Anda di halaman 1dari 35

Consultations between nurse prescribers

and patients with diabetes in primary


care: A qualitative study of patient views

KELOMPOK 4 :
Novian Adriyanti
125070200111036
Niken Asih Laras Ati 125070201111020
Durroh Yatimah
125070201111032

LATAR BELAKANG
Diabetes Mellitus adalah penyakit gangguan
metabolisme karbohidrat, lemak dan protein yang
dihubungkan dengan kekurangan secara absolute
atau relative dari kerja atau sekresi insulin yang
bersifat
kronis
dengan
ciri
khas
hiperglikemia/peningkatan kadar glukosa darah di
atas normal ( Mihardja, 2009)
Data dari studi global menunjukkan bahwa jumlah
penderita Diabets Mellitus pada tahun 2011 telah
mencapai 366 juta orang, dan diperkirakan akan
meningkat menjadi 552 juta orang pada tahun 2030.

CONT
Menurut International Diabetes Federation
(IDF) memperkirakan bahwa sebanyak 183
juta orang tidak menyadari bahwa mereka
mengidap Diabetes Mellitus.
Banyak bukti menunjukkan bahwa pasien
lebih memilih berkonsultasi dengan perawat
resep karena dapat meningkatkan kualitas
gaya hidupnya

IDENTITAS JURNAL
Authours : Karen L. Stenner , Molly Courtenay, Nicola
Carey
Year
: 2010
Title
: Consultations between nurse prescribers and
patients with diabetes in primary care: A qualitative study
of patient views
Language : English
Journal
: International Journal of Nursing Studies
Volume
: 48
Page
: 10 page
Start Page : 37
Keywords : Consultation, Diabetes,Nurse
prescribing,Patient-centred care, Patient views
Doi
: 10.1016/j.ijnurstu.2010.06.006

ANALISA JURNAL

IDENTIFIKASI TOPIK

Eksplorasi pandangan pasien


Pasien diabetes
Konsultasi
Perawat diabetes
Manajemen pengobatan

BAHAN PENELITIAN
Penelitian ini dilakukan di enam situs
perawatan primer di mana perawat
meresepkan obat untuk pasien dengan
diabetes di Inggris.
Data dikumpulkan pada tahun 2009.
Penelitian ini dilakukan dengan 41 pasien
diabetes dan 7 perawat.

CONT
Peserta memiliki usia rata-rata 67 tahun, umur
mulai dari 37-87 tahun. Dengan rincian sbb:
63,4% (n = 26)
36,6% (n = 15)

laki-laki
perempuan

83% (n = 34)
17% (n = 7)

kulit putih Inggris


dari latar belakang etnis
minoritas

TUJUAN PENELITIAN
Tujuan dari penelitian ini adalah untuk
mengeksplorasi perawat resep dari sudut
pandang pasien dengan diabetes.
Tujuan utama adalah untuk mengeksplorasi
pandangan pasien tentang konsultasi dengan
perawat resep dan dampak dari manajemen
obat.
Temuan yang berkaitan dengan pendapat pasien
tentang perawat resep dalam kaitannya dengan
diabetes dilaporkan di tempat lain.

METODE PENELITIAN
1. Desain
Penelitian ini merupakan penelitian kualitatif dg
menggunakan wawancara semi-terstruktur utk
mengeksplorasi pandangan pasien dengan diabetes
di bawah perawatan seorang perawat resep
diabetes.

2. Pengumpulan Data
Wawancara semi-terstruktur
Berlangsung dari 30 sampai 40 menit
Dilakukan dan direkam oleh salah satu dari dua
peneliti kualitatif yang berpengalaman dan tidak
memiliki hubungan dengan peserta penelitian.

CONT
3. Analisa Data
Transkrip yang dikode sistematis dengan bantuan
perangkat lunak komputer untuk analisis kualitatif
(ATLAS Ti).
Dimana kode dikelompokkan bersama-sama dan
data d ekstrak dari masing-masing kelompok atau
kategori untuk dikumpulkan menjadi tema yang
potensial.

4. Pertimbangan Etis
Persetujuan etis untuk studi ini diperoleh dari dua
universitas dan komite penilaian etika dan
persetujuan diperoleh di setiap perawatan primer
terpercaya

HASIL PENELITIAN
Hasil penelitian dikelompokkan dalam tiga
tema utama :
Deskripsi gaya konsultasi perawat
Manfaat dari konsultasi dg perawat resep
Pandangan tentang keterlibatan dan
keputusan

pengambilan

Gaya Konsultasi Perawat


Konsultasi Non-bergegas
She never rushes you out the door; she is always prepared to
listen to you, yes. And even if you turn round and say, look I dont
really understand this can you explain a little bit more, she aint
like looking at the watch going Ive got another client, youve got
to get out. She will sit there and explain it all to you.
Hubungan perawatan
A fortnight before I come in I have all the blood tests done, and
we go through those, whats wrong, whats right and we just talk
about it. I think that is great because you are being treated as an
individual and not as one of a number and I think if you are going
to get nurses, or even doctors, prescribing you shouldnt be one of
a number, it should be personal.

CONT
Kontinuitas
I think you can build up a better rapport and you feel
better seeing just the one person. As I say you can build
up a trust that person which is much better.

Didekati
They (nurse and doctor) have got very different roles
really, and I accept that Dr. X has very different
responsibilities and therefore I would never presume to
ring Dr. X up, whereas I feel quite comfortable ringing
[NP5] up, because I know Dr. Xs commitments and
soon.

CONT
Informasi yg jelas & mudah dipahami

Well I think a doctor would explain to you, but I dont


think a doctors explanation is as good as somebody who is
taking care of you all the time, and actually telling you how
things are working. Yes, Ive got a good doctor and hes
really lovely he really is and he does explain things to you,
but as far as my diabetes is concerned, [NP6] is the
person.And she does talk to you,which is what you want.
They make you feel at ease with it and they have the right
way of explaining it.
She really is a lovely lady. Shes got time for you. That
doesnt mean to say that she spends a whole hour just
with one patient, but even in that five minutes she gets her
point over across to you.

CONT
Pengetahuan dan pengalaman spesialis diabetes
Its like a specialist in any sphere a nurse trained to
on the diabetics side is fine because they are seeing
those patients all day everyday so I think they get far
more knowledge working on a specific subject than as a
general practitioner, who has to be good at most things,
or try to identify most things.
I know for a fact that she goes to lots of training
courses so she knows more about diabetes than a
general practitioner might know.

CONT
Konsultasi luas
If you go to the doctor it is solely on the area
what you want to talk about, but with NP you
can talk about the broad spectrum of it and
she will throw things in like How much insulin
are you taking at the moment? and What
tablets are you on?

Manfaat Konsultasi Dg Perawat Resep


Mengajukan pertanyaan dan memecahkan
masalah
She knows all about you and I can be open
with her because its a face I know. If there
was personal things or anything like, you
know, when you get to know somebody you
can talk to somebody cant you?

CONT
Akses ke saran dan pengobatan
Its a lot easier if I just realised Id run out of
insulin or something, if I rang the doctor now
theres no way he would see me until Monday
morning unless it is a real emergency. If when you
see the nurse and you speak and then youre
prescribed it there and then. It saves time.
I get these terrible itchy legs with the diabetes
and she cured that. Took her a while to do it trying
out different drugs but she eventually came up
with the right combination and she cured it.

CONT
Peningkatan pemahaman
She explained a lot of things that to be quite honest I didnt
really realize. Then she showed me a pattern of what the
insulin was doing and what the new insulin would do and
how it would be beneficial to me. She went through it stepby-step and she explained a lot, and she drew little
diagrams you know, an idiot proof kind of thing so you
understand it.
I think she has got the time to sit down and talk to me,
whereas some people like my first doctor will say What can
I do for you? and I say my sugar levels are going up Oh
well just add more insulin OK. See you next time. You know,
didnt turn round and say you shouldnt be eating this or
you should be eating that. As I say, with NP I can sit down
and talk to her and have a good conversation.

CONT
Saran dan pengobatan yang sesuai pasien
.. and next thing I know he is just talking to the computer
and referring a letter through the computer to someone at
the surgery. At least here you sit down face-to-face and any
concerns, any reservations I have got, because stupid as it
sounds Im scared stiff of needles.
Basically she learned me how to do my insulin, because of
my levels, my blood sugar levels. She taught me that I had to
increase my insulin by like two units each time to try and
reduce the blood sugars down, the average of the blood
sugars. A lot of it, she made me realize, was my diet as well.

CONT
If you do have it, you are not going to live by the
diabetic book every day of your life. Youre not
going to say you are never going to eat a bar of
chocolate. Whereas when I came here she
explained it to me that eating a bar of chocolate
has the same carbohydrate value as three
potatoes, or a carton of orange juice. So they
made me actually they were approaching it from
my point of view so that I would take it on board.

CONT
Up-to-date pengobatan dan saran
..painful injections, when I first went to the doctor he was,
Well err, I dont know-What can we try? and I said could
we try some more needles, different needles? and he said
why do you think that would work? and I thought, you
know, just give me a chance! But if I said to NP the diabetic
nurse, do you think we could try some new needles? shed
say well yes but I dont think that will work, why dont we
try this. She listens and shes got it up here [in memory].
If it wasnt for this nurse I would still be feeling terrible.
Once theyd sorted my thyroid out I was perfectly all right,
but if our NP here had listened to our doctor I would have
been on insulin and still feeling ill. So, not being nasty, she
really does know more about diabetes than what the doctors
do. Shes been absolutely fantastic.

CONT
Keyakinan dan kepercayaan
I am confident, because it [medication] didnt upset
my metabolism at all, it suited me, because they used
to tell me that in the night I should be very careful
because if the blood sugar goes down . . .. it is very
dangerous, and that explanation and everything was
given to me by the Diabetic Nurse not by the doctor or
the Consultant.
You see different ones you get a different its the
same story but they are telling it a different way round
and you get confusing. But if you see the same one its
continuation then.

CONT
Balasan dan kontrol
I feel satisfied in myself and happy. I
genuinely feel wellbeing in myself because she
makes me feel like that. You know she makes
me feel as though I have achieved something.
Shes is giving me something, but Im giving
her something back. I quite like that, I feel
good about myself.

Tampilan Pada Keterlibatan Dalam


Pengambilan Keputusan
Tingkat informasi tentang efek samping
Even though you get a leaflet with all the tablets, she
also tried to tell you the pitfalls of taking the
medication as well. She explains the bits and pieces
like that. Not saying she goes into every one, because
when you look at the list its like [indicating a long list].
But she goes into the common ones. Yes.
Even though they prescribe it to me, when I get it
home I always look through all the leaflet before I take
it.

KRITISI JURNAL

KELEBIHAN
Pada jurnal ini menjelaskan tentang gaya
konsultasi yang diberikan oleh perawat, manfaat
perawat resep dalam berkonsultasi dan
pandangan tentang keterlibatan dan pembuatan
keputusan untuk penderita Diabetes Mellitus.
Serta dijelaskan pula aspek yang paling penting
dari gaya konsultasi yang diberikan oleh perawat
yaitu
seperti
pendekatan
non-bergegas,
perawatan
dan
hubungan,
pendekatan,
kontinuitas, dan pemberian informasi yang jelas
berdasarkan pengetahuan perawat spesialis.

CONT
Banyak manfaat yang dijelaskan dalam jurnal ini,
seperti pemahaman dari penderita Diabetes Mellitus
yang lebih besar terhadap penggunaan obat-obatan
dan kemampuan untuk mengelola sendiri, kemampuan
untuk mengatasi masalah dan meningkatkan
kepercayaan diri dari penderita Diabetes Mellitus.
Sementara itu banyak pasien yang senang dengan
sejumlah informasi yang diterima dan keterlibatan
mereka dalam mengambil keputusan tentang
pengobatan mereka, meskipun masih ada beberapa
kontroversi mengenai konsistensi informasi yang
diberikan tentang efek samping pengobatan.

KEKURANGAN
Jurnal ini pada dasarnya sudah bagus, namun
sebagai sebuah studi kualitatif, hasil temuan
yang didapat dari studi ini mungkin tidak
mewakili pandangan dari semua pasien.
Karena keterbatasan peran perawat yang
mungkin masih belum bisa menggali beberapa
informasi yang ada pada penderita Diabetes
Mellitus.

APLIKASI HASIL PENELITIAN DI


INDONESIA
Di Indonesia pelaksanaan peran perawat sebagai edukator telah
dilaksanakan untuk semua tindakan keperawatan serta penyakit
yang dialami klien, begitu pula untuk penyakit diabetes.
Beberapa penelitian mengenai peran perawat sebagai pemberi
edukasi pada pasien diabetes seperti penelitian yang dilakukan
oleh wahyu fajrimi dengan judul Peran Perawat Dalam
Pemberian Edukasi pada Pasien Diabetes Melitus Tipe 2 di RSUP
H. Adam Malik Medan disebutkan bahwa selain sebagai
pemberi asuhan keperawatan, perawat juga berperan sebagai
edukator, dan konsultan

CONT
Dari jurnal tersebut diperoleh beberapa alasan
mengapa pasien lebih nyaman untuk konsultasi
dengan perawat pemberi resep, antara lain :
Pasien merasa mereka memiliki lebih banyak waktu
selama konsultasi dengan perawat dari mereka akan
dengan Dokter
para perawat selalu mendengarkan, digambarkan
sebagai lebih mudah didekati dari dokter, sebagian
karena gaya mereka dan sebagian karena status
dirasakan mereka dan peran mereka

CONT
informasi yang jelas dan mudah dipahami
perawat umumnya dianggap lebih berpengetahuan
tentang diabetes dan pengobatannya dari dokter ini adalah
sebagai akibat dari spesialis pelatihan perawat dan
pengalaman tangan pertama mereka secara teratur
merawat dan mengelola pasien dengan diabetes
gaya konsultasi luas dan tidak tergesa-gesa dan ramah,
membantu pasien untuk merasa nyaman mengekspresikan
diri, sehingga memungkinkan perawat untuk mendapatkan
pemahaman yang baik tentang kondisi pasien dan gaya
hidupnya
Saran dan pengobatan yang sesuai pasien
keterlibatan dalam pasien pengambilan keputusan serta
tingkat informasi tentang efek samping

CONT
Dari beberapa hal yang disebutkan diatas
merupakan kewajiban bagi perawat di Indonesia
untuk mengaplikasikan hal tersebut dalam
melakukan perawatan terhadap pasien diabetes
khususnya dan semua pasien pada umumnya.
Sehingga perawat dapat mengembangkan diri
selain klinik perawatan luka juga sebagai konsultan
terhadap diabetes.

TERIMA KASIH ^_^