the possibility of a significant CITSH. The result is that patients with
difference in the scores of participants male CITSH (cocaine-induced tactile/ somatic
and female. Dimensions CHAT subscale hallucinations) have a bad addiction and
and total scores of CHAT were significantly more psychiatric comorbidities.
different with women report greater Sheaves, et al. (2016) in his research
severity. Post hoc analysis showed a with survey design, sample was 8580
significant difference in the item Loudness (2000), and 7403 samples (2007).
of PSYRATS and CHAT and the number of Participants filled in a questionnaire
items Negative Content CHAT, women (Revised Clinical Interview Schedule), and
report greater severity. Significant questionnaires emergence of hallucinations
difference was found between the average during the last 12 months was assessed
scores of women (M = 2.6, SD = 1.16) and using two items from The psychosis
the average value of male (M = 1.74, SD = screening questionnaire (PSQ). The results
0.93) on an item Loudness of CHAT; t (42) of this study were participants who have
= -2.66, p = 0.011. difficulty sleep during the last month (I1)
The study by Steenhuis, et al., increases with prevalence experience
(2016) with the initial sample amounted to hallucinations (H1) of 2.9 to 6.6% (2000
694 children from a population-based case- dataset) to 3.1 to 6.3% (2007 dataset),
control with and without AVH Sample after Experience chronic insomnia (I3) increase
5 years amounted to 337 people (aged 12- the prevalence of experience hallucinations
13 years). Cohort study design with the (H1) from 3.8% to 11.5% (2000) and from
156
3.8% to 10.8% (2007). Prevalence of initial assessment between 4 and 6 weeks
chronic insomnia increase support H2 from after the violence occurred and followed up
0.7% to 3.1% (2000) and from 0.7% to for six months thereafter. Types of violence
3.3% (2007). experienced was a confrontation (N = 33), a
Research by Gaweda & Kokoszka random attack (n = 24), robbery (n = 22),
(2013) with a cross sectional and sample violence from family members or friends (n
135 students (98 female and 37 male). Two- = 19) and attacks in the context of work (n
dimensional character and self- = 8), All participants reported injured after
transcendence selfdirectedness getting violent. The results support the
vulnerabilities associated with the hypothesis that peri-traumatic problems
emergence of hallucinations. The result of (data-driven processing, lack of self-
this study is a connection between the referential processing and dissociation), a
conduct meta-cognitive beliefs mediate the negative assessment of the consequences
relationship between the dimensions of trauma (permanent changes, vulnerable
Cloninger's temperament with the self, blame themselves) and maladaptive
vulnerability of hallucinations in healthy cognitive control strategies (depressive
subjects. thoughts, reflections and numbness) can
Research by Solesvik, et al. (2016) have an impact on the likelihood of
with a sample size: 204 patients with first- subsequent occurrence of hallucinations.
episode psychosis. Using a cross sectional Research by Berg, et al., (2015) with
design. It met a result that visual a total sample of 454 patients with SCID-I
hallucination psychotic reported by 26.5% DSM-IV diagnosis of non-affective
patients. Experience childhood trauma psychotic or affective disorder. Using a
increases the likelihood of having psychotic cross sectional design. Patients from ethnic
visual hallucinations. minority groups (n = 69) reported
Ikeda, et al. (2016) conducted a significant trauma, especially trauma of
study with a cohort design. Amount of physical abuse/neglect, and sexual abuse.
samples are 78 and samples after 3 years are They had significantly more behavioral
63. Subitems at BFI indicates that the score symptoms of past hallucinations and
for general fatigue (p = 0.02), mood (p = hallucinations of a lifetime to hear two or
0.042), and relationships with others (p = more voices conversing. Regression
0.021) were significantly lower in patients analysis revealed that the presence of
with non hallucinations than those with first childhood trauma as an intermediary for the
onset of hallucinations. relationship between ethnic minorities and
Study by Geddes, et al. (2016) with hallucinations.
total sample 106 participants received
157
Table 2. Factors associated with hallucinations based on review
Factors associated with hallucinations
Author Trauma Gender Parkinson Brain Religiousity Age Cocain Sleep Self Fatigue Depression
Anatomy Disorder Character
Gaweda, 2013 v
Sheffield, 2013 v
Cohen, 2014 v v v
Kern, 2014 v
Tol, 2014 v
Berg, 2015 v
Kompus, 2015 v v
Geddes, 2016 v
Ikeda, 2016 v v v
Misiak, 2016 v
Sheaves., 2016 v
Solesvik, 2016 v v v
Steenhuis, 2016 v
Roncero, 2017 v
Zhu,. 2017 v
DISCUSSION CONCLUSION AND

A summary of the study review, RECOMMENDATIONS
showed that factors associated with Conclusion
hallucinations consist of many factors and Approximately 70% of data
interrelated, such as violence and trauma in hallucinations experienced by patients with
childhood (physical abuse, sexual abuse, mental disorders are auditory
emotional abuse, emotional neglect, and hallucinations, visual hallucinations 20%,
neglect of the physical), harassment or and 10% are hallucinations of smell, taste
sexual trauma are more prone to get and touch. Hallucinations are perceptions in
hallucinations as the next process, gender the conscious state without apparent
(women are more vulnerable to stimulation of the senses. The quality of the
hallucinations and more disturbed when perception felt by patients with very clear,
experience hallucinations, leading to the substantial and in fact came from outside
subsequent effect which is depression), the the real. Impact that can be caused by
anatomy of the brain (the low volume of patients who have hallucinations are losing
abnormal frontal gyrus of the left inferior control of themselves, so then patients
(IFG) and parahippocampal gyrus impaired sensory perception and behavior
associated with the presence of are controlled by hallucinations. In this
hallucinations), confidence in the minds of situation the patient may commit suicide,
talks in the head-related hallucinations will kills another person (homicide), even
also create hallucinations settled, insomnia damaging the environment. Results found
or sleep disturbance, fatigue, and the that factors associated with hallucinations
greater the level of anxiety, age, self focus, can be obtained from the individual itself
and extreme response is followed by (system anatomy and cognitive perception),
hallucinations. and the environment.
Although there are studies that find
results no significant association between Recomendation
self-image of the hallucinations, but most Subsequent research in the future
of the research found that the predisposing with larger samples and with the same ratio
factors of hallucinations can be obtained of men to women participants could give
from the individual itself (system anatomy more accurate results so that research
and cognitive perception), and the results can be generalized about the
environment. relationship between gender and severity of
hallucinations (Kern, 2014). In addition to
the effect of trauma history of violence or
physical abuse, emotional, sexual, and
neglect increase the severity of
hallucinations characteristic can be more
158
explain about the psychological and factors in older adults with
biological mechanisms involved in the schizophrenia. American Journal of
development of hallucinations and Geriatric Psychiatry, 22(5), 442–
psychosis due to persistent hallucinations. 449.
The results of this study can be a https://doi.org/10.1016/j.jagp.2013.
reference for nurses working in the Mental 07.001
Hospital, General Hospital, and the Depkes RI. (2012). Profil Kesehatan
community to provide nursing Republik Indonesia Tahun
interventions as early as possible. 2012.(Online). Tersedia :
Hallucinations precaution is essential to http://www.depkes.go.id. 23
prevent hallucinations become chronic and November 2017
persist, causing patients unable to return to Gaweda, L., & Kokoszka, A. (2013). A
their neighborhood, depression, or relationship between hallucination
attempted suicide. The relationship proneness and character and
between violence in the cause of trauma or temperament: A mediating role of
injury to the hallucinations have clinical meta-cognitive beliefs in a non-
implications. Nurses should be able to get clinical sample. Psychiatry
the history of patients who reported Research, 208(2), 183–185.
experiencing violence or abuse (physical, https://doi.org/10.1016/j.psychres.2
emotional, sexual), as this would influence 013.01.027
the actions of nursing and medical Geddes, G., Ehlers, A., & Freeman, D.
treatment to be given to them. Nurses (2016). Hallucinations in the
should also be aware of the high correlation months after a trauma: An
between sexual violence, physical and investigation of the role of cognitive
emotional abuse, and consider all types of processing of a physical assault in
violence and harassment as a potential risk the occurrence of hallucinatory
factor for experiencing hallucinations. experiences. Psychiatry Research,
Childhood trauma is a risk factor for the 246(February), 601–605.
emergence of hallucinations in some https://doi.org/10.1016/j.psychres.2
psychotic disorders. Prevention, early 016.10.081
intervention and treatment models should Ikeda, M., Kataoka, H., & Ueno, S. (2016).
be considered for individuals who are at Fatigue is associated with the onset
greater risk into a serious psychiatric of hallucinations in patients with
disorder (Sheffield, 2013). Parkinson’s disease: A 3-year
prospective study.
REFERENCES eNeurologicalSci, 4, 25–29.
Berg, A. O., Aas, M., Larsson, S., Nerhus, https://doi.org/10.1016/j.ensci.2016
M., Hauff, E., Andreassen, O. A., & .04.001
Melle, I. (2014). Childhood trauma Kern, B. (2014). Gender Differences in the
mediates the association between Phenomenological Characteristics
ethnic minority status and more of Schizophrenic Hallucinations,
severe hallucinations in psychotic Disertation 1–99.
disorder. Psychological Medicine, Kompus, K., Loberg, E. M., Posserud, M.
33291714(1), 1–10. B., & Lundervold, A. J. (2015).
https://doi.org/10.1017/S00332917 Prevalence of auditory
14001135 hallucinations in Norwegian
Cohen, C. I., Izediuno, I., Yadack, A. M., adolescents: results from a
Ghosh, B., & Garrett, M. (2014). population-based study. Scand J
Characteristics of auditory Psychol, 56(4), 391–396.
hallucinations and associated https://doi.org/10.1111/sjop.12219
159
Misiak, B., Moustafa, A. A., Kiejna, A., & Association with Childhood
Frydecka, D. (2016). Childhood Trauma. PloS One, 11(5),
traumatic events and types of e0153458.
auditory verbal hallucinations in https://doi.org/10.1371/journal.pon
first-episode schizophrenia patients. e.0153458
Comprehensive Psychiatry, 66, 17– Steenhuis, L. A., Bartels-Velthuis, A. A.,
22. Jenner, J. A., Aleman, A.,
https://doi.org/10.1016/j.comppsyc Bruggeman, R., Nauta, M. H., &
h.2015.12.003 Pijnenborg, G. H. M. (2016).
Riset Kesehatan Dasar (Riskesdas). (2013). Religiosity in young adolescents
Badan Penelitian dan with auditory vocal hallucinations.
Pengembangan Kesehatan Psychiatry Research, 236, 158–
Kementerian RI tahun 2013., 164.
http://www.depkes.go.id Diakses: https://doi.org/10.1016/j.psychres.2
23 Maret 2017 015.12.014
Roncero, C., Grau-López, L., Palma- Van Tol, M. J., Van Der Meer, L.,
Álvarez, R. F., Rodriguez-Cintas, Bruggeman, R., Modinos, G.,
L., Ros-Cucurull, E., Esojo, A., & Knegtering, H., & Aleman, A.
Daigre, C. (2016). Higher severity (2014). Voxel-based gray and white
of cocaine addiction is associated matter morphometry correlates of
with tactile and somatic hallucinations in schizophrenia:
hallucinations. European The superior temporal gyrus does
Psychiatry, 42, 63–69. not stand alone. NeuroImage:
https://doi.org/10.1016/j.eurpsy.20 Clinical, 4, 249–257.
16.11.006 https://doi.org/10.1016/j.nicl.2013.
Sheaves, B., Bebbington, P. E., Goodwin, 12.008
G. M., Harrison, P. J., Espie, C. A., Yusuf, dkk. (2015). Keperawatan
Foster, R. G., & Freeman, D. Kesehatan Jiwa. Salemba Medika :
(2016). Insomnia and hallucinations Jakarta
in the general population: Findings Zhu, J., Shen, B., Lu, L., Lan, W., Pan, Y.,
from the 2000 and 2007 British Zhang, L., … Zhang, L. (2016).
Psychiatric Morbidity Surveys. Prevalence and risk factors for
Psychiatry Research, 241, 141– visual hallucinations in Chinese
146. patients with Parkinson’s disease.
https://doi.org/10.1016/j.psychres.2 Journal of the Neurological
016.03.055 Sciences, 372, 471–476.
Sheffield, J. M., Williams, L. E., Blackford, https://doi.org/10.1016/j.jns.2016.1
J. U., & Heckers, S. (2013). 0.043
Childhood sexual abuse increases
risk of auditory hallucinations in
psychotic disorders.
Comprehensive Psychiatry, 54(7),
1098–1104.
https://doi.org/10.1016/j.comppsyc
h.2013.05.013
Solesvik, M., Joa, I., Larsen, T. K.,
Langeveld, J., Johannessen, J. O.,
Bjørnestad, J., … Brønnick, K.
(2016). Visual Hallucinations in
First-Episode Psychosis:
160
SYSTEMATIC REVIEW EFFECTIVITY OF BANANA (MUSA) AS ANTI-
DIABETIC AGENT ON MICE
Diana Hardiyanti, Diana Pefbrianti, Happy Restu Pratiwi

Email: diana.hardiyanti-2016@fkp.unair.ac.id
ABSTRACT
Introduction: Diabetes Mellitus (DM) is one of degenerative diseases which the number
keeps increasing and can be found around the world. In Indonesia, Riskesdas data shows that
there were an increase of Diabetes prevalence in Indonesia from 5,7% in 2007 to 6,9% or
around 9.1 million in 2013. The management of diabetes can be done pharmacologically or
non-pharmacologically. Banana (Musa) is one of abundant plants that can be easily found,
especially in Asia. Banana is believed to gave antidiabetic property. The aim of this reserach
was to understand the effect of banana in treating hyperglycemia. Methods: The research
journals reviewed in this systematic review were research from 2013 to 2016. Most of the
research is performed on animals. Journal search using search engine, such as ProQuest,
GOOGLE SCHOLAR, SCIENCE DIRECT. Results: All research journals found that banana
can be used as antidiabetic Conclusion: Generally, banana (Musa) is effective to be
antidiabetic agent on diabetic test animals. Yet, further research is needed for the effectivity of
banana’s antidiabetif agent on human, and homogenity of the research types and research
materials.
Keywords: Musa, Diabetes Mellitus, Antidiabetic, Mice
INTRODUCTION Registration Survey in 2014 show that in

Diabetes Mellitus (DM) is one of Indonesia Diabetes was the third number of
the degenerative diseases, which its number the bigest dead cause with presentage of
develops continually, and it can be found in 6,7%, after Stroke (21,1%) and Coronary
the entire world. Genetic factor, lifestyle, Heart Disease (12,9%). Even if it is not
excercise, and diet pattern are complex handled, this condition will be able to lead
etiology of DM (Brito et al., 2009). the derivation of productivity, disability,
Diabetes is disease caused by high and early dying.
level of blood glucose as the result of Diabetes management can be done
pancreas and insulin disturbance. with pharmacological or non-
Symptomps occuring in DM sufferer are pharmacological method (Indrawati et al.,
polydipsia, polyuria, poliphagia, body 2015). The experts of The World Health
weight reduction, as well as pins and Organization (WHO) explained that plant
needles (Hakim, 2010). can be antihyperglycemic source (WHO,
In Indonesia, The Riskesdas data 1980).
show Diabetes prevalence increased from Banana is the plant that grows in
5,7% in 2007 to 6,9% (around 9,1 million) many numbers and can be found easily,
in 2013. The data of International Diabetes particularly in Asia. Banana has many
Federation in 2015 explained the estimation kinds, which one of its kinds is ambon
number of Diabetes sufferer in Indonesia banana (Musa paradisiaca L.) which has
was predicted in the number of 10 million. savor for antidiabetic (Iman & Akter,
Like the world condition, Diabetes, 2011).
nowadays, becomes one of the bigest dead
cause in Indonesia. The data of Sample
161
METHODS was done after experimental animals were
In this sistematic review the fasted, and they got serum for impeding the
research which was reviewed was counted pancreas in producing insulin.
since 2013-2016. The majority of the Research by Kapel, et al (2013)
researchs were conducted in animal. found that there is a decrease on serum
This study sample used animal. The glucose level, insulin secretion stimulation
choosen animal was the house mouse (Mus and obstructing the enzyme acivity related
musculus) or Mencit in Indonesian term to the glucose absorption and the formation
with the age of 2-3 months (Indrawati et al., of AGE on groups of mice that are given
2015), white male rat (Rattus norvegicus) banana extract. Shodenhinde, et al (2015)
Sprague-Dawley which was from seven-to- found that fasting blood glucose of the mice
eight-month-old (Redya et al., 2016). The group that only given NPD is higher than
research which used experimental animals other groups, the mice groups that eceived
gained approval from ethic commitee diabetic medicine Acarbose and mice
previously. groups receiving Booli banana diet and raw
The experimental animals being amala diet has sigificant decrease on blood
used were choosen randomly, and they glucose level. Research by Redya, et al
were taken care in the animal laboratorium (2016) shows after 4 weeks treatment using
with room temperature less than 240, banana extract, significantly the serum
lighting (12 h day/night cycle) adapted for glucose level from diabetes (T2DM)
7 days (Redya et al., 2016): moreover, they decreased. Kaempe, et al (2013) shows that
were given normal pallet diet (NPD). They mice inducted with alloxan, receiving
were divided into some groups— fenolic extract from goroho banana did not
experiment group and control group. The show significant increae on blood sugar
experimental animals were induced by level, mice blood sugar level decrease
serum caused diabetic animal, as induction mostly on the administration of fresh
of streptozotocin (STZ) and saline glucose, banana extract for 67,6 mg/dl (61, 19%).
in one night, before the animals were All research journals found that banana can
fasted. be used as antidiabetic agent.
Banana was extracted with many
methods, and it was treated to be oral DISCUSSION
medicine for experimental animals. Banana Generally, these research journals
which was used in this study was ambon found that bananas are effective for
banana (Musa paradisiaca L) (Kappel et al., antidiabetic agent. These research include
2013), Amala banana and crude Booli Ambon, goroho, booli and amala bananas.
banana (Shodehinde et al., 2015). All treatments given orally, both directly
and extracted. The experiments were
RESULT performed in laboratories on test animals
All of gained journals described induced with diabetes. The results
antidiabetic efectivity of banana to reduce measured from the journals including the
blood glucose level in experimental effectivity of antidiabetic agent in bananas
animals, which were two journals from on test animals, the comparison of blood
Indonesia, one journal from Nigeria, and sugar level decrease with the administration
two journals from India. The aim of this of glibenclamyde, bananas extract and
research is to know the effect of using acarbose, length of time used for tthe
banana for treating hyperglicemi. decrease of blood sugar level.
The number of experimental Ambon bananas have been used in
animals in this research started from 20 to several research, through direct as well as
45 samples, with age from two-to-three- extracted administration, raw bananas, as
month-old. The giving of banana extract well as processed banana peels, this
162
research is still limited to test animals Hyperglycemia. GALENIKA
(Iman & Akter, 2011). Bananas have the Journal of Pharmacy, Vol.
effect on blood sugar level decrease. 2(1)(ISSN : 2442-8744), pp.133-40.
Kaempe, H.S., Suryanto, E. & Kawengian,
CONCLUSION AND S.E.S., 2013. Potensi Ekstrak
RECOMMENDATION Fenolik Buah Pisang Goroho (Musa
Generally, banana (Musa) is Spp.) Terhadap Gula Darah Tikus
effective for antidiabetic agent on test Putih (Rattus Norvegicus). Chem.
animal with diabetes. Yet, further research Prog. No.1, 6.
is reqired for the effectivity of banana’s Kappel, V.D., Cazarolli, L.H. & Pereira,
antidiabetic properties on human, and D.F., 2013. Beneficial effects of
homogenity of research type and materials. banana leaves (Musa x paradisiaca)
on glucose homeostasis: multiple
REFERENCE sites of action. Revista Brasileira de
Brito, E.C. et al., 2009. Previously Farmacognosia Brazilian Journal
Associated Type 2 Diabetes of Pharmacognosy, pp.706-01.
Variants May Interact With Redya, C.K., M. Suriyaa, P.V.V. &
Physical Activity to Modify the Haripriyaa, S., 2016. Synthesis and
Risk of Impaired Glucose physico-chemical characterization
Regulation and Type 2 Diabetes A of modified starches from banana
Study of 16,003 Swedish Adults. (Musa AAB) and its biological
Diabetes, 58(6), pp.1411-18. activities in diabetic rats.
Hakim, B., 2010. Analisis Faktor Resiko International Journal of Biological
Diabetes Mellitus tipe 2 di Macromolecules, 94, pp.500-07.
Puskesmas Tanrutedung, Sidenreg Shodehinde, S.A., Ademiluyi, A.O.,
Rappan. Jurnal Ilmiah Nasional. Obohb, G. & Akindahunsi, A.A.,
Iman, Z.M. & Akter, S., 2011. Musa 2015. Contribution of Musa
paradisiaca L. and Musa sapientum paradisiaca in the inhibition of α-
L.: A Phytochemical and amylase,α-glucosidase and
Pharmacological Review. Journal Angiotensin-I converting enzyme in
of Applied Pharmaceutical Science, streptozotoc ininduced rats. Life
01(05), pp.14-20. Sciences, 133, pp.8-14.
Indrawati, S., Yuliet & Ihwan, 2015. WHO, 1980. The WHO Expert committee
Effects Antidiabetic Extract Water on diabetes mellitus. Second report.
Of The Fruit Peel Bananas (Musa Technical report series, 646.
Paradisiaca L.) IN MICE (Mus
Musculus) Models Of
163
CHARACTERISTICS OF PARENTS’CARING IN THE DEVELOPMENT OF
CHILDREN UNDER FIVE YEARS
Monika Sawitri Prihatini*, Inayatur Rosyidah**

*
STIKes PemkabJombang
**STIKes ICME Jombang
Email: monika.sawitri@yahoo.co.id
ABSTRACT
Introduction: The development of children under five years need the stimulus of his parents,
if early childhood does not give any attention his development, so it cannot be repaired in the
next period, so it will affect the quality of life of children. The objective of this study is to
determine the factors that can affect parenting in stimulating the development of children under
five years. Methods: This study used analytical correlation research design. The population
was mothers with young children in the village of Losari, Ploso Jombang in September 2016
with a number of 220 people. The samples of 150 were used by simple random sampling
technique. The independent variable in this study were the factors which affect the parenting
of elderly people that are maternal age, maternal education, the involvement of fathers,
experience of parenting mothers and the mother's response to stress. The dependent variable in
this research was the development of children under five years. Data analysis techniques used
by chi-square test. Result: All the factors that affected parenting would affect the development
of children under five years also. Conclusion: Children’s development was a continuous
process which required the role of fathers and mothers, fathers and mothers were expected to
stimulate the development together for on reaching the optimal development.
Keywords: Characteristics, Parenting, Development, Children under five years
INTRODUCTION the relationship of parents (Supartini 2004

One of the parents’ tasks of young in Marlani 2014).
children is to care in providing the A child's ability to get each stage of
stimulation of growth and development the development will affect the health of a
starting from before birth phases until the holistic manner. The success/failure
phase of golden age (Soetjiningsih, 2007). experienced in one phase affects the ability
Children under five years period is called to complete the next phases. If a child has a
the golden period of a person, it means that recurring failure of development, the
if in this period a child does not get a good development will lack of ability.
and adequate stimulation from the Otherwise, if successes through its
environment around it so that a child's development, the child will have the ability
development is hampered and even can be to maintain and improve health (Potter &
disrupted (Agrina, 2008). Perry, 2005).
In Indonesia, more caring is played Developmental disorders occurred
by the wife/mother even though parenting if the genetic and environmental factors are
is a responsibility shared by the not able to meet basic needs for growth and
husband/father. Several factors which development of a child. The basic
affect the mother in providing care to requirement is the biopsychosocial needed
children are age of the parents, parental which is include biomedical needs (foster)
education, father involvement, and and psychosocial needs (love and polish).
experience in parenting, parents’ stress and Environment is an important factor to meet
the basic needs of the child. This
164
environment consists of microenvironment factors that can affect parenting in the
(mother/surrogate mother), mini’s development of children under five years
environmental (father, brother, sister, stimulation. This study examined the
socioeconomic status), meso’s factors that affect parenting consists of
neighborhood (things outside the home), maternal age, maternal education, the
and the macro environmental (Soesilowati involvement of fathers, mothers’ parenting
2004 in Marlani, 2014). and maternal stress on the development of
One of effort to detect irregularities children under five years.
early childhood development is the early The population in this study were
detection of developmental disorders of mothers with young children in the village
children. Through early detection and of Losari, Ploso Jombang in September
recognizing the problems in child 2016 with the number of 220 mothers. The
development, the recovery can be done samples were 150 by simple random
early so the child's growth can take place sampling technique. The instrument used in
optimally (Depkes RI, 2010). this study was a questionnaire and
observation sheet with a guide Pre-
METHOD Screening questionnaire Developments
The design of this study used (KPSP). Analysis of the data used the chi-
analytic correlation of cross sectional was square test
aimed to determine the determination the
RESULT
Table1. Parenting’s factor in stimulating the development of children under five
No Characteristic Category Frequency
Ʃ %
1 Maternal age < 20 year 35 23,3
20-35 year 90 60
>35 year 25 16,7
2 Maternal education Elementary-Junior high 56 37,3
Senior High 71 47,3
Diploma 1/Diploma 3/ Bachelor 23 15,3
3 Father’s involvement Good 101 67,3
Not good 49 32,7
4 The experience of mother’s parenting Good 105 70
Not good 45 30
5 Mother’s respond to stress Good 106 70,7
Not good 44 29,3
6 Children development Appropriate 103 68,7
Suspect 41 27,3
Deviation 6 4
Table 2. Statistic result test

Variable p-value
Maternal age Children development 0,048
Maternal education Children development 0,000
Father’s involvement Children development 0,020
The experience of mother’s parenting Children development 0,003
Mother’s respond to stress Children development 0,019
Table 1 showed the results that the characteristics in aged 20-35 years, the
majority (60%) of respondents have the characteristics of the education level almost
165
half (47.3%) of respondents had high The results of factor analysis of the
school. Most (67.3%) showed the mother's education with level of child
involvement of a good father in parenting. development obtained p-value of 0.000,
Mother parenting experience showed the which means that there was no relationship
majority (70%) of respondents have a good between maternal education levels with the
experience in parenting. In most (70.7%) of development of children under five years.
respondents have a good response to Almost all of mothers with secondary
manage stress. The results of observation education had children with appropriate
with a guide Pre-Screening questionnairres developmental. According to Azwar (2011)
Developments (KPSP) showed that the cognition formed by factors such as
majority (68.7%) of respondents have personal experiences, the influence of
children with developmental appropriate. others which is considered important,
Table 2 showed all the factors that culture, mass media, education, emotional
affect the care of children was the mother's and information. Person Education would
age, mother's education level, the affect the mindset of someone. According
involvement of fathers in parenting, Notoatmodjo (2007) the higher education
mother's experience in caring for children level, the easier to accept and develop
and the mother's response to the stress knowledge and technology, thereby
associated with the development of the increasing the productivity which it would
child. improve the welfare of family.
The education level of parents
DISCUSSION influenced on children development, low
Maternal age factor analysis results education levels of parents was a risk of
obtained p-value 0.048, which means that retard in the child's development. This is
there was a relationship between the due to the knowledge and ability to provide
mother's ages with the development of less stimulation than women with higher
young children. Maternal age in this study, levels of education. The education level of
mostly aged between20-35 years with parents, especially mothers greatly affect
appropriate child development. According parenting to their children, healthy
Notoatmodjo (2007) aged of 20-35 years behavior, and education and so on. This
were included in the age of middle adult was consistent with previous studies in
hood group, which was at the age level of Thailand. Children raised by parents with
development of thought patterns was low education have three times risk of
growing. Increasingly underage person's developmental retardation than parents who
level of maturity and strength to be more were highly educated (Isaranurug S, et al.,
mature in thinking and working, it was also 2005 in Ariani & Mardhani, 2012).
associated with the belief that older people Results of factor analysis of fathers'
would be more credible than the higher involvement obtained by p-value of 0.020,
level of maturity yet. which means there was a relationship
According to Hurlock (2007) age is between a father's involvements with the
one aspect that is involved in the formation development of children under five years.
of maturity, the age increases the maturity The involvement of fathers in parenting
level will increase, this will affect the was positively correlated with competence,
pattern of thinking and insight is initiative and social maturity (Stolz, et al,
increasingly wide spread. Mother aged 20- 2005). Father had the role of breadwinner,
35 years already have a maturity as a caring husband and gives a sense of
psychologically and physically so that it security, participate in children's education,
can carry out the exploration and as the protector of the firm, thoughtful and
development in the child stimulation well. loving. The involvement of fathers in
caring also be interpreted as how much
166
work did a father in thinking, planning, feel, had a real experience giving rise to the
notice, monitor, evaluate, worrying and perception of the mother based on the
praying for his son (Hidayati, 2011). experience that would influence the next
Based on the results of the study parenting.
mostly fathers' involvement both in the care Results of factor analysis of
of child development. Beside the mother, mother's response to the stress factor
the father also had a very important role in obtained p-value 0.019, which means there
the development of young children. Both was a relationship between maternal stress
contribute equally large in child responses in children's development. Stress
development, although the roles were done experienced by a father or mother or both
differently and proximity children who tend will affect the ability of parents to perform
to closer with the mother because have the role of parenting, especially in relation
existed since the child in the womb and to coping strategies had in dealing with
breastfeeding. While, the father was able to problems of children. Nevertheless, the
form a close relationship with the child child's condition can also cause the stress in
after period of laboring. the elderly (Agrina, 2008). In daily life,
The results of factor analysis gained parents would be faced with a disturbing
experience caring mother p-value of 0.003, atmosphere cognitive and affective in
which means that there was a relationship childcare. The emergence of tensions in life
between parenting experience with the resulting in problem-solving behavior
development of young children. Most (coping mechanisms) aimed at easing the
parents learned parenting practices from tension.
their own parents. Most of the practice they The stress response in this case was
received, but some were left behind. an important component that affects a
Unfortunately, when the method of the child's development. In this study, most of
parents passed on from one generation to the results obtained stress response was
the next, a practice that was both good and good. It showed that the coping
bad would be forwarded as well (Santrock, mechanisms of the child's mother in the
2007). care of either. Coping mechanism to stress
Previous experienced of parents of caring children was important because in
since they had previous experience in general all parents would experience stress
caring for children would be ready to in parenting. Stress could occur because of
perform the role of parenting and more the characteristics of children,
relaxed (Supartini, 2007). The number of characteristics of parents and neighborhood
children in a family would affect parenting characteristics. Stress experienced by the
applied by parents. The more number of elderly would affect the pattern of care that
children in the family, then there was a will have an impact on children's
tendency that the parents did not apply the development
maximum caring in children because of the
attention and time was divided between the CONCLUSION AND SUGGESTION
children one with another child (Wong, Conclusion
2008). Factors that affected the care of
Based on the results of research children under five years were factors of
experience both in the care of mothers maternal age, maternal education level
provide care development in children under factors, factors of fathers' involvement,
five years, it was because as mothers parenting experience factor and response to
already had more than one child so that the stress factors associated with the
experience of parenting that had previously development of children under five years.
been learning to provide care in the child.
Mother’s experience in previous parenting
167
Suggestion Notoatmojo, Soekidjo. (2007). Pendidikan
For health care providers could dan Perilaku Kesehatan. Jakarta:
apply the knowledge gained by doing Rineka Cipta
outreach to parents that always pay Potter & Perry. (2005). Fundamental
attention to the development of children by Keperawatan: Konsep, Proses dan
actively stimulating the development of the Praktik. Jakarta: EGC.
appropriate stage of the children’s age. Santrock, J. W. (2007). Life Span
Educational institutions were expected to Development: Perkembangan masa
develop courses of nursing children so that hidup. Jakarta: Erlangga
students had a greater insight related to the Soetjiningsih.(2007). Tumbuh Kembang
development of children. Anak. Jakarta: EGC
Stolz, H.E., Barber, B.K & Olsen, JA.
REFERENCES (2005). Toward disentangling
Agrina.(2008). Pengaruh karakteristik fathering and mothering: an
orang tua dan lingkungan rumah assessment or relative importance.
terhadap perkembangan balita di Journal of marriage and family 67,
wilayah kerja PKM Sidomulyo 1076 1092.
Rawat Inap Pekanbaru. Tesis. Supartini, Yupi. (2004). Buku Ajar Konsep
Fakultas Ilmu Keperawatan Dasar Keperawatan Anak. Jakarta:
Universitas Indonesia. EGC
Ariani&Mardhani. (2012). Usia anak dan Wong, D.L, Hockenberry, M.E, Wilson, D,
pendidikan ibu sebagai factor resiko Winkelstein, M &Schwarta, P.
gangguan perkembangan anak. (2009). Buku Ajar Keperawatan
Jurnal kedokteran Brawijaya Vol 27 Pediatrik. Edisi 6. Jakarta: EGC
No 2 Agustus 2012
Azwar.(2011). Sikap Manusia. Jogjakarta:
Gadjah mada Press
Depkes RI. (2010). Pedoman pelaksanaan
stimulasi, deteksi dan intervensi
dini tumbuh kembang anak di
tingkat pelayanan kesehatan dasar.
Direktorat Bina Kesehatan Anak
Dirjen Bina Kesehatan Masyarakat.
Jakarta
Hidayati, F Veronika, S. K. Karyono
(2001). Peran Ayah dalam
Pengasuhan Anak. Jurnal Psikologi
UNDIP. Volume 9 No 1
Hurlock, E.B (2007). Perkembangan Anak.
Jakarta: Erlangga
Marlani, Alfi Poppy. (2014). Faktor-faktor
yang mempengaruhi pengasuhan
orang tua dalam pemberian
stimulasi perkembangan bahasa
pada anak usia toddler di PAUD
Kec. Syiah Kuala Banda Aceh.
Thesis
FakultasKeperawatanUniversitasSy
iah Kuala
168
EFFECTIVENESS HYPNOSIS RELAXATION TECHNIQUES FOR
PATIENTS WITH HYPERTENSION
Ahmad Nur Khoiri, Fahruddin Kurdi, Nurul Hidayah

Program Pendidikan Profesi Ners, Stikes Pemkab Jombang
Email: -
ABSTRACT
Background: Hypertension is a public health problem that is often known as a silent killer.
Persistent systolic blood pressure above 140 mmHg and diastolic above 90 mmHg (Smeltzer and
Bare, 2002). The number of hypertensive patients estimates 15 million people, 90% are essential
hypertension, amount of 4% as controlled hypertension, 50% of them are not aware of a patient,
so it tends to be severe hypertension because it does not avoid the risk factors. The condition occurs
because many patients are unable to control hypertension in non-pharmacological approaches that
hypnosis relaxation techniques. The objective of this study is to analize effectiveness of hypnosis
relaxation techniques for reduce high blood pressure. Methods: This study used quasy experiment,
one group pretest – posttest design. There were 15 participants. used purposive sampling technique
which Wilcoxon analize, p = <0.05. Results: The statistical result p value p (0,002) < α (0,05),
there was significant difference of pretest and posttest. there was significant difference of
intervention to reduce high blood pressure. Conclusion: the conclusion of this study there was
significant influence of relaxation with hypnosis for reduce high blood pressure.
Keywords: relaxation, hypnosis, high blood pressure, and blood pressure.
INTRODUCTION The Internal factors that can be

Hypertension is a public health affect a hypertension were age, gender,
problem that is often known as a silent health status, and lifestyle. In addition to
killer. Persistent systolic blood pressure the wrong dietary factor and the desease
above 140 mmHg and diastolic above 90 that had suffered, the factor of
mmHg (Smeltzer and Bare, 2002). The psychological problems was possible
number of hypertensive patients estimates caused hipertension. These conditions
15 million people, 90% are essential triggers uncontrolled of blood pressure in
hypertension, amount of 4% as controlled people with hypertension. As for external
hypertension, 50% of them are not aware of factors that were known to affect the
a patient, so it tends to be severe incidence of hypertension were the family
hypertension because it does not avoid the system, social, cultural, environmental,
risk factors. The condition occurs because health care systems, and resources
many patients are unable to control influence the incidence of hypertension
hypertension in non-pharmacological (Black, 2009).
approaches that hypnosis relaxation People with hypertension generaly
techniques. would be encouraged to seek health care it
Based the results of Riskesdas self, it purposed to make a blood pressure
(2013) it known that the prevalence of was stable depending the drug. The Reality,
hypertension in Indonesia amounted to the increased of blood pressure were caused
25.8% in the group of age >18 years old. the psychological factor not always can be
This shows that there is a decrease from intervention by drugs, so to control the
2007 that the prevalence was 31.7%. blood pressure that caused psychological
factor, it necessary get the Alternative
169
treatment. So as to control the blood in bawangan village Ploso Jombang on
pressure caused by psychological needed February 15, 2017. The blood pressure of
alternative ways to control it. As it is known respondents had measured first, and then
that relaxation techniques can make calm was given relaxation techniques with
the mind and the physical body, stability of hypnosis approach, for over 30 minutes
blood pressure. Now, Relaxation is not new until 1 hour, and in the last the blood
treatment for the community, most of the pressure of respondent measured again. The
people interpret the relaxation is the relax collected data was tested with comparative
condition, and another understand that analysis Wilcoxon test, p => 0.05.
relaxation is an effort to condition our
physical better by condition our psychic RESULT
more calm, always think positive, and all The Implementation of the study
the problems are face calmly. Relaxation by held on February 15, 2017 at elderly
regulating of breathing will give respond to Posyandu in Bawangan village, Ploso
against the mass discharge (discharge the Jombang.
impulse by mass). Relaxation is also a
condition of decreasing peripheral Tables 2.1 The distribution characteristics
resistance overall, it caused by decreased of the respondents
tone vasoconstriction arterioles that Gender Total %
Male 5 33,4
influence to deceleration of blood flow Female 10 66,6
through arterioles and capillaries vessel, Age Total %
51-60 year 7 46,6
and giving enough time to deliver oxygen 61-70 year 8 53,4
and nutrients to the cells, especially for the According to the table above that explained
brain tissue or the heart and causes the cell most of the respondents were female
metabolism became more either because (66.6%). the distribution by age, the
the ATP energy production increased majority of age were 61-70 years (53.4%)
(Udjiati, 2002). As according Jurf and
Nirschl (1993) explains the benefits of Tables .2.2 Cross tabulation between age
relaxation is able to heal both physically and systolic blood pressure
and mentally. Age
Systolic pressure
%
120 130 140 150 160 170 180
Increasing people's understanding Pre
of good relaxation technique and is 51-60 1 1 4 1 46,6
61-70 3 3 2 53,4
especially for patients with hypertension, in 46, 26,
% 6,6 0 0 6,6 13,3 100
physiology can help control blood pressure 6 6
Post
and in mental can decreased the emotional 51-60 1 1 3 1 1 0 0 46,6
tension and improve the quality of health 61-70 0 0 0 3 2 2 1 53,4
% 6,6 6,6 20 26,6 20 13,3 6,6 100
for patients with hypertension. The
Application of relaxation techniques with a Based on table 2.2 can be explained
hypnotic approach by patients with that indicates there was a difference in
hypertension by self, help to control of systolic pressure between pre and post
blood pressure remained stable effectively. relaxation, such as the pre systolic pressure
of 140 mmHg (0%) in post becomes (20%),
METHOD the systolic pressure of 150 mmHg pre (6.6
This study using of quantitative %) in post (26.6%), then the pre systolic
research, Quasy Experiment, one group pressure of 160 mmHg (46.6%) subsequent
pre-post test design. The population of this post (20%), then pre systolic pressure of
study are elderly with hypertension a 170 mmHg (26.6%) post (13.3% ) and at
mount of 30 people, the sampling tehnique 180 mmHg systolic pre (13.3%) in the post
used purposive sampling, with 15 turned into a (6.6%)
respondents, and held at Elderly Posyandu
170
Table 2.3. Cross tabulation between gender hypertension in the elderly with p-value
and systolic pressure (0.002) <α (0.05). Relaxation is also a
Systolic pressure condition of decreasing peripheral
Gend
12 13 14 15 16 17 18 %
er resistance overall, it caused by decreased
0 0 0 0 0 0 0
Pre tone vasoconstriction arterioles that
33,
Male 0 0 0 0 2 2 1
3 influence to deceleration of blood flow
Fema
0 0 1 1 5 2 1
66, through arterioles and capillaries vessel,
le 7
6, 46, 26, 13, 10 and giving enough time to deliver oxygen
% 0 0 6,6
6 6 6 3 0 and nutrients to the cells, especially for the
Post
33,
brain tissue or the heart and causes the cell
Male 0 1 0 0 3 1 0
3 metabolism became more either because
Fema 66, the ATP energy production increased
1 0 3 4 0 1 1
le 7
6, 6, 26, 13, 10 (Udjiati, 2002). Smeltzer & Bare (2002)
% 20 20 6,6
6 6 6 3 0 describes the relaxation with deep
Based on table 2.3 can be explained breathing can improve the ventilation of
that there were differenced significant alveoli and facilitate the exchange of gases
statistically between gender and systolic and decrease physically and emotional
pressure in pre and post relaxation, for stress. Dianita, (2010) has explained that
example in systolic pressure 140 mmHg in the relaxation had impacted directly to the
pre (6.6%) and the post (20%), then a body functions, especially can decrease
systolic pressure 160 mmHg in pre vital signs. This condition has occurred
(46.6%), and the post turned into (20%). because parasympathetic nervous system as
the result of decrease heart rate, blood
Table 2.4 the Change of systolic pressure pressure and response of relaxation
between pre and post relaxation condition calmer (IBH, 2002).
Respondents Pra Post Sat. Wicxon
1
The blood pressure reduction can
160 150
2 160 140
be affected by a lot of factors. Especially
3 150 140 the elderly has high-risk hypertension. This
4 140 120 is consistent with the data in Table 2.2 that
5 170 150 age range from 50 to 70 years has a
6 170 160 tendency to an increase in blood pressure.
7 160 150
8 Z = -3.140 This condition is also consistent with the
160 150
α = 0,002 results of research by Andria, (2013) based
9 180 180
10 180 170 on data in the field that respondents mostly
11 170 160 elderly people who have hypertension at the
12 170 170 age of 60 years, 54.2% of 58 respondents.
13 160 140 This condition is due to some physiological
14 160 130
15
changes, in elderly increased peripheral
160 160
resistance and sympathetic activity,
Based on Table 2.4 can be showed
baroreceptor reflex sensitivity is reduced,
that score of Z = - 3.14 an α = 0.002, it can
while the role of the kidneys is reduced
be explained there were significant
where renal blood flow and glomerular
effectiveness of relaxation with hypnosis
filtration rate decreases (Gunawan, 2007).
method to decrease blood pressure for
In addition to these conditions, an
hypertension patients.
increase in blood pressure can also be
caused by gender. In Table 2.3 are
DISCUSSION
generally the female gender dominate the
According the result of this study,
incidence of hypertension. It is possible to
showed the relaxation technique with a
occur due to aging. According to Gunawan
hypnotic approach was effective to
(2007) in premenopausal women slowly
decrease blood pressure for patients with
171
begin to lose estrogen during this time REFERENCES
protect blood vessels from damage and Arif, A (2011) The Handbook.
generally begin to occur at the age of 45-55 Hypnotherapy, Scripts dan
years. Response drop in blood pressure Strategis. PT.Elek Media
before and after the intervention relaxation Komplitindo-Gramedia. Jakarta
with hypnotic methods are most of the Andria, KM (2013) Hubungan antara
female gender. This condition is likely due perilaku olahraga, stress dan
to motivation, and concentration of a pola makan dengan tingkat
person. According to IBH, (2002) describes hipertensi pada lansia, Jurnal
"the process of relaxation with hypnosis Promkes, Vol. 1, No. 2 Desember
method approach is done by changing the 2013, ournal.unair.ac.id
concentration of the external focus to an Arikunto,S (2006). Prosedur Penulisan Suatu
internal focus to do their own (Self Pendekatan Praktik. Jakarta. Rineka
Hypnosis) or with the help of others. For Cipta
those who have psychiatric conditions are Black,J.m & Hawks, J.H., (2005). Medical
relatively calm or used to concentrate on surgical nursing: Clinical
management for positive
the internal (meditation, prayer, etc.) tend outcome (Vols 1-2,ed 7). Missouri :
to more easily enter Hipnotic State ". Elseviet Sauders.
Based on the data and description of Gardner,S.F.,(2007). Smart treatment for high
the concepts related to the influence of blood pressure.Jakarta: Prestasi
relaxation with the approach of hypnosis on Pustaka.
patients with hypertension in the elderly, Gunawan, A W(2005). Hipnosis : Meraih
the relaxation with the approach of Sukses dengan Kekuatan Pikiran,
hypnosis provides direct effects on our Gramedia Pustaka Utama, Jakarta
body, tone aterial vasodilation then causes _________(2008). The Secret of
the blood flow smoothly through arterioles Mindset, Gramedia Pustaka Utama,
Jakarta
and capillaries further distribution oxygen
Gunawan, L. 2007. Penyakit Tekanan Darah
and nutrients to the cells, especially the Tinggi. Jakarta : Anggota IKAPI
brain and heart tissue cells. Then the IBH (Indonesian Board of Hipnotherapi),
parasympathetic response resulted in (2002). Buku Panduan Resmi
slowing heart rate, blood pressure drops Pelatihan Hipnosis, IBH .ver.1.00
and the response of a person's relaxation Kroger, (2008). Clinical & Eksperimental
effect becomes more calm and comfortable. Hypnosis, Revised Second Edition.
Age and sex is a condition that can’t be Lippincott Williams & Wilkins
changed greatly affect the degree of blood Santos. Y (2010) Fundamental Hypnosis. Alfa
pressure reduction after relaxation with Omega-NLP Nipno Center.
hypnosis approached, it is possible for age- Surabaya
Sugiyono. 2011. Statistika untuk
related physical conditions and
penelitian. Bandung : Alfabeta.
concentration as well as the motivation of a Susianti. A (2015). Teori dan Konsep Dasar
person. Hipnoterapi. Artikel. Ilmu
Kesehatan- Jiwa.blogspot.co.id
CONCLUSION
Based on the overall results of this
study is the effectiveness of relaxation with
a hypnotic approach to the reduction of
blood pressure in elderly hypertensive
patients significantly.
172
RELATIONSHIP BETWEEN WAIST-HIP RATIO (WHR) AND TOTAL
CHOLESTEROL LEVELS OF EMPLOYEES IN STIKES BINA SEHAT PPNI
MOJOKERTO
Esti Andarini*, Noer Saudah**, Ambar Asnaningsih***, Muhammad Muhlis**

* Faculty of Nursing, Universitas Airlangga
**STIKES Bina Sehat PPNI Mojokerto
***Akper Kosgoro
Email : esti.andarini-2016@fkp.unair.ac.id
ABSTRACT
Introduction: Waist-Hip Ratio (WHR) is an anthropometric indicator which accurate enough
to describe the composition of body fat associated with central obesity. Waist circumference
illustrates the high deposits of dangerous fat in the body, while the hip circumference is a
protective factor in cardiovascular disease events. Method: This research was used correlation
analysis with cross sectional approach. There were two research variables, WHR as
independent variable and total cholesterol levels as dependent variable. Population this study
were all employees of STIKES Bina Sehat PPNI Mojokerto, 79 respondents. Sampling
technique used in this study was purposive sampling. The sample of this study were all
employees of STIKES Bina Sehat PPNI Mojokerto who are accordance with the inclusion
criteria as many as 35 people. Data were collected using meter line to measure waist-hip
circumference and use cholesterol test kit to measure total cholesterol levels. Result: The
results of Spearman Rho Test showed there was no correlation between WHR and total
cholesterol levels, p = 0,688 ( p > 0,05 ) and r = 0.06. Conclusion: This result research showed
there was no significant correlation between WHR and total cholesterol levels of employees in
STIKES Bina Sehat PPNI Mojokerto. So that, not all people who have excessive WHR will
have excessive total cholesterol levels too.
Keywords: Antropometri, Waist Hip Ratio, Total Cholesterol
INTRODUCTION increase in triglyceride levels, and decrease

Waist-Hip Ratio (WHR) is an in High Density Lipoprotein (HDL) levels.
anthropometric indicator which accurate Fat in the abdominal cavity is one triggers
enough to describe the composition of body of cardiovascular disease. One of those
fat associated with central obesity. Waist cardiovascular disease is
circumference illustrates the high deposits hypercholesterolemia which can be known
of dangerous fat in the body, while the hip from the results of the waist and hip
circumference is a protective factor in circumference measurements. Thus, Waist-
cardiovascular disease events (National Hip Ratio (WHR) may indicate
Heart, Lung, and Blood Institute, 2011). hypercholesterolemia and cardiovascular
Cardiovascular risk factors will arise if the disease (Riska, 2008 and Watts G.F.,
WHR have a value greater than or equal to Barrett P.H.R., V. Burke, 2003).
0.85 in women and 0.90 in men - men Based on data from Riskesdas 2013,
(Kaulina 2009; in Antika 2014). An the proportion of population aged > 15
incerease in abdominal fat will cause years with total cholesterol levels above the
abnormalities of lipid metabolism. The normal value refers to the value determined
main abnormalities of lipid fractions is the on the NCEP-ATP III was 35.9%, which is
increase in total cholesterol levels, increase the combined population of borderline
in Low Density Lipoprotein (LDL) levels, category (total cholesterol levels  200-239
173
mg/dl) and high (total cholesterol levels > of WHR is simple and effective in detecting
240 mg/dl) (Riskesdas, 2013). The central obesity, it is necessary to conducted
prevalence of adult male population with further study about the implementation of
obesity in 2013 was 19.7% and in 2013 the this measurement in CHD (Coronary Heart
prevalence of adult women (> 18 year) was Disease). CHD as one of the deadly
32.9% which increase 18.1% from 2007 cardiovascular disease is expected to be
(13.9%), and 17.5% from 2010 (15.5%) detected earlier and prevented by
(Riskesdas, 2013). The results of existing measuring WHR (Antika, 2014). WHR as
research in 2014 showed that 35 of 51 an indicator of anthropometry which
respondents has excessive cholesterol accurate enough to describe the
levels with waist-hip circumference in men composition of body fat to determine
≥ 0.90 cm and ≥ 0.85 cm in women hypercholesterolemia based on total
(Antika, 2014). In STIKES Bina Sehat cholesterol levels. This prompted the
PPNI Mojokerto obtained approximately researchers to conduct research about
40% of employees are overweight and have relationship between Waist-Hip Ratio
a great body, so researcher interested in (WHR) and total cholesterol levels of
conducting research in STIKES Bina Sehat employees in STIKES Bina Sehat PPNI
PPNI Mojokerto. Mojokerto.
The large waist circumference is The purpose of this study was to
associated with increased of risk factors in determine the relationship between Waist-
cardiovascular diseases because waist Hip Ratio (WHR) and total cholesterol
circumference can describe the levels of employees in STIKES Bina Sehat
accumulation of intra-abdominal or visceral PPNI Mojokerto.
fat. If waist circumference > 90 cm for men
and > 80 cm for women, then they are at METHODS
risk of metabolic disorder which affects Based on the purpose of research,
blood pressure, total cholesterol levels, design used in this study was correlation
triglyceride levels, and insulin resistance. analysis with cross sectional approach.
Total cholesterol level is an indicator of Sampling technique used in this study was
early examination or screening which is purposive sampling. The sample of this
mild if compared with triglyceride, LDL, study were all employees of STIKES Bina
and HDL. If someone has total cholesterol Sehat PPNI Mojokerto who are accordance
levels in high borderline or even higher, with the inclusion criteria as many as 35
then the risk of experiencing cardiovascular people.
disease (hypertension, atherosclerosis, The variables in this study were
coronary heart disease, and stroke) will also divided into two that is WHR as
increase (Budiarti, 2015). independent variable and total cholesterol
Lifestyle changes can help decrease levels as dependent variable. In this study,
cholesterol levels and reduce the risk of researcher used a meter line for waist-hip
cardiovascular disease. Another way which circumference measurement and use
can be done is by reducing saturated fat cholesterol test kit “Easy Touch” to
intake, increasing on eat fruits and measure total cholesterol levels. Then the
vegetables, reducing salt intake, losing data were analyzed using SPSS for
weight if overweight, increasing physical Windows with cross tabulating and
activity, smoking cessation, and do not statistical test using Spearman Rho Test.
consume alcohol (Dr. Eleanor Bull, Dr.
Jonathan Morrell, 2008). Measurement of RESULTS
WHR is more sensitive in assessing fat Here are the results of research
distribution in the body, especially fat in the about the relationship between Waist-Hip
abdominal wall. Because the measurement Ratio (WHR) and total cholesterol levels in
174
STIKES Bina Sehat PPNI Mojokerto high dangerous fat in the body, while the
employees. hip circumference is a protective factor in
Table 1. Waist-Hip Ratio of Employees in cardiovascular disease events. have a value
STIKES Bina Sehat PPNI greater than or equal to 0.85 in women and
Mojokerto. 0.90 in men - men (Kaulina 2009; in Antika
Percentag 2014).
Waist-Hip Frequenc An incerease in abdominal fat will
No e
Ratio y cause abnormalities of lipid metabolism.
(%)
1. Normal 21 40 The main abnormalities of lipid fractions is
2. Excessive 14 60 the increase in total cholesterol levels,
Total 35 100 increase in Low Density Lipoprotein (LDL)
Source: Primary data in 2016 levels, increase in triglyceride levels, and
decrease in High Density Lipoprotein
Table 2. Total Cholesterol Levels of (HDL) levels. Fat in the abdominal cavity
Employees in STIKES Bina Sehat is one triggers of cardiovascular disease.
PPNI Mojokerto. One of those cardiovascular disease is
Total Percentag hypercholesterolemia which can be known
No Cholestero Frequency e from the results of the waist and hip
l Levels (%) circumference measurements. Thus, Waist-
1. High 19 54,3 Hip Ratio (WHR) may indicate
2. Low 16 45,7 hypercholesterolemia and cardiovascular
Total 35 100 disease (Riska, 2008)
2. Total Cholesterol Levels of Employees
Source: Primary data in 2016
in STIKES Bina Sehat PPNI Mojokerto
According to the Table 2 above, it is
Table 3. Relationship between Waist-Hip
known that almost all respondents have
Ratio (WHR) and Total
normal total cholesterol levels as much as
Cholesterol Levels in STIKES
19 respondents (54.3%).
Bina Sehat PPNI Mojokerto
Cholesterol is an essential
Employees.
component of all structural cell membranes
Total Cholesterol
and is major component of brain and nerve
Waist-Hip Levels Total
cells. Cholesterol present in high
Ratio High Low concentrations of the tissues glands and in
F % F % F % the liver where cholesterol is synthesized
Normal 12 34,3 9 25,7 11 100 and stored. Cholesterol is a steroid
Excessive 7 20 7 20 16 100 formation of several important materials,
Total 19 54,3 16 45,7 27 100 such as bile acid, folic acid, adrenal cortex
Source: Primary data in 2016 hormones, estrogen, androgen and
progesterone. But cholesterol when
DISCUSION presents too much amounts in the blood can
1. Waist-Hip Ratio of Employees in form deposits on blood vessel walls,
STIKES Bina Sehat PPNI Mojokerto. causing narrowing of blood vessel walls
According to the Table 1 above, it is which called atherosclerosis. When
known that most of the respondents have narrowing occurs in coronary arteries, it
normal WHR as much as 21 respondents can lead to coronary heart disease and when
(60%). WHR is an anthropometric it occurs in the brain's blood vessels, it can
indicators which accurate enough to lead to cerebrovascular disease (Almatsier,
describe the composition of body fat 2009).
associated with central obesity. Waist Although respondents generally had
circumference, illustrates the deposits of normal value of total cholesterol levels, but
175
if it examined per domain, most The aim is to avoid measurement errors due
respondents have excessive total to the influence of fat which had just
cholesterol levels. The higher cholesterol consumed (Antika, 2014).
levels in the blood, then it would be likely Measurement bias was also
to cause cardiovascular disease which can presented in the WHR measurement that is
cause death. respondents did not undress overall. It can
3. Relationship between Waist-Hip Ratio affect the results of WHR measurement.
(WHR) and Total Cholesterol Levels in The WHR measurement was a simple way
STIKES Bina Sehat PPNI Mojokerto to determine fat distribution either under
Employees. the skin or in the intra-abdominal tissue
According to the Table 3 above, it is (Arisman, 2010).
known that respondents who have normal Although these studies showed no
WHR, most of their total cholesterol levels significant relationship because cholesterol
were normal as much as 12 respondents levels was not the same as the waist and hip
(34.3%). circumference, it is important for us to keep
The WHR is a simple method to paying attention and keeping our waist and
describe the distribution of fat in the body hip circumference in normal state, and also
especially in sub-cutaneous and abdominal paying attention to the food intake and
fat tissue. In contrast with a body mass exercise regularly in order to prevent the
index which describes the distribution of fat risk of diseases.
throughout the body, anthropometry value
of waist circumference and WHR describes CONCLUSION AND
the distribution of fat in the abdominal area RECOMMENDATION
(Iman A. Hakim, Amina H. Awad., Nagwa Conclusion
H., Mohamed, & Salwa El-Husseiny, Most respondents in STIKES Bina
1997). Increased WHR is one indicator of Sehat PPNI Mojokerto has normal WHR,
abdominal obesity which is commonly most of them have high total cholesterol
associated with increased risk of chronic levels. Spearman Rho Test results using
disease because of its association with SPSS got value of  = 0.668 and r = 0.06
metabolic syndrome. Diet factor and energy where H0 and H1 accepted. It means that
expenditure through physical activity has a there was no relationship between Waist-
strong influence on the energy balance Hip Ratio (WHR) and total cholesterol
which triggers an increase in WHR levels in STIKES Bina Sehat PPNI
(Hartanti 2008; in Antika 2014). Mojokerto employees. So that, not all
This study showed there was no people who have excessive WHR will have
correlation between WHR and total excessive total cholesterol levels too.
cholesterol levels, p = 0.688 (p > 0.05) and
r = 0.06. This can be interpreted that there Recommendation
was no significant correlation between 1. For people who have excessive WHR
WHR and total cholesterol levels. It is expected to do exercise and
Incompatibility in this reserch reduce excessive food intake in order to
results with the hypothesis due to the make WHR in normal range.
existence of measurement bias in the study, 2. For people who have normal WHR
that is the sample of study was not fasted It is expected to keep WHR from
before. Preferably before cholesterol levels becoming excessive, so the health condition
checked, it is required to fasting 8-12 hours becomes good and avoid the risk of disease.
(overnight) for examination of total 3. For further researchers
cholesterol and HDL levels, 12-14 hours It is expected that further
for examination of triglyceride levels, and researchers can continue research which
9-12 hours for examination of LDL levels. aims to provide information about the
176
importance of keeping the WHR, so that Jalan Dislipidemia di Puskesmas
cholesterol levels can be controlled and the Janti KotaMalang.
research conducted with respondents http://fk.ub.ac.id/artikel/id/filedown
fasting before the study. Research should load/gizi/DIAN%20RISKA. pdf.
be conducted in a private place by using a accessed on November 24th 2015.
minimum of clothes in order to obtain Riskesdas. (2013). Riset Kesehatan Dasar.
accurate measurement results. (http://www.RisetKesehatanDasar.
co.id) accessed on November 24th
REFERENCES 2015.
Almatsier, S. (2010). Prinsip Dasar Ilmu Watts G.F., Barrett P.H.R., Burke V.,
Gizi: Lipida. Jakarta: Gramedia (2003). Waist Circumference,
Pustaka Umum. Waist-to-Hip Ratio and Body Mass
Antika Putri Rindi. (2014). Hubungan Index as Predictors of Adipose
Rasio Lingkar Pinggang Panggul Tissue Compartments in Men In
dengan Kadar Kolesterol Pada Oxford JournalsMedicine . QJM:
Guru dan Karyawan SMA An International Journal of
Muhammadiyah 1 dan 2. Medicine Volume 96, Issue 6 Pp.
Surakarta. 441-447.
http://eprints.ums.ac.id/28052/14/
NASKAH_PUBLIKASI.pdf.
accessed on November 24th 2015.
Budiarti Y. (2015). Hubungan Lingkar
Pinggang dan Kadar Kolesterol
Total Dengan Tekanan Darah Pada
Wanita Usia 46 – 55 Tahun Di Desa
Singocandi Kecamatan Kota
Kabupaten Kudus.
http://perpusnwu.web.id.accessed
accessed on November 24th 2015.
Bull Eleanor , monell jonathan. (2008).
Kolesterol. Jakarta : Erlangga.
Iman A., Hakim., Amina H., Awad., Nagwa
H,. Mohamed ., and Salwa El-
Husseiny. (1997). Blood
Cholesterol and Triglycerides in
Adolescent Egyptian Girls:
Relation to Anthropometric
Measurements In Food and
Nutrition. Bulletin Volume 18,
Number 1
National Heart, Lung, and Blood Institute,
(2011). Coronary heart disease risk
factors.Available:http://www.nhlbi
.nih.gov/health/healthtopics/topics/
hd/atrisk.html. accessed on Pebruari
17th 2015.
Riska DK., Hidayati SS.,Fadhlah
Eriza. (2008). Hubungan Lingkar
Pinggang dengan Kadar
Trigliserida pada Pasien Rawat
177
RELATIONS WITH NUTRITIONAL STATUS IN THE EVENT EARLY
MENARCHE GRADER V AND VI IN SDN 1 KEMAYORAN SURABAYA
Baiq Dewi Harnani R, Bambang Heriyanto

Poltekkes Kemenkes Surabaya
Email: baiqdewihr@yahoo.co.id
ABSTRACT
Introduction: Menarche happens in young women who have entered the stage of maturity,
especially organ reproductive system is an important period in the life cycle of women. This
period can also be a variety of changes that occur in a child's life cycle. In general, the
experienced menarche at age 10-16 years, but this time a girl's first menstruation at the age of
8-9 years were classified as early menarche. Various factors that cause such differences include
nutritional status. The aim of research to analyze the relationship between nutritional status and
the incidence of early menarche. Methods: This type of research is an analytic method with
cross sectional approach. The population in this study were taken from all students of class V
and VI at SDN 1 Kemayoran Surabaya as many as 25 students. The sample of 20 female
students by using simple random sampling technique. Retrieving data using questionnaires and
observation instruments nutritional status and age. Results: The results showed that the
majority of students have a fat nutritional status is as much as 10 students (50%), while
experiencing early menarche as many as 14 students (70%). Cross-tabulation be obtained from
girls who have fat nutritional status more likely to have early menarche i.e. 8 female students
(80.0%). Fisher's statistical test result Exact Test p value = 0.033. Conclusion: It can be
concluded that the nutritional status related to the incidence of early menarche. It can be
concluded that the nutritional status related to the incidence of early menarche. Therefore
expected student's parents pay more attention to growth and sexual development of children
and the factors related to the acceleration of sexual maturity (menarche) mainly related to
nutritional status.
Keywords: Nutritional Status, Early menarche
INTRODUCTION factors that cause such differences include

Adolescence is a time of change staus is nutrition. In general, the
from childhood to adulthood when the experienced menarche at age 12, but this
shape of the body, how to think, act, and the time a girl's first menstruation at the age of
act of an individual, no longer children but 8-9 years were classified as early menarche.
also adults who have not matured. Usually Soetjiningsih, 2010).
a period of change towards puberty is Based on a national survey of the
located at the age of 10-16 years. One of the average age of menarche girls in Indonesia
signs of puberty in girls is menarche, which was 12.96 years with a prevalence of 10.3%
usually occurs at age 10-16 years. early menarche and late menarche by 8.8%
Menarche happens in young women (Coal, 2010). While the results of
who have entered the stage of maturity, RISKESDAS Indonesia in 2012 showed
especially organ reproductive system is an that the average age of menarche in
important period in the life cycle of women. Indonesia is 13 years, with early events in
This period can also be a variety of changes less than 9 years of age or later the age of
that occur in a child's life sikuls. The 17 years. In East Java, Surabaya city,
presence of menstruation in women who especially around 0.1% of young women
were first on everyone's different. Various experiencing early menarche at age 6-8
178
years, and about 26.3% more received menarche impact on the individual reaction
menarche at age more than 14 years. (MOH of young women at the time of first
in 2012). menstruation to in the stimulus of various
As well as the factors that influence factors only in puberty changes are not just
early menarche namely nutritional status, happening in the physical aspect but also
media information, socio-economic, can occur in a change in the status of the
psychological stimulation, hormonal, age social, psychological, economic, education,
of menarche mother, birth outcomes, and anxiety, tension, nervousness, irritability,
physical activity and these studies weight gain, depression, quick to cry.
involving 5358 young women (10-16 years Handling effective in treating anxiety in
old) throughout the territory of Indonesia as students by providing counseling to
the population. (Riskesdas, 2010). The students about ways to deal with anxiety at
improvement in living standards today also menarche by medical personnel such as the
affect the improvement of nutrition and the role of doctors and other health personnel in
decline in age of menarche, may reflect order to reduce anxiety in adolescents at
better nutrition and improved public health menarche in addition to reducing anxiety
(Noor, 2011). Nutritious foods and high fat need to set a pattern that meets nutrient
and animal products, will lead to weight balanced.
gain in adolescent girls. Estrogen levels will The solution according to the above
rise due to high cholesterol. Not just any fat problems that we as health workers should
from the body composition but otherwise provide information to parents of students
influenced by the intake of food and the in order to always pay attention to the
absence of factors debilitating disease. One consumption of their children because the
thing that can affect the formation of future is now very necessary once-
hormones one of which is nutrition, with makananya consumption of nutritious
good nutrition can accelerate the formation eating, and to improve the nutritional intake
of hormones that affect the arrival of of female students in elementary school.
menarche. So, with improved nutrition or a
good nutritional intake can lead to age of METHODS
first menstruation became earlier This research is an analytic research
(Waryana, 2010). The impact of early with cross sectional approach observation.
menarche may affect some malignant The sample size was determined by using a
disease risk factors including metabolic formula of the population of 25 students,
cardiovascular disease (heart) and cancer, Sampling as many as 20 students by using
especially breast cancer when she was an Simple Random Sampling.
adult and early menarche age is a risk factor The experiment was conducted in
for ovarian cancer (Lakshman, 2009). February - March 2016 at SDN 1
Menarche usually depends on several Kemayoran Surabaya. The independent
factors, including women's health, namely, variable of research is nutritional status.
nutritional status, descent and the media The dependent variable is the Early
factor. Nutrients that affect sexual maturity menarche. Instruments used in the form of
at the girl who gets her first period early, questionnaires and direct observation by
they tend to be heavier and higher during measuring height and weight.
the first period than those who have not Data were analyzed using Fisher's Exact
menstruating at the same age. Inhibition of Test test, with significance level α ≤ 0.05.
reproductive hormones that induce
menstruation and lack of knowledge about RESULTS
menstruation in young women can have an Table 1 shows the data on the age
impact on readiness to face menarche. distribution of children most in the age
Readiness or unpreparedness to face group 10 years as many as eight
179
respondents (40%), aged 11 years and 7 Menarche Dini 14 70
students (35%), aged 12 years five Jumlah 20 100
respondents (25%). In Table 3 shows that of the cross
Table 2 shows the distribution of the table showed that the nutritional status of
nutritional status of most of the nutritional skinny does not undergo early menarche
status of obese group of 10 respondents number of 3 respondents (100%), while the
(50%), while the thin nutritional status by 7 nutritional status of obese showed the
respondents (35%), and normal nutritional number of respondents who had
staus as many as three respondents (15%). experienced early menarche as much as 8
respondents (80.0%), and normal
Table 1. Distribution of respondents based on the nutritional status who have early menarche
nutritional status of girls in SDN 1 only 6 respondents (85.7%) and 1 (14.3%)
Kemayoran Surabaya in February 2016. of respondents did not undergo early
Nutritional Status Frequency Percentage (%)
menarche.
Thin 3 15 From the calculation results with
Normal 7 35
Fat 10 50
test Fisher's Exact Test with a significance
Jumlah 20 100 level (α): 0,05 obtained P = 0.033. Fisher's
Exact results calculated above is smaller
Table 2.
Distribution of respondents who than α, means that H1 is accepted.
experienced early menarche in girls at This has the relationship between
SDN 1 Kemayoran Surabaya in February nutritional status and early menarche in
2016
female students in class V and VI SDN 1
Menarche Frequency Percentage
(%) Kemayoran Surabaya.
Tidak Menarche Dini 6 30
Table 3. Cross tabulation of nutritional status relationship with the incidence of early menarche with respondents
who had experienced early menarche at SDN 1 Kemayoran Surabaya, in February 2016.
Status Gizi Menarche Dini Tidak Menarche Total
f % f % f %
Kurus 0 0% 3 100 3 100
Normal 6 85,7% 1 14,3 7 100
Gemuk 8 80 2 20 10 100
Total 14 70% 6 30 20 100
Chi – Square Tests

Value df Asymp. Exact Sig. Exact Sig. Point
Sig. (2- (2sided) (1sided) Probability
sided)
Pearson Chi-Square 8.299 2 .016 .033
Likelihood ratio 8.68 2 .013 .033
Fisher”s Exact Test 6.719 .033
Linier by Linier Association 4.121 1 .042 .051 .046 .037
N of valid cases 20
a. 5 cells (83,3%) have expected caunt less than minimum expected count is, 90
b. The standardized statistic is 2,030.
DISCUSSION the advantages and disadvantages of

The result showed most students weight. School-age children quickly
experience the nutritional status and the affected by the environment. Penchant for
criteria obese by 10 students (50%). Child unusual, such as eating too much fast food.
nutrition problems affect weight judged by Nutrition affects sexual maturity at the girl
180
who gets her first period early, they tend to 3. Based on the results of statistical tests
be heavier and higher during the first period showed that P = 0.033, from the results
than those who have not menstruating at the obtained relationship between
same age. We recommend that the girl nutritional status and the incidence of
menstruating late, weighs lighter than it early menarche grader V and VI SDN 1
already menstruating at the same age, Kemayoran Surabaya.
although the height (TB) they are equal.
(Santy, et al, 2006). Recomendation
The results of the 20 students that 1. For the School
most of the students who had early Party schools should provide education
menarche 14 students (70%). It can be seen to reproductive issues menstruate
that 70% of students who have already earlier mainly due to the acceleration of
experienced a lot of early menarche at an the age of menarche in young women
earlier age. From the above data the factors 2. For Parents
that influence early menarche namely Parents should pay more attention to the
nutritional status. Menarche is the first growth and sexual development of
period that occur due to the complex children and the factors related to the
hormonal system. Most of the young acceleration of sexual maturity
women who are obese are met will be (menarche) mainly related to nutritional
nutritionally than skinny. that the level of status.
quality of better nutrition in today's society 3. For Researchers
trigger early menarche. (Proverawati and Further studies regarding the factors
Misaro, 2009). associated with menarche.
The analysis shows that for the
value of Fisher's Exact Test, Sig. (2-sided) REFERENCE
obtained by 0.00003. Because the value of Aishah, Siti. (2011). The relationship
Sig. (2-sided) 0.00003 <0.05 it can be seen between the age of menarche
that H1 is accepted which means no Nutritional Status of the female
significant relationship between nutritional students of Elementary School
status relationship with the incidence of (SD). Essay. University of North
early menarche. According Andira, Dita Sumatra: Medan.
(2010), Girls who are obese often Almatsier, Sunita. (2009). Basic Principles
experience menarche earlier than of Nutrition. Moulds IX Gramedia,
adolescent girls underweight. Nutrition Jakarta.
affects sexual maturity at the girl who gets Andira, Dita. (2010). Inside Women's
her first period early, they tend to be heavier Reproductive Health. Yogyakarta:
and higher during the first period than those A Plus Books.
who have not menstruating at the same age. Arisman, (2007). Nutrition in the Life
Cycle. Jakarta: Book Medical
CONCLUSION AND Publishers.
RECOMENDATION Alimul Aziz Hidayat. (2010). Methods for
Conclusion Health Research; Quantitative
1. Based on the results obtained, namely Paradigm, First Edition. Surabaya:
the majority of students have a fat Health Books Publishing.
nutritional status Bambang Heriyanto. (2013). Quantitative
2. Based on the results in getting the Research Methods Theory and
majority of students at SDN 1 Applications. Surabaya
Kemayoran Surabaya have experienced Alimul Aziz Hidayat. (2010). Methods for
early menarche Health Research; Quantitative
181
Paradigm, First Edition. Surabaya: Persagi. (2009). Indonesian Food
Health Books Publishing. Composition Table. Jakarta. PT
Bambang Heriyanto. (2013). Quantitative Elex Media Komputindo.
Research Methods Theory and Proverowati and Maisaroh. (2009). First
Applications. Surabaya Menstruation Meaningful
Coal, JR, et al. (2010). Age At menarche In menarche. Yogyakarta: Nuha
Indonesia Girls: A National Survey. Medika hal.58-73
Department Of Pedriatrics, Faculty RISKESDA, (2012). Guidelines for Health
Of Medicine, University Of Research Association menarche.
Indonesia-dr. Mangkusumo Cipto http://riskesda.litbang.depkes.go.id
Hospital 2010Apr: 42 (2): 78-81. RISKESDA. (2013). Prevalence of Child
January 11, 2012. Nutrition Status (TB / U & B / U)
http://isjd.pdii.lipi.go.id/admin/jurn According to East Java province.
al/ 1410265272.pdf Santy, Rini. (2006). Body Mass Index
Ministry of Health of the Republic of Determinants of Young Women in
Indonesia (2012). Guidelines for Bukit Tinggi Year 2006.Jurnal
Management of menarche. National Public Health Vol.1, No.3,
http://depkes.go.id OR December 2006
MOH, (2012). Guidelines for Management Sirajuddin, Saifuddin. (2012). Nutritional
of menarche. http://depkes.go.id Status Assessment Practical
Fatmah and Yati Ruhyati. (2011). Nutrition Guidance In Biochemical and
Fitness and Sports. Bandung: Anthropometric
Lubuk Court. Soetjiningsih. (2010). Subjects:
Gunarsa, S.D. (2009). Development of Developmental Youth and Its
Child and Adolescent Psychology. Problems. Jakarta: Sagung Seto.
Jakarta: PT BPK Gunung Mulia. Suhardjo, (2003). Various Ways Nutrition
Gunarsa, S.D. (2006). Development of Education. PT Bumi Literacy,
Child and Adolescent Psychology. Jakarta.
Jakarta: PT BPK Gunung Mulia. Waryana, (2010). Reproduction Nutrition.
Hurlock, E.B. (2002). Developmental Reader Rihama: Yogyakarta.
Psychology: an approach Wiknjosastro, Hanifa. (2006). Obstetrics,
throughout the life span. Surabaya: Third edition, Jakarta: YBP-SP.
Erland. Wiknjosastro, Hanifa. (2009). Obstetrics,
Ida Ayu Manuaba. (2009). Understanding Jakarta: Yayasan Bina Library
the Female Reproductive Health Sarwono Prawirohardjo.
(2nded). Jakarta. Book Medical Wong, Donna L. (2008). Textbook of
Publishers, EGC, Googlebook, Pediatric Nursing Wong. Issue 6.
accessed on October 19, 2011. Jakarta: EGC.
Lakshman. (2009). Early Age at menarche
Associated with Cardiovascular
Disease and Mortality. The Journal
of Clinic Endocrinology &
Metabolism.Vol.94: 4953-496.
Manuaba, I.B.G. (2004). Obstetrics,
Gynecology and Family Planning
For Education Midwives. Jakarta:
EGC
Notoatmodjo, S. (2010). Medical Research
Methodology. Jakarta: Rineka
Reserved
182
TREADMILL EXERCISE FOR INCREASING WALKING FUNCTION AFTER
STROKE
Fitria Yuliana, Novian Mahayu Adiutama, Muhammad Afif Hilmi, Setyo Kurniawan
Email: firia.yuliana@rocketmail.com
ABSTRACT
Introduction: Stroke is the leading cause of physical disability, weakness in the fulfillment of
daily living activity, difficulty walking, and mental decline in reproductive age and the elderly
who have an impact on socio-economic. From a number of clients post stroke, 10% of clients
can return to work without drawbacks, the disabled 40% lighter and 50% with severe
disabilities. The purpose of this study was to evaluate the effectiveness of treadmill exercise as
motor rehabilitation interventions in improving walking ability in client post stroke. Methods:
The key words, namely: "post stroke, rehabilitation, exercise treadmill, post stroke
rehabilitation". Search journal articles done electronically using multiple databases, namely: E-
Resources, Sage Journal, Pro Quest, Google Scholar, Science Direct. Limitations in the use of
10 years (2006 -2016). Results: In general, all been reviewed journals provide results that
provide benefits as treadmill exercise interventions to improve walking ability in post stroke
client. Conclusion: Some exercise treadmill described as a useful intervention for improving
walking ability post stroke clients. So, expect the stroke patients and their families can be
motivated to do physical activities in order to improve the independence of post-stroke patients.
Keywords: post stroke, rehabilitation, exercise treadmill, post stroke rehabilitation
INTRODUCTION 24 hours due to interruption of cerebral

Stroke is a condition that occurs blood flow that causes central nervous
when the blood supply to the brain is cut off system disorders and cranial nerves. The
by a blockage or rupture of blood vessels, disorder can cause permanent disability in
resulting in the death of cells in some areas the form of locomotor disability. physical
of the brain. Stroke is a serious health changes as is often experienced by the client
condition that requires immediate attention. is experiencing weakness on one side of the
Based on data from Health Research body and difficulty in speaking because of
Association in 2013, there were the decline of cognitive abilities or. This will
approximately 12 patients with stroke per impact on the client's ability to perform daily
1000 population Indonesia. Number of activities, so that the necessary efforts to
patients with stroke in Indonesia is rehabilitate physically restore the ability of
increasing every year. At the end of 2012, an the client to the original state before the
institute noted there had been about 500,000 illness in the shortest time possible.
cases of stroke survivors with the number Rehabilitation is an important part of
12,500 people die from the disease. While the recovery process of stroke patients. The
the rest of disability, whether mild or severe. goal of rehabilitation is to help patients
The high rate of death and disability relearn body functions are disturbed. There
caused by stroke associated with are some skills that should be taught back on
pathophysiological processes that occur in the stroke clients, including client Stroke
the brain tissue. Stroke occurs because of needs and capabilities, among others: self-
functional impairment and global focal brain care skills, such as eating, bathing, dressing,
suddenly and acutely that lasted more than and others; movement skills, such as
183
walking and others; Speech and language who experience stroke for 6 months, and the
skills to improve communication to interact third group was given an exercise program
with others at home under physical therapist control a
with participants who experience stroke for
METHOD 2 months. Each intervention consisted of 36
This method begins with the quest sessions, each session conducted during 12
journal by using PICO framework, post- to 16 weeks in 90 minutes per session. The
stroke patient population is adult, main objective was all participants in each
intervention in this study general physical group at had increased the walking ability
therapy, treadmill training, with results for 1 year post stroke.
expected to improve the ability to walk / During a year 52% of all participants
motor on the client post stroke. And the showed an improvement walking ability
outcome is the effectiveness of treadmill properly. There were not significant
training and improvement of walking ability differences in improvement between early
in clients with post stroke. Then specify exercise or delay in both of training treadmill
keywords to search the journal in English and exercise program at home under
through several databases, among others E- physical therapist control for stroke with the
Resources, Sage Journal, Pro Quest, Google results early exercise obtained: the odds ratio
Scholar, Science Direct. Limitations in the average for the primary outcome, 0,83; 95%,
use of 10 years (2006 -2016). confidence interval between 0.5 to 1.39 and
Search results found 26 journals, delayed outcome obtained the odds ratio of
which have been criticized 15 journals. The 1.19; 95%, confidence interval between
key words are "post stroke, rehabilitation, 0.72-1.99. Each group had the same
exercise treadmill, post stroke improvements in walking speed, the
rehabilitation". Journal selected for review recovery in body movement, balance,
based on studies carried out in accordance general condition and quality of life. There
with the inclusion criteria. Criteria for was no delay in the initiation of the initial
inclusion in this literature review is the severity of motion exercises or initial
respondent who can still practice runs. From reduction effect is influencing the results in
all journals obtained in accordance with the the first year. Reportedly there were ten
theme and then examined and did scientific serious effects associated with exercises that
studies. happen to all participants who received early
training as much as 2.2%; delays in the
RESULT training as much as 3.5%; and at home
Treadmill walking with body weight exercises with as much as 1.6%. As
support compared with home exercise group, each
Research conducted by Pamela W. group had a higher of dizziness or faintness
Duncan, P.T., Ph.D., et al (2011) study during treatment P = 0.008. Among patients
involved 408 participants who had who experienced weakness walk, some risk
experienced stroke during 2 months. It was of falling or even often fall occurred in the
classified according to walking ability group who receiving early training versus to
improvement obtained ability reduction in the other two groups P = 0.02.
moderate level (able to walk 0.4 to <0.8 m According to the study Sara J.
per second) and severe (able to walk <0.4 m Mulroy, Tara Klassen et al (2010) on gait
per second). Participants were divided parameters (walking speed parameter, time,
randomly into three groups of exercises. distance) associated with exercise treadmill
First group was given treadmill exercise by which is based on body weight support
relying on the weight of participants who treadmill training (BWSTT) in post-stroke
experienced stroke for 2 months, the second argues that the special training interspersed
group gain same exercise with participants with strength training results in kinematic,
184
kinetic adaptation, and muscle activation are aerobic treadmill exercise (TAEX) or
strongly associated with an increase in conventional care physiotherapy. Primary
walking speed. In the study Sara J. Mulroy, outcome measures were peak exercise
tara Klassen et all involved 15 participants capacity (maximal O2 fulfillment (Vo2
who had experienced stroke 9 months to 5 peak)) and sustained walking capacity in 6-
years of completing one of three parts of minute walks (6 MW). measures were gait
different training for 6 weeks. One part velocity in 10-m walks, Berg Balance Scale,
consists of 12 sessions of BWSST which functional leg strength, self-rated mobility,
changed 12 parts: gave the barriers on lap and quality of life (SF-12).
lower extremities; forward motion, the The results showed that Thirty-six
defense of the load; arm ergometry or false participants completed the study (18
condition. Gait analysis performed before TAEX,18 controls). TAEX but not
and after 6-week intervention programs. conventional care improved Vo2peak
Activities kinematics, kinetics and (difference 6.4 mL/kg/min, P .001) and
electromyography (EMG) was recorded 6MW (53 m, P .001). Likewise, maximum
from lower limb weakness experiencing, walking speed (0.13 m/s, P .01), balance
while the participants walked on a self- (P .05), and the mental subscore of the SF-
selected training Changes in gait parameters 12 (P .01) improved more after TAEX.
between groups were favorable response So, this study stated that TAEX method is
than participants in lower response groups effective in improving cardiovascular health
that showed an increase in self-selected and movement to the subject with a long
walking speed is greater than 0.08 m/s on a stroke post.
good response groups. Judith M. Lam, Christoph Globas,
Compared with participants in the MD, et al (2010) suggested in his research
low response group, they were in a group of Despite proving overall effectiveness, the
high response indicated a greater increase in response to T-EX varies markedly between
the angle of motion of hip extension terminal individuals. Whereas intensity of aerobic
and hip flexion strength after the training seems to be an important predictor
intervention. The intensity of the soleus of gains in cardiovascular fitness, lesion size
muscle EMG activity during the walk was and location as well as interval between
also significantly higher in participants in a stroke onset and therapy delivery likely
high-response groups after intervention. affect therapy response. These findings may
This study has limitations that only the be used to guide the timing of training and
movement parameters are assessed and had identify subgroups of patients for whom
a small sample size. Special training training modalities could be optimized.
interspersed with strength training exercises In all, 52 participants received T-EX
lead to kinematic, kinetic adaptation, and for 3 (Germany) or 6 (United States) months.
muscle activation were strongly associated Improvements in overground walking
with an increase in walking speed. Changes velocity (10 m/6-min walk) and fitness (peak
in both the hip and ankle biomechanics VO2) were indicators of therapy response.
during a final gesture associated with a Lesion loca-tion and volume were measured
greater increase in the velocity of gait. on T1-weighted magnetic resonance scans.
The results obtained, T-EX significantly
Aerobic Treadmaill Benefit improved gait and fitness, with gains in 10-
Research of Christoph Globas, MD, m walk tests ranging between +113%
et al (2012) involving 38 participants aged and−25% and peak VO between −12% and
over 60 years with stroke hemiparese 88%. Baseline walking impairments or
indication 6 months. Participants were fitness deficits were not predictive of
randomly assessed the level of progress over therapy response; 10-m walk velocity
the past 3 months (3×/week), high-intensity improved more in those with subcortical
185
rather than cortical lesions and in patients experimental design study involving 20
with smaller lesions. Improvements in 6- participants who carried out post-stroke
minute walk velocity were greater in those rehabilitation. With Assessment walking on
with more recent strokes and left-sided the ground (outdoors) measured by the linear
lesions. No variable other than training and angular kinematics GAITRite and a two-
intensity, which was different between trials, dimensional webcam application
predicted fitness gains. respectively. Results obtained while
Following treadmill walking practice, there
Comparison of treadmill exercise and was 6 degrees (95% confidence interval (CI)
walking on the ground 2 to 10) more knee extension at heel strike
Research conducted by Birgitta during overground walking than following
Langhammer (2010) involving 39 patients overground walking practice. Poorer
with stroke in the research samples, and five walkers increased non-paretic limb step
resigned. Interventions conducted by length following treadmill walking practice
researchers was the Treadmill training and more than those with better walking ability
exercise walking outdoors. Which aims to (mean difference 2.2 cm, 95% CI 0 to 5).
compare the effectiveness of treadmill
exercise and walking exercise outdoors in Increased intensity treadmill exercise
stroke. Parameter measurements with does not have a negative impact on new
carried out 10 minutes of overground client ambulation
walking practice followed by 10 minutes of Research conducted Kuys Suzanne
treadmill walking practice at matched heart S, et al (2008) involving individuals with a
rate on separate days. The results obtained first stroke who were undergoing inpatient
from the interventions, There were rehabilitation. Intervention is given to
significant differences in the treadmill group participants, Walking on a treadmill at
6th with distance test (P¼0.04), speed test intensities of 30%, 40%, 50% and 60% heart
(P¼0.03), the running speed in 10 m rate reserve in the one session. Then the
(P¼0.03), the ability of both legs in their parameter that is used is During treadmill
stride: the right leg; P¼0.009, left foot; walking practice, walking pattern was
P¼0.003 and width of step (P¼0.01), measured as linear and angular kinematics
demonstrated use of a more symmetrical while walking quality was measured using
legs in the treadmill group than the group the Rivermead Gait Analysis scale and a
walked outside the room with the visual analogue scale
comparative value 1.02-1.10m: 0,97-0,92m. The results obtained, Walking on the
All participants follow the 100% with the treadmill at 60% heart rate reserve, step
respective program. Training schedule did length of the paretic limb was 0.05 m (95%
not differ between the two groups, but CI 0.01 to 0.10) longer, step length of the
significantly there was little difference in the non-paretic limb was 0.09 m (95% CI 0.05
time spent on exercise treadmill walking to 0.12) longer, and hip flexion at mid swing
exercise outdoors compared with the number was 4 degrees (95% CI 1 to 6) greater than
of comparisons 107 m: 316 minutes at 30% heart rate reserve. At 60% heart rate
(P¼0.002). reserve, hip and knee extension at mid stance
Research conducted by Suzanne S were respectively 3 and 4 degrees more
Kuys, et al (2008) showed that Ten minutes flexed than at 30% heart rate reserve.
of treadmill walking practice resulted in a Walking ability did not affect changes in
similar overground walking pattern walking pattern. Walking quality did not
compared with overground walking practice change with increasing treadmill intensity.
in newly ambulatory stroke patients In a study conducted by Christine M.
undergoing rehabilitation, regardless of Tyrell et all (2011) involving Twenty
walking ability. This study used an patients with stroke walked on a treadmill at
186
their self-selected walking speed, their outpatient rehabilitation, regardless of the
fastest speed, and 2 speeds in between. The client's ability to walk.
parameters used was a motion capture Of all the studies that have been in
system, spatiotemporal gait parameters and the study of treadmill exercise on the client
kinematic gait compensations were post stroke could be one alternative
measured. Results of the research showed interventions on the client post stroke
Significant improvements in paretic- and rehabilitation. Where is the final destination
nonparetic-limb step length and in single- of client care with the stroke itself is to
and double-limb support. Free walk on a restore the physical and psychological
treadmill facilitates a more normal gait in abilities. So that the client is able to adapt to
stroke, without any increase in the new conditions, is able to adjust to the
compensation movement in general, as post and increasing the quality of life in post
circumduction. Improvements in motion stroke clients.
irregularities were observed in the presence
of a small increase in walking speed. REFERENCE
Dean M Catherine, Ada Louise, Lindley I
CONCLUSION AND Richard, Treadmill training provides
RECOMENDATION greater benefit to the subgroup of
Stroke is a disease that causes communitydwelling people after
various disabilities with varying degrees of stroke who walk faster than 0.4 m/s:
severity. Loss of balance, asymmetry, and a randomised trial, Journal of
impaired postural stabilization will be easily Physiotherapy 60 (2014) 97–101
found on the client post stroke. Various Dean M Catherine, Ada Louise, et.all,
physical exercise needed to improve and Treadmill walking with body weight
train the client's post-stroke motor skills, support in subacute non-ambulatory
especially the ability to walk. stroke improves walking capacity
A summary of the research more than overground walking: a
conducted review, demonstrated positive randomised trial, Journal of
effects of treadmill exercise on the Physiotherapy 2010 Vol. 56
improvement of walking ability in stroke Duncan W Pamela, J Katherine, Sullivan,
patients. Nine of the fifteen studies et.all, Body-Weight–Supported
conducted showed that exercise treadmill Treadmill Rehabilitation after
effect on motor function, especially the Stroke, new England journal
ability to walk on the client stroke. One of medicine 2011: 364:21
the fifteen studies show that exercise Globas Christoph, Becker Clemens, Cerny
treadmill with body weight support has no Joachim, et.all, Chronic Stroke
effect in improving the ability of the lower Survivors Benefit From High-
extremities. Moreover, the results also Intensity Aerobic Treadmill
showed that by increasing the intensity Exercise: A Randomized Controlled
treadmill exercise is not harmful and does Trial, clinical research articles 2012:
not affect gait or reduce the quality of 26(1) 85–95
walking in stroke patients newly- Hesse Stefan, Treadmill training with
ambulating. This study adds some support partial body weight support after
for the inclusion of walking on a treadmill at stroke: A review,
a higher intensity in rehabilitation for stroke NeuroRehabilitation 22 (2007) 1–11
patients newly-ambulating. Ten minutes of J Sara. Mulroy, Klassen Tara, er.all, Gait
treadmill exercise turned out to have the Parameters Associated With
same pattern when walking on the ground Responsiveness to Treadmill
compared to just practice walking on the Training With Body-Weight Support
ground on a new stroke patient undergoing After Stroke: An Exploratory Study,
187
Physical Therapy 2010 Volume 90 there any secondary benefits? A pilot
Number 2 study, Clinical Rehabilitation 2008;
Kuys S Suzanne, Brauer G Sandra, Ada 22: 997–1002
Louise, and Russell G Trevor, Tyrell M Christine., Roos A Margaret, et.all,
Increasing intensity during treadmill Influence of Systematic Increases in
walking does not adversely affect Treadmill Walking Speed on Gait
walking pattern or quality in newly- Kinematics After Stroke, Physical
ambulating stroke patients: an Therapy 2011Volume 91 Number 3
experimental study, Australian
Journal of Physiotherapy 2008 Vol.
54
Kuys S Suzanne, Russell Trevor G,
Immediate effect of treadmill
walking practice versus overground
walking practice on overground
walking pattern in ambulatory stroke
patients: an experimental study,
Clinical Rehabilitation 2008; 22:
931–939
Lam M Judith., Globas Christoph, et.all,
Predictors of Response to Treadmill
Exercise in Stroke Survivors,
Research Articles 2010 24(6) 567–
574
Langhammer Birgitta, Stanghelle K Johan,
Exercise on a treadmill or walking
outdoors? A randomized controlled
trial comparing effectiveness of two
walking exercise programmes late
after stroke, Clinical Rehabilitation
2010; 24: 46–54
Mehrholz Jan, Elsner Bernhard, Treadmill
Training for Improving Walking
Function After Stroke, Stroke.
2014;45:e76-e77
Nara Kim, ByoungHee Lee, Yumi Kim,
Wonkyu Min, Effects of Virtual
Reality Treadmill Training on
Community Balance Confidence and
Gait in People Post-Stroke: a
randomized controlled trial, J Exp
Stroke Transl Med 2016:Vol 9 pp 1-
7
Polese C Janaine, Ada Louise, et.all,
Treadmill training is effective for
ambulatory adults with stroke: a
systematic review, Journal of
Physiotherapy 2013 Vol. 59
Smith S Patricia, Thompson Mary,
Treadmill training post stroke: are
188
THE EFFECTIVENESS OF MUSIC TO REDUCE STRESS AND ANXIETY:
A SYSTEMATIC REVIEW
Wildan Akasyah, I Ketut Andika Priastana, Bagus Sholeh Apriyanto

Email: akasyahwildan@gmail.com
ABSTRACT
Introduction: Stress and anxiety are state of physical and psychological stress due to demands
of the self and the environment. Nurses need to provide alternative relaxation therapies, such
as using music. Methods: Database searches are conducted through ScienceDirect, Google
Scholar, Wiley Online Library, Springerlink, Ebsco, PubMed and Scopus with relevant
keywords. Type and year of study, the study design, sample size, sample characteristics,
interventions and results are presented. Results: Articles that met the study criteria were 13
articles. The results showed that listening to music in the context of health care is feasible, easy
to implement and cost-effective interventions for all ages. Conclusion: Listening to music can
be used for stress reduction purposes, with the greatest success when it happens with others or
when overheard by reason of relaxation. Because many of the studies are at high risk of bias,
the findings need to be further investigated. To the feature researchers were recommended to
perform research using randomized controlled trials of type study by the same group. In order
to obtain a smaller risk of bias and results of music therapy interventions have a higher level of
validity.
Keywords: Music, Stress, Anxiety
INTRODUCTION focuses on the experience of listening to

Stress is a major threat to health music therapy is defined as receptive music
because it can trigger the development of therapy (Bruscia, 1998).
diseases in the body (McEwen, 1998). The use of music in psychological
Stress is a common phenomenon in therapies have been recorded throughout
everyday life, so the interventions is history. Music therapy is a noninvasive
necessary to reduce the incidence of stress therapy to treat the symptoms of
in daily life. It is assumed that listening to psychological disorders. treatment by
music has an effect on the health benefits means of a treatment with minimal risk.
(Thoma & Nater, 2011). However, Music has been a part of the way human life
empirical evidence on the effect of listening since prehistoric times and is believed to be
to music to reduce stress is still far from used for therapeutic treatment. Music can
consistent mechanism and underlying be used to support the emotional and
psychobiological stress reduction effect of spiritual needs by creating a more relaxed
this potential - especially in everyday life - mood so that it can be used to control stress.
is still unknown. as submitted by murrock and higgins, music
Music affects various aspects of the can respond to the psychological and
listener (psychological, physical, spiritual, physiological health of recipients so that it
cognitive and social), the application of can change for the better. Chanda and
listening to music in a clinical setting can be Levitin described the evidence that music
quite multifaceted depending on the needs, facilitates health outcomes through the
characteristics and preferences of involvement of neurochemical systems,
individuals with whom the music used embodied by some key neurochemicals
(Grocke & Wigram, 2007). The method mediating the stress response. Additionally,
189
Solanki et al. articulated that music affects RESULTS
the parasympathetic system applicable to The author searched online
the sympathetic system and consequently references on databases and aggregators in
facilitate the relaxation response (Chang Science Direct, Google Scholar, Willey
et.al, 2014). Onine Library, Springerlink, Ebsco,
PubMed and Scopus by keywords and
METHODS showed as many as 957 articles (142 from
A literature search conducted Science Direct, 241 from Google Scholar,
several major databases such as Science 127 from Willey Onine Library, 136 from
Direct, Google Scholar, Willey Onine Springerlink, 86 from Ebsco, 171 from
Library, Springerlink, Ebsco, PubMed and PubMed and 54 from Scopus). Total of 59
Scopus by keywords such as music, stress, articles duplicates are found, so that 39
and anxiety. Type and year of study, the articles were screened. After screening with
study design, sample size, sample the review of abstracts, generated 21
characteristics, interventions and results are articles. Then do a review back to the
presented. overall content of the article and the
entrance criteria are as many as 13 journals.
Article search by database (n=957)

Science Direct (n=142), Google Scholar (n=241), willey online
library (n= 127), Springerlink (n=136), Ebsco ( n=86), Pubmed
(n=171), dan Scopus (n =54)
Articles duplication
(n=895)
Review Abstract
(n=59)
Articles that do not qualify

(n= 39)
(n=52)
Review Full-Text
(n=21)
Articles that do not qualify

(n=8)
(n=52)
Articles used
(n=13)
Figure 1. Flow Chart of Study Selection
DISCUSSION using ambulatory assessment study. The

From six research that used total respondents were 1136. This research
randomized control trial, four studies using was conducted in various countries
quasy and experimental design, and other including Taiwan, USA, China,
190
Switzerland, India, Indonesia, Germany and Intervention is indicated to reduce
Turkey. Music therapy can be administered the stress level of the median to the two to
to patients with an interval one day until one three points on a 10-point scale, reaching
month. From previous studies, show the statistical significance at the 97%
majority of music therapy can reduce stress confidence level with a medium to large
and anxiety significantly. Stress and anxiety effect sizes. This project shows that it is
are lowered, including mild to severe. possible to develop music and respiratory
Stress and anxiety can be derived include interventions so that they can be used in the
stress and anxiety in acute and chronic hospital system, thus providing support for
diseases, adolescents, pregnant women, the increasing the convenience to clients and
students, at the time of examination and visitors during the crisis (Miller and
treatment. Spence, 2013).
Music therapy can reduce stress are Examination of the patient without
found in research (Labbe et.al, 2007, music show increased cortisol levels in
Linnemann et.al, 2015, Chang et.al, 2015, plasma, indicating a high stress level. While
Jiang et.al, 2015, Miller dan Spence, 2013,). in patients with music therapy at the time of
In the lower levels are anxious music the examination showed stable results
therapy research (Prihananda et.al, 2016 characterized by systolic blood pressure is
Yudha et.al, 2015 Toker and Komurcu, relatively low. Patients with high levels of
2016, Hsu et.al, 2016). fear can listen to music to minimize the
In the combined stress and anxiety effects (Sneichder, 2007).
decrease when music therapy intervention
(posttest) (Gautam et.al, 2015, Thoma et.al, CONCLUSION AND
2015). The difference between anxiety RECOMMENDATION
scores were not statistically significant Conclusion
(p>0.05). On the other hand, Newcastle The effect of listening to music to
nursing satisfaction scale with a score of the reduce the stress in everyday life varies
experimental group was higher than the depending on the presence of others. Listen
control group (p <0.01). Finally, when to music with others enhances the effect of
considering the number of fetal movement, reducing stress than listening to music
determined a significant increase in the alone. Thus, in everyday life, listening to
experimental group, while the music music can be used for stress reduction
therapy has the effect of minimizing the purposes, with the greatest success when it
fetal heart rate and blood pressure lowering happens with others or when overheard by
effect (p <0.05) (Toker and Komurcu, reason of relaxation.
2016). Listening to music may have
The results showed that only beneficial effects on anxiety reduction in
listening music can effectively reduce the people with coronary heart disease,
subjective stress levels (p = 0.010). The especially those who had a myocardial
most profound effect was found when the infarction. Reduce anxiety becomes
'relaxation' is stated as a reason for listening important for people with coronary heart
to music, with a subsequent decrease in the disease. Furthermore, listening to music can
subjective level of stress (p≤0.001) and low have an effect on the benefits of systolic
cortisol concentrations (p≤0.001). Alpha- blood pressure, heart rate, respiration
amylase varies as a function of the effects levels, quality of sleep and pain in people
of selected music, the music can boost with coronary heart disease. However, the
energy and relaxation music reduces clinical significance of this discovery is still
activity of alpha-amylase (p = 0.025) less accurate, so they need to be interpreted
(Linnemann et.al, 2015). carefully.
191
Recommendation Allostatic Load. Annals of the New
Future studies are expected to use York Academy of Sciences, 840,
randomized controlled trials with shame 33-44
group and the risk of bias is small so that the Miller, R. & Spence, J. (2013). The impact
results obtained from music therapy of breathing and music on stress
interventions have a high degree of validity. levels of clients and visitors in a
psychiatric emergency room. The
REFERENCE Arts in Psychotherapy (40), 347-351
Chang, H.C, Yu, C.H, Chenc, S.Y. Chena, Prihananda, L., Maliya, A., Kartinah.
C.H. (2015). The Effects of Music (2016). Effect of Classical Music
Listening on Psychosocial Stress Therapy on The Anxiety Level of
and Maternal—Fetal Attachment Hemodialysis Patients at The Pku
During Pregnancy. Complementary Muhammadiyah Hospital of
Therapis in Medicine 23, 509-515 Surakarta. S1 UMS Nursing
Gautam, S. K. Goswami, B. Jain, A. Faculty of Health Sciences
Mondol, S. Gandhi, A. (2015). Schneijder et.al, (2000). Stress Reduction
Effect of music on the stress and Trough Music in Patient
anxiety scores of students attending Undergoing Cerebral Angiografi.
medical college. Asian Journal of Neuroradiologi (2001) 43: 472-476
Biomedical and Pharmaceutical Thoma & Nater. (2014). Effects of Music
Sciences Listening on Pre-treatment Anxiety
Hsu, K.C. Chen, L.F. Hsiep, P.H. (2016). and Stress Levels in a Dental
Effect of music intervention on burn Hygiene Recall Population. Int.J.
patients’ pain and anxiety during Behav. Med. (2 22:498–505
dressing changes. Burns (42), 1789- Toker, E. & Komurcu, N. (2016) Effect of
1796 Turkish classical music on prenatal
Jiang, J. Rickson, D. Jiang, C. (2016). The anxiety and satisfaction: A
mechanism of music for reducing randomized controlled trial in
psychological stress: Music pregnant women with pre-eklamsia.
preference as a mediator. The Arts in Complementary Therapis in
Psychotherapy 48, 62-68 Medicine (30) 1-9
Labbe, E. Schmidt, N. Babin, J. Phar, N. Yudha, T. Kiswati. Hadidi, K. (2015).
(2007). Coping with Stress: The Penurunan Tingkat Kecemasan
Effectiveness of Different Types of Mahasiswa Dengan Pemberian
Music. Appl Psychophysiol Terapi Musik Di Sekolah Tinggi
Biofeedback 32:163–168 Ilmu Kesehatan Dr. Soebandi
Linnemann, A. Ditzen, B. Strahlera, J. Jember.
Doerra, M.J. Natera, U.M. (2015)
Music listening as a means of stress
reduction in daily life.
Psychoneuroendokrinologi (60) 82-
90
Linnemann, A. Strahler, J. Nater, U.M.
(2016). The stress-reducing effect of
music listening varies depending on
the socialcontext.
Psychoneuroendokrinology 70, 97-
105
McEwen, B.S. (1998) Stress Adaptation
and Disease: Allostasis and
192
EFFECTIVENESS COGNITIVE BEHAVIOR THERAPY OF CHANGES IN
BEHAVIOR IN ADULTS WITH CLIENTS ATTENTION DEFICIT
HYPERACTIVITY DISORDER: SYSTEMATIC REVIEW
Endri Ekayamti, Titik Nuryanti, Siti Kotijah, Agung Eko Hartanto

Faculty of Nursing Universitas Airlangga
Email: endri.ekayamti-2016@fkp.unair.ac.id
ABSTRACT
Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a serious mental disorder
that is characterized by three core symptoms: inattention, impulsivity and hyperactivity.
Worldwide prevalence of ADHD in children is estimated at 5% of diagnosis through the DSM-
IV criteria. In adults interference will be settled in two-thirds of the cases with a prevalence of
approximately 2.5 to 4.3%. In Indonesia, the prevalence of ADHD in school age 8-10%, 40-
50% and settled ADHD in adolescence and even into adulthood. Methods: Keywords with
cognitive behavior therapy, non-pharmacology therapy, Attention Deficit Hyperactivity
Disorder, ADHD Adult. Search article publication in the database of PubMed, Science Direct,
Highware, Google scholar and Sage journal. Study inclusion criteria in adult ADHD patients
≥18 years of age over the individual therapeutic interventions bahaviour-based cognitive
therapy, studies that provide behavior change outcomes in adults with ADHD and literature
searches restricted to the issue of 2009- 2016 can be accessed full text in pdf format. Results:
Treatment of individual CBT a significant impact on adult behavior change clients with
Attention Deficit Hyperactivity Disorder (ADHD). Conclusion: Treatment of individual CBT
(cognitive behaviour therapy) had a significant influence on changes in client behavior with
ADHD so that can always be applied as part of efforts to improve the quality of life and
independence of clients ADHD in adulthood.
Keywords: Cognitive Behavior Therapy, a non-pharmacological therapy, Attention Deficit

Hyperactivity Disorder, ADHD Adult
INTRODUCTION impulsive and inattentive behavior.

Attention Deficit Hyperactivity Symptoms usually begin in childhood or
Disorder (ADHD) is a serious mental adolescence and can persist into adulthood,
disorder that is characterized by three core causing clinically significant disruption
symptoms: inattention, impulsivity and (Asherson, 2016). Symptoms, subtypes, and
hyperactivity (Bachmann et al, 2016). the diagnosis of ADHD is being established
Worldwide prevalence of ADHD in according to criteria of DSM-IV lists 18
children is estimated at around 5%. In adults symptoms such as inattention, hyperactivity
interference will be settled in two-thirds of / impulsivity and inattentive behavior
the cases with a prevalence of (Gomes, 2014).
approximately 2.5 to 4.3% (Asherson, Clinical features of ADHD
2016). In Indonesia, the prevalence of condition was quite varied in relation to the
ADHD in school age 8-10%, 40-50% of expression, severity of symptoms, as well as
ADHD persist in adolescence and even into the pathogenesis. It is assumed that these
adulthood (Selecta, 2013). Attention Deficit disorders are very dependent on a
Hyperactivity Disorder (ADHD) is a neuro neurobiological disorder. Individuals with
developmental disorder characterized by ADHD showed abnormal neuronal activity
developmental level is decreased so that in nerve, adults with ADHD often suffer
clients with ADHD become hyperactive, from comorbid disorders such as depression
193
and anxiety. Therefore, multimodal pdf format.
approach can be applied to reduce the
symptoms of adult ADHD comorbid client RESULT
(Bachmann et al, 2016). CBT to decrease the level of ADHD
Pharmacological treatment is often symptoms
recommended for clients with ADHD, with The results of Emilson, et al, 2011,
the assumption that the drug can improve there were statistically significant
the function of brain regions are affected. differences in the ratings to decrease the
However, side effects, contraindications, or severity of symptoms of ADHD among the
non-response can limit the activity of intervention group who received CBT /
pharmacological treatment for ADHD MED with a control group getting TAU /
clients. It is therefore necessary to develop MED. This study uses the RCT design,
non-pharmacological interventions that can study was conducted on 54 respondents. 27
be applied to client ADHD which can help respondents in the intervention group was
reduce the signs and symptoms of ADHD given 15 sessions of CBT therapy for 2
clients as well as improve the quality of life times a week and last for 90 minutes per
and independence of clients in everyday life session, while 27 respondents control group
(Bachmann et al, 2016). A number of receive treatment as usual. The evaluation
studies on the effectiveness of non- was done in before treatment and after
pharmacological therapies have been treatment with 3 months of follow-up.
carried out in several countries. Individual Results of interviews with K-SADS
therapy CBT (Cognitive Behavior Therapy) measurement scale used to measure
is a non-pharmacological therapy that has symptoms of ADHD found the intervention
been developed at this time. Cognitive group CBT / MED has lower rating than the
Behavior Therapy (CBT) is a psychological control group (P <0.01) even after 3 months
intervention that involves the interaction of follow-up there was no significant
between thinking, feeling, and behaving in difference in value (P <0.05). As for the
a person (Somers and Queree, 2007). interview with CGI measurement scale
measuring the severity of ADHD follow-up
METHOD after 3 months have significant values (P
Synthesis method using a modified <0.05). On the scale of the lack of concern
PICO performed on adult clients with for the intervention group obtain significant
Attention Deficit Hyperactivity Disorder / results with P <0.01.
ADHD, who received the intervention The results of the above was also
Cognitive behavioral Therapy / CBT, with supported by the research of Young, et al,
the result of behavioral changes in adults 2015 conducted a study of 95 respondents
with ADHD clients. The keywords used are with adult ADHD who have already been
cognitive behavior therapy, non- treated with the drug-obtain gain (MED)
farmakological therapy, Attention Deficit randomly compared with a control group
Hyperactivity Disorder, ADHD Adult. The who received therapy TAU / MED. The
article Search publication in the data base of intervention group received therapy (CBT /
PubMed, Science Direct, Highware, Google MED) with 15 sessions for 90 minutes each
shcolar and Sage journal. Study inclusion session of intervention R & R2ADHD, has
criteria in adult ADHD patients ≥18 years five treatment module, among others; a)
of age over the individual therapeutic neurocognitive eg knowledge strategy to
interventions bahaviour-based cognitive improve attention, memory, impulse control
therapy, studies that provide behavior and planning, b) solving problems such as:
change outcomes in adults with ADHD and developing thinking skills, problem
literature searches are restricted to the issue identification, conflict management, and
of 2009- 2016 can be accessed full text in make choices c) emotional control, for
194
example: to manage feelings, anger and ADHD. Assessment is based on DSM-IV
anxiety, d) prosocial skills, for example: the diagnostic criteria for ADHD. Each item is
recognition of other people's thoughts and rated with a score of 4 points to the
juice, empathy, negotiation skills and frequency of the symptoms experienced
conflict resolution, e) critical reasoning during the six months. Scores range
example: election evaluating behavioral between 0 and 27 for each of the two
skills. The first step to assess the symptoms subscales (inattention and hyperactive /
of ADHD, and severity of disease. Follow- impulsive) and 0-54 for the total scale. The
up is done within 3 months of treatment. results of the research supported by Young,
The results showed significant gains et al, 2015 also showed significant gains in
decreased in ADHD clinical symptoms and scale BCS with p <0.001; 95% CI: -4.50 to
severity of disease in tiem intervention -1.63
compared to the control group. To scale K- Wymbs Research. Brian T, & Brooke SG
SAD was obtained p <0.001; 95% CI, -7.43 Molina (2015) with the title"Integrative
to -3.38. CGI scale with p <0.001; 95% CI, Couples Group Treatment for Emerging
-1.12 to - 0.46. Adults with ADHD Symptoms", the study
Safren, et al, 2010 in study of 86 aims to test the feasibility and acceptance of
respondents with RCT designs. Research in the CBT program for adults with ADHD
the intervention group was given 12 with couples therapy to treat symptoms in
sessions of CBT therapy and a control group ADHD in the context romantic relationship
received relaxation therapy intervention and with a partner. 15 pairs of participants were
health education. The first step is performed given 6 sessions in integrated intervention,
to assess ADHD symptoms with the given for 11.5 hours each session. The
assessment scale CGI (Clinical Global evaluation was done after the session ends,
Impression) assessment performed at namely in 6 weeks. Then the data is
baseline, post-treatment and at 6 months analyzed and the result is a medium effect
and 12 months for follow-up. Furthermore, on symptoms of impulsivity / hyperactivity
the second is a self-report assessment of (d 0.50; 95% CI; 0.29 to 0.70). As for
ADHD symptoms. The results showed post- reporting by partner obtained the same
treatment CBT therapy significant clients results in improvement with treatment. In
get better value on the CGI scale score (- conclusion participants with adherence to
0.0531; 95% CI-1.01 to - 0.05; P = 0.03), good integrated protocol satisfying results
and the value scale of ADHD (- 4.631; 95% and significantly higher value. Results of
CI, -8.30 to 0.963; P = 0.02) compared with the study showed improvement in
the control group. inattention and hyperactivity / impulsivity
after treatment.
CBT to decrease symptoms of
hyperactivity / impulsivity CBT to the reduction of comorbid ADHD
According to the results of Emilson, et al, symptoms (anxiety and depression)
2011 took a significant decline in the level The results of Emilson, et al, 2011 at BAI
of symptoms of hyperactivity / compulsive scale for the anxiety scale scores which
disorder in adults with ADHD clients. significant with P <0.05 compared with the
Studies using measurement instruments control group. BDI scale to feelings of
with scale Barkley Current ADHD depression with a value of P <0.05. Scale
Symptoms Scale (BCS) obtained good Beck Anxiety Inventory (BAI) is a scale
results at the end of treatment in the designed to assess the severity of symptoms
intervention group (F (1,32) = 7:27, p of anxiety. While the Beck Depression
<0.05) and at three months follow-up (F (1, Inventory (BDI) is a scale used to assess
29) = 20.30, p <0.001). depressive symptoms consisting of 21
BCS scale is used to assess the symptoms of points, with the highest value indicates the
195
severity of depression. Scores were researcher. But the results of a review of 12
classified as minimal (0-13 BDI, BAI 0-7), journal also get that adults with ADHD still
mild (14-19 BDI, BAI 8-15), moderate (20- need treatment from a doctor to
28 BDI, BAI 16-25), or severe (29+ BDI, pharmacological therapy, with additional
BAI 26+). therapy such as CBT non farmacologic is a
Eddy, Laura D et al, 2015 in Case Series significant result of the pharmacological
Report study conducted in four college therapy alone.
students with ADHD, respondents were
given brief therapy CBT 8 sessions, one REFERENCES
hour each week in one semester, done pre- Anastopoulus, Arthur D, and Christian a
treatment and post treatment. The results of king. 2015. A Cognitive-Behavior
a brief study on the four respondents, shows Therapy and Mentoring Program
an improvement of the level of anxiety, and for College Students With
depression depression. These results are ADHD.Cognitive and Behavioral
supported by research from Young, et al, Practice 141-151
(2015), Bramham et al, (2009), Cherkasova. Asherson, Philip. 2016. ADHD Across the
Mariya V, et al, (2016), which show Lifespan. Psychitric Disorders.
improvement in symptoms of anxiety and Elsevier Ltd.
depression respondents. Bachmann, Katharina, Alexandra P. Lam,
and Alexandra Philipsen. 2015.
CONCLUSION AND Mindfulness-Based Cognitive
RECOMENDATION Therapy and the Adult ADHD
Treatment of individual cognitive behavior Brain: A Perspective Neuro psycho
therapy (CBT), whether done individually therapeutic. Frontiers in Psiciatry
or in groups have a significant influence on 7: 117
changes in client behavior of adults with Bramham, Jessica, Susan Y, Alison B, et al.
ADHD which include changes in 2009. Evaluation of Group
knowledge about ADHD symptoms, a Cognitive Behavioral Therapy for
decrease in hyperactivity / compulsive Adults With ADHD. SAGE
disorder, improved quality of life and Puplication. Vol 12 No 5, 434-441.
independence of the client, as well as Doi: 10.1177 / 1087054708314596
reduction of comorbid ADHD symptoms Cherkasova, Mariya V, Lisa R, Cassidy A,
such as anxiety and depression levels. This Lorne C, et al. 2016. Efficacy of
further proves that non-pharmacologic Cognitive Behavioral Therapy With
therapy CBT has a very important role in and Without Medication for Adults
the management of adult clients with With ADHD: A Randomized
attention deficit hyperactivity disorder Clinical Trial. SAGE Puplication,
because, this CBT therapy can help clients Journal of Attention Disorder 1-15
change behavior in everyday life Eddy, Laura D, Canu. Will H, Joshua J,
independently so that clients can improve Broman M, and Kurt D. Michael, et
their quality of life. al. 2015. Brief Cognitive Behavioral
Intervention CBT therapy given to Therapy for College Students With
respondents of the review 12 journals using ADHD: A Case Series Report
various sessions, the duration of the time Cognitive and Behavioral Practice
and duration of the implementation of 22.127 - 140
therapy, ranging from 6 to 15 sessions, with Emilsson, Brynjar, et al. 2011. Medication
a duration varying from 2 times a week, treated Cognitive Behavior Therapy
every week, and every month with duration in Adults with ADHD and Persistent
60 minutes until 1.5 hours each session. Symptoms: A Randomized
Most therapy CBT has been modified by the Controlled Trial. BMC Psychiatry,
196
11: 116 and without medication. BMC
Gomes, Response, and Philip J. Corr. 2014 Psychiatry, 12:30. doi: 10.1186 /
ADHD and Personality: a meta- 1471-244X-12-30
analytic review. Elesevier Ltd. Young. S, Khondoker M, Emilsson B, et al.
Clinical Psychology Review 34, 2015. Cognitive-Behavioral
376-388 Therapy In Medication-Treated
Pettersson, Richard, Staffan Soderstrom, Adults With Attention - Deficit/
Kerstin ES, and Kent W. Nilsson. Hyperactivityi Disorder and
2014. Internet - Based Cognitive Comorbid Psychopathology: A
Behavioral Therapy for Adults With Randomized Controlled Trial Using
ADHD in Outpatient Psychiatric A Multi – Level Analysis. Psilogical
Care: A. Randomized Trial. SAGE Medecine, 45, 2793-2804
Puplication, Journal of Attention
Disorder 1-14. doi: 10.1177 /
1087054714539998
Salonto, MV, Mark, DJ, Wsserstein, J,
Mitchell, K, et al., 2010. Efficacy of
Meta-Cognitive Therapy for Adult
ADHD. Am J Psychiatry; 167: 958-
968
Safren SA, Sprich S, Mimiaga MJ, Surman
C, Knouse L, M Groves, et al. 2010.
Cognitive Behavioral Therapy
Versus Relaxation With Educational
Support For Medication - Treated
Adults with ADHD and Persistent
Symptoms: a Randomized
Controlled Trial. JAMA, 304 (8):
875-880. doi: 10.1001 /
jama.2010.1192
Selecta, MC.2013. Hyperactifity attentions
Deficit Disorder ADHD in children
aged 2years. Media Unila 1 (3): 19-
25
Virta, Maarit, Anita S, Mervi A, Esa C, et
al. 2010. Short cognitive behavioral
therapy and cognitive training for
adults with ADHD - a randomized
controlled pilot study.
Neuropsychiatric Disease and
Treatment, 443-453
Wymbs. Brian T, & Brooke SG Molina.
2015. Couples Group Integrative
Treatment for Emerging Adults With
ADHD Symptoms. Cognitive and
Behavioral Practice 22, 161-171
Weiss, Margaret, Murraay C, Wasdell M,
Greenfield B, et al. 2012. A
randomize controlled trial of CBT
therapy foradults with ADHD with
197
THE IMPLEMENTION OF PREGNANCY MOTHER CLASS AND MOTHER
KNOWLEDGE ABOUT DANGEROUS SIGN OF PREGNANT AND LABOUR IN
WILAYAH KERJA PUSKESMAS PALANG KABUPATEN TUBAN
Teresia Retna P, Wahyuningsih T.N, Hadi Purwanto, Baiq Dewi Harnani

Polytechnic of Health Science, Kemenkes Surabaya
ABSTRACT
Introduction: One of the government's efforts to implement a class of pregnant women at the
village level that proclaimed since 2009, so that pregnant women can increase their knowledge
and skills of mothers about pregnancy, prenatal care, childbirth, postnatal care, newborn care,
myth, infectious diseases and birth certificate (Kemenkes RI, 2011). The purpose of this study
to determine the effectiveness of a class of pregnant women to increased maternal knowledge
about danger signs in pregnancy and childbirth. Method: The study design used is descriptive
analytic cross-sectional approach used. The population was all pregnant women in Puskesmas
Palang of the 100 pregnant women who attend classes pregnant women and 100 pregnant
women who did not attend a pregnant woman. Result: The results of the study of 200 people
the majority of pregnant women aged 26-31 years were 71 mothers, parity (child less than or
equal to two) of 184 mothers, mother's education level high school 83, knowledge of mother by
age with 26-31 year old category enough as many as 34 people (17%), parity (less than or equal
to 2) with enough category 83 (41.5%), the majority of senior secondary education level 18%
(36 people). Conclusion: Analysis of the relationship, there are differences in the effectiveness
of a class of pregnant women to the knowledge of the danger signs in pregnancy and labour,
with the value ρ = 0.000.
Keywords: class of pregnant women, knowledge
INTRODUCTION become 45% such as 380 become

A level of health in a country is 210/100.000 rate of birth. The survey of
made of some indicator,one of them is value SDKI in 2012, the AKI show 359/100.000
of mother dies (AKI). The survey of WHO rate of live.the rate are increase from 2007
(world health organization) in 2011, rate of SDKI survey. It’s show 238 and it’s still not
mother dies in developing countries is still from the target that is 102/100.000 the rate
high.ratio of AKI in developing countries of birth live. The official leader of healthy
reach 450 mother by 100.000 the birth of organization in Tuban, Saiful Hadi,says that
life. If it compare in ASEAN (association of rate of mother dies in pregnancy in Tuban
Southeast Asian Nations), rate of mother are increase from 2014. There are 10 case
dies in Indonesia is still high. The high level which the mother dies whwn she is born her
of AKI is effect of some factor, there are chid. In 2015 until April there are 5 case
direct effect and undirect effect. In which of (kota Tuban.com,Head line ,kesehatan).
the effect are, bleeding, eclampsia, sepsis Many kids of effort that the
and infection. It can be prevented by early goverment do to decrease AKI, such as the
detection of pregnancy. From undirect placement midwife in village, books of
effect, it’s cause of mother disease when she KIA,P4K,PONED in village clinic and
is pregnant. It also because of proverty, the PONEK in the hospital. Another of the
lowest of education and culture. goverment give them a consultation in
One of the indicator of MDGS is the POSYANDU. But the consultation are still
reduce of rate of mother dies (AKI) from illumination of case to another case. It can
1990-2015 as far as 75% and the globals happen when the mother come and she can
198
get the consultation. The material of morning or afternoon which each class 120
consultation are uncoordinator an minute per section, it is including pregnancy
unschedule. calisthenics 15-20 minute (Kemenkes
The cause of mother dies can be RI,2011).
prevented with early detection the Data from the Tuban Healthy
programme of goverment in village or town Organization, the schedule of pregnancy
are proclaimed in 2009 which is support to class is held in 2012 from 1 village 1 groups
increase the knowledge of the mother about which is consist of 20 mothers which age of
pregnancy, labour, puerperium, myth, pregnancy more than 20 week until 36
disease and birth of certificate (Kemenkes weeks. The interview of midwife in Palang,
RI,2011). data of mother dies whwn pregnancy in
One of education media for 2015 there are 3 cases of nifas infection to42
pregnancy mother are KIA books, KIA heartache and Diabetes Mellitus. And the
books are launching since 1994 and Japan evaluation of mother class pregnancy which
Cooperation (JICA=Japan International evaluation and knowledge 90% of
Cooperation Agency), in SK MenKes RI pregnancy mother are come to the
No.284/MENKES/SK/III/2004 says that class,which is show 3 times a weeks and for
KIA books are the manual book which give knowledge (pre and post) , 80% mother
to mother and the children. The books give knows about materials.
us the information and notes about health Based on the data below, we know
and chid. And it is the one and only notes that pregnancy mother less knowledge
about the mother and the children health about pregnancy such as the dangerous
from pregnancy until the babies born. In things in pregnancy times. The research
puerperium time until the baby five month, from Puskesmas palang can increase of
including KB, imunisation, the grow up of quality of service KIA in Indonesia.
babies.
The implementation og class for METHOD
pregnancy mother is held one aweek which The research programme that used
age of mother pregnancy 4-36 weeks. are descriptive analitic and approachment
Especially, mother which 20 weeks cross sectional. Populations are all of
pregnancy, they held calisthenics for pregnancy mothers in Puskesmas Palang
mother. It’s held because the pregnancy are which is 776 mothers. The big sample of
study and don’t be miscarriage and it’s this research is 150 pregnancy mother that
effectifly for the mother. In a class there are consist in the pregnancy mother class and
10 mother pregnancy which is the the control groups are 150 pregnancy
maximum member in the class. The class is mother that an consist in the class
addition class and mother can do it in the
home. The time of calishenics class can be
ANALYSIS AND STUDY

Characteristic of Pregnancy Mother
Tabel 1: Characteristic of pregnancy mother based on age.

Un
No Age Participate in class % participate in class %
1 20-25 27 27 16 16
2 26-31 35 35 36 36
3 32-37 20 20 28 28
4 38-43 14 14 16 16
5 44-49 4 4 4 4
total 100 100 100 100
199
Characteristic of pregnancy mother which participate and unparticipate in pregnancy
class based on age in Kecamatan Palang Kabupaten Tuban most of the class are 26-31 years
old.
Tabel 2 : characteristic of pregnancy mother based on paritas.

No Paritas Participate % Unparticipate class %
class
1 Less than 2
92 92
92 92
2 More than 2 8 8 8 8
total 100 100 100 100
Characteristic of pregnancy mother which participate and unparticipate in the class
based on paritas in Kecamatan Palang Kabupaten Tuban, the majority are the mother less
than having 2 children.
Tabel 3 : characteristic of pregnancy mother based on education level

No Level of Participate % Unparticipate %
education In class In class
1 SD 20 20 20 20
2 SLTP 31 31 25 25
3 SLTA 41 41 42 42
4 PT 8 8 13 13
total 100 100 100 100
Characteristic of pregnancy mother which participate and unparticipate in the class
based on education level most of them are SLTA (senior high school) level.
The knowledge of pregnancy mother

Tabel 4 : The knowledge of pregnancy mother based on age which participate
Knowledge
Age total
less rather good
 %  %  %
20-25 13 13 5 5 9 9 27
26-31 13 13 16 16 6 6 35
32-37 6 6 12 12 2 2 20
38-43 2 2 8 8 4 4 14
44-49 0 4 4 0 4
Total 34 34 45 45 21 21 100
Tabel 5 : knowledge of pregnancy mother based on age which unparticipate

knowledge
age less rather good Total
 %  %  %
20-25 6 6 7 7 3 3 16
26-31 10 10 18 18 8 8 36
32-37 10 10 15 15 3 3 28
38-43 6 6 4 4 6 6 16
44-49 2 2 1 1 1 1 4
200
Total 34 34 45 45 21 21 100
From the both of tabel below show that more than 100 pregnancy mother which
participate in the class 16% are 26-31 years old (16 person), than pregnancy mother who
unparticipate in the class 18% are 26-31 years old (18 person) that have rather knowledge.
This condition are the biggest presentation from all age that researched. Meanwhile age more
than 37 years old. They have rather knowledge but it still little.it happen because capability
in intelectual are decrease.
Knowledge of pregnancy mother based on paritas

Tabel 6 : knowledge of pregnancy mother based on paritas who participate in class
Paritas knowledge
Total
less rather good
 %  %  % 
≤2 31 31 41 41 20 20 92
>2 3 3 4 4 1 1 8
Total 34 34 45 45 21 21 100
Tabel 7 : knowledge of pregnancy mother based on paritas who unparticipate in class

knowledge
Paritas less rather good Total
 %  %  %
≤2 31 31 42 42 19 19 92
>2 3 3 3 3 2 2 8
Total 34 34 45 45 21 21 100
From the both tabel below, it show that paritas of pregnancy mother have two
differences. They are mother who have less than 2 children and more than 2 children. Mother
who unparticipate the class which paritas less than 2 have less and rather knowledge. And
mother who participate which paritas more than 2 also have less and rather knowledge. From
the research, there no connection between paritas and knowledge which participate or
unparticipate to pregnancy mother.
Knowledge of pregnancy mother based on education level

Tabel 8 : knowledge of pregnancy mother based on education level who participate
knowledge
education less rather good Total
 %  %  %
SD 3 3 12 12 5 5 20
SLTP 7 7 18 18 6 6 31
SLTA 24 24 13 13 4 4 41
PT 0 2 2 6 6 8
Total 45
34 34 45 21 21 100
Tabel 9 : knowledge of pregnancy other based on education level who unparticipate in the
class
education Pengetahuan
less rather good Total
201
 %  %  %
SD 7 7 7 7 6 6 20
SLTP 12 12 9 9 4 4 25
SLTA 10 10 23 23 9 9 42
PT 5 5 6 6 2 2 13
Total 34 34 45 45 21 21 100
From the both tabel below, it show that education level from SD (elementary school)
until SLTA (senior high school) have same presentase in less of education it diffence in PT
(university) level, the have small presentase in education. The data show that education level
have many effect for the knowledge of pregnancy moyhers.
Analysis of implementation of pregnancy class with mother knowledge about

dangerous sign of pregnancy and labour
Tabel 10 : Analysis of implementation of pregnancy class with mother knowledge about
dangerous sign of pregnancy and labour
Pregnancy knoweledge total
class less rather good
 %  %  %
Ikut kelas 3 17 45 22.5 21 10.5 100
4
Tidak ikut kelas 1 6 69 34.5 19 9.5 100
2
Total 4 23 114 57 40 20 200
6
Uji Chi-Square Asymp. Sig. (2-sided) = 0,000
From tabel 4.10 below show that mother who have good knowledge and participate
in the class as much as 21 person. And mother who have good knowledge but unparticipate
in the class asa much as 19 person. The result of chi-square test used SPSS 16 it get pvalue
0,000 until sig:p ≤ 0,05, it make more effective in differences of implementation of
pregnancy class and education level of dangerous sign of pregnancy and labour.
202
Characteristic of pregnancy mother who (Senior high school) become 41,5 % (83
participate and unparticipate in the person). SLTP (Junior high School) have
pregnancy class enough knowledge and experience in
From 200 pregnancy mother pregnancy, meanwhile PT (University)
become a research subject in work ship area have a good knowledge and maturity of
in Palang from 26-31 years old become thinking. They also can get more
35,5% (71 person). The age og pregnancy information about health (Depkes RI,2006).
mother when she pregnant it hope not to Education can influence of thinking,
young and not to old. Ages less than 20 atitude and decision of someone make in his
years and more than 35 years have high risk life (Notoatmojo,2003). A mother who have
in labour. A woman when pregnant must high level education usually work outside of
ready in physical, emotion, psycologis, her house and does not have time to
social and economic (Ruswana,2006). Age examined her pregnancy (Depkes RI,2012).
is one of variabel model of demografi which Most of the subject of this research, mother
mean it become of psycologis indicators in who have education level in SLTA (senior
differences, the mother age make an high school) have a good skill to take care
influence to make a decision of taking care her pregnancy than women who have low
af health, if the age are enough, rate of education skill. It because of her activities.
maturity and powerity of someone which
mature in psysical and work Relationship of knowledge based on
(Notoatmodjo,2003). characteristic of pregnant mother
A knowledge in 26-31 years From 100 mothers who participate
become the safety age to women who want the class of pregnancy in 26-31 years old,
pregnant and labour. In this age, the 6% (6 person) among have a good
physical and emotion of women are ready knowledge and mother unparticipate the
to pregnant and take care of her children. In class in 26-31 years old become 8% (8
productif age, women more energic and person) hav the high prosentase of all ages
interested become a mother which research have lowering of intelectual
Paritas of pregnancy mother who knowledge of more 35 years old. According
participate and unparticipate in pregnancy to (Notoatmodjo,2003) which quated by
class, is distinguished from primi and multi Hendra (2008) when the person more
and it’s show a balancing, which participate mature the process of their mentality is
and unparticipate of women who have less more good in some ages. The maturity
than 2 children become 98% (98 person) process cannot as fast as when they are
and more than 2 children become 8% (8 teenager brainstorming of someone is
person). This is hapen because the time of depend of his ages. It can says`that if
research are different. From the theory someone more mature so he has more
(Depkes RI,2012), paritas is one of the knowlwdgw to thinking become lower.
factor who become predisposition of Thisis same which theory taht person in
antenatal. If the paritas high in experience it older age have more knowledge and
make the scare and worried low. experience that he have, it make an effect in
Mother which high paritas they his attitude, and thinking. Beside of
consideration to unparticipate in pregnancy maturity that someone have it cause of his
class because they have done it. More than experience life. Depend of that, someone
that, mother in high paritas or have alot of which younger age does not have more
children does have enought time to take care knowledge and experience in pregnancy
her pregnancy even though to come to the and labour.
class. Education level of pregnancy mother
in wilayah kerja kecamatan palang
kabupaten Tuban is dominate of SLTA
203
Knowledge of pregnancy mother who Acknowledge is the result of object
participate and unparticipate in that a person have (eyes, nose,ears,etc). The
pregnant class based on paritas knowledge of the object is influence of
A mother who have paritas more perspection of the object it self. Half of
than 2 have agood knowledge as much as knowledge influence from they heard, saw,
1% (1 person) meanwhile who etc (Notoatmodjo,2010). From the
unparticipate the class have a good description below we know that mother
knowledge as much as 2% (2 person). who have high education level is more open
Paritas is a condition which is women who minded and more active to get more
have total children that she born. More of information from internet or another media
paritas make of more knowledge and even though she unparticipate in pregnancy
experience to mother it give a good reason class
for pregnancy and learning (salmah,2006).
Paritas have connection of information Knowledge analysis of pregnancy mother
about dangerous sign in pregnancy and who participate and unparticipate in
labour, it cause our experience and another pregnant class
experience (Bobak,2005). The data show that mother who
A mother who have more paritas participate inthe class asa much as 10,5%
have a good knowledge of it depend of (21 person) meanwhile mother who
amother who hare less paritas. It’s because unparticipate in the class asa much as 9,5%
his own experience and another experience (19 person)
that mother have (Notoatmodjo,2003) The result of Chi-Square test with
A mother who have more used SPSS 16 with ρ value 0,000. until Sig:
knowledge and experience in pregnant, ρ ≤ 0,05. So it can be conclusion that the
pregnancy and labour, it make an effect of differences of knowledge effectivitas
her knowledge for the next pregnancy the between mother who participate and
experience include what she do and unparticipate know about the dangerous
perception of the environment. sign of pregnant and pregnancy according
to Notoatmodjo (2003), knowledge are
Knowledge pregnancy mother who influence of some factor such as experience,
participate and unparticipate in education level and facilities to expand our
pregnant class based on education level knowledge we can learn form our
The data below show that the experience and another experience.
dominan is SLTA (senior high school) level Knowledge is important domain to
which presentase of participate mother as over behavior of someone, in experience.
4% (4 person) meanwhile unparticipate Experience base on knowledge better than
mother 9% (9 person). Education include an attitude (Notoatmodjo,2003)
spesial skill method as giving knowledge, Education is a process of learning to
opinion and policy. A women who have increase our ability of something or
good education can make a good decision knowledge, education is a relationship that
for her children and their health some one give to another in one way to the
(Meliono,2007). aim (Nursalam and Pariani,2001).
A education level and a standard of Education influential of way of
education level of someone are connected. thinking, attitude and making decision of
A low knowledge of a person it make a low someone life (Notoatmodjo,2003). The
information that they used. A high research result of unparticipate mother in
knowledge of a person it also make a high class more than 13% from university (PT)
information that they used so they must compared mother who participate in the
know the dangerous sign that happen in her class (8%). This way make a participate and
pregnancy (Prawirohardjo, 2002). unparticipate mother has a same level to
204
have information and increase their Depkes RI, 2012. Pedoman Pelaksanaan
knowledge. Pregnancy class is a tool of Kelas Ibu Hamil. Jakarta: Depkes RI
learning or educated about their health and Evelyn Pearce. Anatomi dan fisiologi
their pregnancy in a group has time to face Untuk Paramedis. Jakarta:
to face in one section. It purpose to increase Gramedia
the knowledge and the skill of the mother Kusmiyati, Y. 2010. Perawatan Ibu Hamil
about their puerperium, baby care, labour, .Yogyakarta : Fitramaya
myth, disease and birth of certificate Mashudi S. 2011. Buku Ajar Anatomi dan
(Depkes RI,2009). Fisiologi Dasar. Jakarta: Medika
From the description below, the Meliono,I.,dkk.2007.Pengetahuan.Dalam:
conclusion of the information source make MPKT Modul 1. Jakarta: Lembaga
the effect of knowledge. Mother who give Penerbitan FEUI
the illumination has 6,21 time more Mochtar, R. 1998. Sinopsis Obstetri jilid I.
knowledge, compare with mother who does Jakarta: EGC
not the illumination (Depkes RI, 2008). It Notoatmodjo, S. 2003.Pendidikan dan
same with the (Depkes RI,2012) theory, Perilaku Kesehatan. Jakarta :
mother activities can increase knowledge Rineka Cipta
about dangerous sign of pregnant and Nursalam; Siti Pariani. 2001.Pendekatan
labour Praktis Metodologi Riset
Keperawatan. Jakarta: CV. Sagung
CONCLUSION AND seto
RECOMENDATION Prawirohardjo, Sarwono. 2002. Pelayanan
There are differences between Kesehatan Maternal dan Neonatal,
implementation of pregnancy class and Jakarta : YBP – SP.
mother knowledge about dangerous sign of Ruswana. 2006. Ibu Hamil Resiko Tinggi:
pregnant and pregnancy with result of chi- Salmah, dkk. 2006. Asuhan Kebidanan
square test with p value 0,000. The Pada Antenatal. Jakarta: EGC.
implementation of pregnancy class in Sudjana, Nana. 2000. Dasar-dasar Proses
kecamatan Palang kabupaten Tuban is Belajar Mengajar.Bandung : Sinar
proved can increase the knowledge for Baru Algasindo
mother in dangerous sign of pregnant and Sulistyowati, A. 2009. Asuhan Kebidanan
labour. It hope that every Puskesmas has Pada Masa Kehamilan.Jakarta
routine activities such as Posyandu and :Salemba
another activities. Winkjosastro, Hanifa. 1999. Ilmu
Kebidanan. Jakarta : Yayasan Bina
REFERENCE Pustaka
Bobak. 2005. Buku Ajar Keperawatan
maternitas. Jakarta: EGC
Cuningham, F Gary. 2006. Obstetri
William, edisi 21. Jakarta: EGC
Departemen Kesehatan Republik
Indonesia.2006.Profil Kesehatan
2005.Jakarta
Depkes RI. 2008. Penyuluhan Kesehatan
Masyarakat. Jakarta :Pusat Promosi
Kesehatan
Depkes RI. 2009. Pegangan Fasilitator
Kelas Ibu Hamil. Jakarta : JICA
Agency
205
ANALYZING OF MOTIVATION IN LEARNING FOREIGN LANGUAGE FACED
BY NURSING STUDENTS
Pepin Nahariani, I’in Noviana, Shanti Rosmaharani

STIKes Pemkab Jombang
Email: pepin.nahariani@gmail.com
ABSTRACT
Introduction: Health Education of nursing has a remarkable growth in the number of graduates
produced. This is also supported Indonesia has a lot of nursing power resources to supply the
world's demand. Foreign languages courses are elective courses which are provided each of
Higher Education that aims to compete abroad. Motivation students have a strong influence in
the decision of the elective courses. Method: This study used qualitative design by three
respondents with in-dept interview with structured questions. To validate the data, the
researcher used data triangulation by lecturers and friends. Result and discussion: The
respondents motivated in learning foreign language to improve the ability of speaking other
language, they motivated to able speaking with people in other countries in order to avoid miss
understanding. They believed that it can increase the quality of students to continue their study
or to work abroad in order to get high levels of life. Recommendation: The foreign language
should be recommended include into the nursing curriculum, so that the students were high
motivated in learning foreign language not only English but also Japanese and Arabic should
be more meeting in the curriculum.
Keywords: foreign language, motivation, nursing education and learning
INTRODUCTION Degree Nursing Program which produced

Health Education especially nursing about 12,000 nurses’ personnel per year.
has a remarkable growth in the number of This amount would be great potential for
graduates produced. One indicator of Good Indonesia to send a nurse in the country in
Higher Education is the availability of order to compete in the international
educational curriculum that supports the (Efendi et al, 2013). Jombang about 845 of
quality of graduates. This is also supported the 1,115 people working as nurses (public
Indonesia has a lot of nursing power health Office of Jombang, 2014). Indonesia
resources to supply the world's demand. nursing crisis known power distribution
Foreign languages courses are elective from the Health Department in 2014
courses which are provided each of Higher reported that 10 370 nurses were in public
Education that aims to compete abroad. hospitals and 4,213 health centers located in
Motivation students have a strong influence communities throughout Indonesia. The
in the decision of the elective courses. number of nurses production in 2014,
There is a gap between the nursing estimated at 60% were utilized in the
staff and his distribution in the country. country, 5% abroad and the remaining work
Indonesia experienced a crisis that access to outside the competence (Efendi et al, 2013).
health care should be adequate for its own From the preliminary study, Stikes Pemkab
population. In Indonesia the number of Jombang offered foreign language courses
diploma and Bachelor of Nursing in 2008 in 8th grades, namely Arabic and Japanese
was 25.517 and increased to 27.909 nurses language.
in 2009. Amount only 36.5%. Recent data Learning foreign language for
from East Java province showed that there nurses are alternative policies in order to
were 55 Nursing Diploma Program and 53 optimize the utilization of nurses who
206
uphold the principles of mutual benefit, question that elicit depth of information.
both between Indonesia and other countries For structure interview, the researcher had
who are partners, and among nurses in interviewed three students from Stikes
Indonesia. Facing from the number of Pemkab Jombang to their opinion on their
existing resources, Indonesia should be able understanding of foreign language used in
to send nurses overseas. One important this institution. The interview should be
reason is the ability to speak a foreign conversational with question flowing, seek
language. With the motivation to learn a understanding and interpretation, while the
foreign language well, it is easy to realize interviewer should try to interpret what
opportunities to work in the nursing being said and clarity and understanding
profession outside the State. throughout the interview, recording
Thus, there is still work is needed to response, the responses were typically
increase the utilization of nurses abroad audio-recorder and complemented with
with regard to the needs of our country. written notes. The research instrument used
Working abroad can be a personal desire or questionnaire also to validate the data. To
motivate culture as an expression of furnish the data, researcher also
freedom and Human Rights (HAM) or investigated the three students perceive
perhaps as a result of financial needs, needs about learning foreign language. The final
work, and the challenge to face the data were in the form of numbers and some
competition of nurses from other countries opinions from the students. The numeric
(Santric et al, 2015) this study is intended to data was analyzed using descriptive statistic
determine the ability of Japanese language in the form of percentages to measure the
and how much interest students of bachelor differences of the performance and
nursing to work on Japan. from the above perception of the respondents.
phenomena the researchers are interested in The ability of learning foreign
doing research on " Analyzing of language can be seen by reading, writing,
motivation in learning foreign language and speaking in the last examination of
faced by nursing students". Japanese language which have been done.
The respondents were interviewed by
METHOD researcher about the motivation of learning
The design of this study is foreign language, and the ability to achieve
descriptive design in qualitative form about these skills. the teachers have some
motivation of nursing students in learning information to improve the methodology
foreign languages, especially English and and style of teaching and find alternatives
Japanese. The researcher conducted a for improvements in teaching foreign
research in Stikes pemkab jombang, in 4 language (Anita, 2009).
grade students on 6th March 2016 – 8th April
2016. The descriptive study designed to
obtain the current status of phenomena and
is directed toward determining the nature of
situation that exists at the time of study.
This study aimed at describing about 1) the
motivation of learning foreign languages in
nursing students, 2) the students’ perception
about foreign language.
The samples of the study were three
students of 4th grade students. They were
interviewed using in-dept interview, it was
appropriate for the situation in which the
researcher wanted to ask open-ended
207
Pilot survey
Make an outline of the interview guideline based on the pilot

survey
Analyze the data and writing report
Figure 1. Data collection flowchart
RESULT AND DICUSSION japan. To make sure, let’s see the interview
To gain the data, the researcher used result below:
interview to know the motivation of “I just learned Japanese language
students in learning foreign language. The for about two months, I felt it was easier
first respondent (miss A) is agreed that than English because Japanese is same in
learning foreign language, especially writing and speaking, not as same as
Japanese language, motivate hers to study English. So, I liked learning Japanese
abroad or working in Japan someday, let language and I hope I can go to japan for
see the interview result of her: holiday or getting a job there, because japan
”I have been learning two foreign is a great country and I want to be there
languages, English and Japanese, I prefer someday (SINH)”
Japanese than English. I want to go to other On the other hand, the researcher
country someday, maybe for continue my also asked the difficulties of learning
study or just holiday or I can work there. So foreign language for respondents, they said
I am very enjoyed and motivated in that difficulties are on writing and speaking
learning the foreign language” (EKP). process, foreign language is different in
This is showed that learning foreign writing and speaking process. To make
language is fun and she studied Japanese sure, let see the interview result below:
since 2010 when she was in senior high “in my experience in learning
school. She understood the writing and foreign language, I found many difficulties
speaking of this Language, the function of in the writing and spelling of the word of
this ability were able to interact with other foreign language” (EKP).
people when she continued her study in “the difficulty of learning foreign
other country. She had high motivation to language for me is the conversation
study Japanese language.We can see the practice, sometimes I faced miss
result of her last examination. understanding with the meaning of it. So, I
The second respondent, give will try to explore my speaking practice to
different respond to answer the question to avoid mistake (SINH)”.
researcher. She explained that she studied Otherwise, From all the three respondents
Japanese language since two months ago, agreed that learning foreign language is
she new comer in learning Japanese important for nursing development and
language, she preferred learning Japanese nursing career. This is supported by the
than English, but she liked to study foreign third respondent, let see the interview
language. She tried to enjoy and focus on below:
learning Japanese language due to she “Learning foreign language is very
wanted to have holiday or getting a job in important to nursing career, to face
globalization era, so that we can compete in
208
national or international. When there are skill but also the ability of speaking foreign
many employees here, we can interact with language. So the bargaining power of nurse
them easily. Otherwise if we work abroad, is high also regard to their salary.
it makes us easier to communicate with “I have been learning foreign
other and minimize the misunderstanding language (in this case I learn japanese
especially we are as a nurse that regard to language) for 7 months. I feel that learning
human being”. the foreign language can increase the
The last beneficial things from quality of graduation, so that the value of
learning foreign language is increased the competitiveness is high, its effects on the
bargaining nurses’ competition not only for salary and the quality of life (REL)”
Table 1. Perception towards motivation in learning the foreign language

No Item Description (1) (2) (3)
1 Have you ever learned the foreign language?
2 How long have you learned Foreign language, how is
your experienced before?
3 Learning foreign language help me to improve my
knowledge?
4 Why and what for you learned Foreign language?
5 Among the other foreign language, why do you
motivate to learn Japanese language?
6 What kind of difficulties that you find in learning
foreign language?
7 Who is the one who motivate you in learning foreign
language?
8 Why do you interest to continue your study/ work in
foreign country?
9 What is the importance of learning foreign language
regard to the development of nursing education?
10 What is the beneficial of learning foreign language to
the improvement of nursing career?
Table 2. Profile of Respondents

No Description EKP SINH REL
1 Age 20 20 19
2 Sex Female Female Female
3 Status 4th grade student 4th grade student 4th grade student
4 Time learning 5 years 2 months 7 years
5 The reason of - For holiday - To continue the - To work in
learning foreign - Just to know study abroad Japan
language how to use the - To work in - Able to
language Japan communicate
- with others
fluently.
209
210
CONSLUSION AND Santric, M.-Milicevic, et al.
RECOMENDATION 2015.Determinants of intentions to
Conclusion work aboard of college and
All the respondents were motivated specialist nursing graduates in
in learning foreign language in order to Serbia.Nurse Education Today 35.
improve their quality of life in getting a job Elsevier.page. 590-596
outside the country, one of the beneficial Mambaunnisa.2104. Pengaruh
from this motivation would be increased Kemampuan Berbahasa Asing
their career in nursing. Altough, there were (Arab-Inggris) Terhadap Prestasi
many diffculties in this learning process. Belajar Siswa.[Skripsi].Fakultas
They still motivated to continue and Ilmu Tarbiyah dan Keguruan,
complete this learning process. Universitas Islam Negeri Syarif
Hidayatullah, Jakarta
Recomendation Lie, Anita. 2004. Paradigm of Curriculum
The foreign language should be in Indonesia. Sekjen Dewan
recommended include into the nursing Pendidikan. Associate Director
curriculum, so that the students were high ASIA TEL
motivated in learning foreign language not
only English but also Japanese and Arabic
should be more meeting in the curriculum.
On other hand, the college held a foreign
language’s day in a day in order to be able
speaking other language in their daily
activity.
REFERENCES
BNP2TKI. 2015. Pengumuman
Pendaftaran Calon TKI untuk
Jabatan Asisten Nurse Asisten
Kangoshi dan Calon TKI Asisten
Careworker Asisten Kaigo
fukushishike Jepang Program Gto
untuk Penempatan Tahun 2016.
Online [http//
bnp2tki.go.id/read/9927/pengumu
man-pendaftaran--calon-tki--untuk-
jabatan-asisten-nurse-asisten-
kangoshi-dan-calon-tki-asisten-
careworker-asisten-
kaigofukushishi--ke-jepang-
program-g-to-g-untuk-penempatan-
tahun-2016.html], diakses Jumat,
11 Desember 2015
Efendi Ferry, et al. 2013. Return migration
of Indonesia nurses from Japan:
where should they go?.Nursing
Education and Practice, 2013,
Vol.3, No.8.Sciedu Press. page.
154-159
211
THE EFFECT OF KANGAROO METHOD ON THE ADEQUACY OF ENOUGH
MONTH AGED BABY AT BLEGA OLOH POLINDES AT BLEGA DISTRICT
BLEGA OLOH KECAMATAN BLEGA
Eny Susanti
Sekolah Tinggi Ilmu Kesehatan (STIKes) Ngudia Husada Madura
Email: srihandayaniadib@gmail.com
ABSTRACT
Introduction: The reducing of ASI becomes the problem for a new mother, and there are
several factors that affect the ASI production. Stimulation touch on the breast when the baby
sucking the nipple causes oxytocin to secrete ASI. The Results of the preliminary study was
conducted on 30 to 31 January 2016. It was found 23 mothers who breastfeed their babies aged
1-3 months. 10 mothers ( 44 % ) of babies got enough ASI . 13 mothers ( 56 % ) of the babies
did not get enough ASI . The aim of research to determine the effect kangaroo method of the
adequacy of breastfeeding in term of babies aged 1-3 months. Method: The design of the
research used was one group Pre -test Post - test in which independent variables was Kangoroo
and Dependent variable was Adequacy of ASI. Respondents in the capture as much as 22
Breastfeeding mothers of infants aged 1- 3 enough months. Mean of data collection using
questionnaires. The sampling technique used was Random Simple Sampling with data analysis
of Wilcoxon Test. Result: The result of preliminary research showed that before being given
the kangaroo method, the adequacy of breast milk was in the poor category as many as 19
respondents (86.3 %). And after kangaroo method was used, the adequacy of breast milk was
in a category quite as many as 13 respondents ( 72.7 % ) . After the Wilcoxon statistical test
resulted p value : 0,001 which means p value< α = 0,05 so that H0 is rejected . The result showed
that there was effect of kangaroo method of the adequacy of breastfeeding in term babies aged
1-3 months. Conclusion: Finally, it is expected to the midwives or health workers to continue
to provide education and demonstrations by using kangaroo care method, so it can help with
milk production in postpartum mothers. The well experience of breastfeeding mothers, it can
help the mothers in successful breastfeed, if they are more in contact with their babies.
Keywords: Kangaroo Method-Adequacy of Breast Feeding Enough month aged babies
INTRODUCTION breastfeeding is influenced time of onset of

Breast is breastfeeding without food feeding, frequency of feeding, emptying the
and drink another addition to the baby. breast during breastfeeding, the baby's
World Health Organization (WHO) states position while feeding, and the baby's
that exclusive breastfeeding during the first ability to suck the milk "a sign that the baby
6 months of a baby is the best because breast is getting enough milk are: Number urinate
milk is the perfect food for babies. in a day at least 6 times, color of urine
Breastfeeding means providing high-value usually colorless to pale yellow, Babies
nutritional substances necessary for the often defecate yellowish seeds, Baby
growth and development of nerve and brain, seemed satisfied, at any time feel hungry
as well as providing substances immunity waking and sleeping enough, Babies least
against several diseases and realize the suckle 10 times in 24 hours, Breast mother
emotional bond between mother and baby. feels soft whenever finished breastfeeding,
(Wulandari, 2009). she can feel tingling because the flow of
Adequate breastfeeding related to milk each time the baby starts to breastfeed,
the adequacy of the volume of milk during she can hear the sound of swallowing softly
breastfeeding. The volume of milk during
212
as the baby swallow the milk, baby gain feeding after a given method of kangaroos
weight (Wulandari, 2009). in term infants aged 1-3 months? Was there
Results of a preliminary study any influence of the adequacy of the
conducted on 30 to 31 January 2016 kangaroo method breastfeeding in infants
Polindes Oloh Blega District of Blega. aged 1-3 months?
Obtained 23 mothers who breastfeed their This research aims were to understand
babies aged 1-3 months. 10 mothers (44%) about certain condition, which was analyze
were breastfeeding her baby, the baby is the effect kangaroo method to provision
getting enough milk. 13 mothers (56%) who adequacy of breastfeeding in term infants in
breastfeed, the baby is not getting enough polides of Blega Oloh. The special purposes
milk marked with a baby is not satisfied were to identify the adequacy of
after each feeding, frequent crying baby or breastfeeding before given a kangaroo
the baby refuses the breast, baby's faces method in infants aged 1-3 months in the
hard and green. village Blega oloh District of Blega.
Factors are affecting the adequacy Identify the adequacy of breast milk is given
of breastfeeding, including the food, the after the kangaroo method in infants aged 1-
frequency of breastfeeding, birth weight, 3 months in the village Blega oloh District
gestational age at delivery, age of mother, of Blega. And also, to analyze the effect
maternal psychological state, the use of the kangaroo method of the adequacy of
contraceptive pill. Suckle 2-3 hours will breastfeeding in term infants aged 1-3
keep milk production remains high. For months.
most women, breastfeeding or expressing
milk eight times in 24 hours will maintain METHODS
milk production remained high in the early The research design used in this
days of breastfeeding, especially the first 4 study is one group pretest-posttest design.
months (Laksono, 2010). In this design before treatment is given prior
The implications for infants not samples were given a pretest (initial test)
enough breast feeding that would interfere and at the end of the study sample was given
with the development and body resistance a post-test (final test). This design is used on
against diseases is weak compared to purpose to be achieved is to know the
infants who received breast milk in full for adequacy of the breast feeding before it is
two years, of course, exclusive given the method of kangaroos and
breastfeeding during the first 6 months is kangaroo methods already given to infants
better then, the gift is continued until the age aged 1-3 months. In this study, the
of infants up to 2 years. independent variable is the Kangaroo and
The physical contact between the dependent variable is the adequacy of
mothers and their infants through breastfeeding in infants aged 1-3 months.
breastfeeding reduces stress when a Operational definition:
newborn baby is separated with his mother, Kangaroo care method is to put the
the stress hormones will cause a decline in baby in inside the pocket so as avoid direct
the immune system or immune system contact between the skin of the mother and
baby. Meanwhile, if done skin contact of the baby's skin so as to provide comfort very
mother and baby, the stress hormones will essential to the growth of the baby, the baby
go back down, so that the baby become easily breastfeeding. Steps to make a
calmer, no stress, as well as respiratory and kangaroo method were: a. After washing
heart rates more stable (Prasetyono, 2008). hands mother wear kangaroo’s mother. b.
Formulation of the problem: How was the Babies placed upright between the two
adequacy of breastfeeding before given a breasts. c. The baby's head turned away to
kangaroo method in infants aged 1-3 the left or to the right. d. Wear a shirt button.
months? How was the adequacy of breast e. In order to the baby's position has not
213
changed use the long cloth wrapped around Adequacy Of f Persentase(%)
the body of the mother. Breast feeding
Adequacy of ASI are: (Pre)
Veryless 0 0
Adequate breastfeeding related with
Less 19 86,4
the adequacy of the volume of milk during Enoght 3 13,6
breastfeeding. Influenced the volume of
milk during feeding time of onset of Total 22 100
feeding, feeding frequency, emptying the
breast during breastfeeding, the baby's
position while feeding, and the baby's According to the table 1 above
ability to suck the milk. The parameters showed that nearly all infants aged 1-3
were: production increased, baby suckle months before being given a kangaroo
frequently (8-12X day), baby looks method adequacy of breast milk in the poor
satisfied, baby looks healthy, baby's weight category as many as 19 respondents
increase. (86.4%).
In this study, researchers
determined based on the estimated Table 2. Frequency distribution based on
population of the entire breastfeeding the adequacy of asi after cast kangaroo at
women are at 23 mothers partisipant of term respondents in polindes blega oloh.blega
infants aged 1-3 months in Polindes Blega 2016
Adequacy Of f Persentase(%)
oloh Blega District of Bangkalan. And a Breast feeding
sample size of 22 people. (Post)
Criteria for inclusion in this study are: Veryless 0 0
1) Mothers with have baby in the age of 1-3 Less 6 27,3
months. Enoght 16 72,7
2) Breastfeeding mothers of baby without
Total 22 100
extra food.
Exclusion criteria in this study were
nursing mothers with childbirth SC. The Based on Table 2 above showed that
sampling technique used in this study using the majority of infants aged 1-3 months
simple random sampling technique. The after the kangaroo method sufficiency given
place of researe at Polindes of Blega oloh breast milk in a category quite as many as
Blega District of Bangkalan. The time 13 respondents (72.7%).
needed for this research was started in July
2016. Table 3. Cross tabulation effect of kangaroo
To determine the effect kangaroo against self sufficiency breastfeeding baby
method of the adequacy of breastfeeding in age 1-3 months months in polindes blega
term infants aged 1-3 months. The test using oloh kec.blega.
statistical test of Wilcoxon Signed Rank Adequacy Of
Test is a non-parametric test were used to Breast feeding
Total
analyze the data in pairs because of the two Pre/ Veryles
s less Enoght
different treatments. Wilcoxon Signed Post
Rank Test was used when the data are not
N % N % N % N %
normally distributed.
Pre 0 0 19 86,4 3 13,6 22 100
RESULT
Post 0 0 6 27,3 16 72,7 22 100
Table 1. Distribusi frequency based on the
adequacy of breastfeeding before given a Total 0 0 25 56,8 19 43,2 44 100
kangaroo method to the respondents in
polindes of blega oloh district blega 2016 Sumber :: Perolehan data primer
214
Based on the above table is Psychic condition and also the food
described that the infants before treatment consumed by the mother can also affect
is given none had sufficient milk in the milk production. But creating breastfeeding
category quite different from the results is from the first day is not always easy because
given treatment after a kangaroo method as many women are facing problems in doing
many as 16 respondents (72.7%) in the so. Circumstances which often occur on the
category of Self in the adequacy of breast first day of breastfeeding is difficult ASI
milk. After the Wilcoxon statistical test out. Terrsebut cause trouble breastfeeding
result value p value: 0,001 significant p mothers feel anxious and worried. Mother
value <α = 0.05 so that H0 is rejected. The became psimis with the amount of milk
result is the effect kangaroo method of the obtained and inhibit milk production.
adequacy of breastfeeding in term infants Moreover, when the lack of maternal
aged 1-3 months. nutrition can cause the quality of breast milk
to decrease. With less milk production, the
DISCUSSION mother be looking at other options to
1. Overview Adequacy ASI Prior to Give provide infant formula milk that caused the
Kangaroo On term infant Baby 1-3 baby's sucking intensity to be reduced due
Months. to alternate with the formula that makes the
The research concludes that nearly milk became less and less that comes out
all infants aged 1-3 months adequacy of (Roesli, 2006).
breast milk in the poor category, as many as
19 respondents (86.3%). Before being given 2. The description of adequacy of Breast
treatment kangaroo method. As the baby Feeding After giving after giving
does not seem satisfied and at times often Kangaroos Method to the term infant Baby
feel hungry, often in breast-fed infant by his aged 1-3 mont
mother, the baby's weight was no Based on the above study showed
improvement. From the questionnaire that the majority of infants aged 1-3 months
results in babies who do not get enough adequacy of breast milk in the category
milk because milk production slightly, enough, as many as 16 respondents
causing the baby rarely BAB. Milk (72.7%). After the treatment given
production will be much if babies feed often kangaroo method. baby enough milk as the
and there is direct skin contact between baby's weight increases, the baby seems
mother and baby can increase the hormone satisfied after feeding, the baby looks
prolactin, which can augment milk healthy, the baby often bowel and yellow-
production. Less production due breastfed green. From the above results after being
baby cannot suck effectively, among other given treatment there kangaroo method
things due to the structure of the mouth and good results are largely breastfed babies
jaw were not good, the wrong attachment have undergone sufficient. This proves that
techniques. Mothers who are malnourished, the kangaroo method can help augment
and the mother's food intake is very milk production and easier to breastfeed the
influential on milk production. baby on demand. In addition to increase
Breast milk production and milk production kangaroo method also
secretion occur after the baby is born that in helps to increase the weight of low birth
one after another later with events weight babies, and can keep the baby warm.
decreased levels of estrogen boosted the Age is a factor that determines
levels of prolactin for milk production. So breastfeeding. In terms of milk production
with the increase prolactin levels, start milk of mothers aged 19-23 years in general can
production activity took place. Stimulation produce enough breast milk than women
touch on the breast when the baby sucking who were older, and able to breastfeed her
the nipple causes oxytocin to secrete milk. baby by a considerable amount.
215
From the results of the yellow. Babies often CHAPTER yellowish
questionnaire infants who have enough seeds, baby gain weight. Kangaroo method
milk to breastfeed is because mothers often can not only be done by the father or mother
every 2-3 hours or 8-12 times a day, so that only other family can also do perwatan
the baby gain weight. Food is also an kangaroo method. Because the kangaroo
important thing week to augment milk care method not only can help in
production increases. When the milk on the breastfeeding, but also biga can increase the
first day has not come out quite disusukan baby's weight.
for 4-5 minutes to stimulate milk Kangoro Mother Care (KMC) or
production. After the production of enough kangaroo care method is to do direct skin
milk, the baby can disusukan for 10-15 contact with the baby or the mother's skin
minutes. Skin to Skin Contact. Where the mother
Adequate breastfeeding related to uses her body temperature to warm the
the adequacy of the volume of milk during baby. This treatment method is also shown
breastfeeding. Influenced the volume of to facilitate breastfeeding leads to increase
milk during feeding time of onset of milk production and milk can be fulfilled
feeding, feeding frequency, emptying the due to frequent contact with the baby's
breast during breastfeeding, the baby's mother and easy breastfeeding.
position while feeding, and the baby's Breastfeeding mothers experience well
ability to suck the milk. Kangaroo care managed, then the mother can breastfeed
method is an effective way to meet the most more successful if they are more contact
basic needs of the baby, that warmth, just with their baby. Breastfeeding stimulates
breastfed, protection from infection, the production of prolactin, thereby
stimulation, safety and love kangaroo care increasing the volume and stimulating
method can protect the babies warm. Can effect ASI output. Contact the closest
start immediately after birth or after the occurs when the mother using kangaroo
baby is stable. KMC can be done in a (skin to skin). Research conducted by Shiau
hospital or at home after the baby home. (1996) which is based on the philosophy of
Babies can still be treated with KMC kangaroos and protect their children. As we
although not able to suckle, give milk wring know, kangaroo pouch put their children in
it by using one of the alternative provision direct contact with the body of the mother,
of drinking (Wahyuni, 2013). after the study is able to suppress ternyataa
way infant mortality. Separation of mother,
3. Effect of Kangaroo Against Self baby and technology used in the neonatal
Sufficiency ASI In Infants Age 1-3 unit makes bonding difficult and create
Months Months. barriers to breast-feeding. Care given by
Based on the above study found way kangaroo mothers who start in a few
that infants before given none had sufficient hours after birth menstitumulasi milk
milk in the category quite different from the production and of course increase the bond
results given after the kangaroo method as between mother and baby. Several studies
many as 16 respondents (72.7%) in the on the effect of FMD on breastfeeding
category of Self in the adequacy of breast indicate that breastfeeding becomes longer,
milk. It shows that the kangaroo care more stable milk production, the number of
method is very efektifdalam increase milk breastfeeding per day increased a lot and
production. most premature babies went home with
The above shows that the method is exclusive breastfeeding (Wulandari, 2009).
very effective kangaroo dala breastfeeding, The above results indicate that the
can be a sign that mengalmi baby enough first respondent decreased, ie, before being
milk as Total urinate in a day at least 6 given the kangaroo method adequacy of
times. Art colors usually colorless to pale breastfeeding infants aged 1-3 months
216
category fairly and after given the kangaroo Laksono. 2010. Perawatan Masa Nifas dan
method babies aged 1-3 months of the ASI. Yogyakarta. Fitramaya
adequacy of breast milk in the poor Notoatmodjo. 2012. Metodologi Penelitian
category. It is a contributing factor that the Kesehatan,Jakarta: Rineka Cipta
baby's mother did the kangaroo method and Nursalam. 2005. Asuhan Pada Ibu dalam
rarely give milk to her baby as if the baby Masa Nifas. Jakarta: Trans Info
slept still not woken up so the baby does not Media.
have kecukupa milk. Nursalam. 2008. Metodologi Riset
Keperawatan. Jakarta: Info Medika
CONCLUSION AND Prasetyono. 2008. Asuhan Kebidanan Masa
RECOMENDATION Nifas”Puerperium Care”.
Postpartum Mothers with babies just Yogyakarta:Pustaka Belajar
months before being given a kangaroo Prasetyono. 2010. Konsp Penerapan ASI
method almost entirely adequacy ASI in the Ekslusif. Jakarta: EGC
unfavorable category. Mothers who have Potter&Perry. 2006. Buku Ajar
infants postpartum months after the Fundamental Keperawatan. Jakarta:
kangaroo method largely given sufficient Penerbit Buku Kedokteran Anak.
milk in the category enough milk. There is Roesli Utami. 2006. Mengenal ASI Ekslusif.
an effect kangaroo method of the adequacy Jakarta: Trubus Agriwidya
of breastfeeding in term infants usia1-3 Roito Juraida. 2013. Fisiologi Pengeluaran
months in Polindes Blega oloh Keca.Blega. ASI. Jakarta: Salemba
Sudarti. 2010. Asuhan Kebidanan
REFERENCE Neonatus,Bayi,Anak Balita.
Akre. 2010. Buku Ajar Asuhan Jogjakarta:Nuha Medika
KebidananPada Ibu Nifas. Sunar Dwi. 2009. Buku Saku Menyusui dan
Yogyakarta: Andi Laktasi. Jakarta: EGC
Ambarwati,E&Wulandari. 2009. Asuhan Siregar. 2005. Faktor-Faktor Yang
Kebidanan Nifas. Jogjakarta: Mitra Mempengaruhi Pemberian ASI.
Cendika Press Jakarta: Buku Kedokteran EGC
Anggraeni Yetti. 2010. Kapita Selekta ASI Wahyuni. 2010. Asuhan Kebidanan Nifas
dan Menyusui.Yogyakarta:Nuha dan Neonatus pada Perawatan
Medika Metode Kangoro. Jakarta: EGC
Arifin,M.Siregar. 2006. Pemberian ASI Yeti Anggareni. 2010. Buku Ajar Asuhan
Ekslusif dan Faktor-Faktor yang Kebidanan Pada Ibu Nifas.
Mempengaruhinya. Jakarta: Nuha Yogyakarta: CV.Andi Offset
Medika
Arikunto, S. 2006. Prosedur Penelitian.
Jakarta:Rineka Cipta.
Baskoro. 2008. Asuhan Pada Ibu dalam
Masa Nifas. Jakarta: Trans Info
Media
Harun Yahya. 2005. Asuhan Kebidanan
Pada Masa Nifas. Jakarta: Salemba
Hayati. 2012. Perawatan Bayi Resiko
Tinggi. Jakarta: EGC
Hidayat, A. 2008. Metode Penelitian
Kebidanan dan Teknik Analisa Data.
Jakarta:Salemba Medika.
Ikatan Dokter Anak Indonesia. 2008. Bedah
ASI. Jakarta: FKUI Depkes RI.
217
THE EFFECT OF ANTICIPATORY GUIDANCE TO MOTHERS' BEHAVIOR IN
CARING OF LOW BIRTH WEIGHT BABIES
M.Hasinuddin, Ulva Noviana

Nursing Program STIKes Ngudia Husada Madura
Email: ulvanhm@yahoo.com
ABSTRACT
Introduction: Low birth weight babies are those born with weight less than 2,500 grams. The
preliminary finding of the research showed that, of 20 mothers, 5 mothers (50%) were not able
to maintain temperature and warmness, 5 mothers (50%) were not able to provide babies with
blankets, 6 mothers (60%) were not able to breastfeed on their babies, and 4 mothers (40%)
were able to prevent infection. This study was aimed to analyze the differences in mothers’
behaviors in LBNB (BBLR) care before and after anticipatory guidance. Method: This research
employed One Group Pre-Test Post-Test Design. Population consisted of 21 mothers who had
LBNB and sample which used simple random sampling technique consisted of 19 mothers.
Questionnaire was used to measure pre and post test. Data analysis technique used Wilcoxon
Signed Rank Test. Result: The result showed before anticipatory guidance of 48,6% with less
category and after anticipatory guidance 87,7% with both categories. Conclusion: Paired T
Test showed that p  0.000  a  0.05 , there was a difference before and after anticipatory
guidance. midwives should provide anticipatory guidance to mothers with low birth weight
babies at home, so that mothers will acquire knowledge and able to prevent hypothermia and
infection.
Keywords: Care of low birth weight babies, mothers’ behaviors and anticipatory guidance.
INTRODUCTION
Infant Mortality Rate (IMR) in Parents should be able to master
Indonesia is still very high, at 32 per 1,000 how to care for the baby, including attention
infants aged 0-12 months, while 13 per to the movement, activity, baby's
1,000 live births, neonatal infants 0-28 days communications to provide what is
19 per 1000. The cause of death of necessary and give the appropriate stimulus
newborns is Low Birth Weight Babies ( to babies. Babies will respond to stimulants
LBW)was accounted for 36% (n=225), and care given by mothers in the form of
followed by congenital malformations crying, increase or decrease in weight ,
(33%, n=210), 198 infants (31%) lack of warmth and cleanliness (Lowdermilk, Perry
oxygen (asphyxia) ), while other newborn & Bobak, 2006).
deaths were caused by sepsis (systemic A preliminary study was conducted
infection), congenital abnormalities and in July 4, 2016 via interviews of 20 mothers
Taruma deliveries (IDHS 2012). Based on data obtained five mothers (50%) who have
the above data the leading cause of infant not been able to maintain the temperature
mortality was Low Birth Weight babies. and warm as they care for their babies just
Babies consider low birth weight like a normal baby is starting to be bathed
when their birth weight are less than 2500 and less attention to the warmth of the baby
grams (Saifuddin, 2009). LBW may put the so experiencing hypothermia, 5 mothers
baby at risk of infection, difficulty (50%) have not been able way swaddle the
breathing, hypothermia and suckling baby, six mothers (60%) have not been able
reflexes are less or nutritional deficiencies to provide breast milk for breastfeeding
can occur (Elizabeth, et.al, 2013). mothers do not come out so that the given
218
formula, but the baby becomes less likely to teaching them on anticipatory guidance at
drink to lose weight, and four mothers (40% the sub-district Puskesmas Kamal Kamal
) able to prevent infection. Based on the Bangkalan
results of a preliminary study on the data get
the low behavior LBW mothers in care METHODS
home. The study design used was quasi
Lawrence Green (1980), analyzing experimental with One Group Pre-Test
human behavior is affected by of three Post-Test Design. The study design is
factors, namely: a). Predisposing factors described as follows:
(predisposing factors), realized in Subject Pra-test Treatment Post-test
knowledge, attitudes, actions, beliefs, K 01 X 02
values, traditions. b). Enabling factors
(enabling factors), which is manifested in Population In this study were all
the physical environment, provision or mothers who had a low birth weight infant
unavailability of health facilities such as and attending health centers in the region of
health centers, medicines, contraceptives, the District Kamal Kamal Bangkalan.
toilets and so on. c). Factors driving or Based on the average number of LBW in
amplifier (renvorcing faktors) that Puskesmas Kamal many as 20 people.
embodied in the attitudes and behavior of Inclusion criteria include:
health workers or other personnel. a. LBW infants in a stable condition
(Notoatmodjo, 2010). b. LBW infants consciousness
Bang, et al (2005) suggest that komposmentis
maternal care in LBW infants greatly c. LBW infants ≤ 2500 grams
impact on the quality of life and survival of Exclusion criteria include:
the baby . the incidence of infection of i. LBW infants with complications
malnutrition and mortality in LBW babies if ii. The infant's mother who refused to
the mothers do not provide a proper care to be the respondent
their The results were supported by Surasmi The sampling technique in this
(2005) that the mother's response to the research is using Simple Random Sampling
problem of low birth weight baby greatly technique
influence a mother's decision to to care for Data was collected using
the baby that will impact on growth and questionnaire with structure close ended
development of low birth weight. Many questions and by observing the maternal
mothers are found to be inadequate in caring behaviour using the observation data sheet.
of their baby properly and expose their baby collection procedure:
to risk of morbidity and mortality. 1. Administrative procedures
Nurses should provide mothers with 2. The data was collected by giving
proper guidance in caring of LBW babies to questionnaires and observations of the
ensure the baby has good quality of life. to
mother in caring of low birth weight
the most important health education for measures using observation sheet (Pre
mothers with LBW babies are ; maintain the Test).
temperature and body warmth LBW babies 3. Provided mothers with anticipatory
at, breastfeeding practices and prevention guidance about the care of LBW at
of infection for LBW babies at home home using flip charts and booklets
(Girsang, 2009). nurse and midwife has an within 7 days
important role in to provide proper guidance 4. Providing guidance in anticipation of
to parents (anticipatory guidance). The the following ways:
research objective was to determine the a. explained about LBW
differences in maternal behavior in caring b. Demonstrate the care LBW
of LBW before and after providing and
219
c. allowed mother to re demonstrate that nearly half (47.4%, n=9).the
what has been thought respondents in elementary education.
d. assisted mothers
e. Performed post test by giving a Table 3. Distribution of Mother Carries
questionnaire with LBW Baby by Education
Data collected were managed Education Frequency Percentage
according to the following stages : EDITIN, (%)
Scoring, coding and tabulating. Univariate
analysis was performed to generate a Primary school 9 47,4
frequency distribution and percentage of Junior high school 4 21
each variable normality of the data was Senior High School 4 21
tested by the Kolmogorov-Smirnov test. the Bachelor 2 10,6
data was normally distributed hence Pairs T
Test was used. Total 19 100
Characteristics of of Mother with
RESULT LBW Baby by number of children at home.
Characteristics of Mother with Based on table 4 it can be seen that almost
LBW Baby By Age. Based on the table one third (36.9%, n=7) of the mothers have
below, it is known that out of 19 mothers only a child.
almost half (47.4%, n=9)of the respondents
were at the age of 15-20 years . Table 4. Distribution of the number of
children at home
Table 1. Distribution of Mothers Having
Number of Frequency Persentage
LBW Babies By Age
Age Group Frequency (f) Percentage (%)
Children (%)
15-20 Year 9 47,4 1 child 7 36,9
21-30 Year 6 31,6
31-36 Year 4 21
2 children 5 26,3
Total 19 100 3 children 4 21
Characteristics of LBW babies 4-7 children 3 15,8
Mothers who have home based jobs. Based
Total 19 100
on the table below it is known that from 19
Mother nearly half of the respondents are in
the work of farmers as many as 8 Capital Characteristics of Mothers who
(42.1%). have babies at home by weight LBW
infants. Based on Table 5 it can be seen that
Table 2. Frequency Distribution of almost all (84.2%, n=16). mothers have low
Mothers Having Babies At home LBW birth weight babies.
Based Jobs
Work Frequency Percentage Table 5. Mothers Having Babies At home
LBW By Weight Infants
Housewife 5 26,3
Weight Frequency Persentage
Teacher 2 10,6
(%)
Private 4 21
farmer 8 42,1 1,000-1,500 3 15,8
1,600-2,500 16 84,2
Total 19 100
Total 19 100
Characteristics of Mother Carries
with LBW Baby by education. Based on the
table below, 3 of the 19 mothers in mind
220
Respondents Pre-Test Persentase (%) Respondents Post- Persentase (%)
code Code Test
1 92 63 1 122 83,6
2 107 73,3 2 117 80,1
3 89 60,9 3 126 86,3
4 72 49,3 4 111 76
5 81 55,5 5 116 79,5
6 71 48,6 6 111 76
7 77 52,7 7 110 75,3
8 75 51,4 8 113 77,4
9 77 52,7 9 109 74,7
10 77 52,7 10 105 71,9
11 76 52 11 117 80,1
12 79 54,1 12 128 87,7
13 88 60,3 13 117 80,1
14 83 56,8 14 111 76
15 80 54,8 15 119 81,5
16 77 52,7 16 111 76
17 80 54,8 17 111 76
18 79 54,1 18 119 81,5
19 80 54,8 19 112 76,7
Based on table 6 above showed that Based on table 7 above showed that
the behavior of the mother in caring of the behavior of the mother in the care of
LBW before anticipatory guidance LBW after doing anticipatory guidance
(anticipatory guidance) in the sub-district (anticipatory guidance) in the sub-district
Puskesmas Kamal Kamal Bangkalan that Puskesmas Kamal Kamal Bangkalan was
less than half 48.6% of the mothers was in 87.7% in the category of good.
Differences in level of mother's
the category of less.
behavior before and after anticipatory
Table 7 Distribution Frequency
guidance (anticipatory guidance) in the sub-
Behavior of Mothers in LBW baby After district Puskesmas Kamal Kamal
Anticipation Guidance Forum (anticipatory Bangkalan.
Guidance)
Table 8 Distribution Frequency Behavior
LBW Between Mother Before And After
Anticipation Guidance Forum (anticipatory
Guidance
No responden Pre-Test Post-Test
1 92 122
2 107 117
3 89 126
4 72 111
5 81 116
6 71 111
7 77 110
75 113
8 77 109
9 77 105
10 76 117
11 79 128
12 88 117
13 83 111
221
14 80 119 do not know what it is care LBW including
15 77 111 the purpose and benefits of treatment LBW
16 80 111 itself as well as how to perform
17 79 119 maintenance of low birth weight is good and
18 80 112 right.
19 The level of knowledge is lacking,
negative attitudes, and actions or lack of
Having performed statistical tests skills that will affect their behavior
using different test Paired T Test result negatively. This is reinforced by the opinion
value p value: 0,001 which means α < 0.05 Notoatmodjo (2010), the higher the person's
so that Ha is accepted H0 is rejected. The level of knowledge the better the acceptance
result was a difference in the mother's of LBW care home and vice versa.
behavior before and after anticipatory
guidance (anticipatory guidance) in the sub- CONCLUSION AND
district Puskesmas Kamal Kamal RECOMMENDATION
Bangkalan. Factors that may affect the behavior
is the age of the mother. The results showed
DISCUSSION that almost half of respondents (47.4%)
Mother's behavior in caring of LBW aged 15-20 years. Such a young age causes
before anticipatory guidance (anticipatory the mother has not had enough experience
guidance) in the sub-district Puskesmas about the care of low birth weight. Less
Kamal Kamal Bangkalan. Based on the understanding will influence the
results that the behavior of mothers in the knowledge, attitudes and actions in the care
care of LBW before anticipatory guidance of LBW. This has led to poor behavior in
(anticipatory guidance) in the sub-district the care of LBW. Southwestern someone
Puskesmas Kamal Kamal Bangkalan by who tends to repeat a good experience and
48.6% less category. tend to avoid the experience was not good
Based on the analysis of (Notoatmodjo, 2007). younger mothers
questionnaires filling knowledge with low have lack of knowledge about the care of
scores are part of what should go into the LBW infants due to lack of experience and
mouth of LBW infants, at what time LBW information obtained from other people and
babies should be dried in the sun, and how the mass media. Therefore, the younger a
mothers swaddle correct LBW babies. At person will will have low level of behavior
the lowest score is the attitude of the in the home care of LBW infants. Another
umbilical cord in LBW infants should not factor influencing the behavior of the
be given or dibumbuhi potions to prevent mother is the education factor.
infection, should have from 7-8 hours in the The results showed nearly half (47.4%)
morning can hang LBW infants mother that of respondents had elementary
the baby's skin is not damaged, and LBW educationleading to lack of maternal
infants should be done so as not cold skin behavior in the care of LBW infants. This is
contact with mother and baby (KMC). At consistent with the theory of Walgito
the lowest score that measures how she (2005), the higher the person's level of
folded and swaddle the baby, how she took education, the easier to understand the
care of the umbilical cord with dry gauze information given to them and will have
and memebungkusnya, and drying the baby better behaviour in caring of baby The
the right way. results also showed that nearly half (42.1%)
This is because the behavior of the of respondents are farmers. Most women
mother in the care of the baby is still lacking working as farmers they do not get the
and very foreign to the people, especially opportunity to obtain more information
mothers with LBW babies at home so they about the care of LBW LBW and implement
222
home care routine and regular. This is Surasmi. 2005. Perawatan Bayi Resiko
supported by Supartini (2005) that the Tinggi. Jakarta: EGC.
demands of time-consuming work that Syahreni, 2009. Anticipatory Guidance
often hamper the fulfillment of the need for Universitas Indonesia. Jakarta
unity in the family. Walgito, B. 2009. Psikologi Sosial (Suatu
Pengantar). Yogyakarta : Andri
REFERENCE offset
Badan Koordinasi Keluarga Berencana
Nasional (BKKBN). 2013. Survei
Demografi Dan Kesehatan
Indonesia (SDKI) 2012. Jakarta:
BKKBN.
Bang AT, Bang RA. 2005. Low Birth
Weight and Preterm Neonatus: Can
they managed at home by mother
and a trained village health worker.
Journal of Perinatology, S72-S81.
Avalaibel online at:
http://www.Nature.com/jp/journal2
5/n1s/pdf/7211276a.pdf (diakses 28
januari 2016).
Elizabeth NL, Christopher OG, Patrick K.
2013. Determining an
anthropometric surrogate measure
for identifying low birth weight
babies in Uganda: a hospital based
cross sectional study. BMC
Pediatric. 13-54.
Hidayati. 2015. Pengaruh Anticipatory
Guidance Terhadap Perilaku Ibu
Pada Perawatan BBLR diakses
dalam
http://opac.unisayogya.ac.id/188/1/
1%20NASKAH%20PUBLIKASI.p
df. (diakses 28 januari 2016).
Notoatmodjo, Soekidjo. 2010. Ilmu
perilaku kesehatan. Jakarta: PT
Rineka cipta
Nursalam, 2011. Konsep dan Penerapan
Keperawatan. Jakarta: Rineka
Cipta.
Saifuddin, Azwar. 2009. Sikap Manusian
Teori dan Pengukurannya Edisi 2.
Yogyakarta : Pustaka pelajar
Sudarti dan fauziah. 2013. Asuhan
Neonatus Resiko tinggi dan
Kegawatan. Yogyakarta: Nuha
medika
223
EFFECTIVENESS OF INTERPROFESIONAL EDUCATION (IPE) PROGRAM ON
STUDENTS PERCEPTION OF TEAMWORK
Athanasia Budi Astuti, Sri Mulyanti

Nursing department, Health Polytecnic of Surakarta
Email: email.atha@yahoo.co.id
ABSTRACT
Introduction: Health problems more complex and require teamwork professions. Teamwork
requiring the same perception among members of the profession. This study aimed to evaluate
the effectiveness of IPE program on students' perceptions of team work. Methods: It is a
combination of research (mixed research) to measure the effectiveness of IPE program to
change students' perceptions of teamwork. Subjects were 8 department of Surakarta Health
Polytechnic students who carry out programme IPE in Ngemplak, Boyolali, with a number of
652 respondents. The sample is 50% of students from each department. Student perceptions
were measured using a questionnaire Interdisciplinary Education Perception Scale (IEPs)
according Luecht, Madsen, and Taugher (1990) combined with FGD students perseption. Data
were analyzed using Two Way ANOVA using SPSS 18 series. Results: (1) The value of the
average of student perceptions before implementing IPE program is 54.32, the highest in
orthotic prostetic (2) The value of the average perception after implementing IPE program is
67.48, the highest in Jamu (3) Program IPE can add friends and new knowledge from other
professions (4) IPE program effectively to improve student perceptions. Conclusions: IPE
programs can effectively improve students' perceptions of teamwork across professions (t = -
13.229; p=0.000).
Keywords: Interprofesional Education (IPE), Teamwork, Student Perception
INTRODUCTION healthcare professionals can work well, if

One of the program Nawa Cita from the beginning of health workers have
Indonesian government is to improve the the same perception on cooperation
quality of Indonesian human life with interprofesional (Thistlethwaite, 2012).
agenda called Program Indonesia Sehat. One effort to do is do the introduction of
Based on this agenda then all of Indonesian multidisciplinary cooperation early on
society are required to actively participate medical students in teamwork interprofesi
in efforts to improve the health and welfare known as Interprpofesional Education
of community. Indonesia Sehat program (IPE). Collaboration among health
would then become a major program of professions is an effort to improve the
health development by the Department of quality of health services. As well as the
Health then applied in the form Year opinion Hind (2003) which states that the
Strategic Plan 2015-2019 Ministry of collaboration is an attempt to improve the
Health (MOH, 2016). On the other hand the quality of health services.
health problems faced by an increasingly WHO (2010) has made a grand
complex society. Apart from the number is design for the character formation of
increasing, the factors causing health collaboration in a form of formal education
problems are also more complicated in the form of interprofessional education.
anyway. That requires a multidisciplinary Interprofessional education (IPE) is an
cooperation of health professions implementation of learning followed by two
(Zwarenstein M et.all, 2009). or more different professions to improve
Multidisciplinary collaboration of collaboration and the quality of service and
224
its implementation can be done in all acupuncture, orthotics prosthetics, and
learning, both undergraduate stage or stages Jamu. Samples were taken by cluster
of clinical education to create professional random sampling, where each department is
health workers. taken at random as much as 50% of each
Understanding and maturity of each department. The number of samples as in
member of the profession to interact and the first table.
work together across professions will
determine the successful completion of the Table 1. Distribution Frequency Number
health problems that are found. Improved of Respondents
knowledge, attitude, and cooperation of Department f %
medical students during the activities IPE Nursing 65 19,94
IPE program is the main objective. Related Midwifery 55 16,87
to this it is essential to do a study on the Physiotherapy 64 19,63
evaluation of a change of attitude and Acupuncture 30 09,20
cooperation skills (teamwork) medical Occupational Therapy 25 07,67
students during the IPE program. Orthotic Prosthetic 28 08,59
This study aimed to identify the Speech therapy 23 07,06
effectiveness of IPE program to increase Jamu 36 11,04
students' perceptions of health Polytechnic Total 326 100
Surakarta on cooperation across professions
RESULT
METHODS All respondents totaling 326
This research is combined (mixed students can follow the research process
research) to measure the effectiveness of until completed, and the results are as
IPE programs in the community to change follows:
students' perceptions of cooperation across
professions. Subjects were all students of 1. Perception of Students Before
Surakarta Health Polytechnic implementing Program IPE
IPE program in District Ngemplak of Table 2. Perception of Students Before
Boyolali, a number of 326 respondents, Program IPE
consisting of the departments of nursing, Program Mean Max
physiotherapy, speech therapy, Midwife 53,04 67,00
occupational therapy, midwifery, Physiotherapy 51,58 65,00
acupuncture, orthotics prosthetics, and Acupuncture 51,18 67,00
Jamu. IPE students' perceptions of the Occupational Therapy 58,22 71,00
program was measured using a Orthotic Prosthetic 64,38 83,00
questionnaire Interdisciplinary Education Nurses 52,23 67,00
Perception Scale (IEPs) developed by Speech therapy 52,60 67,00
Luecht, Madsen, and Taugher (1990) Jamu 52,52 67,00
combined with FGD persespi students. Mean 54,32 83,00
Research start on July to August 2016 Data The second table provide
were analyzed using Two Way ANOVA information value - average student
using SPSS 18 series. perception of the whole departement was
The subjects of this study were all 54.32 with a maximum value or highest is
students of Surakarta Health Polytechnic 83.00 OP (Orthotic Prosthetic)
implementing IPE program Ngemplak
District of Boyolali, a number of 326
respondents, consisting of the departments
of nursing, physiotherapy, speech therapy, Table 3. Results of ANOVA analysis (Post
occupational therapy, midwifery, Hoc) Value Perception Before IPE Program
225
Program Mean Max Occupational Therapy -6,72 ,169
Midwife 11,33 *
,002 Orthotic Prosthetic -12,15* ,000
Physiotherapy 12,79 *
,000 Nurses -11,22* ,000
Acupuncture * Speech therapy -11,81* ,000
13,19 ,000
Jamu -13,06* ,000
Occupational Therapy 6,15 ,379 Based on Table 4 and 5. It is seen
Nurses 12,15 *
,000 that the increase in value - average low is
Speech therapy 11,77 *
,001 majoring in acupuncture, while the lowest
Jamu 11,85 *
,001 maximum value is majoring in OP (Orthotic
Results of ANOVA analysis (Post Prosthetic) is 72. The result of ANOVA F =
Hoc) Value Perception Before IPE Program 5.290 and p = 0.000 shows there is a
Based on Table 2 and 3. It is seen that the difference between the majors, except with
highest average value is majoring in the department of acupuncture with the OT
OT(Occupational Therapy) and these there is no difference (p = 0.169)
values are different from other majors
midwives (p = 0.002), Physiotherapy (p = 3. Effectiveness IPE against Student
0.000), Acupunktur (p = 0.000) , Nurses (p Perception
= 0.000), Speech therapy (p = 0.001), and Table 6. t-test Results Student Perception
Jamu (p = 0.001). As for the majors OT no Before and After Program IPE
difference where the value of p = 0.379. Pre Post t p
54,32 67,48 -13,22 ,000
2. Perception of Students After IPE Table 6 shows the average value of
Program students 'perceptions after IPE program is
Table 4. Value Perception of Students higher than before implementing IPE
After IPE Program program, as well as the value of the t-test p
Program Mean Max = 0.000 (significant differences) so that it
Midwife 67,69 85,00 can be concluded that the IPE program is
Physiotherapy 67,12 83,00 effective to improve students' perceptions
Acupuncture 58,31 74,00 of the IPE.
Orthotic Prosthetic 65,04 72,00
Occupational Therapy 70,47 84,00 DISCUSSION
Nurses 69,53 86,00 The results showed the program
Speech therapy 70,13 88,00 Interprofesional Education (IPE) can
Jamu 71,38 89,00 significantly improve the perception of the
Mean 67,48 89,00 students (p = 0.000). IPE activities in 2016
Table 4. Provide information value - by the Health Polytechnic Surakarta
average student perception of the entire conducted by practicing eight department
department after IPE program increased to with a total number of students each
67.48 with a maximum value or highest also department between 42 up to 52 students.
increase to 89.00 are majoring in Jamu. With the number of departmeent that are
With the results of ANOVA F = 5.920 and very much needed coordination across the
p = 0.000 showed there were differences profession quite intensively. The principle
between each department. of such activities in accordance with the
understanding IPE According to the Centre
Table5. Results of ANOVA analysis for the Advancement of interprofessional
(Post Hoc) Value Perception After IPE Education (CAIPE), which IPE is two or
program more professions learn with, from and about
Program Mean Max each other to improve collaboration and
Midwife -9,37 *
,008 quality of service. IPE is an approach to
Physiotherapy -8,80* ,016 education process two or more different
226
disciplines collaborate in the teaching- perception is a departement as jamu (18.86
learning process with the aim of fostering points) and the lowest is Orthotic Prosthetic
interdisciplinary or interprofesional department with rising 6.10 points.
interactions that increase practices of each As a group basis questionnaire also showed
discipline (ACCP, 2009). IPE occurs when an increase as shown in Table 7
two or more students of different health
professions implement interactive learning Faktor Pre Post Range
with the aim of enhancing collaboration
interprofesional and improve the health or Factor 1. 67,8 71,6 3,84
well-being of patients. Interest Professional
interprofessional education according Competence and
Freeth and Reeves (2004) is to prepare Autonomy
students for healthcare professionals with Factor 2: 58,7 72,4 13,6
the knowledge, skills, attitudes and Perceived Need for
professional behaviors that are essential to Professional
the practice of collaboration Cooperation
interprofesional. Factor 3: 65,8 70,5 4,68
The corresponding concept of IPE, Perception of Actual
the main purpose is to train students in Cooperation Resource
health professions resolve health problems Sharing Within and
through collaboration team and Across Professions
collaboration among health professions. Factor 4: 52,5 69,7 17,1
Implementation in Health Polytechnic Understanding the
Surakarta 8 department practiced together Value and
in one team tasked to investigate and Contributions of Other
resolve the health problems found in the Professional/Profession
family or community. During the IPE Table 7. Shows IPE program
program implementation through provides contribution in improving student
supervision and guidance of the lecturer. perception about interprofesional teamwork
Changes in student perception of the or cooperation across professions. On the
IPE highly variable but generally increasing first factor is about the professional
toward the better. According to table 6, it is competence and autonomy, the average
clear that the value of perception after the student's ability to realize the importance
IPE program better than before with the and autonomy of each profession so that
value of the test results of t-test 0.000 they feel able to solve a health problem.
(<0.005). However, students are also beginning to
realize that there are other professions that
Quantitative Analysis also has the competence and autonomy to
Student perceptions about IPE as overcome health problems. On the second
quantitatively measuring the factor also experienced an increase in value
Interdisciplinary Education Perception - average high enough. This data shows the
Scale (IEPs) that researchers meaning into IPE program can improve the perception or
Indonesian. In the quantitative value of all students understandings about the
the factors of the 18 components of importance of professional cooperation
perception has increased, which indicated teamwork. On this factor, there are two
the average value before implementing IPE questions, namely whether the profession I
program amounted to 54.32 increased to need to work with other professions, and
67.48. Analysis of changes in each whether the profession I have to depend on
departement of study show departement other professions. With the increase in
that have increased the value of the highest value - average showed the students begin
227
to realize the need for cooperation between knowledge from various other professions"
the profession and even in menyelesiakn " Initially hesitant and somewhat lazy to
health problems sometimes other leave the practice, because imagine not
professionals are needed or depending on familiar with the other students, was less
other professions. This result is also the enthusiastic, but after gathering turned out
same as the factor 3 is the perception of to other student was cool, fun, to chatting
resource sharing across the profession, and joking "
which means the program IPE can also "Met a lot of amazing friends, learn to serve
improve students' perceptions about the in the community, learning to be a
need to share the ability or competence of housewife"
each profession, and every member of the Based on the open perception of each of
profession should be willing to help each these groups as general gives an overview
other, cooperate with each other each although initially the students feel
according to its competence. Factors that uncomfortable about having to work or
change is highest at four factors that practice with other professions, but in the
understand the value and contribution of end the student feels comfortable as it gets
professional / Other professions. This is a new friend incredible, can learn from
certainly very good, because the IPE other professions, and work together in
program can improve the perception of the teams across the profession turned out to be
need to understand the roles and functions the happy like their own family.
of each profession in teamwork, and most
importantly, there is no understanding of CONCLUSION AND
the most important professions in the RECOMENDATON
program interprofesional (Ponzer, 2004). Conclusion
These results are consistent with IPE programs effective to improve
Thistlethwaite (2012) were the outcome of students' perceptions of teamwork across
IPE is to increase awareness among professions.
healthcare professionals about the
importance of teamwork and mutual respect Recomendation
among members of the health team. These IPE activities should be continued to
results are also consistent with the concept improve the quality of implementation.
of et.all LeWitt (2015) which describes the
IPE program can improve cooperation REFERENCE
across the profession so memudhkan Barr, H. & Waterton, S. (2013)
solving health problems that are found. Interprofessional education in
health and social care: Report of a
Qualitative Analysis CAIPE education survey. London;
In this study, the researchers also CAIPE
gave an open question about how the Depkes RI (2016) Pedoman Umum
students perception of the IPE program. Program Indonesia Sehat dengan
From the analysis of the results of each Pendekatan Keluarga. Kementerian
group FGD generally obtained as follows: Kesehatan RI. Jakarta P Jakarta
"Like to meet people and get new knowledge Hind M., Norman I., Cooper S., Gill E.
from a variety of professions." 2003. Interprofessional Perception
"Here we learn to work together, although of Health Service student. Journal
only 4 weeks seemed four years that foster Interprofessional care [serial online]
brotherhood" [cited 2009 may 15]: 17 (1); 21-34
"A lot of people meet new and familiar fast available from
like family, very pleasant, no problems, HTTP://www.ncbi.nlm.gov/pubme
every day is always laughing, a lot of added d/12772467
228
Jill Thistlethwaite (2012) Medical
Education 2012: 46: 58–70 a
Blackwell Publishing Ltd 2012.
MEDICAL EDUCATION 2012;
46: 58–70
Lewitt et.all (2015) Interprofessional
Education to Support
Collaborative:An Interdisciplinary
Approach University of the West of
Scotland
Mark N., Karen S.H., dan Teri Peterson
(2007) Journal of Interprofessional
Care,August 2007; 21(4): 425 – 432
Ponzer S.,et.all (2014) Interprofessional
training in the context of clinical
practice: goals and students’
perceptions on clinical education
wards . Medical Education 2004;
38: 727–736
Thistlethwaite J.(2012) Interprofessional
education: a review of context,
learning and the research agenda
Correspondence CMEDRS, School
of Medicine, University of
Queensland, Herston, Brisbane,
Queensland 4006, Australia. Tel: 00
61 7 3365 5206E-mail:
j.thistlethwaite@uq. edu.au 58
Medical Education 2012: 46: 58–70
World Health Organization (WHO).
Framework for Action on
Interprofessional Education and
Collaborative Practice. Geneva:
WHO 2010
Zwarenstein M et.all, ( 2009).
Interprofessional education: effects
on professional practice and health
care outcomes (Review) The
Cochrane Collaboration. Published
by JohnWiley & Sons, Ltd.
229
EFFECTIVENESS OF EDUCATION PROGRAM INTERPROFESIONAL (IPE)
HEALTH STATUS OF FAMILY
Sri Mulyanti, Athanasia Budi Astuti

Nursing department, Health Polytecnic of Surakarta
Email: di_yanti96@yahoo.com
ABSTRACT
Introduction: The family is an important part in the success of health development. Index of
healthy family as a health status indicators and the strategy appears logical to gain of healthy
direction based on the family. Interprofesional Education (IPE) is the strategy of health
education institutions in contributing to improving the health status of the family. Assess the
effectiveness of the program Interprofesional Education (IPE) to the improvement of health
status of the family. Method: This is a Quasi-Experimental research with pre post design.
Subjects were 120 families with healthy family index value <0.800. Treat the form of
counseling families through programs Interprofesional Education (IPE). The research was
conducted from July to December 2016. Results: (1) The value of the average index of a healthy
family before being implemented program IPE 0,400 unhealthy category (2) Index healthy
families after the implementation of the program of IPE is pre healthy with the average value
of 0.690 (3) IPE effective in improving the health status of the family , p = 0.000 (4) there is a
family medical issue that can not be solve because there is no appropriate departement of the
institution handle this issue. Conclusions: IPE effective in improving family health status (p =
0.000)
Keywords: Interprofesional Education (IPE), Status of Family Health, Healthy Family Index
INTRODUCTION Care Function), which functions to maintain

Healthy Indonesian program with a the state of health of family members to
family approach to public health strategy in keep a high productivity. This functionality
Indonesia today. Health development goals was developed into the family duties in the
is to increase awareness, willingness and health field that is familiar with
ability of healthy life for everyone in order development disorders the health of every
to materialize the health of society as high. member of the family, took the decision to
The success of health development is act appropriate health, providing care to ill
largely determined by the synergy and family members, maintains a home
continuity between the various efforts and atmosphere that is beneficial to the health
programs in the community and the and development of the personality of his
government. Efforts to achieve the health family members, and maintaining
priorities in the year 2015-2019 in Healthy relationships reciprocity between families
Indonesian Program implemented by and health facilities.
utilizing all the potentials that exist, On the other hand there are health
whether from the central, provincial, district problems in the family more numerous and
/ city, and society. According the policy, complex, thus requiring treatment from a
health development starting from the health holistically and comprehensively.
smallest unit of society, the family Multiprofesion or cross-profession
(Department of Health, 2016). cooperation is needed to be able to touch all
One function of the family aspects in the family. Efforts and programs
according to Friedman (1998) is a care or to improve understanding of the role and
health maintenance function (The Health functions of the family in health
230
development also should be improved, so as has eight courses namely nursing,
to realize a family that is able to play an midwifery, physiotherapy, orthotic
active part in the program Healthy Prosthetics, Occupational Therapy, Speech
Indonesia. The effort is a shared Therapy, Acupuncture and Herbal
responsibility of health workers in health Medicine. In an effort to participate and to
centers and surrounding communities, prepare health workers who are reliable,
including health education institutions. then the Health Ministry of Health
One of the things that is a challenge for Polytechnic Surakarta since 2015,
health institutions is how to be able to implementing programs Interprofesional
utilize the existing health workforce Education (IPE). IPE conducted with each
optimally to meet the health needs of student menggambungkan Department into
patients, families, and communities with one group of students, so that any one group
cost effective (IPEC, 2011). of students from the Department 8. Each
According to Stevenson (2012), the key to a group was given responsibility for
comprehensive range of cost-efficient is to managing a group of people made up of
increase the effective collaboration between several families. During the practice the
health professionals. This is in line with students are guided by a 2-4 vote lecturer in
WHO statement on the Framework of one area / village to investigate and resolve
Action on Education and Collaborative the health problems in the family, including
Practice interprofessional that to solve the conduct of health education in the
health problems related to many aspects of family so that the health status of families is
life can not be done only with expected to increase. Has not conducted
uniprofesional system. research on.
Interprofesional education (IPE) is This study aims to determine the
one of the educational system that triggered effectiveness of IPE program on family
the WHO as an integrated education system health status.
to prepare for collaboration practice. IPE
occurs when two or more professions learn METHODS
and be able to collaborate in improving This research is quasy Experiment
health (CAIPE, 2011). IPE effective with pre post design to determine the
implementation can produce effective effectiveness of IPE program on family
collaboration practices as well (WHO, health status. Family health status was
2010). IPE is an important step in preparing measured by Healthy Families Index 2016
the readiness of health workers issued by the Ministry of Health of the
collaboration practice better. Many Republic of Indonesia. Test the statistics
developed countries that enter into the used are Dependent Paired t-test with SPSS
educational curriculum IPE (Wilhelmsson 18. The research was conducted from July
et al., 2011). CIHC (2007) states that the to December 2016.
application of the IPE on academic
education can improve the quality of POPULATION SAMPLE AND
practice in the profession, so that it can SAMPLING TECHNIQUES
provide a positive impact on health Respondents are whole families in
services. At the time of taking professional 12 village in Puskesmas Ngemplak
education, students will encounter technical Boyolali which have criteria in Healthy
problems that vary from profession so in Family Index (IKS) <0,800. The number of
solving the problem required inter- samples taken in 120 households using
professional collaboration. cluster random sampling, which each group
Surakarta Health Polytechnic is one of the was given the task of guiding 10 families
Institutes of Health under the Ministry of were drawn at random after all the families
Health of the Republic of Indonesia, which
231
studied by IKS. The study was conducted Pre Post Std
from July to December 2016. 0,400 0,690 0,15 0,000
RESULT Statistical test result with Dependent

1. Family Health Status Before Program Paired t-test as shown in Table 3,
IPE demonstrate the value of p = 0.000
Table 1. Frequency Distribution of (<0.005), the average value after the
Family Health Status Before Program program IPE (0.690) is greater than the
IPE value before the program IPE (0,400), so it
Category f % can be concluded that effective IPE
Healthy (> 0.8) 0 0,00 program to improve the health status of the
Pre Healthy (0.5- 18 15,00 family.
0.8)
UnHealthy (<0.5) 102 85,00 DISCUSSION
Total 120 100 The treatments were a family
coaching by student groups. In the
Table 1 shows that before the family implementation of IPE program that was
made guidance through the IPE program, conducted, each group consists of 10-15
the number of families the most is the students from eight majors. Accompanied
unhealthy status is 102 or 85.00% and by 2- 4 lecturers, the group was given the
families with pre-healthy status, namely 18 responsibility to conduct guidance in 10
or 15.00%. Descriptive analysis results families with unhealthy category or pre
showed the average value is 0,400 including healthy (score IKS, 0,800). During
the category of unhealthy family guidance or IPE program, each family was
given health education and health
2. Family Health Status After IPE Program counseling suit each family problems, and
Table 2. Frequency Distribution of in the implementation of this research, there
Family Health Status After IPE program are also families who were given treatment
Category f % or therapeutic measures such as
Healthy (> 0.8) 24 20,00 physiotherapy, speech therapy, acupuncture
Pre Healthy (0.5- 78 65,00 or acupuncture, as well as other nursing
0.8) actions according to the needs.
UnHealthy (<0.5) 18 15,00 Dependent test based on the research results
Total 120 100 Paired t-test showed value - average IKS
increased from 0,400 (unhealthy family
Table 2 shows the health status of category) increased to 0.690 (pre healthy
the family after guidance through the IPE family category), with the Sig-2 tailed or p
program is at most the number of family = 0.000. These results suggest that effective
groups with pre-healthy status of a number IPE program to improve the health status of
of 78 or 65.00%, and the least is unhealthy the family.
familial status as much as 18 respondents or Interprofesional Education (IPE) is
15.00%. Statistical analysis of descriptive an educational program in which a group of
value - average is .690, including pre students from several departments to
healthy family category. practice together to solve a family health
problem. According to WHO (2010) has
3. IPE Program Effectiveness Against been proven that the handling of the
Family Health Status fragmented health problems that every
Table 3. Test Results Dependent Paired health professional separately working to
t-test address the problem, in fact ineffective. In
Mean Value p countries in the world that still rely on this
232
in the end was unable to resolve the health Through the IPE program problem -
problems in the country itself. It is then, an the problem can be terkaji and handled
awareness of health issues is actually about properly. It is the purpose of the IPE
many aspects of life, and to be able to solve Generally, IPE aims to train students to
these problems one by one, or to improve better understand the role of other health
the quality of health itself, can not be done professionals, so it is expected students will
simply by uniprofessional system. be able to collaborate well when the patient
Contributions to share the discipline it gives care process. Interprofessional patient care
a positive impact on the settlement of processes will improve the quality of health
various health problems. care and increase patient satisfaction
It is also evident in this study, where 120 (CFHC-IPE, 2013). According to Cooper
families managed by Surakarta Health (2004) IPE implementation goals include
Polytechnic students, the majority of improving interdisciplinary understanding
problems that arise very complicated and promote cooperation, competent to
because many factors are involved in it. foster cooperation, making effective use of
Factors - these factors are not just purely resources and efficient, improve the quality
related to the health sector, it is not of comprehensive patient care. Based on
uncommon other factors outside the health this concept, the IPE program conducted by
such as low economic level, low level of the Health Polytechnic Surakarta, according
education, culture, social, and even to the results of this study provide empirical
religious factors. For example, there are evidence can train students with different
families who value a healthy family index is scientific backgrounds - different in doing
very low, because it inhibits the factor of teamwork professions to improve the health
religion and belief of the family to status of the family.
participate in family planning programs, Family by Hanson (2005), as cited
hampering the baby to obtain by Kaakinen et.all (2010) defines a family
immunization, and even just to come to the as two or more individual relationships are
clinic or posyandu also difficult. interdependent and support each other in
The concept in accordance with the terms of emotional, physical, economic.
understanding of IPE by CAIPE (2002), The concept according to explain
which describes the IPE are two or more that in my family there will be cooperation
professions jointly implementing learning and mutual support among its members in
in a particular period in overcoming a all aspects. The health status of the family is
problem. In these activities are studied a dynamic status of the family, not just the
together, from and about each other to absence of disease, but also including the
improve collaboration and quality of health condition of biological, psychological,
services. IPE is an approach to the spiritual culture of family members
educational process two or more different (Hanson, 2005). The concept is evident in
disciplines, collaborating in the teaching- this study, where there are health problems
learning process with the aim of fostering in the family influenced the health status of
interdisciplinary / interaction families in general, such as income
interprofesional appropriate practices that decreases, psychological problems in
improve the quality of discipline or family, cultural and even family also
profession respectively (ACCP, 2009). IPE changed.
occurs when two or more students of IPE program empirically proven to
different health professions implement help families to cope with health issues and
interactive learning with the aim to improve impacts that occur in the family. During the
collaboration interprofesional and improve data collection there are 6 families in which
the health or welfare of the patient / one of my family members diagnosed with
community, in this case the family. pulmonary tuberculosis, in which 3 families
233
(50%) which is the capital of childbearing health problems are handled jointly families
age have not done according to the standard professions provide a better impact, so that
TB treatment. In the family also found a the components contained in the indicators
problem head of the family or the husband of healthy families can be met so that the
had hypertension, and no one toddler that family's health status can be improved.
his body weight does not rise in the second Problems encountered in the
consecutive month - a row. Through the implementation of the IPE is there are
guidance and intervention of a group of several families with problems akutyang
students then it can be treated properly, so disease requiring medication and medical
annggota family Tuberculosis obtain drugs assistance as well as there are some
and to take his medicine regularly, husband problems or severe psychological disorders
hypertension treated with acupuncture and that can not be handled properly. This
drugs from the clinic, and taught to use happens because there are no students who
herbal remedies of students majoring in are competent in accordance with the field
herbs , At the time of the evaluation of the and profession. Solving a problem that's
value of IKS increased. These results are done is by cooperating with the health
consistent with research Gocan S., center and partly addressed with their
Laplante, M.A., and Woodend A. Kirsten mentors.
(2014) who studied the literature and
evaluation studies Interprofesional CONCLUSION AND
Collaboration of Family Health Teams in RECOMMENDATION
Ontario. The results of the study came to the Conclusion
conclusion Interprofesional Collaboration 1. The value of the average - average index
in general can improve the access of of a healthy family before IPE program
cooperation and achievement of the goals of implemented 0,400 unhealthy category
the team of health workers. The conclusion 2. Index healthy families after the
of the review of the literature provides implementation of the IPE program is
information that can be a medium of pre healthy with the average value of
collaboration interprofesional health 0.690
workers to work together in teams so that 3. IPE* effective in improving family
the goal is more easily achieved. health status (p = 0.000)
IPE effectively can be a media or 4. There is still a family medical issue that
family health problem-solving methods. can not be done because there is no
Barr, H. and Waterton, S. (2013) describes appropriate department of the institution
some of the competencies that can be
achieved through the IPE is to understand Recomendation
the role, responsibility and competence of 1. IPE can be implemented in a longer
other professions clearly, working with period of time, if need be held
other professions to solve the conflict in throughout the year
deciding the care and treatment of patients, 2. It should be pursued in cooperation with
to work with the profession others to assess, other courses where the institution has
plan, and monitor patient care, tolerate or not been there, such as psychology,
accept their differences, misunderstandings medicine, as the issue is in the family
and the lack of any other profession,
facilitate meetings interprofesional, and REFERENCE
train an interdependent relationship with ACCP-American College of Clinical
other health professionals. Competence - Pharmacy. 2009. Interprofessional
The real competence is very helpful in the Education: Principles and
process of solving the health problems of Application A Framework for
the family. Proven in this study that the
234
Clinical Pharmacy. Volume 29,
Issue 7 July 2009 Page 879
Barr, H. & Waterton, S. (2013)
Interprofessional education in
health and social care: Report of a
CAIPE education survey. London;
CAIPE
Centre for the Advancement of
Interprofessional Education-
CAIPE (2011). Framework of
Action on Interprofessional
Education and Collaborative
Practice
CFHC-Community and Family Health Care
(2013). Universitas Gadjah Mada
Yogjakarta
CIHC - Canadian Interprofessional Health
Collaborative. College of Health
Disciplines university of british
Columbia Vancouver b C V6T 1Z3
Canada National Interprofessional
Competency Framework
Cooper H., dan Braye Suzy. (2004)
Complexity and interprofessional
education . Learning In Health and
Social Care Volume 3, Issue 4
December 2004 Pages 179–189
Depkes RI (2016) Pedoman Umum
Program Indonesia Sehat dengan
Pendekatan Keluarga. Kementerian
Kesehatan RI. Jakarta P Jakarta
Friedman MR, Bowden VR., dan Jones E.
2003. Family Nursing: Research,
Theory, and Practice .5th . Pearson.
Interprofessional Education Collaborative
Expert Panel. (2011). Core
competencies for interprofessional
collaborative practice: Report of an
expert panel. Washington, D.C.:
Interprofessional Education
Collaborative.
Kaakinen et.all. 2010. Family health care
nursing : theory, practice, and
research.4th ed. Philadelphia. F. A.
Davis Company
235
PERSPECTIVE DEPRESSION IN SOME GROUPS IN SOCIETY: SYSTEMATIC
REVIEW
Sri Widowati, Gandes Widya H, Hanim Nur Faizah, Sahriana

Email: irs.widowati@gmail.com
ABSTRACT
Introduction Depression is a mental health problem that often occurs mainly in the setting of
primary care services, which is still a challenge for the health of the world to continue to do
research. Depression is also a considerable contribution can be considered as the Global Burden
of Disease, and according to WHO, depression will be the most important disease in 2030.
Methods: search articles in the database online including Science Direct, Gale, DOAJ and
HOAJ with entering keyword depression, community groups, drug abuse, adolescen and
pregnance. Of the 28 journals of the depression 15 journals we select and use to do systematic
review. Results: Research have founded factors that influence signifikant against depression
such as pre- and post-natal women, social and economic status, self-efficacy, and assertiveness.
Conclusion Although much research about depression but had not answer the problem of
depression is increasing in society.
Keywords: depression, community groups, pregnance, adolescent and drug abuse.
INTRODUCTION depression and anxiety emotional at 6%

Depression is a mental health (about 14 million) for ages 15 and over.
problem that often occurs mainly in the (Center for Public Communication
setting of primary care services, which is Secretariat General of the Ministry of
still a challenge for the health of the world Health, 2014).
to continue to do research. Depression is Much research has been done
also a considerable contribution can be related to the problems of depression, both
considered as the Global Burden of Disease, about the causes, the association of
and according to WHO, depression will be depression with other health problems,
the most important disease in depression with genetics, depression in
2030.Prevalensi depression depends on the some groups in society and therapies to
methods and diagnostic criteria used at the reduce the occurrence of depression.
time the research is done. In the United Therefore, to see details about the problem
States in 2012 as much as 6.9% of the age of depression including risk factors,
18 years or older (16 million people) suffer depression in various communities, as well
at least one episode of depression within as any therapy that has been done, so we try
one year. (SAMHSA, 2013 in Townsend, to approach with a systematic review. The
2015) .During their lives, about 21% of purpose of this systematic review approach
women and 13% of men will experience are: 1) to identify risk factors and the causes
depression in the clinic. This makes some of depression in various groups in the
researchers refer to depression as "the community, 2) to examine the relationship
common cold of psychiatric disorders" and of depression with other health problems,
the current generation as the "age of and 3) to examine the therapies that have
Melancholia." (Townsend, 2015). In been done.
Indonesia is based on results of Health
Research (Riskesdas) in 2013 that the
prevalence of mental disorders such as
236
METHODS compared to 43 students who are not
Online from 2011 to 2015 including depressed. Scale measuring depression used
the science of direct, database gale, DOAJ were Beck depression scale. Research to 4
and HOAJ. Of the 28 journals of the in order to investigate cross-sectional and
depression 15 journals we select and use to longitudinal relationship between blood
do systematic review. pressure, mood scores and the gene
Monoamine oxidase A (Maoa) in
RESULTS pregnancy cohort of Western Australia,
The risk factors and causes of depression with a total sample of pregnant women in
in some groups in the community. 2900 and carried out a survey on 5,8,10 and
Of 4 journal depressed about the 14 years Anxiety-Depression Score
relationship of depression with genotype, in Obtained from the Childhood Behavior
which his hypothesis of no relationship Checklist on all surveys and depressive
between the incidence of depression in a symptom scores from the Beck Depression
person's genotype. From the research results Inventory for Youth in 14 years. The results
Sharpley et al, 2014 about the comparison are found in 14 years, boys degan risk allele
of the effect of stress in childhood and of SNP rs5905859 and rs3027396 had
current stress, as well as their interaction higher systolic and lower scores his mood.
with the three forms of the 5-HTTLPR. To Longitudinally boy with risk alleles of
determine the relations between genotype, SNPs rs5905859 had higher mean systolic
stress and depression may be supported by trajectory than boys without the risk allele
a positive psychological factor. That cannot rs5905859 SNPs. That means on a sample
be found a significant association between with a low mood have a high systolic blood
genotype, stress and depression scores, but pressure.
the efficacy or durability person will While the group of patients of
prevent the occurrence of depression. schizophrenia, depression experienced by
Depression measurement scale used is the the patient may increase the risk of suicide,
Zung Self-Rating Depression Scale such as research results Rajkhumar et al,
(ZSDS), with sample number 126. While 2015 on reviewing the clinical relationship
the research results Giraldo et al, 2015 with of depressive symptoms in a sample of
the purpose of examining the possible patients in hospital acute schizophrenia
relationship 5 candidate genes with the which is a cross-sectional study design.
incidence of depression, the number of 188 Total sample 72 patients with acute
samples from healthy samples and scale schizophrenia, scale measured by the
depression used HADS (the Spanish Positive and Negative Syndrome Scale for
adaptation of the Hospital Anxiety and Schizophrenia (PANSS), to determine the
depression Scale) and to check the blood level of interference with the functions of
taken genotype perifer. It turned out that the Global Assessment of Functioning
this study found no significant association Scale and for depressive symptoms with the
between the 5 candidate genes with the Calgary Depression Scale for
incidence of depression. Schizophrenia (CDSS). The results showed
Research from Hajebrahimi et al, 11 patients (15.3%) had depressive
2014 of the mRNA levels of Trif and symptoms were clinically significant,
MyD88 in PBMCs of patients with patients with a score of PANSS
depression, with a sample size of 400 psychopathology generally positive have a
students of which 38 students are seen higher risk tinggu to suicide and poor
depressed and non-depressed 43 students as function, mild degree of severity of
control. The result is that the mRNA depression is associated positively with the
expression level of Trif 5.45-fold and 3.98- scale of the PANSS positive and negative
fold increase MyD88 at 38 students correlation with negative PANSS scale.
237
Two studies on depression were also behavior to depression in women
performed on pregnant women and immigrants married in South Korea, the
postpartum group, which in these number of 316 samples from China, the
conditions women at risk of depression as Philippines, Vietnam and other countries.
related to physiological changes and Cross-sectional study design and scale
adaptation. Research Park et al, 2015 about measuring depression is the Center for
the prevalence of depression in pregnant Epidemiologic Studies Depression Scale,
women and its relationship with postpartum the research results there are significant
depression in Korea total sample of 200 differences in the experience of stillbirth,
pregnant women. Depression measurement abortion, morbidity, health status, diet, and
scale used is the Edinburgh Postpartum physical activity between depressed and
Depression Scale (EDPs Korean version) non-depressed.
and socio demographic factors. The results Similarly, in patients with physical
showed the prevalence of depression ranged illnesses such as kidney failure who
from 40.5% to 61.4%, depression in the underwent transplantation, research
second and third trimester had a significant conducted by Ling et al, 2016 which is a
relationship with depression in the cross-sectional study design with a sample
postpartum period, with risk factors for of 287 transplant recipients. The purpose of
depression is not working and the this study to explore the symptoms of
household economy. Subsequent research depression and the factors related to the
on depression in pregnant women is post kidney transplant recipients in China, the
partum depression in Argentina by scale measuring depression used the Self-
Mathinsen et al, 2013. Number of sample of Rating Depression Scale and the results,
86 women 4-12 weeks post partum check- more than half of kidney transplant
ups in health care, depression scale used is recipients experiencing depression, and are
EDPs with cross-sectional design, the result grouped into four periods of the transplant
32 women have EPDS score <10, 16 is 5 years, 5-10 years, 10-15 years and over
women had a score of 10 to 12.16 woman 15 years and there is no difference of
has a score> 13.Skor EPDS> 10 depressive symptoms that appear in the
significantly associated with multiparity, fourth period of the transplant, while factors
complications of pregnancy, childbirth related to depression are employment
complications, cesarean sectio, and status, economic burden, shelter, and
incomplete lactation. support social
Depression research is also done on
student nurses by Rezayat et al, 2014, with Therapies that have been done on
the aim of investigating the correlation depression.
between depression and asertiveness on Lots of therapy that can be done for
student nurses with sample number 248, a the treatment of depression, and would
cross-sectional design and scale of the require research approaches relevant to the
measuring Gambrill and Richey assertion effectiveness and efisiensinya.Adapun
inventory and Beck's depression inventory. dlakukan therapy for depression can include
The results of the study 55.6% of students the results of research by Hui-Ying Can et
have an average asertiveness low and al, 2016 with the aim to investigate the
38.7% had mild to severe depression. effect of Time Slips the Cornell Scale for
Significant relationship between depression Depression in elderly patients with
and asertiveness showed an inverse dementia of mild and moderate, the amount
relationship, asertiveness increase will of sample 43 patients and received the
decrease depression, and vice versa. And intervention Time Slips, a scale of
research by A.Kim et al, 2015 to examine measurement was Observed Emotion
the effects of health status and health Rating scale (OERS), the result showed a
238
significant difference OERS scores before the intervention are the main results. The
and after Time Slips. The next study was sample was 326 (134: IG, 191: CG) is done
also conducted by Katsuki et al, 2011 with randomly and a scale measuring the Patient
the aim to determine the effectiveness of Health Questionnaire (PHQ-D), the
psycho education briefly on the family in German version. The research found that
alleviating psychosocial burden, the amount self-efficacy produces an average
of sample 32 patients with major depressive difference of 3.13 between groups. And
disorder and psycho education brief given depression intervention by the research
to the family in 4 sessions over 6 weeks, the Shalcross et al, 2015 with the aim to
result is scaled Care burden and Expressed evaluate the comparative effectiveness of
emotion (EE) the results of this intervention Mindfulness-based cognitive therapy
that emotional disorders, the burden of care (MBCT) versus active control condition
and emotional expression family all showed (ACC) to prevent recurrence of depression
a significant increase, symptoms of recurrence, reducing the symptoms of
depression or anxiety disorders, decreased depression, and improvement in life
from sixteen families (50.0%) first into 3 satisfaction. Total sample of 92 patients
families (9.3 %) after the intervention. with Major Depressive Disorder with
While music therapy is also done to sequelae and randomly conducted MBCT
lower depression scores, the study was or ACC for 8 weeks. The results of the study
conducted by Attiwannapat et al, 2016. The there was no difference between the MBCT
purpose of this study compared the effects and ACC in the rate of recurrence of
of music therapy in the active group and the depression. Both groups had a significant
group receiving music therapy group reduction in depressive symptoms and
counseling in the treatment of major improving life satisfaction. An interaction
depressive disorder (MDD), with sample show that the pattern of decline in
number 14 patients were divided into 3 depressive symptoms differ between the
groups randomly. The scale of groups, the ACC group experienced a
measurement used is the Montgomery reduction in symptoms immediately post-
Åsberg Depression Rating Scale (MADRS) intervention and then increased gradually
Thai version, the final results both with self- over 60 weeks of follow-up. MBCT group
rated depression scores and quality of life, experienced a reduction in symptoms
from this study was found at 1 month, 3 gradually in a linear and pattern of life
months, and 6 months, both treatment satisfaction same for both groups, but only
groups showed a decline and not significant slightly significant.
in MADRS scores compared with the
control group counseling group. This DISCUSSION
decrease was slightly greater in the active According to Townsend, 2015 that
group compared to the group receiving. depression risk factors include age and
Although there was a trend showing better gender, genetic factors, social status, race
results in self-reports of depression and and culture, marriage status, change of
quality of life, the differences were not seasons and many more risk factors the
statistically significant results of the research. While the risk
Next intervention for depression is factors found in this review is a systematic
the research conducted by Zimmerman et approach to economic and social status,
al, 2016, with the aim of evaluating the self-efficacy, and assertiveness. And
effectiveness of a primary care-based depression in women prenatal and postnatal
Smads, nurse-led, complex interventions to existing risk factors associated with
promote self-management in patients with multiparity, complications of pregnancy,
anxiety, depression or somatic symptoms. childbirth, and not the full board the Kalabia
Changes in self-efficacy for 12 months after sectio breastfeeding. Depression in patients
239
with schizophrenia obtained if the scale of Xiaohong L.et all (2015). Depressive
the PANSS positive, high suicide risk and symptoms and associated factors
vice versa. Measure of depression that is among renal-transplant recipients in
used in all 15 studies above are varied, it is China. International Journal of
certainly a consideration of researchers in Nursing Sciences diakses 7
adjusting the methodology used. Desember 2016 dari journal
Treatment of depression in this homepage:
approach include music therapy, Time http://www.elsevier.com/journals/i
Slips, intervention complex, psycho nternational-journal-ofnursing
education short and MBCT versus ACC sciences/2352-0132
also shows the results of a significant Siv Elin M.et all (2013).IPrevalence and
improvement to reduce depression scores, risk factors for postpartum
although there are some therapies that depressive symptoms in Argentina:
comparison but the results are expected to a cross-sectional study.International
reduce the score of depression have an Journal of Women’s Health.diakses
effect that same. 2 Oktober 2016 dari
http://www.dovepress.com
CONCLUSION AND Christopher F, et al (2014). A comparison
RECOMENDATION of a single genetic factor, twostress
Although much research about factors, and one psychosocial
depression but had not answer the problem coping factoras predictors of
of depression is increasing in society. The depression in an
results of this systematic review is very Australiancommunity sample.
varied although there are some that have Australian
similarities such as socio-economic factors Lin Xiaohong, et al. (2016). Depressive
(not working and economic revenue), racial symptoms and associated factors
and cultural factors are also found in the among renal-transplantrecipients in
above study, but the factor genotype was China. Elsevier: China
found and there was also not found. RajkumarRavi Philip(2015) Depressive
As for the treatment of depression is still Symptoms during an Acute
about cognitive therapy, family psycho- Schizophrenic Episode: Frequency
education, music therapy, and therapy time and ClinicalCorrelates. Hindawi
slips The results of all these therapies found Publishing Corporation: India
to be effective to lower depression scores. Chen Hui-Ying, et al (2016). Effects of
Therefore, research is still needed on TimeSlips on Cornell Scale for
treatment of depression with the Depression in Dementia scores of
methodological approach can be to senile dementia patients. Elsevier:
generalize across all groups of depression. China
Shimodera Shinji, et al (2012). Cost-
REFERENCE effectiveness of family
Xiaohong Lin.et all (2015).Depressive psychoeducation toprevent relapse
symptoms and associated factors in major depression: Results froma
among renal-transplantrecipients in randomized controlled trial. BMC
China.International Journal of Psychiatry: Japan
Nursing Sciences.Diakses 7 Katsuka, Fujika (2011) Pre-post changes in
Desember 2016 dari journal psychosocial functioningamong
homepage: relatives of patients with depressive
http://www.elsevier.com/journals/i disorders after Brief Multifamily
nternational-journal-ofnursing- Psychoeducation: A pilot study.
sciences/2352-0132 BMC Psychiatry: Japan.
240
Kim Jung A. Et, al. (2015). Effects of
Health Status and Health Behaviors
on Depression Among Married
Female Immigrants in South Korea.
Elsevier: Korea
Giraldo Yeimy González, et al. (2015).No
Association of BDNF, COMT,
MAOA, SLC6A3, and SLC6A4
Genes and Depressive Symptoms in
a Sample of Healthy Colombian
Subjects. Hindawi Publishing
Corporation: Colombia
ZimmermannThomas, et al. (2016).
Collaborative nurse-led self-
management support for primary
care patients with anxiety,
depressive or somatic symptoms:
Cluster-randomised controlled trial
(findings of the SMADS study).
Elsevier: Germany
Louise Sandra, et al (2014). Monoamine
oxidase a gene polymorphisms
common to blood pressure and
depression scores in caucasian
children. HOAJ: Australia.
Atiwannapat Penchaya, et al (2016). Active
versus receptive group music
therapy for major depressive
disorder—A pilot study.Elsevier:
Thailand.
Mathisen Siv Elin (2015). Prevalence and
risk factors for postpartum
depressive symptoms in Argentina:
a cross-sectional study. Dovepress:
Argentina.elsevier; USA
Shallcross Amanda J. et al (2015). Relapse
Prevention in Major Depressive
Disorder: Mindfullness Based
Cognitive Therapy Versus in Active
Control Condition. HHS Public
Access; Newyork
RezayatFatemeh, et al. (2014). The Level of
Depression and Assertiveness
Among Nursing Students.
IJCBNM; Irans
241
THE EFFECT OF SPIRITUAL EMOTIONAL FREEDOM TECHNIQUE TO
INCREASE SELF ESTEEM OF SCHIZOPHRENIA IN MENTAL HOSPITAL
SURAKARTA
Endang Caturini Sulistyowati, Ros Endah Happy Patriyani, Insiyah

Health Polytechnic of Surakarta
Email : c.endang@yahoo.com
ABSTRACT
Introduction: Schizophrenia is a chronic psychotic with the prevalence of schizophrenia in
Indonesia is 70%. The schizhophrenia often accompanied by negative feelings self-perception,
and self-efficacy, helplessness, anxiety, behavioral changes. The number of schizhopheria in
Mental Hospital in Surakarta was 93% in 2008. Physical treatment of schizophrenia patients
were included drug delivery and Convultion Electro Therapy (ECT). These treatments were
considered unsufficient so that psychological approach such as psychotherapy can be taken into
account. One provision of psychotherapy patients with schizophrenia is Spiritual Emotional
Freedom Technique (SEFT) which can help individuals to develop skills in improving the
coping mechanisms, reducing anxiety and increasing self-esteem. This study is aimed to
determine the effect of SEFT to change coping mechanisms, anxiety, self-esteem in patients
schizophrenia in Mental Hospital, Surakarta. Method: The research method was quasi
experimental with pre-post test with control group. The data was gathered before and after
giving the SEFT interventions in intervention and control group of schizophrenia patients.The
amount of samples were 64 respondents which were 32 respondents of intervention group and
32 respondents of control group. The research instrument was adapted from Coopersmith Self
Esteem Inventory (CSEI) that consist of 58 items regarding self esteem. Data were analyzed
using paired t-tests., Independent t-test multiple linear regression. Result: The results of this
study showed that there was a significant difference of self esteem before and after SEFT (p
value <0.05). Conclusion: This proves that the existence of a significant change in the patients
in the intervention group SEFT than the control group. The conclusion is that the level of self
esteem could be increased by SEFT with the probability score is 31.3% and could increase
point 4.312 point for self esteem degree.
Keyword: Schizophrenia, Self Esteem, Spiritual Emotional Freedom Technique (SEFT)
INTRODUCTION assessment or low self esteem is a chronic

Schizophrenia is a group of low self-esteem (Stuart & Laraia, 2006).
psychotic reactions that affect many areas Various models of treatment of
of individual functions, including functions schizophrenic patients have been performed
of thinking communicating, receiving and by practitioners in order to help patients to
interpreting reality, feeling and showing solve the problems. The models applied
emotions and behaving in an acceptable vary among healthcare professionals such
rational. Schizophrenia is a severe mental as nurses, psychiatrists, psychologists,
disorder exhibiting behaviors such as: social workers who often work to help
inability to care for themselves, unwilling to patients with mental disorders. Some
socialize, feelings of worthlessness, and / or applied models include: psychoanalytic
showing the affected of unnatural habits, models, interpersonal, social, existential,
causing them unable to have social function supportive and the medical model (Stuart &
in their daily life. Conflict happens to Laraia, 2006). Other model are cognitive
schizophrenia may be due to a negative therapy (CT), behavioral therapy (BT),
assessment in themselves. A negative self logotherapy, therapeutic reality and
242
psychoeducation family (Videbeck, 2008). surrounding areas, Yogyakarta, East Java
Cognitive behavioral therapy (CBT), and West Java. The bed capacity in Mental
educational therapy, thought stopping, Hospital of Surakarta. According to the
bibliotherapy and music therapy were also report of the Hospital, in 2008 the average
utilized in order to help mental ill patient as Bed Occupancy Rate (BOR) was 61.56%
well as (Boyd & Nihart 1998), therapy and the average value Average Length of
assertive, time outs, and token economy Stay (AvLOS) in 2008 was 29 days
(Stuart & Laraia, 2006), and therapy Milieu (Surakarta RSJD Medical Records, 2009).
(Townsend 2005). Based on the recapitulation of ten
Therapeutic nursing progresses with cases for medical diagnosis in the year 2013
the presence of a therapeutic technique is on patient cases, the highest number of
complementary therapy, which is part of the cases of schizophrenia was about 93%. The
complementary modalities. In the western, results of the interview with the head of the
complementary modalities are already room and the nurse room, standard
widely used by professional nursing procedure in patients with schizophrenia is
personnels. Complementary therapies refer psikofarmaka, ECT and psychotherapy
to the fulfillment of human needs as a therapy / education, no SEFT applied.
holistic being. SEFT is one form of Based on the data above, researchers who
complementary therapy. applied SEFT and researches with the title
SEFT helps patients with various of spiritual influence of emotional freedom
current difficulties experienced by a person technique (SEFT) increases self esteem in
in different phase of life. SEFT that is patients with schizophrenia in the Mental
developed from EFT was introduced in Hospital of Surakarta
1995 by Gary Craig. EFT is a simple
method that emphasizes focus on problems METHOD
within the individual accompanied by This study uses a "quasi
gentle tapping on acupuncture points experimental pre-post test with control
(tapping) on the face, upper body and arms. group" (Sugiyono, 2010). Grouping
EFT can help a variety of emotional and members of the sample in the experimental
physical problems. SEFT method is to unite group and the control group was not done at
ourselves with divine power that allows random or random so that the draft is often
people to become happier, more certainty in called the Non-Randomized Control Group
life, the results are not easily stressed so that Pretest Posttest Design (Notoatmojo, 2010).
it can improve mental health (Zainuddin, The research was conducted at the Mental
2009). Hospital of Surakarta from April to June
SEFT is a method that manages the 2014.
potential for systematic consciousness, so it The samples in this study were
can be used for multiple purposes in patients with schizophrenia. The number of
improving the welfare of the soul. SEFT is patient sample was 32 respondents for each
behavioristic method based on intervention group and the control group.
psychotherapy or behavior, it is applied by The Independent variable was Spiritual
the model or technique performed in Emotional Freedom Technique (SEFT),
behavioristik psychotherapy, relaxation, while the dependent variable was patients’
meditation, visualization, logotherapy, and Self Esteem. The instruments used in
cognitive behavioral therapy (CBT). The measuring the Coopersmith Self Esteem
technique used in conducting SEFT is with Inventory (CSEI), consists of 58 items, thus
behavioristik stages (Zainuddin, 2009). obtained scores range between 0-58
Mental Hospital of Surakarta is a reference (Bolton, 2003).
to cases of mental illnesses with the The bivariat analysis two mean test
coverage of service in Surakarta and the namely comparing the means of the two
243
group (Hastono, 2007) with t test Freedom Technique (SEFT). Multivariate
independent, while the t analist bivariat was analysis was also used to proof that there are
used to proof the hypothesis that the patient patient characteristics as factors that
with schizophrenia who get Spiritual contribute to the patient’s self-esteem using
Emotional Freedom Technique (SEFT) double linear regression.
have higher self-esteem compare with
patient who did not get Spiritual Emotional
RESULT
Tabel.1 Independent t test of Self Esteem of Patients Before And After Intervention For
Intervention And Control Group
Kelp N Man SD SE T P
Kontrol 32 1.75 5.37 0.949 -
0.002
Intervensi 32 6.06 5.11 0.902 3.292
Using t test, the results reveals that groups. Average patients self-esteem in the
there is a statistically significant difference intervention group (mean = 6.06) is higher
(p = 0.002), on the self-esteem of patients than in the control group (mean = 1.75),
between the intervention and control with p <0.05.
Table 2. multiple linier regression analisis for SEFT Intervention without controling
respondent characteristics.
Variabel Model I Model II
Koef CI 95 % Koef CI 95 %
Regresi B Batas Batas Regresi Batas Batas
bawah atas P Bawah atas p
Konstanta 1.75 -0.101 3.601 0.064 10.53 2.406 18.658 0.012
IntervSEFT 4.312 1.694 6.931 0.002 4.14 2.501 6.247 0.000
Kelamin -1.923 -4.368 0.522 0.121
Umur 0.018 -0.013 0.162 0.807
Status kawin 1.911 -0.436 4.258 0.108
Pendidikan 0.628 -0.583 2.839 0.303
Pekerjaan 0.971 -1.240 3.183 0.382
Frek dirawat 0.03 -0.541 0.082 0.146
Lama sakit -0.229 -0.254 0.314 0.833
Self esteem respon
sblm intervensi -0.374 -0.501 -0.247 0.000
n responden 32 32
Adjusted R² 13.5% 49%
P 0.002 0.000
244
The analysis results of multiple energy. When the energy flow is disturbed
linear regressions on the model I concludes or blocked, it can result in interruption of
that SEFT interventions effectively the tranquility of the center of thought and
improves the patients’ self esteem. Patients emotion. This leads to negative thoughts
who got SEFT interventions, provide and emotions to emerge (Zainuddin,
patients self esteem 4,312 points higher 2009). SEFT is one of spiritual therapy and
than in patients who did not get SEFT energy psychology offers a more secure
interventions. The difference is statistically manner (without the use of needles), using
significant (b = 4,312; 95% CI 1.694- 6931; only beat lightly with a fingertip (tapping)
p value = 0.002). The analysis shows that on certain body areas of mind, emotions and
there are no differences in the regression negative behaviors will be resolved. When
coefficient b for SEFT interventions someone is in a state of calm and relaxed,
between models I and II models in the the flow of energy in the body's meridians
amount (4312 - 4.14) / 4312 = 4% <(10% - flows smoothly.
20%). The confounding variables were Psychological Reserval is want to be
entered into the model II did not confuse appreciated, in appropriate security,
the estimated effect of SEFT interventions, motivation and desire to release the
so that the estimated effect of SEFT problem. PR can be cured with SEFT by
intervention used the result of the rubbing the palms on the 'afternoon point' or
calculation model of I Adjusted R² 13.5% a knock on the point at hand (karate
in model I. This shows that SEFT choppoint) (Zainuddin, 2009). With 12
intervention can improve self-esteem of energy pathways called meridians energy. If
respondents up to 13.5%. A variety of the energy flow is blocked or garbled, this
confounding variables that do not cause arises emotional disorders or physical
confusion, because no body has the effect of illness (Zainuddin, 2009). Likewise EFT
increasing or decreasing the patients’ self- provides evidence that we are overwhelmed
esteem, which number closes to 0, so it by the energy flowing in our body, and we
almost does not change the results of the can feel it. By tapping some parts of the
estimated regression coefficients b SEFT meridian points of the body, we can feel the
intervention. emotional and physical changes in us. That
change will not happen if there is no energy
DISCUSSION in our body system. This is consistent with
Traumatic events for patients with the nursing actions that had been done to
mental disorders especially schiziphrenic create a sense of security and comfort to the
patient cause patients to experience low client that the massage technique and touch
self-esteem problems. This will have an (touch). Massage is stimulating the skin and
impact in the energy balance of the body so tissues in the body to facilitate the
that the thoughts, emotions and behaviors circulation and provide a relaxing effect
will tend toward negative. While self- (Frisch & Frisch, 2006).
esteem is a positive or negative attitude of The influence of Spiritual
individuals towards a particular object Emotional Freedom Technique (SEFT) in
called themselves (Rosenberg in Mruk, patients with schizophrenia on self esteem
2006). Self-esteem refers to the premise that of patients showed a statistically
an individual evaluation against him (either significant (p <0.05), that there is a
positive or negative) associated with a sense difference on the self-esteem patiens
of preciousness, an individual's belief in the between in the intervention and control
ability itself. groups. The results of this study are
Emotional condition such as anger, supported by Bradshaw (1998) that SEFT
sadness, disappointment stress, panic and significant effect on the reduction on the
fear runs on the same system with the symptomatology, rehospitalisations and
245
improved psychosocial functioning and group especially for their self-esteem.
achievement of treatment goals Development of SEFT for schizophrenia
SEFT therapy combines the energy system patients. Delopment of SEFT for
of the body and spiritual therapies are used schizophrenia patients applied to the
as a therapeutic technique to cope with curiculum of nursing education on the
emotional and physical problems, by psychiatric nursing could be applied in
performing a light knock (tapping) on nerve various areas with different spiritual.
points (meridians of the body). Influence on Hospital as the health care services was a
the spiritual aspects of healing, disease good place to establish SEFT care as one
management, anxiety, and acceptance of of program nursing education in impoving
death has been a concern of nurses. Spiritual patient self-esteem.
characteristics in nursing indicates
recognition that natural factors are not REFERENCES
visible and intangible affects the mind and Bradshaw, W., 1998, Cognitive-Behavioral
behavior. These include the introduction of Treatment of Schizophrenia, A Case
religious and supernatural beliefs. When Study, Journal of Cognitive
people feel the power and influence of the Psychotherapy: An International
outside of the physical existence and time, Journal, 12, (1) 13-25, 1998 (12
they are said to have suffered a Agustus 2014)
metaphysical aspect of spiritual character. Bolton, B. 2003, Coopersmit Self Esteem
Supports and allow patients to talk about Inventory : Test Review, Palo Alto :
their confidence in bringing them closer to Proquest.
the source of spiritual encouragement. This Boyd, M.A., & Nihart, M.A. 1998,
helps giving strength and healing (Hudak & Psychiatric nursing contemporary
Gallo, 2012). SEFT intervention Award for practice, Lippincott, Philadelphia.
3 consecutive meetings of the respondents Frisch,N.C. & Frisch,L.2006, Psychiatric
to change negative thoughts and feelings mental health nursing, (3rd
into the positive thoughts and rationale edition), Thompson Delmar
feelings to change their negative behavior Learning, USA.
into positive behavior. Smetzer (2004) Hastono, S.P. 2007, Analisis data
states that the relaxation response can lower kesehatan. Tidak dipublikasikan,
the yield stress. Hypothalamic activity will Depok.
be inhibited and will decrease the activity of Hudak & Gallo, 2012, keperawatan Kritis.
the sympathetic and parasympathetic. The Pendekatan Holistik, EGC,
sequence of physiological effects and Jakarta.
symptoms and sign will be disconnected Mruk, C.J., 200, Self Esteem, Researh,
and psychological stress will be reduced. Theory, and Practice (3rd Edition).
Respondents feel valueable when the New
current award can behave accordingly. It is Notoatmojo, S., 2010, Pendidikan dan
able to increase the self-esteem of perilaku kesehatan, Rinekacipta,
respondents. Real experience gained can be Jakarta.
directly felt by respondents, so as to trigger RSJD Surakarta, 2008, Profil Rumah Sakit
the ability of respondents to develop their Jiwa Daerah Surakart, RSJD
ability to enhance self-esteem. Surakarta.
Smeltzer ,S.C.(2004). Buku Ajar
CONCLUSION AND Keperawatan Bedah Brunner dan
RECOMENDATION Suddart. Ed.8. vol. 2, EGC, Jakarta.
It comes to the conclusion that Stuart, G. W., and Laraia, 2006, Principles
Spiritual Emotional Freedom Technique and practice of psyhiatric nursing,
(SEFT) is effective for patiens intervention (7"' ed.), Mosby Year B, St. Louis.
246
Sugiyono, 2010, Metode penelitian
administrasi, Alfabeta, Bandung.
Townsend, M., 2005, Essentials of
psychiatric mental health
nursing, F.A.Davis Company,
Philadelphia.
Videbeek, S.L., 2008, Psychiatric mental
health nursing. (3r d edition),
Lippincott Williams & Wilkins,
Philadhelpia.
Zainuddin, A. F., 2009, Spiritual Emotional
Freedom Technique (SEFT) for
Healing + Success + Happiness +
Greatness, Afzan Publishing Jakarta.
247
KNOWLEDGE AND ATTITUDES IN CARDIOPULMONARY RESUSCITATION
(CPR) OF FAMILY MEMBERS OF SUDDEN CARDIAC ARREST (SCA) IN THE
ICVCU OF THE RSUD DR. MOEWARDI SURAKARTA 2016
Widodo, Dwi Ariani, Indi Hastuti

Nursing Major, Polytechnic of Health Science Surakarta
Email: widd70@yahoo.com
ABSTRACT
Introduction: Cardiovascular disease constitutes the first cause of all deaths in the world.
Generally, patients with cardiovascular disease will experience cardiac arrest. Family members
have an important role as the first responder helping their member in providing care before
referring them to appropriate health care facilities. Consequently they must have sufficient
knowledge and attitudes of CPR before giving the appropriate help. The aims of the study are
to identity the family member knowledge and attitudes and their association toward CPR.
Methods: This study used descriptive correlation design with cross-sectional approach.
Result: The study shows significant correlation between knowledge and attitude about CPR as
proven by the r value = 0.333 that > 0.306 from r table. Discussions: Poor knowledge
contributes to poor attitudes. This important finding warns the need of quick solution.
Suggestion. Firstly, future study needs to be deeper including variables and respondents.
Secondly, especially the government needs to provide CPR training to community. The
availability of people who are able to perform CPR will increase the chance of the patient to
get quick and appropriate help, and increase chance to survive
Keywords: Knowledge, Attitude, Cardiac Pulmonary Resuscitation
INTRODUCTION witnessed by their family member. Heart

Cardiac diseases still become the attack often leads to SCA. Therefore it
first cause of death in many countries over indicates that families as the first
the world. In Europe by the year 2014, it responders need to be ready to give
was reported that cardiovascular diseases appropriate help.
contributed to 46% of death in all ages and SCA can be caused by cardiac and
gender (Nicholes et al., 2014). Hollenberg, non cardiac factors (Hollenberg, Svensson
Svensson dan Rosenqvist (2013) reported dan Rosenqvist, 2013). Commonly,
that 5.000-10.000 patients suffer cardiac arrhythmias may lead to the heart stop
diseases out of hospital every year in beating as a result from inadequate blood
Sweden. Sudden Cardiac Arrest (SCA) may supply to the myocardium. As a
happen anytime. Even though there was an consequence blood supply to all of part of
increase in time from the cardiac arrest to the body also inadequate. By looking at the
get CPR and defibrillation, there had been number of the incidents and the effect of the
no significant result in survival rate. In the attack it is very urgent to identify the
United Sated, the incident of SCA was capacity of help at home before the patients
nearly 400.000 annually and constituted as get appropriate help at hospitals of other
the first cause of death in athletes (National health care providers.
Athletic Trainers’ Association (NATA) and Patients with cardiac arrest need
Inter-Association Task Force Consensus help very soon due to the critical time of
Statement, 2007). Vaillancourt (2008) epecially the brain from irreversible
mentioned that 85% heart attack in Canada damage (Olateju and Amoran, 2014). Early
happened in family and 50% of them chest compression during CPR will allow
248
the heart to pump blood to the brain and Two variables were measured and
heart. High quality of CPR may increase the tested to see the association between
chance of the survival. Otherwise, failure of knowledge and attitude toward CPR. A
being late in circulating blood to the brain questionnaire consisted of four open
three to four minutes may result in questions regarding demographic data, 14
irreversible brain damage (Ratha, Panda closed questions related to knowledge, 15
and Pradhan, 2014). Drezner (2009) stated questions regarding to attitude and 2 open
that there are three important steps to handle ended questions related to experience of
SCA that includes the availability of trained CPR and educational mainstream had been
personnel in performing CPR, early CPR developed by the author. After piloted to
and defibrillation. Many countries have other families the result of the returned
trained CPR especially chest compression questionnaire was tested for validity and
only to community as the first responders to reliability. After the questionnaire met the
help SCA people (Ratha, Panda and validity and reliability, there were packed in
Pradhan, 2014). Rahman (2013) had proven close envelop to be distributed to
that CPR training increased knowledge and respondents.
attitude significantly among senior high Bivariate analysis was used to
school students. Similar training has also determine the relationship between two
been conducted in Indonesia to some people variables. This analysis uses correlation test
in the community area but it is very limited of Kendall tau- b considering to test the
training activities to family group. correlation 2 ordinal types of data. SPSS for
More over knowledge about CPR Windows version 17.0 was used to help
is very basic to people to be able to accept analyzing data. To interpret the significance
the CPR skill. No evidence shows value, it was compared with the values of r
knowledge even skill of CPR among table. If the value of Kendall r > r count then
families in Indonesia. As a consequence, it the hypothesis is accepted.
needs harder work to train family in order
to be prepared in case of having their RESULTS
member of SCA. All of 30 questionnaire distributed to the
respondents were completely returned
METHODS (100%). The following tables describe
This study was conducted in dr. result of the study based on different
Moewardi Hospital of Surakarta, Central groups.
Java between January and April 2016.
Descriptive corelational was chosen using Table 1. Distribution of frequency of
cross-sectional approach. After ethical respondent age
clearance was obtained from the hospital Age f (%)
ethical committee, purposive sampling 12-16 1 3.3
technique was applied by choosing families 17-25 9 30.0
having member hospitalized of 26-35 7 23.3
experiencing SCA according to the
36-45 6 20.0
inclusive criteria developed. Thirty
46-55 7 23.3
respondents met the criteria and were asked
to write informed consent before fulfilling Total 30 100
the questionnaire. Each respondent was also
explained the goals of the study, how to Table 1 reveals that almost all respondents
fulfill the questionnaire and how to return, distributes to all age groups equally except
and their rights to be involved in the study only one respondent that was less than 16
voluntarily. years old.
249
Tables 2. Distribution of frequency
according to gender
Table 5 shows that the majority of
Gender f (%) respondents have poor attitude about CPR
Female 17 56.7 (n=13, 43.3%). It is far different from the
number of respondents with good attitude
Male 13 43.3
that only 20% (n=6).
Total 30 100
Table 6. Correlation between knowledge
As can be seen in table 2, the number of and attitude.
female respondents slightly dominates
rather than male (56.7% and 43.3%). variable r value r table
Kendall
Table 3. Distribution of frequency knowledge 0.330 0.306
according to education * attitude
Education f (%)
Junior high school 6 20.0 Table 6 reveals that there is a significant
Senior high school 9 30.0 correlation between knowledge and attitude
Three years degree 5 16.7 about CPR as it is proven by the r value =
Four years / bachelor 10 33.0 0.333 > 0.306 from r table.
degree
Total 30 100 DISCUSSION
Age is one of important factor
Tables 3 indicates that the highest number contributing to the success in mastering
of respondents have four years or bachelor knowledge, attitude even skills. However
degree (n=10) followed by senior high there is no association between age and
school. knowledge (Maryam, 2010). As can be seen
from the statistical test, the majority of
Table 4. Distribution of frequency respondents are categorized as young
according to knowledge level group. This productive age can be forced
Knowledge level F (%) maximally to learn and master any skill
related to CPR.
Good 6 20.0 Seventeen respondents (56.7%) of
Average 10 33.3 this study are female. Only a few of male
Poor 14 46.7 commonly stay at home to witness the
incident attack at home as it becomes the
Total 30 100 family pattern in Indonesia generally that
male have responsibility to go out site for
As can be seen in table 4, the majority of the job. One study conducted by Wang et al.
respondents have low in knowledge of CPR (2015) indicate one of them that male
(n=14, 46.7%). Only 20% respondents students had stability during performing
(n=6) have good knowledge about CPR. chest compression for 8 minutes with good
quality. Meanwhile female students did
Table 5. Distribution of frequency inadequate CPR after 2 minutes. This
according to attitude indicates that female who commonly stay
Attitude F (%) longer with family should be well prepared
Good 6 20.0 with CPR.
Average 11 36.7 As shown on table 3, the majority of
Poor 13 43.3 respondent educations are four years degree
Total 30 100 or bachelor (33.3%). It is beneficial to be
250
effectively trained with that basic of This study shows that the majority
education. Even though chest compression of respondents (43.3%) have poor attitude
is mainly stressed however it still needs on CPR. Trimukaim (2009) states that
capacity to understand every step of the knowledge, is very influence to attitude.
CPR even the rational. Cultural background Another study conducted by Chair et al.
and value may influence the rescuer to (2014) show similar trend that people
make decision to start CPR. Widyastuti especially who had not been trained were
(2009) states that high level of education, unwilling to conduct CPR. It is different
may contribute to the increase of from the study conducted by Narayan et al.
knowledge and support the capacity of (2015) to postgraduate students that
decision making independently. respondents who has positive attitude
In a study conducted by Olateju and toward CPR was slightly higher (52%)
Amoran (2014) that focus on health worker compared to the opposite attitude. Most
it was stated that the need of knowledge and people who are trained and capable of
skill in performing CPR is an absolute at performing BLS correctly, indicating a
primary health care level. By this, desire to help with skills and have lower
knowledge play basic role to move to the anxiety (Bray et al., 2016).
next step. This study shows that most of Eventhough there is insuficient evidence of
respondent knowledge is poor and average the benefit CPR, however providing a quick
(46.7% and 33.3% respectively). It is and adequate CPR is mandatory (Bray et al.,
supported by previous study conducted by 2016), even reducing the gap to get
Chair et al. (2014) the poor Hongkong cardiopulmonary resuscitation and
public knowledge of CPR. Similar finding increasing the success of hospital discharge
was also found by Olateju and Amoran (Roshana et al., 2012). The survival rate of
(2014) among nurses in Remo Area of patients who alredy received CPR out of
Ogun State of Nigeria that the majority of hospital increase before getting help further
respondent did not know to do CPR well. from emergency services.
Moreover they did not renew their This study has several limitations
competence on CPR. However it is in that include the number of respondents is
opposite finding with the study conducted very small. It relates to the time of the study
by Narayan et al. (2015) in which 62.7% that was conducted only three months. In
have average knowledge and 19.6% have addition to the limitation is the variable two
good knowledge. variables. It needs more variables in order
Inadequate knowledge may lead to to get more comprehensive finding.
the low bystander awareness to voluntarily However the complete returned
give quick response. Furthermore lack of questionnaire may strengthen the findings.
knowledge and inability to perform CPR
can end with death (Olateju and Amoran, CONCLUSION AND
2014). It is therefore cardiac arrest need RECOMENDATION
very quick appropriate treatment. The poor This study shows the positive
knowledge of the study is in accordance correlation between knowledge and attitude
with the statement of the respondents toward CPR among family with member
during depth interview that only one experiencing SCA. This poor knowledge
respondent said to have CPR training. In warns to any part of people to learn CPR.
addition, all respondents stated that no one By understanding the importance of CPR it
of the respondents have health educational will increase people awareness to
background. Notoatmodjo (2012) argues voluntarily provide appropriate help in case
that education is one of factors that can of the presence of SCA. The government
influence knowledge. may need to evaluate the urgency of CPR
competence in high school as it already
251
implement to many high school especially Sendiri. Fakultas Kedokteran
in developed countries. Universitas Islam Negeri Syarif
Hidayatullah. Jakarta
REFERENCES Narayan, D.P,R., Biradar, S.V., Reddy,
Bray, J.E., Leary, M., Stub, D., & Finn, J. M.T., & Sujatha, B.K. (2015)
(2016) A systematic review of basic Assessment of knowledge and
life support training targeted to attitude about basic life support
family members of high-risk cardiac among dental interns and
patients. Official Journal of The postgraduate students in Bangalore
European Resuscitation Council. city, India. World J Emerg Med.
Volume 105, Pages 70–78. 2015; 6(2): 118–122. Available
Available from: from:
http://www.resuscitationjournal.co http://www.ncbi.nlm.nih.gov/pmc/a
m/article/S0300-9572(16)30058- rticles/PMC4458471/. Accessed 9th
2/fulltext. Accesed 16th December December 2016
2016. Nicholes, N., Townsend, M., Scarborough,
Chair, SY.A., Hung, M.SY., Lui, J.CZ., P., & Rayner, M. (2014)
Lee, D. TF., Shiu, I.JC., & Choi, Cardiovascular disease in Europe
KC. (2014) Public knowledge and 2014: epidemiological update.
attitudes towards cardiopulmonary European Heart Journal.
resuscitation in Hong Kong: Doi:10.1093/eurheartj/ehu299.
telephone survey. Hong Kong Med Accessed 3th December 2016
J 2014; 20: 126–33. Available from Notoatmodjo, S.(2012) Metodologi
http://www.hkmj.org/abstracts/v20 Penelitian Kesehatan. Jakarta:
n2/126.htm. Accessed 9th December Rineka Cipta
2016. Olateju, S.O., & Amoran, O.E. (2014).
Drezner, J.A. (2009). Preparing for sudden Knowledge and Attitudes towards
cardiac arrest—the essential role of Basic Cardiopulmonary
automated external defibrillators in Resuscitation (CPR) among
athletic medicine: a critical review. Community Nurses in Remo Area
Br J Sports Med 2009; 43:702-707 of Ogun State, Nigeria. Journal of
doi:10.1136/bjsm.2008.054890 Community Medicine and Primary
Available from: Health Care. 26 (1) 88-95.
http://bjsm.bmj.com/content/43/9/7 Available from :
02.abstract Accessed 15th March https://www.ajol.info/index.php/jc
2012 mphc/article/view/125346.
Hollenberg, J., Svensson, L., & Rosenqvist, Accessed 6th January 2017
M. (2013) Out-of-hospital cardiac Rahman, N. (2008) Pengetahuan Perawat
arrest: 10 years of progress in Tentang Kegawatan Nafas Dan
research and treatment. Journal of Tindakan Resusitasi Pada Neonatus
Internal Medicine. Volume 273, Yang Mengalami Kegawatan di
Issue 6. Version of Record online. Ruang NICU, Perinatologi dan
Available from: Anak RSUD Gunung Jati Cirebon.
http://onlinelibrary.wiley.com/doi/1 Rahman, N.H., Sheng, C.K., Kamauzaman,
0.1111/joim.12064/pdf. Accessed T.H.T., Noh, A.Y., Wahab, F.H.,
9th December 2016 Rahman, A., & Dzulkifli, N.S.
Maryam, H. (2010) Hubungan Usia Dan (2013) A multicenter controlled trial
Tingkat Pendidikan Dengan on knowledge and attitude about
Pengetahuan Wanita Usia 20-50 cardiopulmonary resuscitation
Tahun Tentang Periksa Payudara among secondary school children in
252
Malaysia. International Journal of ef/index/id/174, Accessed 22nd
Emergency Medicine. Available January 2016).
from: Wang, J., Zhuo, C., Zhang, L., Gong, S.,
http://www.intjem.com/content/6/1/ Yin, C., & Li, Y. (2015)
37, Accessed 22nd January 2016. Performance of cardiopulmonary
Ratha, K., Panda, S., & Pradhan, R. (2014) resuscitation during prolonged basic
Evaluate the Effectiveness of life support in military medical
Planned Teaching Programme university students: A manikin
regarding Basic Life Support (BLS) study. World J Emerg Med. 2015;
among Intern (B.Sc Nursing) 6(3): 179–185. Available from
Student at Selected Nursing https://www.ncbi.nlm.nih.gov/pmc/
College, Bhubaneswar, Odisha. articles/PMC4566006/. Accessed
IOSR Journal of Nursing and 9th December 2016
Health Science. Volume 3, Issue 1 Widyastuti, Y. (2009). Kesehatan
Ver. II (Jan. 2014), PP 16-19. Reproduksi. Yogyakarta: Fitramaya
Available from:
http://www.iosrjournals.org/iosr-
jnhs/papers/vol3-issue1/Version-
2/D03121619.pdf. Accessed 9th
December 2016
Roshana, S., Batajo., K.H., Piryani, R.M.,
& Sharma, M.W., (2012) Basic life
support: knowledge and attitude of
medical/paramedical professionals.
World Journal of Emergency
Medicine. 3(2): 141–145. Available
from:
doi: 10.5847/wjem.j.issn.1920-
8642.2012.02.011 Accessed 9th
December 2016
Trimukaim. (2009) Pengaruh Pendidikan
Basic Life Support Terhadap
Tingkat Pengetahuan dan
Ketrampilan Mennolong Klien
Gawat Darurat Anggota Karang
Taruna Desa Nogosari Boyolali.
Skripsi.
Vaillancourt, C., Grimshaw, J., Brehaut,
J.C., Osmond, M., Charette, ML.,
Wells, G.A., & Stiell, I.G. (2008) A
survey of attitudes and factors
associated with successful
cardiopulmonary resuscitation
(CPR) knowledge transfer in an
older population most likely to
witness cardiac arrest : design and
methodology. British Medical
Journal. 8:13. doi: 10.1186/1471-
227X-8-13. Avalilable from :
http://www.wjem.org/default/articl
253
EMERGENCY CONDITION AND VULNERABILITY AND MITIGATION EFFORTS
TO FORM SAFE COMMUNITY IN THE TERITORY OF PUSKESMAS CEPER
KLATEN
Sumardino, Widodo
Nursing Major, Polytechnic of Health Science Surakarta
dinolahaku@yahoo.com
ABSTRACT
Introduction: Indonesia is situated in the ring of fire where more than 90 volcanoes are distributed.
The rain volume is also very high and more than thousand rivers acrros this nation. This
characterisic may result in natural disaster. Economy, politic, culture, public safe and stability may
also lead to potensial man made disasters. One of the regions that often experience disaster is Klaten
district. The aims of study to evaluate public preparness toward disaster in four districts in Klaten.
Methods: The method of the study is exsperimental research design. Questionnaire was used for
Pretest-Postest in order to evaluate the effectiveness of delivering education of disaster
management. Sampling technique uses total sampling with 135 respondents. Result: The study
shows that there is significant change of the public knowledge about their preparedness to face
disaster. As it can be seen from the Wilcoxon Signed Rank Test of Z value -8.549 with p value
(Asymp. Sig 2 tailed) is 0.000 that less than critical limit of 0.05. Conclussion: Education of
disaster management is verry esential to public preparedness in order to reduce the impact of
disaster.
Keywords: knowledge, public preparedness, disaster management.
INTRODUCTION arround this country completed by the high

Natural disaster may occur anytime rain volume and more than 5.950 rivers
and everywhere that most commonly difficult accros the country (Intarti, Fitrinita,
to predict. This often impacts to various Widyanto and Simarmata, 2013).
damage of infrastructure, environment even Some disasters can be predicted in
death to the people. Tavakoli, order to decrease the damage. In addition, by
Armohammadian, Safdari and Keyvanara preparing human resources, creating
(2016) report that more than 7823 people regulation, providing appropirate facilitie
were death 140.7 milion injured and 99.2 may reduce the damage or loss from the
bilion US dolar loss from infrastuctural disaster. Several regulations have been made
damage due to 324 natural resources in the by the Indonesia goverment including the act
world during 2014. The first continent that of disaster managment (UU No 24 year
most affected was Asia with 44%. Previous 2007).
diasaster, also occured where 80% of global Previous interview and observation
disaster in Asia and Pasific region effectd to preceded the study in Ceper District, Klaten
the economic loss (ADB and ADBI Institute, in order to support the reasons for conducting
2013). Indonesia was one of the countries that the study. The characteristic of disaster in
included in thos disaster. It cannot be avoided Klaten District are relatively similar. The
due to the location of Indonesia in the ring of examples are earthquake, flood, windstorm
fire. More that 90 volcanous distributed and sometime fire. In Tegalrejo sub district,
254
another potensial disaster may result from the Management from the ministery of Health of
impact the change from agricultur field to Indonesia that consists of 15 points. Validity
industrial field. Early warning sistem has not of instrument was gained after the instrument
been well established. In fact it is very was reviewed by four experts that consist of
important in order to prepare the people two lecturers and two community nurses
before disaster comes and it is hope to reduce having background on emergency disciplin
the damage or loss. and revised by the authors and reviewed again
On the other hand, local wisdom may antil the instrument met the validity.
become potential power that need to be well Wilcoxon Signed Rank Test was
managed. Commonly people have experience utilized becaused of the data gathered did not
of identifying some natural disasters for meet normality of distribution. Computer
example by the change of climate may with SPSS 17 was used to help analizing data.
indicate fores fire, mobilization of wild The study was started by asking
animals from the pic of mountain to around permission by delivering research proposal to
the city may indicate eruption or forest fire. the head of the district and the head of
These experience usually comming from Community Health Center in Ceper. After the
their parent that had been shared generation permission was gained, the next steps was by
by generation. meeting the respondents in four differents
location that were situated in each village hall
METHODS based on the area where the respondents came
This study use experimental study from in different time. In each places with in
design. Pretest was conducted to investigate different time, the authors explained the goal
the begining knowledge of the respondents of the study, the benefit of the study, how to
regarding emergency condition and be involved in the study voluntarily, the rights
vulnerability and mitigation efforts to form of the respondents and informed consent.
safe community in Ceper district. After After informed consents were gained the
receiving education related to emergency respondents in each region were asked to
condition and vulnerability and mitigation fulfill the questionnaire together under
efforts to form safe community, the superfision of the authors.
respondents was tested again to evaluate the
change of knowledge. The scope of the study RESULTS
focused on the area of empowering The response rate of the study is 100%
community in order to be well prepared in with complete returned the questionnaires.
facing disaster. Respondents of the study Results of each place were presented
consist of community leaders and board in separatedly.
four villages: Tegalrejo, Kujon, Kajen and
Jambu Kidul, under the workplace of
Community Health Center of Ceper, Klaten.
This study uses total sample that
consists of 135 respondents. Community
knowledge about their preparedness and
mitigation in order to create safe community
become variable of the study that was
meassured before and after receiving
education. Instrument used in this study was
developed by authors based on
recomendation from Health Cricis Center
255
Table 1. Distribution of frequency according Before treatment
to knowladge in Tegalrejo Village. Valid Cumulative
Before treatment Level Frequency Percent
Percent Percent
Valid Cumulative Poor 16 48.5 48.5 48.5
Level Frequency Percent
Percent Percent
Averag 12 36.4 36.4 84.8
Poor 14 43.8 43.8 43.8 e
Averag 16 50.0 50.0 93.8 Good 5 15.2 15.2 100.0
e
Averag 11 33.3 33.3 45.5
Good 2 6.3 6.3 100.0 e
Total 32 100.0 100.0 Good 18 54.5 54.5 100.0
After treatment Total 33 100.0 100.0
Valid Cumulative Table 2 indicates the simmilar found in
Percent Percent Tegalrejo Village. There are only 5
Poor 2 6.3 6.3 6.3 respondents from Kujon Village having good
Averag 11 34.4 34.4 40.6 knowledge before treatment. More than half
e respondents (54.5%) have improved their
knowledge to be good.
Good 19 59.4 59.4 100.0
Total 32 100.0 100.0 Table 3. Distribution of frequency according
to knowladge in Kajen Village.
As can be seen from table 1, only 2
respondents have good knowledge and the Before treatment
rest between average and poor. After Valid Cumulative
receiving education on disaster management Percent Percent
the proporsion of knowledge among Poor 25 69.4 69.4 69.4
respondents change. Most of respondents Averag 6 16.7 16.7 86.1
have good knowledge (59.4%) and only 2% e
respondents have poor knowledge.
Good 5 13.9 13.9 100.0
Table 2. Distribution of frequency according Total 36 100.0 100.0
to knowladge in Kujon Village. After treatment
Before treatment Valid Cumulative
Valid Cumulative Percent Percent
Percent Percent Poor 8 22.2 22.2 22.2
Poor 16 48.5 48.5 48.5 Averag 16 44.4 44.4 66.7
Averag 12 36.4 36.4 84.8 e
e Good 12 33.3 33.3 100.0
Good 5 15.2 15.2 100.0 Total 36 100.0 100.0
Total 33 100.0 100.0
After treatment Table 3 reveals that most of
Valid Cumulative respondent knowledge from Kajen Village
Level Frequency Percent before treatment is poor and only 5
Percent Percent
respondents reach good knowledge. The
Poor 4 12.1 12.1 12.1
256
change of knowledge proportion among these value is lower from the critical limit of 0.05.
respondents after treatment is not much This means that there is significanlty different
different where only 12 respondents have knowledge before and after tratment.
good knowledge and 8 respondents still have In Kujon village, the Wilcoxon
poor knowledge. Signed Rank Test shows that Z value is -
4.291 with p value (Asymp. Sig 2 tailed)
Table 4. Distribution of frequency according 0.000. This result is lower from the critical
to knowladge in Jambu Kidul Village. value limit of 0.05. Therefore, there is
significantly different of the knowledge of the
Before treatment respondents between before and after
Valid Cumulative treatment.
Level Frequency Percent The Wilcoxon Signed Rank in Kajen
Percent Percent
village reveals that Z value is -3.967 with the
Poor 19 55.9 55.9 55.9 p value (Asymp. Sig 2 tailed) is 0.000. This
Averag 13 38.2 38.2 94.1 result is less than the critical value limit of
e 0.05. This result means that there is
Good 2 5.9 5.9 100.0 significantly different of the knowledge of the
Total 34 100.0 100.0 respondents between before and after
treatment.
After treatment In Jambu Kidul village, the Wilcoxon
Valid Cumulative Signed Rank Test reveals that the Z value is -
Percent Percent 4.347 with the p value (Asymp. Sig 2 tailed)
Poor 7 20.6 20.6 20.6 is 0.000. It is lower than the critical value
Averag 13 38.2 38.2 58.8 limit of 0.05. Therefore it proves that there is
e significanlty different knowledge before and
after tratment.
Good 14 41.2 41.2 100.0 The final statistic test is conducted to
Total 34 100.0 100.0 compare all respondents from four villages
between before and after delivering disaster
As can be seen from table 4, it is clear management. The Wilcoxon Signed Rank
that only 2 respondents have good knowledge Test shows that Z value is -8.549 with the p
before treatment more than half of the value (Asymp. Sig 2 tailed) is 0.000. This
respondent knowledge (55.9%) is poor. result is less than the critical value limit of
However after the education oabout disaster 0.05. Based on that finding it means that there
management delivered there was very big is significantly different of respondent
increase in the number of respondents having knowledge between before and after disaster
good knowledge to be 41.2%. management administration.
Bevariate test was applied to test the
significancy change in each villages. DISCUSSION
Wilcoxon Signed Rank Test was used In recent years, disaster management
becaused the type of normality data was not becomes an issue that is very popular and
normally distributed and chategorized as received much attention from the various
nonparametric statistic. elements of society. Some disaster events
Based on Wilcoxon Signed Rank test have given tremendous lesson in its efforts to
in Tegalrejo Village, it is found that the Z minimize the impact caused by the disaster.
value is -4.564 with the p value (Asymp. Sig However, disaster management is actually
2 tailed) 0.000. Therefore it is clear that the not a new thing. The ancestors have
257
implemented disaster management presence of the industrial busines has not
appropriate levels of capabilities and been seriously reported.
technological development that existed at that Smith (2007) as cited by Kusumasari
time (Kusumasari, 2014). This is indicated by (2014) describs the structural paradigm
the presence of caves as shelters, or the focusing more on the social structure in which
planting of large trees around the area where a person or group of people exist. As
live shows community efforts to reduce the described, this structure emphasizes that with
impact caused by the disaster. the variety of social structures, have put their
In the 20s century disaster existence at risk of disaster. For example
management efforts have gained a more community which are concentrated around
comprehensive concentration where disaster the river banks are at risk affected more from
management have been managed in an flooding, people living in areas that are
organized and standardized globally so that roomy relatively less protected in the event of
management already covers ranging from catastrophic wind, people in the industry is at
preparedness, mitigation, and response to risk of exposure to the impact of disasters as
disasters (Kusumasari, 2014). The disaster a result of technological disaster such as
management in Indonesia is officially explosions, contamination of chemical, and
managed by the National Agency for Disaster fire. In other segment of population density,
Management or Badan Nasional urbanization and the legality of the
Penanggulanan Bencana (BNPB). However, population may also affect the vulnerability
the participation and involvement of various of people to flood (Rufat et al., 2015).
parties, including the various organizations, The majority of respondents in this
both inside and outside the country, including study have not been exposured on disaster
the community need to be increased. management, especially at the stage of the
Togetherness, teamwork and spirit in order to prediction despite exposure to the disaster
manage prepare for a disaster to deal with the itself has often encountered. This is
impact of the disaster is also important. evidenced by the low level of public
Culture of mutual cooperation or gotong knowledge on various questions related to
royong and patriotism are enough to prove mitigation and preparedness. Seneviratne et
and become one of the driving forces of the al., (2011) states that knowledge management
togetherness and mutual care. holds a very vital role in ensuring the
According to Smith, 2007 (cited in availability and accessibility of disaster risk
Kusumasari, 2014), in the social science information when needed. Lack of effective
perspective, there are two concepts known information and knowledge sharing and
paradigm used. There are the paradigm of dissemination of disaster mitigation measures
behavioral and structural paradigm. Four is one of the main reasons to unsuccessful
villages in this study geographically have practices or implementation of disaster
similar characteristics. This area is dominated management. According Seneviratne,
by plains that are mostly functioned as Pathirage, Amaratunga, and Haigh (2011)
agricultural land, plantations and industry. there are eight categories of factors that must
Frequent disasters are very similar, namely be taken into consideration in the
hurricanes, earthquakes and floods. However, management of knowledge, namely
the presence of Mount Merapi about 50 km technological, social, environmental, legal,
also often impacts quite serious. The function ekonimi, managerial / operational, political.
of some areas in Tegalrejo village especially These factors commonly identified in all
have shifted to the industrial center which types of disasters that include three phases as
was quite spacious. Disaster due to the mentioned previously.
258
The role of the various parties, REFERENCES
especially the community itself is needed in A Joint Study Of The Asian Development
order to equip the communities to the Bank And The Asian Development
conditions of understanding and ready to Bank Institute. (2013). Disaster Risk
anticipate the possibility of disaster. If local Management in Asia and the Pacific
resources are inadequate then this is the Issues Paper. Available from
beginning of a national paralysis that aid will :https://www.adb. org/
depend on international aid. Activities such sites/default/files/publication/157232
as counseling, training, study and so can /adbi-rp75.pdf Accessed 15
increase the capacity of communities in November 2016.
disaster management. Birkmann et al., (2013) J. Birkmann, O. Cardona, M. Carreño, A.
argue the association between low awareness Barbat, M. Pelling, S.
of the flood with limited protection against Schneiderbauer, S. Kienberger, M.
flooding and preparedness measures. Keiler, D. Alexander, P. Zeil (2013)
Building awareness of the potential Framing vulnerability, risk and
for disaster is one key to the success of societal responses: the MOVE
preparedness and the provision of complete- framework. Natural Hazards. Journal
complete protection in the event of a disaster. of the International Society for the
In addition to awareness of the potential of a Prevention and Mitigation of Natural
disaster, the perception of the disaster is also Hazards, 2013, vol. 67, issue 2, pages
an important element to be straightened. 193-211 Available
Rufat et al., (2015) prove that the perception from:https://link.springer.com/article
of the risk of disaster is often identified as a /10.1007/s11069-013-0558-5
factor of social vulnerability during the Accesseed 15 November 2016.
mitigation phase and the response to the Intarti, Y.R., Fitrinita, I.S., Widyanto, M.R.,
flooding disasters and on the other the and Simarmata, H.A. (2013).
broader setting. Perception can be awakened Towards Disaster Management in
from the experience of previous events. Rufat Indonesia Case Studies Jakarta and
et al., (2015) mentions that increased Yogyakarta Provinces, International
preparedness is very important for civil Journal of Disaster Recovery and
society, perceptions of risk and the Business Continuity Vol.4 (2013),
dimensions of psychosocial health, which pp.11-22. Available from :
often become problematic because of the http://www.sersc.org/
preparedness is situationally highly journals/IJDRBC/vol4/2.pdf Accesed
dependent and require further identification 20 November 2016
in contrast to other indicators. Kusumasari, B. (2014). Manajemen Bencana
dan Kapabilitas Pemerintah Lokal.
CONCLUSSION AND Yogyakarta: Penerbit Graha Medika.
RECOMENDATION Rufat, S., Tate, E., Burton, C.G., and.,
There are significant differences on Maroof, A.S. (2015) Social
respondent knowledge after socialization vulnerability to floods: Review of
emergency preparedness and mitigation case studies and implications for
efforts toward a safe community against measurement. International Journal
respondents in all villages in this study. of Disaster Risk
Reduction,14(2015)470–486,
Available from: http://ac.els-
cdn.com/S2212420915300935/1-
259
s2.0-S2212420915300935-main.
pdf?_tid=48c2 cfee-b5de-11e6-9754-
00000aacb362andacd nat=14
80387879_3e093500cbd78fd70e
fc160edfd7e3ea Accesed 30
November 2016
Peraturan Kepala BNPB Nomer 4 Tahun
2008 Tentang Pedoman Penyusunan
Rencana penanggulangan Bencana.
Seneviratne, K., Pathirage, C., Amaratunga,
D., dan Haigh, R. (2011). Disaster
knowledge factors: Benefits and
challenges. Available from :
http://usir.salford.ac.uk/23366/1/
23366.pdf Accesed 30 November
2016
Undang-Undang Nomor 24 Tahun 2007
tentang Penanggulangan Bencana.
260
THE STRATEGY OF COMMUNITY NURSING INTERVENSION THROUGH
HEALTH CADRE CONTRIBUTION, HEALTHY LIFE STYLE PERCEPTION, AND
ANAK KANDANG*) EMPOWERMENT IN AN EFFORT TO BREAK THE H5N1
VIRUS TRANSMITTAL CHAIN
Martono, Satino
Nursing Department Health Polytechnic of Surakarta
Email: must_ton@ymail.com
ABSTRACT
Introduction: Avian Influenza is a kind of disease which has potentially threat towards human
health and is deadly in nature so that it is necessary to pay a continuous attention to be research
in order to break the Avian Influenza transmittal chain. One of the efforts is the change of
community behavior through community nursing in terms of the Avian Influenza risk factor.
Methods:The research design is explanatory research using a cross sectional approach
conducted to 34 anak kandang as the samples. Regression test is applied as the statistical test
component. Results: Simultaneous health cadre role, healthy life style perception, and anak
kandang empowerment affect and give contribution towards the effort of breaking the chain of
H5N1 transmittal (F count = 21.399 >F table= 4.45) as much as 68.2% and respectively each health
cadre gives 11.4% of the contribution, healthy life style perception gives 0.1%, and anak
kandang empowerment gives 56.7%. Discussion: The success of Avian Influenza control so
that it will not be a new emerging disease and emerging disease is determined by the role and
support of the community, mainly the role of health cadre, healthy life style perception, and
anak kandang empowerment in the effort of breaking the chain of H5N1 transmittal.
Keywords: perception, empowerment, health cadre role
INTRODUCTION CFR= 79.58%). In Central Java during

The global concord in the Millenium November 2005 until May 27, 2007 there
Development Goals (MDGs) cannot be were 9 cases, with 8 cases of death (CFR=
separated from the direction of national 88.89%).
health development, where every sector of The detail of cases is from Magelang
health service has to work more effectively Regency there were 2 cases, and in
and efficiently to improve the optimum Boyolali, Semarang, 1 Banjarnegara,
level of community health. To meet the Sukoharjo, Wonogiri, dan Grobogann
target of MDGs, it is launched a Regency was respectively 1 case.
development movement related to the The Ministry of Health of Republic
community health which is urgent and deals Indonesia (2017) reports that the cases of
with broad community. One of the wide Avian Influenza in Indonesia are 199 with
spreading health problems in the 167 death cases, and in the last 10 years
community which is a kind of new there has been a decrease of AI cases.
emerging disease and emerging disease and Nonetheless, the problem of AI either
also a deadly one is Avian Influenza (AI). on poultry or human is still a serious one
The Department of Agriculture of demanding a serious attention from all
Republic Indonesia (2009) reported that in sides; community, private and public sector.
the development of AI in Indonesia in 2007 The data analysis result of Boyolali
there were confirmed of 98 cases; 78 death Regency in 2014 reported that there were
* Anak kandang are the workers having a direct

contact with the poultry farming or husbandry
261
2273 chickens in Ngargorejo, Sobokerto towards the efforts of breaking the chain of
had 6500 broilers and 8217 village H5N1 (Y) Virus transmittal in the certain
chickens, Ngesrep had 11500 broilers and period of time. The research design is
4372 village chickens, Gagaksipat had explanatory research using a cross
10500 broilers and 3879 village chickens, sectional approach. The research population
and Sindon had 6000 broilers and 3742 is all the anak kandang making a direct
village chickens (Health Bureau of contact with the chicken coops in the
Boyolali, 2014). The condition provided a chicken husbandry in Ngemplak, Boyolali
potentian threat and risk of H5N1 Virus Regency; 52 respondents. The sample
development. taking technique is Purposive sampling and
The primary success key to break the the quantity of the samples applies the
chain of H5N1 Virus transmittal is Slovin formula:
determined by the role and support of all 52
n  34.sampel
levels of community, mainly by the change 1  52(0.12 )
of community behavior. Selfi, Zakianis, dan The research instrument to take the
Wibowo (2010) explains that the survey data variable of healthy life style
results inform that out of 320 respondents perception, anak kandang empowerment,
62.2% still has poor information about AI, and heath cadre role is questionnaire.
57.1% performs poor personal hygiene,
61% does poor sanitation of food resourcing RESULTS
from poultry and 57.1% acts poor sanitation
of poultry coops. So far efforts carried out Table 1 Caracteristic of Respondents
to cope with the health problem was still Age (years) ⅀
oriented to the disease cure, which means <30 8
that what the community has done in the 31-50 14
health area is just to deal with the one taking >51 12
place that is considered less effective due to Education ⅀
the costly expenses on the cure action. Elementary school 16
Syafrudin and Hamidah (2009) postulate Secondary school 12
the community behavior can be affected by University 6
many factors. The one factor can derive Cadre Experience (years) ⅀
themselves, another person who can <5 8
encourage good or bad behavior, or the
5 – 10 22
surrounding environment supporting their
>10 4
behavioral change. Efforts acted by the
community to help themselves are making
Respondent Age
basic hygiene and sanitation of clean and
Out of 34 respondents under the
healthy life as a habit, and avoiding direct
research in Ngemplak, Boyolali Regency,
contact with sick or suddenly dead poultry.
most of them are are 31-50 years old ;
It is expected that those efforts can create
namely 14 persons (41.2%), 8 are less than
the change of healthy behavior in the
30(23.5%), and 12 are more than
community to prevent any disease because
51(35.3%). The frequency distribution of
of H5N1 Virus.
respondent age in Ngemplak, Boyolali
Regency is illustrated in Table 1.
METHODS
The research aims at explaining the
Respondent Education
correlation between the effect and
Out of 34 respondents, most of them
contributions of predictor of healthy life
are in the level of elementary school, or 16
pattern perception (X1), anak kandang
persons (47.1), 12 are in secondary school
empowerment (X2), heath cadre role (X3),
(35.3%), and 6 are in university level
262
(17.6%). The frequency distribution of kandang empowerment is illustrated in
respondent education in Ngemplak, Table 2.
Boyolali Regency is illustrated in table 1.
Healthy Life Pattern Perception
Cadre Experience Out of 34 respondents, most of them
Out of 34 respondents, most of them is categorized in the low healthy life pattern
have an experience as cadres from 5 to 10 perception level, i.e. 24 persons (70.6%),
year, i.e. 22 persons (64.7%), 4 have more medium level is i.e. 6 (17.6%), and high
than 10 years of experience (11.8%), and 8 level is i.e. 4 (11.8%). The frequency
own less than 5 years of it (23.5%). The distribution of healthy life pattern
respondent experience distribution in perception is illustrated in Table 2.
Ngemplak, Boyolali Regency is illustrated
in Table 1. The Breaking of H5N1 Virus Transmittal
Chain
Table 2 Result Out of 34 respondents, the effort to
Variable beak the chain of H5N1 Virus transmittal is
Health role cadre ⅀ categorized as medium, i.e.16 persons
Low 11 (47.1%), the high category, i.e. 10 persons
Medium 19 (29.4%), and the low category i.e. 8 persons
High 4 ((23.5%). The frequency distribution of
Healthy life pattern perception ⅀ breaking the chain of H5N1 Virus
Low 24 transmittal is illustrated in Table 2.
Medium 6
High 4 Double Regression Analysis
Anak kandang empowerment ⅀ Double regression analysis is
Low 6 applied to investigate the simultaneous
Medium 19 effect of variables of healthy life pattern
High 9 perception(x1), anak kandang
empowerment (x2), and health cadre role
The Breaking of H5N1 Virus ⅀
towards the breaking of H5N1 Virus
Transmittal Chain
transmittal chain. The equation is as follows
Low 8
Table 3. Summary of Double Regression
Medium 16
Result
High 10
Variable Regre t Sig
ssion coun
Health Cadre Role coeffi t
Out of 34 samples, most of health cient
cadre role is categorized as medium, i.e. 19
Coeff. of cadre role 0.537 2.7 0.0
persons (55.9%), low cadre role category
regression 71 09
belongs to 11 (32.4%), and the high one is
Coeff. of perception 0.001 1.1 0.0
owned by 4 persons (11.8%). The frequency
regression 3 69 47
distribution of health cadre role is illustrated
Coeff. of 0.239 3.2 0.0
in Table 2.
empowerment 47 03
regression
Anak Kandang Empowerment
Constanta 16.41 4.2 0.0
Out of 34 respondents, most of the
7 89 00
anak kandang empowerment level belongs
R 0.826
to the medium category, i.e. 19 (55.9%),
R2 0.682
low category 6 (17.6%), and high category
9 (23.2%). The distribution of anak
263
F 21.39 R2 Test (Coefficient Determination)
9 Regression statistic test result gains
Source : Primary Data (Analyzed by SPSS the value of R2 = 0.682 meaning that 68.2%
for Windows version10.0, 2017). health cadre role, health life pattern
perception, and anak kandang
Table 1 presents there is a positive effect of empowerment can explain the breaking of
0.537 on the health role cadre variable H5N1 Virus transmittal chain, and 31.8% is
towards the breaking of H5N1 Virus affected or explained by other variables
transmittal chain. Moreover, healthy life outside the models applied. To investigate
pattern perception impacts positively the variation of the respective independent
towards the breaking of H5N1 Virus variable in explaining the efforts of the
transmittal chain, i.e. 0.0013, and anak breaking of H5N1 Virus transmittal chain,
kandang empowerment effect is 0.239. R2 analysis is conducted to the respective
independent variable (health cadre role,
F-test Statistics health life pattern perception, and anak
F test analysis results in the value of kandang empowerment) towards the
F count =21.399 and F table = 4.45. Because the breaking of H5N1 Virus transmittal chain.
value of F count = 21.399 or higher than the R2 statistical analysis result presents
value of F table = 4.45, F count = 21.399 is aggregate of the predictors of health cadre
located in the area of rejection Ho or role (X1), healthy life pattern perception
acceptance Ha, which means that (X2), and anak kandang empowerment (X3)
simultaneously healthy life pattern = 68.2%. R2 of the predictor of anak
perception, anak kandang empowerment, kandang empowerment variable (X3) =
and health cadre role can explain the efforts 56.7% and R2 of the predictors of health
to break the H5N1 Virus transmittal chain in cadre role and anak kandang empowerment
Ngemplak, Boyolali Regency. variable (X1 and X3)=68,1%, as a result R2
of the respective variable towards the
T-Test-Statistics efforts to break the H5N1 Virus transmittal
Test analysis result leads to the chain is X3*Y= 56.7 %, R2 X1*Y = 68.1% -
comparison of the value of t health cadre role count 56.7% = 11.4 % and R2 X2*Y = 68.2 % -
= 2.771> ttable = 1.690 with the degree of 68,1% = 0,1 %. The result of the R2
thrust of 95% so that Ho is rejected and Ha Stepwise value analysis with the assistance
is accepted, meaning that partially health of SPSS for Windows version 10.0
cadre role has a significant effect towards application programs is illustrated in Table
the breaking of H5N1 Virus transmittal 3.
chain, t healthy life pattern perception count =
1.169>ttable=1.690with the degree of thrust Table 4. Summary of Effective
of 95% so that Ho is accepted and Ha is Contribution Result
rejected, meaning that partially healthy life Variable R2 (coefficient
pattern partially results in a significant Determination)
effect in breaking the H5N1 Virus Health role cadre (X1) 11,4%
transmittal chain and tanak kandang empowerment Healthy life pattern 0.1%
count = 3.247> ttable = 1.690 with the degree perception (X2)
of thrust of 95%, so that Ho is rejected and Anak kandang 56.7%
Ha is accepted or partially anak kandang empowerment(X3)
empowerment provides a significant effect X1, X2, X3 simultaneous 25,4 %
towards the breaking of H5N1 Virus Source: Primary Data (Analyzed by SPSS
transmittal chain in Ngemplak, Boyolali for Windows version10.0, 2017)
Regency.
.
264
DISCUSSION the community-based total sanitation
Health cadre role, healthy life development program either inter or intra
pattern perception, and anak kandang village. The effort is a good support to the
empowerment all together lead to a positive cooperation and also a media to develop the
effect towards the efforts to break the H5N1 community awareness of the importance of
Virus transmittal chain. Simultaneously the prevention of H5N1 Virus transmittal
those variables can explain the varying and the experience sharing about
efforts in breaking the H5N1 Virus overcoming the problem they face together,
transmittal chain in Ngemplak, Boyolali including the breaking of H5N1 Virus
Regency. The anak kandang empowerment transmittal chain by them. Therefore, the
variable provides a greater effect on this health cadre role has a great effect in this
action compared to either health cadre role action in Ngemplak, Boyolali Regency.
or healthy life pattern perception. It According to the statistical test result,
explains that the action of breaking or health cadre role variable towards the
preventing of H5N1 Virus transmittal chain breaking of H5N1 Virus transmittal chain
in the community is predominantly affected obtains the regression coefficient value of
by anak kandang empowerment. The 0.537, meaning that in each 5%
success of the community on this action improvement of health cadre role in terms
cannot be separated from the participation of the healthy life pattern perception and
of anak kandang as the member of the controlled anak kandang empowerment
community. variables the efforts of breaking the H5N1
The empowerment is expected to be Virus transmittal chain follows as much as
able to obtain an internal control of anak 0.537%. Furthermore t test result to
kandang who leads the community to examine and analyze the effect of health
always conduct the preventing or breaking cadre role variable presents that the value of
of H5N1 Virus transmittal chain in their t health cadre role count = 2.771 > t table = 1.690,
neighborhood. The behavioral control, if which clarifies that health cadre role in
supported by a good perception about some partial parts significantly affects the
healthy life pattern perception and the breaking of H5N1 Virus transmittal chain in
health cadre role, can be more effective to the community. This factor is partially
reach the goal. proven to be a significant contribution to the
Based on the research results, to action, i.e. 11.4%. it implies that health
improve the community contribution in the cadre role aspects, dealing with their
preventing or breaking the H5N1 Virus readiness to activate their role, belief to be
transmittal chain, it is necessary to develop skilled in their duties, participation in the
the human resources, the members of the action, and discipline can build positive
community, themselves. All the community behavior and can contribute positively in
actions to reach their goals depend very breaking the H5N1 Virus transmittal chain.
much on their own resources. Syafrudin and The research results in the theory
Hamidah (2009) clarify that the action of formulated by Syafrudin and Hamidah
community empowerment in the health (2009) asserting that health cadre role is one
service may need some cooperation of of the success keys in the development
related parties, among others: local implementation UKBM (upaya kesehatan
government, public figures, health cadres, berbasis masyarakat) or community-based
youths, NGO, and the community member health efforts. The health cadres have the
in general. This action can be implemented opportunity to develop their creativity and
by the support of perception pattern and conduct the observation and evaluation of
health cadre role. the program. The research results is also
Health cadre role is one of the supported by the research conducted by
resources to execute the implementation of Wijaya, Murti, and Suriyasa (2013)
265
elucidating that in the control of The contribution of anak kandang
tuberculosis cases the well-informed health empowerment towards the efforts to break
cadres provide higher potential to be 18 the H5N1 Virus transmittal chain
times more active than the others, the well- Community empowerment cannot be
behaved cadres are 8 times more active than separated from an effort to develop a
the others, and the highly-motivated cadres community-based sanitary program. It is
are 15 times more active than the lowly- expected that anak kandang empowerment
motivated ones. As a result, the more active can develop several methods to burrow and
health cadre role in breaking the H5N1 Virus make use of resources in the community to
transmittal chain in the community are, the improve the community health based on the
higher the success in breaking the H5N1 local wisdom.
Virus transmittal chain will be. Anak kandang empowerment in
Perception is the occurrence of health area, more specifically in terms of
responses which is preceded by sensing the preventing the H5N1 Virus transmittal will
stimulus, organizing, interpreting, increase their skill to identify any health
evaluating, and responding it with some problem in the community and its solution.
action. Hence, healthy life pattern It is expected that anak kandang
perception factor has a contribution in empowerment can give a contribution for
improving the efforts to break the H5N1 the efforts to break or to prevent the H5N1
Virus transmittal chain in the community. Virus transmittal chain in order to increase
Based on the statistical result, this variable the level of community health. Based on the
obtains the value of regression coefficient result of statistic test on anak kandang
of 0.0013 meaning that in every 5% empowerment variable towards the action,
increase of it under the assumption that the the value of regression coefficient is 0.239
other two variables are controlled, the which leads to the 5% increase in every
improvement of the efforts of breaking the anak kandang empowerment under the
H5N1 Virus transmittal chain of 0.0013%. assumption that the other two variables are
On the other hand, the result of t test controlled, so that the increase of the efforts
to examine and analyze the partial effect of to break the H5N1 Virus transmittal chain
each variable shows that tperception count= follows i.e. 0.239%. In the meantime based
1.169<ttable=1.690, which means that the on the t test result to determine the partial
healthy life pattern perception individually effect on each variable, it results in tanak
gives a significant effect on the efforts to kandang empowerment count = 3.247 > ttable = 1.690,
break the H5N1 Virus transmittal chain in which means that anak kandang
Ngemplak, Boyolali Regency. The factor empowerment individually obtains a
partially brings an insignificant contribution significant effect on the efforts to break the
for the efforts to break the H5N1 Virus H5N1 Virus transmittal chain.
transmittal chain of 0.1 %. This factor is proven to be able to give
The research results share the same a positive contribution for 56.7% effect on
stance on Zulfiqqar’s opinion (2013) the efforts. It also means that these aspects
explaining that one’s positive perception of sense of self determination (free to
leads to a positive effect on the adoption of choose the problem solving method), sense
healthy life pattern. Therefore, the of meaning (care about what action is taken
individual and community’s perception due to its impact on himself), sense of
affects the problem-solving process, and the competence (assure with their ability to
decision will encourage someone to take an solve problems), and sense of impact
action to pursue their goal. An action based (believe that what has been done will impact
on perception causes a real behavior leading the surrounding to make the others accept
to an optimum effort to break the H5N1 their ideas) has built a good anak kandang
Virus transmittal chain. empowerment.
266
Empowerment is an idea to develop I Made Kusuma Wijaya, Bhisma Murti, dan
human resources through anak kandang’s Putu Suriyasa., 2013. Hubungan
active participation so that they are able to Pengetahuan, Sikap, Dan Motivasi
conduct their function as anak kandang, Kader Kesehatan Dengan
including the health function. Aktivitasnya Dalam Pengendalian
The research result directs to a Kasus Tuberkulosis Di Kabupaten
research conducted by Susi, (2009) Buleleng. Jurnal Magister
asserting that empowerment is the most Kedokteran Keluarga Vol 1, No 1,
encouraging factor in the implementation of 2013 (hal 38-48)
clean and healthy life behavior. Another http://jurnal.pasca.uns.ac.id.
research conducted by Muljono (2010) Diunduh tanggal 29 Maret 2017
supporting this research explains family Kementerian Kesehatan RI, 2017. Laporan
empowerment can improve their family Kasus Flu Burung ke 98 dan 199.Di
health function. Hence, anak kandang akses.http://www.depkes.go.id/artic
empowerment builds individual and le/view/15040100002/laporan-
community independent behavior to the kasus-flu-burung-ke-198-dan-
extent of the effort to break or to prevent the 199.html. Diunduh Selasa, 28 Maret
H5N1 Virus transmittal chain. 2017
Pudji Muljono, (2010). Model
CONCLUSION AND Pemberdayaan Keluarga Melalui
RECOMENDATION Posdaya (Posdaya Pos Pemberdyaan
Simultaneous health cadre role, Keluarga). Institut Pertanian Bogor:
healthy life style perception, and anak Fakultas Ekologi Manusia
kandang empowerment affect and give Selfi Octaviani Lestari, Zakianis, Wibowo
contribution towards the effort of breaking Ady Sapta, 2010. Upaya
the chain of H5N1 transmittal as much as Pencegahan Flu Burung Masyarakat
68.2% and respectively each health cadre di Kabupaten Tangerang.Jurnal
gives 11.4% of the contribution, healthy life Kesehatan Masyarakat Nasional
style perception gives 0.1%, and anak Departemen Kesehatan Lingkungan
kandang empowerment gives 56.7%. The Fakultas Kesehatan
recommendations of the ventilating concord Masyarakat.Universitas Indonesia,
village communities as container is Edisi Oktober
representative to sit together in the context Sinaga, Dewi Marhaeni, Mubasyir Hasan
of the discussion to know, Identifying and B., 2004. Program Hidup Bersih dan
troubleshooting the behavior of health Sehat, Yogyakarta : Center Magister
especially in the prevention of H5N1. KMPK UGM
Susi Evanta, M.,S., 2009. Tesis Strategi
REFERENCES Pemberdayaan Masyarakat Dalam
Andy Zulfiqqar, (2013)., Persepsi Peningkatan PHBS Individu pada
Masyarakat Tentang Penyakit Masyarakat Pantai Di Wilayah
Terkait Dengan Gaya Hidup Dan Puskesmas Tanjung Rejo Deli
Pola Hidup Sehat. Serdang.Program Studi Magister
Skripsi.ProgramStudi Ilmu Kesehatan Masyarakat
PendidikanDokter Universitas Fakultas Kesehatan Masyarakat
Gajah Mada Yogyakarta. Universitas Sumatera Utara.
Departemen Pertanian RI. 2009. Prosedur Syafrudin dan Hamidah, 2009.Kebidanan
Operasional Standar Pengendalian Komunitas. Jakarta: EGC
Penyakit Avian Influenza.Jakarta:
Direktorat Jenderal Peternakan
267
THE ASSESMENT OF COGNITIVE IMPAIRMENT FOR STROKE PATIENT
Anja H. Kholis, Anis S. Syarifah

Jombang District, High School of Health Science
Email: hesniaanja@gmail.com
ABSTRACT
Introduction: Stroke is a leading cause of long-term disability. Deficit neurological of stroke
have impact in physical, emotional, social, and cognitive aspects. The impact of deficit
neurological may affects long-term quality of life. The purpose of this study was to evaluate
the effectiveness of cognitive impairment assessment for stroke. Method: Using an electronic
database including Pubmed, Sciencedirect, Medline Ebsco Host, Proquest and Springerlink
Library only for English language articles. Combining cognitive impairment, screening
cognitive, screening MoCA, MoCA tools, screening MMSE, MMSE tools, and stroke as the
search keywords. The 603 articles retrieved. Using matching keywords, 40 articles were
selected. Finally, 4 articles were selected which are study of test accuracy among consecutive
patients. Result: Using MoCA test more effective to evaluate cognitive impairment for stroke
patients. Discussion: The MoCA test for patient post stroke can detect cognitive impairment
compared using the MMSE. The MMSE subtest domain score can’t distinguished, while the
MoCA subtest domain score (visuospatial/executive function, attention and recall) can be
distinguished. Assessing executive function can help determine a patient’s capacity to execute
health care and discharge planning decisions.
Keywords: MoCA, MMSE, stroke
INTRODUCTION function of the patients should be conveyed

Cognitive impairment is one of the to the family because it can cause stress on
morbidities after stroke which was reported the family (Gershon et al., 2012).
incidence 10 %. Cognitive impairment Cognitive impairment can be
occurs in 45% of patients in the acute phase. determined by assessing the time of
Cognitive impairment is common in stroke treatment in the acute phase, so patients and
such as impaired attention, memory, families can understand about disability that
orientation, language, executive functions, occurs. Assessment that most often used to
apraxia and agnosia (National Stroke determine cognitive function is MMSE
Foundation, 2010). Patients with cognitive (Mini-Mental State Examination). MMSE
impairment will greatly affect in activity is composed of six domains to assess the
daily living. The perceived difficulties in orientation, registration, attention, recall,
cognitive abilities daily living, such as language, and imitate the picture. Another
memory, attention, decision-making, assessment that can be used is the MoCA
cognitive function and executive (the (Montreal Cognitive Assessment). MoCA
perceived difficulties in the application of test consists of 9 domains which determine
mental functions related to planning, the function of visuospatial/executive, CDT
organizing, calculating, work with memory (clock drawing test), naming, memory,
and learning). Communication difficulties attention, language, abstraction, delayed
are perceived related with verbal recall, and orientation. ROC (Receiver
expression, the production of language, Operating Characteristic) for MoCA with
articulation, understanding and AUC (Area Under the Curve) is 0,882 and
organization. Information about the the corresponding results for the 2 MMSE
patient's condition related to cognitive showed similar AUC 0.839. In this study
268
also mentioned that both MoCA and Pubmed, Sciencedirect, Medline Ebsco
MMSE have a reliable vote for the Host, Proquest and Springerlink Library
diagnosis of cognitive impairment after a only for English language articles.
stroke (Shen, et al., 2016). Combining cognitive impairment,
MMSE failed to detect any decline screening cognitive, screening MoCA,
in cognitive domain (Schweizer et al., MoCA tools, screening MMSE, MMSE
2012). MMSE is widely applied in the tools, and stroke as the search keywords
clinic, but it is inadequate for evaluating shown at table 1. The 603 articles retrieved.
mild cognitive impairment due to Using matching keywords, 40 articles were
sensitivity on visuospatial and executive selected. Finally, 4 articles were selected
function deficits. Otherwise, MoCA can which are study of test accuracy among
detect mild cognitive impairment and more consecutive patients. Table 1. PICO
sensitive for detecting cognitive Strategy
impairment compared to MMSE (Oh, Kim,
Shim & Seo, 2015). Nursing research about Keyword
the importance of cognitive status P Cognitive impairment or screening
assessment in stroke patients is very rare. cognitive
55% of nurses did not identify patients’ I Screening MoCA or MoCA tools
cognitive impairment in the general ward. C Screening MMSE or MMSE tools
Researchers identified 36% out of 182 O Stroke
patients who were treated in the
medical/surgical had cognitive impairment. RESULT
Nurses can only detect cognitive The articles had 1.b level evidence
impairment by 28%. It can be concluded for diagnosis test – study of test accuracy
that the nurses unable to identify impaired among consecutive patients is the second
cognitive function of the patients due to the highest level (Joanna Briggs Institute
lack of knowledge about the assessment of Levels of Evidence and Grades of
cognitive function (Souder & Osullivan, Recommendation Working Party, 2013).
2000). The challenges to obtain an accurate The articles were using consecutive
assessment of cognitive function for nurses sampling, have gold standard and index
in all adult patients are to assess disability test. AUC has classified based on tools
and then looking for reliability, validity, prediction: 0.9 – 1 : perfect ; 0.8 – 0.9 : good
and convenient use (Pangman, Sloan, & ; 0.7 – 0.8 : enough; 0.6 – 0.7 : less ; 0.5 –
Guse, 2000). So, the assessment to find 0.6. The AUC of MoCA were 0.92; 0.85;
problems in a more specific cognitive 0.91; 0.902; it was means that screening can
function in stroke patients is necessary. predict risk of cognitive impairment
respondents were perfectly approaches
METHOD 100%.
Search strategy that use in this
article was an electronic database including
Table 2. Synthetizing the evidence

Outcomes (Yanhong Dong et al., 2010) (Y. Dong et al., 2012) (Larner, 2012) (Salvadori et al., 2013)
Cut of MMSE : MMSE : MMSE : MoCA cut-off 21
point - - 23/24 - 25/26 - ≥26/30
- - 78.7 % correctly - 72 % correctly MoCA :
classified classified - ≥26/30
- MoCA : MoCA :
- - 19/20 - 21/22
- - 85.1 % correctly - 70 % correctly
classified classified
269
Sensitivity MMSE : MMSE : MMSE : MoCA
- 0.72 - 0.88 - 0.65 91,4%
MoCA : MoCA : MoCA :
- 0.83 - 0.88 - 0.97
Specificity MMSE : MMSE : MMSE : MoCA
- 0.83 - 0.67 - 0.89 75,8%
- 0.86 - 0.64 - 0.60
Positive MMSE : MMSE : MMSE : MoCA
Predictive - 0.72 - 0.47 - 0.82 80%
Value MoCA : MoCA : MoCA :
- 0.79 - 0.45 - 0.65
Negative MMSE : MMSE : MMSE : MoCA
Predictive - 0.83 - 0.94 - 0.78 89,3%
Value MoCA : MoCA : MoCA :
- 0.89 - 0.94 - 0.96
ROC MMSE : MMSE : MMSE : MoCA
AUC - 0.84 (95 % CI - 0.83 (95 % CI - 0.83 (95 % CI AUC 0.902
0.75-0.92) 0.77-0.89) 0.77-0.90) p= 0.001
- 0.92 (95 % CI - 0.85 (95 % CI - 0.91 (95 % CI
0.86-0.98) 0.79-0.90) 0.86-0.95)
p= 0.02 Area under ROC:
- MMSE 0.83
(0.77-0.90)
- MoCA 0.91
(0.86-0.95)
Out of four studies, two of them, Mental Status Exam (MMSE) and with
setting for the application and inclusion lengthier neuropsychological assessments
criteria can be combined as a reference in of executive function: Royall’s CLOX
the application screening of MoCA. (clock drawing), Controlled Oral Word
However, all studies agree that cognitive Association Test, and Trail Making Test,
function screening MoCA is more specific oral version (Kennedy & Einstein, 2012).
to assess impaired cognitive function in The evaluation of cognitive
stroke patients. screening at the bedside can be performed
between fifth and ninth day after stroke
DISCUSSION (Salvadori et al., 2013). Assessing
Based on this study, it can be seen executive function can help determine a
that MoCA is more specific and sensitive to patient’s capacity to execute health care
detect cognitive impairment. The MoCA decisions and discharge planning decisions
test for patient post stroke can detect (Kennedy & Einstein, 2012).
cognitive impairment compared using the Nurses have a role in recognizing
MMSE. The MMSE subtest domain score impaired cognitive function of stroke
can’t be 4 distinguished, while the MoCA patients using a sensitive and specific
subtest domain score instrument. MoCA through the application
(visuospatial/executive function, attention of evidence-based nursing to screening
and recall) can be distinguished. Few cognitive function have complete domain.
practitioners are familiar with testing for Nurses have the longer interacting with
executive function, there were brief valid patients and their families, so they can
and reliable instruments yet. The recognize changes and cognitive
instruments listed below have good internal impairment earlier. Through the
consistency, interrater reliability and were enforcement of nursing diagnosis related to
strongly correlated with the Folstein Mini- cognitive function domain, the nurse can
270
provide appropriate interventions for vascular cognitive impairment after
patients and their families. acute stroke. Journal of the
Age, gender, education level affects Neurological Sciences, 299(1–2),
the person's cognitive function. The 15–18.
prevalence of cognitive impairment was http://doi.org/10.1016/j.jns.2010.08
statistically 34% associated with gender .05
(female). Some studies suggest that the Dong, Y., Venketasubramanian, N., Chan,
higher life expectancy for women result the B. P.-L., Sharma, V. K., Slavin, M.
higher number of cognitive impairment. In J., Collinson, S. L., … Chen, C. L.-
2010, life expectancy for men is 69.7 years H. (2012). Brief screening tests
old, while the female age was 77.3 years during acute admission in patients
(Winter Holz, Nunes, Thume, Lange, & with mild stroke are predictive of
Facchini, 2013). vascular cognitive impairment 3-6
Clinical factors and cognitive months after stroke. Journal of
disorders are closely related. Medical Neurology, 5 Neurosurgery &
conditions, severity of stroke, Psychiatry, 83, 580– 585.
neuroimaging characteristics, the history of http://doi.org/10.1136/jnnp-2011-
vascular disease factors such as heart 302070
disease, hypertension, diabetes, and atrial Faizal, M., Zulkifly, M., Ghazali, S. E., Din,
fibrillation can affect cognitive function. N. C., Kaur, D., Singh, A., &
Neurological deficits that occur will affect Subramaniam, P. (2016). A Review
Barthel index score. Barthel index is a of Risk Factors for Cognitive
significant predictor to cognitive Impairment in Stroke Survivors,
impairment 3 months after stroke (Faizal et 2016.
al., 2016). Gershon, R. C., Lai, J. S., Bode, R., Choi,
S., Moy, C., Bleck, T., … Cella,
CONCLUSION AND D.(2012). Neuro-QOL: Quality of
RECOMENDATION life item banks for adults with
This study also has several neurological disorders: Item
limitations, nurse articles which discuss development and calibrations based
about assessment of cognitive function is upon clinical and general population
very rare. Not all articles can be applied testing. Quality of Life Research,
because of setting the application and 21, 475–486. doi:10.1007/s11136-
inclusion criteria in the application 011-9958-8
screening MoCA. Journals are selected not Joanna Briggs Institute Levels of Evidence
a systematic review, so had possibility of and Grades of Recommendation
limitations in the synthesis of the results. Working Party. (2013). New JBI
Indonesia still develop nursing practice Levels of evidence and Grades of
about necessary of the assessment in each Recommendation. Joanna Briggs
hospital. Policy differences of cognitive Institute, (October), 1. Retrieved
impairment assessment. from
http://joannabriggs.org/assets/docs/
REFERENCES approach/JBI-grades
Dong, Y., Sharma, V. K., Chan, B. P. L., ofrecommendation_2014.pdf
Venketasubramanian, N., Teoh, H. Kennedy, B. G. J., & Einstein, A. (2012).
L., Seet, R. C. S., Chen, C. (2010). Brief Evaluation of Executive
The Montreal Cognitive Dysfunction : An Essential
Assessment (MoCA) is superior to Refinement in the Assessment of
the Mini-Mental State Examination Cognitive Impairment.
(MMSE) for the detection of
271
http://doi.org/10.1111/j.1464- (2016). The use of MMSE and
5491.2012.03606.x. MoCA in patients with acute
Larner, A. J. (2012). Screening utility of the ischemic stroke in clinical. The
Montreal Cognitive Assessment ( International Journal Of
MoCA): in place of – or as well as – Neuroscience. Informa Healthcare.
the MMSE ?, 391–396. Souder, E., & Osullivan, P. (2000). Nursing
http://doi.org/10.1017/S104161021 documentation versus standardized
1001839 assessment of cognitive status in
National Stroke Foundation. (2010). hospitalized medical patients.
Clinical Guidelines for Stroke Applied Nursing Research, 13(1),
Management. National Stroke 29–36. doi:10.1016/S0897-
Foundation. 1897(00)80016-6
Oh, H. S., Kim, J. S., Shim, E. B., & Seo, Winter Holz, A., Nunes, B. P., Thume, E.,
W. S. (2015). Development and Lange, C., & Facchini, L. A. (2013).
clinical validity of a mild vascular Prevalence of cognitive impairment
cognitive impairment assessment and associated factors among the
tool for Korean stroke patients. elderly in Bage, Rio Grande do Sul,
Asian Nursing Research, 9(3), 226– Brazil. Revista Brasileira de
234.doi:10.1016/j.anr.2015.04.005 Epidemiologia = Brazilian Journal
Pangman, V. C., Sloan, J., & Guse, L. of Epidemiology, 16(4), 880–888
(2000). An examination of
psychometric properties of the mini-
mental state examination and the
standardized minimental state
examination: implications for
clinical practice. Applied Nursing
Research : ANR, 13(4), 209–213.
doi:10.1053/apnr.2000.9231
Salvadori, E., Pasi, M., Poggesi, A., Chiti,
G., Inzitari, D., & Pantoni, L.
(2013). Predictive value of MoCA
in the acute phase of stroke on the
diagnosis of midterm cognitive
impairment. Journal of Neurology,
260, 2220–2227.
http://doi.org/10.1007/s00415-013-
6962-
Schweizer, T. a., Al-Khindi, T., &
MacDonald, R. L. (2012). Mini-
Mental State Examination versus
Montreal Cognitive Assessment:
Rapid assessment tools for
cognitive and functional outcome
after aneurysmal subarachnoid
hemorrhage. Journal of the
Neurological Sciences, 316(1-2),
137–140.
doi:10.1016/j.jns.2012.01.003
Shen YJ; Wang WA; Huang FD; Chen J;
Liu HY; Xia YL; Han M; Zhang L,.
272
ETIOLOGY FACTORS ANALYSIS THAT INFLUENCE TO CONGESTIVE HEART
FAILURE INCIDENT IN ICVCU DR. MOEWARDI HOSPITAL SURAKARTA
Sugiyarto, Sunarto
Email: -
ABSTRACT
Introduction: Congestive heart failure is a patophysiological state when the heart is unable to
pump blood adequately to meet the needs of oxygen and nutrients of tissues. Etiologic factors
that found in ICVCU dr. Moewardi Hospital Surakarta are hypertension, myocardial infarction,
and pneumonia. Methods: This research is descriptive analytic with cross sectional approach.
Data analysis using logistic regression is used with a sample of 37 respondents. Results: The
results showed the significant influence of congestive heart failure and hypertension (p = 0.05),
myocardial infarction (p = 0:15), pneumonia (p = 0.18). Hypertension is an etiologic factor
dominant effect on the incidence of congestive heart failure with OR = 3,383. Conclusions:
Based on the result, it can be concluded that the three variables (hypertension, myocardial
infarction, and pneumonia) affect on congestive heart failure significantly. Recommendations
in this research is to do further research with a sample of more and longer study time, as well
as increasing the number of variable factors etiology.
Keywords: hypertension, myocardial infarction, pneumonia, congestive heart failure
INTRODUCTION cardiomyopathy, valvular heart disease,

Heart failure, is often called rheumatic heart disease and heart disease
congestive heart failure, is a pulmonic.
patophysiological state when the heart is The etiologies of congestive heart
unable to pump blood adequately to meet failure based on the frequency adulthood
the needs of oxygen and nutrients of tissues are ischemic heart disease as the most,
(Brunner and Sudarth and Price, 2006). valvular heart disease, and cardiomyopathy
Heart failure is caused by structural and and rheumatic heart disease. Statistically,
functional disturbances of the heart there was no difference between the
(Sudoyo, 2009). Factors that can trigger the etiology of congestive heart failure in the
development of heart failure through the elderly with adult (Ardini, 2006). Results of
sudden pressure circulation include a preliminary study conducted by the author
arrhythmias, systemic infections, lung at the ICVCU dr. Moewardi Hospital
infections, and pulmonary embolism (Price, Surakarta in patients with congestive heart
2006). In Indonesia there is no exact data failure, showed the number of patients
about the causes of heart failure, while data admitted during the year 2011 as many as
from the hospital in Palembang 113 patients, and frequent etiological
hypertension as the most common cause, factors are hypertension, myocardial
followed by coronary heart disease and infarction, and pneumonia. The purpose of
valve (Sudoyo, 2009). Research in the dr. this study was to determine the major
Kariadi Hospital in January-December etiologic factor that influenced the
2006, the data showed that the etiology of incidence of congestive heart failure at
elderly congestive heart failure based on the ICVCU dr. Moewardi Hospital, Surakarta.
frequency showed ischemic heart disease
becomes the most etiology, followed by
hypertensive heart disease,
273
METHODS Table 2 Characteristics Frequency
This study used analytic description Distribution of respondents by gender
method with cross sectional approach. The
populations in this study were all patients CHF Cases Not CHF casus
hospitalized in the ICVCU dr. Moewardi Sex Freq
Hospital, Surakarta. The number of samples Percenta Frequen percen
uenc
in this study were 37 patients selected using ge cy tage
y
accidental sampling technique, in which Male 19 70,4 % 7 70%
patients were included in the inclusion
criteria, willing to become respondents and Femal 8 29,6 % 3 30%
has a history of disease are hypertension, e
pneumonia, myocardial infarction. The Total 27 100% 10 100%
research instrument used observation sheet.
Research carried out for 2 months at In Table 2 it can be seen that male patients
ICVCU dr. Moewardi Hospital. with congestive heart failure were 19
respondents (70.4%) and female were 8
RESULTS respondents (29.6%). Male patients who did
Univariate Analysis not suffer from congestive heart failure
Univariate analysis in this research were 7 respondents ( 70%) and female were
is divided on the characteristics of 3 respondents (30%).
respondents include age, gender, and
respondents who experienced a myocardial Table 3 Characteristics Frequency
infarction, hypertension, and pneumonia. Distribution of respondents in hypertensive
The following are the data obtained: patients by age group and gender
Hypertension
Table 1 Characteristics Frequency Variabel
Frequency Percentage
Distribution of respondents by age group
Age
Patient with Patient
<40 3 12,5%
Charact CHF without CHF
>40 21 87,5%
eristics Frequ Perce Frequ Perce
Total 24 100%
ency ntage ency ntage
Sex
<40 7 25,9 2 20% Male 20 83,3%
% Female 4 16,7%
>40 20 74,1 8 80% Total 24 100%
%
Jumlah 27 100% 10 100% In table 3 it can can be seen that patients
with hypertension aged < 40 years were 3
In Table 1 it can be seen that patients with respondents (12.5%), age >40 years were
congestive heart failure aged < 40 years 21 respondents (87.5%), male patients were
were 7 respondents (25.9%), age >40 years 20 respondents (83.3%) and female patients
were 20 respondents (74.1%), patients who were 4 respondents (16.7%).
did not suffer from congestive heart failure
aged <40 years were 2 respondents (20%), Table 4 Characteristics Frequency
and age >40 years were 8 respondents Distribution of respondents’ myocardial
(80%). infarction patients by age group and gender
Miocard Infarction
Variabel
Frequency Percentage
Age
<40 4 14,8%
274
>40 23 85,2% Frequ Perce Frequ Perce
Total 27 100% necy ntage necy ntage
Sex Hypert 20 74,1 4 40%
Male 22 81,5% ension %
Female 5 18,5% Not 7 25,9 6 60%
Total 27 100% Hypert %
ension
In table 4 it can be seen that patients with Total 27 100% 10 100%
myocardial infarction aged < 40 years were
4 respondents (14.8%), age > 40 years were Table 6 shows the frequency distribution of
23 respondents (85.2%), male were 22 respondents with congestive heart failure
respondents (81.5%), and female were 5 who have hypertension as many as 20
respondents (18.5%). respondents (74.1%) and there are seven
respondents (25.9%) who did not have
Table 5 Characteristics Frequency hypertension. The number of respondents
Distribution of respondents Pneumonia who do not suffer from congestive heart
patients by age group and gender failure with hypertension were 4
Pneumonia respondents (40%) and there were 6
Variabel
Frequency Percentage respondents (60%) who did not have
Age hypertension hypertension. Result of
<40 1 20% bivariate analysis showed that hypertension
>40 4 80% effect was 4.2 times greater on the incidence
Total 5 100% of congestive heart failure with value 0.05,
Sex so that these variables are followed in the
Male 3 60% multivariate analysis.
Female 2 40%
Total 5 100% Myocardial Infarction
Table 7 Frequency Distribution of
In table 5 it can be seen that patients with myocardial infarction based on etiologic
Pneumonia aged < 40 years was one factors in patients with congestive heart
respondent (20%), age > 40 years were 4 failure
respondents (80%), male were 3
respondents (60%), and female were 2 Patient with Patient without
respondents (40 %). Etiol CHF CHF
ogy Frequ Percen Frequ Percen
Bivariate Analysis necy tage necy tage
Bivariate analysis were used to see the MI 21 77,1% 6 60%
relationship between these two variables,
Not 6 22,9 4 40%
was each etiological factors on the
MI %
incidence of congestive heart failure.
Total 27 100% 10 100%
Hypertension
Table 6 Distribution of frequency based on Table 7 shows the frequency distribution of
etiology factors of hypertension in patients respondents congestive heart failure
with congestive heart failure. myocardial infarction were 21 respondents
(77.1%) and there were 6 respondents
Etiolog Patient with Patient (22.9%) who suffered myocardial
y CHF without CHF infarction. The number of respondents who
do not suffer from congestive heart failure
275
myocardial infarction were 6 respondents Not 24 88,89 8 80%
(60%) and there were 4 respondents (40%) Pneu %
who did not experience a myocardial monia
infarction myocardial. Result of bivariate Total 27 100% 10 100%
analysis showed that myocardial infarction
effect was 2.3 times greater on the incidence
In Table 8 shows the frequency distribution
of congestive heart failure, with p value
of respondents with congestive heart failure
0.015, so that this variable is continued in
who had developed pneumonia were three
the multivariate analysis.
respondents (11.11%) and there were 24
respondents (88.89%) who did not have
Pneumonia
pneumonia. The number of respondents
Table 8 Distribution of frequency based on
who do not suffer from congestive heart
etiology factors of pneumonia in patients
failure with pneumonia were two
with congestive heart failure
respondents (20%) and there were 8
respondents (80%) who did not experience
Patient with Patient without
a myocardial infarction pneumonia. Result
Etiolog CHF CHF
of bivariate analysis showed pneumonia
y Freq Perce Frequ Perce effect was 0.2 times greater on the incidence
ueny ntage necy ntage of congestive heart failure, with p value of
Pneu 3 11,11 2 20% 0.18, so that this variable is continued in the
monia % multivariate analysis.
Multivariate analysis
Table 9 Summary of Multivariate Analysis
No Variabel B Wald OR 95% CI
1. Hypertension 1,219 2,198 3,383 0,675 - 16,944
2. Miocard Infarction 0,520 0,304 1,681 0,311 - 9,097
3. Pneumonia -1,389 2,233 0,249 0,040 – 1,542
Constanta 0,264 0,98 1,303
In Table 9 it can be seen multivariate forcefully because of the addition of

analysis variables that most influence on the LVEDP. This is the basic of diastolic
variable incidence of congestive heart dysfunction and congestive heart failure
failure is hypertension which its effect is (draperies et al, in Anggraini, 2007).
3,383 times greater on the incidence of The study from Anggarini (2009)
congestive heart failure. and Sudoyo (2009) stated that high blood
pressure causes high pressure gradient
DISCUSSION which must be passed by the left ventricle
Hypertension Process of getting to pump blood. Constantly high pressure
older is marked by decreased organ cause increased cardiac oxygen supply
function causing disorder but not needs. Then initial pain occurs in
pathological process. Reduction of connection with coronary artery disease.
elasticity and aorta compliance and large The increasing of systemic blood pressure
blood vessels will lead to elevation of increase resistance to pumping blood from
systolic blood pressure and left ventricular the left ventricle, it causes consequently
ejection. This will lead to left ventricular cardiac workload increased, and
hypertrophy and interstitial fibrosis (Chen hipertrophy ventricle occurs to increase the
et al, in Anggraini, 2007). The addition of force of contraction, left ventricular
left ventricular wall thickness cause hypertrophy as compensation for the
relaxation / diastole, the atria contract more increase in systemic blood pressure, which
276
in turn actually increase the work of the survived 10 years after the infarction,
heart and will ultimately lead to failure almost 25% attack by heart failure. But this
heart. data is obtained prior to the use of
Data from previous studies, the data thrombolytic, cause of the successful of
from Framingham showed that thrombolytic therapy in maintaining the
hypertension with or without ischemic function of the left ventricle, clients who are
disease is the largest cause of heart failure likely to experience heart failure after
in Europe, while the study in UK infarction is fewer.
hypertension become the cause of 6% Factors that can trigger the
clients with congestive heart failure. development of heart failure through the
Research in 2006 in Kariadi Hospital, circulation sudden emphasis can be
Semarang, obtained the data that the arrhythmias, systemic infection, lung
etiology of heart failure caused by infection (pneumonia), and pulmonary
hypertensive heart disease as much as embolism. The body's response to infection
15.63%. will force the heart to meet the body's needs
Left heart failure is a mechanical increased, so the heart must work harder to
complication most often occurs after pump blood to meet the body's oxygenation,
myocardial infarction. Interrupt myocardial thus providing an additional burden on the
infarction myocardial function due to heart. In addition, the body's response to
causes decreased force of contraction, infection such as fever will force the heart
causing wall motion abnormalities, and to meet the body's metabolic needs increase,
change the develop power of the heart this will lead to a decrease in myocardial
chamber. With the reduced ability of the left contractility so will result in heart failure
ventricle to be empty, then the stroke (Price, 2006)
volume is reduced so that the rest of the Epidemiologically pneumonia tends
ventricular volume increases. This causes to occur in the elderly, but it remains a
increased the left heart pressure. The morbidity and mortality in young adults.
increase in pressure is distributed to the rear The results of Research by Dewi in 2007
to pulmonali vein. showed that 12.5% of patients with
When the hydrostatic pressure in the pneumonia attack adult age and 25%
pulmonary capillary vascular oncotic elderly patients. In a previous study in 2003
pressure exceeded then a process of patients with heart failure were 38.9%
transudation occurs into the interstitial relapse comes with bronchopneumonia.
space. When the pressure is still increased
again, occurred pulmonary edema fluid CONCLUSION AND
permeation due to alveoli. A decrease in RECOMENDATION
stroke volume will cause a compensatory Based on the results of research and
sympathetic response. Heart rate and force discussion, it can be concluded as follows:
of contraction increase to maintain cardiac congestive heart failure disease is
output. Peripheral vasoconstriction occurs influenced by a history of hypertension,
to stabilize arterial pressure and blood flow myocardial infarction, and pneumonia. The
redistribution of organs that are not vital results showed the significant influence of
like kidney and skin in order to maintain congestive heart failure and hypertension (p
perfusion of vital organs (Price, 2006). = 0.05), myocardial infarction (p = 0:15),
Data from previous studies, the pneumonia (p = 0.18). Hypertension is an
Framingham study data showed that acute etiologic factor dominant effect on the
myocardial infarction often triggers heart incidence of congestive heart failure with
failure. The data showed that 9% of clients OR = 3,383The major etiologic factor
who survived three years after the donation affecting congestive heart failure is
will have heart failure. From all clients who hypertension.
277
Recommendation For patients with Theory to Practice. Semarang.
hypertension, myocardial infarction, and Badan Penerbit Universitas
pneumonia, they are expected to always Diponegoro,
maintain their health is by adopting a Hidayat, Aziz. 2009. Metode Penelitian
healthy lifestyle and frequent control to the Keperawatan dan teknik analisis
doctor so that complications of congestive data. Jakarta. Salemba medika.
heart failure can be avoided. For the Gagal Jantung Kongestif Usia Lanjut Pria
hospital is expected to have an instrument dan Wanita di Rumah Sakit Kariadi
to determine a disease that leads to Periode Januari-Desember 2006.
congestive heart failure early so as to Semarang.FK Undip.
anticipate the onset of congestive heart Muttaqin,Arif. 2009. Asuhan Keperawatan
failure. Recommendations in this research Klien dengan Gangguan Sistem
is to do further research with a sample of Kardiovaskuler dan Hematologi.
more and longer study time, as well as Jakarta: Salemba Medika.
increasing the number of variable factors Notoatmodjo, Soekidjo. 2005. Metodologi
etiology. Penelitian Kesehatan.
Jakarta:Rineka Cipta .
REFERENCES Nursalam, 2003. Konsep dan Penerapan
Anggraini, Deza.2010. Hubungan Kejadian Metodologi Penelitian
Hipertrifi Ventrikel Kiri Dengan Keperawatan. Jakarta : Salemba
Riwayat Hipertensi pada Pasien Medika.
Gagal Jantung Kongestif Tahun Price, Silvia., dan Wilson, Lorraine. 2006.
2009 Di RSUP H.Adam Malik Patofisologi.Jakarta : EGC .
Medan.Medan.FK USU. Sudoyo et all. 2009. Ilmu Penyakit Dalam.
Ardini, Desta Nur Ewika. 2006. Perbedaan Jakarta : Interna Publishing.
Etiologi Gagal Jantung kongestif Sugiyono. 2010. Metode Penelitian
pada Usia Lanjut dengan Usia Kuantitatif Kualitatif dan R&D.
Dewasa di Rumah Sakit Dr. Kariadi Bandung : ALFABETA.
Januari-Desember 2006.
Semarang: FK Undip.
Arikunto, Suharsimi. 2010. Prosedur
Penelitian . Jakarta : Rineka Cipta.
Corwin, E.J. 2009. Buku Saku Patofisiologi.
Alih bahasa : Pendit, B.U. Jakarta:
EGC.
Dewi, Pusita Kusuma.2007. Perbedaan
Komorbid Gagal Jantung Kongestif
pada Usia Lanjut dengan Usia
Dewasa di RS.Kariadi Periode
Januari-Desember 2006.
Semarang.FK Undip.
Doengoes, Marylin E. 2000. Rencana
Asuhan Dan Dokumentasi
Keperawatan. Edisi 3. Jakarta:
EGC.
Dwitaryo, Arie Bachtiar. 2006. Heart
failure on the elderly, what
differences on the adult. Dalam :
Semarang Cardiology Update 6th-
7th May Clinical Cardiology : From
278
APPLICATION PROBLEM BASED LEARNING IN LABOR CARE ON THE
IMPROVEMENT OF MOTIVATION AND ACHIEVEMENT MIDWIFERY
STUDENTS
Kolifah
Email: kolifah0607@yahoo.com
ABSTRACT
Introduction: The low quality of education due to a learning process that is not yet effective.
This can be changed with the methods and appropriate learning strategies. Midwifery care
delivery requires real picture so that necessary appropriate learning methods. The purpose of
this study to analyze the effect of PBL on motivation and learning achievement subjects
midwifery care delivery.
Methods: This study design korelatif with "One Group Pre Test Post Test". 3rd semester
student population of the whole number of 47 respondents. Data were analyzed using paired t-
test, the alternative hypothesis is accepted if p <0.05. Results: The results showed that there are
significant differences between the pre and post study, with a value of p = .000. Motivation
before and after implementation of BPL also showed a significant difference with p = .000.
Conclusion: The target to be achieved in this research is to improve the ability of the individual
student in solving problems on a case. Problem Based Learning learning model illustrates real
cases to students that will allow students on work directly in the clinic and work as a
professional midwife.
Keywords: Problem Based Learning, Academic achievement, Motivation
INTRODUCTION appropriate to the learning objectives can be

DIII Midwifery is an educational achieved in accordance with the target. The
institution that is oriented in the health field, use of the learning model is an attempt by
especially obstetrics, where the graduates the lecturers so that a student can be
will serve the community and should be maximized in understanding the subject
able to improve quality in order to be trusted matter, so that after learning maahasiswa
and be competitive in the workforce. will have competence as the demands of the
Knowledge and skills relevant to the world lessons learned. A wide variety of learning
of obstetrics, should be instilled in students models that are implemented have certain
in DIII Midwifery. Quality development characteristics with all the strengths and
undertaken various measures such as weaknesses of each. A model may be good
increasing the quality DIII Midwifery. The for a particular purpose, subject or certain
quality is determined by various factors, circumstances, but may not be appropriate
among others: the factors of learners for other situations. Delivery care required
consists of two factors: the factors of the courses giving the real picture of the labor
student and the student outside factors or and management, so we need a proper
environmental factors (Nana Sudjana, learning methods so that students are
2010: 39). motivated to learn care delivery.
The low quality of education is due Developments in the teaching and
to the learning process is not yet effective. learning process students are expected to
To achieve effective learning, one way to undergo changes in cognitive ability,
use the methods and learning strategies affective and psychomotor. One of the main
279
factors that affect the student in the learning Jombang regency STIKES midwifery
process is the method used lecturer in diploma. Data were analyzed using paired t-
conveying information. When the method test, the alternative hypothesis is accepted if
used is not appropriate, it may be desired p <0.05.
objectives will not be achieved.
So in this study the authors will RESULTS
provide innovative methods in an effort to Application of PBL teaching model
improve the quality of learning that will in the subject began in the middle of the 3rd
lead to improved performance as teachers semester, before starting the model PBL
so motivation can increase student learning measurement of student motivation in
outcomes. The method can use the method learning to follow the conventional model,
that is centered on students, one of them so the motivation value obtained before the
with the methods of PBL (Problem Based implementation of PBL.
Learning) Chan Chang Tik, (2014).
Problem Based Learning is a Table 1 Frequency Distribution of
learning strategy that uses real-world motivation before the application of PBL
problems as a context for students to learn Motivation Frequency %
about critical thinking and problem solving High 9 19.2
skills, as well as to acquire knowledge and Medium 23 48.9
essential concept of the subject matter. Low 15 31.9
Under these conditions, in the learning
Total 47 100
process care delivery need to use the PBL
method that is expected to increase Source: Primary Data 2017
motivation, initiative, creativity, thereby
increasing the value of the achievement of Table 1 shows that nearly half (48.9%) of
students. respondents have low motivation in
learning midwifery care delivery.
METHODS Learning achievement before the
This study design korelatif with application of PBL method derived of
"One Group Pre Test Post Test". 3rd middle Examination score.
semester student population of the whole
number of 47 respondents. Table 2 Frequency Distribution middle
The independent variable in this Examination score
research is the application of the Middle Examination
intervention model Problem Based Score (MEC) Frequency %
Learning (PBL). PBL method is the Very good 19 40.4
application of the provision of case or issue Good 19 40.4
that has been arranged in the learning Enough 9 19.2
module Midwifery Care Delivery. The Less 0 0
dependent variable in this study was the Total 47 100
achievement of learning motivation and Source: Primary Data 2017
learning achievements of students diploma Table 2 shows that nearly half of the
in Midwifery. Instruments in this study is respondents (40.4%) get midterm grades
the evaluation of the implementation of the with a good and very good.
application sheet PBL methods, assessment PBL learning model application
using questionnaires while the motivation starts to matter after the midterms,
for the achievement of students using the conducted over 10 face then assessed
UTS and UAS. The research was conducted student motivation during the lesson.
during the first half of that is the 3rd
semester 2016/2017 academic year in
280
Table 3 Frequency Distribution of achievement before and after
motivation after the application of PBL implementation of the PBL method,
Motivation Frequency % demonstrated significant value 0.000. 95%
High 15 31.9 CI values are between -8.18584 to -
Medium 25 53.2 3.04821.
Low 7 14.9 This indicates that the application of
PBL method in the subject of Obstetrics
Total 47 100
Maternity care is very effective in
Source: Primary Data 2017 improving student achievement.
Table 3 shows that most of the
respondents (53.2%) have medium DISCUSSION
motivation in learning midwifery care The measurement results average
delivery. score motivation to learn before being given
Learning achievement after treatment obtained an average score of
application of PBL method derived from the motivation to learn is 64 to 15 respondents
value of final exams. (31.9%) had low motivation and 23
respondents (48.9%) had moderate
Table 4 Frequency Distribution Final motivation and 9 respondents (19, 1%) have
Examination score a high motivation. After the application of
Final Examination learning methods PBL obtained average
Score (FEC) Frequency % value of 67, comprising seven respondents
Very good 29 61.7 (14.9%) had low motivation and 25
Good 17 36.2 respondents (53.2%) had moderate
Enough 1 2.1 motivation and 15 respondents (31.9%)
Less 0 0 have a high motivation. it indicates there is
Total 47 100 an increased motivation to learn in students
Source: Primary Data 2017 with the application of PBL learning model.
Table 4 shows that most of the Value midterms obtained before the
respondents (61.7 %) get midterm grades implementation of PBL students Prodi DIII
with a good and very good. overall midwifery have Range 29; the
The next step is to analyze the average value (mean) of 72.19, the median
differences in motivation before and after is 74, the standard deviation of 7.23
application of PBL teaching model in the variance of 52.33 minimum value of 56 and
course of midwifery care delivery. Analyze a maximum value of 85.
differences in learning achievement before Final exam grades obtained after the
and after application of PBL teaching model application of PBL students Prodi DIII
in the course of midwifery care delivery, overall midwifery have Range 37; the
preceded test normality test differences in average value (mean) of 77.80 at 78 median,
all the variables. standard deviation of 8.55 variance of 73.11
Statistical test results that there are minimum value of 58 and a maximum value
significant differences in learning of 95.
motivation before and after implementation The results of statistical calculation
of the PBL method, demonstrated above, showed an increase learning
significant value 0.000. and 95% CI values achievement after application of PBL
are between -4.79383 to -2.65298. teaching model in the subject of Midwifery
This suggests that the learning Care Delivery. Test results also showed
motivation of students increased after statistically that the application of PBL
application of PBL learning method. method in the subject of Obstetrics
Statistical test results shows that Maternity care is very effective in
there is a significant difference in learning improving student achievement.
281
The design of PBL problem is a where PBL stimulate the learning process
critical step because PBL is constructed using these problems in real situations.
around problems. Research suggests that Application of PBL method, students are
learning transfer will be more successful given the physiological childbirth cases
and students will be more cognitively and where students act as professionals who will
affectively engaged in problem solving if determine the diagnosis midwife obstetrics.
problems are authentic and meaningful Students can begin working on the case by
within their profession (Wirkala and Kuhn, reading the theories that have been given in
2011). Should an expert, a teacher becomes advance, so that students have the provision
a tutor who will facilitate the learning before solving the problem. The next step
process, and allows students to take a lot of gives students exposure steps of solving the
advantages when they learn. case is based on literature or results of group
Application of PBL which begins discussions. The discussion was followed
with the presentation of cases of labor by lecturing case.
provide stimulation to the students to try to According to the Suci (2008), the
solve the problem. Case or problem learning model of problem based learning
presented is the description of the stages of has characteristics that distinguishes it from
work at the time of the clinic or hospital other learning models, namely that is
where the students work. PBL learning student centered learning or student-
method starts with a presentation in a centered.
sequence based on the steps that correspond Stay with lecturers as facilitators in
to the learning module, students will get a the learning process, the application of PBL
real picture as the world of work so that models lecturers provide support and
students will acquire cognitive skills and appreciation to the students. Social and
knowledge they need in the workplace. contextual support, dealing with how issues
Savery & Duffy in Kuo Shu Huang are the focus of learning can make students
(2012) states "problem-based learning as a motivated to solve it. Competitive
curriculum design that identified students atmosphere between groups can also
not as passive recipients of knowledge but support the group's performance. Social and
as a problem solvers who could develop contextual support should be
disciplinary knowledge ". Application of accommodated by the lecturers to the
PBL students are responsible for their own successful implementation of learning.
learning because of the skills they will need A.M. Sardiman (2011: 73) that
later in professional life in the working motivation is the driving force that has
world. They apply the theories they have become active. Motivation becomes active
earned, find a solution to the problem or the at certain moments, especially when the
given case, and trying how to obtain the need to achieve the goal is perceived or
required information through a variety of urgent. Meanwhile, Mc. Donald (A.M.
sources including the online resources, Sardiman 2011: 71-72) says that motivation
libraries, professionals and experts. is the energy change in a person
This is supported by Fatimah characterized by the emergence of "feeling"
(2012), which stated that the problem based and preceded with the response to their
learning learning model always begins and destination. This is according to the PBL
centered on the problem. learning model where students in the
Learning theories besides giving mentioned case of the new labor cases heard
enough, also need to provide examples of by students to make students become
solving real problems or issues in practice actively solve the problem. Students will be
by utilizing the existing theories. Thus, the encouraged to solve the case presented in
development of a natural learning process is various ways and various activities it is the
simulated by the problems in real situations intrinsic motivation of the students
282
themselves. According to A.M. Sardiman appreciation to students who ask also one
(2007: 89-90) intrinsic motivation are the way to motivate students to be more
motives that become active or function they interested in the subjects that are running.
do not need to be stimulated from the This is consistent with the results
outside because in every individual had no which saw an increase learning
urge to do something. The drive to resolve achievement after application of PBL
cases encourage better student learning that learning method. Motivation of students
will improve the achievement of students. also increased after a given PBL learning
Hamzah B. Uno (2010: 23) study is the method.
change in behavior is relatively permanent It is also supported by the results of
and potentially occur as a result of the research conducted by Agustina (2012),
practice or reinforcement (reinforced entitled "Effects of Problem Based
practice) that is based on the aim to achieve Learning Model Against Critical and
certain goals. This is consistent with the Creative Thinking Skills Students
application of PBL method students Kanjuruhan University of Malang On
motivated to learn. Course Hydrology ". The study proves that
Students try to solve the problem critical and creative thinking of students in
would be motivated to continue to achieve the course of hydrology higher than
the learning objectives, so it will affect the students who received conventional
achievement of students. This is in learning.
accordance with A.M. Sardiman (2011: 86) Application of PBL method will
achievement is the real capacity that results help students learn to solve problems, so
from interactions between the various motivated to learn by learning framework
factors that affect both from within and drawn up. Application of PBL learning
from outside the individual in the study. model that will result in the student learning
One factor that affects learning achievement. It is also supported by the
achievement is the motivation, where results of research conducted by Diana
someone will succeed in learning, in her Stentoft, 2014 The study demonstrates that
desire to learn. Other factors that affect the introducing project-PBL may contribute
learning achievement according to significantly in problembased medical
Sudirman A.M that factor of the self that education.
includes physical state and psychological
factors including the motivation to learn and CONCLUSION AND
factors that come from outside. RECOMMENDATION
Students are given a case study will Application of Problem-based
be compelled to try to resolve so comes the learning model of learning can increase
learning process. The urge to solve the learning motivation of students in the
problem is intrinsic motivation in students, subject of Midwifery Care Delivery.
a strong motivation will improve learning Application of Problem Based Learning
achievement. model of learning increases students'
Lecturer as facilitator also will achievement in the subject of midwifery
affect student motivation in learning, care delivery. This study applied to subjects
motivate students to do at the time of Midwifery Care Delivery which in the
learning prose or outside of the learning course of learning a lot of practice that can
process. Application of PBL teaching not be applied directly to the patient, so that
model in which lecturers as resources in the could be an alternative to be applied to other
excavation of the problem can provide subjects that can not directly practice on
motivation to the students through the patients and could be replaced by
provision of a model (role model) that is administration of the case. Problem Based
good for students. Giving praise and Learning learning model illustrates real
283
cases to students that will allow students on Sardiman, A. M. (2012). Interaksi &
work directly in the clinic and work as a motivasi belajar mengajar. Cetakan
professional midwife. application of PBL ke-21. Jakarta: Rajawali Pers.
method also provides a learning experience Suci (2008). Penerapan Model Problem
that fits midwifery competency exam in Based Learning Untuk
which all the questions are tested in the Meningkatkan Partisipasi
form of vignett. belajar dan Hasil Belajar Teori
Akuntansi mahasiswa jurusan
REFERENCES ekonomi Undiksha. Dalam Jurnal
Agustina, Sri. 2012. Pengaruh Model Penelitian dan Pengembangan
Pembelajaran Berdasarkan Masalah Pendidikan [Online], vol 2 (1), 13
Terhadap Kemampuan Berpikir Halaman.http://
Kritis dan Kreatif Mahasiswa www.google.com//santyasa/Lemlit/
Universitas Kanjuruhan Malang Pendidikan/April_2008/ Ni_Made
Pada Matakuliah Hodrologi. _Suci.pdf.
Malang: Program Pascasarjana Sudarman (2007). Problem Based
(PPS) Universits Negeri Malang. Learning: Suatu model
Chan Chang Tik, (2014) Problems pembelajaran untuk
Implementing Problem-Based mengembangkan dan meningkatkan
Learning by a Private Malaysian kemampuan memecahkan masalah.
University Journal of Problem Dalam Jurnal Pendidikan
Based Learning in Higher Inovatif [Online], vol 2 (2), 6
Education. 2014;2(1):11-17 Halaman.
DOI 10.5278/ojs.jpblhe.v2i1.1005 http://s3.amazonaws.com/academia
Diana Stentoft, Meg Duroux, Trine Fink, .edu.
Jeppe Emmersen, From cases to Wirkala, C. and Kuhn, D. (2011) Problem-
projects in problem-based medical Based Learning in K-12 Education:
education Journal of Problem Based Is it Effective and How does it
Learning in Higher Education. Achieve its Effects? American
2014;2(1):45-62 Educational Research Journal, vol.
DOI 10.5278/ojs.jpblhe.v2i1.1008 48, 5: pp. 1157-1186. , First
Fatimah, F. (2012). Kemampuan Published October 1, 2011.
Komunikasi Matematis dan http://journals.sagepub.com/author/
Pemecahan Masalah Melalui Wirkala,%20Clarice
Problem Based Learning. Dalam Wulandari, B. (2013). Pengaruh Problem
Jurnal Penelitian dan Evaluasi Based Learning terhadap hasil
Pendidikan [Online], Vol 16 (1), 11 belajar ditinjau
Halaman. dari motivasi belajar PLC di SMK.
http://journal.uny.ac.id/index.php/j Dalam Jurnal Pendidikan Vokasi
pep/article/ download/ 1116/1168. [Online],vol 3
Hamzah. B. Uno. (2011). Teori motivasi (2),14halaman.http://staff.uny.ac.id/
dan pengukurannya. Jakarta: Bumi sites/default/files/penelitian/
Aksara. Herman% 20Dwi% 20 Surjono,
Nana Sudjana. (2010). Penilaian hasil %20Drs.,%20M.Sc.,%20MT.,%20
proses belajar mengajar. Bandung: Ph.D./ jurnal%20vokasi %20juni
PT. Remaja Rosdakarya. %202013.pdf.
284
GASTROENTERITIS ACUTE HANDLING AND ACUTE DIARRHEA IN
CHILDREN: SYSTEMATIC REVIEW
Ahmad Kholid Fauzi

Faculty of nursing, universitas airlangga
Email: -
ABSTRACT
Introduction: The main causes of death in patients of acute diarrhea is the severity of the
dehydration caused by excess fluid in the body expenditures. For most cases, hydration is the
most important aspect in the treatment of diarrhea, but rehydration fluid does not impact on the
duration of diarrhea as well as volume. Methods and analysis: We will perform a systematic
review of the literature taken from the site database of medical journals EBSCOhost MEDICAL
Resources: CINAHL, Dentistry and MEDLINE with the inclusion criteria 1) journal published
is the full text, 2) speak English, 3) there reverensi complete, 3) and contains the results of
diarrhe acute or acute gastroenteritis and teraphy and for children without time restrictions. The
collection obtained from 13 journals that discuss the treatment of acute diarrhea and acute
gastroenteritis. Discussion: Of some journals have been conducted systematic review, found a
way of dehydration status assessments pediatric patients, handling both the nutritional and
therapeutic measures as well as drugs that can be used.
Keyword: Acute diarrhea, acute gastroenteritis, children.
INTRODUCTION impact on the duration of diarrhea as well as

Diarrhea is defined medically in volume.
terms of changes in the defecation
frequency, consistency and either weight or METHOD
volume within 24 hours more than 3 times In this paper, the author intends to
and weighing more than 200 g. According explain the causes of diarrhea, and
to the World Health Organization (WHO) treatment should be done in a child with
Acute diarrhea as part of three or more loose diarrhea.To achieve this goal, the authors
stools or liquid per day, for three days or began searching for materials to do
more and less than 14 days. systematic review journals. Searches done
Acute gastroenteritis is becoming a by going to situr database of medical
common disease of infants and children journals EBSCOhost MEDICAL
worldwide. In the United States, acute Resources: CINAHL, Dentistry and
diarrhea are> 1.5 million outpatient visits, MEDLINE with the inclusion criteria 1)
200,000 hospitalizations and about 300 journal published is the full text, 2) speak
deaths / year. In developing countries, English, 3) there reverensi complete, 3) and
diarrhea is a common cause of death among contains the results of acute diarrhe or acute
children aged <5 years, with an estimated 2 gastroenteritis and teraphy and for children
million deaths annually (5). without time restrictions.
The main causes of death in patients After the search, it turns out there
of acute diarrhea is the severity of the are only 8 journals that meet. Finally,
dehydration caused by excess fluid in the turning to google scoolar for an additional
body expenditures. order to achieve the 15 journals. However,
For most cases, hydration is the the review process, there are only 13
most important aspect in the treatment of journals that can be used for two other
diarrhea, but rehydration fluid does not journals exist kecatatan on the contents of
the journal.
285
In the dehydration treatment in 1) a light with a score of 1-4 and a light/
patients with acute diarrhea there are three heavy is 5-8. To measure the score is with
groupings scale for assessment. The scale is the following table (10)
RESULTS
Scale dehydration
Table. 1 Dehydration scale
CHARACTERISTIC SCORE 0 SCORE 1 SCORE 2
General Appearance Normal Thirsty, restless and Drowsiness, fatigue,
lethargic felt cold and clammy;
but irritable when touched can occur coma
Eye Normal slightly Concave very concave
Mucosal membrane Moist Sticky Dry
(Tongue)
Tears There is a little There is no
Handling dehydration 2. Replace the deficient electrolyte

Oral rehydration therapy 3. Contains alkalinizing agents to prevent
The purpose of oral rehydration acidosis
therapy (ORT) is to replace fluids and 4. slightly hyperosmolar (approximately
electrolytes lost through diarrhea. ORT is 250 mmol / l) to prevent the possibility
achieved by providing a solution containing of osmotic diarrhea induction
sodium, potassium and glucose, or another 5. Easy to use
carbohydrate such as rice flour. Intestinal 6. Tasty and preferred, especially for
absorption of sodium and water to increase children
with glucose and other carbohydrates. 7. Easy to get
The nature of oral rehydration solutions
1. Increase the absorption of water and
electrolytes
Treatment is based on the level of dehydration

Table 2. Handling is based on the level of dehydration
TREATMENT REPLACEMENT FLUID FOOD
DEHYDRATION DEFICIT
Continue to
<10 kg body weight: 60-120 breastfeed, or
mL oral rehydration continue the age-
solution (ORS) for every appropriate
diarrheal stool or vomiting normal diet after
Minimal or no episode the initial
Not applicable
dehydration hydration,
> 10 kg body weight: 120- including an
240 mL ORS for each stool adequate caloric
diarrhea or vomiting
intake for
episodes
maintenance *
286
Mild to ORS, 50-100 mL / kg
moderate body weight of more than Same same
dehydration 3-4 hours
Fluid Ringer's lactate or
normal saline
Same;
intravenously in the
amount of 20 mL / kg
if you can not drink,
body weight to improve
managing through a
severe perfusion and mental same
nasogastric tube or
dehydration status; then ORS 100 mL
5% dextrose ¼ normal
/ kg body weight over 4
saline with 20 mEq / L of
hours or 5% dextrose ½
potassium chloride
normal saline
intravenously
intravenously twice
maintenance fluid
* Limit the diet should be avoided during episodes of acute diarrhea. Breastfed infants should continue to support
nurses even during acute rehydration. The baby is too weak to eat can be given breast milk or formula through
a nasogastric tube. formula containing lactose usually well tolerated. If lactose malabsorption appears clinically
substantial, lactose-free formula can be used. Complex carbohydrates, fresh fruits, lean meat, yogurt, and
vegetables all allowed. Carbonated drinks or commercial juices with high concentrations of simple
carbohydrates should be avoided.
Treatment of patients with acute diarrhea

Table 3. Treatment when the patient is in hospital for hospitalization or treatment performed
later.
The Effect On The Other
Antidiarrheal Proof Best
Dose Duration Of Outcome
Drugs Restrictions
Hospitalization Measures
Duration of
LOS reduction of diarrhea; The
diarrhea by risk of
Lactobacillus
10 10 CFU per rotavirus; LOS fo prolonged
rhamnosus GG Meta-analysis
day the trend toward a diarrhea;
(LGG)
reduction, but not Length of
for other etiologies hospitalization
Duration of
diarrhea; The
200-500mg
risk of Meta-analysis
per day (about LOS reduction of
prolonged (Some studies
S. boulardii 04-10 x 10 9 approximately
diarrhea; mempertimbang-
CFU) 1 day
Length of kan LOS)
hospitalization
Exodus stool; systematic

1.1,5mg / kg
Racecadotril not rated duration of reviews;
TID
diarrhea Meta-analysis
10mg for aged
Duration of
<6 months;
diarrhea; fecal
Zinc 20mg> to the not rated Meta-analysis
output; The risk
age of 6
of
months.
287
hospitalization;
Dead
3g for age <1 Duration of
year; diarrhea; The
6g for ages 1-2 risk of
Smektite not rated Meta-analysis
years; 6-12g prolonged
for age> 2 diarrhea; Total
years feces.
Oral fluid
intake;
LOS reduction for The duration of
oral 200-300 / kg rotavirus diarrhea in intravenous controlled
immunoglobulin per day children at risk or in rehydration; studies
severe conditions Resolution of
symptoms of
diarrhea
DISCUSSION Complementary Medicine Volume

In children with acute diarrhea, 12, Number 8, 2006, pp. 723-732 ©
treatment can be done at home for diarrhea Mary Ann Liebert, Inc.
without dehydration or mild dehydration, if Prepared by Caleb K. King, MD et. All.
there are materials for rehydration. Managing Acute Gastroenteritis
Treatment for moderate to severe Among Children Oral rehydration,
dehydration should be performed in maintenance, and Nutritional
hospital and require intensive care. Therapy. Department of health and
Handling is not just limited to human service centers for disease
dehydration, but also on reducing the length control and prevention. November
of stay of patients in hospitals. 21, 2003 / Vol. 52 / No. RR-16
In practice, this review will be 4. WHO. The treatment of diarrhea: a
useful for us to do the treatment of patients manual for physicians and other
with diarrhea. senior health workers. In:
Organization WH, editor. 2005.
REFERENCE AMY CANAVAN, MD and BILLY S.
Jon Waterfi eld. Prescribing for acute ARANT, JR., MD. Diagnosis and
diarrhea. Nurse prescribing 2010 Management of dehydration in
Vol 8 No 4 Children. American Family
Veronica Hall. Recent advances in the Physician. October 1, 2009 Volume
management of acute diarrhea. 80, Number 7
Nurse prescribing 2011 Vol 9 No 11 Emmie Amerine, CRNP, MSN, and Mary
ZHANG Hong-yun, LU Sheng-feng, XIAO Keirsey, RN, OCN, BSN. Managing
Nong. Effect of Warming Shenque acute diarrhea Get answers to
moxibustion on acupoint for the questions about the causes, types,
Treatment of Acute Diarrhea in complications, and treatment.
Children with Infantile Cerebral Nursing, 2006, Volume 36, Number
Palsy. Integr J Chin Med 2009 Dec; 9
15 (6): 454-457 RanD.Goldman, Jeremy N. Friedman,
JENNIFER JACOBS, MD et. All. Patricia C. Parkin. Validation of the
Homeopathic Remedy Combination Clinical dehydration Scale for
in the Treatment of Acute Children With Acute gastroenteritis.
Childhood Diarrhea in Honduras. Pediatrics, volume 122, No. 3,
THE JOURNAL OF September 2008
ALTERNATIVE AND
288
Eas Nelson, et. All. Guideline for the
management acut diarrhea in young
children. in March 2005
Eugenia Bruzzese, Andrea Lo Vecchio, and
Alfredo Guarino. Hospital
management of children with acute
gastroenteritis. 2012 Wolters
Kluwer Health
Chung M Chow. Acute gastroenteritis:
from guidelines to real life. Alberta,
Canada. 2010
CATHERINE A. CHURGAY, MD, et. All.
Gastroenteritis in Children: Part II.
Prevention and Management.
American Family Physician 1066
www.aafp.org/afp Volume 85,
Number 11 June 1, 2012
Eva, khozova. Home Management of acute
diarrhea in children czech. JPGN
Volume 50, Number 5, May 2010
289
ANALYSIS OF INFANT CHARACTERISTICS POSTPARTUM MOTHER ROLE IN
IMPROVING THE ADAPTATION OF MOTHER
Lelly Aprilia Vidayati

AKBID Ngudia Husada Madura
Email: lellyapriliavidayati@yahoo.co.id
ABSTRACT
Introduction: Becoming a mother means to obtain a new identity that requires thinking and a
complete breakdown of yourself. In fact there are women who have not been able to adapt to
the role of mothers by 20%. The purpose of this study was to determine the effect of
temperament, appearance and health of the infant to the mother's role in the implementation of
adaptation Village West Waru Pamekasan. Method: Survey design of this study is cross
sectional analytic approach. Independent variables include the characteristics of the baby's
temperament, appearance and health, while the dependent variable is the adaptation of new
mothers in the implementation of the role of mother. Total population using estimates of ± 25
respondents, sampling using Nonprobabbility Incidental Sampling Sampling, data collection by
giving questionnaires and statistical data analysis with Spearman Rank test with a significance
value of α ≤ 0.05. Result: The results of statistical data analysis with Spearman Rank test for
temperament P_value values obtained (0.01), appearances with P_value value (0.01), and health
with P_value value (0.00) with a significance level α 0.05, respectively, P_value mean value
<α so that H1 is accepted, it means there is the influence of temperament, appearance and health
of the infant to the mother's role in the implementation of adaptation Village West Waru
Pamekasan. Conclusion: Parents should pay more attention to the characteristics of the baby
include temperament, appearance and health that will facilitate parents in adapting to the
implementation of the maternal role.
Keyword: Infant Characteristics, Maternal Role Adaptation Implementation
INTRODUCTION To achieve the role of a mother, a

Being a mother means acquiring a mother ideally capable carry out the process
new identity requires thought and complete followed in 4 (four) stages of the mastery of
decomposition of ourselves. Besides being the role, namely the anticipatory stage
a mother is not only private women who be where the mother is able to adjust social and
a mother, but there are difficulties psychology to her new role later to learn
encountered in carry out the role of mother anything needed to become a mother, as
(Rury, N.S., 2012). Achievement of the role mothers learn about breastfeeding, learn
of the mother (maternal Attainment role) is about child care, cooking exercise, and so
a process that is interactive and evolving on. Stage Formal mother is able to portray
happens all the time, as long as the mother the true role as a mother to obtain a formal
is attached to her baby, acquiring role and guidance in accordance with what
proficiency in performing the tasks required which is expected by the system of women
in that role, and expressed happy and of women as a parent (mother) teaches how
content in that role. Acceptance role to care of the baby to her child (young
includes active interaction receiver role and mothers). informal stage is the stage where
partner roles, each response to cue from women have been able to find a unique way
others and change according to the response in carrying out his new role, and personal
behavior of others (Rosamund, M.B., stage is a stage achievement of the mother's
2008). role. By being able to carry out those steps,
290
a mother would reach her role as a mother others (Nursing Theorists and Their Work,
with a good (Asrinah, et al., 2010). 2006). also increasing the number of abuse
From the preliminary study has been and neglect of children (Rosamund,
done in Waru West Pamekasan, in M.B.,2008).
December 2015 obtained 10 days post A woman in her role as a mother's
partum mothers with postpartum 3-30. Of achievement requires reactions and
the 10 mothers postpartum, 8 (80%) were interactions with people in environment, for
able to do adaptation to the role of mother example: spouse, baby, family and others
with baby influence on the achievement its (Rosamund, M.B., 2008). Therefore, the
role as able to soothe the baby during role or participation husband, baby, family
crying, the baby always located next to the and others is essential to ensure and provide.
mother, was very happy when he first saw This new appreciation of the role (Rury,
her baby, always took the baby talk and N.S., 2012). assumptions Mercer relating to
baby responds with eyes mother, and was the development of the maternal role
able to make calm baby when the mother models for this Attainment Among these are
carry baby care Newborn well. The newborn babies believed to be an active
remaining 2 (20%) have yet to adapt to the partner in the achievement of the mother's
role of mother. Based on that data, they role, influence and be influenced by the role
obtained postpartum mothers has not been of mother and the role of the couple and the
able to adapt to the achievement of her baby will reflect on the competence of the
mother's role as a factor baby. According to mother in its role so that it can grow and
Ramona T. Mercer active role of a woman flourish. One of baby influence on the
in achievement of the mother's role is achievement of the mother's role is
usually started after the baby is born is 3-7 characteristic babies (infant characteristics)
months Postpartum with several factors that include infant temperament, baby
contribute to accomplishing the role of appearance, and status infant health
mother (Atik., 2008). (Andaners, 2011). The midwife's role is also
Success or failure is caused maternal very necessary to help mothers through
role attainment by internal and external labor required to conform the maternal role,
factors, internal factors include maternal identifying, and intervene if there is factors
factors himself as the mother's age at first that influence maternal role attainment or
birth, the perception of childbirth cause stress antenatal (Rosamund, M.B.,
experience, separating mother and child as 2008).
soon as possible, stress social, social The purpose of this study was to
support, personality, self-concept, attitude determine the effect of temperament,
in raising child and maternal health. appearance and health of the infant to the
External factors are factors infants and other mother's role in the implementation of
factors, factors such as temperament baby adaptation Village West Waru Pamekasan.
baby, baby appearance, responsiveness,
status infant health, characteristics METHODS
(temperament, appearance, health), and the This study the types of research
ability to give cues (Nursing Theorists and methods used are Analytical survey. The
Their Work, 2006). Meanwhile, another approach used is Cross Sectional. In This
factor is the cultural background, marital study population is 3-32 days postpartum
status, and socioeconomic status (Asrinah, mothers in the village West Waru
et al, 2010). If the mother's role is not Pamekasan estimated in June 2015 that is ±
reached it will affect growth and 25 for women. In this research there are
development of infants, such as infant criteria namely sample inclusion criteria,
mental development, behavior baby, infant wherein the criteria can determine whether
health status, social skills to interact with
291
or not the sample to be used. Criteria for which include temperament, appearance
inclusion in this study include: and health of the baby inside improve
1. 3-32 days postpartum mothers maternal role adaptation implementation.
postpartum. The dependent variable is the adaptation of
2. 3-32 days-old baby who was living with puerperal women in the implementation of
biological parents. the role of mother. Instruments research
3. Babies who do not have congenital instrument list form of Multiple Choice
defects (congenital malformations). questions. Research time held in June,
This research using this type of 2015.The research was conducted in
sampling techniques nonprobability Village West Waru Pamekasan.
incidental Sampling. The independent
variables are the characteristics of a baby
RESULTS
Infant Temperament Effect of Implementation Role Mothers Against
Table 1. Crosstabulation between infant temperament with adaptation the implementation of
the role of mother in the village of West Waru Pamekasan
Temperam Adaptation Total
ent less enough good
Ʃ % Ʃ % Ʃ % Ʃ %
Difficult 3 50,0 2 33,3 1 16,7 6 100
Slow 3 25,0 6 50,0 3 25,0 1 100
2
Easy 0 0 0 0 7 100 7 100
Total 6 8 11 2 100
5
Spearman rank tesr result α 0,05, P value : 0,01, r : 0,628
Based on the results of Spearman Rank test result of 0.01 <α 0.05 so that H0 rejected
and H1 accepted and the value of r: 0.628, it can be concluded that there is influence of infant
temperament to adaptation implementation of new motherhood.
Influence Appearance Baby Role Mothers Against Execution Adaptation

Table 2. Crosstabulation between the appearance of a baby with adaptation the implementation
of the role of mother in the village of West Waru Pamekasan.
Influence Adaptation Total
appearance less enough good
Ʃ % Ʃ % Ʃ % Ʃ %
Interesting 5 50,0 4 40,0 1 10,0 1 100
0
Not 1 6,7 4 26,7 10 66,7 1 100
interest 5
Total 6 8 11 2 100
5
Based on the results of Spearman Rank test result of 0.01 <α 0.05 so that H0 rejected
and H1 accepted and the value of r: 0.613, it can be concluded that there is influence the
appearance of the infant to adaptation implementation of new motherhood.
292
Baby Health Effects of Mothers Against Adaptation Implementation Role
Table 3. Crosstabulation between the health of babies by adaptation the implementation of the
role of mother in the village of West Waru Pamekasan
Health Adaptation Total

Effects less enough good
Ʃ % Ʃ % Ʃ % Ʃ %
Unwell 6 60,0 4 40,0 0 0 1 100
0
Healthy 0 0 4 26,7 11 73,3 1 100
5
Total 6 8 11 2 100
5
Based on the test results obtained by the results of Spearman Rank 0.00 <α 0.05 so that
H0 rejected and H1 accepted and the value of r: 0.814, it can be concluded that there is influence
the health of babies to adaptation implementation of new motherhood.
DISCUSSION One concept is the mother's role

Infant temperament Role Mothers pencapain where the infant temperament
Against Execution Adaptation temperament easy versus difficult
Based on the results of the cross temperament, this related to whether babies
tabulation shows that infant temperament send a signal that is difficult to read so
easy, entirely produce the adaptation causes impotence and frustration in the
implementation mothering both at 100%, mother (Nursing Theorists and Their Work,
infant temperament are slow to heat up, half 2006). From birth infants exhibit a real
produce adaptations execution-enough individual differences in the way they
mother role by 50%, which is difficult respond to the environment and the way of
infant temperament half resulted in others, especially people old, respond to
adaptation the conduct of the mother's role them and their needs. Babies who have
is less by 50%. Based on the analysis data temperament simple criteria had a moderate
using Spearman Rank can be seen that there activity level,ritmisitas higher, closer, high
is the effect of infant temperament to adapt adaptability, low intensity, natural positive
the implementation of the role of mothers feelings, the threshold is high, very long
in the village West Waru Pamekasan with P attention settled and will lead to the ability
value (0.01) and α Significance level (0.05). of high distraksibilitas adapting a good
Previous research shows that babies who mother in carrying out its role as a
are sensitive to excitatory and can not adapt mother,while the hard-tempered baby
can lead mothers to doubt the their would make a mother less can adapt to the
competence as a mother. And research on execution of her mother's role as taste
the relationship between temperament and inability and frustration in the mother. In
ability to do a good job (motivation fact, 1 infant (16.7%) has a difficult
mastery) found that infants with high temperament to adapt the implementation
mastery tend to be more cooperative and of the role of a good mother. This is because
easier so that adaptability mother in the mother's perception of the birth
performing a task or role of a mother to run experience easy and maternal parity.
well Similarly (Donna L.W., 2008).
293
Appearance Baby Mothers Against the situation. At first babies (10%) have the
Adaptation Implementation Role appearance less adaptation includes the role
Based on the results of the cross of a good mother, this is due because the
tabulation shows that the appearance of the attitude of parenting that is the tendency to
baby which attracts mostly produce act on individual be closed in response to a
adaptation implementation mother role stimulus or a particular object.
good 66.7%, and the appearance of the less
attractive baby half resulted in adaptation Babies Healthy Mothers Against
implementation mothering less by 50%. Adaptation Implementation Role
Based on the results of data analysis using Based on the results of the cross
statistical tests Spearman Rank can be seen tabulation shows that infant health Healthy
that there is the influence of baby mostly produce adaptations
appearance to the adaptation of the implementation of mothering good 73.3%,
implementation of the role of the mother in and the baby's health unhealthy most of
the village of West Waru Pamekasan with a produce the adaptation implementation
value of P value(0.01) and α significance mother's role is less by 60%. Based on the
level (0.05). Appearance is subjective results of data analysis using Spearman
impressions and the cumulative impression Rank it can be seen that there is a baby on
includes physical appearance, nutritional the health effects of adaptation the
status, behavior, personality, interaction implementation of the role of mother in the
with parents and caregivers (also siblings if village of West Waru Pamekasan with a
any), posture, development and speech. value of P value(0.00) and the significance
Physical appearance such as shape of the level α (0.05). The health status of the baby
face normal and in accordance with what is is a disease caused by mother-baby
expected by the family will make the family separation that interfere with the process of
feel happy in doing new baby care born. affection. Infants were considered as an
Abnormal posture such as unbalanced active partner in the process of taking the
posture will cause disillusionment with the role of the mother, would influence and are
family themselves. Personal hygiene baby influenced by the role and development of
will give excellent instructions about the the baby's response interacting with
possibility of a waiver, the source mothers in developing the identity of the
Inadequate financial, housing difficulties or mother is such as eye contact, grasping
lack of knowledge about newborn care reflex, reflex smile, poise in care, behavior
(Donna, L.W., 2008). that is consistent with maternal interaction
In general, every parent has (Nursing theorist and Their Work, 2006).
fantasies and dreams about Ideally the child If the baby is suffering from
figure. Baby attractive appearance make disorders or abnormality attitude of parents
adaptations implementation of the role of a to be colored by disappointment and
good mother. This is because the shape of a Normal anxiety about whether or not the
baby's face appropriate as expected, the baby in the future as well the ability to care
baby good posture without experiencing for her baby (Sitti Saleha, 2009).
disability or abnormalities and infant Conditions affecting the implementation of
personal hygiene maintained. so the mother the adaptation role of the mother of one
happy in the care of newborns. While which is the health of the baby. Health
infants less attractive appearance led to healthy baby criteria babies are able
adaptation implementation mothering less meyusu well (baby relax after feeding,
because the mother feels the baby's face is feeding 10-12 times a day, weight increase,
not the appropriate form as expected, and 2 times / day more colorful yellowish
the baby has not been able to do flexion "seeded", micturition least 6 times in 24
perfectly so she still needs time to be accept hours colored clear / yellow), the baby slept
294
constantly and get up if wanted feeding, involving the mother to be able to hold the
immunizations (Hb), and both the baby's body from the outside at the time janinya
reflexes include reflex tonic neck, grapsing, palpation, listening to the fetal heart rate
Babinski, rooting, sucking, and papillary and the time after childbirth Bounding
cause mother is not worried and anxious Attachment can perform.
about the health condition of the baby so the
mother is able to adapt in carrying out her REFERENCES
role well. Whereas less healthy infant Andaners. 2011. Teori Ramona T. Mercer.
health caused adaptation implementation Bersumber dari
mothering less because the baby can not http://andaners.wordpress.com/201
suckle well that lost weight, and the ability 5/04/15/teori-ramona-t-mercer/
of the baby's reflexes are less well like the (diakses tanggal 15 April 2015).
baby is not able to hold on to something and Asrinah, dkk. 2010. Konsep Kebidanan.
do not get stronger hold if something is Yogyakarta: Graha Ilmu.
taken so that mom was worried and restless Bryar, Rosamund.M. 2008. Teori Praktik
and cause the mother does not feel Kebidanan. Jakarta: EGC.
confident in doing newborn care as a result Marmi. 2012. Asuhan Kebidanan Pada
of adaptation implementation mother role Masa Nifas. Yogyakarta: Pustaka
less. Pelajar.
Purwandari, Atik. 2008. Konsep
CONCLUSION AND Kebidanan: Sejarah dan
RECOMENDATION Profesionalisme. Jakarta: EGC.
1. Infant temperament had an influence on Saleha, Sitti. 2009. Asuhan Kebidanan
the conduct of the adaptation the role of Pada Masa Nifas. Jakarta: Salemba
mother. Babies with easy temperaments Medika.
have mastery high and tend to be more Sari, Rury.N. 2012. Konsep Kebidanan.
cooperative and easier to adaptability Yogyakarta: Graha ilmu.
mothers in performing a task or role of Tomey, Ann.M. 2006. Nursing Theorist
a mother can run well. and Their Work Seventh Edition.
2. Appearance babies have an influence United PStates of America: Elsevier
on the conduct of the role adaptation Wong, L.D. 2003. Pedoman Klinis
mother. Baby attractive appearance as Keperawatan Pediatrik Edisi 4.
appropriate facial shape desire, normal Jakarta: EGC.
posture and personal hygiene baby
awake well will make the mother happy
in doing baby care newborn so that
adaptation implementation mother's
role goes well.
3. Healthy babies have an influence on the
conduct of the role adaptation mother.
Babies who have good health there is no
abnormality or abnormality, the attitude
of the parents will not be marred by
disappointment and anxiety and parents
will feel able to care for her baby so that
adaptation implementation mother's
role goes well.
The midwife's role is indispensable
to help mothers do interaction with the baby
that can be started from pregnancy with
295
THE EFFECT OF DEMONSTRATION METHOD ON THE ABILITY TO CARE FOR
NON-ULCER DIABETIC FOOT OF PATIENTS WITH TYPE 2 DIABETES
MELLITUS (DM)
R E Happy Patriyani, Pahlevi Betsytifani

Nursing Major, Politeknik Kesehatan Kementerian Kesehatan, Surakarta
Abstract
Introduction: Along with the increase of the number of persons with Diabetes in the world, by
2032 a surge of diabetic foot problems will also occur (PERKENI, 2011). Through preventive
measures on how to care for diabetic foot training using demonstration method, those diabetic
foot problems upsurge can be minimized. The objective of this research is to study the impact
of demonstration method on the ability to care for non-ulcer diabetic foot of patients with type
2 Diabetes Mellitus. Method: This research used the quasi-experimental method with one
group pretest-posttest design. The data were analyzed using paired t-test. Thirty respondents
were taken as samples; all are members of Persadia (Indonesia Diabetes Association) of the
Local General Hospital of Gemolong unit. The majority of the samples were females (86.7%),
aged 46-65 (66.6%), and their highest educational level was secondary high-school (40.0%).
Result: The result of the research shows a significant value p=0.000, which indicates that there
is an effect of the demonstration method on the ability to care for non-ulcer diabetic foot of
patients with type 2 Diabetes Mellitus. Conclusion: The research recommended diabetic
persons to apply early detection for abnormalities in their feet prior to the wounds by performing
preventive foot maintenance to reduce the incidences of diabetic foot ulcer complications.
Keywords: Demonstration method, the ability to care for diabetic foot, persons with type 2
diabetes mellitus non-ulcer
INTRODUCTION therapy (insulin), and education (Perkeni

There is a very high occurrence rate 2011). One of the educational materials is
of diabetic ulcer in both developing and the importance of foot care and
developed countries such as happens in maintenance. The ability to do it is a
Indonesia (Perkeni, 2011). Diabetic foot is preventive measure for persons with
the most dreaded chronic complication of chronic DM, in order to decrease the
diabetes mellitus since it entails a quite high possibility of diabetic foot ulcer
risk of amputation as well as life threatening complication (Vatankhah et al 2009).
infections. It is estimated that around a third Diabetic persons should be taught the way
of DM patients will suffer foot problems to do early detection on foot abnormalities
(Yunir, 2011 in Persi, 2011). That prior to the wound by examining the foot
complication can happen due to the and doing regular foot maintenance every
occurrence of hyperglycemia and day, detecting any sore or something that
neuropathy, which cause various changes in may not be normal, which in turns giving
skin and muscle, which in turn, result in chance to prevent larger sores. Those
uneven pressure distribution on the sole of attempts are proven to significantly
the foot, and thus leads to the occurrence of decrease the risk of amputation up to 85%
ulcer (Waspadji, 2007). (Yunir, 2011 in Persi, 2011, and Basuki,
There are four main pillars in type 2 2009).
Diabetes Mellitus (DM) disease Giving a good and proper health
management effort, namely meal planning education can increase the DM sufferers’
(diet), physical exercise (sports), drug awareness to change their behavior in
296
8 International Nursing Conference “Education, Practice And Research Development In Nursing”
th
undergoing the given treatment. DM stated that they never executed health
sufferers who do not receive health education using demonstration method on
promotion have four times higher risk for the foot care of the type 2 DM sufferer.
complication than those who get health Based on those reasons, the
education. Patient educations are smoking researchers were interested to conduct the
cessation, optimize glucose control, research entitled “The Effect of
appropriate footwear to manage foot Demonstration Method on the Ability to
structure and biomechanics and never go Care for Non-Ulcer Diabetic Foot of
barefoot (ADA, 2012). Patients with Type 2 Diabetes Mellitus”.
Health education method employed
in this research is demonstration method. METHODS
This method is chosen to make the This research used the quasi-
participants understand the given material experimental method with one group
better since it employs realia and uses pretest-posttest design. The research
visualization media which can help the population was all persons with type 2
participants to comprehend the skills better diabetes mellitus non ulcer in Persadia of
and which, in psychomotoric way, is more the Local General Hospital of Gemolong,
effective in examining and caring for type 2 Sragen, Central Java. It was executed from
DM suferrers’ feet. There is high March to May 2015. The samples were
involvement level between the educator and thirty respondents with the inclusion
the learners, and the learners are able to criterion of type 2 DM non ulcer sufferers
demonstrate or practice the skills given by who were able to do their activities
the educator (Syaiful and Aswan, 2010). independently and the exclusion criteria of
According to Hurrahman (2008), the DM sufferers who did not join the entire
psychological and paedogical benefits of research activities as well as those who
the demonstration method are the resigned from their position as respondent.
followings: the learners’ attention is more The research independent variable is the
centered; the learner’s education process is demonstration method on how to care for
more focussed on the given materials; and diabetic foot. The dependent variable is the
the impression and experience as the the ability to care for the feet of type 2
learning results are more embedded in the diabetes mellitus non ulcer sufferers. The
participants. instrument used in the research was an
Several results emerged based on observation sheets/check list of the detailed
the interview of ten members of Indonesia Standard Operation Procedure on Diabetic
Diabetes Association (Persadia). They Foot Care. It was the research instruments
stated that they never received health that had been employed by Istiqomah
education on foot care; three persons cared (2008) in her research, which resulted in the
for their feet by washing, drying, and validity test result of 0.632 and the
cutting their toenails and seven only washed realibility test result of 0.9519.
and let their feet dry naturally. The Pre-test was conducted prior to the
researcher’s observation found the research. After the health education
following data: five persons had dirty and intervention using demonstration method
long toenails and ten persons did not have was executed, post-test on diabetic foot care
perfusion nor sensation disturbance and did using observation sheet/check list was
not show any infection. Thus, it is applied. Paired t-test was used to analyze
concluded that they already carried out the data.
diabetic foot care, but it was not yet optimal.
Additional data given by the head of RESULTS
Persadia (Indonesia Diabetes Association) The objective of this research is to
of the Local General Hospital of Gemolong study the impact of demonstration method
297
th
on the ability to care for non-ulcer diabetic average, the scores for the respondents’
foot of patients with type 2 Diabetes ability to care for diabetic foot prior to and
Mellitus. The respondents’ characteristics after the health education intervention using
are mainly females (86.7%), aged 46 -65 demonstration method differ. Detailed
(66.6%), and their highest educational level result can be perceived in table 1.
was secondary high-school (40.0%). On
Table 1. The average distribution of the respondents’ scores on the ability to care for the diabetic
foot based on the results prior to and after the (N=30)
Variable Mean SD SE P value N
Diabetic foot care ability
Before 7.33 1.295 0.237 0.000 30
After 14.73 2.728 0.498
On average, the ability to care for Type 2 DM prevalences often occur after
diabetic foot prior to intervention is 7.33 the age of 40. It is because, as people grow
with the standard deviation 1.295. After the older, the body tissue ability to take the
intervention, the average ability rises to blood glucose steadily decreases (Suiraoka,
14.73 with the standard deviation 2.728. It 2012). The research findings are also
is perceived that the measurement mean prevalent with the reseacrh of Kekenusa
difference prior to and after is 7.40 with the (2013) which states that persons who are
deviation standard 1.754. The statistical test more than 45 year old have eight times the
result score is 0.000. Thus, it is concluded risk of getting the complication if compared
that there is a significant diifference to those under 45 year old.
between the ability to care for diabetic foot There were two obese respondents
prior to and after the health education while other were normal. They already
intervention using demonstration method to managed their diet and routinely did DM
care for diabetic foot. exercises every Tuesday and Friday, so
obesity can be avoided. According to ADA
DISCUSSION (2011), there are four components in DM
The research result shows that management, two of which are diet
female respondents get the highest rank of arrangement and physical exercises.
86.7%. It is in accordance with the research According to Center for Diseases Control
result gained by Trisnawati (2013) that and Prevention (2008), a combination
stated that type 2 DM is more prevalent in between physical activity and the decrease
females, which is brought by the decrease of on the number of the calory being eaten
estrogen hormone levels at menopause. It is induces calorie deficit which in turn, brings
in line with Lincoln’s statement (2010 in about body weight.
Heriani, 2013) that estrogen and The education characteristic of the
progesterone hormones affect the way the respondents with secondary high school is
cells respond to insulin. After the owned by 12 of them (40.0%). Knowledge
menopause, the hormone levels changes is closely related to education. It is hoped
trigger blood sugar level fluctuations. It is that the higher the people’s educations, the
also triggered by the higher fat percentage wider the knowledge they gained. The
of females compared to that of males, which education level affects the knowledge they
in turns, can decrease the insulin sensitivity owned. The higher the education people
in muscle and liver. gained, the easier for them to absorb new
On average, the respondents’ age information (Notoadmodjo, 2010).
characteristic data is between 46– 65 age.
298
th
The research result showed that the method is more effective to improve
respondents’ level of ability improves when respondents’ knowledge on dengue
compared to prior to the intervension. The hemorrhagic fever. Learning to care for
p-value is 0.000. Because the significance is diabetic foot will be more effective if it
(0.000 <0.05), and thus, Ho is rejected while employs realia. Demonstration method to
Ha is accepted. It proves the presence of the care for diabetic foot needs more than one
effect of demonstration method on the sense. It coresponds to Dale’s statement
improvement of the ability to care for non- (1969 in Wibawa, 2007), in which it is
ulcer diabetic foot of DM patients with type stated that the more senses being used to
2. In other words, it shows that receive something, the more and the clearer
demonstration method significantly are the knowledge/understanding gained.
improve the ability to care for nch result is
supported by Waspadji (2007), who stated CONCLUSION AND
that health education is education and RECOMENDATION
training on knowledge and skills for the DM Health education using
sufferers with the aim to support the demonstration method can be employed to
changes of behavior and mindset, in order improve the ability to care for diabetic foot
to reach for better quality of life. of tyoe 2 DM sufferrers. The result of this
Continuous changes of behave individual research will be employed as additional
and mindest executed by the patients can information in identifying diabetic ulcer
affect the ability of the indivual in caring for and in caring for diabetic foot in order to
her/his own health. prevent the diabetic ulcer on type 2 DM
Through better knowledge, it is sufferers. Association of diabetic persons is
hoped that better end result on health hoped to be the place to share knowledge in
management advice, especially on blood improving the ability on DM management,
sugar control, will be gained. It is also in order to prevent chronic DM
hoped that the management of DM and complication especialy on the problem of
caring for diabetic foot gained maximum diabetic ulcers. Diabetic sufferer can do
result, and as such, prevent the occurrence diabetic ulcer early prevention by regularly
of chronic diabetes complications with and individually executing foot care
diabeic ulcer (Basuki, 2009). The research everyday. Subsequent researches may add
results executed by Istiqomah (2008) other variables which may affect the foot
explains that health education intervention care ability of non ulcer DM sufferers. The
techniques using demonstration method variables may cover knowledge, attitude,
shows significant result with the increased and compliance levels in doing foot care
comprehension of 90%. Sagala (2011) and exercise to prevent diabetic ulcers.
(Santyasa, 2007) state that demonstration
method in delivering the information is REFERENCES
clearer, more concrete, more interesting, American Diabetes Asociation, 2012.
and the participants were more active. It is Diagnosis and Clasification of
suitable to teach material involving Diabetes Mellitus, Diabetes Care,
movements, including diabetic foot care. Volume 35, Suplement 1, January
Through demonstration method the 2012.
participants’ attention is more focussed, American Diabetes Association, 2012.
they got clearer perception based on the Diabetes Ready Reference for Nurse
results of their observation, and questioned Practitioner by American Diabetes
problems can be answered by examining the Association and American
demonstration processes (Hasibuan and Academy of Nurse Practitioners.
Moedjiono, 2012). Wibawa’s research United States of America.
results (2007) reveals that demonstration
299
th
Badan Penelitian dan Pengembangan Istiqomah, 2008. Promosi Kesehatan
Kesehatan, 2013. Riset Kesehatan Pencegahan Kaki Diabetik pada
Dasar (RISKESDAS) 2013. Jakarta: Penderita DM Tipe 2 dengan
Kementerian Kesehatan RI. Metode Demonstrasi dan Metode
Basuki, E, 2009. Teknik Penyuluhan Diskusi di Kota Yogyakarta. Tesis
Diabetes Mellitus dalam Soegondo, Sekolah Pasca Sarjana Universitas
S., Soewondo, P. & Subekta, I. Gajah Mada Yogyakarta. No
(Eds). Penatalaksanaan Diabetes Publication.Yogyakarta : FK UGM.
Mellitus Terpadu. Jakarta : Balai Kekenusa, J., Ratag, B., Wuwungan, G.,
Penerbit FKUI. 2013. Analisis Hubungan Antara
Bruner and Suddarth’s, 2012. Text book of Umur dan Riwayat Keluarga
Medical Sergical Nursing, twelfth Menderita Dm dengan Kejadian
edition. Wolters Kluwer Health. Penyakit Dm Tipe 2 Pada Pasien
Lippincott Williams and Wilkins. Rawat Jalan di Poliklinik Penyakit
Centers for Disease Control and Prevention Dalam BLU RSUP Prof. Dr. R.D
(CDC), 2008. Overweight & Kandou Manado. Jurnal Fakultas
Obesity. To make available Kesehatan Masyarakat Universitas
https://en.wikipedia.org/wiki/Cente Sam Ratulangi Manado. To make
rs 8 Februari 2017. available http://fkm.unsrat.ac.id /
Dinkes Provinsi Jawa Tengah, 2012.”Profil wp-content/uploads/2013/08/
Kesehatan Jawa Tengah 2012”. To GLORIA-WUWUNGAN-
make available 091511080.pdf. 16 Maret 2017
http://www.dinkes.jatengprov.go.id Notoadmodjo, S.,2010. Ilmu Perilaku
/.18 Maret 2017. Kesehatan. Jakarta:Rineka Cipta.
Hasibuan., Moedjiono, 2012. Proses Belajar Perkumpulan Endokrinologi Indonesia,
Mengajar. Bandung: PT Remaja 2011. Konsensus Pengelolaan dan
Rosdakarya. Pencegahan Diabetes Mellitus Tipe
Heriani, P., Nauli, F., Woferst, R., 2013. 2 di Indonesia 2011 Cetakan ke 4.
Hubungan Tingkat Pengetahuan Jakarta: PB PERKENI.
Tentang Penyakit Diabetes Melitus Perkumpulan Endokrinologi Indonesia,
Terhadap Mekanisme Koping 2014. Konsensus Pengelolaan dan
Pasien Diabetes Melitus Tipe 2 Di Pencegahan Diabetes Mellitus Tipe
RSUD Teluk Kuantan. Jurnal 2 di Indonesia 2014. Jakarta: PB
Universitas Sumatra Utara. To make PERKENI.
available Ramadona, Ade, 2011. Pengaruh
http://repository.unri.ac.id/handle/1 Konseling Obat Terhadap
23456789/4263 12 Maret 2017. Kepatuhan Pasien Diabetes Melitus
Hurrahman, Fat, 2008. Metode Tipe 2 di Poliklinik Khusus Rumah
Demonstrasi dan Eksperimen Sakit Umum Pusat Dr.M. Djamil
[Online]. To make available Padang. To make available
http://udhiexz.wordpress.com/2008 https://www.google.co.id/
/08/08/metodedemonstrasi-dan- Frepository.wima.ac.id. 3 Pebruari
ekspermen/ 8 Maret 2017. 2017.
International Diabetes Federation, 2014. Sagala, Syaiful.,2011. Konsep dan Makna
International Diabetes Federation Pembelajaran. Bandung: Alfabeta.
Diabetes Atlas 6th Edition revision Santyasa, Wayan I.,2007. Landasan
2014. To make available Konseptual Media Pembelajaran.
http//www.idf.org. 17 Februari Bali: Perpustakaan Universitas
2017. Pendidikan Ganesha.
300
th
Standards of Medical Care in Diabetes, Yunir, 2011 dalam Persi
ADA, 2014. Diabetes Care. Volume 2011.Neuropati Diabetik
37. Supplement 1, Januari 2014. Menyerang Lebih Dari 50%
Standards of Medical Care in Diabetes, Penderita Diabetes. To make
ADA, 2017. Diabetes Care. Volume available
40. Supplement 1, Januari 2017. http://www.pdpersi.co.id/content/ne
Sudoyo, A.W., Setiyohadi, B., Alwi, I., ws.php?catid=23&mid=5&nid=612
Simadibrata, M., & Setiati, S.,2009. 24 Maret 2017.
Buku Ajar Ilmu Penyakit dalam
Jilid III Edisi 5. Jakarta: Interna
Publishing.
Suiraoka. ,2012. Penyakit Degeneratif
Mengenal, Mencegah, dan
Mengurangi Faktor Risiko 9
Penyakit. Yogyakarta: Nuha
Medika.
Syaiful & Zain,A.,2010. Strategi Belajar
Mengajar,Jakarta:Rineka Cipta.
Trisnawati, S., Setyorogo, S.,2013. Faktor
Risiko Kejadian Diabetes Melitus
Tipe II Di Puskesmas Kecamatan
Cengkareng Jakarta Barat Tahun
2012. Jurnal Ilmiah Kesehatan. To
make available
http://lp3m.thamrin.ac.id/upload/art
ikel_sh ara.pdf. 8 Januari 2017.
Vatankhah N, Khamseh ME, Noudeh YJ,
Aghili R, Baradaran HR, Haeri NS.,
2009. The Eff ectiveness Of Foot
Care Education on People With
Type 2 Diabetes in Tehran, Iran.
Primary Care Diabetes 3, 73-77.
Waspadji, S.,2007. Kaki Diabetes, Ilmu
Penyakit Dalam Jilid 3 Edisi 4 Aru
W. Sudoyo, Bambang Setyohadi,
Idrus Alwi, Marcelius Sumadibrata,
Siti Setiadi (ed). Pusat Penerbitan
Ilmu Penyakit Dalam Fakultas
Kedokteran Universitas Indonesia.
Jakarta.
Wibawa, C., 2007. Perbedaan
Efektifitas Metode Demonstrasi
dengan Pemutaran Video Tentang
Pemberantasan DBD Terhadap
Peningkatan Pengetahuan dan Sikap
Anak SD di Kecamatan
Wedarijaksa Kabupaten Pati, Jurnal
Promosi Kesehatan Indonesia. 2 (2).
115-127.
301
th
DETERMINANTS OF ANEMIA IN ADOLESCENT GIRL
Heri Bahtiar, Zulkahfi

STIKES Yarsi Mataram
Email: -
ABSTRACT
Introduction: Anemia is a health problem that often experienced by teens. The prevalence of
anemia in Aik Mual village according to Central Lombok Health Service. From 129 patients
with anemia, who suffered of anemia in men around 13%, while patients with anemia in
adolescent girls around 87%. This aims of this research to determine the dominant factors of
anemia in adolescent girls in SMPN 3 Praya 2016. Method: Type of the research used is
observational analytic. The design of the research is cross-sectional, researchers conducted
observations or measurements of variables at once. Samples used as many as 40 of 67 from
third grade students of SMPN 3 Praya 2016. Result: From statistic test results carried out by
researchers, researcher got the result of family income (p = 0984), knowledge of anemia (p =
0.025), eating habits (p = 0.141) , eating habits inhibitor (p = 0.141) nutrition consumption (p
= 0.499), infectious diseases (p = 0.312), pattern of menstruation (p = 0.036). Conclusion: It
can be concluded that knowledge of anemia and menstrual patterns have a relationship with
the incidence of anemia, while inhibiting food intake, boosters, nutritional intake, and
infectious diseases were not related to the incidence of anemia in adolescent girls in SMPN 3
Praya 2016. The determinant or dominant factor of anemia is knowledge of anemia.
Keywords: Determinants, Anemia, adolescent girl
INTRODUCTION METHOD
Anemia is one of the health Type of this research is
problems that often experienced by teens. observational analytic. The design used
The prevalence of anemia in the Aik Mual cross-sectional. This research will be
village according to Central Lombok conducted on July 2016, in SMPN 3 Praya,
Health Service declared on 129 patients Aik Mula village, Central Lombok.
with anemia, anemia in men by 13%, while Population used in this research all girls in
patients with anemia in adolescent girls as 3rd grade in SMPN 3 Praya as many as 67
much as 87%. This study aims to determine students. Sample in this research are 40
the dominant factors of anemia in students selected with simple random
adolescent girls SMPN 3 Praya, 2016. sampling technique. Data Analysis in this
Anemia is a medical condition in research using Chi-Square.
which the number of red blood cells or the
hemoglobin less than normal. Hemoglobin RESULTS
level less than 13.5 g / 100 ml in men and Families Revenue
in women less than 12.0 grams / 100 The relationship between family
(Proverawati, 21 011). income with anemia can be seen from chi-
Adolescences is defined as the square test results, it can be seen in the
process of gradual transition from cross table between family income with
childhood into adulthood (George and anemia.
John, 2008).
302
Table 1. Families income with anemia
Incidences of Anemia
p value
Anemia No Anemia Total
Family Income High 8 3 11 .984
Low 21 8 29
Total 29 11 40
Based on the chi-square test results obtained p value (0.984)> α (0, 05).
Thus, it can be determined that there knowledge of anemia and anemia can be
is no connection between family income seen from the chi-square test results, it can
with incidence of anemia in SMPN 3 Praya. be seen in the cross table between family
The relationship between income with incidence of anemia.
Knowledge of anemia
Table 2. Knowledge of Anemia
p value
Knowledge of Good 1 3 4 .025
Income Less 28 8 36
Total 29 11 40
Based on the chi-square test results obtained p value (0.025) <α (0.05).
It can be concluded that there is a relationship of knowledge about anemia and anemia
in SMPN 3 Praya.
Table 3. Eating habits inhibiting the absorption of magnesium

p value
Eating habits Good 24 11 35 .141
inhibiting the
absorption of Poor 5 0 5
magnesium
Total 29 11 40
Table 4. Eating habits boosters of magnesium absorption

p value
Eating habits Good 24 11 35 .141
boosters of
magnesium Poor 5 0 5
absorption
Total 29 11 40
303
Table 5. Infection diseases
p value
Infection Uninfected 16 8 24 .312
disease
13 3 16
Infected
Total 29 11 40
Table 6. Consumption of nutrition

p value
Consumption of Good 15 7 22 .499
nutrition
14 4 18
Poor
Total 29 11 40
Table 7. Menstruation Pattern

p value
Menstruation Normal 9 0 9 .036
Pattern
20 11 31
Abnormal
Total 29 11 40
CONCLUSION Ida Farida, 2006, Determinan Kejadian

Knowledge factors about anemia Anemia Pada Remaja Putri Di
and bleeding patterns are factors associated Kecamatan Gebog Kabupaten
with the incidence of anemia in adolescent Kudus. Skripsi: Universitas
girls in SMPN 3 Praya, Aik Mual village, Diponegoro Semarang.
Praya, Central Lombok, while the factors of George Pickett dan John J. Hanlon, 2008,
family income, nutrition consumption, Kesehatan Masyarakat, Jakarta:
infection diseases, consumption of EGC
inhibitors foods and boosters of magnesium Proferawati, 2011, Anemia dan Anemia
absorption are factors which unrelated to Kehamilan, Pustaka : Nuha Medika
the incidence of anemia in adolescent girls Wijayanti, 2011, Faktor yang Berhubungan
in SMPN 3 Praya, Aik Mual village, Praya, dengan Kejadian Anemia pada
Central Lombok. Remaja Putri Siswa SMK AN
Nuroniyah Kemadu Kec. Sulang
REFERENCES Kab. Rembang
Dian G, 2007, Faktor Yang Berhubungan
Dengan Kejadia Anemia Pada
Remaja Putri Di SMA N 1
Kecamatan Ajibarang Kabupaten
Brebes. Skripsi: Universitas Negeri
Semarang
304
THE DIFFERENCES OF NEWBORN WEIGHT INFANT TOWARD SOIL
TRANSMITTED HELMINTHES INFECTION IN PREGNANCY
Baiq Ricca Afrida

STIKES Yarsi Mataram
Email: afridabaiq@gmail.com
ABSTRACT
Introduction: Maternal nutrition status before and during pregnancy has affect toward inters-
uterine growth. This research aimed to differences of newborn weight infant toward soil
transmitted helminthes infection with uninfected. Method: This research is observational
research with cross sectional approach. Samples in this research took with consecutive
sampling, total samples in this research were 50 people. Instrument of the research used
questionnaires, enterotest, baby scale. Processing and analysis data used independent t test.
Conclusion: There were differences of newborn weight infant in mothers infected of soil
transmitted Helminthes (0,046).
Keywords: Soil transmitted helminthes infection, newborn weight infant.
INTRODUCTION absorption process, and hookworm

The infant mortality rate (IMR) in infection will cause of loss of blood from
Indonesia is relatively high around 32 per the gastrointestinal tract (Wiknjosastro H,
1,000 live births. The Millennium 2009). Generally worm infections in
Development goals (MDG's) to reduce humans are caused by worms trichura T., A.
infant mortality rate in Indonesia become 23 lombuicoides, N. americanus, A.doudonale.
per 1,000 live births (WHO, 2013). Hookworm and roundworm infections will
The incidence of low birth of weight lead to lack of energy and protein that will
infant is one risk factor for neonatal cause of nutrition absorption disorder in
mortality due to neonatal mortality rate of patients (Awasthi S., 2003).
60-80% due to low birth weight. The Increasing of anemia risk occur in
prevalence of LBW in the world at 15.5% people infected with hookworm and
and approximately 96.5% came from Trichuris trichura. T.Trichura worm
developing countries (WHO, 2011). increases the risk of anemia greater than
Growth and development of fetus in people who not infected with this worm
the womb is strongly influenced by (Makhoulet al, 2012) . Pregnant women
maternal nutrition before and during with anemia had 3-fold risk of having a
pregnancy where it will affect the weight of baby of low birth weight compared with
infant (Gibney,2009). Babies born with low pregnant women who did not have anemia
birth of weight infant increased the risk of (Syarifuddin, 2011).
prenatal death. Loss of weight starts during Based on the data from Padang
the first trimester of pregnancy influenced Health Department in 2013 found the
of placental function derived from protein incidence of low birth of weight was highest
and maternal factors (R. Bukowski et in Ambacang Public Health Service with
al,2007). incidence rates around 4.5% higher than the
Parasite infection is an important incidence of low birth of weight infant in
problem as the cause of micronutrient Padang around 2.0% (Assia S. and
deficiencies. Worm infection during Kurniawati I ., 2014)
pregnancy will affect on nutrition status of Prenatal care in Indonesia is still
pregnant and the effect on the fetus using minimum standard, maternal health
(Brooker S,2008).Worm infection will problems remains a priority national issue,
decrease the metabolism process, nutrients but efforts to control the problem is still not
305
completely down to main factors that cause most of them are jobless or housewife
the problem. The incidences of Low Birth (84%), and has high level of socioeconomic
of Weight Infant in national level can not (74%).
achieve the MDG targets on 2015. So that's
the result showed the relationship of Table 2. Frequency of infection Soil
nutritional status, hemoglobin levels, soil- Didtribusi Transmited helminthes On
transmitted helminthes infections and other Pregnant Women
several factors in pregnant women at term Variabel Total
with birth weight infants. F %
Soil
METHOD transmitedhelminthes 4 8.0
Types of this research is Infection 46 92.0
observational with. cross sectional Infection
approach. This research conducted as long Un infection
as one year. Samples of the research are
mothers with inpartus who gave birth in a Based on table 2 above most of
Midwife Private Practice in Ambacang respondents are not infected with soil-
Public Health Center. Samples used 50 transmitted helminths worm (92%) and 4 (
people using consecutive sampling 8%) infected, 1 person declared infected
technique The instruments used with Ascarislumbricoides worm with
questionnaire, enterotest, baby scales. number of worm eggs 400 / g in faeces
Feces taken when the mother's straining, It categorized of heavy infection, 1 person
taken about 10 grams and was added to the declared infected with Trichura Trichuris
stool tube and sent to Parasitological worms with number of worm eggs 157 500
laboratory FK Uanad for worm infections / g in feces included in middle infection
examination, weighing the baby's birth category. 2 people infected with both of that
weight in the first hour after birth and then worm, they included in middle infection
recorded on a common questionnaire. The category for A. lumbricoides worm and
data obtained processed and analyzed using heavy infection category for T.Trichuris
independent t test. worm
RESULTS Bivariat Analysis Results
Univariate Analysis Table 3 The difference of birth weight
Table 1. Distribution of Characteristics infants toward soil transmitted helminthes
Frequency of Pregnant Mother infection.
Variabel Total Variabel Mean ±SD SE p
F % valu
Education 39 22,0 e
High 11 78,0 Infected 2375.00±170 85.39 0.04
Low of STH .78 1 6
Occupation
Jobless 42 84,0 Uninfect 3054.35±455 455.6
Work 8 16,0 ed of .68 8
Socioeconomic STH
High (≥ Rp. 1,650,000) 37 74,0
Low (<Rp.1.650.000) 13 26,0 According to the table obtained test
results of independent test showed the
Based on table 1 above, It shows weight of infants on mothers who were not
that from 50 mothers of term studied, infected with worms soil transmitted
mostly highly educated mothers (78%), helminths around 3054.35 grams with
306
standard deviation 455.68 grams, while status of patients (Cunningham FG., 2012).
weight of infants on mothers who were Infections of worm Trichura Trichuris will
infected Soil Transmitted helminths around cause nutrition deficiency, magnesium
2375.00 grams with standard deviation deficiency and protein the worst effects of
170.78 grams with p value = 0.046 with this condition is occurrence damage of
alpha 5% , it can concluded that there is intestinal wall.
differences of birth weight infants on Infections A. Lumbricoides in
women who were infected with soil- humans caused by the spread of infectious
transmitted helminths worm eggs through the ground this occur
very quickly in ground infected of feces
DISCUSSION containing worm eggs (Mordi and
The differences of birth weight infants on Ngawodo, 2007). The results of this
mothers who were infected soil transmited research, 3 mothers who suffered from
Helminths with uninfected mothers worm A. Lumbricoides infections where 1
Based on the results of the research person suffered heavy infections and two
showed there are differences in birth weight others. Patients with worms
infants on mothers who were infected soil A.Lumbricoides, it will cause loss of 0.8
tranmited Helminths with uninfected grams of carbohydrates and 0.035 grams of
mothers p = 0.046 ( p <0.05). protein for every day. One female worm
The condition of the pregnant will produce 240,000 eggs per day, and the
woman with a worm infection will affect the worm will continue to proliferate in the
state of the nutrients in the body. Mothers intestine, how breed of worms
who experience worm infection will A.Lumbricoides is by blocking absosbsi
experience a shortage of nutrients in the area within the intestinal lumen will then
body this is because the worms will live in lead to absorption disorder and nutritional
the intestine and then will live in intestine. deficiencies will occur in people and if it in
The worms will grow in intestine, if pregnancy will cause deficiency transfer of
infected with Trichura Trichuris and nutrients from the mother kejanin so will
Ascarislumbuicoides worm, it will affect affect the growth of the fetus (Irianto K.,
the nutrients in the body in which both types 2009).
of worms will cause a decrease in the body's Conditions worm infected mother is
metabolism and affect of absorption also accompanied by nutritional status
disorder in body thus nutrients that enter the conditions are less where the mother LILA
body will not be enough to meet the body's size 22.1 cm, this condition describes the
needs, so that if this situation occurs during condition of poor nutritional status in which
pregnancy will affect the nutritional needs the mother LILA size below the normal size
of the fetus so the pregnant women were so that the possibility of the mother
infected with worms tend to give birth to experiencing chronic worm infection but no
babies with low birth weight. symptoms because based on the
Research conducted by Ndibazza et examination of the mother has a worm
al (2010), Helminths infections during infection A. Lumbricoides the lightweight
pregnancy can affect the pregnancy adverse category. Birth weight infants of mothers
outcomes. Pregnancy with worm infections who were infected not only influenced by
will result in anemia, protein-energy maternal condition worm infections, but
malnutrition, low birth weight, and prenatal there are other data that support these
death may also occur. Infections caused by conditions where most of the mothers
Ascaris lumbricoides may result of decrease infected with worms have socio-economic
in appetite, decrease the absorption of fat, status is low, and has a circumference of the
protein and will affected damage in upper arm below normal , So that the state
intestinal mucosa, will affect the nutritional of helminth infections can caused worst
307
condition of mothers with maternal Awasthi S., Bundy DAP., Savioli L.,.
nutritional conditions and the effect on (2003). Helminthic infections. BMJ,
labor outcomes. 327, 4313.
T.Trichura heavy worm infections Brooker,S., Hotez PJ., Bundy DAP. (2008).
will cause serious symptoms and impact on Hookworm-Related Anaemia
heavily infected respondents have close among Pregnant Women: A
birth spacing of less than one year, low Systematic Review. Neglected
socioeconomic conditions, the size of a Tropical Diseases, 2 (9), 10.1371.
standard MUAC below normal, and Bukowski R., Smith GCS., Malone FD.,
mothers are heavy anemia, several factors Ball RH., Nyberg DA., Comstock
this greatly affects the health of the mother CH, et al. (2007). Fetal growth in
and the fetus, so the presence of the positive early pregnancy and risk of
results of the worms that can aggravate the delivering low birth weight infant:
condition of the mother's health and the prospective cohort study. BMJ, 10,
effect on fetal growth and development of 1-5.
uterine intera. Mothers who experience Cunningham et al. (2012). Obstetri Wiliam
worm infections tend to give birth to babies (Edisi 22). Jakarta: Penerbit Buku
with a lower birth weight than women who Kedokteran EGC.
did not undergo worm infections, low birth Gibney et al. (2009). Introduction to Human
weight is not only influenced by the Nutrition (2nd Edition). USA:
condition of the women who experienced a Weley Black Well.
worm infection but there are many other Irianto K. (2009). Parasitologi,Berbagai
factors that influence it. Penyakit yang Mempengaruhi
Kesehatan Manusia. Bandung : Y
CONCLUSIONS AND SUGGESTION Rama Widya.
Most pregnant women do not Makhoul Z., Taren D., Duncan B, Pandey
sufferred of soil transmitted helminthes P.,Thomson C.,Winzerling J.,et al.
infection, and there is difference on birth (2012). Risk Faktors Associated
weight infants in women who had infection With Anemia, Iron Deficiency And
of soil transmitted helminthes with mothers Iron Deficiency Anemiain Rural
who did not infected. Nepali Pregnant Women. J Trop
Improving the quality of antenatal Med Public Health, 43, 735-74
care, the health service in women of Mordi RM. and Ngawodo POA. (2007). A
childbearing age and premarital with early Study Of Blood And
detection of the complete examination of Gastrointestinal Parasitas In Edo
health status, laboratory tests such as Statas. African Journal Of
hemoglobin examination level, examination Bioethnology, 19, 2201-2207.
of worms, disease screening which is likely Ndibazza J., Muhagi L., Akishule D.,
to accompany during pregnancy. Kiggudu M., Ameke J., Oweke J., et
al. (2010). Effects of Deworming
REFERENCES during Pregnancy on Maternal and
Asiyah S., Kurniawati I.,. (2014). Perinatal Outcomes in Entebbe,
Hubungan Status Gizi Ibu Selama Uganda: A Randomized Controlled
Hamil Dengan Berat Badan Bayi Trial. Infectious Diseases Society of
Lahir Di Wilayah Kerja Puskesmas America., 50, 531-540
Tiron Kecamatan Banyakan Kediri. Syarifuddin, V. (2011). Chronic Energy
Jurnal Poltekes kemenkes Malang, Deficiency (Ced) At Pregnant
III (1), 36-40. Woman As Risk Faktor Of Low
Birth Weight (Lbw) In Bantul
District. Tesis Program Studi
308
Kesehatan Masyarakat Fakultas
Kedokteran Universitas Gajah
Mada , 5-8.
WHO. (2011). Retrieved 11 20, 2014, from
World Health Organization:
http://www.who.int/maternal_child
_adolescent/dokuments/978924154
8366. pdf
WHO. (2013). world health statistik
2013.feto maternal nutrition and
low birth weight. Retrieved 11 20,
2014, from world health
organization:
http://www.who.int/gho/publication
s/world_helath_statistic/EN_WHS2
013_ full.pdf.WHO.2013
Wiknjosastro, H. (2009). Ilmu Kebidanan.
Jakarta: Yayasan Bina Pustaka
Sarwono Prawirohardjo.
309
FACTORS OF HEALTH INFORMATION AND SUPPORT INCREASE IN
COMPLIANCE WITH TABLET Fe CONSUME PREGNANT WOMEN IN THE
LABOR HEALTH EAST DISTRICT LOMBOK TERARA 2015
Ni Putu Aryani
High School Health And Science Yarsi Mataram
Email: ary.jegeg99@gmail.com
ABSTRACT
Introduction: Riskesdas (2013), 37.1% of pregnant women are anemic, namely pregnant
women with hemoglobin levels less than 11.0 g / dl, the proportions were almost equal in urban
areas (36.4%) and rural areas (37, 8%). Province NTB (Nusa Tenggara Barat) is one of the areas
with the highest prevalence of AKI in Indonesia. The purpose of this study to determine the
factors associated with compliance of pregnant women in consuming Fe tablet in Puskesmas
Terara Regional East Lombok 2015. Method: This research is non-experimental survey with
cross sectional approach. The research was conducted in Puskesmas Terara East Lombok
district in January 2015. Data were collected using questionnaires and have been tested for
validity and reliability and analyzed using univariate, bivariate and multivariate logistic
regression. Result: This study found that only about half, or (54%) of pregnant women who are
obedient to consume iron tablet. Information and support health workers and family support
related to compliance consuming Fe tablet. Conclusion: It is expected that health personnel in
this regard is the midwife can provide information about the health of pregnant women to
enhance the knowledge about health and my family and in this case of anemia in pregnant
women in the form of health promotion, leafleat, and video about health.
Keywords: Compliance pregnant women, information, support health workers
INTRODUCTION pregnant women with iron tablets or tablet

Based Riskesdas Data (2013), that to share blood added to expectant mothers
37.1% of pregnant women are anemic, sebanayk one tablet daily for 90 consecutive
namely pregnant women with hemoglobin days during the pregnancy. Folatlebih iron
levels less than 11.0 g / dl, the proportions supplements known as Tablet Add Blood
were almost equal in urban areas (36.4%) (TTD). Based on MOH (2010), coverage of
and rural areas ( 37.8%). Province NTB TTD (Fe) has reached 92.2%, but it is still
(Nusa Tenggara Barat) is one of the areas quite high prevalence of anemia. The main
with the highest prevalence of AKI in cause of the failure of these activities is the
Indonesia. In 2006 MMR in NTB is 370 per low compliance of the target population in
100,000 live births, in 2008 NTB the consumption of TTD. Lack of
successfully reduced MMR to 320 per compliance TTD consumption caused by a
100,000 live births, but in 2010 increased variety of people's perceptions of taste and
back to 329 per 100,000 live births side effects of the consumption of TTD.
(Riskesdas 2010). Results of a national health survey
The government's efforts to (Suskernas) in 2004 showed that adherence
overcome iron deficiency anemia in higher iron pills along with the height
pregnant women that is focused on the inspection ANC (Antenatal) and the
provision of iron tablet (Fe) in pregnant increasing socio-economic households.
women. The Department of Health Based on data from January 2014
continues to implement programs until December 2014 PHC Terara mark
penanggulanagn iron deficiency anemia in third trimester pregnant women, amounting
310
to 619 pregnant women attending an 619 pregnant women attending an antenatal
antenatal check detected 313 mothers were check detected 313 mothers who are anemic
anemic and in 2013 of 613 targets third and in 2013 of 613 targets third trimester
trimester pregnant women who come pregnant women who come checkups
checkups detected 302 pregnant women detected 302 pregnant women were anemic.
were anemic. This research was to describe and
Based on data ranging from Jan analyze the determinants of information and
Based on the preliminary study conducted support for health workers in order to
with interviews of 10 pregnant women who improve the compliance of pregnant women
received iron tablets for one month (30 consume iron tablet in Puskesmas Terara
tablets) after being interviewed, the result is East Lombok District 2015
5 people do not spend iron tablets and drank
only between 20-25 tablets, 2 taking 25-30 METHODS
tablets. Reasons not spend iron tablets, The survey design is non-
among others: forget, no family members experimental approach using cross-
were reminded, do not know the benefits of sectional data. The research was conducted
iron tablets, feel no need vitamins because in Puskesmas Terara East Lombok, in
healthy, afraid the baby was born too big, January 2015. The population in this study
not be told by health workers about the were all pregnant women in the Puskesmas
importance of iron tablets, given to husband Terara East Lombok district is numbered
because iron tablets can add energy to the 1747 pregnant women with minimal sample
husband as breadwinner, nausea after taking number 132. The data in this study is the
iron tablets, so the color hitam.uari primary data collected using questionnaires.
CHAPTER 2014 until December 2014 The analysis is univariate, bivariate and
Terara health center of the target third multivariate logistic regression.
trimester pregnant women, amounting to
RESULT
Table 1. Demography Data
Umur Frekuensi Persentase (%)
<35 tahun 136 90,7
≥35 tahun 14 9,3
Jumlah 150 100,0
Pekerjaan Frekuensi Persentase (%)
Bekerja 24 16,0
Tidak Bekerja 126 84,0
Jumlah 150 100,0
Pendidikan Frekuensi Persentase (%)
Rendah (SD, SMP) 111 74,0
Tinggi (SMA, PT) 39 26,0
Jumlah 150 100,0
Jumlah Anak Frekuensi Persentase (%)
Cukup (<2) 141 94,0
Banyak (>2) 9 6,0
Jumlah 150 100,0
Pengetahuan Frekuensi Persentase (%)
Rendah 65 43,3
Tinggi 85 56,7
Jumlah 150 100,0
311
Sikap Frekuensi Persentase (%)
Positif 129 86,0
Negatif 21 14,0
Jumlah 150 100,0
Akses Frekuensi Persentase (%)
Jauh 74 49,3
Dekat 76 50,7
Jumlah 150 100,0
Ketersediaan Fe Frekuensi Persentase (%)
Tidak tersedia 24 16,0
Tersedia 126 84,0
Jumlah 150 100,0
Ketersediaan Gizi Frekuensi Persentase (%)
Tidak Tersedia 29 19,3
Tersedia 121 80,7
Jumlah 150 100,0
Informasi Frekuensi Persentase (%)
Tidak terpapar 53 35,3
Terpapar 97 64,7
Jumlah 150 100,0
Dukungan Tenaga Frekuensi Persentase (%)
Kesehatan
Tidak mendukung 66 44,0
Mendukung 84 56,0
Jumlah 150 100,0
Dukungan Keluarga Frekuensi Persentase (%)
Mendukung 87 58,0
Jumlah 150 100,0
Dukungan Tokoh Frekuensi Persentase (%)
Masyarakat
Mendukung 119 79,3
Jumlah 150 100,0
Kepatuhan Frekuensi Persentase (%)
Tidak patuh 69 46,0
Patuh 81 54,0
Jumlah 150 100,0
Table 2. Selection Bivariat

Variable p-value Keterangan
Umur 0,973 Bukan Kandidat
Pekerjaan 1,000 Bukan Kandidat
Pendidikan 0,834 Bukan Kandidat
Jumlah anak 0,303 Bukan Kandidat
Akses 0,032 Kandidat
Pengetahuan 0,000 Kandidat
Sikap 0,385 Bukan Kandidat
312
Ketersediaan Fe 1,000 Bukan Kandidat
Ketersediaan gizi 0,947 Bukan Kandidat
Informasi 0,000 Kandidat
Dukungan Tenaga Kesehatan 0,000 Kandidat
Dukungan keluarga 0,000 Kandidat
Dukungan tokoh masyarakat 0,923 Bukan Kandidat
Bivariate selection results obtained Final Modeling Multivariate

above 5 variables that produces a value of p Logistic Regression Test Results
<0.25 is variable access, knowledge, Variable Information, Health Personnel
information, support health care workers, Support, Access and Knowledge.
and family support.
Table 3. Final Modeling Multivariate

Variable p-value OR 95% CI
(odd ratio)
Informasi 0,006 1,101 0,020-0,520
Dukungan Tenaga 0,026 0,293 0,099-0,865
Kesehatan
Pengetahuan 0,158 0,375 0,096-1,462
Akses 0,088 2,388 0,878-6,493
Variable information is a factor edible. Women require higher iron higher

which is predominant related to the than men because of menstruation and
compliance of pregnant women consume bleeding as much as 50 to 80 cc every
iron tablet (OR = 1.101), meaning that month and iron loss of 30 to 40 mgr.
respondents were exposed to information Besides pregnancy requires additional Fe
will likely 1,101 times to adhere to consume intake to increase the number of red blood
iron tablet compared to respondents who cells and form red blood cells of the fetus
were not exposed to the information after and placenta. The more often a woman
the controlled variable access, support experiencing pregnancy and childbirth will
health workers and knowledge. increasingly lose Fe substance. Total Fe
needed in pregnant women is much greater.
DISCUSSION
Compliance picture Pregnancy Information
Eating Tablet Fe. The results showed that The results showed that most
respondents who dutifully consume iron respondents are exposed to information as
tablet was 54%. Based on previous much as 64.7%. Analysis of the relationship
research, it was found only about 25% Fe information with the compliance of
according WUS meet the nutritional pregnant women consume iron tablet
adequacy rate is 26 micrograms / day. On indicates that respondents who are not
average women taking 6,5μg per day exposed to the information obedient in
through diet. Fe sufficiency not only consuming Fe tablet as much as 7.5%, while
fulfilled intake of food consumption source the group of respondents were exposed to
Fe (beef, chicken, fish, eggs, etc.), but is information that dutifully consume as much
influenced by variations in the absorption of as 79.4% Fe tablet. The statistical test result
Fe. This variation is caused by information relationship with the
physiological changes in the body such as compliance of pregnant women consume
pregnant and lactating thus increasing the iron tablet obtained p-value of 0.000, which
need for the body Fe, Fe type which is means that there is a relationship between
313
compliance information with pregnant after the controlled variable information
women taking iron tablet. access, support and knowledge of health
Health information is a set of data or workers.
facts about health organized or processed in
a way that has meaning for the recipient. REFERENCE
The data have been processed into Almatsier, sunita. (2009). Prinsip dasar
something useful for the recipient means ilmu gizi. Jakarta: Gramedia
that can provide information or knowledge. Pustaka Utama.
Thus, the source of information is the data. ArismanMB, (2004). GiziDaur
Information can also tell a knowledge KehidupanPenerbitBukuKedoktera
gained from learning, experience, or n EGG, Jakarta
instruction. The more people are exposed to Atmarita. (2005). Nutrition Problem in
health information, the better the health Indonesia. Persented in an
behavior. integraded internasional seminar
and workshop on lifestyle-related
Support Health Workers Deseases. Gajah Mada University.
The results showed that support Dikes Lotim. (2013). Laporan Tahunan
health personnel to respondents largely Program Kesehatan Ibu dan Anak,
support as much as 56.0%. Analysis of the Desember 2014.
relationship with the health worker Depkes RI. (2010). Pedoman umum gizi
adherence support pregnant women seimbang (panduan untuk petugas).
consume iron tablet indicates that Jakarta: YBP-SP.
respondents are not supported health Depkes RI. (2002). Program
workers docile in consuming Fe tablet as penanggulangan Anemia Gizi pada
much as 21.2%, whereas in the group of wanita usia subur. Jakarta:
respondents who supported the obedient Departemen Kesehatan
consume as much as 79.8% Fe tablet. Depkes RI. (2000). Panduan pengelolaan
Statistical test results support relationships program perbaikan gizi
with the health worker adherence pregnant kabupaten/kota, Depkes RI Jakarta.
women consume iron tablet obtained p- Dini Kasdu, Meiliasari Mila,
value of 0.000, which means that there is a Purwaningsih R, 2001 info lengkap
relationship between health personnel with kehamilan dan persalinan Penerbit
adherence support pregnant women 3G. Publisher Jakarta
consume iron tablet. Elsy, N. (2012). Faktor-faktor yang
Berhubungan dengan Kejadian
CONCLUSION AND SUGGESTION Anemia pada Ibu Hamil Trimester
Compliance overview of pregnant III di wilayah kerja Puskesmas Air
women consume iron tablet in Puskesmas Dingin Kota Padang.
Terara is half of pregnant women is 54%.
This figure is quite high but still far from an Hernawati. (2011). Hubungan Kepatuhan
iron tablet distribution coverage at the Komsumsi Tablet Tambah Darah
health center that is equal to 92.6% Terara. Dengan Status anemia Ibu Hamil
Variable information and support of health Di Desa Kotaraja Kecamatan
workers is a variable related to the Sikur.
compliance of pregnant women in http//www/bpkPenaburor.id/
consuming Fe tablet. Resources where KPS—Jkt/
respondents were exposed to 1,101 times berita9806/Pendidikan2. htm,
the information would be likely to adhere to diakses tangal 18April 2013
consume iron tablet compared to Manuaba, LB.G. 1999. Ilmu Kebidanan
respondents who were not exposed to health penyakit Kandungan dan
314
Keluarga Berencana. Jakarta:EGG berhubungan dengan kepatuhan
Manuaba, l.B.G. 1998: Ilmu Kebidanan, dalam mengkonsumsi tablet besi di
Penvakit Kandungan dan RSUD Arifin Nu’mang Rappang
Keluarga Berencana Untuk Kabupaten Sidrap.
Pendidikan Bidan, Pnenerbit Buku Notoatmojo.S. 2003. Pendidikan dan
Kedokteran EGC, Jakarta. Perilaku Kesehatan. Rineka Cipta.
Manuaba, l.B.G. 2001. Kapita selekta Jakarta
Pelaksanaan Rutin Obstetri Notoatmodjo, S. (2010). Metodelogi
Mochtar,R.1998. Sinopsis obstetri. Penelitian Kesehatan. Jakarta: PT.
Obstetric fisiologi. Obstetric Rineka Cipta.
patologi jilid 1. Penerbit Buku Prawirohardjo, 2002. Buku Acuan
Kedokteran EGC.Jakarta. Nasional Pelayanan Kesehatan
Ginekologi dan Keluarga Berencana. Maternal dan Neonatal- Yayasan
Jakarta: EGG Bina Pustaka Jakarta
Mulyati. 2009. Faktor-faktor yang
315
EFFECT OF COOPERATIVE PLAY TO SIBLING RIVALRY DIRECT REACTION
IN CHILDREN AGES 8-12 YEARS IN SDN BLEGA 03 BANGKALAN
M.Hasinuddin, Siti Fikrun Annisyak

STIKES Ngudia Husada Madura
Email: hasin_nhm@yahoo.co.id
ABSTRACT
Introduction: Sibling rivalry was jealousy and hate experienced by a child. Results of
preliminary studies conducted on school children in SDN Blega 03, found 8 out of 10
respondents experienced sibling rivalry. The purpose of this study to analyze the effect of
cooperative play on the incidence of sibling rivalry in school age children 8-12 years. Method:
The study design used was quasy Experiment with sibling rivarly approach dependent variable
and independent variables cooperative play. Population study were 55 students who had a sister,
a large sample of 18 respondents were divided into two groups: the treatment group (therapy
cooperativ play) and the control group (get individual play), sampling with purposive sampling
techniques, analysis of data using pairedt t test and independent samples test with α: 0.05.
Result: The results showed that sibling rivalry given cooperative play 9 respondents (100%)
change, while the sibling rivalry given individual game 2 of the respondents (20%) experienced
a change. Conclusion: Based on the statistics by using Independent Samples Test showed 0.009
value ρ <α: 0.05, which means that there is a difference after the cooperative play. Cooperative
play can be recommended as one of the interventions for parents who have children who are at
risk of sibling rivalry.
Keyword: Sibling rivalry, cooperative play
INTODUCTION direct reaction Sibling rivalry is to make

With sibling rivalry is jealousy and children cooperate with cooperative
hate that are usually experienced by a child activities. Cooperative activities that can be
on the presence or birth siblings. Therefore, done is activity in the form of a game.
parents should explain this to the children With sibling rivalry is jealousy and hate that
with illustrations that are simple and easy to are usually experienced by a child to the
understand, so the children aware of the presence or the birth of a sibling. It can be
changes that will occur, for example, transferred by way of giving toys, such as
change the beds and rooms, as well as the dolls, which can be necessary as a baby
preparation of baby equipment (Nursalam, (Nursalam, 2008).
2008). Hurlock (2006) report that sibling
The results of preliminary studies rivalry is caused by several factors, among
conducted on school children in SDN Blega others: The attitude of the parents, the order
03 District of Blega Bangkalan on of position, gender, age differences, number
September 17 of 2015 experience sibling of siblings, the kind of discipline. Wong
rivalry at school-age children as much as 10 (2008) explains that the cooperative play is
respondents showed: children who took her a collaboration of games that are organized
sister to play 40% of children who seek and children playing in a group with other
attention from parents 70%, and the child children. Objectives and achievements
who made her sister cried when the toy grab require an organizing activity, the division
60%. of labor, and role playing of each child to
One strategy that can be applied coordinate with other children.
directly to the children who experienced
316
The immediate reaction sibling 2 Woman 3 33,3 4 44,4
rivalry is a form of behavior that is raised by and woman
the child and tangible aggression, 3 Man and 1 11,1 1 11,1
aggression both verbally and non-verbally woman
in their siblings. According to Fletcher in 4 Woman 1 11,1 1 11,1
Maula (2011) said cooperative play more and man
emphasis on participation, the challenge, Total 9 100 9 100
and doing fun than to beat somebody. Source of data: primary data 2016
METHODS From table 1 shows that the

The research design is quasi- treatment group sex almost halved men and
experimental research design (quasy- boys as much as 4 respondents (44.4%).
experiment), and sampling using purposive While the control group almost half are
sampling nonprobability simple sampling female and women as much as 4
also called judgment sampling by using respondents (44.4%).
paired t-test and independent samples test.
The population in this study were school- Table 2. The frequency distribution of
age children in SDN 03 Blega as many as respondents who experienced
30 children, the study sample number 9 sibling rivalry is based on the
children for the treatment group and the number of siblings.
control group of children 9 to riteria No Number Treatment Control
inclusions: of
a. Children aged 8-12 years who sibling
experienced sibling rivalry with his F (%) F (%)
siblings, 1 Two 5 55,6 4 44,4
b. Willing to do research (approved 2 Three 3 33,3 3 33,3
informed consent), the number of 3 Four 1 11,1 2 22,2
siblings 1-4, Total 9 100 9 100
c. The age range of 2-4 years siblings, Source of data: primary data 2016
d. Family type; main family
From table 2 shows that the treatment
While the exclusion criteria for this study group had a number of relatives mostly two
are: by 5 respondents (55.6%). While the control
a. Respondents with special needs such as group almost half of the respondents who
ADHD, autism, and other his number two as much as 4 respondents
b. Respondents had been ill for a period of (44.4%).
time to provide interventions conducted
by the researchers. Table 3 The frequency distribution of
respondents who experienced
RESULT AND DISCUSSION sibling rivalry by spacing births.
Characteristics of respondents by No Spacing Treatment Control
sex brother and sister births
Table 1 Distribution of frequency of F (%) F (%)
respondents who experienced 1 One year 1 11,1 - -
sibling rivalry by sex 2 Two year 5 55,6 3 33,3
3 Three year 2 22,2 4 44,4
No Gender Treatment Control 4 Four year 1 11,1 2 22,2
F (%) F (%) Total 9 100 9 100
1 Man and 4 44,4 3 33,3 Source of data: primary data 2016
man
317
From Table 3 indicate that the Mean 24,67 21,89
treatment group mostly spacing of two Paired T Test ρ = α = 0,05
years as many as five respondents (55.6%). 0,00
While the control group nearly halved three After analysis of data obtained that
years birth spacing as much as 4 from 9 respondents were given a
respondents (44.4%). cooperative game play found that the
average pre-test results of observations of
Table 4 Distribution of the frequency of post-test 24.67 and 21.89 value. From table
respondents who experienced 5 the results of different test that uses paired
sibling rivalry is based on the samples t-test is obtained ρ value (0.000)
work of parents. <value alpha (0.05) so that it can be
N Work of Perlakuan Kontro concluded there is no difference observed
o parents l values sibling rivalry before and after
F (%) F (%) cooperative game play.
1 PNS 4 44, 6 66,7 Table 6 Distribution of the frequency of
4 respondents in school age children
2 Swasta 1 11, - - who experienced sibling rivalry
1 that get individual game (the
3 Wiraswa 3 33, 1 11,1 control group)
sta 3
4 IRT 1 11, 2 22,2 No. Pre Post
1 Respondent
Total 9 100 9 100 1 30 27
Source of data: primary data 2016 2 29 29
3 31 31
From Table 4 shows that in the 4 29 29
treatment group nearly halved the work of 5 21 21
parents were civil servants as much as 4 6 26 26
respondents (44.4%). While the control 7 30 30
group largely the work of parents of 8 28 28
respondents most civil servants as much as 9 25 25
6 respondents (66.7%). Mean 27,67 27,33
Paired t Test ρ = α = 0,05
Table 5 Distribution of the frequency of 0,347
respondents in school age children
who experienced sibling rivalry After analysis of data obtained that
that gets cooperative play (the from 9 respondents were given the
treatment group) individual games (the control group) found
that the average value of the observation of
No. Pre Post the pre-test post-test 27.67 and 27.33 value.
Respondent From table 6 the results of different test that
1 19 16 uses paired samples t-test is obtained ρ
2 26 22 value (0.347) <alpha value of 0.05, so it can
3 20 17 be concluded there was no difference
4 30 28 observed values sibling rivalry before and
5 27 22 after individual games.
6 18 16
7 29 25
8 25 24
9 28 27
318
Table 7 Distribution of sibling rivalry of the same sex. This would lead to
comparison of observed values in disharmony, because if the sibling pairs
school age children between the have the same sex tend to experience sibling
treatment group and the control rivalry reaction. According Priatna & Jane
group on January 25-February 6, in Rahmawati (2013) it is due to the same
2016. sex siblings can trigger the occurrence of
envy as a result of the same needs and
Responden Treatmen Control characteristics as well.
t t Factors that may lead to sibling
1 16 27 rivalry that is the number of siblings in the
2 22 29 family, if the fewer the number of siblings
3 17 31 in the family would cause undesirable
4 28 29 effects such as sibling rivalry. The results
5 22 21 showed that respondents who received play
6 16 26 therapy cooperative play as much as 55.5%
7 25 30 have a number of siblings two people. This
8 24 28 is in accordance with the opinion of Hurlock
9 27 25 (2006) that a small number of siblings tend
Mean 21,89 27,33 to generate more disputes relationship of the
Independen ρ= α = 0,05 amount of its big brother.
t t test 0,009
Differences sibling rivalry at that age
After analysis of data obtained from children get the individual games (the
the difference between the 2 groups were control group)
given a cooperative game was found that the Based on the results of research
average value of sibling rivalry observation conducted in the control group did not show
in a given school-age cooperative game any change in the value of observation
worth 21.89 and are given individual game sibling rivalry. Pretest performed in the
worth 27.33. The results of the statistical control group showed that the number of
test of independent samples test treatment respondents who experienced a direct
group and the control group ρ value (0.009) reaction high sibling rivalry as much as
<value alpha (0.05), so it can be concluded 77.7%, whereas after postest fixed amount
that there are differences in observed values of 77.7%.
sibling rivalry between treatment and The results showed no decrease in
control groups. This suggests that the effect the number of children who have a sibling
on the decline of cooperation game sibling rivalry can be caused by several factors,
rivalry. among others of the same sex between
brother and sister. In the control group were
Differences in children aged sibling more likely to occur gender and women,
rivalry that get cooperative game play (the this is because girls are more similarities in
treatment group) the way of playing, and the needs and
Based on the results of research characteristics of the same, so the child will
conducted showed the treatment group were arise envy, and a sister may be more chatty
given play therapy cooperative play in the and love set against sister of the younger
post test decreased the 7 respondents who brother. This is in accordance with the
did not experience sibling rivalry and 2 opinion of the Rahmawati Aderson (2013)
respondents still experiencing sibling that the sexes are equal in siblings can lead
rivalry. to envy due to the needs and characteristics
Some of the factors which may as well.
occur among others, sex. The results
showed that nearly half of the respondents
319
Other factors that occurred in the lower direct reaction sibling rivalry through
control group was spacing with their collaborative activities kids to finish the
siblings. Birth spacing adjacent to the mission together. The statistic shows there
incidence of sibling rivalry and the age is a significant effect on the direct reaction
difference between siblings will affect the of sibling rivalry before and after the
way they act. The results showed that in the intervention of cooperative play for ρ value
control group, within the respondent's birth (0.009) <α (0.05). This intervention is
more than half between 2-3 years. appropriate to be applied by parents who
According Woolson in Rahmawati (2013) have school-age children who experience
this is because at such distances have immediate reaction sibling rivalry with his
increased understanding of the child so that brother.
the child tends to be disrupted when one of
the children get a different concern. CONCLUSIONS AND
RECOMENDATION
Differences observed values sibling rivalry Conclusion
in school age children between 2 groups The whole of the respondents were
administration of cooperative game and given cooperative play in the treatment
giving the game individually group had significant decrease after
The results showed that the Given cooperative play for 3 times in 1
treatment group after getting intervention week. Respondents were given almost
cooperative play, sibling pairs who have a entirely individual game in the control
sibling rivalry reaction changed from the group did not decline during the reaction of
previous high of 55.6% to 22.2%. While the sibling rivalry given the individual games in
control group showed no decrease in the 3 times for 1 week. This suggests that the
incidence of sibling rivalry. cooperative play sibling rivalry affect the
The decline in direct reaction to the reaction at school-age children in SDN 03
treatment group sibling rivalry can already Blega.
be seen at the fourth meeting and continued
to increase until the end of the meeting, the Recomendation
sixth meeting. The fourth meeting is a Nurse practitioners need to provide
meeting at the beginning of the second week insight to parents about the importance of
of a total of two weeks of meetings planned. anstisipasi for those who have children of
The first meeting, children are often in the difference between 2-3 years of age and
conflict with their siblings during play the same gender to implement cooperative
cooperatively children are still often fight play for prevention in order to avoid sibling
with rough and even to hit his brother. The rivalry. For further research is need for
second meeting of the third to behavioral more studies using other methods of play to
changes expected due to the provision of reduce sibling rivalry reaction.
intervention by the researchers have not
been so evident in children and siblings. REFERENCE
Observations made by the researchers Hurlock, Elizabeth.B. 2006. Perkembangan
found that during the game the kids, the Anak Jilid 2 Edisi Keenam, Alih
parents of respondents said that their Bahasa: Tjandrasa dan Zurkasih.
children often quarreled before the Jakarta : Erlangga
administration of the intervention. Things Maula, Atiyatul. 2011. Pedoman pengaruh
became different after the intervention of Model Permainan Kooperatif dan
respondents get cooperative play for six Model Permainan Asosiatif dalm
sessions. Peningkatan Keterampilan Sosial
These results have proved that the Anak Taman kanak-kanak. Diakses
intervention of the cooperative play can 26 Oktober 2015 pukul 19.00 WIB.
320
http://etd.eprints.ums.ac.id/13444/1
/DaftarDEPAN.pdf.
Nursalam. 2008. Asuhan Keperawatan Bayi
dan Anak (Untuk Perawat dan
Bidan) Cetakan Kedua. Jakarta:
Salemba Medika
Putra, Dony S.H. 2014. Keperawatan Anak
dan Tumbuh Kembang (Pengkajian
dan Pengukuran). Yogyakarta :
Nuha Medika
Rahmawati, Etika. 2013. Hubungan Antara
Sibling Rivalry dengan Kemampuan
Penyesuaian Sosial Anak Usia
Sekolah. Diakses 26 Oktober 2015
20.00 WIB
http://repository.uinjkt.ac.id/dspab/
handle/123/pdf
Sari, Meida. 2011. Faktor Penyebab dan
Dampak Psikologis Persaingan
Antar Saudara Kandung Pada
Mahasiswa yang Tinggal Satu Kost.
Diakses 11 Sepetember 2015 18.58
WIB
http://berita.php?=persaingan+antar
+saudara
Wong, L.Donna. 2008. Buku Ajar
Keperawatan Pediatrik Edisi Enam.
Jakarta: EGC
Yunanto, Rismawan Adi. 2012. Pengaruh
Cooperative Play Terhadap Reaksi
Langsung Sibling Rivalry Pada
Anak Prasekolah di Desa
Cangkring Kecamatan Jenggawah
Kabupaten Jember. Diakses 11
September 2015 19.00 WIB
http://digilib.unej.ac.id/download.p
hp?id.2515
321
THE EFFECT OF ZINK SUPPLEMENTATION FOR GROWTH DEVELOPMENT
IN CHILDREN
Mamik Ratnawati, Septi Fitrah Ningtyas

Email: mamik.perawat@gmail.com
ABSTRACT
Introduction: Zinc deficiency occurs in many creating countries, especially in children up to
women of reproductive age. Zinc is closely related related to height growth and function of the
body. Cooperate of zinc with critical hormones included to bone Growth and centralization in
the bone grid is high contrasted with different networks. Insuficient blood levels of zinc in the
body in children can affect a child's growth. Methods: The method used by the research journal
PubMed and BMJ. adapted to the journal search and limited research topic of the year 2011-
2017. Result: Zink deficiency can affect on growth development in children. Given zinc
supplementation in children can affect a child's growth. Conclusion: Children with zink
deficiency can affect the growth of children up to 18 years. Supelemtasi zinc can affect bone
metabolism and growth hormones that are needed by infants and young children in developing
countries particularly vulnerable to zinc deficiency. Zinc deficiency can also lead to low body
height in children.
Keywords: zinc, deficiency, growth, child, height, weight, zinc supplement.
INTRODUCTION alopecia,immunity decreases, and

Insufficient blood levels of zinc in hypogonadism on men (Hwan, Lee, Kim
the body including a case that resulted in the 2016).
most widespread micronutrient loss. People Zinc is closely related to height
of all ages are at risk, ranging from children growth and function of the body. Cooperate
to women of reproductive age are at high of zinc with critical hormones included to
risk of zinc deficiency, mainly in low- bone Growth and centralization in the bone
income countries (Petry 2016). grid is high contrasted with different
Growth and development is a networks (Abdollahi 2014) . Infants and
continuous process from conception to age children who have Zinc insufficiencywould
18 years. Components of nutritional are be vulnerable to impaired height growth and
among the factors that determine and plays function of the body (Petry 2016).
an important role in the growth and The purpose of this researchmight
development of children. Children need have been on perform literature review
more intake of zinc to obtain normal growth competency of midwives inthe treatment of
and development (Leon 2009). children with zinc deficiency through
Zinc (Zn) is a structural constituent supplementation with zinc to reduce the
that is essential for cell growth, incidence of zinc deficiency and the
proliferation and differentiation. Zinc has 3 consequences that occur.
main basic functions: to catalyze action of
the enzyme, provides for participation the METHODS
component of proteins, and control gene The search strategy study of the
interpretation. Specific symptoms of Zinc english language that are relevant to the
insufficiency, such as growth retardation, topic conducted using PubMed and BMJ
diarrhea, Postponed puberty, glossitis, restricted from January 2011 to December
erectile dysfunction, nail dystrophy, 2016. Keyword used were zinc, deficiency,
322
growth, child, height, weight, zinc is found over kids with insufficient blood
supplement. Full text articles and abstracts levels of zinc Contrasted in kids with
were analyzed to choose studies that fit the ordinary alternately large amounts of zinc.
criteria. Consideration standards used El-Shazly (2015) showed that the
forreview was theimpact of zinc for growth BMI and zinc serum was higher on menover
development in children. women, in any case there might have been
The research examined in this no significant correlation between levels of
article using the treatment group and the zinc with sex. there is a significant
control group of the respondent to the relationship between zinc supplementation
treatment of children with zink deficiency. in children with BMI. and provision of zinc
Gier et al. (2015) showed that supplements can improve appetite in
several studies conducted on school children.
children in Cuba and Cambodia using Results of research conducted
analysis of height to STH infections and Abdollahi et al. (2014) concluded that zinc
plasma as well as hair zinc.The research in supplementation clinched alongside know
cuba there is no relation between the effect youngsters under 5 A long time of age can
of STH with the child's height by age views affect linear growth of children, especially
of hair zinc. but in cambodia indicate that in developing countries. but the effect of
there is relation between plasma zinc with zinc supplementation when given in 7:03
the child's height by age. months duration and dose range 1-20 mg /
The study by Hamzah, Hamed, day.
Sallam (2012) in fifty children of Egypt pre- Tae Hwan (2016) in Seoul Hanyang
pubertal height lower and Zn deficiency University Hospital expressed about the
showed that the levels of serum IGF-1 and role of micronutrient deficiencies,
IGFBP-3 are low and supplementation Zn especially zinc. Zinc deficiency is known to
for 3 months did not can increase the serum affect bone metabolism. the contribution of
used to increase the growth of children. So zinc in the growth can be explained by the
that Zn supplementation to children in need participation in the synthesis of DNA. Zinc
in the long period of time, thereby has a direct effect on the hormonal system
increasing serum growth in children. of primary (IGF-I / GH) control of linear
Results from Dehghani (2011) in growth in children. Zinc supplementation
Shiraz- Iran explained that there might have will produce a positive impact when given
been no huge correspondence between zinc to children who proved with zinc
levels on children with weight (BMI), deficiency.
height, but the incidence of gentle wasting
also short stature. were relevant higher light
323
RESULTS & DISCUSSION
No Author/yea Population Contro Rando

Title Design Intervention Outcome Result
. r and Sample l m
1. Height, Zinc De Gier et Carried out a 1389 Investigated No Yes Cooperati Relapse investigation
Furthermore Soil- al. 2015 cross- Youngsters gathered ons indicated An huge
Transmitted sectional from 13 information between negative affiliation
helminth study haphazardl once height, tallness to between sth
Infections to y chose STH Age, Zinc contamination
Schoolchildren: schools contamination and sth Furthermore tallness to
An investigation clinched Also zinc spoiling. period and in addition
in cuba and alongside centralization over zinc hair However
cambodia. cuba and. Previously, sure companionship
Starting Possibly (aB-0. 471, p = 0. 033)
with 20 plasma might have been found
haphazardl (Cambodia) or between hair zinc Also
y chose hair (Cuba). tallness to agen.
schools
were
included
2471 in
cambodia.
2. Impact for zinc T Hamza Cohort 50 pre- Auxological Yes No supplemen After 3 months for Zn
supplementation R , I pubertal appraisal Also tationof supplementation for Zn-
around Growth Hamed A, egyptian estimation Zinc might deficient patients, there
hormone insulin T Sallam [27 guys from claiming make huge were Zn rose On the
response Growth M. 2012 and 23 serum Zn, IGF- expands in whole patients Be that
component hub in females 1, insulin stature arrived at typical ranges
short egyptian whose ages response standard On 64 %, IGF-1 levels
kids with zinc went development deviation rose over 60 % yet all
lack. between 3. figure tying score the arrived at typical
2 protein-3 (SDS, ranges to 40 % What's
324
Furthermor (IGFBP-3); and P = 0. more IGFBP-3 levels
e 10. basal 033), rose for 40 % in any
9 years.kno Furthermore serum Zn case arrived at reference
w invigorated GH (P < 0. ranges for 22 %.
youngsters previously, 001), Development speed
for short then 3 months IGFBP-3 (GV) SDS didn't
stature and then afterward (P = 0. contrast the middle of
Zn lack Zn 042), IGF- situations Also controls
supplementatio 1 standard (p = 0. 15) At might
n (50 mg/day). deviation have been higher
score Previously, GH-
(SDS,P <  deficient patients over
0. 01) and non-deficient ones, both
IGF-1 Hosting Zn lack (p = 0.
(P < 0. 01) 03).
.
3. Predominance of S M Carried out a 902 Sex, weight, No Yes Age, sex, There might have been
Zinc Dehghani cross- Youngsters age, and height weight, no huge
insufficiency for et al.2011 sectional age-old 3- were all and height Acquaintanceship
3-18 a study 18 a recorded. ask no between zinc
considerable considerabl permission to significant insufficiency and age,
length of time old e length of the parents and with zink gender, weight, tallness.
kids in Shiraz- time of age to take blood deficiency Those predominance for
Iran. were samples of 4-5 zinc lack might have
haphazardl mL for been 10. 2%, 7. 8%, 4.
y sampled measurement 8%, Also 5. 8% for
for serum of their serum underweight, ordinary
zinc level. zinc level weight, at danger for
overweight and
overweight, separately
(p=0. 207).
325
However, the
predominance from
claiming gentle wasting
Also hindering might
have been
fundamentally higher in
zinc inadequate
Youngsters contrasted
with kids for ordinary or
helter skelter zinc level.
4. Effect of zinc El- shazly Eksperiment Led on 60 Patients were Yes Yes There Zinc supplementation
supplementation et al. 2015 al know haphazardly might have brought about An
on body mass youngsters partitioned been an critical build in intend
index and serum the middle under two expand On serum zinc level Also
levels of zinc and of 5 groups: serum zinc BMI. Serum leptin
leptin in pediatric Furthermor assembly i level diminished essentially
hemodialysis e 18 a (supplemented What's then afterward
patients considerabl group, n=40) more BMI supplementation done
e length of gained zinc Also kids. A critical negative
time of age sulfide diminishe correspondence might
once supplementatio d serum have been watched the
general HD n, What's more leptin after middle of serum zinc
during the gathering ii zinc What's more leptin
pediatric (control, n=20) supplemen levels Likewise an
dialysis accepted tation over aftereffect for zinc
units, placebo kids. supplementation..
Menoufia (cornstarch
school capsules) twice
doctor's Every day to 90
facilities. times.
and Benha
college.
326
5. Oral Zinc Abdollahi Multistage 393 Also Kids for both Yes Yes Oral zink Anthropometric
Supplementation et.al.2014 randomized 445 Assemblies supplemen estimations were
Positively Affects sampling Youngsters accepted tation performed In benchmark
Linear Growth, deign 6-24 schedule iron viable for and around An month to
But not Weight, months of What's more expanding month groundwork done
in Children 6-24 age. multivitamin straight both gatherings. Found
Months of Age alternately Growth that An 0. 5 cm
vitamin An rate of distinction in the stature
What's more d Youngster increase in the mediation
supplements s. aggregation Similarly as
through PHC compared with the
administrations control (P < 0. 001).
. Moms of kids Zinc supplementation
in the needed no impact
mediation around weight increase
bunch were for kids.
required will
provide for a
single dosage
of 5 ml/day
zinc sulfide
syrup
(containing 5
mg natural
zinc) should
their
Youngsters for
3 months same
time
Youngsters in
the control
gathering didn't
327
accept those
supplement.
6. Hair Zinc Level Tae Hwan, Cohort 56 pediatric Biochemical No No The major Calcium. (r=0. 564, 0.
Analysis and Lee Jin, patients (28 studies for clinical 339, p=0. 001, 0. 011).
Correlative Kim males and major manifestat Hair calcium level might
Micronutrients in yong.2016 28 females micronutrients ion of zinc have been associated
Children age, 1-15 and deficiency with serum pre-albumin
Presenting with years) macronutrients is poor (r=0. 423, p=0. 001).
Malnutrition and presenting Were body Furthermore Standart of
Poor Growth with additionally growth. hair zinc were
anorexia, directed Exceptionally associated
malnutritio furthermore for serum vitamin d
n, poor hair mineral (r=−0. 479, p=0. 001),
growth, analyses. which likewise
poor demonstrated
appetite, connection with hair
with/withou levels about first mass of
t other GI the magnesium
symptoms Furthermore calcium.
(diarrhea, (r=0. 564, 0. 339, p=0.
abdominal 001, 0. 011). Hair
pain, calcium level might
constipatio have been associated
n) with serum pre-albumin
(r=0. 423, p=0. 001).
328
Research that has been explored in leptin in pediatric hemodialysis
these article indicate that zink deficiency patients. Int J Nephrol Renovasc
can affect on growth development in Dis. 8: 159–163.
children. Given zinc supplementation in Abdollahi et.al. 2014. Oral Zinc
children can affect a child's growth. Supplementation Positively Affects
However, administration of zinc must Linear Growth, But not Weight, in
regularly and within a span of time Children 6-24 Months of Age. Int J
Prev Med. 5(3): 280–286.
CONCLUSION AND Tae Hwan, Lee Jin, Kim yong. 2016. Hair
RECOMMENDATION Zinc Level Analysis and Correlative
Conclusion Micronutrients in Children
The results of the literature review Presenting with Malnutrition and
on the research that has been done on the 6 Poor Growth. Pediatr Gastroenterol
articles about the effect of zink in children Hepatol Nutr. 19(4):259–268.
so that it can be concluded that children
with zink deficiency can affect the growth
of children up to 18 years. Zinc
supplementation can affect bone
metabolism and growth hormones that are
needed by infants and young children in
developing countries particularly
vulnerable to zinc deficiency. Zinc
deficiency can also lead to low body height
in children.
Recommendation
To prevent and reduce the number
of zinc deficiency in children should be the
provision of zinc supplements on a regular
basis with a certain dose in the long term.
REFERENCE
Gier et al. 2015. Height, Zinc and Soil-
Transmitted Helminth Infections in
Schoolchildren: A Study in Cuba
and Cambodia. Nutrients. 7(4):
3000–3010.
Hamza R, Hamed A, Sallam M. 2012. Effect
of zinc supplementation on growth
Hormone Insulin growth factor axis
in short Egyptian children with zinc
deficiency.Ital J Pediatr.2012; 38:
21.
Dehghani et.al.2011. Prevalence of Zinc
Deficiency in 3-18 Years Old
Children in Shiraz-Iran. Iran Red
Crescent Med J13(1): 4–8.
El- shazly et al. 2015.Effect of zinc
supplementation on body mass
index and serum levels of zinc and
329
A LITERATURE REVIEW; EFFECTIVENESS OF WARM FOOTBATH ON SLEEP
QUALITY IN ELDERLY
RODIYAH, ALIK SEPTIAN MUBARROK, ISWANTO KARSO

Pemkab Jombang Institute of Health Nursing
Email: ners_ody@yahoo.com
ABSTRACT
Introduction: Sleep disorders are common mental disorders reported among the elderly in all
countries, and with nonpharmacological interventions, they could be helped to improve their
sleep quality. Footbath therapy is one of the complementary nursing. This aims of this review
was to amplify the available evidence of warm footbath to improve sleep quality in the elderly
health program. Methods: Using electronics database as search strategy. This study retrieved
evidence from 43 articles accessed from three databases (including PubMed, Proquest,
EBSCO), that limited from 2008 until 2016. After read the abstract, the keywords, and the full
text of retrieved articles, finnally, 5 articles were selected. Results: This study showed that
these studies agreed that the footbath were improving sleep quality for elderly Conclusion: The
available evidence reviewed indicate that footbath therapy is effective to reduce insomnia and
improve sleep quality of elders participated in the five articles.
Keywords: Footbath, sleep quality, elderly.
INTRODUCTION Because long-term use of sleeping

Sleep is a life-sustaining activity pills can cause various side effects, such
that affects every individual’s well-being as physical dependence and cognitive
and quality of life. Sleep deprivation impairment, many of studies have
increases levels of fatigue, anxiety, and examined the effectiveness of
depression, inducing cognitive nonpharmacological treatments for sleep
impairment, sleep-disturbed behaviors, disturbance, including herbal inhalation,
and higher mortality. Although sleep massage, and footbaths. Footbath therapy
disturbance can occur in all age groups, has been reported to effectively enhance
quality of sleep tends to decrease in older the quality of sleep by decreasing core
adults. In particular, older adults who body temperature through peripheral
reside in nursing homes reported higher vasodilation. It has been reported to
levels of stress due to collective living improve sleep by reducing sleep-onset
conditions and poor sleep quality due to latency, increasing NREM sleep, and
unfamiliar environments and living habits reducing REM sleep. Moreover, it is easy
differing from those in their homes. to administer and cost-effective, and it
Sleep disorders and depression are involves minimal risk. The effects of
the most common mental disorders reported footbath therapy vary depending on water
among the elderly in all countries. The most temperature, length of the therapy, and
common sleep complaints in the elderly are subject; however, there are no detailed
trouble falling asleep, waking up during the criteria suggested for older adults. The
night, waking up early in the morning, and purposes of this study were to address
daytime sleepiness. Eser et al. showed that this gap in the literature by (1)
60.9% of the elderly have insufficient sleep. evaluating the long-term effects of
Based on studies conducted in Indonesia, footbath therapy on sleep quality and
67% of the elderly have sleeping disorders sleep-disturbed behaviors and exploring
and 61% have insomnia.
330
the therapy’s effectiveness relative to the and thereby could facilitate the onset of
baseline sleep quality of the participants. sleep and improve sleep quality
The human sleep–wake rhythm is
synchronized with the circadian body METHODS
temperature rhythm. Circadian body Search strategy that used in ths
temperature rhythms are suggested to be study was electronic database search. Using
a signaling pathway for the modulation the electronics database from Ebscho,
of sleep and wakefulness. During the Proquest and Pubmed database. Using
daytime, humans are actively awake and combining keywords of footbath and sleep
experience an increased core body quality Elderly. The articles were restrict
temperature. After core body temperature only for English articles from 2009 to
peaks around 16:00– 20:00, core 2016.The 43 artices were found. Then, 37
temperature declines and prepares the articles were removed for double titles.
body to retire. The decrease in core After read the title, 7 were removed because
temperature rhythms in the evening is of umatched keywords, Finnally after read
mainly determined by heat loss from the the full text, 5 were selected
core to the distal body (extremities),
which is associated with increased skin RESULTS
temperature in the extremities . Warming Based on the selected articles,
the skin can activate the preoptic anterior Comparing the Effects of Reflexology and
hypothalamus. Amplitude, the difference Footbath on Sleep Quality in the Elderly: A
between the peak and trough of core Controlled Clinical Trial (Leila Valizadeh,
body temperature is associated with sleep 2016), In the foot bath group, the
depth. The gradient of temperature from intervention was effective in all the
proximal body sites (infraclavicular, components except sufficient sleep, and
thigh, stomach, forehead) to peripheral using sleeping drugs. In the control group,
sites (feet and hands) (distal– proximal the intervention was not effective in any of
skin temperature gradient, DPG) is an the components of the questionnaire. The
indirect measure of heat dissipation or score changes of the quality of sleep among
loss from the core to the periphery and the three groups showed that the most
is a predictor of sleepiness changes were related to the second and third
There is a relationship between the components, delay in falling sleep and
circadian rhythm of the skin temperature, duration of sleep. Total score changes
core body temperature, and sleep cycle with among the three groups was statistically
awakening regarding function. Rectal significant.
temperature begins to rise in the morning
after waking up and reaches its highest point DISCUSSION
(peak) in the afternoon or evening. Between Multiple factors may affect the
the core body temperature and sleep relationship between body temperatures,
tendency, there is a negative relationship; at thermoregulation and sleep in older
the beginning of sleep, when the core body adults. In addition to body temperature,
temperature significantly reduces, it is more sleep is affected by multiple factors, such
likely to occur. Reduce in body core as mood, life events, and sleep state
temperature (rectal) before and during sleep misperceptions. Single interventions, such
is associated with peripheral vasodilatation as footbath.
and possible heat loss from the body core to Yeung et al. systematically review
the peripheral parts of the body. Therefore, five clinical trials on the effectiveness of
a Footbath with warm water may increase warm footbath and other effective methods
blood flow and ambient temperature, with of dealing with insomnia. Zhao and Cao
no increase or decrease in core temperature; showed that reflexology compared with
331
routine care, significantly reduced sleep health needs of older adults, especially
disorders. According to the findings of this those residing in long-term care facilities.
study, both interventions improved the Consequently, it seems plausible that
quality of sleep in two separate aspects; strategies for enrichingthe lives of elderly
therefore, warm footbath could be people are crucial, and that reminiscence
recommended as consolidations in nondrug offers a method of promoting healthy
treatment of insomnia in the elderly. It ageing.
should be noted that footbath intervention is
an easy and safe intervention, and can be REFERENCE
easily applicable by the elderly themselves; Coats AJ. Life, quality of life and choice in
however, footbath is an intervention that an ageing society. Int J
should be carried out by a nurse or another Cardiol. 2001;78(1):1–3. [PubMed]
person. Therefore, foot bath intervention in Wu ZH, Rudkin L. Social contact,
terms of cost and effectiveness is more socioeconomic status, and the health
preferred. It is the most cheapest among status of older
others. Because there’s no need to pay much Malaysians. Gerontologist. 2000;40
todo this treatment and very suitable for the (2):228–34. [PubMed]
elderly who decline in sleep quality Li J, Yao YS, Dong Q, Dong YH, Liu JJ,
andother functions.an alternative Yang LS, et al. Characterization and
nonpharmacological therapy that is factors associated with sleep quality
effective to reduce insomnia and improve among rural elderly in China. Arch
the sleep quality of potential large older. Gerontol Geriatr. 2013;56(1):237–
43. doi:
CONCLUSION AND 10.1016/j.archger.2012.08.002. [Pu
RECOMMENDATION bMed] [Cross Ref]
Conclusion Amagai Y, Ishikawa S, Gotoh T, Kayaba K,
The available evidence reviewed Nakamura Y, Kajii E. Sleep
indicate that footbath therapy is effective to duration and incidence of
reduce insomnia and improve sleep quality cardiovascular events in a Japanese
of elders participated in the five articles. population: the Jichi Medical
Warm footbath therapy can be offered as a School cohort study. J
alternative care-delivering strategy for Epidemiol.2010;20(2):106–
elderly. However, to ensure that warm 10. [PMC free article] [PubMed]
footbath therapy is effective in various Qiu L, Sautter J, Liu Y, Gu D. Age and
settings that are related to older adults, gender differences in linkages of
nurses must consider the specific values and sleep with subsequent mortality and
experiences of older people in a specific health among very old
cultural group. Chinese. Sleep
The hot water is cheap and simple Med. 2011;12(10):1008–17. doi:
way to relieve stress, insomnia, anxiety, 10.1016/j.sleep.2011.04.014.[PMC
and fatigue by increasing the foot vessel free article] [PubMed] [Cross Ref]
expansion and blood volume is increased Chan MF, Chan EA, Mok E. Effects of
and timely ought to brain of oxygen & music on depression and sleep
nutrients needed to relieve the fatigue. quality in elderly people: A
Thus the hot water foot bath can find randomised controlled
great relief without drugs at home for trial. Complement Ther
elderly. Med. 2010;18(3-4):150–9. doi:
Recommendation 10.1016/j.ctim.2010.02.004. [PubM
Nurses are needed to evaluate and ed][Cross Ref]
design interventions targeting the gerontic
332
Ford DE, Kamerow DB. Epidemiologic Goosmann L, Astrid I. Reflex foot massage
study of sleep disturbances and points. Tehran: Nil; 2010.
psychiatric disorders. An 23. Li CY, Chen SC, Li CY, Gau ML,
opportunity for Huang CM. Randomised controlled
prevention? JAMA. 1989;262(11):1 trial of the effectiveness of using
479–84. [PubMed] foot reflexology to improve quality
Gunnarsdottir TJ, Peden-McAlpine C. of sleep amongst Taiwanese
Effects of reflexology on postpartum
fibromyalgia symptoms: a multiple women. Midwifery. 2011;27(2):18
case study. Complement Ther Clin 1–6. doi:
Pract. 2010;16(3):167–72. doi: 10.1016/j.midw.2009.04.005. [Pub
10.1016/j.ctcp.2010.01.006. [PubM Med] [Cross Ref]
ed] [Cross Ref] Cao XF, Li SF. Prevention of insomnia
Steenkamp E, Scrooby B, Van der Walt C. treated by foot acupressure. Chin
Facilitating nurses' knowledge of Med Modern Distance Edu
the utilisation of reflexology in China.2009;7:168–9.
adults with chronic diseases to Gong YL, Zhang YB, Han C, Jiang YY, Li
enable informed health education Y, Chen SC, et al. [Clinical
during comprehensive nursing care: observation on therapeutic effect of
original research. Health SA the pressing plantar reflex area with
Gesondheid. 2011;17(1):1–12. wooden needle for treatment of
Raymann RJ, Van Someren EJ. Diminished patients with insomnia]. Zhongguo
capability to recognize the optimal Zhen Jiu.2009;29(11):935–
temperature for sleep initiation may 7. [PubMed]29. Hughes CM,
contribute to poor sleep in elderly McCullough
people. Sleep. 2008;31(9):1301–
9. [PMC free article] [PubMed]
333
INTERVENTION TO REDUCE ANXIETY IN NURSING STUDENTS:
A SYSTEMATIC REVIEW
Tantri Arini, Wahyu Darnanik, Deviea Prandesya, Evi Muslicha

Faculty of Nursing, Universitas Airlangga, Surabaya
Email: ar.rhein.arini@gmail.com
ABSTRACT
Background: Conditions of anxiety and other psychological problems was found in nursing
students. Anxiety and stress were received during academic process and professional education,
such as stress due to academic load, the demands of clinical experience and other personal
issues. Various kinds of interventions are recommended to reduce anxiety in nursing student,
but has not been found the appropriate intervention which can be applied to all nursing
education settings, neither clinical education nor profession. Purposes: These sistematic review
is determined, described and analyzed the previous studies in intervention to reduce anxiety for
nursing students. Method: A systematic review was conducted using the PICO searching
method. Research articles published were restricted to 2011-2017 and identified from the
following database: Sage, Google Scholar, Proquest and Science Direct. Results: Article search
obtained 15 articles: 6 articles about mindfullness-based intervention reduction on anxiety. 1
article mentions that anxiety can not be lowered with hatha yoga meditation, while 5 other
articles mentions that mindfullness-based stress reduction on anxiety is more effective for
decreasing anxiety. Conclusion: interventions that were found effective related to
mindfullness-based stress reduction. Those are meditation, hypnosis and others. Meditation is
conducted together with internal reinforcement by words repeatedly.
Keywords: Anxiety, Nursing Students, Systematic Review.
INTRODUCTION coping strategies. Anxiety also can cause

Psychological stress is a common in illness, dependence on health services, and
the profession of nursing. Conditions declining of performance. Nursing is
associated with stress include the demands therefore recognized as a hard profession
of work, unappropriated staffing, increasing and has a lot of stressors associated with it.
number of patients, lack of administrative During the training period, nursing
support, environmental changes of health student must pay attention to the needs of
service, emotional changes due to grieving patients, providing appropriate care, and
and pain process. Stress and anxiety are also explore as much as possible the clinical
experienced by nursing students during experience. Nursing student are different to
their education. Some studies stated that other nurses who already have licensed to
stress experienced by nursing students tend work in health services or in a clinic. They
to be greater than for medical students. are not free to express their opinions and
Nursing students experienced many stages make a decision. Every day during clinical
during their education, including clinical practice nursing students witness the pain
and academic experience (Patterson, 2016). and suffering of patients joy and smiles of
Nursing student anxiety relate to patients. Those emotions can affect their
competition in academic and clinics, the use performance and general outcomes in
of the latest medical technology, financial health care (Torabizadeh, 2016).
problems, interpersonal conflicts, family Various coping stress and anxiety
problems, others physical and mental strategies have been discussed in many
problems, less of social support, and poor studies and are widely published.
334
Interventions to reduce anxiety of nursing Science Direct. Keywords used to search
students that had been reported include: the articles were: "anxiety reduction",
creating positive reinforcement, problem "anxiety intervention", and "nursing
solving approach, time management, student". The articles retrieved from Google
relaxation techniques, and also other scholar using keywords "intervention of
interventions (Patterson, 2016). Many anxiety" and " nursing student".
studies that have been published discuss The inclusion criteria used in this
reducing anxiety from a single perspective systematic review are: the article is
only eg. management of personal thoughts restricted from years 2011-2017, the
or peers only. Based on the data aboved, the research article, thesis or dissertation were
authors consider it necessary to do a published, articles in both English and
systematic review to get assess intervension Indonesian, articles with quasi experimental
for reducing anxiety of nursing student research methods, and research articles with
during the period of education. nursing student as respondents.
As a result of searching by keywords,
METHODS the corresponding articles was found. Then,
This systematic review begins with the corresponding articles were selected and
searching for articles related to the topic. included in the systematic review. The
Searching was conducted using PICO process of screening articles as listed in the
(problem, intervention, comparison and figure below. In the end, 15 articles
outcomes) framework. Problem: nursing obtained in accordance with the purpose of
student, intervention: intervention, systematic review.
comparison: -, outcome: a reduce in
anxiety. The articles were retrieved from
Google Scholar, Sage, Proquest, and
Pencarian dari Science
Direct (n=10)
Pencarian dari
Proquest (n=6)
Penapisan isi Penapisan full
(n=20) text (n=18)
Pencarian dari
google (n=7)
Pencarian dari
Sage (n=3)
Artikel yang
digunakan
(n=15)
Gambar 1. Alur Penapisan Artikel
RESULTS Research conducted by Chosiyah,

a. Reducing Anxiety Using Brain et.al. (2011), reports that anxiety can be
Gymnastics reduced by doing brain gymnastic. This
Quasi-experimental study took 30 samples
335
of 30 final-year nursing students, and Unconscious condition can control
without control group. According to the unconsciously the conscious mind and may
study, brain gymnastics is done by a simple uncover the actual ideas or thoughts far
exercises using water movements, beyond the conscious mind.
abdominal breathing, cross-motion, The conscious mind stores all
positive point, hooks relaxed, draw button, information relating to the physical,
waving legs and double streaks. The emotional, psychological and intellectual
exercise was carried out 10-15 minutes once that had acquired consciously. Whereas the
in each day. Anxiety was measured using unconscious mind automatically stores a
HAMS (Hamilton Rating Scale for person's emotions which are oftenly
Anxiety). The results showed that the illogical and irrational. Through emotions,
students anxiety reduced after brain the individual feelings become known
gymnastics. There was no control group in though sometimes people do not realize
this study. The movements of brain what their feeling are. Research conducted
Gymnastic activate neocortex and by Santoso (2014) emphasized self
parasympathetic nerve and then reduce the directing techniques of hypnotherapy.
increase of adrenaline that relieve Therapist will help students to achieve
psychological and physical tension. relaxed state, then hypnosis techniques
Therefore, the body and soul are relaxed conducted to bridge the person critical
and balanced. thinking, so the person will easily accept the
therapist suggestion.
b. Reducing Anxiety Using Laughter In another study conducted by Song
Therapy (2015), one of the strategies used was
Research on laughter therapy empowering personal thought to reduce
intervention to reduce anxiety was anxiety is mindfulness-based stress
performed by Mathofani (2012). Nursing reduction technique. Mindfulness-based
student anxiety was measured using stress reduction technique is conducted
Hamilton Rating Scale for Anxiety through meditation. Initial exercise
(HAMS). The results showed that anxiety performed for 45 minutes by paying
reduced after laughter therapy. In the study attention to the uncomfortable movement in
did not mention how laughter therapy guide lying position. Then, mindfulness-based
is done. stress reduction is conducted by alternately
standing and sitting, then noted the
c. Reducing Anxiety Using Hypnotherapy breathing rhythm of respondent.
and Meditation Mindfulness-based stress reduction carried
The author found several sources out for 8-10 weeks with meeting duration
that use subconscious or personal mind for 2-2.5 hours per week. The study
approach to cope anxiety in nursing student. reported that anxiety is reduced in the group
One of the studies, Santoso (2014) using mindfulness-based stress reduction.
mentioned that the use of direct suggestion Different result revealed by
in hypnotherapy effectively reduces the Purwaningsih (2013), mentioned that there
students anxiety who are under preparation is no effect of hatha yoga and jogging on
of the thesis. Hypnotherapy is a reducing anxiety on 8th semester nursing
combination of hypnosis and therapeutic student. The treatment group was divided
intervention or healing intervention. The into two, yoga and jogging team. Yoga is
therapist will guide the client to be more conducted twice a week with duration of 90
positive to reduce anxiety. Deep relaxation minutes, while jogging twice a week with
state has a high chance to insert the duration of 30 minutes. Shortcomings in
suggestion, this condition called trance. these study is the absence of control group
Trance is condition of unconscious. and did not explain how hatha yoga and
336
jogging procedure should be performed. So relaxation and group support in reducing
this study can not be compared with similar anxiety in nursing students. Progressive
studies. muscle relaxation conducted in this study is
Study by Malinski (2011), stated not aggressive, inexpensive and had
that co-meditation can reduce anxiety and positive impact. This relaxation technique
facilitate the relaxation. The study was using Jacobson’s progressive muscle
conducted in nursing academy. relaxation. Individual volunteers were
Respondents were all member of nursing asked to relax the muscles for 5-10 minutes
academy, including nursing student, so blood flow smooth to the muscles. Prior
lecturers, staff and others. Co-meditation explanation of the purpose is given before
could be conducted in flexible way, it may performing the progressive muscle
be changed in accordance with the state of relaxation. Progressive muscle relaxation
people. Co-meditation may be done by performed in a relaxed way, respondents
sitting, lying down or standing. The focus of were asked to lie down, accompanied by
the intervention is to create the relaxed comfortable music and in a dark room.
sensation of breathing and spread Then, respondents guided by the therapist to
throughout the body. After that, the think of unstressful things. At the end of the
facilitator will guide respondents and asked sessions, respondents were asked feedback
them to imitate the facilitator words. Then and expressed their feelings. The results of
alternately respondents were asked to say these research that there is significant
positive words during the expiration and relationship between the treatment and
will be imitated by others in those groups. control groups. Anxiety levels reduced
Research conducted by O'Brien more significant in treatment group
(2013), stated that mindfulness meditation compared to support group.
with humor can be used to reduce the e. Reducing Anxiety by Simulation
anxiety of nursing student during practice in Simulations as discussed in this
health care. The mindfulness meditation review is a simulation that is used when the
with humor is done for 4 weeks. The sample nursing student will enter clinical setting
are 73 respondents with control group. This and take the test. Several simulation
technique can be applied by lecturers during techniques will be discussed, including:
the period of education. Mindfulness patients cases simulation using probandus
meditation is done by directing person to be or simulation on standardized patients,
positive thinking. Patterson (2016) in his simulation by look at nursing expert
study mentioned that emotional freedom demonstration, as well as simulation of
technique can reduce anxiety. Emotional learning situations with humor.
freedom technique is done by pressure the One study that investigated the
midpoint of head, face, neck, chest and simulation is Coram (2015), who examined
hands. The therapy is given along with the the effectiveness of expert nurse as role
provision of positive word "Although I'm model to anxiety, self-confidence and
stressed and anxious, but I believe, can clinical judgment. This research was
accept these conditions" repeatedly. conducted on first semester students. The
Measurements of anxiety conducted at 37 treatment group was given a skill
repsondent using STAI (State-Trait Anxiety demonstration video of expert nurses, then
Inventory). These study did not use control the student using standardized simulated
group. patients (probandus) to practice skills as
seen in the video. Prior to the laboratorium
skills, all respondents submit the assigned
d. Reducing Anxiety by Relaxation task were asked before. Then, before video,
Research conducted by Torabizadeh treatment group will be given pre
(2016) studied the effects of muscle conference about the scenario faced, and
337
after that students will watch a video with research studies. According to the
duration of 5-7 minutes performed by systematic review conducted by the author,
expert nurses whose age is not much there were 6 of the 15 articles that examined
different from the respondents. The video the effects of meditation and mindfullness-
contains about nursing care performed on based stress reduction on anxiety. Based on
simulated patients. The results showed that 6 articles, one article stated that anxiety can
there is a difference between control and not be lowered with hatha yoga meditation,
treatment groups. The anxiety of treatment while 5 other articles mentioned that
group reduced when performing mindfullness-based stress reduction is more
simulations on standardized simulated effective for reducing anxiety. All of 6
patients. These study used 43 respondents, articles used quasi-experimental methods,
and had control group. and 3 studies did not use control groups,
Another study conducted by Gore while the other 3 using control groups.
(2011), stated that clinical experience
simulation can reduce anxiety. The Recommendation
simulation begins with a review of progress Based on the results of the study,
notes or patient status for 15-20 minutes. meditation techniques to reduce anxiety can
The facilitator will help to carry out the be done with different procedures, in any
assessment, formulate the priorities of kind of positions and conditions. Therefore,
nursing diagnoses and interventions. further research is needed focus on
Measurements of anxiety performed on 70 implementation of the meditation standard
repsonden using STAI (State-Trait Anxiety procedure.
Inventory. These study did not use control
group. In addition, Kameg (2014), stated REFERENCES
that the use of standardized patients will be Beggs, C., Shields, D., & Goodin, H., J.
able to reduce anxiety. The number of (2011). Using Guided Reflection to
respondents was 69 respondents. Reduce Test Anxiety in Nursing
Students. Journal of Holistic
DISCUSSION Nursing, vol 29 number 2, 140-147,
The results of the study stated that doi 10.1177/0898010110393352.
meditation, hypnosis or therapy that comes Carver., M., L., & O’Malley., M. (2015).
from the inside of mind is more effective Progressive Muscle Relaxation to
than intervention from outside. Meditation Decrease Anxiety in Clinical
techniques to reduce anxiety can be done Simulations. Teaching and Learning
with different procedures, because it has in Nursing (2015) 10, 57-62.
been not found the standard operational Chen, Y., Yang., X., Wang., & Zahng., X.
procedure of meditation. Meditation (2013). A Randomized Controlled
techniques may be performed in any kind of Trial of the Effect of Brief
the position and condition, as far as a person Mindfulness Meditation on Anxiety
feels comfortable. Meditation techniques Symptoms and Systolic Blood
are also carried out in environment that Pressure in Chinese Nursing
make person comfortable. Meditation is Students. Nurse Education Today 33
given together with internal reinforcement (2013) 1166-1172.
by words repeatedly. Chosiyah, N., Saparwati, M., & Novitasari,
L. (2011). Pengaruh Senam Otak
CONCLUSION AND Terhadap Penurunan Kecemasan
RECOMMENDATION Mahasiswa Tingkat Akhir S1
Conclusion Keperawatan Stikes Ngudi Waluyo
Interventions to reduce anxiety are Ungaran. Retrieved January 7,
widely reported as a result of scientific 2017 from
338
http://perpusnwu.web.id/karyailmia Retrieved January 7, 2017 from
h/documents/3423.pdf. http://search.proquest.com/pqdthss/
Coram, C. (2015). The Effect of Expert Role docview/1432008708/fulltextPDF/
Modelling on Anxiety/Serl- 6E65B4205C39476EPQ/2?account
Confidence and Clinical Judgement id=31533.
in Novice Nursing Students. Patterson, S., L. (2016). The Effect of
Retrieved January 7, 2017 from Emotional Freedom Technique on
http://search.proquest.com/pqdthss/ Stress and Anxiety in Nursing
docview/1734104884/fulltextPDF/ Students: a Pilot Study. Nurse
3A4AB23D0121454APQ/17?accou Education Today 40 (2016) 104-
ntid=31533. 110.
Fuson, J., K. (2011). The Use of Music to Purwaningsih, Wahyu, M., Kardiwinata,
Reduce Test Anxiety in Nursing M., P., & Suari, N., W. (2013).
Students. Retrieved January 7, Pengaruh Pemberian Hatha Yoga
2017 from dan Jogging Terhadap Kecemasan
http://search.proquest.com/pqdthss/ pada Mahasiswa Semester VIII
docview/1114505641/fulltextPDF/ PSIK FK Universitas Udayana.
A0D8EBAA56564291PQ/20?acco Retrieved January 7, 2017 from
untid=31533. http://ojs.unud.ac.id/index.php/copi
Gore, T., Hunt, C., W., Parker, F., & ng/article/download/6125/4616.
Raines, K., H. (2011). The Effect of Rawiti, NMR., Adilatri, S. A., & Prapti, K.
Simulated Clinical Experience on G. (2014). Pengaruh Pijat Tangan
Anxiety: Nursing Students’ dna Aroaterapi Lavender Terhadap
Perspective. Clinical Simulation in Tingkat Kecemasan Mahasiswa
Nursing (2011) 7, e175-e180. Sebelum Ujian Lab Klinik
Kameg., K., M., Szpak., J., L., Cline., T., W., Keperawatan). Retrieved January
& Mcdermott., D., S. (2014). 7, 2017 from
Utilization of Standardized to http://ojs.unud.ac.id/index.php/copi
Decrease Nursing Student Anxiety. ng/article/view/10770.
Clinical Simulation in Nursing Santoso, W. W., & Dewi, D. K. (2014).
(2014) 10, 567-573. Efektifitas Hypnoterapy Teknik
Malinski, V., & Franceschi, V., T. (2011). Direct Suggestion Untuk
Exploring Co-Meditation as a Menurunkan Kecemasan
Means of Reducing Anxiety and Mahasiswa Terhadap Skripsi.
Facilitating Relaxation in a Nursing Retrieved January 7, 2017 from
School Setting. Journal of Holistic http://ejournal.unesa.ac.id/index.ph
Nursing, vol 29 number 4, 242-248, p/character/article/view/1098.
doi 10.1177/0898010111398334. Song, Y., & Lindquist, R. (2015). Effect of
Mathofani, W., & Wahyuni, S. E. (2012). Mindfulness-Based Stress
Terapi Tertawa dan Kecemasan Reduction on Depression, Anxiety,
Mahasiswa Program Ekstensi Stress and Mindfulness in Korean
Dalam Menghadapi Skripsi di Nurisng Students. Nurse Education
Fakultas Keperawatan USU. Today 35 (2015) 86-90.
Retrieved January 7, 2017 from
http://jurnal.usu.ac.id/index.php/jkh
/article/view/49.
O’Brien, D. (2013). Using Mindfulness
Meditation Intermixed with Humor
to reduce Anxiety Among Nursing
Students During Clinical Practice.
339
POISONING DUE TO PESTICIDE SPRAYING VIEWED FROM PERSONAL
HYGIENE AND LONG EXPOSURE TO ONION FARMERS IN SUMBERJO
NGANJUK
Indasah, Yuna Ayu Fitrianingtias

Institute of Health Science Surya Mitra Husada Kediri
Email: -
ABSTRACT
Introduction: Pesticide poisoning is the influx of chemicals into the human body through
direct contact, inhalation, ingestion and absorption, causing negative effects to the body.
Poisoning can occur due to the influx of excessive pesticides or for ignoring safety procedures,
health and safety and working equipment are inadequate. The purpose of this study to
determine the effect of personal hygiene and long exposure to poisoning due to pesticide
spraying on onion farmers in the village of Sumberjo, the District of Gondang, the Regency of
Nganjuk. Methods: The design study is observational with cross sectional approach. The
population in the study was all members of farmers 150 farmers with 109 respondents sample
simple random sampling technique. The data collection is using the questionnaire. Results:
The results showed most of the onion farmers have personal hygiene enough categories by 47%
(51 respondents), farmers spraying pesticides with a long exposure of more than 4 hours / day
by 56% (61 respondents), and the farmers who suffered the poisoning was by 42 % (46
respondents). The results of the analysis of ordinal regression test no influence personal
hygiene and long exposure to poisoning due to pesticide spraying by 14.3% to 0.002 p value
<0.05 then H0 is rejected. Conclusion: Pay attention to personal hygiene including the use of
personal protective equipment (PPE) as well as the spraying of pesticides full accordance with
the rules and procedures appropriate security is strongly recommended to farmers to avoid the
danger of pesticide poisoning that can improve the health of onion farmers.
Keywords: onion farmer, pesticide poisoning, personal hygiene, long exposure.
INTRODUCTION Most cases of poisoning in developing

The use of pesticides is increasingly countries, 20,000 of them fatal. Farmers as
high, especially in developing countries in a pesticide users have the highest risk of
Asia, Africa, Central America and Latin exposure to pesticides resulting in disability
America. Developing countries are only and death, the results showed high
using 25% of total pesticide use around the incidence of pesticide poisoning caused by
world (world-wide), but in the case of between 20-50% (MOH, 2005).
deaths caused by pesticides, 99% Test results on blood cholinesterase
experienced by the countries in the region. farmers in Nganjuk (2001) showed that out
According to WHO (World Health of 22 people onion farmers who examined
Organization) this is due to the low his blood cholinesterase activity, 12
educational level of farmers in the country (37.5%) mild poisoning, and 10 (31.25%)
that use tends to be unsafe manner or not in of severe poisoning (Alkadri, 2009).
accordance with existing rules. In some cases direct pesticide
According to estimates by the poisoning, according Djojosumarto (2005)
World Health Organization (WHO) and in Nuryana (2008) states that the work that
Environment Program of the United most often lead contamination is mainly
Nations (UNEP) 1.5 million cases of spraying when applying pesticides.
pesticide poisoning in agricultural workers. Spraying pesticides that do not meet the
340
rules will lead to many effects, including near the fields without using soap and wash
impacts to human health is the incidence of work clothes without using detergent. It
poisoning to the individual farmers often triggers farmers suffered poisoning
(Djafaruddin, 2006) in Nuryana (2008). In from contaminated by exposure to
this case the farmers in spraying pests must pesticides.
use personal protective equipment, conduct From the preliminary study
spraying technique correct, and maintain conducted on 24 April 2016 Sumberjo
personal hygiene to avoid contamination of village there are 5 farmer groups with 30
pesticides, but farmers users tend to members in each group brackish. Onion
underestimate the dangers of pesticides so farmers in the village Sumberjo use an
that they do not comply with the average class of organophosphate
requirements for safety and health in the pesticides to eradicate the pest (plant pests)
use of pesticides including the use of shallots and average farmers to spray 10-15
personal protective equipment and spraying times per season (2 months) depending on
application techniques. Pesticide poisoning the pest (plant pests) that attack the onion
is often not felt and due to unpredictable crop in one year, there are 3 red onion
encouraging them to apply pesticides in season. Spraying activities throughout the
their way because it does not feel disturbed year, so that the level of exposure of
(Djojosumarto, 2005) in Nuryana (2008). farmers to pesticides is very high, it further
Based on preliminary studies that illustrates the risk level of farmers against
researchers do the onion farmers in the pesticide poisoning. Basic information
village of Sumberjo active spraying about pesticide poisoning, personal
pesticides on average had experienced hygiene, and the factors that influence
symptoms of poisoning such as headaches, pesticide poisoning in specific onion
like vomiting, sweating, weakness, even in farmers in the village of Sumberjo is yet
2015 has never been even one (1) case of available.
onion farmers red suffered pesticide Based on the above background, the
poisoning to experience vomiting and researcher interested to study about
fainting were then taken to the District personal hygiene and long exposure to
General Hospital Nganjuk. Based on pesticides on onion farmers against
observations and interviews researchers to poisoning due to pesticide spraying under
farmers in the village of Sumberjo seen the title: "Poisoning Due Pesticide Spraying
from the duration of exposure to pesticides Seen From Personal Hygiene and Long
the farmers on average worked from seven Exposure At Farmers Onion In the village
o'clock to twelve o'clock, if the pest attack Sumberjo the District Gondang Nganjuk ".
increases the farmers also increase the
frequency of spraying, in a week sometimes METHODS
more than three times spraying, and the In this study, it is using
average farmer has more than one rice field, observational study design. This type of
so that every day they have to move from research used in this research is analytic
one to the rice paddy others to do the survey research with cross sectional
spraying, that's what every day brings approach. Total sample is109 respondents
farmers exposed to pesticides longer. who are active members of farmers
Besides personal hygiene onion farmers are spraying pesticides by simple random
still poor, many farmers who wash hands sampling method in the District Gondang
without using soap on the flow got former Village Sumberjo Nganjuk.
stream they passed when spraying, and at The primary data collection is using
meal times they do not use a spoon and still the questionnaire. The questionnaire was
wearing work clothes used when spraying, divided into three groups of questions or
farmers also often bathe in the diesel wells statements include; The first question of the
341
general characteristics of respondents B. Variable characteristics
including pesticide spraying long exposure; Table 2. Characteristics Variable Based on
Secondstatements regarding personal Personal Hygiene, Long Exposure, and
hygiene and; The third statement about the Toxicity Due Pesticide Spraying
poisoning due to pesticide spraying. Characteristics N %
Furthermore, the recapitulation of the Personal Hygiene
questionnaire was analyzed using statistical Good 20 18
test Ordinal Regression. Enough 51 47
Less 38 35
RESULTS
A. Characteristics of Respondents Long exposure
Table 1. Characteristic of Respondents by ≥5 hours / day 48 44
Age, Old Work, Education, And Pesticide <5 hours / day 61 56
Active Ingredients Used Poisoned
Characteristics N % Mild poisoning 44 40
Age poisoning Medium 46 42
20-25 21 19 poisoning weight 19 17
26-31 16 15
32-37 15 14 Source: Data Analysis Results
38-43 18 16
44-49 18 16 C. Test Results Statistics
50-55 16 15 Table 3. Statistical Test Results Model
56-61 5 5 Fitting Information
Long Working
-2 Log Chi- Sig.
2-7 19 17 Model df
Likelihood Square
8-13 21 19
14-19 15 14 Intercept
51.327
20-25 15 14 Only 0.002
36.764 14.564 3
26-31 16 15 Final
32-37 9 8 Statistical test results using ordinal
38-43 11 10 regression test to 109 respondents with α =
44-49 3 3 0.05 was obtained p value of 0.002 (0.002
Education <0.05) reject H0 This means that there is
Never Schools 12 11 the influence of personal hygiene and long
Primary school 27 25 exposure to poisoning due to pesticide
Junior high school 37 34 spraying on onion farmers in Sumberjo
Senior High School 27 25 village Gondang district Nganjuk.
College/University 6 6
Pesticide Active Statistical test results in this study were
Ingredients 23 21 obtained Pseudo R-square value at
Tetraethylpyrophosphate 11 10 Nagelkerke amounted to 0.143 this means
Klorfenafir 10 9 that personal hygiene and poisoning due to
Abamectin 30 28 long exposure affects 14.3% of pesticide
dichlorvos 16 15 spraying and spraying pesticide poisoning
Acetate 11 10 is influenced by other factors amounted to
Triazofos 8 7 85.7%.
profenofos
Source: Data Analysis Results
342
DISCUSSION without the use of PPE, are smoking at the
A. Personal Hygiene time of spraying, pausing to drink and eat
Of the 109 respondents acquired and then continued spraying. At mealtime;
mostly onion farmers have enough personal drink; the smoking or do not bathe or wash
hygiene by category by 47% (51 your hands first with water and soap. If the
respondents). fields far from the wells used to wash hands
Based on the results of cross diesel farmers in rice paddies former street
tabulations age of respondents with gutter flow spraying and rinsed with
personal hygiene known to most farmers potable water carried. So the farmers at the
aged 20-25 years old have enough personal time of eating, drinking, and smoking are
hygiene category of 10.1% (11 still in the condition of the body is not clean
respondents). Long worked with personal and not replace work clothes.
hygiene known to most farmers to work 8-
13 years old have enough personal hygiene B. Long exposure
category by 8.3% (9 respondents). Of the 109 respondents mostly do
Education with personal hygiene is known long exposure to the pesticide spraying
to most farmers with personal hygiene more than equal to 5 hours / day by 56% (61
education SMP have enough categories of respondents).
15.6% (17 respondents). The active Based on cross-tabulations of age
ingredients of pesticides with personal with long exposure to the pesticide spraying
hygiene known to most farmers use is known mostly 20-25-year-old farmer
pesticide active ingredient dichlorvos have spraying pesticide with a long exposure is
enough personal hygiene category was less than 5 hours / day by 11.9% (13
13.8% (15 respondents). respondents). Long worked with long
Personal hygiene onion farmers exposure to the pesticide spraying known to
surveyed in the village Sumberjo most still most farmers to work 8-13 years old
have enough categories. This is because of spraying a pesticide with long exposures
the attitude of farmers in the use of personal more than equal to 5 hours / day by 11.9%
protective equipment (PPE) many are (13 respondents). Education with a long
incomplete because of discomfort when exposure to the pesticide spraying known to
wearing personal protective equipment most farmers spraying pesticides junior
(PPE) is complete. Farmers just wear a hat high school education with a long exposure
and a long shirt to protect from the sun. of more than equal to 5 hours / day
Farmers believe that the situation as it is amounted to 23.9% (26 respondents). The
common. Masks they use are usually in the active ingredient of pesticides used by
form of masks "kerojong" threadbare or farmers with long exposure to the pesticide
torn used instead of a hat and a mask, there spraying known to most farmers use
is also a long-sleeved shirt tied around his pesticide active ingredient dichlorvos
head and covered his face instead of a mask. spraying pesticides by long exposure to
This greatly affects the exposure to more than equal to 5 hours / day 16.5% (18
pesticides can enter through the respiratory respondents).
tract (mouth and nose) or through the skin Based on research in the field most
(inhalation). Rarely do the farmers wear of the farmers in the village Sumberjo
gloves and goggles. spraying more than equal to 5 hours / day,
In addition APD onion farmers in this is because the land owned by farmers
the village of Sumberjo also pay less an average of nearly 1 Ha, so farmers work
attention to personal hygiene in the the farming land owned start spraying,
moments before spraying; at the time of watering morning and evening, cleaning
spraying; and after spraying. Farmers, who grass done alone. Therefore they began
make a habit of pesticide formulations their work from early morning until noon
343
and then resumed again in the afternoon. On the sidelines of spraying or spraying is
Their activities are mostly spent in the finished they normally eat "lunch" they had
fields to care for their onion planting. If brought from home. This can affect the
pests increased by almost all farmers health status of farmers because of
spraying pesticides on a daily basis, it is not cleanliness and personal hygiene is lacking,
uncommon that spraying from morning till they only wash their hands in the rice fields
noon without regard to time and long with makeshift water is not clean and do not
exposure to the pesticide spraying. In fact, use soap. Farmers always underestimate
according to the theory put forward these things when could endanger the safety
Novizan (2002) suggested in general a good and health of farmers.
time to spray the pesticide is in the morning
at 7 am to 10 am and afternoon from 3 pm D. Effect of Personal Hygiene and Long
to 6pm. Exposure Due Pesticide Spraying
Against Poisoning
C. Due Spraying Pesticide Poisoning
Based on the results of the ordinal
Of the 109 respondents found most regression analysis results obtained 14.3%
of the onion farmers in the village of of personal hygiene and long exposures
Sumberjo poisoning was by 42% (46 affect poisoning due to pesticide spraying
respondents). on onion farmers with p value 0.002 <0.05.
Based on cross-tabulations Age Under these conditions, H0 is rejected and
poisoning known to most farmers aged 20- H1 accepted which means that there is the
25 years experienced mild poisoning by influence of personal hygiene and long
8.3% (9 respondents) and poisoning was by exposure to poisoning due to pesticide
8.3% (9 respondents). Long worked with spraying on onion farmers.
poisoning known to most farmers to work Results were also consistent with
8-13 years old suffered mild poisoning of research Aulia (2016), in which the
10.1% (11 respondents). Education with statistical test using the Fisher Exact Test, p
poisoning is known to most farmers with value of 0.038 obtained. Then the p value
junior educational experience mild less than 0.05 (0.038 <0.05), which means
poisoning at 18.3% (20 respondents). The there is a significant correlation between
active ingredients of pesticide poisoning the level of personal hygiene farmer
are known to most farmers use pesticide spraying pesticide poisoning in the Hamlet
active ingredient dichlorvos poisoning was Banjarrejo Cepogo Kembang Kuning
12.8% (14 respondents). District of Boyolali.
Based on the results of research in Related to long exposure in line
the field is a lot of farmers who suffered with the results of Yahya (2009) in which
moderate and severe poisoning. Farmers the statistical test by using ANOVA, p
often complain of headaches, like vomiting, value = 0.003 (p <α = 0.05) so that it can be
watery eyes, blurred vision, sweating, pain interpreted that there is a long exposure
in muscles and sudden tremors after effect vegetable growers use pesticides to
spraying pesticides. These complaints arise farmers of blood cholinesterase activity,
because farmers do not pay attention to the where blood cholinesterase levels signify
procedures spraying appropriate, such as: lower peasant farmers suffered poisoning.
personal hygiene including the use of PPE
is complete, and the spraying technique that CONCLUSION AND
is true, it is not uncommon farmer spraying RECOMMENDATION
is not in accordance with the direction of Conclusion
the wind, blowing nozzle clogged with the Most of the onion farmers have
mouth directly. In addition, farmers often enough personal hygiene categories by
bring their own food and drinks from home. 47% (51 respondents). Most of the onion
344
farmers spraying pesticides by long cleanliness of the water used in
exposure to more than equal to 5 hours / day pesticides applied in including hand
by 56% (61 respondents). Most of the onion washing and showering after spraying,
farmers being poisoned by 42% (46 pesticide storage, compliance in full
respondents). There is the influence of PPE receipts from when preparing
personal hygiene and long exposure to pesticides until such time as pesticide
poisoning due to pesticide spraying on spraying applications, as well as the
onion farmers in the village of Sumberjo examination of blood cholinesterase
the District of Gondang in Nganjuk with p levels in farmers so that the results can
value of 0.002. be used for comparison with the results
of this study, it can then complement
Recommendation theories that can strengthen the
1. For Farmers, is expected to improve research.
personal hygiene and how good
pesticide spraying applications and REFERENCE
according to the rules correctly; more Alkadri Wan. (2009). Pengembangan
active in seeking information in Kabupaten / Kota Sehat. Jakarta:
recognizing pesticide poisoning and Ditjen PP & PL Depkes RI.
how to cope with poisoning due to Aulia. (2016). Hubungan Hygiene
pesticide spraying; as well as routine Perorangan dan Cara Penyemprotan
medical examination at the health Pestisida Dengan Tingkat
center or Other Health Services. Keracunan Pestisida Pada Petani di
2. For Academic See more about these Desa Kembang Kuning Kecamatan
findings, it can be used as one of Cepogo Tahun 2016. Skripsi.
literature in teaching and learning can Surakarta: Universitas
be applied in practice in the field in Muhammadiyah Surakarta.
order to improve preventive measures Departemen Kesehatan RI (2005).
the incidence of poisoning due to Pengggunaan Pestisida. Jakarta
pesticide spraying and promoting health Djojosumarto. (2008). “Pengantar Teknik
status of farmers. Penyemprotan Pestisida”.
3. Health Agencies, expected health (http://www.slideshare.net/djojosu
workers conduct periodic health checks marto/pdf-b4pengantar-teknik-
and provide counseling to farmers penyemprotan). Diakses tanggal 23
about personal hygiene, spraying Mei 2016.
pesticides, and actions to take in case of Djojosumarto. (2008). Pestisida dan
pesticide poisoning. Aplikasinya. Jakarta: Agromedia
4. Agencies Agriculture, agricultural Pustaka.
institutions are expected to provide Nuryana. (2005). Dampak Penggunaan
oversight in the use of pesticides, Pestisida Terhadap Penurunan
provide information pesticide Aktivitas Enzim Asetilkolinesterase
poisoning prevention, help improve Pada Petani Bawang Merah.
safety and health in the form of the Tesis.Program Studi Pengelolaan
provision of a complete PPE, Sumberdaya Alam dan
supervision during the spraying season, Lingkungan. Bogor: Institut
and look spraying technique performed Pertanian Bogor.
by farmers directly WHO. (2005). WHO Guidelines on Hand
5. Other researchers, it is expected that the Hygiene in Health Care (Advance
results of this study can be used as a Draft). Switzerland: WHO Press.
reference for further research such as on Yahya. (2009). Pengaruh Penggunaan
the cleanliness of the farmhouse, the Pestisida Golongan Organofosfat
345
Dan Karbamat Terhadap Aktifitas
Cholinesterase Darah Petani. Tesis.
Makassar: Universitas Hasanuddin.
346
ANALYSIS OF THE MAIN INDICATORS OF NUTRITION AWARE FAMILY
(KADARZI) ON THE OCCURRENCE OF MALNUTRITION IN CHILDREN UNDER
FIVE YEARS IN THE WORK AREA HEALTH CENTERS NORTHERN
TERRITORY OF KEDIRI
Nurwijayanti, Ika Dwi Astutik, Panca Radono

Institute of Health and Science Surya Mitra Husada Kediri
Email: -
ABSTRACT
Introduction: Kadarzi (Nutrition Aware Family) is a family that is able to recognize, prevent
and address nutritional issues of every member. Results: From the research almost all families
with children under five malnutrition is not behaving Kadarzi that 45 families (86.54%) and 7
families (13.46%), others behave Kadarzi. From the statistical test Dummy Linear regression
showed that the 0.02 significance value less than 0.05 means that a significant standard
acceptable alternative hypothesis, that there is the effect of applying Nutrition Aware Family
(Kadarzi) Toward Less occurrence of Nutritional Status in Toddlers In in the Northern Region
Health Center Kediri. The result of the variable nutritional supplement drink affected
occurrence of malnutrition in children under five in the Work area of the City Health Center,
Northern region is in line with research conducted by Jannah (2010) at the Health Center of
north Kambat middle stream Hulu on the effect of vitamin supplementation to changes in
nutritional status (B / U) toddler BGM. After testing subset of the statistics where p value =
0.0000 which is smaller than the value of alpha (0.05). Conclusion: So, there is the effect of
vitamin supplements on Changes in Nutrition Status (W / A) Toddler BGM. One of the factors
that affect the growth and development of children is nutrition. Malnutrition in food cause
impaired child growth that will affect the development of the entire body.
Keywords: kadarzi, malnutrition, toddler
INTRODUCTION According to the World Health

Efforts to improve public nutrition Organization (WHO) in 2012, 99 million
as stated in Law No. 36 Year 2009 on children under five are underweight. But
Health, aims to improve the nutritional this figure has decreased compared to the
quality of individual and community, year 2010 as many as 102 million children
including through the improvement of food under five are underweight. In 2012, 67% of
consumption patterns, behavior all underweight children live in Asia and
improvement aware of nutrition, improving 29% in Africa.
access and quality of services of nutrition East Java Province, in this case the
and health in accordance with the progress Nutrition Section of East Java Provincial
of science and technology. Health Office has activities Nutritional
Nutritional problems occur in every Status Monitoring (PSG). The prevalence of
cycle of life begins in the womb (fetal), infant malnutrition is one of the indicators
infant, child, adult and elderly. A second of the MDGs and the Strategic Plan Health
period of life is a critical period, because at Office of East Java province, based on an
this time there is a growth and very rapid index Weight Loss by Age (W / A), ie from
development. Nutritional disorders that the numbers weight (BW) is very less and
occur during this period resulted in a the weight (BW) less, And based on the
permanent, cannot be restored even if results of PSG in 2014, East Java has
nutrient needs are met for the next period. successfully reached under the MDG target
347
(15.5%) and the Strategic Plan (15.1%) utilization by the public service facilities.
which amounted to 12.6% (10.3% Less Figures achievement toddler was taken to
Weight and Weight Very Less 2.3%). an integrated service post for weighed
Cases of infant malnutrition is still Kediri is still relatively low, in 2014 figure
prevalent in the city of Kediri, namely by of 75.8% achievement, where the toddler
3.4% or 500 toddlers in 2013.pada 2014 by was taken to a target of achieving an
3.5% or 617 children under five, and in integrated service post for weighed is 80%,
2015 by 4.6% or 779 toddlers and public while for the achievement Exclusive
health centre which is most high increase in breastfeeding by 53.5%. This figure is still
cases of infant malnutrition is Public Health very far from achieving the fulfillment of
Center Northern Territory, namely by 4.6% the targets exclusive breastfeeding in the
in 2013, 11.8% in 2014 and 4.7% in 2015. amount of 85%.
There are many factors that can affect the Survey Kadarzi in Kediri on 2014
incidence of infant malnutrition. showed that 51% of families in the town of
The increasing cases of malnutrition Kediri already behaved Kadarzi, while the
in the Work Health Center Northern results of the survey in the Northern Region
Territory is because toddlers do not get the Health Center are as follows: 89.8%
diversification of food, so it does not get the children are weighed regularly to
nutrients are balanced, with the provision of neighborhood health center; 42.9% of
a balanced diet toddler will get nutrition to infants 0-6 months get exclusively breast-
increase their nutritional status, if toddlers fed; 64.8% of families eat a variety of foods;
are not getting a balanced diet the 100% of the families taking iodized salt and
nutritional status will decrease and result in 97% of families drink nutritional
less nutrition. The low exclusive supplement, and which implements the five
breastfeeding which can make children indicators only 59% means that there are
susceptible to disease so that the nutritional 51% of the families in the Northern
status of children has declined or the child Territory Health Center that has not
will get malnutrition. Exclusive behaved Kadarzi.
breastfeeding is very important for toddlers The low behavior nutrient of
because with exclusive breastfeeding families will be able to have an impact on
toddlers will not be susceptible to disease health status and nutritional status of
which will affect the nutritional status of children. This situation can be seen from the
children. As well as the high percentage of 54% children had a fever in the last 3
mothers who work shows that parents months, 20.69% children with malnutrition
cannot directly provide supervision to and 5.17% children with poor nutritional
toddlers, and cannot directly monitor status, when seen in KMS toddlers, the
nutritional status. weight is below the red line. Seeing the
Nutritional condition is affected by impact and some research results as well as
nutrition and infectious diseases are the prevalence of malnutrition, Kadarzi
interlinked. Family and community level behavior is one important part in tackling
nutritional problems is affected by the the acute-chronic nutritional problems as
knowledge and ability of families to provide well as improving other factors such as
food for its members both the number and maternal education, infections, nutrition
types according to the nutritional needs, the consumption and environmental health.
availability of health services and There was a significant influence on the
nutritional quality, affordable, as well as the behavior of households Kadarzi nutritional
ability and knowledge of the family in terms status of children in Trenggalek.
of personal and environmental hygiene. Based on the description above, the
Image that show for the bad researchers want to find out more about the
nutrition behavior also indicated by the low how the analysis of the main indicators of
348
Nutrition Aware Family (Kadarzi) on the and a questionnaire to determine the
occurrence of malnutrition in children behavior of Kadarzi. The research was
under five. The researchers took the title carried out in the region of North City
"Analysis of the main indicators of nutrition community health centers, Kediri City in
aware family (Kadarzi) on the occurrence of August 2016, for approximately 2 weeks.
malnutrition in children under five years in The collections of data were
the Work Area Health centers Northern primary data and secondary data. Primary
Territory of Kediri’. data include data on weight, Kadarzi
indicator data. To determine the weight of
METHODS each respondent weight measurements were
This research design was using taken using digital scales, and then fill out a
observational study with cross sectional questionnaire to determine the behavior
approach. The study population was Kadarzi the family of toddlers with
families who have children with malnutrition through interviews with
malnutrition in the Work Area Health mothers. Secondary data was taken from the
centers Cities Northern Territory Kediri. department of Health Kediri.
The sampling technique in this study is The collected data then will be
simple random as many as 52 toddlers. processed. Data processing is done by
In this research there are editing that is by checking the data
independent variables and the dependent obtained. Encoding is done by giving the
variable. The independent variables studied code on each characteristic. The next
were nutrition aware family (Kadarzi) process is the analysis of the data. The
consist of: a child's weight, exclusive analysis is a Dummy linear regression to
breastfeeding, consumption of diverse food, determine the independent variables are
use iodized salt, and take nutritional most influential on the Nutritional Status
supplements (vitamin A high dose) as Less in Toddlers at Work Areas City Center
recommended, a data collection method the Northern Territory public health.
researchers used was a structured interview
using a questionnaire Kadarzi. The RESULTS
dependent variables studied were Characteristics of the subjects in this
malnutrition in toddlers; the researchers study include gender, age, and weight of
used the tool to collect malnutrition data by malnutrition toddlers. The description of the
using measuring device weight infants in characteristics of the subject as shown in
the form of digital scales. Table 1.
The instruments used are digital
scales to measure the weight of each toddler
Table 1. Characteristics of Research Subjects are gender, Age, Weight of malnutrition Toddler
Characteristics Regularly Weight Exclusive Consumption of Use Iodized Salt Take Nutritional
Breastfeeding Diverse Food Supplements (Vit A)
F % F % F % F % F %
Gender
F 25 48 14 6.9 3 5.8 27 51.9 21 40.4
M 24 46 9 7.3 7 13.5 25 48.1 22 4

Age
12-23 11 21.2 7 13.5 2 3.8 13 25.0 6 11.5
24-25 9 17.3 4 7.7 3 5.8 9 17.3 9 17.3
36-47 19 36.5 6 11.5 5 9.6 19 36.5 18 34.6
48-59 8 15.4 6 11.5 0 0.0 9 17.3 8 15.4
Weight (Kg)
<10 22 42.3 12 23.1 5 9.6 24 46.2 17 32.7
10-15 27 51.9 11 21.2 5 9.6 28 53.8 26 50.0
349
Based on Table. 1 shows that the The Univariate Analysis
majority of subjects who did the indicators After collecting data, coding is done,
of Kadarzi are the male gender, age range editing, tabulating, and analyzing research
between 36-47 months, and weight between data. Result of univariate analysis is shown
10-15 kg. in Table 2.
Table 2 Results Analysis of application Nutrition Aware family (Kadarzi) on the occurrence of
less Nutritional Status in Toddlers.
Variable Sig Value R-Square Unstandardized
Coefficients
(B) Sig (B) Sig (B) Sig
Regularly Weight 0.02 0.219 -0.008 0.967
Exclusive breastfeeding -0.067 0.386
Diverse food 0.242 0.016
Iodize salt - -
Nutrition Suplement 0.286 0.021
Based on the results of data analysis uniform value throughout the toddler using
using regression test Linier Dummy with a iodized salt (100%).
degree of error of 0.05 obtained p-value of
0.02 <0.05, then the alternative hypothesis DISCUSSION
is accepted which means there is the effect Kadarzi (nutrition family aware) is a
of applying Nutrition Aware Family family that is able to recognize, prevent and
(Kadarzi) on the occurrence of malnutrition address nutritional issues of every member.
Work under-fives in the area of public From the research almost all families with
health Center Northern territory town of children under five, malnutrition is not
Kediri. Obtained R-square value of 0.219, behaving Kadarzi that 45 families (86.54%)
which means weighing, exclusive and 7keluarga (13.46%), others behave
breastfeeding, consumption of diverse food Kadarzi. By behaving Kadarzi, the family
and drink nutritional supplements influence expected to have attitudes and behaviors
the occurrence of malnutrition in children can independently realize the nutritional
under five by 21.9%, while 78.1% affected state as well as possible. In the family aware
by other unknown factors. of nutrition at least one member of the
From the five indicators in the family who are consciously willing to make
variable Kadarzi acquired two significant changes in family behaved towards good
variables that are diverse food consumption nutrition and true.
(0.016) and take nutritional supplements These results are consistent with
(0,021), which means the consumption of descriptive research conducted by
diverse food and drink nutritional Nurmayati (2002) in the village Betet
supplements affect the occurrence of Kediri mention that the implementation
malnutrition in children under five. But the Kadarzi only done by some of society who
most variable which influence on the have obstacles educational and weak
incidence of malnutrition is nutritional economic factors.
supplements because it has the largest B The purpose of this study is to
value among other variables (0.286). analyze the main indicators of Nutrition
Consumption of Iodine Aware Family (Kadarzi) on the occurrence
Supplements cannot be analyzed in the of malnutrition in children under five in the
statistics because the results showed that a Work Area Health centers Cities Northern
Territory Kediri.
350
From the statistical test Dummy Results of research on variable drink
Linear regression showed that the 0.02 nutritional supplements influence the
significance value less than 0.05 means that occurrence of malnutrition in children
a significant standard acceptable alternative under five in the Work Area Health Center,
hypothesis, that there is the effect of City of the North region is in line with
applying Nutrition Aware Family (Kadarzi) research conducted by Jannah (2010) in
Toward Less occurrence of Nutritional Health centers Kambat North Hulu river
Status in Toddlers at Work Area Health middle on the effect of vitamin
centers Northern territory city of kediri. supplementation on changes in status
Kadarzi is a movement nutrition (W / A) toddler BGM. After
associated with the program Family Health testing subset of the statistics where p value
and Nutrition (KKG), which is part of the = 0.0000 which is smaller than the value of
Family Nutrition Improvement Effort alpha (0.05). So, there is the effect of
(UPGK). Called Kadarzi if the attitudes and vitamin supplements on Changes in
behavior of families can independently Nutrition Status (W / A) Toddler BGM. One
realize the nutritional state as well as of the factors that affect the growth and
possible which is reflected in the food development of children is nutrition.
consumption of diverse and high quality Malnutrition in food cause impaired child
balanced nutrition. With Kadarzi program growth that will affect the development all
expected to increase notably public health of the body.
to reduce the incidence of malnutrition. In The emergence of malnutrition is
line with the implementation of government not only because the food is lacking but also
programs Kadarzi should still give attention because of the disease. Children who are get
to the people who conducted among others good food but often attacked diarrhea or
by continually promoting and providing fever, finally they will get malnutrition. In
infrastructure facilities in order to achieve contrast, children who eat is not good
Kadarzi program. While for the community enough then the body resistance (immunity)
is expected to continue to participate in may be weakened, so vulnerable to
implementing the program well. infectious diseases, lack of appetite and
Nutritional status of children is one eventually susceptible to malnutrition.
indicator of health assessed the success While variety of foods influence the
achieved in the MDGs (Millennium occurrence of malnutrition in children
Development Goals). The nutritional status under five in health centre Northern region
is important because it is one risk factor for is in line with research conducted by
morbidity and mortality. Kadarzi behavior Purwaningrum (2010) using bivariate
is a factor that can affect the nutritional analysis showed that food intake related to
status of children because the mother has a the nutritional status of children.
habit behavioral nutrition conscious Toddlers with normal nutritional
families will be able to monitor the status, most of them have sufficient food
development and growth of infants. intake. This indicates that food directly
Obtained significant value on 2 affects the nutritional status.
variables: varied food consumption (0.016)
and nutritional supplements (0,021), which CONCLUSION AND
means the consumption of diverse food and RECOMMENDATION
drink nutritional supplements influence the Conclusion
occurrence of malnutrition in children 1. There is the influence of the application
under five. But the most effected variable is of Nutrition Family Aware (Kadarzi)
nutritional supplements with the largest B Toward Less occurrence of Nutritional
value compared to other variables, namely Status in Toddlers At Work Area City
0.286.
351
community health center Northern ________________. 2014. Data Dinas
Territory city of Kediri. Kesehatan Kota Kediri Tahun 2015.
2. Key Indicators of Nutrition Family Kemenkes RI. 2013. Profil Kesehatan
aware (Kadarzi) on the occurrence of Indonesia Tahun 2013.
malnutrition in children under five in http://www.depkes.go.id/resources/
the Work Area Health centers City download/pusdatin/profil-
North region of Kediri is a nutritional kesehatan-indonesia/profil-
supplement. kesehatan-indonesia-2013.pdf
diakses tanggal 29 Maret 2016.
Recommendation Asmarni, dkk. 2006. Winshield Survey
1. Enhancing the role of Posyandu cadre Status Kesehatan, Gizi Bayi dan
through training and guidance prepared Balita di RW 01 Kelurahan Gurun
by the community health center on the Laweh Kecamatan Nanggalo
importance of diverse food and Padang. Padang.
treatment efforts as well as the Nadimin, 2010. Hubungan perilaku
prevention of malnutrition in children KADARZI rumah tangga terhadap
under five. status gizi balita di Kabupaten
2. It is expected that the Department of Takalar Sulawesi Selatan. Media
Health of the can conduct monitoring in Gizi Pangan, Vol. X, Edisi 2, Juli –
the provision of nutritional Desember 2010- hhttp/www. .
supplements needed by infants and diakses 31 Maret 2016.
distribution to the target. RI, Depkes. 2009. Buku Saku Keluarga
3. Further research is expected to do Sadar Gizi (KADARZI)
research use other variables such as Mewujudkan Keluarga Cerdas dan
parenting, household food availability, Mandiri. Jakarta. Ditjen Bina
infectious diseases, and other Kesehatan Masyarakat.
nutritional supplements associated risk RI, Depkes. 2007. Keputusan Menteri
factor of malnutrition Kesehatan RI No.
747/MENKES/SK/VI/2007 tentang
REFERENCE Pedoman Operasional Keluarga
RI, Kemenkes, 2010. Pedoman Pelaksanaan Sadar Gizi di Desa Siaga. Jakarta.
Pemantauan Garam Beryodium di Ditjen Bina Kesehatan Masyarakat.
Tingkat Masyarakat, Jakarta: Dirjen Muchtadi, Deddy. 2009. Pengantar Ilmu
Bina Gizi Masyarakat. Gizi. Bandung: Penerbit Alfabeta..
Dinkes Jatim. 2010. Profil Kesehatan Andriani, Merryana. 2012. Peranan Gizi
Provinsi Jawa Timur Tahun Dalam Siklus Kehidupan. Jakarta:
2010.http://dinkes.jatimprov.go.id/ Kencana Prenada Media Group.
userfile/dokumen/1380615402_PR Almatsier, Sunita. 2002. Prinsip Dasar Ilmu
OFIL_KESEHATAN_PROVINSI_ Gizi. Jakarta: PT.Gramedia Putaka
JAWA_TIMUR_2010.pdf diakses Utama.
tanggal 18 Pebruari 2016
WHO.2012. Joint UNICEF – WHO – The
World Bank Child Malnutrition
Database: Estimates for 2012 and
Launch of Intractive Data
Dashboards.
http://www.who.int/nutgrowthdb/j
me_2012_summary_note_v2.pdf
diakses tanggal 21 Pebruari 2016.
Dinkes Kota Kediri. 2013. Data Dinas
Kesehatan Kota Kediri Tahun 2015.
352
EFFORT TO IMPROVE THE ABILITY OF NURSE IN APPLYING THE PATIENT
CENTERED CARE (PCC) IN HOSPITAL
Aprin Rusmawati, Rahmania Ambarika

Surya Mitra Husada Institute Science of Health
Email: akbaraprin@gmail.com
ABSTRACT
Introduction: Patient Centered Care (PCC) is a new paradigm in health care, which puts the
patient as the center of care. PCC not only to leverage the benefits of technology without
compromising the importance of human to human interactions. Research related to the
implementation of PCC in Indonesia is still very limited. The purpose of this study is to establish
the effectiveness of the PCC training nurses to improve patient’s perception the application of
PCC. Methods: This study uses a Quasi - experimental with pretest – posttest design. The
research sample for the intervention group was inpatients of Harjono Hospital and the control
group were inpatients of Iskak Hospital by using purposive sampling technique. PCC
deployment training given to all nurses inpatient dr. Harjono Ponorogo Hospital by using total
sampling. Results: The results showed statistically with P value 0,000 and α 0,05 that means
significant improvement in patients' perceptions about the application after receiving training
PCC. But when viewed from a clinical application, this training does not show satisfactory
results. Conclusion: PCC training is effective to increase the application of PCC seen from the
patient's perception even though the results obtained are less satisfactory. Necessary efforts in
monitoring of hospital managers to monitor the implementation of the PCC in the hospital.
Keywords: training, Patient Centered Care (PCC), patient’s perception
INTRODUCTION incentives and training for quality

Patient Centered Care (PCC) is a improvement. (Drenkard,2013)
new paradigm in health care, which puts the Several studies have linked the PCC
patient as the center of care. PCC is – low – was mostly done abroad. The result of
tech and high – touch. PCC not only to Bertakis et all research (2011) showed there
leverage the benefits of technology without is a relationship between the PCC with a
compromising the importance of human to reduction in the utilization of health
human interactions. (Forman, 2010) services. It means that the patient and
PCC concept was first reported by family involvement in health care is needed
Harvey Picker in 1988 through the Picker to reduce the number of patients admitted to
Institute in the UK. According to the Picker hospital. PCC also improve health status
Institute in Patient - Centered Care and increase the efficiency of care by
Improvement Guide, the four principles of reducing diagnostic tests and referrals.
the PCC such as dignity and respect, Patient interaction - a nurse during the
information sharing, participation, and treatment process consistent with the
collaboration (Frampton,2008). In the principles PCC effectively to improve the
application of PCC, hospital treatment delivery of nursing care, and to ensure PCC
should involve all aspects related hospital, applied in the treatment process, nurses
Starting from the head, doctors, nurses, should conduct an sustainable assessment
until the non-medical personnel. Strategies of the patient's needs related to their care
that can be employed in the PCC is process and encourage the patient the
leadership training, granting rewards and opportunity to participate. (Jhonson, 2008)
353
Result of Little P et all research preferences, emotional supports, physical
(2001) showed that PCC approach has been comfort, information and education,
proven to reduce the burden on patients' continuity and transition, coordination of
symptoms as a result of disease. This study care, access to care and family and friends.
divides patients' perceptions of the PCC into The nurse as one of the health care
five different components, which include providers in hospital, should apply 8 of
communication and cooperation, personnal these dimensions in accordance with the
relationship, health promotion, positive needs of patients and families. Retrieve the
approach in the diagnosis and prognosis, the importance of the application of PCC by
effects of the disease in the patient's life. nurses, so far in Indonesia has been no
Application of PC directly feel is patient research on the application of patients'
and family while being treated at the perceptions PCC. Therefore, need to do
hospital until they are reset control. The research on the effectiveness of PPC
need for cooperation between providers training the nurses to the patient's
with patients and families to create a perception of the implementation of the
symbiotic mutualism between the two PCC.
parties.
Research of Steward et all (2010) METHODS
and Anderson EB (2002) showed that PCC Population of this research for the
approach in treatment has been shown to intervention group was whole hospitalized
improve patient status. This approach relied of Harjono Hospital and population of the
on the foundation of the relationship control group were all patients hospitalized
between providers and patients, improving of Iskak Hospital. The population will
communication, develop a positive climate, receive training are all nurses
and encourage patients to participate hospitalization of Harjono Hospital.
actively in the interaction between both of Sample of this research for the
them. intervention group was hospitalized of
Data from quality control team of Harjono Hospital and population of the
Harjono Hospital in 2014 adverse event, control group were hospitalized of Iskak
potencial injury incident, near miss. Hospital which fulfill inclusion and
Number of adverse event 7 cases include exclusion criteria. The sample selection for
patient falls and blood transfusion reactions, inpatient nurses of Harjono Hospital who
number of potencial injury incident 4 cases will receive training by using total
all of which are a result of patients without sampling, while the proportion of the
identity bracelet. Data until September 2015 number of patients taken by using purposive
obtained 3 cases of near miss includes an sampling.
error in the administration of drugs from the Measuring instrument used in this
pharmacy and prescriptions are swapped, 5 study is a questionnaire that is used to
cases not expected incident include patient identify the application of PCC by nurses.
falls off the brancard and blood transfusion The questionnaire in the form of a statement
reactions, and 3 cases of potencial injury which is based on eight components of a
incident covering the bed without PCC in the Picker Institute assessed by
protection and patients without identity. patient. Measuring instruments used to test
PCC is a concept of care that focuses the validity and reliability of both content
on patients. Patients and families are the validity and validity construc performed on
main targets of PCC so it needs to be 50 patients of Gambiran Hospital
monitored in terms of the application of
patients' perception. The patient's RESULTS
perception includes application of 8 Based research results, the
dimensions of PCC, such as patient distribution of respondents in the
354
intervention and control as well as the Table 1 showed that in the
statistical test each respondent intervention and control group majority
characteristics. At the educational level of application of PCC in less categories. In the
the statistical test showed p value of 0.000 intervention group application of PCC
with α values of 0.05 it means that level of before intervention 1 respondent (2%) in
education of patients the intervention and good categories dan 5 respondents (9%). In
control groups have different the control group application of PCC before
characteristics. The results of the analysis to intervention 17 respondents (31%) in good
show the job status p value 0.167 with α categories, while after intervention 7
0.05 it means that employment status of respondents ( 13%).
patients in the intervention and control
groups had similar characteristics. Table 2. Patient perception’s application of
Statistical test results related history PCC
of hospitalized showed p value of 0.246 Mean Mean Varia P
Group value
with α values of 0.05 it means that history Before After ns
of hospitalized of patients the intervention Int. 18,94 20,88 1,94 0,000
and control groups have same Control
characteristics. Analysis results of long 23,82 22,22 -1,6 0,012
treated showed p value 0f 0.234 means that Table 2 showed averages between
long treated of patients the intervention and before and after from the intervention group
control groups have same characteristics. increase by 1.94 by using paired T Test
Statistical results characteristic of obtained p value 0.000 <α 0.05, which
nurse the intervention and control groups means that there are differences in the
showed p value 0.001 with α 0.05 means application of PCC in the intervention
that characteristic education of nurse the group between before and after. In the
intervention and control groups have control group, the mean value obtained –
different characteristics. Analysis results 1.6 with p value 0.012 <α 0.05, which
showed p value 0.000 with α 0.05 that means thar there are differences in the
means length of work the intervention and application of PCC in the control group
control groups have different between before and after intervention.
characteristics.
This research uses 27 statement Table 3 Differences Application of PCC
about application of PCC observed from Mean P Mean P
Group value
patient perception’s. Good categories if Before value After
score obtained of 27, and less categories if Int. 18,94 20,88
score under 27. Table 1 showed the 0,000 0,000
Control 23,82 22,22
frequencies distribution of patient
perception’s about application of PCC. Table 3 showed that the application
of PCC in the intervention group after the
Table 1. The frequencies distribution of intervention given at 20.88 and in the
patient perception’s control group gained a mean of 22.22. the
Patient perception’s about application of PCC test results of independent samples T Test
Before After before the intervention was obtained p value
Group of 0.000, which means that there are
Good Less Good Less
differences in the application of PCC in the
N % N % N % N % intervention group and the control group
Int. 5 9 53 91 before the intervention is given. For the test
1 2 57 98
result of independent samples T Test after
Control 7 13 48 87
17 31 38 69 intervention was obtained P value of 0.000,
which means that there are differences in
355
the application of PCC in the intervention Treatment for at least 3 days,
and control group was given after the patients already getting health care include
intervention. nursing, medical and other support services.
The results showed scores of each In addition, the patient was getting used to
subcomponents in the PCC which is divided the situation in hospitals, especially in the
into intervention and control groups given inpatient unit.
both before and after the intervention. The According to invesgators, training
highest score before the given intervention PCC in hospitals Harjono Ponorogo to the
in the intervention group, namely the application of PCC in terms of the
information and education component with perception of patients has increased,
the mean 46.6, while components in the although the results are less than
control group on physical comfort and satisfactory. Application of PCC in
continuity and transition with mean 51.3. Hospitals need to be increased, either by
the highest score awarded after the conducting seminars or workshops and
intervention in the intervention group that is conduct periodical evaluation can be
at the physical comfort with the mean 49.3, performed by the head of nursing or nurse
while the control group of the information managers.
and education with mean 48.4. Rejection must be accompanied by
The lowest score was given after the the signing in the informed refused in
intervention and control both before and accordance with the provisions of the
after the intervention given that the hospital. It aims to protect patients and
components of emotional support with the nurses as a form of matters relating to the
mean 33.33 for the intervention group and lawsuit, the family can sue the hospital in
37.7 for the control group. civil or criminal.
Within a period of one month
DISCUSSION between the provision of training to the
In Rangkuti (2002), one of the questionnaire after training, an increase of 4
factors that influence the perception is a respondents have not been so satisfactory
moments of service (service situation). The that the necessary supervision continuously
situation of service associated with the from the management of the hospital, from
customer’s internal conditions that affect hospital director, head of nursing and head
the performance of services. Service of the room.
performance is determined by the service
provider, the service process and the CONCLUSION AND
physical environment in which services are RECOMMENDATION
provided. Conclusion
Research by Oroh et all relevant The results showed that the patient’s
factors relating to the level of patient perception of the ability of nurses in
satisfaction with nursing care, shows that implementing PCC significantly different,
there is a relationship between the length of but the results obtained are less satisfactory.
treatment with patient satisfaction with Need further research related to
nursing care. Duration of treatment can modification of the PCC concept with the
affect the physical and psycological needs of the bio – psycho – social –
condition of the patient and the family, emotional – spiritual in patients in order to
because the hospital environment is improve the delivery of services to patients.
different from the patient’s residence. Other
patients with variuos medical and nursing Recommendation
diagnoses can add to the anxiety The advice given, among others, the
experienced by the patient. hospital must take a standard operational
procedure (SOP) related to the supervision
356
of the application of PCC in the inpatient E. Oroh, et all. Faktor – Faktor Yang
unit, so obviously the main tasks and Berhubungan Dengan Tingkat
functions and should be documentation as Kepuasan Pasien Rawat Inap
evidence of supervision that can be reported Terhadap Pelayanan Keperawatan
by the head of the room periodically to Di Ruang Interna RSUD Noongan.
nurse managers. It must be done on 2014
scheduled basis at all nurses in the inpatient Forman RN, Harriet. Nursing Leadership
unit and evaluated fair, feedback and follow for Patient – Centered Care. 2010
up. Frampton, S, et all. Patient Centered Care
Improvement Guide. Inc. and Picker
REFERENCE Institute. 2008
Bertakis, et all. Patient Centered Care is Rangkuti F, 2002. Measuring Customer
associated with Decreased Health Satisfaction: Teknik mengukur dan
Care Utilization. 2011 Strategi Meningkatkan Kepuasan
Bev Jhonson, et all. Partnering with Pelanggan. PT Gramedia Pustaka
Patients and families to design a Utama, Jakarta.
patient – and family centered health Steward, M, et all. The impact of Patient
care system. Institute for – Patient – Centered Care on Outcomes.
and family – centered care. PubMed. 2010
www.ipfcc.org. 2008
Drenkard, K, et all. American Association
of Colleges of Nursing. 2013
357
THE QUALITY OF PATIENT SATISFACTION WITH SERVICE INSIDE OF
HEALTH CARE OF A SYSTEMATIC REVIEW
Lukman Hakim , Tiara Putri Ryandini, Mei Widyawati

STIKes NU Tuban, East Java
Email: lukman@stikesnu.com
ABSTRACT
Introduction:one of the indicators of the success of the health care is the satisfaction of the
patient. The patient's own our satisfaction in service can be determined by expectations
Compared with the fact that accepted by the patient. Methods:A literature search was
conducted in Several major databases such as proquest, ScienceDirect, DOAJ, sagepub,
MEDLINE, and google scholar with the limitation of the time used is the January 2006 through
December 2016. Results: as many as fifteen research raised in this study, all of the which have
almost the same purpose how to Increase patient satisfaction in every population. Fourteen of
the study chose random respondents. Conclusion: patient satisfaction with Significantly, so
that it can be concluded that the Satisfaction of Patients actually Refers to the appearance of the
existence of that care or more perfect appearance of the care, then the more perfect also the
quality.
Keywords: Patients satisfaction, quality of management, the quality of service
INTRODUCTION
Community health services as users thing is consistency that the performance of
expect optimal health services in terms of the service, capable of offer a service that
quality health services is feasible and trusted According to the promise and for a
Appropriate what is expected. In addition to upon.Security Agreed that has been in the
the quality of service, increasing the level of behavior of health workers can give trust
education, knowledge and social economic and security for Reviews their customers,
effect on society demands Also an Increase always be polite , and control knowledge
in the quality of health care, one of them the and skills.Empathy that is the ability of
organization of health care in the hospital health workers to understand complaints
staffs about the performance of health. In Patients, pay attention individually, give an
addition, the public critiquing various opportunity to ask and timeliness of so the
aspects of health services especially customer is not too long a wait for
regarding care, Because at the hospital most treatment.Physical evidence that is the state
of the human resources that berinteraksi of the environment around roomates real,
directly with the patient is the nurse, so that and seen from the health service workers
quality of service implemented a by nurses appearance the which includes officers,
can be rated as a good indicator of what the equipment and facilities that is used
bad quality of service at the Hospital (Solihat, 2013).To know the quality of
(Sulistiyono, 2014). According to service that perceived as real by consumers,
Parasuraman (1990) of health services there there is a measure of satisfaction indicator
are five dimensions play of Them of consumers that is situated on five
responsiveness of the willingness and the dimensions of quality of service .The fifth
readiness of health workers to help Patients dimension items, namely: physical
to seek treatment quickly intervening, evidence (tangibles), direct evidence that
respond to demand Patients, and informed includes physical facilities, supplies and
anytime the service will be given. The best materials used hospitals and the appearance
358
of existing employees.Dependability information on the disease and the cure to
(reability), pertaining to the ability of pacient. tangibility (physical evidence) the
hospital services to provide immediate and provision of facilities and physical facilities
accurate since the first time without making that can directly perceived by consumen.
anything wrong and satisfactorily; Inside health treatment services is
responsiveness) (responsiveness, with cleanliness and toilet room. Emphaty
respect to the willingness and the ability of (attention) the ability officers relationships,
employees to help Patients and respond to attention, and understand the consumen
Reviews their demand to respond, as well as needed and responsiveness (responsiveness
inform services accurately; guarantee of the officers) ability of providing services
(assurance) ie includes knowledge, skill, to consumers quickly intervening inside
civility, capable of Cultivating his patient health services a long time waiting for
trust; Empathy (empathy) means ease Patients from the register to Obtain access
inintercourse good communication, to health workers (Kotler , 2000).
personal concern in understanding the
patient as customers and acting sake of RESULTS
Patients. The Relationship Between The Physical
Evidence With Patient Satisfaction
METHODS Based on the data on physical
Searchconduct in some major evidence either, most of the respondents ie
literature like proquest database, as many as 71 respondents (45.0%) feel
ScienceDirect, DOAJ, sagepub, satisfied, as many as 10 respondents
MEDLINE, and google scholar by inserting (10.2%) feel less satisfied. On the physical
keywords Patients satisfaction, quality of evidence is less good, the majority of the
management, the quality of respondents ie Thirteen respondents
pelayanan.batasan time used is january (13.3%) feel less satisfied and 4
2006 until december 1643 article respondents (4.1%) were satisfied. Chi
2016.From acquired, only 15 meet the square analysis Continuity Correction
criteria inclusion.The article criteria for results between the physical evidence to the
inclusion article is: 1) rs / clinic, 2) 5 satisfaction of the Patients Obtain the
indicators measuring quality service, 3) values of URA symp.sig (2-sided) or p
sample of visitors or inpatients / outpatient, value of 0.000. If the value of p is smaller
and 4) parameter is satisfaction Patients than the value of α = 0:05. From the analysis
assessed.The parameters of the satisfaction results Obtained Also the value of the Odds
of Patients who were judged to be using the Ratio (OR) = 23.075. According to Suryati
instruments varity. Fifteen research uses the (2006), aspects of physical evidence
dimensions of responsiveness, assurance Became important as a measure against the
and empathy, while tangible dimensions Ministry. Customer will use the senses of
reliability. Patients and satification Also sight a service quality attributes of
have been influenced by Several among variables. Good physical evidence will
other factors: reliability, assurance, Affect the perception of the customers. At
tangibility, empathy and responsiveness. the same time aspects of the physical
reliability (dependability) is capability evidence IS ALSO one of the sources that
officers of providing services to consumers may Affect the customer's expectation,
with tepat.dalam health services is the Because physical evidence good, hope
assessment of Patients in the ability of customers to higher .this research in line
exertion healt. Assurance officers the which with Irfan et al (2012) in research with
is the ability to provide services to satisfaction 320 of respondents for Patients
customers so that trust can be .Inside health and the quality of service in government
services is clarity of health workers provide hospital in pakistan see the relationship
359
between meaningful dimension physical (2009) on the Effects of Price and Quality
evidence and other dimensions of quality Care Inpatient Satisfaction in North
with satisfaction Patients .Lumintang Sumatra Deli Hospital, says that physical
(2012) in 86 Patients on observational evidence variable has a positive effect on
research about the factors associated with customer satisfaction.
pleasure Patients askes to the public in The Reliability Of The Relationship
Hospital patient in installation b .Rd prof Between Patient Satisfaction
.Dr. Kandou Manado found that the Based on the data, the reliability is
physical environmental conditions a factor good, the majority of respondents as many
that influences Significantly Patients with as 71 respondents (72.4%) are satisfied and
satisfaction (p = 0:03) .Similarly Susmaneli as many as 10 respondents (10.2%) were
dantriana in research on 92 respondents less satisfied. On the reliability is not good,
using a design cut latitude about the quality most respondents as many as 13
of service obstetrics Patients dimension of respondents (13.3%) were less satisfied and
satisfaction. Jampersal program at Hospital as much as 4 respondents (4.1%)
Rokan Hulu Baru week discovered proof of are satisfied. The results of the analysis of
physical dimensions (p = 0.003) dealing in Chi Square Continuity Correction between
a meaningful manner with satisfaction reliability and patient's satisfaction scored
Patients (Susmaneli, 2014) .Kambong et al Asymp.Sig (2-sided) or a p-value of 0.000.
(2013) on research on the relationship If the p-value is smaller than the value of α
between a nurse with service satisfaction of = 0.05 means that H1 is accepted or there is
Patients at PHC Talawaan north Minahasa a relationship between reliability and
region discovered the existence of the patient's satisfaction. From the results
relationship between nurse in service obtained by analysis of
dimensions physical evidence, the value Odds Ratio (OR) = 23 075.
dependability, security, concern with Research from Rahman et al (2013)
satisfication patient and the absence of the to identify factors that affect the quality of
relationship between nurse in service service patient satisfaction in a private
dimensions responsiveness of gratification hospital in Bangladesh with 390
Patients with .Simbala (2013) in research respondents and use 11 variable dimensions
analytic to a draft survey of 100 respondents of quality shows that reliability
found that physical evidence in a significantly associated with patient
meaningful manner Patients associated with satisfaction. Likewise, the study of Faisal et
satisfaction (p = 0.002). So far the research al (2013) about the relationship between
by calisir et al (2012) about the effects of nursing care and patient's satisfaction in
the dimensions of quality against Inpatient A BLU Dr Prof. Dr. RDKandou
satisfaction patient and repeated visits Manado with 85 respondents found no
against 292 respondents by wearing a significant relationship between reliability
method of servqual modified found that and client satisfaction.
physical evidence a factor that is essential Responsiveness With The Relationship
for the satisfaction of Patients and influence Between Patient Satisfaction
the decision to return wearing services the Based on the data, the
hospital was .that Significantly physical responsiveness is good, the majority of
evidence associated with satisfaction of respondents, 75 respondents (76.5%) are
Patients, so that we can conclude that satisfied and as many as 19 respondents
patient satisfaction actually refer to the (19.4%) were less satisfied. On the less
appearance of / the form of services that the good responsiveness, most respondents as
more perfect the appearance of services, many as 4 respondents (4.1%) were less
hence the more perfectly of its quality. satisfied and no respondents who were
Research conducted Lubis and Martin satisfied. The results of the analysis of Chi
360
Square Continuity Correction between satisfaction guarantee to obtain the value
responsive to patient satisfaction scored Asymp.Sig (2-sided) or a p-value of 0.002.
Asymp.Sig (2-sided) or a p-value of 0.002. If the p-value is smaller than the value of α
This study is in line with Simbala et al = 0.05. Research on patient satisfaction in
(2013) in the analytic survey research with hospitals Jombang by Ariyani (2009), also
cross-sectional design of the 100 found that the guarantee would increase
respondents found that responsiveness patient satisfaction with hospital services,
significantly associated with patient thus making patients tend to trust and
satisfaction (p = 0.002). Badri et al (2009) believe will each service performed by the
in research on the quality of health services hospital. Mustafa (2008) in a cross-
and the factors that influence patient sectional analytical research on 30
satisfaction expressed responsiveness as respondents of the relationship between the
one of the 12 indicators that are always patient's perception of the nursing service
included in various studies related to quality quality dimensions found that there was a
of care. In analytical research with 246 significant association between patients'
respondents to compare patient satisfaction perception of the dimension of assurance
with care in government hospitals and with patient satisfaction. According
private hospitals, found that private Tjiptono (2006), the quality of health care
hospitals have numbers high satisfaction in for a patient is not out of satisfaction with
the dimensions of responsiveness and health care received, with a good quality
empathy, while the government hospitals of associated with the cure of disease,
the most undervalued in the dimensions of improving health or fitness, the
responsiveness ( Brahmbhatt et al, 2011). environment pleasant care, and hospitality
The Relations Responsiveness To personnel. Assurance includes the ability
Patient's Satisfaction for the knowledge of the product / service
With the responsiveness of the appropriately, quality hospitality, attention
relationship is the responsiveness of patient and courtesy in providing services, skills in
satisfaction has positive and significant providing information, in providing
impact on patient satisfaction. The better security capabilities in utilizing the services
the customers' perception of the offered, and the ability to instill confidence
responsiveness of the patient satisfaction in customers to the company. Sayed et al
will be higher, and if the patient's (2013) study on the perception of the patient
perception of the responsiveness bad, then as an indicator of the quality of nursing
the lower patient satisfaction. In accordance services in 90 respondents found that
with the opinion Leboeuf (2012), that jaminanberhubungan significantly with
responsiveness as an employee patient satisfaction (p = 0.0). Essiam (2013)
responsiveness of the airport when it is which examines the quality of care and
needed the patient is closely related to patient satisfaction in the health service
customer satisfaction. with quantitative methods on 400
Assurance With Relationship Between respondents identified a significant
Patient Satisfaction relationship between collateral with patient
Basedthe data, the better the satisfaction (p <0:01). Each patient
guarantee, the majority of respondents as basically want to be treated well by the
many as 75 respondents (76.5%) are manager of the hospital. Relations with
satisfied and as many as 19 respondents satisfaction guarantee patient
(19.4%) were less satisfied. On the less Relationship with patient
good collateral, 4 respondents (4.1%) were satisfaction guarantee is a guarantee to have
less satisfied and no respondents who were positive and significant impact on patient
satisfied. Correction Chi SquareContinuity satisfaction. In line with these studies,
the analysis results between patient Winardi, et al. (2014), in a study entitled
361
Effect of Service Quality Customer DISCUSSION
Satisfaction in SMC Inpatient Hospital The results stated that patient
Telogorejo that relate to patient satisfaction satisfaction is actually referring to the
guarantee so that it can be concluded that a appearance/form of service that
good guarantee associated with increased pelayananan appearance more perfect, more
patient satisfaction and patient loyalty. perfect then also the quality. Than it also
In a study on patient satisfaction in needs to pay attention to the amount and
Selangor, Malaysia, by Hayati et al. (2010) homogeneity of subjects (age, gender, level
also found that the guarantee would of disability and the time used in the study)
increase patient satisfaction with hospital so it does not create a bias in the results.
services, thus making patients tend to trust A summary of the research
and believe will each service performed by conducted systematicreview,showed a
the hospital. Indiraswari and Damayanti positive effect on the quality and service
(2012), found also that the guarantee was excellence to client satisfaction. There is a
significantly besides increasing patient relationship between the quality of nursing
satisfaction for services, it will also affect service with health patient satisfaction seen
the assessment of the patient will be other from the dimensions of responsiveness,
variables. reliability, assurance, empathy, and
The Relationship Between Empathy tangibles.
With Patient Satisfaction
Based on data, on a good care, most CONCLUSIONS AND
respondents as many as 72 respondents RECOMMENDATIONS
(73.3%) were satisfied and 13 respondents Conclusions
(13.3%) were less satisfied. At the Satisfaction is as level one's feelings
unfavorable attention, most respondents as after comparing the performance or results
many as 10 respondents (10.2%) were less that he felt with his expectations. The level
satisfied 11 and as many as three of satisfaction is a function of the difference
respondents (3.1%) are satisfied. The between the perceived performance with
results of the analysis of Chi Square expectations. If the performance below
Continuity Correction of attention to patient expectations, then the customer will be very
satisfaction scored Asymp.Sig (2-sided) or disappointed. When performance as
a p-value of 0.000. This is in line with expected, then the customer will be very
research Puspitasari and Edris (2011) satisfied. Meanwhile, when the
regarding the satisfaction of the patients in performance of exceeding customer
the Inpatient Hospital Healthy Families Pati expectations will be very satisfied (Oliver,
get that attention very dominant variable 1998, in Supranto, 2001). Patient
influence on patient satisfaction. Muninjaya satisfaction / customer is service responses
(2011) emphasized the importance of the to the conformity of the level of interest or
dimensions of attention in providing quality expectations of customers before they
services. This is in line with research Rattoe receive services with the service after they
(2013) about the relationship between the receive (Muninjaya, 2011). Therefore,
quality of service with the decision revisited customer satisfaction is determined by
at Bethesda Hospital Tomohon get that expectations compared with the reality that
attention very dominant variable influence is accepted by the customer. Customers
on patient satisfaction. Moreover, studies of include internal customers external
Sulianti (2010) as well as the research of customers andcustomers.
Rondonuwu (2014), found that variables intermediateEndeavored to satisfy
are closely related to attention teriptanya customer needs in all aspects, including
quality services. price, convenience, safety, and timeliness.
362
Recommendation ownload/MHSPCMHGuide.pdf;
Hospitals can arrange patient satisfaction accessed October 4, 2012.
survey program on a regular basis so as to Manengkei, Billy. 2016. The relationship
evaluate the performance of nursing between the quality of the Service
services by improving, upgrading and with patient satisfaction at Space
development of quality of care and make Beam Inpatient Hospital GMIM
efforts to maximize the satisfaction of Love Post Graduate Thesis,
patients 2016.Manado Sam Ratulangi
University in Manado.
REFERENCES Mustafa, A. 2008. Relationship Between
Adams, JG and Makoul, G. (2008), “Patient Perceptions of Patients Against
perspectives on communication Nursing Service Quality
with the medical team: pilot study Dimensions With Patient
using the communication Satisfaction patient wards at the
assessment tool-team (CAT-T)”, General Hospital of PKU
Patient Education and Counseling, MuhammadiyahTemanggung.
Vol. 72, pp. 220-3. Nursing Journal Vol.1 / 2 / Mar /
Al-Abri R, Al-Balushi A: Patient 2008. It 25-33. (Online) .http:
satisfaction survey as a tool towards //jurnal.unimus.ac.id/index.php/FIK
quality improvement. Oman Med J keS/article/view/159 Accessed on
2014; 29(1): 3–7. August 27, 2015
Anderson R, Barbara A, Feldman S: What Mercer, LM, Tanabe, P., Pang, PS, Gisondi,
patients want: a content analysis of MA, Courtney, DM, Engel, KG,
key qualities that influence patient Donlan, SM.
satisfaction. J Med Pract Manage Moret, L., Rochedreux, A., Chevalier, S.,
2007; 22(5): 255–61. Lombrail, P. and Gasquet, I. (2008),
Bhargava, A., Thakur, A., Mishra, B., “Medical information delivered to
Taneja, J., Dogra, V. and Loomba, patients: discrepancies concerning
P. (2012), “Patient satisfaction of roles as perceived by physicians and
microbiological tests done in GB nurses set against patient
Pant hospital”, International Journal satisfaction”, Patient Education and
of Health Care Quality Assurance, Counseling, Vol. 70 No. 1, pp. 94-
Vol. 25 No. 7, pp. 555-564. 101.
Hawthorne G, Sansoni J, Hayes L,
Marosszeky N, Sansoni E:
Measuring patient satisfaction with
health care treatment using the Short
Assessment of Patient Satisfaction
measure delivered superior and
robust satisfaction estimates. J Clin
Epidemiol 2014; 67(5): 527–37.
Hekkert KD, Cihangir S, Kleefstra SM, van
den Berg B, Kool RB: Patient
satisfaction revisited: a multilevel
approach. Soc Sci Med 2009; 69(1):
68–75.
Kugler JP: Military Health System Patient
Centered Medical Home Guide,
2011. Available at
http://www.tricare.mil/tma/ocmo/d
363
Table 1. Research about quality of care and patient's satisfaction in health care
No. Citation State Research Independent the dependent Amount of Results Excess Weakness,
question / variable and variable and sample limitations,
hypothesis measures measuring the bias
1 Billy Indonesi - for know the Determine the Patients will Population of - There is a - inclusion - researchqua
Manengkei, a proof of qualityof service besatisfied if the this study is that relationship criteriaclear sythis
2016 physical with perceivedsignific service hegets at patients who've between experiment
antly,by the leastequal or been reset and - a long
patient physical did not use
Quality of consumer there exceed the outpatients in timestudy
services with satisfaction is a size expectations of the installation evidence a control
satisfaction indicatorof Patients,while space of group.
- to knowing and patient's
patient consumer dissatisfaction hospital
reliabilitywith satisfaction satisfaction r - The
will Arise if the inpatient arc of
patient awat road number of
conveniently to result(outcome) love average
- there is a
satisfaction five dimensions does not meet per month respondents
of service theexpectations amounted to relationship
a little
- to knowing the quality. of the patient 162 patients. between
research.
responsived This research is
an analytic reliability with
satisfaction
survey with satisfaction
- to knowing cross sectional outpatient
- correlation
guaranteeandf study.
between
or the patient's
responsiveness
satisfaction
to the
- with patient satisfaction of
satisfaction to outpatients
mengetahuiem
- there is a
pati
relationship
between
364
collateral with
the satisfaction
of outpatients
- there is a
relationship
between
empathy with
satisfaction
outpatient
2 Azlika M. Indonesi - To Determine Increased public Nurse service This study uses The results of the - The Through this
Alamri, 2015 a the education have parts that analytic survey bivariate analysis collection study,
relationship demanding quality berinteraksi with cross demonstrated an of Data Researchers
Quality of health services, with the patient sectional study. association give
between the Obtained
nursing services especially nursing directly so that The number of between quality suggestions
and patient quality of services that can the quality of samples in this of care nurses through for hospitals
satisfaction level nursing be seen from the services study as many with patient questionna to be Able to
of education and services and dimensions performed by as 89. satisfaction ires. put together a
social security of education level serviqual nurses is an becausevalue p = program of
the organizing of patient (responsiveness, indicator of 0.000 <α (0:05). - the patient
body of satisfaction reliability, good or bad Also bivariate inclusion satisfaction
participants assurance, quality of care test results criteria. surveys on a
with pesertat
(BPJS) empathy, in hospitals. Showed the value regular basis.
Social Security tangibles). of OR 7733 and
Agency (BPJS then to the
) variable level of
education that
there was no
correlation
between level of
365
education and
patient
satisfaction
becausevalue p =
0.750>
α (0:05).
3 Rini Winasih Indonesi - To explain the Factor objective The This research Cultural Strong Future studies
2014 a influence of (innovation performance of usesdesign organisasi organizationa need to be
organizational and risk-taking, nurses and nurse explanatorywith affected by l culture can done
Organizational attention job satisfaction approach. objective factors. creategoodqu to analyze the
culture and
culture and thedetails, cross- Factors affecting ality ofwork effect of
quality of quality of results sectionalThepo QNWL is social life empowerment
nursing work life nurses work orientation, the pulation was all and afor nurses in and job
on the life (QNWL) orientation of nurses Civil environmental improving involvement
performance and on the human Servants in the factors, theperforman on the quality
job satisfaction performance resources, hospital operational ce and job of
of nurses and job orientation, operating room. factors, satisfaction - work life of
team Dr. Soetomo. A administrative of nurses at nurses.
satisfaction of
aggressiveness sample of 95 factors, the Hospital
nurses and stability), nurses Obtained and workplace Dr. Soetomo.
individual by cluster culture. QNWL Improved
factors sampling. Data Affect quality of
(age, sex, marital were Analyzed performance and work life of
status, using job satisfaction of nurses in
education, partial nurses. Job hospitals Dr.
promotion, and leastsquare. satisfaction Soetomoinflu
tenure), Affects the enced by
social and performance of social
environmental nurses. andfactors,
factors environmenta
(communication, l andfactors
366
leadership, operational
relationships factors.
between nurses, administrativ
relationships e
between
departments, and
the relationship
between the
profession),
operational
factors (the
number of
nurses, service
schedule, and
supervision
supervisor),
administrative
factors (policy
organization,
safety and
health,
career
development,
salary and
remuneration).
variable an
intervening is
the culture of the
organization and
quality of work
life of nurses.
367
4 Gustop Amatiria Indonesi - To see if the dimension of pengembangkan Design Cross- an Increase in Of the five while two (2)
2012 a quality of quality method sectionalThe the value of quality dimensions
nursing care have professional population is all pelaksanana dimensions are not related
Quality of Contributed nursingcareof inpatientsin the method measured are Tangiable
to the method
nursing services Significantly to functional mature adult diruangan team was only 3 and Reability.
by using the team can Affect the methods into men and (81.1) improving (three)
Team on improve relationship of methods of women, the quality of dimensions
inpatient patient the above is the team. usingmethod of nursing service are related,
satisfaction in dimension of The change sampling value (81.30) and Responsivene
inpatient responsiveness Began with a purposive thevalue of ss,
(responsiveness) pilot project sampling averagesatisfactio Assurance
, on adult amounted to 90 n (65.24). and Emphati,
assurance inpatient respondents. Aadanya
(assurance) and spacewoman. Measuring significant
Emphati instruments relationship
(Proximity), using a between the
while the questionnaire quality of nursing
dimensions of and the care
Tangible questionnaire using a team to
and Reliability method. patient
does not have a Processing of satisfaction in
significant the data hospitals.
contribution analysiswith the Immanuel Bandar
insatisfaction results of Lampung (pV =
Influencing univariate and 0.0001).
bivariate Chi Of the five
Squaretest. quality
dimensions
measured was
only 3 (three)
dimensions are
368
related,
Responsiveness,
Assurance and
Emphati.
5 Welas Haryati Indonesi To find out if nursing care Knowing the all usersservices there is a The number -
2007 a there is a given because of patient of nursing significant of
significant the weakness of satisfaction careamounted difference respondents
Quality of difference physical, is very to 1820 people between lot
nursing services between the mental, lack of important distributed in 12 the expected
response to the quality of knowledge or Becausebenefit treatment service and the
levels of patient service expected a lack of will thetothe hospital rooms, a sample quality of the
satisfaction and the quality lead to the in order to was 100 people. actual service.
of service ability to carry Evaluate the Data collection
actually outlife current position using
daily-day of hospital questionnaires
Independently. Compared with and
This activity is competitors and documentation.
done in an effort needed to find
to improve the which parts
health, disease are in need of
prevention, repair.
cure,
rehabilitation
and
health care.
6 Abdul Majeed Kuwait - To identify The quality of Patient the data - Exploratory Regarding - Another
Alhashem 2009 factors that the satisfaction can collected during factor analysis the quality of limitation is
influence communication be defined as January 2007 identified six the that we do
Factors link between assessments and May 2007 communicati
patient factors and the not validate
Influencing physicians and made by the through a on link
patient satisfaction in Patients Showed care recipient to questionnaire reliability of the between the
satisfaction in primary health a positive effect care Whether overall scale doctors and questionnair
369
primary health care clinics. on the size of the Reviews their distributed was found 0.61. Patients e in the local
clinics patient expectations randomly. Study Patients environmen
satisfaction have been met limitations / respond most t.
or not negatively.
implications -
One limitation - Another
of this study is drawback is
the exclusion of that some
the private patients are
sector. reluctant to
participate
when they
know that
there is an
incentive
would be
given to
compensate
them for
their time.
7 Pall Biering, USA - To explore the Criteria for The concept of to analyze the Two factors were Internal Casting light
2006 construct construct "patient construct found; one consistency on the concept
validity and validity and satisfaction with validity and consisting of is high and of patient
The concept of sensitivity care" is most sensitivity items other homogeneity satisfaction
sensitivity of
patient resulted in often defined as questionnaire negative tone and with the study
satisfaction with patient findings that an indicator for used in the positive tone of of construct
the construct satisfaction throw some light how well the survey the item. Item validity and
validity and questionnaires on the issues of treatment is conducted in 11 negative tone of sensitivity
sensitivity study intended to definition and received as hospitals texas the items questionnaire
questionnaires obtain a better contributing more
370
understanding measurement expected patient positive tone to
of the concepts nursing care the sensitivity of
concepts, and the instrument.
issues around
size.
8 Xavier Institute India - To understand Improving the Patients were field surveys The data analysis This study - study was
of Management, the patient a quality of satisfied with given to highlighted four provides conducted in
2014 different services in interpersonal patients who important valuable one of the
health care have care, but less were excluded dimensions of insight into
dimension to four major
Measurement of gained much satisfied with in the past from patient the
patient stay in a attention in the the comfort, the public or satisfaction. Four dimensions metropolitan
satisfaction An hospital is last decade due environment, private hospital dimensions are of patient cities in
empirical study regarded as to delivery of sanitation, and in the city. Data significantly and satisfaction India.
essential for care leads to public and collected were positively affect in the Indian
the better health private analyzed using the overall level context and
satisfaction outcomes for instructions. multivariate of patient how they
patients. techniques. satisfaction. affect the
and how
dimensions
dimensions of the overall
affect their patient
overall satisfaction
satisfaction
level.
9 Hong Qin, 2014 Texas To determine UPCERF is one patient Simple random Urgent care - not shown in
patient of the satisfactioninclu sampling service quality the instrument
UCPERF: An satisfaction with instruments for ding indicators (UCPERF) shows on article
Urgent Care one intrument measuring to measure the a positive picture
Patient UPCERF akeulaitas level of health
SatisfactionInstr services care.
ument
371
10 LTC Angelo D. USA shows that the PCMHs Patient of the 200 implementation These studies -
Moore, AN, implementation implement satisfaction is an participants of PCMHs provide input
2016 of PCMHs processes important and from a larger improve patient from the
improve patient without input measurable out- quantitative satisfaction; patient's
Patient provide satisfaction; patient, they risk comes related to study, 148 reduce perspective
recommendation reduce the chance to the experience (74%) of the emergency room and
s to improve emergency room implement of patients and participants to visits, a deeper
patient visits, appropriate included respond to open unnecessary and understandin
satisfaction unnecessary and processes and patients' questions avoidable service g of how
avoidable fail to produce perceptions or costs; and patient
service costs; the expected attitudes about improving access satisfaction
and improving results. their health ing to services is affected by
access to receivers and the provider
services their interaction of health care
with the health actions and
care attributes in
addition
to access to
care.
11 AmieForan,2016 Australi - To develop Evaluate Patient testing phase Interpersonal As a quality Further
Patient a and pilot neuropsychologi satisfaction for (85%) rated facilitator for assurance research could
satisfaction with measure cal hospital- the process of significantly neuropsychologic tool to also
hospital services based neuropsychologi better than the al assessment evaluate include a
patient
based ambulatory cal assessments pre-assessment satisfying neuropsychol broader
neuropsychologi satisfaction services, that are required (79%) and experience, but ogical perspective on
cal include including the in order to feedback (70 also performance. the consumer
themes, extent to which evaluate and %) stage. dissatisfaction experience of
activities and the service is determine how Comments with the physical neuropsychol
interaction intended model changes in given by 32 aspect of the test ogical
settings clinical practice respondents. environment in services
372
specific to of patient- can be valid to addition to the
neuropsychol centered care. be realized in availability of the
ogical the context of service.
this service
assessment
process.
12 Roberta S. USA To analyze Evaluate the To test the Patients during Variables Focus on while gender
Russell 2014 thepatient health system satisfaction visits associated with medical and types of
satisfaction that includes surveys of Access, Moving practice, not service
Patient's survey several types of patient data Through Visit, a hospital, providers do
perceptionqualit clinics, medical from hospital Nurse / Assistant, and includes not appear to
y of specialties and medical center Care Providers several types have any
types of doctors. representative and Personal of clinics, impact on
and determine Issues medical patient
whether significantly specialties satisfaction
additional impact the and types of overall,
analysis can overall physicians in significant
provide the assessment of the analysis. differences
center with service quality. exist by age
useful group,
information to specialized
improve quality doctors and
of care and clinic types
patient
satisfaction.
13 Lorissa USA To determine the physical patient care- Identify at least There are certain The inclusion Padaartikel no
MacAllister, environmental environment called patient 10 known features of spatial criteria for mention of
2016 variables that noted as satisfaction-is variable spatial and the 14 studies how the
influence important to be great interest in environment environmental selected is a samples used
Environmental satisfaction the clean and quiet the healthcare that has been design in hospital clear analysis inresearch
variables that patient's but is not industry, as it proven to have settings or jobs of statistics,
considered an becomes more a direct that affect the variable
373
affect patient essential part of directly related relationship outcome and spatial
satisfaction patient to the income of with health and should be measurable
satisfaction or the provider of behavioral recorded in future predictor
the result of health system , outcomes of research. clear, and
other health patients. variable
outcomes
associated
with health
outcomes or
human
behavior (ie
tariffs, death,
fall, or
rehospitalizat
ion)
14 LVCheldelin USA To test whether Providence Saint telephone All families Eight hundred mail survey there is no
2012 patient Vincent NICU survey is a with patients and thirteen and linear
satisfaction already in place better discharged families included telephone correlation
patient measurement two parallel estimate of the hospital NICU in the study. survey can be found
satisfaction methods affect surveys. One of actual attitude parents respondents between two
measurement the results of them is an of the surveyed at 2 to have a of the five
method exclusive survey populationfamili 42 days after different questions, the
email (Press es discharge attitude that constant
Ganey) and discharged from with two can not be process of
other telephone- NICUand we parallel survey adjusted for mathematical
based survey. can not just do (mailed and the effects of values
the telephone) from methodologic can not be
math August 2010 to al identified.
adjustments December measurement
between surveys 2011. .
to account
formode.
374
differences
Both methods
give us a
population
survey with a
different
attitude.
15, J. Baker 2013 British - to ensure that A coordinated Patient These women Women attend In this study Generalizing
Patient sufficient approach is satisfaction has are invited to for breast the aspects the results are
satisfaction with CNSS adopted to allowed the attend screening that more less
nurse clinical monitor team toquality skriningpayudar assessment, than previous
available to
specialistpractice standards of assurance a center. interactions with studies.
women practice Build aarea of CNS has been
attending among clinical good practice to very helpful.
breast nurse specialists be shared across
screening (CNSS) the
assessment region.
centers.
375
THE EFFECT OF MUROTTAL ALQURAN
ON THE SLEEP QUALITY OF CHILDREN (1-5 YEARS OLD)
Merlyna Suryaningsih
STIKes Ngudia Husada Madura
Email: dear_erlyn@yahoo.com
ABSTRACT
Introduction: A problem often encountered toddler is the poor quality of sleep, which can be
caused by physical and psychological factors. Based on the data in PAUD Muhammadiyah
Bangkalan showed that there is still a lack of quality sleep toddler as much as 60% of children
aged 1-5 years. One method that can used to increase the quality of sleep in children 1-5 years
old is by Murottal AlQur'an. The purpose of this study was to determine the effect of Murottal
Al-Qur'an therapy on the quality of sleep of children aged 1-5 years old in PAUD
Muhammadiyah Bangkalan. Methods: The research design was quasi experimental pre-post
test with control group design. The population of 35 infants who experience the quality of sleep
of children aged 1-5 years old in PAUD Muhammadiyah Bangkalan. The sampling technique
used simple random sampling with 18 respondents are divided into two groups, 9 children in
the control group and 9 children in treatment groups. Independent variable is the Murottal
AlQur'an, the dependent variable is the quality of sleep. Data collection using questionnaires.
The statistical test used Wilcoxon and Mann-Whitney with α = 0.05. Results: The results
showed that was significant difference between the quality of sleep before and after Murottal
AlQur'an on treatment groups (p value 0.009; α = 0.05). Same results in the control group there
was difference between the quality of sleep before and after the observation (p value 0.046; α
= 0.05). In addition, there is a significant difference between sleep quality improvement
between intervention and control groups (p value 0.000; α = 5%). It can be concluded that there
is a therapeutic effect of Murottal Qur'an to increase sleep quality children 1-5 years old in
PAUD Muhammadiyah Bangkalan. Discussion: Based on this study, it is recommended for
parents to give Murottal AlQur'an to their children in 1-5 year old, and rotated for 5-10 minutes
at night when the children going to bed to improve their sleep quality
Keywords: Murottal Qur'an, quality of sleep, Children (1-5 years old)
INTRODUCTION of times in any 24-hour period. But along

Quality of sleep is a person with the maturation toward school years and
satisfaction from sleep experience, include older, they tend to sleep in one phase of a
of sleep initiation, sleep quantity, and feel long, daylight decreases and tends to sleep
fresh when wake up (Gellman, 2013). Sleep through the night (Robotham, 2011). The
problems often encountered is difficulty to level of development of normal sleep
initiate sleep, difficulty falling asleep and patterns, namely, the amount of sleep you
waking up at night but can not sleep. (Sari need 0-2 months of age from 10.5 to 18
paediatrics, 2006). Toddler sleep problems hours per day. ages 2-12 months the amount
in the future may lead to the age of toddlers of sleep it takes about 14-15 hours a day.
and school age, and it can predict the Age 1-3 years the amount of sleep you need
occurrence of sleep and behavioral 12-14 hours a day. At the age of 3-5 years
problems later (Sakartini, 2006). of approximately 11-13 hours a day. 5-12
Sleep habits also have a role as years of age approximately 10-11 hours in a
important as the total amount of sleep time. day. 12-18 years of age about 7-9 hours a
Toddlers and children tend to sleep a couple day (Waluyo, 2011).
376
Based on the preliminary studies in So the study sample size results in
PAUD Muhammadiyah on January 6, 2016 the control group and the treatment group is
there were 10 people in the early childhood 18 people. Sampling is the process of
school students Muhammadiyah selecting the portion of the population to be
Bangkalan, data showed that 20% of people able to represent the population (Nursalam,
have a good sleep quality, 20% of people 2003) Sampling technique using simple
including sufficient quality, and 60% random sampling. Instrument used
children including sleep quality was questionnaire.
lacking. From the above preliminary study
found that the high incidence of lack of RESULT
quality sleep is when you start to sleep at A. GENERAL DATA
night, toddlers aged 1-3 years 12-14 hours 4.1.1 Characteristics of Respondents by Gender
while the age of 3-5 years less than 11/13 Table 4.1 Distribution of Frequency
hours sleep, difficult to wake in the respondents by Gender
morning, and children easily awakened
when environment in noisy. N Gender Treatment Control
Some of the possible solutions with o
the quality of sleep is the Story Telling, f (%) f (%)
massage, music therapy, punggun Massage
therapy, therapy Murotal Qur'an. Besides 1 Male 4 44,4 4 44,
the right solution to improve the quality of 4
sleep in infants become disturbed by 2 Female 5 55,6 5 55,
therapy murotal al-quran. Therapy murotal 6
al-Quran is one of the relaxing effect and Total 9 100 9 100
can reduce anxiety, including the Data source: field data
management of restful sleep patterns in Based on Table 4.1 show that the
infants aged 1-5 years due to problems of treatment group the majority of respondents
physical and psychological factors that are were female that is 5 respondents (55.6%).
often found in infants. With therapy murotal While the control group some respondents
al-quran on infant sleep quality were female that is 5 respondents (55.6%).
requirements can be addressed and met. 4.1.2 Characteristics of respondents by age
Table 4.2 Distribusi frequency of respondents
Because toddlers will feel relaxed and less
age
anxious after therapy murotal the Quran, so
that will make the quality of sleep in infants N Age Perlakuan Kontrol
needs will be met. o
The research design is quasi-
f (%) f (%)
experimental (Quasi eksperiment). With the
approach of pre-post test design with 1 3 years 4 50,0 4 50,0
control group design into two groups:
treatment group and the control group by 2 4 years 2 37,5 3 37,5
revealing the influence. Both groups were 3 5 years 3
observed before the intervention, then the 12,5 2 12,5
group of treatment were observed again Total 9 100 9 100
after the intervention (Nursalam, 2013). Data source: field data
The population in this study are Based on Table 4.2 show that the
each subject (eg, human; clients) that meet treatment group of respondents most 3 year
the criteria established (Nursalam, 2011). In olds as much as 4 respondents (50.0%).
this study, there is a population of 35 infants While the majority of the control group was
in early childhood Muhammadiyah 3 years old as much as 4 respondents
Bangkalan. (50.0%).
377
Less 2 22,2 5 55,6
4.1 Specific Data
In particular the data will be Jumlah 9 100 9 100
presented on data collection which includes Mean 15,89 14,00
a frequency distribution of respondents
Uji p value = α = 0,05
based on the variables studied.
Wilcoxon 0,046
4.2.1 Data Research on Treatment Group
Table 4.3 Differences in the quality of sleep
before and after given Murottal AlQur'an According to the table to do the
Sleep Pre Post taxable income 4.4 Analysis showed that
Quality Treatment Treatment from 9 respondents not provided Murottal
Qur'an (control Group) found that most big
F % F % pre Sleep Quality The experience kuaitas
Good 0 0 6 66,7 Simply Sleep as much as 6 respondents
(66.7), and Sleep Quality The experience of
Enough 4 44,4 3 33,3 post partially Sleep quality less by 5
respondents (55.6).
Less 5 55,6 0 0
Data From The differences showed
Jumlah 9 100 9 100 statistical test findings Willcoxon that
control group pre and post the results
Mean 14,11 19,22 showed that the p value 0.046> α (0.05) so
Uji p value = α = 0,05 that H1 is rejected, and can be deduced that
Wilcoxon 0,009 the Difference Sleep quality before and
after Treatment group toddlers age 1-5
Based on Table 4.3 After analysis of years in PAUD Muhammadiyah
data obtained that from 9 respondents were Bangkalan.
given Murottal Qur'an (the treatment group) 4.2.3 The Effect of Murottal AlQur'an
showed that sleep quality pre part has less before and after Murottal AlQur'an on the
quality in sleep as many as five respondents quality of sleep
(55.6%), and sleep quality in post mostly Table 4.5 The Effect Murottal AlQur'an before
good sleep quality as much as six (66.7%). and after given Murottal Qur'an
Based on statistical test Willcoxon No difference difference
that the treatment group pre and post results in in control
showed that the p value 0.009 <α (0.05) so treatment
that H1 is accepted, and it can be deduced 1 6 -4
that there is a difference in the quality of 2 8 0
sleep before and after therapy murottal 3 6 0
Koran on group treatment of children 1-5 4 4 -5
years old in PAUD Muammadiyah 5
7 -4
Bangkalan. 6 5 0
7 4 0
4.2.2 Data Results In Control group
8 4 -4
Table 4.4 Differences in Sleep quality before
9 2 0
and After That is not given Murottal AlQur'an
Sleep Pre Post Mean 5,11 -1,89
Quality Control Control (rata-rata)
Uji Mann- P value = α = 0,05
F % F % Whitney 0,000
Good 1 11.1 0 0 After analysis of data showed that
Enough 6 66,7 4 44,4 the difference between the 2 groups were
given the Qur'an murrotal therapy and no
378
treatment murrotal the Quran was found From the research that has
that the average difference in the quality of not been given murrotal AlQuran was found
sleep in infants aged 1-5 years were given that the quality of sleep in infants majority
therapy murrotal Al -Qur'an value is -5.11 (55.6%) less sleep quality. This is possible
and that no treatment murrotal Qur'an value because toddlers who feel thirsty and
of 1.89 and a statistical test Mann-Whitney toddlers more sleep during the day that in
treatment group and the control group p the evening fussy toddler and could not
value is 0,000. So the significance is smaller sleep well. This is supported by the theory
than the error rate (0.000 <0.05) specified Tarwoto and Wartonah (2004) that infants
researcher that the error rate of 5% (0.05). sleep quality can be affected by physical
so that, it can be concluded there is a factors and psychological factors. Physical
significant difference in sleep quality factors that affect the quality of sleep can be
between group were given Murottal a malnourished toddler (toddler or child
Alquran and did not given. becomes fussy and can not sleep well). The
research in Carneigie Mellon University
DISCUSSION and the University of Pennsylvania found
In this chapter will be a discussion that the quantity and quality of sleep
of the variables to be studied by comparing actually affects how people can become ill.
the quality of sleep in infants with impaired The characteristics of toddlers get enough
sleep quality Murottal therapy given the sleep, that is, the toddler will be able to fall
Qur'an and that no treatment Murottal asleep easily at night, fit when I wake up, no
Qur'an in ECD Muhammadiyah Bangkalan. fuss, and does not require a nap in excess of
needs in accordance with its development.
5.1 Differences in Quality of sleep in infants Therefore, researchers give
who experience sleep quality before murrotal therapy Qur'an. In the opinion of
and after given Murottal Qur'an in Faradisi (2009) one would be easier to get
PAUD Muhammadiyah Bangkalan the relaxation response. The relaxation
response can arise because there is a
Based on the results of relationship between the mind and the body
research conducted in PAUD (mind-body conection). So hear reading the
Muhammadiyah Bangkalan is known that Qur'an can be referred to also as a religious
in the treatment group gained Wilcoxon relaxation.
statistical test p value is 0.009, so the Group that has been given murrotal
significance is smaller than the degree of AlQuran was found that the quality of sleep
error that has been in infants majority (66.6%) have good sleep
established by researchers that 5% quality. This is possible due to the rhythm
(0.05). It can be concluded no difference in of the Qur'an make children become calm
sleep quality between pre and post given and relax the body, so it can make toddlers
murrotal Qur'an. are not fussy and trigger drowsiness. With a
Based on the results of toddler bed that needs are met so that the
research in PAUD Muhammadiyah quality of sleep toddler be improved. This is
Bangkalan found that there are differences supported by the theory that with a slow
in the quality of sleep in infants between pre tempo and harmonic chant the Qur'an can
and post given murrotal Qur'an. From 9 reduce stress hormones, activate natural
respondents treatment groups before endorphins, increase the feeling of
therapy Murottal Qur'an part has less than 5 relaxation, and divert attention away from
respondents sleep quality and sleep quality fear, anxiety and tension, improve chemical
experienced enough in 4 respondents. system body that lowers blood pressure and
While the post test 6 respondents had a good slows respiration, heart rate, pulse rate, and
sleep quality and 3 respondents had enough brain wave activity, it is this which will
sleep quality.
379
improve so that the circadian rhythm of important than the number of hours of sleep
sleep quality improved (Heru, 2008). itself. In some people, they have enough
The factors that affect the quality of with only slept for 5 hours each night. In
sleep is the age factor. Where in this study sickness may make patients less sleep or not
in part 4 (50.0%) of respondents aged 3 to sleep (Tarwoto and Wartonah, 2004), in
years. This is because age affects the quality (Yadi 2013).
of sleep because of age is one factor that
affects the quality of sleep and sleep a 5.2 Differences Sleep Quality in children
person needs. The need for sleep is reduced without Murottal AlQuran in PAUD
in accordance with age. sleep quality Muhammadiyah Bangkalan.
associated with the disease and ill health. So Based on the results of research
that age has an influence on the quality of conducted in early childhood Bangkalan
one's sleep. Muhammadiyah is known that in the control
This is supported by the opinions group gained Wilcoxon statistical test p
treasures and Hidayati (2012) that the habit value is 0,046 so the significance is smaller
of sleeping patterns also have a role as than the degree of error that has been
important as the total amount of sleep time. established by researchers that 5% (0.05). It
Toddlers and children tend to sleep a couple can be concluded no difference in sleep
of times in any 24-hour period. But along quality between pre and post without given
with the maturation toward school years and murrotal Qur'an.
older, they tend to sleep in one phase of a Based on the research in early
long, daylight decreases and tends to sleep childhood Muhammadiyah Bangkalan
through the night (Robotham, 2011). The regency showed that there are differences in
level of development of normal sleep the quality of sleep in infants between pre
patterns, namely, the amount of sleep you and post diberkan murrotal Qur'an. From 9
need 0-2 months of age from 10.5 to 18 respondents control group pre largely
hours per day. ages 2-12 months the amount enough sleep disturbance as much as 6
of sleep it takes about 14-15 hours a day. respondents. While the post test most of the
Age 1-3 years the amount of sleep you need sleep disorder is less by 5 respondents.
12-14 hours a day. At the age of 3-5 years From this research, group that was
of approximately 11-13 hours a day. 5-12 not given murrotal AlQur'an has significant
years of age approximately 10-11 hours in a value to decrease, it can be possible because
day. 12-18 years of age about 7-9 hours a not given any intervention during the
day (Waluyo, 2011). observation, nothing stimulates the
Based on the research of experts, hypothalamus in the brain to increase
that increasing age, the time spent in sleep production of melatonin so the quality of
decreases. This is due to increased physical sleep infants in the control group did not
activity, such as playing (Suherman, 2000). experience improvement. Though poor
In (Yadi 2013). quality require a treatment in order to
About when a child sleeps, improve. This is certainly in line with the
depending on the age, state of opinions Roccichelli, Stanford, Vandewaa
consciousness, daily activities, and how the (2010) which states that poor sleep quality
state of the child, the child's sleep pattern issues require a treatment. In addition,
changes can affect the quality of sleep, sleep according Golman (2007), a sleep disorder
quality is not only measured by the length can be treated either medically or non-
of a person's sleep during the day. Normal medically.
sleep patterns based on age or The factor that affect the quality of
developmental level may be one indication. sleep was less in children is gender, which
According Kozier (2003), in (Yadi 2013), in this study were female toddler as much as
with a regular pattern of sleep is more 5 toddlers. This has a direct impact on
380
circadian rhythms and sleep patterns. form of psychological effects and
Psychological conditions such as increased neurological effects. The cadence chant
anxiety, restlessness, and often uncontrolled physiological repair nerve - the nerve can
emotions in women. This is supported by improve the body's mechanism toddler
research Kimura (2005) and research elderly so sleep quality to be good (Asrin,
Khasanah & Hidayati (2012) that 52 women Mardiyono and Saryono, 2007).
had poor sleep quality and 17 women had a This is in line with research by
good sleep quality. As for male, 16 male Faradisi (2009) showed that murottal
have poor sleep quality and 12 others had a AlQur'an could stimulate the
good sleep quality. This means that the parasympathetic nervous system which
number of female who have poor sleep have an effect opposite to the sympathetic
quality were more than male. nervous system. So there is a balance in
both the autonomic nervous system. This is
5.3 Effect of the murrotal AlQur'an on the basic principle of the onset of the
quality of sleep in PAUD relaxation response, which is a balance
Muhammadiyah Bangkalan. between the sympathetic nervous system
Based on the results of research and the parasympathetic nervous system.
conducted in PAUD Muhammadiyah Effects of murottal and
Bangkalan is known that in the treatment remembrance among others, can reduce
group were given murrotal Qur'an ie (5.11) anxiety. It also provides relaxing effect on
and the control group were not given the body (tranquility, peace and
murrotal Qur'an is (-1.89). Based on concentration). While voice murottal
statistical test of Mann-Whitney control Qur'an is an alternative therapy that can
group and the treatment group p value is reduce stress and increase comfort. This is
0,000 so the significance is smaller than the caused by the chant melody murottal Qur'an
degree of guilt (0.000 <0.05). So it can be makes the stimulatory effect of hormones -
concluded that there is the effect after the hormone in the body Besides murottal
administration of murrotal AlQur'an. Qur'an makes pendengarmya become closer
Based on the results of research in to God. Someone closer to God would be
PAUD Muhammadiyah Bangkalan, 9 easier to get some peace and relaxation. So
respondents in the treatment group listen murottal Qur'an can stimulate
experienced a significant improvement in relaxation effects and increase the quality of
sleep quality show most experienced sleep (Mardiyono, 2011). It can be
improved sleep 6 (66.7%). Whereas in most concluded that there is a therapeutic effect
of the control group significantly decreased murottal Qur'an to quality early childhood
quality of sleep as many as 6 respondents sleeping toddler in Muhammadiyah
(66.7%). This is because the presence of a Bangkalan. And therapy murottal Qur'an is
given therapy will provide the stimulus that one of the non-medical therapies that can
can stimulate the feeling of being relaxed so improve the quality of sleep toddler.
easy to sleep and sleep needs are met. Vice But in this study, there are several
versa if no treatment is given then no factors that come into effect in improving
stimulus could also stimulate feelings of the quality of sleep toddler, factors that
wanting to sleep. affect the quality of infant sleep is a disease,
This difference occurs because the physical exercise, nutrition, the
treatment group was given the Qur'an environment and the motivation to cover
Murottal therapy, while the control group internal and external factors. Eksteral
was not given the Murottal AlQur'an. factors include environmental factors
Based on the working principle of the conducive crowded and not affect the
Murottal AlQur'an is one kind of sound quantity of the toddler bed. In this study,
therapy. The effects of sound therapy in the environmental factors are not controlled
381
strictly, so that raises the effect also to the Qur'an Murottal Stimlasi against kuaitas
quality of sleep. Meanwhile, internal factors sleeping toddlers aged 1-5 years
include health conditions toddlers b. For educational institutions
(Widianto, 2005). This thesis is expected to add references to
One of the factors that affect the therapy Murottal Qur'an against kuaitas
quality of sleep is a disease that every sleeping toddlers aged 1-5 years As well
disease that causes pain, physical as to improve the quality of education and
discomfort may cause sleep problems. professionalism of health workers.
Physical exercise is exhaustion due to
higher activity may require more sleep to 6.2.2 Practical advice
maintain energy balance was issued. a. For Health Personnel (Hospital)
Nutrition is an important factor for The results of this study may provide
maximizing the golden period of growth of additional scientific information and
the brain is the fulfillment of a toddler knowledge for nurses in providing
nutrition and adequate sleep. ASI proved to stimulation intervention Murottal Koran
contain high protein alpha, alpha protein is in infants in improving the quality and
the first protein in whey protein that is improvement as well as health services.
smooth and easy to digest protein. b. For further research
Environment The environment that is safe The results of this study can be used as a
and convenient for someone to speed up the source of basic data and reference
process of sleep. Instead environmentally literature and literature for further research
unsafe and uncomfortable for someone can to develop a similar research. for further
lead to the loss of serenity that affect the research is expected to increase with the
sleep process. number of larger samples and a wider
range and compare more influence on
CONCLUSIONS Stimulation Murottal Qur'an.
6. 1 Conclusion c. For Parents The results of this study can
Based on research that has been done can be be used as therapy to overcome the
concluded as follows: problem of the quality of sleep in infants,
a. There is a difference in the quality of as well as to increase knowledge.
sleep in children (1-5 years old) before
and after given Murottal AlQur'an in REFFERENCES
PAUD Muhammadiyah Bangkalan. Abdurrochman. (2008). MurottalAL-Quran
b. There is a difference in the quality of : Alternatif Terapi Suara Baru,
sleep in infants who are not given Seminar Nasional Sains dan
Murottal AlQur'an in PAUD Tekhnologi. Lampung : Universitas
Muhammadiyah Bangkalan. Negeri Lampung
c. There are effect of Murottal AlQuran on Agustina, Susanti, (2008). Mendongeng
the sleep quality of children (1-5 years Sebagai Energi Bagi Anak, Jakarta:
old) in PAUD Muhammadiyah Rumah IlmuIndonsia
Bangkalan. Asmadi, (2008). Konsep Dan Aplikasi
Kebutuhan Dasar Klien,
6.2 Suggestions Jakarta:Salemba Medika
After knowing the results of this study, the Alimun Hidayat. Aziz. 2007. Metode
researchers gave the following advice: penelitian keperawatan dan tekhnik
6.2.1 Suggestions theoretical Analisa data. Jakarta : Salemba
a. For professions (nursing) Medika.
This thesis is expected for the Aminati, Dini. 2013. Pijat dan senam untuk
development of professional health bayi dan balita. Yogyakarta :
workers, especially the influence of the BriliantBooks
382
Asman, O. 2008. Qur'anic Healing for Kementrian Agama. 2011, Tafsir Al-Qur an
Spiritual Ailments, Between Tematik, Kesehatan dalam
Tradition, Religious Law and Presvektif Al-Qur an (Tafsir Al-Qur
Contemporary Law. Medical Law an Tematik), Akubisa, Jakarta
Journal, 259-284. Khasanah, K Dan Hidayati, W. 2012.
Aziz, Alimul. 2010. Metode penelitian Kualitas tidur lansiabalai
kesehatan. Surabaya: Health books rehabilitasi sosial "MANDIRI"
publishing. Semarang. Journal nursing studies
Darmojo, et al. 2009. Buku ajar: Geriatrik Khalid. 2012. Promosi Kesehatan, Jakarta :
(Ilmu Kesehatan Usia Lanjut). Rajawali Pers.
Jakarta : FKUI Kozier.,Erb.,Berman.,Synder. 2011. Buku
Elzaky Jamal. 2011. Buku Induk Mu’jizat Ajar Fundamental Nursing Konsep,
Kesehatan Ibadah Terjemahan Proses Dan Praktik Volume 2.
Dedy Slamet Ready, Jakarta : Jakarta : EGC
Zaman. Lumbantobing, S. M. (2004). Gangguan
Faradisi. 2009. Perbedaan Efektifitas Tidur.Jakarta: Balai Penerbit FKUL
pemberian Terapi Murottal Dengan Mindell JA. (2006)
Terapi Musik Klasik Terhadap Empiricallysupportedtreatmentsin
Penurunan Tingkat Kecemasan pediatri psychology:
Pada Pasien Pre Operasi Fraktur Bedrimerefusalandnightwakingsiny
Ekstremitas Di Rumah Sakit Dr. ounggchildren. J PediatrPsychol
Moewardi Surakarta. Surakarta: 1999; 24;465-81
universitas muhammadiyah Mubarok dan Chayatin. (2007). Kebutuhan
surakarta. Dasar Manusia (Teori dan Aplikasi
Golman. 2007. Disturbed Sleep Linked to Dalam Praktek). Jakarta : EGC
Poorer Daytime Function in Older Nursalam. (2005). Asuhan Keperawatan
Woman. The journal of Pittsburg Bayi dan Anak (untuk perawatan
Univercity. dan bidan).Jakarta: EGC
Glaze DG, (2006).Rosen CI, Owens JA. Oliveira. 2010. Sleep Quality Of Elders
Toward a practicaldefinition of Living In Long Term Care
pediatric Institution. Journal of Brazilian
insomnia.CurrentTherapeutic University
Research 2002; 63(suppl B):B4-17. Padila. 2013. Buku Ajar Keperawatan
Goodlin-Jones BL, (2005)Burnham MM, Gerontik. Bengkulu: Nuha Medika.
Gaylor EE, Anders TF, Potter &Pery. (2005). Buku Ajar
Nightwaking, sleep- Fundamental Keperawatan. Edisi 4.
warkorganization, andself- Jakarta:EGC
soothinginthefirstyear of life. Roccichelli, J., Sanford, J., and Vandewaa,
DevBehavPediatr 2001;22:226-33. E. 2010. Managing Sleep Disorder
Hawari. 2005. Al-Qur an Ilmu Kedokteran in Elderly. The journal of
Jiwa dan Kesehatan Mental, Jakarta nursingcenter
: Dana Baktiasa Robotham,2011. Konsep Dan Proses
Hidayat, Aziz Alimul. 2010. Metode Keperawatan Keluarga.
Penelitian Kebidanan dan Teknik Yogyakarta: Graha Ilmu.
Analisa Data. Jakarta : Salemba Ramchandani P, (2008)Wiggs L, webb V,
Medika. Stores G. Asystem-aticreview of
'Izzat, A. M., & 'Arif, M. 2011. Terapi Ayat treatment for
Al-Qur'an Untuk Kesembuhan settlingproblemsandnightwakinginy
Keajaiban Al-Quran Menyembuhan oungchildren. British Medical
Penyakit. Solo: Kafilah Publishing. Journal 2000;320:209-13.
383
.Waluyo, guniadiyo, 2011. Gangguan tidur
anak pada anak.
Http//www.jurnalharian.com/2011/
11/gangguan-tidur-pada-
anak.html/diperoleh tanggal 10
desember 2015.
Wong, Donna L. (2004). Pedoman Klinis
Keperawatan Pediatrik Edisi 4.
Jakarta : EGC
Yadi 2013. Peran Keluarga Dalam Peroses
Hospitalisasi Anak di Ruang Anak
di Rumah Sakit Santa Elisabeth
Medan.Skripsi.
384
FAMILY ENVIRONMENT AND PUBLIC (SOCIAL), INDEPENDENCE ELDERLY,
THE ACHIEVEMENT OF WELFARE OF ELDERLY
Pipit Festi Wiliyanarti*, Hari Basuki Notobroto**, Hamidah***, Kacung Asri*

Department of Community Health Nursing, Muhammadiyah University of Surabaya*
Department of Public Health Airlangga University**
Department of Psychology Airlangga University***
ABSTRACT
Introduction: Elderly was part of the growth and development process. The existence of
physical deterioration and social changes lead to dependency on the activity of its sovereignty.
Elderly who were accustomed for having the activity will be more independent than the elderly
who were in dependency. Family environment in the form of family support and community
support, can affect the condition of the elderly well-being. Elderly are part of the family, which
was expected to provide support in the achievement of physical well-being. Whereas the elderly
themselves, because of decreasing process in the physical, psychological, social and mental
ability, resulted in a lessening in the role and status of the elderly in the family. This study aims
to determine the relationship between the family and society, the independence of the elderly
with the elderly well-being. Method: Descriptive analytic with cross sectional approach was
used in recent study. Samples include 400 elderly and families in Surabaya with Multistage
Random Sampling technique. Collecting data using interviews and observation. Confirmatory
Factor Analysis was used in the data analysis. Result: The result showed that family
environment that supports the well-being of the elderly was an environment that provides
opportunities for elderly to participate in daily activities, family support which given in the
achievement of the elderly well-being were the instrumental support in the form of fulfilling
the daily needs, harmonious home environment; emotional support in the form of trust in the
family, a sense of care to the elderly. Results of the data analysis showed the value of the social
environment, loading factor 0,51; R2 = 0.72, and self independency-loading factor of 0.36; R2
= 2:35. Chi-square 21.79, p-value = 0,2512 RMSEA = 0.002. Conclusion: It showed that the
family and the community environment with the provision of family support, independence
having a significant influence on the elderly well-being. The role of nurses was important to
raise families and the elderly, so that the health, well-being and quality of life of the elderly can
properly be met.
Keywords: family support, the welfare of the elderly
BACKGROUND stage of life. Based on the data which states

Age-related further period with that in 2020 the elderly term increase 25%.
hearts change lifecycle. Around the social Based on data from Susenas states that
environment of elderly life related operate figure elderly population dependency ratio
direct not with welfare (both -being) in 2014 was at 17.02 that show every 100
elderly. The ability of elderly hearts elderly population productive age should
addressing different issues between life, the bear approximately 17 elderly population
life pressure, stress depending on the elderly. Elderly are not earning more and
achievement in successful aging (Adi more must be a dependent family, society
2013). It singers subscribe with the elderly and the government. Socio-economic
personal growth, while the growth conditions of the elderly in Surabaya
depending on the implementation of currently categorized generally cannot
different telecoms developments in every quality living prosperous elderly resulted
385
more low, decrease in the degree of health health is a prayer one dominant aspect
and dependency (on dependence other hearts formation of welfare. The condition
family). Figures elderly dependency in is not fully achieved can in further ages,
2014 ranges from 17.02 stating that every thus impacting in no achievement of
100 elderly population of productive age welfare.
must bear approximately 17 elderly. Elderly Based on the findings of research in
dependency burden value is at surabaya, obtained data that the average
psychological impact of the elderly. elderly have hearts welfare higher-
Environmental media where are a especially men, while more women are
living beings, finding and had characters having moderate welfare. The efforts
and the typical functions which operates undertaken to achieve meaningfulness life
subscribe reciprocal with existence of review are a long stay, worshiping, helping
beings who occupied mainly role the man families, and maintain relationship. The
who have more complex and real. All that forms of support can improve the welfare is
is with may be used by the human a concern, encouragement, information,
environment for human life needs sufficient solutions experienced an issue differences,
review, because carrying that neighborhood financial aid, transportation, entertainment,
has a neighborhood's ability to review health and development service capabilities
support the livelihood of human and other (mahajudin et al, 2008). Another issue not
living things (Azizah, 2011). The only at at elderly term needs parent
neighborhood has a relationship by elderly. compensation, but rather involves cultural
Environment influences such attitude and value. Seniors contribute hearts of cultural
human behavior also the elderly, as well as continuity that pattern of behavior,
human life environment will affect his confidence into the next generation. Elderly
place. who achieve high social status hearts a
If the elderly not being able to run culture where the elderly get the award,
telecoms operating developments optimal respect, instrumental hearts particularly
psychological happiness so not met. useful functions and is valuable in this case
Inability troubleshooting pressure against we can elderly welfare materialized.
environmental and self adjusting Social networking (social network)
underprivileged hearts, feel yourself not may provide further advantages for seniors,
needed, a shape of the psychological stress the good society relations hearts social
experienced by the elderly. If by advanced problems as well as problems related to
age adaptable environment, has optimal health. The ada social support in
development of personal, so it can 'communities as a result from social
overcome psychosocial stress and can networks the ada affect their aid granted by
achieve optimum aging and even aging has the individual, family and' the community
been successfully get. Positive attitude the (gilmour, 2012; heave, brown, et.al, 2012).
is with advanced age is a form of response Based on the description above can
acceptance with conditions aging, be interpreted that the social environment
associated positively with other elderlys affects the well-being of the elderly. The
shown seniors with liveliness in 'the aims of this study were identification of
community leads shown to the formation of family and community interaction
the function of psychological functioning component in the elderly, the identification
the positive (psychological functioning of the physical welfare of the elderly, and
positive) that brings shown to the the analysis of social environmental
realization of welfare psychological influences on physical wellbeing.
(psychological wellbeing) (gilmour, 2012).
Positive self assessment the singer is
praying the welfare indicators. Mental
386
METHOD sample obtained with the multi-state
This study aims to determine the random sampling technique. Data were
characteristics, social environment analyzed using factor analysis confirmary.
component that supports the welfare of the The research variables consisted of ind
elderly. The study is in two phases the first variable that is characteristic of the elderly
phase yaitkomponen social environment and social environment that consists of,
related to the welfare lansia.penelitian this social networks, family and community
is a survey. Conducted on 400 elderly. interaction, problems faced by the elderly in
Samples elderly who live with their families the family.
and aged 60 years and older. The research
RESULTS
Identification of family and community interaction component in the elderly
Indicators Categories Frequency Percentage
Family Not Good enough 6 1.5
environment & Good enough 39 9.8
Community Good 144 36
Very Good 211 52.8
The identification of the physical welfare of the elderly

Indicators Categories Frequency Percentage
Independency High Dependency 2 0.5
Mild Dependency 40 10.0
Low Dependency 126 31.5
Independent 232 58.0
Signifikasi variables
Factor Loading
Indicators tλ 1-δ t1-δ
(λ)
Independency 0,36 13,01 0,50 8.55
Family Environment &
0,51 19,85 0,53 13,35
Community
Results of the data analysis showed highly advanced age plays against further
the value of the social environment, loading development age, environmental conditions
factor 0,51; R2 = 0.72, and self that will provide further support can
independency-loading factor of 0.36; R2 = increasing interest in age to the review
2:35. Chi-square 21.79, p-value = 0,2512 reached welfare (hamidah, 2012).
RMSEA = 0.002. The problems faced by families
hearts advanced age, advanced age tin data
DISCUSSION that 74.5% had problems hearts advanced
The social environment is an age friendly happiness and the issue further
environment where advanced age had reduce age. It singer according to the
interaction to run his social life, while being research conducted by agency for research
a singer is their study of social networks on rights of man, which states that the
around advanced age, advanced interaction independence of advanced age increasingly
age hearts family and 'society, as well as feel you with change shape of large families
issues affecting the hearts of family welfare being a family nucleus that causes potential
and advanced age. Life of the neighborhood for a review express more freely, but things
387
singer actually can make losing the family penelitian Hibah Strategis
as a social basis of stability and regulation. Nasional.Lemlit Universitas
Economic factors play a role being more Airlangga.
hearts singer family and become status Papalia,DE., Old, S.W., & Feldman, R.D.
indicator and life changes. Singer (2008). Human Developmen.
circumstances occurred by for members Newyork: McGraw-Hills.
hearts leaving family home. Even in a state
of hearts family, continued age with
children who lived in a home may act as
caretaker’s grandchildren. An economic
help family expense operates in addition to
adding further flurry on age.
CONCLUSION
Family and community
environment is very good 52.8%, 58.0%
Independent elderly Independence, Results
of the analysis of data Showed the value of
the social environment, loading factor of
0.51; R2 = 0.72, independency and self-
loading factor of 0:36; R2 = 2:35. Chi-
square 21.79, p-value = 0.2512 RMSEA =
0.002.
REFERENCE
Adi.I.R, (2013). Kesejahteraan Sosial,
Jakarta, PT. Raja Grafindo Persada,
Jakarta.
Azizah, L.M ,(2011). Keperawatan Lanjut
Usia, Yogyakarta,Graha Ilmu.
Gilmour, H. (2012). Social participation
and the health and well-being of
Canadian seniors. Health report,
23(4).
Glanz, Karen. 2008. Health Behavior
Education Theory, Research and
Practice.
Hamidah. (2012). Eksplorasi Succesful
Aging melalui dukungan Sosial bagi
lansia di Indonesia dan Malaysia.
Jurnal INSAN. Vol 14. No 02
Hyde, A.L., Mather., & Elavsky,S ,(2013).
Enhancing our understanding of
physical activity and well-being with
a lifespan perpective. Internasional
Journal of Wellbeing, 3(1), 98-115
Mahajudin, M, Adib, &M, Hamidah, 2009.
Meningkatkan Wellbeing Lanjut usia
Melalui Dukungan Sosial yang
berbasis Komunitas, Laporan
388
EFFECTIVENESS EXERCISES OF SELF-ACCEPTENCE: RELAXATION AND
DZIKIR FOR REDUCTION OF BLOOD GLUCOSE DEGREE TO THE PATIENT
OF DIABETES MELLITUS TYPE 2
Mufarika
Nursing Study Program STIKes Ngudia Husada Madura, Indonesia
Email: -
Abstract
Introduction: Diabetes mellitus in the heterrogeneous difference that mark by the reduction of
blood glucose or hyperglukemia. The numeral incident of diabetes mellitus type 2 still high in
the Burneh Health Centre. The purpose of this research is to make some analysis the side effect
for exercises of self-acceptence : relaxation and dzikir for reduction of blood glucose degree to
the patients of diabetes mellitus type 2 in the Burneh Health Centre, Bangkalan Regency.
Method: The research is the kind of experiment research with Design Quasy Experimental
Pretest-Posttest with control group. The population in this research is all the patients of diabetes
mellitus type 2 in the Burneh Health Centre, Bangkalan Regency as many 55 people. With the
sample as many as 18 people who selected at random and the result will analysis with use the
test of paired t-test, and the test of independent t-test. Before doing this research, the average
of blood glucose from 9 respondents that is 266,78. While after doing the exercises of self-
acceptence make down become 249,7. Result: In the analysys of paired t-test showed there are
some effects from the exercises self-acceptence for the reduction of blood glucose to the
patients of diabetes mellitus type 2 with the p value = 0,018. Conclusion: The suggestion for
all health’s staffs in the Burneh Health Centre and also for the other health’s in whereever, they
need to demostrate that is in addition to drug therapy, dietary adjustments, and the healthy
lifestyle for the client/patients diabetes mellitus type 2, the training of self-acceptence can also
help in lowering blodd glocose levels in diabetes mellitus type 2 clients.
Keywords: Exercises Of Self-Acceptence: Relaxation and Dzikir, Blood Glucose, Diabetes

Mellitus Type 2
INTRODUCTION the data showed an increase in patients with

Diabetes mellitus is a heterogeneous diabetes mellitus.
group of disorders characterized by
increased levels of glucose in the blood or Table 1 Number of cases of Diabetes
hyperglycemia. In type 2 diabetes the Mellitus Type 2 from 2013 to 2015 at the
body's ability to insulin can decline (Wijaya health center Bangkalan Burneh
& Putri, 2013). Amount
Number of patients with type 2 No Tahun Patients
diabetes mellitus from year to year tend to Diabetes Melitus
increase. Based on data from the 1 2013 109
International Diabetes Federation (IDF), in 2 2014 125
the year 2030 in the world as much as 552 3 2015 98
million people will have diabetes, and in From the data in Table solid
Indonesia ranks fourth in patients with conclude that there is high incidence of type
diabetes mellitus (Tandra, 2008). 2 diabetes mellitus in Puskesmas Burneh
Preliminary studies conducted in Bangkalan. Factors cause of type 2 diabetes
Puskesmas Subdistrict Bangkalan Burneh is obesity because obesity decreases the
amount of insulin receptors on target cells
389
throughout the body, changes in insulin This study aimed to determine the
resistance and impaired insulin secretion, effect of exercise therapy has resigned
insulin levels are available to be less himself to a decrease in blood glucose
effective in improving metabolic effects, levels in patients with type 2 diabetes
the age of which is likely to increase over mellitus.
65 years, history families of patients with METHOD
diabetes mellitus type 2 (Wijaya & Putri, This research is experimental study
2013). which analyzes the effectiveness of exercise
Complaints that happens is therapy surrender with dhikr to decrease
peripheral neuropathy (tingling), especially blood glucose levels in patients with
in the legs at night time, visual disturbances, diabetes mellitus type 2. The study was
skin disorders such as itching, usually conducted using a control group for
occurs in the pubic area and the area of skin comparison, the study design is called a
folds such as the armpits and under the pretest-posttest design with control group (
breasts, erectile dysfunction, and vaginal Notoatmodjo, 2005).
discharge and itching occurs in women While the design of the study is a
(Wijaya & Putri, 2013). Quasi Experiment. In this design, the
In addition to the pharmacological, experimental group and the control group
treatment in patients with type 2 diabetes was given no treatment. In both treatment
mellitus can be done by way of non- groups starting with the pre-test and after
pharmacological, namely the surrender the treatment is held back measurement
exercise therapy using relaxation (post-test) (Nursalam, 2008).
techniques and dhikr. Relaxation is the The population in this study was the
activation of nerves that stimulate number of patients in 2014, a number of 98
parasimpatetis decline in all the functions patients with diabetes mellitus, the
that raised by the sympathetic nervous sampling technique is simple random
system, and stimulates the rise of all the sampling a total of 18 people with diabetes
functions derived by sympathetic nerves mellitus. In January to March 2016.
(Saleh, 2010). The results of data analysis using a
According to Benson (2000) paired t-test and independent t-test. The
relaxation exercises should be done before criteria for inclusion in this study were
eating so that the relaxation process is not willing to be tested, Muslim, while blood
disturbed by the work of digestion. glucose levels ≥ 200 mg / dl, age ≥ 45 years,
Meanwhile, According to (Sangkan 2006) not accompanied by other diseases.
dhikr as a form of worship in Islam is a
religious relaxation, with utter lafadz God
or Ahad are continually slowly and
rhythmically could lead to a relaxation
response.
In the relaxation required deliberate
physical relaxation in relaxation dhikr
which will be combined with resignation.
Based on the description above mentions
that medical therapy alone without being
accompanied by prayer and remembrance,
is not complete; otherwise prayer and dhikr
alone without being accompanied by
medical therapy, are ineffective (Hawari,
2006).
390
RESULT 7 246 467
Differences in Blood Glucose Levels of 8 312 307
Patients with Type 2 Diabetes Mellitus 9 180 294
Intervention Group (Doing Exercise Average 331,67 360,33
Surrender Yourself: Relaxation &
Dhikr) in Puskesmas Burneh Bangkalan. From the results of different test that
uses a paired t-test p value obtained test for
Table 2 Comparison of Blood Glucose blood glucose levels 0,244. It concluded
Distribution Type 2 Diabetes Mellitus there was no difference in glucose levels
Patients Intervention Group (Doing darahpre and post in the group that did not
Exercise Surrender Yourself: Relaxation & exercise surrender: relaxation and dhikr.
Dhikr)
Responden Blood Glucose Levels Changes in Blood Glucose Levels in
Code PRE POST Patients with Type 2 Diabetes Mellitus
1 224 220 in Puskesmas Burneh Bangkalan
2 197 215
3 312 270 After analysis of data showed that
4 379 354 the changes in blood glucose levels
5 204 180 respondents who exercise surrender:
6 283 254 relaxation and dhikr (the treatment group)
7 206 198 as being significant because of 9
8 273 254 respondents largely decreased by 8 votes
9 323 303 (88.89%). While the blood glucose levels of
Average 266,78 249,78 respondents who do not exercise surrender:
relaxation and dhikr (the control group)
From the results of different test that were increased by 6 (66.67%),
uses a paired t-test p value obtained for strengthening exercises surrender:
0,018 blood glucose levels. It can be relaxation and remembrance can lower
concluded there is difference in blood blood glucose levels in type 2 diabetes
glucose levels pre and post in the group mellitus kliend patient.
who exercised surrender: relaxation and Results of independent t-test p value
dhikr stated is 0.006. So the significance of blood
glucose levels less than the degree of
Differences in Blood Glucose Levels of culpability (0.006 <0.05). It can be
Patients with Type 2 Diabetes Mellitus concluded there is difference in blood
Control Group (Without Exercise glucose levels with exercise surrender.
Surrender Yourself: Relaxation &
Dhikr) in Puskesmas Burneh Bangkalan. DISCUSSION
Table 3 Comparison of Blood Glucose Differences in Blood Glucose Levels of

Distribution Type 2 Diabetes Mellitus Patients with Type 2 Diabetes Mellitus
Patients Control group Intervention Group (Doing Exercise
Responden Blood Glucose Levels Surrender Yourself: Relaxation And
Code PRE POST Dhikr) In Puskesmas Burneh Bangkalan.
1 578 400
2 196 274 There are differences in blood
3 227 382 glucose levels in patients with type 2
4 345 363 diabetes mellitus in the intervention group
5 283 252 (Exercise surrender: relaxation and dhikr).
6 438 504
391
Relaxation therapy as a form of and protein catabolism resulting in the
physical exercise that effectively control mobilization of individual fatty acids and
blood sugar is also one of the relaxation amino acids (Tao & Kendall, 2013).
techniques seem to some people with
diabetes can help, although it is more likely Effect of Exercise Surrender Yourself:
to help people with type 2 diabetes than Relaxation And Dhikr To Decrease
those with type 1 diabetes (Yildirim and Blood glucose levels In Type 2 Diabetes
Fadiloglu 2006). Implementation can be Mellitus In Puskesmas Burneh
performed in conjunction with medical Bangkalan
therapy (Moyad & Hawks, 2009).
Dhikr been selected for repeated Based on the statistical test
pronunciation of words is believed to be an independent t-test can be concluded that
effect on the body than the words that mean there is influence surrender exercises:
nothing (Saleh, 2010). It is connected in relaxation and remembrance to the decrease
selecting respondents was included in the in blood glucose levels in people with
respondents who are Muslims, so that the diabetes mellitus type 2. This shows that
respondent can appreciate and there are differences in blood glucose levels
mentransdensikan sentence spoken dhikr in those who exercise self surrender:
Divine Name. relaxation and remembrance and who do
not exercise surrender: relaxation and dhikr.
Differences in Blood Glucose Levels of Exercise Surrender Yourself (LPD)
Patients with Type 2 Diabetes Mellitus is one method in mind and body
Intervention Group (Doing Exercise intervention, which is a method that
Surrender Yourself: Relaxation And combines relaxation and remembrance with
Dhikr) In Puskesmas Burneh Bangkalan. a training focus on respiratory and words
There was no difference in blood contained in the dhikr (relaxation and
glucose levels in patients with type 2 repetitive prayer) to evoke the relaxation
diabetes mellitus in the control group (no response that is expected to improve
exercise surrender: relaxation and dhikr). symptoms of stress or depressive symptoms
So it can be a comparison with respondents (Subandi, 2009).
to intervention. The relaxation technique is one of
Based on the criteria of age category the nursing interventions that can be given
was also influential as most of the control to patients with diabetes mellitus to
group was aged 56 -65 years of the 5 people. improve relaxation and self-management
Based on the theory that there is in this capabilities. This exercise can help reduce
control group had decreased insulin muscle tension, stress, lowers blood
resistance is more significant than the pressure, increases tolerance to everyday
intervention group. activities, enhance immunity, so that the
The higher the person's level of functional status and quality of life
stressors, the higher the stress level is going improved (Smeltzer and Bare, 2010).
to happen. Cortisol plays many roles in In the analysis of the effects of
maintaining homoeostatis by affecting the exercise surrender relaxation and dhikr on
immune response, metabolic intermediates, blood glucose levels in people with type 2
vascular tone and to some extent, renal diabetes mellitus in Puskesmas Burneh
function. Cortisol reduces glucose uptake Bangkalan, showed that there is a decrease
into cells while simultaneously increasing in blood glucose levels client type 2
the amount of substrate (glukoneogenik diabetes mellitus in the intervention group,
amino acids and glycerol) for the while the control group occurred
conversion of glucose in the liver. Cortisol penigkatan on blood glucose levels.
accomplishes this by stimulating lipolysis
392
Based on the above it can be Saleh, Moh., 2010. Mengapa dan
concluded that the practice of surrender Bagaimana Salat Tahajud
relaxation and remembrance is one therapy Menyehatkan Tinjauan dari Aspek
that can be used in patients with diabetes Psikoneuroimunologi, Makalah
mellitus type 2, so that it can be suggested Seminar
to health workers who were in the Smeltzer, S.C. dan bare, B.G. 2010. Buku
neighborhood health center Burneh Ajar Keperawatan Medikal Bedah
Bangkalan regency could consider Brunner &Suddarth, (edisi 8).
providing training techniques surrender Jakarta: EGC.
relaxation and dhikr as an alternative Subandi, M. A. 2009. Psikologi Dzikir.
therapy in lowering blood glucose levels in Yogyakarta: Pustaka Pelajar.
type 2 diabetes mellitus clients. Tao, L & Kendall, K. 2013. Sinopsis Organ
System Endokrinologi. Tanggerang
CONCLUSION Selatan: Karisma Publishing Group
There are exercises influence Tandra, H. 2008. Segala Sesuatu Yang
surrender: relaxation and remembrance to Harus Anda Ketahui Tentang
the decrease in blood glucose levels in Diabetes. Jakarta:PT Gramedia
patients with type 2 diabetes mellitus in Pustaka Utama
Puskesmas Burneh Bangkalan Wijaya & Putri. 2013. Keperawatan
Medikal Bedah ( KMB 2 )
REFERENCE Keperawatan Dewasa. Jakarta:
Benson, Herbert. MD. 2000. Respon Medical Book
Relaksasi: Teknik Meditasi Yildirim, Y.K., dan Fadiloglu, T. 2006. The
Sederhana Untuk Mengatasi effect of progressive muscle
Tekanan Hidup (Terjemahan). relaxation training on anxity levels
Bandung: Mizan. and quality of life in dialysis
Hawari, dadang. 2006. Aborsi (Dimensi patients, April 20, 2010.
Psikoreligi). Jakarta: Balai Penerbit EDNA/ERCA Journal.
FKUI
Moyad, M., dan Hawks, J.H. (2009).
Complementary and alternative
therapies, dalam Black, J.M., &
Hawks, J.H. Medical-Surgical
Nursing; Clinical Management for
Positive Outcomes, (8th edition).
Elsevier Saunders
Notoatmodjo, Soekidjo. 2005, 2010.
Metodologi Penelitian Kesehatan.
Jakarta: PT Rineka Cipta
Nursalam. 2008. Konsep dan Penerapan
Keperawatan Pedoman Skripsi,
Tesis, dan Instrumen Penelitian
Keperawatan. Jakarta: Salemba
Medika
Saleh, A. Y. 2010.Berdzikir untuk
Kesehatan Syaraf. Jakarta: Penerbit
Zaman
Sangkan, A. 2002. Berguru Kepada Allah.
Jakarta: Bukit Thursina
393
THE SELF-CONCEPT OF CHRONIC RENAL FAILURE PATIENTS WHO
UNDERGOING HEMODIALYSIS IN DR SOERADJI TIRTONEGORO HOSPITAL
Insiyah, Sulistyowati, E.C., Rahmawati, F.M.

Email: insiyahkamal@gmail.com
ABSTRACT
Introduction: Chronic Kidney Disease (CKD) is a health problem that is increased every year.
All stages of CKD are related to the increased risk of cardiovascular morbidity, premature
mortality and the decreased quality of life (Hill, NR, Fatoba, ST, Oke, JL, Hirst, JA,
O’Callaghan, CA, Laseserson, JS, Hobbs, FDR 2016). People who experience chronic kidney
disease(CKD) will require renal replacement therapy, and one of treatment for patient with
CKD is hemodialysis. Patients undergoing hemodialysis will experience psychological,
sociological, spiritual, biological, and physical change that result in the changes of self-concept.
The Purpose of this research was to describe self-concept of chronic renal failure patients who
undergoing hemodialysis in dr Soeradji Tirtonegoro Hospital Klaten. Method: This research is
descriptive survey research design. The sampling technique is purposive sampling of 30
respondents using inclusion and exclusion criteria. Instrument of self-concept used modified
questionnaire from The Tennessee Self Concept Scale (TSCS) (Fitts, WH & Warren, WC 1996)
and Musyanawati (2015). Results: The result showed that 30 respondents (100%) had adaptive
self concept, but respondents showed symptoms that risk on changing self concept. Body image
of respondents are in the positive and negative ranges. Ideal self of respondent was in the
realistic and unrealistic ranges. Self esteem of respondents is in the high and low range. Role
of respondents are in the performance unsatisfactory and satisfactory. Identity respondents are
in the range of clear identity to negative range. Discussion: Overall, the self consept in patients
undergoing hemodialysis are in the adaptive ranges, but respondents showed symptoms that
risk on changing self concept.
Keywords: Chronic Renal Failure, Hemodialysis, Self Concept
INTRODUCTION followed by Aceh, Gorontalo, and North

Chronic Kidney Disease (CKD) is Sulawesi with similar number 0,4%. East
one of disease with high incidence and Nusa Tenggara, South of Sulawesi,
called silent disease because it doesn’t show Lampung, West Java, Central Java,
the sign and symptom at the beginning. Yogyakarta, and East Java province,
Commonly this desease known by the counted 0,3% each province (RISKESDAS
sufferer after the disease has been so bad cited in Health Ministry of Republic
and need medical treatment to replace the Indonesia 2013). Chronic kidney disease is
function of the renal. According to Center pathophysiologic process with various
for disease control and prevention cited in etiology and result in the decreased of
Lukman (2013), the prevalence of CKD in kidney function, progresive and usually end
US in 2002 was counted 345.000 people, with renal failure. Renal failure is clinical
and at the end of 2007 increased to 80.000 condition with the sign of the decrease of
people. Year 2010 the incidence was renal fuction permanently. In the grade of
increased more than 2 million of people. In replacement therapy, it needs dialysis or
Indonesia prevalence of CKD age ≥ 15 renal transplantation as a permanent renal
year in each province, the highest function replacement (Suwitra, K cited in
prevalence in Central Sulawesi 0,5%
394
Sudoyo, A.W., Setiyohadi, B., Alwi, I., K, Psychological defence mechanism
M. S., & Setiati, S (Eds) 2010) and coping style can be place on a
More than 70% countries in the continuum of adaptability ranging from
world reported at least 80% of people matur and adaptive to those that are
suffering from CKD undergoing immature, maladaptive, neurotic, and
hemodialysis (Arova, 2014). The number radical attemps to deal with stressor
of patient ongoing hemodyalisis was 24524 Defence mechanism and coping style are
people (Indonesia Renal Registry cited in necessary to understanding neurogenic
Afiatin 2014). Chronic kidney disease communication disorder. Defence
patient undergoing regular hemodialysis mechanism and coping style play important
increased from day to day. The number of role in psychological adaptation to
patient increased fourfold in the last 5 years. disabilities (Stuart & Laraia 2007).
The number of CKD patients need The availability of accurate data
hemodialysis in Indonesia was estimated regarding the condition of the patient
150.000 people, but the number of patient especially psychological data among CKD
undergoing hemodialysis was only 100.000 patient conducting hemodialysis becomes
people. There is 200.000 new case of CKD important for the nurses to give appropriate
in terminal stadium. (Perhimpunan care by considering psychological aspects
Nefrologi Indonesia 2016). of the patient. Further more knowing the
Hemodialysis could extend life of adaptation process of the patients and
chronic kidney disease patient, however it family through the research becomes
could change the proccces of the disease and important in empowering patients and
couldn’t repair all renal function (Ratnawati family during lifetime treatment. According
cited in Musyanawati, 2015). Hemodialysis to preliminary study conducting in dr.
is treatment as physical stressor that result in Soeradji Tirtonegoro hospital year 2016,
life dimention changes including biological, commonly patient performs hemodyalisis
psychological, sociological and spiritual for 1 – 3 times a week. The number of
changes. According to Asti, A D, Hamid, A patient having hemodialysis average 165
Y S, & Putri, YSE (2014) patients patients each month and the number of
undergoing hemodialisis experienced patient getting hemodyalis average 18
psychological, physical, activity, and people every shiff.
spiritual changes. These changes occurred
from beginning of hemodialysis until the METHODS
long process of hemodialysis. Patient with This research is descriptive research
hemodyalisis experience physical problem by survey to describe self concept of
such as: nausea, vomiting, pain, muscle chronic kidney disease patients undergoing
weaknesses, and oedema. Powerlessness and hemodyalisis. The sampling methods is
deficit self acceptance become psychological purposive sampling with 30 respondens
factor that contribute to the incidence of based inclusion and exclusion criteria.
stress, anxiety and depression. The changes The instrument used in this research
in physical, emotional, spiritual, and is modified questionair TSCS (Fitts, WH &
sociocultural can lead to the changes in self Warren, WC 1996 adapted by Musyanawati
concept (Potter & Perry, 2010). The patient’s 2015). Data was analyzed using univariate
personality should be taken into account, analysis in describing self concept and the
modalities and attention to passive- change in components of self concept
aggressive behavior can be considered as including body image, self ideal, self
suitable intervention for hemodialysis esteem, role, and identity by using
patients (Hyphantis, T, Katsoudas, S & frequency distribution.
Voudiclari, S 2010).
395
RESULTS AND DISCUSSION Total 30 100 %
The result of this result was
presented on the tables of demography such
as: gender, age, marital status, education Table. 7 Frequency distribution of Body
level, work experience and self concept Image
continuum as following tables: Body Image Number Persentage
Positive 151 83.89 %
Table.1 Frequency distribution of Gender Negative 29 16.11 %
Gender Number Persentage Total 180 100 %
Male 15 50.0 %
Female 15 50.0 %
Total 30 100 % Table. 8 Frequency distribution of Self
Ideal
Table. 2 Frequency distribution of Age Self Ideal Number Persentage
Age Number Persentage Realistic 160 88.89 %
Adolesent 1 3.3 % Unealistis 20 11.11 %
Adult 8 26.7 % Total 180 100.0 %
Elderly 21 70.0 %
Total 30 100 % Table.9 Frequency distribution of Self
Esteem
Table.3 Frequency distribution of Marital Self Esteem Number Persentage
Status High 167 92.78 %
Marital Status Number Persentage Low 13 7.22 %
Married 21 70.0 % Total 180 100%
Unmarried 2 6.7 %
Widow 7 23.3 % Table .10 Frequency distribution of Role
Total 30 100 % Role Number Persentage
Satisfied 129 71.67 %
Table. 4 Frequency distribution of Unsatisfied 51 28.33 %
Education Level Total 180 100 %
Education Level Number Persentage
Primary School 10 33.3 %
Junior High School 3 10.0 %
Table.11 Frequency distribution of Self
Senior High School 11 36.7 % Identity
Under and Post Graduate 6 20 % Self Identity Number Persentage
Total 30 100 % Clear 160 88.89 %
Table. 5 Frequency distribution of Work Negative 20 11.11 %
Experience Total 180 100 %
Work Experience Number Persentage
Farmer/Labor 4 13.33 %
Civil 4 13.33 %
Based on the table can be described
Servant/Army/Police that :
Entrepreneur 4 13.33 % 1. Self Concept
No work 18 60.0 % All 30 participants showed adaptive
Total 30 100 % response. However based on
participant response on the component
Table. 6 Frequency distribution of Self of self concept can be explained as
Concept Continuum following. Body image range from
Self Concept Number Persentage positive and negative respones, self
Adaptive 30 100 % ideal range from realistic to unrealistic
Mal Adaptive 0 0 % responses, self esteem range from high
396
to low responses. In term of role, Fear is the most emotional feeling of
participants have satisfaction to patient with CKD undergoing
unsatisfaction response, and the hemodialysis(Andri 2012) Patients
identity of participant range from clear often experienced fear about future and
to negative identity. According to getting denial and anger with their
Gerogianni & Babatsiko (2014) condition. Fear and griefing result from
Chronic disease such as CKD is feeling dependent during lifetime and
continous and progressive process dependent on hemodialysis. This
from how the people accept their body feeling couldn’t be avoided and usually
image to how they can adapt with the the patients make someone else
situation and condition during surrounding them as an object to be
hemodialysis treatment. Patient with scolded.
dialysis treatment have problem with 4. Self Esteem
their job, social status, financial and the This research can be concluded that
limitation of diit in relation to the 92,78% responden undergoing
disease at the beginning. hemodialysis showed high self esteem.
2. Body Image It might be the family giving more help
Table 7 showed that body image and care for the patient, the patient still
response of participants 83,89% have time to interact with others, and
positive and 16,11 % was negative. stiil have existency. Overall
According to Suliswati, Payopo, respondents think that every person has
Maruhawa, Sianturi & Sumijatun strength and limitation. Respondents
(2005) that body image was dynamic, can adapt with the change and pressure
can be changed when the perception during ongoing hemodialysis because
and experience also change. When the they have positif feeling and high self
people already accept their body well, esteem. This statement is supported by
they also will accept the changes of other researcher ( McLeod 2008) where
their body. Gradually people will get people who have high self esteem have
feeling safety and free from anxious positive thinking. It will contribute to
condition. Individual who accept his person’confidence to the own
body image realistically, He/She will capability, acceptance to themselves,
have higher self esteem that other who no worries about other’s thinking and
does’nt like his/her body. Oxtavia optimism.
(2014), supports this study result that From the table 9 there was 7,22%
people with problem of altered body response refer to low self esteem such
image have little chance to have good as feeling useless, feeling unhelped by
quality of life than other people who family, and lack of interaction with
don’t have the problem. others, feeling unimportant and easy
3. Self Ideal quitter. Low self esteem and other
Response of participants in relation components of self concept correlated
to ideal diri due to hemodialysis each other due to horrible effect.
showed that 88,89% was realistic while According (Andri 2012), CKD patients
11,11 % response was unrealistic. often loss of control. They need more
Suliswati, Payopo, Maruhawa, Sianturi time to adapt with the situation such as
& Sumijatun (2005) stated that self role change, feeling as a burden for the
ideal is internal regulation that help family and the effect of hemodialysis
individual to maintain capacity to deal itself to the change of body image.
with conflict or confusing condition in 5. Role
order to balancing and maintaining From table. 10 can be seen that
mental health. 28,33% response of CKD patient
397
showed unsatisfied role. This result different with others. With clear
supported by data such as: the patient identity person thinks himself as unity,
can not participate in community unique and different with others. This
activity, loss job and less participation perception has impact to other
in decision making in the family and components of self concept. Achieving
community, and lack of consentration. self identity is the important thing to
Potter & Perry (2010) stated that one of gain closed relationship as the people
stressor for role performance is sick expressed their identity during making
role where this role included family and relationship with others( Stuart &
community expectation about how the Laraia 2007, Potter & Perry 2010).
people suffering from the disease can Although most of response of
behave as patient. Role conflict occur identity was clear identity, the number
when patient’s expectation and other’s of 11,11% response of CKD patient
expectation conflict each other. was negative identity.This negative
Physical limitations and mental or identity appeared from unhappy
emotional force have impact on feeling, hating himself, feeling
individual and community. The weakness, and feeling different with
physical limitation can impact on the others as negative feeling. This feeling
limitation on social role then this maight occur because CKD patients
situation will influence the relationship assumed that they can’t fulfil their and
among patient, family and community other’s expectation. CKD and
(Bayhakki & Hatthakit 2012). hemodialysis and medication give
On the other hand the research impact on various things such as the
showed that 71,67% response of CKD change of self perception and identity,
patient undergoing hemodialysis was time for working and recreation,
satisfied with their role. The patients marital status, and relationship. CKD is
still had chance to give attention and struggling disease in which this disease
respected by the family , could need continuous treatment such as diit
contribute to make decision making in management, treatment scheduling
family and community, have capability including hemodialysis that result in
to think critically, still work actively the change in self function(
and participating in the community Psychonephrology 2015). Patients
activity. The emotional and financial undergoing dialysis have many
support from the family is needed by psychological disorders and the type of
sick people based on social and dialysis is not of much importance in
traditional value. Then the relationship this regard; so, adequate education and
among individu, family and information for clients in order to use
community can be maintained appropriate methods of adaptation as
optimally (Petrini,Y cited in Bayhakki well as appropriate social relationship,
& Hatthakit 2012). continuing social support and
developing health policies seem
6. Self Identity necessary in order to prevent mental
A number of 88,89% response of disorders and providing required
CKD undergoing hemodialysis services and supports for patients
showed clear identity such as feeling (Shahgholian,N, Tajdari,S, & Nasiri, M
part of the family and community and 2012). Self concept clarity and identity
respect to themselves. This statement commitments influence each other
was proved by the patients stated to not reciprocally across days, the day to day
hate themselves, feeling happy, not changing in identity predicted later
felling weakness, and only feeling
398
anxiety and depression (Schwartz gagalginjal_55123a95a33311c856b
2010). a7ff5
Armiyati, Y 2014, Faktor yang Berkorelasi
CONCLUSION AND terhadap Mekanisme Koping Pasien
RECOMMENDATION CKD yang Menjalani Hemodialisis
This research recruited 30 CKD di RSUD Kota Semarang. Available
patients undergoing hemodialysis in dr from
Soeradji Tirtonegoro hospital. It can be http://jurnal.unimus.ac.id/index.php
concluded that a hundred persen of the /psn12012010/article/download/12
patient had adaptive self concept, however 20/1273
there is still a chance for patient to have Arova, F N 2014, Gambaran Self – Care
change in the component of self concept. Management Pasien Gagal Ginjal
Body image of respondents is in the positive Kronis dengan Hemodialisis di
and negative ranges. Ideal self of Wilayah Tangerang Selatan Tahun
respondents are in the realistic and 2013, Available from
unrealistic ranges. Self esteem of http://repository.uinjkt.ac.id/dspace
respondents is in the high and low range. /bitstream/123456789/25554/1/FA
Role of respondents are in the performance ULYA%20NURMALA%20AROV
unsatisfactory and satisfactory. Identity A%20-%20fkik.pdf
respondents are in the range of clear identity Asti, A D, Hamid, A Y S, & Putri, YSE
to negative range. The result of the research 2014, Gambaran Perubahan Hidup
suggested to the family, care giver, health Klien Gagal Ginjal Kronis yang
professional including nurses who caring Menjalani Hemodialisa. Available
for patients with hemodialysis to maintain from
and give attention to support and spirit to http://ejournal.say.ac.id/ejournal/in
avoid adaptive self concept developed to be dex.php/jkk/article/download/62/
maladaptive self concept as there is still 62
changes in component of self concept that Bayhakki, B & Hatthakit, U 2012, Lived
risk to the development of maladaptive self Experiences of Patients On
concept. As nurses who closed to patient Hemodialysis A Meta-Synthesis.
should applying caring factor, giving Available from https://www.
attention to the patient, empaty and giving researchgate.net/publication/23224
accurate information to the patients. 4841 Lived Experience of Patients
Qualitative research can be conducted for On_Hemodialysis_A_Meta-
the future research in order to gain depth Synthesis
information about self concept of CKD Boyatziz, R E & Akriyou, K 2006, The
patient conducting hemodialysis. Ideal Self as the Driver of
Intentional Change. Available from
REFERENCES http://www.case.edu/provost/ideal/
Afiatin 2014, Simposium Dialisis Indonesia doc/Boyatzis _2006_idealself.pdf.
Renal Registry. Available from Corwin, E J 2009, Buku Saku :
http://ipdi.or.id/materi%20toni/baru Patofisiologi, Edisi 3, EGC, Jakarta.
/3.%20dr.%20Afiatin%20%20IRR Fitts, WH & Warren, WC 1996, The
%20simpondilaiisis.pdf Tennessee Self Concept Scale,
Andri 2012, Aspek Psikososial Pasien Second Edition: Adult form,
Gagal Ginjal Kronik. Available Western Psychology Services, LOS
from Angeles , California. Available from
http://www.kompasiana.com/psikos http://www. wpspublish.com.
omatik_andri/aspekpsikososialpasie Gerogianni, SK & Babatsiko, F P 2014,
n- Psychological Aspect in Chronic
399
Renal Failure. Available from Menjalani Hemodialisis. Available
http://www.hsj.gr/medicine/psychol from
ogical-aspects-in-chronic-renal- http://jom.unri.ac.id/index.php/JO
failure.pdf. MPSIK/article/view/3487/3383.
Potter, PA & Perry, AG 2010, Fundamental
Hill, NR, Fatoba, ST, Oke, JL, Hirst, JA, Keperawatan, Buku 2, Edisi 7.
O’Callaghan, C.A., Laseserson, JS, Salemba Medika, Jakarta.
Hobbs, FDR 2016, ‘Global Psychonephrology 2015, Social Impact.
Prevalence of Chronic Kidney Available from http://
Disease – A Systematic Review and psychonephrology.com/index.php/s
Meta-Analysis’, PLoS ONE, 6 July ocial-impact/.
2016. Available from Schwartz, SJ 2010, ‘Daily Dynamics of
http://www.journals.plos.org. Personal Identity and Self-concept
Hyphantis, T, Katsoudas, S, & Voudiclari, Clarity’, European Journal of
S 2010, Ego mechanisms of Defense Personality,Vol 25, p375-385.
are Associated with Patients’ Available from
Preference of Treatment Modality http://sethschwartz.info/wpcontent/
Independent of Psychological uploads/2010/ 08/Personal-Identity-
Distress in End-Stage Renal and-Self-Concept-Clarity1.pdf.
Disease. Available from
Shahgholian,N, Tajdari,S, & Nasiri, M
http://www.ncbi.nlm.nih.gov/pmc/a
2012, ‘Reviewing and comparing
rticles/PMC2846137/.
Kementerian Kesehatan RI 2013, Available self-concept in patients undergoing
from hemodialysis and peritoneal
http://www.depkes.go.id/resources/ dialysis’, Iran Journal of Nursing
download/general/Hasil%20Riskes and Midwifery Research, 17(2
das%202013.pdf. Suppl1): S85–S90. Avaliable from
Lukman, N 2013, Hubungan Tindakan https://www.ncbi.nlm.nih.gov/pmc/
Hemodialisa dengan Tingkat articles/PMC3696965/
Depresi Klien Penyakit Gagal
Stuart, G W & Laraia, MT 2007, Principles
Ginjal Kronis. Available from
and Practice of Psychiatric
http://download.portalgaruda.org/ar
Nursing, 8th ed, Elseiver Mosby, St.
ticle.php?article=140993&val=579
Louis.
8.
McLeod, S A 2008, Self Consept. Available Suliswati., Payopo, TA, Maruhawa, J,
from Sianturi, Y, & Sumijatun 2005,
www.simplypsychology.org/self- Konsep Dasar Keperawatan
concept.html. Kesehatan Jiwa. EGC , Jakarta.
Musyanawati 2015, Konsep Diri pada
Pasien yang Menjalani
Hemodialisa dan Continous
Ambulatory Peritoneal Dialysis
(CAPD) Di Rumah Sakit Umum
Daerah Dr. Zainoel Abidin Banda
Aceh Tahun 2015. Available from
http://etd.unsyiah.ac.id/pdf.php?id=
17366.
Oxtavia, V 2014, Hubungan Citra Tubuh
dengan Kualitas Hidup Pasien
Gagal Ginjal Kronik yang
400
THE EFFECT OF LEBOYER METHOD TOWARD ANXIETY DECREASE ON
MATERNITY MOTHERS
Nurul Hikmah Annisa
Ikatan Bidan Indonesia
Email: ayoe_cfo@yahoo.com
ABSTRACT
Introduction: According Leboyer that the labour environment is a method in a normal delivery. Sound noise around
mothers who will give birth and the sound of people who were around mothers who will labour, until now there has
been the centre of attention or noticed by birth attendants but this labour environment is very important. This method
of conditioning the mother gives birth in a quiet room with soft music and soft voices have to minimize the stress and
anxiety that will birth mother. This study aims to determine the effect of labour Leboyer method to decrease maternal
anxiety. Methods: This study uses a design quasi-experimental with research design, two groups. intervention
control The number of samples in this study was 15 people in the intervention group and 15 in the control group.
Sampling was done by using purposive sampling. This study conducted in Bumi Sehat clinics and Gianyar Public
health centres Ubud I Bali Province. Results: Data analyzed using-test independent with statistical test result it can
be concluded that there is influence labour of Leboyer method to decrease maternal anxiety in the intervention group
and control group (P = 0:00). Discussion: From the results of this research that labour Leboyer is an effective
method to reduce maternal anxiety so that midwives can apply the Leboyer method in providing care to maternity.
Keywords: Leboyer method, anxiety

of soft music and soft voices have to minimize
INTRODUCTION trauma and stress for both mothers and mothers
Labour is a process of spending or will reduce anxiety birth. Stress is known to
products of conception can live in the uterus contribute to the development of many diseases,
through the vagina to the outside world. Studies people need an antidote to combat stress. In fact,
of various types of birth control have revealed relaxation may be one of the most important
that spontaneous birth is not without danger, one factors in maintaining a healthy body and mind.
of the accesses to address these problems is Relaxation techniques are very important in
through the improvement of service delivery managing stress. Relaxation is very important
program in a safe and appropriate for mothers. for health professionals and therapists should be
Many factors could affect one of which is advised uses relaxation techniques to manage
infrastructure / facilities where labour and stress, stress not only in everyday life but also
delivery environment. Labour environment is the stress caused by the medical condition of
something that is very rarely noticed, labour each patient. Relaxation therapy is the process of
environment in question is the sound of the releasing the tension and restore balance to both
noise, quiet and lighting. (Simkin, 2010). body and mind. The quiet surroundings can also
Voice of noise around a mother who will be soothing heart beat hard, also of the mind. If
labour, the voice of the people who are around the pressure is already mounting, try to set aside
the mother who will labour including voice birth time to listen to music with a tempo that is mild,
attendants are sometimes hard while leading or listen to songs that could make relax.
birth mother and the voice sounds medical Research shows that music can provide a
devices that tinkled around the place of the 'calming effect' equivalent to 10mg of Valium.
mother at birth, until today not the centre of That's why music is often used in relaxation
attention or noticed by birth attendants but therapy. Berlioz and Gentry based on research
labour environment is very important. According that aims to determine the performance of music
to Leboyer (2012), that the labour environment on the pulse and blood circulation. By using
is a method in a normal delivery. The method prospectively study design, with a sample of 10
aims to condition the birthing process that allows mothers maternity. The result is that five of the
mothers to give birth in a quiet room, the strains 10 mothers who were given music therapy it
401
could double cardiac output (Visnu, 2008). maternal, consisting of 15 samples of the
While the research conducted by Thomatis and intervention group and 15 samples for the
Campbell (1971), with the aim of research to control group. Respondents to the intervention
determine the effectiveness Mozart effect to group were given music for +15 minutes and
increase the stimulation (stimulation) quieter then observed with anxiety by using a
facing labour. His research involved 11 women questionnaire, and respondents were observed
giving birth, the result is that mothers who had for the control group +15 minutes and then
listened to classical music for 10 minutes, to observed using a questionnaire. The sampling
experience stimulation (stimulation) quieter face technique used approach, purposive sampling the
childbirth (Cendika, 2010. The case 228). From independent variable in this study is the effect
the preliminary survey conducted by researchers Leboyer method and the dependent variable was
in March 2015 in Tanjung Karang Public Health maternal anxiety. This study consisted of two
Center Mataram with interview method in 10 groups: intervention and control groups, each
women who had a birth experience, 10 mothers group identified by anxiety after therapy is given
said they had suffered anxiety for the success of to classical music. The expected result is the
the delivery process and they never get the music reduction of anxiety in mothers who were given
therapy. Researchers also interviewed 2 the therapeutic intervention of classical music
speciality physicians in Obgyn in Mataram about while undergoing childbirth. The study was
music therapy for women giving birth, the doctor conducted in Bumi Sehat clinics and Gianyar
said, in his room, they provide a musical Public health centres Ubud I Bali Province. The
instrument, but the instrument used only for research was conducted at the date of 10 July to
medical personnel. Researchers are interested in 1 August 2015 during which time the researchers
doing research on the influence of Leboyer expected to meet the desired sample. Data
method to decrease maternal anxiety, collection tool was a questionnaire made by the
particularly on classical music therapy in Bumi researcher based on the existing literature. The
Sehat clinics and Gianyar Public Health Centers questionnaire distributed consists of two parts:
Ubud I Bali Province. the first part is demography: namely age,
education, occupation, income, and parity. While
MATERIALS AND METHODS the second part is a questionnaire to identify
The research design used in this research maternal anxiety after therapy is given to music
is quasi-experiments that are two groups namely in the intervention and control. Anxiety
the intervention and control groups to identify questionnaire using 20 statements include
the effect of the Leboyer method to decrease positive and negative statements with Guttman
anxiety in mothers after maternity given music scale. Positive statements consists of 17
therapy. The population in this research are statements and three statements negative, if
mothers in Bumi Sehat clinics and Gianyar positive statement is answered "no" gets the
Public health centres Ubud I Bali Province. Data value 0, and if the answer "yes" gets the value 1
from Bumi Sehat clinics and Gianyar Public and the negative statement is answered "no" gets
health centres Ubud I Bali Province each month a value of 1, and if the answer "yes" gets the
± 15-20 who perform labour, so the population is value 0. the coefficient ranges between 0.00 to
obtained 80 votes as maternal. The sample was 1.00, with higher values indicate the criteria to
obtained using absolute fixity and using a validation. Validity test is done by content
formula derived sample is 67 people. So the validity to the results of the Content Validity
sample for the intervention group was 67 women Index 0.75. Reliability test using formula
giving birth with music therapy and control Cronbach alpha with 0.75 results obtained from
groups were 67 conventional birth mothers. the 20 statement. Only 17 valid statement and
However, there are limitations of the sample reliable, and 3 reliable statement is invalid and
because the time of the study respondents has have been repaired.
not included criteria. That meet the criteria for
both the intervention and control groups were 30
402
RESULTS Education Level
The research results on the effect of Elementary /First
labour Leboyer method to decrease anxiety in school - - - -
the mother in Bumi Sehat clinic and Gianyar Secondary School 15 100 10 66,7
Public Health Centers Ubud I Bali Province: High School - - 5 33,3
1. Univariate analysis No school - - - -
This analysis used to describe the Total 15 100 15 100
characteristics of each of the variables studied. Occupation
Data that is categorical searched frequencies and Housewife 13 86,7 7 46,7
proportions are age, parity, education, Official Worker 2 13,3 4 26,7
occupation, income and parity. Numerical data Private Worker - - 4 26,7
sought mean and standard deviation that Total 15 100 15 100
maternal anxiety. The results will be presented in
tabular form. The results obtained the majority Income
2 13,3 - -
of respondents in the intervention group aged No Income
20-25 years as many as eight people (53.3%) and <1.000.000
10 66,7 7 46,7
the majority of respondents in the control group 1.000.000-
3 20,0 8 53,3
aged 26-30 years as many as 6 people (40.0%). 2.000.000
Based on the study the majority of respondents >2.000.000
- - - -
in the intervention group secondary education Total
15 100 15 100
(high school) as many as 15 people (100%) and Parity
the majority of respondents in the control group First Child 5 33,3 3 20,0
a high school education (SMA) as many as 10 Second Child 5 33,3 8 53,3
people (66.7%). Based on the work of the Third Child > 5 33,3 4 26,7
majority of respondents in the intervention group Total 15 100 15 100
was (IRT) housewife as many as 13 people
(86.7%) and the majority of respondents in the The results obtained the average maternal
control group were housewives as many as 7 anxiety in the intervention group with 12.87
people (46.7%). Based on earnings majority of standard deviations of 2.386, while the minimum
respondents in the intervention group income value is 11 and the maximum is 18 and 95%
<1,000,000 as many as 10 people (66.7%) and confidence interval from 11.55 to 14.19. And
the majority of respondents in the control group research results in the control group the average
income 1000000-2000000 of 8 people (53.3%). - average maternal anxiety 17.53 with a standard
Based on the parity majority of respondents in deviation of 1.246, while the minimum value of
the intervention group was the son of - 1,2, and 3 14 and a maximum of 19 and 95% confidence
by 5 people (33.3%) and the majority of interval from 16.84 to 18.22. Can be seen in the
respondents in the control group was the son - 2 table below.
of 8 persons (53.3%). Can be seen in the table
below. Table 2: Distribution of maternal anxiety
Min
Table 1. Characteristics of Respondents No Variable Mean SD - 95%
Interventi Control Max
Characteristics of
on group group 1 Anxiety of
respondents
f % F % mothers in 11,55-
Age 12,87 2,386 11-18
interventio 14,19
20-25 years old 8 53,3 5 33,3 n group
26-30 years old 2 13,3 6 40,0 2 Anxiety of 16,8
31-35 years old 5 13,3 2 13,3 14 -
mothers in 4–
36-40 years old - - 2 13,3 17,53 1,246 19
control 18,2
Total 15 100 15 100 group 2
403
synchronize with the speed of the music. So by
2. Bivariate Analysis listening to the music tempo high heart rate will
The bivariate analysis used to compare increase and hear music at a slower tempo will
maternal anxiety in the intervention and control slow the heart rate and body will be relaxed.
groups. In analyzes bivariate data, testing data Based on the results of research conducted Fauzi
used t-. independent. Statistical test results in (2009), demonstrated that training with music
average maternal anxiety in the intervention gives more than just a causal link to the
group 12.87 with a standard deviation of 0616 development of certain parts of the brain in the
and the average maternal anxiety in the control long term. But by listening to music will help the
group 17.53 with a standard deviation of 17.53. positive development of the human brain. This
Statistical test results obtained P value is 0.000, research was also supported by the theory that
it can be concluded that there is the influence of classical music can activate the right hemisphere
classical music therapy significantly reduced is associated with creativity, the right brain
maternal anxiety in the intervention group. It can appears to receive stimulation (stimulation) are
be seen in the table below. nearby, while the left brain is closely related to
the formation of the intelligence of children in
Comparison of Anxiety On Intervention Group formal education. Anxiety experienced by
and Control Group On Mother in Bumi Sehat maternity largely reduced after therapy is given
clinic and Gianyar Public Health Centers Ubud I to classical music with the discovery of an
Bali Province average of 12.87 on the results of the
Standard
Standard
questionnaire respondents. This is supported by
Variable Mean Deviatio P.value N the reported Journal of the American Medical
Error
n Association in 1996, about the results of the
Anxiety study of music therapy in Texas who found 10
mothers in mothers who were given a musical stimulation
12,87 2,386 0.616 15
interventi
can increase the release of endorphins during the
on group
0.000 birth process, so 10 birth mothers give birth to a
Anxiety
mothers in sense of calm and relaxed. From the results of
17,53 1,246 0,322 15 this study have demonstrated that the delivery
control
group method Leboyer effect to the decrease in
maternal anxiety. Thus, classical music can be
used as an intervention in midwifery care at birth
DISCUSSION mothers.
Based on the results obtained that
maternal anxiety in the intervention group CONCLUSION
(12.87) and in the control group (17.53). And t- Labour Leboyer is an effective method
independent test results obtained p-value = 0.000 to reduce maternal anxiety so that midwives can
(<0.05). It can be concluded that there is the apply the Leboyer method in providing care to
effectiveness of classical music therapy to maternity. The results of this research can be
reduce anxiety in women giving birth after the used as information for the development of
intervention. These findings are consistent with science especially obstetrics at maternity,
research conducted by Campbell and Don., PhD particularly on labour. The results of this
(2001), with the aim of research to determine the research expected to be useful in providing
effectiveness of Mozart effect to mothers who information to further research, by conducting
can increase stimulation (stimulation) is calmer similar research that mothers who see the
in the face of labour. (Campbell, 2001) and this anxiety indication of elective and emergency
research is consistent with the results of research given treatment for classical music or using
conducted by (Cecilia, 2008) when a person other Leboyer.
listening to music, then the brain will process
what is heard. Heart rate tends to follow or to
404
REFERENCES Hidayat, A. A. (2007), Metodologi penelitian
Barbara. 2007. Keperawatan Ibu – Bayi Baru kebidanan teknik analisis data. Jakarta:
Lahir, EGC, Jakarta, Salemba medika
Benson, P & Pernoll. 2009. Buku saku Obsetry Manik, M, Sitohang, N, A, & Asiah,N. 2010.
Gynecology William. Jakarta EGC. Panduan penulisan karya tulis ilmiah.
Cendika, D, I. 2010. Panduan pintar hamil dan Medan: Tidak dipublikasikan
melahirkan. Jakarta: Wahyu media. Nolan, M. (2010). Kelas bersalin. Yogyakarta:
Cecilia, S,P. (2008). Janin Tumbuh Cerdas Golden books
Lewat Musik. Diambil pada Tanggal 30 Scott, E. (2007). Research letter : How music
Maret 2008 affects us and why music therapy
http://www.jurnalnasional.com promotes health. retrieved November
Cluett, Elizabeth. R Dan Bluff, Rosalind. 2012. 01, 2007, from
Principles And Practice Of Research In http://www.About.com.Guide.
Midwifery. Reprinted III. Bailliere Silalahi, M. (2009). Cerdas dengan terapi musik.
Tindall.London 8 Februari 2009, from
Depkes, RI. Indonesia Sehat. 2009, from file://F//cerdasdenganterapimusik.com
http://www.jurnalnasional.com Suririnah .(2009). Buku pintar kehamilan dan
Depkes RI. 2010. Standard Pelayanan persalinan, Jakarta: PT. Garamedi
Kebidanan. Edisi Revisi Ke V Cetakan Suyanto, & Salamah, U (2009). Riset kebidanan
Ke III. Departemen KeseTehatan metodologi & aplikasi. Yogyakarta:
Republik Indonesia. Jakarta Mitra cendika offset.
Duxbury, Mitzi L. “Nursing In Neonatology.” Trotter, Robert J. “Leboyer’s Babies.” Science
Neonatology On The Web. News 111 (2007): 59.
Http://Www.Neonatology.Org/Classics/ Videbeck, S. L. (2008). Psychiatric Mental
Mj1980/Ch08.Html. Mead Johnson. Healt Nursingin Buku ajar keperawatan
(Accessed December 9 2015), jiwa, dakam Eko, K. P (Eds). Ansietas &
Evant, Olive.2007. For Infants, Quiet And Warm Gangguan terkait sters (hal. 307-325)
Bath. Columbia. Presbyterian Medical Jakarta : EGC.
Center.(2009). Visnu, J. (2008). Yuk kenali terapi musik,
Fauzi, D. A. (2009), Pengaruh musik bagi Diambil pada tanggal 28 Agustus 2008,
kecerdasan bayi. Jakarta: Harmoni http://tanyadokteranda.com
Gunarya, Dr. Arlina. Tamar, Dr. Muhammad Wijaya, P. (2014) . Terapi musik untuk
dan Ibnu,Indra Fadjarwati. 2010. mengurangi rasa sakit saat persalinan.
Bersahabat dengan stress. Universitas Diambil pada tanggal 10 mei 2015,
Hasanuddin. Makassar http://www.tanyadokteranda.com.
Haws. Paulette S.MSN, RNC, NNP. 2014. Yustina, I. (2008). Pemerdayaaan Masyarakat
Asuhan Neonatus Rujukan Cepat. Untuk Mewujudkan Indonesia Sehat.
Cetakan Ke III. EGC. Jakarta Diambil 10 mei 2015, from http://www.
usu. ac.id.
405

Proceeding Inc Ners Unair 2017 PDF

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Proceeding Inc Ners Unair 2017 PDF

Diunggah oleh

Hak Cipta:

Format Tersedia

COVER

Fakultas Keperawatan Universitas Airlangga

Hak Cipta © 2017,

UNDANG-UNDANG NOMOR 19 TAHUN 2002 TENTANG HAK CIPTA

Penerbit: Fakultas Keperawatan Universitas Airlangga

The Proceeding of 8th International Nursing Conference:

412 hlm, 21 x 29,7 cm

DAFTAR ISI........................................................................................................................... iii

Assalamualaikum Warahmatullahi Wabarakatuh

Honorable Rector of Universitas Airlangga

This international nursing conference is conducted in cooperation with 6 nursing schools

Wassalamualaikum Warahmatullahi Wabarakatuh

Assalamualaikum Warahmatullahi Wabarakatuh

Honorable Rector of Universitas Airlangga

Prof. Dr. Nursalam, M.Nurs (Hons)

Assalamu’alaikum wa-rahmatullahi wa-barakatuh.

May the peace, mercy and blessings of Allah be upon you.

Ladies and gentlemen,

Ladies and gentlemen,

Ladies and gentlemen,

Rector of Universitas Airlangga,

Patron : Rector of Universitas Airlangga

DAY 1, SATURDAY 8th April 2017

DAY 2, SUNDAY 9th April 2017

Certificate Conferment Vice Dean

Nur Hidayati, Yani Erniyawati, Senja Setiaka

INTRODUCTION et.al., 2016). Assessment of pain in

Search electronic database: Google Scholar, Ebscho, ScienceDirect, Medline,

Figure 1. Search algorithm

Achmad Masfi, Aulia Rahman, Sarifudin

Keywords: Nurse Performance, Job Satisfaction, Performance

INTRODUCTION educational factors affecting nurse

Niken Grah Prihartanti, Rini Hayu Lestari

Keywords: MgSO4, Weight Preeclampsia, Eclampsia

INTRODUCTION were 17 people aged ≥35 years and 8 (DHO

* Fisher exact test

Analysis of Effect of MgSO4 On Mother Hospital Jombang PONEK Prevalence Of

d. For Further Research

Annisa Nur Nazmi, Tuty Alawiyah, Diny Kusumawardhani, Arum Dwi

Keywords: Lifestyle Intervention, Diabetes Type 2, Physical Activity, Health Education

INTRODUCTION diagnosed with DM (International Diabetes

Keywords: Honey, diabetic foot ulcer, wound care

INTRODUCTION per 1,000 patients with diabetic ulcers

Articles that has been screened: Article based on exclusion criteria:

Article based on inclusion criteria: 10 articles selected

Table 1. Quality and level assessment of articles.

Devi Mediarti*, Rosnani*, Hidayat Arifin**

Keywords: Rolling Massage, Skills, Cadre

INTRODUCTION of breastfeeding is often considered a problem

Khoirun Nisa, Indrawati, Sylvi Harmiardillah, Nurul Khusnul Khotimah

Keywords: Breast Self-Examination, Early Detection, Breast Cancer

INTRODUCTION biopsy without surgery, breast clinic

Made Mahaguna Putra, Henry Wiyono, Sismulyanto, Nikodemus Sili Beda

Keywords: Chronic obstructive pulmonary disease, traditional chinese medicine,

INTRODUCTION deadly disease. In recent years, much

Irwina Angelia Silvanasari, Amita Audilla, Ifa Nofalia

Keywords: non-pharmacological intervention, quality of sleep, elderly

INTRODUCTION that could cause poor sleep quality on the

DISCUSSION CONCLUSION AND

Nuning Khurotul Af’ida, Nurul Jannah, Mokhamad Nurhadi

Keywords: patient safety, health, health worker

INTRODUCTION Safety is a global issue, it summarized in

I Ketut Andika Priastana, Bagus Sholeh Apriyanto, Wildan Akasyah,

Devi Mediarti, Rosnani, Hidayat Arifin**

Nurul Hikmatul Qowi , Cinthya Surya Nevada, Yuliartiningsih*,

Cinthya Surya Nevada, Nurul Hikmatul Qowi , Yuliartiningsih*,