the proceeding of international joint conference

Transcription

THE PROCEEDING OF INTERNATIONAL JOINT
CONFERENCE
CHALLENGES IMPLEMENTATION OF THE
ASEAN ECONOMIC COMMUNITY (AEC)
IN THE HEALTH SECTOR IN INDONESIA
Reviewers
Rose Nanju MN Unisa BN RN (Faculty of Medicine and Health Science Universiti Sarawak
Malaysia)
Prof. Nursalam ( Airlangga University)
Dr.H.Moch. Agus Krisno Budiyanto,M.Kes (Muhamadiyah Malang University)
Dr. Ali Haedar Sp.EM ( Brawijaya University)
Grand Surya Hotel
15-16th November 2015
Supported by :
i
THE PROCEEDING OF INTERNATIONAL JOINT CONFERENCE:
CHALLENGES IMPLEMENTATION OF THE ASEAN ECONOMIC
COMMUNITY (AEC) IN THE HEALTH SECTOR IN INDONESIA
Editor:
Rose Nanju MN Unisa BN RN (Faculty of Medicine and Health Science Universiti Sarawak
Malaysia)
Prof. Nursalam ( Airlangga University)
Dr.H.Moch. Agus Krisno Budiyanto,M.Kes (Muhamadiyah Malang University)
Dr. Ali Haedar Sp.EM ( Brawijaya University)
Cover Designer:
Arya Ulilalbab, S.TP., M.Kes.
Setting/ Lay out:
Ns. Eko Arik Susmiatin, M.Kep,Sp.Kep,J
Nian Afrian Nuari,S.Kep,Ns,M.Kep
Dwi Setyorini,S.Kep,Ns,M.Biomed
Steering Committee by:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
STIKES Karya Husada Kediri
STIKES Surya Mitra Husada Kediri
STIKES Hutama Abdi Husada Tulungagung
STIKES RS Baptis Kediri
STIKES Bhakti Mulia Pare
FIK Unipdu Jombang
STIKES Patria Husada Blitar
STIKES Satria Bakti Nganjuk
Akademi Kebidanan Dharma Husada Kediri
Institut Ilmu Kesehatan Kediri
Printed by:
UD. Mitra Abadi
Dr. Sutomo 69 Street, Pare, Kediri
Telp: (0354) 398912
Email : [email protected]
ISSN: 2477-0639
ii
COMMITTEE
Committee President
Ns. Ratna Hidayati, M.Kep., Sp.Mat
Committee Vice President
Dr. (PH) Sandu Siyoto, S.Sos.,SKM.,M.Kes
Secretary I
Reni Yuli Astutik, SST., M.Kes
Secretary II
Agusta Dian Eliana, S.Kep.,Ns.,M.Kep
Financial Holders I
Efa Nur Aini, S.Kep.Ns.,M.Kep
Financial Holders II
Sri Mahanani, S.Kep.,Ns.,M.Kep
Ceremonial Committee
Scientific Committee
Publication Committee
Hj. Farida Hayati, M.Kep
Neny Triana, S.Pd.,S.Kep.,Ns
Ita Eko Suparni, SSiT.,M.Keb
Enggar Anggraeni, SST
Yuly Peristiowati, S.Kep.,Ns.,M.Kes
Ns. Aries Wahyuningsih, S.Kep.,M.Kes
Dr. Apin Setyowati, SKM.,M.Kes (Kep)
Masruroh, S.Kep.,Ners.,M.Kes
Endah Susanti, SST
Dian Prawesti, S.Kep.,Ns.,M.Kep
Farida, SKM.,M.Kep
Ulfa Husnul Fatah, M.Kep
Trisnanto, SH.,S.Kep.,Ns.,M.Kes
Siti Komariyah, SSiT.,M.Kes
Ns. Eko Arik S, M.Kep.,Sp.Kep.J
Dwi Setyorini, S.Kep.,Ns.,M.Biomed
Nian Afrian Nuari, S.Kep,Ns, M.Kep
Andi Yudianto, S.Kp.,Ners.,M.Kes
Sri Banun Titi Istiqomah, SST.,M.Kes
Bambang Wiseno, S.Kep.,Ns
Novita, S.Kep.,Ns.,M.Kep
Erlin Kurnia, S.Kep.,Ns.,M.Kes
Eny Masruroh, S.Kep.,Ners.,M.Kep
Levi Tinasari, SKM.,M.Kes
Titin, SST
Erma Herdyana, S.SiT.,M.Kes
Ns. Moch. Maftuchul Huda,M.Kep.,Sp.,Kom
Cucuk Suprihartini, STP.,M.Kes
Yenny Puspitasari, S.Kep.,Ns.,M.Kes
Ns.Sukamto,S.Kep.M.Kes
Sandy Kurniajati, SKM.,M.Kes
Dr. Suprajitno, SKp., M.Kep
Ninik Azizah, SST.,M.Kes
Ahmad Wasis S, S.Kep.,Ns.,MSi
Yitno, S.Kp.,M.Pd
Erni Setyorini, M.Kep
Heru Wahyudi, S.Kep.,Ns.,M.Kes
Susiani E.,SST.,M.Kes
Accomodation and Transportation
Committee
Linda Andri M, S.SiT.,M.Keb
Basiran, S.Sos
Mirthasari Palupi, SST., M.Kes
dr. Nanang Muhibuddin
Decoration and Documentation
Committee
Ahmat Arianto, ST
Dwiono Cahyo Susilo
Arya Ulilabab, M.Kes
Ns. Sujatmiko, S.Kep.,M.Kes
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GREETING FROM COMMITTEE PRESIDENT
On behalf of the committee, it is a great honor me to extend this opportunity to welcome all
of you to International Joint Conference with a theme “Challenges Implementation Of The
Asean Economic Community (AEC) In The Health Sector In Indonesia.” The International
Joint Conference conducted by 10 institution consist of STIKES Karya Husada Kediri, STIKES
Surya Mitra Husada Kediri, STIKES Hutama Abdi Husada Tulungagung, STIKES RS Baptis Kediri,
STIKES Bhakti Mulia Pare, FIK Unipdu Jombang, STIKES Patria Husada Blitar, STIKES Satria
Bakti Nganjuk, Akademi Kebidanan Dharma Husada Kediri, Institut Ilmu Kesehatan Kediri and
supported by Akper Pamenang Kediri.I hope you all have wonderful, fulfilling conference and
are able to take great ideas back to your individual program. Through this conference we
hope there is transfer knowledge, sharing idea so we can respone the change of global needs
across health system .
Ladies and Gentlemen,
This conference brings together academicians, practitioners, researcher as much as 200
participant from different provinces in Indonesia and different countries such as Malaysia,
Filphina.
Finally, I would like congratulate those whose selected papers are included in the
International proceeding and I also would like to thank to the attendance keynote speaker,
expertise, participant and organizing committees of this conference.
Thank you very much and enjoy the conference
Committee President
Ns. Ratna Hidayati, M.Kep., Sp.Mat
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INTERNATIONAL JOINT CONFERENCE AGENDA
2015
NO
1
DAY
TIME
Sunday 07.00-08.00
th
08.00-09.30
15
November
2015
09.30-09.45
09.45-10.30
10.30-11.15
11.15-12.30
12.30-13.15
13.15-14.00
14.00-14.45
14.45-15.15
15.15-16.00
16.00-16.45
ACTIVITY
Registration
Opening Ceremony
National Anthem (Indonesia Raya)
Traditional dance
Speechs
1) The head of commite
2) The regent head of health
department Kediri
3) Prayers
4) Photo session
Tea Break
Key Note 1 (30‟ presentation, 15‟
discuss)
Update Management of Trauma in
Pregnancy: Resuscitation priorities
in the Implementation of ASEAN
Economic Community (AEC)
Key Note 2 (30‟ presentation, 15‟
discuss)
Update Management of HIV-AIDS
in the Implementation of ASEAN
Pray and lunch
Key Note 3
Legal aspect of ethical use of foreign
labor in Indonesia health filed
Key Note 4
Update Management of Stunting in
the Implementation of ASEAN
Key Note 5
The learning strategy (include
hardskill, softskill,
enterpreneurship, and foreign
language capabilities health
students)to face of ASEAN
inUniversiti Sarawak Malaysia
Tea Break and Pray
Key Note 6
Update Management of Acute
Coronary Syndroma (ACS) in the
Implementation of ASEAN
Key Note 7
Disaster Management in the
v
RESPONSIBLE EVENT
COMMITTEE
COMMITTEE
Prof. Dr. Idzwan Zakaria
(Malaysia)
Prof. Dr. Wongsa
Laohasiriwong (Faculty of
Public Health Khon Kaen
University Thailand)
Head of Province Health
Department, Indonesia
Sugeng Irianto, MPS.,PhD
(Indonesian Representatif
WHO)
Rose Nanju (Faculty of
Medicine and Health
Science) Universiti
Sarawak Malaysia
Assoc. Prof. Dr. Wasana
Ruaisungnoen (Faculty of
Nursing KKU Thailand)
Sarah Sandy S.M, Phd
NO
2.
DAY
TIME
Monday 08.00-10.00
th
16
Nopember 10.00-10.15
2015
10.15-11.15
11.15-11.30
11.30-12.30
12.30-
Implementation of ASEAN
ACTIVITY
Oral Presentation (session 1)
Tea Break
Oral presentation (session 2)
CLOSING
Pray and Lunch
City Tour
vi
(Philippines)
RESPONSIBLE EVENT
CONFERENCE
COMMITTEE
CONFERENCE
COMMITTEE
TABLE OF CONTENT
PROCEEDING OF INTERNATIONAL JOINT CONFERENCE
2015
ORAL PRESENTATION
1
2
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5
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Preparedness Strategies For Healthcare Students In Facing AEC: “The Importance Of
Hard Skill, Soft Skill And Foreign Language Competencies” (Rose Ak Nanju Manju)
An Update On The Management Of Trauma In Pregnancy: Resuscitation Priorities
(Mohd Idzwan Zakaria)
Update Management & Emergency Care For Acute Coronary Syndrome (Wasana
Ruaisungnoen)
Cheers: A Framework For Disaster Response And Management Review Of Related
Literature (Sandra Sanches Montano)
Update Management Of Stunting In The Implementation Of Asean Economic
Community (AEC) (Sugeng Eko Irianto)
Personal Hygiene Behavior And Vulvovaginitis Incident On Fertile Women Age In
Obstetrics And Gynecology Ward dr. Iskak Hospital- Tulungagung
(Yenny Puspitasari, Intan Fazrin)
Analysis Motivation In Review Of The Components Employee Participant And Career
Development (Ratna Wardani)
Strategy On Health Care Protection For The Poor Society In Kediri City (Koesnadi)
Cervical Cancer Model On Hela Cell Transplantation Mice (Yuly Peristiowati, Yenny
Puspitasari)
The Effect Of Elderly Exercise To Cognitive Dimensia Elderly Function In
“Mawar”Age Care Facilities (Pslu) Blitar Tulungagung (Prima Dewi Kusumawati)
Social Interaction Affect The Recurrence Of Coronary Heart Disease Patient In Poli
Jantung RSUD dr. Mohamad Saleh Probolinggo (Nia Sari)
The Effect Of Phase I Cardiac Rehabilitation On Activity Tolerance Of Patients With
Coronary Heart Disease (Sutrisno)
Analysis of The Use Of Personal Protective Equipment (Ppe) To Cleaning Service
Work Accident dr. Iskak Hospital Tulungagung (Sandu Siyoto)
Affecting Factors Of Community Preparedness At Disaster Prone Areas Kelud
Mountain (Novita Ana Anggraini)
Correlation Between Anxiety Levels With Dysmenorrhea Incident In Collegians Of
Study Program Of Midwifery Advanced Diploma Stikes Karya Husada Kediri
(Dwi Ertiana)
Difference Of Mothermilk Production Between Massaged Baby And Unmassaged
Baby (Brivian Florentis Yustanta)
The Difference Of The Effectiveness Drinking Of Ginger And Vitamin B6 For
Reduced Nausea And Vomiting Of Pregnancy In Working Area Of Bendo Public
Health Center, Pare Sub-District, Kediri District (Wahyu Wijayati, Anis Setyowati)
Description Of Preeclampsia Risk Factors In Hospital Pare Kediri (Endah
Luqmanasari, Nunik Ike Yunia Sari)
Detection Of High Risk Pregnancy In Integrated Antenatal Care (ANC) At Bendo
Public Health Services Kediri District (Eka Sri Purwandari, Wahyu Nuraisya)
The Risk Factor That Cause The Happening Of Post Partum Haemorrhage In RSUD
Pare Kediri (Fitri Yuniarti)
Description Of Risk Factors Neonatal Jaudience In The Perinatology Of Pare Hospital
Kediri (Dwi Yuliawati, Ita Eko Suparni)
The Influence Of Sosiodemografi Factors On The Incidence Cervical Precancerous
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Lession By Screening With Visual Inspection Acetat Acid (VIA) (Wuri Widi Astuti,
Reni Yuli Astutik)
The Analysis Of Menopausal Complaints Toward Menopause Anxiety At Pelem
Village, Pare Subdistrict, Kediri Regency (Reni Yuli Astutik)
Neonatal Outcomes In Women With Preeclampsia At General Hospital Of Kediri
District On January-June 2015 (Dintya Ivantarina, Estin Gita Maringga)
Correlation Self Appraisal With Pansy‟s Self Identity in 21-35 Years old (Farida
Hayati)
Analysis Of Intervention Of Sick Day Management In Effort To Create
Normoglycemia In Patient Of Diabetes Mellitus Through Family After Discharge
(Eko Arik Susmiatin, Rina Dwi Andari)
Effect Of Aerobic Exercise With Yoga Relaxation Techniques Combined On The
Fatigue Level On Patients With Breast Cancer Undergoing Chemotherapy
(Muhammad Taukhid)
The Effect Of Social Skill Training For The Game Addict On The Children 10-12
Years Old Of Students Class V State Elementary School (Dina Zakiyyatul Fuadah,
Laviana Nita Ludyanti)
Coaching Intervention Model To Improve Comfort In Adolesence With Disminore
(Dhina Widayati)
Mangosteen Peel Ekstracts As Preeclampsia Preventive Therapy On Reducing
Oxidative Stress (iNOS And MDA) In Vivo Studies At The Mice Model Preeclampsia
(Ratna Hidayati)
Slow Deep Breathing Intervention Reduce The Frequency Of Recurrence Of Patients
With Asthma Bronchiale (Nian Afrian Nuari)
Effect Of Giving Cognitive Support And Emotional Spiritual Quotient (Esq) To
Changes Sexual Behavior Patients Hiv/Aids (Joko Sutrisno, Yuly Peristiowati, Alfian
Fawzi)
The Effect Of Corn Flour Adding Proportion (Zea Mays) Towards Degree Of
Provitamin A, Water Degree And Acceptability Of Cake Corn (Rizka Mar‟atus
Sholichah, Arya Ulilalbab, Sindy Anneo Maharani)
The Relation Between The Consumption Degree Of Energy, Protein, Fe, Folic Acid,
Vitamin B12 And Vitamin C Toward Anemia Status For Alcohol Consumers In Jong
Biru Village Kediri Regency (Mirthasari Palupi, Enggar Anggraeni)
The “Kimcil” Phenomenon: Sexual Knowledge And Safe Sex Behaviour Among
Adolescents In Kediri (M. Ali Sodik)
Relationship Of Women‟s Self Perception About Menopause With Self Readiness In
Facing Menopause In Selosari Kandat Kediri (Shinta Kristianti)
Effectivity Progressive Muscle Relaxation Toward Stress At Community Impact Noisy
Highway Street In Pare Kediri (Moch.Maftuchul Huda)
The Impact Of Psychological Bulllying At School Against Student‟s Confidence On
Communication Ability (Dwi Setyorini)
Satisfaction Between BPJS Patients And General Patients Towards Health Services At
Community Health Center (Yoyok Febrijanto, Sandy Kurniajati)
The Importance Of Family Social Support In Improving Self-Care To Elderly (Dian
Taviyanda, Heru Suwardianto)
Nurse‟s Effort In Prevention Of Phlebitis To Patients In hospital (Kili Astarani, Erlin
Kurnia)
Parenting Type Of Authoritative Parents Tends To Inhibitmotor Development To
Preschool Children (Rina Endah Kristini, Kili Astarani)
Relationship Between Smoking Behavior With Sleep Disorders (Insomnia) Of
Adolescent Boy (Leny Indrawati, Presca Adi Prayogo)
The Influence Of Hip Motion Exercises (Stretching) To Decrease Lower Back Pain In
The Elderly Posyandu Wonorejo Country Districts Sumbergempol Tulungagung
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(Ratna Kholidati, Dwi Intan sari)
The Correlation Between The Interest And Motivation Of Becoming A Nurse And The
Learning Achievement Of The Student Of Diploma III In Nursing Science At Hutama
Abdi Husada Health Institute Of Tulungagung (Sri Agustiana)
The Effect Of Massage To The Improvement Of Baby‟s Appetit On The Infants Aged
7-12 Months At Desa Aryo Jeding Kecamatan Rejotangan In Kabupaten Tulungagung
As At 2015 (Yitno, Dian Fitriana Ulfa)
The Effect Of Interleukin-1β Induction On Chondrocytes (Anis Murniati, Siti
Zulaikah, Ma'rufah, Rena Normasari, Sri Fauziyah, Ardani Galih Prakosa)
Personality Type Relationship With Students Learning Achievement Of Nursing
Program Study S1 Stikes Hutama Abdi Husada Tulungagung (Farida, Taufik
Muchlison)
The Effect Of Meditationand Haemoglobin Levelson Learning Concentration (Indah
Rohmawati, Oka Ludianita, Dwi Sixteen Erawati Putri)
Management Of Hyperuricemia With Ergonomic Exercise (Anita Rahmawati)
Psychoeducational Family Therapy To Improve Family Attitudes Towards Pulmonary
Tb Patients (Bisepta Prayogi)
4s‟s Techniques To Physiological And Crying Duration On Newborn (Erni Setiyorini)
Early Stimulation Of Children Aged 12-24 Months To The Gross Motor Development
(Ika Agustina)
Progressive Muscle Relaxation To Improve Quality Of Sleep Neurosis Patient
(Nawang Wulandari)
Carrot (Daucus Carota) And Simvastatin To Changes In Blood Colesterol Levels Of
White Rats (Rattus Norvegicus) With Hyperkolesterolemia (Thatit Nurmawati)
Relationship Between Personal Self-Care Ability And Quality Of Life In Patients
Undergoing Chronic Kidney Failure In Hemodialysis Installations Of RSUD Mardi
Waluyo Kota Blitar (Sandi Alfa WigaArsa)
Effectiveness Of Problem Based Learning Model Towards Student Learning Outcomes
In Midwifery Care Pregnancy Diploma Program (Nevy Norma Renityas)
Relationship Between Knowledge And Attitude With Culture "Tarak" Postpartum
Mothers In Wonodadi Blitar (Ning Arti Wulandari)
Overview Of Fatigue In Cancer Patients Which Undergo Chemotherapy (Ulfa Husnul
Fata)
Improving Nursing Students‟ Speaking Skill By Using Realia As The Media (Wahyu
Wibisono)
Relationship Between Financial Models And Medicine Adherence In Patients With
Diabetes Mellitus Inatalation In Outpatient At Rsud Ngudi Waluyo Wlingi
(Yeni Kartikasari)
The Effect Of Consuming Watermelon Rind Extract (Citrullus Lanatus) Toward The
Decreasing Of Blood Sugar Levels On Diabetes Mellitus Patients In Weru - Paciran –
Lamongan (Arifal Aris)
The Effect Of Giving Common Snake Head (Channa Striata) On Perineal Wound
Healing In Postpartum Mother In BPM Ny. Titin s. Mubin Karanggeneng Lamongan
(Heny Ekawati)
Modisco Supplementary Feedings On The Weight Gain Of Children Under Five Bgm
(Yuyun Fitriani, Vivin Eka Rahmawati, Ike Johan)
Psycho Education Module To Treat Children With Thalasemia To Improve Their
Family Self Care (Ana Farida Ulfa)
Improvement Oxygen Saturation With Soak Foot In Warm Water On Diabetic Foot
(Diah Ayu Fatmawati, Khotimah,)
Comparison Of Propolis And Piper Betle With Honey Topically On Healing SecondDegree Burns White Rat (Rattus Norvegicus) (Herin Mawarti, Muhammad Zulfikar
Asumta and Zuliani)
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The influence of progressive relaxation to decrease pain For patients of sectio caesarea
Surgery in the first and second day (Aris Dwi Cahyono, Wida Wicaksana)
The Influence Factors of Caesarean Section Patient Outcomes in Preparation for
Clinical Pathways Costing of DRGs (Diagnose Related Groups) (Suryono)
Improving Self-Efficacy Using Caring-Based Self-Efficacy Enhancement Intervention
Program In Patients With Type 2 Diabetes Mellitus (Christianto Nugroho)
Effect Of Reminiscence Therapy Of Older People And Self- Acceptance With
Gerotranscendence Theory Approach (Nugrahaeni Firdausi)
The Effect Attitude Exercise Given To Decrease Anxiety To Teacher To child the
first school (Widhi Sumirat)
The Potential of Shalat Tasbeh to Decrease Postprandial Blood Glucose Levels in
Patients With Diabetes Mellitus (Mukhamad Rajin, Afifa S., M. Zhahrul Azhar
Asumta)
Symptom Of Polyuria Decreases Sleep Quality To Patient With Diabetes Mellitus
Type 2 (Dian Prawesti, Selvia David Richard)
Stimulus Effect Cutaneous (Slow-Stroke Back Massage) To Intensity Of Pain Head In
Elderly With Hypertension (Unit Pelayanan Terpadu Pslu Blitar, Tulungagung 2015)
(Sukanto, Dinda Wahyuningtyas)
Family Duty (Caring) Supportsfulfillment Of Mobility Needs To Elderly With
Cerebrovascular Accident (Cva) (Erlin Kurnia, Natalia Yohanes)
The Activity Test of Pandan Wangi Leaves Extract (pandanus amaryllifolius Roxb) for
Solubility of Calsium Kidney Stones by in Vitro Method using atomic Absorbtion
Spectrophotometri (AAS) (Ida Kristianingsih, Dewi Resti Basuki, Siti Mamluk Atul
M3)
The Effectiveness Of Fluid Ringer Acetate Malat Compared With Ringer Lactate Fluid
In Accelerating Time Increase In Blood Pressure In Rats (Rattus Norvegicus) (Ika
Rahmawati, Lizete Auxiliadora Costa Malic)
Changes In Blood Pressure In Hypertensive Patients Who Consume Tomato Juice
(Nurul Hidayah, Arief Bachtiar, Supono)
Effectiveness Of Murotal Music Therapy And Kangaroo Method On LBW Baby‟s
Feeding Time In The Neonates Ward Of Aura Syifa Hospital
(Putri Kristyaningsih, Diah Eliya Humaida)
Parent‟s Attitude In Safety And Injury Prevention To Preschool Children (Selvia
David Richard, Erva Elli Kristanti)
The Effect Of Attitude Toward Behavior, Subjective Norm And Perceived Behavior
Control At Dm Therapy Adherence: Study Theory Of Planned Behavior
(Sheylla Septina Margaretta, Heru Kurnianto Tjahjono, Falasifah Ani Yuniarti)
The Effect Of Bates Methode On Dioptres Decrease Of Low Myopia On Nursing
Students At Iik Bhakti Wiyata Kediri (Sri Wahyuni)
Lesshealth Maintenance And Environmental Health Behavior Increases Ari Incident
To Under-Five-Children (Srinalesti Mahanani, Vitaria Wahyu Astuti)
Study Potential Of Local Plant Pumpkin (Cucurbita Moschata Duch) As Traditional
Medicinal Plants (Suwanto)
The Effectiveness Of Rose Flower (Rosa Chinensis Jacq) Against Candida Albicans
Colonies On Jelly (Sda) Media (Erni Dwi Widyana, Tarsikah, Naimah)
Effectiveness Of Zamzam Water And Alkali Water Toward Ankle Brachial Indexs,
Oxidative Stress And Reduce Hemoglobin A1c In Diabetic Foot Ulcer Patient
(Yohanes Andy Rias)
The Correlation Between Energy And Protein Consumption Levels With Gross Motor
Development Of Undernourished Children Aged 6-24 Month (Yuliana Dwi
Diningrum, Arinda Lironika S, Agustina Endah W)
Comparison Body Mass Index (BMI), Hemoglobin Concentration (Hb), Energy And
Nutrient Intake (Protein, Iron, Vitamin C) Of Female Adolescent (Cucuk Suprihartini,
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Frenky Arif Budiman)
Relationship Body Fat Thickness With Menstrual Cycle Length Students Unusa( Annif
Munjidah, Annisa)
Relation Of Application Leadership Participative Style Head Of Nursing Services With
Employee Job Satisfaction In Asfiyak Graha Medika Clinic, Kencong, Kepung
(Bambang Wiseno)
The Effect Of Tomato Fruit (Solanum Lycopersicum) Toward The Increase Of
Appettite In White Rats (Ratus Norvegicus Strain Wistar) (Experimental Study In
Pharmacology Laboratory of Brawijaya University Malang 2015) (Endah Susanti,Yuli
Admasari, Fariha, Intan Layla Vinurika)
Relation Of Family Role In Fulfilling Requirement Nutrient Child With The Nutrient
Status At Child Age Pre School (4-6 Year) In TK Kusuma Mulya Pare kediri
(Erna Nurhochim, Febrina Dwi , Yunarti Matilde Ade)
The Influencing Bandura‟s Theory Aplication Toward First Pregnant Woman‟s
Knowledge About Umibilical Cord Care (Eva Silviana Rahmawati)
The Correlation Between The Frequency Of Baby Massage And The Sleep Duration
Of Babies Aged 0-18 Months Found At RB Endang Widayat (Maternity Clinic),
Located In Sidoarjo. (Fauziyatun Nisa‟)
Affecting Factors For The Implementation Of Early Detection Of Cervical Cancer By
Visual Inspection With Lactic Acid In Primary Healthcare Centers In Surabaya
(Fritria Dwi Anggraini)
Effects Of Age And Parity On The Incidence Of Preeclampsia In A Public Hospital
District Sidoarjo (Hinda Novianti, Lailatul Khusnul Rizki)
Nurse Experiences In Implementing Logotherapy On Low Self-Esteem Client In
Dr.Radjiman
Wediodiningrat
Lawang In Year Of 2015
(Junianto
Fitriyadi,Katmini,Nurul Cholifah)
Analize Client‟s Demand For The Health Services Which Have Been Percepted By
Nurses And Correlated With Nurses‟ Job Satisfaction (Mohamad Hanifudin)
Comparison Between Technique Tendon Suture Modified Samu (Ms) And Modified
Kessler (Mk) Towards Tendon Suture Strengths (Tensile Strength)
Of Broilers Tendon (Gallus) (Nanang Muhibudin, Erni Rahmawati, Moh. Halimi)
Literature Review: Analysis Of Risk Factors For Post Partum Depression (Reni
Nurhidayah)
Influence The Granting Of Water Decoction Of Betel Leaf Against The Whiteness On
Young Women (Study at Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare
Kediri) (Ulfatin Nafiah, Silfia Sekar Arum, Martha Mai Nggiri)
Effect of Exercise On The Road Fast Weight Changes In Adolescent Obesity Smk
Bhakti Mulia Pare-Kediri (Vika Taulina Ismanto, Amri Nasus Talan)
Influence Of The Traditional Game Congklak About Stress Levels To Pre-School Age
Children In The Daycare Kasih Karunia Foundation Pare - Kediri 2015
(Ahmad Wasis Setyadi,Arif Setiawan,Jitro Gideon Liu)
The Effect Of Giving Extract Of Clove (Syzgium Aromaticum) Toward Acceleration
Healing Of Incision Wound In White Rats(Rattus Norvegicus) (Analytical study in
Pharmacology Laboratory of Brawijaya University, Malang)
(A.Wasis Setyadi,Nanang Muhibuddin,Syamsul Hudha,Nurul Cholifah)
The Relationship Between Parenting Pattern And The Oldest Child‟s Self Care
Independence At Preschool Age In The Permata Ibu Kindergarten Gunung Anyar
Surabaya (Ainun Qoiriyah, Ika Mardiyanti)
The Effects Of Hand Washing And Cutting The Nails Againts Diarrhea In Young
Children In Paud Tunas Mandiri Rt.09 Rw.07 Kelurahan Pacarkeling Kecamatan
Tambaksari Surabaya (Rukmini)
The Effectiveness Of Semi Fowler Position To The Degree Of Spontaneous Perineum
Rupture On Primipara And Multipara Maternal At The Working Area Of Puskesmas
xi
668
675
682
689
696
703
710
717
724
731
738
745
752
759
766
773
780
787
794
Ngadiluwih Kediri. (Susanti Pratamaningtyas)
109 Reproductive Health Counseling Theraphy Towards Sexual Attitudes Of Adolescent
At Pgri Talun Highschool Blitar (Levi Tina Sari)
110 Therapeutic Effect Of Acupuncture And Warm Compresses To Decrease Joint Pain In
The Elderly (Masruroh, Achmad Dany Ardiansyah)
111 The Correlation Of Emotional Intelegency With The Motivation Of Clinical Practice
Result In Stikes Patria Husada Blitar (Maria Ulfa)
112 Effect Of Warm Compresses To The Reduction Of Menstrual Pain (Disminorea)
Primer In Adolescent Girls Boarding School In The Village Maftahucfdxl Uluum
Jatinom Kanigoro District Of Blitar (Laily Prima Monica)
113 Revitalization Of Posyandu Lansia Through Non-Pharmacological Therapy To
Improving Elderly Quality Of Life (Nasrudin, Abdul Ghofar, Indah Mukaromah)
114 Relationship Between Parent‟s Knowledge And The Ability Of Children Preschooler‟s
Self Eating (Andi yudianto)
115 Modeling Adaptive Spline Threshold Autoregressive (Astar) Incidence Dengue
Hemorrhagic Fever (DHF) In Nganjuk From 2010-2014 (Tutut Pujianto)
116 The Effect Of Stimulation Therapy Group Activities Perception On The Level Of
Depression In The Elderly In Pamotan Sambeng Lamogan (Siti Sholikah)
117 Poverty And Lung Tuberculosis In Ponorogo (Sulistyo Andarmoyo)
118 Influence Of Student's Knowledge And Attitude Level About Healthy Life Behavior
Toward Garbage Disposing At IIK Bhakti Wiyata Kediri (Zuyyina Fihayati, Endah
Retnani Wismaningsih, Ruli Asharil)
119 The Effect Of Classical Music Therapy To Increase Glasgow Coma Scale In Moderate
To Severe Traumatic Brain Injury Patients At Mardi Waluyo Blitar Hospital
(Christina Dewi P, Riesa Yuni Pangestuti)
xii
802
809
816
823
830
837
844
851
858
865
872
TABLE OF CONTENT
PROCEEDING OF INTERNATIONAL JOINT CONFERENCE
2015
POSTER PRESENTATION
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
The Correlation Of Knowledge And Attitude With The Decision-Making Of Bride
Couple To Conduct Premarital Check-Up In Work Area Of KUA District Of Pare
Kediri (Ira Haslinda, Tintin Hariyani, Linda Andri Mustofa)
An Experience In Herb Complementary And Alternative Medicine (Nurul Laili)
Literature Review: Partners Of Professional Nursing Students In The Face Of Mea
Through Learning Methods IPE (Interprofesional Education) (Sylvie Puspita, Neny
Triana)
Effectivity Of Beluntas Juice Toward Cholesterol Level In Elderly With
Hypercholesterolemia (Efa Nur Aini, Florena Berty Anggraini)
The Analysis Of The Health Service Staff For Patient Satisfaction In Gambiran Public
Hospital Kediri (Nurdina)
The Relation Teenagers' Knowledge About Puberty And Teenagers' Behaviour (13-15
Years) Against Puberty Age In State Junior High School 3 Wates Kediri (Linda
Ishariani)
The Influence Of The Music Therapy To The Level The Old Age‟s Stress In Bendo
Village, Pare Subdistrict, Kediri Regency (Widyasih Sunaringtyas,Vinda Pratiwi)
The Influence Of Peer Group Support To Social Interaction Of The Elders
(Linda Kristina)
Mean Arterial Pressure As A Mortality Predictor On Severe Traumatic Brain Injury
Patients (Pria Wahyu Romadhon Girianto)
Nurse‟s Role As Care Giver In Implementing Nursing Care Ineffectiveness Airways
Breathing In Patient With Asma Bronchiale (Diana Rachmania, Anggita Windu
Lestari)
Application Of Caring Behavior (Caring) New Students In Satisfaction Of Recognition
D3 Nursing Program Institute Of Health Karya Husada Kediri (Neny Triana, Sylvie
Puspita)
The Analyze Factors Which Is Influence The Occurred Of The Prisoner Anxiety In
Prisoners Of Polres Kediri (Ariani Sulistyorini, Lilik Setiawan)
The Effect Of Stad (Student Team Achievement Division) In Increasing Social Ability
Of Nursing Students In Karya Husada Institute Health Science (Melani Kartika Sari)
Relationship Between Independence Learning And Therapeutic Communication Skill
With Clinical Competence Learning In Program Studi D III Keperawatan Stikes Karya
Husada Kediri (Sutiyah Heni, Ambar Mudigdo, Nunuk Suryani)
The Correlation Between The Quality Of Family Planning Services With The Need
Unmeet Events (Ita Eko Suparni , Eka Sri Purwandari)
Effect Of Using Condoms Events Sexually Transmitted Infection In Prostitutes In
Clinic Sexually Transmitted Infections ( STIS ) Gurah Public Health Service Kediri
Regency (Lingga Kusuma Wardani)
Women's Willingness To Counseling And Testing HIV / AIDS In Tulungagung
(Suci Anggraeni)
Comparison Of New Born Morbidity Between Pervaginam Breech Labor And Sectio
Caesarea With Gluteal Presentation (Linda Andri Mustofa)
Analysis Of Related Factors With Incidence Of Depression In Disaster Victims After
The Eruption Of Mount Kelud In The Western Village Of Besowo Sub-District
xiii
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886
892
898
905
912
919
926
933
940
947
951
958
965
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990
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1004
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
Kenteng Kepung (Didit Damayanti)
Risk Screening Of Pre-Eclampsia And Eclampsia In Pregnant Women In Puskesmas
Ploso Klaten Regency Kediri (Siti Asiyah)
Progressive Muscle Relaxation Therapy Is Effective To Decrease Insomnia To Elderly
(Akde Triyoga, Heru Suwardianto)
Behavioral Factor Of Drop-Out Family Planning Acceptor According Lawrence Green
(Aries Wahyuningsih, Fidiana Kurniawati)
Poor Sleep Quality Affects Severe Impairment Of Cognitive Function To Elderly
(Dyah Ayu Kartika Wulan Sari, Dian Taviyanda)
Individual Characteristics Affect Nurse‟s Performance Based On Kopelman Theory
(Aries Wahyuningsih, Evi Philiawati)
Disability Decrease Quality Of Life Topatients With Leprosy
(Vitaria Wahyu Astuti, Akde Triyoga)
The Warm Water Bath Is Effective To Decrease Sleep Disorder (Insomnia) To Elderly
(Tri Sulistyarini, Desi Natalia Trijayanti Idris)
Contingency Training Role Of Early In The Community To Improve Preparedness Of
Tsunami Hazard On The Beach Sidem District Tulungagung 2015 (Siti Nurhasanah)
The Study Of Mother‟s Knowledge On Diftheria Disease In Posyandu (Maternal And
Child Health Center) Bago Vilage Tulungagung (Yeni Setyo Prastiwi , Azmi Bagus
Prayogo)
Effect Of Health Education About Circumcision Against Anxiety In Children Who
Will Do Circumcision Actions In The District Of Tulungagung Campurdarat
(Hadi Santoso)
The Corelation Of Body Mass Index (Bmi) With Cardiorespiratory Resistance On
Nursing Students Program (Oka Ludianita,Ita Novita Dewi)
The Effect Of Giving Date Palm Extract To Againts Constipation That Happen To
Postpartum Mother (Ninik Azizah, Suyati )
Giving Effect Of Tablet Fe And Vitamin C On Anemia Event Numbers Decline In
Pregnant Women In The Village Peterongan Jombang
(Zakiah, Feny Vitiasaridessy, Dian Puspita Yani)
The Effect Of Giving Honey Topically For Healing Perineum Laceration On Post
Partum Mother (Suyati,Nur Alfi Abidah,Muzayyaroh)
The Influenced Of Early Mobilization On The Fundal Height Decreased Of Post
Partum Mother At Paviliun Melati Rsud Jombang
(Sabrina Dwi Prihartini, Dewi Triloka Wulandari, Siti Roudhotul jannah)
Relationship Between Levels Ofspiritual Intelligence To The Level Of Preoperative
Anxiety In Patients (Pujiani, Didik Saudin, Ainur Rofiqoh)
The Correlation Between The Quality Of Nursing Care With Patients Satisfaction
Level In The Inpatient Unit (Edi wibowo S, Mukhoirotin, Sih Anjar K)
Playing Therapy Decreases Anxiety (Hospitalization) Of toddler
(Rimawati, Srinalesti Mahanani)
Relationship Behaviour of Using Personal Protective Equipment (APD), Healthy and
balanced Diet And Personal Higiene To Skin Health status of scavengers In TPA
Kediri (Indasah, Nur Zuhdana Maula)
The Identification Of Families Stress Level With Adversity Quotient In Caring
Schizophrenia Family Members In The City Of Kediri (Byba Melda Suhita)
Differences Between Contaminated Old Wound Healing Wound Care Using Scours
Onion (Allium Cepa L) Compared With Binahong (Anradera Cordifolia) At The White
Rat (Rattus Norvegicus) (Nove Lestari)
Nutrition On The First 1000 Days Of Life Determinate The Nutritional Status And
Development Children (Miftakhur Rohmah)
The Effect Cognitive Support And Emotional Spiritual Quotient(Esq) To
Immunologist Status Change In HIV/AIDS Patient In Kediri City (Alfian Fawzi ,Yuly
xiv
1011
1018
1025
1032
1039
1046
1053
1060
1067
1074
1081
1088
1095
1102
1109
1116
1123
1130
1137
1144
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1161
1168
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
Peristiowati, Joko Sutrisno)
Stress Management Techniques Seft (Spiritual Emotional Freedom Tehnique) To
Decrease Frequency Of Epilepsy Patients Seizures Tulungagung (Lasman)
Perception Differences In Young Women And Men About Pregnancy At Smk Canda
Bhirawa Pare Subdistrict Kediri, East Java (Enur Nurhayati Muchsin)
The Relationship Of Self Efficacy And Nurse Caring Behavior To Aids Patient In
Isolation Ward Of Rsud Eks Karesidenan Kediri (Dodik Arso Wibowo)
Strategies For Improving Nutritional Status Of Children Under Five In Communities
(Nurwijayanti)
Onion And Ginger Extract To Cholesterol Stabilizers In The Blood (Agusta Dian
Ellina, Mohammad Irfan Helmi Ramadhan)
The Effectiveness Of Sex Education To Knowledge About The Dangers Of Adolescent
Premarital Sex (Agus Supinganto, Kurniatillah )
Out Patient Physical Exercise For Heart Failure Patients More Effective In Improving
Activity Daily Living Than Functional Capacity ( Erni Tri Indarti, Heru Wahyudi)
The Give Of Audio Visual Provision Of Development Language In Pre School Age
Children Kosgoro Kabupaten Nganjuk. (Rahayu Budi Utami, Uswatul Ma‟rifah)
The relationship Of Increased Body Weight Pregnant Mothers Withnewborn Weight
At Home Her Areas Of Public Hospitals(Sujatmiko, Titin Ratnaningsih, Remita Yuli K)
Effectiveness Of Bay Leaves Boiled Water Towards Uric Acid Level Of Hyper
Uricemia Patients In The Village District Of Pace Joho Nganjuk (Trisnanto, Anggi
Ratih Setiorini)
The Difference Of The Cateter Installation Skill Result Of The Study Before And After
Peer Tutoring To Term Midwifery Students Stikes Satria Bhakti Nganjuk On 2013
(Tutik Handayani, Ike Nurrochmawati, Ambar Dwi Retnoningrum)
Correlation Between The Role Of Mother With Adolescent Girls Perception About
Menarche (Dewi Taurisiawati Rahayu)
Star Fruit Consumption On Blood Pressure In Hypertensive Outpatients At Gambiran
Hospital In Inner Disease Poly Kediri (Andayati)
Effect of Initiation Of Breast-Feeding Within One Hour Of The Delivery On MaternalInfant bonding In RSUP M. Djamil Padang 2014 (Dewi Susanti)
Correlation Of Parenting System With Verbal Development Of Preschool Age
Children (Dharma Wanita Kindergarten Sitimerto Pagu Kediri) (Siti Komariyah, Deby
Sintyana Dewi)
Relationship Between Nutritional Status With Anemia Prevalence At 1 st grade Dharma
Husada Midwifery Academy Class 2012 / 2013 (Widya Kusumawati)
The Relation Parity And Acceptor Knowledge About The Injection Contraception
With Be The Interest To Be Injection Familly Planning Program In Ngampel Village
Mojoroto Sub District Kediri City In 2015 (Rofik Darmayanti)
The Relationship Between Mother Knowledge With Attitude Of Stimulation Provides
Growth In Children Age 1-3 Years (Toddler Phase) ( In IHC Orchid Village Jambean
Kras District Of Kediri Regency ) (Erma Herdyana, Indra Saputri)
The Corelation Of Knowledge And Behaviour Of Mother‟s Stimulation For
Development Of Adaptif Motor 1-3 Years Old In Ngampel Village Kediri (Susiani
Endarwati)
Relations Of Herb Consumption Withseverity Of Ckd (Chronic Kidney Disease) At
The Dahlia And Flamboyan Room Hospital dr. Iskak Tulungagung 2015 (Eny
Masruroh)
Relation Between Multiple Pregnancy With A Newborn Baby Weight (Nanik Nuraini,
Nur Hasanah)
The Relationship Between Maternal Communication Skill And Verbal Language
Development In Children Aged 3-4 Years (Nur Hasanah ,Nanik Nuraini)
The Identification Of Families Stress Level With Adversity Quotient In Caring
xv
1175
1182
1189
1196
1209
1216
1223
1230
1237
1244
1251
1258
1265
1272
1279
1286
1293
1300
1307
1314
1321
1328
1335
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
84
85
86
Schizophrenia Family Members In The City Of Kediri (Byba Melda Suhita)
Health Education To Parents To Improve Children Personal Hygiene With Moderate
Mental Retardation (Dewi Ika Sari Hari Poernomo, Maria Anita Yusiana)
The Correlation Between Mother‟s Perception About Exclusive Breastfeeding And
Exclusive Breastfeeding In Pajaran Village Peterongan Jombang
(Mukhoirotin, Zulfa Khusniyah, Fais Sugiarti)
Family Effort In Improving The Compliance Of Patients With Chronic Renal Failure
(CRF) Undergoing Hemodialysis (Kurniawati)
The Relationship Between Fatigue Level Night Sport With Sleep Quality At Teenagers
Futsal Club “ Scholar One” In Sumeleh Futsal Tulungagung 2015 (Suciati,Riki Irawan)
Application Of Blended Learning Method Based Learning Ict For Increasing Interest In
The Course Of Social Cultural Basis (ISBD)
(Sri Banun Titi Istiqomah, Helmi Annuchasari, Arifa Retnowuni)
Related Knowledge Of Exclusive Breast With The Frequency Of Breastfeeding Baby
Age 0-6 Months (In Posyandu Srikaton, District Ngantru, Tulungagung 2015) (Firsta
Sukmawati, Nurhidayati, Sri Agustiana)
The Influence Of Giving Health Education About Napza To Change Attitudes At
Students In VIII Grade Of Smpn 2 Campurdarat, Tulungagung, 2014 (Surtini1, Amita
Audilla)
Process Of Social Legitimacy Of Persons With Mental Retardation In Karang Patihan
Districts Balong Ponorogo (Siti Noor Farida Layla)
Duration Efect Of Treatment And The Family Motivation For Medication Adherence
Of Lepers (Ema Mayasari)
Effect Of Giving Isoflavone Genistein During The Period Of Pre- Pubescent Vagina
Histology , Estradiol Concentration And Ovulation In Female Mice (Mus Musculus L)
(Yenny Puspitasari, Byba Melda Suhita)
Characteristics Multiple Drugs Resistance Patient That Conversion Cultures At First
Months Of Treatment In Dr. Soetomo Surabaya Hospital (Retno Ardanari Agustin)
The Correlation Between Age, Women Fertile Couple‟s Knowledge About Cervix
Cancer And Their Interest To Have Human Papilloma Virus (HPV) Immunization.
(Case Study In RT 02 RW 2 Sidomulyovillage, Semen Distric Kediri Regency)
(Betristasia Puspitasari)
Self-Care Deficit To Patients With Diabetes Mellitus Type 2 Based On Orem Theory
(Desi Natalia Trijayanti Idris, Tri Sulistyarini)
Formulation and Characterisation Of Granule Effervescent Cilembu Sweet Potato
(Ipomoea Batatas (l). Lamk)Extract With Concentration Variation Of Citric Acid And
Sodium Bicarbonate (Dewi Resti Basuki)
Midwifes Science Relationship About Early Initiation With Early Initiation Practices
In Bps Nganjuk District‟s Nganjuk‟s Regency (Fitria Hari Wibawati, Sri Ngayomi,
Titin Ratnaningsih)
Do elderly Use Community Health Centers For Outpatient Care? (Gerardin Ranind
Kirana, Hari Kusnanto Josef, Mubasyisyir Hasanbasri)
Study Of The Needs Of Patient‟s Family Of Palliative Nursing Program Development
At Intensive Care Of Ulin General Hospital Banjarmasin (Ifa Hafifah, Iyus Yosep,
Anastasia Anna)
The Correlation Level Of Education And Mother‟s Age With Mother Attitudes In
Face Of Child Down Syndrome At Menarche (In SLB C1 Putera Asih Balowerti Kota
Kediri) (Lely Khulafa‟ur Rosidah)
The Correlation Between The Motivation Of Becoming A Nurse And The Learning
Achievement Of The Students Of Stratum 1 Nursing Science At Faculty Of Medicine
Lambung Mangkurat University (Herawati, Naya Ernawati)
Progressive Muscle Relaxation Is Effective To Decrease Blood Pressureto Elderly
xvi
1342
1349
1356
1363
1370
1377
1384
1391
1397
1404
1409
1416
1423
1430
1437
1444
1451
1458
1465
1472
87
With Hypertension (Suprihatin, Dian Prawesti)
Relationship Between Nutritional Status With Anemia Prevalence At 1stgrade Dharma
Husada Midwifery Academy Class 2012 / 2013 (Widya Kusumawati)
xvii
1485
ABSTRACT
PREPAREDNESS STRATEGIES FOR HEALTHCARE STUDENTS IN FACING AEC: “THE
IMPORTANCE OF HARD SKILL, SOFT SKILL AND FOREIGN LANGUAGE
COMPETENCIES”
Rose ak Nanju Manju
Email: [email protected]
The ASEAN Economic Community (AEC) shall be the goal of regional economic integration by
2015. AEC envisages four key characteristics, which are a:
i.
ii.
iii.
IV.
single market and production base.
highly competitive economic region.
region of equitable economic development.
region fully integrated into the global economy.
The AEC areas of cooperation among the 10 member countries includes human resources
development and capacity building; recognition of professional qualifications; closer consultation on
macroeconomic and financial policies; trade financing measures; enhanced infrastructure and
communications connectivity; development of electronic transactions through e-ASEAN. The aim is
to integrate industries across the region to promote regional sourcing; and enhancing private sector
involvement for the building of the AEC. The AEC is hoped to transform ASEAN into a region with
free movement of goods, services, investment, skilled labour, and freer flow of capital. As such,
healthcare students should be prepared to compete in the ASEAN AEC market to fulfil the human
resource providence and to be well-prepared in the area of communication, to master several foreign
languages in order to cater the free movement of labour force in the region. This means that the
healthcare staff will care for people from different part of the world, who speaks different languages.
It is expected that the skills of healthcare workers to be at par with others from the other AEC member
countries. This includes the soft skills demonstrated along with their hard skills. As we will be facing
challenges to compete in AEC and also the global markets, we need to be excellent in our soft skills
and also hard skills. Based on the four key areas above, healthcare staff are to be trained to prepare
them to challenge the area of healthcare.
Key word: Preparedness; healthcare staff/student; soft and hard skills; communication skills.
ABSTRACT
AN UPDATE ON THE MANAGEMENT OF TRAUMA IN PREGNANCY: RESUSCITATION
PRIORITIES
Assoc Prof Dr. Mohd Idzwan Zakaria
Department of Emergency Medicine, University Malaya Medical Centre
Trauma death in pregnancy is a downward trend in Malaysia. But it is still the leading cause of nonobstetric cause of mortality and morbidity. The main principle of management of trauma in pregnancy
is aggressive resuscitation of the mother. Stabilization of the mother ensures a better foetal outcome.
Trauma increases risk of spontaneous abortion, preterm premature rupture of the membrane, preterm
delivery, abruption placenta and uterine rupture. This lecture concentrates on the maternal physiology
and its clinical implication in trauma, some special clinical management considerations and perimortem caesarean section. The supine hypotension syndrome is also discussed here and methods to
prevent are also shown. The role of focused abdominal ultrasonography in trauma is also discussed.
The teratogenic risk of radiological imaging is discussed and it is then weigh against the importance
of treating the mother to ensure the fetus is safe. Peri-mortem caesarean is discussed although its
success rate is minimal in our setting.
Keyword: Management, Trauma, Pregnancy, Resuscitation
PERSONAL HYGIENE BEHAVIOR AND VULVOVAGINITIS INCIDENT ON
FERTILE WOMEN AGE IN OBSTETRICS AND GYNECOLOGY WARD
Dr. ISKAK HOSPTAL- TULUNGAGUNG
Yenny Puspitasari, Intan Fazrin
Nursing Faculty Health Institute Of Health Surya Mitra Husada
ABSTRACT
Personal hygiene behavior is an act of maintaining cleanliness and health of a person's
physical and psychological well-being. Someone who have good personal hygiene can
prevent disease, such as Vulvovaginitis. The purpose of this research was to determine
the relationship of personal hygiene behavior and Vulvovaginitis incident
in fertile
women age in Obstetrics and Gynecology ward Dr. Iskak hospital-Tulungagung. The
study design was observational analytic.The population is fertile women age in Obstetrics
and Gynecology ward Dr. Iskak hospital- Tulungagung on 2 - March 27, 2015 as many as
26 respondents with accidental sampling technique with a large sample of 26 respondents.
The independent variables in this research was personal hygiene behavior, the dependent
variable was Vulvovaginitis incident. Instruments used questionnaires, observation
sheets, the statistical test Chi Square α = 0.05.Results of statistical test p value = 0.003
means p <α = 0.05 so that H1 is accepted, then there is a relationship between personal
hygiene behavior and Vulvovaginitis incident in fertile women age.Personal hygiene
behavior is good and right to prevent the incidence of diseases such as Vulvovaginitis
especially in fertile women age, therefore it is necessary to always maintain personal
hygiene so that the physical and psychological well-being.
Keywords:
personal hygiene behavior, Vulvovaginitis, fertile women age
8
with abnormal conditions , Research at the
Obstetrics Gynecology RSCM get data 2%
(age 11-15 years), 12% (age 16-20 years)
of 223 adolescents who were infected in
the pubic area or because Vulvovaginitis
(Kurniadi,
2012).
Health problems are common
genital area in women is flour albus.
Abnormal flour albus can be a symptom of
Vulvovaginitis. As many as 75% of
women in the world have suffered from
flour albus at least once in lifetime, and
45% of them may have twice or more
times (Pribakti, 2012). Based on the results
of a preliminary study that began on
October 13, 2014 at Obstetrics and
Gynecology ward of Dr. Isaac hospital
Tulungagung, from interviews to 16
women of fertile women age, 9 person
declared that they do not
not get
Vulvovaginitis because most
them
understand the importance of protecting
their genital organs by keeping it clean or
perform personal hygiene. Then the 7
person tested positive get Vulvovaginitis
marked as vaginal flushing and itching,
and accompanied by other signs. It is also
influenced by the cleanliness of oneself or
one's personal hygiene is not good.
Vulvovaginitis can affect women
of all ages and it is very common. This
can be caused by bacteria, fungi, viruses,
and other parasites such as Bacterial
vaginosis eg, Candida albicans,
Trichomonas vaginitis, etc. Vulvovaginitis
can be found as well as the use of various
chemicals feminine hygiene products that
actually will kill the normal flora in the
area of femininity. Environmental factors
such as poor hygiene and allergens may
also cause the condition Vulvovaginitis
(Purwanti,
2011).
Humid circumstances on feminine
area will further support growth of bacteria
or fungi. If someone less attention to the
condition of cleanliness, especially in the
area of femininity will arise symptoms such as itching in the area of femininity,
redness and a burning sensation on the
skin, discomfort during or after urination
or during intercourse , irritation and
discharge abnormal liquid.
Condition
Background Study
Vulvovaginitis is inflammation of
the vagina and vulva that is most often
caused by infection with bacteria, fungi,
viruses, and parasites. Inflammation of the
vulva and vagina is characterized by
itching in the pubic area, swelling of the
mucous membranes, the amount of mucus
from the vagina, redness, burning
sensation, irritation, and discomfort on the
skin, especially during or after urination
(Suparyanto, 2011). Vulvovaginitis is one
of the most common reasons why women
visit a gynecologist (Leber, 2009).
Habitual action in maintaining
personal hygiene plays an important role
in this case, particularly in maintaining
cleanliness. Personal hygiene or
cleanliness of the individual is an act to
maintain the cleanliness and health of a
person's physical and psychological wellbeing (Permatasari,
2012). Kinds
of
personal hygiene activities including dental
care, hygiene skin, toe, nails and hands,
including the treatment of genital (Potter,
2005). Cleanliness itself is strongly
influenced by individual values and habits.
Things that affect them cultural, social,
family, education, health and a person's
perception of the level of development
(Christina
et
al,
2011).
Vulvovaginitis often caused due to
bacterial vaginosis. Gardnerella vaginalis
is the most common bacterial cause of
bacterial vaginosis in women of fertile age.
It is mentioned that 50% of active women's
sexuality ever get Gardnerella vaginalis
infection, but only a few are symptomatic.
Approximately 50% was found in users of
IUDs and 86% were found along with
Trichomonas infections. Estimating the
number of patients with bacterial vaginos
very difficult since Gardnerella vaginalis
can be obtained from the vagina in 30-50%
of women who had no symptoms (Juanda
et al., 2007). Cohort study conducted by
Bradshaw et al in 2013 that is cited in the
study Sulistianingsih et al, 2014 stated in
29 health care centers in three states in
Australia to get the 11.8% of women with
bacterial vaginosis and 17.2% of women
9
abnormal if a polynomial, it smelly or
accompanied by itching and pain.
In daily life, it is necessary to
clean and healthy life, which is intended to
avoid germs or bactery, fungi, viruses that
cause disease. Reproductive is one of the
organs that are sensitive and require
special care. Knowledge and good care is a
decisive factor in maintaining reproductive
health
(Ratna,
2010).
The main factor of genital health
problems Events around the vagina is
highly susceptible to infection. Easy
infection occurs because it is situated very
close to the urethra and anus, so that
microorganisms (fungi, bacteria, viruses,
and parasites) easily fit into the vagina
(Muin, et al, 2013). Therefore, it should be
kept in behavior, especially the behavior of
healthy and clean life by further improving
personal hygiene or an action to maintain
the cleanliness and health of a person to
realize the physical and psychological
well-being.
RESEARCH METHODS
The research design used in this
study was observational analytic that is
looking for a relationship
between
variables
in
cross
sectional.
The populations in this study were all
fertile women age
who present at
Obstetrics and Gynecology ward of Dr.
Isaac hospital Tulungagung which amount
26 respondents. Samples used in this study
were fertile women age who meet by the
researchers at the time of data collection in
Isaac hospital Tulungagung that a number
of 26 respondents. This research conducted
on
2
March
27,
2015.
The sampling technique used in
this research was accidental sampling is
taking respondents in the sample by
coincidence, that anyone who by chance
met the researchers can be used when a
sample of people who happen to be found
suitable as a data source.
Data processing is done by editing that is
by checking the data obtained. Coding is
done by giving the code on each
characteristic. Then the scoring the results
of the research. The next process is data
analysis. Analysis of the data was analyzed
using Chi-square statistic test techniques
with the help of Statistical Product and
Service Solutions (SPSS) version 17 to
assess the behavior of personal hygiene
with the incidence of vulvovaginitis in
fertile women age.
RESEARCH PURPOSES
GENERAL PURPOSE
To determine the relationship of personal
hygiene behavior with Vulvovaginitis
incidence in fertility women age in
Obstetrics and Gynecology ward dr. Isaac
hospital
Tulungagung.
SPECIAL PURPOSE
a. To identify personal hygiene behavior in
fertile women age in Obstetrics and
Gynecology ward
dr. Isaac Hospital
Tulungagung.
b. To identify the incidence Vulvovaginitis
in fertile women age in Obstetrics and
Gynecology ward dr. Isaac
hospital
Tulungagung.
c. To analyze the relationship between
personal hygiene
and Vulvovaginitis
incidence in
fertile women age
in
Obstetrics and Gynecology ward dr. Isaac
hospital
Tulungagung.
RESEARCH RESULT
CHARACTERISTIC OF RESPONDENT
Table 1. characteristic of respondent
characteristic
Age
20-29 years old
30-39 years old
40-49 years old
marrital status
10
N
%
9
8
9
34
31
35
characteristic
Single
Married
Widow
N
3
19
4
Education
Primary school
Junior high school
Senior high school
University
STATISTICS TEST RESULT
Table 4 Chi-Square
%
12
73
15
6
8
8
4
Chi-Square Tests
Value df
23
31
31
15
Job
Jobless
5
Private
13
Entrepreuner
7
Public servant
1
Resource: result of data analysis
Pearson Chi- 11.816
2
.003
a
Square
Likelihood
14.121 2
.001
Ratio
Linear-byLinear
11.180 1
.001
Association
N of Valid
26
Cases
a. 3 cells (50.0%) have expected count
less than 5. The minimum expected
count is 1.27.
19
50
27
4
VARIABEL CHARACTERISTICS
Table 2. variable characteristics
characteristics
Personal Hygiene
behavior
good
enough
less
N
%
12
11
3
46,2
42,3
11,5
Symmetri
Measures
c
Valu Approx.
e
Sig.
Nominal Contingenc
by
y
.559 .003
Nominal Coefficient
N of Valid Cases
26
Vulvovaginitis
incident
Positive
11
42,3
Negative
15
57,7
Resource: result of data analysis
Based on the analysis of statistical
test Chi Square (X ²) obtained the value p value = 0.003, so p - value <0.05 then H0
is rejected and H1 accepted meaning there
is relationship between personal hygiene
behavior and Vulvovaginitis incidence in
Tulungagung. With correlation coefficient
personal hygiene behavior with
Vulvovaginitis that is equal to 0,559 events
in the category correlations were in the
range
(0.40
to
0.599).
CROSS TABULATION
Table 3. cross tabulation between
personal hygiene
and Vulvovaginitis
incident
personal
hygiene
behavior
Good
Enough
Less
Total
Asymp.
Sig.
(2-sided)
Positive
Negative Total
n
%
n
%
n
%
1
7
3
11
3,8
26,9
11,5
42,3
11
4
0
15
42,3
15,4
0
57,7
12
11
3
26
46,2
42,3
11,5
100
DISCUSSION
Personal Hygiene behavior in fertile
women
age
11
Results of a study of 26
respondents in Obstetrics and Gynecology
ward of Dr. Isaac hospital Tulungagung
showed almost half of respondents (46.2%)
with good personal hygiene behavior as
many as 12 respondents, nearly half of
respondents (42.3) have quite personal
hygiene behavior as many as 11
respondents, and a small of respondents
(11.5%) have less
personal hygiene
behavior as many as 3 respondents.
Personal hygiene behavior
according Potter and Perry (2005) is an act
of maintaining cleanliness and health of a
person's physical and psychological wellbeing. A person said have good personal
hygiene when, the person can maintain a
healthy body includes cleanliness of the
skin, teeth and mouth, hair, eyes, nose, and
ears, legs and nails, genitalia, as well as the
cleanliness and tidiness of his clothes.
According to Potter and Perry behavior of
someone doing personal hygiene
is
influenced by some factors; body image,
social practices, the status of socio economic, science, cultural variables,
personal choice, and physical condition.
According to researchers opinion
based on the results of the study showed
that nearly half of respondents have good
personal hygiene with this case reflects
that the respondent was aware of personal
hygiene or personal hygiene for
themselves, especially in maintaining the
cleanliness of the female organs. Due to
keep or maintain the cleanliness and health
of a person will strive to realize the
physical and psychological wellbeing. By
having good personal hygiene they're
indirectly trying to prevent from diseases,
especially diseases associated with female
organs.
or get Vulvovaginitis as many as 11
respondents.
Vulvovaginitis is an inflammation
or infection of the vulva and vagina are
often caused by infection with bacteria,
fungi,
and
parasites.
Genesis
Vulvovaginitis cause irritation and itching.
Vulvovaginitis is one of the most common
reasons why women visit a gynecologist
(Leber, 2009). This can be caused by
bacteria, fungi, viruses, and other parasites.
Environmental factors such as poor
hygiene and allergens may also cause this
condition. Vulvovaginitis has signs and
symptoms such as; itching, pain and / or a
burning sensation and discomfort in the
vagina and vulva, and a bright red rash that
affects the inside and outside of the vulva,
sometimes spread widely in the groin,
pubic area, groin and thigh area. It may
happend only a few hours or some days,
weeks,
or
months.
Based researchers opinion on the
results of the study showed positive results
fraction of respondents aged 20-29 years
occurred Vulvovaginitis. Vulvovaginitis
can affect women of all ages. In this study,
a small portion of respondents aged 40-49
years as many as five respondents
positively. Because of the age influence
the perception and mindset of the person,
the age will be growing anyway perception
and thought patterns. Especially in health,
one would have thought that maintaining
health is very important. Moreover, when
the body has a condition that is not health,
then the person should be quick to respond
in such conditions, for example with health
check yourself into the nearest public
health centre or hospital. Ofcourse,
it
would be better to prevent than cure. Some
prevention can be done to prevent a
disease,
particularly
diseases
Vulvovaginitis. The most important thing
in preventing infection is to always
maintain personal hygiene, especially in
the female organs well.
Vulvovaginitis incidence in women of
fertile
age
Research result of 26 respondents
in Obstetrics and Gynecology ward of Dr.
Isaac hospital Tulungagung showed most
respondents (57.7%) results were negative
or did not get Vulvovaginitis as many as
15 respondents, and nearly half of the
respondents (42.3%) the result is positive
Analysis of Personal Hygiene behavior
and Vulvovaginitis incident in women
of fertile age
in Obstetrics and
12
Tulungagung.
skin, teeth and mouth, hair, eyes, nose, and
ears, legs and nails, genitalia, as well as the
cleanliness and tidiness of his clothes.
Personal hygiene behavior is very
important to maintain cleanliness in the
genital organs in order to avoid germs that
cause disease. Such as Vulvovaginitis.
Vulvovaginitis is an inflammation or
infection of the vulva and vagina are often
caused by infection with bacteria, fungi,
and parasites (Leber, 2009). Factors environmental factors such as poor
hygiene and allergens may also cause this
condition.
Based on the results above it can
be concluded that it is true that when
someone who has good personal hygiene
behavior will mos be negative or be spared
from
Vulvovaginitis
incident.
Results of cross tabulation
personal
hygiene behavior
and Vulvovaginitis
incidence in
fertile women age
in
Isaac hospital Tulungagung showed
1
respondents who have good personal
hygiene behavior but the results positive
gets Vulvovaginitis. Based on the data
collected in the specific data summary, it
can be happen because the respondent did
not use pads that are made of materials that
do not cause irritation. Respondents
themselves also often complained of
itching during menstruation and feel
uncomfortable with a bandage used.
However, respondents continue to use the
material that eventually makes irritation
and
irritation
wider.
Results of statistical analysis with
Chi-square test to determine the incidence
of personal hygiene
behavior
Vulvovaginitis
in
Obstetrics and
Tulungagung p value - value = 0.003 (p value <α ie 0.003 <0.05) then H0 rejected
and H1 accepted, which means that there is
a relationship between personal hygiene
vulvovaginitis is equal to 0,559 events in
the category correlations were in the range
(0.40 to 0.599).
CONCLUSIONS AND SUGGESTIONS
CONCLUSION
Based on the research that has been done
in Poli Obstetrics and gynecology ward of
Dr. Isaac hospital Tulungagung 2015 on
26 respondents about personal hygiene
fertile women age, it can be concluded as
follows:
1. Almost half of respondents with good
personal hygiene behavior as many as 12
respondents (46.2%) a total of 26
ward of Dr. Isaac hospital Tulungagung.
2. Most respondents of Vulvovaginitis
incident the result is negative or does not
get Vulvovaginitis as many as 15
respondents (57.7%)
a total of 26
ward of Dr. Isaac hospital Tulungagung.
3. Results p - value = 0.003, (p - value <α
ie 0.003 <0.05) then H0 rejected and H1
accepted, which means that there is a
relationship between apersonal hygiene
According to Iqbal Wahit Mubarak (2011),
the behavior is a set of actions / measures
in response to someone in doing something
and then made a habit because of the value
that is believed. Human behavior is
basically made up of components of
knowledge
(cognitive),
attitudes
(affective), and skills (psychomotor).
Personal hygiene behavior according
Potter and Perry (2005) is an act of
maintaining cleanliness and health of a
person's physical and psychological wellbeing. A person said to have good personal
hygiene when, the person can maintain a
healthy body includes cleanliness of the
13
Vulvovaginitis that is equal to 0,559 events
in the category correlations were in the
range
(0.40
to
0.599).
Kurniadi, I.G.A.M. 2012. Pengetahuan
Dan Sikap Remaja Putri Tentang
Cara Mencegah Dan Mengatasi
Keputihan Di Klinik Remaja
Kisara PKBI Bali. Jurnal Dunia
Kesehatan, Vol. 2 No. 2.
Leber, W. 2009.
Vulvovaginitis.
(http://www.aidsmap.com/Bacteria
l-dan
Greta
Hungson
vaginosis/page/1044636/. Diakses
tanggal 15 September 2014, pukul
16:01.
Mubarak, W.I. 2009. Ilmu Keperawatan
Komunitas. Jakarta : Salemba
Medika.
Muin, M., Salmah, U., dan Sarake, M.
2013. Hubungan Pengetahuan
Penyakit Menular Seksual (PMS)
Dengan Tindakan Kebersihan Alat
Reproduksi Eksternal Remaja
Putri Di SMAN Makassar Tahun
2013.
Jurnal
Kesehatan
Masyarakat, Vol. 5 No. 3 Tahun
2013.
Permatasari, K.B. 2012.
Ketrampilan
Dasar Praktek Klinik Dian Husada
Personal Hygiene.htm.
Diakses
tanggal 15 September 2014, pukul
16:03.
Purwanti, D. 2011. Penyakit Kandungan.
(http//Berbagi Ilmu Bersama Dewi
Penyakit Kandungan.com. Diakses
tanggal 26 Agustus 2014, pukul
13.50.
Potter, A & Perry, G.A. 2005. Buku Ajar
Fundamental Keperawatan :
Konsep, Proses, dan Praktik, edisi
4. Jakarta ; EGC.
Pribakti. 2013. Epidemiologi Penyakit
Menular Seksual (PMS). Jakarta :
Balai Penerbit FKUI.
Ratna, D.P. 2010. Pentingnya Menjaga
Organ Kewanitaan.
Jakarta :
Indeks.
Suparyanto. 2011. Wanita Usia Subur.
(http://dr.Suprayanto.blogspot.com
). Diakses tanggal 26 Agustus
2014, pukul 13:42.
SUGGESTION
Researchers give advice based on research
results
are
as
follows:
For the respondents, with the participation
of responder helped course of this
research, directly or indirectly, they can
find out a little information about personal
hygiene behavior with Vulvovaginitis
incident. Thus the respondent should
further improve personal hygiene properly.
For hospitals, should be able to add
information about the behavior of personal
hygiene with Vulvovaginitis incidence in
fertile women age so that it can be used as
a reference for handling the problem
neighbor Vulvovaginitis events. Besides it
can also add leflat media that contains
information about personal hygiene
behavior is good and right and also about
Vulvovaginitis, so expect the patient or the
public know about the information. As
well as giving a briefing to the nurse or
midwife to suggest to the patient to be
examined, especially when signs and
symptoms arrise in order to prevent
Vulvovaginitis.
For further research, for further
research are expected to conduct research
and develop a topic or issue related to the
incidence of Vulvovaginitis in greater
depth with variable wider.
REFERENCES
Christiana, A., Martono, K., dan Rejeki, S.
2011. Hubungan Antara Vulva
Hygiene Dengan Kejadian Servitis
Di Desa Sambigede Kecamatan
Sumberpucung
Kabupaten
Malang. Jurnal : Ari Christiana.
Djuanda., Ilyas, S., dan Elistiawaty. 2007.
75% Wanita RI Alami Keputihan.
(http://www.detiknews.com/index.
php/detik. Diakses tanggal 15
September 2014, pukul 16:00.
14
AFFECTING FACTORS OF COMMUNITY PREPAREDNESS AT DISASTER
PRONE AREAS KELUD MOUNTAIN
Novita Ana Anggraini
Lecture From Nursing Faculty Health Institute Of Health Surya Mitra Husada
ABSTRACT
Speciality for disaster management needed to loss minimizing affected by its main
disaster in preparedness phase. Disaster Preparedness phase include community as initial
subjects of disaster management as well as disaster victims till be able to manage disaster
at certain limit and expected disaster do not develop to bigger scale. Purpose of the
research is to know Affecting Factors of Community Preparedness at Disaster Prone
Areas Kelud Mountain. Design of the research used analytic descriptive desain with cross
sectional approach. Sampel generated from 360 respondent used cluster sampling
technique consisting of village officials, community leader, jangkar kelud community
member, health worker and community member at Disaster Prone Areas Kelud Mountain.
Result of research data analized using logistic regression method and showed that
contributing variable to preparedness is knowledge (OR 1,509; CI 95%), attitude (OR
1,127; CI 95%), nurses role (OR 1,076; CI 95%), and culture (OR 0,856; CI 95%).
Information given to community will shape community attitude and behaviour facing
disaster preparedness at Disaster Prone Areas Kelud Mountain because in behaviour
shaping based knowledge till shape behaviour eternally. Information spreading about
disaster preparedness performed by nursing may do collaboration between nurses and
jangkar kelud community through community radio so information spreading more
comprehensive and targetted. Affecting factors of community preparedness at disaster
prone areas kelud mountain is role nursing, knowledge, attitude and culture.
Key Word : Preparedness, Disaster, Community
54
55
knowledge and behavior. The importance
of the knowledge society towards disaster
preparedness aims to change people's
behavior in order to be aware of the
disaster. But people tend to be less active
in the dissemination of disaster for
reasons flurry by the job. Lack of public
awareness of disaster preparedness will
also influence the behavior of the
community. Another factor is the
availability of health resources, the nurse
on duty as educators to empower
communities in disaster preparedness.
Providing training to the community is
also required which is associated with the
training of community volunteers for
casualty evacuation and rescue training
and first aid (WHO, 2011). Therefore,
this study was conducted to determine
factors - factors that affect the community
in the face of disaster preparedness Kelud
in Disaster Prone Areas Kelud.
INTRODUCTION
Indonesia is part of the path of the Pacific
Ring of Fire which is a series of lines of
active volcanoes in the world. In a study
also showed that the cause of the disaster
in Indonesia 60.66% of floods, landslides
63.11%, and 65.57% volcano. Higher
percentage obtained volcano it is related
to the position or location of Indonesia
which is a region pacific ring of fire
(Khairuddin, 2011). Mount kelud (+
1,731 m DPAL) is a strato volcano type
which has a crater lake at its peak,
located in the border region of Kediri,
Blitar and Malang. According to data
from the Center for Volcanology and
Geological Hazard Mitigation in
Bandung, eruption of Mount Kelud
recorded history began in 1000 until
1990, the longest interval of intermittent
breaks between 65-75 years and shortest
3 years.
METHODS
In Indonesia the center of the disaster is
BNPB as the giver of command in
collaboration with public, private, and
several related sectors including the
government and the health sector. The
role of the people here as well as
perpetrators of early disaster victims must
be able to handle a disaster within certain
limits in order to prevent disaster into a
larger scale.
This study was observational analytic
research with cross sectional approach
conducted in Disaster-Prone Areas Kelud
Blitar in May-June 2013. The subjects
were selected using cluster sampling
where samples were people living around
the mountain lava flow kelud. Retrieving
data using a questionnaire given to the
people associated with factors that affect
preparedness (the nurse's role,
knowledge, attitudes and cultural)
communities in the face of Kelud. A total
of 360 samples were taken in six selected
villages and villages through which the
lava flows Kelud. Analysis of the data
used to see the relationship between
factors that influence (knowledge,
behavior, culture, the role of nurses,
nurse's knowledge and skills of nurses)
and community preparedness in the face
of a mountain disaster kelud then
performed bivariate analysis. Using a
statistical test Chi-Square test if they
meet and alternatively using Fisher's
exact test with a confidence interval of
95% or p≤0,05. As for the multivariate
analysis using logistic regression
NAP-DRR 2010-2012 explained that the
new paradigm of the implementation of
disaster management is directed to the
concept of community-based disaster
management. Implementation of disaster
management-oriented empowerment and
self-reliance
through community
participation, among others, will lead to
disaster risk reduction efforts with
areas
communities in disaster-prone
independently and avoid the emergence
of a new vulnerability and dependence of
communities in disaster-prone areas to
outsiders.
Karancy (2005) explains that something
which can influence community
preparedness in the face of disaster is the
55
statistical test with a confidence interval
of 95% or p≤0.05.
The role of nurse
knowledge
behavior
culltural
RESEARCH RESULT
In this study, the respondents were 360
respondents consisting of people living in
disaster prone area I, disaster prone area
II and disaster prone area III. It is gained
from 360 respondents were 60
respondents (16.67%) lived in disaster
prone area III, 120 respondents (33.33%)
live in disaster prone area II and 180
respondents (50%) live in disaster prone
area I. Results obtained demographic data
that the average age of the respondents 35
years and a minimum age of respondents
20 years. Characteristics of the sex of the
360 respondents, 269 respondents
(74.72%) were male and 91 respondents
(25.28%) were female. Based on the
characteristics of the educational level of
the 360 respondents the majority of
respondents are junior high school
graduates as many as 124 (34.44%) and a
minority of respondent uneducated
as
many as 8 respondents (2.2%) it is also
affected by economic conditions Disaster
Prone Areas Mt. kelud. Based on the
characteristics of the 360 respondents
earning an average income Rp. 500.000, because the majority of people work as
laborers on plantations and farmers. the
average length of stay is based on the
characteristics of long-stay community
disaster prone area Kelud is 33 years so
that people have experienced at least two
times the eruption of Mount Kelud. Data
obtained information related to disaster
preparedness community with the
majority of people getting information
from television that 151 respondents
(41.94%), while for others that they get
information from the local village
officials that 17 respondents (4.72%) and
total 4 (1.11%) never get information
related to disaster preparedness.
Results of bivariate analysis to determine
the relationship of each variable (the role
of nurses, knowledge, attitudes and
culture) towards community preparedness
Kelud obtained their significance - each
0,004; 0,000; 0,004; 0.007 to p <0.05
which means there is relationship
between the nurse's role, knowledge,
attitudes and culture towards community
preparedness p <0.25 at Chi-Square test.
Test results showed that in a sequence
that affects community preparedness is
knowledge (OR 1.509), attitude (OR
1,127), the role of nurses (OR 1076) and
culture (OR 0.865).
Table 2
Results of Multivariate Analysis
Variabel
The role of nurse
Knowledge
Behavior
Cultural
p
0,30
0,01
0,01
0,22
OR
1,076
1,509
1,127
0,865
DISCUSSION
The Relationship Between The Role of
Nurse With Kelud Community
Preparedness
Results of the analysis showed that the
nurse's role is primarily a community
nurse can influence community
preparedness of disaster-prone areas
Kelud with the results of significant value
0,004 less than alpha (5%). Researchers
get the results of a survey related to the
nurse's role in educating the public
showed a majority of the nurse's role is
less (62.2%). The theory of the formation
of behavior according to Green one that
is a supporting factor (enabling factors) in
the formation of behavior is infrastructure
Table 1
Analysis results Bivariat
Variable
0,004
0,000
0,004
0,007
p-value
56
and health resources. Low role of nurses
in providing education to the public will
have an impact on the information
received that could influence the
knowledge and behaviors of society
towards disaster preparedness.
society in the face of
preparedness (Lakhsmi, 2007).
disaster
Based on the theory of Lawrence Green
et al (1980) knowledge is a predisposing
factor in the formation of behavior.
Knowledge in cognitive domain has 6
levels that know, understand, application,
analysis, synthesis and evaluation
(Notoatmodjo, 2010). In this study the
realm desired by the researchers is to
know and understand the realm of
disaster preparedness in the face of the
mountain erupted. The material must be
known and understood community with
regard to disaster volcano is the type and
characteristics of the hazard, early
warning self-protection tool should be
prepared community in case of volcanic
eruption, volcanic
eruption hazard
material, sanitary water and evacuation
route.
Efforts dissemination of information
related to disaster preparedness is not
only played by health professionals, but
also played by non-medical personnel
such as government or NGOs. In the
region there are Kelud community radio
is a community radio anchor kelud an
active role in the dissemination of
information related to disaster
preparedness volcanoes. The data
obtained from the survey results relating
to the public the information obtained in
Disaster-Prone Areas Kelud majority of
people get information through TV
(41.94%) and radio (40.83%). According
Notoatmodjo (2010) health promotion
method which is used if the target is
public then it should use the method of
mass health promotion. For public health
promotion methods frequently used one
of them the use of electronic mass media,
such as radio and television. Efforts
dissemination of data obtained proved
that although the information obtained
from the community health workers less
but community preparedness in the face
of disaster preparedness has good
(54.7%). This research was supported by
a study conducted by Runblad et al
(2010) conducted on 1,000 respondents
that use the radio to educate the public
effectively to raise public awareness in
the use of clean water in the floods.
The knowledge gained by the society is
also influenced by several factors such as
socioeconomic, experience, education
and age. Knowledge is very closely
related to education, where it is expected
that the higher education then that person
will be more knowledgeable. The result
showed that the educational level of the
people living in Disaster-Prone Areas
Kelud majority is graduated from junior
high school (34.44%). Economic status of
a person will determine the availability of
a facility that is required for certain
activities, so that socio-economic status
will affect a person's knowledge
(Lukman, 2008). Results of this study
found that the average income of people
living in disaster prone area Kelud Rp.
500.000. Getting experienced before
disaster events can also be a lesson for
the public to be more careful and
community preparedness in facing similar
disasters. The experience allows a person
become aware and know the result is then
called knowledge (Vardiansyah, 2008).
The survey results are available to the
public in Disaster-Prone Areas Kelud
society obtained the average length of
stay is 33 years.
Relationship Between Knowledge With
Kelud community preparedness
Results of the analysis showed that the
knowledge society can influence
community preparedness of disasterprone areas Kelud with the results of
0,000 p <0.05. The study was supported
by the results of research conducted on
100 respondents found that there is a
relationship between knowledge and
57
simple and very meaningful in life
include values - values that exist in
society (Williams, 1961). Some cultures
are still embraced by society Kelud is
“Larung Saji ritual” that each year is still
done by local residents is the main people
who are in disaster prone area III which
is close to the area Kelud. People assume
that they should respect the ancestors to
be given safety and lush natural grace.
The same study also found associated
with the trust factor and superstition also
gives an influence on the mindset and
behavior of the people living around
Mount Merapi eruption area. For people
who live in the vicinity of the volcanoes,
where the caretaker who becomes
guardian of the volcano is still more
trusted than the government even the
choice of caretaker to remain in the area
Kinahrejo (one of the areas affected by
the eruption of volcanoes) is followed by
many people around even the government
ask the community for evacuation
(Lavigne, et al., 2008).
Relationship Between Behavior With
Kelud Community Preparedness
Results of the analysis showed that
behaviors can influence community
preparedness of disaster-prone
areas
Kelud with the results of 0.004 p <0.05.
Behavior is covered person's response to
a stimulus or object, both internally and
externally so that its manifestations are
not directly visible, but can only be
interpreted in advance of behaviors
covered. Behavior in reality indicate
suitability response to certain stimuli
(Sunaryo, 2004).
Based Rosenberg's theory known as the
theory of affective-cognitive consistency
in terms of behavior and this theory is
also called two-factor theory is focused
on the components of cognitive and
affective components. In terms of relation
with the volcanic eruption disaster
preparedness related to preparedness
knowledge must be understood by the
community in the process of the
formation of community behaviors in the
face of disaster volcano. The results show
the percentage of behaviors and
knowledge by results (41.9%) and
(49.4%). Other studies related to people's
behaviors in the face of floods in North
Sulawesi were collected from 125
respondents showed that 48.61% of
respondents have a positive behavior,
while 51.39% have a negative behavior
(Kumajas et al, 2012).
Factors
Affecting Community
Preparedness Disaster Prone Areas
Kelud
From the analysis it was found that
sequentially factors that influence
community preparedness is knowledge
(OR 1.509), behavior (OR 1,127), the
role of nurses (OR 1076) and culture (OR
0.865). Based on the theory of Lawrence
Green there is relationship between the
role of nurses, knowledge, behaviors and
culture in shaping the behavior of society
in the face of disaster preparedness kelud
mountain. Health workers who are in
community health centers is a nurse who
has the task as educators is to promote the
health of the community to empower
communities in disaster preparedness
through the organization or community
development.
Relationship Between Culture With
Kelud Community Preparedness
Results of the analysis showed that
culture can influence community
preparedness of disaster-prone areas
Kelud with the results of 0.007 p <0.05.
In the theory of Lawrence Green culture
is one of the predisposing factors of the
formation and behavior of a person who
possesses or believe a certain confidence
will affect their behavior in the face of a
disease that will affect the health (Green,
2000). Some people also see a different
culture, culture is something that is
Knowledge is the most important factor
that effect on preparedness because based
on the Lawrence Green
theory,
knowledge is a factor predisposing
factors that facilitate or predispose the
58
person's behavior. Or cognitive domain
knowledge is very important for the
formation of one's actions (overt
behavior). The results of experience and
research that behavior based
on
knowledge will be more lasting than
behavior that is not based on knowledge
(Anwar, 2010). Thomas & Znaniecki
(1920) in Anwar (2010) asserted that the
behavior is the predisposition to do
certain behaviors, so the behavior is not
only the internal state of psychological
pure of individuals (purely psychic inner
state), but the behavior is more a process
of awareness of the nature of the
individual. Another factor affecting the
behavior is the behavior to the formation
of culture. Unconsciously culture has
instilled a steering line our behavior
towards various issues. Culture has
colored the behavior of members of the
community, because of the culture that
gives the experience of individuals in
society (Anwar, 2010). Therefore health
personnel in charge of people's behavior
in this case related to disaster
preparedness Kelud. As mentioned above
that the behavior of the community is
strongly influenced by socio-cultural in
changing his behavior indirectly also
social and cultural change (Notoatmodjo,
2010).
on the cultural aspects of the
communities in disaster prone area
Kelud.
REFERENCES
Arikunto, S. 2006. Prosedur Penelitian
Suatu Pendekatan Praktik. Jakarta:
Rineka Cipta
Arifin M. H., 2007. Kesiapsiagaan
Bencana Berbasis Masyarakat
Strategi dan Pendekatan. Edisi
Pertama: Jakarta
Azwar. 2010. Teori dan Pengukuran
Pengetahuan, Sikap dan Perilaku
Manusia. Yogyakarta: Nuha
Medika
Bakornas PB. 2007. Pengenalan
Karakteristik Bencana dan Upaya
Mitigasinya Di Indonesia. Jakarta
Bella M., Steffy L., Marry A., Rhogen
G., Jan H. 2011. The Role
Preparedness and Management of
Nurses
During
Disasters.
International Scientific Research
Journal: Philippines University
BNPB. 2005.
Pedoman Penyusunan
Rencana
Penanggulangan
Bencana. Jakarta
CONCLUSION
_____. 2008. Pedoman Penyusunan
Rencana
Penanggulangan
Bencana. Jakarta
Factors affecting the community in the
face of disaster preparedness volcanic
eruption in Disaster-Prone Areas Kelud
are knowledge, behaviors, the role of
nurses and culture.
_____. 2010. Pedoman Umum
Penyelenggaraan Rehabilitasi dan
Rekonstruksi Pasca Bencana.
Jakarta
SUGGESTION
it is required coordination between
health workers with NGOs in the
provision of education on disasters
through community radio anchor Kelud
in order to complete the dissemination
of information and on target. For the
future research, the cultural factors are
expected to further research using
qualitative methods as will be explored
_____. 2012.
Pedoman Umum
Desa/Kelurahan
Tangguh
Bencana. Jakarta
Burke, S., Jeffrey W, Bethel., Amber F B.
2012.
Assessing
Disaster
Preparedness among Latino
Migrant
and
Seasonal
59
Farmworkers in Eastern North
Carolina. California: Departement
of Health Sciences California State
University
Disaster Response: College of
Emergency Nursing Australia
Hansell, A. 2004. Health Hazard fro
Volcanic Gases: A Systematic
Literature Review. London:
Department of Epidemology &
Public Health London
Carole C. J., Larosa, G., Carry A.,
Schoenfisch S. (2007). The Role of
Public Health Nurses In
Emergency Preparedness and
Response:
University
of
Massachusetts Amherst
Hidayati, D.N. 2011.
Kesiapsiagaan
Tanggap Bencana Masyarakat
Kecamatan Ngancar Kabupaten
Kediri Terhadap Ancaman Erupsi
Gunung Kelud. Surabaya
Chapman K & Arbon, P. 2008. Disaster
Preparedness in the Acute Setting.
Australia: Flinders University
IFRC-RCS. 2005. World Disaster
Report: Focus on Information in
Disasters. International Federation
of Red Cross and Red Crescent
Societies. Geneva
Claudia and Frances. 2000. Community
Health Nursing : Theory and
practice 2nd ed : United States
Dahlan, S. 2011.
Statistik untuk
Kedokteran dan Kesehatan.
Jakarta: Salemba Medika
Karanci, A N., Aksit, B., Dirik, G. 2005.
Impact of a Community Disaster
Awareness Training Program in
Turkey: Does it Influence Hazard –
Related
Cognitions
and
Preparedness Behaviors. Turkey:
Middle East Technical University
_____. 2010. Besar Sampel dan Cara
Pengambilan Sampel. Jakarta:
Salemba Medika
Djauhari, N. 2011.
Geologi untuk
Perencanaan. Yogyakarta: Graha
Ilmu
Kadarsetia E., Primulyana S., Sitinjak P.,
Boyson S. U. 2006. Karakteristik
Kimiawi Air Danau Kawah
Gunung Api Kelud. Jurnal Geologi
Indonesia
Douglas, P., Jhonston, D. 2001. Disasters
and Communities: Vulnerability,
Resilience and Preparedness. New
Zealand: Massey University
Khairuddin. 2011. Dampak Pelatihan
Pengurangan Risiko Bencana
Terhadap
Kesiapsiagaan
Komunitas Sekolah. Unsyiah
Banda Aceh. ISSN 2088-4532
Efendi, F M. 2009. Keperawatan
Kesehatan Komunitas. Jakarta:
Salemba Medika
Greeg and Lopes, R. 2004. Volcanic
Worlds: Volcanism in The Solar
System. Praxis Press New York
Knebel, A S., Toomey, L., Libby, M.
2012. Nursing Leadership in
Disaster Preparedness and
Response. U.S Departement of
Health and Human Services
Green, L. 2000. Communication and
Human Behaviour. Prentice Hall,
New Jersey
Kuntz S., Pamela F., Kristine Q., Linda
Strong.
2008.
Disaster
Preparedness White Paper for
Community/Public Health Nursing
Educators. ACHNE
Hammad K., Paul A., Kristinie M G.
2010. Emergency Nurse and
Disaster Response : An
Exploration of South Australian
Emergency Nurses Knowledge and
Perceptions of Their Roles in
60
Kumajas M., Zaenal K., Kliwon H.,
Jailani H. 2012.
Community
Attitudes and Behavior and Its
Influence Towards Social Impacts
of Flood in TondanoRiver Estuary.
International Journal of Civil &
Environmental Engineering
Rundbald, G., Olivia K., Paul R H. 2010.
Communication, Perception and
Behaviour During a Natural
Disaster Involving a „Do Not
Drink‟ and a Subsequent „ Boil
Water‟ Notice: a Postal
Questionnare Study. BMC Public
Health
Lakhsmi. 2007. A Study to Assess The
Knowledge About Disaster
Preparedness Among Inhabitans in
A Selected Urban Area.
Departement of Community Health
Nursing. Bangalore
Rukaesih A. 2004. Kimia Lingkungan.
Yogyakarta
Sastroasmoro, S. 2011. Dasar – Dasar
Metodologi Penelitian Klinis.
Jakarta: Sagung Seto
Langan, J C and Dotti C J. 2005.
Preparing Nurses for Disaster
Management:
Saint
Louis
University School of Nursing
Scott W.E. ., R. M Iverson., S.P.
Schilling., Fisher V. 2000. Volcano
Hazard in the Three Sisters
Region, Oregon. U.S. Geological
Survey
Lavigne, F., Thouret J.C., Voight B.,
Suwa., Sumaryono A. 2000.
Lahars at Merapi Volcano Central
Java : an overview Journal of
Volcanology and Geothermal
Research Vol 1
Schein, E.H. 2004.
Organizational
Culture and Leadership-3rd
Edition. Jossey Bass, San
Fransisco
Sugiyono. 2012.
Metode Penelitian
Pendidikan. Bandung: Alfabeta
Notoatmodjo, S. 2010.
Metodologi
Penelitian Kesehatan. Jakarta:
Rineka Cipta
Susan and Sharon. 2010. Public Health
Nursing and the Disaster
Management Cycle : American
Red Cross
______. 2003. Pendidikan dan Perilaku
Kesehatan. Jakarta: Rineka Cipta
______. 2007. Promosi Kesehatan dan
Ilmu Perilaku. Jakarta: Rineka
Cipta
Sunaryo. 2004.
Psikologi
Keperawatan.
Jakarta:
Kedokteran EGC
Untuk
Buku
Oktarina, R. 2008. Pemetaan Sistem
Informasi
Logistik
Dalam
Penanggulangan Bencana di
Indonesia. http://journal.uii.ac.id/
Vulkanologi.
Sutikno, B. 2001.
Yogyakarta:
Sekolah Tinggi
Teknologi Nasional Yogyakarta
Priyanto, A. 2006. Promosi Kesehatan
Pada Situasi Emergensi. Edisi 2,
Jakarta
Triutomo, Sugeng. 2007. Pengenalan
Karakteristik Bencana dan Upaya
Mitigasi di Indonesi. Jakarta:Edisi
II, Bakornas PB
Renas PB. 2010. Rencana Strategis
Badan Nasional Penanggulangan
Bencana. 2010-2014. Jakarta
Twigg, J. 2009. Characteristic of a
Disaster Resilient Community.
University College London
RAN PB. 2006. Rencana Aksi Nasional
Pengurangan Risiko Bencana.
2006 – 2009. Jakarta
Udayangani, Kulatunga. 2010. Impact of
Culture Towards Disaster Risk
61
Reduction. Salford
University of Salford
UK:
The
UN/ISDR. 2004. Living With Risk: A
Global Review of Disaster Reduction
Initiatives. Geneva: United Nations,
International Strategy for
Disaster
Reduction
Vardiansyah, Dani. 2008. Filsafat Ilmu
Komunikasi Suatu Pengantar.
Jakarta: Indeks
Veenema, T G. 2006.
Expanding
Educational Opportunities in
Disaster Response and Emergency
Preparedness for Nurses. New
York: University of Rochester
School of Nursing
VUSSC. 2005. Introduction to Disastre
Management. Virtual University
for Small States of The
Commonwealth Version 1
WHO. 2011. Regional Case Study on
Role of Nurses and Midwives in
Emergencies and Disasters.
Regional Office for South – East
Asia
62
ANALYSIS MOTIVATION IN REVIEW OF THE COMPONENTS QUALITY OF
WORK LIFE EMPLOYEE PARTICIPANT AND CAREER DEVELOPMENT
Ratna Wardani
STIKes Surya Mitra Husada Kediri
ABSTRACT
Human resource enough with the quality of being high, professional, in accordance with
its function and the task of each personnel is one of indicator the success of hospitals. The
purpose of this research is to know the influence of components quality work of life to
motivation nurses in RSM ahmad dahlan kediri. Population a total of 85 a nurse with
using simple random sampling obtained the total sample 70 nurse. Pearson correlation in
use to know the relationship between a components of quality work of life against
motivation nurse. Regression analysis a liner with approach stepwise used to know the
influence of components quality work of life to motivation nurse. The results of the
analysis in knows that has employee participant and career development influential of
44.6% of motivation where employee participant having influence most dominant.
Keywords : career development, employee participant, nurse motivation
nurse always faced
with demands
idealism a profession and often to face a
range of kind of problems good friend of
the patients and fellow worker.
Service nursing in hospital was a
factor for the quality of service and citra
hospital in the citizens. And also to
participate in improve the quality of
health services, every nurse should have
motivation high that will get a good
performance. Motivation work here is a
condition / of circumstances that affect
someone to keep increasing, direct and
maintain his behavior that deals either
directly or indirectly with the
environment of work. Many factors that
can affect motivation nurse in
implementing responsibilities are in
hospital .
The results of the study Alzeira
(2010) claim that there was a correlation
between components quality work of
life to motivation work nurse so far in a
hospital Tugu 2010. Of all components
quality work of life in the survey pride
to institutions has a strong against
motivation work. From the description
above so research aims to understand the
relationship
between
employee
INTRODUCTION
The hospital is an organization that
formed specifically for the demands of
the needs of people increasingly
complex because people begin to realize
the importance of health. Thing that
since the hospital to give maximum
service to the community. (Amriyati,
2003), the demands will increase heavy
in the face of the era of globalization
now that the change very fast and
simultaneously when is not followed the
existence of resources improve our
mankind hospitals professional and
excellent.
In the hospital, besides profession
doctor, there are also nurse who had an
important role in terms of serve and care
for the sick directly. Of their duties
daily, a nurse often faced in an effort
rescue survival or the life someone.
(Kuntjoro, 2005), good service not
despite the presence of commitment
from a nurse to provide good service to
the patient. (Soeroso, 2003) In running
the role and functions, a nurse are
required to have skill, knowledge, and
concentration high. In addition nor a
16
participant and career development to
motivation employees in RSM Ahmad
Dahlan Kediri.
the driving force behind working spirit.
Strong and the weak motivation a work
of labor come determine big or small
outstanding achievements.
According to Herzberg (Anoraga
2009), system needs the underlying the
motivation, and is divided into two
parties, namely factor hygiene and factor
motivator. Herzberg found that factors
that raises satisfaction work different
from factors that raises dissatisfaction
work. Factors that cause satisfaction
work called factor motivator, which
includes the contents of work is factor
intrinsic from work itself, that includes:
responsibility, progress, work itself,
accomplishment, recognition. While
factors that raises dissatisfaction work
called factor hygiene, pertaining to the
context of work, and is factor extrinsic
from work, includes: administration and
health policy, supervisor, salary,
personal relationships, and working
conditions.
MOTIVATION
According to Edwin B Flippo in
Hasibuan (2007), motivation is a
expertise in driving civil servants and
organization to work more good that
desire civil servants and organizational
goals can be achieved. Thus, motivation
work employees are needed in order to
increase firm production.
The theory Mc Clelland argues in
(Hasibuan 2007) that employees have
stored potential energy, but how this
energy used dependent upon the strength
encouragement the motive for
employees and the situation that exists.
According to this theory is 3 things that
motivates someone.
First, needs
achievement became an propulsion that
motivate of work of someone.
Therefore, this need drives someone to
develop creativity and mobilize all
ability and energy to reach work
performance maximum. Someone will
realize that only on achieving work
performance high will be a greater
incentive. Second, the need for
affiliation be propulsion that will
motivate of work of someone. This need
including demand is to be accepted in
the neighborhood place to work, feeling
respected, feeling forward and not to
fail, and feelings participate. Hence,
motivation someone to fulfill the need
by using energy and develop itself in
order to finish the job. Third, the need
for power became an locomotion
motivation to reach chair or notch the
best. Competition is an appropriate way
to reach this need.
Nurse need to continue to be
motivated to improve its contribution to
because motivation is a source of
propulsion that closely related to labor
productivity, culture and scores of work
in organization. According to ( Anoraga
2009 ), motivation employment is
something raising of enthusiasm or
impulse. Because of that, motivation of
work in psychology commonly called
QUALITY OF WORK LIFE
According to Arnold and Feldman
(1986) in Anggraeni (2009), claim that
the quality of work life intended to
create conditions organization that can
help development employees to learn.
This is proven by the organization as
control the role of how employees does
its work and provide an opportunity to
occupation is to draw and meaningful
for employees so as to cause personal
satisfaction that can affect the
effectiveness of organization.
According to Cascio (2003), the role
of organization to improve the quality of
work life is a business to meet the needs
of employees both physical and
psychological made up of several
components, including:
1. employee participation according to
(Cascio 2003), an attempt
participation in employees may be
done by means form employee
involvement, employee participation
meeting, and quality improvement
teams.
2. Equitable
compensation,
compensation are related for its
17
employees as individuals, because
the size of the compensation is size
hard work the employees.
3. Job security, according to (Cascio
2003) security employees to work
can in achieving by an organization
in the form of retire and status
employees.
4. Safe
environment,
Work
environment having the effect on
labor productivity. If environmental
nice and safe it will cause additional
burdens for employees.
5. Pride, according to (Cascio 2003)
proud to institutions be able to be
implemented by means of
strengthen the identity and image
organization,
increase
the
participation of the community as
well as increase the awareness of for
the environment.
6. Career Development, according to
(Cascio 2003) career development
can be conducted by creating
education and training evaluation,
performance,
and
position
promotion.
7. Wellness, according to Sikula in the
Hasibuan (2005 ), to maintain
employees of a company provide
welfare in the form of compensation
indirect for the provision of facilities
and services.
8. Conflict Resolution, conflicts take
into consideration that there are
problems that need to be resolved in
a relationship, induce to commit
change within one person, grow
encouragement in a burden to solve
problem until now have not realized
that.
9. Communication, according to
(Notoatmodjo, 2007), two way
communication will easier to
understand each other and very help
develop relation which is satisfying
to both sides by created on good
cooperation.
According to (Usman 2009),
program the quality of work life can be
improving communication internal and
group,
improve
coordination,
motivation, and capabilities workers.
Thus programs are able to reach vision,
mission, nor the purpose of more
developed organization.
MATERIAL and METHOD
This research is research
quantitative uses the research
correlational with the approach crosssectional. Research methodology
quantitative can be defined as research
methodology based on philosophy
positivism, used to scrutinize in the
population or a given sample of, data
collection use of the instruments
research,
data
analysis
is
quantitative/statistics, for the purpose of
test a hypothesis that has been set. The
conclusion is the last step of the process
research of response to formulation
problems.
This research in doing in RSM
Ahmad Dahlan Kediri by the number of
a population of 85 nurse. Technique the
sample to research this is simple random
sampling by the number of sample 70
respondents. Stage data processing in
this research include univariate analysis
in used to do analysis on each variable
so that it can be in know the percentage.
Next done analysis bivariate by using
correlation analysis Pearson and to test
hypotheses, which is there are influence
components quality of work life to
motivation nurse use linear regression
multiple with the approach method
stepwise.
RESULT AND DISCUSS
Univariate Analysis
Table 1. characteristic of employees
RSM Ahmad Dahlan Kediri
Variabel
Freq
Percent
Age
< 25 year
25 – 35 year
> 35 year
Length of service
< 6 year
18
21
46
4
29.6
64.8
5.6
55
77.5
>= 6 year
16
Gender
Man
19
52
Women
Marital Status
Married
51
Not married
20
Education
D1/D2
8
D3
49
S1
14
Table 1 above can be knows that age
employees RSM ahmad dahlan kediri
majority exists by the age of 25 - 35
years as many as 46 respondents (64.8
%).To many years working most
workers having long works less than six
years 55 or 77.5 %. Gender respondents
most are women 52 or 73.3 %, with
married status almost all respondents
married as many as 51 respondents (71.8
%). Education respondents most of them
are d3 a total of 49 (69 %).
Bivariate Analysis
Table 2. Correlations component the
quality of work life against motivation
work nurses in RSM Ahmad Dahlan
Kediri
Variabel
p-value
Career development
0.003
Employee participant
0.000
Safe environment
0.040
Job Security
0.048
From table 2 above of nine
components quality of work life with the
motivation work nurses in RSM Ahmad
Dahlan the quality of only four variable
with links with the motivation work
nurse, namely career development,
employee participant, safe environment
and job security.
Multivariate Analysis
Table 3. The influence of components
quality of work life to motivation work
nurses in RSM Ahmad Dahla n Kediri
Variabel
p-value
Career development
0.000
Employee participant
0.000
Safe environment
0.124
22.5Job security
0.051
0.609
0.000
Sig (all variables)
26.8R-Square (2 variabel)
44.6
73.3R-square (4 variable)
44.0
In table 3 it can be in know that
71.8career development and employee
28.2participant affect motivation work nurse,
while safe environment and job security
11.3has not been affecting the motivation
69.0work nurse because the value of
19.7signifansinya more than 0.05. The
influence of fourth variable above to
motivation work of 44 % and influence
two variable the motivation nurse to
work of 46,2 %, while of 53.8 % in stir
by the other factors that not in minutely.
Of both variable above in know that
employee participant having influence
the most dominant to motivation work
nurses in RSM Ahmad Dahlan Kediri.
According
to
ivancenvich
konopaske & matteson in the
(ardiansyah 2009) the concept quality
work of life widely have been used for
increased the motivation work and
improving the condition of who has sent
down motivation such work. (Cascio
2003) outlines nine components quality
of work life consisting of the employee
participant, career development, conflict
r resolution, communication, wellness,
0.352job security, safe environment, equitable
0.608compensation, and proud. According to
0.245Harvey and Brown (Usman, 2009)
0.235quality of work life need to be created
by the Organization to provide balance
in employees in carrying out the work
and personal life.
Of correlation analysis person in
table 2, of the nine components quality
of work life only four component that
has relations with the motivation work
nurse. Career development has a enough
with the motivation nurse, employee
participant had strong ties with the
motivation work nurse, while safe
environment and job security has a weak
with the motivation nurse.
Of table 3 in know that of four
B
variable with links with the motivation
0.408
0.881work nurse, only two variable that has
0.305an effect on motivation work nurses in
RSM Ahmad Dahlan Kediri. Employee
19
participant is a component quality work
of life that has an effect most dominant
to motivation work nurse. The
involvement of nurse is part of the
program motivation derived from
facilities and the assumption described
by the experts and support relations of
persons in work environment. With
there is participation nurses will be
creating a sense of responsibilities of
each individual. In addition the
involvement of nurse to a sense of
belonging to institutions place the
employees work , namely RSM Ahmad
Dahlan Kediri. According to (Siagian
2004) employee participant is the way of
view as in see the extent to which an
employee first will then enclose in
determining decisions sendirl iti on that
job.
It is done to give liberty against the
employee to play an active role to
institutions place they work. The higher
their participant the more higher the
responsibility the employees to complete
the task in give. Efforts to improve
participation nurse can be done by the
leader of RSM Ahmad Dahlan by means
of follow enclose in the meeting,
involving an employee in each meeting,
and development of the quality of team.
The role of the head room to guide nurse
implementing. With the delegation of
given to nurses implementing so will
increase responsibilities and a sense of
belonging to institutions place to work.
The second variables that influence
the motivation work nurse is career
development, this is in accordance with
the (Haryono 2011) in studies conducted
in Hospital Hermina Bogor. In general
career is all forms of work done a during
his lifetime to meet the needs of ideal.
According to (Cascio 2003), career
development can be conducted by
creating education and training,
performance evaluation, and position
promotion. Thus the level of a career in
an institution will increased the
motivation an employee in his job. With
the career development will give
benefits can increase satisfaction work,
can dig potential self of an employee,
and will raise motivation work.
Competitive
environment
demanding RSM Ahmad Dahlan Kediri
to make standard competence nurse
through the level of career nursing that
the implementation of the quality of
service be well maintained. Allowance
level career nurse need to be done so
that each increase level of a career
which also was an improvement
competence nurse able to be rewarded in
a career that the program more effective
level. Thus the level of a career in an
institution make employee improve
quality of work and services provided to
patients more optimal in accordance
with standard minimum service.
CONCLUSION
Of the nine components quality
work of life there are two components
influential to motivation work nurse
namely career development and
employee participant.
Employee
participant into components the most
dominant and had strong ties with the
motivation work nurses in RSM Ahmad
Dahlan Kediri.
REFERENCES
Amriyati, S. S. (2003). Kinerja Perawat
Ditinjau dari Lingkungan Kerja
dan Karakteristik Individu
(Studi Pada Instansi Rawat Inap
Rumah Sakit Umum Banyumas
Unit Swadana Daerah).
Manajemen Pelayanan
Kesehatan, 8-11.
Anoraga, P. (2009). Psikologi Kerja
(Cetakan ke 5). Jakarta: Rineka
Cipta.
Ardiansyah, G. (2009). Pendelang
Pekerjaankatan Job Mapping
sebagai alat bantu dalam desain
u . Depok: Skripsi. Program
Studi Teknik Industri Fakultas
Teknik Universitas Indonesia.
Cascio, W. (2003). Managing Human
Resources : Productivity,
20
Quality of Work Life, Profit (6th
Ed). New York: McGraw-Hill.
Haryono, Y. (2011). Hubungan
Komponen Kualitas Kehidupan
Kerja dengan Motivasi Kerja
Perawat Pelaksana dan Bidan
di Rumah Sakit Hermina Depok.
Depok: Skripsi. Fakultas
Kesehatan Masyarakat
Universitas Indonesia.
Hasibuan, M. (2005). Manajemen
Sumber Daya Manusia Edisi
Revisi. Jakarta: Bumi Aksara.
Hasibuan, M. S. (2007). Manajemen
Sumber Daya Manusia (Edisi
Revisi). Jakarta: Bumi Aksara.
Kuntjoro, T. (2005 Vol. 8 No. 3).
Pengembangan Manaemen
Kinerja Perawat dan Bidan
sebagai Strategi dalam
Peningkatan Mutu Klinis.
Jurnal Manajemen Pelayanan
Kesehatan, 149-154.
Notoatmodjo, S. (2007). Promosi dan
Perilaku Kesehatan. Jakarta:
Rineka Cipta.
Siagian, S. (2004). Teori Motivasi dan
Aplikasinya. Jakarta: Rineka
Cipta.
Soeroso, S. (2003). Manajemen Sumber
Daya Manusia di Rumah Sakit.
Suatu Pendekatan sistem.
Jakarta: EGC.
Usman, J. (2009). Pengaruh Quality of
Work Life Terhadap Semangat
kerja di Pertamina Eksplorasi
dan Produksi Rantau. Jakarta:
Tesis Program Pascasarjana
Unversitas Terbuka.
21
STRATEGY ON HEALTH CARE PROTECTION
FOR THE POOR SOCIETY IN KEDIRI CITY
Koesnadi
Institute Of Health Surya Mitra Husada
Email :[email protected]
ABSTRACT
In general, a guarantee of Public Health (Assurance) has the goal of increasing access to
and quality of health services to the entire community, including the poor in order to
achieve an optimal degree of public health effectively and efficiently. This study
purposed to determine the strategy on health care protection for the poor society in
Kediri. This study was conducted in May to June 2015 using purposive sampling
technique. The approach taken in this study used a qualitative approach. This study took
place in Kediri. The informants are the patients who went to threat in Kediri. The data
showed that a. The services provided by health centers and hospitals according to the
informant was good b. according to all informants every patient should have a health
ansurance like Jamkesmas, Jamkesda or BPJS. c. The response of users health care are
very diverse among them say that using the health insurance may be light d. Almost all
informants said that at there were still obstacles they face, for example, when a family
member was sick and in need of further treatment, they are still difficult to get a room for
treatment because the room is full. e. Almost all respondents want to get legal protection
so that they could be treated safety, comfort and reached
Keywords: Strategy, protection, health care, the poor
of a good quality in itself and the health
ministry.Adisasmito (2007) mentions,
low health status of the poor due to
limited access to health services due to
geographical constraints and cost
constraints (cost barrier) .In addition, the
behavior of people who lack support a
clean and healthy lifestyle is also an
obstacle for the Government to promote
the development of society, especially in
the field of health (Adisasmito, 2007).
The quality of public health are low due
to the public awareness that is low for a
healthy life, a means of health
infrastructure beyond the reach of
community and economic levels of
society who are unable to meet the
needs of health, become a concern for
the developed countries that are
members of the United Nations ( UN).
Implementation of the constitutional
mandate on health insurance of citizens
and the implementation of the
declaration of the United Nations in
INTRODUCTION
Healthy living is a dream for every
human being, because the lives of
healthy people can carry out their
activities with full perfection, both
activities in conjunction with the creator
God Almighty, and the activities of
fellow human beings and their
environment to meet their needs.
Socioeconomic conditions are very
diverse, both in cities and villages, those
who worked as civil servants and private
employees, as well as company workers
and farm laborers, and others.
Differences in social and economic
strata of society, has also resulted in
differences in the degree of health.
Poverty is one obstacle to efforts to
increase well-being and quality of life.
The poverty rate is also the cause of the
poor are not able to meet the demand for
health services are relatively expensive
(Tiyayasih, 2011). However, the high
cost of health care is not the only cause
21
2000 on the Millennium Development
Goals (MDGs) or the Millennium
Development Goals, the Government of
Indonesia has set a policy on the
guarantee and protection of public
health, with the enactment of Law No.
40 Year 2004 on National Social
Security System (State Gazette of the
Republic of Indonesia Year 2004
Number 150, Supplement to State
Gazette of the Republic of Indonesia
Number 4456) called UU.SJSN, and
Law No. 36 Year 2009 concerning
Health (State Gazette of the Republic of
Indonesia Year 2009 Number 144,
Gazette of the Republic of Indonesia
Number 5063) called the Health Act. as
well as Law No. 24 of 2011 on the
Social Security Agency (State Gazette
of the Republic of Indonesia Year 2011
Number 116, Additional State Gazette
of the Republic of Indonesia Number
5256) called the Law of BPJS.
The philosophical foundation of Law
No. 40 of 2004 on National Social
Security System, as stated in the
preamble to weigh states: "a. that
everyone is entitled to social security to
be able to meet the basic needs of a
decent life and improve dignity towards
the realization of Indonesian society that
is prosperous, just and prosperous; b.
that in order to provide a comprehensive
social security, the country developed a
National Social Security System for all
Indonesian people ". Social security in it
is of public health insurance philosophy
is to bring people of Indonesia a
prosperous, fair and prosperous, and the
State ensure the implementation of
public health insurance, through the
National Social Security System.
As the providers of public servants,
hospital and health centers should
implement the law properly. That is,
should carry out duties as institutions
that provide health services to the
community as well as the obligations
mentioned above, including the poor
have either Jamkesmas card or no
Jamkesmas card, domiciled either in
Kediri or outside Kediri, if they require
health services at the General Hospital
of Kediri, they should be given good
service according to the authority given
by legislation, and not be rejected on the
excuses where the room does not exist,
or pay for the drug itself to the reason
the office of PT Askes closed on
holidays , as the mandate of the Social
Security Act and the Regulation of the
Minister of Health on the
implementation of the guidelines
Jamkesmas. The law must be
implemented well in order to create the
legal law which creates of public
welfare with free public health
guaranteed in hospitals. Based on the
background above, this dissertation take
the topic “STRATEGY ON HEALTH
CARE PROTECTION FOR THE
POOR IN KEDIRI CITY"
METHODS
Research
Design:
Qualitative
descriptive.
Place and Time: This study was
conducted in Kediri in May 2015
Population and Sample: The informant
as
much
as
15
people
In this study, the data collection
methods used by researchers is the depth
interviews with informants
RESULTS AND DISCUSSION
A.Result
1. The characteristics of informants
Informants research on health care
protection strategies of the poor in
Kediri are composed of 15 informants
include age, gender, job, holding health
cards
From these results obtained
informant characteristic data
are
housewives aged between 40 and 67
years. Based on the characteristics of
sex are all female. Based on all sex their
jobs are housewives. Health cards of the
characteristics possessed 9 using
Jamkesmas while others use BPJS.
From the results of research from day to
day care in health centers has improved.
But precisely the existing services at the
Hospital which according to one
informant is still lacking and not very
pleasant for the informant.
22
The Informant also says that in all health
centers and hospitals of all health
workers there suggest that poor patients
should have a health card such as
Jamkesmas, or Jamkesda or BPJS where
the cost for the treatment is cheap.
Almost all informants said that by using
the health card to be cheaper treatment,
drug - any drug can be obtained easily
and inexpensively. Even the fee can be
deducted from the salary of her husband.
Obstacles faced by the informant are
very wide - range for example, each
time going hospitalization rooms, the
rooms in the hospital are always full.
That's what always made them feel
uncomfortable.
All informants say he wants to get legal
protection for them as medical personnel
perform a medical act not in accordance
with the procedure. They want the
service at the Hospital of the best,
comfortable, safe, cheap and affordable.
well as guarantee to obtain medical care
from the state.
B. Discussion
Means and facilities to protect the
welfare of the community is felt by the
poor is very limited. This is because the
geographical situation in the region and
knowledge of the importance of health is
not maximum. And the public
perception is still less maximum of the
health card itself.
2. Obstacles in the implementation of
the protection of public health services
for the poor in Kediri.
Obstacles encountered in service is not
all government regulations and policies
known by the poor, as well as the
limited means and facilities available, as
well as the dedication of health staff in
providing services for the poor is not
maximized.
Low health status of the poor due to
limited access to health services due to
geographical constraints and cost
difficulties. Besides the behavior of
people who lack support a clean and
healthy lifestyle is also an obstacle for
the government to advance the
development of society, especially in the
field of health (Adisasmito, 2007)
1. The implementation of the protection
of public health services for the poor in
the city Kediri
The results showed that nearly all of the
patients who seek treatment either in the
clinic or are in the hospital using health
cards. And if they do not already have it
health staff recommends obtaining the
health card immediately
3. The model of the legal protection of
poor people in obtaining health services
in Kediri
Article 34 paragraph 3 of the 1945
Constitution states that "the State is
responsible for the provision of health
care facilities and viable
public
facilities”
"If it is about the protection it will be
related to the law, don‟t you , now I also
want to like it so that when there will be
an error due to actions taken by the
health staff as the poor we can be
protected" (informants 1)
Indonesian government policy set
national social security system aims for
the creation of social security including
public health insurance, which can be
enjoyed thoroughly by the community.
Legal protection
is a subjective
condition stating the presence of
necessity on ourselves a number of legal
subjects to quickly acquire a number of
sources, to the continued existence of
legal subjects that are guaranteed and
protected by law, so that its power is
organized in the decision making
process politically and economically,
Based on the above statement, it can be
interpreted that every Indonesian citizen
is guaranteed by the state to prosper and
unseen, dwelling and its surroundings as
23
especially in the distribution of
resources, both at the individual and
structural rankings (Hadjon, 1987)
2. It is imperative to improve the
socialization of all the rules and
policies for all medical staff and the
public in Kediri.
To obtain legal protection in the health
services, the government should be more
aggressively again to socialize on the
health service, so that people know and
are able to apply the program correctly.
References:
Achmad Ali, dkk (2012), Menjelajahi
Kajian Empiris Terhadap Hukum,
Kencana Prenada Media Group,
Jakarta.
CONCLUSIONS
AND
SUGGESTIONS
Conclusion
1.Poor people who seek treatment at
health centers and in hospitals all have
already used health cards to obtain
health services.
2.Obstacles encountered in service are
not all regulations and government
policies known by the poor, and there
are still many limited structures and
infrastructures and the available
facilities, as well as the dedication of
health staff in providing services to the
poor is not maximized.
Adisasmito,dkk
Kesehatan,
Jakarta.
(2007),
Rajawali
Sistem
Persada,
A.Mashur
Effendi
,(2005)
Perkembangan Dimensi Hak Asasi
Manusia
(HAM)&
Proses
Dinamika Penyusunan Hukum Hak
Asasi Manusia (HAKHAM), Ghalia
Indonesia
Andersen, Gosta Esping with (Duncan
Gallie, Anton Hemerijck and John
Myles) (2002), Why We Need a
New Welfare State. OXFORD
University Press Inc, New York.
3. Strategies that can be used are:
· Availability of legislation and
government policies is clearly
known, understood and performed by
health workers and the poor in
hospitals and health centers in Kediri.
· Availability of facilities and health
care facilities for the poor in
hospitals and health centers is
adequate in Kediri
· The availability of human resources
in health care services in hospitals
and health centers is dedicated to the
poor for the health services without
discrimination.
Annisa Rahmayanti (2012) Pencapaian
Tujuan Pembangunan Milenium di
Indonesia;
http://mdgsdev.bps.go.id/, download 7 Agustus
2013.
Anonim. 2008.
Bupati/Walikota
Segera Tetapkan Data Peserta
Askeskin.
http.V/prapatazom .
Diakses tanggal 18 September
2008.
Anonim. 2008. Karakteristik Pelayanan
Kesehatan. www.astaqauliyah.com
. Diakses tanggal 28 Januari 2009.
Suggestion
1. It is imperative that leaders in
hospitals and health centers instruct
all of their employees to apply the
motto 5 S (senyum, salam, sapa,
sopan, santun) = (smiles, greetings,
personal contact, polite, wellbehaved) in serving patients.
Alvin Y. So. 1990. Social Change and
Development,
Modernization,
Dependency and World-System
Theories.
London:
SAGE
Publications, Inc.
A.
24
Willan,James. 1990.
Hospital
Management.
MacMillan
Education Ltd., London.
Dedi Irawan (2010), RSUD Gambiran
Tidak Melayani Pasien Jamkesmas,
http://www.kedirijaya.com/2010/04
/09/ download 2 Mei 2012.
Arif Kurniawan (2009),
RSUD
Gambiran Abaikan Pasien
Jamkesmas
http://log.viva.co.id/news/read/110
824. download 2 Mei 2012
------------ (2011),RSUD Gambiran
Belum Siap Jalankan
Progra
Persalinan
GRATIS,
http://www.kedirijaya.com/2011/05
/28/, download 5 januari 2012.
Azwar, Azrul. 1995. Menjaga Mutu
Pelayanan Kesehatan : Aplikasi
prinsip Lingkaran Pemecahan
Masalah. Pustaka Sinar Harapan.
Jakarta.
------------- (2013), Sehari, Rumah Sakit
Pemkot Kediri Tolak 8
Pasien,http://www.kedirijaya.com/
2013/03/19/ download 19 Juli
2013.
Badan Pusat Statistik. 2006. Tingkat
kemiskinan di Indonesia Tahun
2005-2006. http://www. bps.go.
id.Di akses tanggal 19 Oktober
2008.
Edelman, Marc and Angelique
Hangerud.:
2006,
The
Anthropology of Development and
Globalization; From Classical
Political
Economy
to
Contemporary
Neoliberalism.
Blackwell Publishing, Malden MA
USA, Victoria, Australia.
Bahder johan nasution ,
hukum
kesehatan, Rineka Cipta, Jakarta,
2005.
Belch, G. E., and Belch, M. A. (2009),
Advertising and Promotion: An
Integrated
Marketing
Communication Perspective, 8th
Edition, New York: McGraw-Hill.
Brewer, Anthony (2000), Kajian Kritis,
Das Kapital Karl Marx, teplok
Press, cetalkan kedua, Jakarta.
Budiman, Aditya. 2012.
Kebijakan
Tentang Jampersal, Rokok, & Bok (
Biaya Operasional Kesehatan ).
http://adithia14.blogspot.com/201
2/04/kebijakan-tentangjampersal-rokok-bok.html.
Diakses tanggal 1 Maret 2013.
Edwards, Michael. (2004),
Civil
Society: Polity Press in association
with Blackwell Publishing Ltd,
Malden, MA 02148, USA .
Fitzpatrick, Tony (2001),
Welfare
Theory:
An
Introduction,
PALGRAVE, New York.
Goodin, Robert E. (1988), Reasons For
Welfare: The Political Theory of
the the Welfare State. Princeton
University Press, New Jersey.
B. Uno, Hamzah. 2007, Teori Motivasi
Dan Pengukurannya. Bumi Aksara.
Jakarta.
Handoko, Hani.
Sumberdaya
Yogyakarta.
Contterrell, Roger. 1992. The politics
of Jurisprudence: A Crititical
Introduction to Legal Philosophsy.
University of Pennsylvania Press,
Philadelphia.
Chamsyah, Bachtiar.
Penanggulangan
Kemiskinan.Rakyat
Books,Jakarta
.
1997. Manajemen
Manusia.
BPFE.
Kusumaatmadja,
Mochtar. 1986,
Pembinaan Hukum dalam
Kerangka
Pembangunan
Nasional. Binacipta . Bandung.
2006.Teologi
Levine, David P and Abu Turab Rizvi.
(2005),
Paverty
Work
Freedom; Political Economy and
the Moral Order, hal. 41
Merdeka-
25
Cambridge
Cambridge.
University
Press,
(SKTM) Di RSUD Dr Abdul Aziz.
http://one.indoskripsi.com.Diakses
tanggal 28 Januari 2009.
L.A. Hart. 1972. The Concept of Law.
The English Language Book
Society and Oxford University
Press, London-Great Britain.
Paton. G.W. 1969. A Text Book of
Jurisprudence. Oxford University
Press, Oxford.
Lili Rasyidi, dkk (2002), Pengantar
Filsafat Hukum, Mandar Maju,
Bandung.
Pemerintah Kota Medan. 2008. Dinas
Kesehatan
Kota
Medan
Tandatangani Mou Dengan 17
Rumah
Saikit
Rujukan
Jamkesmas.
www.pemkomedan.go. id.Diakses
tanggal 13 Nopember 2008.
Mahmud Marzuki, Peter. 2009.
Pengantar Ilmu Hukum, Kencana,
Jakarta.
Maksum, Mohamad (2009), Kedaulatan
Rakyat Tani : Kunci Keadilan,
Keberlanjutan dan Kesejahteraan,
Makalah Seminar Hari Bumi ke 29,
Satu Nama, Yogyakarta 22 April.
Manulang. M. (1996). Dasar-Dasar
Manejemen. Edisi XV, Bahasa
Indonesia. Jakarta.
M.
Hadjon. Philipus. 1987.
Perlindungan Hukum Bagi
Rakyat Indonesia.
Surabaya:
BinaIlmu.
M. Friedman, Lawrence. 1975. The
Legal System: A Social Science
Persfective. New York. Russell
SageFoundation.
Midgley, James (2005), Pembangunan
Sosial; Perspektif Pembangunan
dalam Kesejahteraan Sosial,
Deperta Depag RI, Jakarta.
Pemerintah Kota Medan. 2008.
Jamkesmas untuk Medan
412.249
Warga.
www.pemkomedan.go. id.Diakses
tanggal 13 Nopember 2008.
Prakoso, Hukum Asuransi Indonesia,
Rineka Cipta, Jakarta, 2004.
Prodjodikoro, Hukum Asuransi di
Indonesia. Intermasa, Jakarta,
1986. Djoko
Purwoko,
Bambang,
(2009),
"Membangun Keamanan Ekonomi
melalui
SJSN",
Makalah
disampaikan dalam Konferensi
Internasional tentang Pertumbuhan
yang insklusif yang disponsori oleh
GTZ di New Delhi, Oktober 2009 .
Rahardjo, Satjipto. 2000. Ilmu Hukum.
Bandung: Citra Aditya Bakti.
Nawawi, Hadani. 1990.
Metode
Penelitian Bidang Sosial. Gajah
Mada
University
Press.
Yogyakarta.
Radjagukguk,
Erman.1993,
Pembaharuan Hukum Memasuki
PJPT Kedua Dalam Era
Globalisasi. Majalah Hukum dan
Pembangunan, No. 6. Jakarta.
…………. 1995. Metode Penelitian
Bidang Sosial.
Gajah Mada
University Press. Yogyakarta.
…………. 1998. Menejemen SDM.
Gajah Mada University Press.
Yogyakarta.
Repley, John (2007), Understanding
Development, Theory and Practice
in The Third World, United Press
of America, Colorado.
Noveniawanata. 2008.
Pelayanan
Kesehatan Bagi Pasien Pemegang
Surat Kartu Tidak Mampu
Ritzer, George (1983), Sociological
Theory, Alfred A. Knoff Inc, First
Edition, New York USA
26
Susetiawan (2000) Konflik Sosial,
Kajian Sosiologis Hubungan
Buruh, Perusahaan dan Negara di
Indonesia, Pustaka Pelajar,
Yogyakarta.
Rothstein, Bo and Sven Steinmo.
(2002), Restructuring The Welfare
State: Political Institution and
Policy
Change.
Palgrave
MacMillan, New York.
Suryonoa, Agus (2011), Manejemen
Sumber Daya Manusia, Etika Dan
Standar Profesional Sektor Publik.
UB Press. Malang.
Rukminto, Isbandi. 1994. Psikologi,
Pekerjaan Sosial dan Ilmu
Kesejahteraan Sosial Dasar-Dasar
Pemikiran. PT. Raja Grafindo
Persada. Jakarta.
Syafei, Chandra. 2008. Jamkesmas &
Permasalahan
di
Sumut.
http://www.yaahowu.
com/?p=896.Diakses tanggal 13
Nopember 2008.
The
Schiller, Bradley R. (2008),
Economic of Poverty and
Discrimination Tenth
Edition.
Pearson Education, Inc, New
Jarsey.
Tabb, William K (2001) Tabir Politik
Globalisasi, Percetakan Lafandel
Pustaka, Yogyakarta.
Tiyasasih, Devitha Angesti, (2011),
Skripsi. Pelaksanaan penerapan
pasal 29 ayat (1) huruf b uu
nomor 44 tahun 2009 tentang
Rumah Sakit berkaitan dengan
Perlindungan Hukum bagi Pasien
Pengguna Jamkesmas (studi di
RSUD dr. M. Soewandhie
Surabaya),
Fakultas Hukum
Universitas Brawijaya.
Shrimp, T.A, (1997)
”Advertising,
Promotion and Supplemental
Aspects of Integrated Marketing
Communication”, The Dryden
Press.
Singarimbun, Nasri. 1989.
Metode
Penelitian Survey. LP3S. Jakarta.
Sobur, Alex. 2003. Psikologi Umum
Dalam Lintasan Sejarah. CV.
Pustaka Setia. Bandung.
Soehartono, Irawan. 2004.
Metode
Penelitian Sosial.
PT. Remaja
Rosdakarya. Bandung.
Thoha, Miftah. 1998.
Pelaku
Organisasi, Konsep Dasar Dan
Aplikasi. Raja Grafindo Persada.
Jakarta.
Soerjono Soekanto (1982), Kesadaran
Hukum dan Kepatuhan Hukum,
Rajawali Pers, Jakarta.
Tri wasono, hari (2010).Pasien Miskin
Tak Mendapat Tempat di RSUD
Gambiran.
http://www.tempo.co/read/news/20
10/04/09/ download
5
Januari 2012.
---------------,
2004.
Pokok-Pokok
Sosiologi Hukum, Radjagrafindo
Persada, Jakarta.
SP.Hasibuan,
Malayu.
(1999).
Manajemen Sumber Daya Manusia
, Dasar Dan Kunci Keberhasilan.
Haji Mas Agung. Jakarta.
Usman, Sunyoto.2003.Pembangunan
dan Pemberdayaan Masyarakat.
Pustaka Pelajar, Yogyakarta.
Suradmin (2010), Pasien Jamkesmas
Diminta
Bayar,
http://surabaya.tribunnews.com/201
0/10/31/ download tanggal 13
Oktober 2013.
Walgito, Bimo. 1999. Psikologi Sosial.
PT Rineka Cipta. Jakarta.
Wallerstein, Immanuel. 1989:
The
Modern World-System, vol. III: The
Second Great Expansion of the
27
Capitalist World-Economy, 17301840's. San Diego: Academic
Press.
http://adithia14.blogspot.com/2012/04/k
ebijakan-tentang-jampersal-rokokbok.html. diakses 02 Maret 2013
Warassih, Esmi. 2005. Pranata Hukum:
Sebuah Telaah Sosiologis. PT.
Suryandaru Utama, Semarang .
PERATURAN
UNDANGAN
Undang-Undang Dasar Negara Republik
Indonesia Tahun 1945 (UUD NRI
Tahun 1945)
Wibowo I dan Francis Wahono (ed)
(2003) Neoliberalisme, Cindelaras
Pustaka
Rakyat
Cerdas,
Yogyakarta.
World Health Organization.
Pendidikan Kesehatan.
ITB. Bandung.
PERUNDANG-
Undang-Undang Nomor 40 Tahun 2004
tentang Sistem Jaminan Sosial
Nasional (Lembaran Negara
Republik Indonesia Tahun 2004
Nomor 150, Tambahan Lembaran
Negara Republik Indonesia Nomor
4456),
Undang-Undang Nomor 36 Tahun 2009
tentang Kesehatan (Lembaran
Negara Republik Indonesia Tahun
2009 Nomor 144, Tambahan
Lembaran Negara Republik
Indonesia Nomor 5063).
1992.
Penerbit
Yoga Aditama, Tjandra. 2001.
Manajemen Administrasi Rumah
Sakit,Universitas
Indonesia,
Jakarta.
Yu J. 1998. Hospital & It’s Community.
Hospital Management International.
http://mediabidan.com/ruang-lingkupjaminan-persalinan/. diakses 02
Maret 2013
http://dinkes.jatimprov.go.id/contentdeta
il/12/2/132/jaminan_persalinan_ja
mpersal.html. diakses 02 Maret
2013
http://dinkes.bantulkab.go.id/berita/baca
/2012/04/23/084644/programjaminan-persalinan-jampersalkabupaten-bantul-tahun-2012.
diakses 02 Maret 2013
UU
No 13 Tahun 2003 tentang
Ketenagakerjaan
Peraturan Menteri Kesehatan Republik
Indonesia
nomor
03/MENKES/PER/V/2011 tentang
Pedoman Pelaksanaan Program
Jaminan Kesehatan Masyarakat,
Peraturan Menteri Kesehatan Republik
Indonesia nomor 631/Menkes/per/
III/2011 Tentang Petunjuk Teknis
Jaminan Persalinan
http://sehatnegeriku.com/mengupaskebijakan-jaminan-persalinan/.
Permenkes RI No. 631/ Menkes / Per /
III /2011 Tentang Petunjuk Teknis
Jaminan Persalinan. diakses 02
Maret 2013
http://www.gizikia.depkes.go.id/wpcontent/uploads/2011/05/BukuJuknis-Jampersal_Final_versicetak1.pdf. diakses 02 Maret 2013
Permenkes RI No. 2581 / Menkes / Per /
XII / 2011 Tentang Petunjuk
Teknis Pelayanan Kesehatan Dasar
Jaminan Kesehatan Masyarakat
http://www.depkes.go.id/downloads/PE
RATURAN_MENTERI_KESEHA
TAN_JUKNIS_JAMPERSAL.pdf.
Keputusan Menteri Kesehatan Republik
Indonesia
Nomor.
515/Menkes/SK/III/2011 tentang
Penerima Dana Penyelenggaraan
Jaminan Kesehatan Masyarakat
http://agus34drajat.files.wordpress.com/
2010/10/buku-saku-jampersal1.pdf.
28
A HELA CELL-IMPLANTED MOUSE MODEL OF CERVICAL CANCER
Yuly Peristiowati, Yenny Puspitasari
ABSTRACT
Cervical cancer constitutes the second leading cause of death to heart disease with a
prevalence of 100 to 350 in every 100,000 individuals annually. It is a primary cancer of
the cervix (cervical canal and/or portio). Carcinogenesis is a somatic event since the
accumulation of genetic and epigenetic changes cause changes in the normal regulation of
molecular control of cell proliferation. The purpose of the present study was to develop a
cervical cancer model by implanting HeLa cells into immunosuppressed mice. True
experiments were conducted with 5 DDY mice of 2 months in age and 2030 gr. in
weight obtained from the Integrated Research and Testing Laboratory (LPPT) 4 of
Gadjah Mada University. Mice were injected with 0.5 mg/kg of dexamethasone for 7
days to suppress their immunity. Furthermore, 1 ml (8 x 106 per microlite) of HeLa cells
was injected intracutaneously into the back of the mice. Mice were observed for
nodulation at the injection site. Upon reduction of nodule growth, dissection and
histopathological examination were carried out with hematoxylin and eosin (H&E)
staining. Results showed that the cutaneous tissue of HeLa cell-implanted mice had largesized cells, greater nuclear volume than that of the cytoplasm and cells losing contact
inhibition. The features of HeLa cells implanted into the cutaneous tissue resembled the
vaginal cytologic smears of patients with cervical cancer, in which the cells have been
washed away from the surface of the tumor or aspirated from the mass through a fine
needle.
Keywords: Model, cervical cancer, HeLa cells
HeLa cells can be used to test
antitumor
activity,
tumorigenic
transformation, cytotoxicity, cell
biology and bacterial invasion.
Morphologically, HeLa cells are
epithelial cells invaded by the human
papilloma virus (HPV) tope 18. The
cells are immortal and highly
aggressive, making it easy to invade
other cell culture/tissue (Doyle and
Griffiths, 2000). Among the grounds for
selecting HeLa cells for use in cervical
cancer research is that it has the p53
gene that can be induced by the tested
compound resulting in cell apoptosis
(Desaintes et al., 1999).
INTRODUCTION
Cervical cancer is a primary cancer of
the cervix (cervical canal and/or portio).
Half a million cases are reported
annually and the incidence is higher in
the developing countries. This is
potentially due to non-routine
implementation of Pap smear screening
programs. In Latin America, subSaharan Africa and Southeast Asia,
including Indonesia, cervical cancer
ranks second after breast cancer. In
Indonesia, it was reported the number of
new cases of cervical cancer was 100 in
100,000 women per year or 180,000
new cases aged 45 to 54 years.
Additionally, cervical cancer tops the
list of 10 most common cancers in
women. The course of cervical cancer
represents one model of multistep
carcinogenesis, beginning from earlystage carcinogenesis to changes in
morphology to invasive cancers.
Cervical cancer is caused, among
others, by infection
with Human
Papilloma Virus (HPV), leading to
abnormal changes in the cervical cells
(Riono, 1999). Human palpillomavirus
is a DNA virus infecting human skin
and mucous membranes (Desaintes et
27
al., 1997). When it infects a cell, the
HPV type 18 will express the proteins
E6 and E7 (Thierry et al., 1987, cited by
Desaintes et al., 1997). These proteins
are suppressor proteins that affect cell
proliferation and death. E6 binds to p53
to degrade p53 to prevent cells from
undergoing apoptosis, while E7 binds to
PRB, leading to cells‟ continuous
proliferation (Dyson et al., 1989, cited
by Desaintes et al., 1997).
hormones that enhance cell growth.
Albumin serves as transport protein,
lipids as cell growth support and
minerals as enzyme cofactor. All the
components of RPMI-serum media are
to provide the cells with sufficient
nutrients in order to survive and
proliferate (Freshney, 1987).
Furthermore, 1 ml (8 x 106 per
microlite) of HeLa cells was injected
intracutaneously into the back of the
mice. Mice were observed for
nodulation at the injection site. Upon
reduction of nodule growth, dissection
and histopathological examination were
carried out with hematoxylin and eosin
(H&E) staining.
The purpose of the present study
was to develop a cervical cancer model
by implanting HeLa cells into
immunosuppressed mice.
METHODS
The present study used the true
experiment design with 5 DDY mice of
2 months in age and 2030 gr. in weight
obtained from the Integrated Research
and Testing Laboratory (LPPT) 4 of
Gadjah Mada University. Mice were
injected with 0.5 mg/kg of
dexamethasone for 7 days to suppress
their immunity.
RESULTS
1.
Cervical cancer
induction
HeLa cell-implanted mice
of
Cancer in the present study was induced
by implanting HeLa cells into the back
of
immunosuppressed
mice.
Implantation was carried out by
injecting 8 x 106 HeLa cells per
microlite. Results showed 100% of the
mice developed nodules in their skin.
Induction of cancer produced local and
unmetastatic tumors. Intracutaneous
implantation of HeLa cells were aimed
at maintaining the cells in place. This
situation allowed for nodulation at the
implantation site.
HeLa cells obtained from the
LPPT 4 of Gadjah Mada University
were grown from the liquid nitrogen
storage with 70% ethanol. Cells were
transferred to a sterile conical tube
containing the RPMI 1640 medium.
Subsequently, cells were centrifuged at
325 g for 5 min. the pellets were added
with the growing medium containing
20% PBS. The cells were then grown in
a tissue culture flask and incubated at
37°C in 5% CO2. The confluent cells
were subsequently harvested and
washed with PBS without Ca and Mg.
Cells were released by adding 0.25%
trypsin and then 10 ml of RPMI 1640.
Cells were centrifuged for 5 min.
Furthermore, cells were added with the
growing medium 20% PBS to obtain a
concentration of 8 x 10 6/100 microlites.
The formed nodules were initially
soft in consistency since it contained
HeLa cell suspension but it then
changed to be hard in consistency on
day 3 of implantation.
The medium used in the HeLa
cell culture was RPMI 1640-serum since
it contains nutrients required by the cells
such as amino acids, vitamins, organic
salts and glucose, while serum contains
28
aspirated from the mass through a fine
needle.
Figure 1.
Nodules produced by
implantation of HeLa cells into the back
of mice. It appeared on day 3 of
intracutaneous implantation and was
hard in consistency.
Figure 3. The features of HeLa cells
implanted into cutaneous tissue. Results
of H&E staining (1000x magnification)
showed cells of similar size with the
nuclear volume larger than that of
cytoplasm. The cells were not adherent
to each other.
The growth of
nodules was
observed daily for 12 days. Nodules
began to appear
on day
3 of
implantation. It reached the optimum
value on day 8 and then began to decline
on day 9.
1
DISCUSSION
A cervical cancer modeling by intraepithelial implantation of 1.5 x 106 HeLa
cells into the skin tissue was made by
Marquez-Lemus et al. (2005) into the
legs of female nu/nu mice of 34 weeks
in age. It was capable of producing
tumors appearing on day
15 of
implantation without metastasis. The
nu/nu (nude) mice are genetically
mutated mice to have no thymic glands.
Thus, they cannot produce T cells
(lymphocytes) that play an important
role in the immune system, leading to
incapability to generate an immune
response. Therefore, nude mice cannot
reject a xenograft, or a tissue transplant
from other species.
Nodule Volume Curve
0
H1 H2 H3 H4 H5 H6 H7 H8 H9 H10H11H12
K3
K4
Figure 2. The curve of nodule volume
produced by implantation of HeLa cells.
2.
Microscopic features of HeLa
cells implanted into mice
Results showed that the cutaneous tissue
of HeLa cell-implanted mice had largesized cells, greater nuclear volume than
that of the cytoplasm and cells losing
contact inhibition. HeLa cells implanted
into the cutaneous tissue could not form
massive tumors. The features of HeLa
cells implanted into the cutaneous tissue
resembled the vaginal cytologic smears
of patients with cervical cancer, in
which the cells have been washed away
from the surface of the tumor or
The present study used DDY mice
of 2 months in age and 20-30 gr. in
weight. Mice were intramuscularly (IM)
injected with 0.5 mg/kg B.W. of
dexamethasone into their thigh for 7 days
aimed at depressing their immune
system. Dexamethasone is a steroid that
depresses the immune system. However,
it should not be used excessively since it
29
can damage the immune system of mice,
leading to death. Of 5 mice used in the
study, one was dead after dexamethasone
injection. The success rate of the
immunosuppression technique used in
the study was 100%, as evidenced by the
mice‟s appearing relatively weak and
losing appetite
after dexamethasone
injection.
However,
the
immunosuppression was also temporary;
thus, naturally the formed nodules would
shrink and eventually disappeared.
8 of implantation. This showed that the
cells
have been subjected to
inflammatory process due to stimulation
of HeLa cells implanted. Implantation of
HeLa cells into the cutaneous tissue
caused infiltration of neutrophils to the
implantation site, resulting in swelling in
the cutaneous
layer. A proper
intracutaneous implantation was shown
by the presence of cells in the cutaneous
layer.
Cancer cells have a morphology
different from that of normal cells (Price
1994). Thus, hematoxylin and eosin (H
& E) staining is required on the
emerging nodules. In the present study,
examination of HeLa cell- implanted
skin tissue (nodules) by the use of the H
& E staining method indicated largesized cells with pink nuclei and nuclear
volume larger than that of
the
cytoplasm. Cells were not adherent to
one another (loss of contact inhibition).
HeLa cells implanted into the citaneous
tissue could not form massive tumors.
One of the forms of immune
response to the implantation of cells is
inflammation. In the implantation site,
the pre-capilary arterioles will be dilated
and the post-capillary venules will be
narrowed, thereby increasing the local
blood flow. These events may cause
swelling and redness typical of
inflammation
(Campbell,
2004).
Swelling and redness can be clearly
observed after isolation of nodules.
Inflammatory responses are
initiated by the presence of chemical
signals. The chemical signals derive
from the invading organisms/cells. The
chemical signals are pro-inflammatory
cytokines, such as
histamine and
serotonin. Histamine produced
by
circulating leukocytes, called basophils,
and mast cells can be found in the
connective tissues. In the event of a
lesion, these cells stimulate the release
of histamine and trigger enlargement
and increase in capillary permeability.
Leukocytes and cells of damaged tissues
secrete prostaglandins which in turn will
increase blood flow to the injured site.
An increase in local blood flow and
capillary permeability will increase
macrophage migration to the injured
tissue. Furthermore, macrophages, along
with neutrophils, will phagocytize dead
(necrotic) tissues (Campbell, 2004).
The features of HeLa cells
implanted into the cutaneous tissue
resembled the vaginal cytologic smears
of patients with cervical cancer, in
which the cells have been washed away
from the surface of the tumor or
aspirated from the mass through a fine
needle (Price, 1994). Tumor cells have a
large prominent nucleus of irregular
shape and few cytoplasms (Damjanov,
2000).
REFERENCES
Campbell,
NA.,
Reece.,J.B
Mitchell.,L.G., Biologi, Edisi
ke-5 jilid 1, diterjemahkan oleh
Wasmen Manalu, Penerbit
Erlangga, Jakarta., 2004, hal
75.
Damjonov,
I.,Histopatologi,
di
terjemahkan oleh dr. Brahm U.
Pendit, cetakan ke-1, Penerbit
Medika , Jakarta., 2000, hal 65.
Desaintes,C., Goyat, S., Yanif.,M.,
Thierry, F. Papilomavirus E2
indus p53-independent apoptosis
Nodules
formed
after
implantation of HeLa cells contain
tumor cells and cells produced by
immune reaction. Results of the present
study showed that the optimum
termination was observed on days 7 and
30
in HeLa cells, Oncogene,1999.
18, 4538-4545.
Griffiths, G.D., Leek, M.D. and Gee,
D.J. The toxic plant proteins
ricinand abrin induce apoptotic
changes
in
mammalian
lymphoid tissues and intestine,
J. Pathol., 1987.,151,221-229.
Marquez-Lemus,
V.A., NoguezJuarez,B.M., Salano-Rodriguez,
L., Perez Zepata, A.J., RamonGallegos, E., Schneider-
Ehrenberg, O.P and Graue.
Wiechers, F. In vivo study of
Biological
Effects
of
Photodynamic Therapy on
Cervical Cancer,
Physica
Scripta 2005., 71,1-4.
Price, S.A. Patofisiologi: Konsep Klinis
Proses-Proses Penyakit , edisi
ke-4 buku 1, diterjemahkan oleh
Peter Anugerah, 119-120,
Penerbit
buku Kedokteran
EGC., 1994, Jakarta
31
THE EFFECT OF ELDERLY EXERCISE TO COGNITIVE DIMENSIA
ELDERLY FUNCTION IN “MAWAR”AGE CARE FACILITIES (PSLU) BLITAR
TULUNGAGUNG
Prima Dewi Kusumawati
Institute Of Health Surya Mitra Husada
Email:[email protected]
ABSTRACT
Elderly would decrease of nerve cells in the brain that would lead to dementia in the
elderly. Effective ways that could be used by the elderly to decrease aging process. The
aim of this study was to determine the effect of Elderly exercise to cognitive dimensia
elderly function in “Mawar” age care facilities (PSLU) Blitar Tulungagung.This study
design was quasi-experimental approach to One Group Pre Test - Post Test design. The
population all dimensia elderly in “Mawar” age care facilities (PSLU) Blitar
Tulungagung totaling 15 respondents with a total sampling method obtained a sample of
15 respondents. Results of statistical test Paired Samples T-Test p value 0.027 to 0.027
value <0.05 can be concluded that the H0 is rejected, which means there was influence of
elderly exercise cognitive function in dimensia elderly function in “Mawar” age care
facilities (PSLU) Blitar Tulungagung.Exercise elderly provides benefits that emotional
stress is reduced, the mind is more clear, the relationship between humans and the
atmosphere is more relaxed and happy, language skills and memory increases, people
become more passionate, more creative and efficient, people feel more healthy because
the stress is reduced.
Keywords: Exercise Elderly, Elderly Cognitive Function
Statistics, 2010). In the Asia Pacific
region, the number of elderly people will
increase rapidly from 410 million in
2007 to 733 million in 2025, and
estimated to be 1.3 billion by 2050
(Murwani, 2011).
INTRODUCTION
The process of aging and being aging is
a natural process that everyone
experiences (Atum, 2008). Entering old
age means setbacks, such as physical
deterioration characterized by sagging
skin, graying hair, beginning toothless,
lessening clear hearing, getting eyesight
worse, being slow motion, and not
having figure proportional (Nugroho,
2008).
The number of elderly people who are in
dormitory of PSLU Blitar Tulungagung
around 77 inhabitants, whereas in
Mawar dormitory of PSLU Blitar
Tulungagung, there were 14 people still
in good health. Elder is an old person
because of his old age changes the
biological, physical, psychological, and
social. This change will affect all aspects
of life, including health. Therefore, the
health for the elders needs special
attention while providing motivation for
the elderly people can live productively
based on their abilities (Health Act No.
36 of 2009 Article 138).
The elderly population in Indonesia in
2006 amounted to approximately 19
million (8.9%) with a life expectancy of
66.2 years, in 2010 amounted to 23.9
million (9.77%) with a life expectancy
of 67.4 years and in 2020 is estimated at
28.8 million (11.43%) with a life
expectancy of 71.1 years (the Central
Bureau of Statistics, 2010). The amount
includes the fourth largest after China,
India and Japan (the Central Bureau of
31
The increasing number of the elderly
population will be able to provide a
problem - the problem of disease in the
elderly. According to the Ministry of
Health in 1998, there was 7.2% of the
population aged 60 years and older up to
cases of dementia. A total of 5% of old
age 65-70 years suffers from dementia
and will double every 5 year reaching
45% at the age above 85 years
(Nugroho, 2008). Dementia is a disorder
of memory function that occurs slowly,
and can disrupt the performance and
daily activities (Atum, 2010).
The purpose of this study is to determine
the influence of exercise for cognitive
function from elderly people with
dementia in the Mawar Dormitory of
PSLU Blitar Tulungagung.
MATERIAL AND METHOD
Research design
Based on the research objectives, the
design of the study is quasiexperimental. The model used is the pre
and post-test without control.
Population and Sample Research
The design of the study is quasiexperimental design with pre and post
test without control. Sampling technique
in this research is total sampling where
all population can be sampled, and the
samples are elderly suffering from
dementia amounts to 15 people.
Independent variables of this study are
elderly exercise while the dependent
variable is the cognitive function in
elderly dementia. And data analysis uses
Paired sample t-test.
Dementia is marked with disturbances of
memorizing and learning something new
in short term, eloquence interference
(difficult to name objects and search for
words to speak), wrong about the place,
time, person or object, difficult to count,
unable to plan, organize, make decisions
and other things (Sumijatun, 2005).
The results of a preliminary study
conducted by researchers at Dormitory
of PLSU Blitar Tulungaggung are the
number of elderly people 80 and the
number of elders in Mawar Dormitory is
15 people. The results of interviews of
15 elderly people in Mawar Dormitory
of PSLU Blitar Tulungagung showed
that they often perceived in the
dormitory and often forgetful when they
put something, it is easy to forget the
names of fellow elders and often
confused when someone asks.
RESULTS
1. Characteristics of respondents
a. By age
The way to improve cognitive function
for the elders is a group therapy with
Reminiscene therapy is beneficial to
maintain individual identity and also can
improve the cognitive function, because
the elders will use his past to defend his
opinions and criticism (Johnson, 2005).
The other way to improve cognitive
function is Brain Gym or sports. It can
also use exercise for the elders to inhibit
the aging process. Exercise for elders
will not only facilitate the flow of blood
and oxygen to the brain, but also
stimulate both sides of the brain to work
(Tammase, 2009).
Figure 1 shows almost all
respondents are 60 -74 years (73%)
b. Based on Gender
32
Figure 2 shows most of the respondents
are male (53%)
Dormitory of PSLU Blitar Tulungagung
based on the research results of
cognitive value before being granted
elderly exercise the respondents with the
highest cognitive value was as much as
seven respondents (47%).
c. based education
According Pudjiastuti (2003), that
decrease of the cognitive function
ability due to morphological and
biochemical, decreased brain weight
for the elders due to a reduced
content of protein and fat in the brain
so that the brain becomes lighter.
Axons, dendrites and nerve cell
bodies experience many changes;
dendrites which serve as a means for
communication between nerve cells
change to become thinner and lose
cell contact between nerve cells,
nerve conductivity decreased so that
the movement becomes slow.
Figure 3 shows that the majority of the
respondents are no schooling (53%)
2. Characteristics of variables
a. MMSE before being given elderly
exercise
2. Cognitive Function after being given
elderly exercise for
Elders with
Dementia in the Mawar Dormitory of
PSLU
Blitar
Tulungagung
The results of the study are after being
given elderly exercise for Elders with
Dementia found that mild cognitive
score as many as 8 respondents (53%).
Figure 4 shows that most of the
respondents have moderate cognitive
function (47%)
There are several ways to cope with the
occurrence of dementia in the elderly,
both pharmacological and non
pharmacological. In this study, we use
non-pharmacological means by giving
for 15 minutes exerciser for the elders
every day for 3 days. In addition,
researchers are consistent with the
theory stated by an expert who
discovered the exercise movements for
elders stating that therapeutic exercise
for elders conducted over 1 time a day
within 15 minutes for 3 days, on a
regular basis can reduce the decline in
cognitive function (Denisson, 2009).
b. MMSE after being given elderly
gymnastics
Figure 5 shows that most respondents
have mild cognitive functions (53%)
3. The effect of elderly exercise for the
elders with Dementia on Cognitive
Function In the Mawar Dormitory of
PSLU Blitar Tulungagung based on the
statistical test result with Paired sample
Discussion1. Cognitive Function for
Elderly people with Dementia before
given elderly exercise the Mawar
33
t-test p value 0.027 thus obtained 0.027
<0.05 it can be concluded that the H0 is
rejected, which means that there is
influence of elderly exercise with
cognitive function for the elders with
dementia in the Mawar Dormitory of
PSLU Blitar Tulungagung. The results
showed that elderly exercise for the
elders is significantly beneficial in
improving the cognitive function of
elderly people with dementia proved by
the meaningful score results in cognitive
function after being given elderly
exercise.
The result of this study is expected to
provide objective information and
feedback related to the handling of the
elderly people who have dementia to
optimize cognitive function by elderly
exercise. For elderly people with
dementia is expected to do elderly
exercise regularly.
3. For Researcher
The result of this study is expected to
add the knowledge and experience for
the researchers themselves in conducting
research on elders with dementia,
especially in optimizing cognitive
function by elderly exercise.
Conclusion
1. It was found that before doing elderly
exercise 15 mostly elderly respondents
have moderate cognitive functions are
seven respondents (47%).
4. For further research
The result of this study is expected to be
used as a source of information in future
research as well as other measures such
as cognitive therapy to optimize
cognitive function for elderly people
with
dementia.
2. It was found that after doing elderly
exercise 15 respondents mostly elderly
people have mild cognitive functions i.e.
8 respondents (53%).
3. Based on the research showed the
value of .8667 and a pre-test to post-test
value of 1.4000 so that it could be seen
an increase in cognitive function before
and after treatment 5,333. Whereas the
results of statistical test Paired Samples
Test using SPSS with = 0.05. P value
0.027 to 0.027 value <0.05 it can be
concluded that the H0 is rejected, which
means that there is an influence of
elderly exercise with cognitive function
for elderly people with dementia in the
Mawar Dormitory of PSLU Blitar
Tulungagung.
Bibliography
Dahlan, Sopiyudin. 2008. Statistika
Untuk
Kedokteran dan
Kesehatan. Jakarta : Salemba
Medika
Dennison, Paul E,. Gail E. Dennison.
2008. Buku Panduan Lengkap
Brain Gym. Jakarta : Grasindo
Depkes RI. 2008. Pedoman Pembinaan
Kesehatan Usia Lanjut Bagi
Petugas kesehatan. Jakarta :
Direktorat Pembinaan Kesehatan
Masyarakat.
Suggestion
Hartati. 2010. Clock Drawing : Asesmen
Untuk Demensia. Semarang :
Fakultas Psikologi Universitas
Diponegoro.
1. For Respondents
The result of research on elderly
exercise therapy is expected to be used
for pre-seniors with dementia and to
prevent the occurrence of a more severe
degree
of
dementia.
2. For Elder Dormitory of PSLU Blitar
Tulungagung
Jonhson, M.H,. 2005. Developmental
Cognitive Neuroscience, Edisi 2.
Oxford : Blacwell Publishing
34
35
36
SOCIAL INTERACTION EFFECT THE RECURRENCE OF
CORONARY HEART DISEASE PATIENT IN POLI JANTUNG
RSUD Dr. MOHAMAD SALEH PROBOLINGGO
Nia Sari
STIKes Surya Mitra Husada
ABSTRACT
The recurrence is a condition of the patient when arissing the same symptom
which is like before dan makes the patient must nurse back. The condition arround or the
society that is full of stress with dietary habit that is not healthy can cause someone
infected a heart attack. The purpose of this research is for analyze the effect of social
interaction on the recurrence of coronary heart disease patients. The kind of this research
used quantitative approach with cross sectional design. The data is got by using a
questioner paper for social interaction and medical record for recurrence. The totality of
the samples that are taken in this research are 57 respondents By “Simple Random
Sampling”. This research on February until Juni, 2015. From 57 respondent which is
researched, 71,93 % of the respondents gets relapse and 28,07% of the respondents gets
relapse over the last month. From 71,935 of the respondents who is relapse, 21,1% has a
bad social interaction.The test results of Logistic Regresion with α = 0,05 got the variable
result which is influenced significant on recurrence is social interraction (p=0,026). To
prevent the recurrence of coronary heart can be done by healthy social interaction in
communities.
Key words : Coronary Heart, Social Interraction, Recurrence
35
heart disease (CHD), 23.73% of primary
hypertension, 18.9% of heart failure,
myocardial infarction 7.5% and there are
still some other heart disease. From the
above results it can be concluded that
patients with coronary heart disease
continues to grow each year, and CHD
is also the largest type of heart disease
during 2014 in the Hospital Dr.
Mohamad Saleh Probolinggo.
INTRODUCTION
Indonesia today has a double burden in
the face of disease problems. On one
side of communicable diseases are still
high even tends to increase, on the other
hand non-communicable diseases are
generally classified as degenerative
disease began to increase. One of the
degenerative disease is the leading cause
of death is coronary heart disease
(CHD). The disease is generally caused
by the behavior or unhealthy lifestyle
(Notoatmodjo,
2011).
Cardiovascular disease (CVD) is the
leading cause of death in many develop
countries and looks for a rising trend as
a cause of death in many developing
countries. Coronary heart disease (CHD)
is the cause of that need more in-depth
attention to the developing countries.
Impact of economic progress, the rapid
eradication of infectious diseases. As a
consequence, on the other hand CHD
shifted into the main cause of death in
which previous infectious disease is the
leading cause of death. High levels of
plasma total cholesterol, arterial
hypertension and smoking are three
major risk factor for CHD.
Hipercholesterolemia occupies a very
important
position
because
hipercholesterolemia is the only risk
factor that can lead to the onset of
artherosclerosis. Diet
is related to
hipercholesterolemia. Diet is one of the
main environmental factors causing
coronary heart disease through blood
cholesterol. The scientific evidence in
recent years shows the importance of the
role of social factors as determinants of
the health status of non-communicable
diseases, especially in this case
cardiovascular disease (Bulletin of
Health
Indonesia,
2012).
Based on data obtained from cardiac
poly Hospital Dr. Mohamad Saleh
Probolinggo, it was found that each year
the number of patients with heart disease
is increasing. The increase in the number
of patients with heart disease from 2013
to 2014 increased from 8191 to 10.311
patients or 25.88%. The percentages of
30.73% of heart disease is coronary
MATERIALS AND METHODS
RESEARCH
This study uses a quantitative approach,
using cross sectional design. Social
interaction data obtained using a
questionnaire. While the variable
dependentnya is recurrence outpatient
coronary heart disease (CHD). The
population in this study were all
outpatients coronary heart disease
(CHD) in the heart poly Hospital Dr.
Mohamad
Saleh
Probolinggo.
On average there are 66 patients a week
which will be used as the study
population. Samples are taken as many
as 57 respondents,
with "Simple
Random Sampling" technik. Data
analysis using logistic regression.
RESULTS
Characteristics of the subjects in this
study include sex, age, education level
and occupation. The description of the
characteristics of variables as in table 1.
Table 1. Characteristics of Research
Based on gender, age, education level
and occupation.
No
Karakteristik
1
Sex
Male
Female
2. Age
<50 th
≥50 th
Education level
3
SD
SMP
SMA
PT
36
N
%
33
24
57,89
42,11
9
48
15,79
84,21
9
8
27
13
15,79
14,04
47,37
22,81
4
5
6
7
Occupation
Swasta
PNS
Tdk bekerja
Social Interaction
Good
Bad
Smoking
Smoker
No
Recurrence
yes
never
Total
14
12
31
24,56
21,05
54,39
44
13
77,19
22,81
3
54
5,26
94,74
41
16
57
71,93
28,07
100
Hospital Dr. Mohamad Saleh
Probolinggo showed that of the 57
respondents surveyed, 13 respondents
(22.81%) had a poor social interaction,
and 44 respondents (77.19%) have a
good social interaction. Of the 13
respondents who have poor social
interaction, the average of them is a man
who does not work and aged over 50
years. Social interaction is said to be bad
because most of them are rarely interact
or cooperate with groups in the
community such as for example,
Posyandu elderly, spiritual groups,
group gathering and so forth. So that
they are the elderly tend to be aloof and
less interaction with groups in the
community, so the majority, or 10 of 13
respondents poor social interaction, they
tend
to
experience
stress.
According Soekanto 2006, social
interaction is the key to all social life. In
the absence of communication or
interaction between each other then
there may be a life together. If only the
physical line of sight between each
other, can not produce a form of social
groups can interact. And the age factor
also affects the elderly lazy to interact
and cooperate with social groups
because they feel he is old, their ability
to interact with and adapt to already not
optimal due to the aging process.
Based on Table 1 it can be seen that the
majority of respondents are male as
many as 33 people (57.89%), aged more
than 50 years as many as 48 people
(84.21%) and have a high school
education level as many as 27 people
(47 , 37%), most respondents do not
work as many as 31 people (54.39%),
the majority of respondents have a good
interaction as many as 44 people
(77.1%), there are three (5.26%) of
respondents who have smoking as many
as three people, as many as 41
respondents (71.93%) experienced a
recurrence.
Table 2. Results
regression analysis
Variabel
Social Interaction
of
the
logistic
Sig.
OR
0,026
3,576
Recurrence Outpatient Coronary Heart
Disease in Space Poly Heart Hospital
Dr. Mohamad Saleh Probolinggo
Recurrence is a condition in which the
patient's symptoms are the same as
before and the resulting patient should
be nursed back (Andrew, 2008). Family
with full of stress can trigger a heart
attack. In people who are susceptible to
heart disease in need of attention and
recognition of risk factors that exist in
people and that immediate action can be
taken against these patients in a short
time in order to avoid complications that
can bring unintended consequences.
According to Niven, in 2005 the factors
that influence relapse is noncompliance,
depression, behavioral patterns, and the
individuals
themselves.
P value of social interaction = 0.026 <α
= 0.05, which means that H0 is rejected.
Results of logistic regression test
showed no significant influence of social
interaction with the patient relapse. And
the value of OR = 3.576, which means,
the worse the social interaction of a
patient then the person is more likely to
relapse 3 times greater compared with
patients who have good social
interaction.
DISCUSSION
Social interaction outpatient coronary
heart disease (CHD) in the heart poly
37
Based on the results of a study of
outpatient coronary heart disease (CHD)
in the heart poly Hospital Dr. Mohamad
Saleh Probolinggo found that of 57
respondents surveyed, as many as 41
people (71.93%) experienced a relapse
and 16 did not have a relapse or 28.07%.
From the results of cross tabulation
between respondent characteristics with
recurrence as many as 23 respondents
(40.4%) who experienced a relapse-sex
male, 33 respondents (57.9%) who
experienced recurrence over 50 years,
14 respondents (24, 6%) who
experienced a relapse are college
graduates and 24.6% of high school
graduates, and as many as 22
respondents (38.6%) who did not work
also experienced a relapse.
Conclusion
1. Social interactions in outpatients
coronary heart disease (CHD) in the
Hospital Dr. Mohamad Saleh
Probolinggo showed that 13 respondents
(22.81%) had a poor social interaction,
and 44 respondents (77.19%) have a
good
social
interaction.
2. Results of statistical test by using
logistic regression showed no significant
influence of social interaction with the
patient
relapse.
Suggestion
1. Patient and Family Outpatient CHD
a. Outpatient coronary heart disease
should have to further enhance friendly
relations
with
their
peers.
b. For families of patients should
continue to provide support and keep
control of the activities conducted in
order to maintain the health of the
patient.
2. For Hospital Dr. Mohamad Saleh
Probolinggo
Can be added to the program of
relaxation for people with coronary heart
disease, such as the holding of yoga to
reduce stress levels and maintain the
health
of
CHD
patients.
3. For Educational Institutions
Once this study is expected to further
research to follow up on other factors
that influence relapse patients with
coronary
heart
disease.
4.
For researchers Coming
Once this study is expected to further
research in order to pay more attention
to the frequency of recurrence of CHD
patients.
REFERENCES
Albery I.P dan Munafo, M.
2011.Psikologi
Kesehatan
Panduan
Lengkap
dan
Komprehensif Bagi Studi
Psikologi
Kesehatan.Yogyakarta : Palmall
Arikunto, Suharsimi. 2010. Prosedur
Penelitian suatu Pendekatan
Praktik. Jakarta : Rineka Cipta
Feldman, Robert S. 2012. Pengantar
Psikologi
(Understanding
Psychology). Jakarta : Salemba
Humanika.
Hidayat, Alimul. 2011. Riset
Keperawatan dan Penulisan
Ilmiah.Jakarta : EGC
Kabo, Peter. 2008. Mengungkap
Pengobatan Penyakit Jantung
Koroner. Jakarta : Gramedia
Pustaka Utama
Niven, Neil. 2005. Psikologi Kesehatan
Pengantar untuk Perawat &
Profesional Kesehatan Lain.
Jakarta : EGC
Notoatmodjo, Soekidjo.2011. Kesehatan
Masyarakat Ilmu &Seni. Jakarta
: Rineka Cipta.
Ridwan, Muhamad. 2009. Mengenal,
Mencegah, Mengatasi Silent
Killer Jantung Koroner.
Semarang : Pustaka Widyamara.
Sugiyono. 2013. Metode Penelitian
Kuantitatif Kualitatif dan R &
D. Bandung : Alfabeta
Supriyono, Mamat.2008. Faktor-Faktor
Resiko yang Berpengaruh
terhadap Kejadian Penyakit
Jantung
Koroner
pada
Kelompok Usia <45 Tahun.
Tesis.Semarang : Universitas
Diponegoro, 13-34
Soekanto, Soerjono. 2006. Sosiologi
Suatu Pengantar. Jakarta : Raja
Grafindo Persada.
Wilkinson, Greg. 2005.Stres.Jakarta :
Dian Rakyat
38
39
THE EFFECT OF PHASE I CARDIAC REHABILITATION ON ACTIVITY
TOLERANCE
OF PATIENTS WITH CORONARY HEART DISEASE
Sutrisno
STIKES Surya Mitra Husada Kediri
Email :[email protected]
ABSTRACT
Phase I cardiac rehabilitation program is one of the efforts to achieve a functional level
that allows patients to perform their own activity early in preparation to carry out daily
activities at home and yet, to prevent unfavorable effects of prolonged bed rest. This
program needs to be implemented as soon as possible in patients who have stable
hemodynamics since in ICU/ICCU until the time to discharge from the hospital. The
purpose of this study was to identify the effect of phase I cardiac rehabilitation toward
activity tolerance in patients with Coronary Heart Disease. The design of the research was
a quasi experiment design with post test only non-equivalent control group. The sample
was 24 respondents. The measurement tools used the Barthel index, six-minute walking
test, digital sphygmomanometer and digital oxymeter. The results showed that there is a
significant difference in the ability to perform ADL (p value=0.004), but there is no
significant difference in systolic blood pressure (p value=0.875), diastolic blood pressure
(p value=0.179), SpO2 (p value=0.920), pulse (p value=0.428), and the maximal VO2 (p
value=0.220) between the intervention and control groups after being given the phase I
cardiac rehabilitation. Further, the ability to perform activities (ADL) of respondents in
the intervention group is significantly higher than the control group and the maximal VO 2
values of the intervention group shows a better value than respondents in the control
group. It can be concluded that phase I cardiac rehabilitation exercise have an effect on
the tolerance activity in patients with CHD. Therefore, nurses as part of a cardiac
rehabilitation program team are expected to assist patients in improving their adaptability
on tolerance activity.
Keywords: phase I cardiac rehabilitation, tolerance activity, coronary heart diseases
(CHD)
recognized to have the largest
proportion
causes
of
death
cardiovascular diseases (48%), followed
by cancer (21%), and chronic respiratory
diseases (12%).
INTRODUCTION
Coronary heart disease is a disorder of
the coronary arteries due to a block or
plaque of atherosclerosis. The term
atherosclerosis comes from the Greek
meaning intima thickening of the
arteries (sclerosis, thickening), and
accumulation of lipids (athere, pasta)
which characterizes the typical lesions
(Lewis, Dirksen, Heitkemper, Bucher,
and Camera, 2011). WHO statistics
(2012) describes the global mortality
estimate of 57 million in 2008, 36
million (63%) are caused by noncommunicable diseases. Risk factors for
non-communicable diseases that are
Coronary heart disease is causing the
reduced amount of oxygen needed by
the myocardium.
If the oxygen
requirement is not met according to the
needs, it will cause myocardial
ischemia. Conditions such as this will
reduce cardiac contraction and
movement disorder if persistent occur
which eventually causes hemodynamic
changes of the body. Furthermore, the
left ventricular function will decrease
39
and may reduce cardiac output with
reduced stroke volume (the amount of
blood ejected each time the heart beats).
One result of the decreased cardiac
output or low perfusion and decreased
peripheral blood flow causes weakness /
fatigue in patients (Anderson &
McCarty, 2005).
Improve Physical Functioning in
Refractory Angina: A Pilot Study. The
results showed
that after cardiac
rehabilitation, patients showed an
increase in physical abilities compared
with patients in the control group the
level of achievement Progressive Shuttle
Walk (p value = 0.005) and the total
distance (p value = 0.015).
Weak conditions in patients with
coronary heart disease requires the
patient should reduce physical activity
with complete bed rest to reduce the
heart's work and the need for oxygen in
the body. Bed rest is given to patients
with coronary heart disease because of
weakness or fatigue caused by the
prognosis of the disease. However, total
bed rest can increase the activity
intolerance in patients. The impact that
occurs when the patient does not do
early mobilization or physical activity
gradually cause bad effects to the
physical condition of the body. This is in
line with research conducted by
Dolansky et al (2010) which says that a
physical disability due to heart disease
occur because of decreased aerobic
capacity and threshold / tolerance to
perform physical functions.
Research on cardiac rehabilitation phase
1 has also been carried out in Indonesia
by I Made Mertha (2010) with the title
PengaruhLatihanAktifitasRehabilitasiJa
ntungFase I TerhadapEfikasiDiri Dan
KecemasanPasienPenyakitJantungKoro
ner Di RsupSanglah Denpasar with the
results of data analysis showed that there
is a significant influence of exercise
activities to increase self-efficacy (p
value = 0.001), and to decrease anxiety
respondents (p value = 0.001) after the
exercise intervention activities.
Phenomenon above shows the immense
possibilities for patients with coronary
heart disease activity intolerance, but
because the disease process is also due
to the effects of totall bed rest or not
carried out his early mobilization after
patients got hemodynamically stable
condition. Research on the effect of
cardiac rehabilitation phase I to increase
activity tolerance in patients with CHD
has not been widely described in the
nursing research in Indonesia. Therefore
this research was conducted
to
determine “The Effect of Phase I
Cardiac Rehabilitation on Activity
Tolerance of patients with Coronary
Heart Disease”.
Management to overcome the negative
effect caused by coronary heart disease
and to prevent the re-admission of
patients to the hospital with the same
complaint, the cardiac rehabilitation
program can be administered to patients
ranging from hospitalization to longterm maintenance program / outpatient.
According to The National Hearth
Foundation of Australia (2004), cardiac
rehabilitation are all measures that are
used to help people who suffer from
heart disease reactive, achieving life
satisfaction and prevent a recurrence of
heart disease.
METHOD
The research design was quasiexperimental research design with posttest-only non-equivalent control group.
The number of samples in thisresearch
as many as
24 respondents, the
respondents were divided into two
intervention and control. The inclusion
criteria respondents, namely (1) Patients
with a diagnosis of CHD were treated in
the ICCU was continued in a regular
patient room. (2) Willing to be a
Other studies of cardiac rehabilitation
program in patients with coronary heart
disease are also carried by Asbury,
Elizabeth Webb, Probert, Wright,
Barbir, Fox, & Collins, (2012) with the
title of Cardiac Rehabilitation to
40
responder. (3) Patients are invited
smooth
communication.
While
exclusion criteria: (1) Angina that
continues/uncontrolled, (2) heart block
degree two or three, (3) Patients CHD
haemodynamic not stable (systolic> 200
mmHg, diastolic> 110 mmHg,
tachycardia/HR>
130x/mnt,
hypotension), (4) the ventricular or atrial
arrhythmias are severe, (5) Patients with
coronary heart disease with
complications such as arrhythmias,
congestive heart failure (CHF)
functional class III-IV, (6) Patients with
CHD muskulosketal system problems.
Sistolik
Diastolik
Frekuensinadi
SpO2
116.82
117,53
76.86
81,94
84.79
81,66
97,5
97,5
10.88
11,14
9.09
8,84
10.69
8,18
0,89
0,44
Tabel 1.2
Distribution of respondents by VO2 max and
ADL on the sixth day (n1 = n2 = 12)
Variabel
VO2
Analysis of the data used is the analysis
of univariate and bivariate. The
statistical test used for bivariate analysis
is independent t test test (for normal
numerical variables) and test Mann
Whitney test (for numerical variables
are not normal) (Hastono, 2001).
ADL
Kelompok
Intervensi
Kontrol
Intervensi
Kontrol
Mean
19.14
16.86
97.08
87.50
SD
5.20
3.43
5.42
7.54
In the bivariate analysis showed that the
values obtained are not significant (p
value> 0.05) from the average variable
pulse rate, systolic blood pressure,
diastolic blood pressure and SpO2 after
intervention for five days in both the
respondents both intervention and
control, it is showed no significant
difference between the two groups. On
the sixth day ADL measurement values
obtained are significant (p value =
0.004), which says there is a significant
difference between the intervention
group and the group. While the variable
VO2 max no significant difference (p
value = 0.22) between the intervention
and control respondents.
Result
Characteristics of respondents or
confounding variables in this study
obtained. On this research, the mean age
of the respondents is at 55.29 years, with
the majority of the male sex 18 (75%).
History of smoking among respondents
obtained more than half of the
respondents do not smoke are 14
(58.33%) of respondents, and in this
study the majority of respondents have a
body mass index of obesity as many as
17 (70.8%) of respondents.
Characteristic variable pulse
systolic blood pressure, diastolic
pressure, SpO2, VO2 max, and
data can be seen in Table 1.1 and
1.2
Intervensi
Kontrol
Intervensi
Kontrol
Intervensi
Kontrol
Intervensi
Kontrol
Discussion
Effect of cardiac rehabilitation phase
I of the systolic blood pressure,
diastolic blood pressure, pulse rate
and SpO2 responder after
intervention.
rate,
blood
ADL
Table
Tabel 1.1
Distribution characteristics of respondents
based on the average of the mean pulse
frequency of blood pressure (systolic and
diastolic) and mean SpO2 post
intervention and control interventions
respondents (n1 = n2 = 12)
Variabel Kelompok Mean SD
Results of this research showed a mean
systolic blood pressure intervention
respondents less than control
respondent, it is possible to intervention
respondents have started a process of
adaptation to the condition of the body
because it has given physical activity
exercises for five days. So that
41
hemodynamic conditions began to
change when the body perform physical
activity. Physical exercise regularly and
continuously will cause the body's
adaptive changes. This is consistent with
research that studies conducted Stem &
Cleary (1982) that regular exercise will
lower systolic blood pressure. This
research is in line with the literature that
suggests that exercise regularly and
continuously can provide chronic effects
on the body as a decrease in systolic
blood pressure through the process of
spending Nitrite oksit a potent
bronchodilator after four weeks of
exercise (Gormley& Hussey, 2005).
In this research, the mean diastolic
blood pressure values
in control
respondents is higher than intervention
respondents. It is possible
the
intervention of respondents have started
a process of adaptation to the condition
of the body because it has given
physical activity exercises for five days.
As in systolic blood pressure response.
Based on the theory of physical activity
exercises if done continuously, the heart
muscle and skeletal muscle will
experience an increase in employment
adaptation to chronic namely
hypertrophy. Enlargement of muscle
mass from the normal state can be
between 300 g and 500 g (Huonker et al,
1996). This can lead to end-diastolic
volume will increase, and it will also
stoke volume increase heart. So the
diastolic blood pressure will decrease.
Research conducted Spartaro (1991)
also reported a decrease in systolic 8and
diastolic 5 respondents who frequently
perform regular physical activity. It is
possible to occur in the intervention
group who had suffered during the given
intervention adaptation exercise physical
activity.
result analysis found
there is no
significant difference in mean systolic
post intervention in the intervention and
control. It showed no difference in the
average value of systolic blood pressure
was statistically the second respondent.
The maximum value of systolic blood
pressure in the intervention respondents
in the amount of 137.02 mmHg,
indicating increase in systolic pressure
value is not shown in conditions that
endanger the health of the respondent or
still within the tolerance limits of the
body. It can be said that the cardiac
rehabilitation phase I does not cause
harmful effects if done in accordance
with procedures and strict supervision.
The analysis results obtained p value not
significant that the average diastolic post
intervention in the intervention and
control. It showed no statistically
significant difference in mean diastolic
blood pressure in both groups.
Respondents were given a five-day
intervention during physical activity and
exercise interventions show the value of
the increase in diastolic blood pressure
after the intervention. The maximum
value of diastolic blood pressure in the
intervention respondents were given a
physical exercise-based interventions
obtained by 76.86 mmHg. This value
indicates no increase is so large and
endanger the health condition of
respondents coronary heart disease.
Increasing the value of diastolic blood
pressure in intervention respondents
during the given intervention is in line
with the theory advanced by Gormley&
Hussey (2005) that during the
Based on the theory advanced by
Gormley& Hussey (2005) acute effect
of physical activity was immediate
activation of the sympathetic nerves in
the heart and blood vessels can release
adrenaline in the blood circulation of the
adrenal medulla. One of these effects
that cause vasoconstriction of blood
vessels. Body compensated to accelerate
the flow of blood in the body as a result
of physical activity also increases the
heart rate so it needs a large preload as
compensation of increased heart rate.
Vasoconstriction necessary for blood
flow to be fast to meet the needs of large
preload so after load also must be
increased.
42
movement of the body or physical
activity then it will be activated the
sympathetic nerves in the body that lead
to increase
contraktility heart and
accelerate the work of fibers Purkinje
that serves to accelerate emptying the
contents of the heart volume. This
causes an increase in diastolic blood
pressure in the body.
the left atrium, predicted as the cause of
the appearance of atrial fibrillation
during cardiac rehabilitation.
Exercise physical activity on a regular
basis will provide a great benefit to the
body of the adaptation process occurs
both at the heart organ and the blood
vessels in the body. This is consistent
with the theory put forward by Kusuma
(2003) which says that physical activity
(exercise) increases the blood flow is
pulsatile increase the production of
nitric oxide (NO) which parallel
increase production of EDRF
(endothelial relaxing factor derive).
Coronary blood flow at rest about 200
ml / min (4% of total cardiac output)
increased to 350 ml / min (increase of
150 ml / min) while moderate weight
training. If the heart rate increases to 10
times only, the coronary blood flow
increased to 224 ml / min, which means
an increase of 24 ml / min and already
exceeds 4 ml / min, as a condition of
increased production of nitric oxide.
Moderate physical activity (exercise or
walking) will increase the heart rate to
110 beats per minute, an increase of 40
times seadainya resting heart rate of 70
beats per minute. Research in the
laboratory showed that the increased
flow of 4 ml / min was able to produce
nitric oxide, which means it is sufficient
to stimulate the improvement of
vascular
endothelial
function
(Takahashi, 1997). Nitric oxide (NO) is
a potent vasodilator that is located in the
intima layer (endothelium) of the
arteries where the compound is very
important for blood vessels to reduce the
risk of atherosclerosis.
The analysis results obtained p value not
significant mean pulse rate post
intervention in the intervention and
control. It showed no statistical
difference in the average value of the
pulse frequency of respondents
intervention and control after the
intervention. In this
reseach, the
frequency of the pulse values obtained
after exercise increased physical activity
among respondents intervention. The
increase in the pulse frequency of the
respondents intervention is the result of
several mechanisms in the body due to
the movement of the body or as a result
of physical exercise. When the physical
exercise
increased
sympathetic
stimulation of the heart organ that
affects the heart's electrical system,
especially the SA node
therefore
increasing heart rate/pulse (Gormley&
Hussey, 2005). This effect can be seen
when the body physical activity are
irregular or can be said is the acute
effects of physical activity on the body.
The increase in the pulse rate that
exceeds the maximum limit should
feared the presence of an electrical
disorders on the heart and can threaten
death to the respondent. This will lead to
atrial fibrillation according to research
conducted by Giaccardi et al, (2011)
which said that the incidence of atrial
fibrillation was significantly high
number of patients who follow a cardiac
rehabilitation program that is sorely
lacking in exercise intensity physical
activity compared with that follows
program of physical exercise with
moderate intensity. This is due to the
large volume of the left atrium and the
low effort emptyvalumepemompoaan to
Results of the analysis we found no
significant values
mean oxygen
saturation post intervention
in the
intervention and control. It showed no
significant difference in the average
value of the oxygen saturation in both
groups post intervention. In this study
found an increase in oxygen saturation
after cardiac rehabilitation interventions
conducted
in the respondents
43
intervention. It is very useful to
respondents to assist in accelerating the
healing process of the disease.
Based on the literature it is said that
there is one example of respiration also
plays a role in increasing the working
capacity of the body is the breathing
exercise prescription for patients with
post-operative
cardiac
surgery.
Peripheral to tolerate the practice of
physical activity, many patients require
special breathing while working, which
could increase lung volume and gas
exchange capacity and, consequently
improve the distribution and capture
systemic oxygen and increase exercise
tolerance (McKirnan&Froelicher, 1993).
Based on the literature says the
existence of some mechanism of
changes in the respiratory system during
a physical activity on the body: (1) The
dilution air in the dead-space lungs
during inspiration as a result of the
increased pressure of pulmonary
alveolar (PO2), causing vasodilation of
the pulmonary arteries that are activated
by the receptor Blood vessels are
hypoxic. (2) increase in thoracic volume
during the development of lung
parenchyma during inspiration. (3) an
increase in cardiac filling the right side
along with an increase in the
exploitation of moments of inspiration,
this means an increase in venous return
and that will increase the ejection
volume of the right ventricle and
pulmonary systolic pressure. With this
change, the efficiency of ventilation and
perfusion of the body tissue will be
balanced (Gormley& Hussey, 2005).
This led to the intervention of
respondents experiencing respiratory
system of compensation which improves
the functional capacity of the lungs can
eventually increase the maximum
working Traffic from the body.
Effect of Cardiac Rehabilitation
Phase I Against Capability ADL and
VO2 max Respondents.
Results of bivariate analysis of the
ability to perform activities of daily
living (ADL) in the intervention group
and the control group showed a
significant difference. In this study, the
intervention group get exercise physical
activity gradually in accordance with the
capacity and condition of the
respondents, while the control group
without exercise just given bed rest
alone. So it can be said that the exercisebased cardiac rehabilitation that physical
activity can stimulate the adaptation and
improvement of exercise tolerance
capability in the intervention group
compared with the control group.
In this research, interventionrespondents
always increase even improvement of
the respiratory system, while at the
controls of the respondents there were
some respondents who sometimes
experience down the value of saturation.
On the intervention of the respondents
only one of the respondents who
experienced a decrease in oxygen
saturation, whereas the control of the
respondents there were eight
respondents
who
experienced
deterioration in oxygen saturation. It is
possible the intervention of respondents
functional capacity of the lungs had
increased as a result of the intervention
given the exercise of physical activity
compared to control respondent.
Based on the first congress of cardiac
rehabilitation in Hamburg in 1977,
insists that the need for early
mobilization in patients with heart
disease (Balady, Fletcher, Froelicher et
al, 1994). Phase I is the effort to be done
while the patient is still being treated,
the main purpose of this phase is to
reduce or eliminate the adverse effects
of the condition due to total bed rest, to
educate early and that the patient is able
to perform daily activities independently
and safely (Basuni et al, 2009). Another
theory says that one of the objectives of
rehabilitation of cardiac rehabilitation
phase I that patients can perform selfcare and activities of daily life (ADL)
44
and domestic work except for up and
down stairs (Garrison, 2001).
Physical activity everyday is useful not
just to get a healthy body condition but
also beneficial to mental health,
entertainment in preventing stress.
This study ADL ability intervention
group obtained only three respondents
who have a value below 100, it indicates
that the Barthel index on respondent
intervention is better than the control
respondents were only two respondents
who had ADL value of 100. The results
are also consistent with research
conducted by Weberg et al (2013) which
says that a significantly increased
function and physical role, increased
ability and endurance to pain on the
effects of cardiac rehabilitation phase I,
and the disclosure directly from the
respondents experienced an increase in
physical and mental after following
cardiac rehabilitation Phase I. Improved
physical function and role, increased
ability and endurance to pain due to a
cardiac rehabilitation phase I also found
in a study conducted by Hsu et al (2011)
the research done on post-CABG
patients and organ transplants.
Results of bivariate analysis were not
significant values between maximal
oxygen uptake (VO2 max) in the
intervention group and the control. It
showed no significant difference VO2
maximum value of both respondents
statistically. At respondents intervention
lowest value of VO2 max respondents,
11.15 ml / kg / min, which means all
respondents have been able to meet the
target of cardiac rehabilitation phase I (>
3 MET = 10.5 ml / kg / min), but the
respondent control limits bottom of VO2
max is nothing less than the expected
target of Phase I of 10:34 ml / kg / min.
Physical activity the body will consume
the oxygen that will be used as fuel in
energy production. One's ability to
consume oxygen during physical
activity to the formation of energy, until
it reaches the maximum value without
being able to go up again though with
the addition of the intensity of the
exercise known as VO2 Max (Astorin,
2000).
Another study said the effect of exercise
physical activity on improving exercise
tolerance was also carried out by
Marzolini et al (2008) who showed that
a combination of aerobic exercise and
resistance cause changes more evident
in physiological adaptations such as
muscle strength and endurance, and
body composition compared to aerobic
exercise alone in patients with coronary
artery disease. Physical exercise-based
cardiac rehabilitation also reduces
overall mortality / cardiovascular
disease mortality [RR 0.87 (95% CI
0.75, 0.99) and 0.74 (95% CI 0.63,
0.87), respectively
-masing], and
hospitalizations [RR 0.69 (95% CI 0.51,
0.93)] in the short term (<12 months of
follow-up). Cardiac rehabilitation does
not reduce the total risk of MI, CABG or
PTCA (Strange, 2011). Numerous
studies have also shown that aerobic
training increases muscle strength and
exercise tolerance in patients after openheart surgery and patients
with
MiocardInfark (Ueshima et al, 2005).
The gold standard to measure
cardiovascular fitness is maximal
oxygen consumption (VO2 max). it is
defined maximal oxygen consumption
as a measure of exercise are achieved by
an individual, who at that point of
fatigue or symptoms that arise prevent
such individuals to exercise more
(Garrison, 2001). This is in line with
research Belardinelli (1999) who said
that clearly defined, measured by
exercise tolerance
and oxygen
consumption as well as a good predictor
of prognosis in patients with
cardiovascular disease.
Based on the theory advanced by
Guyton (2007) not only the respiratory
system are instrumental in determining a
person's VO2 maximum, but there are
four systems that determine the
45
maximum VO2 is the respiratory
system, cardiovascular, biochemical
oxygen transport and network systems.
The fourth system is interrelated to one
another, so that when the respiratory
system is in good condition but there are
one or more of the three other systems in
the state is not good then it can affect
the value of a person's VO2 maximum.
While the value of a person's VO2
maximum is also determined by a
person's posture, between the one and
the other will certainly be different if
say both equally healthy but have a
different body portur. This is in line with
research conducted by Nury (2011)
which says that the main determinant of
the cycle runs in addition to height is leg
length measurements when the
maximum VO2.
The results also show the benefits of
exercise-based cardiac rehabilitation
phase I of physical activity that can be
done by a nurse if a physiotherapist
human resource is not in the hospital.
Phase I cardiac rehabilitation nursing in
the world can be said to help the patient
in the process of adapting to be able to
perform daily activities independently,
improve the tolerance of the patient's
activity.
CONCLUSION
On this study, the mean age of the
respondents is at 55.29 years, with the
majority of the male sex 18 (75%).
History of smoking among respondents
obtained more than half of the
respondents do not smoke are 14
(58.33%) of respondents, and in this
study the majority of respondents have a
body mass index of obesity as many as
17 (70.8%) of respondents.
The mean systolic blood pressure of
both groups showed similar values and
within normal limits. Mean diastolic
blood pressure in the control group was
slightly higher than in the intervention
group and both were within normal
limits. The mean frequency of the pulse
after the intervention in the intervention
group was slightly higher than in the
control group and both were within
normal limits. The mean SpO2 after the
intervention in both groups of equal
value.The mean maximal VO2 greater
intervention group than in the control
group.The mean ADL higher
intervention group than in the control
group.
It was found no significant difference
between the systolic blood pressure,
diastolic blood pressure, pulse rate, and
oxygen saturation after the intervention
in the intervention and control.
There are significant differences ability
to perform ADLs between intervention
and control groups on the sixth day. But
there was no significant difference
between the value of the maximum VO2
intervention and control groups on the
sixth day.
This study shows the difference between
the value of the maximum VO2
intervention and control groups was not
so great can be seen from the average of
the two groups is 19.14 ml / kg / min
and 16.87 ml / kg / min. From this it was
found that the mean maximal VO2
values greater intervention group than
the control group. Value of maximal
VO2 could be improved on a person,
with increasing VO2 maximum, it can
be said the maximum working ability of
the body to be achieved. This is
according to research conducted by
Ueshima et al (2004) peak VO2
increased by less than 25% after
exercising, especially in patients who
have undergone heart valve surgery.
This research can provide input that
cardiac rehabilitation program that is
most important is when Phase I, which
in this phase requires the mobilization of
patients as early as possible to reduce
the undesirable effects of bedrest old
(thrombophlebitis,
hypotension
orthosatik, muscle atrophy, etc. etc.) and
knowledge about the disease in order to
return later after there is a change of
behavior in the control of risk factors
that may lead to heart disease occur so
do not get heart disease later in life.
46
This research requires a socialization
programs the Phase I cardiac
rehabilitation program based physical
activity practice, to accelerate the
healing process in patients that could
reduce the lenght of stay (LOS) patients.
And the need for nurses to give an
evaluation of the
action exercise
physical activity is given to know the
development of tolerance to the patient's
physical activity.
The need to develop therapeutic
modalities nursing to overcome the
problems associated with the physical
activity of the patient's therapy, which
can be applied in providing training
physical activity in patients requiring
early
mobilization
during
hospitalization. And disseminate
information about the importance of
mobilization as early as possible after
the patient's hemodynamic condition
stabilized, to reduce the unfavorable
effects of total bedrest.
statement for health care
professionals
from
aha.
Circulation; 90;1602-1610.
Basuni, Radi; Andang, H. Joesoef;
Dede,
Kusmana.(2009).
RehabilitasiKardiovaskular Di
Indonesia.J
KardiolIndones.
30:43-5. ISSN 0126/3773.
Belardinelli, R; Georgiou, D; Cianci, G;
Purcaro, A. (1999). Randomized,
controlled trial of long-term
moderate exercise training in
chronic heart failure: effects on
functional capacity, quality of
life, and clinical outcome.
Circulation; 99:1173-82.
Dolansky, M.A., Xu, F., Zullo, M.,
Shishehbor, M., Moore, S.M.,
&Rimm, A.A. (2010). Post-Acute
Care Services Received by Older
Adults Following aCardiac Event:
a Population-Based
Analysis.
Journal of Cardiovascular
Nursing, 25,342-249
Garrison, Susan. (2001).
Dasardasarterapi&rehabilitasifisik.Jaka
rta :Hipokrates.
Garrison, Susan, J. (2003). Lippincott
Williams and Wilkins Handbook :
Handbook of Physical Medicine
and Rehabilitation Basics (2nd
Edition). LWW, p.172-180.
Gormley, John and Hussy, Juliette.
(2005).
xerciseTheraphy :
Prevention And Treatment Of
Diseases. Oxford : Blackwell.
Giaccardi M, Macchi C, Colella A,
Polcaro P, Zipoli R, et al. (2011).
Postacute
rehabilitation after coronary
surgery: the effect of preoperative
physical
activity on the incidence of
paroxysmal atrial fibrillation. Am
J
Phys
Med
Rehabil ; 90:308–15.
Hastono, P.S. (2001).ModulAnalisis
Data.Depok : FKM-UI
Heran, B.S; Chen, J.M.H; Ebrahim, S;
Moxham, T; Oldridge, N; Rees,
K; Thompson, D.R; Taylor, R.S.
(2011). Exercise-based cardiac
rehabilitation for coronary heart
This research can be a reference to
conduct further research that can
improve understanding and knowledge
of the cardiac rehabilitation program,
especially the phase I. Maybe it could be
done further research to determine the
relationship of drugs and laboratory
values (hemoglobin, hematocrit, and
others) are influential toward physical
activity in a cardiac rehabilitation
program phase I.
REFERANSI
Anderson, S And McCarty, L. (2005).
Patofisiologi
:KonsepKlinik
Proses-proses Penyakit. Edisi
6.Volume 1.Jakarta : EGC
Asbury, Elizabeth, Webb, C, Probert, H,
Wright, C, Barbir, M, Fox, K,
Collins, P. (2012). Cardiac
Rehabilitation to Improve
Physical
Functioning
in
Refractory Angina: A Pilot Study.
Cardiology 2012; 122;170-177
Balady, J.G; Fletcher, B.J; Froelicher,
V.F,et al. (1994). AHA
medical/scientific
statement:
position statement: cardiac
rehabilitation programs: a
47
disease (Review).The Cochrane
Library, Issue 7.
Hsu, C.J; Chen, S.Y; Su, S; Yang, M.C;
Lan, C; Chou N.K et al, (2011).
The effect of early cardiac
rehabilitation on health-related
quality of life among heart
transplant recipients and patients
with coronary artery bypass graft
surgery. Transplant Proc;
43:2714-7.
Huoker, M; Halle, M; and Keul, J.
(1996).Structure and fungtional
adaptation of the cardiovascular
system by training.International
journal of sports medicine 17,
S164-172.
I
Made
Merta
(2010).
PengaruhLatihanAktifitasRehabili
tasiJantungFase
I
TerhadapEfikasiDiri
Dan
KecemasanPasienPenyakitJantun
gKoroner Di RsupSanglah
Denpasar.TesisUniversitas
Indonesia.
Lewis, Dirksen, Heitkemper, Bucher,
Camera. (2011). Medical Surgical
Nursin : Assessment and
Management of Clinical Problem
(Eighth edition,Vol. 1). USA :
ELSEVIER
Stangl, V, et al, (2002). Coronary
atherogenic risk factors in
women, Eur Heart J; 23:17381752.
Weberg, M, Hjermstad, M.J, Hilmarsen,
C.W, Oldervoll, L. (2013).
Inpatient cardiac rehabilitation
and changes in self-reported
health related quality of life – a
pilot study. Annals of Physical
and Rehabilitation Medicine 56;
342–355.
World Health Organization.(2012).
World
Health
Statistics
2012.WHO Library Cataloguingin-Publication Data.
48
ANALYSIS OF THE USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE)
TO CLEANING SERVICE WORK ACCIDENT
Dr. ISKAK HOSPITAL TULUNGAGUNG
Sandu Siyoto
Institute Of Health Surya Mitra Husada Kediri
ABSTRACT
Accident is an event that is unexpected and undesirable. The use of personal protective equipment is
one of the factors that cause accidents. Personal protective equipment is a set of tools used by workers
to protect all or part of his body against the possibility of any potential hazards in the workplace or
work accident. The purpose of this study was to determine the effect of the use of personal protective
equipment (PPE) to cleaning service work accident. This study uses a quantitative approach to the
observation method. Data were obtained using a questionnaire. The population in this study were all
cleaning service in Dr.Iskak hospital Tulungagung as many as 71 people. The sample were 62 people.
The sampling technique using Simple Random Sampling. The results of data analysis with logistic
regression test is obtained (p = 0.005) (p <0.05). The results of this study concluded there is the
influence of the use of personal protective equipment (PPE) to cleaning service work accident.
Keywords: Personal Protective Equipment, Work Accident
who are at risk. The officer in charge of waste
management should ensure that all risks have
been identified and rapid protection available.
Based on data from the ILO (International
Labour Organization) in 2008, each year an
estimated 1.2 million workers died from
workplace accidents. Meanwhile, citing data in
Anggraini Social Security in 2010, there were
98 711 cases. Of that number, 2,191 workers
died, and raises a number of 6667 people
permanently disabled. The number of claims to
be paid for these cases reached more than Rp
401 billion. Press release International Labour
Organization (ILO) in 2013 recorded 160
million cases of work-related accidents with
about 2 million deaths annually. On April 28,
2014, in the framework of the occupational
safety and health worldwide, stating that cases
of occupational illness and accidents has risen
337 million and 2.3 million deaths annually.
Based on data from the Indonesian
Kemenkertrans death rate from workplace
accidents and occupational diseases in
Indonesia is still very high, the data up to
September 2013 recorded 9 workers die per
day.
Based on the preliminary results of a study
conducted on 15 people, no workers wearing
full personal protective equipment. 3 people
claimed get stabbed needle, two people never
exposed to infectious fluids and the first person
ever to slip while working. Based on the
above, the researcher was interested to study
about “Analysis Use of Personal Protective
INTRODUCTION
One effort to increase productivity is to
provide protection to workers for her work.
This protection is given with the intent to
obtain assurance worker health and safety so
that they avoid accidents. Work accident is an
event that is unexpected and undesirable that
may disrupt the process that has been set for an
activity (Kurniawati, 2013).
Hospital as a health care institution with core
service activities of preventive, curative,
rehabilitative and promotive have positive and
negative impacts. The positive impact is the
increasing level of public health, while the
negative impacts among others are garbage and
medical waste or non-medical that can cause
disease and pollution that needs special
attention. The number of hospitals in Indonesia
in 2014 amounted to 2,415 with as many as
296 087 beds and solid waste as much as 376
089 tonnes / day of wastewater as well as 48
985 tonnes / day (Departement of Health,
2014). As a result of accidents and
occupational diseases can attack all workers in
the hospital, one of them being a cleaning
service. Cleaning service has the greatest risk
of exposure to hazardous biological substances
(biohazard), contact with the disposable
medical instruments (disposable equipment)
such as used syringes, IV tubes former. That
requires safety and health efforts to prevent
and control accidents occupational diseases in
hospitals. Therefore, protection is very
important to prevent injuries for all workers
48
Equipment (PPE) to Cleaning Service Work
Accident Dr. Iskak Hospital Tulungagung”.
The purpose of this study was to analyze the
effect of use of Personal Protective Equipment
(PPE) ) to Cleaning Service Work Accident
Dr. Iskak Hospital Tulungagung.
The benefits of this research are as an input
that can be used as measures and efforts to
improve occupational health and safety
programs to prevent occupational injuries, so
as to create a workplace that is safe and
convenient for all employees as well as the
maximum increase in labor productivity.
mostly male sex a number of 38 respondents
(62%) while the female number of 24
respondents (38%).
Figure 3
Characteristics of Respondents
According to Education On
Hygiene Officer at Dr. Iskak
Hospital Tulungagung
Based on Figure 3 shows that respondents
whose level education most are high school
number 28 respondents (45%), junior school of
24 respondents (39%), primary school number
seven respondents (11%), whereas that is un
educated number of 3 respondents (5%).
RESEARCH METHODS
This type of research used in this research is a
correlational study with a "cross-sectional"
which emphasizes the time measurement /
observation of independent and dependent
variables only once in a while.
The population in this study is all cleaning
service at Dr. Iskak Hospital Tulungagung as
many as 76 people. The sampling technique
used in this study is simple random sampling
with a total sample of 62 people. Data were
collected through interviews and observations.
The study was conducted in March 2015. Data
were analyzed using logistic regression
statistical tests.
Figure 4 Characteristics of Respondents based
on employment status on cleaning
service at Dr. Iskak Hospital
Tulungagung
Based on Figure 4
shows that most
respondents are not permanent employee status
a number of 52 respondents (84%), while the
status of permanent employee number 10
respondents (16%).
RESEARCH RESULT
Figure 1 Characteristics of Respondents by
Age At Hygiene Officer at Dr.
Iskak Hospital Tulungagung.
Based on Figure
1 shows that most
respondents are in the age group 21-30 years
by 56%, the age group 31-40 years by 26%,
and the group of less than 20 years at 18%
Figure 5
According to the marital status of
cleaning service at Dr. Iskak
Hospital tulungagung
Based on Figure 5 shows that the marital status
of respondents the most is not / has not been
married a number of 35 (56%), while
respondents were married a total of 27 (44%)
Figure 2 Characteristics of Respondents by
Gender In Cleaning Service in Dr.
Iskak Hospital Tulungagung
Based on Figure 2 shows that the cleaning
service at Dr. Iskak Hospital Tulungagung
49
Table 2 Distribution Gender Against Use of
Personal Protective Equipment At the
cleaning service at the Dr. Iskak
Hospital Tulungagung
use of PPE
Total
Gender
Y
T
Y
T
N
% N % N %
Male
16
67
2
58
3 61
2
8
Female
8
33
1
42
2 39
6
4
Total
24 100 3 100 6 100
8
2
In Table 2 shows that the use of personal
protective equipment based on sex in the
cleaning service at the Dr. Iskak Hospital
Tulungagung. Respondents who use PPE men
67% and women 33%. While respondents were
not using PPE male some 58% and women
42%.
Table 3 Distribution Old Working Against the
Use of Personal Protective
Equipment At the cleaning service at
the Dr. Iskak Hospital Tulungagung
Use of PPE
Worki
Total
ng
Y
T
Y
T
Long N %
N
%
N
%
<1
1
42
15
39
25
40
Year
0
1-5
1
58
21
55
35
56
Year
4
>5
0
0
2
5
2
4,0
Years
Total
2 100 38 100 62 100
4
protective equipment based on longer work.
Respondents who use PPE with long work <1
year 42% 1-5 years 58%, while those not using
PPE long work <1 year 39% 1-5 years 55%
and> 5 years 5%.
Table 4 Distribution of educational status
Against Use of Personal Protective
Equipment At the cleaning service at
Use of PPE
Total
Educat
Y
T
Y
T
ional
N
%
N
%
N
%
Un
1
4
2
5
3
5
educat
ed
Primar
2
8
5
13
7
18
y
School
High
10
42
14 37
24
39
Figure 6 Diagram Distribution of Respondents
According to Use of
Personal
Protective Equipment
Based on the picture 6 shows that respondents
who use personal protective equipment a
number of 24 respondents (39%), whereas that
does not use personal protective equipment a
number of 38 respondents (61%).
Figure 7 Pie Diagram Distribution of
Respondents Against Accidents
Based on the picture 7 diagram shows that the
incidence of occupational accidents in the
cleaning service in Dr. Iskak Hospital
Tulungagung number of 42 respondents (68%)
said they had experienced a work accident,
while 20 respondents (32%) claimed to have
never had an accident.
Table 1 Age distribution Against the Use of
Personal Protective Equipment At the
cleaning service at the Dr. Iskak
Hospital Tulungagung.
use of PPE
Total
Age
Y
T
Y
T
N % N %
N
%
<20
4
17 7 18
11
18
Year
21-30
1
66 1 47
34
55
Year
6
8
31-40
4
17 1 32
16
26
Year
2
>40
0
1
3
1
2
Years
Total
2 100 3 100
62
100
4
8
protective equipment based on the age range
cleaning service
at Dr. Iskak
Hospital
Tulungagung. Respondents who use PPE age
<20 years of a 17%, 66% aged 21-30 years and
31-40 years of age 17%. While respondents
who do not use personal protective equipment
(PPE) age <20 years some 18%, 21-30 years
47% 31-40 32% and> 40 years of 3%.
50
cleaning service at Dr. Iskak Hospital
Tulungagung
Accident
Total
PPE
Never
Ever
N
%
N
%
N %
Yes
13
65, 11
26,0 2 39,
0
4 0
No
7
35, 31
74,0 3 61,
0
8 0
Total 20
100 42
100
6 100
2
At table 7 above shows the use personal
protective equipment against work accidents.
Respondents who use PPE and Never crashed
some 26%, respondents who use PPE and
never had an accident some 65% of
respondents who do not use PPE and never had
an accident some 74%, while those who did
not use PPE and work accident number 35 %.
Tabel 8 Results Effect Analysis Using Personal
protective equipment against work
accidents At a cleaning service at Dr.
Iskak Hospital Tulungagung
Variables in the Equation
St
B S. Wa d Si Exp
ep
E ld
f g. (B)
a
The
1.6 .5 7.9 1 .0 5.23
1
use of
55. 86 88
05 4
PPE
Consta .9 3.9 1 .0 .162
nt
1.8 20 23
48
22
a. Variable (s) entered on step 1: The
use of PPE.
The analysis showed the use of personal
protective equipment (PPE) against
occupational accidents in the cleaning service
at Dr. Iskak Hospital Tulungagung p value =
0.005 (p <0.05) means that there is the effect
of the use of personal protective equipment
(PPE) against workplace accidents.
Respondents who use personal protective
equipment are possibly five times to avoid
workplace accidents when compared to
workers who do not use personal protective
equipment and statistically significant as well
as related.
School
Senior
11
46
17 45
28
45
High
School
Univer
0
sity
Total
24
100 38 100 62 100
protective equipment by educational status.
Respondents who use PPE school status no
amount of 4%, primary school 8%, 42% junior
high school, high school 46% . While not using
PPE school status does not amount to 5%, SD
13%, 37% junior and senior 37%.
Table 5 Distribution Employmentof
Status
Against the Use of Personal
Protective Equipment In the cleaning
service at the Dr. Iskak Hospital
Tulungagung
The use of PPE
Emplo
Total
yee
Y
T
Y
T
Status N %
N
%
N
%
Indepe 2
83
32
84
52
84
ndent
0
Depen 4
17
6
16
10
16
dent
Total
2 100 38
100
62 100
4
In Table 5 shows the use of personal protective
equipment based on employment status.
Respondents who use PPE status of nonpermanent employees 83% and the number of
permanent employees 17%. While respondents
were not using PPE status of permanent
employees 84% and 16% permanent staff.
Table 6.Distribusi Marital Status Against the
Use of Personal Protective
Equipment in the cleaning service at
The use of PPE
Total
Marital
Y
T
Y
T
Status
N % N % N %
No / Not
1 50 2
60 3
56
married
2
3
5
Married
1 50 1
40 2
44
2
5
7
Total
2 100 3 100 6 100
4
8
2
In Table 6 shows the use of personal protective
equipment based on marital status.
Respondents who use PPE status of unmarried
50% and 50% are married. While respondents
were not using PPE status is not married some
60% and 40% are married.
Table: 7 Distribusi Use of Personal Protective
Equipment Against Accidents in
DISCUSSION
Use of Personal Protective Equipment (PPE) to
the cleaning service in Dr.Iskak Hospital
Tulungagung that of 24 respondents (39%)
who use PPE while 38 respondents (61%) did
not use PPE. Judging from the use of gloves
44% do not use and 56% use, the use of masks
48% do not use and 52% use, the use of apron
51
watertight 95% do not use and 5% use, the use
of the shoes 100% use, while the use of hats or
headwear 100% do not use. This is due to lack
of compliance officers in the use of personal
protective equipment as well as the lack of
availability of personal protective equipment
for the cleaning service. Proved to be only
available one spilkit box in one area, while the
officer is in one of the area between 6-8
cleaning service. Besides lack of supervision
and lack of sanctions for cleaning service make
cleaning service negligent in using personal
protective equipment.
Personal protective equipment (PPE) according
to OSHA or the Occupational Safety and
Health Administration is a tool used to protect
workers from injury or illness caused by
contact with hazards in the workplace, whether
it is chemical, biological, physical radiation,
electrical, mechanical and other , The use of
PPE is used to protect the body from harm job
can cause illness or accidents and labor can
work with more secure because it can avoid the
various occupational hazards. Thus, the use of
PPE has an important role because it is useful
not only for workers, but also useful to the
company.
The number of accidents on the cleaning
service at the Dr. Iskak Hospital Tulungagung
is 42 respondents (68%) never had an accident
at work, and 20 respondents (32%) have never
had an accident at work. Judging from the
respondents fell 29% has been dropped and
71% never fall, 24% of respondents had
experienced punctured and 76% have never
experienced punctured, 44% of respondents
had experienced exposure to liquid infectious
and 56% of respondents were never exposed to
liquid infectious, 40% respondents had spilled
hazardous liquids and 60% of respondents
have never spilled liquids deadly; 35% of
respondents had collided and 65% of
respondents had never hit, 31% of respondents
never inhaling toxic gases and 69% of
respondents never inhaling poisonous gas, 26%
of respondents never exposed chemicals and
74% of respondents were never exposed to
chemicals. World Health Organization (WHO)
defines accident as an event that can not be
prepared in advance countermeasures so as to
produce a real injury. Classification of
accidents due to work according to Labour
Organization is based on the type of accident:
such as a fall, hit by falling objects, pierced,
pinched, movements that exceed the
capabilities, contact with hazardous materials
or radiation, Other types, including accidents
Data not sufficient or other accidents that have
not entered. While classification according to
the cause include: machinery, transport
equipment, materials, substances and radiation,
work environment, other causes that do not
include these factions ,
Results from the analysis of data obtained (pvalue: 0.005) (p <0.05) means the use of
personal protective equipment has a significant
relationship * with workplace accidents in the
Tulungagung. The results showed that
respondents use personal protective equipment
(PPE) 5 times to avoid accidents. While
workplace accidents influenced by the use of
personal protective equipment (PPE) by 18%.
Based on the theory of work accidents caused
by several factors and one of them is because
they do not use personal protective equipment.
As for how to prevent accidents by Ramli 2010
is to wear personal protective equipment in
earnest without coercion, aware of the
importance of workplace safety and comply
with the regulations that exist, because 85% of
workplace accidents are caused by human
factors with unsafe acts , Joseph 2007 study on
Factors Related Accidents also mentioned that
there is a significant association between the
use of personal protective equipment at work
accidents with a value of (p: 0.013) (p <0.05).
From the research that has been done and it
can be concluded from the discussion of
matters related research about the effect of the
use of Personal Protective Equipment (PPE)
against occupational accidents in the cleaning
service at Dr. Iskak Hospital Tulungagung.
Use of Personal Protective Equipment (PPE) to
the cleaning service at the Dr. Iskak Hospital
Tulungagung of 62 respondents, only 39%
were using PPE, while 61% did not use PPE.
The number of accidents caused by work in the
Tulungagung of 62 respondents 68% had had
an accident at work and 32% have never had
an accident while work. The use of personal
protective equipment has a significant
influence with workplace accidents in a
cleaning service
at Dr. Iskak
Hospital
Tulungagung namely with (p-value: 0.005) (p
<0.05).
With regard to the outcome of research and
discussion and conclusion, then the advice that
can be given is a cleaning service should be
submissive in the use of personal protective
52
equipment to reduce the risk of workplace
accidents.
Maintain and take care of personal protective
equipment has been provided by either.
BIBLIOGRAPHY
Arikunto, Suharsimi. 2010.
Prosedur
Penelitian. Jakarta : Rineka Cipta
Depnakertrans. 2012. Data Kecelakaan Kerja
dan Penyakit Akibat Kerja Menurut
Provinsi. Jakarta : Ditjen PPK
Depnakertrans. 2014.
Sambutan dalam
Rangka Hari Keselamatan dan
Kesehatan Kerja pada tanggal 12
Januari
2014.
Jakarta
:
Mensosnakertrans
Hidayat, Alimul Aziz A. 2011.
Riset
Keperawatan dan Teknik Penulisan
Ilmiah. Jakarta : EGC
ILO. 2013. Press release International Labour
Organization (ILO) pada tanggal 26
April 2013
Keputusan Menaker Nomor 609 Tahun 2012
Tentang Pedoman
Penyelesaian
Kasus Kecelakaan Kerja dan
Penyakit Akibat Kerja
Kurniawati, Dewi. 2013. Keselamatan dan
Kesehatan Kerja.Surakarta: Aksarra
Sinergi Media
Notoadmodjo, S. 2010. Metodologi Penelitian
Kesehatan. Jakarta : Rineka Cipta
Nuratika, Desi. 2013. Identifikasi Kecelakaan
kerja dan Gambaran Penggunaan
Alat pelindung Diri pada Petugas
Laundry.Skripsi: Jakarta
Nursalam. 2011. Pedoman Skripsi, Tesis, dan
Instrumen Penelitian Keperawatan.
Jakarta : Salemba Medika
Ramli, Soehatman. 2010. Sistem Manajemen
Keselamatan dan Kesehatan Kerja
OHSAS 180001. Jakarta : Dian
Rakyat
Ramli, Soehatman. 2013. Sistem Manajemen
Keselamatan dan kesehatan Kerja
OHSAS 18001. Jakarta: Dian rakyat
RI, Depkes. 2008.
Kesehatan dan
Keselamatan Kerja Laboratorium
Kesehatan. Jakarta: Depkes RI
RI, Depkes. 2011. Pedoman Pencegahan dan
Pengendalian Infeksi di rumah sakit
dan Fasilitass Pelayanan Kesehatan
, Kesiapan Menghadapai Emerging
Infectious Diseas.Jakarta: Depkes RI
Ridwan.2012. Metode dan Teknik Menyusun
Proposal
Penelitian.Bandung:
Alfabeta
RSUD Dr. Iskak. 2014. Buku Panduan
Penggunaan Alat Pelindung Diri
(APD): Tulungagung
Rukiyah.2013.Undang-Undang
Ketenagakerjaandan Aplikasinya.
Jakarta: Dunia Cerdas
STIKes Surya Mitra Husada. 2013. Buku
Panduan Penyusunan Proposal dan
Skripsi : Kediri
Sugiyono. 2013. Statistika Untuk Penelitian.
Bandung : CV Alfabeta
Sugiyono. 2013.Metode Penelitian Kuantitatif
Kualitatif dan R&D.
Bandung:
Alfabeta
Suma‟mur. 2009. Higiene Perusahaan dan
Kesehatan Kerja (HIPERKES) edisi
2. Jakarta : Sagung Seto
Undang-Undang Nomor 1 Tahun 1970 tentang
Keselamatan Kerja
53
AEROBIC COMBINATION WITH RELAXATION YOGA TO FATIGUE LEVELS IN
PATIENTS WITH BREAST CANCER UNDER CHEMOTHERAPY PROGRAM
Muhammad Taukhid
STIKES Karya Husada Kediri
E-mail: [email protected]
Abstract
Background : Fatigue is feeling tired physically, psychologically, cognitively perceived
cancer patients while undergoing therapies for the disease, including chemotherapy. The
purpose of this study was to determine differences in the level of fatigue in cancer patients
between before and after aerobic exercise combined with relaxation techniques of yoga.
Methods : This study used Quasi-experimental design with pre-test – post-test control group
in patients with breast cancer in the course of chemotherapy. The sampling methods used
purposive sampling. The fatigue level was collected by subjective instruments Pipper Fatigue
Scale (PFS), and then analysed by the Independent and Dependent T test, and multivariate
analysis used linear regression with a significance value of α <0.05. Results : There were
differences in the level of fatigue post-test between the intervention group and the control
group with a difference of 1.25 (p = 0.013). History of previous exercise may explain the
17.8% level of fatigue that occurs in patients with breast cancer in the course of chemotherapy,
the rest was explained by other variables. Conclusion : There were a decrease in the level
fatigue statistically, however clinically the level of fatigue remain the same categories.
Keywords : fatigue, aerobic, yoga, breast cancer
quality of life and ability of daily activities
(Wagner, Cella, 2004). Signs and
symptoms of fatigue characteristics are
multi-biopsychosocial, so that if two people
who experience fatigue, the appearance
symptoms will not exactly match.
Introduction
Fatigue is an overwhelming exhaustion
more than normally, which are not relieved
by rest and nutrition intake. Cancer related
Fatigue (CRF) associated with cancer
process and the side effect of cancer
therapy. The incidence of fatigue in the US
reaching 95% of all cancer patients
undergoing chemotherapy or radiotherapy
(Mustian, 2007). Most incidents fatigue that
is between 28% -91% suffered by breast
cancer patients who undergo therapy
(Hofman et. Al, 2007).
CRF are generally influenced by a history
of less activity and psychological stress
experienced as a result of cancer. Based on
the priorities effectiveness against fatigue,
Mitchell, Beck, Hood, Moore, Tanner
(2007) recommend giving exercise to
intervene against fatigue.
Suggested
exercises include walking, cycling,
swimming, resistance training or exercises
combined. Nursing interventions that are
judged to be effective fatigue management
is performed for activity management and
energy conservation, one of the
interventions which includes relaxation
techniques.
Escalante and Manzullo (2010) tried to
apply the technique
combination of
CRF will affect the ability, physical
capacity, and quality of life of cancer
patients, so they will rely on others for daily
necessities such as household activities,
transportation, personal needs such as
eating and bathing. CRF perceived
multidimensional feeling, the dimensions
are behaviour, cognitive, psychological and
social. Fatigue felt by the majority of cancer
patients during therapy may reduce the
223
pharmacological and non-pharmacological
therapies, among others: energy
conservation, regulation of sleep, exercise,
relaxation, antidepressants, analgesics,
stimulants, anxiolytic and nutritional
counseling. The results are 59% of the 140
respondents reported less fatigue.Methods
of combination therapy to reduce fatigue
have also been made in the research
Decker, Cline-Elsen, Galaggher, (1992) and
Kim, Kim, (2005), using nursing
interventions breath relaxation techniques
with yoga positions. The cancer patients
were given the intervention reported lowerlevel experience fatigue.
Danismaya research results (2008), who did
the application of relaxation techniques of
yoga in patients with breast cancer, showed
a decrease in the level of fatigue on the 5th
day of intervention. Research by wahyuni
(2012) suggested that the walking exercise
program can reduce fatigue levels in breast
cancer patients.
The above studies indicate that intervention
aerobic (walking exercise) as well as the
relaxation of yoga is effective in lowering
the level of fatigue. However, so far
researchers have not found a combination
of aerobics with yoga relaxation of the
intervention to be effective in lowering the
level of fatigue. This study aimed to
determine differences in fatigue levels in
breast cancer patients in chemotherapy
program between before and after the
combination of aerobic exercise and
relaxation techniques of yoga.
exercise , then the patient rested for 2
minutes , then the patient is asked to
perform Shavasana position yoga as a form
of relaxation for 8 minutes. Rest breaks
given to minimize the discomfort that can
be perceived by the respondents.
Data were collected by questionnaires for
the pre-test and post-test. Analysis of data
using frequency distribution, bivariate
analysis Independent and Dependent T test
and multivariate analysis using linear
regression.
Most respondents chose to participate in the
study and are willing to take measurements
and interventions at each residence. All
existing identity documents and data in this
study have been agreed only use initials, all
the information from respondents in the
form of a hard copy stored in a locked filing
cabinet and the data in the form of soft copy
stored in a specific folder is secured by
using a password. During participated in the
study respondents are treated fairly and
impartially , by providing the same
treatment , but in a different time .
Intervention control group given a
combination of aerobic exercise with
relaxation techniques of yoga after data
collection is complete .
RESULT
Obtained 34 respondents by sex married
women are divided into two groups ,
namely 17 respondents in the intervention
group and 17 respondents as the control
group . The mean age of the respondents
51.5 years old, mean body weight 57.71 kg,
and the mean fatigue score of 6.04 (95%
CI). Table 1 displays the characteristics of
respondents
METHODE
The research was used Quasi-experimental
pre test post test with control design in
patients with breast cancer under
chemotherapy program at RSUD Kediri and
Amelia Hospital Kediri on April until June
2014. Using purposive sampling technique
34 participant were recruited from 110
patients by medical data record and
encountered patients at one day care
services unit. Aerobic data was collected
with observation sheets about exercise time
schedule, and fatigue levels data obtained
with Pipper Fatigue Scale (PFS). Initially
the patient is asked to perform continuous
walking for 10 minutes as a form of aerobic
224
TABEL 3
Faktor-faktor yang mempengaruhi tingkat fatigue
Adjusted
R
R2
P value
R square
0,012*
Langkah 1
0,594
0,353
0,311
0,178
0,001*
Langkah 2 0,451 0,203
TABLE 1
Based on the results of statistical tests, it
was found that a significant reduction in
fatigue scores between before and after
doing a combination of aerobic exercise
Variable
n
(%)
with relaxation techniques of yoga in the
Occupation
intervention group (p = 0.001; α = 0.05).
a. Having a Job
(14,7)
5
Based on test results, a decrease in fatigue
(85,3)
b.
Jobless
29
scores were significantly also occurred in
Education
the control group (p = 0.004; α = 0.05).
a. Low Education
Based on further testing of the level of
(does not school,
27 (79,4)
fatigue post test between the intervention
Elementary,
Junior)
group and the control group there were
b. Higher Education
7
(20,6)
significant differences in levels of fatigue (p
(High School and
= 0.013; α = 0.05). Table 2 shows the
Universities)
differences in levels of fatigue post test
Cancer
Stadium
between the intervention group and the
a. Stadium II
25 (73,5)
control group
b.
Stadium
III
9
(26,5)
TABLE 2
Differences in levels of fatigue post-test,
Therapy History
intervention group and the control group
a. Nothing
23 (67,6)
Mean
b.
Exist
11 (32,4)
Mean±
P
Different
Exercise
History
SD
value
(CI 95%)
a. None
30 (88,2)
Fatigue Levels
(11,8)
b. Exist
4
intervention
4,3±1,6
Types
of
chemotherapy
drugs
1,25
group
16 (47,1)
(0,29-2,22) 0,013* a. Tamoplex
Fatigue Levels
b. Cyclospamit
11 (32,4)
5,5±1,8
control group
c. Doxorubyn
7
(20,6)
independent t test *p < 0,05
by cancer therapy undertaken. The feeling
will make the patient's physical abilities
Based on the test results of multivariate
decline. The high level of perceived fatigue
linear regression, the level of fatigue in
of breast cancer patients, is associated with
breast cancer patients under chemotherapy
a decrease in daily activities performed by
program is influenced by prior treatment
patient (Rotonda, Guillemin, Bonnetain,
history and a history of previous exercise (p
Velten, Conroy, 2013). Therefore, physical
<0.05). Also shown in Table 3 the previous
exercise becomes one of the main
exercise history can explain the fatigue that
recommended treatment for patients with
occurs in cancer patients under
fatigue, so that the patient's ability to
chemotherapy program, the rest is
independently returned. Physical exercises
explained by other variables.
ranging from the mild to severe intended to
Uji regresi Linier *p < 0,05
allow someone to have regular activities, so
Langkah 1 : riwayat terapi, riwayat atihan
that the body will be able to compensate for
Langkah 2 : riwayat latihan
the decrease in the patient's physical
Faktor dependen : tingkat fatigue
abilities. If a person feels himself
psychologically incapable, then his body
DISCUSSION
will respond to the same thing, so it will be
Cancer related fatigue is a feeling of fatigue
the condition of the patient's body
that appears persistently, along with the
increasingly weak.
cancer therapy. Fatigue can arise from the
Accordingly, in this study interventions that
patient's physical condition declined due to
can increase the activity of the respondent
the disease process, and may also be caused
to provide physical fatigue management by
225
walking exercise, and psychological
management by providing relaxation
techniques of yoga. The results in this study
showed a difference between level of
fatigue before and after applying a
relaxation techniques of yoga in patients
with breast cancer under chemotherapy
programs. Chemotherapy is a protocol that
is almost used in all cancer treatment. Be
aware that chemotherapy is a treatment
method using a type of cytotoxic drugs,
which is intended to inhibit the regeneration
of cells. Inhibition mechanism occurs in all
cells of the body, not least on healthy cells
or non-cancerous, so it's also a factor that
contributed to the decline in patient's
physical abilities. important for patients
who are undergoing chemotherapy and
experiencing fatigue to keep improving
activities of daily routine, to compensate for
attenuation effects caused by chemotherapy
drugs on normal cells. Routine activities
such as cooking, sweeping, walking around
the house is the method forms of simple
aerobic activity that can be done by cancer
patients in order to maintain their physical
abilities. In accordance with the results of
several previous studies which revealed that
aerobic exercise (walking exercise) can be
beneficial to the fatigue levels of patients
who are in treatment programs (Velthuis,
Agasi-Idenburg, Aufdemkampe, Wittink
2010; Wahyuni, 2012; Mustian, Sprod,
Janelsins, Peppone , Mohile, 2012; Mayo,
Moriello, Scott, Dawes, Auais, Chasen,
2014).
Decrease in fatigue scores that occurred in
the intervention group can explain that
feeling of fatigue experienced by cancer
patients can be improved by doing aerobic
exercise. These types of exercises can strike
a balance between the needs and the
production of energy needed by the body to
improve physical abilities. Aerobics can
increase the cardio-respiratory activities
that will increase the supply of oxygen to
the muscles. The presence of oxygen in the
muscles will increase energy metabolism
through oxidation of fats, carbohydrates and
protein to
form a small part
Adenotriphosphate / ATP (Hernawati, nd
downloaded from file.upi.edu). ATP is the
basic ingredient of energy, so that when
production increases it will be directly
proportional to the body's ability to perform
its duties and functions. Conversely, a
decrease in activity (deconditioning) result
in the breakdown and loss of enzymes
involved in cellular energy production
level. The use of oxygen and energy
sources become inefficient. Aerobic
exercise is conducted into a stimulation for
the body to change the reserves of energy
sources into the base material of energy.
This is consistent with the first and second
laws of thermodynamics theory, which
states that energy can neither be created nor
destroyed; energy can only be redistributed
or changed from one form to another
(Winningham and Barton-Burke 2000).
Aerobic exercise program can be used as an
exercise to minimize energy loss in cancer
patients whose chemotherapy by using
oxygen consumption as an objective
parameter in measuring performance.
Aerobic exercise showed progress in terms
of performance that produces energy
despite cancer patients undergoing
chemotherapy. Individuals who perform
activities would not feel too tired compared
to individuals who do not indulge, this is
because the energy in individuals whose
activities continue to be distributed though
the energy used continuously, the opposite
situation occurs in individuals who do not
perform activities, energy continues to be
required but there is no activity undertaken
to produce energy anymore. The exercise
program can also provide benefits for the
psychosocial health of cancer patients, by
improving the ability of themselves and the
quality of life (Doyle, C., et al., 2006).
Physically, history or the patient's ability to
perform activities before experiencing
fatigue becomes a factor that greatly affect
the compensation body when experiencing
fatigue. Analysis of the comparison
between each of the factors that influence
fatigue in this study suggests that a history
of activity contributed 17.8% to the
occurrence of fatigue in breast cancer
patients (Table 3).
Meanwhile, the research results also
illustrate that yoga relaxation techniques
226
also contribute to the score of fatigue
respondents. Yoga is useful to provide and
increase the sense of calm in respondents
feeling after doing a series of exercises.
According Shindu (2013) with yoga
positions Shavasana (position lying like a
corpse / relaxation in total) will take place
gentle pressure on the glands that secrete
hormones to a
more stable, blood
circulation becomes more smoothly, the
body will describe the tension of his
muscles, the mind becomes quieter and
more serene sense of being. Relaxation
become appropriate method chosen for the
management of fatigue caused by the
burden of or stress of feeling in the minds
of cancer patients. Stress experienced by
patients could be due to progressive disease
process, the phase of self-acceptance on the
patient's health status, or because of
saturation in undergoing cancer therapy
who repeatedly and for a long time.
According to Hans Selye (in the Canadian
medical hall of fame, 2013) stress
syndrome originated from a situation in
which the body is not specifically respond
to various stimuli. Under conditions of
stress hypothalamus secretes corticotropin
releasing hormone (CRH), further to
stimulate the pituitary to secrete cortisol
and directly or indirectly adrenal secrete
adrenocorticotropic hormone (ACTH),
GRH, Somatostatin and release factors
(releasing) the hypothalamus and pituitary
hormones other. Cortisol and ACTH will
issue vasopressin and catecholamines,
causing an increase in blood pressure and
heart muscle contraction. Clinically, this
phase will bring a feeling of tension
accompanied by signs such as ulcers, high
blood pressure and heart attacks.
symptoms that may aggravate tension
fatigue does not occur.
The results also showed that the level of
fatigue also decreased in the control group,
who did not get a combination of aerobic
exercise with relaxation techniques of yoga.
Generally, it can be overcome with fatigue
restoration techniques, such as; ensure a
proper diet, ensuring a good sleep patterns,
adjusting a good lifestyle, understanding
the psychological problems associated with
fatigue, as well as coping management for
the energy loss (Victoria Minister for
Health, 2013). Decrease fatigue that occurs
in the control group could be acceptable
because some respondents have
chemotherapy schedules predetermined, so
it is difficult to predict the peak of the
respondent fatigue. In addition, the distance
between the last chemotherapy respondents
to the implementation of the research is
very varied, there is a direct postchemotherapy and some that have a few
weeks after the last chemotherapy. In the
opinion of Otti (cited in Danismaya, 2008)
that the peak fatigue occurs on day 7 to day
10 after chemotherapy session and will be
back at the starting point before the next
cycle. So when performed assessments of
respondents could not be ascertained were
at the height of fatigue or not, because it
may just have been a recovery from fatigue
experienced conditions.
Interventions that have been given during
this study is safe and can be done
independently by the respondents during
the period of chemotherapy. It is based on
the absence of a report from the
intervention group who runs a combination
of aerobic exercise and yoga relaxation
techniques that are harmful and harm him.
A decrease in fatigue scores in the
intervention group was significantly higher
when compared with the control group.
Fatigue scores are clinically categorized
into four categories, namely; a score of 0
for categories not fatigue, the score 1-3 to
the category of mild fatigue, fatigue score
of 4-6 to the category of moderate and
severe fatigue category 7-10 (Pipper, et. al,
1998 and NCCN, 2014). Decline in average
scores are statistically obtained either from
0.52 to 1.82 in the intervention group and
Further processing of the situation would
lead to a decrease in the secretion of
insulin, glucagon and the intake of oxygen
in the body. The impact, decrease energy
production, while the energy needs in
cancer patients who are undergoing
chemotherapy are very large. This gap that
causes the inadequate energy for the body,
causing fatigue. Therefore, cancer patients
need to be taught relaxation methods as an
effort to adapt to stress, in the hope
227
the control group, from the initial score in
the range of 6 scores fell in the range of 5
and 4.
Fatigue score 4-6 clinically categorized into
moderate category, so it can be concluded
that the decrease in fatigue that occurs only
statistically significant, but clinically
decrease in fatigue that occurs still within
the same category, or do not decrease.
Several other studies also reveal the same
thing, that the reduction in fatigue after
exercise and relaxation of yoga
significantly only shown in the statistical
calculation, but not clinically significant
difference (Schwartz, Mori, Gao, Nail,
King, 2001 Danismaya 2008, Mustian et. al
2009). However, the research results
Mustian et. al (2009) added that although
not clinically significant changes occur
fatigue, cancer patients were given
continuous training to observations of three
months showed an improvement in quality
of life. As well as on the research results
Danismaya (2008) further explained that
the provision of the relaxation techniques of
yoga over three days showed a decrease in
fatigue clinically significant, namely from
fatigue category of being on the first day
become the category of mild fatigue on the
fifth day. Exercise and physical activity that
exceeds the portion of the ability of cancer
patients can also potentially lead to fatigue,
thus creating the opportunity to exacerbate
fatigue, therefore in this study are still using
the criteria of minimal intervention, namely
with a frequency of three days a week. Such
determination is based on the optimal
frequency in adults aerobic ie at least 3 days
a week (Whalet, 2006) and the duration of
time of at least 10 minutes in a day
(Newton cited in CCWA, 2009). While
Danismaya (2008) also mentions that a
change fatigue of cancer patients given
yoga relaxation occurs from the third day of
exercise. This study is an initial attempt to
determine the effectiveness of the
combination therapy which has not found a
reference frequency and duration for the
implementation of the combination in
previous studies, so that some of the above
considerations are used to determine the
frequency and duration of combined
aerobic exercise with relaxation techniques
of yoga for three consecutive days.
The results showed a significant influence
between the combination of aerobic
exercise with relaxation techniques of yoga
in
cancer
patients
undergoing
chemotherapy, after three days of
observation. But according to the law of
Thermodynamic III discovered by Rudolf
Clausius (in Barton-Burke
and
Winningham, 2000) stressed that energy
can not only be modified in other forms, but
also constantly less available for work.
Whenever energy is converted, it always
takes more energy than the energy
expended a system. This theory can be the
basis of that intervention provided in this
study can not necessarily eliminate fatigue
in just three days, because the body needs a
continuous supply of energy along with
energy use. So that respondents who
perform these interventions are also at risk
for getting tired because of the energy
requirements continuously. However, at
least by providing a combination of aerobic
exercise with yoga relaxation techniques on
an ongoing basis to balance energy needs,
can stimulate the aerobic
energy
metabolism and relaxation of yoga can save
energy by minimizing internal stress.
According Winningham (in King and
Hinds, 2003) about the proposition of rest
and activity states that too much / little
break will result in fatigue, as well as too
much / little activity will also lead to
fatigue, so the dynamic balance between
activity and rest will minimize fatigue, and
otherwise the imbalance of which will
aggravate fatigue.
In addition, fatigue become a different
problem to individuals who have completed
cancer therapy. Individuals who are no
longer undergo therapy and be considered
free of cancer called cancer survivor.
Fatigue is still a problem that can interfere
with quality of life for cancer survivors
significantly. According Servaes, Verhagen,
Bleijenberg (2002), 38% of women with
breast cancer who have completed cancer
therapy still merasakana exhausted after 29
days post-therapy. Fatigue is also still
perceived by 1/3 of women with breast
cancer 10 years after completion of therapy
228
(Bower, Ganz, Desmond 2006). Theory and
research conducted in patients undergoing
cancer therapy can not be applied in a
population of cancer survivors, solutions
that can be given in this population is to
improve themselves to be able to adapt and
perform independently of the fatigue
management are still being experienced.
CONCLUSION
There are differences in fatigue levels in
breast cancer patients who received a
relaxation techniques of yoga. The decline
is statistically significant, but clinically no
significant changes in levels of fatigue
either the intervention group or the control
group. Special interventions for fatigue in
cancer patients in this study may be one of
the nursing interventions, so that nurses can
implement it in order of nursing, especially
in the area of oncology nursing. Further
research is needed, especially regarding
intervention to determine the long-term
results of the implementation of the
intervention.
Specific interventions for fatigue in cancer
patients so far is not widely held by
hospitals that deal with cancer therapy. The
results could be used as a basis for
interventions against fatigue that occurs in
cancer patients in hospitals, both in
hospitals and in the center of the regional
hospital.
informed choices. CA Cancer J Clin,
56(6): p. 323-53.
Escalante P. C., Manzullo F. E. (2009)
Cancer-Related Fatigue: The Approach
and Treatment. J Gen Intern Med,
24(Suppl
2):412–6
DOI:
10.1007/s11606-009-1056-z
Hernawati, (n.d). Produksi asam laktat pada
exercise aerobik dan
anaerobik.
diunduh
dari
file.upi.edu/Direktori/FPMIPA/JUR._P
END._BIOLOGI/.../FILE_2.pdf
Hofman M., Ryan L. J., Figueroa-Moeley
D. C, Jean-Pierre P., Morrow G. R..
(2007). Jacobsen PB, Hann DM,
Azzarello LM, et al. Fatigue in woman
receiving adjuvant chemotherapy for
breast cancer: characteristics, course
and correlates. J Pain Symptom
Manage, 22: 277–88
Kim, S.D., & Kim, H.S. (2005). Effects of a
relaxation breathing
exercise on
fatigue in hematopoietic stem cell
transplantation patients. Journal of
Clinical Nursing, 14, 51–55.
King, C. R., Hinds, P.S. (2003). Quality of
life: from nursing and patients
perspectives, theory and research. 3rd
ed. Jones & Bartlett Publisher.
Mayo NE, Moriello C, Scott SC, Dawes D,
Auais M, Chasen M. (2014).
Pedometer-facilitated
walking
intervention
shows
promising
effectiveness for reducing cancer
fatigue: a pilot randomized trial. Clin
Rehabil. pii: 0269215514536209.
[Epub ahead of print] PubMed PMID:
24917586
Mitchell A. S., Beck L. S., Hood E. L.,
Moore K., Tanner R. E. (2007).
Putting evidence into practice:
evidence-based intervenstion cancer
and its treatment. Clinical journal of
oncology nursing. 11 (1):99-113.
Mustian M. K., Morrow R. G., Carroll J.
K., Moseley D. C., Pierre P. J.,
Williams C. G. (2007). Integrative
nonpharmacologic
behavioral
interventions for the management of
cancer-related fatigue. The Oncologist,
12:52–67.
Doi:10.1634/theoncologist.12-S1-52
REFERENCES
Bower J. E., Ganz P. A., Desmond, K. A.,
(2006). Fatigue in long-term breast
carcinoma survivors: a longitudinal
investigation
Danismaya I. (2008). Pengaruh teknik
relaksasi Yoga terhadap tingkat fatigue
pada penderita kanker payudara pasca
kemoterapi di rumah sakit Hasan
Sadikin Bandung (Thesis). Diunduh
dari http://lib.ui.ac.id/opac/ui/
Doyle, C., Kushi L. H., Byers T, Courneya
K. S., Demark-Wahnefried W., Grant
B., ... & Andrews K.
S. (2006).
Nutrition and physical activity during
and after cancer treatment: an
American Cancer Society guide for
229
Mustian M. K., Peppone L., darling V. T.,
Palesh O., Heckler E. C., Morrow R.
G. (2009). A 4-week home-based
aerobic and resistance exercise
program during radiation therapy : a
pilot project randomized clinical trial. J
support Oncol, 9:158-167.
Mustian KM, Sprod LK, Janelsins M,
Peppone LJ, Mohile S. (2012).
Exercise Recommendations for
Cancer-Related Fatigue, Cognitive
Impairment,
Sleep
problems,
Depression, Pain, Anxiety, and
Physical Dysfunction: A Review.
Oncol Hematol Rev. 8(2):81-88.
PubMed PMID: 23667857; PubMed
Central PMCID: PMC3647480
National Comprehensive Cancer Network.
(2014). NCCN clinical practice
guidelines in oncology (NCCN
guidelines) cancer-related
fatigue
version 1.2014. NCCN.org. diunduh
dari
http://www.nccn.org/professionals/phy
sician_gls/f_guidelines.asp#supportive
Pipper BF., Dibble SL., Dodd MJ., Weiss
MC., Slaugther RE., Paul SM. (1998).
The revised piper fatigue scale:
psychometric evaluation in women
with breast cancer. Oncol Nurs Forum.
25(4):677-84.
PubMed PMID:
9599351
Rotonda C., Guillemin F., Bonnetain F.,
Velten M., Conroy T. (2013). Factors
associated with fatigue after surgery in
women with early-stage
invasive
breast cancer. The oncologist, 18:467475. Doi 10.1634/theoncologist.20120300
Schwartz L A, Mori M., Gao R., Nail M.
L., King E. M. (2001) Exercise reduces
daily fatigue in women with breast
cancer receiving chemotherapy. Med.
Sci. Spsorts Exer.; vol. 33, no. 5:000000.
Servaes P., Verhagen S., Bleijenberg T.
(2002). Determinants of
chronic
fatigue in disesase-free breast cancer
patients: a cross sectional study. Annal
of Oncology,13: 589-590
Shindu P. (2013). Panduan lengkap yoga:
untuk hidup sehat dan seimbang.
Bandung : Mizan Media Utama.
The Canadian medical hall of fame (2013).
Dr. hans Seyle. Diunduh dari
http://www.cdnmedhal.org/dr-hansseyle
Velthuis MJ, Agasi-Idenburg
SC,
Aufdemkampe G, Wittink HM. (2010).
The effect of physical exercise on
cancer-related fatigue during cancer
treatment: a meta-analysis
of
randomised controlled
trials. Clin
Oncol (R Coll Radiol). 22 (3) : 208-21.
doi:
10.1016/j.clon.2009.12.005.
PubMed PMID : 20110159.
Victoria Minister for Health. (2013).
Fatigue fighting tips reproduced from
the
better
health
channel
(www.betterhealth.vic.gov.au). State
of
Victoria. Diunduh dari
http://www.betterhealth.vic.gov.au/Fati
gue_fighting_tips.pdf
Wahyuni S.I., (2012). Walking exercise
programme (WEP) menurunkan cancer
related fatigue pada pasien kanker
payudara di rsud Ibnu Sina Gresik.
Diunduh
dari
http://journal.unair.ac.id/filerPDF/abstr
ak_5631129_tpjua.pdf
Wagner, L.I. & Cella D. (2004). Fatigue
and cancer: causes, prevalence and
treatment approaches. Br J Cancer,
91(5): p. 822-8.
Winningham M.L., Barton-Burke,
M.
(2000) Fatigue in cancer:
a
multidimensional approach.
United
Kingdom: Jones and Bartlett Publisher,
inc
230
COACHING INTERVENTION MODEL TO IMPROVE COMFORT IN ADOLESENCE
WITH DISMINORE
Dhina Widayati
Bachelor of Nursing Study Programe STIKES Karya Husada Kediri
ABSTRACT
Disminore is one of the most common problems experienced by Adolesence during menstruation.
Disminore management can be performed pharmacological and non-pharmacological. In nonpharmacological one of which can be done by a model of coaching intervention through the
abdominal stretching. Coaching is one type of intervention in the theory of comfort "Colcaba". This
study aims to determine the effect of coaching intervention models to improvr comfort of adolesence
with dysmenorrhea. This study design using pre-experimental, with the approach of one group pre-test
post-test design. Sample size are 20 respondents gotten by accidental sampling technique. Data were
analyzed using the Wilcoxon Sign Rank Test with results ρ value = 0.001 (<α = 0.05), which means
there is the influence of coaching intervention models to improve level comfort of adolesence with
dysmenorrhea. After the intervention most of the respondents increased comfort, from mild levels to
be high. This is because the movement of the abdominal stretching can stimulate the hypothalamus to
excite endogenous opioids that produce endorphins, which can reduce pain intensity disminore and
increased comfort with a mechanism can make the muscles around the stomach to relax, reduce pain
and make the body feel comfortable. Abdominal stretching can be applied in the Schools, especially
in the provision of health education and be learning in physical health education.
Keywords: abdominal stretching, coaching, comfort
various problems that interfere with and affect
the activity of which the symptoms of
premenstrual tension (tension before
menstruation), mastodinia, mittelschmerz
(pain during ovulation) and dysmenorrhea
(pain during menstruation).
Dysmenorrhea is not a disease but a
physical disorder arising from abnormalities of
the pelvis are debilitating female. The main
manifestations of dysmenorrhea is painful
cramping in the lower abdominal area and
spread back or surface of the thigh. In the
more severe symptoms are often accompanied
by nausea, vomiting, diarrhea, dizziness and
even fainting. These symptoms cause many
women who complained of pain and requires
resting (Bobak, 2010).
Based on the cause of dysmenorrhea is
divided into two primary dysmenorrhea
experienced by women who are menstruating
prostaglandins cause arising from the work
INTRODUCTION
Adolescence starting from age 12 to
age 23 years were a period of dynamic
development characterized by changes in the
physical development of social cognitive and
emotional so quickly. The earliest changes at
this time that the physical or biological
development of one teenager menstruate. At
puberty women also experience emotional
changes that change as the peak emotional
instability emotional development this is
caused by an increase in sexual hormone is so
rapid (Guyton, 2006).
Menstruation or menstruation is
physiological changes that occur periodically
women and influenced by reproductive
hormones. This period is important in terms of
reproduction, usually occurs every month
between adolescence and menopause (Bieber,
2011). But in menstruation sometimes arise
235
contained in the cervix and uterus.
Prostaglandins work increase uterine
contractions and the excessive levels will
activate the large intestine. Prostaglandins can
reduce or inhibit temporary blood supply to
the uterus, which causes the uterus deprived of
oxygen causing myometrial contractions and
pain. Unlike the secondary dysmenorrhea
usually experienced by women with certain
diseases disorders include endometriosis,
pelvic infection, appendicitis and cervical
cancer (Anurogo 2011; Prawirohardjo, 2011).
In the epidemiological study of
approximately 70-90% of cases of menstrual
pain occurs when adolescence (Anurogo,
2011). According Wales (2006 quoted of
Fatima, 2007), premenstrual syndrome
experienced by 50% of women with socioeconomic medium that come to the clinic
gynecology and approximately 14% of women
between the ages of 15 to 35 years experience
premenstrual syndrome very great influence
that require them to take a break from school
or office. According santoso 2008
dysmenorrhea is the case in Indonesia is of
primary dysmenorrhea, dysmenorrhea
percentage in Indonesia amounted to 64.25%,
which is divided from primary dysmenorrhea
as much as 54.89% and in secondary
dysmenorrhea as much as 9.36%. According to
Hendrik, 2006 as many as 60-75% of young
women experience primary dysmenorrhea
provided three-quarters of women experience
dysmenorrhea pain mild to moderate and a
quarter again experiencing severe pain.
Fatimah Research 2007 conducted in
Semarang, showed that 71.9% of the 154
respondents experienced premenstrual
syndrome. About 40% of women aged 14-50
years experiencing premenstrual syndrome. In
most of the young girls of
primary
dysmenorrhea an ordeal is quite disturbing and
should be experienced by every month so that
young women must be able to seek appropriate
solutions to overcome them.
Management of the intensity of pain
during dysmenorrhea can be done in two ways,
namely by pharmacological and nonpharmacological treatment early in patients
with menstrual pain primer is to provide
medicines penghilangrasa pain and 80% of
patients experienced a decrease in pain of
menstruation after taking drugs inhibiting
prostaglandin (Arifin, 2008; Anurogo , 2011).
Some ways nonpharmacologic to relieve
dysmenorrhea that is safe and without side
effects include warm compresses, messase,
distraction, getting enough sleep, low-salt diet,
physical activity / exercise and increased use
of diuretics naturally like celery (Bobak et al.,
2005) ,
As according to Woo and McEnerney
(2010 in Charles 2012) there is a strategy that
New eventto dysmenorrhea with vitamin B1,
B6, and vitamin E, magnesium and omega 3,
exercise, acupuncture and Chinese medicine.
Many researchers say exercise can cope with
dysmenorrhea and exercise more safe and
contains no side effects due to use of the
physiological processes of the body it is
supported by the results of the Daley (2008)
which states exercise effective in reducing the
intensity of primary dysmenorrhea and study
of istiqomah 2009 stating motion gymnastics
effective in reducing the scale of
dysmenorrhea dysmenorrhea. In the exercise
the body will produce endorpien produced by
the brain and spinal cord that can serve as a
natural tranquilizer, causing a sense of relaxed
and comfortable (Arifin, 2008). According
Thermacare (2010 in the Retna 2011), exercise
that effectively lower scale of dysmenorrhea is
abdominal stretching exercise to increase
muscle strength abdominal flexibility stomach
and immune system in certain circumstances,
as well as relaxation breathing for relaxation,
release tension and improve pulmonary
ventilation so that the blood oxygen can
lowering the scale of dysmenorrhea (Wong, et
al. and Smeltzer 2002).
Distraction is a technique used to
reduce pain by means of diverting attention for
example to sing, pray, tell loudly, and listen to
music, music therapy is a way to reduce pain
by distracting and thoughts to the music is
heard so that the client's awareness of the
painful menstruation or dysmenorrhea is
reduced , listening to music can stimulate the
release of endorphins that can reduce pain and
make the mind relaxes (Potter, 2011).
Dysmenorrhea arising during menstruation is
very influential on the activities of daily living
many symptoms resulting decline in immunity
and the effect on the emotional level of women
when dysmenorrhea not be handled will have
an impact on activity disorder menstrual
moving backward, infertility, pregnancy is not
detected, the infection and the emotional
disorders emerging feelings of tension and
anxiety that will affect personal skills and
236
emotional changes occur that make girls labile
decreased
concentration.
Therefore,
dysmenorrhea symptoms must be addressed in
order to avoid harmful impact. According
Kolkaba, humans have a comprehensive
response to the stimulus / stimuli are complex
and a sense of comfort is the result that comes
as a response to the stimulus. The context of a
sense of comfort as a holistic experience
viewed from four aspects: physical,
psychospiritual, environmental and social
(Tomey and ALIGOOD, 2006). Abdominal
Streching provide interventions are expected
to provide a sense of comfort in adolescent
girls with disminore pain.
This study aims to determine the effect
of coaching intervention models: abdominal
streching towards comfort in adolescent girls
with dysmenorrhea.
1
2
3
7
6
7
35
30
35
Amount
20
100
Table 1 shows that nearly half of respondents
(35%) aged 13 years and 15 years (35%).
2. The age of menarche.
Table 2 Frequency Distribution of
Respondents by age of menarche
No Age of
Frequency %
menarche
1 11 years
11
55
2
12 years
6
30
3
13 years
2
10
4
14 years
1
5
Amount
20
100
The data shown in Table 2 shows that most
respondents (55%) had menarche at age 11
years.
3. Intensity of pain
Table 3 Respondents Frequency Distribution
Based on Ordinary Perceived Pain (in days)
No Days
Frequency
%
1 1
9
45
2 1-2
8
40
3 1-3
3
15
Amount
20
100
METHOD
This study uses a pre-experimental
design with the approach of one group pre post test design. The population is adolesence
at SMPN 1 Srengat experiencing disminore.
The sample size in this study were 26
respondents through accidental sampling
technique. In this study sample will be selected
candidate must meet the requirements of the
inclusion criteria set by the researchers.
Criteria for inclusion in this study are as
follows: (1) Young women who experience
disminore during menstruation (mild pain,
moderate, severe), (2) Young women who did
not take analgesics when disminore, (3) Young
women ages 13 -15 years with disminore are
willing to become respondents. Exclusion
criteria included: (1) Young women who have
reproductive diseases, such as endometriosis,
uterine polyps, ovarian cyst and uterine
myoma, (2) Young women who experience
pain due to other complications. In this study,
the independent variable is the model of
coaching intervention: abdominal stretching.
The dependent variable in this study is comfort
and pain of dysmenorrhea.
RESULTS AND ANALYSIS
General Data
1. Age
Table 1. Frequency Distribution
Respondents by Age.
No Age
Frequency %
13 years
14 years
15 years
Table 3 shows that almost half of respondents
(45%) had pain dysmenorrhea for 1 day
4. Efforts
Independent Dysmenorrhea
Treatment
Table 4. Frequency Distribution of
Respondents by Management Efforts
Disminore
No Management Frekuensi
%
1
Drug
7
35
2
Jamu
3
15
3
Rest
9
45
4
Other
1
5
Amount
20
100
Table 4 shows that in reducing pain, almost
half of respondents (45%) is done with a
break.
of
Specific Data
1. Level of Comfort Prior to Do coaching
intervention: abdominal streching
237
Table 5 Distribution of the frequency of
respondents criteria based on pre
implementation comfort level coaching
intervention: abdominal streching
Comfort
Criteria
Low
Frequenc
y
10
causing increased tone of the myometrium
resulting in excessive uterine contractions. In
general, primary disminore felt pain before
menstruation or during menstruation, this pain
usually lasts 48 to 72 hours (Anurogo, 2011).
This is due on the first day of menstruation has
occurred decay of the cells in the walls of the
endometrium that stimulate contractions of the
uterus, causing pain during menstruation
prefix.
Characteristics of respondents by self
effort in handling disminore, nearly half of the
respondents do independent effort to overcome
the pain disminore with rest. According
Sukarni et al (2013), breaks it is one of the
efforts by non-pharmacological pain
management. Happy indeed break action
carried out adolescent girls who experience
disminore at school. However it is less
effective, because when girls break takes too
long so that it will interfere with the learning
process in schools. It is feared that if the break
is always used as a way to reduce menstrual
pain, will lead to affective and cognitive
impairment in subjects abandoned when
disminore. If the attempt to self-break is also
done in-house, the young women will
increasingly think of the pain that is felt, so
keep pain disminore. Then it can interfere with
daily activities and the young women will
increasingly affect disminore perceived pain.
Difikirkan something negative then the result
will be negative.
%
50%
Medium
4
20%
High
6
30%
Amount
20
100%
Based on the table above the majority
(50%) of respondents have a comfort level in
the low category as many as 10 respondents.
Disminore is pain during menstruation, usually
accompanied by cramps and centered on the
lower abdomen. Menstrual pain, it can occur
vary from mild to severe pain (Prawirohardjo,
2011). Causes of primary disminore influenced
by endocrine factors starting from low levels
of progesterone in the late phase of the corpus
luteum. Hormone progesterone prevents
uterine contractility while the hormone
estrogen stimulates uterine contractility
(Anurogo, 2011). This pain is felt in the
moments before or prefix menstruation that
occurs due to uterine contractions due to the
decay of endometrial cells.
Characteristics of respondents by age
and menarche, most respondents had ages
between 13 to 15 years. Most had menarche at
age 11 years. Ie mid teens aged 13 to 15 years
old is still prone to menstrual pain or pain
disminore, this is because the primary
disminore pain began to emerge from six
months to two years after menarche (Sukarni
et al, 2013). According Anurogo (2011),
menarche at an early age can indeed be a
trigger of primary disminore. This is because
at this period of rapid increases include
reproductive function thus affect the
occurrence of changes both physical and
psychological development. It is also affected
because of the reproductive hormone is not yet
stable.
Table 5 Characteristics of respondents
by regular menstrual pain is felt, almost half of
the respondents feel pain disminore on the first
day alone. According Sukarni et al (2013), the
pain inflicted exposed to increased levels of
prostaglandins in the endometrium, causing a
decrease in progesterone in luteal phase skhir,
2. Level of Comfort After the Forum coaching
intervention: abdominal stretching.
Table 6 Distribution of the frequency of
respondents criteria based on comfort level
post implementation of coaching intervention:
abdominal streching
Criteria Frequency
%
Low
2
10%
Medium
High
Amount
11
7
20
55%
35%
100%
Based on the table above half (50%)
of respondents experienced a decrease in pain
disminore ie mild pain as much as 10
respondents. Disminore is a medical condition
that occurs during menstruation or periods that
can interfere with activities and require
medication which is characterized by pain or
238
pain in the abdomen or pelvic area (Judha et
al, 2012). Abdominal stretching is one of the
relaxation techniques with gentle exercise that
aims to stretch the muscles, especially in the
abdomen, so as to make the muscles around
the abdomen be relaxed and smooth blood
circulation (Nurhadi, 2007). Streching
abdominal movement more emphasis on
quietness and comfort, which has positive
effect on physical and psychological health. If
the body in a relaxed state, the body will
secrete endogenous opioids that produce
endorphins. If we do a physical exercise / sport
lightweight body will produce β-endorphin,
the hormone most efficacious among other
hormone (Haruyama, 2011).
Disminore pain occurs due to
abdominal muscle strain due to the decay of
the cells of the endometrium during
menstruation. A decrease in pain scale and
increase the perceived comfort of respondents
affected by abdominal stretching. These
interventions can reduce pain disminore
because this movement can stimulate the
hypothalamus that can secrete endogenous
opioids from the body and produce
endorphins. Endorphin is a natural sedative
substances derived from the body so as to
make the body feel more relaxed and
comfortable.
Based on research, the majority of
respondents feel pain disminore as age of
menarche at age 11 years. Ie mid teens aged 13
to 15 years old is still prone to menstrual pain
or pain disminore, this is because the primary
disminore pain began to emerge from six
months to two years after menarche (Sukarni
et al, 2013). The primary risk factor disminore
yaiti influenced by age of menarche at age less
than 12 years old, unmarried, and long periods
of time (Anurogo, 2011). Young women
whose menarche age gap of more than two
years prior to the age now, it would be easy
decreased pain intensity disminore. This is
because at adolescence there is a process of
growth, resulting in peningkatann namely
reproductive organs have started to mature and
reproductive hormones begin to stabilize.
Disminore perceived because girls also started
to decrease in physical activity so that more
can arrange a lifestyle that is light exercise
simply by doing abdominal stretching and
more able to avoid other factors that trigger the
pain disminore. A person's behavior in health
requires knowledge that these young women
will avoid and will not experience stomach
pain due to disminore.
3. Effect of coaching intervention: abdominal
stretching for Comfort Level With Young
Women Dysmenorrhea
Cross Tabulation Table 7 Effect of coaching
intervention: abdominal stretching of the pre
respondents comfort
and post intervention
Comfort
Level
Pre
Low
Medium
High
Amount
Low
Medium High Amount
f %
f %
f%
F %
2 10 0
0 0 0
2 10
8 40 3 15 0 0 11 55
0 0
1
5 6 30 7 35
10 50
4 20 6 30 20 100
Based on the table above shows that
the respondents perceived comfort level before
the intervention is implemented mostly (50%)
of respondents have a comfort level in the low
category. Once implemented the intervention
increased comfort, the majority of respondents
have a comfort level in the medium category.
Wilcoxon analysis results with significance (ρ)
= 0.001 and α = 0.05 where ρ <α then ρ =
0.001 <0.05 means that H1 is accepted,
meaning that there is the influence of coaching
intervention models: abdominal stretching of
the level of comfort in adolescent girls with
disminore.
Results of research on the impact of
coaching intervention: abdominal stretching of
the level of comfort in young women with
dysmenorrhea in SMP Negeri 1 Srengat, the
Wilcoxon test analysis showed that there is an
increased comfort after coaching intervention
models: abdominal stretching. Significant
level (ρ) value = 0.001 and α = 0.05 of the
analysis results obtained (ρ) value = 0.001 and
α = 0.05 is H1 accepted, it means that there is
the influence of coaching intervention models:
the streching abdominal increase the comfort
by reducing the intensity of pain disminore in
adolescent girls in SMP Negeri 1 Srengat.
Abdominal stretching is one
alternative to reduce pain due disminore. This
intervention is a series of movements
performed continuously by stretching muscles,
239
especially in the
abdomen. Streching
abdominal disminore made at the time, and
can be done several times until it feels
comfortable. Movement is done can be done
independently, in groups, or even with the help
of an instructor. Streching abdominal goal to
help reduce the complaints of abdominal pain
during menstruation and to help young women
to relax.
In accordance with the implementation of the
first, starting from the gymnastic movements
relaxed sitting position with your left leg
straight ahead, then the right leg is bent
transverse to the side of the left leg. Inhale
while turning the body to the right. Exhale to
its conclusion, and then do back in the right
direction. Do this several times with the same
intensity and in a matter of 2 x 8 count.
Movement started from movements easy to
difficult (Senior, 2008). This movement can
suppress the diaphragm so as to increase the
contractility of the heart muscle and lungs so
that a smooth blood circulation.
In accordance with a second implementation,
the body supine sleeping position, then slowly
bent left leg is placed on the chest, then the
right leg bent, placed on the left leg, the
position of the left hand is placed under the
left leg. Perform full diaphragmatic breathing
until it feels comfortable. Do the same with the
other leg and count 2 x 8 count. If we do light
exercise / physical exercise the body will
release endorphins that reduce pain
(Haruyama, 2011). This movement aims to
relax the muscles thighs, pelvis, abdomen and
back so as to expedite the circulation of blood
by pressing the diaphragm so that the
contractility of the heart muscle that can later
be increased blood circulation and muscles
around the stomach becomes more
comfortable.
In accordance with the implementation
of the third, still in the body supine sleeping
position, with legs bent. Then slowly lift the
abdomen, pelvis, chest with hands remain
beside the body. Perform full diaphragmatic
breathing until it feels comfortable and is
calculated as 2 x 8 count. This movement aims
to relax the abdominal muscles, chest, thighs,
hips and back so that blood circulation more
smoothly so that the body is getting nyerasa
relaxed and comfortable.
of the fourth, the telengkup sleeping posture,
with legs straight back. Then slowly lift the
abdomen and chest with his hands as a
pedestal. Perform full diaphragmatic breathing
until it feels comfortable and is calculated as 2
x 8 count. This movement aims to relax the
abdominal muscles, chest, thighs, hips and
back so that blood circulation more smoothly
so that the body is getting nyerasa relaxed and
comfortable.
of the fourth, sitting cross-legged slowly, then
save the head and body towards the front with
the hand position is straight forward. Do it
while a deep breath and count 2 x 8 count.
This movement aims to relax the muscles
around the stomach and can also suppress the
movement of the diaphragm thereby
increasing muscle contractility of the heart and
lungs so it can be blood circulation and the
body feels more comfortable.
of the sixth, with relaxed sitting position right
leg straight, left leg bent inward. Then the
right hand holding the fingertips right leg and
left hand is pulled towards the right. Perform a
deep breath until you feel comfortable and
count 2 x 8 count. Do the opposite and repeat
several times until it feels comfortable. The
movement of being able to relax the muscles
due to cover the thigh, abdomen, waist,
pinggung and hands so that the blood
circulation throughout the body become more
smoothly and the body becomes relaxed and
comfortable.
Based on the theory that there can be
defined that the interventions that have been
given to respondents who experienced pain
disminore very positive effect on physical and
psychological health by using deep breathing
and can stimulate the body to release
endorphins endogenous opioids that
mengkasilkan. Endorphin is a natural sedative
that comes from inside the body. If the body
relax then we put the body in the correct
position and comfortable. Muscles are not
tense and do not require so much oxygen and
sugar, slow the heart beat, blood pressure
drops, breath easier, relaxed body condition,
the body can stop the production of hormones
adrenaline and all the necessary hormones
during stress, so it can reduce pain.
Looks very significant difference from
the results of the post-test, proving that the
abdominal stretching effect on comfort and
pain intensity disminore in adolescent girls.
But in addition to the therapeutic factors,
240
respondents could set lifestyle and other
factors that could cause pain intensity
disminore being dropped off by exercising
regularly and be able to avoid the factors that
trigger increased disminore.
In accordance with catherine kolcaba theory,
elaborated on the theory of comfort in nursing.
Kolcaba linking the three types of comfort
with the convenience of four experiences:
physical, psychospiritual, environmental and
social. It is known that the appropriate
assessment of the experience of comfort in the
physical context, clients complain of pain
scale 6. After Abdominal Stretching
combination of six exercises, consisting of
paint stretch, lower trunk rotation, hip stretch,
abdominal strengthening: curl up, lower
abdominal strengthening, and the bridge
position to reduce menstrual pain for 10
minutes and evaluated using instruments
cheklist comfort behaviors, pain in the client
down from the pain scale 6 to 5. During done
Abdominal Stretching technique clients are
less able to focus on doing stretching exercises
abdominal muscles, tend to be relaxed and still
thinking pain he felt and the client still
grinning withstand pain. Then do the
Abdominal Stretching into two, clients seemed
more relaxed and feel more comfortable and
clients say the pain slightly reduced so that the
pain scale fell from 5 to 4.
In the evaluation using instruments comfort
behaviors checklist after being given the
implementation of the second increased value
is 0.67 to 0.77. This shows that an increase in
comfort. Pain scale clients are included in the
category of being so continued action to
reduce pain to mild pain that limits scale 1-3.
At the time of abdominal stretching techniques
third, clients feel more comfortable, and can
no longer stand the pain grinning, clients say
the pain much less than at the beginning prior
to abdominal stretching, pain scale 4 fell to 3.
And the score of the instrument balanced ride
comfort behaviors checklist to 0.99. The
higher the score the higher the level of
comfort. Abdominal stretching techniques,
effective to reduce pain because the exercises
are designed to increase muscular strength,
endurance, and flexibility of muscles, which is
expected to decrease menstrual pain
(dysmenorrhea) in women. This exercise
should be done at the time of menstrual pain
(Thermacare, 2010).
Abdominal stretching techniques can
reduce stress and can increase the production
of endorphins that affect pain reduction.
Researchers are also using music that clients
are more relaxed because the client's
psychological state can affect the intensity of
pain. In accordance with the theory Kolcaba
(2005) in Peterson and Bredow (2010: 259)
suggests some assumptions about the comfort
among others: 1). Humans have a holistic
response to the complex stimulus,
2).
Convenience is a holistic expected results
related to the discipline of nursing, 3). People
are trying to meet the needs of active comfort.
Convenience is more than the absence of pain,
anxiety, and other physical discomfort.
CONCLUSION
Comfort level with disminore girls before
coaching intervention: abdominal steching,
mostly in the low category. Comfort level after
doing the coaching intervention: abdominal
steching in adolescent girls half of the
respondents have a comfort level in the
medium category.
Coaching intervention:
abdominal steching can improve comfort
through reduction in pain intensity disminore
in adolescent girls.
ACKNOWLEDGEMENT
Thanks to the respondents, all participants
SMPN 1 Srengat and Emy Nurul Hidayah as a
partner in this study.
REFFERENCE
Anderson, B. 2010. Stretching in the office.
Cetakan 1. Penerjemah: Ratih Ramelan.
Jakarta: PT Serambi Ilmu Semesta.
Anugroho D, Wulandari. 2011. Cara Jitu
Mengatasi Nyeri Haid. Yogyakarta: C.V
Andi.
Anurogo. 2008. Segala sesuatu tentang nyeri
haid. Diperoleh 1 Juli 2015 dari
http://www.kabarindonesia.com/berita.p
hp?pil=3&dn=2008061916480
Arifin, S. 2008. Nyeri Haid. Jakarta: EGC.
241
Asmadi. 2012. Tehnik Prosedural
Keperawatan: Konsep dan Aplikasi
Kebutuhan Dasar Manusia. Jakarta:
Salemba Medika.
Perry, S.E., Hockenberry, M.J., Lowdermilk,
D.L. & Wilson, D. 2010. Maternal child
nursing care. Fourth Edition. Mosby:
Elsevier Inc.
Bobak, I.M., Lowdermilk, D.L., Jensen, M.D.,
& Perry, S.E. 2005. Maternity Nursing.
Fourth Edition. Mosby-Year Book, Inc.
Peterson, Sandra J. & Bredow, Timothy S.
2010. Middle Range Theories,
Application to Nursing Research.
Second edition. Philadelphia: Lippincott
William & Wilkins.
Bobak, Lowdermilk, Jensen. 2010. Buku Ajar
Keperawatan Maternitas. Edisi 4.
Jakarta: EGC. Hal 29-51.
Potter, P.A. & Perry, A.G. 2006.
Fundamentals of nursing: concepts,
process, and practice. Fourth Edition.
USA: Mosby-Year Book Inc.
Guyton, A.C. 2006. Buku ajar fisiologi
kedokteran. Edisi 7. Bagian III. Alih
Bahasa Effendi & Melfiawati. Jakarta:
EGC.
Prawirohardjo, S. 2011. Ilmu Kandungan.
Edisi 3. Jakarta: PT Bina Pustaka
Sarwono Prawirihardjo. Hal 182-185.
Puji A. Istiqomah. 2009. Efektifitas Senam
Disminore dalam Mengurangi
Disminore pada Remaja Putri di SMU
N 5 Semarang. Diperoleh tanggal 15
Juni 2015 dari
http://keperawatan.undip.ac.id
Hendrik. 2006. Problema haid: tinjauan
syariat islam dan medis. Cetakan 1.
Solo: PT Tiga Serangkai Pustaka
Mandiri.
Judha M, Sudarti, Fauziah A. 2012. Teori
Pengukuran Nyeri & Nyeri Persalinan.
Yogyakarta: Nuha Medika. Hal 31-55.
Santoso. 2008. Angka kejadian nyeri haid
pada remaja Indonesia. Diperoleh 3 Juli
2015 dari http://www.infosehat.com/inside_level2.asp?artid=758
Kolcaba, Katherine. 2003. Comfort theory and
practice: a vision for holistic health
care and research. New York: Springer
Publishing Company.
Senior. 2008. Latihan peregangan. Diperoleh
3 Juli 2015 dari
http://www.cybermed.cbn.net.id
Kolcaba, Katharine., DiMarco, Marguerite.
2005. Comfort theory and its
application to pedriatric nursing. A
pedriatric nursing, 31,187-94.
Sukarni I, K.Wahyu P. 2013. Buku Ajar
Keperawatan Maternitas. Yogyakarta:
Nuha Medika. Hal 37-53.
Lestari, Herna. 2011. Kesehatan Reproduksi
Modul Mahasiswi. Yayasan Pendidikan
Kesehatan Perempuan, Jakarta.
Thermacare 2010. Abdominal stretching
exercises for menstrual pain. Diperoleh
8 Juli 2015 dari
http://www.chiromax.com/Media/abstre
tch.pdf.
Tomey, Alligood. 2006. Nursing Theorist and
Their Work. 6th edition. Toronto: The
CV Mosby Company St. Louis
Tomey, A.M., & Alligood, M.R. 2010.
Nursing Theorist and Their Work. 7th
edition. Maryland Heights, MO: Mosby
Elsevier.
Manuaba, IBG. 2010. Buku Ajar Penuntun
Kuliah Ginekologi. Jakarta: Trans Info
Media. Hal 631-640.
Ningsih, R. 2011. Efektifitas Paket Pereda
terhadap Intensitas Nyeri pada Remaja
dengan Disminore di SMAN Kecamatan
Curup. Tesis. Diperoleh tanggal 2 Juli
2015 dari http://www.lontar.ui.ac.id
Nurhadi. 2007. Cara mudah tetap sehat.
Diperoleh 8 Juli 2015 dari
http://www.hady82.multyply.com.
Woo, P. & McEneaney, M.J. 2010. New
strategies to treat primary
242
dysmenorrhea. The Clinical Advisor.
Diperoleh 26 Juni 2015 dari
http://proquest.umi.com/pqdweb?index=
6&did=2195246451.
Wong, Donna L., Eaton, Marylin
Hockenberry, dkk. 2009. Wong buku
ajar keperawatan pedriatric. Vol 1.
Jakarta: EGC.
243
SLOW DEEP BREATHING INTERVENTION REDUCE THE FREQUENCY OF
RECURRENCE OF PATIENTS WITH ASTHMA BRONCHIALE
Nian Afrian Nuari
Bachelor of Nursing Study Programe STIKES Karya Husada Kediri
ABSTRACT
Asthma is one of the problems that arise for people in various age and number of asthmatics is
growing. Exercise have been widely used as complementary therapy people with Asthma
Bronchiale. The goal this research is to analize effect of slow deep breathing intervention reduce
the frequency of recurrence in patients with Asthma Bronkiale. This study used Pre Experimental
Design with One Group Pre-Post Test. The samples in this study used purposive sampling
technique with 10 respondents, while the instrument measured the value of PEFR used a flow meter
and the frequency of recurrence in patients with Asthma Bronchiale checklist sheet and analyzed
using the dependent sample t test (paired t test) with α 5%. The results showed that most
respondents (88%) showed PEFR values increased and 60 % of respondents experienced a decrease
in the frequency of recurrence of Asthma Bronchial after intervening slow deep breathing. Based on
analysis of Paired T Test on PEFR values (p = 0.001) and the frequency of recurrence of asthma (p
= 0.003), so it can be concluded that there is effect of slow deep breathing with the frequency of
recurrence of Asthma Bronchiale. Slow deep breathing in the lungs causing get plenty of oxygen
will flow throughout the body. This supports the activity of the cells and stimulate spending
hormone such as endorphins to prevent the recurrence of asthma. Proper asthma management
among others are making near-normal lung function, prevent recurrence, control regularly slow
deep breathing.
Keywords: Slow, Deep, Breathing, Recurrence, Asthma ,Bronchiale
treat this disease. (nugroho, 2009). In
indonesia is estimated to 17% of the
population suffer from asthma in its various
forms (sahat, c, 2008). Various studies show
that asthma pravalensi in indonesia estimated
3 to 8.0%. For people with asthma in east java
in 2003 as many as 21 925 people.
To assess the severity of disturbance can be
assessed by lung function tests that the
inspection checks spirometridan peak
expiratory flow (ape). In addition to using
spirometry, ape value can be obtained through
a simple examination using meter peak
expiratory flow (pef meter). Results of
pulmonary function tests in patients with
asthma, it is known the existence of airway
obstruction if fev1 (forced expiration volume
first second) / fvc (forced vital capacity) <75%
or fev1 <80% predicted value. Monitoring
peak ekspiratory flow rate (pefr) is important
to assess the weight of asthma, the degree of
INTRODUCTION
Asthma is one of the problems for the people
who were raised in various ages. Asthma is a
chronic inflammatory disease respiratory
disorder characterized by episodes of
wheezing, difficulty breathing, chest tightness
and coughing. According to who, about 100 to
150 million people worldwide are persons
with asthma. This number continues to grow
as many as 180,000 people every year. In
indonesia, the prevalence of asthma is not
known for certain, but estimated 2-5% of
indonesia's population suffer from asthma
(moh,
2006).
In 2005 estimated 400 million people
worldwide suffer from asthma with added
180,000 annually. The prevalence of asthma
morbidity and mortality recently reported
increasing worldwide, despite various new
drugs continue to be developed and used to
251
diurnal variation, the treatment response when
an acute attack, detection of worsening
asymptomatic before it becomes serious, the
identification of the originator for example
exposure to the working environment and the
frequency of recurrence of asthma (guidelines
for the diagnosis and management of asthma
in indonesia, 2003). In the study ambareesha,
kondam et al (2012) reported on a study of
medical students showed a slow deep
breathing can improve pulmonary function
(vital capacity, forced vital capacity and peak
expiratory flow rate).
Proper asthma
management among others are making nearnormal lung function, prevent recurrence,
control regularly and improve your fitness
with exercise or exercise that is recommended
(yunus, 2006). Respiratory muscles is one of
the interventions in patients with bronchial
asthma. Many theories that explain how
respiratory muscle training is expected nati
can improve lung function one is to slow deep
breathing techniques.
Slow deep breathing is a yoga practice which
concentrates more on breathing and can be
applied in patients with asthma. Slow deep
breathing is beneficial to increase the
maximum oxygen intake, and the circulation
of blood to and from the lungs that can
improve lung function (nadera, reyna, 2009).
Research pramanik, et al. (2009) in adult
patients found that respiratory bhastrika
pranayamic in adults able to stimulate the
frequency and duration of nerve impulses that
activate the receptor pulmonary during tidal
volume. It was able to increase vasodilation in
blood vessels to lower peripheral resistance in
the blood vessels so that it can lower blood
pressure. , bhargava research results r (1998),
shows the slow deep influence on the
autonomic nervous changes associated with
breathing and increase vagal rhythm and
reduce
sympathetic
changes.
The novelty of this study is the
implementation of the slow deep breathing is
rarely applied by people with asthma and have
not done much research in indonesia on slow
deep breathing with asthma sufferers in
indonesia. Therefore, it was necessary to
examine the effect of slow deep breathing is
the pulmonary function in patients with
asthma and frequency of recurrence of the
disease.The purpose of this study was to
determine the effectiveness of the method of
Slow Deep Breathing in lowering the value of
Peak expiratory flow rate (PEFR) and the
frequency of recurrence in patients with
Bronchial asthma.
METHOD
The research design used in this research is to
draft Pre Experiment Design One Group PrePost Test. This research was conducted in
Puskesmas Bendo Kediri region and time of
the study started in January-August 2015. The
population in this study were all patients with
asthma bronchiale in Puskesmas Bendo in
January - July 2015. In this study, researchers
set a number of samples of 10 people with a
sampling technique
by using purposive
sampling. PEFR value measuring instruments
used in the form of tools and sheet Peakflow
meter check list. Frequency of Recurrence
Asthma.
The instrument used was the observation
sheet. Slow deep breathing intervention for 1
month and monitored by researchers. Within a
period of 1 month later, researchers conducted
a post test to measure the return value of PEFR
and
asthma
relapse
frequency.
Bivariate analysis was conducted to determine
differences in PEFR value and frequency of
asthma relapse during the pre-test and post-test
with statistical test dependent sample t test
(paired t test) with α (standard error) of 5%.
RESULT
a.Age
Bronchial Asthma frequency distribution of
patients by age, can be seen below:
Figure 1. Diagram Frequency Distribution
Based Asthma Patients Age in June 2015
Kediri
Based on Figure 1 indicates as many as five
respondents (50%) had 61-70 years of age, 3
252
respondents (30%) were aged 51-60 years,
10% aged 31-40 years and 10% of respondents
aged 41-50 years.
b.Gender
Bronchial asthma patients the frequency
distribution by sex can be seen
below:
Based Asthma Patients Body Height in June
2015 Kediri
Based Asthma Patients Sex in June 2015
Kediri
Based on Figure 4 shows as many as eight
respondents (80%) have a height of 141-150
cm, one of the respondents (10%) have a
height of 131-140 cm and 1 respondent (10%)
have a height of 151-160 cm.
Based on Figure 2. shows as many as nine
respondents (90%) were female and 1
respondent (10%) male sex.
e.Weight
c.Long suffering Bronchial Asthma
40%
60%
1-5 Tahun
6-10 Tahun
Based Asthma Patients Body Height in June
2015 Kediri
Based Asthma Patients Sex in June 2015
Kediri
Based on Figure 5 shows as much as 6
respondents (60%) had a body weight of 31-40
kg, 3 respondents (30%) weight 41-50 kg and
1 respondent (10%) weight 61-70 kg.
Based on Figure 3 shows as many as six
respondents (60%) suffered from asthma for 610 years and 4 respondents (40%) suffered
from asthma for 1-5 years.
d.Body Height
253
2. PEFR value respondents during the pretest and post-test
can be seen
below:
month, and as many as 1 of the respondents
(10%) experienced a frequency recurrence 56x / month. After the intervention Slow
Breathing deep as 3 respondents (30%) to not
relapse, 3 respondents (30%) had experienced
a recurrence frequency 1-2x / month and 3
respondents (30%) experienced a recurrence
frequency 3-4x / month.
Data Analysis
Normality test using Kolmogorov Smirnov test
data analysis with statistical tests Paired t test
showed that the obtained PEFR p value of
0.001 (p <0.05), which means that there are
differences in PEFR values before and after
the intervention of slow deep breathing. While
the frequency of recurrence of asthma was
obtained p 0.003 (p <0.05), which means that
there are differences in the frequency of
recurrence of asthma before and after the
intervention of slow deep breathing.
Figure 6. Diagram PEFR Value during pre and
post test on Asthma Patients in June 2015
Kediri
Based on Figure 6 shows as many as nine
respondents (88%) experienced an increase in
the value of PEFR after intervention Slow
deep breathing and 1 respondent (12%) did not
experience an increase in the value of PEFR
after the intervention.
DISCUSSION
1. PEFR Value Analysis in Pre test
The result showed that prior to dintervensi
Slow Deep Breathing by 5 respondents (50%)
has a value of PEFR below 250 l / sec and as
one of the respondents (10%) has a value of
PEFR 250 l / sec, and as many as four
respondents (40%) PEFR above has a value of
250 l / sec. This suggests that in patients with
asthma tend to have below normal PEFR value
in accordance with a count of the age and
height.
To assess the severity of a disorder that occurs
in asthma can be assessed by lung function
tests, namely the examination of spirometry
and peak expiratory flow examination (APE).
In addition to using spirometry, APE value can
be obtained through a simple examination
using meter peak expiratory flow (PEF meter).
Results of pulmonary function tests in patients
with asthma, it is known the existence of
airway obstruction if FEV1 (forced expiration
volume first second) / FVC (forced vital
capacity) <75% or FEV1 <80% predicted
value. Monitoring Peak Ekspiratory Flow Rate
(PEFR) is important to assess the weight of
asthma, the degree of diurnal variation, the
treatment response when an acute attack,
detection of worsening asymptomatic before it
3.The Frequency Of Recurrence Bronchial
Asthma
Frequency of recurrence bronchial asthma in
pre-test and post-test can be seen below:
Figure 7. Diagram frequency of recurrence
during pre and post test on Asthma Patients in
June 2015 Kediri
Based on Figure 7 shows prior to the
intervention as much as 6 respondents (60 %)
experienced a recurrence frequency 3-4x /
month, a total of three respondents (30%)
254
becomes serious, the identification of the
originator for example exposure to the
working environment and the frequency of
recurrence of asthma (Guidelines for the
diagnosis and management of asthma in
Indonesia, 2003).
Mulyadi (2011) states that PEFR study in
adults with asthma tend to decrease and male
gender are also likely to experience a decrease
in PEFR due to the influence of smoking
history and others. While the value of PEFR in
adults who suffer from lung disease also
decreased the most with a value of 50-80%.
This is in line with research that people who
suffer from respiratory problems such as
asthma bronchiale impaired PEFR. The results
showed that as many as 8 respondents (80%)
have a height of 141-150 cm and as much as 6
respondents (60%) had a body weight of 31-40
kg. PEFR values of the respondents varied
according to the height of being owned
respondent. This is consistent with Mulyadi
(2011) states that the normal PEFR values
associated with the individual's height and
weight of individuals and PEFR values are
also influenced by age, sex, history of
respiratory problems and lung disease. It can
be concluded that the normal value is affected
PEFR weight and height.
applied in patients with asthma. Slow deep
breathing is beneficial to increase the
maximum oxygen intake, and the circulation
of blood to and from the lungs that can
improve lung function (Nadera, Reyna, 2009).
In normal conditions we put on 10-15% of our
ability to breathe every day. Deep slow
exercise will increase the amount of blood
being exchanged in the lungs. In normal
conditions the amount of air entering the lungs
in one minute keparu is as much as 16 x
500ml, whereas when doing yoga exercises
has increased 4 x 4800 ml. Some of the
benefits of yoga breathing is to increase
breathing capacity, improve breath control,
and increase the supply of oxygen.
Pramanik, et al. (2009) in adult patients found
that respiratory bhastrika pranayamic in adults
able to stimulate the frequency and duration of
nerve impulses that activate the receptor
pulmonary during tidal volume. It was able to
increase vasodilation in blood vessels to lower
peripheral resistance in the blood vessels so
that it can lower blood pressure. With the
stimulus, there will be an increase in lung
function and the effect on patient PEFR
values.
Slow Deep Breathing is an attempt to regulate
and control the breath consciously that include
setting the length and duration of inhalation
and exhalation as well as efforts to hold his
breath. With the application of slow deep
breathing regulator happen coping
mechanisms capable of inhibiting the release
of CO2 that stimulate Bohr effect that will
increase the amount of catalyst in chemical
reactions release of oxygen from hemoglobin,
which will accelerate the distribution of
oxygen to the tissues. Besides, breathing
exercises are also able to increase the use of
NO (Nitric Oxcide) which stimulates Guanylil
cyclase that activates cGMP and GTP that
activates cGMP dependet that stimulates
myosin light-chain phospatase activity that
causes relaxation of the respiratory tract,
causing dilation that can improve lung
function measured by the value of Peak
expiratory flow rate (PEFR) in patients with
Bronchial asthma. Attempts setting of slow
deep breathing breath on both inhalation and
exhalation can also increase muscle flexibility
intercostalis, pectoralis and trapezius resulting
in increased levels of O2 in the lung that will
improve lung function.
2. PEFR Value Analysis in Post test
The result showed that after intervention Slow
Breathing deep by 2 respondents (20%) had
PEFR values below 250 l / sec and 8
respondents (80%) had PEFR values above
250 l / sec. This is consistent with research
Ambareesha, Kondam et al (2012) reported on
a study of medical students showed a slow
deep breathing can improve pulmonary
function (Vital Capacity, Forced Vital
Capacity and Peak expiratory Flow Rate).
Proper asthma management among others are
making near-normal lung function, prevent
recurrence, control regularly and improve your
fitness with exercise or exercise that is
recommended (Yunus, 2006).
Respiratory muscles is one of the interventions
in patients with Bronchial asthma. Many
theories that explain how respiratory muscle
training which is expected later can improve
lung function one is to Slow deep breathing
techniques.
Slow deep breathing is a yoga practice which
concentrates more on breathing and can be
255
3. The Frequency of Recurrence Analysis
Bronchial Asthma in Pre Test
will berbedapada every height and weight
(Guyton & Hall, 2001).
The result showed that before intervention
Slow Breathing deep as 6 respondents (60%)
month, a total of three respondents (30%)
month, and as many as 1 of the respondents
(10%) experienced a recurrence frequency 56x
/
month.
Based on the characteristics of respondents by
age is obtained as much as 50% of asthma
patients aged 61-70 years. Most who develop
asthma in adulthood. Based on the Report of
the Basic Health Research (RISKESDAS) in
2007 found that the tendency of the prevalence
of asthma has a tendency prevalence increases
with age. The airways of asthmatics have
distinctive properties that is very sensitive to
various stimuli. Asthma attacks can occur at
any age from children to adults (Sandaru,
2007).
Younger asthma patients under age 30 years of
about 70% due to hypersensitivity. In patients
with asthma who are older, the cause
hypersensitivity to non-allergic irritants in the
air such as dust, respiratory tract infection,
fatigue, changes in weather and excessive
emotional expression. Allergic reaction that
occurs will stimulate
the formation of
abnormal IgE antibody in large quantities and
these antibodies cause allergic reactions. This
is consistent with the findings that most of the
respondents have more than 30 years of age
with the age in which individuals experience
hypersensitivity thus higher recurrence
frequency becomes higher.
Based on the characteristics by sex obtained
mostly female. This is consistent with the
results RISKESDAS 2007 which states that
the prevalence of asthma there were no
differences
by
sex.
The results showed that as many as 8
respondents (80%) have a height of 141-150
cm and as much as 6 respondents (60%) had a
body weight of 31-40 kg. Weight and height
affect the respiratory muscle strength and lung
function, these results are related to the theory
that someone who has a high body large it will
have the function of pulmonary ventilation is
higher than the smallish. Inspiratory and
expiratory function is affected by the height
and weight as the ability to expand the chest
4. The Frequency of Recurrence Analysis
Bronchial Asthma in Post Test
The result showed that after intervention Slow
Breathing deep as 3 respondents (30%) to not
relapse, 3 respondents (30%) had experienced
a recurrence frequency 1-2x / month and 3
respondents (30%) experienced a recurrence
frequency 3-4x / month. Bhargava (1998), also
showed Slow deep influence on the autonomic
nervous changes associated with breathing and
increase vagal rhythm and reduce sympathetic
changes. Results were in line with this study
that the autonomic nervous changes that will
improve the lung function of patients.
Slow Deep Breathing reduce sympathetic
activity and give relaxation response.
Relaxation of skeletal muscle also increases
lung expansion. During slow deep breathing
patterns will increase bronchiale increasingly
enlarge the blood perfusion to alveoli. It is
able to support a controlled breathing patterns
and help reduce sensitivity to allergens that
come from the environment. This mechanism
which can affect a decrease in allergic
reactions that may decrease the frequency of
asthma relapse.
Slow breathing in the deep causes the lungs to
get oxygen and oxygen will flow throughout
the body. If breathing is done regularly and
concentrate, then the wave amplitude
frequency bioelectrical energy fields in the
body will take place slowly and steadily. This
supports the activity of the cells and organs of
the body to be in sync and stimulate spending
antibodies that work against a variety of
sources of disease and stimulate spending
hormone such as melatonin, endorphins that
calm the nerves and the mind. This is what
causes asthma patients bronhiale can avoid
repeated asthma attacks because the mind
relaxed and stress do not cause the patient
could avoid the stressor or allergens trigger
asthma attacks.
CONCLUSIONS
RECOMMENDATIONS
AND
The results showed that the method of Slow
deep breathing can affect the value of PEFR
and asthma relapse frequency. Slow deep
breathing method is able to increase the value
256
PEFR patients with asthma bronchiale and
able to reduce the frequency of relapse of
patients with asthma. Suggested this method
can be applied as one exercise that is easy and
inexpensive that can be carried out
continuously by patients
with asthma
bronchiale.
Hidayat, Azis Alimul. 2007. Metode penelitian
keperawatan dan tehnik analisis data.
Khanam, AA, Sachdeva U & Gulleria R. 1996.
Study Of Pulmonary and Autonomic
Functions Of Ashma Patients After
Yoga Training. The Journal
Physiology Pharmacology Volume 40
(4). 1996. Pp. 318-324
Mulyadi, Zulfiitri, & Nafsiah, Siti. 2011.
Analis Hasil PEFR Pada Pasien
Gangguan Pernafasan Di Pesisir Kota
Banda Aceh. Jurnal Respirology
Indonesia Volume 31, No.2, 2011.
Nadera, Reyna, 2009.
Menyembuhkan
penyakit asma secara alami. Jakarta:
Gramedia
Nugroho, sigit. 2009.Terapi pernafasan pada
penderita asma. Yogyakarta
Nursalam. 2003.
Konsep & Penerapan
Metodologi
Penelitian
Ilmu
Keperawatan: Pedoman Skipsi, Tesis,
dan Instrumen Penelitian. Jakarta:
Salemba Medika, hal 16-21
Notoatmodjo, Soekidjo. 2005. Metodologi
penelitian kesehatan. Jakarta: Rineka
Cipta.
Potter, Patricia A. 2005.
Buku Ajar
Fundamental Keperawatan Vol. 2.
Jakarta: EGC.
Prasetya, Arief Widya.. 2011.
Pengaruh
Latihan Nafas Metode Butekyo
Terhadap Peak Expiratory Flow Rate
(PEFR)
dan Derajat Kontrol
Penderita Ashma. Thesis. Universitas
Airlangga
Pramanik, Tapas, Sharma, Hari Om,et al.
(2009). Immediate Effect of Slow
Pace Bhastrika Slow deep on Blood
Pressure and Heart Rate. The
Journal
Of
Alternative And
Complementary Medicine Volume
15, Number 3, 2009, pp. 293–295,
REFERENCES
Ambareesha, kondam et al . 2012. A study to
evaluate the effect of vital capacity
(vc), forced vital capacity (fvc) and
peak expiratory flow rate (pefr) in
subjects practicing slow deep . Inter J
Cur Res Rev. Vol 04 issue 19
Bhavanani AB , Sanjay Z , Madanmohan.
2011. Immediate effect of sukha slow
deep on cardiovascular variables in
patients of hypertension. International
Journal Of Yoga Therapy [Int J Yoga
Therap] . (21), pp. 73-6.
Bhargava R , Gogate MG , Mascarenhas JF.
1998. Autonomic responses to breath
holding and its variations following
slow deep.
Indian Journal Of
Physiology And Pharmacology
[Indian J Physiol Pharmacol] 1998
Oct-Dec; Vol. 32 (4), pp. 257-64.
Black, Joyce & Hawk, Jane. 2005. Medical
Surgical
Nursing;
Clinical
Management For Positive Outcome.
St.Louis: Elsvier.Inc.
Camalia, S.Sahat.2008. Pengaruh senam asma
terhadap kekuatan otot pernafasan
dan fungsi paru pasien asma di RSU
Tangerang.
Thesis.Universitas
Indonesia
Dabhade AM ,Pawar BH , Ghunage MS ,
Ghunage VM. 2012. Effect of slow
deep
(breathing exercise) on
arrhythmias in the human heart.
Elsevier Country of Publication:
United States NLM ID: 101233160
Depkes RI. 2003. Pedoman diagnosis dan
penatalaksanaan asma di Indonesia
Guyton & Hall . 2001. Buku Ajar Fisiologi
Kedokteran. Jakarta : EGC, hal 14,
119, 120, 122, 124, 126
257
EFFECT OF GIVING COGNITIVE SUPPORT AND EMOTIONAL SPIRITUAL
QUOTIENT (ESQ) TO CHANGES SEXUAL BEHAVIOR PATIENTS HIV/AIDS
Joko Sutrisno*, Yuly Peristiowati**, Alfian Fawzi***
ABSTRACT
HIV is a health problem that threatens
Indonesian and many countries around the world.
Currently no country is free from problem HIV (Djuanda, 2011). Increases Case HIV/AIDS in
the world , including in Indonesian, is one thing that soulder be a concern of many patients. One
thing is considered to be a source of spread
HIV/AIDS is a ryski sexual behavior . Risk
Sexual Behavior a sexual activity ,especially those associated with vaginal and anal intercourse
by individuals with sexual partners so that it becomes vulnerable to contracting sexually
transmitted diseases as HIV/AIDS. One of the efforts to suppress the increase of HIV cases is
chages in the sexual behavior of the sufferer so it does not infect other people who are stilln
healthy . This result before and after intervantion Cognitive Support an ESQ Support Sexual
behavior research before treatment to 80% commit sexual behaviors that lead to the spread of
HIV / AIDS and after treatment 36% perform sexual behavior that causation to the transmission
of HIV / AIDS. obtained from analysis Wilcoxon p value ,035 ≤ α 0:05 proved to effect
cogntive support and increase to Emotional Spiritual Quotient (ESQ) expected sexual
behavior patient HIV IDS. So the they will be more motivated to live better and carry out useful
activities and get closer God ,Chages and Behavior an attitude positive and treatment are
rutinely expected to increase Quality of life and status of people living with HIV /AIDS.
Keyword : Cogntive Support, Emotional Spiritual Quotient (ESQ) , Sexual Behavior
mother -to-child HIV NTRODUCTIONand
positive ( 4.1 % )
MSM ( Men Sex Men ) ( 2.5% ) (Ditjen PP
& PL Kemenkes RI, 2013).
Based on the data obtained from the Dr.
ISKAK Hospital Tulungagung known that
the patients with HIV / AIDS in 2006 was
35 people , 2007 is as much as 42 , Year
2008 is as many as 62 people , 2009 was as
much as 96 , Year 2010 is a total of 103
people , 2011 is as much 107 , 2012 is as
many as 144 people , in 2013 was as much
as 152 people . Based on the data obtained
from space chrysanthemums during the last
5 months is known that in September 2013
is as many as 11 people , in October are as
many as 26 people , November is as many
as 17 people , December is as much as 4
people . While the month of January 2014
is as much as 7 people (medical record
RSUD Dr. Iskak Tulungagung, 2013).
The role of health care in the prevention
and control of disease HIVdilakukan
through outreach to the community ,
INTRODUCTION
Globally an estimated 42 million people
living with HIV/AIDS, They are
composed 38,6 million adult, 50% of
whom were women (19,2 million) and
under 15 year (3,2 million) (WHO,
2007).according to report case of HIVAIDS from April to Juni 2013 in
Indonesian the prevalence of report AIDS
as many as 320 people
. The highest
percentage of AIDS in the age group 30-39
years ( 33.8 % ) , followed by the age group
20-29 years ( 28.8 % ) and the age group
40-49 years ( 11.6 % ) . The ratio of AIDS
among men - men and women is 2 :
1.Jumlah highest AIDS were reported from
South Sulawesi ( 80 ) , East Nusa Tenggara
( 76 ) , Lampung ( 50 ) , Banten ( 31 ) and
Southeast Sulawesi ( 25 ) .Persentase
highest AIDS risk factor is sex risk in
heterosexual ( 78.4 % ) , the use of nonsterile syringes to IDUs ( 14.1 % ) , from
258
mentoring high-risk groups and behavior
change interventions
communities, HIV testing and counseling
services, Harm Reduction services,
treatment and periodic inspection of
sexually transmitted diseases (STDs), blood
safety donors and other activities that
support the eradication of HIV
(Notoadmodjo, 2003).
Besides, awareness of the self in people
with HIV to not do things - negative things
like sex uncomfortable still be done. One
attempt was made to change the attitudes
and behavior of people with HIV are giving
cogntif support in the form of provision to
people living with HIV and their family
members, in addition to information also
given motivation, psychological assistance,
and providing spiritual guidance (Rasmun,
2004). Dihapkan by administering cogntif
supportdapat change the attitudes and
behavior of people with HIV become
positive attitude and behavior, so that all
activities undertaken will memotvasi HIV
patients to improve their quality of life.
Positive behavior will result in an increase
in the immune system of HIV patients,
which is indicated by elevated levels of
CD4.
Based on the above phenomenon, the
researcher interested in conducting research
with title
“Effect Of Giving Cognitive Support And
Emotional Spiritual Quotient (Esq) To
Changes
Sexual Behavior Patients
Hiv/Aids”
Cognitive Support and
Emotional
Spiritual Quotient (ESQ) in Kediri
City .
c) Analysis
Effect Of
Giving
Cognitive Support And Emotional
Spiritual Quotient (Esq) To Changes
Sexual Behavior Patients Hiv/Aids
in kediri city
METHODS
This Research use methods
Quasi
Eksperimental using a study design One Group Pretest - Posttest Design. This
research with population
20 Patient
HIV/AIDS
in groups Kelompok
Dukungan Sebaya (KDS) in kediri. The
sample used in this study are same 18
patients with HIV/AIDS in groups
Kelompok Dukungan Sebaya (KDS) in
Kediri City .
a) Inclusion Criteria
The inclusion criteria as follows :
Patients with HIV / AIDS yang
incorporated in peer support groups (
KDS ) in Kediri Patients who have HIV
/ AIDSyang incorporated in peer support
groups ( KDS ) in Kediri which is a
group at risk of transmitting HIV / AIDS
.
All Patients Patients with HIV /
AIDSyang incorporated in peer support
groups ( KDS ) in Kediri using ARVs
regularly .
b) Exclusion Criteria
The exclusion criteria as follows :
Patients with HIV / AIDSyang
hospitalized in the Hospital ( in the
condition of the drop )
Patients with HIV / AIDSyang cared for
in the home are not conscious
OBJECTIVE DAN BENEFITS
Objective Research
1. General objective
Know Effect Of Giving Cognitive
Support And
Emotional Spiritual
Quotient (Esq) To Changes Sexual
Behavior Patients Hiv/Aids in kediri
city .
2. Special Objective
a) Identification of
diffrent Behavior
on Patient HIV/AIDS before Giving
Emotional
City .
b) Identification of diffrent Behavior
on Patient HIV/AIDS after Giving
This sampling used is Purposive Sampling
methode namely sampling of members of
the population in accordance with the
criteria that have been known.
This Independent
Variabel to giving
Cognitive Support and Emotional Spiritual
Quotion Variabel Dependen. Changes
Sexual Behavior Patients Hiv/Aids.
259
KDS formed to the concerns and
needs of fellow sufferers of HIV / AIDS in
gaining support on an individual basis.
KDS can provide a comfortable and safe
place to interact, exchange ideas and
information where solving an issue for
people living with HIV, the preservation of
confidentiality, and apart from a sense of
isolation and remove the stigma and
discrimination of people with HIV / AIDS.
Data Analysis
Data analysis techniques were used to
examine the Influence of Cognitive Support
and ESQ Against Changes in sexual
behavior in patients HIVpada Peer Support
Groups (KDS) in Kota Kediridengan using
test T-Test
included the testing of
nonparametric yaituuntuk compared
between the two groups of related data with
a level of confidence α = 0.05. In the
calculation process aided by the help of
Statistics Programme For Social Sience
(SPSS) For Windows. To Wilcoxon Test
Drawing conclusions hypothesis test results
are:
KDS support given in the form of
motivation both in patients and in the
patients' family. This support is done * with
the establishment of peer support groups
(KDS) Friebdship plus in the town of
Kediri, in which a container to provide
support, motivation, and increased
knowledge of HIV. KDS dilakuan
activities, among others, performed once
every month regular meetings that discuss
permasalaha- Sesma problems that occur in
people with HIV. The problems are
discussed from their physical health,
regularity of taking antiretrovirals, as well
as problems concerning the psychological
condition of people living with HIV. In
addition to discussing the problems also are
donors movement of partners involved This
form of material assistance, as well as
moral support and increased knowledge by
giving counseling. KDS's presence in the
city kediri provides many benefits for
people with HIV. They can meet with
friends - friends who have suffered the
same so that they do not feel alone and
lonely in the fight against the disease.
1. If p ≤ α = 0.05 means that H0 is rejected
and H1 accepted meaning There
Influence of Cognitive Supportdan ESQ
Against Sexual Behavior Change in
Patients HIVpada Peer Support Groups
(KDS) in Kediri
If p> α = 0.05 means that H0 is
2.
accepted and H1 rejected, which
means not There Influence of
Cognitive Supportdan ESQ Against
Sexual Behavior Change in Patients
with HIV Peer Support Group (KDS)
in Kediri
RESULT
Peer Support Groups (KDS) in the
town of Kediri is a group that is potentially
in assisting people living with HIV to the
fullest. Therefore, its existence is need for
support from the community and from the
government. Empowerment of the KDS in
the town of Kediri should try as much as
possible to help people living with HIV in
problem solving and provide motivation
and good memberikandukungan moral, and
spiritual. Expected with the implementation
of science and technology for the people
who carried on by STIKes Surya Mitra
Husada Kediri can increase KDS role in
pemberikan troubleshooting solutions for
people with HIV / AIDS both physical
problems, psychological and spiritual and
efforts to combat HIV / AIDS in the town
of Kediri.
PLHIV who are members of the
Peer Support Groups (KDS) Friend Ship
Plus in Kediri town of 100 people, they are
composed of at risk groups such as female
sex workers, drug users, Homo sex and also
housewives. Until now recorded in Kediri
in 2014, there were 456 patients in which
354 were patients and 102 HIV is AIDS. Of
the total HIV / AIDS mother tumah ladder
ranks second after the WPS (Women Sex
Workers). Data from the Regional AIDS
Commission Kediri record number of 69
people with HIV / AIDS is a housewife.
260
KDS Friendship Plus was
established on October 28, 2007 which has
a secretariat at the Jalan Banjaran Gg. Carik
No.
71B
Kediri,
E.mail:
[email protected].
KDS
organizational structure Friendship Plus
chaired by Yudho, secretary / treasurer
sister Mira, Division Kolif women and
children, brothers and sisters Narmi
Services Access Division
27%
married
unmarried
73%
Figure 5.3 Characteristics of
respondents by marital status at KDS
group Friendship Plus Kediri April 19
s / d 25 April 2015
Identifikation
characteristic
of
responden
a. Characteristics of Respondents by
Gender
d. Characteristics of Respondents
Based on ARV Consumption
e.
47%
53%
Male
20%
routine
consumption
Women
53%
27%
respondents by Gender at KDS group
Friendship Plus Kediri April 19 s / d
25 April 2015 Figure 5.1
Characteristics of respondents by
Gender at KDS group Friendship Plus
Kediri April 19 s / d 25 April 2015
Variabel Of Research
a. Identification of Sexual Behaviour
HIV / AIDS before Intervension
Cognitive support and Emotional
and Spiritual Support
employee
27%
13%
7%
33%
No
Consumption
respondents by consumption of drugs
in the group of KDS Friendship Plus
Kediri April 19 s / d 25 April 2015
b. Characteristics of Respondents by
Job
20%
concumtion no
routine
teacher
20%
entrepren
eur
WPS/Muci
kari
Transmissi
on
80%
respondents by job group KDS
Friendship Plus Kediri April 19 s / d
25 April 2015
preventio
n
respondents by sexual behavior
Before treatment at KDS group
c. Characteristics of Respondents by
Married Status
261
Friendship Plus Kediri April 19 s /
d 25 April 2015
decisions requires information that is
relevant, useful, accurate and true.
1.2 Identification of diffrent Behavior
on Patient HIV/AIDS after Giving
Emotional
City .
sexual behavior after treatment at KDS
group Friendship Plus Kediri 67% to
prevention or 33 % transmission
deseases
b. Identification of Sexual Behaviour
HIV / AIDS after Intervension
Cognitive support and Emotional
and Spiritual Support
33%
transmission
67%
Cognitive can be enhanced by changes
in beliefs, emotions and behaviors.
Another way to approach health social
cognitive behavioral example is the
effort to find ways of behavior related
to health started from the consideration
of people - those on health also take
preventive measures depends directly
on the outcome of confidence or health
assessment (Herawani, 2012).
social support from family members,
close friends, tetanga. Social support
as cognitive consisting of knowledge,
information, verbal or non-verbal
advice, real help or action is given by
the familiarity of social and emotional
benefits or have the effect of behavior
on the part of the recipient.
1.3 Analysis Effect Of Giving Cognitive
Support And Emotional Spiritual
city .
proven to exist effect of Cognitive and
Emotional and Spiritual Support
support to changes in sexual behavior
patient HIV –AIDS dengan nilai P
Value ,,035 ≤ α 0:05 proved effect
cogntive support and increase to
Emotional Spiritual Quotient (ESQ)
expected sexual behavior patient
HIV IDS.
Cognitive is the acquisition,
structuring and use of knowledge
covering every mental behavior
associated with the understanding of
consideration,
information
management, problem solving, gaps
and beliefs (Nurbani, 2008).
So the they will be more motivated to
live better and carry out useful
prevention
respondents by sexual behavior after
treatment at KDS group Friendship
Plus Kediri April 19 s / d 25 April
2015
c. Analysis Effect Of Giving Cognitive
Support And Emotional Spiritual
city proven to exist effect of Cognitive
and Emotional and Spiritual Support
support to changes in sexual behavior
patient HIV –AIDS dengan nilai P
Value 0,035 ≤ α 0:05 proved effect
cogntive support and increase to
Emotional Spiritual Quotient (ESQ)
expected sexual behavior patient
HIV IDS
DISCUSSION
1.1 Identification of diffrent Behavior
on Patient HIV/AIDS before Giving
Cognitive Support and Emotional
City .
Sexual behavior Before treatment at
KDS group Friendship Plus Kediri to
transmission
deseases 80% or
prevention 20%
According Herawani (2012), Cognitive
Function Support (Information) that is
as raw material for the decision, which
everyone in any time will take the right
262
activities and get closer God ,Chages
and Behavior an attitude positive and
treatment are rutinely expected to
increase Quality of life and status of
people living with HIV /AIDS.
Darwis, S. D. 2003. Metode Penelitian.
Jakarta : EGC.
DepKes, RI. 2005.
Profil kesehatan
Indonesia 2005. Dibuka pada website
: http.//www,depkes.co. id. Pada
tanggal 6 januari 2008).
CONCLUTION AND
REKOMENDATION
Conclution
1. From the research for a while it can be
concluded that the provision of cognitive
support and ESQ treatment in patients
with HIV / AIDS Kelompok Dukungan
Sebaya (KDS) Friendship Plus Kediri
can be received well by respondenm,
and respondents calls for this therapy
regularly and continuously
2. This
results of the identification
characteristics of respondents by sex
53% male, 33% self-employed by
occupation, by married status 73% did
not / not married, based on consumption
of 53% routine ARV ARV consumption,
based on examination of 57% Normal
CD4 levels and based blood tests
3. Sexual behavior research before
treatment to 80% commit sexual
behaviors that lead to the spread of HIV
/ AIDS and after treatment 36% perform
sexual behavior that causation to the
transmission of HIV / AIDS.
DepKes, RI. 2010. Riset Kesehatan Dasar.
Jakarta : Badan penelitian dan
pengembangan
kesehatan
Kementrian Kesehatan RI. 2010.
Djuanda, Adhi. 2011. Ilmu Penyakit Kulit
dan Kelamin. Jakarta : Balai Penerbit
FKUI.
Ditjen PP & PL Kementerian Kesehatan RI.
2013.
Laporan Perkembangan
Situasi HIV & AIDS Di Indonesia
Triwulan 2 Tahun 2013. Jakarta.
DinKes Jawa Timur, 2013.
Hawari, D. 2004. Al Qur‟an : Ilmu
Kedokteran Jiwa dan Kesehatan
Jiwa”.
Edisi III (Revisi).
Yogyakarta: PT. Dana Bhakti Prima
Yasa.
Herawani, 2012.Pendidikan Kesehatan
Dalam Keperawatan. Jakarta : EGC.
5.1 Recomendation
1. Giving to cognitive support and
ESQ in maintenance support odha
and giving motivation support aand
guidance both morally and
spiritually to be able increases
prevention ODHA in order to
increase its life expectancy and
Quality of live.
2. It should be further analysis to
determine the effect of treatment on
sexual behavior ODHA and
improving the mental status and
addiction to sexual habit.
Halim, M.S & Atmoko, W.D. 2005.
Hubungan Antara Kecemasan Akan
HIV/AIDS Dan Psychological WellBeing Pada Waria Yang Menjadi
Pekerja Seks Komersial.
Jurnal
Psikologi. 15 : 17 - 31.
Kurniawati, 2006. Coping Stres Pada
Orang Dengan HIV/AIDS (Sebuah
Studi Kasus). Skripsi. Surabaya :
Fakultas Psikologi Universitas
Airlangga.
REFERENCES
Lazarus, R.S & Folkman, S. 1984. Stress,
Appraisal and Coping. New York :
Spranger.
A.Aziz, Alimul Hidayat. 2010. Metode
Penelitian Keperawatan Dan Teknik
Analisis Data. Jakarta : Penerbit.
Salemba Medika.
263
Mandal, 2010. Penyakit Infeksi. Jakarta :
Erlangga Medical Series.
Umar Zein, 2006. 100 Pertanyaan Seputar
HIV/AIDS Yang Anda Ketahui. USU
Press, Medan.
Nihayati, A. 2012. Dukungan Sosial Pada
Penyandang HIV/AIDS Dewasa.
Skripsi. Surakarta : Fakultas
Psikologi
Universitas
Muhammadiyah Surakarta.
WHO, 2007. Pencegahan AIDS melalui
promosi kesehatan : Masalah yang
sensitif. Bandung : Penerbit ITB.
Notoatmodjo, Soekidjo. 2003, Pendidikan
dan Perilaku Kesehatan. Jakarta :
Rineka Cipta.
Notoatmodjo, Soekidjo. 2007. Metodologi
Penelitian Kesehatan.
Jakarta :
Rineka Cipta.
Nursalam, 2008. Konsep dan Penerapan
Metodologi
Penelitian
Ilmu
Keperawatan. Jakarta : Salemba
Medika.
Nugroho, P. 2009. Coping Stres Pada
Orang Dengan HIV dan AIDS.
Skripsi. Malang : Fakultas Psikologi
Universitas Muhammadiyah Malang.
Nurbani, F. 2008. Dukungan Sosial Pada
ODHA. Skripsi. Jakarta : Fakultas
Psikologi Universitas Gunadarma.
Phillips, K.D. 2007.
Social Support,
Coping, and Medication Adherence
Among HIV-Positive Women with
Depression Living in Rural Areas of
the Southeastern United States. AIDS
PATIENS CARE and STDs. 21 : 667
- 680.
Rasmun, 2004. Stres, Koping dan Adaptasi.
Sagung Seto. Jakarta : EGC.
Sugiyono, 2011.
Metode Penelitian
Kuantitatif Kualitatif
Dan R&D
(Edisi Revisi). Bandung : CV.
Alfabeta.
Stuart & Sunden, 2002. Principles and
practice of psychiatric nursing sixth
edition. St.Louis Missouri : West
Line Industrial Drive.
264
RELATIONSHIP OF WOMEN’S SELF PERCEPTION ABOUT MENOPAUSE WITH SELF
READINESS IN FACING MENOPAUSE IN SELOSARI KANDAT KEDIRI.
Shinta Kristianti
Prodi Kebidanan Kediri Poltekkes Malang
ABSTRACT
Perception is interpretation process about something pass through seeing, hearing, and feeling sense.
Menopause is the last of menstruation which is experienced by woman which still influenced by
reproduction hormone, which will seem to uncomfortable thing in running life. It needs self readiness
physically and psychologically in facing menopause. Purpose of this research was knowing the
relation of self perception of 45th-55th years old woman about menopause with self readiness in
facing menopause in Selosari Kandat Kediri.
The research design was analytic survey with cross sectional time approach. The research was
implemented in June 2014 with population 45th-55th years old woman in Selosari Kandat Kediri,
sample was taken from population were 79 respondents. The instrument was questionnaire. The data
analysis by Fisher Exact Statistic test.
Women who had negative perception with ready category contains of 49 women (62,03 %), women
who had positive perception with readiless category contains of 0 women (0 %). It was gotten from
accumulation value of ρ account < ρ table (0 < 0,05).
This research will show that there was relation of self perception of 45 th-55th years old woman about
menopause with self readiness in facing menopause in Selosari Kandat Kediri. Health staff have to
give counseling about menopause in local area.
Keywords: Perception, Menopause, Readiness
BACKGROUND
Women have a complex body. They
experience a life with a process of
development of anatomical, physiological, and
reproduction, beginning in childhood, then
grew into adolescence and adulthood. At the
same time, growing and developing organs as
well as a perfect woman. The most typical and
distinctive of the women is the reproductive
system. This is due to all of the processes that
formed the reproductive system since women
still fetus to grow up. Perfection was marked
by the beginning of menstruation and from
that moment all the organ anatomy, physical,
and reproductive work together to enhance the
female reproductive function. The process
continues until the expiration of productive
women, when menstruation stops permanently
(Kasdu Dini, 2005).
In general, people prefer to use the term
"menopause", although the term is not
appropriate, because menopause is only a
momentary occurrence, namely the last
menstrual bleeding. The most appropriate use
is climacteric, the period of transition from the
reproductive phase to the phase of aging
caused by the declining function of the
generative (Baziad, 2003). Climacteric is a
phase that women pass down the aging process
and stop fertility. Menopause is a life after the
last menstruation. Because it is the phase of
life premenopausal women before menopause
(Benson,
2008).
Menopause occurs at that age varied,
occurring on average menopause age 45-50
years, at present there is a tendency, for the
occurrence of menopause at an older age of
menopause for example in 1915 is said to
occur at the age of 44 years, while in 1950 the
menopause occurs at age approaching 50
years. According Manuaba (1999) the average
menopause occurs at age 45-50 years with a
clinical picture of normal menstruation stops.
Most women begin experiencing symptoms in
their 40s and reached its peak at the age of 50
years. Most experienced symptoms for less
than 5 years old and about 25% over 5 years
(Sibagariang, 2010). In the course of his life a
woman who reaches the age of about 45 years,
287
aging ovaries, so it is unable to meet the
hormone estrogen (Manuaba, 2009). Some of
the changes that occur in the body due to lack
of the hormone estrogen are: hot flashes (hot
flushes), vertigo, sweating a lot, paresthesias
(disorders skin feeling like tingling), spinal
pain, muscle pain, depression, insomnia,
vaginal discharge, and menstrual disorders
(Sibagariang, 2010). In addition, the symptoms
of menopause often acute and long-anxiety
effect, such as cardiovascular disease and
osteoporosis. Emotionally, menopause may
indicate the timing of major change when
women have the opportunity to make the
assessment of the life he had been through, she
may have to adapt to the changing role within
the family and society, and have to face
changes in the body and in life expectancy.
Changes in physical, social, and emotional
life, as well as psychological changes in
women to make menopause become one of the
biggest shake-up and self-analysis for some
women. Menopause is an event that is very
individual, with a variety of problems due to
the "middle age" that accompany so how every
woman receives and undergo a physical
change is highly variable (Andrews, 2009).
Such a situation can occur when individuals
are not ready to face the climacteric,
menopause, and senium (Manuaba, 2009).
As a result of physical changes that can last
longer and can affect the way women face
other stresses that may arise at the same time.
It‟s to very easy to blame the menopause for
all the physical and emotional disturbance
experienced by women in their ages. This
assumption could be wrong, but it is true that
the area of a woman's life that can always be
managed by women suddenly become difficult
to manage. Some women require treatment
and other therapies, in addition to hormone
replacement therapy, to help them cope with
some aspects of their lives. Some women who
arise in midlife is better treated using other
therapies, not only hormone replacement
therapy (Andrews, 2009).
METHODOLOGY
The research design was analytic survey
with cross sectional time approach. The
research was conducted in June14 with
population 45th-55th years old woman in
Selosari Kandat Kediri, sample were 79
respondents was taken by
purposive
sampling. Independent
variable of
data from this study was
women‟s self
perception about menopause. Dependent
variable was self readiness. The instrument
was questionnaire, and the data analysis by
Fisher Exact Statistic test.
RESULT
Women’s Self Perception Women about
Menopause
The survey showed that 62,03% of clients had
negative perceptions
Table 1. Frequency Distribution Women‟s Self
Perception Women about Menopause
No.
Perception
f
%
1.
Positive
30
37,97
2.
Negative
49
62,03
Total
79
100
Self Readiness in Facing Menopause
The survey showed that 100% ready in facing
menopause
Table 2. Frequency Distribution of Women‟s
Self Readiness
RESEACH OBJECTIVES
The objective of this research was anallyzing
women‟s self perception about menopause
with self readiness in facing menopause.
No.
Readiness
f
%
1.
Ready
79
100
2.
Not Ready
0
0
79
100
Total
288
Relationship of Women’s Self Perception
about Menopause with Self Readiness in
Facing Menopause
covers everything that broaden the knowledge
of themselves and the world in which they live
(Team Developer Education FIP-UPI, 2007).
Based on the research results of Umi Rizky
The majority of respondents were women aged
Sari in 2009, most of the respondents have less
45-55 years who have a negative perception of
knowledge about menopause with negative
the category is ready to face menopause as
perceptions of menopause complaints by 25
many as 49 people (62.03%)
people. Sufficient information about
menopause have a positive impact on the
Table 3 Correlatios Analysis Result
reaction of the respondents in facing
menopause. Based on the above explanation,
Readiness Ready
Not
Total
ρ
the perception is the process of interpretation
Ready
Value of a person through the senses of sight, taste,
Perception f
f%
%
f
%
and hearing. So what is seen from others, feel
30 37,97 0
0 30 37,97
Positive
0 the symptoms before menopause, and obtain
information from others about menopause may
49 62,03 0
0 49 62,03
Negative
lead to the perception of oneself. Negative
79 100 0
0 79
100
Total
perception may also be caused because the
mother has not feel the menopausal symptoms.
Based on the results of data processing by
One can understand the information in the
Fisher Exact test statistic ρ value is 0, the error
surrounding circumstances. Mothers who have
level of 5% (0.05) the obtained values of 0.05
low knowledge, information held too little.
ρ table. This means that ρ value <ρ table (0
The higher the knowledge, the higher the
<0.05). With these results H0 is rejected and it
absorption rate of the information so that the
can be said that there is a correlation self
information acquired can be well understood.
perception women age 45-55 years of
Conversely the lower knowledge, the patterns
menopause the readiness self in face
of thought to be low so that the absorption rate
Menopause.
of the information also becomes less. Low
knowledge may also lead to a negative
DISCUSSION
perception.
Self Perception of Women’s Women about
Menopause
Self Readiness in Facing Menopause
The distribution of respondents by readiness in
facing menopause is entirely categorized as
ready as many as 79 people (100%). This is
supported by research Atik Ismiati the year
2010, the distribution of respondents by
readiness of menopause largely categorized
ready. A person who ready can control
depression, anxiety, and emotional disorders in
the face of the problems of menopause
(Sukarni, 2013).
Perception of Self Female Age 45-55 Years of
Menopause
Perception of the respondents in this study are
categorized into two, namely the perception of
positive and negative. Respondents said to
have a positive perception if the total score >
mean and have a negative perception if the
value of the mean total score ≤ Mean. The
results showed that more than half of the
respondents self perception of women aged
45-55 years of menopause is negative as many
as 49 people (62.03%).
Based on the above explanation, the readiness
defined as a state of the mother to prepare her
to face menopause, both physically and
psychologically. The period of this change will
be passed well, if the woman is able to adapt
to new conditions as they arise. A woman
approaching menopause should always think
positive that the condition is something that is
natural, in order to be able to prepare
themselves to face the menopause.
Soenaryo (2004) stated that the perception of
the individual can realize and understand about
the state of the environment in the surrounding
areas as well as on the state of the individual
concerned. This is consistent with the theory
that perception is an experience that is
generated through the senses of sight, hearing,
and smell (Setiawati, 2008). In the broadest
sense, both formal and informal education
289
menopause and establish confidence if the
information that many around. Mothers who
have a low probability of knowledge
increasingly narrow social life because they
only relate to those around her house, so it has
little understanding and not much in touch
with mothers who have high knowledge that
allows mothers do not obtain information or
insight about the menopause. Conversely, the
lower the knowledge is not necessarily the
more negative perceptions of menopause,
when obtaining information or insight a little
around.
Relationship Self Perception Women Age
45-55 Years of Menopause the Self
Readiness in Facing Menopause
Results of this analysis showed that there was
no connection Self Perception Women Age
45-55 Years of Menopause the Readiness Self
in Face Menopause in Hamlet Village
Nglarangan Selosari Kandat Subdistrict
Kediri. It was found that respondents who
have a negative perception is more prepared to
face menopause as many as 49 people
(62.03%) and respondents who have a positive
perception of the category is ready to face
menopause as many as 30 people (37.97%).
According to the perception of the process of
extracting the information that is preparing to
respond (Grace H, 2009). Thus, it is necessary
to study how much information about the
woman's climacteric owned, perception of
stress experience, who relied on for a
dependent, and ask for help (Bobak, 2004). Of
course, support from family members, to make
it more expedient to face attitude that
menopausal women (Harmanto, 2006). There
should also foster reading craze that has
extensive knowledge about life. It would
increase confidence that the larger (Santoso
2009). If you experience symptoms that make
you feel uncomfortable, then you should
consult with health professionals (Astikawati,
2006).
This is supported by research Atik Ismiyati in
2010, that there is a correlation between the
level of knowledge about menopause with the
preparedness of menopause in premenopausal
mothers in Housing Sewon Asri Yogyakarta.
Seeing the existing data can be explained there
are some things that cause this hypothesis is
accepted, the perception appears to be no
reaction from the person to prepare for the
menopause. A person's perception was
correlated with readiness in the face of
menopause. It is influenced by pegetahuan.
Knowledge varies greatly affect research.
Though knowledge has nothing to do with the
perception of menopause and menopause
preparedness. The higher the knowledge, the
higher the absorption rate of the information
so that the information acquired can be well
understood. Conversely the lower knowledge,
the patterns of thought to be low so that the
absorption rate of the information also
becomes less. The higher the increasingly
positive perception
of knowledge about
Other studies above also states that there is a
relationship of knowledge about menopause
with menopause preparedness. Perceptions
arise because of the knowledge of a person.
This shows the perception that emerged
resulted readiness in the face of menopause, so
it does not interfere with the role of the
individual. Therefore, in this study, low
knowledge is not necessarily less prepared to
deal with menopause. Many mothers who have
a negative perception, prepared better to face
the menopause. Here also the necessary
support so that more families can accept the
fact, as well as consultation with a health
worker if you feel uncomfortable in dealing
with the symptoms of menopause.
CONCLUSION
It conclude that more than half of the
respondents had negative perceptions of
menopause and all respondents are ready to
face menopause. There is a relationship selfperception of women aged 45-55 years of
menopause with readiness in facing
menopause.
REFERENCES
1. Andrews, Gilly. 2009. Buku Ajar Kesehatan
Reproduksi Wanita. Jakarta: EGC
2. Astikawati, Rina dan Amalia Safitri. 2007.
Simple Guide Menopause. Jakarta: Erlangga
3. Azwar, Saifuddin. 2005. Sikap Manusia
Teori dan Pengukurannya Edisi Ke 2.
Yogyakarta: Pustaka Pelajar Offset
290
4. Baziad, Ali. 2003.
Menopause
Andropause. Jakarta: YBP-SP
dan
5. Benson, Ralph C. 2008. Buku Saku Obstetri
dan Ginekologi Edisi 9. Jakarta: EGC
6. Bobak, dkk. 2004. Buku Ajar Keperawatan
Maternitas. Jakarta: EGC
7. Fakultas Ilmu Komputer, Universitas
Indonesia.
2008.
http://www.kamusbesaronline.com. Diakses
jam 16:39, tanggal 7 Maret 2014.
8. Hardjito, Koekoeh. 2012.
Pengantar
Biostatistika. Jawa Timur: Forum Ilmiah
Kesehatan
9. Harmanto, Ning. 2006. Ibu Sehat dan Cantik
dengan Herbal. Jakarta: PT Elex Media
Komputindo
10. Heffner J., Linda dan Danny J. Schust. 2005.
At A Glance Sistem Reproduksi Edisi Kedua.
11. Hidayat, A. Aziz Alimul. 2007. Metode
Penelitian Kebidanan dan Teknik Analisis
Data. Jakarta: Salemba Medika
12. ___________________.
2009.
Metode
Penelitian Kebidanan dan Teknik Analisis
Data. Jakarta: Salemba Medika
13. Ilmi, Nuril dan Titin E..N. 2012. Hubungan
Persepsi Menopause dengan Kecemasan
Menopause. Sidoarjo
14. Irianti, Indah dan Nina Herlina. 2010. Buku
Ajar Psikologi untuk Mahasiswa Kebidanan.
Jakarta: EGC
15. Ismiati, Atik. 2010. Hubungan Tingkat
Pengetahuan tentang Menopause dengan
Kesiapan Menghadapi Menopause Pada Ibu
Premenopause. Surakarta.
16. K. Sukarni Icesmi dan Margareth ZH. 2013.
Kehamilan, Persalinan, dan Nifas
Dilengkapi dengan Patologi. Yogyakarta:
Nuha Medika
17. Kasdu, Dini. 2005. Solusi Problem Wanita
Dewasa. Jakarta: Puspa Swara
18. Mahfoedz, I. 2011. Teknik Menyusun KTISkripsi-Tesis-Tulisan dalam Jurnal Bidang
Kebidanan, Keperawatan dan Kesehatan.
Yogyakarta: Fitramaya
19. Manuaba, Ida Ayu C., dkk. 2009. Memahami
Kesehatan Reproduksi Wanita Edisi 2.
Jakarta: EGC
20. Muaris, Hindah. 2003. Makan sehat dan
Lezat di Masa Menopause Sarapan. Jakarta:
PT Gramedia Pustaka Utama
21. Notoatmodjo, Soekidjo. 2010. Metodologi
Penelitian Kesehatan. Jakarta: Rineka Cipta
22. Nugroho, NSK. 2008. Transformasi Diri
Memberdayakan Diri Melalui Hipnoterapi.
Jakarta: PT. Gramedia
23. Nursalam.2009. Konsep Dan Penerapan
Metodologi penelitian Ilmu Keperawatan
Pedoman Skripsi, Tesis, dan Instrumen
Penelitian Keperawatan. Jakarta: Salemba
Medika
24. Pusat Data dan Informasi Kementrian RI.
2013. Gambaran Kesehatan Lanjut Usia Di
Indonesia. Jakarta: Buletin Jendela Data dan
Informasi Kesehatan
25. Rahmat H, Dede. 2009. Ilmu Perilaku
Manusia Pengantar Psikologi untuk Tenaga
kesehatan. Jakarta: TIM
26. Rosenthal, M. Sara. 2009. Pedoman untuk
Wanita Revolusi Terapi Hormon.
Yogyakarta: B. First.
27. Santoso, Hanna dan Andar Ismail. 2009.
Memahami Krisis Lanjut Usia Uraian Medis
dan Pedagogis-Pastoral:Jakarta: Gunung
Mulia
28. Setiawati, S dan A.C Dermawan. 2008.
Proses Pembelajaran dalam Pendidikan
Kesehatan. Jakarta: TIM
29. Sibagariang Ellya, Eva, dkk. 2010.
Kesehatan Reproduksi Wanita. Jakarta: TIM
30. Sugiyono. 2010. Statistika untuk Penelitian.
Bandung: Alfa Beta
31. Sujianti dan Chandra Ayu Dhamayanti.
2012. Buku Ajar Psikologi Kebidanan.
Jakarta: TIM
32. Sunaryo. 2004.
Psikologi
Keperawatan. Jakarta: EGC
291
untuk
33. Syafrudin dan Yudhia Fratidhina. 2009.
Promosi Kesehatan untuk Mahasiswa
Kebidanan. Jakarta: Trans Info Media
34. Tim Pengembang Ilmu Pendidikan FIP-UPI.
2007. Ilmu dan Aplikasi Pendidikan. PT.
Imperial Bhakti Utama : Jakarta
Menopause di Kelurahan Tlogosari Kulon
Semarang. Semarang : Jurusan Ilmu
Kesehatan Masyarakat, Fakultas Ilmu
Keolahragaan, Universitas Negeri Semarang
36. Waluyo, Srikandi. 2010. 100 Questions &
Answer: Menopause atau Mati Haid. Jakarta:
PT Elex Media Komputindo.
35. Umi, Rizky Sari. 2009. Hubungan antara
Tingkat Pengetahuan tentang Masa
Menopause dengan Persepsi Keluhan Masa
292
SMOKING BEHAVIOR WITH SLEEP DISORDERS (INSOMNIA) OF ADOLESCENT BOY
IN JEPUN VILLAGE, SUBDISTRICT TULUNGAGUNG
Leny Indrawati 1, Presca Adi Prayogo 2
STIKes Hutama Abdi Husada Tulungagung
Abstract
Smoke and insomnia has hand in glove relevance. Even smoking is not predictor‟s the one only
divides insomnia, but then nicotine which consists in smoke can cause stress on sympathetic nerve
and parasympathetic nerve, so causes that person will make a abode to awake. To the effect this
research which is to identify corelation between smoking behaviour with sleep disorder (insomnia) of
adolescent boy in Jepun Village, Tulungagung‟s district Tulungagung‟s Regency. This observational
method utilize analytic method. Executed research at Jepun‟s subdistrict Tulungagung on 17 th
February – 17th March 2015, by use of research design “Cross Sectional”. This observational
population is all adolescent boy which smoke, technics sampling utilizes purposive sampling with
sample 47 striplings. For research it utilizes statistical quiz formula corelation Spearman-Rho. Base
observational result, gotten that smoking behaviour of adolescent boy at Jepun‟s subdistric,
Tulungagung‟s Regency at 2015, which is stripling with weight level smoker 43 persons (91,5%),
Lightweight smoker 4 persons (8,5%) and insomnia on adolescent‟s Jepun‟s subdistrict boy which
weight insomnia 43 (91,5%), lightweight level of insomnia 4 persons (8,5%). From statistical quiz
result corelation Spearman-Rho gotten p = 0,000 < a = 0,05 therefore h0 refused and h1 accepted, its
mean available Relationship smoking behaviour with sleep disorders (insomnia) on adolescent boy at
Jepun, Tulungagung‟s District / Regency. Progressively heavy behavioural smoking on stripling,
therefore getting weight too insomnia level on that adolescent. Expected adolescent one smoke at a
swoop experience insomnia will stop to smoke than insomnia that their suffering can get over or
minimal dwindling level acuted.
Keyword: Smoking Behavior, Sleep Disorders (Insomnia), Adolescent Boy
INTRODUCTION
cardiovascular disease, cancer, fertility
disturbing, born less months, Death or
absent from work or school. Adolescent
who
smoking, growth and development of his
lungs immediately affected would be the
smoking
immediately.
The other effect of smoking is can cause
insomnia. Nicotine in cigarettes classified
stimulants. Stimulants are substances
which gives a refreshing effects as well as
caffeine and cocholate. Efect from nicotine
is more stronger, evidenced with Research
of Punjabi and his colleagues in 2006
examined the effects of nicotine on the
sleep patterns of someone. (Prasadja,
2009).
Smoking And Insomnia has a close
The international research conducted US
Census Bureau, International Data Base of
2004 as reported by From Cureresearch,
Saturday (05/01/2010) Indonesian people
of 2004 amounted to 238 452 million, as
many as 28 053 million people in
Indonesia the affected
insomnia or
approximately 11.7 % . This Data just
based indications are generally not take
into account genetic factors, culture,
environment, social, and ras. It can
continue to grow as living style changes.
(www.health.com
downloaded
on
February
5,
2012)
Consequences of smoking can increase
incidence of respiratory tract infections
differences, cough, asthma, sinusitis,
336
relationship. Although smoking is not the
only predictor for insomnia, but nicotine
contained cigarettes cause tension on
Sympathetic nerve and parasympathetic
nerve, causing the person would stay
awake. In fact, when someone sleep, all
nerves and human organ in relaxation,
even Heartbeats was throbbing slow. On
this essentially condition, man who can not
sleep or experiencing insomnia is a
condition where the someone nerves still
continues work (contracts) when the
person wants to review highly feel sleepy
or relaxes nerve-the nerve to review a rest.
Then, substances that can cause the
triggering of the dopamine hormone for
example is the caffeine in coffee, nicotine
in cigarettes, and the alcohol in alcoholic
beverages.
(downloaded
www.eMedicine.com on March 9, 2012)
The data is justified Posted Dr. dr.
Nurmiati Amir, SpKJ admitted that
Indonesia Population About 10 Percent
Paid From having trouble of sleep. Normal
time for adult for a review of sleep is 6-7
hours. But the most of patients with
Insomnia sleep 3-4 hours only. "Insomnia
is a one medical condition frequently
encountered but not diagnosed so no
treated well," as Dr. dr. Nurmiati SpKJ in
Event Management Comprehensive
Insomnia press conference at the Novotel
Mangga Dua Square, Jakarta, Saturday
(05/01/2010) . According to her, if the
Condition Continues to left unchecked,
can reduce quality of life of sufferers so
the impact triggering accidents. So it takes
behavioral therapies and medications to
review deal with insomnia. (www. health.
com to download on February 5, 2012).
Based on the findings of research carried
Posted Health Center Tulungagung
Tulungagung subdistrict Jepun during the
month of April 2012 in at works region,
the findings showed that smokers largest
are young men in the Tulungagung district.
There are 47 teenagers (80, 49%) of the
results of research findings is a smoker
(PHC
Data
Jepun,
2013).
Based on the reason, researchers ALSO
addition to experience, as well as many of
the adolescents that already smoke,
researchers are interested in a review
examining Relations the smoking behavior
of young men age 15-23 years with
Disorders Sleep Patterns (insomnia) in the
Jepun village of Tulungagung subdistrict
METHODS
In carrying out the research, researchers
using the design study "observational"
study namely on the research object is a
moment. Research and observation on
independent and dependent variables from
the object of research conducted in
conjunction in limited time, means that the
object is not researched or continuously
observed over specific time periods.
That study was based on location
Jepun Village Tulungagung subdistrict So
the population of the research is some
teenagers in the Jepun Village of
Tulungagung subdistrict. Based the Data,
the details of the study population was 47
Paid adolescence. Acumulated data of this
study uses instrument label form interview
and kuesionar then regrouped includes
tabulation in accordance with drawn sub
variables.
In analyzing the relationship smoking
behavior with sleep disorders (insomnia) at
Young Men in the Jepun Village of the
District / Tulungagung 2015 using
Computer Assisted SPSS (Statistical
Product and Service Solution Version 16
Windows) By type Rho-Spearman
statistical test. To determine the
relationship is p value ≤ α of 0.05 means
that H0 is rejected, H1 accepted and
Means stated there is relationships
smoking behavior with sleep disorders
(Insomnia) in young men in rural Jepun, If
the value of p > α 0.05 means that H0 is
accepted, and H1 rejected Means stating
there is no relationships smoking behavior
with sleep disorders (Insomnia) in young
men in rural Jepun.
337
RESEARCH RESULT
A.
General
Data
1. Characteristics of respondents by age
male population in villages Jepun
subdistrict / district Tulungagung. Based
on Research findings showed
that
respondents that amounts of the 47
teenagers, mostly big respondents aged 1823
years
(85%).
2. Characteristics of respondents by job
man in the village Jepun subdistrict /
Tulungagung From the research findings
showed that respondents that amounts of
the 47 teens, teens work in Jepun village
sub-district / Tulungagung, Most big
teenager not work
(70%).
B.
Special
Data
1. Smoking Behavior on young men in the
village of Jepun.
Age
The
mid
teens
(15-18)
Late
Teens
(18-23)
Total
Smoking Behavior
Mild
Moder Weight
ate
F % F % F
%
4 8,5 0
0
8
17
12
25,
5
0
0
0
0
35
74,
5
35
74,
5
4
8,5
0
0
43
91,
5
47
100
most the weight smokers there are 43
teenagers.
b.
Based on the study findings showed that
teenagers. 18-23 year-old big portion
Already Namely Heavy smokers as much
as
35
teenagers.
Job
Smoking Behavior
Mild
Total
Moder
ate
Weight
∑
Smoking
level
%
Frequency
(F)
Percentage
(%)
Lightweight
4
8.5
30
Medium
Weight
0
43
0
91.5
33
70
Period
47
100
47
100
F
%
F
%
F
%
Work
0
0
0
0
14
30
14
Not
Working
4
8,
5
0
0
29
61,5
Total
4
8,
5
0
0
43
91,5
c.
a.
respondents that amounts of the 47 teens,
from the data that is most are not working
behave smoke weight by 29 teenagers.
respondents that amounts of the 47 teens,
338
Total
∑ %
b.
2. Sleep Disorders (Insomnia) IN young
men in the village of Japan
a
Insomnia
level
Frequenc
y (F)
Age
The
mid
teens
(15-18)
Percentage
(%)
Light
weight
Medium
4
0
0
Weight
43
91.5
Period
47
100
Late
Teens
(18-23)
Total
8.5
Mild
∑
%
F
4
12
25,5
0
0
0
35
74,5
35
74,5
4
8,
5
0
0
43
91,5
47
100
Sleep Disorders (Insomnia)
Light
weight
Me
diu
m
F %
F % F
%
F
%
4 8,5
0 0
0
4
8,5
Medium
0
0
0 0
Weight
0
0
Total
Mode Weight
rate
% F % F
%
8, 0 0 8
17
5
0
Heavy
Total
c.
Jobs
Lightwei
ght
Total
adolescents, aged 18-23 years most big
insomnia weight that's been experiencing
as many as 35 teenagers.
.
Smoking
Behavior
Insomnia
4 8,5
0
0
0
0
0
0 0 43
91,5
43
91,5
0 0 43
91,5
47
100
F
0
4
Insomnia
Moder
ate
% F %
0
0
0
8,5 0
0
F
8
35
4
8,5
43
Mild
Work
Not
Working
Total
0
0
Weight
%
17
74,
5
91,
5
adolescents, small portion that not working
with experience lightweight insomnia 4
adolescents (8.5%), Weight experiencing
insomnia that work at 8 teenagers (17%)
and most big that not work with Insomnia
weight experienced by 35 adolescents
(74.5).
respondents That amounts Of the 47
adolescents, adolescents experiencing
Insomnia Most big weight of 43 teenagers.
3. Relationship smoking behavior with
Sleep Disorders (Insomnia) in young men
339
Total
∑ %
8
3
9
4
7
17
83
100
in the village of Jepun subdistrict /
Tulungagung.
problem. There are many phenomena
today we can see that teens especially
teenage boys already to do smoke or being
a
smoker.
Smoking behavior also influenced Work
factors, base on Posted Theory *
According Sitepoe (1997) that smoking
For teenagers, especially teenage boys has
become commonplace and can proud For
them, even many of those who already
become Active smokers. In Indonesia,
children younger Starting smoking due to
several factors, including the influence of
the others, Peer Pressure, Want to
customize the Self, Work. Work problem
in Someone smoke Become Habits Should
smoking be done BECAUSE WITH
MORE Someone Becomes Quiet even
Cigarettes contained Chemicals such as
nicotine stimulates the brain The order The
smoker
feels
Smart.
ON findings The study was conducted
Posted Research shows that teens are
smoking more Final compared WITH the
midle. Based on Theory The older
teenagers Age The Ripe and Ready
ACCEPT trials and matters would be
faced, because that Posted Should End
teen CAN anticipate Smoking behavior.
Based on the findings of research done
Turns that in adolescents Final MORE
CAN precisely Many Are Becoming
Heavy smokers caused Smoking habits
Already Long And Difficult to review in
the High-Level avoid even more against
smoking
dependence.
Facts on the differences
of some
researchers believe that adolescents That
Works interaction will be more spacious,
so the potential for a review Posted
affected his social environment, whereas
adolescents who do not work have less
Insights The affected area so it does NOT
ABOUT Dangers And Lack Knowledge of
the smoking. Based on Well then teenWorking and NOT Work have Heavy
smokers
Behavior.
B. Sleep Disorders (Insomnia) ON Teens
Based on Table 4.4 it is known that
adolescents CAN The Insomnia weight of
respondents that amounts of the 47 young
men in rural Jepun, adolescent smokers
The Weight And Insomnia weight totaled
43 (91.5%), The lightweight smokers and
insomnia Lightweight 4 (8.5%)
C.
Research
Statistics Test Results Obtained Spearmanrho value of p = 0.000, while α = 0.05, p ≤
α It‟s mean H0 is rejected, H1 accepted
and there is Relation between Smoking
Behavior with Sleep Disorders (Insomnia)
at Young Men in the Jepun village of the
District / Tulungagung 2015.
DISCUSSION
A. Smoking Behavior on young men
Based on Table 4.1 the study findings
showed that 47 Respondents who are
heavy smokers of 43 (91.5%), with
lightweight smokers 8,5% (4 orang). From
the Data indicate that Of the 47 young men
in the village of Jepun the majority is
weight
smokers.
Based covers cross-tabulation table 4.2 Of
the 35 respondents aged 18-23 years are
weight
smoker.
Under cross-tabulation table covering 4.3
between the smoking behavior of teenage
boys work in Rural Jepun Tulungagung
2015 showed that of the 33 teens who do
not work there are Lightweight smokers
behaves 4 teenagers, and behave in weight
smokers are 29 adolescent smokers.
Based on The Smoking behavior is
influenced Posted factors Age, base on
Posted Theory According to Hurlock
(1999) that the age of youth smoking used
on as emblem maturity. more teen age old
who has a psychological that more on
mature from a younger age, so
increasingly age somebody, Ready The
accept trials are also hearts and various
340
43 teenagers (91.5%). Clearly seen that
91.5% there are 43 young smokers in
Jepun village experience Insomnia Sleep
Disorders
Weight.
From the findings include cross-tabulation
tables 4.5 BETWEEN THE Age of
teenage boys with Insomnia in the village
of Jepun Tulungagung 2015 showed that
most adolescents aged 18-23 years big
weight's been experiencing Insomnia That
is a total of 35 adolescents (74.5%).
From the findings include cross-tabulation
table 4.6 BETWEEN Insomnia WITH
Works teenage boys in the village of Jepun
Tulungagung 2015 that shows that do not
work as many as 39 teenagers and there
are 35 adolescents (90%) that have trouble
sleeping weight As well as the four teens
(10%) Lightweight who have trouble
sleeping.
Based on the level of Insomnia The
affected Age factors, Supported WITH
Theory * According to the Theory
Noorkasiani And S.Tamher (2009) that the
Age of factors affecting the psychology of
man, The More age can increasing of
problem Should think so hard to review
Night's
Sleep.
Based on the level of Insomnia What
factors influenced the work.In Posted in
Support BY
Theory * According
Noorkasiani And S.Tamber 2009 that
states Insomnia Often Occur ON Work
that has activity until hours or work to be
done as soon as possible, thereby ALSO
Student Very Often Less sleep in because
The
Many
tasks.
ON findings The study was conducted
Posted Research shows that teens End
more likely to have insomnia than middle
teens. In Researchers WITH Increasingly
Age The Many problems Should think so
hard to review Night's Sleep.
Facts on the differences of some
researchers argue that the initial theory
According WITH include cross tabulations
BETWEEN THE work with Insomnia at
young men in the village Jepun
Tulungagung 2015 That shows the
percentage of insomnia weight, ON
adolescents who worked more big of
juvenile who is NOT ON works.
Researcher advise review go to Bed Late
BECAUSE can disturb activities the next
day.
C. Relationship Smoking Behavior WITH
Sleep
Disorders
(Insomnia)
Based on the data Table 4.7 obtained
young smokers in Jepun Village, District /
Tulungagung as much as 47 teenagers.
ON teenager who have Weight smokers
And weight Insomnia totaled 43 teenagers
(91.5%).
ON Above analysis founded Statistics Test
Results Obtained Spearman-rho value of p
= 0.000, while α = 0.05, BECAUSE p <α
then H0 rejected and H1 accepted. Its
mean there is Relation between Smoking
Behavior with Sleep Disorders (Insomnia)
ON Teens in Jepun subdistrict /
Tulungagung.
Effects Of Tobacco OR Cigarette Giving
stimulation Lighter depression, fishing
Disorders Power, insomnia, feeling,
Thinking process, behavior and
psychomotor functions. When compared to
other addictive substances Cigarette very
big effect, so dependence To Cigarette
hard to break review of Sleep (Roan, 1979:
33).
Proven smoking behavior can cause
insomnia, Where Rafknowledge (2004:
58) states that one thing that can cause
insomnia is nicotine. Nicotine is a
stimulant in Cigarettes. Nicotine is a
stimulant substance that function to review
the working suppress nerve, Sympathetic
Nerve Namely And the parasympathetic
nerve to review contracting OR Fixed
Work.
* According to the researchers Smoking is
Associated WITH Proven Sleep Disorders
(insomnia) that experienced by young men
in the village of Jepun Tulungagung.
Increasingly Heavy smoke teenager more
Tougher Sleep Disorders (insomnia) that
experienced. And conversely more
Lightweight Smoking behavior, The Light
also Sleep Disorders (insomnia) that
experienced.
341
It initials accordance BY results include
cross-tabulations Relations BETWEEN
Smoking Behavior WITH Sleep Disorders
(Insomnia) AT Young Men in the village
of Jepun subdistrict / Tulungagung That
shows that, of the respondents That
amounted to 47 young men in rural Jepun,
juvenile who Weight smokers And
Insomnia Weight amounted to 43 persons
(91.5%) and The light smokers and
insomnia Lightweight 4 persons (8.5%).
for a student to continue the review of
research WITH Methods more Better.
With Adding materials research A more
complete and latest accordance BY
Advancement of Science That The longer
Increasingly Evolving as well as Research
Methods The DIFFERENT degree of
difficulty compared with what has been
done Posted researchers
BIBLIOGRAPHY
Alghifari, Abu. 2003 Teen Fashion Victims.
Bandung: Mujahid.
Conclusions and Suggestions
From the findings of this study concluded
that:
1. Smoking behavior of young men in the
village Jepun, District / Tulungagung
2015, are teenagers who are heavy
smokers are 43 persons (91.5%).
2. Level Insomnia ON young men in Jepun
Village, District / Tulungagung CAN
teenager who weight Insomnia are 43
(91.5%).
3. There is a relationship between the
behavior of smoking with Disorders Sleep
Patterns (insomnia) at adolescents boy in
the Village of Jepun, District /
Tulungagung
2015.
As the Researchers suggestion :
1. For Respondents CAN expected
increase understanding ABOUT Smoking
behavior, and Insomnia so CAN stop
smoking, smoking resulted CAN
BECAUSE Jazz hospital diseases such as
lung, heart, cancer, and Insomnia.
2. For Health workers should MORE
improve health education To the young
men in particular, in order to determine the
impact of cigaret and BE MORE
Maintaining healthy And Environment
there
around.
3. For Educational Institutions are
expected to multiply literature of smoke
that relation Sleep Disorders (insomnia) so
that young people in rural Jepun CAN
anticipate the danger posed smoke .
4. For Further Research papers WITH the
research, is expected to be an inspiration
Anonymous. May 31, 2009. 10 Country WITH
Paid Smokers World's Largest
http://nusantaranews.wordpress.com.
Accessed 6 April 6 April accessible
.......... ..........
Wake up, A.P. Attitude 2008. Wisely For
Smokers. Jakarta: Indocamp.
Budiarto. 2001. Biostatistics for a review of
Medicine and Public Health. Jakarta:
EGC.
Bustan, M.N. 2000. Epidemiology of
Infectious Diseases NO. Rineka
Copyright: Jakarta.
Ministry of Health. 2008. The Indonesia
Health Profile 2007. Jakarta: Ministry
of Health of the Republic of Indonesia.
Hidayat, Aziz Alimul. 2006. Introduction to
Basic Human Needs. Jakarta: Salemba
Medika.
Hurlock, Elizabeth. 1999. Developmental
Psychology. Jakarta. PT Gramedia.
Listiani, Amelia SS 2007. The Secrets of Sleep
Well Tonight. Jakarta: Interaksara.
Notoatmodjo, Soekidjo. 2005. Health
Research Methodology. Jakarta: PT.
Rineka Reserved.
342
Nursalam. 2000. Methodology of Nursing
Research. Jakarta: Infomedika.
Sriati, Aat. 2008. Overview ABOUT Stress.
Faculty of Nursing, University of
Padjadjaran Bandung.
Pdpersi. 2003. What's With Cigarette. http .//
www.red-bondowoso.or.id. Accessed
6 April ..........
Sugeng Hariyadi. 1997. Development of
Students. Semarang. Teachers'
Training College Semarang.
Prasadja, Andreas. August 29, 2009. And
Sleep Health Smoking Behavior.
http://sleepclinicjakarta.tblog.com/.
Accessed 6 April ..........
Trim, Bambang. 2006. Smoking ITU
Ridiculous. Jakarta: Exact Ganesha.
Google Translate for Business: Translator
ToolkitWebsite TranslatorGlobal
Global Market
Prasadja, Andreas. 2008. World Mirror of
Medicine. Obstructive Sleep Apnea,
35, 331-333.
Qimi. June 20, 2009. Impaired Sleep Patterns.
http://www.kaltimpost.co.id. Accessed
6 April ..........
Riyanto, Agus. 2009. Processing and Data
Analysis Health. Bantul: Nulia
Medika.
Saryono. 2010. The set of instruments for
Health Research. Bantul: Nulia
Medika.
Sastroasmoro, Sudigdo And Sofyan Ismael.
1995. Fundamentals of Clinical
Research Methods. Jakarta. FKUI.
Sitepoe, Mangku. 1997. Preventing Smoking
Dangers. Jakarta: Gramedia.
Smet, Bart.1994. Health Psychology. Jakarta:
PT Gramedia Widiasarana Indonesia.
Soamole, Iqbal. 2006. Relationship Between
Attitudes Toward Smoking Article
Search Google ON Adolescent
Smoking Behavior. Thesis S1.
Semarang State University in 2006.
343
THE INFLUENCE OF HIP MOTION EXERCISES (STRETCHING) TO DECREASE
LOWER BACK PAIN (LOW BACK PAIN) IN THE ELDERLY POSYANDU WONOREJO
COUNTRY DISTRICTS SUMBERGEMPOL TULUNGAGUNG 2015
Ratna Kholidati 1, Dwi Intan sari 2
Abstract
Agingis a biological process that isunavoidable. This phase i scharacterized for some decline
inphysical activity and psychological and ageaggravate lowerback pain, as happens decrease the
body's functions, especially bone elastic and onenonpharmacological treatment of lower back pain is
the physical exercise such a ship motion exercises (stretching) which include slight and easy exercise.
The goal in this research is know the influence of hipmotion exercises (stretching) to decrease low
back pain in the elderly in the village Elderly IHC Wonorejo Sumbergempol Tulungagung subdistrict.
The design used in this study is Quasy-experiment by comparing the results of pre test and post test.
The study population was all elderly people of lower back pain in the Village Elderly IHC Wonorejo
Kecamatam Sumbergempol Tulungagung on March 8, 2015, March 10, 2015 and March 14, 2015.
Samples were taken with total sampling technique with a number of 32 respondents in accordance
with the inclusion criteria. Retrieving data using observation sheets, and the data were analyzed with
statistical test Wilcoxon Signed Rank Test. From the results of the study showed that there is
influence of hip motion exercises (stretching) to decrease low back pain in the elderly in the village
Elderly IHC Wonorejo Sumbergempol Tulungagung sub district indicated by the value of ρ=0,000<α
=0,05. Therefore from these results we can conclude that the elderly experience lower back pain (low
back pain) can be done physically exercises (stretching) to reduce lower back pain (low back pain) in
the elderly.
Keywords: Elderly, Lower BackPain, Hip motion exercises (Streching).
have been hit by lower back pain (Paliyama,
2004).
The more we age, the level of perceived
pain and the number of elderly with lower
back pain increased with age, especially over
65 years. And the average low back pain
experienced by both sexes, but an outline of
women into the higher incidence of the Low
Back Pain (LBP). One of the things that cause
this is menapouse. Menapouse cause women
produce less estrogen that one of its functions
is to maintain bone density. When these
hormones are produced, and slightly less than
the body needs, the risk of Low Back Pain
(LBP) to be larger that is aggravated by heavy
work or sitting too long (Jayson, 2002).
Based on data from the Central Statistics
Agency (BPS) in 2011, the number of elderly
in Indonesia reached 18.96 million people. Of
these 11.16% of which are in East Java
province or region ranked number two highest
INTRODUCTION
Aging or growing old is a biological
process that is unavoidable. The aging process
occurs naturally, it can cause
physical
problems, mental, social, economic,
psychological. Potentially causing any
circumstances that tend to the health problems
of mental health in general and specifically in
the elderly (Sumosadjuno, 2005).
Stage elderly is a condition that must be
faced by every human being, this stage is
characterized by the presence of some decline
in physical activity and psychological
(Prawitasari, 2004).
Age is a factor that aggravate the
occurrence of lower back pain, so it is usually
suffered by older people due to a decrease
fungsi¬-function body, especially the bones so
it is no longer elastic like the time when
young. But as is often found young people
343
number of lansianya after Central Java
(Indonesia National Media, 2009).
According to the WHO in 2011, In the
UK reported the prevalence of low back pain
in a population of approximately 16.5 million
per year. And in the United States 60-80%
reported experiencing lower back pain or Low
Back Pain.
Epidemiological data regarding low back
pain in Indonesia does not exist, but an
estimated 40% of the population of East Java
island aged over 55 years had suffered from
back pain, the prevalence in males 18.2% and
13.6% in women. Incident based on patient
visits to several hospitals in Indonesia ranging
between 3-17% (Sadeli & Tjahjono, 2011).
According RISKESDAS (Health
Research) in 2013, the prevalence of joint
disease diagnosis based health workers (Health
Workers) in Indonesia and 11.9 percent based
on the diagnosis or symptoms of 24.7 per cent.
Prevalence based diagnosis of health workers
(Health Workers) Bali's highest (19.3%),
followed by Aceh (18.3%), West Java (17.5%)
and Papua (15.4%).
Based on the data in Posyandu in
November 2014 in the village Wonorejo
districts sumbergempol tulungagung district,
unknown number of elderly who recorded 61
elderly people and there are 35 elderly people,
or about 22% of elderly with low back pain.
Biologically elderly population is a
population that is experiencing the aging
process continuously. Which is characterized
by declining physical endurance is
increasingly vulnerable to disease that can
cause death. This is due to changes in the
structure and function of cells, tissues
and organ systems. Most elderly who
frequent complaints are pain in the lower back
area (Hutapea 2005).
Pain is an inconvenience in the
development of events will mempenga ruhi
various components in the body. The impact of
pain can affect the physical, behavioral, and
influence on daily activities.
Although the pain is usually handled
through the use of drugs, some technical nonpharmacological may also help control the
pain: masasse, nerve stimulation with
electrical transcutaneous (transcutaneous
electrical nerve stimulation (TENS)), peng use
of hot or cold compresses, meditation,
hypnosis, and stretching , These techniques are
generally safe, easily available, and can be
done at home or in an environment of acute
care facilities (Stanley, 2006).
In the treatment of back pain there are
several actions that can be done in relieving
back pain either by physical training or
exercise pinngul motion. This exercise is not
only to relieve pain, could be to
merileksasikan muscles in the lower back due
to regular physical exercise or sport back
muscles will be more flexible and relaxed so it
would be free to move and the pain can be
reduced (Davies, 2007).
Stretching (stretching) not only for
athletes, but also for active people require
stretching to relieve them from the pressure of
stiff muscles. A number of researchers have
shown that the more we age, the elasticity of
the muscles will decrease, and stretching helps
maintain flekbisilitas and assign physical
appearance. If done correctly and regularly,
stretching would be nice (Burke, 2001).
Provision of hip motion exercises /
stretching can help to reduce the time of the
pain. Because it will automatically train the
pelvic muscles become supple (aqila smart,
2010).
Based on the description above, the
researchers interested in conducting research
"The influence of hip motion exercises
(stretching) to decrease lower back pain (low
back pain) in the elderly posyandu wonorejo
country
districts
sumbergempol
Tulungagung".
METHODS
The study design used quasyexperiment with using one-group pre-post test
design. characteristic of this type of research is
the use of a causal relationship by engaging a
group of subjects. Group of subjects was
observed before the intervention, and then
observed again after the intervention
(Nursalam, 2003).
Population in this research is all elderly
Posyandu Wonorejo In Sumbergempol
Tulungagung subdistrict to 56 people.
In this study the samples used all elderly
low back pain (low back pain) at Posyandu
village districts Wonorejo sumbergempol
Tulungagung total of 32 respondents, with the
inclusion and exclusion criteria.
In data collection that is used for
measuring instrument research was the
observation sheet.
344
The research was conducted on the 8th of
March, 10 March and 14 March 2015 in the
village of Wonorejo Elderly IHC
Sumbergempol Tulungagung subdistrict.
In analyzing the effect of hip motion
exercises (stretching) of the lower back pain in
elderly Elderly In Village Wonorejo IHC
Tulungagung subdistrict Sumbergempol 2015,
using statistical test of Wilcoxon Signed Rank
test. If the p value <0.05 was said to be
significant
namely the null hypothesis (Ho) is rejected,
then H1 accepted meaning stated there Effect
of hip motion exercises (stretching) of the
lower back pain in the elderly, while p value ≥
0.05, the null hypothesis is accepted and H1
rejected the means no Influence claims no hip
motion exercises (stretching) to decrease low
back pain in the elderly.
RESULT AND ANALYZE
1. Low Back Pain Before Exercise Motion Hips (Stretching) (Pre-test).
Table 1 Distribution of Respondents Frequency Measurement Based on Lower Back Pain (Low
Back Pain) Prior Following Hip Motion Exercise (stretching).
Number
Low Back Pain
Frequency
Procentase
(%)
1
2
3
Weight
Moderate
Light
Summary
16
13
3
32
50%
40,6%
9,4%
100%
Based on Table 1 above it can be seen
that out of 32 respondents before given
stretching half experiencing severe back
pain as many as 16 people (50%).
2. Low Back Pain After Exercise Motion Hips (Stretching).
Table 2 Distribution of Respondents Frequency Measurement Based on Lower Back Pain
Prior Following Hip Motion Exercise (stretching).
Number
Low Back Pain
Frequency
1
2
3
Weight
Moderate
Light
Summary
0
22
10
32
Based on the table 2 above can be
seen that out of 32 respondents after given
motion exercises Hips (Stretching) most
experienced moderate pain as many as 22
people (68.8%).
Results of statistical test Wilcoxon
Signed Rank Test in getting the value ρ =
0.000 where ρ <0,05 so that Ho rejected
Procentase
(%)
0%
68,8%
31,2%
100%
and H1 accepted which means there is
significant influence between the
administration of Motion Exercise Hips
(Stretching) The Lower Back Pain (Low
Back Pain) In elderly In elderly Posyandu
Wonorejo village Sumbergempol
Tulungagung.
345
Researchers agree with the above
theory, that hip motion exercises
(stretching) can reduce the level of lower
back pain in the elderly. Stretching not only
performed in the elderly but can be done by
all ages.
A. The results of lower back pain before hip
motion exercises (stretching).
From the results of this study in
elderly hip motion before training
(stretching) at Posyandu Village Wonorejo
Sumbergempol Tulungagung subdistrict, of
32 respondents showed that respondents
who experienced light of low back pain are
3 (9.4%), moderate of Low Back Pain were
13 (40.6%) and weigh of Low Back Pain as
much as 16 (50%) of the data is mostly
elderly people experience lower back pain
(Low Back Pain) total weight 16 people
(50%).
In the treatment of back pain there
are several actions that can be done in
relieving back pain either by physical
training or exercise pinngul motion. This
exercise is not only to relieve pain, could
be to merileksasikan muscles in the lower
back due to regular physical exercise or
sport back muscles will be more flexible
and relaxed so it would be free to move and
the pain can be reduced (Davies, 2007).
Researchers agree with the above
theory, that hip motion exercises
(stretching) done regularly can help to
reduce pain in the lower back and free to
indulge and pain can be reduced.
C. The Effect of Exercise motion analysis
Hips (Stretching) The Lower Back Pain
On Elderly
Results of statistical test Wilcoxon
Signed Rank Test in getting the value ρ =
0.000 where ρ <0,05 so that H0 rejected
and H1 accepted which means there is
significant influence between the
administration of Motion Exercise Hips
(Stretching) The Lower Back Pain (Low
Back Pain) In Elderly In elderly Posyandu
Wonorejo
village
Sumbergempol
Tulungagung subdistrict 2015.
In the treatment of back pain there
are several actions that can be done in
relieving back pain either by physical
training or exercise pinngul motion. This
exercise is not only to relieve pain, could
be to merileksasikan muscles in the lower
back due to regular physical exercise or
sport back muscles will be more flexible
and relaxed so it would be free to move and
the pain can be reduced (Davies, 2007).
In accordance with the results
obtained by researchers and theory shows
the influence of lower back pain before
being given a hip motion exercises
(stretching) and given setelahh hip motion
exercises (stretching). This proves that the
given hip motion exercises (stretching) in
the elderly can reduce lower back pain (low
back pain). Means the provision of motion
exercises / Hips (stretching) no effect on
low back pain (low back pain) in the
elderly.
B. The results of lower back pain after hip
motion exercises (stretching).
From the results of this study in
elderly hip motion after training
(stretching) at Posyandu Village Wonorejo
Sumbergempol Tulungagung subdistrict, of
32 respondents showed that respondents
who experienced low back pain (Low Back
Pain) light as much as 10 people (31.2%)
and lower back pain (Low Back Pain) was
as much as 22 (68.8%) of the data is mostly
elderly people experience lower back pain
(Low Back Pain) was as much as 22 people
(68.8%).
Stretching is not only in the show for
the athletes, but also for active people
require stretching to relieve them from the
pressure of stiff muscles. A number of
researchers have shown that the more we
age, the elasticity of the muscles will
decrease, and stretching helps maintain
flekbisilitas and assign physical
appearance. If done correctly and regularly,
stretching would be nice (Burke, 2001).
CONCLUSIONS
Based on the results of the study the
effects of exercise hip motion (stretching) of
the lower back pain (Low Back Pain) in
elderly Posyandu Wonorejo Village District of
Sumbergempol Tulungagung 2015 can be
inferred from the 32 respondents in the
analysis by using statistical test of Wilcoxon
Signed Ranks Test with a value of ρ = 0.000,
meaning that ρ <α = 0.05, so that H0 rejected
H1 accepted and that means no influence
346
Granting Motion Exercise Hips (Stretching)
With Lower Back Pain Decline In Elderly In
Rural Elderly IHC Wonorejo Sumbergempol
Tulungagung subdistrict 2015.
Pain (Online).( http://innappni.or.id.
Accesed on 26th october 2014).
Ismiati Cahyo, dkk. 2010. Posyandu & Desa
Siaga. Yogyakarta : Nuha Medika
ACKNOWLEDGEMENT
Nursing education institutions should
equip students with knowledge about handling
nonfarma-psychology lower back pain in the
elderly, which can later be equipped nurses in
applying science and knowledge to the people,
especially the elderly.
The result is expected as fill material for
both increased insight and knowledge and
skills perawata in increasing knowledge about
how to lose lower back pain in the elderly,
efforts are made to improve education and
health promotion activities to the public.
Malcolm. 2003. Seri Kesehatan Bimbingan
Dokter pada Nyeri Punggung. Jakarta :
Dian Rakyat.
REFERENCE
Potter, Patricia A; Anne Griffin Perry. 2005.
Buku Ajar Fundamental Keperawatan:
Konsep, Proses, dan Praktik Edisi 4
Volume 2. Jakarta : EGC.
Notoatmojo, S. 2003. Metodologi Penelitian
Kesehatan. Jakarta : Rineka Cipta.
Nugroho, W. 2000. Keperawatan Lanjut Usia.
Jakarta : EGC.
Metodologi
Penelitian
Ilmu
Keperawatan : Pedoman Skripsi, Tesis
dan Instrumen Penelitian Keperawatan.
Jakarta : Salemba Medika.
A.Aziz. 2008. Metode Penelitian Keperawatan
dan Teknik Analisi Data. Jakarta :
Salemba Medika.
Arif, M. 2000. Kapita Selekta Kedokteran.
Jakarta : Media Aesculapius Fakultas
Kedokteran Universitas Indonesia.
Rakel. 2002. Nyeri Pinggang Bagian
Bawah (onli-ne).
(http://www.nyeripunggungbawah.com
accesed on 26th october 2014)
Arikunto,S. 2005. Prosedur Penelitian Suatu
Pendekatan Praktek.Edisi
Revisi
keempat. Jakarta : Rineka Cipta.
Santoso. 2013. Ilmu Faal Olahraga (Fisiologi
Olahra-ga). Bandung : PT Remaja
Rosdakarya.
Asmadi. 2003. Konsep Aplikasi Kebutuhan
Dasar Klien. Jakarta : Salemba Medika.
Setiadi. 2007.
Konsep & Penulisan Riset
Keperawatan. Yogyakarta: Graha Ilmu.
Bimariotejo. 2009. Low Back Pain (LBP).
(online). (Website
http://bimaariotejo.wordpress.com
accessed on 26th october 2014)
Smeltzer, Bare. 2002. Buku Ajar Keperawatan
Medikal Bedah Brunner & Studdarth.
Jakarta : EGC.
Stanley M, Patricia GB. 2006. Buku Ajar
Keperawatan Gerontik Edisi 2.Jakarta:
EGC.
Brunner & Sddarth. 2002.
Keperawatan
Medikal-Bedah. Jakarta : Buku
Kedokteran EGC.
Sugiyono, 2009 .
Metode Penelitian
Kuantitatif Kulalitatif dan R&D. Jakarta
: CV Alfabeta.
Davies. 2007. Buku Pintar Nyeri Tulang dan
Otot. Jakarta : publisher by Erlangga.
Tamsuri, Anas.2006.
Konsep dan
Penatalaksanaan Nyeri. Jakarta : EGC.
Fallen R, Dwi Budi R. 2011. Catatan Kuliah
Keperawatan Komunitas. Yogyakarta:
Nuha Medika.
Yuflihul. 2010. Pengaruh Latihan Gerak
Pinggul (Stretching) Terhadap Nyeri
Punggung bawah pada Lansia Di Dusun
ketejer Desa Suka Makmur Kecamatan
Gerung Kabupaten Lombok Barat NTB.
Ebook‟Yuflihul Kharir. Accessed on
28th october 2014.
Hidayat, A.Aziz Alimul. 2007.
Riset
Ilmiah. Jakarta: Salemba Medika.
Idyan, Z. 2008. Hubungan Lama duduk Saat
Perkuliah an dengan Keluhan Low Back
347
(The Coreelation Between The Interest and Motivation of Becoming A Nurse And
The Learning Achievement of The Student of Diploma III In Nursing Science at
Hutama Abdi Husada Health Institute Of Tulungagung
Sri Agustiana
Abstract
The objective of this research are to investigate : ( 1 ) the correlation between the interest
and the learning achievement, (2) the correlation between the motivation and the learning
achievement, (3) the simultaneous correlation between the interest, motivation and the
learning achievement.The method for this research was an observational analytical with
the correlation design. The research started from December 2009 up to Agust 2010. The
population, were all student semester IV ( fourth ) with total 91 student and all student
semester VI ( sixth ) with total 121 students. As well as independent variable in this
research were interest and motivation of becoming a nurse. The data at the research were
gathered by using quetionnaire and document analysis. The data were then analyzed by
using the multiple correlation technique of analysis.According to the result from analysis
data and discussion which done by using significant 1% shows : (1) there is signification
correlation between the interest and the learning achievement as indicated by r count > r
table ( 0,764 > 0,159 ) with ρ = 0,000, (2) There is significant correlation between the
motivation and the learning achievement as indicated by
r count > r table ( 0,632 >
0,159 ) with ρ = 0,000 ; (3) there is simultaneous correlation between the interest,
motivation and the learning achievement as indicated by Fcount > Ftable ( 103,58 > 4,74
)The result can be conclude that the research place founded students which have high
interest and motivation to become a nurse, the academic achievement also high, the
students which have moderate interest and motivation to become a nurse, the academic
achievement also moderate. For the students to become a nurse, the academic
achievement is fairly. This is caused by, the support from parent is strong but interest and
motivation not come from their self. For the academic institution, better increase the
learning achievement for student by way at improve and increase the quality teaching
process, fulfill tool and infrastructure, as well as adequate human resources.
Keyword : Interest, Motivation, Learning achievement
INTRODUCTION
The right choice for high school
graduates who are interested and
motivated to get a job is to continue
their education to higher education such
as Diploma III. One lane professional
education in the health sector is
education of Nursing Diploma III
program. In the late, interest of the
students entering the Diploma Nursing
education tends to decrease. It can be
seen from the data STIKes Hutama Abdi
Husada Tulungagung, the number of
applicants in the year 2006/2007 as
many as 152 people, as many as 139
people in 2007/2008, 2008/2009 115
people and as many as 111 people in
2009/2010. One contributing factor is
the lack of interest and motivation of
students.
STIKes Hutama Abdi Husada
Tulungagung D-III Study Program of
Nursing is the formal educational
institutions that educate students to
become professional nurses. To
determine the success STIKes Hutama
Abdi Husada Tulungagung as a
professional educational institution
needs assessment of students‟ academic
achievement. Cumulative Performance
Index (IPK) is a number that indicates
the achievement of students from the
350
first semester till the final semester.
Predicate graduation Nursing D-III
program in STIKes Hutama Abdi
Husada Tulungagung as follows: IPK
2.00 to 2.75 predicate satisfying, IPK
2.76 to 3.50 VERY satisfying, IPK of
3.51 to 4.00 cumlaude.
Student interest and motivation
essential to achieve something to be
desired. Students who have an interest
and high motivation to become a nurse,
then academic achievement is also high.
But in reality, many students who are
not interested in becoming a nurse.
Though graduates of the Diploma of
Nursing has a pretty good prospect. To
achieve a high cumulative grade point it
is necessary interest and motivation to
become a nurse. Therefore it is very
important to identify: whether there is a
relationship between the interest and
motivation to be a nurse with the
Learning Achievement (in Students of
D-III Nursing Program in STIKes
Hutama Abdi Husada Tulungagung).
The purpose of this research is
to analyze the relationships between
interest in learning achievement;
analyzing the relationship between
motivation and academic achievement;
analyze the relation interest and
motivation and learning achievement.
Husada Tulungagung totaling 297
students.
The sampling technique using
the Stratified Random Sampling.
Stratified Random Sampling is a
sampling technique by means of
stratification of the list of all units of the
population. The sample in this research
is the Students of D-III Nursing Program
in semester IV and VI. Forth semester
students numbered 60 people. Sixth
semester students numbered 79 people.
Data were collected using a
questionnaire. Questionnaire to gauge
interest consists of 10 questions and
questionnaires for measuring motivation
consists of 17 questions. The answer
choices are strongly agree, agree,
undecided, disagree and strongly
disagree. Whereas, this measure is used
to obtain data learning achievement is a
document in the form of student
achievement scores such the last
semester of IPK.
Hypothesis test uses multiple
correlation test. Double correlation is a
number that indicates the direction and
strength of the relationship between two
independent variables together. Double
two-variable correlation formula is:
√
METHODS
study was observational
analytic
correlational design. Reasons for using
analytic
observational
design
correlational design is to determine the
relationship between the independent
variables (interest and motivation to be a
nurse) and the dependent variable (the
learning achievement). This research is
cross sectional. Dependent and
independent variables were taken
simultaneously with one observation.
This research was conducted in
Tulungagung D-III study program of
Nursing. This study was conducted from
December 2009 to August 2010. The
population in this study were all students
of Nursing D-III STIKes Hutama Abdi
Testing the significance of the
multiple correlation coefficient can use
the Ftest with the formula:
(
)(
The calculation results are then
compared to the price of Ftable (4.78). If
the Fcount larger than Ftable then H0
rejected and H1 accepted. This means
there is a significant relationship shared
between the interest and motivation and
academic achievement.
Results of this study consisted
of general data and specific data.
General data include age and gender.
While specific data consists of the
351
)
interest to be a nurse, be a nurse
motivation and learning achievement.
The frequency characteristics of
respondents by sex female 80 people
(58%), while the male gender as many
as 59 people (42%). The frequency
characteristics of the respondents
according to the age of students 15-20
years as many as 46 people (33%), and
21-25 years as many as 93 people
(67%).
Data student interest in
becoming a nurse showed seven
respondents (5.04%) have high interest,
88 respondents (63.31%) had moderate
interest, and 44 respondents (31.65%)
had a low interest.
Data student motivation to be a
nurse showed 6 respondents (4.32%)
have high interest, 104 respondents
(74.82%) had moderate interest, and 29
respondents (20.86%) had a low interest.
Data student achievement shows
three respondents (2%) had a
performance index is very high, 79
respondents (57%) had a grade point
well, and 57 respondents (41%) had a
grade point enough, and no one has the
less IPK.
The correlation of student‟s
interest in learning achievement of D-III
study program students of Nursing
STIKes Hutama Abdi Husda
Tulungagung in 2010 showed there is
correlation. This is indicated by the test
results with the Pearson product moment
correlation values obtained rcount > rtable is
0.764 > 0.159 (p = 0.000). While the
relationship between motivation and
learning achievement of D-III study
program students of Nursing of STIKes
Hutama Abdi Husda Tulungagung in
2010 also showed there is correlation.
This is indicated by the test
results with the Pearson product moment
correlation values obtained rcount > rtable is
0.632 > 0.159 (p = 0.000).
Data from multiple correlation
test the correlation interest and
motivation to be a nurse and learning
achievement in the study program
Student Nursing D-III STIKes Hutama
Abdi Husda Tulungagung in 2010 as in
the following table:
Correlation
Value
r1
0,764
r2
r3
0,632
0,777
Multiple
Correlation
Test
Fcount =
103,58
Ftable = 4,78
significant
The table shows that there is a
significant correlation between interest
and learning motivation and academic
achievement. With a standard error of
1%, the price of the F table = 4.78 and
the price of the F count = 103.58. F
count larger than F table (103.58 >
4.78). Then H0 is rejected and Ha
accepted. This means that there is a
significant relationship between interest
and motivation and academic
achievement.
DISCUSSION
1. Relationship between Interests and
Learning Achievement
According to the theory
Sandjaja (2005) that an activity will be
performed or not is dependent once by a
person's interest towards the event. This
means that interest is very dependent on
the values that make a person have a
choice in life. Interest is the
psychological aspect of a person to pay
high attention to certain activities and
encourages concerned to carry out such
activities. With the support element of
learning that support the learning
process, it will facilitate the learning
activities of students. Students with high
interest will arise in the spirit of high
achievement. While low interest will
cause the students are not interested in
learning.
The results showed no
significant relationship between interest
to be a nurse and academic achievement.
The value of rcount > rtable is 0.764 >
0.159 (p = 0.000). Students who have an
interest in being in the category of
enough about 88 people (63.31%) as
352
well as academic achievement and also
quite good.
These results indicate the
suitability of theory and research results
showed that the higher a person's
interest to be a nurse, then the learning
achievement also increased.
2. Relationship between Motivation
and Learning Achievement
According to Hamalik (2008),
that motivation is the energy change in a
person who is characterized by the
emergence of feelings and reactions to
achieve the goal. Motivation is the
driving factor in the self-learning
students. Motivation is very important in
improving student achievement.
Students are highly motivated will seek
to learn at any time. Instead students
who have low motivation, it is also low
learning motivation. This makes them
lazy to learn, easily discouraged, and
dependent on others.
significant relationship between
motivation to be a nurse and academic
achievement. The value of rcount > rtable is
0.632 > 0.159 (p = 0.000). Students are
highly motivated as much as 50% with
excellent academic
achievement.
Students who have the motivation was
as much as 74% with good learning
achievement. And only 26% of students
have enough learning achievement.
Based on theory and the results
showed that students who have high
motivation, the achievement of high
academic achievement as well. While
students who have low motivation, then
the achievement of learning is also
small.
3. Relationship between Interest and
Motivation
with
Learning
Achievement
According
Poerwodarminto
(1990) learning success is the mastery of
knowledge or skills developed by each
subject and shown in the form of test
scores. Learn to show some change in
behavior as a result of exercise, or
interaction with the environment.
Interest and motivation has an important
role in the learning process. Interest and
high motivation will strengthen a person
to achieve what is desired. Students who
have an interest and motivation to
become a nurse more enthusiastic about
learning and acquiring learning
achievement. This is in accordance with
the opinion of Sardiman (2007) that the
learning process goes smoothly
accompanied by high interest to learn.
significant correlation between the
collective interest and motivation to be a
nurse and academic achievement. Prices
Fcount > Ftable is 103.58 > 4.78.
From the description it can be
concluded that the interest would
influence the motivation to learn. And
the higher the motivation, the better
academic achievement. Meanwhile, the
lower the interest, the motivation will
decline thus affecting the academic
achievement as well.
CONCLUSIONS
From the results of research and
discussion, it can be concluded that:
there is a correlation between interest in
becoming a nurse with the achievement
of students with rcount > rtable table is
0.764 > 0.159 (p = 0.000). There is a
relationship between motivation to be a
nurse with the achievement of students
with rcount > rtable table is 0.632 > 0.159
(p = 0.000). And there is a significant
relationship shared between the interest
and motivation to be a nurse with
student achievement, as shown by
Fcount > Ftable (103.58 > 4.78).
Suggest that can be given are:
education institutions, should improve
learning achievement of the students to
improve their motivation. In addition,
the organization of the learning process
should be supported by adequate
infrastructure. Creating a conducive
learning environment, and improve the
quality of teaching and learning
processes. For students, should be able
to follow the teaching and learning
process in accordance with the
provisions stipulated. Students need to
increase interest and motivation to learn
353
to achieve optimal learning. In addition
to outstanding students awarded.
Suggestions for researchers, this study
can be used as a reference
implementation of future studies.
REFERENCE
Arikunto S, 2002. Prosedur Penelitian
Suatu Pendekatan Praktek.
Jakarta: Rineka Cipta.
Mudjiman H. 2006. Belajar Mandiri
(Self – Motivation Learning).
cetakan pertama. Surakarta: LPP
UNS dan UNS Press.
Notoadmodjo S. 2005.
Metodologi
Rineka Cipta.
Nursalam. 2003. Konsep dan Penerapan
Metodologi Penelitian Ilmu
Keperawatan.
Surabaya;
Salemba Medika.
Arikunto. 2008. Tinjauan Tentang Minat
Belajar
Siswa
Nursalam.
2003.
Manajemen
http://sobatbaru.blokspot.com/2
Keperawatan Aplikasi dalam
008/10/tinjauan-tentang-minatPraktek
Keperawatan
belajar-siswa.html
, October 7th,
Profesional. Surabaya: Salemba
2008.
Medika.
Dalyono, M. 2005.
Psikologi
Pendidikan. Jakarta: Rineka
Cipta.
Purwanto S. 1999. Pengantar Perilaku
Manusia untuk Keperawatan.
Jakarta: EGC.
Diknakes. 2009. Petunjuk Pelaksanaan
Sipesimaru. Jakarta.
Riwidikdo Handoko. 2008. Statistika
Kesehatan. Yogyakarta: Mitra
Cendekia Press.
Diknakes. 2008. Kurikulum Berbasis
Kompetensi Diploma III
Keperawatan. Jakarta.
Diknakes. 2008. Pedoman Kegiatan
Akademik Program D III
Keperawatan. Tulungagung.
Akper Hutama Abdi Husada.
Sanjaya W. 2008. Strategi Pembelajaran
Venlana Prenada. Jakarta:
Media Group.
Sardiman. 1996. Interaksi dan Motivasi
Belajar Mengajar. Jakarta: PT.
Raja Grafindo Perkasa.
Dimyati. 1994.
Belajar dan
Pembelajaran.
Jakarta:
Direktorat Jenderal Pendidikan
Tinggi. Departemen Pendidikan
dan Kebudayaan.
Sardiman. 2007. Interaksi dan Motivasi
Belajar Mengajar. Jakarta: PT.
Raja Grafindo Perkasa.
Hamalik. 2008. Psikologi Belajar dan
Mengajar. Bandung: Sinar Baru.
Setyowati. 1997. Peningkatan Motivasi
Kemampuan Kerja dan Budaya
Kerja. Pelatihan Manajemen
Keperawatan. Jakarta: FIK. UY.
Irwanto. 2002.
Psikologi Umum.
Jakarta: PT. Prenhalindo.
Siti
Mangkunegara. 2005. Evaluasi Kinerja
SDM. Bandung: Refika
Aditama.
Pariani dan Nursalam. 2001.
Metodologi Riset Keperawatan.
Surabaya: CV Sagung Seto.
Slameto. 2009.
Pentingnya Minta
Belajar Bagi Peningkatan
354
Prestasi
Belajar
Siswa.http://wartawarga.gunadar
ma.ac.id/2009/12/pentingnyaminat-belajar-bagi-peningkatanprestasi-belajar-siswa/
December 14th, 2009.
Sugiyono. 2000. Metode Penelitian
Bisnis. Bandung: CV. Alfabeta.
Sugiyono. 2007.
Penelitian.
Alfabeta.
Statistik Untuk
Bandung: CV.
Slameto. 2003. Belajar dan FaktorFaktor yang Mempengaruhinya.
Jakarta: PT. Rineka Cipta.
Surakhmad W. 2004.
Pengantar
Penelitian Ilmiah Dasar,
Metode dan Teknik. Bandung:
Tarsito.
Uno. H. B. 2007. Teori Motivasi dan
Pengukurannya. Jakarta: PT.
Bumi Aksara.
Widayatun Rusmitri. 1999.
Ilmu
Perilaku. CV. Saung Seto.
Winardi J. 2001.
Motivasi dan
Pemotivasi dalam Manajemen.
Jakarta: Raja Grafindo Aksara.
Wiratmadja Pochiati. 2008. Metode
Penelitian Tindakan Kelas. PT.
Remaja Rosdakarya.
Zanikhan. 2009. Minat Belajar Siswa.
http://zanikhan.multiply.com/jou
rnal/item/1206. August 13th,
2009.
Sukmadinoto dan Syaodik Nana, 2009.
Metode Penelitian Pendidikan.
PT. Remaja Rosdakarya.
Swansburg. 2001. Pengembangan Staff
Keperawatan. Jakarta: EGC.
355
THE EFFECT OF BABY MASSAGE TO THE IMPROVEMENT OF BABY’S
APPETITE ON THE INFANTS AGED 7-12 MONTHS AT ARYOJEDING,
REJOTANGAN, TULUNGAGUNG
2015
Yitno1, Dian Fitriana Ulfa2
Abstract
Currently many infants less appetite. Physiotherapy is a very large role in helping the
growth process is the optimal infant massage, which is one of the benefits is that it can
increase appetite and weight. The aim in this study was to determine the effect of
massaging babies aged 7-12 months to increase appetite in the village of Aryo Jeding
Rejotangan Tulungagung subdistrict. The method in this study using the analytical
method. by using the design study "Pre Experimental (one group pretest-posttest)". The
study population was all infants aged 7-12 months were enrolled in the Village District of
Aryo Jeding Rejotangan that meet the criteria for inclusion and exclusion criteria as much
as 20 respondents, and respondents who have been actually have criteria as a sample. For
this study using the formula Willcoxon Signed Rank Test. Based on the results of the
study Effects of Infant Massage Ages 7-12 Months Against Increased Appetite held on 23
– 28 February 2015 showed that 20 respondents before massaging all have less appetite,
whereas after massaging all have normal appetite. From the statistical test result obtained
Willcoxon Signed Rank test P = 0.00 <α = 0.05 then H0 is rejected and H1 accepted,
meaning that there Effect of Infant Massage Ages 7-12 Months Against Increased
Appetite in the village of Aryo Jeding Rejotangan Tulungagung subdistrict Year 2015.
From this it can be concludedthat all infants aged 7-12 months experienced a lack of
appetite so that the importance of infant massage physiotherapy done to improve the
baby's appetite so as to achieve optimal growth according to age.
Keywords : Infant Massage, Infant Appetite, Baby.
PRELIMINARY
Infancy is the golden period and also
as the critical
period of people
development. It‟s said to be a critical
period because at that time the baby is very
sensitive to the environment and it‟s said
to be golden because infancy lasted a very
short and can not be repeated, if during
these infants suffered malnutrition and
don‟t get optimal treatment, the effect was
lost generation, the lost generation
(Department of Health).
Infancy is divided into 2 (two)
periods, neonatal period and post-natal
period. Neonatal period starts from the age
of 0-28 days, while the post-neonatal
period starting from the age of 29 days - 11
months. Babies are individuals who are
weak and
need adaptation process.
Difficulty process of adaptation will cause
the baby get weight loss, developmental
delay, behavioral irregular even to death
(Mansur, 2009).
Physiotherapy has very big role in
helping the optimal growth and
development, so that it will form a quality
generation. Infant massage is a form of
physiotherapy that has positive effect on
the growth and development of infants
beside giving
supplementary feeding
(Roesli, 2001).
According Roesli (2001) infant
massage therapy is the oldest known
human touch and the most popular. Infant
massage is a form of stimulus / tactilekinesthetic stimulation is accompanied by
stimulation of verbal communication as the
357
embodiment of love affection of parents to
the baby who have benefits for the baby.
Infants are massaged by their parents will
have a tendency to increase appetite or
weight, good emotional and
social
relationships.
In 2011 the number of babies in
Indonesia are 4.3726 million inhabitants of
toddlers 21,805,008 or 20.05% (Ministry
of Health Indonesia, 2011). In Indonesia
the implementation of infant massage in
rural communities still held its role by
consider traditional birth attendants
(TBAs). Because they consider traditional
birth attendants better understand and
proficient to do infant massage has been
practiced for centuries. (Roesli, 2010).
Based on the results
of
RISKESDES in 2013 about the nutritional
status of infants in the East Java, namely
the prevalence of underweight children
with Zscore <-3.0 SD. The prevalence by
province and national. One of indicator to
determine the child should be treated in the
management of malnutrition is a very thin.
The prevalence of very thin nationally in
2013 is still quite high at 5.7% severe
malnutrition and malnutrition 13.9%, there
is an increase compared to the year 2010
are poor nutrition and malnutrition of 4.9%
and 13.0% in 2007 malnutrition 5,4% and
13.0% malnutrition. Over all prevalence of
malnutrition and malnutrition increase in
2013.
Generally, malnutrition is one of the
terms of
the disease-Protein Energy
Malnutrition (MEP), that is a disease
caused by lack of energy and protein.
Depending on the degree of energy-protein
deficiency that occurs, then the
manifestation of the disease was different.
MEP is often termed mild malnutrition.
Whereas marasmus, kwashiorkor (often
also termed malnutrition or HO), and
marasmik-kwashiorkor include as heavy
MEP.
Infant who get malnutrition is a
threat for future generations. This infancy
is a growth and development period that‟s
very rapid. If during these infants suffered
malnutrition and do not get optimal
treatment then the impact is lost
generation. Physiotherapy has very big role
in helping the optimal growth and
development, so that it will form a quality
generation. Infant massage is a form of
physiotherapy that has positive effect on
the growth and development of infants
beside giving
supplementary feeding
(Roesli, 2001).
In the book Guidelines for Infant
Massage (Utami Roesli 2005) mentioned
that one of the benefits of touch therapy or
massage can improve appetite and weight.
If these actions are taken on a regular basis
and in accordance with the procedures and
techniques of baby massage, therapy could
be beneficial for the baby.
The positive influence of massage or
touch on growth and development process
of infants and children has long been
recognized by humans. Infant massage can
started after the baby is born, that‟s sure
the younger infants should
not be
massaged as in infants. Touch and infant
massage is done slowly and gently so the
baby feel comfortable and make appetite to
be great (Billy, 2005).
Baby massage therapy has several
benefits, there are make comfortable,
stimulate blood circulation and increase
energy, enhance endurance baby, reducing
stress and make babies sleep better, can
build love with parents (Roesli, 2009).
Besides the benefits, there are also
disadvantages among infants who were not
massaged, that is the babies who do not
gain weight, more slowly than the babies
were massaged. And also have irregular
sleep patterns than babies who massaged
(Roesli, 2010).
Baby massage
is one of touch
language and massage in baby after birth
could provide guarantees for sustainable
body contact that can sustain the feeling of
safety in baby. Touch will also stimulate
blood circulation and will add energy as
waves of fresh oxygen will be more sent to
the brain and througho ut the body (Roesli,
2001).
Notice of the phenomenon,
researchers interested in conducting the
study titled "The Effect of Baby Massage
Ages 7-12 Months To Increased Appetite
In Aryo Jeding, Rejotangan, Tulungagung
2015".
358
RESEARCH METHODS
The study design is a strategy as
guide the researchers guide on the whole
process of research (Nursalam, 2007).
In this study use "pre-experimental
(one group pretest-posttest)". This study
was done by giving a pretest (initial
observations)
before
given
the
intervention, after the intervention is given,
then given posttest (concluding
observations) (Aziz, 2008). This design is
also no comparison group (controls), but it
already made the first observation (pretest)
which allows researchers can test the
changes after the experiment (Setiadi,
2007).
Population is all subject or object
with particular characteristics that will be
studied. Not only the object or subject
being studied but all the characteristics or
properties owned by the subject or the
object. (Aziz, Alimul, 2003).
The population in this study were all
infants aged 7-12 months were enrolled in
Aryo Jeding, Rejotangan, Tulungagung
there are about 20 babies.
Sampling technique used in this
study is purposive sampling technique,
sampling based upon a something purpose.
(respondents were chosen correctly - does
have criteria as a sample) (Aziz Alimul,
2003).
Instruments / measuring instruments
used in this study is the observation sheet,
that is a worksheet to observe and measure
the level of achievement. (Aziz Alimul,
2003). Analysis using the Wilcoxon
Signed Rank Test. If the results of the
analysis showed p value <α (0.05) is said
to be significant, the null hypothesis (H0)
is rejected, then accepted H1 means that
states there Effect of Baby Massage 7-12
Months Against Increased Appetite In
Aryo Jeding, Rejotangan, Tulungagung
2015.
RESEARCH RESULT
1. Identification
Appetite
Before
Massaging
Table 1. Description of the appetite data
before Massaging in infants
aged 7-12 months.
No
1
2
3
4
5
6
Age
7
8
9
10
11
12
Min
Max
Mean
SD
5
6
7
6
7
8
5,67
6,33
7,25
0,577
0,577
0,500
0,707
0,447
0,577
7
9
9
8
10
10
7,50
9,20
9,67
Source: Observation Research 2015
Based on the results of the study
showed that from 20 respondents, 3
respondents aged 12 months has value average appetite as much as 9,67.
2. Identification of Appetite After
Massaging
Table 2. Description of the appetite data
after Massaging in infants aged
7-12 months.
No Age Min Max Mean SD
1 7
6
7 6,67 0,577
2 8
7
8 7,67 0,577
3 9
8
9 8,25 0,500
4 10 9 10 9,50 0,707
5 11 10 11 10,20 0,447
6 12 11 12 11,67 0,577
showed that from 20 respondents, 3
respondents aged 12 months has value average appetite as much as 11,67.
3. Analysis of The Effect of Baby
Massage 7-12 Months Against
Increased Appetite
Table 3. Decription data of the effect of
baby massage in Infants 7-12 month to
increase appetite
Data
Age
Before
After
7
5,67
6,67
8
6,33
7,67
Rata - rata
9
10
7,25 7,50
8,25 9,50
359
P
11
9,20
10,2
0
12
9,67
11,6
7
0,026
and regulated by the close interaction
between the digestive tract, adipose
tissue and the brain. Decrease in
appetite is called anorexia, while
polyphagia (or "hyperphagia")
is
increased eating.
Appetite is said to be good /
normal when the feeding process in
order to meet the nutritional needs of
the body, especially the energy balance
running optimally (Arali, 2008).
From the results above the
researchers think there is compatibility
between theory and the results of
research, conducted massage is an
attempt to add increased baby‟s appetite
to obtain optimal conditions during the
infant period.
Based on the table above shows that
of the 20 respondents on average appetite
before and after massaging have test
results Willcoxon Signed Rank Test
showed that the value of P = 0.026 (P <α =
0.05), which means there Effect of Baby
Massage Ages 7-12 month Against
Increased Appetite In Aryo
Jeding,
Rejotangan, Tulungagung, 2015.
DISCUSSION
A. Identification
Massaging
Appetite
Before
The results showed, the baby‟s
appetite before massaging from 20
respondents aged 7-12 months on
average have less appetite than normal.
Lack of appetite / lost will cause
in weight loss that is undesirable and
some other impacts, it cause strongly
influenced by
the eating procces
disorders
(physiological)
and
psychological influences (Arali 2008).
Based
on
AKG
nutrient
deficiencies because of poor eating
quality can cause various disorders of
growth process and endurance.
From the result
above the
researchers found a compatibility
between theory and the results of
research, massaging regularly will
increase the appetite. This is
accordance with Roesli‟s opinion
(2005) which said that the benefits of
baby massage can increase weight,
growth and endurance.
B. Identification
Massaging
of
Appetite
C. Effect of baby massage 7-12 Months
Against Increased Appetite
After
The results showed, the baby‟s
appetite after massaging from 20
respondents aged 7-12 months have an
average appetite approaching normal
figures.
Appetite is the desire to eat food,
feel hungry (srimulyati, 2003). Appetite
exists in all higher forms of life, and the
function is to regulate intake energy
sufficient to maintain metabolic needs
360
Based on data analysis to
determine the effect of massage infants
aged 7-12 months to increased appetite
with statistical test Willcoxon Signed
Rank Test p value = 0.026 where p =
0.05, so that H0 rejected and H1
accepted, which means there Effect of
Infant Massage Ages 7 -12 Months
Against Increased Appetite In Aryo
Jeding, Rejotangan, Tulungagung 2015.
The correlation
above is
supported by the theory from Roesli
(2009) infant massage can increase the
intestinal peristaltic and increase in
vagal tone (the brain's neurons to-10),
which can lead to increased levels of
the enzyme absorption gastin and
insulin, it can increase appetite and
absorption food becomes better so that
weight‟s baby who
appetite and
massaged are increase than the baby
who are not massaged.
In this study, the importance of
infant massage is proven effect to
increase the appetite for optimal growth
of the baby during this time. This is
supported by research from Laurentina
Fitriany & Novita Nurhidayati In Clinic
Physiotherapy Handicamp International
Wedi Klaten 2007, entitled Effects of
Infant Massage Against Increased
Appetite Baby Age Above 6 Months,
stating that babies are massaged
increased vagal tone (the brain's nerve
to 10) that will lead to increased levels
of absorption gastin enzymes and
insulin. Thus, food is absorbed better so
the appetite massaged baby more than
who are not massaged.
A. Conclusion
Based on the results of research at
in
Aryojeding,
the respondent
Rejotangan, Tulungagung can be
conclude that from the 20 respondents
were analyzed using statistical tests
Willcoxon Signed Rank test with p <α
= 0.05, so that H0 rejected and H1
accepted, which means there Effect of
Baby Massage Ages 7 -12 Months To
Increased Appetite In Aryo Jeding,
Rejotangan, Tulungagung 2015.
B. SUGGESTIONS
1. Suggestions for Development of
Science
The result is expected as input to
add knowledge and skills of nurses in
increased appetite. The efforts made to
improve baby massage and health
promotion to the public.
2. Suggestion for Program Development
Educational institutions should
give education for their students that is
knowledge about the effect of baby
massage
to
increase appetite.
Knowledge about the effect of baby
massage to increase the appetite will be
the provision of nurses in applying
science and knowledge to the
community.
BIBLIOGRAPHY
Arikunto, Suharsini. 2006.
Prosedur
Penelitian Suatu Pendekatan
Praktki. Yogyakarta : PT. Rieneka
Cipta
Alimul, Aziz. 2007. Metode Penelitian
Dan Teknik Analis Data. Jakarta :
Salemba Medika
.2003. Riset Keperawatan dan
Teknik Penulisan Ilmiah. Jakarta :
Salemba Medika
Laporan Riskesdes RI. 2013. http : //www.
DRiskesdes.co.id
diakses 05
.
Januari 2015 jam 09.47
Depkes RI, 2006.Pedoman Umum
Pemberian Makanan Pendamping
ASI (MP-ASI)
Lokal. Jakarta.
http://www.depkes/makananpenda
mpingASI.com
, diakses tanggal 13
Januari 2015 jam 20.07
Prabantini, Dwi. 2010.
Makanan
Pendamping ASI. Yogyakarta : CV
ANDI OFFSET
Hidayat, A. 2007. Metode Penelitian
Kebidanan dan Teknik Analis
Data. Jakarta : Salemba Medika
Ikatan Dokter Anak Indonesia. 2010.
Indonesia Menyusui.
Jakarta :
Badan Penerbit IDAI
Maharani, Sabrina.2009. Pijat Bayi dan
Senam Sehat Untuk Bayi.
Jogjakarta : Kata Hati
Mansur, H. 2009. Psikologi ibu dan anak
untuk kebidanan. Jakarta : Salemba
Medika
Notoadmojo, Soekidjo. 2003. Ilmu
Kesehatan Masyarakat. Jakarta : Rineka
Cipta
. 2003. Pendidikan
Dan Perilaku Kesehatan. Jakarta :
Rineka Cipta.
Nursalam, 2005. Asuhan Keperawatan
Bayi dan Anak. Jakarta : Salemba Medika.
.2003. Metodologi Penelitian
Kesehatan. Jakarta : Salemba Medika.
, 2008. Pendidikan Dalam
Medika
Rahayu.2010. Faktor Yang Mempengaruhi
Pengetahuan Pijat Bayi. Jakarta :
Trubus Agriwidya
Rahmat, Mohamad.2003.
Biostatistik
Aplikasi
pada
Penelitian
Kesehatan. Jakarta : Buku
Kedokteran EGC
Roesli, Utami. 2009. Pedoman Pijat Bayi.
Jakarta : Trubus Agriwidya.
. 2008. Pedoman Pijat Bayi
Prematur Dan Bayi Usia 0 – 3
bulan. Yogyakarta :
Trubus
Agriwidya.
361
Rosalina, Ina. 2007. Fisiologi Pijat Bayi.
Jakarta : Trikarsa Multi Media.
Soetjiningsih.1995. Tumbuh Kembang
Anak: Jakarta : Penerbit Buku
Kedokteran EGC.
362
THE EFFECT OF INTERLEUKIN-1Β INDUCTION ON CHONDROCYTES
Anis Murniati 1, Siti Zulaikah 2, Ma'rufah 2, Rena Normasari 3, Sri Fauziyah 4, Ardani
Galih Prakosa 5
1
(Department of Nursing, STIKES Hutama Abdi Husada, Tulungagung, Indonesia)
2
(Department of analitical medicine, AKMAL, Malang, Indonesia)
3
(Department of Pathology, Faculty of Medicine, University of Jember, Jember, Indonesia)
4
(Department of Fisiology, Faculty of Medicine, UNISMA, Malang, Indonesia)
5
(Department of Fisiology, Faculty of Medicine, Brawijaya University, Malang, Indonesia)
e-mail: [email protected]
Abstract
IL-1β is a glycoprotein molecule produced and secreted in an inactive form called pro-IL-1β. IL1β stimulates the synthesis and activity matrikmetalloproteinase (MMPs), one of which is MMP13 and it also synthesis the other enzymes that cause cartilage degradation. IL-1β has the ability
to suppress the synthesis of type 2 collagen, proteoglycans and inhibit TGF-beta serves to
stimulate the proliferation of chondrocytes. Chondrocytes are cells contained in avascular tissue,
synthesize all the elements contained in the cartilage matrix. The changes that occurred during the
chondrocytes in vitro conditions also occur in the body of patients with osteoarthritis (OA). This
research is a true experimental by using post-test only control group design, The aim of this
research is to know the changes of chondrocytes and secretion of MMP-13 after being
given recombinant human IL-1β. The result showed chondrocytes become hypertrophic, the cells
swollen and the secretion of MMP-13 increased, the results are analized used un-paired t test
obtained (p = 0.000), there are differences in the secretion of MMP-13 between groups were
given IL-1β with a group were not given IL-1β. Chondrocytes induced IL-1β to produce MMP-13
and type X collagen which shows dedifferentiation toward hypertrophic phenotype. Stimulation
of IL-1β activates several MAPK kinase (MAPKK) will then phosphorylates and activates
MAPK, p38, c-jun N-terminal kinase (JNK) and extracelullar signal-regulated kinase (ERK)
which will translocate into the nucleus. Next, MAPK phosphorylates and activates several
transcription factors (ATF-2, c-jun, Elk-1 and Ets-1) that play a role in the transcription of MMP
will further increase in the expression of Nuclear factor kappa B (NFkB) and activator protein 1
(AP- 1) and the secretion of proinflammatory cytokines occurs stimulation were able to induce
chondrocytes to synthesize the MMPs and stimulates the normal chondrocytes becomes
hypertrophic
Keyword : IL-1β induction,chondrocytes, hypertrophic, MMP-13
ability to induce chondrocytes and synovial
to synthesize MMPs, IL-1β has the ability to
suppress the synthesis of type 2 collagen,
proteoglycans and inhibit TGF-beta which
serves to stimulate the proliferation of
chondrocytes
(Alejandro,
2011). Chondrocytes which were induced by
IL-1β produce proteins that are not found in
cartilage that produce collagen type I and III.
It also produces alkali phosfatase,
osteonectin, MMP-13 and type X collagen
Introduction
IL-1β is one type of cytokine that
plays an important role in the inflammatory
response associated with the infections and
diseases related to the immune system. IL-1β
is a glycoprotein molecule produced and
secreted in an inactive form called pro-IL1β. IL-1β stimulates the synthesis and
activity of matrikmetalloprotein and other
enzymes that cause cartilage degradation. IL1β is a pro-inflammatory cytokine, has the
364
which shows dedifferentiation
toward
hypertrophic phenotype. It could be used as a
marker chondrocytes osteoarthritis (OA)
(Prasadam et al, 2010). The morphology of
hypertropic chondrocyte has characteristics
that drastically increased cell volume,
chromatin core spread, a number of glycogen
particles visible existing in the cytoplasm. In
cytoplasm there
are many
rough
endoplasmic reticulum, Golgi apparatus and
lysosomes shape becomes very large.
Chondrocytes synthesize the matrix
metalloproteinases (MMPs) to break down
the collagen type 2 and aggrecan. MMP has a
workplace in a matrix surrounded by
chondrocytes (Felson, 2008). Stimulation of
cytokines to injury can stimulate matrix
remodelling, but the over stimulation of IL1β can increase matrix degradation. TNF
induce chondrocytes to synthesize
prostaglandins (PG), nitric oxide (NO), and
other proteins that have an effect on the
synthesis and degradation of matrix. NO
which were
produced will inhibit the
synthesis aggrecan and improve the process
of protein breakdown on the network
(Felson, 2008). Cartilage
have a slow
metabolism, with the change of matrix slow
and orderly balance between synthesis and
degradation. However, in the early phases of
development OA has a very active
metabolism (Felson, 2008). At the onset of
OA, chondrocytes are stimulated to release
aggrecan and collagen type two which is
inadequate to the cartilage and joint
fluid. Aggrecan in cartilage will often run out
and braid collagen will easily loosened
(Felson, 2008). The complex of matrix
articular cartilage
composition make
chondrocytes difficult to replicate in the
severe damage of collagen. During the early
stages of OA, chondrocytes in vivo respond
to structural changes in the surrounding
cartilage matrix by proliferate and synthesize
matrix proteins, proteinase, and the anabolic
and catabolic factors.The changing nature of
OA chondrocytes reflected fibrillation,
depletion matrix, grouping the cells and
changes in the quantity, distribution, or the
composition of the matrix proteins. Evidence
of phenotypic modulation is shown in the
increase of collagen type I, III, hypertrophic
chondrocytes, collagen type X and the others
chondrocytes differentiation
(Felson,
2008). Mechanism of IL-1β in stimulating
normal chondrocytes
changes
into
chondrocytes that have a phenotype such as
OA is to interact with the receptor, and then
activate MAPK signaling and activate the
transcription factor through AP-1, NFkB to
stimulate MMPs that causes degradation of
matrix degradation. In OA, the process of the
matrix extracellular degradation by matrix
metalloprotein (MMPs) faster than
endogenous inhibitors of MMPs, it‟s called
tissue inhibitors of metalloproteinases
(TIMPs), which inhibit the degradation of
matrix extracellular, this happens because the
pathogenesis of OA, chondrocytes secrete
proinflammatory cytokines, one of which is
IL -1β (Nagase et al, 2010). This will
exacerbate OA cytokines by stimulating
excessive secretion of matrix degradation
thus complicate treatment. Based on the
above, the researchers wanted to know the
role of IL-1β to changes either in the form of
chondrocyte cells and secretion of MMP13. This study is expected to be the initial
research for the development of therapeutics
through the blocking of IL-1β or MMP-13.
Materials and Methods
This research is a true experimental
by using post-test only control group design,
The aim of this research is to know the
changes of chondrocytes and secretion of
MMP-13 after being given recombinant
human IL-1β. It using
random sampling
technique. The experimental group was
treated with human IL-1β recombinant and
the control group was not induced by IL-1β
then observed and measured the cells form
and secretion of MMP-13. Each treatment
was repeated 3 times.
Material
Cell line (Clonetics ™ Nhac-kn LONZA),
Dulbeco's
Modified
Eagle's
Medium (DMEM), Growth
medium (Clonetics ™ CGM ™ BulletKit ™
LONZA), medium differentiation (Clonetics
365
™ CDM ™ BulletKit ™ LONZA),
Chondrocyte ReagentPack ™, sodium
alginate, a solution of CaCl2, NaCl solution,
a solution of Na citrate, H2O, fetal calf serum
(FCS), phosphate buffered serum (PBS), and
fetal bovine serum (FBS). IL-1β human
recombinant (Biolegend, California, Cat No.
579 402 ) 10 ng / ml (Mathew,
2001). Material for measurement type II
collagen is collagen type II (R & D)
antibody-coated 96-well plates (Bioassay
Technology Laboratory, Shanghai. Cat no.
E0717Hu), materials measurement of MMP13 is a microwell plate coated with
monoclonal antibody to human MMP-13 (
Abnova, Taipei, Cat no.KAO182) 96 well,
Biotin-Conjugate anti-human
MMP-13
polyclonal antibody, Streptavidin-HRP,
MMP-13 Standard, lyophilized, Assay Buffer
Concentrate 20x (PBS with 1% Tween 20
and 10% BSA ), sample Diluent, Wash
Buffer Concentration 20x (PBS with 1%
tween 20), substrate solution and stop
solution.
Cell culture
Thawing process, the chondrocyte cell line
grown in sterile conditions in a laminar air
flow (LAF). Thawing cell cryopreserved at a
temperature of 37 ° C to melt. The culture
medium (chondrocyte cell growth medium
bulletkit TM LONZA) 1 ml was added to the
medium containing the chondrocyte cryovial
then dissolved transferred into 25
cm 2 culture flask already containing
medium. Cell chondrocytes then cultured in a
humidified incubator 37 ° C, 5% CO 2 until
the cells attached to the base flask cultures
after 2 days the cells were washed with
serum free media and the culture medium
was replaced with fresh medium, the cells
were allowed to grow up to form a
monolayer of fibroblast-like cell and achieve
confluency 80-90%. The process of
subculture, a culture that has reached
confluency 80-90% then subcultured using
reagentPack TM chondrocyte
subculture
reagents. If 90% of the cells had detached,
trypsinisasi process was stopped by adding 6
ml of room temperature trypsin neutralizing
solution (Lonza) and transferred in a 15 ml
falcon tube and centrifuged at 1000 rpm for
10 minutes.Obtained pellets (solid phase)
which is the chondrocyte cells. Furthermore,
the cells were collected for diredeferensiasi
become
mature
chondrocytes
cells. Redifferensiasi
process,
prechondrocyte cells can dirediferentiation into
chondrocyte cells cultured in suspension by
means of alginate bead. To ensure that cells
cultured chondrocytes was carried out using a
measurement of collagen type 2 medium then
replaced with elisa media which is containing
IL-1β dose of 10 ng / ml for the group treated
incubated 24 hours later was measured
MMP-13, a group that was not given IL-1β
also measured MMP 13, before it is taken
cell culture medium was observed with a
microscope to see the changes in cell
morphology.
Measurement of MMP-13 by ELISA
After preparing all reagents and samples to
be measured, samples were taken from the
medium, add 50 mL sample diluent into the
sample well, add 50 mL biotin conjugate at
all well, cover with adhesive films after
incubation at room temperature for 2 hours in
microplate shaker 400 rpm. After 2 hours of
opening the cover, aspirated and washing all
well with wash buffer, washing is done 3
times, aspirated and dried with a tissue. Then
add 100 mL of streptavidin-HRP diluted at
all well, cover with adhesive films after
incubation at room temperature for 1 hour at
400 rpm shaker mikroplate. After 1 hour
open the cover, aspirated and washing all
well with washing buffer, washing is done 3
times, aspirated and dried with tissu. added
100 mL of TMB substrate solution at all well
and incubation at room temperature for 10
minutes, keep it away from light. Add 100
mL of stop solution into each well shaken
gently until it forms a uniform color (± 1
hour). ELISA results read by ELISA reader
at a wavelength of 450 nm. Calculation
multiplied by 2 as the dilution factor.
Result
Culture in the flask after thawing observed
every 2 days when replacing
medium. Observations
using
light
366
microscope to see the development of the
cell. After reaching confluency 80% in the
flask, the cells were transferred into 24-well
culture plate and the medium was changed
every 2 days, the cells were allowed to grow
until it reaches
confluency
8090%. Chondrocyte cells that are too long are
planted in monolayer tend to undergo dedifferentiation. Chondrocyte cells that round
will lose the properties of phenotype and
morphologic change into fibroblast like
chondrocyte (chondrocyte similar to
fibroblasts) (Figure 1 (B)). In these
circumstances, markers such as collagen type
2 in chondrocytes will go down or not
generated so as to restore the properties of
chondrocytes, should redifferentiation for 3
weeks using alginate bead. Fibroblast like
chondrocyte not produce collagen type 2,
while
physiologically
chondrocytes
producing collagen type 2 so as to ensure
chondrocyte
phenotype
results
redifferentiation have normal chondrocytes,
the measurement of collagen type 2 (De
Ceuninck, 2004). As a comparison
measurement of collagen type 2 of the culture
medium DMEM-10% FCS without
cells, fibroblast like cell culture medium
before redifferentiation and medium of
chondrocyte cells after redifferentiation
(Figure 1 (A)). Measurements by ELISA.
light microscope magnification of 400x,
chondrocytes culture transformed nature
into fibroblast like cells (B) before
diredifferensiasi, forms flattened, elongated,
translucent white color, arrows indicate
cells undergoing changes resemble
fibroblasts.
collagen type 2 concentration
(ng/ml)
100
80
60
40
20
0
b
a
a
DMEM-10% Chondrocytes Chondrocytes
FCS (without cells before cells after
cells)
differentiation differentiation
Medium
Figure 2. The concentration of collagen
type 2 chondrocyte cell culture medium,
measurements
using
ELISA
method. Medium DMEM-10% FCS
without chondrocyte cells, collagen type 2
concentration of 15.3 ng / ml, DMEM
medium chondrocyte cells that change
into fibroblast like cell morphology (B), the
measurement results of type 2 collagen
concentration of 15.6 ng / ml and DMEM
medium chondrocyte cells after
diredifferensiasi (C), collagen type 2
concentration of 77.9 ng / ml.
The results (Figure 2) used as a benchmark
further treatment is administration of IL-1β
and incubated 24 hours. After incubated 24
hours later seen with microscope and got a
few cells undergo hypertrophy (Figure 3).
(A)
(B)
Figure 1. Cell culture chondrocytes day 8 in
medium DMEM-10% FCS seen with a light
microscope magnification
of 400x,
chondrocytes reached confluency 80%,
rounded cell shape, fluorescent yellow light
(A) and chondrocyte cell culture day 11 in
medium DMEM-10% FCS, seen with a
367
chondrocyte cell cultures after induction of
IL-1β, the medium is taken 24 hours after
induction of
IL-1β.The
average
concentration of MMP-13 cell culture
chondrocytes without induced IL-1β of
1.422 ng / ml, the cell culture chondrocytes
induced IL-1β amounted to 7.947 ng /
ml. Examination by ELISA method.
Analysis and discussion
The role of IL-1β
in chondrocyte
morphology
Observation of cell shape chondrocytes in
group induced IL-1β and were not induced
differences morphology that is at
chondrocytes were not induced IL-1β cells
are round and small whereas in the group
induced showed morphological chondrocytes
transformed into hypertrophy, cell shape
enlarged ( figure 3). IL-1β is a proinflammatory cytokine, has the ability to
induce chondrocytes and synovial to
synthesize MMPs, IL-1β has the ability to
proteoglycans and inhibit TGF-β that serves
to stimulate the proliferation of
chondrocytes. IL-1β is a cytokine that plays a
role in the inflammatory process (Alejandro,
2011). This is consistent with most previous
research that states in cultured chondrocytes
induced IL-1β to produce proteins that are
not found in cartilage that produce collagen
type I and III. Chondrocytes induced IL-1β
also produces alkali phosfatase, osteonectin,
MMP-13 and type X collagen which shows
dedifferensiasi
toward
hypertrophic
phenotype
(Prasadam et
al, 2010). Hypertrophy occurs due to IL-1β
interacts with the receptor and activate signal
MAPK and work to activate the transcription
factor through AP-1, NFkB to stimulate
spending MMPs that degrade the matrix and
release cytokines, stimulates cells to the
dedifferensisasi so chondrocytes undergo
changes in phenotype become hypertrophic.
(A)
(B)
Figure 3. Comparison of morphological
between normal chondrocytes with IL-1β
induction chondrocyte. Redifferentiation
chondrocyte cells in medium (Clonetics ™
CDM ™ BulletKit ™ LONZA), was
observed using inverted microscope with a
magnification of 200x. (A). showed
morphological normal chondrocytes in
alginate
beads
and
medium
redifferensiasi. (B). Morphology shows
chondrocytes that have been induced by IL1β for 24 hours, chondrocytes undergo
morphological
changes
become
hypertrophic, dilated cell shape. This
morphological change one marker has
become OA chondrocytes. The arrows
indicate cells undergoing hypertrophy.
Results of measurements of the
concentration of MMP-13 in the group
induced and not induced as follows:
MMP-13 concentration
(ng/ml)
10
*
8
6
4
2
0
IL-1β (-)
Sample
IL-1β (+)
The role of IL-1β in chondrocyte in the
secretion of MMP-13
Changes in chondrocyte metabolism driven
by the presence of pro-inflammatory
Figure 4. Comparison of concentrations of
MMP-13 cell culture chondrocytes without
induced IL-1β and MMP-13 concentration
368
mediators. One of the pro-inflammatory
mediators potential and play an important
role in the pathogenesis of OA is IL-1β, IL1β has the ability to stimulate chondrocytes
for the synthesis of MMP (Aigner et
al, 2006; Roman, 2006; Weber, 2010).). In
this study showed that the induction of IL-1β
increases the secretion of MMP-13
significantly compared to the group that was
not induced (Figure 4). Induction of IL-1β
activates several transcription factors such as
NF-kB, AP-1, c-jun terminal kinase (JNK)
and p38 MAPK. Activation of NF-kB is able
to induce some of the target gene
transcription works on the inflammatory
process, immune system, cell proliferation,
cell cycle and apoptosis. NF-kB activation
may induce several MMP genes, one of
which MMP-13, so that the OA increased
MMP-13.
Results of the study says the average
concentration of MMP-13
in normal
chondrocytes 1.422 ng / ml, while the IL-1βinduced chondrocyte average concentration is
7.947 ng / ml. SPSS test results un-paired t
test obtained (p = 0.000),
there are
differences in the secretion of MMP-13
between groups were given IL-1β with a
group who were not given IL-1β which
analyzed data from 3 repetitions. These
results are consistent with the theory and
research Alejandro (2011) which states that
the induction of IL-1β stimulates the
synthesis and activity of matrix
metalloprotein (MMPs) and other enzymes
that cause cartilage degradation. IL-1β is a
pro-inflammatory cytokine, has the ability to
induce chondrocytes and synovial to
synthesize MMPs, IL-1β has the ability to
proteoglycans and inhibit TGF-β that serves
to stimulate the proliferation of
chondrocytes. Another study by Shan (2004)
explains that the induction of IL-1β can
decrease the expression of transcription
factors after
6
hours
of
induction. Experimental research models of
OA, MMP-13 expression correlated with the
pathological
chondrocytes
undergo
hypertrophic differentiation in the
development of OA. Immunostaining results
on research Kobayashi et al (2005) found an
increase in MMP-13 in OA chondrocytes and
expressed also type X collagen which is
hypertrophic marker. In severe conditions
found to co-localization of MMP-13 and type
X collagen in the areas adjacent to the
destructive lesion.
Conclusion
IL-1β causes morphological changes in
chondrocyte cells become larger and
stimulates increased secretion of MMP-13.
The statistic result significantly different
between the secretion of MMP-13 induced
IL-1β group.
Acknowledgement
We thank you for your input and discussion
with Prof.Dr.dr.Handono Kalim, Sp.PD., KR
so as to complete the research properly.
Reference
Afif., Nebbaki, Fatima, Hassan, M. Kapoor,
Benderdour, Nicolas Duval, Jean-ierre
Pelletier, Johanne Martel-Pelletier., Fahmi
H. Egr-1 contributes to IL-1- ediated
downregulation
of
peroxisome
proliferator-activated
receptor
g
expression in human osteoarthritic
chondrocytes. Arthritis Research &
Therapy. 2012, (14): 69.
Alejandro M. Florian. IL-1 and it's role in
osteoarthritis. Open
Journal
Of
Medicine. 2011.1 (1): 3
Weber, P. Wasiliew, andM. Kracht, Interleuk
in-1 (IL-1) pathway, Sci Signal, 2010 3
(105), cm 1
Conaghan, f. 2008. Osteoarthritis National
clinical guideline for management in
adults careAnd. Eds Birrel et al. Royal
College of Physicians andrews place:
london. (11): 319.
De Ceuninck F. Lesur C. Pastoureau. Caliez
A. Sabatini M. Culture of chondrocytes in
alginate beads. Methods in molecular
medicine. vol.100: Cartilage and
369
osteoarthritis, vol 1: Cellular and
mollecular tools eds Sabatini et al. 2004:
.15-22
Felson MD. David T. Osteoarthritis of the
knee.
The
New
England
Journal. NEJM. 2008 (354): 841-848.
Firestein, GS Budd, RC Gabriel, SE
McInnes, IB and O'Dell, JR Cartilage and
Chondrocyte. Textbook
of
Rheumatology. Ed. by Firestein et
al. Elsevier
Saunders. Philadelphia. Vol.9. 2013. 97115.
Jeremi, Christin. Role of inflamation in the
pathogenesis of
OA. Therapeutic
advances
in
Musculoskeletal
dissease. Therapeutic Advances in
Musculoskeletal Diseases. 2012. (6): 2034
Malemud, CJ Matrix metalloproteinases
(MMPs) in health and disease:
an overview. Bioscience, 2006.
(11):
1696-1701.
Mathew. And
Brinckerhoff,
C. transcriptional
Regulation
of
Collagenase (MMP1, MMP13) Genes in
Rheumatoid. Res Arthritris 2001. (4): 157164 ..
Nagase H and Y. Okada. Proteinases and
matrix degradation. (Eds) Kelley WN,
Harris ED, Ruddy S, Sledge CB. Textbook
of rheumatology. Philadelphia, Saunders,
WB. vol. 6. 2013: 323-41.
Nagase H, Visse R, Murphy G. Structure and
function of matrix metalloproteinases and
TIMPs. Biochim Biophys Acta. 2010.1803
(1): 55-71
Roman-Blas andSA. Jimenez.NF-kB as a
potential therapeutic targets in
osteoarthritis
and
rheumatoid
arthritis. Osteoarthritis
and
Cartilage. 2006 (14): 839-848
Tesche, F; Miosge, N. New aspects of the
pathogenesis of osteoarthritis: the role of
fibroblast-like chondrocytes in late stages
of the disease. HistolHistopathol. 2005.
(20): 329-337
Tetlow LC. Adlam DJ. Woolley. Matrix
metalloproteinase and proinflamatory
cytokine production by chondrocytes of
human cartilage osteoartritic. Arthritis
Rheum. 2001 (32): 585-594
T. Aigner, S. Soeder, andJ. Haag, IL-1beta
and BMPs - interactive players of
cartilage matrix degradation and
regeneration,
Eur
Cell
Mater, 2006, (12), 49-56
T Kobayashi, K Notoya, T Naito, S Unno, A
Nakamura,
JM
Pelletier,
JP
Pelletier. Pioglitazone, a Peroxixome
Proliferator-Activated Receptor gamma
Agonists, Reduce the Progression of
Experimental Osteoarthritis in Guinea
Pigs. Arthritis & Rheumatism, 2005 (52 ),
479-487.
Wu
QQ. Zhang
Y.
Chen. 2002. Mechanoregulation
of
chondrocyte proliferation, maturation and
hypertropy. Exp Cell Res. (3). 383-391.
Z. Shan, K. MasukoHongo, S. Dai, H. Nakamura, T. Kato, an
d K. Nishioka, A Potential Role of 15Deoxy-Δ 12,14 -prostaglandin
J2 for
Induction of Apoptosis in Human
Articular Chondrocyte Arthritis, The
Journal
of
Biological
Chemistry, 2004. 279 (36)
370
THE RELATIONSHIP PERSONALITY TYPE WITH STUDENTS LEARNING
ACHIEVEMENT OF S1 NURSING PROGRAM GRADE II
STIKES HUTAMA ABDI HUSADA TULUNGAGUNG
Farida1, Taufik Muchlison 2
Abstract
Student achievement can be seen from the Grade point semester and grade point average
(GPA). Many people are found learning achievement in the form of a high GPA, only
those who possessed Intelligence Questions (IQ) is high, but the level of IQ is not the
only factor that determines the success of a person, because there are other factors that
influence the personality. This study aims to determine the relationship with the
Personality Type of Student Learning Achievement Study Program S1 Nursing Level II
STIKes Hutama Abdi Husada Tulungagung. The experiment was conducted in February
to March 2015. This type of research using correlation design with cross sectional
approach. All students study population is S1 Nursing Program Level II STIKes Hutama
Abdi Husada Tulungagung and samples are Most students study program S1 Nursing II
STIKes Hutama Abdi Husada Tulungagung using simple random sampling technique as
many as 54 people. Collecting data using questionnaires and personality type card study
results, the data were analyzed with used Chi Square test. The results of the 54 students
mostly exstovert personality and get a very good learning achievement as many as 17
people (58%). Statistical test Chi Square test obtained value ρ = 0.032 <α = 0:05 so that
H0 is rejected and H1 accepted, where there is a relationship between personality type S1
Nursing Program students study the level II STIKes Hutama Abdi Husada Tulungagung.
This study shows that there is a relationship between the type of personality to the
achievement of students, therefore creating an atmosphere or a supportive learning
method in accordance with the type of personality could increase the achievement of
students.
Keywords: Personality, Academic Achievement, Student
Student in relation with education,
is a subject that has the potential to
develop a pattern of life, and become the
object of the whole form of activity and
creativity, so it is expected to show the
quality it has to obtain satisfactory
academic achievement. Learning
achievement is a benchmark used to
measure student‟s ability to understand
the material and awarded after student
get learning in an institution and within
a certain period in the form of value
(Naam, 2009).
The value of student achievement
called Performance Index (IP). Grade
distinguished on their GPA (IPS) and a
grade point average (GPA).
The
calculation of grade point average at the
end of the semester, by calculating the
PRELIMINARY
Education is a necessity for
humans. Every man needs education
until whenever and wherever he is
because without education, we will be
difficult to develop and even backward.
Education is divided into
formal
education, non-formal and informal.
Formal education is pursued through
education in schools such as Elementary
School / equivalent, Junior High School
/ equivalent, Senior High school /
equivalent and Universities. Non-formal
education is obtained from the institute
courses, training institutes and similar
educational unit. Informal education
acquired in the family and society
(Yusniati, 2008).
371
values that have been entered in the
semester. GPA is used as an input
evaluation study of student success and
academic sanctions (Diknakes, 2014).
Learning achievement in the form
of a good GPA/IPK is very important for
students because it will increase the
chances of getting a scholarship and
affect the work that can be obtained in
adulthood. Many people give opinion
that to reach learning achievement in the
form of a high GPA/IPK, everybody
must have a high Intelligence Questions,
Intelligence Questions is a provision that
would make it easier to learn and in turn
will produce optimal learning
achievement. However, the level of
Questions Intelligence is not only the
one that determines a person's success,
because there are other factors that
influence (and Melissa Lim, 2012).
Intelligence Questions
(IQ)
accounted for only 20% for success,
while 80% is the contribution of other
factors. There are other factors which
influence learning achievment. They are
external factor that include family
circumstances, teacher/lecturer, teaching
proccess and social motivation and
internal factors include aptitude,
motivation, intelligence, physical health
and personality. From this, it is stated
that a person's personality is one of the
factors that
influence achievement
(Goleman, 2007).
A study entitled "The relationship
with the Personality Type Academic
Achievement at the Faculty of Medicine,
University of Riau 2006", personality
types studied are personality type A,
type B personality, and personality type
AB. The final conclusion, there is a
relationship between personality type
with academic achievement in students
of the Faculty of Medicine class of
2006 University of Riau (Lusiana,
2009).
The study documentation in
Tulungagung on S1 Nursing Program
level 1 academic year 2013/2014 in
getting the data that the percentage of
students who earn GPA/IPK below 3.0
is 46%, while the percentage of students
who earn GPA/IPK value over / equal
to 3.0 is 54%. From these data it can be
concluded that there are still many
students who have GPA/IPK less than
satisfactory, if it continues, it will be a
negative impact (S1 Prodi Academic
Unit of Nursing, 2014).
The negative impact that may arise
when low GPA/IPK is, the students will
feel insecure and difficult to make
competition with other students who are
superior in getting scholarships and jobs
and will certainly interfere with future
students. In the long run, the quality of
the institution will also decrease. It will
lead to the decline in the interest of the
registrant or high school students /
equivalent to study at the institution. To
prevent it, it needed a proper solution
(Arifin, 2009).
Alternative solutions that can be
used by teachers / lecturers is to change
strategy centered learning teacher
(Teacher Center Learning) with teacher
always gives lecture become a Student
Center Learning and the teacher as a
facilitator train students for a discussion
group and seminars. This is according
to the student is extroverted because it
is easily sociable, optimistic and
talkative, is also appropriate for students
who are introverted personality who has
a shy nature, difficult to express their
opinions and pessimistic because of the
learning strategy is a student who has an
introverted personality can learn speak
his mind and increase self-confidence
(Naisaban, 2005).
Based on the above, researchers
interested in conducting research titled
“The Relationship Personali ty Type with
Students Learning Achievement of S1
Nursing Program Grade II STIKes
Hutama Abdi Husada Tulungagung”
RESEARCH METHODS
The design of this research used design
correlation with cross sectional
approach. Cross sectional design is
study design or
he observed
measurements
carried
out
372
simultaneously at a time or all the time
(Hidayat, 2007).
The population in this study is all
students study program S1 Nursing
Grade II STIKes Hutama Abdi Husada
Tulungagung.
The sample in this study is the
majority of students study program S1
Nursing Grade II STIKes Hutama Abdi
Husada Tulungagung as much as 54
students, with the inclusion
and
exclusion criteria.
Measuring tool wear data collection
questionnaire research that has been in
the validity and reliability and Card
Study Results (KHS).
The research was conducted on 24
February to 4 March at STIKes Hutama
Abdi Husada Tulungagung.
Analysis of data Personality Type
Relationship with Student Learning
Achievement Program S1 Nursing II
Tulungagung, using statistical test Chi
Square. If the p value <0.05 was said to
be significant, the null hypothesis (H0)
is rejected, then H1 accepted meaning
stated there Personality Type
Relationship with Student Learning
Achievement S1 Nursing II program,
while p value ≥ 0.05 then the null
hypothesis is accepted and H1 rejected,
which means that states there is no
relationship with the Personality Type of
Student Learning Achievement Program
S1 Nursing II
Source : Research 2015
RESULTS
3. The relationship personality type
with students learning achievement
of s1 nursing program grade II
STIKes Hutama
Abdi Husada
Tulungagung
Tabel 3 The relationship personality
type with students learning
achievement of s1 nursing
program grade II STIKes
Hutama Abdi Husada
Tulungagung.
Based on table 1 above it can be
seen that most students S1 Nursing
Study Program II STIKes Hutama
Abdi Husada Tulungagung have
extroverted personality
types as
much as 29 people (54%).
2. Student Learning Achievement
Study Program S1 Nursing II
Tulungagung.
Table 2
Distribution of the
Student Learning Achievement
Program S1 Nursing II STIKes
Hutama
Abdi
Husada
Tulungagung.
No
1
2
3
Learning
achievement
Enough
Good
Excellent
Total
F
%
12
18
24
54
22,22 %
33,33 %
44,45 %
100%
Source: Research, 2015
Based on the table 2 above can
be seen that almost half of the
students of S1 Nursing II STIKes
Hutama Abdi Husada Tulungagung
learning achievement is excellent /
very good to have as many as 24
people (44.45%).
1. Personality Type
Student S1
Program Nursing Grade II STIKes
Hutama
Abdi
Husada
Tulungagung
Table 1 Personality Type Student S1
Program Nursing Grade II STIKes
Hutama Abdi Husada Tulungagung
No Personality Frequency Procentage
1
Introvert
25
46,3 %
2 Ekstrovert
29
53,7 %
Total
54
100%
373
Learning Achievment
Excelle
Enough
Good
nt
F %
F %
F
%
12,
16,6
16,6
96
Introvert 9
9
7
7%
7%
%
31,
Ekstrover
5,56
16,6 1
47
3
9
t
7
%
6%
%
44,
1 22,2 1 33,3 2
45
Jumlah
4
2 2% 8 3%
%
Source : Research, 2015
Personal
Type
Based on Table 4.3, students who
have introverted personality types with
excellent achievement is as much as 7
(12.96%) and students who
have
personality types extrovert with an
excellent / very good achievement is as
much as 17 people (31.47%), concluded
that nearly half of respondents who have
a very good learning achievement is the
respondents who
have extroverted
personality types
as much as
17
respondents (31.47%).
Results of statistical test ChiSquare obtained ρ = 0.032, while α =
0.05 for ρ <α then H0 rejected and H1
accepted. Meaning There is Relationship
Between Personality Type Learning
Student Achievement Program S1Grade
II STIKes Hutama Abdi Husada.
active, happier working group, easy
expression and prefers to interact
with many people at once. There are
many factors that can affect a
person's personality type.
Stephen and Timothy (2008)
reveals there are several factors that
can affect a person's personality that
include heredity, environmental and
situational conditions. And F.G.
Robbins (in Suryabrata, 2006) also
suggests there are five factors that
form the basis of personality, namely
nature, prenatal environment,
individual
differences,
the
environment, and motivation.
Researchs believe the theory and
the facts above, the environmental
factors are among the factors that
determine an individual's personality
type, especially in a campus
environment that demands a Prodi S1
Nursing student to master the theory
and clinical practice in the field.
Maybe that's why Prodi S1 Nursing
student who has type kepribadin
more extrovert than the extrovert
personality type.
2. Student
Learning Achievement
Grade II Stikes Hutama Abdi Husada
The result in table 2 show that
out of 54 respondents grade II have
different learning achievement. From
the data obtained show of 54
students, almost half of the
respondents had excellent/ very good
learning achievement as much as 24
respondents (45%).
Learning achievement is a
change in behavior skills, or abilities
that can grow over time and not due
to the growth process, but the
learning situation. Embodiment
forms of the results of the learning
process can be either talk or writtensolving and problem-solving skills as
well as directly measured or assessed
using a standardized test (Sobur,
2006).
Learning achievement is not
only influenced by Intelligence
Questions course, there are many
DISCUSSION
1. Personal Type Students Grade II
STIKes hutama
Abdi Husada
Tulungagung
The result of the research shows
that from 54 respondents have
different personality type. Based on
Jung (Sunaryo, 2004) reveal that
there are two types of human
personality is introverted and
extroverted personality types.
Table 1 shows that of the 54
students, most have a personality
type ekstovert totaling 29 students
(54%). According to Jung (in
Sunaryo, 2004) this personality type
tend to be happy with someone,
confident (sometimes to excess),
374
factors that influence it. According to
Ahmadi (in Septiarini, 2011) factors
that affect the process and the
learning outcomes of students in
school, can be broadly divided into
two parts, namely internal factors
(factors
physical
health,
physiological,
intelligence,
motivation, interests and personality)
and external factors (family
circumstances, teachers and teaching,
teaching tools, social motivation,
environment /
opportunities and
curriculum).
Researchers give opinion from
the theory and the facts above, the
learning achievement is not only
influenced by Intelligence Questions
course, there are many factors that
affect the learning achievement one
of which is the motivation and
interest, with the motivation and
strong interest then someone will be
active in learning so that it will get
the value learn a great achievement.
The results are consistent with
the theory Ahmadi (in Septiarini,
2011) which states that personality is
one of the factors that influence
learning achievement. Learning
achievement with excellent category
are mostly owned by students with
personality types extrovert, according
to personality traits ekstovert active,
friendly, confident, happy to discuss
and bold expression so as to
encourage them to provide
achievement of optimal (Sunaryo,
2004).
Researchers agree with theory
above as characteristic personality
types ekstovert be one of the factors
that can improve learning
achievement because it has
characteristics of social skills,
express their opinions and provide
counseling / solutions to public
health problems. It is also supported
by a previous study conducted by
Lusiana (2009) on the Relationship
of Personality Types with Academic
Achievement at the Faculty of
Medicine, University of Riau Force
2006 ", personality types studied are
personality type A, type B
personality, and personality type AB.
With results of the research, there is a
relationship between personality type
with academic achievement
in
students of the Faculty of Medicine
class of 2006 University of Riau. In
common with this study is equally
aims to determine the relationship of
the type of personality and academic
achievement. Differences of this
study with previous studies is if the
previous study
examined are
personality types A, B and AB, but
this study examined are introverted
and extroverted personality type.
Based on this research and the
results of
previous studies,
the
researchers concluded there is a
correlation between the type of
personality
and
academic
achievement, thus the personality
type is affecting the students to get a
good
learning
performance,
3. Relations with the Personality Type
of Student Learning Achievement
Program S1 Nursing II STIKes
Hutama Abdi Husada
The results in Table 3 obtained a
student who has an introverted
personality type with a very good
achievement is as much as 7
(12.96%) and students who have
personality types extrovert with a
very good achievement is as much as
17 people (31.47%), it can be
concluded that nearly half of the
respondents who have a very good
learning achievement is the
respondents who have extroverted
personality types as much as 17
Statistics Chi Square test
results in Table 4 was obtained p
value = 0.032, while α = 0.05 for p
<α then H0 rejected and H1 accepted.
That is no relationship between
personality type and Achievement of
Student Learning Nursing Program
S1.
375
therefore, the institution is expected
to choose the method of learning that
suits the type the personality of each
student in order to obtain optimal
performance.
c. For further Researcher
Further research is needed
to look for a more complete
supporting
data
about
personality types and learning
achievement, so as to develop
further research
in order to
better.
CONCLUSIONS AND
SUGGESTIONS
A. Conclusions
From the result of the
research, it shows almost half of 54
students have personality type extrovet
with excellent / very good learning
achievement
17
students
(31,47%) and value ρ = 0,032, so it can
concluded there is relationship between
personality type with learning
achievement of S1 Nursing Program
Grade II STIKes Hutama Abdi Husada
Tulungagung.
BIBLIOGRAPHY
Arifin, Z. 2009. Evaluasi Pembelajaran,
Prinsip, Teknik, Prosedur.
Bandung:
PT.
Remaja
Rosdakarya.
Diknakes. 2014. Pedoman Kegiatan
Akademik Program S-1
Keperawatan.
Tulungagung:
STIKes Hutama Abdi Husada.
Goleman, D. 2007. Emotional
Intelligence
(Terjemahan).
Jakarta: PT. Gramedia Pustaka
Utama Grafindo Perkasa.
Hidayat, A.A.A 2007. Metodologi
Penelitian Keperawatan dan
Teknik Analisa Data. Jakarta:
Salemba Medika.
Lim, P.S. & Melissa, N.A.L.Y. 2012.
Big Five Personality Predictors
Of Post-Secondary Academic
Performance. Pertanika Journal
Social Science & Humanika, 4 ,
973 - 988.
Lusiana. 2009. Hubungan Tipe
Kepribadian dengan Prestasi
Akademik pada Mahasiswa
Fakultas Kedokteran Universitas
Riau Angkatan 2006, diunduh
tanggal 25 Desember 2014 dari
ejournal.unri.ac.id.index.php/JI
K/
article/download/672/665.pdf.
Naam, S. 2009. Hubungan Konsep Diri
dengan Prestasi Akademik
Mahasiswa S1 Keperawatan
Semester III Kelas Ekstensi
PSIK FK USU medan.
Universitas Sumatera Utara,
Fakultas Kedokteran. Diunduh
tanggal 23 November 2014, dari
http://repository.usu.ac.id/bitstre
am
/123456789/14291/1/09E00579
B. Suggestions
1. For Development Program
a. S1 Nursing Program
With this research,
educational institutions can be
expected to develop a program
to create a mood or learning
support method according to
personality type S1 Nursing
Program students grade II
Tulungagung.
2. For Develompment Science
a. For Educational Institution
For
educational
institutions can be expectated
to provide more reference
books about personality and
academic avhievement.
b. For Development Nursing
Science
It‟s expected to
further
develop nursing science in the
field of education, especially it
can be the basic to determine the
student's education strategy which
has introverted and extroverted
personality, and further advance
the science of nursing research in
enhancing the value of learning
achievement.
376
Naisaban, L. 2005. Psikologi Jung, Tipe
Kepribadian Manusia dan
Rahasia Sukses dalam Hidup
(Tipe Kebijaksanaan Jung).
Jakarta: PT. Grasindo.
Septiarini, N. 2011. Hubungan Tipe
Kepribadian dengan Indeks
Prestasi pada Mahasiswa
Program A Di Fakultas
Keperawatan
Universitas
Sumatera Utara. Fakultas
Kedokteran,
Universitas
Sumatera Utara. Diunduh
tanggal 26 Desember 2014, dari
http://repository.usu.ac.id/handle
/123456789/26923.
Robbins, Stephen P. dan Timothy A.
Judge. 2008. Perilaku Organisasi
Edisi ke-12. Jakarta: Salemba
Empat.
Sobur, A. 2006. Psikologi Umum.
Bandung:
Pustaka Setia.
Sunaryo. 2004. Psikologi untuk
Keperawatan. Jakarta: Penerbit
Buku Kedokteran EGC.
Suryabrata, S. 2006. Psikologi
Kepribadian. Jakarta: Rajawali Pers.
Yusniati. 2007. Manusia dan
Masyarakat Pelajaran Sosiologi
untuk SMA/MA. Jakarta :
Ganesha Exact.
377
THE EFFECT OF MEDITATION AND HAEMOGLOBIN LEVELS ON LEARNING
CONCENTRATION
Indah Rohmawati 1, Oka Ludianita 2, Dwi Putri Sixteen Erawati 3
1
Prodi DIII Nursing STIKes Hutama Abdi Husada Tulungagung
2 ,3
Prodi SI Nursing STIKes Hutama Abdi Husada Tulungagung
Abstract
Producing quality graduates is the hope of all the educational institutions, for it during the
course of one's physical condition must be healthy and not anemic. In addition
concentration is necessary for the student to learn the material provided can be
absorbed. Good concentration is when a being in the alpha state, this can be accomplished
one of them when students are trained meditation. The research objective is to prove the
effects of meditation and haemoglobin levels on learning concentration. Analytical
research type experimental design with randomized controlled trials (RCT) and carried
for 28 day. population Nursing student in Prodi DIII STIKes Hutama Abdi Husada
Tulungagung fourth semester amounted to 74 students, with a purposive
sampling technique obtained 56 samples, the distribution of control and experimental
group (trained meditation)
done with Proportionate
cluster random
sampling technique. Practice meditation conducted for 28 days. HB levels were measured
using Cyanmethemoglobin, learning concentration to use Bourdon Wiersma test. The
technique of data analysis use independent t test. There is a statistically significant effect
of meditation on the learning concentrations, seen from a p-value of 0.000 for speed, p
0.006 for accuracy, and p 0.000 for constancy. There is no statistically significant effect
of Haemoglobin levels on learning concentrations, seen from the p-value of 0.933 for
speed, p 0.126 for accuracy, and p 0.670 for constancy, this is because in this research
was not found samples had higher levels of HB less than normal
Keywords: Meditation, Learning Concentration, hemoglobin levels (HB)
INTRODUCTION
Learning quality one can be seen from
the starting measuring student achievement
through the cumulative achievement index
(CPI). One can achieve the expected
achievement when in the process of
learning to concentrate. Various attempts
have been made to improve student
learning concentration eg improvement of
instructional media, improving the quality
of lecturers as well as the improvement of
facilities and infrastructure supporting
learning, but the fact still be obtained
Students who are not able to concentrate,
including the Students in STIKes Hutama
Abdi Husada Tulungagung. Concentration
learning is centralizing power of thoughts
and acts on an object to be examined with
flush or set aside everything that has
nothing to do with the object being studied
(Surya, 2009). One of the tools for
measuring the concentration of learning
is Bourdon Wiersma Test, including speed,
accuracy and constancy.Categorized group
concentration measurement results using
standard
norm
values Wieghted
Scores (WS). Rate of speed is the quality
of attention that is manifested by the
cumulative number of seconds in
completing the test material. The ability of
perception is to describe the precision
strike group specified point. Based on the
level of vigilance recorded figures shortest
and longest completion of the test, is used
as the determination of constancy
completion of work
Someone who has the HB levels
lower than the normal value or mangalami
anemia can mangalami thought process
disorder, decreased concentration,
378
memory, intelligence and ultimately the
learning achievement of children is low
(Yuriastien E, Prawitasari D, Febry AB,
2009). H B is a protein that is rich in
iron. HB most important function is the
transport of oxygen and carbon dioxide
(Muttaqin, 2008). To determine whether a
person is deprived of blood or not, can be
determined by measuring hemoglobin
levels. Determination k Adar hemoglobin
can be defined in various ways, including a
method t allquist, Sahli, oxyhemoglobin
method, or a method sianmethemoglobin.
But there anya h 2 an acceptable method in
hemoglobinometri
clinics,
ie
oxyhemoglobin,
and
sianmethemoglobin. Limit of normal levels
of HB strongly influenced by age, sex, and
height of residence from sea level (Hand
W and Haribowo USA, 2008). The normal
value of hemoglobin of male
approximately 14-18 gr am / dL, while
women 12-16 gr am / dL (Asmadi,
2008). Values above can be different on
each - each laboratory but not would be too
far from the value above. There is also a
laboratory which does not distinguish
between men or women by men or older
women.
Good concentration is when a being in
the alpha state (relaxed without stress is
marked by the opening of 88%
subconscious mind (Olivia, 2007).
Meditation can make our brain waves to
the alpha state (Sukmono, 2013). Exercise
regular meditation can help improve our
ability to change with the brain
consciousness lowering the brain waves of
a beta, alpha, theta to delta (Mustajib,
2010). M anfaat meditation among
others improve confidence and selfcontrol, m Enhancing the ability to focus
the mind, sera can m engeluarkan
hormone endorphin (Rodenbeck, 2007). E
ndorphins can be generated when the
condition of the wave g o
no (Brainwave) are in phase between alpha
and theta. Endorphins not only makes
feeling
refreshed
and
energized. Endorphin substances can also
improve concentration and memory
(Mustajib, 2010). Rehearsal meditation
within a period of 8 weeks was found to
alter brain structure, based on analysis
of magnetic resonance imaging (MRI)
research results from Sara Lazar
researchers
from Psychiatric
Neuroimaging Research Program
MassachusettsGeneral Hospital found the
density of the substance of gray (gray
matter) increased in the hippocampus that
are important to the process learning,
memory, awareness, compassion and
introspection, as well as a decrease in the
density of gray substance in the amygdala,
which plays an important role in anxiety
and stress, (Sukmono, 2013). The point of
all this depends on the student, unable or
unwilling to control yourself to stay
focused on what is being learned.
The research objective is to prove the
effects of meditation and haemoglobin
levels
on
learning concentration.
Hypothesis 1) there is the effect of
meditation on learning concentration of , 2
) there is no effect of HB levels on learning
concentration
METHODS
This research analytic experimental
design with random control trial (RCT). do
in STIKes Hutama Abdi Husada
Tulungagung Jl. Dr. Wahidin Sudiro
Husodo Tulungagung. population in this
research is Student of diploma III Nursing
STIKes Tulungagung III level II semester
of academic year 2013/2014 which
amounted to 74 students. Samples partly
Student of diploma III Nursing level II, III
semester of 2013/2014 academic year who
meet the inclusion criteria, namely the
status of active students, willing to become
respondents, as well as the exclusion
criteria are sick more than 1
week. Samples numbered 56 students.
Meditation is done for 28 days was
conducted from May 31 s / d July 2, 2014,
primary data collection (HB levels and
learning concentration) was made on July
3, 2014 obtained through examination of
the levels of HB and assessment of
learning concentration, both in the control
group (not trained in meditation) and the
treatment group (trained meditation). The
level of HB manner
using a
spectrophotometer Cyanmethemoglobin
379
collaboration with the laboratory Enggal
Saras Tulungagung, while learning
concentration was measured using an
instrument Bourdon Wiersma test. Data
analysis techniques, the characteristics of
the sample data continuous are described
in n, mean, SD, minimum and maximum.
Katagorikal data sample data
characteristics are described in n and
percentage (%). To determine 2 sample
unpaired have average values different
statistically tested with independent t test
RESULT
A description of the characteristics of
the respondents using univariate
analysis. The univariate analysis aims to
determine the number and percentage of
respondent characteristics. Here are the
data about the characteristics of
respondents who became research subjects
Table. 1 Characteristics of Respondents Research
Gender
Number (n)
Man
18
Female
38
amount
56
HB levels
Number (n)
Percentage (%)
32.1
67.9
100
Percentage (%)
≥ 18 g / dL
12- 18 g / dL
10.7
89.3
Based on Table. 1 it is known that 38
(67.9%) of the respondents are female,
meaning that many study subjects were
female. Judging from the level of HB
89.3% of the study subjects had higher
levels of HB 12 to 18 g / dL.
Description of the research
variable data to the data katagorikal
didiskripikan in n and percentage (%), for
6
50
continuous data analysis presented in the
form of minimum, maximum, mean and
standard deviation.
Presentation data variable research (Data c
ontinuous) This aims to determine the
average scores HB levels and learning
concentration compared with a maximum
score of assessment, as follows:
Table. 2 Description of the variable data research HB levels, the concentration of study
and meditation status
N
Minimum Maximum Mean SD
HB levels meditation group
28
13.2
18.6
15.9
1.60
Speed meditation group
28
3.9
12
8.9
2.44
Accuracy meditation group
28
0
15
2.4
3.30
Constancy meditation group
28
0.1
8
1.4
1.71
HB levels of the control group
28
13.5
19.6
15.9
1.70
Speed control group
28
6
14
11.4
1.98
Accuracy control group
28
0
20
5.7
5.10
Constancy control group
28
1.4
15.5
5.8
3.75
Speed group HB levels normal
50
3.9
14
10.1
2.59
Accuracy group HB levels normal
50
0
20
4.4
4.71
Constancy group HB levels normal
50
0.1
15.5
3.6
3.68
Speed group HB levels above normal
6
6.4
12
10.2
1.98
Accuracy group HB levels above normal 6
0
4
1.3
1.51
Constancy group HB levels above
6
0.2
9.2
3
3.44
normal
Valid N (listwise)
56
380
Granting the status of Meditation
Not Meditation
Meditation
amount
Table 2 shows that the participants on the
assessment of the levels of HB score the
average and maximum values The same
good level of HB control group as well as
the levels of HB treatment groups. As for
the concentration of study in the treatment
n
28
28
56
%
50
50
100
group receive an average score and the
maximum value is better when compared
with the control group. Judging from the
status of meditation
partially of
respondents do meditation as many as 28
respondents (50 %)
Table. 3 Independent T Test results about different of learning concentration between
groups of not meditation and meditation
Concentration Group
n
Mean
SD
t
p
speed
Not meditation
28
11.4
1.98
4,10
0,000
Meditation
28
8.9
2.44
Accuracy
Not meditation
28
5.7
5.10
2,86
0,006
Meditation
28
2.4
3.30
constancy
Not meditation
28
5.8
3.75
5.61
0,000
Meditation
28
1.4
1.70
Table 3 shows that there is a mean learning
concentration difference between the 2
groups of student, mean differ significantly
because
better for the group
meditation. Judging from the p value of 0,
000 for speed, value of p 0.006 for the
accuracy and value of p 0,000 for
constancy. Thus the p-value is smaller than
the value of α (5%) or 0.05 means that
there is effects meditation with learning
concentration.
Table 4 Independent T Test results about different of learning concentration between the
study group with HB levels <18.1 and HB levels > 18.1
Concentration
Group
n
Mean
SD
t
p
Speed
HB > 18.1
6
10.2
1.98
0.08
0.933
HB < 18.1
50
10.1
2.59
Accuracy
HB > 18.1
6
1.3
1.51
-1.55
0.126
HB < 18.1
50
4.4
4.71
Constancy
HB > 18.1
6
3
3.44
-0.43
0.670
HB < 18.1
50
3.6
3.68
Table 4 shows that the mean difference the
concentration of learning between the two
groups, the mean was not significantly
different. Judging from the p-value 0.933
for speed, the p-value 0.126 for accuracy,
and the p-value 0.670 for constancy thus
the p-value is bigger than the value of α ( 5
% ) or 0.05 means that there no effect of
HB levels with a learning concentration
DISCUSSION
The effects of meditation on learning
concentrations
Concentration learning is centralizing
power of thoughts and acts on an object to
be examined with flush or set aside
everything that has nothing to do with the
object being studied, (Surya, 2009). This
concentration can be developed through
practice, Hakim (2004). For example,
through
the
practice
of
379
meditation. Meditation is a conscious
process to focus a lot of attention to the
course (Suryani, 2006)
Meditation done right means not just
sit still and thoughts still wander anywhere
will be able to generate positive effects
such as increased concentrations of
learning. To so do your meditation
correctly needs to be done regularly
practice meditation. In this study, the
treatment group doing the meditation
exercise for 28 days with a long time of 30
minutes a day in STIKes Hutama Abdi
Husada Tulungagung. With the practice of
meditation on a regular basis, it is expected
the students have become accustomed
meditative under any circumstances,
including in the learning process or
while working on a questionnaire
Bourdon Wiersma test. This is in line
with the opinions Ada (2013) that the
benefits of meditation is the harmony
of mind, which is not cleaved by the
ghost of the past and worries about the
future. Students who are already doing
the meditation exercise while working
on a questionnaire Bourdon Wiersma
test students' attention is concentrated on
what is being done, and stop trying to do
several things simultaneously ignoring the
various factors that do not favor, for
example, the noise from the atmosphere
outside the classroom, the number of tasks
from other academic subjects which must
be resolved, and others. Their minds
remain concentrated on what is happening
at the moment, they are doing today is
working on a questionnaire Bourdon
Wiersma Test and not think about what had
happened either failure which can lead to
depression or feeling useless and success
that can lead to a sense of fun that
excessive and taste arrogant, and not
thinking about what's coming, which made
them anxious, fear and stress, what matters
is currently done with the best. It can be
shown from the average value listed in
Table 2 that the value of the average speed
of 8.9 seconds treatment groups included
in good criteria, while the control group
11, 4 seconds is included in the criteria of
sufficient treatment group means faster and
better
in
completing
the
questionnaire Bourdon Wiersma Test
compared with the control group. Judging
from the treatment group had a mean
accuracy of 2.4 included in the criteria
good enough and the control group had a
mean of 5.7 is included in sufficient
criteria, which means a more accurately
treatment groups, fewer mistakes in cross
out or does not answer the
questionnaire Bourdon Wiersma Test when
compared with the control group. Judging
from the mean value constancy treatment
group had a mean of 1.4 included in good
criteria and a control group that has a mean
of 5.7 is included in sufficient criteria,
which means the treatment group had a
better constancy in work on the problems
when compared with the control group.
All of these conditions can be
achieved if the student is able to control
and calm the mind and emotions. So
according to researchers meditation is not
just sitting still for practice concentration,
but more important is the control of our
thoughts and emotions in all
situations. That is meditation just as the
means to achieve a meditative
(tranquility). This is in accordance with the
opinion of Krishna (2003) that meditation
is a way of life which is the basis of life for
a person to become meditative. "When it
has reached the level of meditative, we like
having the on off button in terms of
emotion". In this case for example when
working on a questionnaire Student Test
Bourdon Wiersma, Students who do
meditation will be able to control his
emotions so much faster in the work on the
problems, more constant
and more
accurate.
Based on Table 3 obtained the data
that the p-value of 0.000 for the speed, p
0.006 for accuracy, p 0.000 for
constancy. Thus the p-value is smaller than
the value of α (5%) or 0.05 means there
studying the effects of meditation with
concentration. According to researcher
Sara Lazar of Psychiatric Neuroimaging
Research Program at Massachusetts
General Hospital of the results of research
379
mentioned that the practice of meditation
within a period of 8 weeks was found to
alter brain structure, based on analysis
of Magnetic Resonance Imaging (MRI)
find the density of the substance of
gray (gray matter) increased in the
hippocampus is important for learning,
memory, awareness, compassion and
introspection, as well as a decrease in the
density of the substance of gray in the
amygdala, which plays an important role in
anxiety and stress (Sukmono 2011 ).
Results of research at North Western
University also proved that when someone
is learning something, the brain "reward"
themselves by producing endorphins. In
other words, learning and memory, will be
easier to do if there are quite a lot of
endorphins in our brain, a condition that
can occur when the brain is at the right
waves (Mustajib, 2010)
In line with the opinion attributed to
the results
of research, learning
concentration of students in the treatment
group is better when compared with the
control group it can be caused because by
giving the meditation practice, although
only
28
days
using
music alpha meditation, when
doing
questionnaire Bourdon
Wiersma Test, students can organize brain
waves in the alpha state, because according
Sukmono (2011) meditation is one way to
regulate brain wave patterns, meditation
can make our brain waves to the alpha
state. In this study, researchers did not see
directly how a brain wave conditions while
working
on
a
questionnaire
Students Bourdon
WiersmaTest. Researchers only observe
the effects of the alpha brain waves. If the
student is able to make his brain waves in a
state of alfa, the endorphins will be
released. According Rodenbeck (2007) one
of the benefits of meditation is to produce
endorphins, further Sukmono (2011)
explains that the hormone endorphin will
be issued when our brainwaves in the
alpha state. Mustajib (2010) also mentions
that endorphin substances can also
improve concentration and memory. That
is why at the moment working on
questionnaires Bourdon Wiersma test
Students who are already doing the
meditation exercise can focus or
concentrate on what he was doing
compared to students who do not do
meditation for 28 days, in addition to the
student who has been doing the meditation
exercise may not experience anxiety and
stress and have fun juice that makes them
relax.
The effects of HB level on learning
concentrations
Physical health, healthy condition and
fit for example no deficiencies of HB
levels (anemia) affect the concentration of
one's learning. HB carries oxygen to all
body tissues, then decreasing levels of HB
will result in decreased oxygen levels,
including to the brain. Oxygen deficiency
is certainly going to affect the amount of
energy produced (energy being a little),
and the need for energy to be able to
concentrate decreased. According Astawan
(2008) that one of the effects of anemia is
that it can decreases the ability of to
concentrate
Based on the table 1 in getting the
data that 50 respondents (89.3%) of the 56
respondents had higher levels of normal
HB and 6 (10.7%) had levels above normal
HB. Based on Table 4 obtained the data
that different from the mean concentration
of learning, to speed and constancy mean
did not differ significantly better in the
group with high levels of HB normal or
groups that had higher levels of HB above
normal, but for accuracy mean
significantly different, because it more
closely to the group which has HB levels
above normal with a mean value of 1.3 is
smaller when compared with the group
who had higher levels of normal
HB. Judging from the p value of 0.933 for
the speed, p 0.126 for accuracy and p
0.670 for constancy thus the p-value is
bigger than the value of α (5%) or 0.05
means that there is no effect HB levels on
the learning concentration
Associated with the above theory,
basically the result of this study are
consistent with above theory even though
the levels of HB proved not to have
380
significant effect with the
learning
concentrations, but still supports the theory
above, it is in because the results of the
study are not found respondents who had
higher levels of HB below normal (<11 g /
dL) were included in the criteria of anemia
that can decrease the
learning
concentrations. So since this study only
groups with higher levels of normal and
above normal HB and did not have HB
respondents who had levels below the
normal functioning as a comparison that
can not prove that the HB levels has an
effect on learning concentrations.
In addition to not finding respondents
who had higher levels of HB below
normal, to support research that the levels
of HB does not affect the learning
concentrations, also the discovery of the
mean levels of HB were similar between
the treatment group and the control group,
this can be evidenced in Table 1 that the
level of HB between the treatment groups
and the control group had the same mean is
15.9 g / dL, whereas the concentration of
learning both the speed, accuracy and
constancy has a mean and maximum score
better in the treatment group compared
with the control group. If levels of HB
proved either directly with the learning
concentration, this is because there are
other factors that lead to increased learning
concentration and in this study is
meditation. meaning that although between
the treatment group and the control group
had a mean level of HB same, but because
of the treatment group was given
meditation exercise for 28 days so that an
increase of the concentration of learning
CONCLUSIONS
a. There is a statistically significant effect
meditation on the learning
concentration, Viewed from a p-value
of 0.000 for speed, for accuracy` p
0.006 and p 0.000 for constancy
b. There is statistically significant no
effect HB levels on the learning
concentration Viewed from a p-value of
0.933 for the speed, p 0.126 for
accuracy and p 0.670 for the constancy,
this is because in this study was not
found samples had levels HB less than
normal
REFERENCES
Ada, M., 2013. The time for silence, peace,
and healing. [Online] Available at:
http://www.baliusada.com/index.p
hp?option=com_content&task=vie
w&id=141&Itemid=46 [Accessed
17 September 2013].
Asmadi, 2008. Technical Procedural
Nursing:
Concepts
and
Applications Basic Needs Client.
Jakarta: Salemba Medika.
Astawan, M., 2008. Efficacy Colorful
food. Jakarta: Gramedia Pustaka
Utama.
Hakim, T., 2004. Effective Learning.
Jakarta: Puspa Swara.
Handayani W dan Haribowo A.S, 2008.
Textbook
Nursing
with
Hematologi.Jakarta
System
Disorders: Salemba Medika.
Mustajib, A., 2010. The Secret Powerful
Brain Therapy. Semarang: Wahyu
Media.
Muttaqin, A., 2008. Textbook Nursing
with
Respiratory
System
Disorders. Jakarta: Salemba
Medika.
Olivia, F., 2007. Helping Children Have
Memories Super. Jakarta: Elex
Media Computindo.
Rodenbeck, C. 2007. Meditation series
Guidelines To Be Healthy For
Busy People. Batam: Karisma
Publishing Group.
Scandinavia, C. R., 2004. Cognitiv
Scanner Function, Function and
Parameterization. [On line]
Available
at:
http://www.crs.dk/function.html.
[Accessed May 26, 2014].
Sukmono, RJ, 2011. Boosting Intelligence
brain with meditation. Jakarta:
Vision Media.
381
Solar, H., 2009, into a human learner.
Jakarta: Elex Media Komputendo.
Suryani, L. K. 2006. Meditation Candle.
Jakarta: Yayasan Obor Indonesia.
Yuriastien E, Prawitasari D, Febry AB,
2009. Games Intelligence Therapy
for Infants and Toddlers. Jakarta:
Revelation
Media
382
MANAGEMENT OF HYPERURICEMIA WITH ERGONOMIC EXERCISE
Anita Rahmawati
.
Program Studi Pendidikan Profesi Ners, Stikes Patria Husada Blitar
[email protected]
ABSTRACT
Hyperuricemia has been increased because of the lifestyle change. Hyperuricemic
metabolism will produce highly purine rate called uric acid. Exercise will reduce that
highly purine rate. Ergonomic gym exercise will also reduce blood pressure, heart rate,
respiratory rate, and will give comfortable of sleep.
The purpose of this research was to learn the significance between ergonomic
exercise and uric acid rate on client with hyperurisemic.
The study was pre experiment with One Group Pretest Posttest design. The
sample was hyperuricemia elderly client in posyandu lansia which fulfill the inclusion
criteria. The respondents ergonomic exercise in every day for two weeks and uric acid
rate was measured before and after research. The data was served in the frequencydistribution table and analysed with normality test using Kolmogorov-Smirnov and
Paired Sample T-test with significancy α ≤ 0,05.
The results shown that the urid acid level was decrease (uric acid mean and
standart deviation for pretest 7,06 ± 0,85 and post test 3,94±1,84). Paired sample T-test
analysis found different significant value (p=0,000). Ergonomic exercise can be one of
intervention to decrease uric acid rate for hiperuricemia.
Key word: hyperuricemia, ergonomic excecise, urid acid level, elderly
Introduction
Uric acid had been known since
two-thousand years ago and be well
known as one of the oldest disease. In
order to human time life improvement,
the incidence of the disease is getting
increased because of bad life style,
include uncontrolled eating pattern. Uric
acid is a crystal-shaped that become the
end of purine metabolism (derivative
from nukleoprotein), so uric acid is the
latest product of purine metabolism
which usually cannot tolerate highly.
Everyone have uric acid in their body
because in every normal metabolism
process always produce uric acid. In the
other hand, highly uric acid rate coming
from many triggers like food or
everything in which contain purine.
Fortunately, our body contribute about
eighty-five percent purine derivatives
for daily need. It means that purine
demand from food only about fifthteen
percent (Hesen, 2009).
Hyperurisemic incident all over the
world is nominally vary, estimated
between 2,3%-17,6%
while gout
incident between 0,16%-1,36%. In USA
the prevalence number of client with
asymptomatic hyperurisemic from
general population is about 2%-13%. In
the hyperurisemic study on the hospital
there are higher prevalence between
17%-28% because of disease and drug
influent. In Indonesia, hyperurisemic
prevalence is about 24,3% on male and
about 11,7% on female (Indriawan,
2009).
Many people in Indonesia that life
with hyperuricemia doesn`t aware their
condition except their symptoms lead to
be severe. Uric acid could be relieved in
the way to make the rate normally with
control of the consumption of meal and
prevent the food with higher purine rate.
In addition, neither drinking water nor
exercise could be useful to increase the
circulation so that can excrete excessive
purine in our body. One of the exercises
that useful for hyperurisemic client is
the ergonomic gym exercise. In some
places there are many ergonomic gym
exercise groups, e.g. MASUSEI
385
(Yayasan Masyarakat Suka Senam
Ergonomik), East Bekasi Gym Groups,
and many more, which a large number
of their member had given the testimony
that stated if the gym exercise could be
useful to control many diseases like
migraine, vertigo, gout, and diabetes
mellitus. Ergonomic gym exercise is not
the same as yoga or other fitness that are
more complex. Actually, the exercise
movement use general movement from
our daily activities and every person
would be able to do this exercise. Even
this exercise is used by everyone, there
is no pain either during exercise activity
or after exercise is finished. Because
hyperurisemic client is susceptible with
pain on their joint so the exercise must
have simple and no tiring movement.
The important thing is continuity and
consistency on doing this exercise
(Khairumi, 2012).
General purpose in this research was
to learn the effectiveness of ergonomic
exercise toward uric acid rate on
hyperurisemic client and the specific
purpose was to measure uric acid rate on
hyperurisemic client before ergonomic
exercise, to measure uric acid rate on
hyperurisemic client after ergonomic
exercise and to analyse the effectiveness
of ergonomic exercise toward uric acid
rate on hyperurisemic client.
.
RESULT
Tabel 1
Method
The study was pre experiment with
One Group Pretest Posttest design. The
sample was hyperuricemia elderly client
in posyandu lansia which fulfil the
inclusion criteria. Respondents act in
every day ergonomic exercise for two
weeks and uric acid rate was measured
before and after research with easytouch GCU. The sample were taken
based on inclusion criteria: first stage
hyperurisemia (hyperurisemia client
which was not followed with symptom
like continues severe pain, arthritis,
tofi/tofus and able to do ergonomic
exercise. Exclusion criteria was
respondents who did not do routine
ergonomic exercise.
Ergonomic exercise process in this
research base on
instrument SOP
(Standar Operasional Prosedur) had
created by researcher
base on
ergonomic exercise by
Wratsongko
(2009). While in ergonomic exercise
process, the researcher was helped by
two enumerator for observed respondent
exercise movement by observational
sheet. The data was served in the
frequency-distribution table and has
analysed with normality test using
Kolmogorov-Smirnov
and Paired
Sample T-test with significancy α ≤
0,05.
The Frequency Distribution of responden based on age, sex, job,
education, purine dietary and BMI
No description
1. Age : 45 - 59 years old
60 - 74 years old
75 - 90 years old
2. Sex: Male
Female
3. Job: Housewife
Had rest
private
4. Educational: Junior High School
Senior High School
University
F
frequency
1
14
1
7
9
3
11
2
10
4
2
%
percentage
6,2
87,6
6,2
43,7
56,3
18,8
68,7
12,5
62,5
25,0
12,5
Purine Dietary: Intermediate
9
56,3
5.
386
High
7
1
12
3
16
6.
BMI Thin
Normal
Fat
Total
Tabel.2
43,7
6,2
75,0
18,8
100
The average level of uric acid in Hyperuricemia client before and after
Ergonomic Exercise
Uric acid level
Mean
Std. Deviation
7,06
3,94
0,85
1,84
Before exercise
After 2 week exercise
paired sample T-test
0,000
DISCUSSION
Uric Acid Level on Hyperuricemia
Client Before Ergonomic Exercise
The mean of uric acid level for
Respondent before had done ergonomic
exercise 7,06 mg/dl. The majority of
respondent had intermediate purine
dietary (56,3 %). This condition was
the same as experimental result which
had done by Setyoningsih and Darmono
(2009) in RSUP Dr.Kariadi Semarang
that shown if purine intake was the
predominant risk factor for
hyperuricemia.
In this research
Male more
susceptible than female, but in female
hyperuricemia incident would be higher
after menopause because estrogen help
uric acid to be excreted before
menopause. Uric acid disease more
frequent in erderly and less in people
before 60 year age (Kertia, 2009). Sex
distribution of hyperuricemia client in
experimental group slightly increase on
female and majority of them have uric
acid level higher than male respondent.
The effect of elderly age and menopause
was considered as the cause of why uric
acid level on female respondent
relatively higher than male. There were
correlation between uric acid level with
menopause and water consumption
(Fajarina, 2011)
Body mass index (BMI) was one of
the measurement of nutrition status. The
result of BMI respondent in this
research majority found on normal BMI.
Based on the research done by Choi et
al., in Pramudya (2009) found that
between dietary factor and gout risk
factor were not depend on Body Mass
Index (BMI). This was strengthen by
research in Sokaraja, Banyumas where
found if there were no correlation
between uric acid level and BMI
(Kumalasari, 2009).
Uric Acid Level on Hyperuricemia
Client After Ergonomic Exercise
After sixteenth respondent had
done ergonomic exercise routinely for
two weeks, uric acid level decrease
from 7,06 mg/dl
to 3,94 mg/dl.
Hyperuricemia was a condition where
uric acid level in the blood higher more
than normal (male about 3,5 - 7 mg/dL,
female about 2,6 - 6 mg/dL) so uric
acid would be accumulated in body
tissues formed crystal on joint (Sari,
2010).
Almost all of the experimental
group respondent who are firstly
hiperuricemia then to be normal after
ergonomic exercise routinely for two
weeks but there were
one of
experimental group respondent have
increase in uric acid level. From the
process
ergonomic
exercise
observation, this respondent always
stopped her movement while in sit
movement because unable to retain pain
and heat. In hyperuricemia client or
386
food intoxication will fell like burnout
(Sagiran, 2009).
Conclusion
1. The average uric acid level
hyperuricemia client
before
ergonomic exercise was 7,06 mg/dl.
2. The average uric acid level
hyperuricemia
client
after
ergonomic exercise was 3,94 mg/dl,
3. There were an effect of ergonomic
exercise toward uric acid level
hyperuricemia client. Based on
paired sample t-test shown p value
p= 0,000
Influence Ergonomic Exercise
Toward Uric Acid Level on
Hyperuricemia Client
Based on paired sample t-test p=
0,000 shown that there were significant
different uric acid level between before
and after ergonomic exercise.
According to Wratsongko from
Indonesian Ergonomic Gym& Health
Care, purpose of doing ergonomic
exercise was a part of prevention and
rehabilitation from every disease.
There are five principal movements
in this ergonomic exercise that had
benefit in each of the movement. In first
movement, stand upright with straight
vision make the body relax, two arms
twist backwards maximally to
optimalize nerve function on pleksus
brakialis in stimulate nervus system on
lungs, hearts, hepar, stomach, and
intestines so that metabolism would be
optimal too. Those movements were
followed by stand on tiptoes to increase
stimuli sensory nervous system and to
increase uric acid excretion flow in
where that uric acid accumulated more
on tiptoes joint. The second movements
were bend our body frontward with our
hand hold on foot ankle to our back
joint, elbow, thigh and knee until feeling
drawled or pulled. This step could bent
ligament and muscle on the joint and
increase blood circulation so the uric
acid flow that accumulated on joint
could fast too. The third movements
were to help the optimally from renal
function in uric acid excretion. In the
fourth movements two hands grasp foot
ankle to give relaxation effect on
sympathetic nerve system so that
relaxation of the circulation wall would
be happening. The fifth movements
were the most important movement in
reduce uric acid level because those
could burn uric acid, fat, and toxin in
our body, strengthen low back area and
renal function (Isran, 2012).
Acknowledgement
This study had no control group and
so can not be clear whether the reduction
in the level of uric acid caused by
ergonomic exercise or by other factors.
Various confounding factors that may
reduce the uric acid level was not
investigated in this study.
Refferences
Cole, J.R. dan Azmi. 2010. Inilah Senam
Ergonomik dan Manfaatnya.
http:Zonajurnal.com. 15 Maret
2013 (10:30)
Hensen dan R. Tjokorda. 2007.
Hubungan konsumsi Purin dengan
Hipersemia Pada Suku Bali di
daerah Pariwisata Pedesaan.
http://ejournal.unud.ac.id/abstrak.p
df. 17 Maret 2013 (14:10)
Indriawan, I. 2009. Penyakit Asam Urat.
http:repository.unikom.ac.id/repo/s
ector/kampus.13 maret 2013
(11.10)
Isran. 2012. Pedoman Sehat Tanpa Obat
dengan Sholat dan Pijat. Kawan
Pustaka. Jakarta
Khairumi. 2012. Senam Penderita Asam
Urat.
Kertia, N. 2009. Asam Urat. Bentang
Pustaka. Jakarta.
Kumalasari, T. Saryono. I. Purnawan.
2009. Hubungan Indeks Massa
Tubuh dengan Kadar Asam Urat
Darah pada Penduduk Desa
Banjaranyar Kecamatan Sukoraja
Kabupaten Banyumas. Jurnal
Keperawatan Soedirman (The
Soedirman Journal of Nursing).
4(3):119-124.
386
Notoatmodjo,
S. 2010.
Metode
Rineka Cipta.
Nucleus Precise News Letter Edisi – 1).
Asam
Urat
atau
Gout.www.mirbrokers.com/.../New
sletter%2070%20Edisi%201%20%20Asam%20Urat%20310120111.
pdf. 13 maret 2013
Setyoningsih, R dan Darmono. 2009.
Faktor-faktor yang Berhubungan
dengan Kejadian Hiperurisemia
pada Pasien Rawat Jalan RSUP
dr.Kariadi Semarang.
Skripsi.
Diponegoro Semarang.
Sari, M. 2010. Sehat dan Bugar Tanpa
Asam Urat. Cetakan ke-1. Araska
Publisher. Jakarta.
Sagiran. 2007. Mukjizat Gerakan Sholat.
Qultum Media. Jakarta.
Tenggara. J. 2009. Elderly Exercise –
Olahraga Untuk Lanjut Usia,
Bagian I. FKUI-RSCM. Jakarta
Wratsongko, M. 2006. Pedoman Sehat
Tanpa Obat. Elex Media
Komputindo. Jakarta.
Weaver, A.L. 2008. Epedemiology Of
Gout. Cleveland Clinic Journal
OfMedicine. 75 (5):9-12.
387
PSYCHOEDUCATIVE FAMILY THERAPY UNTUK MENINGKATKAN
SIKAP KELUARGA TERHADAP PASIEN TB PARU
(Psychoeducational Family Therapy To Improve Family Attitudes Towards
Pulmonary TB Patients)
Bisepta Prayogi
STIKes Patria Husada Blitar
ABSTRACT
Tuberculosis(TB) remains a major global health problem. This leads to poor health among millions
of people every year and is now ranked second leading cause of death from infectious disease
world wide, after the Human Immunodeficiency Virus (HIV). The objective of this study was to
analyze the effectivenes of family therapy psycoeducative to to improve family attitudes of
patients with pulmonary tuberculosis. This study used quasy experiment pre-post test control group
design. Total sample was 32 respondents taken using purposive sampling, the sample divided into
experiment and control group. The data were analyzed by Paired T Test, and Independent T Test,
with significance value of 0.05. Paired T Test analysis showed that psychoeducative family therapy
had effect on increasing family attitude of towards pulmonary TB patients (p =0,000).
Psychoeducative family therapy improved family attitudes.
Keywords: psychoeducative family therapy, attitudes of family, Pulmonary TB Patients
__________________________________________________________________________
prevalence of pulmonary tuberculosis in
Indonesia 730,000 cases or 297 cases per
100,000 population. According to WHO
tendency of new cases of pulmonary TB in
Indonesia increased that in 2000 there were
430,000 cases of pulmonary tuberculosis and
in 2012 there were 460,000 new cases
(WHO, 2013).
TB eradication in Indonesia has been
implemented since 1969 through the National
Program Tuberculosis Eradication Program
(P2TB) by the Ministry of Health, and since
1995 further intensified
by means of
treatment strategies using Directly Observed
Treatment
Short
course
(DOTS)
recommended by WHO. But in reality after
running 9-10 years of DOTS, treatment
success rate has yet to reach the target set by
the Ministry of Health is able to cure 85% of
TB patients with Acid Resistant Bacteria
(BTA) (+) were treated. From global
surveillance results have been reported TB
germ resistance against Anti-Tuberculosis
Drugs (OAT) in patients with TB for one
type of OAT (DR-TB Drug Resistant-TB) by
12.6% and for more than 2 types of OAT
(MDR TB, Multi-Drug Resistant TB) of
2.2% (Depkes, 2002).
INTRODUCTION
Tuberculosis (TB) remains a global
health problem. The most recent estimate that
there are 8.6 million new TB cases in the
world in 2012 and 1.3 million deaths from
TB (just under 1.0 million among HIVnegative people and 0.3 million deaths
associated with HIV-TB). Most of these TB
cases and deaths occur among men. In 2012,
there were an estimated 2.9 million TB cases
and 410,000 deaths among women, as well as
the estimated 530,000 cases of dan74.000
death in children. The actual number of TB
deaths could be reduced given that most
could be prevented if people can use health
services for diagnosis and appropriate
treatment.
The program
of short-term
treatment of first-line drugs available and can
cure about 90% of cases for decades (WHO,
2013).
Indonesia take on fourth place in the
world for the number of TB cases after India,
China, and South Africa. In 2012 there were
460,000 new cases of TB in Indonesia or 185
per 100,000 population. There are about
67,000 deaths from pulmonary tuberculosis
or 27 people per 100,000 population. The
392
At the national level, East Java is one
contributor to the invention of the number of
pulmonary tuberculosis patients under the
second highest in West Java Province. In
2012, the figure Case Detection Rate (CDR)
of 63.03% with the number of new cases
(positive and negative) as many as 41 472
people and as many as 25 618 new smearpositive cases. These conditions are still far
from the target CDR stipulated that 70% (east
java public health office, 2013).
Data in the East Java Public Health
Office in 2012 showed the results of
treatment of TB patients can be seen from the
cohort of patients in 2011. The number is
calculated by summing the new smear
positive TB patients with the final results of
treatment to heal and complete treatment is
divided with smear-positive TB patients
treated in cohort same period and multiplied
by 100%. The results of treatment in East
Java showed a pretty good number, because
it has achieved treatment success rate of over
90%. Only 9 (nine) districts / cities that have
not yet reached a success rate of 90%. Target
2014, a treatment success rate of 90% can be
achieved by 100% of districts / cities (East
Java Public Health Office, 2013).
In 2012 the number of new cases in
Blitar is 180 cases per 100,000 population.
The mortality rate of pulmonary TB in Blitar
is 17 people per 100,000 population. Of the
104 patients with pulmonary tuberculosis
treated, the number of people who recover is
80, meaning that the level of success in the
treatment of pulmonary tuberculosis in Blitar
is 80%, whereas the target is 90% success
rate. Cure rate in Blitar reached 76.92% of
the target of 85%. Data of patients drop out
as much as 5 patients (4.8%). The figure is
still within the target of <5% (East Java
Public Health Office, 2013).
To improve discipline and prevent
non-adherent
patients in the treatment
program needs the support of the family. The
support given to family members who suffer
from pulmonary tuberculosis in the form of
psychosocial support which could be a
positive support to any activity undertaken.
By providing information to families about
the disease and advise on effective coping
mechanisms, psychoeducation
program
reduces the tendency of clients to relapse and
reduce the effects of this disease on other
family (Townsend, 2009) .Berdasarkan
research conducted by Sulistiowati (2012)
that psycoeducative family therapy effective
in enhancing the ability of families both
psychomotor
and cognitive in treating
patients with pulmonary TB disease.
Based on evidence based practice,
psychoeducation is a therapy that is used to
provide information to families to improve
their skills in caring for their family
members, it is expected that the family will
have a positive coping to stress and load
experienced (Goldenberg & Goldenberg,
2004). In the family psychoeducation there
are 5 sessions: identification of problem,
client care,
stress management,
load
management
family,
community
empowerment. Thus, one alternative solution
to optimize the support
is to use
psychoeducative
family
therapy.
Psychoeducative family therapy with means
to facilitate local social structures (families,
groups, and communities) are likely defunct
so as to re-provide effective support to the
needy related stressful life experiences.
The design of this study was Quasi
Experiment with pre and post test control
group design. The Population was pulmonary
TB patients and families (PMO) in the city of
Blitar. The sampling technique
used
purposive sampling with a sample 16
respondents of treatment group and 16
respondents of control group.
The independent variable was Psycho
Educative Family Therapy, while the
dependent variable
is the
attitude of
pulmonary TB patient's family. Instruments
used: 1)
The questionnaire
to collect
demographic data of respondents including
sex, age, education, occupation, marital
status, religion, income, relationship with the
PMO patients, the number of families and
family-type, 2) questionnaire to measure the
attitude of the family. The data collected then
processed and analyzed using statistical test
Paired t Test, and Independent t test with
significance level p≤0,05.
393
RESULT
This chapter describes the results of
research, which includes:
1.
The effectiveness of psycho educative
family therapy to family attitudes
Statistical test results in the group
treated with Paired T Test p = 0.000, which
showed no change attitudes before and after
treatment, the control group Paired T Test
results p = 0.333 showing no change in
attitude. Statistical test results Independent T
Test after intervention was obtained p =
0.000 in both groups showing that there is a
significant influence on attitudes between the
treatment group and the control group (see
table 1).
Table 1. The effect of psycho educative
family therapy to family attitudes
N
SD
Mean
Treatment
Pre
Post
test
Test
16
16
4,195 2,872
28,44 34,38
Paired T Test
p=0,000
Control
Pre
Post
Test
Test
16
16
3,074 3,146
21,13 21,19
Paired T Test
p=0,333
Difference (∆)
Treat Control
ment
16
16
3,492
0,25
5,94
0,06
Independent T
Test
p=0,000
DISCUSSION
1.
The effect of psycho educative family
therapy to family attitudes.
Most respondents in the treatment
group were 9 respondents (56.3%) before
being given psychoeducative family therapy
have a negative attitude. Attitude is the
response of someone who is still closed to a
stimulus or object. Components of attitude
consists of the trust (confidence), the idea
and the concept of an object, the emotional
life or emotional evaluation of an object and
a tendency to act. According to Wright &
Leahay (1994) trust is a sub category of
assessment which is something underlying
ideas, opinions and assumptions are owned
by the family. Changes in the domain
knowledge is an intermediary changes in
attitudes and behavior. In the affective
domain is facilitated family to share the
experience of caring for a family member
suffering from pulmonary tuberculosis and
provide family support.
The attitude of the family treatment
group on average have increased from the
previous negative to positive. In the first
session found a problem that most of the
patient's family or the PMO did not want to
help remind patients to take medication time.
If the family does not help remind patients
when to take medication, patients forget to
take medication for a very large. This is then
followed up, especially in the second session
of therapy. In the second session is given
psychoeducation about the attitude that
should be done by the family (PMO), and the
roles of the family in the treatment program
undertaken by the patient. Improved attitudes
in the treatment group this may occur
because of the
continuous interaction
between researchers and respondents during
the study. Attitudes can be influenced by
one's personal experience, the attitude is
formed when a personal experience involving
emotional factors.
The attitude of the family in the
control group there were 1 rise respondents
and 15 respondents remain. Respondents who
experienced an increase in the value of the
attitude though not obtain the intervention
can be caused, because the respondents still
interact socially with others, such as health
care workers, other family or those that are
considered important.
Conclusions
Psychoeducation can improve the
attitude of the family (PMO) patients
suffering from pulmonary tuberculosis in
Blitar through the provision of psychoeducation about the care of patients with
pulmonary TB.
Suggestions
For nurses can be used as a study to
consider the psychoeducational family
therapy as an alternative solution in order to
optimize treatment program at psien
pulmonary tuberculosis. Provide activities
that are psychologically based on the family
of pulmonary tuberculosis in an effort to
improve medication adherence. Family is
expected to cooperate with the health care
394
team in monitoring the development of the
Tuberkulosis.www.googlescholar.com
.
diakses pada tanggal 21 November
2012.
condition of
patients with pulmonary
tuberculosis, and provide optimal support to
family members suffering from pulmonary
tuberculosis.
Kasran, S. (2006). Penatalaksanaan rasa
nyeri pada lanjut usia: Universa
Medicina.
LITERATURE
Azwar, S. (2003). Sikap Manusia : Teori dan
Pengukurannya.
Edisi
Kedua.
Yogyakarta: Pustaka Pelajar.
Balai
Kemenkes RI.(2011).Pedoman Nasional
Penanggulangan Tuberkulosis.Jakarta.
Larasati, Tika. (2009).Jurnal Kualitas Hidup
pada Wanita yang Sudah Memasuki
Masa Menapause. Universitas
Gunadarma.
http://www.gunadarma.ac.id diakses
pada tanggal 10 Februari 2013.
Pengobatan dan Pemberantasan
Penyakit Paru (BP4) Surabaya. Dinas
Kesehatan
Propinsi
Jawa
Timur.(2003).Laporan perkembangan
Pelayanan
tahun
2002-2003.
Surabaya.
Notoatmodjo, S.(2007).Ilmu kesehatan
masyarakat. Jakarta: Rineka Cipta.
Brunner & Suddart.(2002).Buku ajar
keperawatan medikal bedah.Jakarta:
EGC.
Nursalam.(2013).Metodologi Penelitian Ilmu
Keperawatan. Jakarta: Salemba
Medika.
Carpenito, L.J. (2000).
Diagnosa
Keperawatan; Aplikasi pada praktik
klinis. Ed. 6. Jakarta: EGC.
Pieter, H. & Lubis, N.L. (2010). Pengantar
Psikologi dalam
Keperawatan.
Jakarta:Kencana.
Dahlan, Sopiyudin.(2011). Statistika untuk
Kedokteran dan Kesehatan. Jakarta:
Salemba Medika
Potter, P.(2005).Fundamental of Nursing
Edisi I.Jakarta : EGC.
Dinkes Provinsi Jawa Timur. (2013).Profil
Kesehatan Provinsi Jawa
Timur
2012.http://dinkes.jatimprov.go.id/
,
diakses pada tanggal 16 November
2013
Rachmawati. (2006). Nyeri musculoskeletal
dan hubungannya dengan kemampuan
fungsional fisik pada lanjut
usia.Jakarta: Universa Medicina
Friedman, M. (2001).Family Nursing:
Research, Theory & practice, fourth
edition. Stamford: Appleton & Lange.
Gerungan. (2002).
Psikologi
Bandung: Refika Aditama.
Smeltzer, J.M., & Bare,
BG. (2002).
Textbooks of Medical Surgical
Nursing, 10th edition. Philadelphia:
Lippincott William & Wilkins
Publisher.
Sosial.
Stuart G. W.,& Laraia M. T. (2005).
Principles and Practice of Psychiatric
Nursing (8th Ed). Missouri : Elsevier
Mosby.
Goldenberg, H. Goldenberg, I. (2004).
Family Therapy: An Overview,
Cangage Learning.
Guyton & Hall.(2006). Textbook Of Medical
Physiology. 3rd Ed. St Louis: Mosby
Elsevier. Inc.
Hutapea, Tahan
Dukungan
Kepatuhan
Sulistiowati, ni made dian. (2012). Effect of
family psyco-education therapy for
family capability in caring the family
member with mental disorder.
Proceeding of international nursing
conference, the association of
indonesian nurse education center
P. (2009).Pengaruh
Keluarga terhadap
Minum Obat Anti
395
(AINEC). jawa timur. surabaya.
November 2013
Suprajitno.(2002).Asuhan
Keperawatan
Keluarga. Jakarta: EGC.
WHO.(2013).Global Tubeculosis Report
2013.http://www.who.int/en/
diakses
.
pada tanggal 15 November 2013.
Townsend, Lisa. Groza, Victor,. Crystal,
Stephen. (2009). Guidelines for
Psychiatrists Providing Treatment for
Foster
Youth.http://guilfordjournals.com/doi/
abs/10.1521/capn.2009.14.5.5?journal
Code=capn
. Diakses pada tanggal 15
Wright, LM & Leahay,M.(1994).Nurses and
families a guide to family assessment
and intervention. second edition.
Philadelphia: FA.Davis Company.
396
The Effectiveness of 4s’s Techniques To Physiological And Crying Duration Of
Newborn
Erni Setiyorini
Pediatric Nursing
Blitar, Indonesia
085645646666 and email:[email protected]
Abstract
For a hospital birth, there are numerouse routine procedures, such as injection,
blood sampling procedures and many other which can administered. The procedures
made newbon uncomfortable by pain then have impact to short and long term. Newborn
express their pain in defferent ways. Previous study have shown that newborn who
experience many painful procedures may show changes to their behaviour in later
childhood. The purpose of this study was determine the effect of 4s‟s techniques on
physiological responses and duration of crying after venous blood sampling.
We conducted a prospective, post test only control group design. Newborn
consist of 46 samples, were divided into 2 group, 23 samples control group with 1s‟s
technique and 23 samples treatment group with 4s‟s technique. The data collected by
accidental sampling at November 2014 by observation sheet. Data Analysis used T-Test
and Wilcoxon Signed Rank Test.
Result showed that 4S‟S technique had effect on physiological responses on pain
(heart rate with p=0,004, respiratory rate with p=0,000, temperature with p=0,000) and on
duration of crying with p=0,001).The 4s‟s technique decrease pain on newborn with
physiological responses indicator and decrease length of crying.
Keyword: The 4s‟s technique, physiological response, crying duration, newborn
INTRODUCTION
For a delivery in hospital,
newborn administered on various
procedures resulted in pain, discomfort,
or noxious stimulation. These include
general procedural pain, such as blood
sampling procedures, injection. Normal
newborns experience painful procedures
as a component of routine care. Haouari
and Coworkers (1995) estimate that
every newborn undergoes at least one
heel stick or venipuncture. procedure
and that over 1 in every 10 newborn
have two or five injections or blood
taken for testing. Based on data obtained
from Ngudi Waluyo Wlingi Hospital,
from January to September 2014 there
were 1385 births and 942 term infants.
From these data a 100% gain venous
blood sampling procedures (Data
Register RS Ngudi Waluyo Blitar,
2014).
Differences in pain management
in neonates have evolved over three
decades. Perception early to said that the
development of neuroanatomical and
neuroendocrine in pain response
neonates less than complete,
accompanied by fears of analgesia that
can potentially damage the respiratory
system (Lippmann et al, 1976, Rackow
et al, 1960). Anand and Craig suggested
that reported neonatal pain behavior as
nonverbal. Some neonatal pain
assessment methods based on different
combinations of indicators of
physiological,
biochemical
and
behavioral pain (Khurana, Hall and
Anand, 2005). Newborns demonstrate
autonomic/ visceral, motor and state
behavior changes in relation to
venipuncture. Pain in infants will
respond by crying and moving the entire
body. One of them through facial
expressions, crying, movements arm, leg
movements, breathing patterns, and
stimulation status, so the assessment
399
suggested the response in newborn using
observations a sign of behavioral and
physiological responses (Wong et al,
2009).
Some procedure of inventions
that repeated pain early in life can
interfere with the development of the
central nervous system permanently
(Hatfield, Meyers and Messing, 2012).
Physiological studies indicate that the
experience of pain and stress very early
to have immediate consequences in
newborn. Assessment and treatment of
pain is a complex subject and a
challenge when the individual was still a
baby. Reviews conducted by Page
(2004) shows the long-term
physiological consequences of pain,
including changes in the central nervous
system and changes in responsibility of
neuroendokrin and the immune system.
Wati (2004) explains that the pain
experienced by the baby raises three
effects: the immediate, short term and
long term. Soon experienced the effects
of newborn is the emergence of a sense
of fear, anxiety, sleep and wake
disorders, decreased food consumption,
increased production of stomach acid.
Short-term
effects can cause
immunological disorder (the body's
defense), delayed healing, impaired
formation of emotion, while the longterm effects on memory formation of
pain, growth retardation, changes in
response to pain.
Pain management in neonates
has not been a major concern for health
workers; this is caused by the inability
of the baby to convey pain, fear of
negative side effects used anlgesics, a
mistake to interpret the expression of
pain in newborn as an expression of
fear, health workers concern for priority
disease management (Hockenberry &
Wilson, 2007). Darcia Narvaes a
psychologist explains her opinion about
continues crying on newborn. According
her the methods of letting a baby cry is
dangerous because it can caused brain
cell death of newborn. The mechanism
is when the newborn is stressed, they
release cortisol, a hormone that can
cause the death of brain cells. While, at
birth, new baby's brain develops 25%
and growing very fast their first year
(Kartikawati, 2011).
From interviews with nurses in
Edelweiss, intervention was given after
invasive procedure in newborn, there
was no specific treatment. Generally
soon after a blood drawn, then the baby
would
be returned to its original
position, which is only swaddling (1S s)
and they were not considered when the
baby stops crying, sometimes can be
immediately stopped crying, sometimes
prolonged duration of crying.
Various methods are used to
treat pain in
newborn
with
pharmacological
and
non
pharmacological. Preferably non
pharmacological interventions on minor
invasive procedures because the side
effects are minimal (American and
Canadian Academy of Pediatrics, 2000).
One non pharmacological methods that
can be applied in dealing with infant
pain is 4s's technique. The initial
concept of physical intervention
techniques adapted from 5s's composed
of swaddling, side-stomach
position,
shushing, swinging and sucking. Based
on concept that newborn lost fourth
trimester. They not yet ready living at
wide world, they still missing lived on
mother whomb. The swaddling almost
similar with mother whomb, gaved
warm temperature. Side-stomach
position help their gastrointestinal and
gaved support. Shushing like sound of
mother artery near whomb and giving
message that mother here, available for
newborn. Swinging
(when baby at
mother whomb about 9 month, they
living at amnion fluid and every
movement giving sensation to baby, like
shaking). Sucking giving comfort affect
on newborn, like position at whomb they
sucking their thumb. The research
conducted by Dr. Harrington (2010)
states that most babies who get physical
intervention 5s's stop crying within 45
seconds, while receiving
a sugar
solution were still crying 2 minutes after
vaccination invasive procedures (Gupta,
400
2012).One of reason we did dot apply
sucking paciffier in this research
because of pacifier use may be
associated with early breast weaning or
may be a marker of breastfeeding
difficulties; therefore, it should be
avoided until breastfeeding is well
established (Sexton and Natale, 2009).
The 4s's technique research I did before
also showed that the 4s's technique
influenced physiological pain responses
(heart rate and oxygen saturation), while
the respiration rate showed no difference
in the control group and the treatment
group (Setiyorini, 2015).
Wintiyah
(2014) studied of applications of the 4s's
technique for the crying duration of
newborn showed that the 4s‟s technique
influenced on duration of crying babies
with p value: 0,001.
Based on background above, the
researchers interested in conducting
research on the effect of 4s's technique
on physiological responses (HR, RR,
temperature) and crying duration of
newborn post venous blood sampling
procedures.
dependent variables was physiological
responses (heart rate, respiratory rate
and temperature) and crying duration of
newborn.
Data analysis with T-Test and
Wilcoxon Signed Rank Test.
RESULT AND ANALYSIS
RESULT
General data
Table 1 Characteristics of samples
4s‟s technique
Characteristics
F
%
Type of birth
Normal
7
30,4
Cesarean
16
69,6
Gender of newborn
Male
8
34,8
Female
15
65,2
Specific data
Table 2 The effect of 4s‟s technique on
physiological responses (HR,
RR, temperature) post venous
blood sampling procedures.
Gro Min Me Ma Stat
up
ima an xim isti
l
al
c
test
Heart 4s‟s 115 12 138
rate
tech
3,8
niqu
2
p=0
,00
e
Con 100 13 162
4
trol
4,8
6
40 42, 48
Respi 4s‟s
ration tech
78
p=0
niqu
rate
,00
e
0
Con
38
47
60
trol
Temp 4s‟s
36, 36, 37,3
eratur tech
6
99
p=0
e
niqu
,00
e
0
Con
36 36, 37
trol
67
METHODS
The research design was quasy
experiment with post test only of control
group. The population of this research
was newborn at Edelweis Room at
Ngudi Waluyo Wlingi Hospital with
venous blood sampling procedure. The
data was collected on November 2014.
The inclusion criteria were: newborn
first day aged, weight ≥2500 gram, not
in illness, apgar score of 7-10, not using
infusion, first blood sampling procedure,
newborn crying during and after blood
sampling procedure. A samples of 46
newborn was taken by accidental
sampling, which were divided into 23
newborn with treatment 4s‟s technique
(swaddling, side-stomach position,
shushing, swinging) and 23 newborn
with 1s‟s technique (swaddling) as
control group.
The independent variable of this
study was the 4s‟s technique
(swaddling, side-stomach position,
shushing, swinging). While the
Table 3 The effect of 4s‟s technique on
crying duration newborn post
401
C
f
7
16
10
9
venous
blood sampling
procedures
Grou Min Me Max Stat
p
imal an imal istic
test
Cryi 4s‟s
8
20, 40,5
tech seco 32
ng
6
dura niqu
nd sec seco
tion e
ond nd
p=0
Cont 13,1 30, 50,1 ,001
rol
2
14
2
seco sec
nd ond
According table 2, the results
showed that the average heart rate on
treatment group was lower than the
control group, but heart rate in both
groups remained in the normal range.
The decrease in heart rate was one
indicator that the intensity of pain
experienced on newborn treatment
group has decreased compared to the
control group.
Respiration rate showed that the
treatment group was lower than the
control group. This data also as the
indicator of decreased pain on newborn.
Statistic test showed that the 4s‟s
technique affected on newborn
respiratory rate with p value=0,000.
While the temperature of the
treatment group had an average higher
than the control group, but still on
normal range temperature.
After
delivery, in addition to breathing and
circulatory adaptation, the newborn must
take control of body temperature.
Getting too warm was as likely as
getting too cold, so parents must
continue to monitor, touch and feel their
baby to ensure baby was not too hot or
too cold, because both over chilling and
overheating are SIDS risk factors and
could impact the health and well being
of infants (Williams,
1996).
Temperature deviations were key signs
of illness. Variation temperature on
newborn affected by external factors.
Fransson, Karlsson dan Nilsson (2005)
on they studi emphasises the importance
of close physical contact with the
mothers for temperature regulation
during the first few postnatal days.
According this research temperature on
treatment group had an average higher
than control group but still on normal
range. The 4s‟s technique given more
time to newborn contact with caregiver
than 1s‟s technique. Normal temperature
for infants and children is usually higher
than the normal adult temperature. At
birth, heat-regulating mechanisms are
not complete developed, so a marked
fluctuation in body temperature may
occur during the infant‟s first year of life
(The Brookside Associates Medical
ANALYSIS
Characteristics of newborn
Based on Table 1, most types of
labor experienced
by mothers of
newborn was cesar both the control and
treatment groups most of newborn with
female gender. Biological factors in
genetic variations causing different
types of neurotransmitters and receptors
in moderate pain. There were limited
data that gender also influence the
behavior of pain, the female gender had
an increased expression of behavior in
response to acute pain compared to male
babies. Unknown gender differences
associated with pain processes and
expressions of pain (Fuller, 2002;
Guinsburg et al, 2000 on Rollman GB,
Abdel-Shaheed J, Gillespie JM, Jones
KS, 2003).
The effect of 4S’s technique on the
physiological responses (HR, RR,
Temperature) on newborn post
venous blood sampling procedures.
Venous blood sampling
procedure is one of routin procedures
has effect pain. Pain is stressor for
newborn. During and soon after pain
procedure infant responses by
physiological, behavioral and physic.
Hockenberry & Wilson (2007) states
that the interpretation of pain through
physiological responses which are vital
signs, variations increased heart rate,
rapid and shallow respiration and
oxygen saturation decreased.
402
one only senses an the 4s‟s technique
involving various senses.
Education Division, 2007). Beside that,
when newborn got pain procedures, they
are responses by behavioral, its also
produced calor.
The result of changed
physiological responses supported by
Harvey Karp research by recondition on
womb mother. Swaddling
made
newborn restrict room and stopped
extreme movement, giving message that
time to sleep. Side-stomach position,
newborn after delivery have morro
reflex and they felt almost fall when got
surprising stimuly. Fast method to calm
baby at stress condition by side-stomach
position. Shushing with sound of mouth
“ssssshhhhh” near ear baby as loud as
their crying sound. This sound almost
same with artery mother. Swinging is
rocking movement at our arms, this
movement not more than 1 until 2 inchi
from side to side. Stimulation by used
many of senses such as sight, hearing
and touching more efective for decrease
pain than used just one of senses.
CONCLUSION
There was an effect of the 4s‟s
(swaddling, side-stomach
position,
shushing and swinging) to physiological
responses (heart rate with p
value=0,004, respiratory rate with p
value=0,000 and temperature with p
value=0,000) and the 4s‟s technique
effect on crying duration newborn post
venous blood sampling procedures with
p value=0,001.
ACKNOWLEDGEMENT
The limitation of this research was on
samples, we didn‟t control the first
condition on newborn, newborn hungry
or not, newborn felt cold or hot, felt
comfortable or not and another factors
influenced newborn prolonged to crying.
REFERENCES
Barr RG, et al. Effectiveness of
educational materials designed
to change knowledge and
behaviors regarding crying and
shaken-baby
syndrome in
mothers of newborns: a
randomized, controlled trial.
Peds.2009;123:972-80St. JamesRoberts I: Distinguishing between
infant fussing, crying and colic:
How many phenomena? in Lester
B, Barr R, eds:Colic and
Excessive Crying, Report of the
105th Ross Conference on
Pediatric Research, 1997, 3-14.
The effect of 4S’s technique to crying
duration on newborn post venous
blood sampling procedures
Table 3 showed that crying
duration on treatment group shorter than
control group. There was an effect the
4s‟s technique on crying duration of
newborn post venous blood sampling
sith p value=0,001. The cries of the
newborn were a reaction to external and
internal stimuli. Bradelton, 1962 at
McCarrol and Fariz, 2010 conducted
that cries is responses of need, such as
changes of temperature, hungry, pain
and discomfort. Short crying duration
support phsychosocial
development
children on formatting senses trust
versus mistrust. Ignored crying baby
caused disturbance at future
phsychosocial development (Wong,
2009). Infants normally cry about 1 to 3
hours a dat. The reason for a newborn to
cry when hungry, thristy, tired, lonely or
pain. It is also normal for a baby to have
fussy period in the evening. Physical
intervention to reduce pain by involving
various senses is more effective than the
Fransson AL1, Karlsson H, Nilsson
K.2005. Temperature variation
in newborn babies: importance
of physical contact with the
mother.
http://www.ncbi.nlm.nih.gov/pub
med/16244210. acess at October
30, 2015.
Gupta S.2012. The 5s’s: Easing Baby
pain after vaccine shots.
http://thechart.blogs.cnn.com/201
2/04/16/the-5-ss-easing-babypain-after-vaccine-shots/.
403
Hatfield LA, Meyers MA, Messing TM.
2012. A systematic review of the
effects of repeated painful
procedures in infant: is there a
potential to mitigate future pain
responsivity?.
http://dx.doi.org/10.5430/jnep.v3n
8p99. acess at October 30, 2015.
Haouari N, Wood C, Griffiths G, Levene
M. The analgesic effect of
sucrose in full term infants: a
randomised controlled trial.
BMJ.
1995
Jun
10;310(6993):1498–1500. [PMC
free article] [PubMed]
Henry P.R, Haubold K and
Dobrzykowski T.M. 2004. Pain
in the Healthy Full-Term
Neonate: Efficacy and Safety of
Interventions.
http://www.medscape.com/viewar
ticle/481612 acess at Nopember
2015.
Hockenberry MJ & Wilson D.2007.
Wong’s nursing care of infants
and childrens (8th ed). St. Louis:
Mosby Elsevier.
Karp H.2012.Happiest baby on the
block. Gramedia: Jakarta.
Kartikawati D.2011. Buku ajar dasar –
dasar
kegawatdaruratan.
Khurana S, Hall R.W, Anand KJS. 2005.
Treatment of Pain and Stress in
the
Neonate.
http://neoreviews.aappublications.
org/content/6/2/e76. acess at
October 30, 2015.
Medical Education Division, Brookside
Associates .2007.Lesson 4: vital
signs.
http://www.brooksidepress.org/Pr
oducts/Nursing_Fundamentals_II/
lesson_4_Section_1A.htm. acess
at october 15, 2015.
Page GG.2004. Are there long – term
consequences of pain in
newborn in newborn or very
yaoung
infants.
http://www.ncbi.nlm.nih.gov/pmc
/articles/PMC1595204/#citeref38.
Acess at October 30,2015.
Rollman GB, Abdel-Shaheed
J,
Gillespie JM, Jones KS. 2003.
Does past pain influence current
pain:
biological
and
psychosocial models of
sex
differences.
http://defiant
.ssc.uwo.ca/faculty/
rollmanpdfs/60_2004%20Rollma
n%20et%20al%20%20Past%20pa
in%20Eur%20J%20 Pain.pdf .
acess at October 30, 2015.
Setiyorini E. 2015. The effect of 4S’s
technique to physiological and
behavioral responses on
newborn. Proceeding Book The
1st International Nursing
Confrence STIKes Hang Tuah
Surabaya, June 6, 2015.
Sexton S and Natale R. 2009. Risk and
benefits
of
pacifiers.
http://www.aafp.org/afp/2009/041
5/p681.html acess at October 15,
2015.
Wintiyah.2014. Pengaruh Swaddling,
side position, sushing dan
swinging (4S’s) terhadap durasi
tangisan bayi paska prosedur
pengambilan darah di Ruang
Edelweis RS Ngudi Waluyo
Wlingi. Skripsi. STIKes Patria
Husada Blitar.
Wong DL, dkk. 2009. Buku Ajar
Keperawatan Pediatrik, Ed. 6,
Vol.1. Alih Bahasa Agus Sutarna
dkk. Jakarta: EGC.
Williams SM, et al. 1996.Sudden
Infant Death Syndrome:
Insulation from Bedding and
Clothing and its Effect
Modifiers. International Journal
of Epidemiology; 25, 366-75.
404
THE EFFECT OF EARLY STIMULATION IN CHILDREN AGE 12-24
MONTH OF GROSS MOTOR DEVELOPMENT
IN THE CORNER INFANT HEALTH CARE 1 VILLAGE CORNER
DISTRICT DISTRICT PONGGOK BLITAR
Ika Agustina
email:[email protected]
Abstract
Growth and development is a process that occurs in life. Development stage in children
is a series of regular growth from one stage of development to the stage of development
of generally applicable. The aim of this study was to determine the effect of early
stimulation of children aged 12-24 months against gross motor development at IHC
Corner 1 Corner Village District of Ponggok Blitar. The study design used is a preexperimental with one group pre-post test design. The sample from this study were 20
infants in the IHC Corner Village Corner Ponggok District of Blitar. The sampling
technique used was total sampling. The analysis in this study used paired samples t test
and assisted by using SPSS program. The results showed an increase in the percentage of
gross motor development of children before and after the early stimulation that motor
development with the appropriate category of 7 respondents, or 35% to 16 respondents or
80%. While the dubious category of 13 respondents or 65% after stimulation given to 4
respondents or 20%. In addition, there were no children who have a distorted gross motor
development. Based on statistical test sample paired t test showed p value = 0.024 <=
0.05, indicating the effect of early stimulation on the development of gross motor
toddlers. The results of this study were expected to be used as a reference for monitoring
the implementation of the stimulation and early detection to toddlers
KEYWORDS: Early stimulation, development of gross motor Toddlers Age 12-24
Months
children who have little or no
stimulation(Soetjiningsih, 2008).
In the process of gross motor
development at age 12-24 months,
namely walking, standing without
holding, walking backward and kicking
a ball, a child required special
stimulation to encourage children to
dare to do the stage of development in
accordance with his age. An important
role in stimulating the development of
children is to train children especially
gross motor development. Someone
children must be trained to perform
motor development in order to avoid
delays (Hurlock, 2008).
Unknown approximately 80% of the
number of children who have
INTRODUCTION
Growth and development is a process
that occurs in living organisms. The
process of growth and development of
children have occurred since conception
until the end of adolescence. Every
organ and function have different
growth rates. Development in children is
a chain and orderly growth of one stage
of development to the stage of
development of generally applicable
(Fida and Maya, 2012). One of the
factors that affect growth and
development are stimulated. Stimulation
is essential in growth and development.
Children who are purposeful and regular
stimulation will grow faster than
406
developmental disorders also have
difficulty in setting the body's balance.
This body balance adjustment problems
related to the vestibular system or
systems that regulate the balance in the
body. If not treated immediately, this
difficulty will be taken continuously by
the children to school and when they
will cause problems in the gross motor
(Monks, 2004).
Blitar town has about 3,817 children
aged 0 to 1 year, about 1,840 children
aged 1 to 2 years, approximately 4,687
children ages 3 to 5 years. This means
that children aged 0 to 6 years as many
as 15 939 have been growing and
developing well or perhaps even risky.
On 13 April 2008 the City Health Office
Blitar cooperate with ties pediatrician
Indonesia (IDAI) East Java and the
division of child development and
adolescent part of a community health
center RSU Dr Sutomo Surabaya hold
events early detection of child
development mass (DDTKA-mass) in
the City Blitar with a pre-screening
questionnaire method development
(KPSP) (ejournal.umm.ac.id).
Based on the results of secondary
data conducted in IHC Corner 1, were
not in accordance with the toddler stage
of its development (doubtful) in Infant
Health Care Corner 1. Thus the
phenomenon the authors wanted to
examine the effect of early stimulation
of children aged 12-24 months against
gross motor developments in Infant
Health Care Corner 1.
Based on the results of secondary
data conducted in IHC Corner 1, were
not in accordance with the toddler stage
of its development (doubtful) in IHC
Corner 1. Thus the phenomenon the
authors wanted to examine the effect of
early stimulation of children aged 12-24
months against gross motor
developments in Infant Health Care
Corner 1.
The research problem were: "How
is the effect of early stimulation of
children aged 12-24 months against
gross motor development at Infant
Health Care Corner 1 Corner Village
District of Ponggok Blitar?
The aim of the study was to find out
the effect of early stimulation of
gross motor development.
While the specific objectives were
(1)Identify gross motor development in
children aged 12-24 months before it
was given early stimulation. (2) Analyze
the effect of early stimulation of
gross motor development.
The theoretical benefits of the
research was expected to increase the
understanding and ability in the growth
and development of children by
providing the fulfillment of love,
grindstones and good parenting to
children so that children can grow and
develop in accordance with his age
level. The practical benefit was it was
expected to improve the implementation
of the stimulation and early detection to
infants through cadre's to give an
example of stimulating the development
of the baby in the family.
Design of this study was preexperimental with one group pre-post
test design.The
subjects were all
children aged 12-24 months in Infant
Health Care Corner 1. The Sampling
technique used total sampling. The
independent variable
was
early
stimulation. The dependent variable was
gross motor development. The analysis
407
in this study used paired samples t test
and assisted by using SPSS program.
Based on the results of the
research showed that 20 toddlers, 65%
or 13 children under five gross motor
development before early stimulation in
the category of dubious then after given
early stimulation gross motor
development of infants to 80% or 16
children in the appropriate category. Of
the 20 infants, showed an increase in the
percentage of gross motor development
of children before and after the early
stimulation that the motor development
of the appropriate category from 35% to
80%. In addition, there were no children
who have a distorted gross motor
development. Based on statistical test
sample paired t test showed p value =
0.024 <= 0.05, indicating the effect of
early stimulation on the development of
gross motor of toddlers.
RESULT AND ANALYSIS
RESULT
Characteristics of respondents
listed in the table below.
Table 1.
Respondents
No
1
Characteristics
Of
Characteristics
Age
f
%
12 - < 15 month
15 - < 18 month
18 - < 21 month
21 - < 24 month
8
2
3
7
10
15
15
35
f
12
8
%
60
40
Table 2.Gender
No Gender
1 Man
2
Female
Table 3. Toddler Nutrition
f
Toddler nutrition
No
Eating a day 3X
20
Table 4. History Of Toddler
No History of toddler
f
1
2
Nothing
Exist
18
2
ANALYSIS
Gross Motor Development Of
Children Aged 12-24 Months Before
Early Stimulation
Based on the results of research
conducted in Infant Health Care 1
Corner Village District of Ponggok
Blitar, showed that from 20 children
aged 12-24 months, 13 respondents or
65% growth of gross motor
development of infants before early
stimulation in the dubious category.
While 7 respondents, or 35% gross
motor development of infants before
early stimulation
in the category
appropriate.
The
gross motor
development in infants who still doubt
category could be due to the lack of
stimulation in infants by parents,
because when seen from the common
data that includes nutritional research
toddlers 100 % children got balanced
nutrition. While based on a history of
the disease 90% children under five do
not have a history of the disease, while
%
100
%
90
10
Table 5. Gross Motor Development Of
Infants Before Early Stimulation
No Category
f
%
1
7
35
Corresponding
2
13
65
Doubtful
3
0
0
Diverge
Table 6.Gross Motor Development Of
Infants After Early Stimulation
No Category
f
%
1
16
80
Corresponding
2
4
20
Doubtful
3
0
0
Diverge
408
70% parenting authoritatively. There
were no complications of childbirth. It
could be concluded from the general
data not obtained it leads to the
development of children who are not
good. Lack of stimulation was done to a
child's development could be caused by
lack of knowledge of mothers on the
stimulation of the development as well
as ways or methods of doing so in
infants. Lack of knowledge of the
respondents attributed to the lack of
information and experience in providing
stimulation mother (Notoatmodjo,
2010).
Information about the development
of sufficient stimulation would increase
knowledge and ultimately encourage
motor development of children. It was
appropriate according to the source who
said that the information would have an
influence on the knowledge. With less
get a true and accurate information will
make the respondents do not have a
good understanding of the method for
stimulation in children. Mothers tend to
did not deliver stimulation could
significantly help the development of
gross motor baby (Notoatmojdo, 2011).
The young age of the baby is still
considered to be particularly vulnerable
should be taught something so she just
gave the need for affection and only
quieted the baby so that it grows
naturally. The assumption that gross
motor development will progress
automatically to the child's age, is a false
assumption (Fida and Maya, 2012)
If the mother has a good knowledge
not necessarily also able to provide a
good development for toddlers. Good
and bad behavior is also influenced by
the environment, human, social,
economic, cultural and others.
Gross
Motor Development In
Children Aged 12-24 Months After
Early Stimulation
conducted in Infant Health Care
Corner 1 Corner Village District of
Ponggok Blitar, that of 20 children aged
12-24 months, 16 respondents or 80%
gross motor development of infants after
early stimulation in the appropriate
category and 4 respondents or 20% of
children under five in the category
dubious.
A lack of compatibility with KPSP
gross motor development could be
attributed to the success of the
stimulation of the progress made and
supported by the fulfillment of the basic
needs of children, grindstones,
compassion and parenting that have
been carried out by the mother. While 4
respondents or 20% children still in the
category of dubious because at the time
there is a post assessment toddler in a
state of less healthy or sick, fussy so as
it affects the assessment.
Based on the results, 90% of infants
were exclusively breastfed 0-6 months
and 100% children immunized
complete. Physical needs-biomedical
(FOSTER) include food or nutrition is
the most important needs, basic health
care,
including
immunizations,
breastfeeding, weighing babies or
children who regularly, treatment when
sick, and others, board or adequate
housing,
hygiene
individual,
environmental sanitation, clothing and
physical fitness, recreation, and others.
With the fulfillment of basic needs to
children who either course will
encourage the improvement of gross
motor development of infants. Toddlers
become nutritional needs were met and
that their immune stimulation can be
done well.
409
The results showed 70% parenting
toddlers apply authoritative style.
Meeting the needs of emotion or
affection (ASIH) is the affection of his
parents (father, mother) will create a
close bond (bonding) and a trust basis
(basic trust). The need for mental
stimulus (Sharpen) is the forerunner in
the process of learning (education and
training) in children. Mental stimulation
(Sharpen) was develop the mental
development of psychosocial namely
intelligence, skills, independence,
creativity, religion, personality, moralethical, productivity, etc.
If the
fulfilment of love,
grindstones and custody can be met by
either the stimulation given to children
under five will be successful. Some
stimulation given to children aged 12-24
months are for children who are still
babies (unable to walk), which could be
trained include crawling, standing
exercises, throwing, and so on. Mother
invites toddlers to play and induce
mothers to crawl or take a ball or
throwing objects. As for children who
can walk, a mother can train some
movements, for example: running,
climbing stairs, climbing chair,
spinning, and so on. Up and down the
couch at home are also sometimes given
to help the development of gross motor
skills of children. Mothers taking
children play involving these
movements and the children are always
under the supervision of a parent while
doing so. So that early stimulation is
given able to improve gross motor
development in children according to
age levels (Fida and Maya, 2012).
gross motor development of children
before and after the early stimulation
that motor development with the
appropriate category of 7 respondents,
or 35% to 16 respondents or 80%. While
the dubious category of 13 respondents
or 65% after stimulation given to 4
respondents or 20%. In addition, there
were no children who had a distorted
gross motor development. Statistical test
results obtained paired sample t, p value
= 0.024 to p value = 0.024 <= 0.05,
indicating the effect of early stimulation
on the development of gross motor
toddlers. An increase in gross motor
development in infants, indicating early
stimulation was a good method to
improve gross motor development in
infants.
The most important period in the
development of the child was the
toddler, because at this time the basic
growth that will influence and determine
the next child development. In infancy,
the development of language skills,
creativity, social awareness, emotional,
and intelligence to walk very fast and
create a foundation for further
developments (MOH RI, 2006).
In child development are critical
times, in which the necessary
stimulation or stimulation useful for
developing potential, that require
attention. Stimulation of the parents, in
addition to aid development, the aim
was also to detect whether a child
develops motor properly or not, whether
in accordance with the task of
development of the child's age at the
time. Early detection was crucial in
order to provide solutions or anticipate
when gross motor development of the
child was not the appropriate stage of its
development, although it is still
important to remember that each child
must be different. If the developing
Effect Of Early Stimulation With
Gross Motor Development
showed an increase in the percentage of
410
gross motor normal and optimal, this
certainly will be supporting the child's
level of self-confidence, health, and
happiness together (Soetjiningsih, 2012
).
Fida dan Maya. 2012. Pengantar Ilmu
Kesehatan Anak. Yogyakarta:
D-Medika
Hidayat, Alimul. 2007.
Metode
Penelitian Kebidanan
dan
Teknik Analisa Data. Jakarta:
Salemba Medika
CONCLUSIONS
From the research and data analysis
showed following results:
1. The development of gross motor
skills of children aged 12-24 months
before early stimulation majority of
respondents in a dubious category at
65%.
2. The development of gross motor
skills of children aged 12-24 months
after early stimulation almost entirely of
respondents in the appropriate category
at 80%.
3. The results of the analysis with paired
sample t test showed p value = 0.024 <=
0.05 so that it could be stated that early
stimulation influence on gross motor
development of children aged 12-24
months.
Hurlock,
2008.
Perkembangan.
Erlangga.
Jakarta: Trans Info Media
Martiningsih,wiwin.Pengaruh Stimulasi
terhadap Perkembangan Anak
Sebagai Tindak Lanjut DDTK
Masal Pasca pencatatan Recor
Muri di Kota Blitar. Online
diakses pada tanggal 11
September
2014
(http://www.ejournal.umm.ac.id/
index.php/.../1138
umm
scientific journal)
Monks. 2004. Psikologi Perkembangan.
Yoyakarta:
Gadjah
Mada
University Press.
Notoatmodjo,
Soekidjo.
2010.
Metodologi Penelitian. Jakarta:
Rineka cipta
REFFERENCES
Notoatmodjo,
Soekidjo.
2011.
Metodologi Penelitian. Jakarta:
Rineka cipta
Arikunto. 2010 . Prosedur Penelitian.
Jakarta: PT Rineka cipta
Nursalam,2011. Konsep dan Penerapan
Keperawatan. Jakarta: salemba
Medika
Cahyaninsih,
Sulistyo.
2011.
Pertumbuhan
Perkembangan
Anak dan Remaja.
Depkes
Psikologi
Jakarta:
R.I.2006.
Pedoman
Pelaksanaan Stimulasi,Deteksi,
dan Intervensi Dini Tumbuh
Kembang Anak . Jakarta:
Depkes RI.
Nursalam. 2008. Konsep dan Penerapan
Keperawatan. Jakarta: salemba
Medika
Soetjiningsingsih. 2012. Tumbuh
Kembang Anak. Jakarta : EG
411
THE EFFECT OF PROGRESSIVE MUSCLE RELAXATION TO IMPROVE THE
QUALITY OF SLEEP OF NEUROSIS PATIENT
Nawang Wulandari
Program Studi Pendidikan Profesi Ners, STIKes Patria Husada Blitar
[email protected]
ABSTRACT
Neurosis is a psychic reaction with typical anxiety. Anxiety may cause physical
imbalance such as the increase of blood pressure, insomnia, muscle tension and
palpitations. Muscle tension and sleep difficulties are common anxiety response
symptoms experienced by the society. Progressive muscle relaxation therapy is a
relaxation of the tightening and relaxing movement on the muscles of one particular body
part at a time to provide physical relaxation. The muscles are tightened and relaxed in a
series of movement.
This study aimed to determine the effect of progressive muscle relaxation to
improve the quality of sleep of neurosis patients.
Pra-experimental research design with One Group Pre-Post Test with purposive
sampling was conducted with the number of samples was 13 respondents. This study used
a questionnaire to measure sleep quality while to measure the improvement of the quality
of sleep used PSQI questionnaire, and the data were analyzed used bivariate analysis
using the T-test.
The result of the quality of sleep before and after the therapy on the treatment
was p 0.000. It means there was some effect on progressive muscle relaxation therapy to
improve the quality of sleep neurosis patient, so the hypothesis could be accepted.
From the results, it could be concluded that the progressive muscle relaxation
therapy could be used to improve the quality of sleep of neurosis patients.
Keywords: Progressive Muscle Relaxation, Sleep Quality, Neurosis
INTRODUCTION
Neurosis is a mental disorder in
which the psychological condition of the
client are in fear and anxiety chronic,
people put more pressure on the perceived
negative emotions to the subconscious,
where it affect the feelings, thoughts,
behavior and health of the body of a person
who experienced it. Individuals who in the
span of life have positive thoughts to the
events in his life will develop a positive
emotional response. Likewise, individuals
who have negative thoughts toward an
event experienced always use the negative
thoughts and irrational when the stressor
appear¹. This is an impact on physical and
psikis² one of neurosis. Anxiety can cause
physical imbalance such as increased
blood pressure, insomnia, muscle tension
and palpitations. While the psychological
imbalances that can arise for example
difficulty concentrating, confusion, loss of
control and imbalance social1.
Based on the results of basic
medical research (Riskesdas) Indonesia in
2013, the prevalence of emotional
disorders as many (6%)2. Among a variety
of mental disorders, neurotic disorders
(anxiety neurosis) is a mental disorder that
is most widely found in the community
that is 2-4%3. In Blitar City particularly in
Puskesmas Kepanjen Kidul Blitar there are
35 clients with a diagnosis of neurosis who
visit every month, and there are no further
interventions to address them.
The prevalence of anxiety
increased in line with the course of the
disease and symptoms. Anxiety can
provide the signs and symptoms of the
complaints expressed subjectively or that
can be observed with the observation that
consists of the physical, cognitive, social
413
and psychological behavior. Muscle
tension and difficulty sleeping is a
response to the anxiety that is often
experienced clients. Several factors can
affect sleep as physical, psychological,
social and environmental. Changes in the
physical, psychological,
social and
environmental results in reduced time of
sleep.
Psychotherapy more effective than
medical therapy in the long-term
evaluation, as psychotherapy aimed at
helping the patient or family to change the
pattern of cognitive, behavior that is based
on a deep understanding of the problems
experienced by patients and their family.
Progressive muscle relaxation
therapy can be applied to clients with
anxiety neurosis. Relaxation exercises
aimed to distinguish the feelings
experienced during be straightened muscle
groups and compared when the muscles in
a state of tension. By knowing the location
and feel the muscles tense then the client
can feel the loss of tension as one response
to anxiety more clearly where therapy is
progressive muscle relaxation
can
stimulate spending chemicals endorphins
and enkephalins and stimulate signaling
the brain that causes the muscles to relax
Table 1. Characteristics of Respondent
Variabel
Age (Year)
and improve blood flow to the brain.
Progressive muscle relaxation can make
the mind feel calm, relaxed and easier to
sleep4.
The aim of this study was to
determine the effect of progressive muscle
relaxation therapy to improve the quality
of sleep neurotics in Puskesmas working
area Kepanjen Kidul Blitar.
METHODS
This research was a quantitative
research used Pre Experimental with PrePost Test design. The population in this
study was all neurotics in Puskesmas
Kepanjen Kidul Blitar as 35 people. The
Sampling technique used in this research
was purposive sampling as 13 respondents.
The instrument to measure sleep
quality used PSQI (The Pittsburgh Sleep
Quality Index) questionnaires. The
implementation of the entire study takes 6
weeks. 5 weeks
were use for the
implementation and one week of therapy
were use to evaluate the quality of sleep
after therapy. The data analysis used
consisted of univariate and bivariate
analyzes. In univariate analisis used
statistical test Paired t-test.
s by Age
Mean
SD
45,15
9,998
Min
31
Max
58
Table 2. Characteristics of Respondents by Sex, Occupation, Education,
and Marital
status
Variable
Category
Ʃ
n
%
Sex
Male
6
42,9
Female
7
53,8
Wrking Privately
6
42,9
Occupation
Farmer
1
7,1
Not Work
6
42,8
Married
11
78,6
Marital Status
Single
2
14,3
SD
3
21,4
Education
SMP
6
42,9
SMA
4
28,6
414
Most of the respondents were female gender. This type of work, the respondent is
working privately, to the marital status of the majority of the respondents were married as
many as 11 people. And for the respondent's educational level is junior high school.
Table 3 Distribution of Neurotics Sleep Quality Before and After Intervention
Sleep Quality
Paired t-test.
Interven
N
si
St. Deviasi Min-Max
Mean
95% CI
Pre
13
17,15
1,519
15-19
16,24P 0,000
18,07
Post
13
13,38
2,022
10-16
12,1614,61
the quality of sleep neurotics on the average was 17.15 before the intervention,
after the intervention has been changed into 13.38. Sleep quality score before and after
progressive muscle relaxation with a p-value of 0.000 (p value <0.05).
ANALYSIS
Neurosis Patients Sleep Quality Before
Given Progressive Muscle Relaxation
Therapy In Puskesmas Kepanjen Kidul
Blitar.
The results showed that the
average quality of sleep neurotics before
given progressive muscle relaxation
therapy was 17.15.
Poor sleep quality could be
anxiety, fear and worry that excessive
respondents experienced a decline due to
the condition of the disease or health
status, environmental conditions and other
psychological conditions. In addition,
some factors trigger a decrease in the
quality of sleep is also associated with diet,
habits of the use of drugs to help you sleep
and daily activities were performed. In this
study, the majority of respondents, namely
private work as a maker of craft that
demands high job completion precipitate
stress that impact on the fulfillment of
sleep. Emotional stress causes the stress
that often leads to frustration so that the
individual would have difficulty to start
sleeping or otherwise.
Smoking habits performed by male
respondents were also concerned with the
difficulty to start sleeping, this was
because nicotine causes an increase in time
awake. Nicotine has a half-life of about 1-2
hours so that individuals who smoked
more than one cigarette in a few hours
before sleep will have difficulty to start
sleeping.
In this study, the average sex of the
respondents in the treatment group was
women. Women 2-3 times more prone to
anxiety than men, this was because women
were putting emotion. So that in times of
stress, the more untouched emotion,
aspects that impact on their health5
conditions.
Neurosis Patients Sleep Quality After
Given Progressive Muscle Relaxation
Therapy In Puskesmas Kepanjen Kidul
Blitar.
The average score of PSQI
respondents after being given progressive
muscle relaxation therapy was 13.38. The
average score of sleep quality decreased
from before therapy, where the average
quality of sleep 17.15. This shows that the
average decrease in score indicates
improvement in sleep quality.
The assessment of quality of sleep by
PSQI based on a score of 7 components
include appraisal quality of sleep
subjectively, sleep efficiency, sleep
duration, the accuracy of sleep, a history of
the use of drugs to help you sleep, things
disturb of
sleep, the perceived impact
associated with sleep problems. The sum
score of PSQI would describe the quality
of sleep in which a high score indicates
bad sleep quality6.
Progressive muscle relaxation was part
of a relaxation therapy that was used as a
coping skill that teaches clients when and
how to do relaxation and comfort under
415
conditions that can cause anxiety. This
therapy was done with motion tightens and
relaxes the muscles on one body part at a
time to give a feeling of physical
relaxation.
Progressive muscle relaxation showed
benefit in reducing the tensions that will
fix various physiological and
psychological symptoms. The stress
response was part of a closed feedback
path between the muscles and the mind.
Assessment of the stressors lead to muscle
tension which sends stimulus to the brain
and make feedback path7. Relaxation
exercises was one of self-management
techniques that are based on the workings
of the sympathetic and parasympathetic
nervous system. Muscle relaxation would
inhibit the pathway by activating the
parasympathetic nervous system works.
Physiologically the
body, to produce
endogenous to inhibit pain impulses
generated by the perceived tension.
Consists of endogenous endorphins and
enkephalins, when the body remove these
substances then one effect was to relieve
tension be perceived8.
The relaxation response
occurred
because
parasympathetic autonomic
nervous system activity raphe nuclei,
causing changes that can control the
activity of the autonomic nervous system
in the form of a reduction in oxygen
function, frequency of breathing, pulse
rate, muscle tension, blood pressure, as
well as alpha waves in the brain so it was
easy to fall asleep.
Neurosis patients sleep quality before
and after progressive muscle relaxation
therapy in Puskesmas Kepanjen Kidul
Blitar.
The results showed that there were
differences in sleep quality scores neurosis
patients with p 0.000 (α <0.05), which
means that there is the effect of
progressive muscle relaxation therapy
against in this study, the average patient
has decreased the quality of sleep before
therapy.
This was caused by the various
conditions experienced by respondents
include family conditions, relationships
with family members, delinquency, a
relationship with a spouse, loss of loved
ones and so on. Someone who were
experiencing anxiety would lead to an
imbalance in terms of physical vital signs,
eating disorders,
sleep patterns and
tensions musle9. Sleep disorders are
perceived them difficult to start sleeping,
easily awakened at night and did not get a
good sleep quality that impact on their
daily activities.
Progressive muscle relaxation were
done by the respondents in a
full
concentration in which respondents were
asked to distinguish between feelings
experienced when the muscle groups be
limp and compared when the muscles in a
state of tension, and given the suggestion
in the form of comfort to the respondents
feel the relaxation maximum turned out to
show a benefit in reducing tension and
anxiety respondents experienced even a
few respondents who feel the maximum
relaxation stated doze off because of
perceived convenience.
Therapy was well done and full of
concentration would improve a variety of
physiological and psychological symptoms
because it could create a state of relaxed
and effective in improving sleep. Another
opinion that some of the techniques that
could be done to increase the need for
sleep quality and quantity was bootzin
methods and methods of relaxation, but the
approach were the most widely used
relaxation is progressive muscle relaxation.
Progressive muscle relaxation was
based on the mechanism of action of
progressive muscle relaxation in
influencing the need for sleep, which
occurs the relaxation response
(Trophotropic) that stimulates all the
functions which works opposite to the
sympathetic nervous system in order to
reach a state of relaxation and calm. This
relaxed feeling would be forwarded to the
hypothalamus to produce Corticotropin
Releasing Factor (CRF), which would
stimulate the pituitary gland to increase the
production of several hormones, such as βEndorphin, enkephalin and serotonin10.
The relaxation response occurred
because the activity of the parasympathetic
416
autonomic nervous system so that the
raphe nuclei caused changes that can
control the activity of the autonomic
nervous system in the form of a reduction
in oxygen function, frequency of
breathing, pulse rate, muscle tension, blood
pressure, as well as alpha waves in the
brain so it is easy to fall a sleep.
Sleep was one of the basic requirements
relating to the maintenance and restoration
of health that allows the body and mind
continue to function optimally. During the
period of sleep the brain would process the
long-term memory, integrate new
information as well as tissue repair brain
and nerve cells and plays a role in the
biochemical processes. Less quality sleep
was very harmful and affect the well-being
of the negative impact on the function of
physiological, psychological and work of
someone11. Progressive muscle relaxation
could make the mind feel calm, relaxed
and easier to sleep4.
3. Hawari,D. (2007). Pendekatan Holistik
pada Gangguan Jiwa Skizofreni.
Jakarta: FK-UI.
CONCLUSIONS
Based on the research results, it
could be concluded that there were
significant progressive muscle relaxation
therapy to improves the quality of sleep
neurotics in Puskesmas Kepanjen Kidul
Blitar
7. Bebbington, P.E., Brugha, S., Meltzer,
H et al. 2000. Neurotic Disorders and
The Receipt of Psychiatric Treatment.
Journal
Psychological Medicine,
30(1369-1376).
ACKNOWLEDGEMENT
Limitation research in the
implementation of this study has
limitations that technical issues such as
location of residence respondents in 7
villages so it takes a long time. And the
samples used only involve one group and
no control group
REFFERENCE
1. Stuart, G.W. 2009. Principles and
Practice of Psychiatric Nursing (9th
edition). St. Louis: Mosby
2. Badan Penelitian dan Pengembangan
Kesehatan Departemen Kesehatan RI.
2007.
Laporan Nasional Riset
Kesehatan Dasar. www. riskesdas.
litbang depkes. go.id. diakses tanggal 2
Februari 2015.
4. Conrad, A., Roth, W.T. 2007. Muscle
Relaxation Therapy for Anxiety
Disorders: It Works But How?. Journal
of Anxiety Disorders, 21 (243–264).
5. Kaplan & Sadock. 2007. Sinopsis
Psikiatri: Ilmu Pengetahuan Psikiatri
Klinis Jilid 1. Jakarta: Bina Rupa
Aksara.
6. Bush, L.A., Armento, E.A., Weiss.J.B
et al. (2012). The Pittsburgh Sleep
Quality Index in Older Primary Care
Patients With Generalized Anxiety
Disorder: Journal Psychometrics and
outcomes
following
cognitive
behavioral
therapy
Psychiatry
Research,
199
(24–30).
www.elsevier.com/locate/psychres
8. Smeltzer,S.C & Bare,B.C. (2002).
Buku Ajar Keperawatan Medikal
Bedah Brunner & Suddart edisi
88.Jakarta: EGC.
9. Stuart, G.W & Laraia, M.T. 2005.
Principles and Practice of Psychiatric
Nursing (7th edition). St. Louis:
Mosby.
10.
Ramdhani, N & Putra, A.A. 2008.
Pengembangan multimedia relaksasi.
Yogyakarta: bagian psikologis klinis
fakultas psikologi UGM.
11.
Riegel, B., Weaver, T.E. (2009).
Poor Sleep and Impaired Self-Care:
Toward a Comprehensive Model
Linking Sleep, Cognition, and Heart
Failure Outcomes. Eur J Cardiovasc
Nurs, 5(337-344).
417
12.
Varcolis, E.M. 2006. Psychiatric
nursing clinical guide: assesment tools
and diagnosis. Philadelphia. W.B
Saunders Co.
13.
Keliat, B.A, Akemat. 2010. Model
Praktik Keperawatan Profesional Jiwa.
Jakarta: EGC.
14.
Colten, R., Harvey., Altevogt,
M.B. (2006). Sleep Disorders and Sleep
Deprivation: An Unmet Public Health
Problem. Washington, DC: The
National Academic Press.
15.
Iyus, Y. (2007). Keperawatan
Jiwa. Bandung: Refika Aditam
418
The Comparison of effectiveness between carrot (Daucus Carota) and Simvastatin to
Changes in Blood Cholesterol Levels of white rats (Rattus Norvegicus) with
Hyperkolesterolemia
Thatit Nurmawati
Pendidikan Ners, STIKes Patria Husada Blitar
email: [email protected]
Abstract
High level blood cholesterol can impact on diseases. Carrot known with high beta
carotene able to reduce blood cholesterol levels. The aim of the research was to determine
the comparison effectiveness between carrots and simvastatin on cholesterol levels in
hypercholesterol rats. The type of the research was experiments used randomized
control-group pretest - post test design. The samples were divided into simvastatin and
carrots treatment groups, each of 8 rats. Hypercholesterolemia by administering highcholesterol diet. Treatment using raw carrots with 1.25cc dose for 3 days. Measurement
of cholesterol levels using Touch Essay data analysis with Willcoxon and Mann-Whitney.
The results showed decreased cholesterol simvastatin groups as much as 12.5% (P =
0.069> α = 0.05), and the treatment group as much as 37.5% (P = 0.208), but the
statistical test showed no effect of carrots on blood cholesterol levels. While the
effectiveness of the results between treatment and control group (P = 0528> α = 0.05),
indicating no effect to decreased levels of good cholesterol and a control group treated
group. No effect on decrease in cholesterol levels could be caused by factors of betacarotene absorption easier if you boil carrots. Additionally only 3% beta-carotene in raw
carrots was released during digestion.
Keywords: levels-cholesterol, hypercholesterolemia, carrots, beta-carotene
INTRODUCTION
No contagious diseases become a
leading cause of death globally . Data
WHO (world health organization) shows
that of the 57 million deaths that occurred
in the world in 2008, as many as 36 million
or nearly two- thirds were caused by no
contagious diseases. Several cases of no
contagious disease including hypertension,
coronary heart disease, diabetes mellitus,
stroke, cancer and chronic respiratory
diseases (Bulletin of the window and
Health Information , 2012). Based on a
sample of 1.5 % 300,000 heart diagnosed
by a doctor , as much as 0.5 % on the
interview with the doctor , 0.3 % had signs
and symptoms of heart disease and as
many as 0:13 % had heart failure
The coronary heart disease become
one of the major cause of death caused by
narrowing of the lumen of blood vessels of
the heart or often called atherosclerosis
(Kabo 2008) The emergence of
atherosclerosis triggered by a buildup of
cholesterol
in
the
blood
(hypercholesterolemia).
Cases
of
atherosclerosis increase if there are factors
- risk factors that can be changed include
high diit , hypertension, diabetes mellitus,
smoking, obesity, and stress (Brunner and
Sudart, 2000). In addition, there are other
factors that cannot be changed among
others ras, sex, ages and
genetic
(Mutaqqin, 2009). High-fat diet can cause
hypercholesterolemia by triggering the
accumulation of cholesterol (Muttaqin,
2009). Cholesterol is a nutrient or
component of the complex fat needed by
the body as one of the highest sources of
energy and also is the manufacture of
sterol (Nurwahyuni, 2006). Cholesterol is
divided into HDL (high destiny
lipoprotein) cholesterol is the type that
contains a lot of protein and LDL (low
destiny lipoprotein) cholesterol is the type
with a lot of fat. When excess levels of
420
LDL will settle on the walls of the arteries
that can lead to narrowing until closing.
Therefore, an increase in LDL is one of the
oxidants in the body (Fikri, 2009). Then
attempt to decrease cholesterol levels in
the blood is expected to reduce cases of
atherosclerosis. Therefore, researchers
wanted to use herbs. Herb is a plant or
plants that have the purpose or value in the
treatment because it contains an active
substance that is useful for therapeutics.
Advantages of herbal plants which lack
side effects, processed naturally without
chemicals, easily available and affo (Iklan
Pos, 2014). One of plants used is carrots
(Daucus Carota)
Plant carrots (Daucus Carota) is no
stranger to the world community, because
always there regardless of the season. The
community has many cultivate
as
plantation that profitable.
Plant carrots (Daucus Carota) is an
annual herb, can be consumed
as
vegetables, juices and even for snacks.
Besides the price is relatively affordable,
Carrots (Daucus carota) have low side
effects (Cahyono, 2006). Based on the
results of the study showed that the
consumption of raw carrots every morning
can lower blood cholesterol up to 11%
(Julianti, Nurjanah and Soetrisno, 2009).
This is because there is a compound in
carrots beta-carotene. Based on research
Parwata (2010) serves as an antioxidant
beta carotene which has the ability to
reduce free radicals, especially singlet O2.
Taking beta-carotene derived from carrots
are safe and will not give toxic effects to
100,000 IU per day. This is in contrast to
the excessive synthetic beta carotene have
potential risks as prooxidan (Muchadi,
2009). The walls in carrots also contain
pectin, which is a type of dietary fiber,
which is water-soluble (Soluble dietary
fiber). This type of fiber acts to lower
cholesterol levels and blood sugar
(Vallerie, 2009).
Higher beta-carotene in carrots is
still raw, but the absorption of betacarotene more easily if the carrots boiled
first (Muchadi, 2009). Also based on
laboratory test results MOH nutritional
composition of ingredients in raw carrots
more than in cooking and presentation of
other (MOH, 1995). Based on research in
carrots (Daucus Carota) contained beta
carotene 7.6 mg, alphakarotin 3.4 mg,
vitamin E 465 mcg, Vitamin B1 69 mcg,
Vitamin B2 53 mcg, nocotamide 500 mcg,
acid pentofanat 270 mcg, Vitamin B6 270
mcg, phosphoric acid 26 mcg, 0.7 mg
vitamin (Rozaline, 2006). Therefore, the
researchers want to do research on the
effectiveness of the carrot (Daucus Carota)
on cholesterol levels in rats (Rattus
norvegicus).Research Question
Are there any potential differences in
cholesterol reduction in white rat Rattus
norvegicus after carrots compared with
simvastatin?
METODS
Independent variable : processing of
carrots, carrots dose and duration of
administration. Dependent variable
:
decrease in blood cholesterol levels. The
design of this study was true experiment
using pretest posttest control group design.
The sample is based on a formula Federer,
the (t-1) (n-1) ≥15, t is the treatment group,
n is the number of samples per treatment
group. Then the number of samples in each
treatment is 8 of rats. Cholesterol levels
obtained by measuring the blood of rats
before treatment carrots. The provision of
a diet high in cholesterol (egg yolk duck,
goat oil, lard, flour) in feed. Treatment of
carrot (blended), filtered and then
administered by sonde. Measurement of
blood cholesterol levels by taking from the
tail end. Analysis of the data used was
Kruskal Wallis statistics to examine
differences in the speed of cholesterol
reduction using 95% confidence level used
by SPSS 17.
This study aims to determine the
differences decrease blood cholesterol
levels by using the carrot (Daucus carota)
were given to rats (Rattus norvegicus) after
administration of a diet high in cholesterol.
During the study, there was no samples
droup-out, complications or serious side
effects.
421
cholesterol levels of white rats treated
group before being given a raw carrot is
greater than in the control group were also
not given the treatment by a margin of 6
mg / dl.
Table 2 also shows the results of
research in the form of cholesterol after
N Weight
Pre
Post
o
(gr)
∑
%
∑
% treatment in the treatment group and the
1 100-150
1
6.25
9
56.25control group. From these results indicate
2 160– 200
12
75
2
12.25that high cholesterol levels in the treatment
3 210– 250
3
18.25
5
31.25group was 349 mg / dl. While the lowest
was 137 mg/ dl. Value - average
cholesterol treatment group mice who had
Based on table 1, before treatment
been given a raw carrot was 185.25 mg /dl.
75% weigh 160-200 grams. While the
In the control group the highest cholesterol
percentage of weight loss with 6:25
level is 218 mg / dl and the lowest
smallest 16% of rats. Body weight of rats
cholesterol levels of 117 mg / dl. Value after treatment given change of weight
average cholesterol levels after the control
range 100-150 gr changed from 6:25%
group given cholesterol drug was 169.75
increase to 56.25%. weight gain also
mg / dl. After calculating the average
occurred in the range of 210-250 g of
obtained - average cholesterol levels of
18:25% increase to 31.25%. However, for
white rats after the treatment group was
the range of 100-150 g decreased from
given raw carrots is greater than the
75% to 12.5%.
cholesterol levels of mice white given
cholesterol drug therapy with a difference
The Distribution Of Cholesterol Levels
of 15.5 mg/dl. From the comparison of the
Of Rats On Pre And Post Treatment
difference between the average - average
Table 2 The distribution of cholesterol
results from before and after treatment
levels of rats on pre and post treatment
Simvastatin
showed
that an increase in average
Daucus (mg/dl)
(mg/dl) differences - cholesterol rats from the
No
Sample
Pre
Post
Pre
Postdifference between the previous average of
141
162
100
154
1
1
138
1506 mg/dl to 15.5 mg / dl. Of the difference
2
2
207
167
3
3
132
165
112
218could be concluded that a change in
4
4
171
168
100
150cholesterol levels between before and after
5
5
147
137
164
117treatment.
Distribution Of Rats Weight On Pre
And Post Treatment.
Table 1. Distribution of rats weight on pre
and post treatment.
6
7
8
6
7
8
Median
150
159
100
145.75
168
174
349
185.25
131
179
153
139.75
145
209
207The Distribution
169.75Of Rats On Pre
Based on the table 2 cholesterol
treatment group had the highest cholesterol
levels 207 mg / dl and the lowest
cholesterol level is 100 mg / dl. Value average cholesterol levels of white rats in
the treatment group before being given a
raw carrot was 145.75 mg / dl. While the
control groups were not given the
treatment had the highest cholesterol levels
179 mg / dl and the lowest cholesterol
level is 112 mg / dl. Value - average
cholesterol levels of white rats control
group was 139.75 mg / dl. After tabulation
of data obtained average - average
Of Cholesterol Levels
And Post Simvastatin
Treatment
levels of rats on pre and post simvastatin
treatment
Simvastatin
Pre
Post
No
Sample
(mg/dl)
(mg/dl)
141
162
1
1
2
2
138
150
3
3
112
218
4
4
100
150
5
5
164
117
6
6
131
145
7
7
179
209
8
8
153
207
422
Median
Average range
Α
P : 0.069
139.75
169.75
30
Based on Table 3 the results before and
after drug administration cholesterol in the
control group obtained average - average
before being given treatment was 139.75
mg / dl and the average - average after
being given treatment with the drug was
169.75 mg / dl. Based on the above
tabulated results are an increase in the
average - average cholesterol levels before
and after treatment of cholesterol drug
delivery. While based on the data of the
table is a decrease in cholesterol levels
before and after treatment as much as
12.5% of all samples. Changes in
cholesterol levels before treatment was 164
mg / dl after being given the drug
treatment of cholesterol dropped to 117 mg
/ dl. But based on statistical result obtained
P = 0.69 in other words P> α = 0.05 which
means acceptable and there is no effect of
cholesterol drugs against cholesterol test
animals white mice.
The Distribution Of Cholesterol Levels
Of Rats On Pre And Post Daucus
Carota Treatment
levels of rats on pre and post Daucus
carota treatment
Daucus Carota
No Sample
Pre
Post
(mg/dl)
(mg/dl)
1
1
100
154
2
2
207
167
3
3
132
165
4
4
171
168
5
5
147
137
6
6
150
168
7
7
159
174
8
8
100
349
Rata rata
145.75
185.25
Average range
39.5
α
P : 0.208
Based on Table 4 in the treatment
group obtained average - average before
being given a raw carrot was 145.75 mg /
dl and the average - average after given
raw carrots increased to 185.25 mg / dl.
Based on these results it can be concluded
there is an increase in the average average cholesterol levels before being
given a raw carrots and after given raw
carrots. However, based on the table there
is also a decrease in cholesterol levels
37.5% of the total number of samples
treatment groups. Among rats No. 2 with
cholesterol levels of 207 mg / dl to 167 mg
/ dl, the mice no 4 with cholesterol 171 mg
/ dl changed to 168 mg / dl and no rat 5147
mg / dl changed to 137 mg/dl. Different
things also occur in mice No. 8 is
characterized by an increase drastic of
cholesterol before treatment of 100 mg / dl
increased to 349 mg / dl. But based on
statistical results available P = 0.208, in
other words P> α = 0:05 so that it can be
concluded that there was no effect on
cholesterol levels of raw carrots test
animals white mice.
Cholesterol Mice After Treatment In
The Treatment Group And The Control
Group
Table 5 Cholesterol mice after treatment in
the treatment group and the control group
Post
Post
No
Sample
control
treatment
(mg/dl)
(mg/dl)
162
154
1
1
2
2
150
167
3
3
218
165
4
4
150
168
5
5
117
137
6
6
145
168
7
7
209
174
8
8
207
349
α
P : 0.528
Based on the table 5 after the test
statistics on the results of the effectiveness
of the provision of raw carrots and giving
cholesterol drugs obtained P for 0528.
because the value P> of the α = 0.05, then
the hypothesis is rejected, which means
there is no influence. it can be said that
there is no effect of raw carrot to decrease
cholesterol levels either the control group
or the treatment group.
423
DISCUSSION
Carrots are one of the root vegetables
that are rich in bioactive compounds.
Carrots has become a major vegetable and
is commonly known as and carotene
content (Sharma, et al, 2012). Carotene as
an antioxidant dampen singlet oxygen and
prevent lipid peroxidation, the effect
resembles the effects of vitamin E and
vitamin C in protecting
DNA and
membranes from oxidative attack
endogenous (Robbins, et al., 2004;
General, 2013).Carotene acts as an
antioxidant to prevent a chain reaction
generated hydroxyl radicals thus
preventing disconnection chain fatty acids
in membranes and prevents the formation
of disulfide bonds (-SS) the protein so it
does not lose its biological activity for the
formation of energy (Mayes, 2002).
Carotenoids are lipophilic so that play a
role in cell membranes to prevent lipid
peroxidation. β carotene is a compound
that can give electrons (electron donor) to
free radicals or oxidants so that a stable
radical compounds (Meyes, 2002; General,
2013). β carotene is known as an excellent
antioxidant, due to its ability to quench
singlet oxygen and peroxyl radical
scavenger (Agung, 2013). he results
showed no difference in each treatment to
reject the hypothesis. Probably due to the
levels of β carotene contained in carrots is
still very low. This is in line with research
Heber and Lu (2000), which shows that at
the same concentration of various
carotenoid compounds, β carotene will
have lower antioxidant activity. The
addition of carotenoid intake can increase
the concentration of lipoprotein
carotenoids
In addition there is also a pectin
carotene in carrots. Pectin is able to
decrease absorbance bile acid but only
slightly lowering cholesterol (Leveille,
1966) pectin binding bile acids and
increased spending that is then wasted with
feces. Bile acid binding by pectin causes
bile acids out of the enterohepatic cycle.
Decrease the amount of bile acids cause
liver uses cholesterol in the blood as a
precursor of bile acids. Increased faecal
bile acid or cholesterol is lost can result in
decreased plasma cholesterol and increase
the turnover of cholesterol biosynthesis in
animals (Linder, 1992). Will tetepi on the
results of this study showed no pectin high
cholesterol absorption capability. Pectin
levels in carrots is very small, about 7.4%
There is no difference in treatment can
be influenced metabolism in rats of
different bodies. When the number of
calories derived from food is less than
energy expended the endogenous savings
will be issued (Ganong, 2002). Food
absorption there may be differences in
each individual and therefore contributes
to increased levels of cholesterol
(Haryanti, 1997). The conditions allowing
the mice to spur the production of stress
hormones epinephrine, norepineprin,
corticotropin and
glucocorticoids that
activates hormone-sensitive lipase that
breaks down triglycerides, triglycerides
and free fatty acids increase. The stress
hormone causes the active genes in fat
cells that can multiply and thrive.
Comparative Analysis Of Cholesterol In
Pre And Post Control Group
Based on the results of data
processing showed that
there were
decreases in cholesterol levels before and
after treatment as much as 12.5% of the
test animals, but based on statistical result
obtained P = 0.69 in other words P> α =
0.05 which means acceptable and there is
no effect of cholesterol drugs against
cholesterol test animals white mice. It is
possible researchers used the lowest dose
in the study. The dose used was 0144 mg.
based on research results Venesa et al
(2013) volume required is 10 mg
simvastatin medications for cholesterollowering effect in rats. In line with the
research Unneyputty (2013) the dose of
simvastatin to rats of 0.18 mg / day / 200
gr BB. Another possibility rat cholesterol
level changes caused by the activity of the
rats based on the observations
of
researchers, rats
experienced enough
activity. Because of the activity on a
regular basis can improve HDL cholesterol
and pressing total cholesterol and LDL
cholesterol and triglycerides burn to lose
weight. In addition to food activity also
424
affects changes in cholesterol levels. foods
that contain a lot of cholesterol, trans fats
and high in saturated fat such as cheese,
lard, beef brain and viscera increase
cholesterol levels in the blood. Stress
experienced by the rats within lasts long
enough will destroy the balance of body
functions so that it can raise cholesterol
and blood pressure (Wijayakusuma. 2008).
Comparative
Analysis Cholesterol
Levels Of Mice In The Treatment
Group Before And After Given Raw
Carrots
Based on the results of data
processing are cholesterol-lowering
amount of 37.5% of the treated group of
mice. But based on statistical results
obtained P = 0.208, in other words P> α =
0:05 so that it can be concluded that there
was no effect on cholesterol levels of raw
carrots test animals white mice. There may
be because of the absorption of white mice
terhadapa raw carrots. This is in line with
research Muctadi (2009) argued that a
higher content of beta carotene in carrots is
still raw, but the absorption of carotenoids
easier if carrots boiled first. Raw carrots
have tough cell wall makes the body can
only convert less than 25% beta-carotene
into vitamin A. Based Rukmanan (2006)
Carrots can be eaten in various ways, but
only 3% of beta carotene in raw carrots is
released during the digestion process takes
place, this can be increased to 39% through
cooking and add palm oil.
Comparative
Analysis Cholesterol
Levels Of Mice In The Treatment
Group And The Control Group
Based on the results of a statistical
test the effectiveness of the provision of
raw carrots and giving cholesterol drugs
obtained P for 0528. The P value> of the α
= 0.05, then the hypothesis is rejected,
which means there is no effect, it can be
explained that there was no effect of
cholesterol-lowering both the control
group and the treatment group. This is
caused due to the timing of therapy is only
3 days. According to research conducted
Vanese et al (2013) cholesterol changes
which occurred in the first week can also
be caused due to environmental stress, and
changes in the type and pattern of food
suddenly. As soon as rodents can adapt to
food, metabolism lasted well so that
cholesterol in the blood can go down by
itself
CONCLUSION
The results of this study had
demonstrated that there were no effect of
Daucus carota on high levels cholesterol
white rats (Rattus norvegicus)
ACKNOWLEDGEMENT
The sample size is the least. Time research
to short treatment so alteration not
maximal
REFERENCES
Anonymous,
2004.
Carrot.
http://en.wikipedia.org/wol.iki/carrot.
online diakses tanggal 6 mei 2015
Biokimia Harper Edisi 25 Robert
k.Murray; Daryl k.Granner ; Peter
A.Mayes and Victor w.Rodwel, 2003
EGC.
Fikri F. 2009. Memahami, Mendeteksi
Bahaya Kolesterol. Arr-Ruzz Medi:
Jakarta
Iklan Pos. 2014. Sehat dengan herbal.
Jakarta: Iklan Pos
Julianti, Nurjanah dan Soetrisno. 2009.
Bebas Hipertensi dengan Terapi Jus.
Jakarta: Gramedia Pustaka Utama
Kabo. 2008. Mengungkap Pengobatan
Penyakit Jantung Koroner. Jakarta:
Gramedia Pustaka Utama.
Nurwahyuni A. 2006. Efek Kolesterol
Daun
Sambung
Nyawa
TerhadapKolesterol
LDL dan
Kolesterol HLDL Darah Tikus
Diabetik
Akibat
Induksi
Streptozotozin. Skripsi Universitas
Negeri Semarang
Rozaline. 2006. Terapi Jus dan Sayur.
Jakarta: Puspa Swara
Smeltzer ,Suzane C
Buku ajar
keperawatan medikal
– bedah,
Brunner & Suddarth
edisi 8 vol.2
Jakarta.
Uneputty, Yamlean dan Kojong. 2013.
(Annona
Potensi Infusan Sirsak
muricata L)
terhadap kadar
425
kolesterol darah tikus putih jantan
(Rattus Norvwgicus).
Vanessa, Purwijantiningsih dan Aida.
2013. Pemanfaatan minuman serbuk
instan kayu manis (Cinnamomum
Burmanii BI) untuk menurunkan
kadar kolesterol total darah pada
tikus putih (Rattus Norvwgicus).
Wijayakusuma H. 2008. Ramuan herbal
penurun Kolesterol. Jakarta: Pustaka
Bunda.
426
THE CORRELATION OF PERSONAL SELF-CARE ABILITY AND QUALITY
OF LIFE IN PATIENTS UNDERGOING CHRONIC KIDNEY DISEASE IN
HEMODIALYSIS INSTALLATIONS OF RSUD MARDI WALUYO BLITAR
Sandi Alfa Wiga Arsa
Abstrac : Chronic kidney disease is condition occurs if the patient could survive only
with help of hemodialysis machine. In this state, the patients not only have to survive
alone but also to achieve a certain level of their welfare. This quality of life should be
maintained in management of clinical nursing for these patients. Self-care ability is one of
the factors that is considered to have a relationship with the quality of life for chronic
kidney disease patients. As many as 30 patients were being respondents to this research
by filling out a questionnaire of personal care ability and quality of life that is modified
from KDQOL-SF v 1.3. The data were analyzed using Spearman rho correlation with
SPSS version 17. The results showed p value: 0.008 and rs: 0.473. This means that the
correlation was strong and had positive correlation directions between self-care ability
and quality of life for the patients of chronic kidney Disease. If the level of the self-care
ability is higher, they will have a better quality of life. With the increasing number of the
patients who can conduct a personal self-care ability will increase the contentment, or socalled a psychic satisfaction, because of the fulfillment of the requirement for a good life
for both of external requirements and their perception. In addition, this satisfaction will
drives an individual to gives a good value for their quality of life.
Keywords : quality of life , self-care, chronic kidney disease.
INTRODUCTION
Along with the development of
globalization era, Indonesia is one of the
developing countries that
are now
executing to develop in every sector
including health. Riskesdas 2007 in SKN
2009 show an increase in cases of noncommunicable diseases (such
as
cardiovascular diseases and cancer) are
quite significant; making Indonesia has a
double burden. Chronic kidney disease is
one of the non-communicable diseases is
quite rapid development rate of sufferers.
Kidney failure is a clinical condition
characterized by the irreversible decline in
kidney function, to a degree requiring
kidney replacement therapy which
remains, in the form of dialysis or kidney
transplantation (Aru W Sudoyo et al,
2009). Peritoneal dialysis, hemodialysis
and kidney transplantation is the treatment
given to patients with chronic kidney
failure. Hemodialysis is a treatment that
has been chosen by patients with chronic
kidney failure. Hemodialysis is used for
patients with end stage kidney failure or
acute disease patients requiring dialysis
short time (Nursalam & Fransisca, 2006).
Hemodialysis can extend life without clear
boundaries, this action will not change the
natural history of the underlying kidney
disease, and does not restore kidney
function, and patients will continue to
experience a number of problems and
complications (Smeltzer & Bare, 2004).
The quality of life of patients will
gradually decrease over the course of the
disease experienced. Where a person
perceives himself departed with normal
living conditions / ideal to hazardous
conditions or without health that need
dialysis to stay alive. One of the factors
that are considered researchers affect the
quality of life is the ability to self-care,
which is a form of business to meet the
needs of these patients in order to survive.
Based on the Report of Indonesian Renal
Registry in 2010 by the Association of
Nephrology Indonesia (PERNEFRI).
Shows the number of new hemodialysis
patients and hemodialysis patients were
still active in 2007, 4977 new patients a
number of people, in 1885 the number of
active patients; In 2008 new patients a
number of 5392 people, in 1936 the
number of active patients; In 2009 new
427
patients a number of 8193 people, 4707
active patients; In 2010 the number of new
patients 9649 and 5184 active patients
(PERNEFRI, 2010).
Based on preliminary survey dated January
11, 2012 at Mardi Waluyo Hospital
Hemodialysis installation Blitar, from
2009 to 2011 patients continues to
increase. Currently available 8 daily
dialysis machine and this machine is never
empty. The number of patients on
hemodialysis installation Mardi Waluyo
Hospital amounted to an average of 14
people every day who do dialysis.
Hemodilisa engine number and business
hours only in the morning and afternoon
shift considerably less installation space
because according to data Mardi Waluyo
Hospital hemodialysis there are still 45
patients with chronic renal failure have not
been able to obtain dialysis services here.
In addition to therapy with hemodialysis,
patients with chronic renal failure should
be able to adapt to the circumstances that
happened. Restrictive diets will change the
patient's lifestyle and perceived as a
nuisance and undesirable for many patients
with chronic renal. Because food and
beverages is an important aspect of
socialization, patients often feel excluded
when with other people because there are
only a few food choices are available to
him (Aru W Sudoyo et al, 2009). In
addition, patients with chronic kidney
failure who receive hemodialysis actions
undergone many changes in many aspects
of life.
According to Mercedes-Moreiras (2011)
the first aspect that changes is welfare,
where the progressive state of renal
worsening will reduce also the functions of
other organs, such as restrictions on food,
diet control, decreased sexual function, and
others, make the patient feel things that he
liked to be limited, so that the change in
subjective well-being of himself. Second,
is the self-image, problems such as
discoloration of the skin, body odor,
reduction urinary function, and others can
make patients assess themselves negatively
and using feelings of inferiority. This
limits the feeling of social and family
relationships that can bring introversion.
The third is the fulfillment of basic needs,
where the frequency of dialysis can
damage and limit the patient's lifestyle. On
the other hand the feeling of inferiority
accelerates physical deterioration,
passivity, ignorance and dependency,
which can often be left with the help of
another person, the family and social
environment. The last aspect that changes
are the mental attitude, anxiety is always
present at all times in the life of the patient
because every day faces the risk of death.
Anxiety causes
stress, somatization,
obsessive attitude, depression, aggression
and so on.
With various changes in various
aspects of the person's going to do
something on his own in maintaining the
life, health and welfare, called Dorothea
Orem as care themselves. The ability of
daily self-care activities was important for
health. There are eight elements of
universal self care needs identified include
air intake, water intake, food intake,
elimination function, activity / rest, social
interactions, precautions against the
dangers of life, and live a normal life. With
self-care (non-medical factors) that have
been pursued and action hemodialysis
(medical factors) capable slow down
progression to kidney failure, are important
factors in the morbidity and mortality of
patients with chronic renal failure. Of the
two factors of medical and non-medical
has been done, the patient will perceive
himself about his position in life.
Perception and self-assessment of the
patient's health status is called MercedesMoreiras (2011) as the quality of life.
Quality of life is very important in the
clinical management of patients at this
time, because the patient is not just hoping
to survive alone, but hopes to achieve a
certain level of prosperity. Improving the
ability of self-care for patients with chronic
kidney failure is needed to increase quality
of life of these patients. Improved quality
of life will greatly affect the life
expectancy in patients with renal failure.
Based on the above, it is necessary and
important to know the correlation of selfcare ability and quality of life of patients
with chronic renal
failure receiving
428
hemodialysis action in Hemodialysis
Installation General Hospital of Mardi
Waluyo Blitar.
The research problem in this research was:
How is the correlation of self-care with the
quality of life of patients with chronic
renal failure in Hemodialysis Installation
Mardi Waluyo Hospital Blitar.
The general objective of this research was
to explain the correlation of self-care
ability and quality of life of patients with
chronic renal failure receiving
hemodialysis action in Hemodialysis
Installation General Hospital of Mardi
Waluyo Blitar. While the specific
objectives of this research were: 1) Identify
the ability of self-care patients chronic
kidney disease, 2) Identify the quality of
life of patients chronic kidney disease, 3)
analyze the relationship between the ability
of self-care patients with chronic renal
failure with the quality of life in the
Installation Hemodialysis Hospital Mardi
Waluyo Blitar.
Theoretical benefit of this research was to
add the treasures in the science of nursing
intervention on arrange patients with
chronic renal failure receiving
hemodialysis action, practically this study
can be used as one way to improve the
quality of life of patients with renal failure
receiving hemodialysis action.
version 1.3. Data analysis
Spearman's Rho with p ≤ 0:05.
using
RESULT
Table 1 Value quality of life and self-care
of patients with chronic renal
failure
Quality of
Life
Self care
Mean
12.9333
73.8300
Std.
1.96404
9.87980
Range
8.00
38.50
Minimum
8.00
48.20
Maximum
16.00
86.70
Deviation
Table 2 Value of correlation between selfcare with the quality of life of
patients with chronic renal failure
Spearman rho
Probabilty (p
Correlation
value)
Coefficient
(rs)
0,008
METHODS
The research design was correlational to
assess the correlation of self-care with the
level of quality of life in patients with
chronic renal failure who received the
action hemodialysis, research carried out in
the installation Hemodialysis Regional
General Hospital Mardi Waluyo Blitar, on
on 5 - May 19, 2012, with a population of
42 patients still undergoing regular
hemodialysis, the sampling technique was
total sampling. The independent variable
was the ability of daily self-care of patients
with chronic renal failure
and the
dependent variable was the quality of life
of patients with chronic renal failure
receiving hemodialysis action.
Data collection tool in this study was
questionnaire self-care ability and
questionnaire SF KDQOL modified
0,473
Based on the table above, obtained
probability value of 0.008. Because the pvalue ≤ 0.05, it means that there is a
significant correlation between self-care
ability and quality of life. The value of the
correlation coefficient obtained from the
SPSS statistical test is rs: 0.473 which
shows a positive correlation coefficient
with a sufficient degree of correlation. It
can be concluded that the relationship was
strong and positive relationship between
the ability of self-care with the quality of
life of patients with chronic renal failure
who receive hemodialysis
action in
Hemodialysis Installation Mardi Waluyo
Hospital Blitar.
429
DISCUSSION AND ANALISIS
Self Care
Nursing independent (self-care)
by
Dorothea E. Orem was an implementation
of the activities initiated and conducted by
the individuals themselves to meet the
need to maintain life, health and wellbeing according to the circumstances,
either healthy or sick. Based on this study
the ability of self-care acquired by 6
people in the category ability of self-care
partial was only some of these patients can
meet the needs of self-care daily, and the
majority of respondents included in the
ability of self-care self-sufficient, as many
as 24 people with a sense could be said of
these patients does not need any help at all
in meeting the needs of daily self-care.
From the data tabulation of data obtained
minimum value of self-care was at the 8
and the maximum value obtained was 16.
While in the category of total or require
full assistance in fulfilling the needs of
daily self-care, was not found in research
in Hemodialysis Installation Mardi Waluyo
Hospital Blitar.
Actually, necessary of self-care
by
Dorothea E. Orem learned and influenced
by individuals themselves, the
environment, health and nursing. Self-care
was the first step by individuals that take
place on an ongoing basis according to the
circumstances and its existence, good
health and perfection. Self-care
independent universally assumed as the
ability to meet life daily care that have
been identified to the respondents in this
study through questionnaires
include
moderately air intake, moderate intake of
water, moderate intake of food, the
fulfillment of the functions of elimination,
balance between activity and rest,
fulfillment activities and social
interactions, precautions against the
dangers of life, and is able to live a normal
life.
Disappearance category abilities self care
total respondents possible because the
respondents themselves quickly adapt to
the circumstances they were experiencing
now, the everyday environment where they
often come face to face with renal failure
patients other and share experiences
neighbor of self-care that must be done, the
self-awareness of their health status was
also greatly contributes to the patient's
ability to self-care, and health education on
self-care given by nursing staff in hospitals
Hemodialsa Installation the Mardi Waluyo.
Quality of Life
Quality of life is the perception person
about the individual how assess their own
health. It is influenced by several factors,
medical and non-medical interconnected.
Pain, or effect to one's physical area, has
an impact to the psychological condition of
people and relationships. MercedesMoreiras uses the term Health-Related
Quality of Life because it is defined
formally as when the physical, emotional
and social reasonable or are expected to be
affected by a medical condition or
treatment. The concept of Health-Related
Quality of Life (HRQOL) shows the
impact of a disease or medical action
against the physical symptoms, functional
status, and mental and social functioning.
Agus Yuono in 2000, the quality of life
decreases with increasing age, patients
with terminal renal failure young age will
have a better quality of life because
typically have better physical condition.
Male gender have a lower quality of life
than in women, and the longer undergoing
hemodialysis the lower the quality of life
of patients. Etiology or cause of chronic
kidney disease nephrotic diabetic disease
has a poorer quality of life than patients for
other reasons (Bergstrom, 1985 in Agus
Yuono 2000).
Based on the research quality of life of
patients with kidney failure in
Hemodialysis Installation Mardi Waluyo
Hospital Blitar very varied, with the
acquisition of a minimum value is 48.2 and
the maximum value obtained 86.7. The
average value of the quality of life
obtained from 30 respondents was 73.83.
Assessment of quality of life particularly a
maximum value of 100, the number 100
can be said to approach the quality of life
of patients with chronic renal failure, the
better. Age, education, the last ever taken
of respondents do not have a meaningful
role. Age and educational status does not
430
guarantee a person's past can assess and
perceive a state of pain they experienced
well. According to Mercedes Moreiras
quality of life is affected by the physical,
psychological and social relations. Based
on research conducted Agus Yuono
(2000), a precursor of diabetes mellitus
disease has a significant role in the quality
of life. In this study did not prove so
because the number of patients with
chronic renal failure in this study the
majority had hypertension predecessor
disease. In the grouping of sex, women
have a better quality of life than in males
with a minimum value the quality of life in
women is 68.20, the minimum value of the
quality of life in men 48.20, while the
maximum value obtained in women was
86.7 and 86.4 in men. The difference
between the quality of life gained men and
women, may be because men are usually
more active in the work, and make a living
for his family so that the male has a
standard priority higher quality of life
compared with patients female. As a result
the quality of life of men will get lower
when compared to women. Quality of life
of respondents undergoing hemodialysis 120 months long enough to dominate the
minimum value of the quality of life to
appear as much as 4 respondents in the
four lowest value and 4 respondents in
moderate values. This can caused initial
adaptation period or tolerance of a patient
with chronic renal failure undergoing
hemodialysis the first time both
psychologically and physically.
In a previous study conducted by Agus
Yuwono in Hemodialysis Unit of Hospital
Dr. Kariadi (2000) shows the nutritional
status, etiology, and the number of
comorbid affect the quality of life, whereas
sex, duration of HD and age do not have a
meaningful relationship. Research results
Kusman Ibrahim (2009) revealed that there
were significant differences between the
quality of life by gender and other
accompanying health problems, whereas
there was no significant difference in the
quality of life of patients according to age,
education level, and the longer undergo
hemodialysis. Each research area has
different factors that have a significant
relationship with quality of life. As in this
study, a factor that has not been previously
studied the ability of self-care that turned
out to have quite a significant relationship
in the quality of life of patients with
chronic renal failure.
Relationship between Self-Care Ability
with Quality of Life
From the statistical test using Spearman's
rho correlation test with SPSS version 17
is the result p value of 0.008. Because the
value of p <0.05 then the H1 is accepted it
means there was a significant correlation
between self-care ability and quality of
life. The value of the correlation
coefficient obtained
from the SPSS
statistical test was rs: 0.473 correlation
coefficient that shows the correlation
between the levels of self-care with the
quality of life considerably. Positive values
obtained in the correlation coefficient have
a meaning, the higher the self-care ability
the higher the quality of life of patients
with chronic renal failure in Hemodialysis
Installation Mardi Waluyo Hospital Blitar.
The ability of self-care
was an
implementation of the activities initiated
and does by individuals themselves to meet
the need to sustain life, health and wellbeing in accordance with the state of both
sick and healthy, the results of this study
show the ability of self-care that was
owned patients with chronic renal failure
have a encouragement or motivation of its
own to live with what happened to him
today. With more and more patients could
perform independence in self-care could
improve satisfaction, or can be called
psychic satisfaction for the fulfillment of
their needs, both externally and perception
needs. And satisfaction was what drives an
individual gives good value for itself in the
quality of life.
CONCLUSIONS
Self-care ability of patients with chronic
renal failure who receive hemodialysis
action in Hemodialysis Installation Mardi
Waluyo Hospital Blitar with an average
value of 12.93 which if considered to be in
an independent category. The average
value of the quality of life that was 73.83,
431
Moreiras, Mercedes P. 2011. “Assessment
of
Health-Related
Quality
of
Life:TheCinderella
of
Peritoneal
Dialysis?”,accesed
on
February
192012(http://www.hindawi.com/journals)
Nursalam. 2008. KonsepdanPenerapan
MetodologiPenelitianIlmuKeperaw
atan.Jakarta:SalembaMedika.
NursalamdanFransisca B.B. 2006.Asuhan
KeperawatanpadaPasiendengan
GangguanSistemPerkemihan.
Jakarta. SalembaMedika.
Nursalam. 2003. KonsepdanPenerapan
MetodologiPenelitianIlmuKeperaw
atan.Jakarta:SalembaMedika.
O‟Callaghan, C.A. 2007.
At Glance
SistemGinjal,
Terjemahan
Elizabeth
Yasmine,edisikedua.Jakarta:
Erlangga.
PerhimpunanNefrologi Indonesia
(PERNEFRI). 2010. Report of
Indonesian RenalRegistry 2010.
Smeltzer, Suzane C and Bare, Brenda
G.2001.BukuAjarKeperawatan
MedikalBedah Bruner &Suddarth,
Terjemahan :AgungWaluyo.
Jakarta: EGC
Saryono.2010. Kumpulan Instrumen
PenelitianKesehatan. Bantul:
NuhaMedika.UnitPenelitidan
PengabdianMasyarakat. 2009.
getting closer to the 100 it can be said the
renal failure, the better. There was
correlation between self-care ability and
quality of life with a p-value: 0.008 and rs:
0.473
ACKNOWLEGEMENT
The limitations of the study
using a questionnaire that is sometimes the
answer given by the sample did not show
real state. In addition to assessing the
renal failure can be changed according to
time with the psychological and emotional
state of patients when assessed.
REFFERENCES
AgusYuono. 2000. UniversitasDiponegoro
Semarang.
KualitasHidupMenurutSpitzer pad
PenderitaGagalGinjal Terminal
yang
MenjalaniHemodialisis
diUnit Hemodialisis RSUP Dr.
Kariadi Semarang.
ArifMuttaqindanKumala Sari. 2011.
AsuhankeperawatanGangguanSist
emPerkemihan.Jakarta:
SalembaMedika.
Alligod, Martha R and Tomey, Ann M.
2006.Nursing Theorists and Their
Work, Seventh Edition. Greenville,
North Carolina: Mosby Elsevier.
Aru W. Sudoyo., dkk. 2009. IlmuPenyakit.
Dalam, Edisi V Jilid II. Jakarta:
InternalPublish.
AwiMuliadi W.2011. GagalGinjalKronik
(Chronic Renal Failur)
TahapAkhir.accessed on January 17
2012. (www.infodokterku.com)
Draft SKN 2009.Accessed March 122012
.(http://www.depkes.go.id/SKN20
09.pdf)
Jonathan Sarwono, StatistikItuMudah:
PanduanLengkapuntukBelajarKom
putasiStatistikMenggunakan SPSS
16PenerbitUniversitasAtma Jaya
Yogyakarta,2009
Kidney Disease Quality of Life Short Form
(KDQOL-SF ™), Version 1.3.A
Manualfor
Use
andScoring.Accesed on March 20
2012. (http://www.rand.org)
432
THE EFECTIVENESS OF
PROBLEM BASED LEARNING MODEL DEPEND ON LEARNING
OUTCOMES STUDENT IN COURSE PREGNANCY ON OBSTETRICAL
CARE ON DIPLOMA PROGRAM
Nevy Norma Renityas
Program Studi D3 Kebidanan STIKes Patria Husada Blitar
[email protected]
ABSTRACT
The changes in a Health education system must be done for better
education. Midwifery care in pregnancy is health education courses in midwifery
department. In order to get the optimal result of education, it is required an
innovative learning models. There are many models of learning innovation such
as example problem based learning. Based on the consideration above, researchers
want to analyze the effectiveness of Problem Based Learning depend on learning
outcomes student in course Pregnancy on Obstetrical Care learning Diploma
Program.
This research was done in STIKes Patria Husada Blitar on 25 February
until March 8 th 2015. This research used quantitative approach, quasy
experimental. The population and the sampel was the students in the third
semesters in the total amount of 38 student divide into 2 groups in random. The
control group was discussion group in the amount of 18 people. Problem based
learning group (experimental group) consists of 20 people divided into 4 groups,
each group consists of five people. The Independent Variable was Problem Based
learning while the Dependent Variable was learning outcomes.
The results of the research showed there was a significant difference with
different test results using a t-test ( t:-5,46) between learning outcomes using
problem based learning model and class group discussion on pregnancy
midwifery care courses. The problem based learning model is more effective than
group discussions.
Keywords: Problem Based Learning, Learning Outcomes, Pregnancy on
obstetrical Care
INTRODUCTION
Day by day, the problems faced by
many people tend to be increased. It makes
the competition to gain something also
getting tougher.
The Demands and
challenges in world worked always
changes especially healthy.In this case , a
change in a system of health education
must be changes more beter. Lecturer is
very important in the change, one of the
changes that can be made by the lecturer is
a change in the learning process.
Midwifery pregnancy is a health education
course of obstetrics.In Course Pregnancy
on obstetrical care the student is expected
to get the optimal learning. Lecturers have
an important role in the learning process.
The lecturers have to be creative and
innovative in their lessons. During this
time, the methods used lecturer in the
learning process of pregnancy care in
addition to conventional methods, there are
also some student-centered
methods
include a method in a class discussion. The
method is performed by a group discussion
presented in front of the class. STIKes
Husada Patria is one of the health
institutions in the district blitar. Based on
434
observations in the classroom, especially
learning model that can be applied to the
the second class of the third level can be
real world, especially learning healthy in
identified problems that occur. These
course pregnancy on obstetrical care.
problems can be stated as follows:
Based on consideration above, the
1. The low pregnancy
test scores
researcher want to analyze of effectiveness
midwifery care, especially the subject
of model problem based learning depend
matter of pregnancy care. In the academic
on learning outcomes student in course
year 2011/2012 due to the limit value of
pregnancy on obstetrical care on program
midwifery pregnancy is 75. Students who
diploma
get test scores 75 as much as 40% and
students who scored <75 as much as 60%.
2. Inappropriate
method chosen and
METHOD
applied. In the implementation of learning,
This research was done in STIKes
lecturers less attention to the learning
Husada Patria Blitar, on February 25process but more attention on the end
March 8 2015,
this research used
result.
quantitative approach, experimental quasy.
3. Difficulty students to answer the
The Population and sample in this study
question and less interaction between other
was the third semester students in total
students.
amount 38 students, divided into 2 groups,
Discussion class model was good for
choice in random. Discussion groups
course pregnancy on obstetrical care on
(control) in the amount 18 people,Problem
program Diploma. But the researchers tried
Based
Learning
(experimental
to use problem based learning model in
group)consist of 20 people were divided
STIKes Patria Husada.
into 4 groups. Each group consist 5 people.
If the learning process was well ,student
The independent variable was Problem
participation has also increased. I hope the
Based Learning, dependent variable was
learning outcomes will be increased. The
learning outcomes.
researchers trying to apply problem-based
RESULT AND ANALYSIS
The Difference of Learning Outcomes depends on Learning group discussion Model
and PBL in Course Pregnancy On Obstetrical care On Program Diploma
This Research used 38 sample. 18 people for group discussion and 20 people for Problem
Based Learning Group.
Table 1 The Difference of Learning Outcomes depends on Learning group
discussion Model and PBL in Course Pregnancy On Obstetrical care On Program
Diploma
no
1
2
3
4
5
6
7
interval
35-40
41-45
46-50
51-55
56-60
61-65
66-70
Jumlah
Group discussion
2
4
8
3
1
0
0
18
435
frequensy
%
11.11
22.22
44.44
16.67
5.56
0.00
0.00
100
PBL
0
0
3
6
7
2
2
20
%
0
0
15
30
35
10
10
100
Primery Source The Difference of Learning Outcomes depends on Learning group
discussion Model and PBL in Course Pregnancy On Obstetrical care On Program
Diploma
The data table consideration above can show that higher value on Group Problem Based
Learning. Group discussion not show that the higher value for the learning outcomes in
course pregnancy on obstetrical care. And it show that PBL more effective to increase
learning outcomes.
Diagram 1 The research of The Difference of Learning Outcomes depends on Learning
group discussion Model and PBL in Course Pregnancy On Obstetrical care On Program
Diploma
From the histogram considered above higher value show on PBL student. And the
student in group discussion not show that have higher values. It show that PBL more
effective than group discussion.
ANALYSIS
PBL was a adult learning. Adult
Learning was learning based on considered
a problem learning in contextual problem
thus stimulating student to learning, this
model give student more motivating for
learning(Claire, et all, 2001) in learning
outcomes show that there was different
learning participation student depend on
PBL model and group discussion. The
statistic result show that P=0,014, it means
there was different PBL and Group
discussion. The research result show that
PBL give Good indicator amount of 9
people than group discussion amount 4
people. Indicator least once on PBL
nothing, in group discussion indicator least
once amount 4 people. This was due
because the participation learning on PBL
show good quality to expression opinion in
course Pregnancy obstetrical care. The
contribution expression opinion was very
important. It show in participation chart
amount 20 people just 1 doubters in
expression opinion. In Group discussion 4
people doubters that opinion. Many things
effect participation learning accept student
consentration. Other affect was technical
factor from learning model. The research
show that learning model affect the
participation. In PBL based on considered
adult learning it means actif to find more
experience with learning source, which
centered student, if the adult learning used
give more motivating for student learning.
Group PBL consist tutor, chairmain, and
members. The tutor excite, motivating the
members to think critical and to pay
attention. Chairman members also officiate
set a time (Saptono, 2003; karim, et all
2007;Sudjana,2004; Suradjiono, 2004)
Effectivenss of Model PBL show that
member name Riski Dwi A(score 5) from
PBL group have good participation be
compared ST widatul jannah have enough
participation (score 3). The name of
members veni antikasari from Group PBL
have least participation (score 2). Not beter
than tika epiana from group discussion
have good participation (score 4). But the
outline Model PBL more effective to
increase participation learning.
The research show that any
different mean and median, learning
outcomes PBL between group discussion.
Learning Outcomes mean with PBL more
higher than learning outcomes group
discussion.The statistic result show
(t:0,00)signivicants. About that same in the
teory that show learning outcome get from
436
the effort to find mastery knowledge and
basic skiil in various in life aspect, so it
seems in individualism about the used
values attitude, knowledge and basic skill
change attitude quantitatively. To change
learning outcomes more better, must to
used good learning model, like a problem
based learning. This learning model
demand the student to more active than
before in learning process. PBL was
outanding factors to influence learning
outcomes(sudjana,2004).
The result show that any
difference significant from learning
outcomes.In Group discussion show
learning outcome score 46-50 amount 8
people. And PBL amount 4 people.
Altough this score not good but it show
that PBL more effective than group
discussion. In half score 60 point show that
PBL amount 7 people and group
discussion amount 1 people. Higher scre
getting Group PBL amount 4 people. And
than group discussion nothing at all for
getting higher score.
CONCLUSIONS
Any different significant with
different result test used t-test (t:0,00)
between learning outcomes PBL with
group discussions in course pregnancy on
obstetrical care. It show that PBL more
better than group discussions. And in fact
that PBL more efective to increase learning
outcome.
ACKNOWLEDGEMENT
The limitation of this study was
the researcher cannot controll the
confounding factor that can influence the
result.
REFERENCES
Alimul, A. 2007. Metode Penelitian
kebidanan & Tehnik Analisa data.
Ali Muhammad. 2004. Dasar-dasar
Proses pembelajaran. Bandung:
Sinar Baru Algesindro
Bondan, D. 2011. Mengembangkan
softskiil siswa melalui
pembelajaran Matematika berbasis
masalah. Skripsi Pendidikan
Matematika Universitas Negeri
Yogyakarta.(Unpublished)
Claire, Major, Palmer. 2001. Assessing the
effectiveness of Problem Based
Learning in Higher Education.
Cambridge:
Cambridge
University Press.
Depkes. 2002. Komunikasi efektif . USAID
IBI.
Duch, B. 1995. Problem A Key Factor in
PBL. England.
Evan, G. 2001. Problem based Instruction
In M Orey(edt) Emerging
Prespective
on
Learning
Teaching And Technology.
Hastuti Noer, Rosyidin, Fadiawati Noor,
Hasnundiyah Neni. 2011.
Mengembangkan Soft skill siswa
melalui pembelajaran matematika
berbasis masalah.
Prosiding
Seminar nasional pendidikan
MIPA. Bandar Lampung
Helen, V. 2001. Varney Pocket Midwives
in Endah Pakaryaningsih(edt).
Jakarta:EGC.
Ign M. 1995. Penilaian hasil belajar Siswa
di sekolah. Yogyakarta :
Konisius.
Karim, S, Noor Suheniana. 2007.
Penerapan
pendidikan
pembelajaran berbasis masalah
untuk meningkatkan penguasaan
konsep
fisikan
serta
mengembangkan ketrampilan
berpikir tingkat tinggi dan ke
Cakapan ilmiah. Proposal Hibah
Kompetitif UPI. 2007. Bandung:
Tidak Diterbitkan.
Limbong thabitha. 2008.
Gambaran
karakteristik penderita abortus
inkomplit Di RSU Daerah Kota
Mamuju. Jurnal media Kebidanan
Poltekkes Makasar.
Manampiring, A. 2008. Prevalensi Anemia
dan tingkat kecukupan zat besi
pada anak sekolah dasar di desa
Minahasa. Lapran penelitian
untuk penelitian Dosen Fakultas
Kedokteran Sam Ratulangi.
Manado.
Mandriwati, GA. 2008. Asuhan Kebidanan
Ibu Hamil. Jakarta: EGC
437
Muhson Ali. 2009. Peningkatan Minat
Belajar dan pemahaman masalah
melalui penerapan Problem based
learning.
Jurnal pendidikan
Volume 39 No 2 november 2009
hal 171-182.
Nana, S. 2005. Dasar-dasar Proses belajar
mengajar. Bandung: Sinar Baru
Algesirdo.
Prawirohardjo, S. 2003. Ilmu Kebidanan.
Jakarta: PT Bina Pustaka
Sarwono.
Pusat Pendidikan Tenaga Kesehatan. 2003.
Asuhan Kebidanan kehamilan.
Jakarta.
Purwanto. 1990. Evaluasi Pendidikan.
Bandung: Lembaga Penelitian
IKIP Bandung
Pusdiknakes. 2001 Buku Asuhan antenatal.
WHO:JHPEG.
……………... 2001.
Konsep Asuhan
Kebidanan. WHO:
JHPEG
RSUD. Dr. H. Soemarno Sosroatmodjo .
2010. Standard Pelayanan Medik
Obstetri dan Ginekologi.
Departemen kesehatan Kuala
Kapuas.
Rustam M. 1998. Sinopsis Obstetri.
Jakarta:EGC.
…………. 2000. Sinopsis Obstetri Jilid II
deteksi dini adanya komplikasi hal 290300. Jakarta: EGC;.
Sabrina, Junaidi Edy, Hannah Fadhilah.
2010. Farmakoterapi “Anemia”.
Program studi Farmasi &
Komunitas Sekolah Farmasi
Institut Teknologi Bandung.
Saifudin, Bari, Abdul. 2002. Panduan
Praktis Pelayanan Kesehatan
Maternal
dan
Neonatal.WHO:JHPEG
Sagala, S. 2007. Konsep dan Makna
Pembelajaran. Bandung :
Alfabeta
Saptono, R. 2003. Is Problem based
Learning (PBL) a better
approach for engginerring
education?CAFEO-21
(21st
Conference of the Asian
Federation
Of Engginering
Organisation). Yogyakarta 22-23
Oktober 2003.
Subagyo, Suharto Agung, Winarsih Dyah.
2011. Hubungan antara anemia
dalam kehamilan dengan kejadian
BBLR di RSUD Dr Soeroto Ngawi
tahun 2011.Ponorogo.
Sudjana, D. 2004. Model Pembelajaran
Pemecahan Masalah. Bandung:
Lembaga penelitian IKIP Bandung.
Sudjana, N. 2005. Dasar-dasar Proses
belajar mengajar. Bandung: Sinar
Baru Algesirdo.
Sugiyono. 2012.
Metode penelitian
Pendidikan (pendekatan kuantitatif,
Bandung:
kualitatif,
R&D).
Alfabeta.
Sunarto, Santoso Heru, Nugroho Heru,
Sunarko Heru. 2012. Hubungan
kejadian anemia kehamilan dengan
kejadian perdarahan post partum di
Poned Ngawi. Jurnal penelitian
kesehatan suara Forikee Volume III
no 2 April 2012.
Suprihatiningsih. 2009. Faktor-faktor yang
berhubungan dengan komplikasi
kehamilan pada Ibu hamil. Jurnal
Kesehatan Metro SaiWawai Vol II
No 1 Edisi Juni 2009.
Suprijono, Agus. 2009.
Cooperative
earning Teori dan Aplikasi
PAIKEM. Yogyakarta: Pustaka
Pelajar.
Suradijono, SHR. 2004. Problem Based
Learning Apa dan bagaimana
Makalah Seminar”Penumbuhan
Inovasi Sistem Pembelajaran
Pendekatan Problem Based
Learning Berbasis ICT (Information
& Communication Technology)”
Yogyakarta: 15 Mei 2004.
Sweet B.R. 1997. Mayes Midwifery.
Jakarta: EGC
Varney. 1997. Varney Midwifery. Jakarta:
EGC
Wiknjosastro, H. 2002. Ilmu Kebidanan.
Jakarta: PT Bina Pustaka Sarwono.
Wildan, Moh. 2008.
Dokumentasi
Kebidanan. Jakarta: Salemba
Medika
Yuni Kusmiyati, Puji Heni, Sujiyanti.
2008. Perawatan ibu Hamil.
Yogyakarta: Fitramaya.
438
439
THE CORRELATION OF KNOWLEDGE AND ATTITUDE WITH
"Tarak" CULTURE OF POSTPARTUM MOTHERS IN WONODADI
BLITAR
Ning Arti Wulandari, Zaenal Fanani.
STIKES Patria Husada Blitar
Abstract
Indonesia is a multicultural society. Each region has a different culture that is embraced
by the trust from the previous generation."Tarak" on postpartum mothers is a habit of not
eating chicken dishes, meat, eggs and certain other foods, fearing the wound did not heal
and their infants vomiting after breastfeeding. Cultural aspect is very important to
facilitate in providing nursing care. The purpose of this research was to identify
correlation between knowledge and attitude with a culture of "tarak" in the postpartum
mothers at Wonodadi Blitar.
The design of this research was crossectional with a sample of 40 mothers in the
postpartum at Wonodadi Blitar taken by Consecutive sampling with inclusion criteria:
maternal postpartum phase of letting go. The variable in this research was the knowledge,
attitudes about postpartum maternal nutrition and culture "tarak". The instruments used
questionnaire. The result by Spearman rank analysis showed no correlation between
postpartum maternal nutritional knowledge of the culture of incontinence with a value of
ρ = 0, 658, correlation between attitude and cultural behavior "tarak" with the value ρ =
0.01. eventhough the level of knowledge of mothers of postpartum in nutrition was good
but it did not guarantee that the mother did not follow the culture of "tarak", this is in
accordance with Manurung (2012) that culture is not only influenced by the knowledge
but also a strong belief. While the attitude is a feeling that followed the tendency to act so
that the attitude of postpartum mothers have a correlation with the "tarak". Therefore, the
role of nurses is very important in reconstructing the culture of "tarak".
Key Word: Knowledge, attitudes, culture "Tarak", postpartum mothers
Background
Post partum period called postpartum or
puerperal period is a period or time since
the baby was born and the placenta comes
out until the next six weeks, accompanied
by the restoration of the organs associated
with the content, which changes as injury
and other related
During childbirth ( Suheri . Et al , 2008) .
While the purpose of the provision of care
during childbirth, according Saleha (2009),
among others maintains the health of
mother and baby, detect problems; write
your health education and providing family
planning
services.
Maternal care
community is very important in this
regard. In nursing theory, saw man should
nurse holistic in providing nursing care.
Differences in cultural values is also part
of a holistic human
Indonesian society is a multicultural
society. Each region has a different culture
that is embraced by the trust from previous
generations. Many people who believe in
the culture of previous generations because
the culture was obtained from parents who
think they have more experience. With this
belief they are convinced that the behavior
he does will bring positive results and
beneficial to their health. Not all
treatments are performed based on the
heritage can be fully accepted, could have
carried out such treatments provide less
favorable health outcomes for mother and
baby (Manurung, 2009). Behavior or
habits that harm eg nursing mothers are
prohibited from eating foods that fishy eg
fish, eggs and others because the baby will
441
sweat odor. Postpartum mothers are
prohibited nap. Post partum mothers had to
sleep sitting or half-sitting for fear of bad
blood rose to the eye (Mubarak et al,
2012). Based on the preliminary research
conducted in September 2012 in the
Cempaka (space Ruling) Hospital Ngudi
Waluyo Wlingi obtained 15 of the 22
mothers postpartum do not want to eat
chicken dishes, meat and eggs because
their parents forbid fearing the wound did
not heal and their breastfeeding infants
vomiting. Based on interviews with the
head of the room, the nurse had provided
health education about the importance of
nutrition to patients‟ post-partum mothers.
Some elements involved in the sociocultural according to Mubarak, et al (2012)
among other things: knowledge, belief, art,
morals, law, customs and abilities as well
as custom made by the community.
Knowledge has a profound influence on
health. Likewise, related public confidence
about the care of the sick is very influential
on the public health level. Culture is the
behavior resulting from human perception,
behavior that would be stronger if it is
based on the powerful stance anyway.
Medeleine Leininger developed the
concept of transcultural nursing, bringing
the role of cultural factors in nursing
practice into the discussion on how to
provide nursing care according to need.
According Leinenger (1978) transcultural
nursing is a nursing service berfocus on the
behavior of individuals or groups, as well
as the process to maintain or improve
health behavior and the behavior of
physical pain and psikokultural provided to
clients in accordance with the cultural
background (Tommey and Alligood,
2006). Swasono Statement (1998) in
Manurutng (2009) argue that there are
some people kepercayaaan value
associated with post partum care, with
knowledge of the cultural aspect is
important to be known by health workers
to facilitate the approach to providing
health care. This of course requires special
attention to overcome. According to
nursing theory leineinger medeline there
are several strategies are in use in
providing nursing care, among others
maintaining the culture, the culture of
negotiation and change the culture
(Tommey and Alligood, 2006). From the
description above, the researchers wanted
to identify how the correlation between
postpartum maternal nutritional knowledge
and attitude to culture "incontinence" in
postpartum mothers in Wonodadi Blitar
METHODS
The research design used cross sectional, which connects between knowledge and culture
"incontinence" and attitude with a postpartum mother culture "incontinence" in the
mother postpartum. Knowledge in this research was knowledge about postpartum
maternal postpartum maternal nutrition, attitude in this research is the attitude of
postpartum mothers in meeting their nutritional culture whereas "incontinence" was the
behavior not eats tempeh, tofu, egg, chicken, meat/ goat, fish freshwater and saltwater
fish. The sample in this research was 40 people listed in the postpartum maternal health
centers Wonodadi. The sample in this research were drawn in a way convenient sampling
with inclusion criteria postpartum mothers who are already in the phase of letting go, the
mother and the baby does not have a particular disease and do not have allergies to
certain foods. This research was conducted from September 26 to October 6, 2014.
RESULTS
Postpartum maternal characteristics in
Blitar Wonodadi as many as 40 people as
in the table below:
Table 1 Postpartum maternal characteristics in
Wonodadi -Blitar
442
characteristics of Respondents
Age
≤ 20 years
21-30 years
31-40 years
41-50 years
Education
Elementary School
Junior High School
Senior High school
Prioriy to
Primipara
Multipara
Occupation
Housewife
Privat employees
3
16
20
1
7
18
15
14
26
36
4
Information about postpartum
maternal nutrition
No
Ever
Table 2
30
10
Table 3 above shows that 43 % of
respondents have a good attitude towards
nutrition postpartum mothers and 20 % of
8% respondents had a very bad attitude
40% towards the fulfillment of postpartum
50% maternal nutrition.
2%
Table 4 Frequency distribution of " Tarak "
culture in postpartum mothers
17%
45%
38% Culture " Tarak "
Frequ percen
tage
ency
(%)
35%
9
23%
65% Do not follow the culture of "
Tarak "
90% Following some cultures
"
5
13%
10% Tarak "
Following culture " Tarak"
26
64%
overall
%
75%
25% Based on Table 4 above shows that the
majority of 64 % of respondents follow the
culture of “tarak” and only 23 % who do
not follow the culture of “Tarak”
The frequency distribution of
knowledge about postpartum
Table 5
maternal on postpartum
maternal nutrition
Pengetahuan
Good
Sufficient
f
Frekuensi
15
25
The correlation between
postpartum maternal nutritional
knowledge of the culture of
Tarak" postpartum mothers
Persentase
(%)
Culture
37%
" tarak "
63%
Table 2 above shows that most respondents Followin
have sufficient knowledge of as many as g culture
25 people ( 63 % )
" Tarak "
overall
Table 3 Frequency distribution attitude
postpartum maternal postpartum Followin
maternal nutrition in meeting g some
cultures
attitude
frequency
percentage
" Tarak "
(%)
43%Do not
17
Good
15
38%follow
Sufficient
8
20%the
Bad
culture of
443
Knowlegdement
Good
Sufficie
nt
Total
N
1
6
(%)
40
N
1
0
(%)
25
N
2
6
(%)
65
2
5
3
8%
5
12
7
18
2
5
9
23
"
ρ
0,658
have sufficient knowledge anyway, it was
evident that one of the factors affecting the
level of knowledge is education. In
addition to educational information is also
Table 5 above shows that the Spearman
greatly affect a person's knowledge. Based
rank test results obtained value of ρ = 0658
on Table 1 of the 40 respondents 75% had
which means that there is no correlation
never received information about
with postpartum “tarak “ culture .
postpartum maternal
nutrition.
The correlation between with a postpartum
Table 6
Information could be received from
maternal nutrition of“tarak” culture in
the media or health workers, in this
postpartum mothers.
case the role many are nurses.
Therefore Wonodadi PHC nurses
"Tarak”
Attitude
Total
ρ
should provide health education
Culture
Bad
Not
Good
particularly on postpartum maternal
good
nutrition.
N % N % N % N %
Following
1 3 3 8 8 2 2 65
Postpartum Maternal Attitude In
culture "
5 8
0 6
Meeting Nutrition
Tarak "
overall
Table 3 shows that postpartum
0,01
mothers who have a good attitude as
much as 43%. According
Following
0 0 4 1 1 3 5 12
Notoatmodjo (2010) knowledge,
some
1
thoughts, beliefs and emotions play
cultures "
an important role in determining the
Tarak "
attitude intact. These results strongly
support the theory tersbut, of the 17
Do not
0 0 1 3 8 2 9 23
respondents who have a good
follow the
0
attitude, 12 have a good knowledge
culture of "
anyway. According to the theory
Tarak”
Anwar (2007) health communication
using the design principles of
teaching is one of the efforts to foster an
Table 6 above shows that the Spearman
attitude. The theory is supported by the
rank test results obtained value ρ = 0.01 ,
results of this research, based on table 1
which means that there were correlation
postpartum mothers who never get
between attitudes in nutrition with a
information about postpartum maternal
postpartum mother " tarak"culture
nutrition as much as 75%. Information
obtained through communication poses.
Knowledge About Nutrition Maternal
Communication is the exchange of
Postpartum Maternal Postpartum With
thoughts, feelings and opinions and give
Cultural "Tarak"
advice in which occur between two or
more
people
work
together.
Table 2 shows that most respondents
Communication is also an art to compose
(63%) have sufficient knowledge about
and deliver a message in a way that is easy
postpartum maternal nutrition. One's
so that others can understand. Therefore,
knowledge according Notoadmodjo (2010)
health professionals, especially nurses play
could be affected by several external
an important role in changing attitudes in
factors, namely, education, information
meeting the nutritional postpartum
and experience. Based on Table 1 of the 40
mothers. Providing health education
respondents were educated terakir SPM as
through the media and attractive method is
many as 18 (45%) of the 18 respondents 15
the right way to make it easier to
who have enough knowledge. While
respondents were educated last 7 SD whole understand the postpartum mother and
" Tarak
444
motivated to apply. If the postpartum
mother can understand very well it will
form a good attitude as well. Of a good
attitude will have a tendency to behave
well.
“Tarak " Culture Of Mother Postpatum
Indonesian society is a multicultural
society. Each region has a different culture
that is embraced by the trust from previous
generations. Many people who believe in
the culture of previous generations because
the culture was obtained from parents who
think they have more experience. With this
belief they are convinced that the behavior
he does will bring positive results and
beneficial to their health. Culture is the
behavior resulting from the perception of
cultural manusia.Masyarakat Wonodadi
Blitar have in providing care to mothers
postpartum, one of which is the culture of
"tarak". Culture "incontinence" behavior is
not consuming all kinds of proteins, among
others; do not eat meat beef or mutton,
chicken, eggs, tempeh, tofu, fish,
freshwater and marine fish. Blitar
Wonodadi community considers consume
meat, chicken, eggs, fish, freshwater and
saltwater fish will lead to the failure of
wound healing. While consuming tempe
and tofu would result in accumulated dirt
eye on breastfeeding infants. Culture
"tarak" adopted Wonodadi Blitar society is
very contradictory to the theory Widasari
(2009) which says that the fulfillment of
adequate protein will help the healing
process.
Based on Table 4
shows that 26
respondents (65%) followed tarak overall
culture, which means did not take all of the
above proteins. While 5 respondents (13%)
follow some cultures continence which
means do not consume any animal protein?
According to nursing theory leineinger
medeline there are several strategies are in
use in providing nursing care, among
others maintaining the culture, the culture
of negotiation and change the culture
(Tommey and Alligood, 2006). Based on
the theory Wonodadi PHC nurse can
provide nursing care to negotiate a culture
at 65% of respondents who follow the
culture of "tarak" as a whole by providing
knowledge that protein is essential for
wound healing and nutrition to the baby.
While the 13% who follow some cultures
"tarak" could be given nursing care to
maintain the culture or the culture of
negotiation because although postpartum
mothers do not consume animal protein,
the protein needs met mothers of vegetable
protein.
Correlation
Between
postpartum
maternal nutritional knowledge of the
culture of “tarak”
Based on Table 5 shows that the test
results obtained with the Spearman rank ρ
value > 0.05, which means that there was
no correlation between postpartum
maternal nutrition to the culture of “tarak"
. Some elements involved in the sociocultural according to Mubarak , et al (
2012) among other things : knowledge ,
belief , art , morals , law , customs and
abilities as well as custom made by the
community . Knowledge has a profound
influence on health. The theory is not in
accordance with the results of this research
, 65 % of respondents who follow the
culture of " tarak " overall , 40 % have a
good knowledge of postpartum maternal
nutrition . Such conditions show that other
elements , namely trust, tradition and
habits Wonodadi community was very
strong against the culture of " incontinence
.
Wonodadi public confidence towards
“tarak “ culture strong need special
attention . According Leinenger (1978 )
transcultural nursing is a nursing service
berfocus on the behavior of individuals or
groups , as well as the process to maintain
or improve health behavior and the
behavior of physical pain and psikokultural
provided to clients in accordance with the
cultural background ( Tommey and
Alligood , 2006) . According to the
research most of respondents who embrace
the culture of “tarak " have a good level of
knowledge about postpartum maternal
nutrition , so that according to nursing
theory transkultur cultural negotiation not
only to individuals but also families who
care for postpartum mothers . Negotiations
445
culture can be done by providing
counseling to families or even society at
large about the importance of postpartum
maternal nutrition.
Correlation Between Attitude In
Meeting With Postpartum Maternal
Nutrition Culture “Tarak”
Based on Table 6 shows that the test
results with rank Spearman ρ value < 0.05 ,
which means that there was a correlation
between attitudes in meeting with a
postpartum maternal nutrition culture "
tarak " . According B.Karr Snehandu
(1983 ) in Notoadmojo (2010 ) or the
resultant behavior was the result of the
stimulus ( external factors ) and response (
internal factors ) in the subject or The
person who behaves . While culture was
the behavior resulting from human
perception .
According to the theory lawrence Green in
Notoatmojo (2010 ) said that behavior to
own some of the factors that influence it ,
among others praktor predisposing factors
that allow
and amplifier factors .
Predisposing Factor of behavior such as
knowledge, attitudes, beliefs, beliefs ,
values , traditions and so on . The theory
was in accordance with the results of this
research , 65% of postpartum mothers who
embrace the culture of " tarak " overall 38
% had a very bad attitude and 8 % had a
bad attitude towards the fulfillment of
postpartum maternal nutrition .
Based on the results of the research 75 %
had never received information about
postpartum maternal nutrition. This is
consistent with the theory that some of the
factors that facilitate the occurrence of
behavior was the facility in infrastructure
or health behaviors. Therefore, the role of
health personnel on duty at the health
center Blitar Wonodadi very important to
negotiate on the culture of “tarak " . It was
also proven from the results of this
research of 65 % of respondents who
follow incontinence culture overall 40 %
had good knowledge about nutrition
postpartum mothers and 20 % of
respondents have a good attitude towards
the fulfillment of nutrition , but they still
behave " tarak " . This was because the
huge belief in the culture of “tarak“ in
Wonodadi Blitar .
Conclusions
1. There were no correlation between
postpartum maternal nutrition to the
culture of " tarak " postpartum
mothers in Wonodadi Blitar
2. There were correlation between
attitudes in meeting with a postpartum
maternal nutrition culture " tarak "
postpartum mothers in Wonodadi
Blitar
ACKNOWLEDGEMENT
The instrument not yet passed by validity
and reliabily test.
We cannot control honesty of respondent
because of researcher little interaction with
them during resesearch and may they not
yet belief with us.
REFERENCE
Azwar, saiffudin.2007. Sikap
Manusia,teori
dan
pengukurannya.
Yogyakarta.Pustaka pelajar
Depkes
RI.
2009.Pedoman
Pelaksanaan Kelas Ibu Hamil.
Jakarta.
Dirjend
Bina
Kesehatan Masyarakat
Manurung, Yunani Dewi. 2009.
perawatan Post Partum
Menurut Perspektif Budaya
Jawa.
Sumatera Utara.
Universitas Sumatera Utara
(skripsi)
Mubarak, dkk. 2012. Pengantar dan
Teori Ilmu Sosial Budaya Dasar
Keperawatan. Jakarta: EGC
Notoatmodjo, Soekidjo. 2010.
Promosi kesehatan teori dan
aplikasi. Jakarta: Rineka Cipta
446
Nursalam. 2008.
Konsep dan
Penerapan
Metodologi
penelitian Ilmu Keperawatan.
Saifudin dan Yusuf. 2010.
Nikmatnya seks islami. Hal.
116. Yogyakarta: pustaka
Marwa
(Anggota IKAPI).
(ebook online)
Saleha, sitti. 2009.
Asuhan
Keperawatan pada Masa Nifas.
Suherni, dkk. 2009. Perawatan Masa
Nifas. Yogyakarta: Fitramaya
Supatemi Yeni (2013). Struktur
budaya dan sosial ibu post
partum berdasarkan pendekatan
teori
keperawatan
transkultural
medeleine
leininger di kecamatan
wonotirto. Stikes Patria Husada
Blitar. (Skripsi)
Syaifudin A, dkk. (2006). Buku Acuan
Nasional Pelayanan Kesehatan
Maternal dan Neonatal.
Jakarta: YBPSP
Tommey and Alligood. (2006).
Nursing Theorist and Their
Work.
Philadelphia USA:
Mosby.
Wong,D.L,
Hockenberry M, Wilson,D,
Winkelstein,M.L,
&
Schwartz,
P.(2002). Buku
Ajar Keperawatan Pediatrik
Wong, Ed 6, Vol I.Alih
Bahasa
Agus
Sutarna.
Jakarta:EGC.
447
OVERVIEW OF FATIGUE IN CANCER PATIENTS
WHICH UNDERGO CHEMOTHERAPY
Ulfa Khusnul Fata
Nursing Study Program of STIKes Patria Husada Blitar
Jl. Sudanco Supriyadi 168 Blitar, Jawa Timur
Abstract
One of the side effects of chemotherapy in cancer patients is fatigue. Fatigue is a feeling of
tired, exhausted, or lack of energy that can that may take in several days, weeks, or months.
The purpose of this study was to identify fatigue on cancer patients which undergo
chemotherapy. The population of this study was adult cancer patients that undergoing
chemotherapy in the Dharmais Cancer Hospital Jakarta. The research method was
descriptive with a sample size of 95 respondents. The sampling technique used consecutive
sampling. The data collection used questionnaires by respondents and accompanied by the
researcher. The result of this study showed that 53 (55.8%) of respondents experienced mild
fatigue, and 42 (44.2%) of respondents experienced severe fatigue. Fatigue in cancer patients
undergo chemotherapy often causes by physical and psychological problems. The
predisposing of fatigue in patients undergoes chemotherapy including cancer burden,
treatments of cancer, nutritional problems, infections, and psychological factors including
depression, anxiety, and stress. Therefore, identification of the causes of fatigue is needed to
prevent more severe fatigue in cancer patients undergo chemotherapy.
Keywords: cancer, chemotherapy, fatigue
The experience of fatigue in 90%
cancer patients at some point during the
course of their illness and it has been
noted to worsen when cancer treatment
begins (Barnes & Bruera, 2002; Escalante
et al., 2001; Yeşilbalkan, ȌU.,
Karadakovan, A., & Gőker, E., 2009).
Diminished performance status and the
presence of disease-related symptoms
often cause fatigue before treatment with
chemotherapy (Grant, Golant, Rivera,
Dean, & Benjamin, 2000; Yeşilbalkan,
ȌU., Karadakovan, A., & Gőker, E.,
2009), but fatigue also can be worsened
by pain, anemia, sleep disturbance, and
nutritional, mood, and activity issues
(National Comprehensive Cancer
Network [NCCN], 2008; Yeşilbalkan,
ȌU., Karadakovan, A., & Gőker, E.,
2009).
Patients who experience severe
and persistent fatigue have a truly
impaired quality of life, as this condition
affects their social activities, leisure time,
work and responsibilities (Romito et al.
2011).
BACKGROUND
Fatigue is a common symptom in
patients with cancer (Piper et al. 1998 ;
Yeşilbalkan, ȌU., Karadakovan, A., &
Gőker, E., 2009). According to The
National Comprehensive Cancer Network
(NCCN), Cancer Related Fatigue (CRF) is
a “distressing persistent, subjective sense
of tiredness or exhaustion related to
cancer treatment that is not proportional to
recent activity and that interferes with
usual functioning” (Mock et al., 2007, p.1
; Given, B., 2008).
Compared
with
fatigue
experienced by healthy individuals,
cancer related fatigue is more severe,
more distressing, and less likely to be
relieved by sleep or rest (Kwak, SM., et
al., 2011).
The incidence of fatigue among
patients with cancer is well-documented,
with 75%-99% of patients who undergo
chemotherapy describing it as increasing
with every cycle (Nail & Jones, 2001 ;
Kuchinski, AM., Reading, M., Lash, AA.
2009).
448
Factors contributing to fatigue are
surgery, chemotherapy,
pain, sleep
disturbance, anemia, gastrointestinal
disturbance, and emotional distress
(Anderson, N.J., & Hacker, E.D, 2008).
Fatigue has a significant impact on the
overall quality of life. In the fatigue study,
of the 419 patients with cancer who
participate in a telephone interview, 78%
experienced fatigue during the course of
their treatment. Fatigue adversely affected
patients in their daily lives more than did
pain (61% vs 16%). The fatigue study
involved a telephone survey of 379
patients with cancer who had previously
received chemotherapy. Seventy-six
percent of the patients reported
experiencing significant fatigue at least a
few days each month during their most
recent chemotherapy cycle (Errihani, H,
& Tazi, EM, 2011).
Until now, overview of fatigue
overview in cancer patients undergoing
chemotherapy still necessary to developed
in Indonesia. Therefore, based on the
description above, author interested in
conducting research on the description of
fatigue incancer patients undergoing
chemotherapy.
The general purpose of this study was to
describe of fatigue in cancer patients
undergo chemotherapy in inpatient unit
and ambulatory short of care Dharmais
Cancer Hospital Jakarta.
Whereas the specific purposes of
this research are: 1) indentifyng fatigue in
cancer patients undergo chemotherapy, 2)
identify the age, Hb, stage of cancer, types
of chemotherapy, cycles of chemotherapy,
sex, type of cancer, pain, sleep quality,
nausea and vomiting, anxiety, depression,
physical activity in cancer patients
undergo chemotherapy.
Schwartz Cancer Fatigue Scale which is a
questionnaire to assess fatigue in cancer
patients.
Researchers identify potential
respodents with medical records that are
ajusted to the inclusion and exclusion
criteria. Then, the questionnaires filed out
by respondents with assisted by
researchers. Data analysis was to know
the description of fatigue in cancer
patients undergo chemotherapy.
RESULT
Table 1.
Distribution of respondents by age and
hemoglobin levels in the Dharmais
Cancer Hospital, June 2013 (n = 95)
Varia
ble
Mea
n
Medi
an
SD
Age
45,5
4
46,0
0
10,1
02
10,8
81
10,6
00
1,37
98
Mi
n–
M
ax
21
65
95%
CI
43,4
8;
47,5
Hb
6.3
–
13,
8
10,5
99 ;
11,1
6
Table 1 describe the results of the
analysis of the mean respondents age in
this study was 45,54 ± 10,102 years (95%
CI: 43,48 ; 47,49) with the age range of
21 – 65 years. While the average level of
haemoglobin range of 6,3 g/dl -13,8 gr/dl.
Table 2.
Distribution of respondents by sex and
types of cancer in the Dharmais Cancer
Hospital, June 2013 (n = 95)
Variable
Frequency Percentage
Gender
Male
26
27,4
69
72,6
Female
RESEARCH METHODS
This study was descriptive. The
sample was cancer patients undergo
chemotherapy at the Dharmais Cancer
Hospital Jakarta in 2013 and the number
of sample was 95. The samplin methode
used consecutive sampling with inclusion
and exclusion criteria. Instruments used in
this research was Questionnaire Revised
Types of
cancer
Ca
Mammae
KNF
LNH
Ca Kolon
449
37
13
10
6
5
4
38,9
13,7
10,5
6,3
5,3
4,2
Variable
Ca
Ovarium
Ca Cerviks
Another
Frequency
20
stadium 3 of 52 respondents (54.7%). The
following analysis data result obtained
types of chemotherapy combination of
FAC as much as 29 respondents (30.5%),
and nearly half undergo cycles of
chemotherapy more than 4 reaching 28
Table 4.
Distribution of respondents by pain,
sleep quality, nausea and vomiting in
the Dharmais Cancer Hospital, June
2013 (n = 95)
Variable
Percentage
21,1
Table 2 describe the distribution
of respondents were female as much as 69
respondents (72.6%), as well as the
distribution of respondents by types of
cancer is breast cancer by nearly half as
much as 37 respondents (38.9%)
Table 3.
Distribution of respondents by stadium
of cancer, types of chemotherapy, and
cycles of chemotherapy in the
Dharmais Cancer Hospital, June 2013
(n = 95)
Frequenc Percentag
Variable
y
e
Stage of
Cancer
Stage 1
Stage 2
Stage 3
Stage 4
Types of
chemoterapy
FAC
Cisplatin
Paxus
Lain-lain
Cycles of
chemotherap
y
Cycle 1
Cycle 2
Cycle 3
Cycle 4
Cycle > 4
2
27
52
14
2,2
28,4
54,7
14,7
29
12
4
50
30,5
12,6
4,2
52,6
9
13
27
18
28
9,5
13,7
28,4
18,9
29,5
Pain
Nothing
Mild
Moderate
Severe
Sleep
Quality
Good
Bad
13
29
45
8
13,7
30,5
47,4
8,4
17
78
17,9
82,1
11
11,6
Nause and
33
34,7
Vomiting
Normal
37
38,9
Mild
11
11,6
Moderate
3
3,2
Severe
Worse /
Very severe
Table 4 descibe the distribution of
respondents by level of pain was obtained
almost half of the respondents
experienced moderate pain as much as 45
respondents (47.4%), and nearly all
respondents are poor sleep quality as
much as 78 respondents (82.1%). The
frequency distribution by nausea and
vomiting showed that nearly half of
respondents had experienced nausea and
vomiting in the category were as much as
37 respondents (38.9%).
Table 5.
Distribution of respondents by anxiety,
depression, and physical activity in the
Dharmais Cancer Hospital, June 2013
(n = 95)
Variable
Table 3 describe the distribution
of respondents standium of cancer was
450
Variable
Anxiety
Normal
Borderline
Abnormal
Depression
Normal
Borderline
Abnormal
Physical
Activity
Pasif
Minimal
active
Active
DISCUSSION
Describe of Fatigue in Cancer Patients
which Undergo Chemotherapy
The research result showed that nearly
half (44.2%) of respondents experienced
severe fatigue. Fatigue is common
symtom experienced by cacer patients and
cancer survivor. Fatigue may be defined
as a distressing, persistent, subjectives
sense of tiredness or exhaustion related to
cancer or cancer treatment that is not
proportional to recent activity and
interferes with usual functioning. Fatigue
is multidimensional symtom because it
ecompasses physical, mental, and
emotional aspects. Patients can experience
fatigue anywhere along the spectrum of
cancer care (Escalante & Manzullo,
2009). Several factors play the occurence
of fatigue, however, no specific
pradictivefactors have been indentified in
the literature. Age is consedired a
predictive factor though the evidence is
conflicting. Younger patients, les that 34
years do better that older patients.
Similarly, men men over 75 years of age
were found to experience 11 time more
fatigue thant their younger counterparts
(Narayan & Koshy, 2009).
34
35
26
35,8
36,8
27,4
59
20
16
62,1
21,1
16,8
33
42
20
21,1
44,2
34,7
Table 5 showed that almost half
of respondents experienced a borderline
anxiety as much as 35 respondents
(36.8%), and almost were not experience
depression as much as 59 respondents
(62.1%). The frequency distribution of
respondents by physical activity showed
that nearly half of the respondents
included in the category of activity
minimal as much as 42 respondents
(44.2%).
The mean age of respondents was 45,54
years old with the age range 21-65 years.
It was consistent the theory that older
people had of higher of fatigue than
younger. The age effect on the incidence
of fatigue because the higher a peson‟s
age, the ability to regenerate cells wil
decrease. It was may lead to the incidence
of fatigue in cancer patients receiving
chemotherapy.
CONCLUSIONS
1.
The result of the study showed that
the mean age was 45,54 years old
with the age range 21-65 years old.
While the mean of heamoglobin level
was 10.881 with the lowest value was
6.3 g/dl and the highest was 13.8
g/dl.
2. Overview the majority gander of
respondens (72.6%) were women.
The types of cancer was almost half
of teh respondents (38.9%) were
breast cancer, and the most (54.7%)
Table 6.
Distribution of respondents fatigue in
the Dharmais Cancer Hospital, June
2013 (n = 95)
Variable
Fatigue
Mild
53
55,8
fatigue
42
44,2
Severe
fatigue
Table 6 showed that almost half of the
respondents experienced severe fatigue
that was 42 respondents (44.2%).
451
were stage 3. The types of
chemotherapy were received almost a
half of respondent (30.5%) was a
type of FAC chemotherapy
combination.
3. Almost a half (44.2%) of respondents
experinceing mild fatigue and almost
a half (47.4%) of respondents had
moderate pain. Sleep quality of
respondent (38.9%) experienced
mdoerate nausea and vomiting.
REFFERENCES
Anderson, N.J., & Hacker, E.D. (2008).
Fatigue in Women Receiving
Intraperitoneal Chemotherapy for
Ovarian Cancer: A Review of
Contributing Factors.
Clinical
Journal of Oncology Nursing, 12(3),
445-454.
doi:
caac.20073
[pii]10.3322/caac.20073 [doi]
Errihani, H, & Tazi, EM. (2011).
Evaluation and Management of
Fatigue in Oncology: A
Multidimensional Approach. Indian
Journal of Palliative Care / May-Aug
2011 / Vol-17 / Issue-2.
Escalante, C.P., & Manzullo, P.J. (2001).
Cancer-Related
Fatgiue: The
Approach and Treatment. Journal of
General Internal Medicine, 24, 412416.
Given, B. (2008).
Cancer-Related
Fatigue: A Brief Overview of Current
Nursing
Perspectives
and
Experiences. Clinical Journal of
Oncology Nursing
Volume 12
Number 5.
Kuchinski, AA., Reading, M., & Lash,
AA. (2009).
Treatment-Related
Fatigue and Exercise in Patients with
Cancer: A Systematic Review.
Medsurg Nursing. Vol. 18/No.3.
Kwak, SM., et al. (2011). The relationship
between interleukin-6,
tumor
necrosis factor-α, and Fatigue in
terminally Ill Cancer Patients.
Palliative Medicine 26(3) 275-282).
Narayanan, V., & Koshy, C. (2009).
Fatigue in cancer: A review of
literature. Indian Journal of
Palliative Care, 15(1), 19-25.
Romito, et al. (2011). Is Cancer Related
Fatigue more strongly correlated to
haematological or to psychological
Factors in cance patiens?. Support
Care Cancer (2008) 16.943-946.
Yeşilbalkan, ȌU., Karadakovan, A., &
Gőker, E. (2009). The Effectiveness
of Nursing Education as an
Intervention to Decrease Fatigue in
Turkish
Patients
Receiving
Chemotherapy. Oncology Nursing
Forum Vol. 36, No. 4.
452
IMPROVING NURSING STUDENTS’ SPEAKING SKILL
BY USING REALIA AS THE MEDIA
Wahyu Wibisono
STIKes PATRIA HUSADA BLITAR
Jln. Sudanco Supriyadi no.168 Blitar
Telp: 085649587182
ABSTRACT
English become the most important things in facing the issue of ASEAN
ECONOMIC COMMUNITY (AEC) especially in the health sector since english is one of
the international language use in asean. So, preparing medical employees with English
become a great issue to be solved. This study was intended to apply realia as the media to
improve students speaking skill.
The research design used in this study was collaborative Classroom Action
Research. The collaboration was done with one English teacher of STIKes Patria Husada
Blitar. This Classroom Action Research was implemented in one cycle only which
involved four stages namely planning, implementation, observation, and reflection. To
know how far the implementation of realia as the media in teaching writing were
successful, the researcher gained the data in the form of students‟ involvement during
teaching learning activity and speaking score in role play. To get those data, the
researcher used several instruments; those were observation checklist, field notes.
The finding of this study showed that by using realia as the media, the students
could speak and communicate much better than before when they were taught by using
other speaking instructions. In terms of the students‟ individual writing product, in
preliminary study, the number of students who passed the minimum passing grade (64)
was only 2 students (9.09%). On the other hand, in Cycle 1, all of the 22 students (100%)
could pass the minimum passing grade (64).
The improvement of students‟ writing skill was due to the use of realia as the
media in teaching speaking which consisted of several activities for the students so that
they were enthusiastic in joining the class. In addition, it was suggested for the lecturers
and/ or teacher to apply and modify this technique in their classes.
Keyword: realia, speaking skill
455
English become the most
important things in facing the issue of
ASEAN ECONOMIC COMMUNITY
(AEC) especially in the health sector since
english is one of the international
language use in asean. So, preparing
medical employees with English as early
as possible will be a the best way to face
the challenge. STIKes Patria Husada
Blitar is a medical college located on Jln.
Sudanco Supriyadi 168 Blitar. There are
two departments in this college: the
nursing department and the midwifery
department. Based on the curriculum book
of STIKes Patria Husada Blitar, English
is a compulsory subject which should be
taken by the students. This college
provides English courses for the students
which focus on the English for Academic
Purposes (EAP) (Panduan Pendidikan
Ners dan Bidan STIKes Patria Husada
Blitar, 2011). This course focuses
instruction on skills required to perform in
an English-speaking academic context
across core subject areas generally
encountered in a university setting. In this
EAP course, the students will be taught
vocabulary, grammar, and also the four
skills (reading, writing, speaking, and
listening) of English, but the English will
be tied up to meet the specific needs of the
students, in this case is English for
medical purposes. There are six English
courses in the nursing department and one
English course in the Midwifery
Department (Panduan Pendidikan Ners
dan Bidan STIKes Patria Husada Blitar,
2011).
Based on the researcher‟s
experience in dealing with the students in
STIKes Patria Husada Blitar, the EFL
students frequently get difficulties in
English. Among those difficulties,
speaking is considered to be difficult by
the students. Based on the observation, the
students had low motivation and were not
interested in the class. They felt that
speaking was a
difficult activity.
Moreover, the teaching learning process
was still insufficient in the classroom.
The first things which need to be
solved was the teacher‟s technique in
teaching writing because teacher played
an important role in managing the class so
that students would not get bored and also
feel excited on having a writing class.
Next, the condition of the teaching
learning process in the class should be
changed
into more cooperative
atmosphere between teacher and students
and among students and not competitive
atmosphere in order to create a conducive
teaching learning process in speaking
class.
In this research, the researcher is
interested in using realia as the media in
teaching speaking since he considered that
realia would be more effective than other
previous techniques which had been used
in speaking class. Realia is considered to
be effective in teaching speaking of
nursing students because the nursing
students were often exposed to the real
objects of medical instruments so that by
using realia, it is expected that students‟
motivation in speaking will increase.
Furthermore, they will also get benefit in
writing and practicing, so that they will
get both the speaking process and the
practicing process.
In this research, realia were used
as the media in teaching speaking of
procedure text. In order to increase the
understanding the concept of realia, many
experts have already made a definition of
realia. Celce-Murcia & Hilles (1988) state
that realia is objects of any origin used to
illustrate vocabulary and structure in the
L2. Furthermore, realia is concrete objects
and the paraphernalia of everyday life
(Zukowski-Faust, 1997). The examples of
realia are objects such as coins, tools, and
textiles that do not easily fit into the
orderly categories of printed material. In
education, realia are objects from real life
used in classroom instruction, so by using
realia students are exposed to the real
objects. A realia gives students the
opportunity to use all of their senses to
learn about a given subject, and is
appropriate for any grade or skill level. A
realia provides language learners with
multisensory impressions of the language
which, as Rivers (1983) notes, is "learned
456
partly at least through seeing, hearing,
touching, and manipulating" items.
Interaction with authentic materials aids in
contextually grounding instruction by
bringing students into contact with
language as it is used in the target culture
in order to meet actual communication
needs. The use of realia, then, can
enhance linguistic and cultural
comprehensibility, which are both
prerequisites for real language learning.
Realia has advantages and
disadvantages. Jones (1994) explains the
advantages of realia. First, realia which
deals with real things with which one will
interact in life is the best learning situation
possible. Second, real objects are plentiful
and available everywhere. Third, real
items can be observed and handled,
providing concrete learning experiences
for the student. Fourth, dealing with realia
motivates the learner. Fifth, realia can be
used as part of the evaluation system. The
last is realia learning can be extended
through the use of displays.
On the other hand, realia also has
disadvantages. First, real things are not
always readily available. Second, realia
are not always practical for use in the
classroom (size of a real object may be
too large for instance a submarine or too
small for instance a single human cell for
classroom study). Realia such as live
animals, certain electrical and mechanical
equipment, etc., can represent potential
hazards for the learner and the teacher.
Real objects often are expensive. Realia
need to maintain original structure (while
some realia can be dismantled, many
others cannot be, e.g., cutting open a
person to see how the heart functions.).
Third, affective learning is unpredictable
through realia. Fourth, if left sitting
around the classroom, realia can be a
distraction. The last is storage and
retrieval can create problems. The
researcher decided to choose realia as the
media in teaching writing because the
nursing instruments were available and
easy to be found in this college so that
teacher and students were found any
obstacles in finding and using the realia.
METHOD
The research is designed using
classroom action research which is
intended to solve a particular problem
encountered by a teacher in the teaching
and learning process, especially in the
teaching speaking. According to Harmer
(2001), action research is the name given
to a series of procedures which is engaged
by teachers to improve aspects of their
teaching, and to evaluate the success and
suitability of certain activities and
procedures. Burns (1999) also states that a
major focus of action research is on
concrete and practical issues of immediate
concern to particular social groups or
communities. Based on the statements
above, classroom action research is the
research that is held by the teacher in the
class and school where he/she teaches by
improving the process and teaching
practices.
A classroom action research
design is suitable as the research design in
this study because the researcher is an
English teacher who often finds some
problems faced by the students in
mastering the lessons. The students have
difficulties in speaking. Moreover, the
researcher tries to solve the problem. It is
in line with the basic point of the
classroom action research that is to
propose a strategy, technique, or media in
the teaching and learning process to
overcome the students‟ problem in
mastering a particular subject. In this
research, the researcher proposes using
realia as the media in teaching speaking.
Realia is considered to be suitable in this
research because realia has never been
implemented as the media in teaching
speaking in this college. The previous
studies proposed by Darojat (2011) and
Rokhmawati (2011) show that realia can
improve students‟ writing skill. In
conducting the research, the researcher
worked collaboratively
with one
collaborator who was involved from the
beginning up to the end of the process of
the research activity in arranging the
lesson plan, instructional material,
teaching learning activities, the action,
and evaluation. Before starting the
456
research activity, the researcher and the
collaborator discussed all of the things
related to the process in order to meet the
same perception about the strategy being
implemented, the procedure of the
teaching and learning process being
carried out, how to collect the data using
the instruments, and how to score the
students‟ test using the scoring rubric. In
this research, the researcher acted as the
practitioner who taught speaking by using
realia, whereas the collaborator acted as
the observer who observed the
implementation of the action in the
classroom. During the process of
implementing the strategy, the
collaborator observed the students‟
activities by using observation checklist
and field notes. At the end of the teaching
and learning process, the students were to
make role play.
After implementing the strategy,
the teacher and the collaborator conducted
reflection or discussion. In this session,
the researcher and the collaborator
analyzed the data from observation
checklist, field notes, and the result of the
test, in order to find out whether the
criteria of success in use are achieved or
not. Finally, the researcher and the
collaborator drew the conclusion. Based
on the conclusion, the researcher and the
collaborator discussed and solved the
problems continuously until they reach the
standard. The original plan would be
revised and would be changed into a new
cycle until the criteria of success have
been achieved.
presenting the research findings in Cycle
1.
FINDINGS
The result of the research deals
with how to improve the students‟ ability
in speaking using realia as the media. It
contains the research findings of the
implementation of the classroom action
research which cover the students‟
involvement during the implementation of
the action and students‟ speaking ability,
the results of the observation checklist,
and the field notes. To know the students‟
problem in speaking, the data in
preliminary study are provided before
In relation to the students final
scores in preliminary study, based on table
3.7, it could be seen that 11 students or
more than a half students got E, 9 students
got D, and 2 students got BC.
The Students’ Speaking Score in the
Preliminary Study
All of the students score for each
aspect in speaking could be seen in Table
3.6 below. In this table, no students were
in the level of excellent. Most of the
students‟ writing products on procedure
text were in the level of fair.
Table 3.6 The Level of Students ’ Speaking Score in all
Aspects in Preliminary Study
STUDENTS SPEAKING SCORE
Level
Pronu
Grammar Vocab
Fluency
nciatio
ulary
n
0
Excellen
0
0
0
t
1
1
1
1
Very
3
4
3
6
good
12
16
17
12
Good
6
1
1
3
Fair
Poor
Total
22
22
22
22
In brief, the table 3.6 the level of
students speaking score in each aspect
could be seen in that the students‟
speaking score were mostly in the level of
fair.
Table 3.7 Students’ Final Score of Speaking in
Preliminary Study
Grade Score
Number of studens
A
84-100
0
AB
77-83
0
B
71-76
0
BC
64-70
2
C
56-63
0
D
41-55
9
E
0-40
11
Total
22
Moreover, after being analyzed,
based on Table 3.7, the researcher found
out that there were only 2 students who
passed the passing grade BC (64); the rest
of the students (20 students) did not pass
the passing grade. The number of the
students who passed and did not pass the
457
Comp
rehen
sion
0
1
4
15
2
22
Table 3.14 The Level of Students ’ Writing Score in all
Aspects in Cycle 1
minimum passing grade could be seen in
Table 3.8.
STUDENTS WRITING SCORE
Level
Pronunc Gram
iation
mar
3
0
Excellent
Very
14
10
good
4
12
Good
1
0
Fair
0
0
Poor
22
22
Total
Table 3.8 Students’ Final Score of Procedure Text in
Correlation with the Minimum Passing
Grade in Preliminary Study
Score
>64
<64
Total
Number of Students
2
20
22
Category
Passed
did not pass
Vocab
ulary
2
17
3
0
0
Fluency
22
2
16
4
0
0
Comprehen
sion
0
3
19
0
0
22
22
In brief, the level of students
speaking score in each aspect in Cycle 1
could be seen in table 3.14. In this table,
the students had already made some
improvement compared to the scores in
preliminary study. It could be seen that
the students‟
speaking score
were
increased, mostly in the level of very
good.
Cycle 1
Grade
A
AB
B
BC
C
D
E
Figure 3.8 Percentages of Students Final Score in
Preliminary Study
In brief, it can be seen from the
figure 3.8 showing the diagram of the
percentage of students‟ final score in
preliminary study. In this figure, it could
be seen that 90,91% of the students did
not pass the minimum passing grade of
the score 64(BC), while only 9,09% of the
students had passed the minimum passing
grade of 64 (BC).
Score
84-100
77-83
71-76
64-70
56-63
41-55
0-40
Total
Number of Students
3
3
13
3
0
0
0
22
In relation to the students‟ final
scores in Cycle 1, based on table 3.15, it
could be seen that 3 students got score A,
3 students got AB, 13 students got B, and
3 students got BC. The diagram of this
finding can be seen in Figure 3.15.
The results of the research and
development correspond to the research
questions as mentioned in the following
sections.
Moreover, after being analyzed,
based on table 3.15, the researcher found
out that all of the students had already
passed the passing grade BC (64). The
number of the students who passed and
did not pass the minimum passing grade
could be seen in Table 3.16.
The Result of Students’ Speaking Score
on cycle 1
All of the students score for each
aspect of the speaking could be seen in
Table 3.14. In this table, the students‟
made some improvement compared to the
scores in preliminary study. There was no
student in the level of poor. Most of the
students‟ speaking score were in the level
of fair very good.
Correlation with the Minimum Passing
Grade in Cycle 1
Score
>64
<64
Total
458
Number of Students
22
0
22
Category
Passed
did not pass
6
In brief, it can be seen from the
figure 3.16 showing the diagram of the
percentage of students‟ final score in
Cycle 1. In this figure, it could be seen
that all of the students or 100% passed the
minimum passing grade of the score
64(BC).
Based on the result of the
students‟ speaking score, there was a great
improvement of the students‟ average
score from the students on the preliminary
study to the students‟ speaking score on
the Cycle 1. The average score on the
preliminary study was 44,3 and the
average score of the students‟ on the first
cycle was 76,3. It means that there was a
32 point of average score improvement. In
the preliminary study, there were only 2
students who achieved the score above the
criteria of success. Meanwhile, in the
Cycle 1, all of the students had already
passed the minimum score of the criteria
of success that is 64 or BC. For detailed
information about the improvement of the
students‟ score in Cycle 1 compared to the
score in the preliminary study can be seen
in Table 3.1
4
5
68
96
-
-
64
64
-
-
2
22
9,09%
100%
90,91
%
0
0%
Table 3.18 The Students’ Improvement in each Aspect
of Writing
Stage
Preliminary Study
Cycle 2
Aspect
Writing
of
Content
Organization
Vocabulary
Grammar
Mechanics
Table 3.17 The Students’ Speaking Improvement in
Cycle 1.
N
Preliminary
Cycl Percentage
PreAspects
o
Study
e1
Cycle 1
Study
1 Average
44,3
76,3
Score
2 Min Score
33
69
Max
Score
Criteria of
Success
Achieving
Criteria of
Success
20
Based on the students‟ scores on
table 3.17, it can be concluded that the
implementation of the process writing
approach in the Cycle 1 met the criteria of
success. The average score was 76.3.
There were no students who got score
under 64. The lowest score in the first
cycle were BC which were acquired by 3
students, 13 students got score B, 3
students got score AB, and 3 students got
score A. The student‟s lowest score was
69 and the highest students‟ score was 96.
The data above showed that the students‟
achievement in their
speaking had
achieved the criteria of success.
There was also an improvement in
terms of the aspect of speaking. For
detailed information about the students‟
improvement in speaking of each aspect
can be seen in Table 3.18.
Figure 3.16 Percentages of Students Final
Score in Cycle 1
3
Not
Achieving
Criteria of
Success
459
Mean
Min
Score
Max
Scor
e
Mean
Min
Score
Max
Score
2,11
2,34
2.20
2.25
2.23
1,5
1,5
1,5
1,5
1,5
4
3
4
4
4
3,89
4
4
3,68
3,14
2,5
3,5
3,5
3,5
3
5
5
5
4,5
4
Based on the score of the
students‟ final score in Cycle 1, it can be
concluded that the implementation of the
strategy on the first cycle had met the
criteria of success. The average score of
the Cycle 1 was 76,63. In addition, all of
the students or 100% of the students had
reached the criteria of success.
DISCUSSIONS
The realia were designed to
achieve the objective of teaching
speaking. The objective was that the
students were able to make a droleplay
based on the realia used. In this case,
realia was very useful because it helped
the students to arrange the sequence of
steps on how to use/operate something
into correct order. It was confirmed by
many experts, for instances, Doff (1995)
states that the use of real conditions using
the target language items helps the
students absorb the point faster and
memorize them longer. Meanwhile
Kreidler (1971) mentioned that realia can
be used to teach fast drill of the tenses. In
this activity, medical instruments are
excellent aid. To help the students practice
with imperative sentence, the using of
medical instruments can help a lot rather
than just teach them theoretically.
Furthermore, Celce-Murcia and Hilles
(1998) also suggested that realia can be
used in conjunction with storytelling and
role play techniques to contextualize the
grammar lesson, as well as facilitate
memory and learning. Moreover, Soames
(2008) mentioned some advantages of the
implementation of realia. First, using
realia stimulates the mind, and is one way
of encouraging creativity by involving the
senses. Second, realia saves time, as
recognition of an object is immediate and
so cuts out the need for lengthy
explanations and drawing funny pictures
on the board. Third, bringing realia into
the class is a great icebreaker, and serves
as a useful tool to prompt conservation.
Forth, using realia will generate interest
and help create an atmosphere conducive
to learning. The last, realia breathes life
into new vocabulary, and the chances of
the students remembering the new words.
The teaching
of
speaking
consisted of pre, whilst, and post
activities. In the pre speaking stage, the
researcher activated the students‟
background knowledge by using
brainstorming. Brainstorming activity
helps the students to collect ideas,
viewpoints, or ideas related to the topic
being discussed. This was in line with
Raimes (1983) who states that
brainstorming is an activity to produce
words, phrases, ideas as rapidly as
possible without concerning for
appropriateness, order or accuracy. In this
part, the teacher asked the students to
mention medical instruments they usually
used in nursing standard operating
procedure. This activity is essential to
promote creativity and tolerate for
collecting many possible answers. After
the students were familiar with some
medical instruments, the teacher decided
to continue to the next activity.
The teacher asked some questions
to the students related to the terms of the
part of the medical instruments used in
nursing standard operating procedure. It
was proposed to make the students
familiar with the vocabulary and give
chance for the students who have known
the terms before to share the information
with other friends.
After that, the teacher presented
the model of speaking of nursing SOP. It
was about the procedure of “how to check
blood pressure”. The teacher explained
the model of nursing SOP so that the
students understand it. By presenting a
model, the students could understand the
form of writing they were supposed to
speak. Brown (2001) stated that by
reading and studying a variety of relevant
types of text, students can gain
information insight both about how they
should write and about subject matter that
they may become the topic of their
writing. This finding is parallel with the
idea stated by Eanes (1997) that the
activities or strategies in the prewriting
stages should help students to develop
their background knowledge and organize
thoughts.
The teacher and the students
discussed the model together. Through the
discussion, the students could comprehend
the how to speak and what to speak.
However, the teacher should give
guidance by asking some questions so that
the students had good understanding of
the model. Therefore, presenting the
model becomes an effective way to
facilitate the students to transfer their
ideas.
The next activity was group task.
In this action, the teacher asked the
students to make a group of four. Their
task was; first, observe/practice with the
realia in term on how to operate the realia.
Second, make a draft about procedure
460
Realia to Improve Students‟ Speaking
Ability in Procedure Text”. In this
research, the researcher used realia to
improve students‟ speaking ability,
because realia is real object that can be
used as a medium in teaching learning
process and most of
students are
interested in it. In this research, the
researcher used many kinds of realia. In
the first cycle, the researcher used
candles, bar of match and candle holder.
Then, in the second cycle, she used a
water faucet, a soap, and a towel. In third
cycle, she used pencils and sharpener. The
result of research shows that realia used in
teaching speaking procedure text with the
ninth grade of students MTs Mathalibul
Huda Jepara in The Academic Year of
2010/2011 can improve students‟
speaking ability. In terms of the realia
being used, there was a difference
between this study and another previous
study. Both previous research by Darojat
(2011) and by Rokhmawati (2011) took
the MTs N students as the object of the
study, while in this research, the
researcher will take the fifth semester
students of nursing department.
Rokhmawati (2011) used household
appliances and stationary such as candles,
match, candle holder, water faucet, soap,
towel, pencils and sharpener, while in this
research the researcher used the medical
equipment which is used in the nursing
Standard Operating Procedure such as
thermometer,
stethoscope,
sphygmomanometer, etc because nursing
students are expected to be able to use
those kind of tools in their profession.
To know whether the teaching
and learning process had achieved the
objectives or not, it was necessary to
conduct evaluation. The result of the
evaluation should be led to the
improvement on students‟ speaking score.
In this study, there was a significant
improvement on students‟ speaking skill
compared to the teaching and learning
process of speaking before applying realia
as media.
The result of the analysis on the
students‟ final product on
speaking
showed that the students‟ skill in speaking
paragraph on how to operate the realia.
Then, they exchange their draft to other
group. After that, they did peer revising.
The students should give comments or
suggestions to their friends‟ draft. It was
intended to train the students in giving
feedback to their friends‟ draft for
correctness in term of content,
organization, and grammar. Brown (2001)
states “peer editing is a true sharing
process”. Through this strategy, the
students learn to be better writers and
better readers. Besides, it enabled them to
have close relationship with each other.
However, the teacher should give
intensive guidance. The fact showed that
some of the students reluctant to ask for
the teacher‟s help though they found
difficulties in accomplishing the task. So,
the teacher should proactively help the
students without waiting for the students
to raise questions. After getting the
feedback from their friends and the
teacher, the next stage was rewriting. In
this stage, the students revises their draft
based on their friends‟ and the teacher‟s
feedback.
The last stage was the postspeaking activity. In this stage, the
students were given a chance to make a
role play. The role play activities could be
done by asking the students to present role
play in front of the class
Referring to the previous
relevant studies in the use of realia to
improve students‟ English skill, the
finding of this study showed the same
result as Darojat (2011). He implemented
realia to teach writing procedure texts.
The results of the study revealed that the
implementation of realia as media to teach
writing procedure texts is effective in
improving the students' writing ability of
the ninth grade students of MTs N Liwa in
writing procedure texts. Besides, the
results of the study showed that the
students were enthusiastic, motivated, and
actively involved in teaching and learning
process using realia as media in the
teaching and learning process. Another
research that supports realia is effective to
be used in language teaching was done by
Rokhmawati (2011) entitled “The Use of
461
had improved significantly from
preliminary to cycle 1. Before the action
was implemented, the mean score of
students was D or 44.3. After the strategy
had been implemented, the mean score of
the first Cycle 1 became B or 76.3.
the problem faced by the students in a
certain class and certain topic. This study
focused on the effort to improve the
students‟ ability in speaking in term of on
how to do something/how to operate some
modern appliances. As the result, it had
been successful. Based on the research
findings, some suggestions, particularly
for the teachers and/or lecturers who want
to apply this approach in their speaking
classes, and for the next researchers who
want to conduct similar study, are
proposed to improve the quality of the
teaching and learning process in the
future.
Firstly, the result of the research
will be advantageous for STIKes Patria
Husada Blitar. As has been discussed
previously, this study provides an
alternative approach in teaching and
learning writing that can be used for the
lecturers in solving their students‟
problem in
speaking. However, the
lecturers should be more aware in the time
management, particularly in handling
students-teacher conference otherwise it
would spend much time. To make the
time effective, it would be much better if
the lecturers could manage the meetings
less than five meetings. Additionally,
since the students are not accustomed to
be actively involved in the class activities,
the lecturers should give activities that can
stimulate students‟ cooperativeness and
activity.
Secondly, based on the
effectiveness of the implementation of
realia as a media to teach speaking, it is
suggested that the English teachers
implement the strategy as an alternative
strategy in English instruction and create
the students-centered instruction. In
addition, in applying this strategy, the
teacher should be active in monitoring the
students and proactively give effective
guidance to the students. Furthermore, the
teacher should be creative in the teaching
and learning process so that the students
will never feel bored. Furthermore, in
implementing the strategy, the teachers
should be aware of the following
considerations. First, the teacher should
clarify their instructions and explanations
CONCLUSION AND SUGGESTION
This chapter presents the
conclusion and the suggestion in reference
to the research finding and discussions
presented in the previous chapter. The
conclusion deals with the students‟
improvement in speaking and the using of
realia as the media in teaching and
learning process of speaking. In addition,
the suggestions are directed to English
teachers and further researchers who want
to continue to do research in the same
field in the future.
Conclusion
Referring to the findings of this
study, realia can be an effective media in
the teaching of speaking. The realia can
improve the students‟ ability in speaking
and the students‟ involvement in the
teaching and learning process. In this
study, the students‟ speaking scores was
significantly improved in Cycle 1
compared with those in Preliminary study.
The number the students who got score
above 64 (BC) as the minimum passing
grade set by the researcher was also
improved from the Preliminary study to
Cycle 1.
The data showed that the students‟
participation in Cycle 1 is categorized as
very good because most of the students
involved actively in the teaching and
learning process. Most of the students
participated actively in the teaching and
learning process, such as: paying attention
to the teacher‟s explanation, answering
the teacher‟s question, making a group,
making a draft, giving comments to their
friends‟ draft, revising draft, and making a
role play.
Suggestion
This study proposed realia as
media to improve the students‟ ability in
speaking. It was conducted to overcome
462
more and more since it is still hard for non
English students to understand
instructions in English. Second, during the
process, it is better for the teacher to use
modeling for providing examples of how
the students should speak, and pronounce.
Third, the teacher should give intensive
guidance to the students in each stage of
the speaking process when the students do
the task. The last, there must be a
sufficient number of dictionary in the
class in order to help the students find the
appropriate words that they used in their
speaking. It is a must because inability of
the students to organize the ideas was
mainly caused by the insufficient
vocabulary they already mastered.
Finally, further researchers who
are interested in the same field of the
study, it is suggested that they apply this
strategy. They can propose realia as media
to help the students learn how to describe
something/someone. Besides they can
investigate the research about the
effectiveness of realia in the teaching of
vocabulary
REFERENCES
Celce-Murcia, M. & Hilles, S. 1998. Techniques and Resources in Teaching Grammar.
Hongkong: Oxford University Press
Darojat, Muhammad. 2011. Using Realia to Improve the Ability of the Ninth Graders of
MTs N Liwa Lampung Barat in Writing Procedure Texts. Unpublished S2 Thesis.
Malang: Graduate Program State University of Malang.
Jones, Anthony S.D.,& The Black River Group. 1994. The Expert Educator. Fond du Lac
WI: Three Blue Herons Pub
Rivers, W. 1981. Teaching Foreign Language Skills. Chicago: The University of Chicago
Press
Tim Penyusun Kurikulum STIKes Patria Husada. 2011. Panduan Pendidikan Ners dan
Bidan STIKes Patria Husada Blitar. Blitar: STIKes Patria Husada
Zukowski-Faust. 1997. What is meant by Realia? Arizona: AZ-TESOL Newsletter
463
THE CORRELATION OF FINANCIAL MODELS AND MEDICINE
ADHERENCE IN PATIENTS WITH DIABETES MELLITUS
INATALATION OF OUTPATIENT AT RSUD NGUDI WALUYO WLINGI
Yeni Kartika Sari, Nanang Yudhi Prasetyo, Wiwin Martiningsih
Email:[email protected]
Abstract
Medication adherence in patients with Diabetes Mellitus is important in
achieving treatment goals and effective in preventing some of the complications
of Diabetes Mellitus. Patients with chronical diseases such as Diabetes Mellitus
whose treatment requires a long time even a lifetime to note about the social
economy, especially how patients pay for treatment.
The purpose of this study was to determine the correlation between
financial models and medicine adherence in patients with diabetes mellitus of
Outpatient in RSUD Ngudi Waluyo Wlingi.This study was a type of nonexperimental research design and analysis of cross sectional. This study was
conducted in 68 patients with Tipe 2 Diabetes Mellitus at Outpatient RSUD Ngudi
Waluyo Wlingi, in Nopember 2014, the samples were taken by accidental
sampling technique. The correlation score of medication adherence with financial
models was analized using Spearman Rank test.
It was found that there were correlation between financial models and
medicine adherence in patients with diabetes mellitus by p value 0,000. It was
important to improve health education about medicine adherence and how to
acces financing to support their treatments.
Key words: medicine adherence, financial models
diabetes. The number of diabetics in
urban areas of Indonesia in 2003 was
8.2 million people. While 5.5 million
people in rural areas. It is estimated
that 1 of 8 people in Jakarta have
diabetes. The high count of patients
in urban areas is partly due to
lifestyle (Prapti Utami, 2009).
Based on data obtained in
Outpatient of Ngudi Waluyo Wlingi
hospital that the average patient
visits during 2009 was 259, in 2010
the average patient visit was 278, in
2011 the average patient visit was
300 and in 2012 the average patient
visit was 295. Then in 2013, 33 visit
patient was new patient and 311 visit
patient was the old patients. In 2014
Introduction
Diabetes mellitus is a disease
characterized by high blood sugar
levels. Basically, this is because the
body lacks
insulin substance
produced by the pancreatic gland.
Disadvantages here could be the
lacking amount of insulin that, or the
insulin is quite but it works less well.
Diabetes mellitus
is a
chronic
degenerative disease / not curable but
blood sugar levels can be stabilized
to normal (Sukarjdi, 2009).
According to WHO Indonesia
ranks fourth largest number of
diabetics in the world. In 2000 there
were approximately 5.6 million
people in Indonesia
who have
462
until September, the average patient
visits were 354.
It is estimated that there are
still many people (about 50%) who
have not been diagnosed
with
diabetes mellitus in Indonesia witch
was only two-thirds of diagnosed
people who have undergoing
treatment, both non-pharmacologic
and pharmacologic. From the
undergoing such treatment is only
one-third
are
well-controlled
(PERKENI 2011 ). Whereas patients
with diabetes mellitus if it does not
receive appropriate treatment will
have a negative impact on the
patient's own form of occurrence of
various complications. Which it will
further increase the burden
of
medical expenses that should be
covered by the patient.
Based on this
condition, noncompliance of diabetes mellitus
patients maybe
due to
socioeconomic related factors. In patients
with chronic diseases
such as
diabetes mellitus whose treatment
requires a long time and even a
lifetime must note about the social
economy, especially how to finance
patient treatment. If the patient is in
lower economic level or do not know
about the existence of the system of
financial model dedicated to him,
the patient will tend to disobey in the
treatment. Based on research of Isa
and Baiyewu in Ramdani, 2012,
showed that lower quality of life in
patients type 2 diabetes is influenced
bybsocio-economic factors that is
associated with financial problems or
financial availability to support their
The
lower
treatment.
of
socioeconomic
status is also
associated with poor adherence in
patients with diabetes
mellitus
(Faradhilah,
2014).
Medication
adherence in patients with Diabetes
Mellitus is important in achieving
treatment goals and effective in
preventing
some
of
the
complications of Diabetes Mellitus.
Patients with chronical diseases such
as Diabetes Mellitus whose treatment
requires a long time even a lifetime
to note about the social economy,
especially how patients pay for
treatment, (Putri, 2008).
Various studies have shown that
generally patient compliance in the
treatment of chronic diseases is low.
The research involving outpatients
showed that more than 70% of
patients do not take medication
according to the right dose (Basuki,
2009). According to a WHO report
in 2003, the average compliance of
patients on long-term therapy for
chronic disease in developed
countries is only 50%, whereas in
developing countries, the number is
even lower (Asti, 2006).
From the analysis of some of the
opinions of experts known that
medicine adherence is influenced by
many factors. These factors include
economic factors. Estimates that
there are states that 20% of
hospitalization as a result of noncompliance of patients to treatment
(Sarafino, 2013)
There were various financial models
at Ngudi Waluyo Wlingi hospitasl
such as general financial, BPJS and
Jamkesda. Based on observation
there, the 80% of 354 visit of
diabetes mellitus patient to
September choosen BPJS as
financial models and a lot of patients
who used a general financial and
463
Jamkesda moved to BPJS financial
models.
analyzed by Spearman rank test with
significance level ≤ 0.05
Based on the above description of
the importance of
sustainable
financial models
to support the
treatment of patients with chronic
diseases such as diabetes mellitus,
the researchers were interested to
know the correlation of Financial
Models and Medicine Adherence in
Patients with Diabetes Mellitus
Inatalation in Outpatient at RSUD
Ngudi Waluyo Wlingi.
Result and Analysis
The Gender of Respondents
Table 1 The Distribution of
Respondent‟s
Gender In Outpatient of
Ngudi
Waluyo Wlingi Hospital,
November
2014
Gender
Male
Female
Total
The general purpose of this research
was to explain the correlation
between Financial Models and
Medicine Adherence in Patients with
Diabetes Mellitus Inatalation in
Outpatient at RSUD Ngudi Waluyo
Wlingi While the specific purposes
of this study were: 1) Describe the
financial model of diabetes mellitus
patient in Outpatient of Ngudi
Waluyo Wlingi hospital. 2) Describe
the medicine adherence of diabetes
mellitus patients in Outpatient of
Ngudi Waluyo Wlingi hospital. 3)
Analyze the relationship between
financial models and medicine
adherence in patients with diabetes
mellitus inatalation in Outpatient at
RSUD Ngudi Waluyo Wlingi.
Amount
25
43
68
Procentage
37%
63%
100%
The Employment of Respondents
Respondent‟s
Employment In Outpatient
of
Ngudi Waluyo Wlingi
Hospital,
November 2014
Employment
House wife
Private Job
Farmer
Pentionary
Teacher
Government
emp
Total
Jumlah
19
15
7
23
3
1
Prosentase
27,9%
22,1%
10,3%
33,8%
4,4%
1,5%
68
100%
The Education Of Respondents
Respondent‟s
Education in In Outpatient of
Ngudi
Waluyo Wlingi Hospital,
November
2014
Method
This research was non-experimental
research with cross sectional method.
The sample in this research was 68
people who suffer from diabetes
mellitus who visited the Outpatient
of Ngudi Waluyo Wlingi hospital
with accidental sampling technique
The independent variable of this
research was financial model while
the dependent variable was the
medicine adherence. The data were
Education
Elementary
Junior High
Senior High
Diploma/
bachelor
Total
464
Amount
21
18
17
12
Procentage
30,9%
26,5%
25%
17,6%
68
100%
happens because the
ongoing
financing needed when the level of
compliance to be achieved successful
therapy with either (WHO 2003), in
which the BPJS patient is no
guarantee continued their threatment.
While on public patients there was a
possibility of high socio-economic
status so that they could pay for their
treatment, because the sustainable
financing needed if the level of
medicine adherence to be achieved
works so well (WHO, 2003).
From the results of the
research obtained from the data that
there were 22 people who have a
moderate level of compliance in
which 13 people were patient with
public financial models. In addition
to socio-economic factors that could
affect adherence, the majority of
respondents (8 people) answered yes
when asked if they feel that therapy
was complicated, this means that
factors associated therapies such as
the duration, the treatment regimen,
previous treatment failures , changes
of treatment, the unfavorable effects
of the drug, side effects, and the
availability of medical support to
deal with them was a prominent
factor in influencing
medicine
adherence (Takiya et al, 2004).
While in the BPJS financial model
there were 9 people with moderate
adherence and the majority of
respondents (4) have the same
answer with 8 respondents of public
financial models.
The result also showed that
there were 6 people have low
adherence level and most of them (4
patient) are public financial models
that were commonly influenced by
socioeconomic factors which
socioeconomic status were low also
associated with poor adherence in
patients
diabetes
mellitus
Cross-tabulation financial
model with medication adherence
of Diabetes mellitus patients
Table 4 Cross Tabulation Financial
Model
with medicine adherence of
Diabetes mellitus patientsIn
Outpatient of Ngudi Waluyo
Wlingi
Hospital, November 2014
Financial
Model
BPJS
General
Spearman
Rank
Medication Adherence
High
37
3
0,000
Moderate Low
9
2
13
4
The above table shows that
there was a correlation between
financial model
with medicine
adherence in diabetes mellitus
patients, with the results of analysis
using SPSS 16 software with
Spearman Rank test P value of 0.000
was obtained, and in this case of
course P value less than 0.05.
Discussion
Based on the research results could
be obtained that the majority of
respondents, 40 people have a high
compliance rate (58.8%), 22 with
moderate compliance rate (32.4%),
six people had a low compliance rate
(8.8%). It could be obtained from the
study also that patients with diabetes
mellitus using BPJS were 48 people
(71%), and patients who use public
financing were 20 people (29%).
The 40 people who have a
high density of as many as 37 people
(92.5%) were respondents who use
BPJS financial model, while 3
people (7.5%) are respondents who
use public financial model. This
465
(Faradhilah, 2014). Whereas in BPJS
patients there are 2 people who have
low level of adherence in which the
majority of them answered yes when
asked if they sometimes forgets to
take medication. It was appropriate
with that some of the factors related
to clients adherence affected factors
was reportedly forgetfulness (WHO,
2003), besides of course also due to
the lack of motivation of the client to
perform the treatment, as well as the
level of education of the patients
were low
(elementary shool),
considering education can affect the
level of patients' knowledge about
the importance of regularity of taking
the drug, it was appropriate because
education were a process of changing
attitudes and code of conduct of a
person or group and also mature
human effort through the efforts of
the teaching and training (Meliono
Irmayanti, 2007).
From the results of this study
showed that BPJS patients have a
high compliance rate of more than
patients who used public financial
model in which of the 48
respondents who used
as 37
respondents (77.1%) have a high
compliance rate. While in public
financial model patients from 20
respondents there were 3 respondents
(15%) had a high compliance rate.
This condition occurs because BPJS
patients had availability of financing
for access to treatment, while the
public financial model patient not
necessarily guarantee the availability
of financing because it depend on the
social economic status. At the level
of moderate compliance there were
more BPJS patient than public client
that was 13 respondents (65%) and
in BPJS patients from 48 respondents
have 9 respondents (18.75%) with
high levels of complianc. It was a
fact that there were other factors that
affect adherence in this case that
were relevant with therapy factor.
At the low level of medicine
adherence the amount of public
patient are more than BPJS patient
where from 6 low adherence
respondents, 4 of them were public
financial models,
this condition
could be happens because in public
patients not necessarily guarantee the
availability of sufficient financial
access to treatment, while BPJS
patients have other factors affecting
adherence that were factors related to
the client them self.
Conclusion
There were
correlation
between model of financial model
with medicine adherence in diabetes
patients in Outpatient of
Ngudi
Waluyo Wlingi Hospital with α
significance value of 0.000.
Acknowledgement
Among patients
with a
number of public financial and BPJS
patients in this study is not the same
REFFERENCES
Asti, Tri. 2006. Kepatuhan Pasien :
Faktor
Penting
dalam
Keberhasilan Terapi.
Info
POM, Vol. 7, No. 5, diakses
Januari
2011
dari
(http://perpustakaan.pom.go.id
/Koleksi/Buletin%20Info%20P
OM/0506.pdf)
Basuki,
Endang.
2009.
Penatalaksanaan
diabetes
mellitus terpadu. Jakarta: Balai
Penerbit FKUI.
Irmayanti, Meliono, dkk. 2007.
MPKT Modul 1. Jakarta:
Lembaga Penerbitan FEUI.
466
PERKENI,
2011.Konsensus
Pengelolaan Dan Pencegahan
Diabetes Mellitus Tipe 2 Di
Indonesia
Putri, 2008,
Analisis Efektivitas
Biaya Penggunaan Antidiabetik
Kombinasi pada Pasien
Diabetes Melitus Tipe 2 Rawat
Jalan Di RSU Pandan Arang
Boyolali. Skripsi, Universitas
Muhammadiyah
Surakarta.
Surakarta, tidak dipublikasikan
Ramdani, Deri. 2012. Gambaran
Kualitas Hidup Berdasarkan
Karakteristik Pasien DM Tipe2
Di Rumah Sakit Umum Pusat
Hasan
Sadikin.
(http://www.academia.edu/.../b
ab 1 pendahuluan). Di akses
tanggal 9-10-2014
Ramdani, Deri. 2012. Manajemen
Berkas Dan Isi Rekam Medis.
(http://www.academia.edu3275
264./Management Berkas dan
Isi Rekam Medis). Di akses
tanggal 10-10-2014
Sukardji,
Kartini.
2009.
Penatalaksanaan diabetes mellitus
terpadu. Jakarta : FKUI
Surya, Faradhilah Adi. 2014.
Hubungan Tingkat Kepatuhan
Minum Obat Penderita DM
Tipe2
Terhadap
Kadar
Hba1c.(http://www.scribd.com/
doc/234158166/HubunganTingkat-Kepatuhan-MinumObat-Penderita-DM-Tipe
2Terhadap-Kadar-Hba1cSkripsi). Di akses tanggal 1010-2014
Sarafino,
E.P.
2013.Health
Psychology: Biopsychosocial
Interaction, Second Edition.
New York: John Wiley &
Sons, Inc.
Soegondo, Sidartawan. 2009. Hidup
secara mandiri dengan
Diabetes mellitus, kencing
manis, sakit gula. Jakarta :
Penerbit FKUI.
Takiya, 2004.
Meta-analysis of
interventions for medication
adherence
to
antihypertensives. Annals of
Pharmacotherapy,
38(10),
1617-1624.
(www.theannals.com/content/3
8/10/1617.full)diakses
18
september 2014.
Utami, Prapti.2009.Solusi Sehat
Mengatasi
Diabetes.Jakarta:Agromedia Pustaka.
WHO, 2003. Adherence to Long
Term Therapies Evidence for
Action.
(Online)
(http://apps.who.int/medicine
docs/en/d/Js4883e/) diakses 7
oktober 2014
467
THE EFFECT OF CONSUMING WATERMELON RIND EXTRACT
(CITRULLUS LANATUS) TOWARD THE DECREASING OF BLOOD SUGAR
LEVELS ON
DIABETES MELLITUS PATIENTS IN WERU - PACIRAN - LAMONGAN
Arifal Aris, S.Kep, Ns, M.Kes.
Nursing Program of STIKES Muhammadiyah Lamongan
ABSTRACT
Diabetic is a cronic disease that characterized by hyperglycemic. This disease is a
problem that often occurs in the society, with their high blood sugar levels. One way to
control blood sugar levels is by pharmacological and non-pharmacological. One of the
ways is using the essence of watermelon rind juice/extract (Citrullus Lanatus), because
rind extract of watermelon contains citrulline that produces nitric oxide, which nitric
oxide is capable of lowering blood glucose. The purpose of this research is to know the
effect of watermelon rind extract (Citrullus Lanatus) toward the decreasing of sugar
levels of diabetic patients in Weru, Paciran, Lamongan.
The method used in this research is quasy eksperimental using pre test and post test
design. Population in this research is all diabetic patients in Togosadang Health Center,
Weru, Paciran, Lamongan at October. The population is 31 patients with the sample is 28
patients. The sampling technique used is simple random sampling. The instrument is
Glukotest. The method to analyze the data is using paired t-test with α = 0,005.
The result of this research is that the patients in treatment group given watermelon rind
extract get decreasing in their blood sugar levels attaining 10 of them(71,4%) anf they
who get increasing in ther blood sugar levels reaching 4 of them (28,6%). But in the
control groups not given watermelon rind extract do not get decreasing on their blood
sugar levels, none of them (100%). It measured using paired t tets α 0,05 with significan
0,000 (p < 0,05). From this result, we can conclude that there is effect of consuming
watermelon rind extract to the diabetic patients in Weru to decrease their blood sugar
levels..
Based on the result of this research, it can be concluded that to control blood sugar levels
is by combining pharmacology medicine with herbal medicines, one of the ways is by
using watermelon rind extract (Citrullus lanatus).
Key words: watermelon rind extract (citrulus lanatus), blood sugar levels, diabetic.
diabetics in the world currently reached
200 million and is estimated to increase
more than 330 million in 2025. The
reasons for this increasing are the raising
of life expectancy and doubled high
population growth with increased rates
of obesity linked with urbanization and
dependence on processed foods. In the
United States, 18.2 million people with
diabetes (6.3% of the population),
almost one-third of them are unaware
that they have that illness. (Corwin,
2009)
1. INTRODUCTION
Diabetes is derived from Greek
word which means 'drain or divert'
(siphon). Mellitus from Latin word
which means sweet or honey. Diabetes
mellitus (diabetic) can be defined as an
individual that drains much urine
volume with high glucose level.
Diabetes mellitus is a disease
characterized by hyperglycemia with the
lack of absolute insulin or the decreasing
in the relative insensitivity of cells to
insulin. Based on the current
epidemiological evidence, the number of
469
Diabetes mellitus is a disease that is not
contagious which its‟
pravelence
increases from year to year. Diabetes
mellitus often referred to as 'The Great
imitator', because this disease
contaminates all organs of the body and
causes many complaints. The symptoms
vary widely and can occur gradually, so
the patient will not aware of the changes
such as they drink more often, urinate
frequently or even lose their weight.
(Andi D, P, 2007)
According to data of the Health Ministry
in 2008, there were 5.7% of Indonesia's
population (about 12 million people)
suffer from diabetes mellitus and 11% of
that amount is a group of prediabetes. In
the projection of 2030, it is estimated
that the number will rise into more than
21 million people (Hidayati, 2009).
Likewise, people with diabetes mellitus
in the Surabaya also continues to rise, it
can be said that the diabetic currently
reaches 180,000 people, 6% of society
on that region, while in Lamongan about
200,000 or 12% of the population
allegedly affected by diabetes mellitus
(Nur and Ayi 2008).
Based on the data obtained from
Puskesmas Tlogosadang Paciran, it is
found 360 people who have tested their
blood sugar levels
in January to
September 2014, 212 of them (58.84%)
have a normal blood sugar levels and
148 of them (41.16%) have abnormal
blood sugar levels. Based on the initial
survey conducted in September 2014 in
Weru Paciran, it got 10 people suffering
from diabetes mellitus, 7 of them or
70% with a high blood sugar levels. Of
all the people to be sampled for this
survey, 10 people did not do additional
therapies or alternative treatments for
lowering their blood sugar levels. From
these data it can be concluded that the
problem of blood sugar levels of
diabetic is still high or can not be
controlled.
There are some factors that could affect
the success in controlling blood sugar
levels are diet, stress, drugs,
environment, sports, elucidation about
diabetes mellitus and the role of the
family in
motivating them and
supervising their diet.
Diabetes mellitus is already known
widely as a disease characterized by the
increasing of blood sugar levels, and can
occur because of hereditary factors.
Therefore, the treatment of diabetes
should be conducted
as early as
possible, in order to prevent the
occurrence of various complications.
The treatment of diabetes can be with
chemical drugs or with natural drugs. To
avoid the consequences of the use of
diabetes medications that can harm
health if consumed in a long term that
can cause undesirable adverse effects on
health is by controlling blood sugar
levels. To control the blood sugar levels
is by combining pharmacology drugs
and herbal medicines. One of the ways
is to eat watermelon (Citrullus lanatus),
especially its‟ rind (the white one), the
process is simple and has no side effects
that is safe to eat for health.
Watermelon is a plant of tropical and
subtropical Afrika. Gurun Kalahari is
the central of its divergence. Recently,
this plant has grown rapidly in many
other countries such as China and the
United States. Watermelon is a crop that
grows vine and require sunlight.
Watermelon is favored by many people
from infants to adults, because this fruit
is really sweet and its color is red or
yellow that is quite tempting to make
everyone who see it keen to savor.
Watermelon contains a lot of water
which is about 92% of its containt so it
will taste delicious when it is consumed
by the time we feel thirsty. Unripe
watermelon can be used as a vegetable
in making food. While the watermelon
rind can be used as raw material for
making candied or pickled while the
seeds are used to make
kwaci.
(Khomsan, 2009).
In Indonesia, watermelon‟s seeds are
commonly consumed as snack and
known as kwaci. The fruit is eaten as a
dessert or dishes laid outon the table.
Mozambik of watermelon is further
processed, for example, a traditional
alcoholic beverage made of its extract.
470
Some people use this plant and its fruit
for animal feed, even just a few that do
that. One respondent showed that the
consumption of watermelon is able to be
used as a medicinal treatment. In his
watermelon‟s
leaves
opinion,
maceration is able to cure earache, while
the flesh is able to cleanse the bowels
and has the effect of watermelon
afrodifiak. Kind of watermelon in this
research is varied consisting white,
yellow, and red flesh watermelon. In his
research, Sugiyanta expect that the
watermelon rind contains citrulline
producing nitric oksida. Nitrad oxide is
capable of lowering blood glucose and
triglyceride mice with diabetic.
Researcher explained that citrulline is
useful for nitrad oxide systems of human
that has a high potential as an
antioxidant and vasodilation and dilating
blood vessels to increase blood flow to
the tissues that need it. (Trufus, 2013).
From the description above, one of the
ways to control blood sugar levels is by
combining pharmacology medicine with
herbal medicines, one of which is by
consuming watermelon rind (Citrullus
lanatus). The researcher is interested in
examining the effect of watermelon rind
to decrease blood sugar levels of
diabetic patient in Weru, Paciran,
Lamongan.
Table 1 The distribution of respondents
characterized by gender in the treatment
group.
Table 1 shows that nearly all
respondents with diabetes mellitus in
treatment group are women with the
amount of 12 respondents (85.7%). The
(14.3%) is male with the amount of 2
respondents.
(2) Characteristics by gender in the
control group.
Tabel 2 The distribution of respondents
based on gender in the control group.
Table 2 shows that the majority of
respondents with diabetes mellitus in
control group are female with the
amount of 9 respondents (64.3%), and
the reaming is male (35.7%) with the
amount of 5 respondents.
2. RESEARCH METHOD
The design of this study uses Quasy
Experimental using Pre-Test and PostTest Design. The population of this
study is all diabetes patients in Weru
who come to Puskesmas Tlogosadang,
Paciran, Lamongan in October. The
amount of the population is 31 people.
The sample of this study is 28 people
taken using simple random sampling.
The instrument used is Glukotest.
2) haracteristics based on Age
(1) Characteristics
treatment group.
by
age in
the
by age in the treatment group
3. RESULT
General Data
1) The characteristics based on Gender.
(1) Characteristics by gender in the
treatment group
471
respondents ger rising on their blood
sugar levels (28, 5%).
2) Blood sugar levels In the control
group.
Tabel 6 The distribution of blood
sugar levels in the control group
Based on Table 3, it can be explained
that 6 respondents aged 50-59 (42.8%)
and one respondent aged <40 (7.1%).
(2) Characteristics based on age in the
control group
by age in the control group
Table 6 shows that the blood sugar
levels in the control group given
watermelon rind extract/juice are 14
respondents. No one got decresing on
their blood sugar levels (100%)
3) Comparison of Blood sugar levels In
Treatment and Control Group.
Tabel 7 The comparison of data
distribution on blood sugar levels
between treatment group and control
group.
Based on Table 4, it is explained that 7
respondents aged 50-59 (50%) and no
one aged <40.
Particular Data
1) Blood sugar levels In The Treatment
Group.
Table 5 The data distribution of Blood
sugar levels in the treatment group
Table 7 shows the differences between
blood sugar levels in the treatment group
and the control group given watermelon
rind extract/juice of 14 respondents. Ten
patients in treatment group
given
watermelon rind extract got their blood
sugar levels decreases (71.4%) and 4
participants got their blood sugar levels
increases (28.6%). On the other hand, 14
patients in the control group not given
watermelon rind extract did not get
decreasing on their blood sugar levels
(100%).
It is supported by the results of the test
using SPSS 16.0 using t test sample
independent with significance
0.00
Table 5 shows that the blood sugar
levels of the patients in the treatment
group given watermelon
rind
juice/extract are 14 respondents. Ten
respondents get decreasing on their
blood sugar levels (71.4%), and 4
472
where α = 0.05. Then H0 is rejected, it
means that there are differences in blood
sugar levels among respondents who
given watermelon rind extract and them
who were not on the diabetes mellitus‟
patients in Weru, Paciran, Lamongan.
regularly consumed, at least, in seven
days to obtain maximum results.
2. Blood sugar levels In the Control
Group
The results in table 4.6 shows that blood
sugar levels in the control group who
were not given watermelon rind extraxt
is 14 people and all the respondents get
decreasing on their blood sugar levels
(100%).
Based on the results, it can be concluded
that all patients who were not given
watermelon rind extract
did not
experience changes in their blood sugar
levels. It is because the control group
was given no treatment. Based on the
observations, many respondents are less
active in controlling their blood sugar
levels, such as the lack of regular
exercise, do not eat properly. There are
several factors that can affect the
success in controlling the levels of blood
sugar, such as: diet, stress, family roles,
medicine, environment, and sport
(Guyton, 2007). Thus, maintaining the
body to stay healthy is very salient.
Some of the ways to do that are by
maintaining a proper diet, exercising
regularly, and keeping the mind to avoid
stress.
4. DISCUSSION
The discussion of this study is in
accordance with the purpose of the
research, statistical result and the effect
of watermelon rind juice to decrease
blood sugar levels on diabetes mellitus‟
patients in Weru, Paciran, Lamongan in
the year of 2015. They are as follows:
1. Blood sugar levels
In the
Treatment Group
The results written in Table 4.5 shows
that the blood sugar levels of diabetic
patients in the treatment group given
watermelon rind extract are 14 people,
10 patients got decreasing on their blood
sugar levels (71.4%) and 4 patients
stayed the same in their blood sugar
levels (28.6%).
Based on the data above, it can be
concluded that the majority of patients
after consuming watermelon rind juice
got decreasing on their blood sugar
levels. According Trufus, (2013) white
watermelon rind
extract contains
citrulline producing nitric oxide; nitric
oxide is capable of lowering blood
glucose and triglycerides of diabetics. In
addition, citrulline is useful to nitric
oxide system in human body and it is
very potential as an antioxidant and
vasodilation. It dilates blood vessels to
increase the blood flow in the body and
distribute it to the tissues that need it.
The levels of citrulline in watermelon
rind reached 24.7 mg, more than the
flesh that only 16.7 mg. Citrulline in
watermelon red fleshy (7.4 mg) is less
than the citrulline of yellow-fleshed
watermelon
(28.5 mg).
Thus,
watermelon rind juice has qualitative
benefits as herb because it has been used
as a medicine to lower blood sugar
levels in diabetes mellitus‟ patients.
Watermelon rind extract/ juice should be
3. The differences between Blood
sugar levels In Treatment Group
and Control Group
Table 4.7 shows the differences between
blood sugar levels in the control group
and the treatment
group given
watermelon rind extracts. It shows that
10 diabetic patients get decreasing on
their blood sugar levels (71.4%) and 4
diabetic patients did not experience the
same (28.6%). Whereas in the control
group, the diabetic patients who were
not given watermelon rind juice, all of
them did not get decresing on their
blood sugar levels (100%).
Based on the data above, it can be
claimed that all participants, diabetic
patients, who consumed watermelon
rind juice got decreasing on their blood
sugar levels.
According to Trufus
(2013), white watermelon rind extract
473
contains citrulline-producing
nitric
oxide. Nitric oxide is able to lower
blood glucose and triglycerides of
diabetes. Whereas in the control group,
all the patients
were not given
watermelon rind juice and they did not
get any level changes on their blood
sugar levels. It is caused that the control
group were not given the treatment. The
factors that could affect the success in
controlling the levels of blood sugar are
diet, stress, family roles, medicine,
environment, and sport (Guyton, 2007).
By studying the theories and the results
described above, watermelon rind
extract can influence to the decreasing
of blood sugar levels in diabetes
mellitus‟ patients in Weru, Paciran,
Lamongan. Thus Sari watermelon rind
can be used as an alternative medicine
for lowering blood sugar levels.
medical personnel or medical team, but
also the whole individual should take a
part.
To facilitate the information about the
effect of consuming watermelon rind
extract on diabetic patients, it is needed
to be held counseling to the patients and
their family.
5.2.2 For Health Institutions
By the development of the effect of
watermelon rind juice to decrease blood
sugar levels
in diabetes mellitus‟
patients, this research is hoped to be able
to support the research as additiona
existing theories.
5.2.3 For Other Researcher
To conduct further research, the other
researcherscan use larger number of
respondents with more accurate method.
They are also able to study using other
influences such as diet, reducing stress,
medicines, comfortable environment,
regular exercise, and role of family to
motivate and supervise the diabetic
patients in their diet to eat fruit and
vegetables regularly with low sugar.
5. CLOSING
5.1 Conclusion
After analysing the data and see the
results of the analysis, the researchers
can draw some conclusions as follows:
1) There is reduction on the blood
sugar levels of diabetic patients
in the group given watermelon
rind extract in Weru, Paciran,
Lamongan.
2) There is no reduction on the
blood sugar levels of diabetic
patients in the group not given
watermelon rind extract
in
Weru, Paciran, Lamongan.
3) There are differences on the
blood sugar levels between
group given watermelon rind
extract and the group not given
the extract of watermelon rind
in Weru, Paciran, Lamongan.
DAFTAR PUSTAKA
Andi, Dyah Pratiwi. (2007).
Epidemologi dan Isu
Mutakhirnya http//
wordpress.com/2007/12/10/.
Diakses: tanggal 10 Oktober
2012.
Corwin, E. J. (2009). Buku Saku
Patofisiologi. Jakarta: EGC.
Davey, Patrick. (2005). At Glance
Medicine. Jakarta: Erlangga.
David, Rubenstein. (2005). Lectura
Notes on Clinical Medicine,
Ahli Bahasa Annisa RahmaniaJakarta: Erlangga.
Guyton, Athur C. (2007). Buku Ajar
Fisiologi Kedokteran. Jakarta:
EGC.
Hasim.(2012). Etika Dalam Melakukan
Penelitian
Eskperimen.https://hasim319.w
ordpress.com/2012/05/12/.
5.2 Suggestion
Based on the above conclusions, there
are some efforts that need to be
considered:
5.2.1 For Nursing Profession
To overcome the increasing of blood
sugar levels is not only done by the
474
Diakses: tanggal 23 Desember
2014.
Hidayat, A Aziz Alimul. (2007).
Edukasi Penting Untuk Kendali
Pravelensi
Diabetes.http://www.jurnal
medika.com-192-edukasipenting-untuk-kendalikan
pravelensidiabetes.html.Diakses tanggal
10 oktober 2012.
Hidayat, A Aziz Alimul. (2007).
Metode Penelitian Keperawatan
dan Teknik Analisa Data.
Jakarta: Salemba Medeka.
Hidayat, A Aziz Alimul. (2007). Riset
Keperawatan dan teknik
penulisan ilmiah. Jakarta:
Salemba Medeka.
Khomsan, P. A. (2009). Rahasia Sehat
Dengan Makanan Sehat.
Jakarta: PT Kompas Media
Nusantar.
Kowalak, Jenifer P. (2011). Buku Ajar
Patofisiologi. Jakarta: EGC
M.N. Bustan. (2007). Epidemologi
penyakit tidak menular, edisi
tiga. Jakarta: EGC
Nur dan Ayi.(2008). DM tertinggi, tren
Narkoba Naik.
http://www.Jawapos.go.id.
Diakses tanggal 08 oktober
2012.
Notoatmodjo, Soekidjo. (2005). Metode
Penelitian Kesehatan Edisi
Revisi. Jakarta: Rineka Cipta
Nursalam. (2008). Konsep dan
Penerapan Metodologi
Penelitian Ilmu Keperawatan,
Nursalam. (2003). Konsep dan
Penerapan Metodologi
Penelitian Ilmu Keperawatan:
Pedoman Skripsi, Tesis dan
Instrumen Penelitian
Keperawatan. Jakarta: PT
Salemba Medika
Prince, Sylvia Anderson. (2005).
Patofisiologi: Konsep Klinis
Proses-Proses Penyakit. Jakarta:
EGC
Robbins, H.B. (2008) Buku Ajar
Patologi Volume 2. Jakarta:
EGC
Sidartawan, Soeganda. (2004).
Penatalaksanaan Diabetes
Mellitus Terpadu. Jakarta: FKUI
Suharsimi, Arikunto. (2002). Prosedur
Praktek. Cet.13. Jakarta: PT
Rineka Cipta
Tjokroprawiro, Askandar. (2004). Hidup
Sedat dan Bahagia Bersama
Diabetes, Jakarta: Gramedia
Pustaka Utama.
Trufus.(2013). 100 Plus Herbal
Indonesia Bukti Ilmiah dan
Racikan vol 11. Bandung: PT
Trubus Swadaya.
475
THE EFFECT OF GIVING COMMON SNAKE HEAD (CHANNA STRIATA) ON PERINEAL
WOUND HEALING IN POSTPARTUM MOTHER
IN BPM NY. TITIN S. MUBIN KARANGGENENG LAMONGAN
Heny Ekawati
Stikes Muhammadiyah Lamongan
ABSTRACT
Perineal wound is a wound caused of the birth canal laceration well as in episotomy or not, at the time
of birth the fetus. One of the way for fast perineal wound healing is gived common snakehead. The
aim study for knowing the effect of giving Common Snakehead (Channa Striata) On Perineal Wound
Healing In Postpartum Mother. The design of the study uses Quasy Experimental. The population is
all of postpartum mother in BPM Ny. Titin S. Mubin, Amd. Keb in February to April 2014. The
sampling technique uses consecutive sampling. Sample are taken by 30 respondents to include
inclusion criteria. The research data is taken using observation sheets and SOP. Processing data using
editing, coding, and tabulating, and then analyzed using the mann whitney test with a significance
level α = 0,05. The result showes almost entirely or 80% perineal wound healing fast category
experienced of postpartum mother is given common snake head (Channa Striata). While, almost
entirely or 86.7% perineal wound healing slow category experienced of postpartum mother not given
common snakehead (Channa Striata). The results of statistical tests obtained results are the effect of
giving common snakehead (Channa Striata) on wound healing of the perineal with a value of Z = 3598 and with a significance level of 0.000 (p <0.05). The conclusion, giving common snakehead can
used as alternative for perineal wound healing.
Key word : postpartum mother, wound perineal, given common snakehead
indications such as (1) a large baby, (2)
abnormal head position, (3) Birth buttocks, (4)
extraction forceps are difficult, (5) shoulder
dystocia (Saifuddin, 2008). Meanwhile,
according to Varney (2007), perineal
laceration can be classified as follows: 1) the
degree: laceration involving the vaginal
mucosa, posterior fourchette and perineal skin.
2) Second degree: laceration that resulted in
the vaginal mucosa, posterior fourchette,
perineal skin and muscles of the perineal. 3)
Degree three: Lacerations involving the
vaginal mucosa, posterior fourchette, perineal
skin, perineal muscles and the external anal
sphincter. 4) Degrees Four: Lacerations
involving the vaginal mucosa, fourchetter
posterior perineal skin, perineal muscles,
external anal sphincter, rectum and anterior
wall.
In the wound healing process in
addition to new mothers require proper wound
care, also require nutrition mainly albumin and
protein. When albumin and protein
requirement is rarely met in the wound healing
process of the tissue cells of the body will be
hampered in building and replacing the cells in
INTRODUCTION
Childbirth is the process of spending
the products of conception that can live in the
uterus through the vagina from the outside
world (Wiknjosastro, 2005). Childbirth is a
normal process that occurs at the expense of
the fetus at term gestation (37-42 weeks), was
born spontaneously with the presentation in
the back of the head that lasted 18 hours, with
no complications for both the mother and the
fetus. (Prawirohardjo,
2002). However
perineal laceration occurred in nearly all first
births and not infrequently also in the next
delivery. Perineal wound is a wound in the
perineal because of the birth canal laceration
well as episiotomy and delivery of a fetus
(Wiknjosastro, 2005).
The cause of perineal injuries can be
caused by two factors: 1) Maternal factors:
maternal factors such as (1) parturition
precipitatus are not controlled and are not
helped, (2) The patient is not able to stop
pushing, (3) parturition hastily resolved to
urge Excessive fundus, (4) edema and fragility
of the perineal. 2) Indication of the fetus: fetal
476
the wound tissue perineal wound healing
process lasts so long. In Indonesia ancestral
herb for healing after childbirth is still widely
used, even by modern society in this way has
not been widely used. For example, perineal
sutures for wound healing, traditional societies
use common snakehead to be consumed daily
in order to accelerate the process of wound
healing of the perineal. However, meeting the
needs of albumin and protein by using a fish
cork has not been widely used, but according
to the study conducted by prof. Dr.. Ir. Eddy
Suprayitno MS, fish cork containing albumin
is high enough so that it can accelerate wound
healing of the perineal and the rapid wound
healing can prevent the occurrence of
infections (Kordi, 2010).
In the community itself is still a lot of
mothers who experience postpartum perineal
wound healing delays, where the 7th day after
the wound is still there crusta, no adhesions at
the turn of the bandage, no scarring, no signs
of infection, inflammation and granulation are
still not visible, the former wound is not good
(Pusdiknakes, 2003).
Based on data from the World Health
Organization (WHO) in 2009 there were 2.7
million cases of rupture of the perineal at birth
mother. This figure is estimated to reach 6.3
million by 2050, along with the high midwife
midwifery care that do not know well. In the
26 million Americans who experience
maternal perineal rupture, 40% had rupture of
the perineal because of the negligence of the
midwife. In Asia rupture of the perineal is also
a considerable problem in the community,
50% of the incidence of rupture of the perineal
in the world occur in Asia. The prevalence of
maternal experiencing perineal rupture in
Indonesia in the age group 25-30 years is 24%
while at the maternal age of 32 -39 years by
62%.
The results of the initial survey
conducted by researchers for one week in
BPM Ny.Titin S. Mubin, Amd.Keb.Lamongan
Karanggeneng there were 10 mothers who
experience postpartum perineal wound. Of the
10 mothers there are 7 people or 70% of new
mothers experience a delay in wound healing
of the perineal and 3 people or 30% of
puerperal women have experienced in the
wound healing process. Based on the data in
the above description, that the majority of new
mothers experience a delay in wound healing
of the perineal.
Physiologically perineal wound will
begin to improve within 6-7 days postpartum.
As for some of the factors that affect wound
healing of the perineal are internal factors and
external factors. Internal factors that affect the
healing of the perineal include: (1) Nutrition.
Nutritional factors, especially protein will
greatly affect the wound healing process
perinium because the network is in desperate
need of protein turnover. Protein requirements
will be needed in the process of wound healing
lacerations of the birth canal, because this
protein serves as a building block cells that
have been damaged. When this protein needs
are lacking in wound healing process the tissue
cells of the body will be hampered in building
change cells and tissue in the birth canal
laceration wound healing process lasts so long
(Kartika, 2008). (2) Personal hygiene or vulva
hygiene. If personal hygiene maintained in less
postpartum mothers will lead to an infection
(Moya, 2003). Personal hygiene or lack of
personal hygiene can also slow healing, it may
cause foreign objects such as dust and germs
(Smeltzer, 2002), (3) maternal condition. If the
condition of a healthy mother, then the mother
can take care of themselves well. (4)
Descendants, (5) age, (6) hemorrhage, (7)
hypovolemic, (8) local edema factor, (9)
nutritional deficit, (10) oxygen deficit, and
(11) over the activity. While external factors
affecting the perineal wound healing include:
(1) Environment. Support from family, where
the mother will always feel the protection and
support and advice, especially parents in
caring for hygiene after childbirth. (2)
Tradition. sutures for wound healing after
surgery, using a traditional community fish or
fish cork curse to be consumed daily in order
to accelerate the process of wound healing
stitches. (3) Knowledge. If the mother's lack of
knowledge thereof problems of food
consumed wound healing will take a long time
(4) Socio-economic, (5) Handling officer, (6)
Network Management, (7) Drugs (Smeltzer,
2002).
Impact of delay in the first perineal
wound healing is infection, which affected
locheaperineal conditions and moisture will
greatly support the proliferation of bacteria
which can cause infection in the perineal. The
second occurrence of complications, the
emergence of infection in the perineal can
propagate in the gallbladder or in the birth
canal that can result in the emergence of
477
infectious complications and bladder
infections in the birth canal. And the third is
the occurrence of postpartum maternal death,
treatment of complications that can lead to a
slow death in women post partum physical
condition is still weak postpartum mothers
(Ambarwati, 2008).
To accelerate wound healing of the
perineal there are many ways, such as through
improved nutrition by eating foods high in
calories and high in protein. Common sources
of protein are meat, milk, bread, cereal, eggs,
fish, nuts, and seeds (Boyle, 2008). According
Kordi (2010), catfish (Channastriata) is one
kind of fish that contain albumin and protein
are high enough. Protein and albumun very
function as a builder substance cells that have
been damaged, so that wound healing will take
place faster. With a high content of protein and
albumin, common snakehead
could
potentially be used by the public for the
wound healing process, especially
postoperative wounds, burns and after
childbirth. For the role of nurses is expected to
help provide counseling to new mothers on
how to optimize the perineal wound healing by
encouraging the fish to consume common
snakehead.
Because many factors affect the
perineal wound healing researchers interested
in conducting research on nutrition, which is
intended to improve nutrition by researchers is
"Giving Nutrition Improvement With
Common Snakehead (Channastriata)".
S. Mubin, Amd.
Sumberwudi 2014.
No
Keb
Village
Age
Jumlah
Prosentase
Responden
(%)
1. < 20 thn
5
16.7
2. 20 – 30 thn
15
50
3. > 30 thn
10
33.3
Total
30
100
Sources Primary Data: Study Pebruari-April
2014
Based on the above data shows that of
the respondents who experienced a postpartum
mother's perineal wound most or 50% aged
20-30 years and a fraction or 16.7% were aged
<20 years
2) Characteristics of respondents by
level of education
Table 2.Distribution of Respondents by
Education Mothers Experiencing
Postpartum The perineal wound in
BPM Ny.Titin S. Mubin, Amd.
Keb Village Sumberwudi 2014.
No
Education
1.
2.
3.
4.
PrimarySchool
Junior High School
High School
College
Juml
ah
4
4
17
5
Prosent
ase (%)
13.3
13.3
56.7
16.7
Jumlah
30
100
2014
the respondents who experienced postpartum
maternal perineal wound over part or
education high school and 56.7% or 13.3%
fraction education elementary and junior high
school
METHODS
This study uses Quasy-Exsperimental.
In this study population was 300 respondents
and the sample in this study consisted of 30
respondents 15 respondents control group and
the treatment group of 15 respondents. The
sampling method used in this study is
Consecutive sampling.
RESULTS
1. The General Data
age
Table 1. Distribution of Respondents by Age
Mothers Experiencing Postpartum
The perineal wound in BPM Ny.Titin
Jobs
478
Table 3. Distribution of Respondents by
Mother Employment Ruling scarred
perineal in BPM Ny.Titin S. Mubin,
Amd. Keb Village Sumberwudi
2014.
No
Jobs
Jumlah Persentase
(%)
1.
Farmer
3
10
2. Employee
9
30
3. Merchant
8
26.7
4.
Don‟t
10
33.3
work
Jumlah
30
100
2014
mother's perineal wound almost half or 33.3%
do not work and a small portion or 10% are
farmers.
1) The Perineal Wound
Process of Control Group
Diagram 1. The perineal wound Healing process of
control group in BPM Ny.Titin S. Mubin, Amd. Keb
Desa Sumberwudi Tahun 2014
1.
2.
3.
Jumlah
Cepat
Lambat
13.3%
perineum Wound Healing Process
Based on the above data shows that
respondents that new mothers in the control
group was 86.7% or almost entirely wound
healing process is slow and categories perineal
fraction or 13.3% wound healing process
perineal fast category.
2) The Perineal Wound Healing
Process of Intervention Group
Diagram 2. the perineum wound healing process of
intervention group n BPM Ny.Titin S. Mubin, Amd. Keb
Desa Sumberwudi Tahun 2014
Persentase
(%)
46.7
36.7
16.7
Frekuensi
Parity
86.7%
Frekuensi
14
12
10
8
6
4
2
0
4) Characteristics of respondents
based on parity
Table 4.Distribution of Respondents by Parity
Mothers Experiencing Postpartum
The perineal wound in BPM
Ny.Titin S. Mubin, Amd. Keb
Village Sumberwudi 2014.
No
Healing
Primipara
14
Multipara
11
Grandemultip
5
ara
Jumlah
30
100
2014
mother's perineal wound partially or almost
46.7% had 1 child (primiparous) and a small
portion or 16.7% had> 2 children
(grandemultipara).
14
12
10
8
6
4
2
0
80
%
Cepat
Lambat
20
%
Properineum Woun Healing Process
Based on the above data indicate that
respondents puerperal women in the treatment
group or 80% almost entirely wound healing
process faster and categories perineal fraction
or 20% of the wound healing process is slow
perineal category.
2. Data Special
3) Effect of Commond snake head (
Channa striata) The Perineal
479
turnover (Boyle, 2008). 2) Personal hygiene or
vulva hygiene affect wound healing of the
perineal, if personal hygiene maintained in less
postpartum mothers will lead to an infection
(Moya, 2003). 3) The condition of the mother.
Maternal health condition both physically and
mentally, can lead to long recovery. If the
condition of a healthy mother, then the mother
can take care of themselves well. 4) Age: Age
is closely related to wound healing, because
the older person will decrease the speed of
wound healing. Faster wound healing occurs at
a younger age than in older people. People
who are already advanced in years can not
tolerate stress such as tissue trauma or
infection (Smeltzer, 2002).
The result showed that the cause of the
slowdown in the perineal wound healing than
the control group because it was not given fish
cork, they also undertake to abstain from foods
that lack nutritional needs are met, lack of
attention to personal hygine so easy to breed
bacteria and cause infection, and lack of
activity. These factors led to the possibility
that the perineal wound healing process in the
control group lasted longer.
In the treatment group were given fish
cork 12 respondents showed rapid wound
healing perineal categories namely wound
healing perineal<7 days, the average wound
healed on days 5-7. Nutrition is one of the key
wound healing. Puerperal women are
encouraged to eat with a balanced diet, enough
carbohydrates, proteins, fats, vitamins and
minerals (Suherni, 2009).
One source of protein that can be
obtained from fish cork that can aid in wound
healing, it is because the catfish can increase
endurance. Common snakehead meat contains
high protein and albumin. In addition,
common snakehead meat also contains a
complete amino acid, as well as micronutrients
zinc, selenium, and iron. Other content in fish
flesh is alisin cork, allyl sulfide, and furostanol
glycosides that can help repair damaged tissue
in the wound, so that wound healing can take
place more quickly (Suprayitno. E, 2003).
Above theory in accordance with the
results of research in Ny BPM. Titin S. Mubin
Amd. Keb sumberwudi Karanggeneng
Lamongan village where the results of
statistical tests indicate that there is the effect
of common snakehead (Channa striata) on
wound healing of the perineal. Providing
methods to improve nutrition in the form of a
Wound Healing In BPM Ny.Titin S.
Mubin, Amd. Keb 2014.
Diagram 3 Effect of Common Snakehead
(Channa Striata) the Perineum wound healing
in BPM Ny.Titin S. Mubin, Amd. Keb Tahun
2014
proses Penyembuhan Luka
25
20
15
Perlakuan
Kontrol
10
5
0
0
20
40
jumlah responden
Z = -3.598 dan = 0.000
Based on the above data shows that in the
control group perineal wound healing process
is slow category, where the wound healed after
day 7. Whereas in the treatment group
respondents puerperal women perineal wound
healing process including fast category, where
the wound is healed before day 7.
Based on the results of statistical tests
using the Mann Whitney in SPSS version 16
with the results obtained Z = -3598 and where
Ho is rejected, which means there is the effect
of common snakehead (Channa striata) on
wound healing of the perineal in BPM
Ny.Titin S. Mubin, Amd. Keb 2014. Granting
common snakehead (Channa striata) can
accelerate wound healing of the perineal in
postpartum mothers.
DISCUSSION
In the control group was given fish without
cork 13 respondents indicated category
perineal slow wound healing wound healing
perineal> 7 days, the average wound healed at
day 14-21.
There are several factors that can affect
the perineal wound healing include: 1)
Nutrition. Nutritional factors and nutrients,
especially protein will greatly affect the
wound healing process in the perineal because
the network is in desperate need of protein
480
fish cork in hopes of repairing damaged tissue
in the wound, so that wound healing can take
place more quickly.
CONCLUSIONS
RECOMMENDATIONS
DayaIkanGabus.Edisi 1. Yogyakarta:
ANDI
Moya J, Morison. (2003). Manajemen Luka.
Jakarta: EGC
Prawirohardjo,
Sarwono.
(2002).
PelayananKesehatan Maternal dan
Neonatal.CetakanKelima.
EdisiKetiga. Jakarta: BinaPustaka
Pusdiknakes. (2003). Asuhan Kebidanan Post
Partum. Jakarta: Pusdiknakes
Saifuddin, Abdul Bari. (2008). Buku Acuan
Nasional Pelayanan Kesehatan
Maternal Dan Neonatal. Jakarta:
YBPSP
Smeltzer, Suzanne C, dkk. (2002).
Keperawatan Medikal Bedah, Edisi 8
Vol 1, Jakarta: EGC
Suherni. (2009). Perawatan Masa Nifas.
Yogyakarta: Fitramaya
Varney, Helen. (2007). Buku Ajar Asuhan
Kebidanan Edisi 4. Jakarta: EGC
Wiknjosastro,
Hanifa.
(2005).
Ilmu
Kandungan. Jakarta: YBPSP
AND
1. Conclusions
There is the effect of common snakehead
(Channa striata) on wound healing of the
perineal in BPM Ny.Titin S. Mubin, Amd.
Keb 2014.
2. Recommendation
Giving common snakehead can be used as
an alternative to accelerate wound healing of
the perineal in postpartum mothers.
REFERENCES
Ambarwati. (2008). Asuhan Kebidanan Nifas.
Yogyakarta: Mitra Cendekia.
Boyle, Mauren. (2008). Pemulihan Luka:
Seri Praktik Kebidanan.
Jakarta:
EGC.
Kordi, M. Ghufran H. (2010).
PanduanLengkapBisnisdan Budi
481
THE INFLUENCE OF PROGRESSIVE RELAXATION TO DECREASE PAIN
FOR PATIENTS OF SECTIO CAESAREA SURGERY
IN THE FIRST AND SECOND DAY
Aris Dwi Cahyono, Wida Wicaksana
Akademi Keperawatan Pamenang
Abstract
After the effect of Sectio Caesarea anesthesia has finished, they will feel pain on body
organ where surgery is done. There are two methods to decrease pain of Sectio Caesarean
surgery by using medicines and using progressive relaxation technique. The purpose of
this research is to identify the influence of progressive relaxation to decrease pain for
patients of Sectio Caesarea surgery in Maternal Room General Hospital of Kediri
Regency in 2014.
Research design was Pre-Post Test Experiment. The populations 38 patients of post
section caesarean surgery in the first and second day. Sample used purposive sampling
and consisted of 9 respondents. Data analysis was implemented by comparing pain scale
pre and post intervention and being analyzed as descriptive. Research result showed that
pre-intervention, value of mean was 5,66 with standard deviation 1, and post-intervention,
value of mean was 4,66 with standard deviation 1,5. Analysis result showed a decrease of
mean value 1 and standard deviation 0,54. There was influence of progressive relaxation
to decrease pain for patients of Sectio Caesarea surgery. It is hoped for medical staffs to
use progressive relaxation technique as one of chosen therapies to decrease pain scale
beside of medicines.
Key words : Progressive Relaxation, Pain, Post Sectio Caesarean Surgery.
technique is to focus on a muscle
activity in a sustainable manner by
identifying the tense muscles then
lowers the tension by doing relaxation
techniques to get a feeling of relaxation
(Murphy, 1996).
In Indonesia, the percentage of
Caesarea Sectio big enough. In
government hospitals in the year 2008
the average labor with Sectio Caesarea
by 11%, while at the Private Hospital
could be more than 30%. And recorded
from 17 665 birth rate there is 35.7% 55.3% of mothers giving birth to the
process of sectio caesarea. In East Java,
Regional General Hospital Dr. Soetomo
as the largest referral hospital in East
Java was found that the incidence of
labor with Sectio Caesarea in 2008 was
1478 cases (23.3%) of the total 6335
deliveries
(Yudhoyono,
2008).
Meanwhile, according to a preliminary
study conducted at the maternity ward
Kediri District Hospital on 19 November
Background
Sectio Caesarea is an act of
delivery of a fetus that has been able to
live together with the placenta and
membranes are transabdominal through
the uterine incision. In the operation
process used anesthetic so that the
patient does not feel pain during surgery.
But after the operation is completed and
the patient began to realize and react to
the anesthesia wears off, the patient will
feel pain in the body that had surgery.
Many women complain of pain in
stitches, this complaint is actually
reasonable because the
body is
experiencing injuries and healing can
not be perfect, especially if the wound is
relatively long and deep. However, there
are two methods to reduce pain in a
natural scale postoperative Sectio
Caesarea mother is in Pharmacological
and non-pharmacological drug use one
of them with progressive relaxation
techniques. Progressive relaxation
511
2013 was recorded incidence Sectio
Caesarea deliveries on average each
month in 38 patients.
This increase is allegedly due to
improved techniques and facilities, the
operation lasted more aseptic, anesthetic
techniques improved, comfort pasectio
caesarea higher operating, and the length
of the short growing and can choose the
date of birth as you wish (Roeshadi,
2006). Nevertheless Caesarea operation
does not mean free of risks or problems.
Research by Hillan about pain post
Sectio known that on days 1-2 clients
still experiencing pain in the wound, and
even almost half of women lasts until
they return home, and even about 32%
of patients who performed the cesarean
is still experiencing pain in injuries, and
often pain in the wound after returning
gain weight thus requiring analgesics.
Steer, 2004 stated that relaxation
is a method of transfer of nonpharmacological pain that is often used
in the UK. Steer in the study reported
that as many as 34 women using
relaxation, by induction of relaxation for
15 minutes can significantly reduce the
sensory component of pain. Pillips
added that the emotional component of
pain is also reduced so that the effect of
exacerbating anxiety was also reduced
due to the impact of the relaxation
(Mander, 2004). Relaxation can be used
in episodes of acute and chronic pain to
reduce pain. Usually it takes 5-10
training sessions before a client can
effectively minimize pain. Patients who
already know about the relaxation
techniques may just need to be reminded
to use such techniques to reduce or
prevent the pain. The basic aim of
relaxation is to help people to relax, and
thus improve the various aspects of
physical health. Besides, there are also
some other benefits, which lead to inner
peace, reduced anxiety, lower heart rate,
reduce blood pressure, a greater
resistance to disease, mental health
getting better and better memory.
Many patients and health teams
tend to view drugs as the only method to
relieve pain, but many non-
pharmacological nursing activities that
can assist in the relief of pain. One of
them is progressive relaxation, nonpharmacological methods of pain relief
that has a very low risk. Although such
action is not a substitute for drugs, such
action is necessary to shorten episodes
of pain that lasts only a few seconds or
minutes.
Based on the above description
researchers interested in conducting
“The Influence Of
research on
Progressive Relaxation To Decrease
Pain For Patients Of Sectio Caesarea
Surgery In The First And Second Day”
in the Maternity Room of the District
General Hospital Kediri.
Formulation of the Problem
Based on the description of the
background of the problem, it can be
formulated research problem, namely “Is
there a The Influence Of Progressive
Relaxation To Decrease Pain For
Patients Of Sectio Caesarea Surgery In
The First And Second Day in the
Maternity Room of the District General
Hospital Kediri?”
Purpose
1. General Purpose
To determine differences in the level
of pain in patients with postoperative
Sectio Caesarea before and after
being given the progressive
relaxation technique in Maternity
Room General Hospital of Kediri.
2. Special Purpose
a. Identify the level of pain before
the progressive relaxation in
patients with postoperative sectio
caesarea in the first and second
day.
b. Identify the level of pain after
doing the progressive relaxation
in patients with postoperative
sectio caesarea in the first and
second day.
c. Analyzing the influence of
progressive relaxation to decrease
postoperative pain in patients
512
sectio caesarea in the first and
second day.
3
4
5
6
7
8
9
Mean
Median
Modus
stand. Dev
Research Design
research is the design of preexperimental design One group pretestposttest, which in this design there is no
comparison group (control, but most do
not already made the first observation
(pre-test) that allows researchers can test
changes occurred after the experiment.
Pre test
test
01
Treatment
X
4
5
5
7
6
5
7
5,66
6
6
1
Based on the table shows that out
of 9 respondents surveyed 11.11% or 1
respondent experienced pain with pain
scale 4, 33.33% or 3 respondents
experiencing pain with pain scale 5,
33.33% or 3 respondents experiencing
pain with pain scale 6 and 22.22% or 2
respondents experiencing pain with pain
scale 7. the mean 5.67, median 6, 6
mode and standard deviation 1.
Post
02
The independent variable in this
study is a progressive relaxation. The
dependent variable in this study is the
reduction of postoperative pain in
patients Sectio Caesarea.
The study population was 38
patients with postoperative sectio
caesarea experiencing pain in the first
and second day. In this study, samples
taken part sectio caesarea postoperative
mothers who experience pain in the first
and second day as many as 9
respondents. In this study, the sampling
technique used was purposive sampling,
where the technique of determination of
sample by choosing among a population
sample in accordance with the desired
researchers in accordance with the
criteria. The data analysis was done
through descriptive analysis, the
observation of the frequency table.
Frequency table consists of a column - a
column that contains frequencies and
percentages for each category.
2. Pain scale respondents action after
progressive relaxation techniques
Code
Scale Pain
1
5
2
4
3
4
4
4
5
3
6
7
7
5
8
3
9
7
Mean
4,67
Median
4
Modus
4
Stand. Dev
1,5
Based on the table shows that out
of 9 respondents surveyed 22.22% or 2
scale 3, 33.33% or 3 respondents
experiencing pain with pain scale 4,
22.22% or 2 respondents experiencing
pain with pain scale 5 and 22.22% or 2
scale 7. The Mean Value 4.6, 4 Median,
Research Result
1. Respondents pain scale before action
is taken progressive relaxation
techniques
Code
Pain Scale
1
6
2
6
513
mode 4 and the Standard deviation of
1.5.
3. Analysis of the effect of progressive
relaxation in patients with
postoperative sectio caesarea in
Maternity Room General Hospital
District Kediri.
Resp.
Decrease
Before
After
Number
pain scale
1
6
5
1
2
6
4
2
3
4
4
Tetap
4
5
4
1
5
5
3
2
6
7
7
Tetap
7
6
5
1
8
5
3
2
9
7
7
Tetap
Mean
5,66
4,67
1,5
Median
6
4
1,5
Modus
6
4
1
Stand.
1
1,5
0,54
dev.
conducted it appears that there is a
decrease pain scale by the respondents,
the descriptive statistical tests obtained
prior to action relaxation techniques
mean value of 5.66, the median value of
6.00, the value of 6:00 mode, and
standard deviation of 1. After the action
is obtained the mean 4.67, median
values of 4.00, 4.00 value mode, and
standard deviation of 1.5. Value
indicates a decrease in the mean value of
1.5, the median value of 1.5, the value of
mode 1 and a standard deviation of 0.54
so that H0 is rejected and H1 accepted.
It showed no effect of relaxation
techniques on a scale decrease
postoperative pain in patients sectio
caesarea on the first day and the second
in the Maternity Room General Hospital
of Kediri.
Discussion
1. Pain scale before the patient is given
the actions of progressive relaxation
techniques.
Pain scale before being given a
progressive relaxation technique that
measures of 9 respondents surveyed
in the last 2 weeks Mean pain scale
score was 5.6, median 6, 6 mode and
standard deviation 1.
Pain is an uncomfortable
feeling, whether mild or severe. Pain
is defined as a condition that affects a
person's existence is unknown and if
someone ever experienced (Tamsuri,
2007). According to the International
Association for the Study of Pain
(IASP), pain is an emotional
experience unpleasant feelings as a
result of actual or potential damage,
or describe the condition of the
occurrence of damage.
According to the researcher
scale of perceived pain patients in the
Maternity Room District General
Hospital Kediri is influenced by
several things including the age and
experience of sectio caesarea
operation. Showed that of the
majority of respondents aged 20-30
years and 2 respondents had never
undergone surgery sectio caesarea. It
can be concluded that the different
scale of perceived pain patients due
to surgery sectio caesarea experience
before.
2. Pain scale after the patient is given
the actions of progressive relaxation
techniques.
The scale of the pain that is
felt after the patient is given the
actions of progressive relaxation
techniques, decreased pain skla into
Mean Value 4.6, 4 Median, Mode 4,
the standard deviation is 1.5.
Progressive
relaxation
technique is to focus on a muscle
activity by identifying the tense
muscles then lowers the tension by
doing relaxation techniques to get a
feeling of relaxation (Murphy, 1996).
It is also based on the theory of the
514
gate control, explaining that the pain
that occurs in a person due to certain
stimuli such as surgery can be
blocked when the interaction
between the pain stimulus and the
stimulus to the fibers that transmit
sensations of pain blocked on the
circuit gate resistor, this reversal can
be done through distraction or by the
action of relaxation (Sutherland,
2005).
According to researchers pain
scale decline in respondents
influenced surgery sectio caesarea
experience and capabilities of
different respondent in conducting
progressive relaxation techniques are
taught. So with relaxation techniques
is expected patients assisted by
nurses can use it as an action to lower
the scale of pain experienced, in
addition to using the drug.
different respondents in performing
relaxation techniques are taught, so
the impact on respondents' perceived
pain scale. So the difference in
results or the effect of relaxation
techniques performed in this study
indicate that the need for health
workers to improve the ability to
analyze the factors that affect pain
scale and improve skills in using the
techniques of progressive relaxation
as one alternative to reduce the pain
scale for patients other than use
drugs.
Conclusion
1. Pain scale measures a patient prior
to relaxation techniques obtained a
mean value of 5.6, the median 6, 6
mode and standard deviation 1.
3. Progressive relaxation influence on
reducing postoperative pain in
patients sectio caesarea on the first
day and the second in the Maternity
Room General Hospital District
Kediri.
Based on the results of the
study showed a decrease in the pain
scale sixth respondent after given
action relaxation techniques, to
obtain penurunkan mean values of
1.5, 1.5 median, mode 1, and
standard deviation of 0.54 means that
there is a decrease in the pain scale of
respondents.
The factors that affect pain
scale include age, gender, culture,
anxiety and past experiences and
progressive relaxation techniques.
Progressive relaxation is an effective
way to rest the muscles through an
appropriate manner, followed by
mental relaxation and mind (Davis,
2005).
According to researchers, the
differences decrease pain scale on
each individual is different. That is
because many factors ranging from
differences in age, experience sectio
caesarea operations, and the ability of
2.
The scale of the patient's pain after
the
relaxation
techniques
implemented measures showed that
the mean value of 4.6 median value
of 4.00 mode value of 4.00 and a
standard deviation of 1.5.
3.
Patient pain scale before and after
the implemented measures showed
a decrease in mean values of 1.5
median value of 1.5 mode value of
1 and a standard deviation of 0.54.
There dilakukanya influence action
relaxation techniques to decrease
pain scale figures on maternal
postoperative sectio caesarea in
Maternity Room General Hospital
District Kediri.
Suggestion
1. For health agencies
Progressive relaxation technique is
one of the nursing treatment that is
easy and inexpensive can be
selected to be applied to nursing
actions for clients with problems of
pain.
2.
515
For educational institutions
Relaxation techniques are one
option for clients with problems of
3.
4.
pain, so it can be entered into the
laboratory skills of students in the
achievement of competence.
Farrer,
For the general public
Mothers with post Sectio Caesarea
expected to apply relaxation
techniques
as
a
nonpharmacological therapies that are
safe and easy to reduce pain.
Astuti, Puji. (2010), cermin Dunia
Kebidanan. www.cermin
dunia
kebidanan.com
(download )
Notoatmojo,
Notoatmojo,
(2003).
soekidjo.
(2005).
Metodologi
Penelitian
Kesehatan. Jakarta : PT
Rineka Cipta.
Notoatmodjo, S. (2010). Metodologi
Penelitian Kesehatan ,
Ed.Rev 1 .Jakarta : PT
Rineka Cipta
Reference
Potter, P.A & Perry, A.G.(2005)
Fundamental Keperawatan Konsep,
Proses Dan
Praktik, Jakarta: EGC
Nursalam.
Smeltzer, S. C, & Bare.(2001). Buku
Ajar Keperawatan Medikal
Bedah. Jakarta. EGC
Smeltzer, S. C, & Bare.(2002). Buku
Ajar Keperawatan Medikal
Bedah. Jakarta. EGC
Torrance, C & Serginson. E (1997).
Surgical
Nursing.
Bridgend,
Midglanmorgan:WBC
Book Manufactured. Ltd
A. (2007). Konsep
Penatalaksanaan
Nyeri.jakarata : EGC
soekidjo.
Metodologi
Penelitian
Kesehatan. Jakarta : PT
Rineka Cipta.
For further research
This study can be used as a source
of information for further research
pengembangkan. Future studies
may consider factors that affect
pain scale such as age, experience
sectio caesarea operations and the
ability of respondents to do
relaxation techniques taught.
Tamsuri,
Hellen. (2001).Pearawatan
Maternitas.Edisi
2 :
ECG.Jakarta
Dan
Cuninghamm. F.G, (2007) Obstetri
William, vol ipenerbiy
buku kedokteran egc,
Jakarta
516
(2003). Konsep dan
Penerapan
Metodologi
Keperawatan. Jakarta :
Salemba Medika
THE INFLUECING OUTCOME FACTORS OF CAESAREA SECTIO PATIENTS IN
PREPARATION FOR THE CLINICAL PATHWAYS COSTING OF DRGS AT PARE –
KEDIRI HOSPITAL
Suryono
Akademi Keperawatan Pamenang Pare, Jl. Mahakan No. 05 Pare- Kediri,
Email [email protected]
Abstract
Clinical Pathway is a concept of comprehensive service to plan the patient that are using standard of
medical service and Nursing care during hospitalization. Research design is correlational approach
observation with secondary input variables including Hb, age, class of service, indication, medicine,
wound care, and nutrition. The output variables are LOS (Length of Stay), cost, wound, mobilization,
and complication using statistical analysis with multiple linear regression. Populations in this study
were all patients hospitalized with caesarean section at Pare Hospital, Kediri, east Java, Indonesia.
Multiple linear regression analysis showed that Hb variable positive correlate to the LOS(r=0,136).
Antibiotic variables also showed positive correlation with the hospital cost (p=0,041). From multiple
logistic regression analysis, wound care is more influenced (B=161,98) to wound healing process,
mobilization and complications more than another variables. This result can be used for early basic to
arranged clinical pathway at caesarean section patient with some consideration such as age, infant
indications, nutrition, antibiotic combinations, wound care, diabetic mellitus, prolonged delivery, and
hypertension with complications.
Key words : Clinical pathway, caesarean section
mobilization and complications of caesarean
sectio patients at Delivery Room Pare Kediri
Hospital. The benefits of this research can be
used as the initial data for the hospital to
arrange Clinical Pathway.
1. Framework Concept
Scheme 3.1 research conceptual
framework
Background
On July 1st, 2007 the Ministry of Health
of Indonesia has introduced Diagnosis Related
Groups (DRG's INA) which will be used as the
basis for a claim payment insurance patient
hospital. But the government in implementing
the INA DRG's not give the basis for
calculating the financing so detailed yet clearly
the cost of each component of health care. As
a basis for determining the cost of health
insurance services
can be used Clinical
pathway (theoretical cost driver).
Clinical pathway is one component of the
DRG system casemix consisting of
codefication and action procedures and the
calculation of costs. Clinical pathway into
something that should be developed by each
hospital, where the insurance company or the
government would require hospitals to provide
quality health services at a reasonable
cost(Yunita,2009).
Formulation of the problem in this study
are the factors that affect the LOS, costs,
wound healing time, mobilization and
complications of caesarea sectio patients in
maternity room Pare Kediri hospital. While the
goal of this research is to identify factors that
affect the LOS, costs, wound healing time,
Hypothesis: there is influence of the
characteristics (Hb, age, class of service)
indication, medicine,
doctor, nurse
intervention, and nutrients to the LOS, costs,
wound healing time, infusion time off ,
catheters time off and complications.
3.Researchmethods
The study design: a correlational approach
"observational" using retrospective secondary
data aims to identify factors - factors that
affect patient outcomes caesarea sectio. The
population in this study were all hospitalized
518
patients with cesarea sectio in the General
Hospital of Pare Kediri. While the independent
variables examined included the data Hb, age,
class of service, indications, medications,
nutrition, the actions of doctors, nurses, and
LOS include the dependent variable, the cost,
time healing wounds, immobilization time,
and complications.
4.Research result
The result showed that the distribution of
respondents mother who gave birth by cesarea
sectio mean age was 31.1 years. The general
status of the mother when viewed from the
maternal haemoglobin concentration was 9.4
mg%. The majority of respondents in this
study using a class of service insurance as 74
respondents (92.5%). Most caesarea sectio
conducted with mothers indicated that 59
(73.8%). The majority of doctors use
amoxicillin antibiotic
injection and oral
amoxcillin 48 (60%), wound care nurse
performed, a majority of only 1 x during care
after surgery 64 (80.8%). While the lenght of
stay (LOS) of respondents found that the
average patient is treated for 4.8 days. The
total cost incurred respondents means is
3.910.000 rupiah. Majority of the wound
healing time for 7 days, as many as 64
respondents (80%), the distribution of
respondents by the ability start to mobilize, a
majority on the first day of 52 respondents
(65%).
1) The Influencing Factors To LOS
a. The Influence of Age and Hb
The relationship between LOS and age
shows with a low correlation (r = 0.241) and a
positive pattern means that the older have
higher of LOS . Statistical test results found
relationship/significant influence of maternal
age with LOS (0.031) (Table 4.1).
The mean of hospitalization long days
patients with poor insurance is 4.85 or 5
days. Patients with Health Insurance the
mean of hospitalization is 4 days, while in
the general patient have 4 days of
hospitalization. Statistical results test
obtained p = 0.437, which means it can be
concluded there was no effect of financing
sources with LOS. While the average long
day of hospitalization of caesarea sectio
patients with an indication is 4.95 days.
Statistical test results obtained value of p =
0.067, meaning there is no influence
between caesarea sectio with a long day of
hospitalization.
The mean long days of hospitalization
patients with amoxicllin injection therapy
and oral amoxicillin is 4.92 or 5 days. The
mean of patients with amoxicillin injection
therapy and oral cipro is 4.25 days of
hospitalization, cipotaxim injection therapy
and oral amoxicillin has average of 4.60
days, while in patients with therapy oral
cipro and cipotaxim injection means 4.85
days. Statistical test results obtained value
p = 0,470 which means there is no
influencing between medicine therapy with
LOS.
The mean long days of hospitalization
patients with one time wound care is 4.44
days, patients with wound care 2 times the
average length of stay was 6.13 days and
patient with three times wound care the
average is 9 days. Statistical test results
obtained p = 0.000, which means there is
significant influence between the LOS
wound care.
The mean
of long days of
hospitalization caesarea sectio patients with
nutritional/ dietary
high-calorie highprotein is 4.75 days, while the dietary highcalorie high-protein-low salt means was
5.80 days. Statistical results test obtained
value of p = 0.019, meaning there is
influence between nutrition/diet with long
days of hospitalization. (table4.2).
Table 4.1. Correlation and regression analysis
of age and Hb with LOS
Table 4.2. Distribution The mean LOS
According Class Service
a. The Effect of Nursing Class, Caesarea
Sectio Indication, Medicine, Wound
care and Mutrition To LOS.
519
0.822, which means there is no class effect
with the cost of hospital care. The mean cost
of hospital patients on caesarean sectio with an
indication of the capital is 3.950.000 rupiah 797,642.991 rupiah. While the mean with baby
indication is 3.800.000 rupiah - 297,905.704
rupiah. Statistical results test obtained value of
p = 0.275, meaning there is no influence
between patients caesarean sectio with hospital
cost.
The Mean hospital costs patients with
amoxicillin injection therapy and oral
amoxicillin is 3.770.000 rupiah -. 231.590.4
rupiah ,-. Patients with amoxicillin injection
therapy with oral ciprofloxacin the means
days of hospitalization is Rp. 4.010.000,-, 359.290.6 rupiah, cipotaxim injection and oral
amoxicillin its average 3.920.000 rupiah 860.610.9 rupiah whereas in patients with
therapy cipotaxim injection and oral
ciprofloxacin means 4.390.000 rupiah,1.346.163.5 rupiah. Statistical test results
obtained p = 0.041, which means there is the
influence of medicine therapy with hospital
costs.
The Mean hospital costs in patients with
wound care one time is 3.940.000 rupiah, 756.545.9 rupiah, in patients with wound care
2 times the average cost of hospital is
3.770.000 rupiah, - and wound care 3 times its
average 4,020.000 rupiah -. Statistical test
results obtained p = 0.690, which means there
is no significant influence of the wound care
with hospital costs.
The mean of hospital cost patients
caesarea sectio with nutrition / dietary highcalorie high-protein is 3.870.000 rupiah - with
a standard deviation of 636.348.4 rupiah while
the high-calorie high- protein low salt diet
means is Rp 4.430.00 with a standard
deviation of 1380550.6 rupiah. Statistical test
results obtained value of p = 0.088, meaning
there is no influence between nutrition/diet
with long days of hospitalization (Table 4.4).
Table 4.4. Distribution The mean cost of
hospital According Class Service
2) The Influential Factors To Cost
a. The Influence of age and Hb
The relationship of age with the cost of
the hospital showed a low correlation (r =
0.105) and a positive pattern means that the
older the higher cost of RS. Statistical results
test found no significant effect (p = 0.000)
between age and hospital costs. While the
relationship haemoglobin with hospital cost
shows a low correlation (r = 0.078) and a
positive pattern means higher Hb levels will
make higher hospital costs. Statistical results
test found no significant effect (p = 0.000)
between Hb with hospital costs(Table4.3).
Table 4.3. Linear Regression Results The
effect of age and Hb Against Hospital Costs
b. The Effect of Nursing Class, Caesarea
Sectio Indication, Medicine, Wound Care
and Nutrition
Mean hospital costs patients with poor
insurance is 3.920.000 rupiah -. Patients HI
(Health Insurance)
the average cost is
3.610.000 rupiah - while the general patient
means is 3.770.000 rupiah - 174.300,281
rupiah. Statistical test results obtained p =
520
b. The Effect of Nursing Class, Caesarea
Sectio Indication, Medicine, Wound care
and Nutrition for Wound Healing Time
Average time of wound healing patients
with poor insuranc is 8.08 days. For Health
Insurance Patients mean of wound healing
time is 7 days, whereas in the general patient
means also 7 days. Statistical test results
obtained p = 0.455, which means there is no
influence of the class of service with the
wound healing time.
Average time healing wounds of
patients caesarea sectio with an indication is
8.19 days. While the baby with indication
means is 7.48 days. Statistical results test
obtained value of p = 0.166, meaning there is
no effect between the caesarean sectio
indication with wound healing time.
Average time of wound healing in
patients with amoxcilin injection therapy and
oral amoxicillin is 8.15 days. Patients with
amoxicillin injection therapy and oral cipro
have mean of long days of hospitalization is
7.00 days, cipotaxim injection and oral
amoxicillin its average 7.67 days, while in
patients with therapy oral cipro and
cipotaxim injection means 8.15 days.
Statistical results test obtained p = 0.639,
which means there is no influence of
medicine therapy with wound healing time.
Average time of wound healing in
patients with wound care one time is 7.16
days, patients with wounds care 2 times the
average hospitalization time is 11.33 days
wound healing and wound care 3 times its
average 12.00 days. Statistical results test
obtained p = 0.000, which means there is
significant influence between the wound care
and healing time.
Average time of wound healing with
means dietary high-calorie high-protein is 10
days. Statistical results test obtained value of
p = 0.090, there is no difference or effect
between nutrition / diet with wound healing
time (Table 4.6).
Table 4.6. Mean Distribution According
Wound Healing Care Class, Indication,
Medicine, Treat Wounds and Nutrition
3) The Influential Factors of Wound
Healing Time
The relationship of age with wound healing
time showed a low correlation (r = 0.204) and
a positive pattern means that the older have
longer of the wounds healing time. Statistical
results test found no correlation/significant
influence of maternal age and the healing time
of wound (0.069). The relationship of
haemoglobin with wound healing time showed
a low correlation (r = 0.085) and a positive
pattern means higher Hb levels will have
longer of healing time wounds. Statistical
results test found no correlation/significant
effect (p = 0.453) between Hb with wound
healing time (Table 4.5).
Table 4.5. Correlation and regression analysis
of age and Hb with Wound Healing Time
521
(60%). On the results of statistical tests on
wound care obtained p = 0.000, which means
there is significant influence between the
wound care wound healing time. (Table 4.8).
Table 4.8. Mean Distribution According
Wound Healing Care Class, Indication, Drug,
Wound Care and Nutrition
4)
The Influencing Factors of Patient
Mobilization To Caesarea Sectio In
Delivery Room Pare Kediri Hospital.
The results test found no statistically
significant relationship between maternal age
at the time of wound healing (0.069).
Likewise, the results of statistical tests
between Hb with wound healing time no
significant effect (p = 0.453) (Table 4.7.).
Table 4.7. Logistic regression analysis with
age and Hb Wound Healing Time
5)
The Factors that influence the
occurrence of complications
The test results found no statistically
with complications (p = 0.061). Likewise, the
results of statistical tests between Hb with
complications no significant effect (p =
0.453). More can be seen in Table 4.9.
c.
The Effect of Nursing Class, Indication,
Medicine, Wound Care and Nutrition
Results of the analysis of the majority of
the average wound healing time for 7 days
occurred in treatment classes HI 1 (100%) and
General 5 (100%), and indication of babies
were 19 (90.5%), antibiotics that used a
combination of injection and amoxcicilin oral
ciprofloxacin 4 (100%), wound care one time
as many as 62 (96.9%) and with dietary highcalorie high-protein were 62 (82.7%). While
the wound healing time will be longer (median
12 days) in patients with wound care 2 x 13
(86.7%), three times as many as 1 (100%) and
dietary high-calorie high-protein-low salt 3
Table 4.9. Logistic regression analysis of age
and Hb with Time Mobilization
Effect of Nursing Class, Indication, Medicine ,
Wound
care,
and
Nutrition
Results of the analysis do not occur the
majority of complications in the treatment of
class HI 1 (100%) and General 5 (100%), and
indication of babies were 19 (90.5%), which
used a combination of antibiotics oral
ciprofloxacin and amoxcicilin injection 4
(100% ), wound care one time as many as 62
522
(96.9%) and with dietary high-calorie highprotein were 62 (82.7%).
Statistical result test of complications with
treatment classes
obtained p =
0.444;
indication p = 0.162; antibiotics p = 0626;
nutritional value of p = 0.083; which means
there is no effect between treatment classes,
indication, antibiotics and nutrients with the
occurrence of complications. While the wound
care obtained p = 0.000, which means there is
significant influence between patient wounds
with complications (Table 4.10].
Table 4.10. Distribution of Respondents
According to the Class Care and Occurrence
of Complications
0.12 days associated with maternal
hemoglobin concentration and increased LOS
related to wound care.
While the cost of the regression line equation
hospital = Rp 3.582 million + Rp 170,200.2 *
antibiotics, which means that we can predict
hospital costs by using variable antibiotics,
which is the relationship shown significant
positive relationship hospital costs will rise by
Rp. 3.582.000 - with regard to antibiotics used.
More can be seen in Table 4.11.
Table 4.11. Results of Multiple Linear
Regression Analysis LOS and Costs
Constant
Hb
Wound
care
Antibiotic
LOS
1,45
Days
0,12
1,82
Hospital cost
Rp 3.582.000,-
-
Rp 170.200,2
-
From the results of multiple logistic regression
analysis, it turns out the variables that
significantly affect the wound healing time
was wound care and nutrition. It also looks
interaction between the wound care nutrition
with P Value = 0,000. Thus the final model is
the model with interaction. Of the three
variables, the variables that most influence on
the LOS is variable nutrient (Exp B = 178.89).
While the results of the analysis of
mobilization, it turns out the variables that
significantly affect only the mobilization of the
wound care alone, with Exp B = 7.475.
However found the interaction between patient
wound with class of service in their influence
on the mobilization (p Value = 0.002).
On the results of the analysis of complications,
wound care only significant effect on the
incidence of complications. But in these
complications did not reveal any interaction
between age, wound care and nutrition in their
influence on complications (0.094), but the
wound care among the three most effect on the
incidence of complications (Exp B = 161.98).
(Table 4.12.)
Furthermore, multivariate analysis of the
dependent variable for the scale of numerical
data (LOS and Hospital cost) using multiple
linear regression analysis to predict the value
of LOS and hospital cost by using independent
variables. As for the scale of categorical data
the dichotomous (wound healing time,
mobilization, and complications) using
multiple logistic regression analysis. Terms of
independent variables that can be continued in
a multiple linear regression analysis and
multiple logistic regression is if the value of p
Value <0.25.
LOS on the dependent variable, the regression
line equation obtained LOS = 1.45 + 0.12 * Hb
+ 1.82 * wound care, which means that we can
predict LOS using variables Hb and wound
care, where the relationship shown is positive
relationship which means the LOS will rise by
Table 4.12. Results of Linear Regression
Analysis & Logistics Double Wound Healing
Time, Mobilization and Complications.
523
responses (60%). Selection of antibiotic
combination is among the most inexpensive
price compared to other types of antibiotics.
Wound care nurses do a majority of just 1 time
for treated after surgery as many as 64
respondents (80.8%). Because the healing
process epithelialization on day 2-3 then it is
not advisable to open the wrapping on that day
so that enough nurses to do it once, for the
next patient enough control to poly outpatient.
Diet given to the majority of respondents was
93.8% dietary high-calorie high-protein.
. This diet is best to expedite the healing
process in post-cesarea mother's condition,
because in addition to the calories for the
recovery of the general health status of the
mother, the protein to aid in cell regeneration
(Sugeng, 2004)
Results of research on the distribution of
the dependent variable length of stay (LOS) of
respondents obtained a mean of 4.8 days. The
total cost incurred respondents means is
3.910.000 rupiah. Majority of the wound
healing time for 7 days, as many as 64
respondents (80%) with the indicator does lift
the seam during the control patients in poly
outpatient. The majority of respondents have
been mobilized since the first day of 52
respondents (65%). Immediate mobilization
gradually very useful to help the healing of
wounds. Mobilization is useful for preventing
thrombosis and embolism (Novita, 2007).
Other findings of 64 respondents (80%) had no
complications, and complications as much as
20% in the form of caesarean section wound
that has not healed up to the 12th day. In
accordance with the theory of short-term
complications in cesarea sectio deliveries is
happening escape of stitches, bleeding,
haematuria and infection, while in the long run
will occur sepsis. May undergo surgical
wound dehiscence (wound is open back) and
infections. Local causative factor in
dehiscence no bleeding, wound infection,
suture less good and less good surgical
technique (Potter and Perry, 2006).
2} The Influential Factors To Length Of
Stay Patient Caesarea Sectio In Delivery
Room Pare Kediri Hospital
Statistical results test found no significant
relationship between maternal age with Length
Of Stay (LOS) (p = 0.031). However, the
relationship of age with LOS showed a low
correlation (r = 0.241). From the age variable
linear regression analysis found a positive
5. Discussion
1) Overview Patient Characteristics Input of
Caesarea Sectio
The result showed that the distribution of
respondents mother who gave birth to the
caesarea sectio the average age was 31.1 years.
The age of the theoretical or technological
advances health is still relatively old safe from
the standpoint of the health of the mother's
reproductive system both for normal childbirth
or caesarea sectio. While respondents mean
Hb levels of 9.4 mg%. Hb is relatively small
under normal indicator in women (10 mg%).
Hb levels correlated with the distribution of
blood supply to the wound area, which in turn
affects the healing process, both the caesarea
sectio and the wound healing process of the
reproductive system of women after pregnancy
and childbirth (Sylvia, 2006). Class of service
selected respondents using the majority of
insurance as many as 74 respondents (92.5%).
However, based on patient rights and
obligations of hospitals, health workers shall
not discriminate treatment of patients,
including based on the class of service. Which
may be different only hospital facilities are
provided, so that the logic does not affect or
relate to the healing process.
While the distribution characteristics of the
client based on the indication does the
majority of caesarea sectio is an indication of
the mother as many as 59 respondents (73.8
This indication is also not relevant to the
healing process, so long as it is detected or
treated early. Doctors in Pare hospitals
majority prescribe antibiotics oral amoxicillin
and amoxicillin injection, as many as 48
524
correlation, which means that the older the
respondent, the longer days of hospitalization.
These results are consistent with the theory
that with increasing maternal age, disruption
of cellular repair mechanisms (Wahyudi,
2000) thereby increasing the long days of
hospitalization.
From the analysis of patient variable wound
was found that these variables proved
significant effect on the long days of
hospitalization in the mother post caesarea
sectio
, this means that there are differences among
the three intervals do LOS wound care. In
accordance with the results of the mean LOS
of 4.8 days, whereas in the fourth day of new
mothers are given care of the wound, which
subsequently allowed to go home and
outpatient care enough if the observation is
currently visible injuries wound care improves.
The provision of care wound on the fourth day
post caesarean sectio is to adjust the theory
where sterile wound healing process that has
entered the stage of epithelialization is around
the third and fourth days (Potter and Perry,
2006).
Nutritional factors also affect the long
days of hospitalization in the mother post
caesarea sectio (P = 0.019). This situation is
consistent with the theory that with good
nutrition, the recovery process is also good
that the mother would sooner go home from
the hospital (Sugeng, 2004).
For further when analyzed with multiple linear
regression equation regression line LOS = 1.45
+ 0.12 * Hb + 1.82 * wound care, which
means that we can predict LOS using variables
Hb and wound care, where the relationship
shown is a significant positive relationship
LOS will rise by 0.12 days associated with
maternal hemoglobin concentration and
increased LOS related to wound care. The
results are consistent with the theory that
hemoglobin levels correlated with the
distribution of blood supply to the wound area,
which in turn affects the healing process, both
the caesarea sectio and the wound healing
process of the reproductive system of women
after pregnancy and childbirth (Sylvia, 2006).
3) The Influence Factors To Cost
Statistical test results found no significant
relationship between maternal Hb with Length
Of Stay (LOS) (p = 0.000). Of linear
regression analysis, the association of Hb with
hospital costs patterned positive means higher
Hb levels higher hospital costs, but the
strength is relatively low relationship (r =
0.078). These results are consistent with the
results of the analysis on the dependent
variables LOS, where the dependent variable
LOS also negatively correlated with
haemoglobin. LOS is closely related to the
cost of the hospital, the higher LOS greater the
cost to be
incurred hospital patients.
In the analysis of the cost of hospital care class
p value = 0.822 which means there is no
significant impact to the cost of hospital care
class. Statistical test results indicated cesarea
sectio with hospital costs obtained p = 0.275 ,.
But unlike the analysis of the antibiotics used
in hospital costs, which gained statistical test
result obtained p = 0.041, which means there is
the influence of drug therapy with hospital
costs. The findings are consistent with the
more expensive antibiotics are used, meaning
the higher the costs incurred hospital patients.
But not relevant to the results obtained in the
analysis of antibiotics with LOS.
From the analysis of patient variable
wound was found that this variable was not
shown to significantly affect the cost of posthospital maternal caesarean sectio (p = 0.690).
While nutritional factors do not affect the cost
of post-hospital maternal SC (p = 0.088).
Nutrition assist in the recovery of the mother
post caesarea sectio, so the LOS and costs
decreased.
For further when analyzed with multiple linear
regression equation regression line hospital
costs 3.582.000 rupiah = 1 + 170,200.2 rupiah
* antibiotics, which means that we can predict
hospital costs by using variable antibiotics,
which is the relationship shown significant
positive relationship Hospital costs will rise by
Rp. 3.582.000, - associated with antibiotic use.
The results are consistent with the fact that a
combination of antibiotics prescribed by a
doctor, will determine the size of the hospital
costs. A positive relationship between the cost
of the hospital with antibiotics on the results of
this study in accordance with the theory, which
serves antibiotics against microorganisms so
that no infection (Sulistia, 2005).
4) The Influential Factors of Wound
Healing Time
The test results found no statistically
at the time of wound healing (0.069). While
the results of the statistical test between Hb
with wound healing time no significant effect
525
(p = 0.453). In the statistical analysis of
treatment classes obtained p = 0.440, which
means there is no class effect of treatment with
wound healing time. While the analysis does
indication caesarean sectio, obtained p =
0.280, which means there is no indication does
influence between SC with wound healing
time.
Selection of a combination of antibiotics also
has no effect on wound healing time (p =
0.626). The wound care proven effect on
wound healing time for patients in Pare
hospitals post caesarea sectio (p = 0.000). In
accordance with the results of the mean LOS
of 4.8 days, whereas in the fourth day of the
new mother is given once a wound care, which
subsequently allowed to go home and
outpatient care enough if the observation is
currently visible injuries wound care improves.
The provision of care wound on the fourth day
post caesarea sectio is to adjust the theory
where sterile wound healing process that has
entered the stage of epithelialization is around
the third and fourth days. Therefore, the
opening of the bandage before the third day is
not allowed because it can disrupt the network
epithelialization process (Potter and Perry
2006).
Results of statistical analysis on the
nutritional value obtained p = 0.083, meaning
there is no influence between nutrition / diet
with wound healing time. To further after
analyzed by multiple logistic regression was
obtained variables that significantly affect the
wound healing time was wound care and
nutrition. It also looks interaction between the
wound care nutrition with P Value = 0,000.
Thus the final model is the model with
interaction. Of the three variables, the
variables that most influence on wound
healing is nutritional variables (Exp B =
178.89). The results are consistent with the
theory, where the frequency of hospitalization
injuries most a little showing the wound well,
considering the patient wound made to wait
after three-four days post c that adapts to the
theory so as not to interfere with the process of
epithelialization wounds as a caesarea with
positive wound healing process and to further
patients for outpatient treatment (Perry and
Potter, 2006).
5} The Influencing Factors of Mobilization
Patient To
Time Caesarea Sectio
In
Delivery Room Pare -Kediri Hospital.
The age factor does not significantly
influence the mobilization time (p = 0.507).
Similarly, hemoglobin (p = 0.453), grade of
treatment (p = 0.174), indicative caesarean
sectio (p = 1.000), antibiotics (p = 0.440), and
nutrition (p = 0.468) did not affect the
mobilization time.
Wound care factors proven to affect the
mobilization of maternal time post caesarea
sectio in Pare hospitals (p = 0.001). The
indirect effect of the action is to help the
patient wound healing process so that patients
are motivated for immediate mobilization.
Immediate mobilization gradually be very
useful to assist wound healing irritation.
Mobilization is useful for preventing
thrombosis and embolism. Conversely if too
early mobilization can influence wound
healing (Novita 2007).
To further after analyzed by logistic
regression, it turns out the variables that
significantly affect only the mobilization of the
wound care alone, with Exp B = 7.475.
However found the interaction between patient
wound with class of service in their influence
on the mobilization (p Value = 0.002). The
results are consistent with the theory, where
the frequency of hospitalization injuries most a
little showing the wound well, considering the
patient wound made to wait after three-four
days post SC that adapts to the theory so as not
to interfere with the process of
epithelialization wounds as a sign of positive
wound healing process and to further patients
for outpatient treatment (Perry and Potter,
2006).
6) The Influence factors that affect the
occurrence of complications of Caesarean
section Patients In Delivery Room Pare Kediri Hospital.
The age factor proved to be no
significant effect on
the occurrence of
complications (p = 0.061). Likewise, the Hb
factor (p = 0.453), grade of treatment (p =
0.444), indication (p = 0.162), medicine
(0626), and nutrition (p = 0.083). Only the
factor hospitalization proven effect on the
occurrence of complications in patients in
hospitals Pare post caesarean sectio (p =
0.000). To further after analyzed by logistic
regression, it turns out the variables that
significantly affect
the occurrence of
complications is simply wound care alone,
with Exp B = 161.98, and there were no
interaction between age, wound care and
526
nutrition in their influence on complications
(0.094).
6. ImplicationsResearch
In this study, patients with complications
of caesarean section wound healing time so
that the average 9-12 days of hospitalization
(LOS) for 9 days because obstetric doctors in
Pare hospitals do not allow patients go home if
the wound is still wet (in case of complications
in the postoperative wound) , so that the
wound care needs to be performed 2 times.
This usually occurs in patients with an
indication of entrance is indicative of a mother
with diabetes mellitus, prolonged labor and
with high blood pressure that affects the cost
increase in caesarea section patients to Rp
4.43.000, -. The variable class of service as a
source of financing in this study did not affect
the outcome of patients sectio, so that in
accordance with the Law on Consumer where
there is no difference in terms of the provision
of care services that lead to the healing process
of patients in hospitals, except the room
facilities were acquired, so the cost issued
approximately Rp. 3.61.000, -.
Based on these images we can conclude
the preparation of
Clinical Pathway
restrictions on caesarea sectio patients in terms
of age at least patients aged 25-31 years,
because it affects the patient LOS factors to be
4 days, while the diet given was High-calorie
high-protein and the time required for wound
healing is 7 days and 1 day mobilization.
Antibiotics are used can be used is a
combination of
amoxicillin and oral
amoxicillin injection, wound care enough 1kali
done after the patient is allowed to go home
because the incision is dry (no complications
in the wound) and outpatient treatment at the
time determined by the treating physician.
Indication of incoming patient is an indication
that the baby does not affect the relative length
of stay because usually the mother was
discharged so that the total costs needed by
patients is approximately 3610.000 rupiah.
7. Limitations Research
a. Secondary data nutrients in Pare
Hospital Delivery Room just shows
the type but
can not reflect the amount of intake
that is acceptable to the patient.
b. The analysis carried out in one
direction and a stage that can not be
identified properly. Further research
is advisable to use Path analysis for
the perfection of research analysis.
c. Collecting data in this study is only
done in Pare Hospital so that these
results can not be generalized.
8. Conclusion
Factors that proved influential on
maternal LOS post caesarea sectio in hospitals
Pare was wound care and nutrition, factors that
proved to affect the cost of post caesarea sectio
hospital in the mother's age, Hb, and medicine.
While the wound care factors shown to affect
the wound healing time. Wound care factors
also proved to be an effect on the time of
mobilization, in addition to wound care and
nutritional factors are also shown to influence
the occurrence of complications in patients
with post caesarea sectio in Pare hospitals.
9. Suggestions
To determine the cost efficiency in the
preparation of Clinical Pathway for caesarea
sectio patients in Pare hospitals to consider is
the age factor, Hb, class of service,
indications, wound care, antibiotic use,
nutrition and complications. Of the 7 (seven)
factors are more influential to the cost is
ranging from nutrition, wound care,
indications, and Hb, further factor of
antibiotics used and age.
References
Baker, J. J. (1998). Activity Based Costing and
Activity Based Managemet for Health
Care.
Gaithersburg, Maryland,
Aspen,inc.
Cate , S, BHsc 2005, „Clinical pathway in the
emergency department : Successful
implementation of „Adut Patients who
are
Febrile
Following
Chemotherap‟pathway‟, Australian
Emergency Nursing Journal vol. 8, pp.
27-34.
Cheah, J 2000, „Development and
Implementation of Clinical Pathway
Programme in Acute Care General
Hospital in Singapore‟, International
Journal for Quality in Health Care,
Vo. 12, pp. 403-12.
Firmanda, D 2006, „ Penyusunan Clinical
Pathway untuk Case-Mix‟, in
Pertemuan Penerapan Coding System
dan Software Case-Mix Rumah Sakit
di Indonesia, Direkturat Jendral Bina
Pelayanan Medik Depkes RI, Hotel
527
Padanaran Semarang, 11 – 14 Juli
2006.
Firmanda, D 2007, „Implementasi Clinical
Pathways dalam Pengendalian Mutu
dan Biaya di rumah Sakit‟, in Analisis
dan Pengendalian Biaya Rumah
Sakit,. Lembaga Pengembangan
Sumberdaya Kesehatan (LPSK)
Jakarta, p. 46, 8-9 Juni 2007.
Francess DB, DaM, Suzanne M, Rebekah A,
Daniel J, John D, Daryl L 2006, „What
Providers from General Emergency
Department Say About Implementating
a Pediatric Astma Pathway‟, Clinical
Pediatrics, Vol. 45, p. 8. Retrieved
March 20, 2009.
Potter and Ferry, Dasar-Dasar Keperawatan ,
Jakarta : EGC : 2005.
Group, EDC October 2001,
Emergency
Demand Critical Pathways Project.
Hastomo, Sutanto Priyo, 2001, Analisis Data,
Jakarta : Universitas Indonesia Press.
Ida Bagus, GM, SpOG 2001, Kapita Selekta
Penatalaksanaan Rutin Obstetri
Ginekologi dan KB, Jakarta : EGC
Judith J, Baker, PhD, CPA 1998, Activity –
Based Costing and Activity – Based
Management For Health Care, Dallas,
Texas
Lorenzo E. Ferri, MLSF, MD. Donna D.
Stanbridge, RN 2006, „Patient
Perception of a Clinical Pathway for
Laparoscopic Foregut Surgery‟, The
society for surgery of the Alimentary
Tract, Vol. 1091, p.4.
Martius, G. (1997). Bedah Kebidanan Martius.
Penerbit Buku Kedokteran : EGC.
MC Ramos, P, RN and Catherina Ratiff, PHD,
RN, CETN, Cs 1996, „The
Development and Implementation of
an Integrated Multidiciplinary Clinical
Pathway‟, The 28th Annual Confrence
of the Wound, Ostomy and Contince
Nurses Society.
Notoatmojo, S. (2002). Metodologi penelitian
kesehatan. Jakarta: Rineka Cipta.
Notoatmojo, S.
(2003). Ilmu Kesehatan
Masyarakat. (cetakan pertama).
Notoatmojo, S.. (2003). Pendidikan dan
perilaku kesehatan. (cetakan pertama).
Novita, L. (2007). Tinjauan Lama Perawatan
Pasca Seksio Sesarea di Instalasi
Rawat Inap Obstetri dan Ginekologi
RSUD Arifin Achmad Pekanbaru
Periode 1 Januari – 31 Desember
2006. Fakultas Kedokteran Pekanbaru,
Riau. Sarjana
Nursalam dan Pariani. (2001). Pendekatan
praktis: Metodologi riset keperawatan.
Jakarta: CV Infomedika.
Nursalam dan Pariani. (2003). Pendidikan dan
perilaku kesehatan, Cetakan pertama.
Jakarta: Rineka Cipta
Panella, MS, F. Di Stanislao 2003, „Reducing
Clinical Variations With CP; Do
Pathway Work‟, International Journal
for Quality in Health Care, vol. 15,
no. 6, pp. 509 – 21.
Person, A., (1986). Nursing models for
practice,
London. Heinemann
Nursing.
Potter & Perry (2006).
Fundamental
Keperawatan (Konsep, Proses, dan
Praktik), Jakarta : EGC, edisi 4, vol.2
Pudjirahardjo, W. J., S. Supriyanto, et al.
(1998). Analisis Biaya Satuan dan
Penyesuaian Tarif Pelayanan Rumah
Sakit.
Surabaya, Administrasi
Kesehatan
Masyarakat-Fakultas
Kesehatan Masyarakat-UNAIR.
Ramos, MR, C 1997, The Development and
Implementation of an Integrated
Multidiciplinary Clinical Pathway‟,
Ostomy and Continence Nurse Society,
vol. 0022, no. Profesional Practice, p.
66.
Roy, S.C., (1991), The Roy adaption model;
the definitive statement. New Jersey.
Applenton- Century Crofts.
Sugeng S,., (2004)
Kesehatan dan GIzi,
Jakarta : Rineka Cipta.
Sylvia A.,(2006), Fatofisiologi Konsep Klinis
Proses-Proses Penyakit, Jakarta :
EGC, Edisi 6.
Rubianti, A. (2003). Hubungan Antara CiriCiri Demografi, Medis dan Pelayanan
Kesehatan Ibu Melahirkan dan
Tindakan Seksio Sesarea Pada Ibu-Ibu
Yang Melahirkan di RS Fatmawati
Jakarta. Magister Manajemen Rumah
Sakit Yogyakarta, Gajah Mada.
Magister.
Thabrany, Hasbullah. 2005.
Pendanaan
Kesehatan dan Alternatif Mobilisasi
Dana Kesehatan di Indonesia. Jakarta:
PT. Raja Grafindo Persada.
Tsafrir, V, MD, MBA, Wande Pratt, BA, Josef
E Fischer, MD, FACS, Charles M
528
Vollmer Jr, MD, FACS, Mark P
Callery, MD, FACS 2007, „Deviation
Based Cost Modeling :A Novel Model
to Avaluate the Clininical and
Economic Impact of Cilincal
Pathways‟. J Am Coll Surg vol. 204,
pp. 570-9.
Vanhaehct, K, Msc, RN, PHD An D. Karel De
Witte Msc, PHD. Roeland Depreitere
Msc And Walter Sermeus Msc,
PHD,RN 2006,‟Clinical pathway audit
tools: a systematic Review‟, Journal of
Nursing Manajemant, vol. 14, pp. 52937.
Verdu, AM, P Lopez, V Gil, A Marti nHidalgo, J A Castan 2009,‟Clinical
pathways as a healthcare tool: design,
implementation and assessment of a
clinical pathway for lower-extremity
deep venous thrombosis‟, Qual Saf
Health Care 2009; 18:314., vol. 18,
pp. 314-20.
Wahjudi N,. (2000), Keperawatan Gerontik.
Jakarta : EGC, Edisi 2
Wiknjosastro, H., A.B. Saifudin, et.al. (2007).
Ilmu Bedah Kebidanan. Jakarta :
Yayasan Bina Pustaka Sarwono
Prawirodihardjo.
Yulita, H 2009, „Kesiapan SDM dan
Infrastruktur dalam penerapan INADRG‟, in Strategi Implementasi
Clinical Pathway dan INA-DRG di
Rumah Sakit Magister Manajemen
Rumah Sakit Universitas Brawijaya,
Malang.
529
IMPROVING SELF-EFFICACY USING CARING-BASED SELF-EFFICACY
ENHANCEMENT INTERVENTION PROGRAM IN PATIENTS WITH TYPE 2 DIABETES
MELLITUS
ChristiantoNugroho S.Kep.Ns.,M.Kep
Akper Pamenang Pare and Dsn. Sindurejo-Ds. Kunjang-Kec.Ngancar-Kab.Kediri
ABSTRACT
Introduction: Patients with diabetes mellitus (DM) tend have impaired coping mechanisms,
one of which being low self-efficacy.The purpose of the present study was to demonstrate the
effects of caring-based SEEIP on the improvement in self-efficacy in patients with type 2
diabetes. Methods: The study used a quasi experiment design, in which the experimental
group was given caring-based SEEIP intervention, while the control group received routine
care given by doctors and nurses.Samples were 17 participants of Prolanis(Program
PengelolaanPenyakitKronis, or Chronic Disease Management Program) selected by a simple
random sampling technique. The independent variable was caring-basedSEEIP and the
dependent variable was self-efficacy of patients with type 2 diabetes. Data were collected
using questionnaires, which were then analyzed using paired t-test and independent t-test,
while confounding variables were analyzed using multiple linear regression.Results: Results
showed that caring-based SEEIP had effects on improving self-efficacy of patients with type
2 diabetes with a p-value of 0,000 (α < 0.05), meaning that there was a significant difference
before and after the caring-based SEEIP intervention.Discusion:When an individual thinks
that he or she is God‟s perfect creature, the individual would maintain his or her body well.
Caring-based SEEIP had effects on improving self-efficacy of patients with type 2 diabetes
mellitus. Future researchers could develop this concept for other diseases.
Keywords: Caring-based SEEIP, self-efficacy, type 2 diabetes mellitus
INTRODUCTION
Diabetes mellitus (DM) is a group
of metabolic diseases with characteristic
increase in blood glucose level
(hyperglycemia). Often times DM patients
accept diabetes diagnosis difficult, when
especially they knows their life are
regulated by diet and drugs (Kai G.Kahl,
2014). DM patients will be negative
attitude when during treatment, negative
attitude toward the disease and treatment
will be cause to DM management failure,
this may affect patients of life quality and
social skills (Soegondo, 2011).
That introduction survey results are
diabetes patients in Kediri District has less
DMSES self efficacy (46-58%) and PTES
(30-37%). Diabetes independently Selfmanagement that effective is gotten if the
individual has knowledge, skills and selfefficacy to perform
DM. behavior
management. one way to improve selfefficacy by applying SEEIP (Self Efficacy
Enhancement Intervention Program) based
Caring in DM patients. This the purpose
research was to prove the influence SEEIP
caring based on the increase in selfefficacy in patients with type 2 diabetes.
Someone who
has only the
knowledge, attitudes, and specific skills in
the absence of self-efficacy are high,
indicating a belief that he was able to do
something, it is unlikely that someone
would commit such acts or behavior
(Edberg, 2010). Based previous research
Wu, et. Al (2011) stated that the program
SEEIP have an influence on self-efficacy.
525
Damayanti (2012) also states the same
thing that
self-efficacy enhancing
intervention program in DM patients,This
program increase self-efficacy patient to
do self-care.
SEEIP is one the techniques of
learning to improve self-efficacy
to
patients who adopted the cognitive theory
of social (social cognitive theory, SCT)
proposed by Bandura comes from four
main sources of influence, among other
things: (1) performance accomplishments,
(2) vicarious experience ( 3) verbal
persuasion, (4) somatic and emotional
state (Bandura, 1997). Meanwhile, to
support awareness of himself and others
we add model of caring by Jean Watson
with 10 caritasnya values of humanity,
trust-hope,
sensitivity terdahapyourself
and others, a relationship of trust and
mutual help, expression of positive and
negative, systematic problem
solving
methods, teaching and learning through
interpersonal relationships, support,
protection, mental, physical, social,
cultural and spiritual environment, human
needs and the strength of the existential
phenomenological (Alligood, 2014)
RESULTS
Patients withtype 2 diabetes mellitus
identification is Self Efficacy
Table1. Differences Self Efficacy type 2
diabetes patients are before and
after treatment to treatment group
and control group of Diabetes
group in BPJS
branch Kediri,
Kediri,District in
April-May
2015.
Treatment
Control
(n
=
17)
(n = 17)
Variabel
M
M
p
P
(SD)
(SD)
Self Efficacy (DMSES)
Pre–Post 1
-21,706 ,000 -,029
,868
(12,572)
(,717)
Pre – Post 2
-28,382 ,000 -,235
,399
(13,563)
(1,120)
-6,676 ,000 -,206
Post 1 – Post 2
,130
METHODS
Design research uses
quasiexperimental, by the experimental group
were given intervention based SEEIP
Caring, while control group received
routine maintenance carried out by doctors
and nurses. Samples were some
participants Prolanis (Chronic Disease
Management Program) amounted to 17
people chosen by simple random
sampling. SEEIP-based
independent
variable is the dependent variable is
Caring and Self - Efficacy Patient DM
Type 2. Data were collected using a
questionnaire DMSES and PTES, then
analyzed using paired t-test, independent ttest, while confounding variables using
multiple linear regression.
Table1. to refer in treatment groups show
that Self Efficacy(DMSES &PTES) has a
p value is <0.000, α<0.05, its which means
that any significant changes before and
after SEEIP based Caring. In contrast to
control group showed that Self Efficacy
(DMSES &PTES) has a p value greater
with α<0.05, which means are not change
before and after SEEIP based Caring.
(4,334)
(,532)
Self Efficacy (PTES)
Pre – Post 1
-25,471 ,000
,294
(16,164)
(1,213)
Pre – Post 2
-27,000 ,000
,118
(15,996)
(1,269)
Post 1 – Post 2
-1,529 ,001 -,176
(1,463)
(1,185)
526
,332
,707
,548
Table2. Self Efficacy type 2 diabetes
patients is identification
in the
treatment group and control group
after to do SEEIP indiabetes
group in BPJS branch in Kediri,
Kediri in April-May 2015.
Treatment
Control
Variabel
p
(n=17)
(n=17)
M (SD)
M (SD)
55,06
55,06
1,000
Pre
(13,236)
(13,236)
76,76
55,09
,000
Post 1
(13,579)
(5,483)
83,44
55,29
,000
Post 2
(13,815)
(2,984)
Pre
Post 1
Post 2
66,59
(16,086)
92,06
(1,345)
93,59
(1,805)
73,00
(17,288)
72,71
(16,744)
72,88
(16,733)
Correlation characteristics Respondent
with Self Efficacy
Table
3.Correlation variables
are in
research diabetic groups in the
region of the branch BPJS Kediri
in Kediri, in April-May 2015.
Post – 1 (T2)
T
Col.
(p) (vif)
Group
,000 1,787
Age
,935 1,547
Gender
,068 1,431
Therapy
,842 1,376
Work
,066 1,895
Education
,031 4,709
Sick
,517
1,302
Complication ,609 1,069
DMSES PRE ,000 3,230
Group
,000
1,597
Age
,842
1,633
Gender
,922
1,430
Therapy
,325
1,339
Work
,036 1,842
Education
,147 3,513
Sick
,243 1,222
Complication ,967 1,062
PTES PRE
,000 2,046
Variabel
,271
,000
,000
The results analysis show that Self
Efficacy (DMSES & PTES) in pre ( do not
do SEEIP based Caring) the difference
was not significant, and after SEEIP
showed results that Self Efficacy (DMSES
& PTES) on post1 (T2), post2 (T3) has a
value p value = 0.000, α> 0.05, which
means that self-efficacy
were not
significant differences between treatment
and control groups. While seeing a change
in the treatments group are mean number
self-efficacy show DMSES post 1
(76.76%) and post 2 (83.66%) in both
categories that were
previously pre
(55.06%) in medium category and self
efficacy PTES post 1 (92.06%) and post 2
(93.59%) in both categories that were
previously pre (66.59%) in the medium
category. This differs significantly from
results of self-efficacy to control group are
lean to remain medium category.
F
(p)
,000a
,000a
Post – 2 (T3)
t
Col.
F
(p)
(vif) (p)
,000
,621
,161
,972
,091
,086
,285
1,787
1,547
1,431
1,376
1,895
4,709
1,302
,934
,000
1,069
3,230
,000
,943
,831
,241
,052
,183
,191
,810
,000
1,597
1,633
1,430
1,339
1,842
3,513
1,222
1,062
2,046
Test analysis results are f (p value
0,000, α <0.05), which means together
variable (group, age, gender, treatment,
employment, education, duration of
illness, complications, pre dmses and
PTES) significantly affects the self
efficacy and the t test analysis on the
variable group, dmses and pre PTES (p
value 0,000, α <0.05) which shows that the
variable group and self efficacy in pre
influence on self-efficacy, but variables
(age, sex, treatment, employment,
education,
duration
of
illness,
complications) has a p value greater than
α, which means these variables
individually have no effect on selfefficacy. These results are also supported
by the analysis of collinearity shows the
value of vif<10 thus concluded variable
(group, age, gender, treatment,
527
,000a
,000a
illness, complications, self-efficacy pre)
does not occur multikolinearitas or does
not happen a strong correlation with self
efficacy.
similarity with the observer's own self. The
more people who are observed to have a
resemblance to him, the greater the
potential for self-efficacy that will be
contributed by this factor. While helping
individuals gain confidence in healing,
positive thinking. The more people have a
strong belief and positive thinking, then
the self-efficacy would be optimal.
Verbal persuasion is persuasion
that other people verbally or by yourself
(self-talk) that can be used effects how
people act or behave. Individuals under the
influence or the suggestion that he was
able to overcome the problems to be faced.
Someone who confidence always given
and the drive to recover and be able to
control the disease, it will show behavior
to try to recover and control, vice versa.
This factor nature may come from outside
or within the individual himself. The
influence that can be given by the giver of
persuasion is a sense of trust to the grantor
of persuasion and believed that he was
able to manage his illness. The same time
through verbal persuasion
helps to
appreciate the power of existentialphenomenological namely appreciate and
realize that the life-death-suffering is a
blessing from God and believe in the
possibility of the magic / miracles of
healing from God and recalling that the
individual is a creature cipataan God's
most perfect and continue loved by God.
Emotional arousal is generating
positive emotions so that people have the
confidence to perform a particular action.
Emotional condition (mood) also affect a
person's decision-making related to his self
efficacy. Emotional state that accompanies
the individual when he was doing an
activity will affect a person's self-efficacy.
Emotion is meant strong emotions such as
fear, stress, anxiety and joy. These
emotions can increase or decrease one's
self efficacy. At the same time dividing
issues with other individuals, which help
the individual that he has friends and
relatives who always supported him.
DISCUSSION
The results show that significantly
affect Caring based SEEIP Self Efficacy
patients with type 2 diabetes, is evidenced
by the significant changes after treatment
with the value Self Efficacy (DMSES &
PTES) has a value of value <0.000, α
<0.05, which means that the significant
changes before and after SEEIP (table 1)
and supported the existence of differences
between treatment and control groups,
namely Self Efficacy (DMSES & PTES)
on post1 (T2), post2 (T3) has a value of
value = 0,000, α> 0 , 05 which means that
self-efficacy
were no significant
differences between treatment and control
groups (Table 2).
This situation is caused by a
program-based Caring SEEIP given to
patients with type 2 diabetes mellitus
include Performance Accomplishments
which recalls the accomplishments or
experience the best ever achieved by the
patient in the past in controlling diabetes.
Good performance in the past experienced
by the patient will make increase the
expectation of efficacy, while the
experience of failure will decrease the
efficacy of the individual. At the same
time it helps the individual to have a sense
of love, care, trust, hope, sensitive,
positive thinking, creative problemsolving, the best learning experience, and
confidence to cure both to themselves and
to others.
Vicarious experience is the
experience gained from others or emulate
their behavior to get what others get. Selfefficacy will increase if observing the
success that has been achieved by others,
whereas the self-efficacy would decrease if
individuals observing someone who has
the equivalent of his Traffic failure. Given
the influence of these factors on the selfefficacy is based on the observed
528
This is consistent with the results
of the study conducted by Wu, et. Al
(2011) which states that the program
SEEIP have an influence on self-efficacy.
Damayanti (2012) also states same thing
that self-efficacy enhancing intervention
program in patients with DM, the program
enhances patient self-efficacy
in
performing self-care.
Potter and Perry (2009) stated that
confidence of the patient's health can be a
powerful motivation to take actions that
can reduce the disease or reduce the
severity. The role of nurses as educators
took part in providing the knowledge and
motivation to patients.
Trento, et.al (2004) in Atak,
Gurkan and Kose (2006) explained that the
health education group problem solving
increase knowledge about diabetes and
improve the decision making lifestyle
changes to manage the disease. Similarly,
Anderson, et al (1995) in Atak, Gurkan
and Kose (2006) conducted a study on the
effects of health education about DM, with
health education about disease
management obtained a change of
psychosocial and skills where someone
with type 2 diabetes develops
keyakinananya about coping psychology
DM
called
confidence
DM.
Research nyut et al (2010), which
conducts research on self-efficacy, self
care and control blood sugar result that the
provision of education can improve self
efficacy 62% and 30% self-care behavior.
Self-efficacy is the belief in one's
ability to organize and execute courses of
action required to manage a situation that
will occur (Bandura, 1994).
It is also supported by results of
Table 3. on other factors that affect selfefficacy, ie the t test analysis on the
variable group, dmses and PTEs pre
indicates that the variable group and self
efficacy in pre influence on self-efficacy,
but variables (age , gender, treatment,
illness, complications) has a p value
greater than α, which means
these
variables individually have no effect on
self-efficacy. These results are also
supported by the analysis concludes
variable collinearity (group, age, gender,
treatment, employment, education,
duration of illness, complications) do not
occur or do not occur multikolinearitas
strong correlation with self efficacy.
Results were showed statistically
many female respondents, but there is no
relationship between gender and selfefficacy, means that men and women have
the same ability in solving various
problems or to cope, and to behave as
expected. Men and women possess the
same confidence in their ability to behave
as expected to manage the disease.
Age of respondents average 47 years, the
results not statistically significant
relationship of age with self-efficacy this
is due to the older respondents have
complications or comorbidities that will
further reduce the function of the physical
so that patients do not feel able to do the
treatment himself with such good though
sport, whereas in the adult respondents
were more likely to focus on perjaan and
household.
The average education level of
respondents junior high school graduates,
according to the results of this study that
education level was not associated with
self-efficacy can be interpreted that the
higher the education level of respondents
do not guarantee good self efficacy. The
level of education is high on the
respondents in this study is a formal
education in general not describe specific
education about DM, but respondents with
higher education should be easier to
understand and accept the information that
helps in improving efficacy of himself.
Based on current experience researching,
there are some respondents who are well
educated and know how to correct diabetes
management, but is still difficult
melaksanakannnya a variety of reasons
including the one about exercise and diet
DM.
The average respondent has a job,
529
according to the results of this study that
the job no association with self-efficacy, it
is because the working conditions can be a
source of stressors that can reduce a
person's ability to solve problems. Stress
conditions is one of the risk factors that
can aggravate the condition of patients
with diabetes mellitus type 2, which will
have an impact on the decline in selfefficacy in the management of his
diabetes.
Long experience DM is mean of
respondents two years, the results of this
study there was no significant relationship
between old suffering from diabetes with
self-efficacy, due to the length of
experience DM will happen much damage
to cells and body functions so more easily
appeared a variety of physical disorders
and metabolic or in other words
complications have occurred. someone
with komlikasi will experience a variety of
disorders and limitations that can cause
low self efficacy of patients.
The above results differ from test
analysis f in Table 3. stating jointly
variables (group, age, gender, treatment,
illness, complications, pre dmses and
PTEs) significant effect on self-efficacy.
This suggests that there are factors other
than the four elements of self efficacy
which affect self-efficacy in individuals,
although these factors do not stand alone
but affects together, are consistent with the
theory Bandura (1977) states in addition to
the four sources of efficacy and process
information can be also influenced by the
characteristics of the individual and the
environment. Ideally, self-efficacy
strengthened through a variety of
experiences related and will influence
subsequent behavior. Someone will decide
to behave based on reflective thinking, the
use of knowledge in general, and the
ability to perform an action.
based Caring can improve Self Efficacy in
patients with type 2 diabetes mellitus.
RECOMMENDATIONS
Application of Caring based SEEIP
can be applied to health care institutions to
develop an integrated system of services
and provides the means for the Center Self
Efficacy Restoration as an effort to
increase confidence in type 2 diabetes
patients in the care of her. Caring based
SEEIP program can be applied to cases of
other chronic diseases that require
treatment eg patients with hypertension,
stroke, kidney failure, and in palliative
care.
REFERENCES
ADA, 2012. Diagnosis and Classification
of Diabetes Melitus.
Diabetes
Care, II(1), p.35.
Alligood, Martha R., 2014.
Nursing
Theorist and Their Work. 8th ed.
United Satates of America:
Elsevier.
Atak, N. Gurkan,T. & Kose,K., 2006. The
effect of education on knowledge,
self management behaviour and
self efficacy of patient with type 2
diabetes. Australian journal of
advanced nursing , pp.66-74.
Bandura, A., 1977. Self-efficacy: Toward a
unifying theory of behavioral
change. New York: Psychological
Review.
Bandura, A., 1994. Self-efficacy. 1st ed.
New York: Academic Press.
Bandura, A., 1997. Self-Efficacy: The
exercise of kontrol. New York:
Academic Press.
Damayanti, S., 2012. Analisis Praktik
Residensi Keperawatan Medikal
Bedah: Penerapan teori adaptasi
Roy pada pasien dengan gangguan
sistem
endokrin.
Jakarta:
Universitas Indonesia.
Edberg, M., 2010. Buku Ajar Kesehatan
Masyarakat; Teori Sosial dan
Perilaku. Jakarta: EGC.
CONCLUSIONS
Application of SEEIP (Self
Efficacy Enhancing Intervention Program)
530
Kai G.Kahl, Ulrich, Christoph, Conrad,
Marie, Michael, Peter.,
2014.
Depression, anxiety disorder, and
metabolic sydrome in a population
at risk for type 2 Diabetes Melitus.
Brain and Behaviour, pp.1-7.
Patricia A Potter, A.G.P., 2009. Buku Ajar
Fundamental
Keperawatan.
Jakarta: EGC.
Sandhi W.Nyut, Nopporn H, Nawarat S,
Thiltipat R., 2010. self-efficacy,
self-care behaviour and glycemic
kontrol among type-2 diabetes
patients attending two private clinic
in yangon,myanmar.
Southeas
Asian J Trop Med Public Health,
pp.943-51.
Shu-Fang V.W, Mei-chen L,Shu-Yuan L,
Yu-Ying L, Tsae J.W, Heng H T.,
2011. Effectiveness of a selfefficacy program for persons with
diabetes: A randomized kontrolled
trial. Nursing and Health Science,
pp.335-43.
Soegondo, S., Rudianto,P., Subekti, I.,
Pranoto, A., Arsana, P.M., et al..,
2011. Konsensus pengelolaan dan
pencegahan diabetes melitus tipe 2
di Indonesia 2011. Jakarta: PB
Perkeni.
531
EFFECT OF REMINISCENCE THERAPY OF OLDER PEOPLE AND SELFACCEPTANCE WITH GEROTRANSCENDENCE THEORY APPROACH IN
JOMBANG INSTITUTION AND GERIATRIC OF PUHJARAK COMMUNITY
HEALTH CENTER KEDIRI
Nugrahaeni Firdausi
Akademi Keperawatan Pamenang Kediri
Introduction: Aging process is a natural phenomenon. Aging process is change
to physical, social, psychological, moral and spiritual to older people. That change can to
effect low self-acceptance. Older people of low self-acceptance will correlated with high
depression level. This research purpose was analyse effect of reminiscence therapy to
self-acceptance older people with gerotranscendence theory approach in Jombang
Institution and Geriatric of Puhjarak Community Health Center Kediri. Method: This
research used a quasy experiment two groups with non randomized pretest-posttest
control group design approach. This research sampling technique used purposive
sampling, so 28 samples got to selected was based on inclusion and exclusion criteria.
This research independent variables was elderly self-acceptance and the dependent
variable was the reminiscence therapy. The instrument used data collection of selfacceptance questionnaire from modification psychological well-being questionnaire Ryff
(1989). Data were analyzed using paired t test and t test independent. Result: The results
showed that treatment group in Jombang Institution, there was increasing acceptance
older people with p= 0.001, whereas the control group was p= 0.021. Value pretest was
self-acceptance between treatment and control group showed p= 0.139, and the posttest
value was p= 0.000. The treatment group was Puhjarak Community Health Center Kediri,
there was increase self-acceptance older people p= 0.001, whereas the control group was
p= 1.000, between value were pretest self-acceptance treatment and control group to
show p= 0.226, and the posttest value was p= 0.000, differences between value were
posttest self-acceptance treatment group in Jombang Institution and Geriatric of Puhjarak
Community Health Center Kediri p= 0.854, and the value control group was p= 0.017.
Discussion: Reminiscence therapy can increase self-acceptance in the older people
through gerotrancendence theoretical approach, but older people acceptance effected age
were too, stay nursing homes long time, history life, sadness, environmental, and social
support. Suggestion for next researcher expected can do qualitative research about selfacceptance older people and respondents are strict controls observing and environmental
research so to give maximum results.
Keywords:
self-acceptance older people, reminiscence therapy,
theory
gerotranscendence
INTRODUCTION
Increasing degree of health and
well-being of the population at this time
will have an effect on the increase in life
expectancy in Indonesia (Kemenkes RI,
2013). The Central Statistics Agency
(BPS) reported that life expectancy in
2010 was 69.43 (with the percentage of
the elderly population is 7.56%) and in
2011 to 69.65 years (with the percentage
of the elderly population is 7.58%).
Number of older people in the province
with the highest percentage of three
contained in Yogyakarta (13.04%), East
Java (10.40%), and Central Java
(10.34%). Changes in physical, social,
psychological, moral and spiritual occur
in the older people can lead to negative
self-acceptance (Mariana, 2014).
The research of Tika &
Saifuddin (2013) showed that of 54
532
older people, found 31 (59.6%) older
people have enough self-acceptance, and
3 (5.8%) older people have less selfacceptance, while the data collection
showed that two out of three people
(66.67%) in the Jombang institution had
a lack of self-acceptance, and one
(33.33%) had self-acceptance well, the
same data was also obtained on Geriatric
of Puhjarak Community Health Center
Kediri, from three older people, single
people (33.33%) of older people had
enough self-acceptance, one person
(33.33 %) had less self-acceptance, and
one person (33.33%) had good selfacceptance.
Gerotransenden theory is a
theory explaining the aging process, in
this process the thought patterns of the
older people will become more
extensive and cosmic (Jonson &
Magnusson, 2001). Thorstam in Thorsen
(1998) mentions that gerotransenden is a
universal phenomenon that occurs in any
process of aging. The research of
Tornstam (1994, 1997a, b, 1999, 2003),
quantitatively demonstrate that the
gerotransenden theory positively
correlated with age, but in fact, only
about 20% of the population. achieving
a high degree of gerotranscendence
without difficulty (Tornstam, 2011).
Johnson & Magnusson (2001)
mentions that changes to the natural
aging process is described by the
gerotransenden theory an awareness in
old age toward wisdom. Gerotransenden
sign is divided into three levels, the
cosmic level, the level of self, and the
level of the individual and social
relations (Tornstam in Jonson, 2001). At
the level of self, gerotransenden theory
outlines the developments associated
with the aging process (Wadensten,
2005). Older people who do not have
self-acceptance will view themselves as
depressed, too boast of his past, or use a
self-defense mechanism to deal with
change associated with increasing age
itself (Sari & Nuryoto, 2002).
Reminiscence
therapies
currently used as a therapy for treatment
of depression in the older people, while
the influence of the reminiscence
therapy to improve self-acceptance has
not been done. The using of
reminiscence therapy by motivating the
older people to remember the ability he
has, whether biological, psychological,
social, spiritual, and cognitive, so the
limitations due to the aging process can
be minimized (Syarniah, 2010). Elderly
will become more focused on the needs
of others, and obsession with body
switch with self-acceptance
which
results in life satisfaction (Tornstam,
2011). This research purpose was
analyse effect of reminiscence therapy to
self-acceptance older people with
gerotranscendence theory approach in
Jombang Institution and Geriatric of
Puhjarak Community Health Center
Kediri.
METHOD
This research used a quasy
experiment two groups with non
randomized pretest-posttest
control
group design approach, with research
time was 4 weeks in Jombang Institution
and Geriatric of Puhjarak Community
Health Center Kediri.
This
research
sampling
technique used purposive sampling, so
28 samples got to selected was based on
inclusion and exclusion criteria. Twentyeight samples were in Jombang
Institution divided into two groups, 14
samples were treatment group, and 14
samples were control group. Puhjarak
Community Health Center was divided
into two, each 14 samples were
treatment group, and 14 samples were
control group. This research independent
variables was elderly self-acceptance
and the dependent variable was the
reminiscence therapy. The instrument
used data collection
(pretest and
posttest)
of
self-acceptance
questionnaire from modification
psychological well-being questionnaire
Ryff (1989),
which contains 14
questions. Format attitude scale
questionnaire self-acceptance is a Likert
533
scale. In the questionnaire of selfacceptance, there are four possible
answers, Strongly Agree, Agree,
Disagree and Strongly Disagree. This
measure are items favorable (item
number 1, 2, 5, 6, 8, 12, and 13) and
items unfavorable (item number 3, 4, 7,
9, 10, 11, and 14). Score 4 for Strongly
Agree, 3 to Agree to Disagree 2, and 1
for Strongly Disagree, while for item
unfavorable scoring is the opposite.
Assessment questionnaire is indicated
by a score of acceptance of yourself,
better when the score 43-56, acceptance
of self-sufficient when the score 29-42,
and the acceptance of self-less when the
score 14-28.
Instruments for the
independent variable reminiscence
therapy is SAK.
Retrieval of data held in
Jombang Institution and Geriatric of
Kediri in March 2015, while the process
of research carried out on April 23,
2015- May 16, 2015. The respondents
determined in accordance with the
criteria of the sample and sampling
techniques. Respondents who have been
selected will be given an explanation
about the purpose and benefits of
research. Respondents that had been
collected was then given an explanation
of the technical guidelines of treatment
research/SAK in accordance with the
group (treatment or control) in order to
obtain informed consent from each
respondent. Pretest is done by using a
questionnaire form self-acceptance, so
the initial score obtained before the
intervention. Scores of self-acceptance
questionnaire
obtained
from
questionnaires acceptance modification
of psychological well being
questionnaires Ryff (1989).
The data collection process is
assisted by observers who have studied
and understand the research activity.
Respondents in the treatment group was
given the research activities in the form
of reminiscence therapy as much as six
sessions, the first session that activities
reminiscing childhood with 2 meetings,
the second session in memory of
adolescence with 2 meetings, third
session in memory of adulthood with
two meetings, fourth session in memory
of a family with one meeting, the fifth
session of reminiscing elderly period
with 2 meetings, and the sixth session is
the evaluation of the achievement of
self-integrity. Implementation of the
reminiscence performed with a duration
of 20-30 minutes, every meeting held
3x/week, was done 2 days in a period of
4 weeks. The final assessment carried
out by the end of the 4th week,
performed on all groups using a
questionnaire form self-acceptance back
to find out the scores after the
intervention. Respondents in the control
group was not given any intervention,
just doing everyday actions of each
respondent, but after the study ended,
the control group will also be given the
same treatment as the reminiscence of
older treatment group before.
Data were analyzed using paired
t test to determine the difference before
and after implementation of an
intervention and t test independent to
determine the comparison between the
groups treated and untreated.
RESULT AND DISCUSSION
Results of observations about
the characteristics of survey respondents
which include gender, age, marital
status, and length of stay in Jombang
institution or longer follow Geriatric of
Kediri will be described below.
534
Tabel 1 Respondent characteristics in Jombang institution or longer follow Geriatric of
Puhjarak Community Health Center Kediri April-May 2015
Jombang Institution
Geriatric of Puhjarak
CHC
No Characteristic Treatme
Total
Control
Treatme
Control
s
nt group
group
nt group
group
Gender
f
%
f
%
f
%
f
%
Ʃ
%
1. Male
3 21,4
3
21,4
1
7,1
1
7,1
8
14,3
2. Female
1 78,6
11
78,6
1 92,9 1
92,9
48
85,7
1
3
3
Amount
1
100
14
100
1
100 1
100
56
100
4
4
4
f
%
F
%
f
%
f
%
Ʃ
%
Age (year)
1. 60-65
4 28,6
1
7,1
4 28,6 3
21,4
12
21,4
2. 66-70
2 14,3
1
7,1
4 28,6 5
35,7
12
21,4
3. 71-75
8 57,1
12
85,7
6 42,9 6
42,9
32
57,1
Amount
1
100
14
100
1
100
1
100
56
100
4
4
4
Bartlett‟s test
p=0,848
of Sphericity
%
f
%
f
%
f
%
Ʃ
%
Marital status f
1. Married
2 14,3
1
7,1
4 28,6 5
35,7
12
21,4
2. Widow
1 71,4
11
78,6
9 64,3 8
57,1
38
67,9
0
3. Widower
2 14,3
2
14,3
1
7,1
1
7,1
6
10,7
Amount
1
100
14
100
1
100 1
100
56
100
4
4
4
Ʃ
Length of
f
%
f
%
f
%
f
%
%
stay
1. < 3 month
0
0
1
7,1
0
0
0
0
1
1,7
2. 3 month –1
4 28,6
1
7,1
6 42,9 6
42,9
17
30,4
year
3. 1-5 year
8 57,1
6
42,9
8 57,1 8
57,1
30
53,6
4. > 5 year
2 14,3
6
42,9
0
0
0
0
8
14,3
Amount
1
100
14
100
1
100
1
100
56
100
4
4
4
Characteristics of respondents in
Jombang institution and Geriatric of
majority are female, are in the age range
71-75 years old, a widow, length of stay
in Jombang institution is in the period of
1-5 years, and longer follow Geriatric of
Puhjarak Community Health Center also
within 1- 5 years for respondents who
are older people in the Geriatric of
Puhjarak Community Health Center.
Results of the assessment of
self-acceptance older people in Jombang
institution in the treatment group and the
control group
before and after
reminiscence therapy can be seen in the
following table:
535
Tabel 2 Assessment of self-acceptance older people in Jombang institution in the
treatment group and the control group before and after reminiscence therapy of
the April-May 2015
Self acceptance
Treatmen group
Control group
Pretest
Posttest
Pretest
Posttest
F
%
f
%
f
%
f
%
Well
0
0
12
85,7
0
0
1
7,1
Enough
12
85,7
2
14,3
13
92,9
13
92,9
Less
2
14,3
0
0
1
7,1
0
0
Amount
14
100
14
100
14
100
14
100
Mean±SD
32,14±2,742
50,14±4,258
34,07±3,832
37,36±3,003
Mean difference
18
3,29
Wilcoxon signed
p=0,001
p=0,021
rank test
The results showed that after
is marked by the return of past memories
treatment reminiscence therapy, selfand conflicts (Butler, 1996).
acceptance older people in the treatment
Implementation of therapy have a
group experienced a significant
positive influence in improving selfimprovement after reminiscence
acceptance in the older reminiscence
therapy. Older people before
people.
implementation reminiscence therapy
Increased self-acceptance in the
more focus on the lack of theirselves and
treatment group after treatment
desire to change the past, after the
reminiscence therapy still not up on all
reminiscence therapy become more
the respondents, there are two categories
grateful and accept all its shortcomings
of respondents who have enough selfas a gift from God that must be grateful.
acceptance despite given reminiscence
At the level of self gerotransenden
therapy, there are respondent 2 and 6.
perspective, there is a change of
Self acceptance on respondents 2 and 6
rationality eolder people obsession with
does not increase significantly in both
body switch with self-acceptance and
categories, although there is an increase
become more focused on the needs of
in the value of her acceptance.
others, resulting in life satisfaction. SelfRespondent 2 are aged 75 years old, a
acceptance is an introduction to personal
widow, and lived in Jombang institution
abilities
and
accomplishments
for 7 years. Interviews showed that
themselves, along with the acceptance of
during the research process that
the limitations of self (Corsini, 2002).
coincided with the arrival of the students
Reminiscence therapy carried by
practice makes respondent 2
motivating the elderly to recall
remembered her grandchildren that are
capabilities, whether biological,
outside Java were sorely missed, so
psychological, social, spiritual, and
make respondent 2 feel sad. Pannes in
cognitive, so the limitations due to the
Hurlock (1978) argued that a person
aging process can be minimized.
who receives him is someone who is not
Memories, in the Gerotransenden
troubled by itself, does not have the
perspective seen as an important element
burden of feeling of self, so it has plenty
in the development process of the older
of opportunity to adapt to the
people, because contribute in developing
environment.
an identity and a sense of reality through
The research of Tornstam (1994,
memories (Tornstam in Wadensten,
1997a, b, 1999, 2003), quantitatively
2006). Butler (1996) illustrates that
demonstrate that the gerotransenden
people of all ages reviewing their past in
theory positively correlated with age,
various ways in life. Remembering the
but in fact, only about 20% of the
past is a normal developmental task that
population, which reached a high degree
536
of gerotransenden without difficulty
(Tornstam, 2011).
Gerotransendence
process
towards this, some people may be
hampered by a variety of reasons, one of
which is retained hope. Self-acceptance
older people besides influenced by
reminiscence therapy is also affected by
age, adaptation to the environment and
circumstances in the individual's own
personal self.
Respondent 6 is a 60-year-old,
widow, and the length of stay in
Jombang institution is 3 years.
Respondent 6 said that during the
process of research, respondents still
work as usual and maintain good
relations with friends, but from
observation during the research process,
respondent 6 is not too interact with
other. Other respondents said that
respondent 6 did not like to associate
with other, because of differences in the
background.
Hurlock (1980) explains that the
attitude or response from the
environment to form an attitude towards
oneself (self attitude), the individual
who received the appropriate attitude
and fun of their environment tend to
receive him. Baltes & Baltes in Newman
& Newman (1979) said that the
adaptability make an important
contribution for older people to achieve
successful aging. This is because
successful aging strategies involve older
people who used to accept the changes
that happened to him. Other factors that
lead to self-acceptance is the age of
maturity, according to Akçakoca in
Ceyhan and Ceyhan (2011), age may
affect the level of self-acceptance on a
person, the more a person's age, the
higher the level of acceptance of
himself.
Implementation
of
reminiscence therapy in improving selfacceptance in the older people through
gerotransenden theoretical approaches
do not all give good results, but is also
influenced by the history of one's life
that should help understand and provide
coherence of life (Tornstam, 2005).
Increased of self-acceptance older
people in the treatment group after
reminiscence therapy in accordance with
previous studies, the research Moral et al
(2013), which indicates that the
reminiscence therapy given positive
effect in improving the psychological
well being of older people in the posttest and follow-up, with self-acceptance
as one dimension of psychological well
being. This is supported by the
observation of memories during therapy
in Jombang institution group, which
showed that out of 14 respondents, all of
them participated in the therapy with
enthusiasm.
The respondents recalled
independently after listening to
instructions and rules of conduct.
Results of the evaluation showed
activity of all respondents score more
than 3 per session, which indicates that
in following the activities, the
respondents can be followed with
enthusiasm and complete from start to
finish.
The evaluation results are
supported by previous studies that the
use of reminiscence therapy can
motivate the elderly to remember the
ability he has, whether biological,
psychological, social, spiritual, and
cognitive, so the limitations due to the
aging process can be minimized
(Syarniah, 2010). Memories in the
gerotrancendence perspective seen as an
important element in the development
process of the older people, because
contribute in developing an identity and
a sense of reality through memories
(Tornstam in Wadensten, 2006). In the
process of gerotransenden changes
materialistic and rational view of the
world becomes more cosmic and
transcendence, which is usually
accompanied by an increase in life
satisfaction. At the level of self-change
view of themselves and the physical
retrospect and acceptance of, the
individual and social relationships occur
selectivity
against
superficial
relationships, while at the cosmic level
changes the feeling that grew into a part
537
of the universe. This perspective
changes resulted in a lot of thought back
to childhood, a period that was revised
and understood in a new way (Tornstam,
2005). Reminiscence therapy given
significant influence in increasing
acceptance in the older people, but
increase self-acceptance in the older
people is also affected by age, length of
stay, and an environment that is not
observed in this study.
Kelompok kontrol yang tidak
mendapatkan terapi kenangan, sebagian
besar responden lanjut usia mengalami
peningkatan penerimaan diri, dan
terdapat satu responden lanjut usia yang
mengalami peningkatan penerimaan diri
yang signifikan, yaitu pada kategori
cukup meningkat menjadi kategori baik,
yaitu pada satu responden (7,1%).
Peningkatan tertinggi terdapat pada
responden 9, yaitu dari penerimaan diri
kategori cukup menjadi penerimaan diri
kategori baik.
The control group that did not
receive therapy memories, most
respondents increased self-acceptance,
and there is an respondents who
experienced a significant increase selfacceptance, which is in the category
increased to a category quite well, which
is on one of the respondents (7.1% ).
The highest increase contained in the
respondent 9, which is quite a category
of self-acceptance into either category of
self-acceptance.
Respondent 9, aged to 75 years, widow,
and the length of stay in Jombang
institution is 3 years. Observed during
the research activities underway indicate
that the respondents in the control group
who did not receive therapy during the
study period memorable stay abreast of
daily activities in Jombang institution. In
the second week, the student practices of
some institutions do gerontik nursing
practice, and the existence of these
students can not be controlled optimally
in this study. Ryff (1989) says that
social support is one of the factors that
influence the high and low levels of
psychological well being of individuals,
with self-acceptance is one dimension of
psychological well being. Observation
and extracting information to clients that
support this theory is the data obtained
that the respondent 9 during the study
period was very pleased with the visit of
the students, the respondent 9 can talk
and express their feelings to the students
companion, every day someone
accompany, as a granddaughter.
The participation of students
practice that can not be controlled
optimally in this study, because the
study period coincides with the time
gerontik nursing practice students from
several institutions. It is also consistent
with research Masyithah (2012) who
said that there is a significant
relationship between self-acceptance and
social support for patients with poststroke. The data obtained from the study
in the control group showed that the
cause of the increase in the older people
acceptance in Jombang
institution
influenced by social support factors that
are not observed in this study.
Results of the assessment of selfacceptance differences in Jombang
institution between the treatment group
and the control group can be seen in the
following table:
538
Tabel 3 Assessment of self-acceptance differences in Jombang institution between the
treatment group and the control group in April-May 2015
Self acceptance
Pretest
Postest
Treatment
Control group
Treatment
Control
group
group
group
Mean± SD
32,14±2,742
34,07±3,832
50,14±4,258
37,36±3,003
Mean difference
1,93
12,78
t test independent
p=0,139
Mann whitney
p=0,000
Results of self-acceptance older
people in the treatment group and the
control group before being implemented
reminiscence therapy indicate that the
level of self-acceptance older people
between the treatment group and the
control group was no difference value of
acceptance between the two groups
before being implemented reminiscence
therapy, showed the data homogeneous,
and among the treatment group and the
control group there was no difference
between the two background prior to the
reminiscence therapy. Strict control is
needed on research, because many
factors can affect self-acceptance in the
oder people, such as self-understanding,
realistic expectations, the absence of
environmental barriers, social behavior
accordingly, the absence of emotional
stress, memories of success, good selfidentification good, self perspective,
parenting good childhood, and selfconcept steady (Hurlock, 1974).
Results of the assessment of selfacceptance elderly in the treatment
group and the control group after
reminiscence therapy showed that there
are differences in the value of selfacceptance
significant
between
treatment groups who received
reminiscence therapy and a control
group that did not receive reminiscence
therapy. Moral et al (2013), explained
that the therapy has positive effect in
improving the psychological well being
of older people in the post-test and
follow-up, with acceptance of ourselves
as one dimension of psychological well
being. Acceptance of self-assessment
results indicate conformity with the
results of previous studies showing that
reminiscence therapy can increase selfacceptance in the older people.
Results of the assessment of selfacceptance in Geriatric of Puhjarak
Community Health Center
in the
treatment group and the control group
before and after reminiscence therapy on
can be seen in the following table:
Tabel 4. Assessment of self-acceptance older people in Geriatric of Puhjarak Community
Health Center in the treatment group and the control group before and after
reminscence therapy of the April-May 2015
Self acceptance
Treatment group
Control group
Pretest
Posttest
Pretest
Posttest
f
%
f
%
f
%
f
%
Well
0
0
12
85,7
0
0
0
0
Enough
14
100
2
14,3
13
92,9
13
92,9
Less
0
0
0
0
1
7,1
1
7,1
Jumlah
14
100
14
100
14
100
14
100
Mean±SD
36,21±3,867
49,71±5,980
34,29±3,361
34,29±3,292
Mean difference
13,5
0
Wilcoxon signed
p=0,001
p=1,000
rank test
539
in the
treatment group before and after the
implementation of the reminiscence
therapy showed that there is a significant
increase in self-acceptance
after
reminiscence therapy. Reminiscence
therapy of an activity that aims to learn
about theirselves, in the perspective of
gerotransenden aims to develop,
reorganize, change of identity, and
perception of the world (Tornstam,
1999b).
in the
treatment group before and after the
implementation of the reminiscence
therapy showed that there is a significant
increase in self-acceptance
after
reminiscence therapy. Reminiscence
therapy of an activity that aims to learn
about yourself, in the perspective of
gerotransenden aims
to develop,
reorganize, change of identity, and
perception of the world (Tornstam,
1999b).
Increased self-acceptance in the
treatment group is not maximized, there
are two respondents increased
acceptance, but did not arrive at either
category, despite an increase in the value
of self-acceptance, that the respondents
11 and 14. Respondent 11, 62 years old,
a widow, and a long follow Geriatric of
Puhjarak Community Health Center is 1
year. Respondent 11 said that the time of
her life in old age, respondent 11 was
not able to enjoy her old age in peace,
because they still have to take care of
her grandchildren were entrusted by his
parents who worked as Labor Indonesia,
when returning home, a job taking care
of grandchildren is always wait.
Respondent 14 was 60 years old,
married, long followed Geriatric of
Puhjarak Community Health Center is 3
years, said that in her old age still have
to support themselves busy, although her
husband also worked odd jobs.
Kalimaftika & Saifuddin (2013)
stated that the activity increases fatigue
that can affect the older people selfacceptance. The process towards
gerotransenden hampered or stopped,
can cause psychiatric symptoms
including depression, anxiety, fear of
death, hate and a feeling that life has
been stolen, that for some people
commit suicide is the final breakout
(Jung in Tornstam, 2011).
Results of observations during the
study showed that all respondents were
keen to follow the activities of the 14
respondents, all of them participated in
the presence of 100%. All respondents
recount memories of the good old days
with an enthusiastic from the start of
operations until the activity is over, even
respondent 9, 10, and 13 show the
objects memories of the past that still
exist, such as the gramophone, tools
knitting and embroidery equipment.
Results of the evaluation showed
activity of all respondents score more
than 3 per session, which indicates that
in following the activities, the
respondents can be followed with
enthusiasm and complete in accordance
with SAK.
Respondents 4, 6, and 13 said that
the memory of the good old days to
make happy, accept aging as an
advantage that can motivate to live
better longer. This is consistent with
previous studies that show that
reminiscence therapy significantly
improved psychological well being in
the treatment group compared with the
control group (Jo Chiang et al., 2009).
Reminiscence therapy given significant
influence in increasing acceptance in the
older people, but increase selfacceptance in the older people is also
influenced by the activities and
environments that can not be strictly
controlled in this study.
Community Health Center in the control
group during the pretest and posttest
showed that the respondents' level of
self-acceptance still remains as the
pretest, which means there is increasing
acceptance during the pretest and
540
posttest. This means that the background
in the treatment group and the control
group
before
implementation
reminiscence therapy is the same
background.
Observed during the study
showed that the respondents in the
control group perform daily activities as
usual, and actively participates in older
people in Geriatric of Puhjarak
Community Health Center every month.
Low self-acceptance in the older people
if left untreated will cause a negative
impact, as expressed by Kalimaftika &
Saifuddin (2013), that self-acceptance
older people is low will correlate with
high rates of depression in the older
people. Older people who have low selfacceptance will easily fall in depression
conditions and limitations due to the
aging process can not be minimized.
Results of the assessment of selfacceptance older people in the treatment
group and the control group before the
reminiscence therapy showed that there
was no difference in the value of
acceptance between the two groups
before treatment reminiscence therapy.
Strict control is needed on research,
because many factors can affect selfacceptance in the older people, such as
self-understanding,
realistic
expectations, the absence of
environmental barriers, social behavior
accordingly, the absence of emotional
stress, memories of success, selfidentification good, self perspective,
parenting good childhood, and selfconcept steady (Hurlock, 1974).
self-acceptance older people in the
treatment group and the control group
after therapy performed a memorable
show differences in the value of selfacceptance
significant
between
treatment groups
who received
reminiscence therapy and a control
group that did not receive reminiscence
therapy. This is consistent with previous
studies, that there is an increased
psychological well being, that selfacceptance is one of the dimensions
after treatment reminiscence therapy
(Afonso et al., 2011). Meiner and
Lueckenotte (2006) describes the
therapeutic use of memories with the
motivation and discussion on the older
people about past experiences that
experienced and problem solving efforts
undertaken at the time, so as to develop
the identity and rationality elderly.
Effect of reminiscence therapy of the
most significant role in increasing selfacceptance in the older people.
self-acceptance differences in Geriatric
of Puhjarak Community Health Center
control group can be seen in the
following table:
541
Tabel 5. Assessment of self-acceptance older people in Geriatric of Puhjarak Community
Health Center between the treatment group and the control group after reminiscence
therapy of the April-May 2015
Self acceptance
Pretest
Postest
Treatment
Control group
Treatment
Control
group
group
group
Mean± SD
36,21±3,867
34,29±3,361
49,71±5,980
34,29±3,292
Mean difference
1,92
15,42
Mann whitney
p=0,226
p=0,000
is support from the surrounding
environment. Memories in the
self-acceptance differences in the
gerotransendence perspective seen as an
control group aged between Jombang
institution and Geriatric of Puhjarak
process of the older people, because
Community Health Center at the time of
contribute in developing an identity and
the posttest show that there are
a sense of reality through memories.
differences in the value of selfGerotransenden processes associated
acceptance among older people control
with age, but in fact, this process can
group. Such differences may be caused
hampered by various things, such as
by environmental factors that may affect
expectations restrained, life crisis, grief,
the acceptance of older memories that
and the environment. The results
are present in addition to therapy when
showed that the effect of therapy
the study took place, and less can be
remains the most significant
controlled
optimally.
reminiscence therapy in increasing selfThe existence of students as one of
acceptance older people, because they
social support can affect self-acceptance
can be trained themselves independently
elderly, this is in accordance with the
by the respondents without having to
statement of Hjelle and Ziegler (1981),
wait another supporting role.
that acceptance would be better if there
CONCLUSIONS
RECOMMENDATION
AND
Conclusions
Implementation of reminiscence
therapy can improve the acceptance of
older people in the treatment group
compared to the control group in
Jombang institution and Geriatric of
Puhjarak Community Health Center. In
the control group there was an increase
in Jombang institution self-acceptance
because of the lack of strict controls on
the environment during the process of
the study. Self-acceptance older people
in Jombang institution and Geriatric of
control group before implementation
reminiscence
therapy
showed
homogeneous values. Memories as an
process of the older people in
developing identity and a sense of
reality. Implementation of reminiscence
therapy in improving self-acceptance in
the
older
people
through
gerotransendence theoretical approaches
do not all give good results, but is also
influenced by the history of life,
including life crisis, grief, and
environment should help understand and
provide coherence of life. Comparison
of self-acceptance older people in the
treatment group in Jombang institution
and Geriatric of Puhjarak Community
Health Center provide equally good
effect in improving self-acceptance
older people. The value of selfacceptance that differ between the older
542
people control group in Jombang
institution and Geriatric of Puhjarak
Community Health Center posttest when
implemented due to lack of control over
the environment.
Recommendation
Jombang institution as the
residence of the older people and
Geriatric of Puhjarak Community Health
Center as implementing health care for
the older people is expected to use the
reminiscence therapy as a way to
increase self-acceptance in the older
people.
Nurses can use the reminiscence therapy
to improve self-acceptance in the older
people so that limitations due to aging
can be minimized.
Researchers then expected to
conduct qualitative research on selfacceptance in the older people and social
support affects self-acceptance.
Observing strict control of the survey
respondents and the environment so as
to provide maximum results should be
done.
Older people can independently use
reminiscence therapy as an alternative
way to increase self-acceptance older
people.
REFERENCES
2011.
„Reminiscence,
psychological well-being, and
ego integrity in portuguese
elderly people‟,
Journal of
Educational Gerontology, 37:
1063–1080, 2011. Diakses 08
Juni 2014
Azizah, L.
M 2009. „Pengaruh
pendekatan pengenangan indah
(reminiscence
approach)
terhadap penurunan tingkat
depresi.‟
http://adln.fkm.unair.ac.id/gdl.p
hp?mod=browse&op=read&id=
adlnfkm-adln-lilikmarif-1212
.
Tanggal 5 Desember 2013. Jam
22.15 WIB.
Butler, R. N 1996, Life review In J. E.
Birren (Ed.), Encyclopedia of
gerontology,Vol. 1 (pp. 53-59),
Academic Press, San Diego
Gallo, J. J 1998, Buku saku gerontologi
edisi 2, EGC, Jakarta
Ceyhan, A. A. & Ceyhan, E. 2011,
Investigation of university
students' self-acceptance and
learned resourcefulness: a
longitudinal study, High
Education
Chief, VandenBos, G.R 2006. APA
dictionary of psychology 1st ed,
Afonso,
American
Psychological
Association, Washington DC
Collins, C 2006, „Life review and
reminiscence group therapy
among senior adults‟.
Cozort, R.W 2008, „Revising the
Gerotranscendence Scale for
Use with Older Adults in the
Southern United
States and
Establishing
Psychometric
Properties of the Revised
Gerotranscendence Scale‟.
Cumming, E., & Henry, W 1961,
Growing old: the process of
disengagement, Basic Books
Inc, New York
Gallo, J. J 1998, Buku saku gerontologi
edisi 2, EGC, Jakarta
Hardywinoto & Setiabudhi, 1999,
Panduan gerontologi: tinjauan
dari berbagai aspek,
PT.
Gramedia Pustaka Utama,
Jakarta
Hjelle, L.A. and Ziegler, D.J. 1981,
Personality theories: basic
assumptions, research, and
application.
2ndEdition,
McGraw-Hill Kogakusha Ltd,
Tokyo
543
stroke‟, Skripsi, Institut Agama
Islam Negeri Sunan Ampel,
Surabaya
Mariana, 2014.‟ Hubungan antara self
acceptance dengan kebahagiaan
pada
masa
lansia.‟
http://library.gunadarma.ac.id/re
pository/view/3773819/hubunga
n-antara-self-acceptancedengan-kebahagiaan-padamasa-lansia.html/. Tanggal 10
November 2014. Jam 10.00
WIB.
Meiner, S. E., & Lueckenotte, A. G
2006, Gerontological nursing
(3rd ed.). Mosby, St. Louis
Moral, J.C.M., Ruiz, L.C., Rodríguez,
T.M., & Galan, A.S 2013,
„Effects of a reminiscence
program among institutionalized
elderly adults‟,
Journal of
Psicothema, Vol. 25, No. 3,
319-323. Diakses 08 Juni 2014
Murwani & Priyantari, 2010, Gerontik,
konsep dasar dan asuhan
keperawatan home care dan
komunitas,
Fitramaya,
Yogyakarta
Nazir, M 2014, Metode penelitian,
Graha Indonesia, Bogor
Nevid, J.S., Rathus S. A. & Green B
2005, Psikologi abnormal edisi
kelima, Jilid Dua, Erlangga,
Jakarta
Newman, B.M. & Newman, P.R. 1979,
Development through life: a
psychological
approach,
Revised Edition, The Dorsey
Press, Illinois
Nugroho, 2008, Keperawatan gerontik
& geriatrik edisi 3. Jakarta:
EGC
Nursalam, 2013, Metodologi penelitian
ilmu keperawatan pendekatan
praktis Edisi 3, Salemba
Medika, Jakarta
Nurviana, E.V 2006, „Penerimaan diri
pada penderita epilepsi‟. Jurnal
Psikologi Proyeksi Fakultas
Psikologi
Universitas
Diponegoro, Vol.5, No. 1
O‟Rourke., Cappeliezb, P., & Claxton,
A 2011, „Functions of
Hurlock, E.B 1974,
Personality
development, Tata McGraw Hill
Publishing, New Delhi
Hurlock, E. 1978,
Personality
development,
McGraw-Hill
Publishing Company, Tokyo
Hurlock, E.B. 1980,
Psikologi
perkembangan:
suatu
pendekatan sepanjang rentang
kehidupan, Erlangga, Jakarta
Johada, M. 1958, Current consepts of
positive mental health, Basic
Books, New York
Jonson, H. & Magnusson, J.A 2001, „A
new age of old age?
gerotranscendence and the re enhancantment of aging‟,
Journal of Aging Studies, 3(13),
pp.317 - 331.
Kai, J.C., Chu, H., Chang, H.J., Min,
H.C., Chung, H.C., Hung, Y.C.,
& Kuei, R.C 2009, „The effects
of reminiscence therapy on
psychological
well-being,
depression, and loneliness
among the institutionalized
aged‟, International Journal of
Geriatric Psychiatry, 25: 380388. Diakses 08 Juni 2014
Kalimaftika & Saifudin, 2013,
„Hubungan penerimaan diri
dengan tingkat depresi pada
lanjut usia (lansia) di dusun
lebak adi desa lebak adi
kecamatan sugio kabupaten
lamongan‟, Jurnal Psikologi,
Vol.01, No.XIV
Keliat, B.A., dkk., 2006, Modul basic
course community mental health
nursing,
Fakultas
Ilmu
Keperawatan
Universitas
Indonesia dan World Health
Organization
Lahey, B.B. 2002, Essentials of
psychology, McGraw-Hill, USA
Lemeshow, S., Hosmer, D.W., Klar, J.
& Lwangsa, S.K., 1990,
Adequacy of sample size in
health studies. World Health
Organization
Masyithah, D. 2012, „Hubungan
dukungan sosial dan penerimaan
diri pada penderita pasca
544
reminiscence
and
the
psychological well-being of
young-old and older adults over
time‟, Journal of Aging &
Mental Health, Vol. 15, No. 2,
272–281. Diakses 08 Juni 2014
Rubin, T.E 1974, DR. Rubin, please
make me happy: the common
sense of mental health. Arbor
House: New York
Ryff, C.D 1998,. „Happiness is
everything, or is it? exploration
on the meaning of pwb.‟
Journal of Personality and
Social Psychology, 57, 10691081. Diakses 08 Juni 2014
Ryff, C.D. & Keyes, C.L.M 1995, „The
structure of PWB revisited.‟
Journal of
Personality and
Social Psychology, 69, 719-727.
Diakses 08 Juni 2014
Ryff, C.D. & Singer, B 2008, „Know
thyself and become what you
are: An eudiamonic approach to
psychological
wellbeing‟,
Journal of Happiness Studies, 9,
13–39. Diakses 08 Juni 2014
Santrock, J.W 2002,
Life span
development Eight edition, Mc
Graw-Hill Companies, New
York
Sari & Nuryoto, 2002, „Penerimaan diri
pada lanjut usia ditinjau dari
kematangan emosi‟,
Jurnal
Psikologi, No.2, 73-88
Soekanto, 2001, Sosiologi suatu
pengantar,
Raja Gravindo
Persada, Jakarta
Stanley, M., K.A. & Beare, P.G., 2005,
Gerontological
nursing:
promoting successful aging with
older adults 3rd ed, F. A. Davis
Company: Philadelphia
Syarniah, 2010, „Pengaruh terapi
kelompok
reminiscence
terhadap depresi pada lansia di
panti sosial tresna werdha budi
sejahtera provinsi kalimantan
selatan”,
tesis
Doktor,
Universitas Indonesia, Jakarta
Thorsen, K 1998. „The paradoxes of
gerotranscendence : the theory
of gerotranscendence in a
cultural gerntological and post
modernist
perspective‟,
Norwegian
Journal
of
Epidemiology, 8(2), pp.165 –
176
Topaz, M., Jordan, M.T.,
Mackenzie,
M
2014,
„Construction, deconstruction,
and
reconstruction: the roots of
successful aging theories‟,
Nursing science quarterly, Vol.
27(3) 226–233
Tornstam, L. 1999, „Gerotranscendence
and the functions of
reminiscence, Journal of Aging
and Identity, 4(3):155-166
Tornstam, L 2011, „Maturing into
gerotranscendence‟, Journal of
Transpersonal
Psychology,
43(2), 166–180
Undang-Undang Republik Indonesia
Nomor 13 tahun 1998 tentang
kesejahteraan lanjut usia
Videbeck, S.L. 2008, Buku ajar
keperawatan jiwa, Edisi Bahasa
Indonesia, EGC: Jakarta
Wadensten, B., & Carlsson, M 2003,
„Theory-driven guidelines for
practical care of older people,
based on the theory
of
gerotranscendence‟, Journal of
Advanced Nursing, 41, 462-47
Wadensten, B 2005, „Introducing older
people to the theory of
gerotranscendence.‟ Blackwell
Publishing, 2(5), pp.381 – 389
Wadensten B., & Carlsson, M 2007,
„The
theory
of
gerotranscendence in practice:
Guidelines for nursing – part
III‟, International Journal of
Older People
Watt, L.M. & Cappeliez, P 2000,
„Integrative and instrumental
reminiscence therapies for
depression in older adults:
intervention strategies and
treatment effectiveness‟, Aging
& Mental Health, Vol 4(2),
166± 177
545
546
THE EFFECTS ATTITUDE EXERCISE GIVEN
TO DECREASE ANXIETY TO TEACHERS
TO CHILD THE FIRST TIME SCHOOL
Widhi Sumirat
Akademi Keperawatan pamenang
The success of educating in socialization can be seen from the ability of the individual to adapt oneself
to various situations. This research is experimental study with pretest-posttest control group design.
Giving attitudional guidance to children when they interact with the teacher using positive
conditioning was aimed at lowering children‟s anxiety. The data was collected using questionnaire and
observation, in order to obtain data connected to the characteristic of the children, school components,
and anxiety indicators towards the teacher. The sample used in this study are all the population which
comprised of 16 children, divided randomly into the experimental group consisted of 8 children, and
the control group also with 8 children. The result of the analysis showed that the decrease of anxiety
towards the teacher in experimental group was higher than that of the control group. Conclusion,
giving attitudional guidance to children with anxiety towards the teacher could lower the children‟s
anxiety
Keywords: attitudional guidance, anxiety towards the teacher, children on their first day at
school
INTRODUCTION
Socialization is the process whereby an
individual‟s standards,
skills, motives,
attitudes and behaviors are shaped to conform to
those regarded as desirable and appropriate for
his or her present or future role in society.
Socialization process of education takes place
throughout one's life through a learning process
that guided and supervised. The learning process
can take place within the family through the role
of parenting and school environment through
teaching and mentoring role of teacher. The
success of the educational process of
socialization can be seen from a person's ability
to make adjustments yourself. One common
problem that parents often complained about the
ability of self-adjustment of the first children to
school is school refusal with anxiety when in a
school environment.
The results of preliminary studies conducted
in March 2011 in the working area of preschool
education in kindergartens and elementary
UPTD Wates Subdistrict average anxiety
problems were recorded from 30 children
13.3%, which is 3.3% of children with anxiety
when interacting with teachers. Handling is done
in this case school teachers to the child's anxiety
problems, has not been well standardized.
Provision of training with a positive attitude
conditioning in children who experience anxiety
when interacting with teachers, is expected to
reduce his anxiety.
METHOD
The study design was experimental with a
pretest-posttest
control group design. The
exercise is an independent variable and attitude
toward teachers anxiety as the dependent
variable. Engineering data collection using
questionnaires and observation, which aimed to
obtain data related to child characteristics,
components and indicators of school anxiety
about the teacher. The sample used in this study
using the entire population of 16 children, which
were randomly divided into study group and
control group of 8 children 8 children. The
results were analyzed using descriptive analysis.
Exercise attitude given to children for two weeks
with three times the assessment of indicators of
anxiety about the teacher that is before
treatment, 1 week after treatment and 2 weeks
after treatment. Assessment conducted on the
study group by providing a positive sign on the
indicators of anxiety to the child's teacher can be
maintained for 5 minutes and then also the child
is given food or a toy he likes, while the control
group given no training but observation of
indicators of anxiety attitude toward teachers is
still being done with the assessment the same
study group. Score assessment of indicators of
542
Table. 2
Respondent’s Father
Characteristics in Study Group and
Control of Preschool Education in
Kindergartens and Elementary UPTD
Wates Subdistrict, June 2011
anxiety about the teacher who determined if the
child is able to retain four (4) attitudes toward
teachers 'anxiety decreased until the end of the
study assessed children do not worry, children
are able to maintain a three (3) attitudes toward
teachers' anxiety decreased until the end of the
study assessed the child mild anxiety, children
are able to maintain one or two (half) attitude
decreased anxiety for teachers until the end of
the study assessed the child and the child's
anxiety was not able to maintain four (4)
attitudes toward teachers' anxiety decreased until
the end of the study assessed the child serious
anxiety.
N
o
1
RESULT AND DISCUSS
Result
Table. 1 Respondent Characteristics in Study
Group and Control
of Preschool
Education in Kindergartens and
Elementary UPTD Wates Subdistrict
June 2011
N
o
1
2
3
2
Group
Respondent
Characteris
tics
Age (year)
<6
≥6
2(50%)
6(50%)
2(50%) 4(100%)
6(50%) 12(100%)
Gender
Male
Female
6(50%)
2(50%)
6(50%) 12(100%)
2(50%) 4(100%)
Study
(n=8)
Control
(n=8)
Birth
Grade
Single child 3(37,5%) 5(62,5%)
Eldest child 1(100%)
0(0%)
Middle
1(100%)
0(0%)
child
Youngest
3(50%) 3(50%)
child
Total
3
4
8(100%)
1(100%)
1(100%)
Responden
t’s Father
Characteri
stics
Age (year)
20 – 25
26 – 30
31 – 35
36 – 40
Group
Study
(n=8)
Control
(n=8)
Total
0(0%)
0(0%)
6(66,7%)
2(28,6%)
0(0%)
0(0%)
3(33,3%)
5(71,4%)
0(0%)
0(0%)
9(100%)
7(100%)
1(20%)
3(75%)
4(80%)
1(25%)
5(100%)
4(100%)
4(57,1%)
3(42,9%)
7(100%)
0(0%)
0(0%)
0(0%)
Work
Status
Work
None
7(50%)
1(50%)
7(50%)
1(50%)
14(100%)
2(100%)
Income
(million)
None
<1
1
1(50%)
0(0%)
7(58,3%)
1(50%)
2(100%)
5(41,7%)
2(100%)
2(100%)
12(100%)
Education
grade
Elementary
First
secondary
school
High
secandary
school
University
Characteristics of respondent‟s father in the
study group and the control group of Preschool
Education in Kindergartens and Elementary
UPTD Wates Subdistrict, are in the age range
31-35 years, high secondary school, work, and
income more than 1 million.
6(100%)
Characteristics of respondent in the study
group and the control group of Preschool
UPTD Wates Subdistrict, are in the age range is
more and equal to six years, male, and birth
grade of single child.
543
Table. 3
Respondent’s Mother
Characteristics in Study Group and
Control of Preschool Education in
Kindergartens and Elementary UPTD
Wates Subdistrict, June 2011
o
1
2
3
No
1
Respondent’s
Mother
Characteristics
Age (year)
20 – 25
26 – 30
31 – 35
36 – 40
Education
grade
Elementary
2
First secondary
school
High secandary
school
University
3
4
0
0%
0
0%
8
100%
8
100%
0
(0%)
0
(0%)
8
(61,5%)
0(0%)
1
(100%)
2
(100%)
13
(100%)
0(0%)
Assessment of the level of anxiety towards
the teacher in study group and control before
treatment are in the level of severe anxiety.
1
(33,3%)
1
(25%)
5(62,5%)
2
(66,7%)
3
(75%)
3
(37,5%)
0
(0%)
3
(100%)
4
(100%)
8
(100%)
1
(100%)
N
Levels of
N
Anxiety
o
3
(50%)
5
(50%)
6
(100%)
10
(100%)
5(50%)
2
(66,7%)
1
(33,3%)
10(100%)
3
(100%)
3
(100%)
1
(100%)
5(50%)
5(50%)
1
(33,3%)
2
(66,7%)
Table. 5
Assesment of Level Anxiety
Towards The Teacher in Study Group
and Control After 1 Week Treatment
1
2
3
4
Characteristics of respondent‟s mother in the
study group and the control group of Preschool
UPTD Wates Subdistrict, are in the age range
31-35 years, high secondary school, not work,
and no have own income.
None
Mild
Anxiety
Moderate
Anxiety
Severe
Anxiety
1
2
3
4
544
8
100%
5
62,5 %
0
0%
3
37,5 %
Table. 6 Assesment of Level Anxciety
and Control After 2 Weeks Treatment
N
o
Before Treament
Study
Control
After 1 Week Treatment
Study
Control
(n=8)
(n=8)
N
%
N
%
0
0%
0
0
0
0%
0
0
the teacher in study group and control after 1
week treatment, study group are in the level of
moderate anxiety level, and control group 5 (
62.5 % ) are in moderate level and 3 ( 37.5 % )
are in severe anxiety.
N
Table. 4
Assesment of Level Anxiety
and Control Before Treatment
N
(n=8)
%
0%
0%
1
(100%)
2
(100%)
5
(38,5%)
0(0%)
None
NLevels of
Anxiety
N
0
0
control
(n=8)
3(50%)
1
Total
(n=8)
%
0%
0%
Study
(n=8)
Work Status
Working
Income
(million)
None
<1
4
Group
None
Mild
Anxiety
Moderate
Anxiety
Severe
Anxiety
N
0
0
Levels of
Anxiety
None
Mild
Anxiety
Moderate
Anxiety
Severe
Anxiety
After 2 Weeks Treatment
Study
Control
(n=8)
(n=8)
N
%
N
%
0
0%
0
0%
0
0%
1
12,5
%
7
87,5
7
87,5 %
%
0
0%
1
12,5 %
the teacher in study group and control after 2
weeks treatment, study group 1 ( 12.5 % ) are in
level mild anxiety and 7 ( 87 , 5 % ) are in
moderate anxiety, and control group 7 ( 87.5 % )
are in moderate anxiety , 1 ( 12.5 % ) in severe
anxiety.
Table. 8 Median Score of Level Anxciety
and Control Before, After 1 and 2
Weeks Treatment
Before
Level
N sNof
Anxi
o
ety
Table. 7
Level Anxiety Towards The
Teacher in Study Group and Control
Before, After 1 dan 2 Week Treatments
Leve
N lsNof
Anxi
o
ety
1 Non
e
2 Mild
Anxi
ety
3 Mod
erat
e
Anxi
ety
4 Seve
re
Anxi
ety
Before
Stud
i
N %
0 0
%
0 0
%
Kont
rol
N %
0 0
%
0 0
%
0 0
%
0 0
%
8 10
0
%
8 10
0
%
After
Treatment 1
Week
Studi Kontr
ol
N % N %
0 0
0 0
%
0 0
0 0
%
8 10
0
%
0 0
%
5 62
,5
%
3 37
,5
%
After
Treatment 2
Week
Studi Kontr
ol
N % N %
0 0
0 0%
%
1 12 0 0%
,5
%
7 87 7 87,5
,5
%
%
0 0
%
1 None
2 Mild
Anxi
ety
3 Mode
rate
Anxi
ety
4 Sever
e
Anxi
ety
Median
After
1 Week
Treatment
Stud
Cont
Stud Cont
y
rol
y
rol
Sc N Sc N Sc N Sc N
or
or
or
or
e
e
e
e
0
0 0
0 0
0 0
0
0
0 0
0 0
0 0
0
After
2 Weeks
Treatment
Stud Contro
y
l
Sc N Sc N
or
or
e
e
0
0 0
0
1
1 0
0
0
0 0
0 23
8 15
5 15
7 18
7
32
8 32
8 0
0 12
3 0
0 4
1
4
8 4
8 3
8
8
8
8
3
2
3
Median score of level anxiety towards the
teachers in the study group and the control group
before treatmeant is 4.
teachers in the study group and the control group
after 1 week treatmeant is 3.
teachers after 2 weeks treatment, in the study
group is 2, and control group is 3.
1 12,5
%
the teacher in study group before treatment are
in the level of severe anxiety, after 1 week
treatment are in the level of moderate anxiety
level, and after 2 weeks treatment 1 ( 12.5 % )
are in level mild anxiety and 7 ( 87 , 5 % ) are in
moderate anxiety
the teacher in control group before treatment are
in the level of severe anxiety, after 1 week
treatment 5 ( 62.5 % ) are in moderate anxiety
and 3 ( 37.5 % ) are in severe anxiety, and after
2 weeks treatment 7 ( 87.5 % ) are in moderate
anxiety , 1 ( 12.5 % ) in severe anxiety.
Table. 9
Assesment of Children’s Age in
Study Group and Control Between Anxiety
Towards The Teacher After 2 Weeks
Treatment, June 2011
Study Group
Levels of
Anxiety
After 2
Weeks
Treatme
nt
None
Mild
Anxiety
Moderate
Anxiety
Severe
Anxiety
Total
Control Group
Levels of
545
None
Age (year)
<6
≥6
0(0%)
0(0%)
0(0%)
1(100%)
Total
2
(28,6%)
0(0%)
5
(71,4%)
0(0%)
0(0%)
1
(100%)
7
(100%)
0(0%)
2
(25%)
6
(75%)
8
(100%)
Age (year)
<6
≥6
0 (0%)
0 (0%)
Total
0 (0%)
Anxiety
After 2
Weeks
Treatme
nt
Mild
Anxiety
Moderate
Anxiety
Severe
Anxiety
Total
0 (0%)
0 (0%)
2(28,6%
)
0 (0%)
2 (25%)
0
(0%)
5
7
(71,4%) ( 100%)
1(100%)
1
(100%)
6 (75%)
8
(100%)
Table. 10 Assesment of Children’s Gender
in Study Group and Control Between Anxiety
Study Group
Levels
of
Anxiet
y After
2
Weeks
Treat
ment
None
Mild
Anxiety
Moderat
e
Anxiety
Severe
Anxiety
Total
Control Group
Levels
of
Anxiet
y After
2
Weeks
Treat
ment
None
Mild
Anxiety
Moderat
e
Anxiety
Severe
Anxiety
Total
5
(71,4%)
2
(28,6%)
0(0%)
0(0%)
6 (75%)
2 (25%)
Gender
Male
Female
0(0%)
0(0%)
0(0%)
0(0%)
Study Group
Level
s of
Anxi
ety
After
2
Week
s
Treat
ment
Assesment of children‟s age in study group
and the control between anxiety towards the
teacher after 2 weeks treatment, is levels of
anxiety happening of children less than 6 years
of age is 28.6 % , smaller than the above age
children and equal to 6 years ( 71.4 % ).
Gender
Male
Female
0(0%)
0(0%)
1(100%)
0(0%)
Table. 11 Assesment of Children’s Birth
Grade in Study Group and Control Between
Anxiety Towards The Teacher After 2
Weeks Treatment, June 2011
None
Mild
Anxi
ety
Mode
rate
Anxi
ety
Sever
e
Anxi
ety
Total
Total
0(0%)
1
(100%)
7
(100%)
Control
Group
Level
s of
Anxi
ety
After
2
Week
s
Treat
ment
0
(0%)
8
(100%)
Total
0(0%)
0(0%)
5
(71,4%)
2
(28,6%)
7
(100%)
1(100%)
0(0%)
6
(75%)
2 (25%)
1(100
%)
8
(100%)
None
Mild
Anxi
ety
Mode
rate
Anxi
ety
Sever
e
Anxi
ety
Total
Singl
e
0
(0%)
0
(0%)
Birth Grade
Eldes Midl
t
le
0
0
(0%) (0%)
0
0
(0%) (0%)
3
(42,8
%)
1
(14,3
%)
0
(0%)
1
(14,3
%)
Youn
gest
0
(0%)
1
(100
%)
2
(28,6
%)
Total
Total
0
(0%)
1
(100
%)
7
(100
%)
0
(0%)
0
(0%)
0
(0%)
0
(0%)
3(37,
5%)
1(12,
5%)
1(12,
5%)
3(37,
5%)
8(100
%)
Singl
e
0
(0%)
0
(0%)
Birth Grade
Eldes Mid
t
dle
0
0
(0%) (0%)
0
0
(0%) (0%)
Youn
gest
0
(0%)
0
(0%)
Total
0
(0%)
0
(0%)
4
(57,1
%)
0
(0%)
0
(0%)
3
(42,9
%)
7
(100
%)
1
(14,3
%)
0
(0%)
0
(0%)
0
(0%)
1
(100
%)
5(62,
5%)
0(0%
)
0(0
%)
3(37,
5%)
8(100
%)
Assesment of children‟s birth grade in study
group and the control between anxiety towards
the teacher after 2 weeks treatment, is levels of
anxiety going on greater than of single child and
a youngest is almost three times compared to the
eldest and middle child.
Assesment of children‟s gender in study
anxiety is happening in male 71.4 % , higher
than female (28.6 %) .
546
Table. 12
Assesment of Father’s Income
in Study Group and Control Between Anxiety
Study Group
Levels
of
Anxiety
After 2
Weeks
Treatm
ent
None
Mild
Anxiet
y
Moder
ate
Anxiet
y
Severe
Anxiet
y
Total
Control Group
Levels
of
Anxiety
After 2
Weeks
Treatm
ent
None
Mild
Anxiet
y
Moder
ate
Anxiet
y
Severe
Anxiet
y
Total
Parent’s Income
(million)
Father
None
≤1
>1
0
0
0
(0%)
(0%)
(0%)
0
0
1(100
(0%)
(0%)
%)
0
(0%)
1(100
%)
1
(14.3
%)
1
(14.3
%)
5
(71,4
%)
7
(100
%)
0
(0%)
0
(0%)
0
(0%)
0
(0%)
1
(12,5
%)
1
(12,5
%)
6
(75%
)
8
(100
%)
Parent’s Income
(million)
Father
None
≤1
>1
0
0
0
(0%)
(0%)
(0%)
0
0
0
(0%)
(0%)
(0%)
Table. 13 Assesment of Mother’s Income in
Study Group and Control Between Anxiety
Study Group
Total
Level
s of
Anxi
ety
After
2
Week
s
Treat
ment
None
Mild
Anxiet
y
Moder
ate
Anxiet
y
Severe
Anxiet
y
Total
Control Group
Total
Level
s of
Anxi
ety
After
2
Week
s
Treat
ment
0 (0%)
0 (0%)
1
(14.3
%)
2
(28,6
%)
4
(57,1
%)
7
(100
%)
0
(0%)
0
(0%)
1
(12,5
%)
2
(25%
)
1
(100
%)
5
(62,5
%)
1
(100
%)
8
(100
%)
None
Mild
Anxiet
y
Moder
ate
Anxiet
y
Severe
Anxiet
y
Total
Parent’s Income (million)
Mother
None
≤1
>1
0(0%)
0
0 (0%)
(0%)
1
0
0 (0%)
(14,3% (0%)
)
4(57,1
1
2
%)
(14,3 (28,6%
%)
)
Total
0 (0%)
1
(100%)
7
(100%)
0(0%)
0
(0%)
0 (0%)
0 (0%)
5(62,5
%)
1
(12,5
%)
2
(25%)
8
(100%)
Parent’s Income (million)
Mother
None
≤1
>1
0
0
0 (0%)
(0%)
0
0
0 (0%)
(0%)
Total
0 (0%)
0 (0%)
5
(71,4%
)
2
(28,6
%)
0 (0%)
7
(100%)
0
0
(0%)
1
(100%)
1
(100%)
5(62,5
%)
2(25
%)
1(12,5
%)
8(100
%)
Assesment of mother‟s income in study
anxiety happening of mother no income greater
than who earn more than 1 million and nearly
three times the mothers who earn less than and
equal to 1 million.
Assesment of father‟s income in study group
and the control between anxiety towards the
teacher after 2 weeks treatment, is levels of
anxiety happening to fathers who earn more than
1 million more than who earn less than and
equal to 1 million and none .
Discuss
1. Analysis Decrease Levels of Anxiety
Toward The Teachers
Results of the assesment of levels anxiety
towards the teachers to child the first time
school before and after 1 and 2 weeks treatment,
547
showed that decrease anxiety scores towards the
teachers.
Anxiety to child at the school occured,
because of the attitude and behaviors of teachers
less friendly, unfriendly and incompetent (Astuti
et al, 2010). According to Hurlock (2006), fear
or anxiety to child may be influenced by the
intelligence, gender, socioeconomic status,
physical condition, social relationships, birth
grade and personality. Negative perceptions to
pre-school child has it happened because the
development of cognitive, social, emotional and
moral child not develop optimally, then
habituation positive through exercise posture by
giving food or toys are preferred, and in
accordance with the child's development, can
reduce attitudes and beliefs of children not good.
(Freud; in Singgih and Yulia (2003)).
Decrease of levels anxiety towards the
teachers in the study group occurred because of
the effect attitude exercise, that is positive
conditioning to reduce the situation is less fun
and also a process of maturation, while decrease
of levels anxiety towards teachers in the control
group occurred as a result of maturation of child
and also through the process of imitating or
equate themselves with friends.
Age characteristics of child influence to
develop intellectual, so that child can ability to
perceive a stimulus that is received will be
carefully and appropriately. Perception child
positive, and a less pleasant experience which
can lead to anxiety.
Gender characteristics of child influence to
interests and values, in which the interest and
value of boys is higher than women.
Birth grade characteristics of child influence
to social and emotional develop.
Characteristics of parents, influence to the
role and to take care of the child. Anxiety
towards the teacher to child the first time school,
because age of parents in the range of young
adult, and elementary education. Thats can
influence to the understand and ability to take
care of the child. Parents does not meet the
principles of mental health, less aware of their
responsibilities and domestic tranquility can not
be realized, while the father has not been wise.
Anxiety towards the teacher to child the first
time school, because the competence of teachers
not good. According Singgih and Yulia (2008),
the teacher is the central figure at the school
environment, and guide who learn of the
develop personality. The successful achievement
of tasks and obligations lies in the relationship
that is conducive that could be created with full
communication of affection, respect, sincerity
and the warmth of the teacher to the child.
Favorable relations requires the ability to
understand the students, the culture, and the
corresponding value of child development.
2. Analysis The Effects Attitude Exercise
Given To Decrease Anxiety To The
Teachers To Child The First Time School
Results of the assesment of median scores in
the study group and the control group after 1 and
2 weeks of treatment, showed that difference.
Decrease median scores in both groups after 1
week of treatment, and after 2 weeks of
treatment of control group did not experience a
decrease in median scores. Decrease of median
score that is indicate to given attitude exercise
for 2 weeks have an effect of levels anxiety
towards teachers to child the first time school.
According to Hurlock (2006), emotional
development of child depends on factors
ripening (maturation) and learning factors, of
which the most important of the two is a factor
of learning because it can be controlled. Process
Children's learning process can be through trial
and error, imitating, likening herself,
conditioning and training. Hurlock (2006) also
says that child really like the safe environment
that is conducive. This environment can be
created through the control of the environment
by making the experience unpleasant emotions
(reward).
Exercise attitude is very helpful to reduce the
anxiety towards the teacher to child the first
school. Children initially had trouble adjusting
in school or have a less pleasant experience
when interacting with teachers, there will be
insecurity, lack of confidence and calm.
CONCLUSION AND RECOMENDED
Conclusion
1. Results of the assesment of levels anxiety
towards the teachers to child the first time
school before and after 1 and 2 weeks
treatment, showed that decrease anxiety
scores towards the teachers. Decrease of
levels anxiety towards the teachers in the
study group occurred because of the effect
attitude exercise,
that is positive
conditioning to reduce the situation is less
fun and also a process of maturation, while
decrease of levels anxiety towards teachers in
the control group occurred as a result of
maturation of child and also through the
548
process of imitating or equate themselves
with friends.
2. Results of the assesment of median scores in
the study group and the control group after 1
and 2 weeks of treatment, showed that
difference. Decrease median scores in both
groups after 1 week of treatment, and after 2
weeks of treatment of control group did not
experience a decrease in median scores.
Decrease of median score that is indicate to
given attitude exercise for 2 weeks have an
effect of levels anxiety towards teachers to
child the first time school. Exercise attitude is
very helpful to reduce the anxiety towards the
teacher to child the first school. Children
initially had trouble adjusting in school or
have a less pleasant experience when
interacting with teachers, there will be
insecurity, lack of confidence and calm.
http.Upi.Adu/Direktori/FIP/Jurnal PGTK.
(sitasi Juli 2011)
Frogratt, W. (2006). Free From Stress: Panduan
Mengatasi Cemas. Bhuana Ilmu Populer.
Jakarta
Gunawan, Ary. (2000). Sosiologi Pendidikan.
Jakarta. EGC
http//en wikipedia org/wiki/Cognitive Behavior
Therapy, 2008
Hurlock, Elizabeth B. (2006). Perkembangan
Anak. Jilid 1. Jakarta. Erlangga
Kearney, Silverman. (1996). Defined Refusal
Behavior.
Kecamatan Wates. (2010). Profil Kecamatan.
Kediri. Pemerintah Kabupaten Kediri
Mulyatningsih, Rudi., Sunu P., Kuswadi Y.,
Manik R. (2006). Bimbingan Pribadi Sosial
Belajar. Jakarta. Grasindo
Nelson. (2000). Ilmu Kesehatan Anak. Volume
1. Editor Richard E.Behrman, Robert M
Kliegman, Ann M Arvin. Editor edisi Bahasa
Indonesia A Samik Wahab Edisi 15. Jakarta.
EGC
Noorlaila, Iva. (2010). Panduan Lengkap
Mengajar PAUD. Yogyakarta. Pinus Book
Pbulisher
Notoadmodjo, Soekidjo. (2002). Pendidikan dan
Perilaku Kesehatan. Jakarta. Rineka Cipta.
Notosoedirdjo. Moeljono., Latipun. (2007).
Kesehatan Mental Konsep dan Penerapan.
Cetakan V. Malang. Universitas
Muhammadyah Press
Ramalah, Savitri. (2003). Kecemasan
Bagaimana Mengatasi Penyebabnya, Edisi 1.
Jakarta. EGC
Remschmidt, Belfer. (2004). Goodyer.
Facilitating Pathways Care, Treatment and
prevention In Child and Adolecent Mental
Health. Spinger medizin verlag. Berlin
Hiedelberg
Semiun, OFM. (2007). Psikologi Untuk
Keperawatan. Jakarta. Grasindo
Singgih, D Gunarsa., Yulia Gunarsa. (2003).
Psikologi Perkembangan Anak dan Remaja,
Jakarta, Gunung Mulia
Singgih, D Gunarsa., Yulia Gunarsa. (2008).
Psikologi Perkembangan Anak dan Remaja,
Jakarta, Gunung Mulia
Sudiyanto. (2007). Bimbingan Teknis
Psikoterapi CBT, FK UNS
Sunaryo. (2002). Psikologi Untuk Keperawatan.
Jakarta. EGC
Sunaryo. (2004). Psikologi untuk Keperawatan.
Jakarta. EGC
Recomended
1. Create a positive environment when dealing
with children with problems of adjustment at
the begin of school, the first of at least 2
weeks
2. Do development and assessment of teacher
competence on a regular basis to stimulate
increased understanding and ability of
teachers to master the competence.
REFERENCE
Abdullah, Mulat Wigan. (2006). Sosiologi
Untuk Anak SMP Semester VII. Jakarta.
Grasindo
Astuti, Endang Sri., Rosminingsih., Retno
Widajati., Tuti Sukarni dkk. (2006). Bahan
Dasar Untuk Pelayanan Konseling pada
Satuan Pendidikan Jilid I. Jakarta. Grasindo
Baron, Robert A., Donn Byrne. (2007).
Pembentukan Sikap Melalui Sosial Learning
and Social Comparison Dan Dipengaruhi
Faktor Eksternal Atau Internal. Journal
Komunika Volume 10 Nomor 1 Oktober
2007
Bernstein, Bettina E. Separation Anxiety and
School Refusal Treatment and Management.
http.// emedicine.medscape.com/article (sitasi
tahun 2000)
Collins, Mallary M., Fortenal. (1992).
Pendekatan Positif. Cetakan I. Diterjemahkan
oleh Kathleen Sri Wahdani. Jakarta. Gunung
Mulia.
Ernawulan,Syoiodih. Makalah Perkembangan
Perilaku Sosial Anak Pra Sekolah.
549
Thabirajah, et.al. (2008). Understanding School
Refusal: a handbook for proffesionals in
educational health and social care. Jessica
Kingsley. London
Thalib, Syamsul Bachri. (2010). Psikologi
Pendidikan Berbasis Analisis Empiris
Aplikatif. Jakarta. Kencana
Tim Pengembang Ilmu Pendidikan, FIP-UPI.
(2007). Ilmu dan Aplikasi Pendidikan.
Bandung. Intima
Wong, Donna L.. (2008). Buku Ajar
Keperawatan Pediatrik Edisi 6 Volume 1.
Alih Bahasa Agus Sutarna dkk. Jakarta. EGC
550
STIMULUS EFFECT CUTANEOUS (SLOW-STROKE BACK MASSAGE) TO
INTENSITY OF PAIN HEAD IN ELDERLY WITH HYPERTENSION
(Unit Pelayanan Terpadu PSLU Blitar, Tulungagung 2015)
Sukanto1, Dinda Wahyuningtyas2
[email protected]
Abtract
Hypertension is systolic blood pressure greater than or equal to 140 mmHg and
diastolic blood pressure greater than or equal to 90 mmHg One of the risk factors that
lead to this unstability is aging process so that the primary clinical symptoms of
headache. One of the non-pharmacological ways to cope with this pain is by applying
cutaneus stimulation with slow-stroke back massage method. The mechanism of
cutaneous stimulation using the principle of gate control theory and the theory of
endorphins. The purpose of this study was to determine the effect of cutaneous stimulus
(Slow-Stroke Back Massage) to the intensity of headache in the elderly with
hypertension. The design used is to one group pretest-posttest. The research began
February 23th until March 7th, 2015. The sample of this study were elderly people aged 55
to 80 years using purposive sampling technique were 30 elderly. The data collected by
observation. The results of the 30 respondents before given stimulus cutaneous mostly
experienced moderate pain is there are 21 (70%) of respondents, and after given stimulus
cutaneus a small portion experienced mild pain is there are 7 (23.3%) of respondents.
According of Wilcoxon Signed Rank test that p value (0.000) <α (0.05), then H 0 is
rejected and H1 accepted that there is effect of cutaneous stimulus (Slow-Stroke Back
Massage) to the intensity of headache in the elderly with hypertension.This research
showed that administration of cutaneous stimulusis very effective in order to reduce the
intensity of headache. Then of the cutaneous stimulus (slow-stroke back massage) can be
used as an alternative option toreduce the intensity ofheadachein patients with
hypertension.
Keywords
: Slow-Stroke Back Massage, Headache Intensity,Hypertension, Elderly
referred to as 'The Silent Disease' or
hidden disease. (Hartono, 2012).
WHO
(World
Health
Organization) said that cardiovascular
disease is the largest cause of death in
the population aged 65 years or older
with more number of deaths in
developing countries. Based on the data
Lancet (2008), the number of
hypertensive patients world
wide
continues to increase. In India, the
number of hypertensive patients reached
60.4 million people in 2002 and an
estimated 107.3 million people in 2025.
In China, 98.5 million people have
hypertension and increased to 151.7
million in 2025. In the the other in Asia,
there were 38.4 million people with
PRELIMINARY
Indonesia will experience an increase in
the number of elderly population the
21st century. High increase in the
number of elderly who have the
potential to cause various problems both
from the aspect of social, economic,
cultural, and health (Nugroho, 2000).
Health problems of aging occur on
various body
systems such as
hypertension. Hypertension is one of the
most deadly diseases in the world,
because the disease can cause
complications such as heart failure and
stroke. Hypertension is a condition in
which a person's blood pressure to rise
which systolic blood pressure / diastolic
exceeds 140/90 mmHg. It is often
563
hypertension in 2000 and is predicted to
be 67.4 million people in 2025. Data
patients with hypertension in Indonesia
reach 17-21% of the population and
mostly undetected. In general, more
women than men suffer from
hypertension. It is closely related to diet,
especially salt intake, which is generally
higher (Muhamaddun, 2010).
Based on the results of a
preliminary study conducted by
researchers at UPT PSLU Blitar,
obtained the data in October 2014 there
are many elderly
suffer from
hypertension. For the last 2 months there
are 56,25% as many as 45 elderly people
who suffer from hypertension of the
total elderly. While the prevalence of
hypertensive patients who experience
headaches as many as 30 elderly ie
37.5% of the elderly who are 80 elderly.
(UPT PSLU Blitar in Tulungagung,
2014).
The impact of hypertension that
can lead
closed blood vessels
(vasoconstriction), there by resulting in
a decrease in cardiac output. If there is a
decrease in cardiac output, the tissues of
the body will experience a shortage of
nutrients and O2. As cardiac
compensation will increase to meet the
needs of network contraction resulting in
increased hydrostatic pressure of the
blood vessels. Stiffness and increased
hydrostatic pressure causes the lowest
threshold of pain the brain blood vessels
easily touched (hit), and the sensation of
head pain will be felt hypertension.
According Marlia (2009)
general treatment of hypertension that is
pharmacological
and
nonpharmacological. One of the actions
complementary or non-farmacologist in
reduce symptoms of hypertension like
help to reduce the perception of pain or
provide comfort in nursing is the
Massage and touch sensory integration
techniques that affect the activity of the
autonomic nervous system (Potter and
Perry, 2006).
Relaxation is very
important to helps clients to improve
comfort and free themselves from the
fear and the stress of illness and pain
experienced endless (Potter & Perry,
2005).
Based on the above phenomenon,
researchers are interested to knowing
and proving there any influence
cutaneous stimulus (Slow-Stroke Back
Massage) to the intensity of headache in
the elderly with hypertension in UPT
PSLU Blitar in Tulungagung 2015.
RESEARCH METHODS
The design study is using a one-group
pre-post test design. characteristic of this
type of research is the use of a causal
relationship by engaging a group of
subjects. Group of subjects was
observed before the intervention, and
then observed again after the
intervention (Nursalam, 2003).
The population in this study
were all elderly with hypertension in
UPT PSLU Blitar in Tulungagung as
many as 45 elderly. In this study sample
used mostly elderly people who suffer
from hypertension with headache in
UPT PSLU Blitar in Tulungagung that
meet the criteria desired by the
researchers, the number of respondents
are 30 people.
In collecting data is used
observation and interview for measuring
instrument research.
This experiment was held on
February 23 until March 7, 2015 in Unit
Pelayanan Terpadu PSLU Blitar in
Tulungagung.
In analyzing the effect of the
stimulus effect of cutaneous (SlowStroke Back Massage) to the intensity of
headache in the elderly with
hypertension in UPT PSLU Blitar in
Tulungagung 2015, using the Wilcoxon
Signed Rank test statistic Tes.Bila p
value <0.05 was said to be significant,
the hypothesis 0 (Ho) is rejected, then
H1 accepted meaning stated there Effect
of stimulus effect of cutaneous (SlowStroke Back Massage) to the intensity of
hypertension, while p value ≥ 0.05,
hypothesis is accepted and H1 rejected,
which means no cutaneous stimulus
effect Effect (Slow-Stroke
Back
564
Massage) to the intensity of headache in
the elderly with hypertension.
moderate pain
respondents.
is
7
(23.3%)
of
3. The Result of statistical test
From the data obtained, the next test
statistics using the Wilcoxon Sign Rank
T-test and showed sig. (2-tailed) less
than 5% (p = 0.000) <( = 0.05), thus
the results obtained H0 rejected and H1
accepted meaning
there is
effect,
cutaneous stimulus effect (Slow-Stroke
Back Massage) to the intensity of
Tulungagung.
RESULTS
1. Initensity Head Pain Before Awarded
Stimulus cutaneous
(Slow-Stroke
Back Massage).
Table 1. Distribution of frequency
intensity characteristic of the headache
before it is given stimulus cutaneous
(slow-stroke back massage) in UPT
PSLU Blitar in Tulungagung on 23
February -7 March 2015.
No. Categori Frequen Prosenta
es
cy
se (%)
1 No pain
0
0%
2 Less pain
9
30 %
3 Moderate
21
70 %
pain
4 Hard pain
0
0%
Jumlah
30
100 %
DISCUSSION
A. The results Head Pain Intensity
Stimulus Before Giving cutaneous
Stimulus
(Slow-Stroke
Back
Massage)
Source : Penelitian tahun, 2015
Table 1 above shows that out of
30 respondents largely there are 21
experiencing moderate pain (70%) of
respondents.
2. Head Pain Intensity Stimulus
Provided After cutaneous (SlowStroke Back Massage).
Table 2. Distribution of frequency
characteristics of headache intensity
after cutaneous stimulus is given (slowstroke back massage) in UPT PSLU
Blitar in Tulungagung on 23 February -7
March 2015.
No. Categories Freque Prosentase
ncy
(%)
5
16,7 %
1
No pain
2
Less pain
18
60 %
3
Moderate
7
23,3 %
pain
4
Hard pain
0
0%
Jumlah
30
100 %
Source : Penelitian tahun, 2015
Table 2 above shows that of the
30 respondents, some small experience
565
From table 1 the data obtained that
before given stimulus cutaneous (slowstroke back massage), of 30 respondents
mostly experienced moderate pain that is
there are 21 (70%) of respondents, 9
(30%) of respondents experienced mild
pain and 0 (0%) respondents did not
complain of the pain.
Pain is everything that someone says
about the pain and occurs whenever
someone has told that he felt pain (Potter
and Perry, 2005), so that each individual
will perceive pain in different ways
depending on other factors that affect
pain such as experience past, anxiety,
culture, age, the placebo effect (Smeltzer
& Bare, 2008) and the meaning of pain
and coping style (Potter & Perry, 2006)
and also factors of disease.
Based on the above theory and fact,
researchers believe that pain is a natural
response of the body to respond to the
presence of an abnormality in the body
system. This happens because the
response to pain that is felt by each of
the indivitu vary depending on factors
other causes such as age, anxiety,
culture, the placebo effect, the meaning
of pain and coping styles. Response to
pain that is felt by the client begins with
a decrease in the body's organ systems,
especially that of blood vessels that can
lead to atherosclerosis, resulting in a
decrease in cardiac output may increase
the hydrostatic pressure of the blood
vessels arises sensation of pain. The
individual response to pain through three
phases: activation starts when the first
individual receiving pain stimuli to the
body reacts to pain include muscular and
emotional responses. The second stage
is the stage of reflection, at this stage the
pain that arises very great but brief. And
the third stage is the stage adaptation, if
pain lasts longer then the body will
adapt to a pain, so that individual
responses to pain vary. It was also
evident from the research data that
showed that before being given
cutaneous stimulus of 11 respondents
aged 75-90 years old, all experienced
moderate pain that is there are 11
(100%) of the respondents, and of the 19
respondents who suffer from mild
hypertension, almost all of which pain
was that there were 17 (89.5%) of
respondents.
the attributes certainly the experience of
pain is that pain is an individual (Potter
& Perry, 2003) so the response that
occurs after treatment can not be
compared with others. Mechanisms of
pain reduction can be explained by the
gate control theory, the pain intensity
lowered by blocking the transmission of
pain at the gate (gate), and the endorphin
theory, namely the decrease in pain
intensity was influenced by increased
levels of endorphins in the body. With
stimulus cutaneous (slow-stroke back
massage), can stimulate the fibers A beta
are numerous in the skin and responds to
a light massage on the skin so that the
impulse delivered more quickly. This
makes the stimulation comes from the
dominant impulse input A beta fibers so
that the gate closes and pain impulses
can not be transmitted to the cerebral
cortex to be interpreted as pain. In
addition, the descending control system
will also react by releasing
endorphinyang is the body's natural
morphine that block pain transmission
and perception of pain does not occur
(Potter & Perry, 2005). Cutaneous
stimulus correct use can reduce the
perception of pain and helps reduce
muscle tension that can increase pain,
decreased pain intensity, anxiety, blood
pressure, and heart rate were
significantly (Mook E, 2003)
Referring to the theory and the above
facts the researchers found the presence
of nursing actions such as the provision
of cutaneous stimulus (slow-stroke back
massage) for 10 minutes on the subject
of the research, the intensity of the
headache that is felt client can be
decreased. This occurs because of the
influence of the fibers A that can block
the transmission of pain impulses and
also the presence of endorphins which
are natural morphine in the body so it
can reduce the intensity of the headache
that is felt by the client. It was also
supported by research data shows that
before being given cutaneous stimulus
of 11 respondents aged 75-90 years old,
all experienced moderate pain that is
there are 11 (100%) of the respondents
B. The results Head Pain Intensity
Stimulus After Giving cutaneous
Stimulus
(Slow-Stroke
Back
Massage)
Cutaneous stimulus (slow-stroke back
massage) for 10 minutes on the subject
of the study show the results as listed in
Table 2, which shows that of the 30
respondents, some small experience
moderate pain there are 7 (23.3%) of
respondents, 18 (60 %) of respondents
experienced mild pain and 5 (16.7%) of
respondents did not complain of pain.
According to the theory explained
that pain is a condition such as an
unpleasant feeling, is very subjective
because the feeling of pain is different
for each person in terms of scale or the
level, and only the person who can
explain or evaluate the pain they
experienced (Alimul, 2006). Decrease in
pain intensity value of each individual is
different even though the stimulus that
causes pain and was given the same
treatment. It is associated with one of
566
and after a given stimulus cutaneous
nearly half experience moderate pain
that is there are 5 ( 45.5%). And of the
19 respondents who suffer from mild
hypertension,
almost
entirely
experiencing moderate pain that there
were 17 (89.5%) of the respondents and
after a given stimulus cutaneous nearly
half experience moderate pain that is
there were 5 (26.3%)
atherosclerosis, loss of elasticity of the
connective tissue and a decrease in
vascular smooth muscle relaxation,
which in turn lowers the ability of
distension and tensile strength of blood
vessels. Consequently, the aorta and
large arteries diminished ability to
accommodate the volume of blood
pumped by the heart (stroke volume),
resulting in decreased cardiac output and
increased
peripheral
resistance
(Rohaendi, 2008). Increased pressure
may touch peripheral blood vessels
around it so sensation the pain felt by
the individual. Management of nonpharmacological measures can be taken
to reduce the intensity of headache is the
stimulus cutaneous (slow-stroke back
massage). Mechanism of this technique
is with gate control theory, the pain
intensity lowered by blocking the
transmission of pain at the gate (gate),
and the endorphin theory, namely the
decrease in pain intensity was influenced
by increased levels of endorphins in the
body. With stimulus cutaneous (slowstroke back massage), can stimulate the
fibers A beta are numerous in the skin
and responds to a light massage on the
skin so that the impulse delivered more
quickly. This makes the stimulation
comes from the dominant impulse input
A beta fibers so that the gate closes and
pain impulses can not be transmitted to
the cerebral cortex to be interpreted as
pain. In addition, the descending control
system will also react by releasing
endorphins which are the body's natural
morphine that block pain transmission
and perception of pain does not occur
(Potter & Perry, 2005).
Based on theory and the facts
above, the researchers argue that the
stimulus cutaneous the elderly who
experience headache very effective in
order to reduce the intensity of the
headache that is felt client, it looks at the
differences in the intensity of headache
in the elderly with hypertension before
and after stimulus cutaneous ( slowsroke back massage). This stimulus can
dilate blood vessels, muscles become
relaxed, can stimulate the fibers A and
C. The results of the analysis of
cutaneous Stimulus Effect (SlowStroke Back Massage) Against
Pain Intensity Head On Elderly
with Hypertension
Based on the results of statistical tests
Wilcoxon Sign RankT-testdengan α =
0.05 was obtained p value = 0.000. Thus
the p value (0.000) <α (0.05), then Ho is
rejected. From the analysis above, it can
be concluded that the stimulus cutaneous
(slow-stroke back massage) has an
influence on the intensity of headache in
the elderly with hypertension.
According to the theory,
explained that the sympathetic nervous
system stimulates the blood vessels in
response to emotional stimuli. The
adrenal glands also stimulated, resulting
in additional activity vasoconstriction.
The adrenal medulla secretes
epinephrine causes vasoconstriction.
The adrenal cortex to secrete cortisol
and other steroids, which can strengthen
the vasoconstrictor response of blood
vessels. Vasoconstriction leading to
decreased blood flow to the kidneys,
causing release of renin. Renin stimulate
the formation of angiotensin II, a
vasokonstriktorkuat, which in turn
stimulate the secretion of aldosterone by
the adrenal cortex. This hormone causes
the retention of sodium and water by the
kidney tubules, causing an increase in
intravascular volume, all these factors
tend to trigger a state of hypertension.
For
consideration
gerontology,
functional and structural changes in the
peripheral vascular system responsible
for blood pressure changes that occur in
the elderly. These changes include
567
stimulate endorphin pengeuaran of the
body so as to block the transmission of
impulses to be transmitted to the brain
(cerebral cortex). It was also reinforced
by research data from Sumartini and
Grhasta Dian Perestroika which showed
that this stimulus can reduce pain
intensity and can also stimulate the
hormone endorphin which Brazilians of
morphine naturally from the body, so the
pain that arises can be neutralized
resulting in a decrease in the intensity
experienced by individuals. It was also
proved by the research data shows that
before being given stimulus cutaneous
majority of respondents experiencing
moderate pain that is there are 21 (70%)
of respondents, and after a given
stimulus cutaneous small proportion of
respondents experienced moderate pain
that is there are 7 (23.3%) of
respondents , And from a small portion
of respondents who experienced a mild
pain that is there are 9 (30%) of
respondents, having given no cutaneous
stimulus large majority of respondents
who experienced a mild pain that is
there (60%) of respondents. Thereby
providing a stimulus cutaneous (slowstroke back massage) can be used as an
alternative option to reduce the intensity
of headache in the elderly with
hypertension in non pharmacological
relatively no side effects.
hipertensi PSLU Tulungagung Blitar
2015.
SUGGESTION
1. For Developers Sciences
Nursing education institutions should
equip students with knowledge of
non-pharmacological treatment in the
elderly who suffer from hypertension
with symptoms of headache, which
later can be equipped nurses in
applying science and knowledge to
the people, especially the elderly.
2. For Developers Program
The result is expected as fill material
for both increased
insight and
knowledge and skills nursing in
increasing knowledge about how to
lose headache in the elderly, efforts
are made to improve education and
health promotion activities to the
public.
SOURCES
Arikunto,S. 2005. Prosedur Penelitian
Suatu Pendekatan Praktek.Edisi
Revisi keempat. Jakarta : Rineka
Cipta.
Arikunto, Suharsini. (2000). Prosedur
Praktek. Jakarta :PT. Rineka Cipta
Ahmad,
H.A.2002.Ilmu Penyakit
Dalam.jilid I. Jakarta : Galia Indah.
Azwar,
S.2006.Metode
Penelitian.Yogyakarta : Pustaka
Pelajar
Darmojo, B. 2006. Buku Ajar Geriatri
(Ilmu Kesehatan Usia Lanjut) Edisi
Ke-3. Jakarta : Balai Pustaka FKUI.
Hidayat, A.Aziz Alimul. 2007. Riset
Ilmiah. Jakarta: Salemba Medika.
Hutapea, R. 2005. Sehat dan Ceria di
Usia Senja. Jakarta: Rineka Cipta.
Kusyati, E. 2006. Keterampilan dan
Prosedur
Laboratorium
Keperawatan Dasar. Jakarta : EGC.
Mansjoer, Arief.2001 Kapita Selekta
Kedokteran, Edisi 3. Jakarta : Media
Aesculapius FKUI.
Mardi Mario.2009.Rahasia Hidup Sehat
dan Efesien. Jakarta : Gramedia
Pustaka Utama
CONCLUSIONS AND
SUGGESTIONS
CONCLUSION
the influence of stimulus cutaneous
(Slow-Stroke Back Massage) to the
intensity of headache in the elderly with
Tulungagung, 2015 can concluded from
30 respondents with analyzed by using
statistical test of Wilcoxon Signed
Ranks Test with a value of ρ = 0.000,
meaning that ρ <α = 0.05, so that H0
rejected H1 accepted and that means the
stimulus effect of cutaneous (SlowStroke Back Massage) to the intensity of
headache in the elderly with UPT
568
Maryam, dkk.2008. Mengenal Usia
Lanjut Dan Perawatannya. Jakarta :
Salemba.
Midyuin, 2010. Rancangan Penelitian
cross
sectional.
http://dhinierha.blogspot.com/2009/r
ancangan-penelitian-crosssectional.html.tanggal 30 November
2014.
Mok, E; Chin Pang Woo. 2004. The
Effects of Slow-Stroke Back Massage
on AnxietyandShoulder Pain
InElderly
Stroke
Patients.http://www.sciencedirect.co
m/science, Diakses 30 October 20014
Notoatmojo, S. 2003.
Metodologi
Penelitian Kesehatan. Jakarta :
Rineka Cipta.
Notoatmojo, S. 2002.Pendidikan dan
Perilaku Kesehatan. Jakarta :
Rineka Cipta
Nugroho, W. 2000. Keperawatan Lanjut
Usia. Jakarta : EGC.
Metodologi
Penelitian
Ilmu
Keperawatan : Pedoman Skripsi,
Tesis dan Instrumen Penelitian
Medika.
Nursalam dan Pariani,S. 2003 .
Pendekatan Praktis MetodoLogi
Riset Keperawatan. C.V. Jakarta :
Sagung Seto.
Potter, Patricia A; Anne Griffin Perry.
2005. Buku Ajar Fundamental
Keperawatan: Konsep, Proses, dan
Praktik Edisi 4 Volume 2. Jakarta :
EGC.
Sabri,luknis dan Sutanto Priyo Hastono.
2008. Statistik Kesehatan.Jakarta:
Rajawali Pers
Sarwono, Jonathan.2000.Analisis Data
Penelitian. Yogyakarta : CV Andi
Offset
Smeltzer, Bare. 2002.
Buku Ajar
Keperawatan Medikal Bedah
Brunner & Studdarth. Jakarta : EGC.
Sugiyono, 2009 . Metode Penelitian
Kuantitatif Kulalitatif dan R&D.
Jakarta : CV Alfabeta.
Suharsono.2004.The Dance Of Minds.
Kementrian Kesehatan RI. Jakarta
Suparman, 2005 . Jurnal Cermin Dunia
Kedokteran No.146 . Jakarta.
Surewati.2003.Ilmu Penyakit Dalam
Jilid 3. Jakarta : Graha Ilmu
Stanley M, Patricia GB. 2006. Buku Ajar
Keperawatan Gerontik Edisi 2.
Jakarta: EGC.
Syarifudin B. 2009.
Panduan TA
Keperawatan dan Kebidanan dengan
SPSS. Yogyakarta : Grafindo Litera
Media
Tamsuri, Anas.2006.
Konsep dan
Penatalaksanaan Nyeri. Jakarta : EGC.
.
569
The Activity Test of Pandan Wangi Leaves Extract (pandanus amaryllifolius Roxb)
forSolubility of Calsium Kidney Stones by in Vitro Method
using atomic Absorbtion Spectrophotometri (AAS)
Ida Kristianingsih1, Dewi Resti Basuki2, Siti Mamluk Atul M3
FAKULTAS FARMASI
INSTITUT ILMU KESEHATAN BHAKTI WIYATA KEDIRI
Abstract
Pandanus amarylliflius Roxb.folium has been used from generation to generation as
kidney stones medicine. Mursito (2001) in his book said thaPandanus amarylliflius Roxb
folius has flavonoid as one of the constituents. In accordance with Pramono (1986), one
of the kidney stones medicine mechanisme is by forming dissolvable calcium-flavonoid
complex. The experiment was purposed to know whether water extract of Pandanus
amarylliflius Roxb folium contains flavonoid and could dissolve calcium contained in
kidney stones. Kidney stones as subject were homogenized its fitrated sefted using a mess
45, and then to test of qualitatively analized chemically. Pandanus amarylliflius
extracted with water and get analized qualitatively with Wilstatter Test. The kidney
stones divided into seven group, each of them soaked in aquadest, Calcusol 1,2%,
solution, Pandanus amarylliflius Roxb. Folium extract 0,625%, 1,25%, 2,5%, 5% and
10%,during ±5 hour with temperature ±37°C. Quantitative analize with Atomic
Absorption Spectrophotometer was done to the solution after soaking. Qualitative
analysis of kidney stones calcium shows positive results. Flavonoid qualitatif analysis
with Wilstatter Test shows possitive results of flavonoid with carmine colours. Atomic
Absorption Spectrophotometer data analysis by One Way Anova shows significant
differentiation the amount of dissolved kidney stones calcium in aquadest negative
control and 1,2% Calcusol as positive control are 0,3812 ± 0,0027 ppm and 1,4053 ±
0,0051 ppm; The0,625%, 1,25%, 2,5%, 5% and 10%, Pandanus folium extract could
dissolved kidney stones calcium 1,4590 ± 0,0065 ppm, 2,8419 ± 0,0078 ppm, 2,5909 ±
0,0176 ppm, 2,9439 ± ,00740 ppm, 5,4445 ± 0,02562 ppm. The experiment results shows
that water extract of Pandanus amarylliflius Roxb.,. Leaves contains flavonoids and
could dissolve calcium in kidney stones. The experiment results shows that water extract
of Pandanus amarylliflius Roxb., folium contains flavonoids and could dissolve calcium
in kidney stones
Keyword : Pandanus amarylliflius Roxb., kidney stone, calcium, Atomic Absorption
Spectrophotometer
causing turbidity or urine becomes
concentrated. The next result of
blockage in the drain from the kidney to
the bladder which can disrupt the
smooth flow of urine. If the urine is
obstructed exit of the kidney, there will
be accumulated of urine in the kidney.
In addition, it can also lead to infection
due to the emergence of bacteria or
viruses from the bladder. Accumulation
of urine in the kidneys and infection that
lasts a long time will lead to a decrease
INTRODUCTION
The people considers
that the used of traditional medicine was
safer than chemical medicine, so that
they prefer to used traditional medicine
to cure many diseases. They are usually
consumed in the form of stew, steeping,
or directly consuming that are
considered nutritious (Anonim, 2008).
Kidney stones were one of the
health problems in the urinary system,
because the body is dehydrated, its
577
in the physiological function of the
kidneys.
Traditional
medicine
used
empirically is pandan wangi (Pandanus
amaryllifolius Roxb). it used by the
community as a laxative medicine
kidney stones.
The people used it
hereditary and based on their
experiences used boil water of pandan
wangi leaves to treat kidney stones. One
of the laxative mechanism drug by
dissolving kidney stones are calcium
kidney stones. Pandan wangi leaves,
according Dalimartha (2000) contains
flavonoids. In his research, Pramono
(1986), states that the mechanism of
dissolution of calcium kidney stones
with the possibility of the formation of
complexes between ionic calcium
kidney stones with a hydroxy group
carbonyl flavonoids contained in
traditional medicine. Rahardjo study
(2003) showed that infusion of pandan
wangi leaves can dissolve calcium
kidney stones. Some results
phytochemical screening of pandan
wangi contains alkaloids, saponins,
flavonoids, tannins, and a dye. These
flavonoids can be extracted with ethanol
70%. Ethanol can be used to sum up the
relatively high polarity substance until
relatively low.
Pandan wangi
leaves ethanol
extract is obtained through maceration
which are a method that is suitable for
compounds that do not withstand
heating to high temperatures and is often
used for extracting the ingredients which
floured smooth simplicia (Voigt, 1994).
Preparations of infusa can only sum up
the substances that are polar, penyarian
this way produce pollen that is unstable
and easily contaminated by bacteria and
fungi, therefore the juice obtained must
not be stored for more than 24 hours.
Another disadvantage is the cause
swelling of the cell so that the active
ingredient will be firmly attached to the
bulbs. While the dosage forms in
addition to the extract can be stored for
longer also can be used repeatedly.
Method
1.
Processing of simplicia
Pandan Wangi
Leaves plants
grow away from water sources and
harvested during the dry season. The
leaves are taken is growing 8 strands of
shoots up to 8 strands of the base and
than its were cut 10 cm from the base of
the leaf. Leaves were disorted and
washed with flow of water. The leaves
are allowed to dry with air flow and Its
not exposed to direct sunlight.
2. Preparation of pandan wangi
ethanol extract
Pandan Wangi Leaves were dried
under shade and then were powdered
with a sieve number 8 made extrac.
Extraction using 170 g (10 parts)
simplicia pandan wangi leaves by
maceration with ethanol 70% as much as
1.275 ml (75 parts). Maceration
performed for 5 days with stirring twice
a day. Maserat obtained from filtration
was collected. The remaining pulp
macerated again 2 days, filtered and
collected to obtain 1700 ml (100 parts).
Maserat obtained evaporated with a
rotary evaporator at a temperature of not
more than 500C, until a thick
consistency is formed future. The
Extract is made by weighing 10 grams
of pandan wangi leaves extract is
dissolved in 100 ml of solvent (DMSO
and distilled water).
3. Treatment of kidney stones disease
Kidney stones
are made of
powder by means of crushed using a
mortar and sieved with a mesh size 45.
After sifted powder kidney stones
washed with distilled water and dried
flows.
4. Preparation of calcusol 1.2%
(a
therapeutic dose of 1 day)
Calcusol as a positive control, six
capsules calcusol (3 x daily therapeutic
dose of 2 capsules) is opened and its
contents weighed 2.4 grams gained
weight. The powder is then dissolved in
distilled water to 200 ml (volume one
drink)→ levels of 2.4 g / 200 ml = 1.2%
578
dilute with water as much, whipped and
left. Red to orange color is given by the
flavonoids, dark red color is given by
the flavonol or flavonon, green to blue
color is given by the aglycone or
glycoside.
5. Test the identification of calcium
kidney stones in vitro
Test identification of calcium kidney
stones by using chemically qualitative
inorganic analysis. Powder kidney
stones included a test tube and reacted
with detection reagents:
7. Grouping and treatment of test
subjects
Kidney stone test subjects were
divided into seven groups. The first
group, a negative control, were given
distilled water, kelompak II, the positive
control, given calcusol solution 1.2%.
Group III to VII consecutive extract
fragrant pandan leaves grading 0.625%,
1.25%, 2.5%, 5% and 10% .
The seventh group of test subjects
are treated as follows, as much as 50 mg
powder kidney stones soaked with 5 ml
of the test solution as specified above in
the tube and placed in a water bath with
a temperature of 370C for 5 hours and
shaken every half hour for one minute.
After 5 hours the filter with filter paper,
the filtrate obtained was analyzed by
atomic spectrophotometer to determine
the solubility of calcium.
a. Carbonic
Kidney stones are already included in
the test tube was added HCl 10%, when
gas formation means CO3 (+).
b. Calcium
the test tube was added 3 ml of HCl
10%, then heated and added saturated
ammonium oxalate through the tube
wall (not shaken), the white precipitate
like fog means calcium (+).
c. Oxalate
the test tube was added 1 ml of HCl
10%, then bring to a boil and coupled
with MnO2 tip of a spoon. If the gas
arises, then oxalate (+).
d. Phospat
Kidney stones are already included in a
test tube add 4-5 drops of HNO3, then
heated until the powder kidney stones
8. Preparation of standard curve
Making the standard curve begins
with a calcium stock solution of 1000
ppm. Laruatn stock calcium prepared by
dissolving 2.497 grams of CaCO3 in
100 ml of HCl 1M and added distilled
water up to 1000 ml. Solution standard
curve then pipette 10 ml and 100 ml plus
aqudest. This solution is called the
working standard solution with a
concentration of 100 ppm. Of the
working standard solution is then diluted
to obtain a standard solution standard
with konsentrasi1 ppm, 2 ppm, 3 ppm, 4
ppm, and 5 ppm.
1 ppm standard solution prepared
by diluting 1mI 100 ppm calcium
solution using distilled water to 100 ml
Calculation:
V1 x C1 = V2 x C2
Description :
V1 = volume solution of
working stones CaCO3
6. Qualitative test pandan wangi
leaves extract with test method
Wilstatter
a. Preparation of experiments
Take the equivalent of 10 grams
of extracts of plant material. Whipped
repeatedly with hexane until the extract
is colorless. Discard the hexane phase.
Mix the residue with 10 ml of 80%
ethanol and then filtered to filtrate into 2
equal parts a lot (A, B). A tube is used
as a control.
b. Test wilstatter "cyanidin"
Tube supplemented with 0.5 mL
of concentrated HCl, then add 3-4 slices
of magnesium. Observe the color change
occurring within 10 minutes. If the stain
is weak, the solution is taken in half and
added to 1 ml of octyl alcohol. Then
579
C1 = concentration of CaCO3
working standard solution (100
ppm)
V2 = volume of standard
solution (100 ml)
C2 = concentration of standard
solution (1 ppm, 2 ppm, 3 ppm, 4
ppm, 5 ppm)
Standard solution 2 ppm, 3 ppm, 4 ppm,
5 ppm created using the same way.
Atomic spectrophotometer set the
conditions for the determination of
levels of calcium. The condition of the
tools used are:
Lamp current: 7.5 Ma
Wavelength: 422.7 nm
Oxidant: Air 3 kg / cm²; 15 l / min
Fuel: Acetylene; 1.1 kg/cm²; 2l/ min
Once the conditions are appropriate
tools, raw absorbance readings
performed and samples.
Figure 1. Standard Curve Profile
A. Randemen
Pandan
Wangi
Leavesextract
Extract Method Used In This
Study Is Maceration. Simplicia dry
powder pandan wangi leaves used a 170
g. Extraction solvent ethanol 70% as
much as 1700 ml. Do as much as 3x.
Extraction results are collected and then
evaporated with a boiling water bath
until thick extract obtained. And is
calculated on the weight of crude drug
extract randemen early.
Randemen extracts = the total weight of
the extract obtained x 100 ml
Simplisia initial weights
9. Sample Preparation
A sample of the filtrate results
immersion kidney stones filtrate samples
diluted with distilled water immersion
results with distilled water, pandan
wangi leaves extract 0.625%, 1.25%,
was diluted 10 times is done by taking a
1 ml sample was then added to 10 ml of
distilled water. Samples pandan wangi
leaves extract 2.5%, 5% and 10%
diluted 50 times by taking a 1 ml sample
was then added to 50 ml of distilled
water.
10. Preparation tool
580
Table 1. Results randemen extract
Replication
initial Weight
(g)
1
2
3
170,0003
170,0002
170,0001
Weight
extrac (g)
17,0230
17,0180
17,0220
Average
B. Results Making Fragrant Extract
(Pandanus Amarillifolius Roxb.)
Randement
extract
17,023
17,018
17,022
17,021
C. Results Qualitative Test Method
Flavonoids With Wilstatter
Assay was done by qualitative
chemical. Begins by weighing 10 grams
of extract. Then extract that has been
weighed mixed with hexane in a
separating funnel. The mixture is shaken
repeatedly until the extract is colorless.
Hexane phase discarded, the residue is
added 10 ml of 80% ethanol, filtered and
the filtrate was divided into two parts as
much (A and B).
- The weight of the powder herbal
P.Wangi leaves: 170 grams
- The volume of ethanol 70% : 1700 ml
- Weight viscous extract : 17.021 grams
- Percentage randemen:
% Randemen =
weight extract thick x 100
the weight of powder
% Randemen = 10.012%
Table 2 Results of the qualitative examination of flavonoids
Tube
A
B
treatment
_
added 0.5 ml HCl concentrated, then
added 3-4 magnesium.
D. Qualitative Results Of Kidney
Stones
Before the identification test of
calcium, then the kidney stones crushed
and sieved with a mesh size of 45. Tests
conducted in vitro method of qualitative
inorganic chemical analysis. Kidney
stone powder reacted with calcium
reagent identification, ie carbonate
solution, a solution of calcium, oxalate
solution, and a solution of phosphate.
observed deposition of calcium
compounds are formed.
result
Negatif control
Old red its
showed that contain
flavonoid
E. Levels of Measurement Results
Samples with AAS
Soaking kidney stones with pandan
wangi leaves extract distilled water
negative control and positive control
calcusol, levels of 0.625%, 1.25%,
2.5%, 5% and 10%, carried out for 5
hours at a temperature of 37°C and
every 30 minutes done shaking for 1
minute. After soaking for 5 hours,
filtrate screening results were analyzed
dissolved calcium content using atomic
absorption spectrophotometer
581
Table 3. Results of the qualitative examination of calcium kidney stones
NO
1
2
3
4
Treatment
Result
Carbonat Assay
Kidney stone powder + HCl 10%
Calcium Assay
Kidney stone powder + 3 ml of
HCl 10%, heated + NH4 oxalate
saturation through the wall of the
tube (do not shake)
Oksalat Assay
examination
Sulfate
Kidney stone powder + 1 ml of
HCl 10%, boil + tip of a spoon
MnO2
Phospat Assay
idney stone powder + 3 ml of HCl
10%, heated + NH4 oxalate
saturation through the wall of the
tube (do not shake)
CO3
+
A white precipitate is
formed like a fog
+
Arising gas
+
Pale yellow
-
Table 4 Results of measurements of samples with SSA
Sample
Neg control.Aquades
Pos. control Calcusol 1.2%
P.Wangi extract 0.625
P.Wangi extract 1.25%
P.Wangi extract 2.5%
P.Wangi extract 5%
P.Wangi extract 10%
Absorbance
0.0382
0.1162
0.1204
0.2258
0.2066
0.2335
0.4241
Concent
ration
(ppm)
0.3813
1.4046
1.4597
2.8426
2.5907
2.9436
5.4442
Dilution
factor
Concentration of
sample (ppm)
10
10
10
10
50
50
50
3.813
14.046
14.597
28.426
129.535
29.436
272.21
Figure 2. Histogram test solutions versus the average Ca dissolved by atomic
absorption spectrophotometer, the results of immersion calcium kidney
stones with the test solution for 5 hours
582
In this case, the researchers only
identify the elements which generally
form kidney stones among other things
carbonate, calcium, oxalate, and
phosphate. However, the most important
element in this study is calcium. For
qualitative analysis of calcium, carried
out by first adding calcium powder with
10% HCl. The addition of 10% HCl
aims to dissolve the calcium. Selection
of HCl 10% based on the theory that
most of the compounds in the form of
calcium kidney stones of calcium
oxalate. This is evident in the analysis of
oxalate which showed positive results.
Calcium oxalate is only soluble in strong
mineral acid HCl 10% so selected that a
strong mineral acid as the solvent of
calcium oxalate. After the addition of
10% HCL and heated, then the solution
was added ammonium oxalate.
Calcium analysis results are as follows:
CaCl2 + (COONH4) 2 Ca (COO) 2 +
2NH4Cl
The addition of ammonium
oxalate solution causes the formation of
a white precipitate such as fog (+). The
above reaction shows that the subject of
kidney stones were used in this study
contains calcium.
Flavonoid qualitative
analysis
carried out by Wilstatter Test. This
analysis aims to determine the content of
flavonoids in pandan wangi leaves
extract used in the study. Flavonoida are
polar compounds that can form
complexes with metal ions. Wilstatter In
tests, the addition of magnesium as the
metal ion. In literature, it is mentioned
that the test is done by extracting the
equivalent of 10 grams of plant material.
and added hexane until colorless.
The purpose of the addition of
hexane is to attract chlorophyll that can
interfere during the examination of
flavonoids. Then, the hexane phase
discarded, the residue mixed with 10 ml
of 80% ethanol. This filtrate
concentrated HCl plus 0.5, then added 34 magnesium metal. Results can be seen
after 10 minutes. From this test get a
deep red color that identifies a class of
flavonoid compounds flavonols.
RESULT AND ANALYSIS
Pandan wangi used in this study
was obtained from Purwodadi. This
study begins with the identification of
pandan wangi will be used. This step
aims to ensure that the plants used are
not wrong and actually comes from
Pandanus amaryllifolius Roxb species.
The extraction method used in this
research was maceration with ethanol
70% as solvent. Ethanol are neutral, can
inhibit the growth of mold and bacteria,
non-toxic, can be mixed with water at
any ratio, and the time required for a
concentration of less (Depkes, 1986). So
it is expected these solvents can obtain
optimal active substances because it can
attract active substances that dissolve in
water or in alcohol. The amount of 70%
ethanol used in this maceration is 10
times the weight of crude drugs.
Pandan wangi leaves extract made
with a series of levels of 0.625%,
1.25%, 2.5%, 5% and 10%, the selection
is based on a series of levels of study
Rahardjo with levels of 10% proved to
have an influence on the solubility of
calcium kidney stones. For further
research then made a different dosage
forms that extracts fragrant pandan
leaves with lower levels, and whether
the dosage form of the extract has an
effect on the solubility of calcium
kidney stones.
Kidney stones before it is treated
with fragrant pandan extract, than it
washed with distilled water flowing and
dried. Afterwards, kidney stones crushed
and then sieved with a sieve mesh size
of 45. The purpose of the washing is
done to remove impurities that exist in
kidney stones. While sifting is done so
that the size of the kidney stone that is
used uniformly. To determine the
content of calcium in the kidney stones
were used then conducted a qualitative
analysis of the chemical calcium.
One purpose of this study was to
determine the effect on the solubility of
fragrant pandan extract calcium kidney
stones in vitro, therefore, needed kidney
stones contain calcium as one of the
constituent components.
583
Quantitative analysis of the
solubility of calcium kidney stones is
done by adding 50 mg powder kidney
stones each into 7 groups. The seventh
group include: 5 ml of distilled water as
a negative control, 5 ml calsusol 1.2% as
positive control, and sample each 5 ml
pandan wangi leaves extract 0.625%, 5
ml pandan wangi leaves extract 1.25%,
5 ml pandan wangi leaves extract 2.5%,
5 ml pandan wangi leaves extract 5%,
and 5 ml pandan wangi leaves extract
10%,. Soaking carried out for 5 hours at
a temperature of ± 37 ° C and every
minute is done shaking for 1 minute.
After soaking for 5 hours, 7 groups
filtered using filter paper.
In this study, used Calcusol
positive control because
it is a
traditional medicine that kidney stones
proven efficacious and have been
determined by a doctor.
As for the negative control used is
distilled water. The use of negative
control aims to look at the possibility of
dissolution of calcium for treatment
during soaking and shaking. Selection of
atomic absorption spectrophotometer is
based on the ability to measure levels of
metals with high accuracy and low
detection limit. Atomic absorption
spectrophotometer can detect calcium
metal to levels of 0,002 ppm. Analysis
of calcium in fragrant pandan extract
made with flame atomization at a
wavelength of 422.7 nm, air oxidant 15 l
/ min, acetylene fuel 2 l / min.
A wavelength of 422.7 nm is the
wavelength of maximum spectral
calcium. A mixture of air-acetylene
flame temperature required to reach
about 2300 ° C. The high temperatures
needed to melt, evaporate, then
mengatomkan calcium metal which has
a melting point of 838 ° C and a boiling
point of 1440 ° C. Before measuring the
absorbance of the sample
prior
measurement of the absorbance of
standard
solutions.
Absorbance
measurement standard solutions aimed
at obtaining the raw curve equation used
to calculate the level of calcium in the
sample extract fragrant pandan leaves.
Standard curve of standard solution
absorbance measurement results can be
seen in Table 4. Before the measurement
of absorbance, sample first made sample
dilution. The sample dilution due to high
calcium in the sample. Absorbance
measurement results show the sample
absorbance after being diluted. The
concentration of dissolved calcium in
the sample before dilution can be
calculated by multiplying the dilution
factor with the concentration of calcium
measured.
Atomic absorption spectrophotometer
analysis results processed using
descriptive statistical methods to
determine whether a data Explore each
sample has a normal distribution and
homogeneous variants. Explore normal
distribution in statistics ditujukkan with
the ratio between the value of skewness
and kurtois and strandart error no more
than ± 2. Variant data are expressed
homogeneous when its significance is
greater than 0.05%. Explore the results
of the analysis show that the data were
normally distributed and had
homogeneous variant.
Analysis of the One Way
ANOVA statistical method performed to
see whether there are differences in the
data from each sample and whether it is
a significant difference or not. Methods
One Way Anova been a parametric
analysis method for data with one free
variable that is first of the two
treatments and unpaired.
Calcium solubility data analysis
using One Way ANOVA showed
significance value less than 0.05 (sig.
<0.05). Sig. <0.05% indicates that there
is a difference in the average value of
the solubility of calcium kidney stones
in distilled water negative control,
positive control calcusol 1.2% and
pandan wangi leaves extracts of each
level. To find out which groups that
have an average difference of dissolved
calcium, and if the difference is
significant, the use of comparative
analysis with the Tukey HSD method.
In the analysis of Tukey HSD
average significant difference between
584
samples is shown with significance
value of less than 0.05. Significance
value obtained from the comparison of
the average solubility of calcium each
sample in Tukey HSD analysis is less
than 0.05. it can be said that the average
solubility of calcium in distilled water
negative control, positive control
Calcusol 1.2%, and the pandan wangi
leaves extracts from each of the different
levels of meaning or difference is real or
significant. It is marked on the Mean
Difference column contained an asterisk
(*).
The amount of calcium dissolved
in pandan wangi leaves extract and the
percentage increase of the negative
control and a positive control Calcusol
distilled water of 1.2% can be seen in
Table V. Comparison between the
negative control and a positive control
calcusol distilled water of 1.2%
indicates that the ability to extract
fragrant pandan leaves 2 , 5% calcium
kidney stones dissolve the lower
2.5909% and 84.3663.
Aquadest comparison with the
negative control and positive control
Calcusol 1.2% indicated that the ability
of pandan wangi leaves extract 0.625%,
1.25%, 5% and 10% are able to dissolve
calcium kidney stones with each
percentage increased,
282.6381 ±
3.8265, ± 645.3675 102.2272, 672.1198
± 109.4855, 287.4315 ± 1327.9916,
although a less capable but wandan
pandan wangi leaves extract 2.5% still
has the potential to dissolve calcium
kidney stones because Tukey HSD
analysis results showed significant
differences between calcium dissolved
in a pandan wangi leaves extract 2.5%.
Histogram test solutions versus
the average Ca dissolved by atomic
absorption spectrophotometry, results
immersion calcium kidney stones with
the test solution for 5 hours. Histogram
relationship between the test solution
with the amount of dissolved calcium
indicates that the higher the
concentration of the extract, the amount
of dissolved calcium also higher.
Flavonoids contained in the extract to
form soluble complexes with calcium so
that an increasing number of flavonoids
would increase the amount of dissolved
calcium.
Research pandan wangi leaves
extract effect on the solubility of
calcium kidney stones in vitro results
that pandan wangi leaves extract content
of 0.625% to 10% can dissolve calcium
kidney stones. ability to dissolve
calcium kidney stones caused by the
flavonoids in pandan wangi leaves
extract.
This study is the first step to
determine the ability of pandan wangi
leaves extract kalsim in dissolving
kidney stones. Further studies need to be
performed in vivo to determine the
ability of pandan wangi leaves extract in
dissolving calcium kidney stones.
CONCLUTION
The experiment results shows that water
extract of
Pandanus amarylliflius
Roxb.,.folium contains flavonoids and
could dissolve calcium in kidney stones
REFERENCES
1. Anonim. 2008. Sediaan Galenik.
Jakarta: Departemen Kesehatan
RI
2. Anonim. 1979.
Vademekum
Bahan Obat Alam. Jakarta:
Depkes RI
3. Anonim. 2008.
Buku Pintar
Tanaman
Obat.
Jakarta:
Agromedia, 16-17.
4. Cahyono. 2009. Bagaimana Cara
Mencegah dan Mengatasi Batu
Ginjal. yogyakarta
5. Dalimartha, Setiawan. 2000. Atlas
Tumbuhan Obat Indonesia. Jilid I.
Trubus Agriwidya. Jakarta. 103104
6. Gandasoebrata,
R.
1968.
Penuntun Laboratorium Klinik.
Jilid I. Dian Rakyat. Jakarta. 186187
7. Gandjar, Ibnu, Gholib. 2007.
Analisis
Kimia
Farmasi.
Yogyakarta
585
8. Harbone, J, B. 1987. Metode
Fitokim; Penuntun Cara Modern
Menganalisis
Tumbuhan.
diterjemahkan oleh Padmawinata,
K. 70. ITB. Bandung
9. Kristanti,
Alfinda.
2008.
Fitokimia. Airalangga University
press. Surabaya
10. Kristijono, Ary. 2008. Obat
Tradisional dan Fitofarmaka.
Kediri
11. Moechtar. 1989. Farmasi Fisika,
Bagian Larutan dan Sistem
Dispersi. Gadjha Mada University
Press. Yogyakarta. 32-59
12. Mursito. Bambang. 2001.
Ramuan Tradisional Untuk
Gangguan Ginjal. Jakarta
13. Pedrosa,
Ciriacc,
1978.
Phytochemical Microbiological
Screening Of Newdicinal Plants.
Philipines: University Of Santo
Thomas Manila, 15-16.
14. Pramono. 1986. Kemungkinan
Mekanisme
Pembentukan
Kompleks Polifenol obat Kencing
Batu Tradisional. Buku Panduan
Ilmiah Nasional II. Fitoterapi dan
Fitofarmaka. Mipa Jurusan
Farmasi ITB. Bandung
15. Purnomo. 2008. Dasar-dasar
Urologi.Fakultas
kedokteran
University. Brawijaya
16. Robinson,
Trevor.
1995.
Kandungan Organik Tumbuhan
Tinggi. ITB press. Bandung
17. Salisbury, Frank. 1995. Fisiologi
Tumbuhan. jilid II. ITB press.
Bandung
18. Soleh, Achmad Zanbar. 2005.
Ilmu Statistika, Pendekatan
Teoritis dan Aplikatif Disertai
Contoh Penggunaan SPSS.
Bandung: Rekayasa Sains, 197216.
19. Vogel. 1990. Texbook Of Macro
and Semimicro
Qualitatif
Inorganik Analysis. Edisi V.
revisi oleh G Svehla. alih bahasa
L. Setiono dan H. Pudjaatmaka.
PT. Kalman Media Pusaka.
Jakarta. 300-302
20. Voigt, R. 1994. Buku Pelajaran
Teknologi
Farmasi.
Di
Terjemahkan Noerono, S. edisi V.
551-564. Gadjah Mada University
Press. Yogyakarta
586
THE EFFECTIVENESS OF FLUID RINGER ACETATE MALAT COMPARED WITH
RINGER LACTATE FLUID IN ACCELERATING TIME INCREASE IN BLOOD
PRESSURE IN RATS
(RATTUS NORVEGICUS)
Ika Rahmawati¹, Lizete Auxiliadora Costa Malic²
Nursing Major Faculty of Health Science
Institut Ilmu Kesehatan Bhakti Wiyata Kediri
Abstract
Dehydration is described as a state of disturbed fluid balance that can be caused by various types of
disease. One of the signs and symptoms of dehydration is a decrease in blood pressure. Dehydration
occurs due to loss of water more than on the water inlet. Fluid administration is one of the measures
taken to overcome the problem of dehydration. Ringer Acetate Malate fluids containing electrolytes
are balanced with concentrations similar to those found in human plasma. Ringer Lactate fluid is a
crystalloid liquid that is widely used in fluid therapy. The levels of sodium in the crystalloid solution
called Ringer Acetate Malate is more similar with the plasma of the human body than Ringer lactate
therefore Ringer Acetate Malate more isotonic than Ringer Lactate. Acetate metabolism also obtained
3-4 times faster than Lactate. Experimental animals used in this study were white rats (rattus
norvegicus) totaling 14 samples. This study aims to determine the effectiveness between the
administration of Ringer Acetate Malate fluid compared with Ringer Lactate fluid in accelerating time
increase in blood pressure in rats. Type of research is quantitative research, design true eksperimental
approach pra test- post test group design. Data collection using observation. Data were analyzed by
Independent T Test statistical test to determine differences in Ringer Acetate Malate fluid and Ringer
Lactate fluid in rats. Based on the survey results revealed that the increase in blood pressure in rats by
administration of Ringer Acetate Malate fluid there is an increased and accelerated the volume of
urine produced by the average amount of 0.3625 cc in less than 2 hours. While Ringer Lactate for
fluid administration in increasing blood pressure and accelerate time amount of urine produced
volume is 0.275 cc within 2 hours or more. The results of statistical tests using Independent T Test
found the difference between giving Ringer Acetate Malate fluids with Ringer's Lactate with values
obtained α = 0.017. Conclusions from this study that there is a difference between giving fluids
Ringer Acetate Malate with Ringer Lactate fluid in accelerating time increase in blood pressure in
rats. Increased blood pressure more quickly by providing fluid Ringer Acetate Malat than using fluid
Ringer Lactate.
Key Words : Ringer Acetate Malate, Ringer Lactate, Blood Pressure
584
dehydration if fluids and electrolytes are not
replaced either through oral rehydration
solution Salts (ORS) or through intravenous
fluids (15). Children are smaller (toddlers) are
more susceptible to dehydration due to the
composition of body fluids large, immature
kidney function, and inability to meet their
own needs independently (independent) (7).
The main goal of fluid therapy Ringer
Acetate Malat (RAM) is in lieu of extracellular
fluid, prevents dehydration, prevent
hypotension, correcting fluid and electrolyte
deficiency rapidly (rehydration therapy) and to
prevent nutritional deficiencies (5). Based on
the amount of fluid lost dehydration can be
categorized into 3 among others: without
dehydration, mild dehydration moderate, and
severe dehydration. Diarrhea without
dehydration children appear unconscious, not
sunken eyelids, lips and tongue wet, skin
turgor back quickly, in this case can be given
ORS as much as 5 to 10 ml/kg. On being
discovered signs of mild dehydration sunken
eyes, children restless or cranky, thirsty to
drink with gusto, pinch back by slow stomach.
In this case the child should get as much ORS
75 ml/kg administered over 3 hours by
monitoring the progress of hydration. In the
severe dehydration, the child looks
unconscious, sunken eyes, can not drink or
drink lazy, the abdominal skin pinch the return
is very slow. In this situation the child must be
hospitalized and receive intravenous fluids
100ml / kg for 6 hours in infants aged under 12
months and 3 hours for children older than 12
months (13).
RAM solution is different from the
solution of Ringer Lactate (RL), where lactate
is mainly metabolized in the liver and a small
portion of the kidney , while acetate is
metabolized in almost all tissues of the body,
especially in muscles. The RAM solution
containing electrolytes are balanced with
concentrations similar to those found in human
plasma. This solution can be used for handling
fluids in the perioperative haemostasis and can
be used to replace the volume of provisional
intravasal (9) .
Based on the above, the researchers are
interested in doing research on the
effectiveness of the liquids Ringer Acetate
Malat compared with Ringer Lactate fluid in
accelerating time increase in blood pressure on
the White Rat (Rattus norvegicus) .
INTRODUCTION
Dehydration is a condition that
disturbed fluid balance that can be caused by
various diseases (7). Dehydration occurs due
to loss of water (output) more than on the
water inlet (input) (13). Discharge is usually
accompanied by an electrolyte (9).
Dehydration caused by diarrhea is the
leading cause of death in infants and toddlers
(7). Data from the World Health Organization
(WHO) in 2004 in the WHO (2009), showed
diarrhea is the second leading cause of child
deaths in the world with 1.5 million children
die each year from this disease. In the United
States, dehydration occurs around 7 % in
patients older than 65 years who were
hospitalized with an average length of 14 days
and occurs in 82 % of febrile patients being
treated at home. Dehydration is one of the
main reasons elderly patients taken to the
emergency room (8). Data in Indonesia
obtained from the emergency department of
the Department of Internal Medicine RSUPNCM in 2000-2001 where as many as 45% of
elderly patients who were brought to the
emergency room, suffering from dehydration.
Dehydration occurs more frequently in
adolescents (48.1 %) compared to adults
(44.5%) (3). Based on the results of research
conducted by Ella (2007),
entitled
Relationship diarrhea with dehydration
Genesis Figures show pediatric patients with
diarrhea in Dr H. Adam Malik of the 39
samples analyzed, 76.9 % found dehydrated
mild or moderate and 23.1 % severe
dehydration . Based on these data we can see
that the incidence of diarrhea with dehydration
in children is still quite high.
Based on data taken in hospital
emergency rooms Gambiran Kediri, morbidity
of diarrhea with dehydration in January to
October 2014 to reach 184 cases. In acute
diarrhea with severe dehydration, blood
volume is reduced so that it can have negative
consequences in infants and children the
symptoms include shock of hypovolemic
(heartbeat becomes rapid, rapid pulse, blood
pressure decreases, the patient becomes weak,
decreased consciousness, diuresis decrease),
disruption electrolyte, acid-base
balance
disorders, and acute renal failure (9). During
episodes of diarrhea, water and electrolytes
(sodium, chloride, potassium, and bicarbonate)
is lost through liquid stools, sweat, urine and
breathing. Death can follow severe
585
Table 3 Production of urine
production period
METHODS
This type of research is quantitative
research, experimental, quasi-experimental
research design with the approach of the pre test and post-test group design . In both groups
started with the pre-test, and after the
treatment is completed held back measurement
(post-test) (13). Animals used in this study is
the White Rat (Rattus norvegicus) totaled 14
tails are male 2-3 months old weighing 200300 g and get the same nutrients. Selection of
male rats so that there are no hormonal
influences and pregnancy. This study used rats
as an animal is widely used as experimental
animals, easy to obtain, have a quick response,
give an idea scientifically that may occur in
humans, and are relatively inexpensive.
Age
1
2
2- 2,5 months
6
8
Percentage
(%)
42,85
57,14
14
100
Frequency
2,6 -3 months
Total
No
DISCUSSION
After collecting data using observation
sheet is then processed, interpreted and
analyzed according to the variables studied.
The effectiveness of fluid Ringer Acetate
Malat against time increase in blood
pressure in rats (Rattus norvegicus)
Results of the study increase in blood
pressure in rats obtained Ringer's acetate
malate fluid is a liquid that is effective in
accelerating the production of white rat urine
so that a white rat blood pressure increase
becomes faster. It can be seen from the
increase and acceleration of volume of urine
produced by the average number of 0.3625 cc
in less than 2 hours . With fluid administration
of Ringer's acetate malate in the amount of 2
cc and using a 3 cc syringe (14) .
Theoretically RAM fluid is isotonic
fluids similar to body fluids (1). This RAM
fluids containing electrolytes are balanced
with concentrations similar to those found in
human plasma. RAM is an isotonic balanced
electrolyte solution which can adjust to human
plasma by not ignoring physiology important
electrolytes in it. RAM is different from the
solution of Ringer Lactate (RL), where lactate
is mainly metabolized in the liver and a small
portion of the kidney, while acetate is
metabolized in almost all body tissues,
especially in muscle (1). Acetate metabolism
also obtained 3-4 times faster than lactate.
Ringer Acetate malate has been widely
available in many countries. This liquid is
particularly indicated as a replacement for the
acute fluid loss (resuscitation), such as
diarrhea, dengue fever, burns/shock
hemoregik. In lieu of fluid during a surgical
Sample Characteristics Frequency
Distribution Based Weight Loss
Weight
200-250
1 grams
260-300
2 grams
Total
Frequency
14
Percentage
(%)
4
28,57
10
71,42
Fluid
Based on Table 3 shows the results of
urine output with fluid administration of
Ringer acetate malate is the average number of
0.3625 cc in less than 2 hours (40 minutes to 1
hour), while the average of urinary production
for Ringer Lactat is 0.275 cc within 2 hours or
more.
Based on Table 1 shows the
characteristics of the sample based on age can
be explained that the mice age 2,6-3 months as
much as 8 samples (57.14 %) and 2-2.5
months old as 6 samples (42.85 %) .
Table 2
urine
Rate urine Duration of urine
output
production
RAM 0,3625 cc < 2 hour (40
1
minutes s.d 1
hour)
2 RL 0,275 cc 2 hours/more
No
RESULT
Table 1 Sample Characteristics Frequency
Distribution by Age
No
and
100
Based on Table 2 shows the
characteristics of the sample by weight can be
explained that the white rat body weight 260300 grams by 10 samples (71.42 %) and body
weight of 200-250 grams of 4 samples (28.57
%).
586
procedure, fluid loading time of induction of
regional anesthesia, priming solution in action
cardiopulmonary bypass, and is also indicated
in acute stroke complicated by dehydration
(6). The benefits of fluid loading at the time of
induction of anesthesia, for example,
demonstrated by studies Ewaldsson and Hahn
(2001) which analyzed the effect of 350 mL of
RAM quickly (within 2 minutes) after the
induction of general anesthesia and spinal
against volume kinetic parameters. This study
shows the provision of RAM can prevent
arterial hypotension induced central
hypovolemia is common after general
anesthesia/spinal.
According to Hahn and Drobin (2003)
RAM does not encourage cell swelling,
because it can be given in acute stroke,
particularly if there is suspicion of cerebral
edema. For obstetric cases , Onizukka et al
(2009) tried to compare the effect of rapid
infusion of Ringer Lactate Ringer Acetate
Malat with against the maternal and fetal
metabolism and acid-base balance in 20
patients who underwent combined spinal and
epidural anesthesia before seksiosesarea . This
study shows giving Ringer Acetate Malat
better than Ringer 's lactate for the 3
parameters above , because it can improve
neonatal lactic acidosis (a condition common
in babies born to mothers who experienced
pre-eclampsia or eclampsia) .
Based on the results of the study,
administration of fluid Ringer Acetate Malat is
effective compared to administration of
Ringer's lactate liquids which time the rats
increased blood pressure becomes faster as
measured from the white rat urine production
quicker and more.
administered intravenously or subcutaneously.
Fluid Ringer lactate abbreviated as "LR" ,
"RL" or "LRS, where lactate is mainly
metabolized in the liver. Ringer Lactate is a
fluid hipotonis where absorption in the human
body a little longer. At neurotraumatologi,
hypotonic fluid such as Ringer 's lactate should
be avoided because of the risk of edema
cerebral (1).
According to the conclusions of
researchers on Ringer's lactate for fluid
administration can increase blood pressure in
rats but it takes a little longer because of the
white rat urine production and a little too long.
The effectiveness of fluid Ringer Acetate
Malat compared with Ringer Lactate fluid
in accelerating time increase in blood
Results of research in accelerating a rise
in blood pressure in rats showed that more
effective use of fluid Ringer Acetate Malat in
accelerating time increase in blood pressure in
rats compared with fluid Ringer Lactate, this is
evidenced by statistical tests using T Test
Independent of the declared value Asymp sig
0.017. Ringer Acetate Malat an isotonic
balanced electrolyte solution which can adjust
to human plasma by not ignoring the
physiology of important electrolytes in it (1).
RAM solution is different from the solution of
Ringer Lactate (RL), where lactate is mainly
metabolized in the liver and a small portion of
the kidney, while acetate is metabolized in
almost all tissues of the body, especially in
muscles. Acetate metabolism also obtained 3-4
times faster than lactate (6). RAM is an
isotonic solution is a solution similar to the
body fluids. The RAM solution containing
electrolytes are balanced with concentrations
similar to those found in human plasma. This
solution can be used for handling fluids in the
perioperative haemostasis and can be used to
replace the volume of provisional intravasal
(9). The difference with a solution of Ringer
Lactate (RL) which is now frequently used in
resuscitation purposes is that the RAM
containing anions acetate and malate
metabolism which has a role as a precursor
bicarbonate, will neutralize acidosis
hyperchloraemic (1).
Ringer's lactate is fluid hipotonis with
blood and intended for intravenous
administration. This liquid can also be
administered subcutaneously. Fluid Ringer
Ringer Lactate fluid
administration
effectiveness over time increase blood
Results showed there was an increase in
blood pressure in rats by administration of
Ringer's lactate fluids but not too significant
because urine production takes a little longer.
It can be seen from the increase and
acceleration of volume of urine produced by
the average number of 0.275 cc within 2 hours
or more. With Ringer's lactate for fluid
administration in the amount of 2 cc and using
a 3 cc syringe (14).
In theory Ringer lactate fluid is a liquid
hipotonis with blood. Administration may be
587
lactate abbreviated as "LR", "RL" or "LRS,
where lactate is mainly metabolized in the
liver (1). Solution Ringer Lactate is often used
for fluid resuscitation after blood loss due to
trauma, surgery, or burns. Previous, was used
to induce the production of urine in patients
with kidney failure. Another use is a common
treatment of renal failure in small animals,
where a solution is given subcutaneously
instead of intravenously. Managing fluid in
this way allows the solution to be given to the
animals quickly and not require the presence
of blood vessels. The liquid is then slowly
absorbed from under the skin into the blood
stream of animals. Solution Ringer Lactate
used as a by-product of the metabolism of
lactate in the liver to overcome acidosis, which
is a chemical imbalance that occurs with fluid
loss of acute renal failure . Ringer Lactate is
not suitable for maintenance therapy because
the sodium content (130 mEq /L) is considered
too high, especially for children, and the
potassium content (4 mEq / L) is too low,
given the need for daily electrolytes (1).
Thus the researchers conclude that the fluid
Ringer's acetate malate and fluid Ringer's
lactate can be used to speed up the increase in
blood pressure in rats but more effective in the
resuscitation fluid is a liquid malate Ringer's
acetate.
REFERENCES
1. Braun, B. 2011. Manfaat isotonisitas
ringerfundin vs hiponatremia pada ringer
laktat dan ringer asetat (hipotonis).
Germany : KoTM FVT
2. Ewaldson Carl Arne, Hahn Robert G. 2005.
Anesthesiology. American Society of
Anesthesiology
3. Gustam, Hardinsyah, Dodik Briawan. 2012.
Faktor Risiko Dehidrasi pada Remaja dan
Dewasa. Skripsi Institut Pertanian Bogor
4. Hahn. 2010. Volume kinetics for infusion
fluids. Anesthesiology
5. Hartanto WW., 2012. Terapi cairan dan
elektrolit
perioperatif.
SMF/Bag.
Farmakologi Klinik dan Terapeutik/ Fak.
Kedokteran Universitas
Padjadjaran.
Bandung : FK Unpad
6. Hartanto R V. 2007. Perbedaan perubahan
konsentrasi natrium plasma antara preload
20 cc/kgbb ringer laktat dibandingkan
dengan preload 20 cc/kgbb ringer asetat
malat. S.Ked [thesis]. Semarang:
Universitas Diponegoro
7. Huang. L.H, Anchala, K.R, Ellsbury, L.
George, S.C. 2009. Dehydration. Available
from :
http://emedicine.medscape.com
(accessed 15 Juni 2012)
8. Friedman J.N, Goldman R.D,
Srivastava R, and Parkin PC. 2004.
Development of a Clinical Dehydration
Scale for Use in Children Between 1
and 36 Months of Age. The Journal of
Pediatrics
CONCLUSIONS
1. Giving Fluid Ringer Acetate Malat
effective to speed up the increase in blood
pressure in rats (Rattus norvegicus). It can
be seen from the increase and acceleration
of volume of urine produced by the average
number of 0.3625 cc in less than 2 hours.
2. Giving Fluid Lactate Ringer effective in
increasing blood pressure in rats (Rattus
norvegicus) but it takes a little longer. It
can be seen from the increase and
acceleration of volume of urine produced
by the average number of 0.275 cc within 2
hours or more.
3. Fluid Acetate Ringer Lactate Ringer's
Malat and liquid can be used to speed up
the increase in blood pressure in rats but
more effective in the resuscitation fluid is a
liquid malate Ringer's acetate. This is
evidenced by statistical tests using the Test
T Independent stating Asymp sig value of
0.017.
9. Latief S A, Suryadi K A, Daclan M R.
2009. Analgesia regional. Dalam: Latief S
A, Suryadi K A, Daclan M R, editor.
Petunjuk praktis anestesiologi. Edisi ke-2.
Jakarta : Bagian anestesiologi dan terapi
intensif FK UI
10.Nursalam. 2013. Metodologi Penelitian
Ilmu Keperawatan. Edisi 3. Jakarta :
Salemba Medika
11.Notoatmodjo, 2005. Metodologi penelitian
kesehatan. Edisi ketiga. Jakarta : Rineka
Cipta
12.Plaiser, A. 2010. Plasma Water as Tool in
the Assessment of Dehydration in Children
with Acute Gastroenteritis. Eur J Pediatr
13.Suraatmaja. 2010. Keseimbangan cairan
dan elektrolit tubuh. Jakarta : Sagung Seto
14.Rusdi, Budipramana V.S. 2010.
Perbandingan pemberian ringer laktat
dan ringer asetat dalam meningkatkan
588
kadar laktat darah pada iskemia hepar
akibat ligasi vena porta (studi
eksperimental pada kelinci) [Karya
akhir penelitian]. Surabaya : Bagian
bedah FK-UNAIR/RSU dr.Soetomo
15.WHO, 2009. Pelayanan kesehatan anak di
rumah sakit pedoman bagi rumah sakit
rujukan tingkat pertama dikabupaten/kota.
WHO dan Departemen Kesehatan RI.
Jakarta.
589
EFFECTIVENESS OF MUROTAL MUSIC THERAPY AND KANGAROO
METHOD ON LBW BABY’S FEEDING TIME IN THE NEONATES WARD OF
AURA SYIFA HOSPITAL
Putri KristyaningsihI, Diah Eliya HumaidaII
Nursing Major Faculty Of Health Science
Abstract
Kangaroo method is a treatment method for low birth weight (LBW) or premature baby,
by doing skin to skin contact between mother and the baby. Music therapy is the use of
music as therapy equipment to repair, maintain, develop physical mental and emotional
health. While murotal music therapy is a technique that used to cure a disease by using
the verses of the Holy Al-Quran. The design of this study is pre-experimental post only
design. The sample are 24 babies that were stayed in Neonate Ward of Aura Syifa
Hospital Kediri. This study use the inclussion and exclussion criterias to determine the
samples. The sampling technique that is used in this study is purpossive sampling. The
data collected by using the observation sheet, statistical test that used is Kruskal Wallis
with ρ ≤ 0,05. From the test, the p value is 0.000, which means this study‟s result is
statistically significant. The result showed that baby‟s feeding time on kanggaroo method
group is 18 to 22 minutes time span, on murotal music therapy group is 14 to 16 minutes,
on control group is 13 to 16 minutes. From the study we can conclude that kangaroo
method is more effective to increase baby‟s feeding time. Kangaroo method is more
effective because the kangaroo method using skin to skin contact technique between
mother and baby, hence the baby can feel more comfort and baby‟s feeding time becomes
longer.
Keywords : Kangaroo Method, Murotal Music Therapy, Baby‟s Feeding Time
tension reflective and measured
quantitatively and qualitatively by a
computer-based (8).
INTRODUCTION
Low birthweight infants (LBW) is baby
newborn‟s weight less than 2500 grams
regardless of gestational age (6). LBW
consists of LBW preterm or and fullterm or
post-term with growth
retardation in the uterus (4). LBW with
preterm pregnancy, usually experienced
a complications. While the LBW with
full-term pregnancy commonly are the
organs are mature so it is not too
problematic in treatment (1).
According to the Indonesian
Demographic and Health Survey (14),
Indonesia infant mortality rate is 34 per
1,000 live birth. The amount is higher
than the Millennium Development Goals
(MDG's) by 2015, a target which is to
reduce infant mortality rate of 25 cases
per 1,000 live births. One of the main
causes of infant mortality is LBW
infants, about 29% (13).
Murotal music therapy can accelerate
the healing, it has been proven by some
experts, as has been done by Ahmad al
Khaidi, Director of Islamic Medicine
Institute for Education and Research in
Florida, the results of these studies show
a positive results, that listening to the
verses of the Holy Al-Quran have a
significant effect in reducing the nervous
According to
the World Health
Organization (WHO) in 2007, in
developing countries, nearly 70% of 5
million neonatal deaths and 17 of the 25
million deliveries per year give birth to
babies with low birth weight (less than
2500 grams). Each year, an estimated 20
million babies are born with low birth
598
therapy can also affect the baby‟s
feeding time and which one is more
effective between kangaroo method and
murotal music therapy to increase the
length of breastfeeding in infants LBW
is not known yet. That is why
researchers interested in studying the
effectiveness between kangaroo method
and murotal music therapy in increasing
LBW baby‟s feeding time. The research
was done in Aura Shifa Hospital. Aura
Syifa Hospital is a hsopital taht focus on
mother and child treatment.
weight (LBW). The main cause of this
case can be due to the preterm or
prematurely born or impaired growth
during unborn or Intra Uterine Growth
Retardation (IUGR) (12).
The prevalence of LBW in Indonesia
ranged from 2 to 17.2%, and its donates
about 29.2% of Infant Mortality Rate
(IMR). The high morbidity and
mortality rates of low birth weight
infants remains a major problem. The
value of Infant Mortality Rate (IMR) in
Indonesia is 34% and the incidence of
low birth weight (including preterm
birth) in Indonesia reached 29% where
the incidence of low birth weight is a
health issue first and as a contributor to
death in the perinatal period, followed
by asphyxiation 27% and sepsis 5.4%. It
is estimated that the incidence of
premature and low birth weight in
Indonesia is diminishing but it is still
quite high at 52% per 100 live births (1).
METHODS
The research used the Pre-experimental
Post Only design with control design,
this study uses a therapy for the
respondents and the aim is to search
whether there is an influence between
the therapies, so we can conclude the
effect after we give the therapy (5).
Sampling technique that used in this
study is purpossive sampling technique,
is a technique by choosing he sample
among a population appropriate with the
researcher‟s desire (aim and problem of
this study), so that the sample can
represent the characteristics of the
population that has been known
previously (9). And using inclussion
criterias that have been determined by
researchers (the baby did not experience
severe respiratory problems, the babies
do not experience Hiperbilirubin, no
congenital abnormalities, the mother is
willing to participate, Moslems for
murotal music therapy group).
In East Java, LBW is still the highest
cause of neonatal deaths, in 2001
amounted to 36.23% and in 2002
amounted to 34.72%. Based on
preliminary studies that researchers do
in Aura Syifa Hospital during the last 5
months from July, June, August,
September and October, the incidence of
babies of low birth weight are born
normal and operations by 33% or 164 in
2014 with a range of weight 1900 grams
to 2500 grams of number 492 births.
There are some data from previous
research, the effect of kangaroo method
and murotal music therapy affect the
baby with low birth weight, but whether
the kangaroo method and murotal music
RESULT
Table 1. Frequency Distribution Characteristics of Respondents Based Weight LBW
babies in Neonatal Space Aura Shifa Hospital Kediri
No.
1
2
3
Baby‟s weight
1000-1500 grams
1600-2000 grams
2100-2500 grams
Total
Frequencies
3
4
17
24
599
Precentage (%)
12,5
16,7
70,8
100
Table 2. Frequency Distribution of Respondents by Old Time Breastfeeding At LBW
infants in Neonatal Space Aura Shifa Hospital Kediri
No
.
Baby‟s
weight
14-15
minute
s
16-17
minute
s
18-19
minute
s
20-21
minute
s
22-23
minute
s
4
0
0
0
1
1
3
0
0
0
7
1
1
4
2
12
4
1
4
3
1000-1500
grams
1600-2000
2
grams
2100-2500
3
grams
Frequencies
1
Total
24
Table 3. Frequency Distribution of Respondents by Old Time Breastfeeding At Each
group of LBW babies in Neonatal Space Aura Shifa Hospital Kediri
N
o
Group
Kangaroo
method
Murotal
2
music
therapy
3
Control
Frequencies
1
14-15
minute
s
16-17
minutes
18-19
minute
s
20-21
minute
s
22-23
minute
s
0
0
1
4
3
5
3
0
0
0
6
11
2
5
0
1
0
4
0
3
Based on table 1, the characteristics of
respondents by weight can be explained
that LBW infants of low birth weight
infants are the most dominant is the
gram weight of 2100 -2500 as many as
17 samples (70.83%).
Total
24
therapy 14-17 minutes there are 8
samples and the control group 14-17 8
minutes also 8 sampled. To identify
significant differences in the length of
feeding time, the data were statistically
test, using Kruskal Wallis Test (10).
Fromthe test we get p value 0.000,
where the signifcant level is p <0.05, it
means that H1 is accepted,it is more
effective to use kangaroo and murotal
music therapy to increasing baby‟s
feeding time.
Based on table 2, LBW infants feeding
time according to the weight that the
weight can be explained 1000-1500 long
feeding time 14-15 minutes 22-23
minutes 4 samples and 1 sample. 16002000 weight long feeding time 14-15
minutes 1 minute 16-17 samples and
there are 3 sample. While weight 21002500 long feeding time 14-15 minutes 7
samples, two samples of 16-19 minutes,
20-23 minutes there were six samples.
DISCUSSION
Effect of Kangaroo method on LBW
baby’s feeding time
Based on table 3, the distribution of
feeding time each group is known for a
kangaroos feeding time range from 1823 minutes 8 samples, murotal music
The result showed that the kangaroo
method is the most effective method to
increase the feeding time on baby with
LBW in Aura Syifa Hospital. The time
600
for feeding on respondents range from
18 to 22 minutes is proved by the value
of Mean Rank 60.50, with baby weight
from 1000 to 1500 grams is 1 sample
and weight 2100- 2500 grams are 7
samples.
Weight 1600 to 2000 grams are 3
samples and weight 2100 to 2500 grams
are 5 samples.
Murotal music therapy gives great effect
if played to the baby, it was revealed by
Dr. Nurhayati (dalam 9), according to
her research, 48-hour-old baby whom
played Quranic verses from the tape
recorder showed a response to smile and
be quieter. Murotal therapy consists of
sentences that written in Al-Quran,
played for 15 minutes that can provide
psychological impact towards the
positive, this is because when murotal
played will be translated by the brain
which will give rise to a sense of
comfort and calm (11).
For the babies, kangaroo method useful
for reducing consumption of calories,
prolong the baby's sleep time, improve
bonding between the baby and mother,
causing a calming effect that lowers the
stress (marked with cortisol levels low),
reducing the incidence of nosocomial
infections, serious illnesses or lower
respiratory infections , body temperature
more quickly reach 36.5oC temperature,
heart rate and respiratory rate relative in
the normal range, reduce stress on the
baby, baby's behavior becomes better,
which would seem baby alert, cry less,
more frequent breastfeeding, increasing
the baby weight (2). For mothers,
kangaroo method is useful to facilitate
breastfeeding and implementation of the
early breastfeeding, increase milk
production, improve mother‟s selfesteem, improving the bonding and
affection of a mother with a baby and
provide psychological influences in the
form of serenity in the mother and
family (7).
Music murotal can increase the
breastfeeding time but not too
significant, music murotal may be less
significant in influencing suckling time
on LBW infants due to the timing of the
music therapy murotal possibility of
sound frequencies less according to the
condition of each child, but still can be
used daily for therapy supporters.
Effectiveness between kangaroo
method and murotal music therapy to
the baby’s feeding time
Statistically, it was found that the length
of feeding time in LBW baby in the
Aura Syifa Hospital more effective
using kangaroo method and murotal
music therapy compared to control
group, it was proved by the results of
statistical tests Anova Non parametric
Kruskal Wallis test stating Asymp sig
value is 0,000.
According to the conclusions based on
research studies that have been done
kangaroo method is more effective
because the baby directly touch the
mother so the baby can be more comfort
and familiar, it can affect baby‟s
suckling time. This is supported by the
theory of the Kangaroo method above.
Effect of Music Therapy Against
Murotal Long Time Feeding in
Infants LBW
Kangaroo method is a simple way to
care for newborns and use the mother's
body temperature to warm the baby. The
baby is naked, wearing only a diaper and
a hat, and the baby is placed vertically /
upright in the chest between mother‟s
breasts, naked chest, then covered (7).
While Murotal is one of the music that
has a positive influence for the hearing.
Murotal therapy can accelerate healing,
it has proved by various experts as it has
The results showed that there is an effect
of music therapy for abbay feeding time
at Aura Syifa Hospital. The data showed
that music theray can influence baby‟s
feeding time but not too significant. It is
from the result of statistical test Mean
Rank at 27.02. With time for
breastfeeding from 14 to 16 minutes.
601
done Ahmad al Khadi, president of the
Islamic Medicine Institute for Education
and Research in Florida, USA. In the
seventeenth annual conference of the
American Medical Association, US
missuori region, Ahmad Al-Qadi made a
presentation on the results of his
research with the theme of the influence
of the Koran on the perspective of
human physiology and psychology.
Results of these studies showed positive
results that listen to the verses of the
Quran have a significant effect in
reducing the tension cord is reflective
and the results recorded and measured
quantitatively and qualitatively by a
computer-based tool (8).
minutes. while the control group
breastfed longer time between 13-16
minutes. Feeding time 13-14 minutes 1
samples, 15 samples of 5 minutes and 16
minutes of 2 samples. Kangaroo method
is the most effective method because it
is influenced by the technique of skin to
skin between the mother and the baby so
the baby can feel comfort and calm.
Refferences
1. Depkes, Asuhan Neonatal
Esensial: Paket Pelatihan
Pelayanan Obstetri Dan
Neonatal
Emergensi
Komprehensif
(PONEK),
Jakarta,2008
This study shows that both of them can
be used to increase the feeding time, but
the most effective is to use the Kangaroo
method than using Murotal Music
Therapy. This is possible because the
kangaroo method has several advantages
such as there is direct contact or skin to
skin between the baby with the mother
that the baby gets a sense of comfort and
calm while in the mother's arms.
Kangaroo method is a settlement in a
state where medical technology and
obstetrics extremely limited or no
tersediannya for LBW care as in
developed countries.
CONCLUSSION
RECOMMENDATIONS
2. Fatmawati, S, Andi, 2013.
Pengaruh Perawatan Metode
Kanguru Terhadap Fungsi
Fisiologis Bayi Prematur Dan
Kepercayaan DiRI Ibu Dalam
Perawatan
Bayi.
Jurnal
Keperawatan Soedirman, vol 8,
no 3. Palu
3. Gusmiran, 2005, Rugyah Terapi
Religi sesuai sunnah Rasullah
SAW, Jakarta: Pustaka Marwa
4. Messak, Rima.2012. BBLR.
Nusa
Cendana.
(http://www.scribe.com diakses
tanggal 8 Desember 2014 pukul
23.11 WIB)
AND
5. Nursalam, 2013. Metodologi
Penelitian Ilmu Keperawatan:
Pendekatan Praktis Edisi 3.
Conclussion
From the research that has been done,
the kangaroo method is the most
effective method to increase the baby‟s
feeding time with the time span of 18-23
minutes. For feeding time 18-19 minutes
1 sample, 20-21 minutes 4 samples, and
22-23 there were 3 samples so that all
amounted to 8 samples. Murotal music
therapy itself has a span of 14-16
minutes. Long feeding time 14 minutes
2 samples, 15 minutes 3 samples and 3
samples with long feeding time 16
6. Proverawati.A, dan Sulistyorini,
C. A, 2010. Bayi Berat Badan
Lahir Rendah, Jogjakarta: Nuha
Medika
7. Rahardjo,Kukuh. Marmi. 2014.
Asuhan Neonatus, Bayi, Balita,
dan
Anak
Prasekolah.Yogyakarta: Pustaka
Pelajar
602
8. Remolda, P.2009. Pengaruh ALQuran pada manusia dalam
prospektif Fisiologi dan
Psikologi.
(http://www.theedc.com.
Tanggal akses24 Oktober 2014)
12. Uhudiyah,Uut dkk. 2003.
Perawatan BBLR dengan
Metode Kanguru. Jakarta.
Perkumpulan
Parinatologi
Indonesia (Perinasia)
13. WHO. Perinatal Mortality.
Report
No:
WHO/FRH/MSM/967. Genewa:
WHO 2004
9. Saryono. 2010. Metodelogi
Penelitian
Kesehatan.
Yogyakarta: Mitra Cendekia
Press.
14.
10. Sugiyono, 2007. Stastistika
Untuk Penelitian.Bandung: CV
ALFABETA IKAPI
11. Sunarto, Achmad.(Eds), 1999.
Terapi Penyakit Dengan AlQur‟an dan Sunnah. Pustaka
Amani: Jakarta
603
, Data Kematian
Maternal dan Perinatal tahun
2006 dan 2007 KIA, Jakarta
2008.
(http://ejournal.umm.ac.id/index
.php/keperawatan/issue/view/22
6/show/toc)
THE EFFECT OF ATTITUDE TOWARD BEHAVIOR, SUBJECTIVE NORM AND
PERCEIVED BEHAVIOR CONTROL AT DM THERAPY ADHERENCE: STUDY
THEORY OF PLANNED BEHAVIOR
Sheylla Septina Margaretta1, Heru Kurnianto Tjahjono2, Falasifah Ani Yuniarti3
Abstract
Diabetes Mellitus cause physical complications that can aggravate the psychological pressure.
Provision of education is one of the four main pillars of the management of DM. Educational Theory
of Planned Behavior-based DM is an education with individual approach that includes support and
guidance DM therapy at home which aims to improve treatment adherence DM. In education TPB
has been given to people with diabetes are among antesenden TPB The Attitude Toward Behavior,
Subjective Norm and Perceived Behavior Control which would contribute significantly to the
compliance behavior therapy with DM. To identify a number of antesenden ie Attitude Toward The
Behavior, Subjective Norm and Perceived Behavior Control described in TPB to behavior therapy
adherence DM. This study used data analysis method that includes the step of measurement and
interpretation of the value of Attitude Toward The Behavior, Subjective Norm and Perceived
Behavior Control according to the principles Theory of Planned Behaviour (TPB), the next step
performed statistical tests include test bivariate correlation third antesenden TPB attitude towards
compliance DM therapy performed on 34 sempel with sample selection using purposive sampling.
The results on the F test probability value (sign) 0.000> 0.05, so it can be concluded that the Attitude
Toward The Behavior, Subjective Norm and Perceived Behavior Control unacceptable influential in
predicting the intentions of people with diabetes to comply with therapy DM, with variable Attitude
Toward The Behavior showed a stronger effect than any other variable that is obtained by value ttest (sign) 0.033> 0.05 and the value of the regression coefficient β attitude and subjective norm is
positive, it indicates that this variable has a strong correlation with DM therapy adherence. R2 values
obtained from the results of the three variables simultaneously perceived by 70.4% effect on DM
therapy adherence. The three antesenden TPB ie Attitude Toward The Behavior, Subjective Norm
and Perceived Behavior Control DM attitude towards compliance with therapy showed that all three
received antesenden influential in predicting intention to comply with DM DM therapy. TPB-based
education so highly can be used to improve coping and treatment adherence penyadang DM.
Keywords: Educational DM, individual coping, compliance DM and Theory of Planned Behavior.
612
million people die of infectious diseases every
year, which is 63% of global deaths in the
world (WHO, 2013) 5. In 2035 is expected to
rise DM 14,152.2 thousand people or 6.7% of
the population of Indonesia soul (IDF, 2013)6.
Boss, M & Cjarles, A., (2013)7 shows that in
North Africa DM complications ranged from
8.1% to 41.5% in retinopathy complications,
21% to 22% complications arise albuminuria,
6.7% to 46 , 3% complications nephropathy
and 21.9% to 60% neuropathic complications
arise.
American Diabetes
Association
INTRODUCTION
Theory of Planned Behavior (TPB) or
the theory of planned behavior is one theory
of learning for educational use in the patient's
interpersonal approach. This theory was
developed by Ajzen 1967. This theory
includes three things namely; beliefs about
the likely outcomes and evaluation of the
behavior (behavioral beliefs), beliefs about
the expected norm and motivation to meet
these expectations (normative beliefs), as well
as beliefs about the factors that can support or
hinder behavior and awareness of the strength
of these factors (control belief ) (Nursalam,
2013)1. Many studies use TPB approach to
look at the human intention, one study
conducted by Tjahjono, HK et al, (2013) 2 who
has studied the intention of management
students Muhammadiyah University of
Yogyakarta in IT-based entrepreneurship. In
addition to viewing the intention TPB can be
used to view human behavior as the research
that has been done by (Zoellner et al, 2012)3
concluded that the educational approach can
decrease intentions TPB in sugar
consumption. Research conducted
by
8
(ADA) (2014) menganjuran treatment to be
followed with diabetes include diet planning,
exercise and regular activity, drugs control,
and follow the educational program DM.
Education given to people with diabetes
should be done continuously and progress
must be observed by health workers
(Soegondo 2009)9. Researchers have found
that satisfaction with the quality of the
interpersonal relationship between patients
and health workers were significantly
associated with treatment compliance DM
(Sherbourne, 1992 in St. Paul, S et al.,
2001)10, so it is necessary to educate health
workers using interpersonal approach to
patients with the aim of achieving therapeutic
success DM. The provision of education to
people with diabetes by strengthening the
three basic beliefs of TPB are: behavioral
beliefs, normative beliefs and beliefs control
is expected to provide confidence, the
intention (intention) to accept the conditions
and the intention to recover so as to improve
therapy adherence DM.
4
Rashidian & Russel (2012) also concluded
the use of TPB are very helpful in the
intention (intention) in understanding a
doctor's prescription, so that it can be
concluded TPB is a theory of effective
learning in the field of health one of them in
the provision of health education.
In the health sector needs to approach
interpersonal between nurses and patients in
the delivery of education communication
(Ajzen, 1988, in Nursalam 2013)1. Provision
of education is one of the important part of
diabetes management. These diseases include
the category of non-communicable diseases in
the world's biggest killer, no less than 36
HYPOTHESIS
In general it can be said that the better the
attitude and subjective norms toward a
behavior, and large semkain perceived
613
H3:
The behavior of people with diabetes
to comply with therapy DM
significantly influenced by subjective
norm with diabetes to comply with
therapy DM
Perceived behavior control is a condition
where people believe an action it easy or
difficult to do (Dharmmesta, 1998)11.
behavioral control, the stronger the intention
of the individual to perform an action
(Dharmmesta, 1998)11. Based on the above,
the proposed hypothesis as follows:
H1: Behavioral therapy to comply with
DM
DM
jointly
influenced
significantly by the attitude toward
the behavior, subjective norm and
perceived behavior control is in
keeping with DM DM therapy.
Gordon Allfort in Setiadi (2003)12 proposed a
definition menganai attitude toward the
behavior is a mental and terms in connection
with readiness to respond, organized through
experience and influence that lead
to
behavioral or dynamic. If we analogy with the
attitude towards compliance with DM DM
therapy mean attitude towards compliance
DM DM is studying the tendency to evaluate
the therapeutic results either liked or disliked
consistently.
Based on the above,
the
researcher took hypothesis as follows:
H2:
to comply with therapy DM
significantly influenced by the
attitude toward the behavior of people
with diabetes to comply with therapy
DM
Subjective norm as social factors indicate the
perceived social pressure to perform or not
perform an action or behavior (Dharmmesta,
1998)11. Subjective norm formed of
normative beliefs and willingness to obey the
wishes of others that are considered
important. Normative beliefs regarding the
condition that the individual or group of
important referents will agree or disagree with
the execution behavior. The strength of each
normative beliefs generated through the
motivation of the person to follow referents
and estimates of subjective norm is obtained
by summing the results of all referents
pentin). Based on the above, the researcher
took hypothesis as follows:
11
Ajzen in Dharmmesta (1998)
have stated
that perceived behavior control effect on
intent or directly on the behavior itself. Based
on the above, the researcher took hypothesis
as follows:
H4:
to comply with
therapy DM
significantly influenced by
the
perceived behavior control people
with diabetes to comply with therapy
DM.
METHODS
Data analysis method used in this study
includes the step of measurement and
interpretation of the value attitude toward the
behavior, subjective norm and perceived
behavior control according to the principles
Theory of Planned Behaviour (TPB), the next
stage of statistical tests include test bivariate
correlation third antesenden TPB attitude
towards compliance with therapy DM , The
research model form shown in Figure A
below:
Attitude Toward
The Behavior (X1)
Subjective Norm
(X2)
Perceived
Behaviour Control
(X3)
614
Therapy
adherence
DM (Y)
In this study, researchers used multiple linear
regression analysis model.
Formula of
multiple linear regression model as follows:
 Y =β1X1 + β 2X2 + β 3X3 Where:
 Y =the dependent variable (adherence
therapy DM)
 X1 = Independent 1 (Attitude Toward
The Behavior)
 X2 = Independent 2 (Subjective
Norm)
 X3 = Independent 3 (Perceived
Behavior Control)
 β 1, 2, 3 = coefficient of regression
approach ( holistic) which is based on the
framework of the adaptation system,
consisting of 33 questions covering
compliance with DM in terms of diet,
medication, and exercise control. The answer
from the compliance questionnaire using
Likert scale with a scale of 1: TP (never), 2:
JR (rarely), 3: KD (sometimes), 4: SR (often),
5: SL (always).
This research was conducted in the
village of Wajak Lor, District Boyolangu,
Tulungagung, East Java in March 2015 by all
people with diabetes in the village Wajak Lor,
District Boyolangu, Tulungagung Java Tumur
some 78 people. This study using purposive
sampling or sampling with inclusion criteria
set by
the researchers.
With sample
calculation sample of 34 people. Criteria for
inclusion in this study were DM willing as a
respondent, can read and write, aged 15-70
years, with at least one elementary school, do
not have other concomitant diseases eg heart
disease. This study has been declared worthy
of ethics on October 6, 2014 by the Research
Ethics Committee of the Faculty of Medicine
and Health Sciences
University of
Muhammadiyah Yogyakarta.
Questionnaires spreadsheet of the
data belief DM therapy made using the
Theory of Planned Behavior approach made
by researchers based on the results of
discussions with experts Prof. Heru Kurnianto
Tjahjono. Retrieved 28 instrument consists of
variable beliefs (bi) is the variable that is the
strength of your belief that by keeping DM
therapy will gain certain benefits, variable
evaluation (ei) is the variable that indicates to
you whether to comply with the DM therapy
will provide good benefits , variable
normative beliefs (ni) is the variable that
indicates that family / friends (group
referents) advise you to adhere to the DM
therapy, motivational variables (mi) is the
variable of motivation to carry out
compliance DM therapy with suggestions of
family / friends (a group referent), variable
access to the controls (ci) is an assessment
you that in order to comply with the DM
therapy is easy and not difficult, belief
variables control (pi) that is your belief based
on experience about the sources of
opportunities such as information and
facilities necessary to comply with the DM
therapy with 5 answers that strongly agree,
agree, neutral, disagree, strongly
setuju.Sedangkan DM therapy adherence
attitude measurement using a questionnaire
developed by the research Hidayat (2013)13
based on the Concept System Model Betty
Neuman's developed that overall human
Correlation The
Attitude Toward
Behavior,
Subjective Norm and Perceived Behavior Control
Compliance Behavior Therapy Against Persons
with DM in the village Wajak-Lor, BoyolanguTulungagung 2015
Variabel
β
t
Sig. F.Sig R
Attitude
Toward The
Behavior
Subjective
Norm
Perceived
Behaviour
Control
,532
2,233 ,033
,381
1,758 ,089 0.000 0.444
-,341
-2,008 ,054
1) Attitude Toward The Behavior
Based on t test analysis significance value
of 0.033 is smaller than the probability of
error of 0.05. It concluded that compliance
with therapy is significantly influenced by
615
2
the DM Attitude Toward The Behavior
DM
2) Subjective Norm
of 0.089 is greater than the probability of
error of 0.05. It can be concluded that the
therapy compliance with DM was not
significantly affected by Subjective Norm
DM.
3) Perceived Behavior Control
of 0.054 is greater than the probability of
error of 0.05. It concluded that compliance
with diabetes treatment significantly
influenced by Perceived Behavior Control
DM.
4) From the table above it can be seen that
the independent variable is the attitude
toward the behavior, subjective norm and
perceived behavior control simultaneously
and significantly affect the dependent
variable DM compliance with therapy that
is indicated by the significance of 0.000 is
smaller than the probability of error is
0.05, it can be said that the F-test reject Ho
and accept Ha proposed that compliance
with DM therapy jointly influenced
significantly by the attitude toward the
behavior control is felt with DM.
5) From the above calculation is obtained
Adjusted R2 = 0.444, or 44.4%, this means
that the variations in treatment adherence
(Y), which can be explained by the
regression equation was 44.4% influenced
attitude toward the behavior, subjective
norm and perceived behavior control while
the rest to 55.6% influenced by other
variables that are outside the equation.
Patient compliance is a health care
concept that affects all areas of health
nursing, including the handling of Diabetes
Mellitus. Attempts to change a behavior
health improvements
are constantly
a
component of compliance that requires a
health education (Society of Endocrinology
Indonesi, 2006)14. Health education is a
process of dynamic change in behavior.
Changes in behavior is not just a material
transfer process but change happens
awareness of individuals, groups or
communities (Mubarak et al, 2007)15.
According to Edelman and Mandle
(2002) in Widiastuti (2012)16 health education
purpose is to make people achieve optimal
health levels through its own actions.
Education is an effective strategy and the
potential to reduce the risk of complications
for patients with Diabetes Mellitus so as to
reduce the economic cost of diabetes care.
Patients with diabetes who understand the
condition will be responsible for the
compliance of DM therapy (Jenhani, M., et
al., 2005)17.Edukasi would be more effective
if nurses understand the theory of learning
required. Educational process applied in this
study is education DM using the theory of
planned behavior (Theory of Planned
Behavior / TPB). Correlation tests were
conducted attitude toward the behavior,
subjective norm and perceived behavior
control simultaneously and significantly
influence the behavior of people with DM
variables in complying with Diabetes Mellitus
therapy that is directed by the significance of
0.000 is smaller than the probability of error
is 0.05, it can be said that the test F unity
hypothesis is accepted that compliance
behavior in keeping with DM DM therapy
jointly influenced significantly by the attitude
toward the behavior, subjective norm and
perceived behavior control with DM. The
results support the first hypothesis that
explains that the behavior of people with
616
diabetes to comply with therapy together DM
influenced significantly by the attitude toward
the behavior, subjective norm and perceived
behavior control with DM. So it can be
explained that the better or the positive
attitude of people with diabetes to compliance
therapy and subjective norms are positive ie a
willingness DM to follow the advice of
people they consider important such as family
and friends, as well as more easily control
behavioral perceived in this case is a
assessment of therapy that are not considered
difficult and beliefs based on the experience
of the sources of information and
opportunities such as health facilities will
encourage greater the behavior of people with
diabetes to comply with therapy DM.
Of the t-test results it can be said that
the attitude toward the behavior has a
significant value for 0,033 is smaller than
probilitas error of 0.05. It can be concluded
that the behavior of people with diabetes to
comply with therapy DM significantly
influenced by the attitude toward the behavior
of people with diabetes to comply with
therapy DM. Results of the study received the
second hypothesis. This is because autonomy
in being owned by people with diabetes to
comply with therapy DM is high. It shows
that the decision to comply with the DM
therapy involves a lot of internal factors such
as personality, perception, motivation and so
forth.
Objective norm variable has a value
of greater significance than the 0,089 error
probability of 0.05. It can be concluded that
the behavior of persons with DM DM ntuk
adhere to therapy was not significantly
affected by the subjective norm to comply
with DM DM therapy. Results of this study
contradicts the third hypothesis. So it can be
explained that family and friends are
considered important role has no role or lower
for people with diabetes to comply with
therapy DM. This can be caused by the
decision to adhere to the therapy prescribed
by his own behavior.
Perceived behavior control variable
has a value signikasi for 0,054 is greater than
the error of 0.05. It can be concluded that the
behavior of people with diabetes to comply
with therapy DM was not significantly
affected by the perceived behavior control
people with diabetes to comply with therapy
DM. The research result is in contrast to the
fourth hypothesis. So it can be explained that
the condition reality assessment of therapy is
not considered difficult and beliefs based on
experience about the sources of opportunities
such as information and health facilities do
not affect people with diabetes to comply
with therapy DM, it is due to that raised still
feel the difficulty adhere to therapy for life
should be they live as well as information
sufficient experience which is felt less so
influence the behavior of people with diabetes
who tend to be non-compliant in the
implementation of DM therapy.
Determian coefficient of the test
results are Adjusted R2 = 0.444, or 44.4%,
this means that the variations in treatment
adherence (Y), which can be explained by the
regression equation was 44.4% influenced
attitude toward the behavior, subjective norm
and perceived behavior control while the rest
to 55.6% influenced by other variables that
are outside the equation. This is in line with
research conducted by (Trinh et al, 2012)18
learning theory TPB assessed effectively be a
useful model to explain physical activity in
patients with cancer of kidney, development
interventions physical activity based on TPB
effective in promoting physical activity in
patients with cancer of kidney and can be
important in the improvement of health.
It can be concluded that the attitude toward
the behavior, subjective norm and perceived
behavior control influential in predicting the
behavior of people with diabetes to comply
with therapy DM.
617
Sugar
sweetened
Beverage
Consumption. Journal J Nuert Educ
Behav. 2012 March; 44 (2): 172-177,
doi. 10.1016 / j.jneb.2011.06.010
4) Rashidian and Russel (2012). General
Practitioners' Intentions and prescribing
for Asthma: Using the Theory of Planned
Behavior to Explain Guideline
Implementation. Journal Int J Prev Med.
2012 January; 3 (1): 17-28. PMCID:
PMC3278865
5) WHO. (2013). Diabetes Mellitus 2013.
WHO accessed on December 24, 2013
fromwww.who.int?mediacenter/factsheet
s/f3312/en/
6) IDF. (2013). Global Burden, accessed
October
1,
2013
from
http://www.idf.org/diabetesatlas/5e/theglobal-burden
7) Bos. M., and Cjarles A. (2013).
Prevalence and complications of diabetes
mellitus in Northern Africa, a systematic
review. Bos and Agyemang journal
BMC Public Health, 13: 387, December
24,
2013
diakse
of
http://www.biomedcentral.com/14712458/13/387
8) The American Diabetes Association
(ADA). (2014). Diabetes Standards of
Medical Care inDiabetes. Volume 37,
Supplement 1, January 2014
9) Soegondo, S., (2009). Integrated
management of diabetes mellitus.
Jakarta: Central diabetes and lipid Dr
Cipto Mangunkusumo and School of
Medicine, in collaboration with WHO
and Ministry of Health RI
10) Paul S. Ciechanowski, M.D., M.P.H. et
al. (2001). The Patient-Provider
Relationship: Attachment Theory and
adherence to treatment in diabetes. Am J
Psychiatry. 158: 29-35. doi: 10.1176 /
appi.ajp.158.1.29
11) Dharmmesta, B.S. 1998 Theory Of
Planned Behavior In Research Attitude,
Intention and Consumer Behavior,
Journal of Urban. No. 18 / VII / 1998.
12) Setiadi, N.J. 2003. Consumer Behavior:
Concepts and Implications for Strategy
CONCLUSION
1)
2)
3)
4)
5)
The first hypothesis test results showed
that the attitude toward the behavior,
subjective norm and perceived behavior
control simultaneously significant
influence on treatment
adherence
behavior with DM.
The second hypothesis test results
showed that the attitude toward the
behavior significantly in people with
diabetes to comply with therapy DM
The third hypothesis results showed that
significantly subjective norm no
significant effect on the behavior of
people with diabetes to comply with
therapy DM.
The fourth hypothesis test results show
that perceived behavior control is
significantly no significant effect on the
behavior of people with diabetes to
comply with therapy DM.
From the test results are determian
coefficient Adjusted R2 = 0.444, or
44.4%, this means that the variations in
treatment adherence (Y), which can be
explained by the regression equation was
44.4% influenced attitude toward the
behavior control while the rest of 55.6%
is influenced by other variables that are
outside the equation.
REFERENCES
1)
2)
3)
Nursalam (2013). Methodology of
Nursing Research. Salemba Medika:
South Jakarta
Tjahjono, HK, et al. (2013). Students
intentions IT.Jurnal Yogyakarta-based
Entrepreneurship Business Strategy vol
17, no 1, p 17-27.
Zoellner, et al. (2012). Exploring the
Theory of Planned Behavior to Explain
618
13)
14)
15)
16)
17)
18)
and Marketing Research, First Edition,
First Printing, Pernada Media. Bogor.
Hidayat, F. (2013). Coping relationship
Individuals With Compliance Levels for
People with Diabetes Mellitus As
Persadia Member RSMM Branch Bogor
Perkeni (2011). Consensus management
and prevention of type 2 diabetes
mellitus in Indonesia 2011. Jakarta:
Indonesian Society of Endocrinology
Mubarak., Et al (2007). Health
Promotion An Introduction to Teaching
and Learning in Education. Yogyakarta:
Graha Science.
Widiastuti
(2012).
Structured
Educational Effectiveness Based Theory
of Planned Behavior and Quality of Life
Empowerment Against Coronary Heart
Disease Patients Pondok Indah Hospital
in Jakarta. Thesis. University of
Indonesia
Jenhani, M., Gaha, K., Nabouli, R., et al.
(2005).
Effectiveness of patient
education on glycemic control insulin
patiend treated in general practice.
Diabetes Metabolism, 376-381
Trinh et al, (2012). Correlates of physical
activity in a population-based sample of
kidney cancer survivors: an application
of the theory of planned behavior. Trinh
et al. International Journal of Behavioral
Nutrition and Physical Activity 2012,
9:96
619
STUDY POTENTIAL OF LOCAL PLANT PUMPKIN (CUCURBITA MOSCHATA
DUCH) AS TRADITIONAL MEDICINAL PLANTS
SUWANTO
Biology Department, Faculty of Sciences, Institute of Health Sciences Kediri
Abstract
The times will change the paradigm of society on effective medicinal plants, even does
not recognize the effectiveness of medicinal plants that exist around, nowadays many
types of diseases that attack the human body, one being the issue of global terms is
diabetes this can be caused by genetic factors and environment. With the various types of
diseases that attack the body, the work done by the sick patient is treated in a modern
rather than through traditional medicine. Indonesia country rich in biodiversity, one of
which is the pumpkin (Cucurbita moschata Duch) which is the local plant as a traditional
medicinal plant.
Part of the pumpkin plants can be utilized, such as fruit pulp, seeds, leaves and flowers as
a cure diseases, among others, anti diabetes mellitus, anti-cancer, healing of burns,
prostate, and bladder intestinan and some other diseases.
Medicinal plants pumpkin contains active molecules that can be used as a traditional
medicine such as; fruit pulp, seeds, flowers, and its leaf. The nutrient content of yellow
squash plant parts such as; Protein, vitamin A, beta-carotene, potassium, vitamin C,
unsaturated fatty acids, phosphorus, phytoestrogens, selenium, fiber, cucurbitacin E,
calcium, zinc, other vitamins and minerals.
Keywords: Traditional medicine, Cucurbita moschata Duch, Nutrition.
Introduction
Indonesia country rich in biodiversity,
one of which is a pumpkin that is the local
plant as a traditional medicinal plant. More
than 200 species of medicinal plants that
can be used for health, the effective of
medicinal plants for the benefit of society
as a treatment to 75% [1]. In 1985 WHO
(World Health Organization) predicts that
about 80% of the world population has
been utilizing medicinal plants (herbal
medicine, phytotherapy, phytomedicine or
botanical medicine) for primary health [2].
The times will change the paradigm of
the public about the effectiveness of
medicinal plants, even does not recognize
the effectiveness of medicinal plants that is
around, now many types of diseases that
attack the human body, one being the issue
of global terms is diabetes mellitus this can
be influenced by genetic and environment.
With the various types of diseases that
attack the body, the work done by the sick
patient is treated in a modern rather than
through traditional medicine,
because
people generally prefer something instant
and recover quickly from his illness
treatment, can not see the negatives of
modern medicine. Modern medicine can
cure the disease on the body but through a
process that is rather long, and the result
does not cause negative dapak. The proof
of our ancestors utilizing medicinal plants
so that her immune system strong is not
easily attacked by the disease. Modern
medicine can cure the disease on the body
but through a process that is rather long,
and the result does not have a negative
impact. The proof of our ancestors
utilizing medicinal plants so that the body
resistance is strong is not easily attacked
by the disease.
Traditional medicine should be returned
to the old days, when treating diseases by
utilizing our existing plants around the
plant is believed to treat disease. Medical
tradition left by our ancestors must be
guarded and applied to health. Medical
tradition of a society can not be separated
from local culture. Perception of the
633
concept of illness, healthy, and varieties of
plants used in traditional medicine are
formed through a process of socialization
that have historically been trusted and
believed to be true. Traditional treatment is
all treatment efforts by other means outside
of medicine based on knowledge that is
rooted in a particular tradition [3].
Medicinal plants known to contain
many different types of antioxidants. The
study of medicinal plants in China shows
the content of flavonoids, lignin, bisbenzyl,
coumarine, and terpenes.
Flavonoid
pigment is an aromatic compound found in
green plants and includes compounds
chalcone, flavanone, flavone, biflavonoid,
dihydroflavonole, anthrocyanidine, and
flavonole. Mexico also reported that in
many medicinal plants used for the
treatment of various diseases such as
infections, arthritis, heart disorders,
headache, fever, asthma. After analysis of
bioactive components, it turns out many
medicinal plants contain antioxidants that
ranged from 27 to 972 mol Trolox
equivalents per gram of dry weight..
However, in addition to antioxidants,
the results of research conducted by the
researchers that the compounds contained
in plant pumpkin serves as diabetes [4] [5],
inhibition of tumor growth, wound healing,
hypoglycemic effect and hypolipidemic,
[6] [7] [8] [9]; antifungal, antibacterial and
anti-inflammatory activity, antioxidant
effects, and prevent the growth of, and
reduce the size of the prostate,
antihypertensive [5] [10].
Pumpkin plants usually cultivated in
dry land and only as a secondary crop
when approaching dry season. Pumpkin
plants included in the family
Cucurbitaceae [11]. The plants are annual
crops that are spreading (vine) by means of
a flat-shaped tool holder. The plants are
annual crops that are spreading (vine) by
means of a flat-shaped tool holder.
pumpkin stems are strong enough and a
length of 12 m, the surface of the trunk
contained fur / hair ness rather sharp and
triangular rod shape, the surface dark green
stems [12]. Pumpkin plant leaves is a
single leaf which has a compound leaf. The
leaves along the stem and leaves rounded
shape, the color of the leaf surface dark
green and dark green no white spots. While
the flowers of pumpkin is uniseksual
monoecious reddish yellow.
Pumpkin
plants can be grown in lowland and
highland. While the ideal altitude is
between 0 m - 1500 m above sea level
[13][14].
Pumpkin is a family Cucurbitaceae,
pumpkin plants classified as fruit-bearing
crops [11]. Pumpkin plants consisting of
130 genera and 800 species are cultivated
around the world, so these plants are very
general and is known by many people.
Some of which include plant pumpkins are
squashes,
gourds and
melons
[15][16][17][11].
In this paper was
delivered on plant morphology local
pumpkins, the content of the plant
pumpkin, pumpkin potential of local plants
as a cure for diabetes and potential of local
plants pumpkin as an anti cancer.
Morphology of Pumpkin
Plant pumpkin as a vegetable and
medicinal plants, these plants grow spread
and classified in types of crops that will
soon die after fruiting. Pumpkin plants has
been widely cultivated in countries such as
Africa, America, India, China, and
Yougoslavia [13][10].
Pumpkin plant can be classified as
follows[18]:
Kingdom
: Plantae
Divisi
: Spermatophyta
Sub divisi
: Angiospermae
Kelas
: Dicotyledonae
Ordo
: Cucurbitales
Familia
: Cucurbitaceae
Genus
: Cucurbita
Spesies
: Cucurbita moschata
Duch.
Pumpkin is an annual plant that is spread
or propagate by intermediaries who shaped
flat toolholder as shown in (Figure 1).
Strong enough and long stem and on the
surface of the rod are hair ness rather
sharp. Leaf width (10-25 cm up to 13-35
cm), and on the surface there are green leaf
innocent and there is also green but there
are white patches on the surface of the leaf,
flower have five petals and five sepals
[19].
634
Source: [12]
b
a
c
Figure 1. Morphology of pumpkin (Cucurbita moschata Duch)
Description : (a) stem and petiole; (b) Spots on the green leaf of pumpkin; (c) parts of
flower consist of 5 sepals and 5 petals
Pumpkin shaped fruit flat round, oval,
round egg upside down, bottles, elongated
oval, round, long, and a bokor with lots of
grooves (15-30 groove) as shown in
(Figure 2). Large fruit and the colors vary
(although the fruit is old but the color of
the fruit still young green because of fruit
pumpkin has not been picked in the stalk
so that the chlorophyll in the fruit is still
a
e
there, while the fruit has been harvested
yellow whitish because of fruit pumpkin
after being picked from stems and stored
so that the chlorophyll in the fruit is not
there). Thick thick flesh of about 2 to 3 cm
and slightly sweet taste. Weights pumpkin
fruit an average of 3-5 kg, for large-size
pumpkin can weigh up to 20 kg per fruit
b
c
f
g
d
h
Source: [14]
Figure 2.
Variations fruit shape pumpkin (Cucurbita moschata Duch)
Description: (a) Round flat; (b) Oval; (c) Round egg; (d) Bottle (e)
Elongated oval ; (f) Round; (g) long; (h) Bokor.
The content of pumpkin
Pumpkin contains the active molecule
in the flesh of the fruit, seeds, flowers, and
its leaf, the content of the parts of the plant
pumpkin, among others, proteins, petida,
polysaccharides, sterols of the
aminobenzoic acid, vitamin A, vitamin C,
[20]; all parts of pumpkin plants can be
utilized, such as seeds and skin of the
pumpkin as a tapeworm treatment, part of
the interest can be used as a healing of
burns and healing sore throat [21]. The
contents of pumpkin flower as follows;
635
Tabel 1: The content of pumpkin flowers [21].
Nutrient
Proximate
Water
Energy
Protein
Total lipid (fat)
Carbohydrate, by difference
Mineral
Calcium (Ca)
Iron (Fe)
Magnesium (Mg)
Phosphorus (P)
Potassium (K)
Sodium (Na)
Vitamins
Vitamin C, total ascorbis
acid
Thiamin
Riboflavin
Niacin
Folate, DFE
Vitamin B-12
Vitamin A, RAE
Vitamin A,
Vitamin D (D2+D3)
Vitamin D
Lipid
Fattt acid, total saturated
Fatty
acids.
Total
monousaturated
Fatty
acids,
total
polyunsaturated
Cholesterol
Unit
Value per 100 gram
g
kcal
g
g
g
95.15
15
1.03
0.07
3.28
mg
mg
mg
mg
mg
mg
39
0.70
24
49
173
5
mg
28.0
mg
mg
mg
µg
µg
µg
IU
µg
IU
0.042
.0.075
0.690
59
0.00
97
1947
0.0
0
g
g
0.036
0.009
g
0,004
Mg
Pumpkin seed
oil is generally
dominated by oleic (± 50%), linoleic (±
30%) and palmitic acid (± 15%)
phytosterol, [22] the content of the seeds is
beneficial for people affected by
hypertrophy. Phytosterol the seeds can act
as a cure prostate. Pumpkin seed oil
contains vitamins A, D, and E. Vitamins A
and E are antioxidants that function as
0
inhibitors of free radicals that can mencega
cancer diseases, especially cancer of the
prostate. pumpkin seeds proven to aid in
the prevention of prostate disease and
cancer and small intestine and seeds
contain a lot of potassium, calcium,
magnesium, phosphorus, Zonc and
selenium, all the content of the seed used
to treat intestinan and bladder.
633
Tabel 2. Nutrient in pumpkin [21]
Nutrient
Unit
Energy
KJ
Carbohydrate
g
sugars
g
Dictary fiber
g
Fat
g
Saturated
g
Monounsaturated
g
polyunsaturated
g
Protein
g
Vitamin A
µg
Beta-carotene
µg
Thiamine (vit. B1)
mg
Riboflavin (vit. B2)
mg
Niacin (vit. B3)
mg
Pentothenic Acid (B5)
mg
Vitamin B6
mg
Folate (vit. B9)
µg
Vitamin C
mg
Vitamin E
mg
Calcium
mg
Iron
mg
Magnesium
mg
Phosphorus
mg
Potasium
mg
Sodium
mg
Zinc
mg
Potential local plant pumpkin as an anti
cancer.
The term cancer in medical science
is the abnormal growth of cells. Cancer
cells grow in an uncontrolled way, and
cause malignant cancer that attacks on
nearest parts of the body. Cancer cells, did
not spread to other parts of the body via
lymph or blood flow, called metastasis. All
tumors are not cancerous in nature; there
are some benign tumors, benign tumors do
not invade nearby tissue, and spread to
other parts of the body. More than 200
types of cancer has been identified that
harm the human body.
Has identified that the factors that
influence the increase of cancer that
attacks the body such as smoking,
radiation exposure,
obesity, lack of
physical
activity,
environment,
psychology. More than 5-10% of cancer
diseases caused by hereditary factors.
Cancer can be diagnosed using
Value per 100 gram
109
6.5
136
0.5
0.1
0.05
0.01
0.01
1.0
369 (46%)
3100 (29%)
0.05 (4%)
0.110 (9%)
0.6 (4%)
0.298 (6%)
0.061 (5%)
16 (4%)
9 (11%)
1.06 (7%)
21 (2%)
0.8 (6%)
21 (2%)
44 (6%)
340 (7%)
1 (0%)
0.32 (3%)
biochemical tests, and advice from a
doctor. Chemotherapy, radiation therapy
and surgery is the procedure adopted for
the treatment of cancer. Of the procedure
for the treatment of cancer can be
menimbuklan negative impacts, the use of
medicinal plants for treating cancer
diseases are safer than treatment with
chemotherapy. [23].
Medicinal plants are the main source
for the treatment of cancer, medicinal
herbs have anti-cancer compounds. Some
herbs have been known to cure and control
of cancer include pumpkin plants. [21]
[24] that plant pumpkin as a medicinal
plant has many nutritional content such as;
Protein, vitamin A, beta-carotene,
potassium, vitamin C, unsaturated fatty
acids, phosphorus, phytoestrogens,
selenium, fiber, cucurbitacin E, calcium,
zinc, other vitamins and minerals, etc..
Pumpkin plants are not only used as
prevention of cancer disease but can be
634
used for healing several diseases. All parts
of pumpkin plant organs such as flower,
leaves, roots, and seeds have benefits for
disease treatment. The organs of these
Cucurbitaceae showed anti-cancer activity
which inhibits the oxidation of blood,
isolated from polymorphonuclear cells and
mononuclear cells. Anti-cancer potential of
the seed extract of Cucurbitaceae Telfairia
occidentalis showed significant activity
with other extracts [25]. The following
results can be seen in Table 3.
plants can be useful as an anti-cancer
drug plants.
It was reported that the family
Cucurbitaceae have potential anti-cancer.
Telfairia occidentalis seed extract of
Table 3. Anticancer activity of crude extract
occidentalis against HeLa cells [25].
Extract
GI50(µg/mL)
Crude extract
171.3±1,24
Hexane
14.6±1.22
Dichloromethane
25.0±0.57
Ethyl acetate
43.3±0.73
Butanol
55.3±0.57
Aqueous
51.3±0.83
Doxorubucin (µM)
0.61±0.003 µM
and fractions of seed of Telfairia
LC50 (µg/mL)
244.0±1.29
72.6±1.16
81.3±1.52
88.6±1.38
78.3±1.15
92.0±1.18
7.80±0.80 µM
TGI (µg/mL)
216.4±3.23
21.6±1.05
46.3±1.04
3.60±0.30 µM
Note: Data are represented as mean ± SEM of three independent experiments; Values in
the table are concentrations of extract/fraction expressed as μg/mL; GI50 =
Concentration of the drug causing 50% growth inhibition of the cells; TGI =
Concentration of the drug causing total growth inhibition of the cells; LC50 =
Lethal concentration of the drug that killed 50% of the cells.
Potential local plant pumpkin as
antidiabetic.
Diabetes mellitus is one of the oldest
diseases known to man, is derived from the
Yunani language which means that the
sweet urine. This is illustrated from the
usual symptoms of this disease that
appears on urination in large quantities
and sugar. Medically can be defined as a
metabolic disorder caused by a deficiency
of the hormone insulin resulting in blood
glucose can not be stored and utilized by
the body's cells become energy [26].
There are various types of diabetes
mellitus, but there are two main types of
diabetes mellitus type 1, a said disease
diabetes mellitus when fasting glucose
levels ≥ 126 mg / dl or 2 hours after eating
≥ 140 mg / dL but less than 200 mg / dL,
the glucose tolerance is said to be weak
[27]. Diabetse mellitus type 1 is a disease
of hyperglycemia due to absolute lack of
insulin. People with this disease must
receive insulin replacement. Diabetes
mellitus type 1 is usually found in people
who are not fatter aged less than 30 years,
by comparison the men slightly more than
women. Incidence of type 1 diabetes
mellitus peaking in adolescence or early
age, eat out often called juvenile diabetes.
However, it turns out type 1 diabetes can
occur at any age [28].
Diabetes mellitus type 1 is thought to
arise as a result of autoimmune destruction
of β cells of the islets of Langerhans which
is triggered by the environment.
Autoimmune attack can occur after a viral
infection for example mumps, rubella,
sitomegavirus chronic, or after exposure to
drugs or toxins (eg class of nitrosamines
found in preserved meats). At the time of
diagnosis of diabetes mellitus type 1 is
being established, found antibodies to the
cells of the islets of Langerhans in the
majority of patients. Causes a person to
produce antibodies against the cells of the
islets of Langerhans is unknown. Any of
the possibilities is that there is an
environmental agent that antigenic change
pancreatic cells to stimulate the formation
of autoantibodies. It may also be that
634
individuals who have diabetes mellitus
type 1 have in common antigens between β
cells pangkres them with viruses or certain
medications, so the immune system fails to
recognize that these cells are the pancreatic
cells themselves [28].
Diabetes mellitus type 2 is a type of
diabetes mellitus are more common, many
sufferers compared with type 1 diabetes
mellitus. Patients with type 2 diabetes
mellitus reach 90-95% of all patients with
diabetes mellitus population. Generally,
people older than 45 years, but lately
people with diabetes mellitus type 2 has
not been revealed clearly. Genetic and
environmental factors influence is large
enough to cause the occurrence of diabetes
mellitus type 2, among others, obesity, a
diet high in fat and low in fiber, and lack
of physical activity [29].
Individuals who suffer from type 2
diabets millitus still resulting in insulin,
but there insentivitas cells to insulin. There
may be a genetic link between obesity and
prolonged stimulation of insulin receptors.
The prolonged stimuli on these receptors
can cause a decrease in the number of
insulin receptors found on cells. It may
also be individuals who suffer from
diabetes mellitus type 2 produce insulin
autoantibodies associated with insulin
receptor, inhibiting access to the insulin
receptor, but does not stimulate the activity
of the carrier. The reason is what makes
diabets mellitus type 2 is also called noninsulin-dependent
diabetes mellitus
(NIDDM), because insulin still produced
by pancreatic β cells [28].
The prevalence of diabetes mellitus is
expected to double by 2030 compared to
2007. During this time the treatment has
been done for people with diabetes is
insulin injections and oral drug delivery
antidiabetic have side effects such as
headache, dizzy, nausea, and anorexia as
well as relatively inexpensive so many
people are trying to control blood glucose
levels in the traditional way using
materials nature such as herbal plants [30].
The research states that a medicinal
pumpkin plant (Cucurbita moschata) as
antidiabetes mellitus as follows: [17]
polysaccharide extract of
Cucurbita
moschata cause significant inhibition at
concentrations of α-glucosidase with 0.70.9 mg / ml.[31] powder on the species
Cucurbita moshata have hypoglycemic
properties of type 2 diabetes mellitus. [32]
polysaccharide capable of lowering blood
glucose concentration, increase serum
insulin improve glucose in mice were
given treatment using alloxan will then
damage the cells β pangkreas in mice,
therefore, can cause diabetes mellitus,
alleged that the polysaccharide has
antioxidant properties that protect cells β
pangkreas.
The results showed that among the
proteins extracted, globulins constitute the
most abundant class of storage proteins in
all five species selected. Citrullus lanatus
and Cucurbita moschata presented the
highest levels of globulin (275.34 and
295.11 mg/g dry matter, respectively). The
results of electrophoresis showed that all
species possess acidic and neutrals
albumins and globulins, with molecular
weight of protein subunits ranging from
6.36-44.11 kDa for albumins, 6.5-173.86
kDa for globulins and 6.5-49.66 kDa for
glutelins. The 6.36 kDa of albumin subunit
protein and the 6.5 kDa of globulin subunit
protein were present in all the species. The
oral glucose tolerance test showed that the
globulins of the seeds of all species except
Cucumeropsis mannii caused significant
drop in blood sugar (88 – 137.80%,
compared to the controls, p<0.05). These
findings showed that the selected
Cucurbitaceae seeds contained globulins
with significant anti-hyperglycaemic
activity. It is therefore highly encouraged
to
pursue investigations towards
development of peptide-drugs
and/or
phytomedicines from these bioactive
proteins which could be used as affordable
alternative therapy against DM [33].
Conclusions
Indonesia country rich in biodiversity, one
of which is a pumpkin that is the local
plant as a traditional medicinal plant. More
than 200 species of medicinal plants that
can be used for health, the effectiveness of
medicinal plants for the benefit of society
as a treatment to 75% [1].
634
Pumpkin contains the active molecule in
the flesh of the fruit, seeds, flowers, and its
leaf, the content of the parts of the plant
pumpkin, among others, proteins, petida,
polysaccharides, sterols of the
aminobenzoic acid, vitamin A, vitamin C,
[20]. Pumpkin plants as medicinal plants
can be used to control cancer, [21] [24]
that plant pumpkin as a medicinal plant has
many nutritional content such as; Protein,
vitamin A, beta-carotene, potassium,
vitamin C, unsaturated fatty acids,
phosphorus, phytoestrogens, selenium,
fiber, cucurbitacin E, calcium, zinc, other
vitamins and minerals. The pumpkin plants
as medicinal plants can be used as antidiabetic, [17] polysaccharide extract of
Cucurbita moschata Duch cause
significant inhibition at concentrations of
α-glucosidase with 0.7-0.9 mg / ml. [31]
powder on the species Cucurbita moshata
have hypoglycemic properties of type 2
diabetes mellitus. [32] polysaccharide
capable of lowering the concentration of
blood glucose, serum insulin increases
glucose repair in rats given the treatment
using alloxan then will destroy pancreatic
β cells in mice, therefore, can cause
diabetes mellitus, that polysaccharides
have antioxidant properties that protect
cells of the pancreatic β.
Acknowledgement
Thank you, I thank the rector of the
Institute of Health Sciences Kediri, head of
research institutions and community
service IIK kediri which gives the
opportunity and motivation to the author,
so I can finish the scientific papers.
Refrences
[1] Yamada, H. 2008 Whistler award
lecture. International Carbohydrates
Symposium. Oslo, Norway.
Lokakarya tentang Penelitian Praktek
Pengobatan Tradisonal. Badan
Penelitian dan Pengembangan
Kesehatan, Deparetem Kesehatan
Republik Indonesia. Ciawi, 14-17
Desember 1988.
[4]
[5] Manal, K. A. 2006. Effect of pumpkin
seed (Cucurbita pepo L.) diets on
benign prostatic hyperplasia (BPH):
chemical
and
morphometric
evaluation in rats. World Journal of
Chemistry 1 (1): 33-40.
[6]
Fu, C., Shi, H. and Li. Q. (2006). A
review on pharmacological activities
and utilization technologies of
pumpkin. Plant Foods for Human
Nutrition, 61: 70-77.
[7]
Inngjerdingen, M., Inngjerdingen, K.
T., Patel, T. R., Allen, S., Chen, X.
Y., Rolstad, B., Morris, G. A.,
Harding, S. E., Michaelsen, T. E.,
Diallo, D. and Paulsen, B. S. 2008.
Pectic
polysaccharides
from
Biophytum petersianum Klotzsch, and
their activation of macrophages and
dendritic cells. Glycobiology, 18:
1074-1084.
[8]
Košťálova, Z., Hromádková, Z.,
Ebringerová, A., Polovka, M.,
Michaelsen, T. E., Paulsen, B. S.
2013. Polysaccharides from the
Styrian oil-pumpkin with antioxidant
and complement-fixing activity.
Industrial Crops and Products, 41:
127-133.
[9]
Asgary Sedigheh, Moshtaghian
Seyyed Jamal, Setorki Mahbubeh,
Kazemi Somayeh4, Rafieian-kopaei
Mahmoud, Adelnia Azadeh6 and
Shamsi
Fatemeh,
2011.
Hypoglycaemic and hypolipidemic
effects of pumpkin (Cucurbita pepo
L.) on alloxan-induced diabetic rats.
African Journal of Pharmacy and
Pharmacology Vol. 5 (23): 26202626.
[2] Dorly. 2005. Potensi Tumbuhan Obat
dalam Pengembangan Industri
Agronomi. Bogor: ITB.
[3]
Jia, W., Gao, W. and Tang, L. 2003.
Antidiabetic herbal drugs officially
approved in China. Phytotherapy
Research, 17: 1127-1134.
Sosrokusumo, P. 1989. Pelayanan
pengobatan tradisional di bidang
kesehatan jiwa. Dalam: Salan, R.,
Boedihartono, P. Pakan, Z.S.
Kuntjoro, dan I.B.I. Gotama (ed.).
635
[10] Ashok Sharma, Ashish K. Sharma,
Tara Chand, Manoj Khardiya, Kailash
Chand Yadav. 2013. Antidiabetic and
Antihyperlipidemic Activity of
Cucurbita maxima Duchense
(Pumpkin) Seeds on Streptozotocin
Induced Diabetic Rats. Journal of
Pharmacognosy and Phytochemistry.
Vol. 1 (6): 108-116.
[11] Weng, Y., and Sun, Z. (2012) Major
Cucurbit Crops. In Wang, Y., Behera,
T. K., Kole, C. Genetics, Genomics
and Breeding of Cucurbits St. Helier,
Science Publishers.
[12] Suwanto. 2015. Potential of Local
Food Pumpkin ( Cucurbita moschata
Duch ) as Diversification of Rice to
Food
Security.
International
Conference on Life Sciences and
Biotechnology. Exploration and
Conservation of Biodiversity. Biology
Department, Faculty of Mathematics
and Natural Sciences, The University
of Jember.
[13] Dietmar, F. 2005. Extract of Pumpkin
Seeds Suppresses Stimulated
Peripheral Blood Mononuclear Cell
Invitro. American Journal of
Immunology (1): 6-11.
Botanicae Horti Agrobotanici Cluj,
39: 34-40.
[17] Song, Y., Zhang, Y., Zhou, T., Zhang,
H., Hu, X. and Li, Q. 2012. A
preliminary study of monosaccharide
composition and α-glucosidase
inhibitory effect of polysaccharides
from pumpkin (Cucurbita moschata)
fruit. International Journal of Food
Science & Technology, 47: 357–361.
[18] Hutapea, J. R. 1994. Labu Kuning
(Cucurbita moschata Duch). CCRCFarmasi UGM. Yogyakarta.
[19] Agbagwa, I. O., B. C. Ndukwu, and S.
I. Mensah. 2007. Floral biology,
breeding system, and pollination
ecology of Cucurbita moschata
(Duch. Ex Lam) Duch. Ex Poir.
Varieties (Cucurbitaceae) from part of
the Niger Delta, Nigeria. Turk. J. Bol.
31: 451-458.
[20] Yadav, N., Morris, G., Harding, S. E.,
Ang, S. and Adams, G. G. (2009).
Various non-injectable delivery
systems for the treatment of diabetes
mellitus. Endocrine, Metabolic &
Immune Disorders-Drug Targets, 9:
1-13.
[14]Yuliani, S., E.Y. Purwani, S. Usmiati,
dan H. Setiyanto. 2004. Penelitian
Pengembangan Teknologi Pengolahan
Pangan Berbasis Sagu, Sukun dan
Labu Kuning: Kegiatan Penelitian
Pengembangan Teknologi Pengolahan
Berbasis Labu Kuning. Laporan
Akhir.
Balai Besar Litbang
Pascapanen Pertanian, Badan Litbang
Pertanian, Departemen Pertanian.
[21]
[15] Huang, G., Tan, J., Tan, X. and Peng,
D.
2011.
Preparation
of
polysaccharides from wax gourd.
International Journal of Food
Sciences and Nutrition, 62: 480-483.
[23] Mushtaq Ahmed, Muhammad Imran
Khan, Muhammad Rashid Khan,
Nawshad Muhammad, Amin Ullah
Khan1 and Rahmat Ali Khan1. 2013.
Role of Medicinal Plants in Oxidative
Stress and Cancer. Journal Scientific
Reports, 2 (2): 1-3.
[16] Noelia, J., Roberto, M. M., de Jesus,
Z. J. and Alberto, G. J. 2011.
Chemical and physicochemical
characterization of winter squash
(Cucurbita moschata D). Notulae
Abasalt Hosseinzadeh Colagar,
Omolbanin Amjadi Souraki. 2012.
Review of Pumpkin Anticancer
Effects. Journal Quran Med.1(4): 7678.
[22] Radovich, T. 2011. Farm and Forestry
Production and Marketing profile for
Pumpkin and Squash
(Cucurbita
spp.). Permanent Agriculture
Resources. USA, pp. 2-12.
[24] Johnson, E. J., and Johnson, T. J.
1996. Economic plants in a rural
Nigerian market. Economic Botany,
30: 375-381.
636
[25] Jude E. Okokon, Ashana Dar Farooq,
M. Iqbal Choudhary, Bassey S. Antia.
2012. Immunomodulatory, Anticancer
and Anti-inflammatory Activities of
Telfairia occidentalis Seed Extract
and Fractions. International Journal of
Food Nutrition and Safety, 2(2): 7285.
[26] Clark, Marie. 2004. Understanding
Diabetes. England: John Wiley &
Sons‟s Ltd.
[27] Sukandar. 2008. ISO Farmakoterapi.
Jakarta: PT. ISFI Penerbitan.
[28]
Corwin, E.J. 2009. Buku Saku
Patofisiologi. Jakarta: Penerbit Buku
Kedokteran EGC.
[29] Direktorat Jenderal Bina Kefarmasian
dan Alat Kesehatan Departemen
Kesehatan RI. 2005. Pharmaceutical
Care Untuk Penyakit Diabetes
Mellitus. Jakarta.
[30] Okky Meidiana Prameswari, Simon
Bambang Widjanarko, 2014. Uji Efek
Ekstrak Air Daun Pandan Wangi
Terhadap Penurunan Kadar Glukosa
Darah dan Histopatologi Tikus
Diabetes Mellitus, Jurnal Pangan dan
Agroindustri, 2 (2): 16-27.
[31] Chen, Z., Wang, X., Jie, Y., Huang,
C. and Zhang, G. 1994. Study on
hypoglycemia and hypotension
function of pumpkin powder on
human. Jiangxi University of
Traditional Chinese Medicine, 25, 50.
[32] Li, L., Fu, F., Yukui, R., Guanghui,
H. and Tongyi, C. 2005. Effects of
protein-bound polysaccharide isolated
from pumpkin on insulin in diabetic
rats. Plant Foods for Human Nutrition,
60, 13-16.
[33] Clautilde Mofor Teugwa, Thaddée
Boudjeko, Bruno Tugnoua Tchinda,
Pascaline Chouadeu Mejiato and Denis
Zofou, 2013. Anti-hyperglycaemic
globulins from selected Cucurbitaceae
seeds used as antidiabetic medicinal
plants in Africa. Jornal BioMed Central
Complementary and Alternative
Medicine 13 (63): 2-8.
637
THE EFFECTIVENESS OF ROSE FLOWER (ROSA CHINENSIS JACQ)
AGAINST CANDIDA ALBICANS COLONIES ON JELLY (SDA) MEDIA
Erni Dwi Widyana, Tarsikah, Naimah
Poltekes Kemenkes Malang
Abstract
Approximately 90% of women in Indonesia have the potential to experience fluor albus.
Fluor albus is mostly caused by Candida albicans. C.Albicans is a fungus that often
causes infections on people. Herbal medicine is one alternative that can be used as a raw
material for anti fungi medication of C. albicans. The purpose of this study was to
determine the effectiveness of rose flower (Rosa Chinensis Jacq) against Candida
albicans colonies. This research was an experimental laboratory with "Posttest Only
Control Group Design", using four repetitions with a concentration of 7.5%, 10%, 12.5%,
15% and 17.5%. The hypothesis test used was One-way ANOVA (Analysis of Variance)
with a significance level of 0.05. Analysis at 7.5% concentration, the growth of the
colonies was 148.75 CFU/ml; at 10% concentration, the growth of the colonies was 123
CFU/ml; at 12.5%, the growth of the colonies was 86 CFU/ml, at 15%, the growth of the
colony was 29 CFU/ml; at 17.5 %, the colony growth was 0, so it can be concluded the
higher concentration of rose extract, the lower number of Candida albicans colonies. Rose
extract (Rosa chinensis Jacq) is effective in inhibiting the growth of the Candida Albicans
fungus with Minimal Killing Levels of 17.5%. Further studies on toxicity test on rose
extracts (Rosa chinensis Jacq) against Candida albicans are expected.
Keywords: Rose flower (Rosa Chinensis Jacq), Candida albicans
Introduction
Fluor albus is a very common
symptom experienced by many women.
About 90% of women in Indonesia have
the potential to experience fluor albus.
Research data on women's reproductive
health shows that 75% of women in the
world suffer from fluor albus at least
once in their lifetime, 45% of them
would experience this twice or more
(Yatim, 2005).
Fluor albus is divided into
physiological
and
pathological.
Physiological fluor albus occurs before
ovulation, before and after menstruation
or as hormone influence on pregnancy,
while the pathological factor occurs due
to vaginal infection, Trichomonas
vaginalis infection, candida albicans
fungal
infection,
reproduction
malignancy or caused by foreign bodies
in the birth canal. Candidiasis is the
most frequent cause. The infection often
happens on the vulva and results in
ithciness. The fungal attacks the cells in
vaginal tract and vulva skin cells. About
15% of women are infected, but the
symptoms of fluor albus and itching
occurs in 3% to 5% of women.
Candida albicans is one of the
organisms function as normal flora in
human bodies and is not dangerous. But
C.albicans is also one of the funguses
that cause infections on people. It is
usually a local infection such as oral and
vaginal infection (Manuaba 2008).
Candida albicans is a facultative
anaerobic organism that is capable of
cell metabolism in both the anaerobic
and aerobic atmosphere. This fungus
grows at a temperature of 280C - 370C
and at a pH of about 4.5-6.5. Candida
albicans will have fermentation process
in an aerobic or anaerobic condition,
which will ferment glucose, maltose and
640
sucrose which will then produce acid
and gas (Simatupang, 2008).
Treatment for fluor albus due to
infection caused by Candida fungus
usually starts with avoiding or
eliminating predisposing factors before
medication with chemical drugs.
Medical treatment with chemical drugs
does give satisfactory results, but it has
side effects such as fever, vomiting,
muscle spasms, and hypotension. Herbal
medication is one alternative that mostly
people choose when they are reluctant to
use medical treatment using chemical
drugs, so that it is necessary to do
research on the
medicinal herbs
(Riskillah, 2010).
Herbs that can be used as a natural
ingredient for treating fluorine albus
among others are turmeric, ginger,
pomegranate, papaya fruit, yellow
flowers, hibiscus, kembang pukul empat
flower, and rose flower (Fitzania, 2010).
Rose (Rosa chinensis Jacq) contains
vitamin C, B, E and K. Its atsiri oil also
contains geraniol, limonene,
citrate
substance, citronellol, linalol, nerol,
eugenol, feniletilalkohol, farnesol, gallic
acid and nonilal-dehida.
The result
of the research
conducted by Tripathi (2002) states that
gallic acid
content on roses has
antifungal effect against 17 kinds of
fungi in concentrations of 3%. Yi Zhong
Cai, et.al (2005) mentions that rose
flower (Rosa chinensis Jacq) contains a
lot of hydrolyzable tannins, flavonoids
and anthocyanins. Flavonoid found in
rose is about 41 mg / 100 g dry.
Flavonoids, tannins and antioxidant
activity found in roses can inhibit the
growth of bacteria and fungi (Sigh, et.al
2009).
treatment group were given extracts of
rose flower (Rosa chinensis Jacq).
Sampling
The samples used were vaginal
Candida albicans from Microbiology
Laboratory of the University of
Brawijaya cultured in a petri dish with
SDA medium (Sabouraud dextrose
Agar), using four repetitions for each
extract concentration of roses (Rosa
chinensis Jacq) which are 7.5%, 10%,
12.5%, 15%, 17.5%.
Data Collection and Instrument
Stage 1
Make rose extract (Rosa chinensis Jacq)
using maceration method by providing
500g of fresh rose petals, dried in room
temperature. Once dried, mash them
using the blender then weigh them. Put
100gr of dry sample into an Erlenmeyer
glass with the size of 1 liter, soak with
methanol to a volume of 900 ml (3
times), then whisk until thoroughly
mixed (± 30 min) and allowed to stand
one night to settle. Take the top layer of
the mixture of ethanol with active
substances that have been drawn up and
put in the 1 lt evaporation flask. Attach
the evaporation tube on evaporator and
fill up the water bath with water. Let
methanol solution separate from the
existing active substance in the flask.
Wait until methanol flow stops dripping
from the container flask (± 1.5 to 2
hours for 1 flask). Put the result into a
plastic bottle and store it in the freezer.
Stage 2:
Rose Extracts Test (Rosa chinensis
Jacq) against Candida albicans colonies.
1) Pre-test. It is conducted to find out
the concentration of flower petals
extract. On this test, the killing
ability of each extract with
concentration of 5%, 7.5%, 10%,
12.5%, 15%, 17.5% with a ratio of (1
cc of aquabidest:100) x concentration
of the extract.
2) 65 grams of Saboraud Dextrose Agar
powder is added to 70 ml of distilled
water; stir and cover it with
Method
This research was an experimental
research laboratories using dilution Tube
Test to determine the effects of roses
antifungal (Rosa chinensis Jacq) against
Candida albicans in Vitro. It used
"Posttest Only Control Group Design"
with colonies of Candida albicans
641
aluminium foil and sterilize with
autoclave together with the
instruments used for 15 minutes with
the temperature of 121ºC.
3) First layer of liquid Saboraud
Dextrose Agar is poured into
sterilized petri dish and let it to
become solid
4) Take 1 ml of 1 ml Candida albicans
culture using heated osche above
spiritus lamp until it is getting heated
then let it cool
5) Give 0.1 ml rose petal extract (Rosa
chinensis Jacq) with concentration of
7.5%, 10%, 12.5%, 15%, 17.5%.
6) Do a full streaking on Saboraud
Dextrose Agar media as much as
10µ1
7) Petri dish is incubated for 24 hours in
incubator with temperature of 37º
8) Calculate the growth (Colony
Counter) using Total Plate Count
(TPC) method
9) Repeat the experiment as much as 4
times.
Minimum Killing Level is the lowest
concentration of an antimicrobial that
can kill fungi (characterized by the
absence of bacteria growth in SDA
medium) or colony growth of less than
0.1% of the number of colonies on
initial inoculum (original inoculum / OI)
in SDA medium by one ose streaking
(Dzen et al., 2003). The results of
streaking on SDA medium can be seen
in figure 1.
Result And Analysis
Table 4.1 The result of Candida
albicans colony calculation on Pre-test
Concentration
5%
7.5%
10%
12.5%
15%
17.5%
The number of growing
Candida Albicans colonies
193
151
128
77
29
0
From table 1 it can be seen that a
concentration of 5% is able to inhibit the
growth of Candida albicans colonies.
With a concentration of 17.5% there is
no growth of Candida albicans colonies.
Test Result of the Growth of Candida
Albicans
642
(c)
(b)
%
(a)
(d)
(e)
Figure 1. Candida Albicans growth on many rose extract flower with jelly
media
Source: Primary Data
Caption:
(a) Growth of colonies of Candida Albicans with concentration of 7.5%
(b) Growth of colonies of Candida Albicans with concentration of 10%
(c) Growth of colonies of Candida Albicans with concentration of 12.5%
(d) Growth of colonies of Candida Albicans with concentration of 15%
(e) Growth of colonies of Candida Albicans with concentration of 17.5%
The result of descriptive analysis
about the data of the number of
Candida albicans colony growth
at a concentration of 7.5%, 10%,
12.5%, 15% and 17.5% can be
seen in the following table:
Table 2. Calculation Results of the number of Candida
albicans colonies in each concentration
Concentration
Repetition
I
II
III
IV
Average
The number of growing Candida
Albicans colonies
7.5%
10%
12.5% 15% 17.5%
149
127
96
31
0
149
115
70
26
0
146
115
62
25
0
151
123
86
29
0
148,75
123
86
29
0
Based on the observation in Table
2, it was found out that by the
increasing concentration of rose petals
extract, the number of colonies that
grow on the SDA (Saboraud Dextrose
Agar) is also increasingly reduced.
7.5% concentration resulted in the
largest and most dense growth of
fungal colonies, that is 149 CFU/l.
Meanwhile, at a concentration of
17.5%, there is no growth of Candida
albicans colony.
From the result
of isolated
Candida albicans colony growth and
calculation, the killing ability
minimum level of rose extracts can be
determined. That is, on the SDA with
colony growth <0.1% of the original
640
inoculum. The minimum killing level
of rose extracts in this treatment was
17.5%. Prior to statistical analysis to
determine mean differences of each
rose extract concentration, normality
and homogeneity tests were conducted.
Table 4 The result of Homogeneity
test: Levene One Way
ANOVA on the number of
Candida
Colonies
Concentration
Normality Test Results
Normality test results on the
number of Candida albicans colonies
of each rose (Rosa chinensis Jacq)
petals extract concentration
with
Shapiro-Wilk test can be seen in Table
3.
7.5%
10%
12.5%
15%
The number of
Candida Albicans
Colonies ()
0.572
0.224
0.768
0.650
The Results of Variant Data Analysis
on the Number of Candida albicans
Colonies in
average number of Candida
Albican colonies (CFU/ml)
7.5%
10%
12.5%
15%
The number of Candida
Albicans Colonies

Average ± SD
Levene
148.75 ± 2.062
0.692
120.00± 6.000
78.50± 15.351
27.75 ±2.754
Homogeneity test results in Table 4
shows the value of> 0.05 ( = 0.692),
which indicates that the data is
homogeneous, so that the One-Way
ANOVA test requirement is met, which
should be in a normal distribution and
the variance should be the same
Table 3 The Results of the ShapiroWilk normality test on the
number of Candida albicans
Colonies
Concentration
albicans
The results
Shapiro-Wilk
normality test as shown in Table 3
shows that the value of> 0.05, so the
significance of all the data on the
number of colonies of Candida
albicans at each concentration is at
normal distribution.
160
140
120
100
80
60
40
20
0
7,5% 10% 12,5% 15% 17,5%
rose extract concentration
Homogeneity Test Results
Homogeneity test of the average
number of Candida albicans colonies
at each rose petals (Rosa chinensis
Jacq) extract concentration were tested
with Levene test using One Way
ANOVA.
Each Concentration
Graph 1 Average Number of Colonies of
Candida albicans in Each Concentration
Graph 1 shows the significant
reduction in the number of colonies in
with rose extract provision, wherein
the more number of
extract
concentration the less number of
Candida albicans colonies were grown.
641
Table 5. Results of ANOVA test on Total Colonies of
Candida albicans in Each Concentration
Concentration
N
(X)
SD
F

7.5%
10%
12.5%
15%
17.5%
4
4
4
4
4
148.75
120.00
78.50
27.75
.00
2.062
6.000
15.351
2.754
.000
270.439
0,000
chinensis Jacq) has anti-fungal potency
against Candida albicans.
Based on Table 5 it can be
concluded that H1 is accepted which
means that there are significant
differences in the various
concentrations of rose extracts (Rosa
chinensis Jacq) between concentrations
of 7.5% to 17.5%.
From ANOVA test results in table
5 and graph 1, it can be concluded that
the more concentration of rose petals
extract, the less number of growing
Candida Albicans colonies. This shows
that rose extracts (Rosa
LSD (Least Significance Difference)
Test Results on the Number of
Colonies of Candida albicans in each
concentration.
After ANOVA
test, it was
followed by LSD Post Hoc Test to
determine which groups are different
and which groups did not differ
significantly in the number of colonies
of Candida albicans.
Table 6. Mean Difference Test Result using LSD Post Hoc Test on
Dependent Variables in Each concentration.
Concentration
Group (I)
7.5%
10%
12.5%
15%
17.5%
*
Group (J)
10%
12.5%
15%
17.5%
7.5%
12.5%
15%
17.5%
7.5%
10%
15%
17.5%
7.5%
10%
12.5%
17.5%
7.5%
10%
12.5%
15%
Mean
Difference
(I-J)
28.750*
70.250*
121.000*
148.750*
-28.750*
41.500*
92.250*
120.000*
-70.250*
-41.500*
50.750*
78.500*
-121.000*
-92.250*
-50.750*
27.750*
-148.750*
-120.000*
-78.500*
-27.750*

Remark
0,001
0,000
0,000
0,000
0,001
0,000
0,000
0,000
0,000
0,000
0,000
0,000
0,000
0,000
0,000
0,001
0,000
0,000
0,000
0,001
Significantly different
The mean difference was significant at <0.05
From Table 4.6 above it can be seen
that there are differences in the
concentration of each extract of rose
petals with the average number of
641
Candida albicans colonies ( = 0.000,
 = 0.001, <0.05).
albicans poliferation.
Flavonoids have antifungal effect
which is very effective in inhibiting
cell growth (Orhan D., 2009).
Biological flavonoids activities were
done by destroying the cell wall of
Candida Albicans consisting lipid and
amino acid which react with alcohol
groups on a flavonoid compound that
will break down the cell walls and the
compound can enter the fungi cell
nucleus. Furthermore, in the fungi cell
nucleus, this compound will contact
the DNA in Candida albicans fungi
cell nucleus and through differences in
polarity between the lipids making up
the DNA with alcohol groups on
flavonoid compound, there will be a
backlash that would damage the lipid
structure of the DNA of the Candida
albicans. The activity of flavonoids is
due to their ability to form complexes
with the extracellular proteins which is
soluble with cell walls, so that
microorganisms cannot attach and
invade the host cell. Lipophilical
flavonoids may also damage microbe
membrane. Flavonoid compounds also
inhibit topoisomerase II enzyme work
on microorganisms associated with
microorganism proteins (Melderen,
2002). DNA gyrase is one of the of
topoisomerase II class of enzyme,
DNA gyrase twists the strands of DNA
and decipher DNA strands. The more
lipophilic a flavonoid, the more ability
to destroy the bactery cell wall
(Cowan, 1999). Tannin contained in
rose extract believed to have the same
mechanisms as other phenolic
compounds in inhibiting and killing
the growth of fungi and bacteria and
can react in an inactivation function
way of genetic material (Branen,
1993). Tannin can also form complex
compounds that are irreversible with
proline, a complete protein which has
the effect of inhibiting the synthesis of
proteins to inhibit cell wall. Tannin
also has the ability to inhibit reverse
transcriptase enzyme from the
microbial cells.
In addition, Tannin can also
Analysis
Rose extracts have antifungal
effect against Candida Albicans that
can be seen in table 1 showing that the
higher the concentration of rose extract
used, the smaller the number of colony
growth of Candida albicans. It can also
be stated that the higher the
concentration of the rose extracts the
higher antifungal effects. The result of
One-Way ANOVA statistical test on
Table 5 obtain F count = 270.439, with
a value of = 0.000, it is significant
with α <0.05, so that <0.05 then H1
is accepted, which means that there are
differences between the mean value of
colonies of Candida albicans of each
extract concentration rose (Rosa
chinensis Jacq). Test results in Table 6
on LSD Post Hoc Test which showed a
highly significant difference from all
group of rose extract concentration
which shows <0.05.
Rose extract has anti-fungal effect
against the Candida albicans fungus
which is caused by active substances
that are soluble in methanol flavonoid.
Suitable with Yi Zhong CAI, et.al
(2005) research which states that are
hydrozable content of tannins,
flavonoids and anthocyanins in roses.
There are 17 types of flavonoids that
have been identified and 7 types of
flavonoid which has not been
identified at the roses, and there are 15
types of anthocyanins which are
mostly classified as monoglicocides or
diglicocides, cyanidin, pelargonidin
and peonidin (Mikanagi, et.al, 2000).
Roman I, et al, (2013) in his study also
states that roses contain ascorbid acid
compounds, polyphenols, flavonoids
and antioxidant activity. The content of
vitamin C in rose is about 0.51 g / 100
g of dried roses, flavonoid about 41 mg
/ 100 g dried roses, and citric acid
approximately 3.34 g / 100 g of dried
roses (Arthur A, 2012) .Vitamin C
contains in roses decrease Candida
641
inhibit the C-14 demethylase enzyme
which is also a catalase enzyme, which
serves to spur ergosterol. Ergosterol
forms a major component of the
plasma membrane of fungi. With the
disruption of this enzyme function then
it cannot synthesize ergosterol
normally. This causes plasma
membrane structure does not form
properly and the function is disrupted
(Deacon, 1997).
Eukaryotic cell
plasma membrane such as C. Albicans
cell has an important role in osmotic
regulation, nutrient absorption,
excretion and cell wall biositesis.
Aside from being a major component
of the plasma membrane, ergosterol is
also involved in the formation of
chitin, which is one component of the
polysaccharides cell wall and has a
very important role in germination.
Thus, inhibition of the formation of the
plasma membrane ergosterol C.
albicans of cells also mean inhibition
of reproduction (Albert et al, 2002).
In addition to the number of cells,
the cell mass can also be used as a
measure for the growth of the C.
albicans fungi. Dawes and Sutherland
(1992) state that the growth of single
cells (including
fungi) can be
interpreted as an increase of cell mass.
The results of this study indicate that
the concentration of 7.5%, 12%,
12.5%, 15% rose extract cannot affect
or inhibit cell mass accretion. This
happens because the compounds in
roses at these concentrations have not
been able to get through the cell walls.
At a concentration of 17.5% it can
affect C. albicans cell mass accretion,
which means interfering
with
metabolism, so there is no increase in
the number of the colonies at this
concentration.
Killing Level of rose extracts (Rosa
chinensis Jacq) against
Candida
albicans was 17.5%.
Acknowledment
The Author would like to thank
the Health Polytechnic of Malang,
Microbiology Lab of FK UB, and
many people who have contributed to
this current study.
References
Braner, LA. 1993. Antimicrobial in
Food. Marcel Dekker, Inc, New
York.
Crowan, MM. 1999.
Clinical
Microbiology
Review-Plant
Products
Antimicrobial
Agent.Ohio Departement of
Microbiology, Miami Universiti,
Vol.4,
No.2,
P.564-582,
(Online).http://smccd.net/accounts/
case/ref/564.pdf. diakses tanggal 5
November 2013
Deacon., J.W. 1997.
Modern
Mycology.Blackwell Scientific
Publication. London
Dzen, S.M., dkk. 2003. Bakteriologi
Medik. Banyumedia Publishing.
Malang
Fitzania. 2012. Toga Sehat. Cara
Mengatasi Keputihan secara
Alami.
http://www.togasehat.com/2012/0
3/cara-mengatasi-merawatkeputihan-secara.htmlFitzania.
2010. Bunga Mawar Sebagai Obat
Herbal.http://fitzania.com/bungamawar-sebagai-obat-herbal/
Lin-Sen
Qing, et.al., 2012.
Identification of Flavonoid
Glycosides in Rosa Chinenses
Flower
by
Liquid
Chromatography-tandem
Mass
spectrometry in Combinatoin with
1
3 C Nuclear Magnetic Resonance.
Journal Chromatogr A.: 1247:
130-137. http;//j.chroma/2013
Manuaba, IBG. 2008. Gawat Darurat
Obstetric-Ginekologi
Dan
Obstetric-Ginekologi
Sosial
Untuk Profesi Bidan. Jakarta:
EGC.
Conclusion
Rose extract
(Rosa chinensis
Jacq) is effective in inhibiting the
growth of Candida Albicans fungus.
The higher concentration of rose
extract, the higher growth declining of
Candida Albicans fungus. Minimum
642
Orhan, D, et.al., 2009. Antibacterial,
Antifungal and Antiviral Activies
of
Some
Flavonoid.Microbiological
Research.165 (20100. 496-504.
http://www.Sciencedirect.com
Prawirohardjo, S. 2008.
Ilmu
Kandungan. Jakarata: Yayasan
Bina Pustaka.
Prayetni, 2001.Asuhan Kebidanan Pada
Ibu
Dengan
GangguanReproduksi.
Jakarta:
Pusdiknas Depkes RI.
2010.
Candida
Riskillah, A.G.
Albicans.Faculty of Medicine –
University of Riau. Pekanbaru,
Riau.
©
Doctor's
FiLez.(http://www.DoctorsFilez.tk
Roman I, et.al. 2013. bioactive
Compounds And Antioxidant
Activity Of Rosa Canina L.
Biotypes From Spontaneus Flora
of Transylvania.Chemistry Central
Journal.
7:73.
http;//Journal.chemintrycentral.co
m/content/7/73. diakses tanggal 5
November 2013
Sigh, Sheena, Robbins N, Zaas A, Scheel
WA, Perfect JR, Cowen, LE. 2009.
Hsp90 Governs Echinocandin
Resistance in the Pathogenic
Yeast Candida albicans via
Calcineurin. Research Article.
Tersedia
dalam
journals.plos.org/plospathogens/ar
ticle?id=10.1371/journal.ppat.100
0532
Simatupang, Maria Magdalena.2009.
Candida Albican. Departemen
Mikrobiologi.
Fakultas
Kedokteran UniversitasSumatra
Utara.
Tersedia
dalam
http://repository.usu.ac.id/bitstrea
m/123456789/1935/1/09E01452.p
df
Tripathi G, Wilshire C, Macaskill S,
Tournu H, Budge S, Brown AJB.
Gcn4 co-ordinates morphogenetic
and metabolic responses to amino
acid starvation in
Candida
albicans.MBO J. 2002 Oct 15;
21(20): 5448–5456.
Yatim, F, 2005. PenyakitKandungan.
Jakarta: Pustaka Populer
Yi-Zhong CAI, et.al, 2005. Phenolic
Antioxidants
(Hydrolyzable,
Tannis,
Flavonols
and
Anthocynins) Identified by LCESI-MS and MALDI-QIT-TOF
MS From Rosa Chinensis
Flowers. The University of Hong
Kong.
643
EFFECTIVENESS OF ZAMZAM WATER AND ALKALI WATER TOWARD
ANKLE BRACHIAL INDEXS, OXIDATIVE STRESS AND REDUCE
HEMOGLOBIN A1C IN DIABETIC FOOT ULCER PATIENT
Yohanes Andy Rias
Departement of Medical Surgical, Collage of Nursing,
Bhakti Wiyata Institute of Health Sciences, Indonesia
Abstract
DFU that can affect oxidative stress so result in an imbalance between oxidants and
antioxidants mechanisms. The imbalance can be affected by water consumption such as
zamzam water and alkaline water. it can be neutralize acidic conditions in the body, the
cells used for hydration, and removing toxins and produce insulin efiseien. We have
carried out this study in diabetic foot ulcer patients to evaluate the effect of Zamzam
water be compared Alkaline water on their oxidant antioxidant status, glycemic control,
vascularization (Ankle Brachial Indexs) and lipid profile as long as 61 day. The patients
were randomly divided into two groups each drank one liter/day of water for 61 day; one
group received alkaline water while the other drank zamzam water. This study was a
experimental design with purposive sampling and than pre and post test controlled grups
design. Results after two months of water consumption were compared with their
corresponding baseline values in the same groupusing paired t-test. Statistical
significance was set at p<0.05. Regarding these results, based on the results of research
that correlated with a literature review, it can be concluded that Zamzam water and
alkaline water can affected by ABI, reduce hemoglobinA1c, and blood glucose, but no
significant influence on TBARS, MCH, ESR. Further research is needed in this area to
confirm the results and explore the mechanism behind HbA1c lowering effect produced
by zamzam water and alkaline water compared and hystology of pancreas organ.
Keyword: zamzam water, alkali water, ankle brachial indexs, oxidative stress,
hemoglobin a1c, diabetic foot ulcer
647
Introduction
Diabetes Mellitus (DM) is a disease of
carbohydrate metabolism disorders include
chronic caused by a deficiency of insulin
hormone in relative or absolute terms with
complications of diabetic foot ulcers 1,2.
Diabetic foot ulcer (DFU) is a neurological
disorder as a re

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