REVIEW JURNAL

“INTERVENSI POSTUR TUBUH PADA FOWLER 30° UNTUK

MENGURANGI SESAK NAFAS PADA PASIEN GAGAL JANTUNG
KONGESTIF”

Disusun oleh:

KELOMPOK 1 RS LABUANG BAJI

PRECEPTOR INSTITUSI PRECEPTOR LAHAN

( ) ( )

PROGRAM STUDI PROFESI NERS

FAKULTAS KESEHATAN
MASYARAKAT UNIVERSITAS MUSLIM
INDONESIA 2023
 KEBUTUHAN OKSIGENASI

Judul Asli : Intervensi Postur Tubuh pada Fowler 30° untuk

Mengurangi Sesak Nafas pada Pasien Gagal Jantung
Kongestif: Studi Kasus

Penulis : Anggi Jamiyanti, Sarah Arnika Simatupang, Trias Eka

Nurlela, Eka Afrima Sari, Yusshy Kurnia Herliani,
Ramdani
Di Publikasikan : 31 Desember 2022

Abstrak : Pendahuluan: Sesak nafas pada penderita gagal jantung

kongestif disebabkan oleh terganggunya fungsi paru
karena adanya edema pulmonal. Salah satu upaya yang
dapat dilakukan untuk mengatasi sesak nafas dan
memperbaiki status oksigenasi adalah dengan mengubah
posisi trunk posture in fowler 30° .
Studi kasus ini
dilakukan untuk menganalisis penerapan posisi trunk
posture in fowler 30° pada pasien gagal jantung
kongestif yang mengalami sesak nafas. Metode:
Penelitian ini menggunakan desain evaluatif yaitu studi
kasus pada pasien dengan kongestif heart failure dengan
sesak nafas. Hasil: Setelah dilakukan oberservasi
pemberian posisi trunk posture in fowler 30° selama 3
hari perawatan, terdapat perubahan tekanan darah, denyut
nadi, pernafasan dan saturasi oksigen pasien. Simpulan:
Posisi trunk postur in fowler 30° dapat mengurangi sesak
napas pada pasien gagal jantung kongestif.
A. LATAR BELAKANG

1. Latar belakang Pemilihan jurnal

Pada tahun 2020, Kesehatan Global Data Exchange (GHDx) melaporkan

jumlah kasus gagal jantung kongestif di dunia mencapai 64,34 juta kasus
dengan 9,91 juta kematian (Lippi & Sanchis-Gomar, 2020). Angka kejadian
gagal jantung di Indonesia sebesar 1,5% dari seluruh penderita gangguan sistem
kardiovaskular pada tahun 2018 (Kemenkes RI, 2019).
2. Latar Belakang Penelitian dalam jurnal
Gagal jantung kongestif (CHF) adalah suatu kondisi kronis di mana
otot jantung tidak mampu memompa cukup darah untuk memenuhi kebutuhan
tubuh akan energi darah kaya oksigen. Gagal jantung kongestif disebabkan oleh
kelainan struktural atau fungsional pengisian ventrikel atau pengeluaran darah
dari jantung.
Penelitian dilakukan pada tahun 2021. Pasien Tn. T berusia 57 tahun,
dirawat dengan diagnosa medis gagal jantung kongestif kelas III dan mengalami
sesak nafas. Pasien datang ke RS dengan keluhan bengkak di sekujur tubuh
sejak satu bulan yang lalu, sesak nafas, dan batuk. Pasien merupakan perokok
aktif selama 21 tahun dan memiliki riwayat penyakit hipertensi dan diabetes
melitus sejak tiga tahun lalu.

B. TUJUAN

1. Tujuan Review Jurnal

Bertujuan untuk memberikan informasi, gambaran, ide/gagasan tentang

jurnal yang telah dibuat dan mempermudah dalam membahas inti hasil
penelitian ataupun jurnal yang telah ada serta menambah ilmu penegtahuan dan
wawasan terkait hasil yang akan di review khususnya dalam bidang
keperawatan.
2. Tujuan Penelitian Dalam Jurnal
Bertujuan untuk mengetahui seberapa efektif postur pada posisi fowler
30° dalam menurunkan sesak nafas pada pasien gagal jantung kongestif dan
juga seberapa efektif intervensi ini bisa diterapkan di semua pasien yang
mengalami sesak nafas.
C. METODE
Penelitian ini menggunakan studi kasus dengan analisis data menggunakan analitik
deskriptif pada pasien gagal jantung kongestif yang mengalami sesak napas.

D. HASIL
Hasil evaluasi yang diperoleh pada pasien setelah dilakukan perubahan posisi adalah
kesadaran pasien akan compos mentis, tidak terlihat adanya penggunaan otot bantu
pernafasan yang berlebihan, penurunan nilai hemodinamik mendekati batas normal, dan
peningkatan saturasi oksigen. Respon pasien terhadap perubahan posisi ini adalah sesak
napas berkurang dan merasa lebih nyaman.

E. PEMBAHASAN
Pemilihan posisi yang tepat dapat meredakan sesak napas yang dialami pasien gagal
jantung kongestif, salah satunya adalah posisi Fowler. Posisi Fowler atau posisi setengah
duduk merupakan posisi yang sering diterapkan secara klinis dalam memberikan
kenyamanan pada pasien. Posisi ini diberikan dengan cara memiringkan kembali tempat
tidur antara 30° dan 60° dari posisi terlentang dengan posisi lutut keluar atau lurus (Kubota
et al., 2015).
Penelitian sebelumnya menguji apakah volume sekuncup (SV) lebih tinggi dan detak
jantung (HR) lebih rendah pada posisi Fowler dengan tubuh bagian atas tegak
dibandingkan posisi Fowler dengan seluruh tubuh tegak pada subjek yang lebih tua dan
lebih muda. Hasil penelitian menunjukkan bahwa batang atas tegak selama posisi Fowler
memungkinkan pemeliharaan SV dan menghambat respons takikardia dibandingkan
dengan batang tegak, tanpa memandang usia. Batang atas yang tegak pada posisi Fowler
dapat membantu mengurangi stres ortostatik dan memfasilitasi aktivitas rutin dan
percakapan pada pasien yang lemah (Kubota et al., 2017).
Posisi Fowler yang digunakan pada studi kasus ini adalah postur batang tubuh pada
posisi fowler 30° , dilakukan dengan cara meninggikan tulang punggung lurus sejajar
kepala hingga membentuk sudut 30° dari tempat tidur. Lutut sedikit terangkat untuk
menciptakan sudut 15o. Postur batang tubuh pada posisi fowler 30° dapat mengurangi
sesak nafas dengan membantu meningkatkan ekspansi paru secara maksimal. Konsumsi
oksigen pasien gagal jantung dengan posisi ini juga dapat berkurang dibandingkan dengan
posisi berbaring, dimana posisi organ di perut yang menekan diafragma sangat minim.
Pasien gagal jantung kongestif yang diposisikan dengan postur trunk in fowler 30° dapat
 menurunkan aliran balik vena ke atrium sehingga menurunkan volume akhir diastolik dan
peningkatan fungsi ventrikel. Ekstremitas bawah pada posisi ini menopang gaya gravitasi
untuk memperlancar aliran darah ke perifer. Postur batang tubuh pada posisi fowler 30°
mendukung pasien gagal jantung kongestif untuk beristirahat guna mengurangi beban
jantung dan menjaga kestabilan volume sekuncup. Berkurangnya beban jantung dan
stabilnya volume sekuncup mendukung denyut nadi dan tekanan darah mencapai batas
normal (Kubota et al., 2015; Awolola et al., 2022).
Dengan pemberian postur badan pada posisi fowler 30° terjadi perubahan status
tekanan darah, nadi, pernafasan dan saturasi menuju normal. Intervensi ini juga relatif
mudah dilakukan dengan persiapan peralatan minimal. Perlu dilakukan pengukuran
perubahan status hemodinamik dan pernafasan secara berkala untuk mendapatkan hasil
intervensi yang akurat.

F. ANALISIS JURNAL
1. Kelebihan
Pemaparan teori jelas dan lengkap dengan menggunakan referensi terbaru.

2. Kekurangan
Jurnal tidak memberi rekomendasi apa yang diberikan untuk penelitian
selanjutnya, pada jurnal ini juga tidak di jelaskan resiko apa yang akan yang
terjadi saat diimplementasikan terhadap pasien, pada jurnal ini juga tidak ada
penjelasan berapa lama waktu pemberian posisi fowler.

G. IMPLIKASI KEPERAWATAN
Implikasi keperawatan pada jurnal ini adalah Posisi Fowler atau posisi setengah
duduk merupakan posisi yang sering diterapkan secara klinis dalam memberikan
kenyamanan pada pasien. Posisi ini diberikan dengan cara memiringkan kembali tempat
tidur antara 30° dan 60° dari posisi terlentang dengan posisi lutut keluar atau lurus,
sehingga posisi fowler 30° dapat mengurangi sesak nafas dengan membantu meningkatkan
ekspansi paru secara maksimal.
H. APLIKASI DI RUMAH SAKIT
Posisi fowler merupakan posisi setengah duduk dengan sudut sandaran antara 30°
dan 60° , bagian kepala tempat tidur pasien/ klien dinaikkan. Posisi duduk ini dilakukan
bertujuan untuk mempertahankan serta meningkatkan kenyamanan dan memberikan ruang
pada pernapasan pasien.
I. HAMBATAN DAN SOLUSI APLIKASI JURNAL
Hambatan : Pada saat melakukan posisi fowler pada jurnal ini tidak
dipaparakan adanya hambatan saat pemberian posisi fowler.

J. KESIMPULAN
1. Kesimpulan pada penelitian
Kesimpulan Penelitian ini yaitu mengungkapkan bahwa penerapan postur trunk in
fowler 30° dapat mengurangi sesak napas pada pasien gagal jantung kongestif dengan
membantu meningkatkan ekspansi paru maksimal, menurunkan konsumsi oksigen,
dan meminimalkan kompresi diafragma. Postur batang tubuh pada posisi fowler 30°
juga dapat mengurangi beban jantung dan menjaga kestabilan volume sekuncup,
sehingga membantu mencapai tekanan darah dan denyut nadi normal. Pemberian
postur batang tubuh pada posisi fowler 30° dapat dijadikan salah satu pilihan
intervensi untuk menunjang terapi farmakologi pada pasien gagal jantung kongestif
dengan keluhan sesak nafas.
2. Kesimpulan pembaca
Jurnal ini dapat dijadikan literatur terapi yang efektif diberikan kepada pasien dengan
keluhan sesak napas.
JURNAL PENDIDIKAN KEPERAWATAN INDONESIA
e-ISSN 2477-3743 p-ISSN 2541-0024

The Intervention of Trunk Posture on Fowler 30° to Reduce Shortness

of Breath in Congestive Heart Failure Patients: Case Study
Anggi Jamiyanti1*, Sarah Arnika Simatupang1, Trias Eka Nurlela1, Eka Afrima Sari1,
Yusshy Kurnia Herliani1, Ramdani2
1
Departement of Medical Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
2
Rumah Sakit Umum Daerah dr. Slamet Garut, Garut, Indonesia
*Corresponding email: anggi19001@mail.unpad.ac.id

ARTICLE INFO
How to Cite:
Jamiyanti, A., Simatupang,
S.A., Nurlela, T.E., Sari, E.A,
Herliani, Y.K., & Ramdani,
R. (2022). Intervention of
Trunk Posture on Fowler 30o
to Reduce Shortness of Breath
in Congestive Heart Failure
Patients: Case Study. Jurnal
Pendidikan Keperawatan
Indonesia, 8(2), p. 107–112
DOI:
10.17509/jpki.v8i2.50539
Article History:
Received: 1.
October 10, 2022
ABSTRACT
Introduction: Shortness of breath in patients with congestive heart failure is
caused by impaired lung function due to pulmonary. One of the efforts that can be
made to overcome shortness of breath and improve oxygenation status is to change
the position of the trunk posture in fowler 30° . Objective: This case study was
conducted to analyze the application of the 30° trunk posture in the fowler
position in patients with congestive heart failure who experience shortness of
breath. Method: The research used a case study of patients with congestive heart
failure who experience shortness of breath. Result: After giving a 30° trunk
posture in the fowler position for three days of treatment, there was a change of
blood pressure, pulse rate, respiration, and oxygen saturation of the patient.
Conclusion: The position of the trunk in fowler posture 30° can reduce shortness
of breath in patients with congestive heart failure.
Keywords: Congestive Heart Failure, Shortness of Breath, Trunk Posture in Fowler 30°
ABSTRAK

Revised:
December 02, 2022
Accepted:
December 27, 2022
Published:
December 31, 2022
Copyright©2022 by authors,
all rights reserved. Authors
agree that this article remains
permanently open access
under the terms of the
Creative Commons
Attribution-ShareAlike 4.0
International License
Pendahuluan: Sesak nafas pada penderita gagal jantung kongestif disebabkan
oleh terganggunya fungsi paru karena adanya edema pulmonal. Salah satu upaya
yang dapat dilakukan untuk mengatasi sesak nafas dan memperbaiki status
oksigenasi adalah dengan mengubah posisi trunk posture in fowler 30° . Studi
kasus ini dilakukan untuk menganalisis penerapan posisi trunk posture in fowler
30° pada pasien gagal jantung kongestif yang mengalami sesak nafas. Metode:
Penelitian ini menggunakan desain evaluatif yaitu studi kasus pada pasien dengan
kongestif heart failure dengan sesak nafas. Hasil: Setelah dilakukan oberservasi
pemberian posisi trunk posture in fowler 30° selama 3 hari perawatan, terdapat
perubahan tekanan darah, denyut nadi, pernafasan dan saturasi oksigen pasien.
Simpulan: Posisi trunk postur in fowler 30° dapat mengurangi sesak napas pada
pasien gagal jantung kongestif.
Kata Kunci: Gagal Jantung Kongesti, Sesak Nafas, Trunk Posture in Fowler 30°

INTRODUCTION oxygen-rich blood. Congestive heart failure is

Congestive heart failure (CHF) is a chronic caused by structural or functional disorders of
condition in which the heart muscle is unable to ventricular filling or blood ejection from the heart
pump enough blood to meet the body's need for (Yancy et al., 2017). In 2020, the Global Health

107
 Jamiyanti, A., Simatupang, S.A., Nurlela, T.E., Sari, E.A, Herliani, Y.K., & Ramdani, R. | Intervention of Trunk Posture
on…
Data Exchange (GHDx) reported that the number
of cases of congestive heart failure in the world
reached 64.34 million cases with 9.91 million
deaths (Lippi & Sanchis-Gomar, 2020). The
incidence of heart failure in Indonesia was 1.5%
of all patients with cardiovascular system
disorders in 2018 (Kemenkes RI, 2019).
Typical signs and symptoms of patients
with congestive heart failure are shortness of
breath when doing activities or resting, fatigue,
peripheral edema or swelling of the legs,
tachycardia, tachypnea, pulmonary rales, pleural
effusions, increased jugular venous pressure and
hepatomegaly (Bauersachs et al., 2019). Shortness
of breath (dyspnea) is the symptom most often felt
by patients with congestive heart failure, which is
caused by pulmonary function failure due to
pulmonary edema (Rahayu, 2020). Pulmonary
edema will reduce the diffusion process in the
alveolar membrane, thereby interfering with gas
exchange and oxygen delivery by blood to the
tissues. This process will cause patients with
congestive heart failure to experience a decrease
in oxygen saturation and hypoxemia (Wijayati,
Ningrum, & Putrono, 2019). The lying position
will exacerbate shortness of breath because the
fluid will be distributed to the lungs more quickly
(Pambudi & Widodo, 2020).
Patients with congestive heart failure
require immediate treatment, both
pharmacologically and non-pharmacologically, to
improve the worsening of the condition, improve
the hemodynamic status, eliminate pulmonary
congestion and improve tissue oxygenation (Muti,
2020). Respiratory system problems experienced
by patients with congestive heart failure require
prompt and appropriate treatment to prevent the
worsening of the patient's condition. Nurses can
perform several independent or collaborative
actions to facilitate efforts to increase gas
exchange and oxygen saturation in patients with
congestive heart failure. There have been many
studies describing interventions that nurses
can carry out independently
in handling respiratory problems in patients with
heart failure, including breathing exercises
(mindful breathing, deep breathing
108
exercises), active range of motion exercises, and
positioning (Pambudi & Widodo, 2020).
Changing the position (positioning) of the patient
is a significant action that can reduce respiratory
problems. This aims to increase the volume of
blood in the lungs due to the influence of gravity
on venous blood flow to reduce the tightness felt
by patients with congestive heart failure (Katz et
al., 2018). Position selection is very influential in
patients with respiratory problems. Several
positions include supine, pronation, lateral, and
fowler (Kozier et al., 2011).
Proper positioning is essential in heart
failure patients who experience shortness of
breath. One of the positions that can be done
effectively to improve the hemodynamic status
and oxygen saturation is the 30° trunk posture in
fowler position (Kubota et al., 2015). The
difference with the usual Fowler or semi-Fowler
position is that besides increasing blood volume in
the lungs and chest expansion, this position can
reduce pressure on the abdomen and diaphragm in
patients accompanied by ascites.
This position is done by elevating the
straight spine parallel to the head to form a 30°
angle from the bed, and then the knees are
elevated to create a 15o angle. The force of gravity
influences this position to help expand the chest
and reduce pressure on the abdomen and
diaphragm when breathing.
Based on this background, this case study-
based research aimed to determine how effective
the trunk posture in the fowler 30° position is in
reducing shortness of breath in patients with
congestive heart failure. Therefore the results of
this case study can be used as an alternative
position for patients with shortness of breath,
especially in patients with congestive heart
failure.
METHOD
The research used a case study with data
analysis using descriptive analytics in patients
with congestive heart failure who experience
shortness of breath. Written informed consent was
obtained from the patient. The researcher obtained
a research permit from the hospital with approved
reference number 800/109/RSU/III/2021.
JPKI 2022 Vol. 8 No.2
 Jamiyanti, A., Simatupang, S.A., Nurlela, T.E., Sari, E.A, Herliani, Y.K., & Ramdani, R. | Intervention of Trunk Posture
on…

Patient Information extremities.

The study was conducted in 2021. Patient
Mr T, a 57-year-old, was treated with a medical
diagnosis of class III congestive heart failure and
experienced shortness of breath. The patient came
to the hospital complaining of swelling all over
the body since one month ago, shortness of
breath, and cough. The patient has been a heavily
active smoker for 21 years and has had a history
of hypertension and diabetes mellitus since three
years ago.

Clinical Findings
Based on the assessment results, patients
complained of shortness of breath which was felt
continuously and got worse when the patient lay
down or moved. The patient's consciousness is
compos mentis. The patient looks weak and
breathless. The results of measuring vital signs in
the form of blood pressure 190/120 mmHg,
respiratory rate 25x/minute with oxygen therapy 4
liters/minute using a nasal cannula, pulse
68x/minute, and temperature 36.5°C. Examination
of the respiratory system revealed that the patient
had grade III shortness of breath. There is chest
muscle retraction with symmetrical left and right
chest movements. There was no tenderness in the
chest area, the results of resonant left and right
lung percussion, dullness in the right basal lung,
auscultation of vesicular breath sounds, and no
crackles and wheezing.
The patient's conjunctiva was anemic.
Percussion results found dullness on the left chest
on ICS III-V and ICS III-V on the right
parasternal line. At the time of auscultation at ICS
II, right-left sternum, and ICS V mid-clavicle left,
a regular rhythm was heard, and there were no
additional sounds. CRT returns in >3 seconds, and
nails appear pale and acral in both cold
extremities. The patient's abdomen was ascites,
and there was no tenderness, the abdomen was
hard, while the liver was not assessed on
palpation. Abdominal dullness percussion in the
4th quadrant with auscultation of bowel sounds
8x/minute. Both the upper and lower extremities
are edematous (pitting edema ++), there is a
decrease in strength in the muscles of both
JPKI 2022 Vol. 8 No.2 109
Jamiyanti, A., Simatupang, S.A., Nurlela, T.E., Sari, E.A, Herliani, Y.K., & Ramdani, R. | Intervention of Trunk Posture
on… The results of the supporting examination
for the ECG examination revealed the presence
of mitral P waves in leads I and II and inverted T
in V3, V4 and V5. A chest X-ray examination
revealed cardiomegaly without pulmonary
engorgement and right pleural effusion. While
the results of clinical chemistry and hematology
examinations obtained blood sugar at 276
mg/dL, hemoglobin 10.6 g/dL, platelets
97,000/mm3, albumin 2.54 g/dL, urea 62
mg/dL, and creatinine
2 mg/dL. The therapy program given to the
patient included nasal cannula oxygen 4
liters/minute, 2 ampoules of farsik/12 hours, 5
units of levemir at 22.00, novorapid 4 units
(morning, afternoon, evening), omeprazole 40
mg/12 hours, vitamin K 1 ampoule/8 hours, KSR
600 mg (morning), amlodipine 5 mg/8 hours,
spironolactone 1 mg (morning), candesartan 8
mg (morning), ISDN 5 mg/8 hours, concor 2.5
mg (morning), trimetazidine 1 /12 hours,
aminoral 1/8 hours.

Figure 1. Position Trunk Posture in Fowler

30°
(Kubota et al., 2017)

Therapeutic/Nursing Intervention
The intervention given is to change the
position of the trunk posture in fowler 30° in
patients with congestive heart failure who
experience shortness of breath. The change in
position was carried out by taking into account
the physical condition and comfort of the patient,
the researcher changed the patient's position by
elevating the bed so that the patient's position
became a trunk posture in fowler 30° , where the
spine is raised straight parallel to the head to
form a 30° angle from the bed, then the knees
are slightly elevated to form a 15o angle.
Positional accuracy was measured using a simple
arc ruler at the corner of the bed. This position is
maintained while monitoring the patient's
condition. After the first

110 JPKI 2022 Vol. 8 No.2

 Jamiyanti, A., Simatupang, S.A., Nurlela, T.E., Sari, E.A, Herliani, Y.K., & Ramdani, R. | Intervention of Trunk Posture
on…

15 minutes, the researcher will again measure the
patient's vital signs to see changes in values,
especially for respiratory status and oxygen
saturation.
Follow-up and Outcomes
Measurement of blood pressure, pulse and
respiration rate were measured before being given
a position change intervention. After 15 minutes
of intervention, measurements were taken to
evaluate the changes. The intervention will be
stopped if the patient feels a difference in a worse
direction, such as feeling more congested and
anxious.
RESULT AND DISCUSSION
After changing the supine position to trunk
posture in fowler 30° , there was a change in the
patient's blood pressure, pulse rate, respiration and
oxygen saturation. The results of the evaluation
obtained in the patient after changing position
were the patient's awareness of compos mentis, no
excessive use of auxiliary respiratory muscles
were seen, a decrease in hemodynamic values
approaching normal limits, and an increase in
oxygen saturation. The patient's response to this
position change was that shortness of breath was
reduced, and they felt more comfortable.

Table 1. Observation of Vital Signs after Intervention in Trunk Posture in Fowler 30°
No Data Before the position of the trunk posture After the position of the trunk posture
in fowler 30° in fowler 30°
1 Blood pressure 190/100 mmHg 180/90 mmHg
2 Respiratory rate 24 x/minute 19 x/minute
3 Pulse rate 75-76 x/minute 73-75 x/minute
4 Oxygen saturation 95% 97-99%.

Based on the table above, after being given lower in Fowler's position with the
the position change intervention, there was a
decrease in blood pressure from 190/100 mmHg
to 180/90 mmHg. There is a decrease in the
respiratory rate to within normal limits and an
increase in oxygen saturation. From these results,
nursing problems can be partially resolved, where
the patient's response to the intervention can
overcome the symptoms that arise in patients with
congestive heart failure, namely shortness of
breath. Shortness of breath felt by the patient
decreased, and oxygen saturation increased after
being given a trunk posture in the fowler 30°
position.
Choosing the right position can relieve
shortness of breath experienced by patients with
congestive heart failure, one of which is the
Fowler's position. Fowler's position or semi-
sitting position is a position that is often applied
clinically in providing comfort to the patient. This
position is given by tilting the bed back up
between 30° and 60° from the supine position
with the knees out or straight (Kubota et al.,
2015). Previous studies tested whether stroke
volume (SV) was higher and heart rate (HR)
JPKI 2022 Vol. 8 No.2 111
 Jamiyanti, A., Simatupang, S.A., Nurlela, T.E., Sari, E.A, Herliani, Y.K., & Ramdani, R. | Intervention of Trunk Posture
upper
on… body upright than in Fowler's position
with the whole body upright in older and
younger subjects. The results showed that the
upright scion during Fowler's position enabled
maintenance of SV and inhibited tachycardia
response compared to the upright trunk,
regardless of age. An upright scion in
Fowler's position can help reduce orthostatic
stress and facilitate routine activities and
conversation in debilitated patients (Kubota et
al., 2017).
The Fowler position used in this case
study is a trunk posture in the fowler 30°
position, performed by elevating the straight
spine parallel to the head to form an angle of
30° from the bed. The knees are slightly
elevated to create a 15o angle. The trunk
posture in the fowler 30° position can reduce
shortness of breath by helping to increase
maximum lung expansion. Oxygen
consumption of heart failure patients with this
position can also be reduced compared to the
lying position, where the position of the
organs in the abdomen that compresses the
diaphragm is minimal. Congestive heart
failure patients positioned in a trunk posture
in fowler 30° can reduce venous return to the
atria, thereby reducing

112 JPKI 2022 Vol. 8 No.2

 Jamiyanti, A., Simatupang, S.A., Nurlela, T.E., Sari, E.A, Herliani, Y.K., & Ramdani, R. | Intervention of Trunk Posture
on…

end-diastolic volume and improving ventricular M. C., Hilfiker-Kleiner, D., Mbakwem, A., .
function. The lower extremities in this position
support the force of gravity to facilitate blood
flow to the periphery. The trunk posture in the
fowler 30° position supports congestive heart
failure patients to rest to reduce the burden on the
heart and maintain a stable stroke volume. The
reduced heart load and stable stroke volume
support the pulse rate and blood pressure to reach
normal limits (Kubota et al., 2015; Awolola et al.,
2022).
With the provision of a trunk posture in the
fowler 30° position, there is a change in blood
pressure, pulse, respiration, and saturation status
toward normal. This intervention is also relatively
easy to perform with minimal equipment
preparation. It is necessary to measure
hemodynamic and respiratory status changes
regularly to get accurate intervention results.

CONCLUSION
This research revealed that applying a trunk
posture in fowler 30° can reduce shortness of
breath in patients with congestive heart failure by
helping to increase maximal lung expansion,
lower oxygen consumption, and minimize
diaphragmatic compression. The trunk posture in
the fowler 30° position can also reduce the
burden on the heart and maintain a stable stroke
volume, thereby helping to achieve normal blood
pressure and pulse rate. Providing a trunk posture
in the fowler 30° position can be used as an
intervention option to support pharmacological
therapy in patients with congestive heart failure
with complaints of shortness of breath.

REFERENCES
Awolola, E. O., Maharaj, S. S., Ojo, O. T., &
Adeyeye, O. O. (2022). Efficacy of
Pulmoary exercise administered in Supine,
45 degrees, or 90 degrees long sitting
position on pulmonary parameters of
patients with COPD: A Study Protocol.
medRxiv. https://doi.org/10.1101/2022.01.
30.22270106
Bauersachs, J., König, T., van der Meer, P.,
Petrie,
JPKI 2022 Vol. 8 No.2 113
Jamiyanti, A., Simatupang, S.A., Nurlela, T.E., Sari, E.A, Herliani, Y.K., & Ramdani, R. | Intervention of Trunk Posture
on… . . de Boer, R. A. (2019). Pathophysiology, Terhadap Perubahan Haemodinamik Pada
diagnosis and management of peripartum Pasien
cardiomyopathy: a position statement
from the Heart Failure Association of the
European Society of Cardiology Study
Group on peripartum cardiomyopathy.
European journal of heart failure, 21(7),
827-843. https://doi.org/10.1002/ejhf.1493
Katz, S., Arish, N., Rokach, A., Zaltzman, Y., &
Marcus, E.-L. (2018). The effect of body
position on pulmonary function: a
systematic review. BMC pulmonary
medicine, 18(1), 1-16. https://doi.org/10.
1186/s12890-018-0723-4
Kemenkes RI. (2019). Laporan Nasional
Riskesdas 2018. Jakarta: Lembaga
Penerbit Badan Penelitian dan
Pengembangan Kesehatan (LPB).
Kozier, B., Erb, G., Berman, A., & Snyder.
(2011). Buku Ajar Fundamental
Keperawatan, Konsep, Proses dan Praktik
(7 ed. Vol. 1). Jakarta: EGC.
Kubota, S., Endo, Y., Kubota, M., Ishizuka, Y.,
& Furudate, T. (2015). Effects of trunk
posture in Fowler's position on
hemodynamics. Autonomic Neuroscience,
189, 56-59.
https://doi.org/10.1016/j.autneu.2015.01.00
2
Kubota, S., Endo, Y., Kubota, M., & Shigemasa,
T. (2017). Assessment of effects of
differences in trunk posture during
Fowler’s position on hemodynamics and
cardiovascular regulation in older and
younger subjects. Clinical interventions in
aging, 12, 603. https://doi. org/10.
2147%2FCIA.S132399
Kupper, N., Bonhof, C., Westerhuis, B.,
Widdershoven, J., & Denollet, J. (2016).
Determinants of Dyspnea in Chronic
Heart Failure. Journal of Cardiac Failure,
22(3), 201–209.
https://doi.org/10.1016/j.cardfail.
2015.09.016
Lippi, G., & Sanchis-Gomar, F. (2020). Global
epidemiology and future trends of heart
failure. AME Med J, 5(15), 1-6.
https://doi. org/10.21037/amj.2020.03.03
Muti, R. T. (2020). Pengaruh Posisi Semi Fowler
Dengan Kombinasi Lateral Kanan
114 JPKI 2022 Vol. 8 No.2
 Jamiyanti, A., Simatupang, S.A., Nurlela, T.E., Sari, E.A, Herliani, Y.K., & Ramdani, R. | Intervention of Trunk Posture
on…
Gagal Jantung Di Ruang ICCU Rumah
Sakit Umum Daerah Margono Soekarjo
Purwokerto. Viva Medika: Jurnal
Kesehatan, Kebidanan Dan Keperawatan,
13(02), 124-140. https://doi.org/10.35960/
vm.v13i02.519
Najafi, S., Dehkordi, S. M., Haddam, M. B.,
Abdavi, M., & Memarbashi, M. (2018).
The effect of position change on arterial
oxygen saturation in cardiac and respiratory
patients: A randomized clinical trial.
Journal of Clinical and Diagnostic
Research, 12(9), OC33–OC37. https://doi.
org/10.7860/JCDR/2018/36282.12130
Pambudi, D. A., & Widodo, S. (2020). Posisi
Fowler Untuk Meningkatkan Saturasi
Oksigen Pada Pasien (CHF) Congestive
Heart Failure Yang Mengalami Sesak
Nafas. Ners Muda, 1(3), 146-151.
https://doi.org/ 10.26714/nm.v1i3.5775
Puspita, D., Nur, B. M., & Jumaiyah, W. (2019).
Efektifitas Posisi Tidur Miring Kanan dan
Semifowler Terhadap Kualitas Tidur Pada
Pasien Gagal Jantung Kongestif Di RSUD
Dr. Soedarso Pontianak. Jurnal
Keperawatan Dan Kesehatan. Retrieved
from http://jurnal-
stikmuh-ptk.id/index.php/JK2/article/view/
105
Rahayu, L. P. (2020). Management
Pengoptimalan Kebutuhan Oksigen Pada
Pasien Gagal Jantung Di Unit Perawatan
Intensif: A
JPKI 2022 Vol. 8 No.2
Literatur Review. Jurnal Berita Ilmu
Keperawatan, 13(2), 84-92. https://doi.org/
10.23917/bik.v13i2.11499
Virani, S. S., Alonso, A., Aparicio, H. J.,
Benjamin, E. J., Bittencourt, M. S.,
Callaway, C. W., Tsao, C. W. (2021). Heart
Disease and Stroke Statistics-2021 Update:
A Report From the American Heart
Association. In Circulation (Vol. 143).
https://doi.org/10.1161/CIR.000000000000
0950
Wijayati, S., Ningrum, D. H., & Putrono, P.
(2019). Pengaruh Posisi Tidur Semi Fowler
450 Terhadap Kenaikan Nilai Saturasi
Oksigen Pada Pasien Gagal Jantung
Kongestif Di RSUD Loekmono Hadi
Kudus. Medica Hospitalia: Journal of
Clinical Medicine, 6(1), 13-19.
https://doi.org/10.36408/ mhjcm.v6i1.372
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J.,
Casey Jr, D. E., Colvin, M. M., . . . Givertz,
M. M. (2017). 2017 ACC/AHA/HFSA
focused update of the 2013 ACCF/AHA
guideline for the management of heart
failure: a report of the American College of
Cardiology/American Heart Association
Task Force on Clinical Practice Guidelines
and the Heart Failure Society of America.
Journal of the American College of
Cardiology, 70(6), 776-803. http://dx.doi.
org/10.1016/j.jacc.2017.04.025
115