Di susun oleh:
IRMAWATI TOHAMBA
14420212131
2022
REVIEW JURNAL
KEBUTUHAN ELIMINASI
Judul Asli :
Abstrak :
Latar belakang: Bladder Training merupakan salah satu aplikasi dari Evidence
Based Nursing (EBN) untuk menurunkan gangguan eliminasi urin pada pasien
mengembangkan tonus otot dan otot sfingter kandung kemih untuk tujuan yang
maksimal Tujuan: Tujuan dari EBN ini adalah untuk mengidentifikasi efektivitas
Bladder Training (tunda buang air kecil) dalam mengurangi gangguan eliminasi
urin pada pasien Chronic Kidney Disease (CKD). Hasil: Hasil dari aplikasi EBN
ini didapatkan bahwa pada saat pemberian bladder training hari pertama pasien
belum merasakan sensasi ingin buang air kecil dan pada saat pemberian bladder
training hari kedua klien sudah merasakan sensasi ingin buang air kecil.
mudah dilakukan, aman dan praktis secara teknis untuk mengurangi gangguan
J. KESIMPILAN
Gangguan eliminasi urin merupakan masalah yang mengganggu
kenyamanan pasien. Pasien yang mengalami gangguan eliminasi urin erat
kaitannya dengan peran perawat dalam memberikan asuhan keperawatan
dalam menangani pasien gangguan eliminasi. Intervensi terapeutik
nonfarmakologis adalah intervensi penting untuk memastikan perawatan
berkualitas tinggi. Beberapa hasil penelitian melaporkan bahwa intervensi
Bladder Training (menunda buang air kecil) merupakan metode yang
mudah dilakukan dan sangat efektif dalam mengurangi gangguan eliminasi
sehingga dapat meningkatkan kenyamanan pasien dan meningkatkan
kualitas pelayanan keperawatan yang diberikan.
Hospital Management Studies Journal (Homes Journal) Volume 3 No. 1, February 2022
ISSN: 2746-878X (Print), 2746-8798 (Online)
ABSTRACT
ARTICLE INFORMATION
Background: Bladder Training is one of the applications of
Received th
: November 24 , 2021 Evidence Based Nursing (EBN) to reduce urinary
Revised : November 30th, 2021 elimination disorders in Chronic Kidney Disease (CKD)
Available online : February 27th, 2022 patients with urinary catheters. Bladder training is bladder
training that aims to develop muscle tone and bladder
sphincter muscles for maximum purpose
CORRESPONDENCE
Objectives: The purpose of this EBN is to identify the
effectiveness of Bladder Training (delay urination) in
Phone: - reducing urinary elimination disorders in Chronic Kidney
Disease (CKD) patients
Email: risnah@uin-alauddin.ac.id Result: The results of this EBN application were found that
at the time of administering bladder training,on the first day
the patient has not felt the sensation of wanting to urinate
KEYWORDS and at the time of giving bladder training on the second day
the client has felt the sensation of wanting to urinate.
Bladder Training (delay urination), urinary Conclusion: Bladder training (delay urination) can be
elimination disorders, Chronic Kidney Disease recommended as a non-pharmacological therapy to reduce
(CKD)
urinary elimination disorders, is easy to do, safe and
technically practical to reduce elimination disorders in
Chronic Kidney Disease (CKD) patients.
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Hospital Management Studies Journal (Homes Journal) Volume 3 No. 1, February 2022
ISSN: 2746-878X (Print) 2746-8798 (Online)
and the lowest prevalence of chronic kidney balance disorder which is characterized by
failure is West Sulawesi with a percentage of decreased levels of creatinine clearance and
1.8%. Meanwhile, the prevalence of chronic increased serum creatinine levels because the
kidney failure in South Sulawesi reaches 3.5% kidneys are no longer able to maintain body
(Riskesdas, 2018). homeostasis so that there can be a decrease in
The prevalence of chronic kidney consciousness in the patient and lead to death
disease based on age, namely those aged 65-74 (Tarwoto & Wartonah, 2015).
years, reached 8.23%, while those aged 15-24 One of the non-pharmacological ways
years reached 1.33%. Based on gender, male to treat urinary elimination disorders is bladder
with a percentage of 4.17% and female as training (Bladder Training) . Bladder training
much as 3.52% (Riskesdas, 2018). is bladder training that aims to develop muscle
Some of the causes of chronic renal tone and bladder sphincter to function
failure are different including plelonephritis . optimally, there are 3 types of bladder training
Plelonephritis is an infectious and methods , namely kegel exercise, delayed
inflammatory process that usually begins in the urination, and scheduled bathroom trips .
renal pelvis, the renal canal that connects to the Kegel exercises are exercises to tighten or
urinary tract (ureters) and the renal strengthen the pelvic floor muscles, delay
parenchyma or kidney tissue. Infections can urination is to delay urination, while scheduled
result from many types of bacteria, especially bathroom trips are to schedule urination
from colonic bacilli. The original from fecal (Pamungkas Reza, M, 2013).
urinary tract contamination. When bacteria Bladder training is bladder training that
invade kidney tissue, progressive damage is aims to develop muscle tone and bladder
triggered resulting in loss of kidney function. sphincter muscles for maximum purpose.
The most common site of attack is the renal Bladder training is usually used for stress
medulla, the part responsible for concentrating incontinence, urge incontinence or a
urine. Thus, patients with this condition have combination of both or what is known as
decreased ability to concentrate urine. mixed incontinence. Bladder training that
The impact of urinary elimination requires the client to delay voiding, fight or
disorders in patients with chronic renal failure block the sensation of urgency and urinate at a
are changes in urinary excretion, increased predetermined time and not in accordance with
blood pressure, nausea, which is characterized the urge to urinate. The purpose of bladder
by edema or decreased urine output volume training is to prolong the interval between
and pruritus which is characterized by dry and client urinations, stabilize the bladder and
scaly skin. Another impact of urinary relieve urgency (Shabrini, 2015).
elimination disorders is a fluid-electrolyte
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Hospital Management Studies Journal (Homes Journal) Volume 3 No. 1, February 2022
ISSN: 2746-878X (Print), 2746-8798 (Online)
Bladder training methods include whether the article is feasible or not as a basis
delayed urination and scheduled urination. for implementing EBN. After that, the
Delay urination is an exercise to hold / delay proposal was prepared. And then all the
urination. In patients with a catheter still equipment needed was prepared, namely
attached, delay urination is done by clamping arterial clamps.
or tying the urine stream to the urine bag. This The application of EBN was carried out
action allows the bladder to fill with urine and in the Mamminasa Baji inpatient room at
the detrusor muscle to contract while releasing Labuang Baji Hospital Makassar on March 03
the clamp allows the bladder to empty its to March 04, 2021. And identification of the
contents. This exercise is done 6-7 times per subjects involved in the application of this
day until the patient can delay urination EBN with the inclusion criteria of patients who
(Nurhasanah & Hamzah, 2017). had a catheter inserted, communicative
The results of Fajar Dwi's research patients, carried out when they were about to
(2020) after the delay urination exercise be released ( aff catheter) and did not have a
showed that almost half of the patients had urinary tract infection.
improved by no longer experiencing urinary The procedure for implementing EBN
incontinence, while in patients who underwent is carried out by taking into account the clinical
scheduled urination exercises it was known condition of the patient, reviewing the patient's
that half of the patients had improved and no basic data including age, weight, height, BMI,
longer experienced urinary incontinence. In and pharmacological drugs, examining the
addition, bladder training can also prolong the patient's BAK, recording urine output before
time to excrete urine, increase the amount of bladder training (delay urination) is performed.
urine retained by the bladder, improve control The steps for bladder training (delay
of the urge / urge to urinate according to a urination) are:
schedule and reduce / eliminate urinary 1) Nurse washing hands; 2) bring the
incontinence. equipment close to the patient's bedside; 3)
METHODS wear sterile gloves; 4) measure the volume of
The application of EBN begins with urine in the urine bag and empty the urine bag;
finding phenomena in the room which is 4) clamp or tie the catheter according to the
formulated in the form of clinical statements program (for 1-2 hours) which may fill the
with the PICO format ( Problem, Intervention, bladder with urine and the detrusor muscle
Comparation, and Outcome ) and searches for contracts, in order to increase the residual urine
appropriate articles that can answer client volume; 5) encourage the patient to drink
questions. Then one of the articles is selected according to the program (200-250cc); 6) ask
and a critical appraisal is carried out to find out
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Hospital Management Studies Journal (Homes Journal) Volume 3 No. 1, February 2022
ISSN: 2746-878X (Print) 2746-8798 (Online)
work operational standards. On the first day of with catheter insertion causing the bladder to
implementation of bladder training, 3 cycles of not feel the sensation of urination and the
training were given with a time of 2 hours for sphincter cannot close properly. If good,
each cycle. The first administration at 15:00 muscle tone and sphincters become weak and
was evaluated at 16:00 then the clamp was then cause incontinence.
released at 17:00, the second administration at CONCLUSSION
18:00 was evaluated at 19:00 then the clamp Impaired urinary elimination is a
was released at 20:00, and the third problem that interferes with patient comfort.
administration at 19:00 20:00 is evaluated at Patients who experience urinary elimination
21:00 then released at 22:00. Every time disorders are closely related to the role of
bladder training (delay urination) is given, the nurses in providing nursing care in dealing
client is advised to drink 200 cc-250 cc in order with patient elimination disorders. Non-
to fill the bladder. pharmacological therapeutic interventions are
This is in line with the results of important interventions to ensure high-quality
research by Dwi Febrianto (2015) which states care. Several research results reported that
that Bladder Training is effective for Bladder Training intervention (delay
stimulating the voiding sensation. This is urination) is a method that is easy to do and
because Bladder Training will stimulate the very effective in reducing elimination
bladder which causes the bladder to increase disorders so that it can increase patient comfort
control of the urge to urinate. and improve the quality of nursing services
In line with Purnomo (2016) said that provided.
the results of research in general found that the
Bledder Training intervention was proven to REFERENCES
be significantly able to overcome the problem Fajar Dwi, et.al. (2020). The Effect of Bladder
Training on Reducing Urinary
of urinary incontinence after urinary Incontinence in Post BPH Surgery
catheterization, both with the scheduled Patients. Journal of Nersing and Health
(JNH). Vol. 5. No. 2. pp. 100-107.
urination method and delayed urination which
Fatimah, Endah Nur. (2015). Smart Strategy
was carried out every day for 6-7 times of for Developing SOP (Standard
exercise in the day before urinary catheter Operating Procedure) . Yogyakarta:
New Library Press
removal. In implementing the bladder training
Mubarok, et al, (2013). Textbook of Basic
intervention, the patient is first given an Human Needs. Jakarta: EGC
understanding of incontinence and the bladder Nurhasanah, T., & Hamzah, A. (2017).
training method, to increase the success of Bladder Training Affects the Decrease
in the Incidence of Urinary
urinary incontinence problems, it requires Incontinence in Post-Bph Surgery
cooperation between the nurse and the patient Patients in the Inpatient Room of RSud
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Hospital Management Studies Journal (Homes Journal) Volume 3 No. 1, February 2022
ISSN: 2746-878X (Print) 2746-8798 (Online)
41
ABSTRAK
Latar belakang: Bladder Training merupakan salah satu aplikasi dari Evidence Based Nursing
(EBN) untuk menurunkan gangguan eliminasi urin pada pasien Chronic Kidney Disease (CKD)
MIND MAPPING dengan pemasangan kateter urin. Pelatihan kandung kemih adalah pelatihan kandung kemih
yang bertujuan untuk mengembangkan tonus otot dan otot sfingter kandung kemih untuk tujuan
yang maksimal Tujuan: Tujuan dari EBN ini adalah untuk mengidentifikasi efektivitas Bladder
Training (tunda buang air kecil) dalam mengurangi gangguan eliminasi urin pada pasien
Chronic Kidney Disease (CKD). Hasil: Hasil dari aplikasi EBN ini didapatkan bahwa pada saat
Penulis : pemberian bladder training hari pertama pasien belum merasakan sensasi ingin buang air kecil
dan pada saat pemberian bladder training hari kedua klien sudah merasakan sensasi ingin buang
Risnah, Eva Yustilawati,
air kecil. Kesimpulan: Bladder training (menunda buang air kecil) dapat direkomendasikan
Sudarmi, Roamah sebagai terapi nonfarmakologis untuk mengurangi gangguan eliminasi urin, mudah dilakukan,
Di Publikasikan : Homes aman dan praktis secara teknis untuk mengurangi gangguan eliminasi pada pasien Chronic
Journal, Volume 3 No. 1 Kidney Disease (CKD).
Februari 2022
ANALISIS JURNAL
1. Kelebihan :
sebelum peneliti melakukan penelitian, peneliti mencari artikel
yang sesuai dengan penelitian yang akan dilakukan kemudian
TUJUAN melakukan penilaian kritis untuk mengetahui layak atau tidaknya
tindakan tersebut sebagai dasar pelaksanaan EBN.
1. Tujuan review jurnal Untuk mengetahui efektifitas Sebelum prosedur pelaksanaan EBN dilakukan peneliti
pelatihan bladder pada pasien gangguan eliminasi urine. memperhatikan kondisi klinis pasien, mengkaji data dasar pasien
2. Tujuan penelitian dalam jurnal Tujuan dari EBN ini meliputi usia, berat badan, IMT, dan obat-obatan farmakologis,
adalah untuk mengidentifikasi efektivitas Bladder pemeriksaan BAK pasien, pencatatan urine output sebelum bladder
Training (tunda buang air kecil) dalam mengurangi training dilakukan.
gangguan eliminasi urin pada pasien Chronic Kidney 2. Kekurangan : Sampel yang di gunakan pada penelitian hanya satu
Disease (CKD). orang, sehingga kurang memperkuat hasil dari penelitian ini.
1. IMPLIKASI KEPERAWATAN
Dengan adanya penelitian ini sangat membantu perawat dalam
memberikan asuhan keperawatan bagi pasien yang mengalami
gangguan eliminasi urin menggunakan intervensi terapeutik non
farmakologis.
2. APLIKASI DIRUMAH SAKIT
Dalam penelitian ini rumah sakit dapat memberikan pelatian bladder
kepada pasien dengan gangguan eliminasi urin dimana pelatihan ini
sangat membantu dalam mengatasi gangguan eliminasi urin.