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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
ii
PROSIDING The 3rd International Nursing Conference (2019)
“Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Hak Cipta © Akper Keris Husada, Akper Pelni, Akper Cikini, Akper Pasar Rebo, Jakarta 2019 Hak Terbit pada Penerbit Akper Keris Husada Penerbit Akper Keris Husada Jakarta JL. Yos Sudarso Komplek Marinir Cilandak Jakarta Selatan Tlp./Fax : 021 7884 5502 Email: info@akperkerishusada.ac.id http://akperkerishusada.ac.id
Cetakan pertama, Oktober 2019
ISBN: 978-623-91765-0-1 Desain cover & layout: Fitri Annisa, Ns.Sp.Kep.An Editor: Yuanita Panma, M.Kep., Ns.Sp.Kep.MB Fitri Annisa, M.Kep., Ns.Sp.Kep.An Hak cipta dilindungi undang-undang. Dilarang memperbanyak karya tulis ini dalam bentuk dan dengan cara apapun, termasuk fotokopi, tanpa izin tertulis dari penerbit. Pengutipan harap menyebutkan sumbernya.
iii
PREFACE
3rd INTERNATIONAL NURSING CONFERENCE
“Nursing Contribution at Disaster Risk Management:
Psychosocial Impact and Learning from Nations”
Asalamualaikum Wr.Wb, Good afternoon and welcome to
the THIRD INTERNATIONAL NURSING
CONFERENCE.
First of all I would like to thank Allah SWT, God Almighty
for the blessing of our conference today .
In this opening remark I want to welcome
- Associate Prof. Dr. Orapan Thosingha from Mahidol University, Thailand;
- Khortimas YOK Nursing Team Supervisor from Cambodia;
- Prof. Dr. Budi Anna Keliat, SKp, MAppSc from Universitas Indonesia;
- Masfuri, SKp, MN from Nurse Assosiation of Emergency and Disaster - Indonesia;
I also would like to thank
- The Chairman of PPNI, the Indonesian Nursing Profession Organization, today
represented by Mister Masfuri SKp. MN as The Chairman of the Foreign Affair
Division in PPNI.
- The Chairman of AIPViKI, The Association of Nursing Academic in Jakarta Mrs
Sylvia M.Kep
- The Chairman of YARSI Foundation Prof. Dr. Jurnalis for the outstanding venue here
in Arr-Rahman Auditorium.
And last but not least to
- The Directors of all four Nursing Academic ; PELNI; KERIS HUSADA; CIKINI and
PASAR REBO Nursing Academy for the partnership in holding this important seminar.
The purpose of the second Nursing International Seminar is to give global insights and
knowledge of the newest development in Nursing Higher Education.
iv
Aside from that, it is also a responsibility of Private Higher Education Institutions to develop
themselves not only in National but also International Scope.
Hopefully, all 900 (nine hundred) participants from Indonesia and abroad will have a fruitful
seminar with our Guest Speakers and the Oral Presentation from four Nursing Academies.
This event shall open a way for other international activities such as student exchange, lecturer
exchange and joint research. We humbly wait for the invitations from Thailand, Cambodia and
Indonesia.
Last but not least, please forgive all the mishaps to motivate us to be better in the future.
I hereby open The Second International Nursing Seminar, Bismillah
Chairperson of Organizing Committee
Ns. Tatik Setiarini,S.Kep.,M.KM
v
TABLE OF CONTENTS
Cover
Preface ................................................................................................................... iii
Table of Contents ............................................................................................... v
Committee ........................................................................................................... vi
Conference Schedule ......................................................................................... vii
Oral Presentation Schedule ............................................................................... viii
Abstract and Full Texts of Oral Presentation
1. Sri Hunun Widiastuti, Achir Yani Hamid, Tuti Nuraini,
Novi Helena.. ............................................................................................. 1-12
2. Ira Sukyati ................................................................................................... 13-21
3. Ennimay ...................................................................................................... 22-38
4. Yenny, Krisna Yetti, Yusron Nasution ................................................. 39-52
5. IGA Dewi Purnamawati .......................................................................... 53-64
6. Siti Nurhayati .............................................................................................. 65-74
7. Yuanita Panma ........................................................................................... 75-83
8. Labora Sitinjak, Burhanuddin Tola, Mansyur Ramly .......................... 84-98
vi
The Committee PROCEEDING The 3rd International Nursing Conference Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations Jakarta, Indonesia (2019) The Chief : Ns. Tatik Setiarini, S.Kep, MKM Secretary : Ns. IGA Dewi P, M.Kep.Sp.Kep.An Treasurer : Ns. Lince Siringo Ringo, M.Kep, Ns.Sp.Kep.An Logistics Coord. : Buntar Handayani, M.Kep. MM Event Division: 1. Ns. Elfira Rahmawati, M.Kep, Sp.Kep.An 2. Ns. Henny Kusumawati, M.Kep, Sp.Kep.J 3. Ns. Samsinar, S.Kep
Scientific Division: 1. Ns. Yuanita Panma, M.Kep., Sp.Kep.MB 2. Ns. Fitri Annisa, M.Kep., Sp.Kep.An 3. Ns. Sri Hunun, M.Kep., Sp.Kep.J Food Logistics Division: 1. Tini Wartini, S.Kep., M.Kes 2. Reni Kusumawati, SH 3. Ns. Eni Sumartini, M.Kep
Documentation Division: 1. Ns. Sri Atun, M.Kep., Sp.Kep.J
Equipment Division: 1. Ns. Cecep, S.Kep., M.Kep 2. M. Sofyan Alkatiri
Editor:
1. Fitri Annisa, M.Kep., Ns.Sp.Kep.An 2. Yuanita Panma, M.Kep., Ns.Sp.Kep.MB
Reviewer : Ns. Tantut Susanto, M.Kep, Sp.Kep.Kom, Ph.D
ISBN : 978-623-91765-0-1 Cetakan : Pertama, Oktober 2019 Publisher : Penerbit Akper Keris Husada Jakarta JL. Yos Sudarso Komplek Marinir Cilandak Jakarta Selatan Tlp./Fax : 021 7884 5502 Email: info@akperkerishusada.ac.id http://akperkerishusada.ac.id
vii
Conference Schedule
Dates Time Event
June 22th 2019
07.00-08.30 Registration
08.30-09.00 Welcome dance Opening Ceremony Sing “Indonesia Raya” Sing “INNA March” Welcoming Speech from:
1. The Chief of the Committee 2. The Chief Of INNA
09.00-11.15 1. Keynote Speaker 1: Prof Budi Anna Keliat, SKp, MAppSc “Overcoming Psychosocial Impact After Disasater: Guidelines on Mental Health and Psychosocial Support in Emergency Settings”
2. Keynote Speaker 2: Associate Prof. Dr. Orapan Thosingha (Thailand) “Emergency and Disaster Preparedness: Core Competencies for Nurses”
3. Keynote Speaker 3: Masfuri, SKp, MN “Nursing As A Part of Country Global Ratification for Disaster Risk Education”
4. Keynote Speaker 4: Khortimas YOK (Cambodia) “Disaster Nursing Research and Education: Now and The Future”
11.15-12.00 Discussion
12.00-13.00 ISOMA
13.00-16.00 Oral Presentation
16.00-17.00 Discussion
17.00-17.30 Door Prize
viii
Oral Presentation Schedule
Name Title Time
1. Sri Hunun Widiastuti, Achir Yani Hamid, Tuti Nuraini, Novi Helena
The Influence Of Group Supportive Therapy On Family Ability To Train &Quot;Self Care&Quot; Children With Multy Disabled Visually Impaired (MDVI) In SLB G Rawinala Jakarta
13.00-13.30 WIB
2. Ira Sukyati Analysis Of Factors Affecting Young Women Attitudes Toward Female Hygiene And Perineal Hygiene Behavior
13.30-14.00 WIB
3. Ennimay Evaluation Of Nurse Profession Education Program In Stikes Pekanbaru
14.00-14.30 WIB
4. Yenny, Krisna Yetti, Yusron Nasution
Analysis Of The Role Of Peritoneum Characteristics And Glucose Concentration In Drain Volume In CAPD Patients In Cci Cikini Hospital, Jakarta
14.30-15.00 WIB
5. IGA Dewi Purnamawati
The Relationship Of The Mother Education Level With The Growth Of Toddlers In Posyandu Rw 12 Puskesmas Kelurahan Gedong Jakarta Timur
15.00-15.30 WIB
6. Siti Nurhayati Therapeutic Play Optimalization In Pediatric Post Operative Pain With Levine’s Conservation Model Approach
15.30-16.00 WIB
7. Yuanita Panma Factors Affecting Depression In Hemodialysis Patients
16.00-16.30 WIB
8. Labora Sitinjak, Burhanuddin Tola, Mansyur Ramly
The Evaluation Of Indonesian Nurse Competence Standards Adapted With 4.0 Industrial Revolution
16.30-17.00 WIB
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
THE INFLUENCE OF GROUP SUPPORTIVE THERAPY ON
FAMILY ABILITY TO TRAIN"SELF CARE" CHILDREN WITH
MULTY DISABLED VISUALLY IMPAIRED (MDVI)
IN SLB G RAWINALA JAKARTA
Sri Hunun Widiastuti1 , Achir Yani Hamid2 , Tuti Nuraini3 , Novi Helena4
1. Ns. Sri Hunun Widiastuti, M.Kep.Sp.Kep.J: Akademi Perawatan RS PGI Cikni
Email: sri_hunun08@yahoo.com
ABSTRACT
The reactions and perceptions of parents towards their children 's influence affect the way they care for and
have an impact on the level of development and self - care of children. The purpose of this study was to
determine the effect of supportive group therapy on the ability of parents to train self care for double blind
children in SLB G Rawinala East Jakarta. The design used in this study was a quasi experiment pre-post test
with control group with 51 respondents, consisting of 26 respondents for the control group. This therapy is
mutual support therapy, given in 4 sessions and carried out for 6 weeks. Parental cognitive, affective and
psychomotor abilities were analyzed using T test, Chi-Square and simple Linear Regression. The results showed
a significant increase in parental ability after being given therapy in the intervention group.
Keywords: parental ability, supportive group therapy, self, care, double blind.
Background
Mental health is something that is needed by
everyone to produce quality human beings
who are free from mental disorders.
According to Stuart & Laraia (2005), mental
health is a state of well-being characterized
by feelings of happiness, balance, feeling
satisfied, self-achievement and optimism.
Law No. 36 of 2009 concerning mental health
states that mental health efforts are intended
to ensure that everyone can enjoy a healthy
mental life, free from fear, pressure and other
disorders that can interfere with mental
health. These efforts consist of preventive,
promotive, curative, rehabilitation of patients
with mental disorders and psychosocial
problems. Every citizen has the right to get
rights in mental health services which include
equality of treatment in every aspect of life in
various settings in the community.
One community order that has the right to
live a healthy life as stated in the Law, is a
family that has children with special needs,
namely families that have children who are
different from normal children in mental
characteristics, sensory abilities,
communication skills, social behavior or
physical characteristics (Kirk and Gallagher,
1986). Wiliam (in Hallahan & Kauffman,
2006) states that children with special needs
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
are divided into 9 categories, one of which is
severe disabilities which in Indonesian is
called tunamajemuk or tunaganda.
Based on the National Census data (Susenas)
in 2003, people with multiple disabilities
according to the type of disability and types
of regions, rural and urban, were 5.64%.
Persons with multiple disabilities according
to the type and causes of disability are as
follows, congenital birth 57.47%, accidents /
natural disasters / riots 16.13% and because
the largest percentage of causes of disability
is congenital birth, the psychological burden
caused by the presence of children should be
anticipated.
Mangunsong, et al. (1998) defines a disabled
child as a child who has a combination or
combination of two or more physical or
mental disorders or disabilities that require
educational, psychological, medical, social
and vocational services to exceed the
services usually available to children with a
single disability. intended so that children
can develop their abilities optimally as
optimal as possible.
In connection with this research, tunaganda
is more focused on multiple disabilities and
visual impairment (MDVI) or as other
double-blind people, ie someone who has
"limitations" physically, sensory, mentally or
is a combination of their lack of vision,
compared to those who have development
and also normal education (Tilstone et al,
2004).
Families that have children with special
needs, including double-blind children, are
also a community mental health problem.
Parents and all family members tend to react
negatively, such as being shocked, denying,
angry, embarrassed, feeling worthless,
disappointed, sad, grieving, etc. (Zelalem,
2002). The reaction arises because the
response from "loss" of the expectation of the
birth of a baby is normal and the reality is not
the case.
Reactions that arise for the presence of
children with special needs, (Blacher, 2002)
divides it into three stages. First, parents are
said to experience a period of emotional
crisis characterized by shock of regret and
distrust. In the second stage, this reaction is
followed by a period of emotional
irregularities which includes changes in
feelings from anger, guilt, depression,
shame, low self-esteem, rejection of children
and excessive participation. In the third stage
is the stage where they begin to accept their
child. This is the phase of loss.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
This can be understood, because the
condition of children with dual blindness has
several characteristics that require more
attention, among others, the average of them
is slow to learn new skills, difficulties in
applying and maintaining new skills learned,
communication difficulties, physical and
motoric development disorders, ability of
independent care (self care) and repetitive
behavior that is not appropriate (Heward,
1996).
All reactions experienced by parents have an
impact on all children's development. This
happens reciprocally, children experience
developmental delays because parents, are
still in reaction to emotional crises and
emotional irregularities. Parents continue to
be in that position, because they tend to think
that their children will not be able to develop.
According to Warren and Trachtenberg,
(1987, in Zelalem, 2002), perceptions of
parents of their child's special needs
influence how to care for and care for their
children.
Although double blind children have all their
limitations and characteristics, they still need
learning opportunities. Every child, both
"normal" and has special needs, should have
equal opportunities in education and teaching
(Carolina, 2006), even the involvement of
parents becomes greater in education for
their children. This shows that parents play
an important role in the process of growth
and development of their children, especially
in children's independence for daily activities
and self care (Miles% Rigio, 1999).
Keterlibatan orangtua dalam membelajarkan
dan The involvement of parents in teaching
and training their children can be enhanced
by the provision of psychotherapy. Some
psychotherapy that can be given to families
is the Psychotherapy group, the Education
Group, Self Help Group (Videbeck, 2006),
supportive groups (Rockland, 1993 in Stuart,
2005; Teschinsky, 2000 in Videbeck, 2006),
and Multiple Family Therapy (Anderson , et
al., 1986 in Bedell et al., 1997). From a
variety of psychotherapy that are useful in
optimizing family empowerment in training
the self-care abilities of multiple blind
children, supportive groups are an alternative
therapy option aimed at improving the
family's ability to be a support system.
Supportive Group is an organized therapy to
help members exchange experiences on
certain problems in order to improve their
coping. Supportive Group is aimed at
reducing family burden and increasing
family coping and increasing social support
(Fadden, 1998, Witux, et al., 2000 in Chien
et al., 2006).
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
General Purpose: It can be obtained an
overview of the Effects of Group Supportive
Therapy on Family Ability to Train "Self
Care" for Children with Dual Blindness
Research Methods
This study was a quasi experimental study
with a quantitative method using the design
of "Quasi experimental prspost test control
group" with supportive therapy intervention
groups on May 23 to June 10, 2010. The
sampling technique was Concecutive
sampling. The study was conducted to
analyze the improvement of the family's
ability to train child care in comparing
groups who got and who did not receive
supportive group therapy. Respondents
numbered 51 people. The statistical test used
was univariate and bivariate with dependent
analysis and independent sample t-test and
Chi-Square and simple linear regression with
display in the form of tables and frequency
distributions.
Result
The study was conducted at the Bakti Luhur
Jakarta SLB school, of 51 respondents, 26
respondents who received supportive group
therapy and 25 respondents who did not
receive supportive group therapy, the results
of the analysis were as follows:
a. The results of the analysis of family
characteristics showed that a total of 51
parents were included in this study with
an average age of 40.27 years with the
youngest age of 18 years and the oldest
57 years, the most family education was
secondary education (graduating junior
high and high school) 74.3% the family
is working at 83.8% and the level of
family income shows that the largest
proportion of families shows that the
largest proportion is families with
income of more than 1 million, 87.6%
and under 1 million at 12.2%. The most
family relationships with
children are biological parents of 78.4%.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Table 1. Analysis of Group Equality Before Supportive Groups are given
Table 2. Family Ability Analysis in both groups before supportive group therapy
Table 3 Family Capability Analysis before and after therapy for supportive groups
in both groups
Ability Group N Mean SD SE T P Value
Cognitive
(pre Test)
Intervention 26 20,42 1,629 0,139 1,563 0,127
Control 25 19,24 3,431 0,686
Affective
(pre test)
Intervention 26 52,46 3,361 0,659 1,975 0,555
Control 25 50,08 5,049 1,010
Psychomoto
r (Pre test)
Intervention 26 21,69 5,555 1,089 1,059 0,226
Control 25 26,36 3,377 0,675
Group N Mean SD Median Min-Maks 95% CI
Intervention 26 20,42 1,629 21,00 16-23 19,77-21,08
Control 25 19,24 3,431 20,00 6-23 17,82-20,66
Intervention 26 52,46 3,361 53,00 46-59 51,10-53,82
Control 25 50,08 5,049 50,00 41-Be59 48,00-52,16
Intervention 26 21,69 5,555 23,50 9-29 19,45-23,94
Control 25 26,36 3,377 28,00 19-30 24,97-27,75
Ability n Mean SD SE T P-Value
Cognitive
Pre Test 26 20,42 1,629 0,319 -2,403 0,024
Post Test 26 21,62 2,228 0,437
Difference 1,20 0,599 0,118
Affective
Pre Test 26 52,46 3,361 0,6059 -5,318 0,000
Post Test 26 58,31 4,662 0,914
Difference 5,85 1,302 0,255
Psychomotor
Pre Test 26 21,69 5,555 1,089 -5,590 0,000
Post Test 26 26,69 4,269 0,837
Difference 5,00 1,286 0,252
Cognitive
Pre Test 25 19,24 3,431 0,686 2,000 0,057
Post Test 25 19,04 3,446 0,689
Difference -0,20 0,015 0,003
Affective
Pre Test 25 50,08 5,049 1,010 -1,365 0,185
Post Test 25 50,20 5,066 1,013
Difference 0,12 0,017 0,003
Psychomotor
Pre Test 25 26,36 3,377 0,675 1,693 0,103
Post Test 25 26,20 3,317 0,663
Difference -0,16 0,060 0,012
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
b. Equality Test Results of family
characteristics, namely age by using
independent T-Test and family relations,
education, work and income between the
intervention group and the control group,
using the Chi-Square test were equivalent
(p-value> 0.05). In table 1 shows the
equality of family abilities in the
intervention group and the control group.
The following is the result of an analysis of
the family's ability to train self-care of
children before supportive group therapy
shows an average (1) average cognitive
ability of 19.83, standard deviation of 2.025,
minimum score of 6 and maximum value of
23, (2) Affective ability is 51.23 standard
deviation 4.205, minimum value is 41 and
maximum value is 59. For the average
psychomotor ability is 24.03, standard
deviation is 4.47, minimum value is 9 and
maximum value is 30. Minimum value for
cognitive ability is 0 and a maximum value of
23 while the minimum value of affective
ability is 17 and the maximum value is 68, and
for psychomotor abilities the minimum value
is 0 and the maximum value is 30. Results can
be seen in table 2.
The ability of the family to practice self care
for blind blind children, in groups that
received TKS and family groups that did not
receive TKS, before and after TKS was
tested, using dependent paired T-tests, the
results are presented in table 3.
The results of the analysis in Table 3 show
that before and after giving TKS, family
groups that received TKS had a significant
increase in cognitive, affective, and
psychomotor abilities in training self care for
blind blind children. On cognitive abilities
increased significantly by 1.2 with p = 0.024
(ὰ = 0.005). This increase has shown the
average score of cognitive abilities to be
included in the good category (minimum
score of good category = 15.5). Affective
ability also increased significantly by 5.85
with p = 0.000 (ὰ = 0.05). This increase has
shown that the average score of affective
ability is included in the good category
(minimum score of good category = 46.5).
Significant improvement also occurred in
psychomotor abilities which was equal to
5.00 with p = 0,000 (ὰ = 0.05). This increase
has also made the average score of
psychomotor abilities reach the minimum
limit of good categories (minimum score of
good category = 20.5). The results of the
statistical test can be concluded that at alpha
5%, before and after the TKS, there was a
significant increase in the average cognitive,
affective, and psychomotor abilities in the
7
PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
family group who received TKS in training
self care for blind blind children (p < ὰ 0.05)
Family cognitive and psychomotor abilities
in training self care for blind blind children
before and after, in a family group that did
not get TKS occurred a decrease. Cognitive
abilities fell by -0.16 with a decrease of -0.2
with p = 0.057 (ὰ = 0.05). Psychomotor
ability has decreased by -0.16 with p = 0.103
(ὰ = 0.05) while the affective ability of the
family in training self care for children with
dual blindness, before and after, has a
nonsignificant increase of 0.12 with p =
0.185 ( ὰ = 0.05) is the same as (p-value>
0.05). The results of the statistical test can be
concluded that at alpha 5% there was a non-
significant increase in family cognitive
abilities in training self care for double blind
children in the group who did not receive
TKS before post-TKS (P <5 0.05) but there
was a decrease in cognitive abilities and
family psychomotor with (p> ὰ 0.05).
The results of the analysis in Table 3 show
that the difference in increase in cognitive,
affective and psychomotor abilities in the
family group who received TKS was
significantly higher compared to the family
group who did not get TKS (P <5 0.05).
The difference in the ability of the family to
train self-care for dual blind children in the
family group who did not receive TKS was
carried out using the independent T-Test. The
results of the analysis are presented in the
following table 5.10:
Table 4 Analysis of family abilities in
ATG Self Care training after supportive
group therapy in both groups Group N Mean SD SE T P-Value
Intervention 26 21,61 2,228 0,437 3,158 0,003
control 25 19,04 4,336 0,689
Difference 4,21 0,447
Intervention 26 58,31 4,663 0,94 5,940 0,000
control 25 50,20 5,066 1,013
Difference 3,92 3,125
Intervention 26 26,69 4,269 1,026 3,287 0,006
control 25 26,20 3,317 0,837
Difference 14,10 0,336
The results of the analysis in Table 4 show
that there are significantly higher differences
in cognitive, affective, and psychomotor
abilities, in families who received TKS
compared to family groups that did not get
TKS (p <5 0.05), that is, respectively (0.003
; 0,000; 0,006).
Social support given to families through
supportive group therapy, is one of the
interventions to increase the potential of
parents as a source of coping for individuals
and main teachers, for children with special
needs (Miles & Regio, 1999). The family is
the biggest source of development for
children, related to the role of parents to
empower children to do selfcare.
Factors that contribute to the ability of the
family to train self care for blind blind
children, including age, education,
employment, income and family relations
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
and supportive group therapy, were analyzed
using a simple linear regression correlation
test.
The results of the analysis are obtained as
follows: a. the contribution to the cognitive
ability of the family in training self care for
children with multiple visual impairments
shows that there is no contribution to family
characteristics with (p> ὰ 0.05). Obtained the
coefficient of determination (R square) of
0.285, this means that the variable TKS has
the opportunity to increase cognitive abilities
by 28.5% while the rest by other factors.
As for family affective abilities, results were
obtained: there were no family characteristics
(age, occupation, income and family
relations) that contributed to the affective
ability of the family in training self care for
blind blind children, with (p> ὰ 0.05) except
education (p < ὰ 0.05). The coefficient of
determination (R square) is 0.585, this means
that the TKS variable has the opportunity to
increase affective abilities by 58.8% while
the rest is by other factors.
For psychomotor abilities, it shows that there
are no family characteristics (age of family
relationship, education, employment, and
income) that contribute to the family's
psychomotor abilities in training self care for
children with multiple visual impairments
(p> 5 0.05). The value of the coefficient of
determination (R square) is 0.459, this means
that the TKS variable has the opportunity to
increase psychomotor abilities by 45.9%
while the rest is by other factors.
Based on the results of the above analysis it
can be concluded as follows, that supportive
group therapy can be an alternative to
overcome the difficulties of parents in caring
for and training children. Family
characteristic factors, do not affect the ability
of the family to train children, this is in line
with the opinion of Fontaine (2003), that the
main characteristic of the ability of families
to care for their children is the ability to
produce productive stress. This means that
families need psychosocial ventilation
(psychological burden) in training their
children, so parents need to gather with other
parents who have the same child (Mitchel &
Brown, 1991).
According to Seligman & Darling (1997), the
ability of parents to educate, teach and
collaborate with professional staff is strongly
influenced at the stage of parent's denial of
their children with special needs. Warren and
Trachtenberg, 1987 (in Zelalem, 2002),
emphasize that perceptions of parents on
their children's specific needs influence how
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
to care for and care for their children. This is
because the delay in the development of the
child or the independence of the child in
doing self care is determined by the stage of
parent's acceptance of the child.
(Through supportive group therapy, parents
learn from each other together, share
experiences, situations and problems so as to
reduce the psychological burden and improve
individual coping skills to complete
unpleasant experiences, ignorance of
confusion and stressful situations from each
member's condition (Grant Iramu, 1997 in
Hunt, 2004).
Based on the above, the researchers argue
that the ability of families to train children is
not determined by family characteristics (not
contributing), but is determined by a sense of
comfort in accepting children's limitations,
which in turn motivates parents to teach
children about self care. Berdasarkan hal
tersebut diatas, peneliti berpendapat bahwa
kemampuan keluarga melatih anak tidak
ditentukan oleh karakteristik keluarga (tidak
berkontribusi), tetapi ditentukan oleh rasa
nyaman menerima keterbatasan anak, yang
selanjutnya memotivasi orangtua untuk
membelajarkan anak dalam hal self care.
Conclusion
a. Family characteristics that have double
blind children on average are 40.3 years
old. The family group that received TSK
averaged 42.54 years old while the family
group that did not receive TSK averaged
38 years.
b. Respondent characteristics for the
intervention group and the control group
and the ability of parents to provide self
care training, before getting group
supportive therapy increased
significantly. In the intervention group.
c. The effect of group supportive therapy on
the ability of parents to provide self care
exercises before and after group
supportive therapy increased
significantly. In the intervention group.
d. The increase in the ability of parents to
provide self care training to parents who
received supportive group therapy was
significantly higher compared to groups
that did not receive supportive group
therapy significantly higher than those
who did not receive supportive group
therapy.
e. Supportive group therapy has the
opportunity to increase cognitive abilities
by 28.5%, and improve affective abilities
by 58.5% and psychomotor abilities by
45.9% after being controlled by other
factors.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
f. The ability of parents to provide self care
training is not influenced by family
characteristics, namely: age, education,
work, income and family relationships.
Suggestions
Related to the conclusions of the research
results, there are several suggestions,
namely:
a. An organization organization needs to be
established that allows the soul nursing
service area to expand in the world of
education, especially SLB. Follow-up is
coordination between the Ministry of
National Education (Directory of
Special Education) with the Provincial
Health Office through SLB education
institutions and mental nursing.
b. The Ministry of Health of the Republic
of Indonesia sets out a policy to improve
health promotion efforts in health
promotion groups in healthy groups
based on community according to the
mental health issue in the world, namely
community empowerment.
Understanding of community is
understood together as a large, formal
and informal area.c. Organisasi profesi
menetapkan terapi suportif kelompok
sebagai salah satu kompetensi dari
perawat spesialis keperawatan jiwa.
c. Build networks to collaborate with
schools in conducting continuous
training to parents and it is hoped that
this will become a pilot project for
similar schools. It can be started from
school insulated with SLB G Rawinala
and educational institutions of the
Faculty of Nursing.
d. Nursing tertiary education should
develop therapy for healthy groups in
order to improve family capacity in a
variety of social settings, including the
world of education.
e. Evidence based in developing
techniques for the provision of mental
nursing care for all health service
settings in the application of group
supportive therapy for families who have
children with special needs, maybe even
other therapies.
f. The need for further research is carried
out on the wider community, for the use
of other specialist therapies.
g. Further research is needed for the role of
other parents in children with special
needs using the same or different
methodologies.i. Perlu diteliti lebih
lanjut tentang faktor perancu lain,
misalnya usia anak karena ada pendapat
semakin dini usia anak dilatih, semakin
banyak kesempatan mengembangkan
potensinya.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
h. Need to improve the implementation of
therapy; module or evaluation tool.
i. The instruments that have been carried
out in this study should be used as a
measurement tool and refined for the
same therapy.
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Stuart, G.W & Layton, L., Anderson, A.,
Gerrish, R., Morgan, J., & Williams, A.
(2004). Child development and
teaching pupils with special
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educational needs. London & New
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Zelalem, F. (2002). The attitudes of
parents towards their blind children : a
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Videbeck, S.L .(2006). Psyhiatric mental
health nursing. (3rd Ed). Philadelphia:
Lippincott Williams& Wilkins.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
ANALYSIS OF FACTORS AFFECTING YOUNG WOMEN
ATTITUDES TOWARD FEMALE HYGIENE AND PERINEAL
HYGIENE BEHAVIOR
Ira Sukyati
Lecturer AKPER Pasar Rebo Jl. Tanah Merdeka No. 16, 17, 18 Jakarta Timur
E-mail: sukyatiira@gmail.com
ABSTRACT
Adolescence is a transition from childhood to adult life, at this time is the beginning of the development of puberty,
where menstruation occurs. Menstruation is considered a natural phenomenon that usually occurs during the
teenage stagewhich starts at the age of 12 years. The problem that is often experienced in this period is teenagers
are often reluctant to discuss menstrual problems with their parents, friend or anyone, this causes disregard for
clean health practices during menstruation.By getting good knowledge and knowing the practices during
menstruation. By getting good knowledge and knowing the practice of maintaining hygiene during menstruation
will avoid the risk of productive tract infections this study aim to analyze the factors that influence attituuted towards
hygiene of the female area and the behavior of performing perineal hygiene during menstruation. This study uses
across sectional research design. The number of respondent in this study uses a cross sectional research design.
The number of respondents in this study were 100 teenagers who have an age range of 17 -20 years who have
experienced menstruation. The results of this study found that maternal work is the factor that most influences
adolescent attitudes toward cleanliness of the female area and the behavior of performing perineal hygiene during
menstruation.This helps teens prevent infection as early as possible and improve reproductive health in the female
reproductive organs.
Keywords: Menstruation, reproductive organ infections, adolescents.
INTRODUCTION
Menstruation thus reflects the start of the
puberty period in women. Young women
who have experienced menstruation
experience different changes that occur in it,
both physically and psychologically. The
problem that is often experienced in this
period is that teenagers are often reluctant to
discuss menstrual problems with their
parents, friends or anyone, this causes
disregard for clean health practices during
menstruation, by getting good knowledge
and knowing practices to maintain
cleanliness during menstruation will avoid
risk of reproductive tract infections
(Logeswari, 2015). According to UNESCO,
(2014) Several factors are needed so that
young women who are just menstruating can
practice their hygiene properly, namely
having accurate knowledge, the availability
of health workers or professional teachers,
the availability of facilities for
environmental hygiene and sanitation such
as the availability of sufficient water and
trash bins to dispose of sanitary pads, the
availability of safe sanitary pads. According
to Sharvanan (2016) in his research stated,
puberty is a challenge for young women to
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
be able to prepare for changes that occur in
the body. In some parts of the world it is
found that adolescents do not know what to
do when menarche occurs, this will have a
negative impact on physical and emotional
development that causes a decrease in self-
esteem, while the physical impact caused in
research conducted by Kanal et al (2016),
adolescents who do not prepare for the
changes that occur, do not know how to do
perineal hygiene properly so that they
experience reproductive tract infections by
2.7%. Therefore. In Turkey, the majority of
teens said that the majority of menstruation
education should be provided by health
professionals (54.4%) compared to families
(30.0%) or teachers (5.9%). Most teenagers
do not have good knowledge about
menstruation (Shah et al. 2013).
Based on a brief description in the
background of the problem above, the
researcher formulated a research question,
namely "What factors most influence the
attitudes of young women towards the
cleanliness of the female area and the
behavior of performing perineal hygiene
during menstruation.
METHOD
The target population of this study are all
teenagers who are part of the student rebo
market, adolescents who have experienced
menstruation. Has an age range of 17-20
years. This study uses several
questionnaires, namely Questionnaire A
containing the characteristics of
respondents. Questionnaire B contains
adolescent knowledge about healthy
menstruation, and questionnaire C about the
behavior of adolescents performing perineal
hygiene during menstruation. This is in
accordance with the objectives in this study
to find out the factors that most influence the
attitudes and behavior of adolescents in
maintaining the cleanliness of the female
area during menstruation. The questionnaire
has been used in research (Prajayanti 2009).
The design in this study is an analytic
descriptive design to evaluate the
characteristics of respondents and conduct
the Kolmogorov-Smirnov test to determine
the normality test of the data. Multivariate
analysis using linear regression is used to
determine the factors that most influence the
occurrence of adolescent attitudes and
behavior in maintaining the cleanliness of
the female area during menstruation.
RESEARCH RESULT
Characteristics of Respondents for
Gynecologic Cancer Survivors
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Based on table 1 1, this study shows that
respondents have the age category of late
adolescents aged from 18 to 20 years
(100%), have high knowledge (84%), with
menarce age of most early adolescents, 11 to
14 years (98%), most had a regular
menstrual history of 2 to 6 days (79%) and
obtained sources of information related to
menstruation mostly from mothers or sisters
(53%), with most maternal education having
a high education level of 78% and work as
much as 61% as housewives (78.9%), have
higher education (high school - tertiary
institutions) by 60%.
Table 1. Distribution of Characteristics of Teenage Respondents who have received
Menstruation in the Akademi Keperawatan Pasar Rebo in 2018 (n = 100)
Variabel Kategori Frekuensi Persentase (%)
Age Middle Age Teenagers (15-17
years
Late teens (18-20 years)
0
100
0
100
Education Higher Education (SMA-PT) 78 22.0
Low Education 22 78
Employment Works 61 61.0
Housewife 39 39.0
Length Irreguler (> 6 hari) 21 21
menstruation Reguler( < 6 hari) 79 79
Adolescence (15-7 th) 2 2
menarche Intermediate Teenager
(11-14 th)
98 98
Sourches Internal(siblingpr,mother) 47 47
Information External(friend,print
media, teacher)
53 53
knowledge High 84 84
Low 16 16
Based on table 2 above, a bivariate test has
been carried out with the results that there is
a p-value <0.25, namely occupation and
mother's education and age of menarce and
adolescent knowledge.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Table 2 Relationship of Respondent Characteristics with Attitudes towards the cleanliness of
femininity in AKPER Pasar Rebo in 2018 (n = 100)
Variabel Mean SD SE P value CI 95%
Employment
Housewife 78.74 5.88 0.94 0.069 -0.14-
3.76
Works 76.93 3.95 0.50 0.096 65.94-
77.69
Education
High 77.91 5.09 0.57 0.297 -1.09-3.55
Low 76.68 3.82 0.81 0.225 -0.78-
3.24
Length Menstruation
Reguler 77.58 5.02 0.56 0.819 -2.65-2.10
Irreguler
77.85 4.28 0.93 0.803 -2.48-1.93
Menarche
Adolescence 1.50 4.84 0.48 0.225
1.31-1.69
Intermediate Teenager 1.37 4.94 0.70 0.438 1.23-1.51
Knowledge
High
Low
76,29
75,75
5,39
5,47
1,34
0,59
0,07
0,08
-2.22-1.63
-4,92-0,27
-4,97-0,32
Based on table 3 after the bivariate test, p-
value <0.25 was not found, so the mother's
work variable was made one of the variables
that could represent variables for the next
stage, namely mother's work, because the p-
value was close to 0.25.
Table 3 Relationship of Respondent Characteristics with perineal hygiene behavior during
menstruation at the Rebo Market AKPER 2018 (n = 100)
Variabel Mean SD SE P value CI 95%
Employment
Housewife 76.89 6.00 0.96 0.315 -1.08-3.34
Works 75.77 5.04 0.64 0.334 -1.18-3.43
Education High 76.19 5.64 0.57 0.603 -2.65-2.10
Low 76.27 4.75 0.81 0.588 -2.48- 1.93
Length Menstruation
Reguler 77.58 5.02 0.56 0.819 -3.35-1.96
Irreguler
77.85 4.28 0.93 0.803 -3.29-1.89
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Menarche
Early Teens 76.20 5.49 0.55 0.940
-8.04-7.44
Intermediate
Knowledge
High
Low
76.50
75,75
76,29
0.70
5.39
5.47
0.50
1,34
0,59
0.709
0,71
0,71
-2.22-1.63
-3,50-2,41
-3,61-2,51
Table 4 Results of the Characteristics of Respondents Selection of with Attitudes towards the
cleanliness of the female area and the behavior of perineal hygiene during menstruation in
AKPER Pasar Rebo (2018).
Variable attitude Behaviour
p- valeu p-value
Employment
Housewife 0.069 0.315
Works 0.096 0.334
Education
High
Low
0.297
0.225
Menarche
Early Teens 0.225
Middle 0.438
Pengetahuan
Tinggi 0,07
Rendah 0.08
In table 4 shows the variables that may be included in multivariate modeling.
Tabel 5.5 Pemodelan Multivariat Sikap Remaja
Model Coefficients B P value ( R2) R
Model 1
constant 70,59 0.09 0,302
Employment
Age of Menarche
1,9
5,3
0.05
0.13
Resources
Knowledge
-1.0
2,0
0.25
0,13
Model 2
constant 70,59 0.078 0,280
Age of Menarche 4,7 0.17
Mother’s Job
Knowledge
1,9
1,9
0.05
0,14
Model 3 0,245
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Model Coefficients B P value ( R2) R
constant 75,15 0.06
Employment
Knowledge
1.69
2,16
0.08
0,09
Model 4
Constant
Employment
76,93
1,80
0,06
0,33
0,183
DISCUSSION
In this study shows that the average
respondent most of them are those who have
the age category of late adolescents aged
from 18 to 20 years, have high knowledge
(84%), with the age of menarce most of the
early teens namely 11 to 14 years ( 98%),
most had a regular menstrual history of 2 to
6 days (79%) and obtained sources of
information related to menstruation mostly
from mothers or sisters (53%), with most
maternal education having a high education
level of 78% and work as much as 61% as
housewives (78.9%), have higher education
(high school - tertiary institutions) by 60%.
The results of this study are in line with the
results of research conducted by Susanti et
al (2015), which is obtained that the
frequency distribution of respondents'
knowledge which is the most
knowledgeable is around 52.9%. The results
of research that has been done suryati
(2012), namely the characteristics of
mother's education have higher education
mostly 66.7%, most mothers work not
working, most respondents have high
knowledge 53.2%. According to Yanti, et al
(2014), it was found that there were
characteristics of respondents that most of
them had a high level of knowledge about
menstruation by 57.1% and the majority of
respondents aged 16 years were 47.1%.
While based on research conducted by
Novitasari, et al (2014). Most have good
knowledge about menstruation, while the
majority of information sources are obtained
from parents.
The three studies are based on the
characteristics of young women respondents
in the above studies that have a match in the
level of knowledge, it is because most of the
respondents were high school educated so
that the information obtained is the same.
Sources of information can stimulate
knowledge about menstruation, but in
receiving information respondents have
different perceptions so that it will affect the
level of knowledge that only merely knows,
understands or has a wrong perception. So
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
even though information has been freely
accessed, but whether or not knowledge
depends on each individual in attention,
understanding and discovery of information
received. (sermon 2014). Based on the
above research, respondents are in the
category of middle to late adolescents,
which means that the increase in
respondents' knowledge is also influenced
by age, the more age the better the ability to
catch and think patterns of a person so that
the knowledge gained is getting better. The
biggest source of information is obtained
from parents. Communication between
parents, especially mothers and children is
at risk of providing information that is better
understood by children so that it will be able
to increase children's knowledge.
Factors that Most Influence adolescent
attitudes towards cleanliness of the
female area and behavior of perineal
hygiene during menstruation.
The results of this study can be found that
maternal work is the most influencing factor
in adolescent attitudes towards cleanliness
of the female area and the behavior of
perineal hygiene during menstruation. The
results of this study are in line with
Purnamasari and Notobroto (2015), that
there are 75% of respondents working
women who have an impact on the source of
information received related to good
attitudes and behaviors towards the
cleanliness of the female area when
menstruation increases. Support information
provided to young women includes what is
meant by menstruation, how to practice
hygiene behavior during menstruation so
that the support provided will foster
adolescent self-confidence because of the
changes that occur and help prevent health
problems during menstruation (Sommer et
al., 2015). Other studies that are in line are,
according to Mandasari, (2009) found that
most respondents in this study are working
mothers who have an impact that
adolescents have a good role because there
is more information about menstruation,
because working mothers tend to be easier
to get access better for various information
including health. According to Sooki et.al
(2016), mothers are the most recent source
of information about the menstrual process
by 60%.
In principle, the role of mothers in preparing
teenagers with menstruation and various
problems is very important. The role of the
mother includes as educators, drivers, role
models, supervisors, friends, inspiration,
counselors and communicators. The role of
the mother is very important in the process
of growth and development of children,
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
especially during adolescence, if the mother
does not have adequate sources of
information about menstruation, it may
cause health and welfare problems such as
infections in the reproductive tract.
Research Limitations
Respondents' backgrounds that have the
same thing are teenagers who are continuing
their studies at AKPER Pasar Rebo so that
they do not have different respondent
characteristics and this results in research
results that are very difficult to generalize
elsewhere.
6.3 Implications of Research Results
The results of this study have implications
for nursing services, especially maternity
nursing, namely the need for training in
mothers about preparing teenagers at
puberty (especially with regard to
menstruation). Puberty in adolescence is the
most important period. Puberty causes
physiological, biological and psychological
changes and this period is very important to
improve reproductive health, so that there is
no disruption by planning the training of
mothers who have young women by
involving groups in the community,
religious groups can make the first step in
health services for improve adolescent
reproductive health (Naghshineh, 2017).
This helps teens reduce PMS (premenstrual
syndrome) and prevent infections and
improve adolescent reproductive health.
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kesehatan Indonesia 2012: Kesehatan
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SMA Muhammadiyah 7, Yogyakarta.
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Perambalur District. Dissertation.
Mandasari dan Anjarwati (2009). Gambaran
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Menarche pada Siswi MTs
Muhammadiyah 2 Muntilan
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Karya Tulis Ilmiah tidak
dipublikasikan.
Naghshineh, et al. (2017). Knowledge of
Mothers about Puberty Health In Gils
: A Survey In the Center Of Iran.
International Journal Of Travel
Medicine and Global Health. 2017;
5(3); 102-106
Putri R.H (2016). Hubungan Antara
Kebutuhan pelayanan Suportif
Dengan Kualitas Hidup Pasien
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Terapi. Universitas Indonesia
Potter, P & Perry, A. (2005). Buku Ajar
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Proses dan Praktik. Edisi 4. Jakarata :
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Purnamasari dan Notobroto (2015).
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kependudukan, Vol. 4, No. 2 Desember 2015:
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Rahmatika, (2010). Pengaruh Pengetahuan
Dan Menstruasi Sikap Tentang
Personal Hygiene Menstruasi
Terhadap Tindakan Personal Hygiene
Remaja Puteri Pada Saat Menstruasi
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Shah SP, Nair R, Shah PP, Modi DK, Desai
SA, Desai L (2013) Improving quality
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Sriniva. (2017). Menstrual Hygiene Among
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
EVALUATION OF NURSE PROFESSION EDUCATION PROGRAM IN
STIKES PEKANBARU
Ennimay
Ennimay, S.Kp., M.Kes : Universitas Negeri Jakarta ; STIKes Hang Tuah Pekanbaru
E-mail : Ennimay_im16s3@mahasiswa.unj.ac.id ; Ennimay@yahoo.com
ABSTRACT
Introduction: Professional nursing personnel are needed to meet the demands of the community for nursing care
services. Health colleges are required to be able to produce competent medical graduates. This study aims to
evaluate the implementation of Nurse professional education programs at Pekanbaru STIKes. Method: This study
used a research design evaluation model Context, Input, Process, Product. The partisipant were 16 person which
taken by purposive sampling. Data collecting used focused group discussion and in depth-interview. Data analyze
used data comparison with evaluation criteria. Results: Nurse professional education goals and planning have been
made according to Nurse professional education curriculum and has been carried out in accordance with the
regulations. The implementation was used the preceptorship model. Otherwise, Nurse graduates who pass the
competency test nationally are still below 100%. Conclusion there were still obstacles in the guidance process on
practical setting. Recomendation: improvements were needed in the guidance process.
Keywords: Evaluation program, education, nurse profession, preceptor, competency test
INTRODUCTION
The amount of public demand for quality
health services requires professional nursing
staff to produce competent and professional
nurse graduates, each college is required to
be able to produce graduates who are in
accordance with market needs, one of which
is curriculum development. Research
(Zapko, Ferranto, Blasiman, & Shelestak,
2018) concluded that with serial simulations
and obtaining simulation experience more
than once in a row are methods that valuable
for clinical instruction. If implemented
properly, simulations can improve student
satisfaction and confidence. Research
(Zieber & Sedgewick, 2018) on
Competence, confidence and memory recall
in nursing students using a mixed method
research design states that interventions are
effective in enhancing both their perceptions
of competence and confidence immediately
within a period of three months, the memory
capacity of knowledge also statistically
significant over a period of three months.
Nurses as a profession that carries out
nursing care and practice, with the
qualifications required to have a Registration
Certificate (STR) as written evidence and
official records issued by the Indonesian
Health Personnel Council (MTKI). Based on
the data obtained from the 4 STIKes in
Pekanbaru, it can be concluded that from a
total of 589 competency test participants
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
from 2014 to 2017 it was found that the
average graduation rate = 57.3%, and those
who did not graduate = 42.7%. This shows
that the graduation results are still low.
Where the number of students who do not
pass is quite high and can cause high
unemployment due to not having a
competency test certificate which is a
requirement to obtain a nurse registration
certificate (STR). The high rate of disability
is closely related to the performance of the
learning system and the quality of graduates.
Many participants competed in the National
Professional Education Program competency
test and especially in Pekanbaru who were
incompetent, namely the passing of
competency test participants as much as
57%. So it is still questionable how the
quality of graduate nurses in Indonesia and
the implementation of the Nurse Professional
Education Program at STIKes in Pekanbaru
city.
Competency test is the process of measuring
the knowledge, skills and behavior of
students in universities that hold higher
education in health in accordance with the
Minister of Education and Culture
Regulation Number 12 of 2016 concerning
Procedures for Implementing Competency
Test for Health Sector Students, Ministry of
Research, Technology and Higher Education
(Kemenristekdikti, 2017). According to
(HTP, 2017) the implementation is carried
out by the Organizing Committee
determined through the Decree of the
Minister of Research, Technology and
Higher Education. This exam is intended to
achieve competency standards of graduates
who meet work competency standards and
the National Competency Test can be used as
part of educational quality assurance. health
in Indonesia. So from that starting in 2014,
2015, 2016 and 2017 there have been four
consecutive years of professional
proficiency test with CBT (Computer Based
Test) system.
The research conducted by (Kholifa &
Kusumawati, 2016) on Nurse graduate
students who took the competency test found
that the obstacle of graduates in facing
competency tests was due to confusion and
lack of clinical experience, increased
anxiety, hesitation when answering
questions and problematic computer mouse
used. answering questions, this resulted in
many Nurse students not passing the
competency test. Research (Abdillah, 2016)
said there was a relationship between try out,
GPA, learning style and the value/
graduation rate of Indonesian nurse
competency test results. This study aims to
evaluate the implementation of professional
education programs for nurses in
Pekanbaru's STIKes. Novelty in this study
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
with the CIPP evaluation model has never
been done in Indonesia.
METHOD
The study used a CIPP evaluation model
design Context, Input, Process, Product
(CIPP) in Pekanbaru STIKes. The object of
evaluation is the Professional Nurse
Education Program with subjects includes
clinical preceptors, academic preceptors,
nurse graduates. The research instrument in
this study used guidelines for in-depth
interviews, questionnaires and Focus Group
Discussion (FGD). Where the instruments
made refer to the CIPP model which
includes context, input, process, and product
and outcome to assess the evaluation of
professional education programs in
Pekanbaru STIKes. The technique of data
analysis used data comparative by
evaluation criteria. This research was passed
the ethical clearance reviewed by Ethical
Committee of STIKes Hang Tuah
Pekanbaru.
RESULT
The results of the study Evaluation of the
Nurse Profession Education Program in
Pekanbaru STIKes using the CIPP Model
(Contexs, Inputs, Process Products) with the
object of research is the Nurse professional
education program in Pekanbaru. There were
four STIKes which were the subjects of the
study, namely HTP STIKes, PN STIKes, AI
STIKes and PMC STIKes.
1. Context Evaluation Results
Sub-focus 1. Objectives of competent
professional Nurse education programs
The context evaluation results focus on
how to achieve the goals of the Nurse
professional education program related
to the rules underlying the
implementation of education, curriculum
standards used, the process of preparing
for the implementation of educational
programs and processes in setting
educational goals. The program
objectives of each institution are made
according to the needs of nursing
services where each institution describes
them in accordance with the Tri Dharma
of higher education and as a guide in
making Nurse education curriculum. The
regulations that underlie the
implementation of educational programs
and curriculum standards used are
curriculums set by the DIKTI (Director
General of Higher Education) and the
Association of Indonesian Nurse
Education Institutions (AIPNI). The four
institutions use the same national
standards in designing the making of the
Nurse professional education
curriculum. The curriculum used is a
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
curriculum that was established by
AIPNI in 2009 which was later updated
to become the 2014 National
Qualifications Framework (KKNI)
curriculum which was approved by the
DIKTI in 2015 and applied in the 2016
school year.
2. Input Evaluation Results
Sub-focus 2: Planning of the Nurse
professional education program
learning system at Pekanbaru STIKes
Input evaluation aims to find out the
planning of the Nurse professional
education program learning system. The
evaluation results obtained were that the
four institutions had formulated a
learning system plan on the part of the
study program. The plan was submitted
to the foundation and the study program
could only carry out the learning process
after obtaining approval from the
foundation. All institutions involved in
this research are private institutions
under the auspices of the foundation. In
order to meet the resource requirements
in conducting professional education for
Nurse, the profession coordinator will
appoint a course coordinator who is
responsible for the implementation of
professional practice, the course
coordinator appoints academic
preceptors who are in accordance with
their scientific fields. The clinic
preceptor is appointed by the hospital
management with a decree from the
Director with minimum criteria is Nurse
education level and have a minimum of
two years work experience and have a
preceptors certificate.
Learning system planning is made
referring to the availability of resources,
starting from the number of students who
re-register, then the study program
makes proposals about the funding
needed for the operation of educational
programs submitted to the foundation.
The profession coordinator with the team
designed the Clinical practice setting
where students practice and make MoUs
with the clinical praactice institutions,
according to the guidelines of
professional practice.
Academic and clinical preceptors
collaborate in guiding students by
dividing the guidance schedule within 1
week 3 days of academic preseptors and
3 days of clinical preseptors because
there are still limited resources of
lecturers. Academic preceptors
education for at least magister nursing
and clinical preceptors is minimum
Nurse profession (bachelor degree) with
a minimum of 2 years experience).
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
The recruitment process of professional
education program students is students
who have completed their undergraduate
in bachelor degree nursing education,
coming from their own institutions but
two of the participants stated that the
institution accepts students from outside.
Students register again, then students are
registered again at Ministry of Research
and Technology in Higher Education to
obtain the Student Identification Number
(New NIM. Requirements must be
undergraduate nursing. Students make
statements following the profession for 1
year.
Each institution has an organizational
structure and the majority of its
organizational structure forms are line
and functional organizational structures.
This can be seen from the structure of the
study program chairman, secretary,
treasurer, coordinator of professional
education programs nurses, subject
coordinators and preceptors.
The profession coordinator made a
proposal to prepare the budget needed in
the implementation of the professional
education process. The resource of
budget comes from students and approve
to the foundation through the chair of
STIKes. The head of the study
program/profession coordinator appoints
the course coordinator, the profession
coordinator with the team to design
where the practice land is, which MoU
will be developed, determine the
schedule, and make the budget plan. The
clinical practice of the Nurse profession
refers to the guidance of the Nurse
profession clinical practice that has been
made by each institution, then prepares
for its implementation. Institutional
support is given by giving permission to
all Nurse education institutions in
Pekanbaru to carry out professional
practice by making an MoU between
educational institutions and the clinisal
practice institutions.
3. Results of Process Evaluation
Sub-focus 3. Implementation of Nurse
professional education learning
program at STIKes Pekanbaru.
The implementation of the Nurse
professional education program is in
accordance with the guidelines of
professional practice made by each
institution with the collaboration
between the academic preseptor and the
clinical preseptor regarding learning
outcomes to obtain student competency.
Academic preceptors and clinical
preseptors collaborate on clinical
practice in the guidance process, related
to the achievement of learning to be
achieved when students practice. Before
students begin to practice a perception
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
equation between academic and clinical
preceptors is held, when the perception
equation has been prepared a guidebook
related to the schedule and activities to be
carried out, as well as the standard of
assessment. But at the time of the same
perception when there is input from the
clinical practice related to the results of
the previous evaluation, we will make
improvements. Students prior to going to
the ward held orientation and
socialization about infection prevention
and control in the ward.
In the guidance process, it was found a
problem where the academic preseptor
could not come to guide according to an
agreed schedule and the clinical
preseptor could not guide students
because of his busy life as head of the
ward and team leader. To find out the
results of student competency
achievement during the practice of Nurse
profession at the end of the stase,
students will be evaluated. The form of
evaluation that has been carried out by
the four institutions focuses on the ability
of students to carry out nursing care for a
case. The evaluation methods carried out
included the Direct Observational
Procedural Skill Test (DOPS), Student
Oral Case Analysis (SOCA), managed
case reports, mini seminars and
counseling presentations. In addition to
cognitive and psychomotor aspects, the
assessment also includes affective
aspects, where students' soft skills while
practicing nurses in the room are also
assessed by preceptors, both clinical
presidents and academic preceptors.
After the guiding process of clinical
preceptors and academic presidents
conducts evaluations of student
competency achievements at the end of
the stase before students move rooms by
holding DOPS examinations, case
seminars, health education, to get
feedback on student learning outcomes.
If students fail to be given the
opportunity to repeat by looking for their
own cases. The final assessment is given
according to the criteria that have a
percentage in the practice manual. If
there is a failure, students are given the
opportunity to repeat until their
competence is achieved. Then each
clinical preceptor will submit an
evaluation and give the evaluation report
of each student at the end of the stase to
the profession coordinator in accordance
with the evaluation format in the practice
manual for the Nurse profession.
Complaints from students also have
academic presidents who have never
come to guide the hospital. The
expectations of students to improve their
competencies so that those who become
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
clinical preceptors are nurse
practitioners, for the assessment of
actions taken by students should involve
the nurse practitioners, at the beginning
of the students practice so that academic
preseptors are also in the ward.
4. Results of Product Evaluation
Sub-focus 4. Achieving the results of the
Nurse professional education program
at STIKes Pekanbaru.
Evaluation results conducted by
researchers on professional professors in
Pekanbaru, namely Stikes PN, Stikes
PMC, Stikes HTP, and Stikes AI
conducted by researchers on 589
competency test participants held from
2014 to 2017 found that participants who
passed the test National competence on
average is as much as 57.3%, so there are
42.7% who do not pass the competency
test. This is not in accordance with the
target of graduates who are supposed to
be 100%. The low graduation rate of the
Nurse national competency exam has an
impact on the process of obtaining
registration letters (STR) Nurse which is
a requirement to get a job in a health
service facility because the competency
test certificate is a requirement to obtain
a STR.
5. Outcome Evaluation Results
Sub-focus 5: Impact of Nurse
professional education graduates
Based on the data from the tracer study
obtained from the one of STIKes related
to the length of time to get a job in a
branch less than three months of
graduation, there was an increase from
2014 to 2017. For a 3-12 month waiting
period there was a decrease in the
percentage of graduates. This is because
students have got jobs faster. The data
from the tracer study obtained from the
other STIKes is that the average waiting
time for graduates to work is around
three to four months from 2014-2017.
The majority of graduates from both
institutions work in private institutions.
Based on the results of discussion of
researchers with nursing managers from
well-known private hospitals in the city
of Pekanbaru, there have been several
graduates from one of STIKes who were
trusted as head of the ward and team of
managers, and some were sent to follow
advanced skills training, such as
hemodialysis nursing training, ICU,
emergency, this is given as a reward for
their achievements during work. In
addition, the nursing manager also stated
that he was happy to receive graduates
from one of STIKes because they had
better ethics, while skills could be honed
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
according to the length of work
experience. Not all Nurse graduates work
in Pekanbaru, some graduates return to
work in regencies that are spread in Riau
Province.
DISCUSSION
1. Context Aspects (Context)
Sub-focus 1. Objectives of professional
education programs Nurse: Nurse
professional graduates who are
competent.
The results of the evaluation and analysis
on the aspect of the context, it was found
that the basis for the implementation of
educational programs and curriculum
standards used was the curriculum
established by DIKTI and AIPNI. Each
institution has its own characteristics in
accordance with the university's vision
and mission. Institutional curriculum
development has followed the rules of
competency-based curriculum design
and curriculum referring to the AIPNI
and KKNI.
The program's objectives are in
accordance with Minister of Research
and Technology of Higher Education
Regulation No. 44 of 2015 concerning
the National Standards for Higher
Education and Minister of Research and
Technology of Higher Education
Regulation No. 12 of 2016 concerning
procedures for implementing
competency tests for health sector
students. Relevance to the target, where
the goal is to produce graduates with
GPA ≥ 3 and get a professional
certificate when graduating, this is in
accordance with the Minister of Research
and Technology Regulation No. 44 of
2015 article 5. The duration of study for
professional programs is one to two years
after completing the undergraduate
program, this is in accordance with the
curriculum guidelines referring to the
2014 AIPNI KKNI. The other target
clarity is that professional graduates must
be able to obtain competency certificates.
The process of formulating professional
education objectives involves several
parties, including Nurse practitioners
who also act as stakeholders, foundations
and experts. The goal is to involve
stakeholders as well as evaluate
programs that have been implemented
previously, provide input for program
improvement and also know the needs of
the field. The five principles in setting
effective goals according to Locke and
Latham's in (Pawar, 2017) are the clarity
of goals must be specific and clear,
challenging, easy and boring goals are
demotivating but maintaining a realistic
balance, do not expect everyone in the
team to achieve goals (to spin straw into
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
gold), commitment: your employees
must understand and buy goals from the
set, provide feedback through the entire
process. this helps to keep the goals on
track, the complexity of the task: think
about the time scale and detail the
process into sub-destinations by
regularly reviewing. Goals must be
clearly measurable, unambiguous, and
there is a period of time. People judge
goals based on the importance of an
anticipated achievement. Objectives
must be understood to be effective. There
is feedback in order to clarify
expectations, adjust the difficulty of the
target and get recognition. Give people
enough time to fulfill the objectives,
considering the complexity of the task.
The objectives of professional education
programs that have been made by each
institution having the same basis or
reference and are of a national nature.
2. Input Aspects
Sub-focus 2. Planning learning systems
for professional Nurse education
programs at Stikes Kota Pekanbaru.
Strategic planning is the blue print of an
organization that is used to build future
success. An inclusive process and
considering current and future trends and
innovations to organize activities that are
needed sustainably, expanding or
developing to remain competitive in the
health care industry (Rousell L., Thomas
PL & Harris JL, 2016) . This statement is
in line with the opinion (Rowland and
Rawland, 2002) that planning begins
with the philosophy of nursing. They
make this planning phase as a stage:
determine goals, collect data, develop
action plans, develop actions, and
evaluate. The input aspect discusses the
planning of the Nurse professional
education program learning system. The
results of the evaluation on the input
aspect are that all institutions have
guidebooks that become references in the
implementation of professional
education programs. The input aspect
also discusses the availability of
resources to support the implementation
of the Nurse professional education
program. The resources needed start
from human resources who will act as a
preseptor, both academic preceptors and
clinical preceptors. The recruitment of
professional program lecturers has
fulfilled the qualifications set in
accordance with the Minister of Research
and Technology regulations No. 44 of
2015, namely having a minimum
education in a nursing master with a
minimum of two years work experience.
The recruitment of clinical preseptors has
qualifications based on PP no.19 of 2005
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
concerning national education standards,
namely having an equivalent level of
education or above from students and
having become clinical advisers for at
least 2 years.
In addition to the receptors, students also
have qualifications in the recruitment
process. The main requirements of
students in the professional program are
to have passed the nursing degree
program as set out in the 2015 KKNI. All
institutions involved have a line and
functional organizational structure. Line
and functional organizational structures
have vertical and horizontal relationships
that must complement each other to
create good coordination within an
organization (Swansburg dan
Swansburg, 2015).
The draft budget for the Nurse
professional education program has been
tailored to the needs of each semester.
According to Government Regulation
No. 19 year 2005 related to financing
standards, in article 62 there are three
types of costs, namely investment costs,
operating costs and personal costs.
Investment costs include the cost of
providing facilities and infrastructure,
the development of human resources and
permanent working capital. Personal
costs are educational costs that must be
spent by students to be able to follow the
learning process regularly and
continuously. Operating costs consist of
salaries of educators and education
personnel as well as all benefits attached
to salaries and consumable educational
materials or equipment.
Personal costs are the main source of
funding in professional education
programs, where students pay tuition
fees every semester. The budget for
professional education program nurses
refers more to operating costs, namely
budgeting is calculated based on the
needs of activities to be carried out at
each stage of the profession. Details of
the budgeted costs include management
fees, structural fees, functional fees. The
budget for the professional education
program team is a personal and
operational budget. This is in line with
the results of the study (Williams and
Taylor, 2008) stating that financial and
organizational commitment is important
to be implemented in clinical practice for
nurse educators.
The facilities and infrastructure on the
student's practice land are sufficient but
there are still equipment that are lacking
so that for the practice students must
bring themselves or borrow from
campus. Students feel uncomfortable
because there is no special room for
discussion rooms and lockers to store
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
their belongings. The results of Manar
Nabolsi's study, Arwa Zumot, Lina
Wardam, FaAthieh Abu-Moghli (2012)
recommend that it is a challenge for
nursing / preseptor educators to support a
conducive learning environment,
improve the quality of student practice
experience, and narrow the gap between
theory and practice.
Preparation of practical activities is
carried out before practicing students,
including by collaborating with
institutions on clinical practice
institutions. The four institutions stated
that before students carry out
professional practice each institution
cooperates with a practical land in the
form of a Memorandum of
Understanding (MoU). In his opinion
(Munir Fuady, 2018) the MoU is a form
of cooperative bond made by both parties
(institutions and practice landowNurse)
formally in the form of legal documents
that explain the agreement between the
two parties who agree with each other
which then binds them in a cooperation
agreement. The aim of the MoU was as a
big picture of the agreement, a
memorandum of understanding was
made and signed by institutional
executive officials where the content was
more general. While the contents of a
more detailed agreement will be made
and negotiated by staff who master
technical matters. The MoU has juridical
benefits and economic benefits. The
support of institutions / institutions in the
implementation of professional
profession education practices, the four
institutions received support from
foundations and clinical practice
institutions by giving opportunities to
students from all four institutions to be
able to practice. This is in line with the
results of the study of Pour Dehkordi and
Shohani (2016) which states that to
improve the quality of nursing practice,
collaboration between educational
institutions and clinical practice
institutions is needed.
3. Process Aspects (Process)
Sub-focus 3. Implementation of Nurse
professional education learning
program at Pekanbaru STIKes.
The curriculum applied is in accordance
with the AIPNI curriculum guidelines.
The curriculum is a set of plans and
arrangements regarding the content, as
well as study materials and lessons as
well as ways of delivery and assessment
that are used as guidelines for the
implementation of teaching and learning
activities. The Nurse professional
education curriculum used is the
Indonesian National Qualifications
standard (KKNI) according to the
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
national standards of higher education.
This is in line with the results of research
conducted by Hall and Guidry (2013)
stating that the Nurse education
curriculum includes the development of
expertise related to the understanding of
the culture and transcultural practices
adopted by the community.
Related to professional student practice
learning activities, the four institutions
carry out learning activities in
accordance with the Nurse professional
curriculum program curriculum guide.
This is in line with the results of the study
(Humphreys, Gidmans and Andrews,
2000) stating the contribution of clinical
practice institutions used including nurse
educators in providing clinical
experience, practical methods of learning
on the ground also have an impact on
students. Research (Salminen, et al,
2009) suggests for the future of nursing
education to be based on nursing facts,
teaching and must improve research on
nursing education.
According to (Swihart, 2007) Nurse
profession practice activities, which are
guided by a preseptor. Receptors are
experienced and competent staff nurses
who receive formal training to function
at this capacity and who act as role
models and resources for new nursing
staff personnel. According to (Adgey,
2018) Preceptorship is a period to
support new nurses who are qualified to
make the transition from students to
develop their next practice. The
preceptorship program is usually 4-6
months. Preceptors are qualified and
experienced nurses whose role is to
support new nurses. Preparation of
clinical and academic preceptors is
carried out jointly with the clinical
practice institutions. The appointment of
Academic preceptors is determined by
the institution while the clinical
preceptor is determined by the leader of
the clinical practice institutions. The
qualification of an academic preceptor is
to have a Masters degree in nursing, a
minimum of two years experience and a
certificate of preceptorship, while a
clinical preseptor is a staff of nurses with
a minimum education with a minimum of
two years experience and a certificate of
preceptorship. Based on the statement of
the profession coordinator from the four
institutions, it was found that the
appointment of preseptors on the practice
land was still not in accordance with the
qualifications of the preseptor
determined.
Guidance activities could evaluate the
implementation of the teaching and
learning process of professional students
on clinical practice institutions. Results
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
of the study (Sari, et al, 2016)
recommending the preseptor model in
clinical learning can improve student
competency achievement. In line with
the results of the study (Jokelainen, et al,
2011) states that using the mentor
method helps students have a better
learning experience and the learning
provided can be done systematically.
Research (Jamshidi, L., 2012) states that
clinical learning must focus primarily on
knowledge skills and attitudes.
Research (Scronce, 2013) on the clinical
conferences in nursing education states
that preceptors must support and
encourage a positive environment that is
conducive to fostering trust, honesty,
openness, sharing and discussion.
Clinical conferences make students feel
comfortable sharing and expressing their
opinions without feeling afraid of being
tried by a preceptor or without fearing
what students say will affect their value.
(Billing and Halstead, 2012) state that the
best thing is the planned clinical success
of the conference. Preceptors must have
ideas or topics that might be discussed,
also flexible enough to allow students to
convey important issues that they
encounter or that make them worry.
Obstacles were found during the
guidance process, for example some of
the clinical preceptors did not conduct
pre and post conferences when students
came to practice. Some academic
preceptors did not come to guide students
on clinical practice institutions. Most
clinic preceptors cannot guide students
because of their busy life as head of ward
and team leader. The researchers'
conclusions are that there needs to be a
change in the process of student scales on
practical land and appoint clinical
preceptors from care staff who can be
used as role models at the time students
practice clinics.
Monitoring and evaluation is carried out
by academic preceptors and clinical
preceptors together by following the
practice guidelines as a reference for
assessment. This was conveyed by all
four institutions. The purpose of
monitoring is to find out whether the
ongoing activities are in accordance with
agreed plans and procedures. Monitoring
is carried out when activities are in
progress to ensure the suitability of the
process and achievements in accordance
with the plan or not. (RI Ministry of
Health, 2017) Evaluation is a series of
activities designed to measure the
effectiveness of the teaching / learning
system as a whole, while learning
evaluation is the process of determining
the acquisition of learning outcomes
based on certain criteria. Evaluation is
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
carried out to find out the final results or
achievements of the activities or
programs carried out at the end of the
activity. The results of the conclusions
obtained, monitoring and evaluation
activities have been carried out by the
four institutions. Competency tests are
conducted to evaluate the achievement of
student competencies after practicing on
a particular stage. The evaluation
includes cognitive, psychomotor and
affective aspects. Evaluation methods
carried out include the Direct
Observational Procedural Skill Test
(DOPS), Student Oral Case Analysis
(SOCA), managed case reports, mini
seminars and counseling presentations.
Clinical learning have to focused on the
knowledge, skill and attitude (Jamshidi,
2012). It can be concluded that the
competency test activities carried out by
the four institutions have fulfilled the
realm of achieving educational goals,
especially professional Nurse education.
Each preceptors makes a final report on
each stase and submits reports on the
results of student activities to the
profession coordinator. According to
experts (about knowledge, 2019) Reports
are a form of presentation of a fact about
a situation or an activity, and basically a
fact that is presented is the responsibility
assigned to the reporter. The matter
presented is in the form of material or
information based on the objective
situation experienced by the reporter
himself or seen, heard and felt by
himself. Reports are made when the
reporter has carried out an activity or an
activity.
4. Product Aspects
Evaluation of product aspects aims to
determine the achievement of the results
of professional Nurse education
programs in Pekanbaru. The aspects
evaluated include the achievement of
curriculum objectives, achievement of
competencies, results of competency
tests and graduation certification.
Evaluations are carried out at various
sources, both from the related data and
also evaluating the parties concerned.
Evaluation results are related to
achieving curriculum objectives based
on the results of national competency
tests, that curriculum objectives have not
been fully achieved. This is concluded
from the passing of the competency test
which is still low and has not reached the
graduation target, which is 100%. This
can occur based on the results of the
analysis of the guidance process during
student practice, namely there are still
limited academic preseptors and clinical
preseptors in guiding students during
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
practice. The clinic preseptor which is
the majority of the head of the room and
the team leader has its own busy life as a
room manager so it is not focused on
guiding students during practice. At the
time of the examination the student still
has limitations in carrying out the exam
using a computer system, students are
still confused with the CBT examination
system, need careful preparation to take
the exam.
Competency testing is carried out with
the aim of obtaining a competency
certificate which will be a requirement in
managing STR. So that students cannot
continue the process of making STR,
where STR is a requirement that must be
met if you want to work professionally.
This has been regulated in the Minister of
Health Regulation Number 1796 of 2011
concerning Registration of Health
Workers.
5. Outcome aspects
Sub-focus 5. Impact of Nurse
professional education graduates.
Placement of graduate graduates who
work from the results of questionnaires
filled in by HR and Nursing managers in
several hospitals in Pekanbaru states that
the placement of graduates is in
accordance with the scientific field with
good work performance, and possessed
competencies according to the expected
criteria. The input from the hospital
where the graduates work is the need for
additional soft skills and local material.
Awal Bros Hospital suggested that Nurse
educational institutions improve their
students' skills, insights and critical
thinking. For graduates who excel in
hospitals promote them as head of the
room and team manager, and send some
of them to attend further education about
special skills in accordance with hospital
needs, such as ICU training,
Hemodialysis and emergencies. In line
with (Swansburg and Swansburg, 2015)
state that training and education
development are needs to produce the
competency which needs in job
appraisal. With professional work
graduates can have an impact on good
cooperation, which is and established
with partNurse in the hospital so that
good teamwork can be formed that can
provide job satisfaction for internal
customers and external customers in this
case patients, families and institutions.
This has an impact on improving the
image of the hospital where they work.
CONCLUSION
Based on the results of the discussion
it can be concluded that in the aspect of sub
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
focus context 1: The objectives of the Nurse
professional education program from the
four institutions have been made in
accordance with the needs of nursing
services by describing them according to the
Tri Dharma of Higher Education which is
made as a guide in the preparation of Nurse
professional education curriculum. In the
aspect of sub focus input 2: The Nurse
professional education program learning
system has been implemented in accordance
with the curriculum guidelines of each
institution. The guide includes a description
of the practice schedule of students, practice
sites, group division, standard assessment
and final evaluation of each stase
undertaken, by considering lecturer
resources with Masters Nursing
requirements, with a minimum of 2 years
work experience. In the aspect of the sub
focus process 3: The implementation of the
Nurse professional education program at the
Pekanbaru STIKes is in accordance with the
practice guidelines that have been made by
each institution. In the process of learning on
clinical practice institutions using the
preseptor method. On the basis of sub-focus
products 4: Achievement of the results of the
Nurse professional education program at
Stikes Pekanbaru is not yet in line with the
achievement targets as evidenced by the
passing of the national student competency
test is still low. In the sub-focus aspects of
outcome 5: The results of Nurse professional
education graduates indicate that graduates
who have worked in both private and public
service facilities are considered good, work
in accordance with their fields and can
contribute in providing nursing services
professionally.
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kompetensi Ners Indonesia. Jurnal
penelitian administrasi publik, 2(2),
373-380.
Adgey, P. (2018). What is Preceptorship and
How Can It Help Newly Qualified
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AIPNI. (2016). Kurikulum Inti Pendidikan
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Asosiasi Institusi Pendidikan Ners
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Evaluasi Program Pendidikan (2
ed.). Jakarta: Bumi Aksara.
Fuady, M. (n.d.). Arti Memorandum of
Understanding (MoU): Pengertian,
Tujuan, Manfaat dan Jenisnya.
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Hall, M. B., & Guidry, J. J. (2013).
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Hasanpour-Dehkordi, A., & Shohani, M.
(2016). Nursing Instructor and
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doi:10.7860/JCDR/2016/18925.840
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Jamshidi, L. (2012). The Challenges of
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and Lifelong Learning from the
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Jokelainen, M., Turunen H Fau -
Tossavainen, K., Tossavainen K Fau
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Fau - Coco, K., & Coco, K. (2011).
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placements. Journal of Clinical
Nursing, 20(19-20), 2854-2867.
Kemenkes. (2011). Peraturan Menteri
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tentang Registrasi Tenaga
Kesehatan. Jakarta.
Kemenristekdikti. (2017). Permenristekdikti
Nomor 12 Tahun 2016 Jakarta.
Kholifa, & Kusumawati, W. (2016).
Hambatan Lulusan Ners dalam
menghadapi uji kompetensi Ners
Indonesia. The Indonesian Journal
of Health Science, 7(1), 40-47.
Nabolsi, M., Zumot, A., Wardam, L., &
Abu-Moghli, F. (2012). The
Experience of Jordanian Nursing
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Pawar, Y. (2017). Understanding Locke and
Latham’s 5 principles of goal-
setting. Retrieved from
https://upraise.io/blog/locke-
lathams-principles-goal-setting/
Rousell, P. L. Thomas, & J. L. Harris.
(2016). Strategic Planning and
Change Leadership: Foundations for
Organizational Effectiveness In L.
(Eds.),Management and Leadership
for Nurse Administrator (7th ed., pp.
149). Sudbury, Massachusettes:
Jones and Bartlett Learning.
Sari, S. M., Ennimay, Marni, E., &
Anggreny, Y. (2016). The
Implementation Of Preceptorship
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Pencapaian Kompetensi Mahasiswa
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Scronce, C. N. (2013). Clinical Conferences
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Swansburg, R. C., Swansburg, L. C. (2015).
Pengembangan Staf Keperawatan:
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SDM. Terj. Agung Waluyo dan
Yasmin Asih. Editor Monica Ester.
Jakarta: Buku Kedokteran EGC.
Swihart, D. (2007). Nurse Perceptor
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Williams, A., & Taylor, C. (2008). An
investigation of nurse educator’s
perceptions and experiences of
undertaking clinical practice. Nurse
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08.05.012
Zapko, K. A., Ferranto, M. L. G., Blasiman,
R., & Shelestak, D. (2018).
Evaluating best educational
practices, student satisfaction, and
self-confidence in simulation: A
descriptive study. Nurse Education
Today, 60, 28-34.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
ANALYSIS OF THE ROLE OF PERITONEUM CHARACTERISTICS
AND GLUCOSE CONCENTRATION IN DRAIN VOLUME IN CAPD
PATIENTS IN CCI CIKINI HOSPITAL, JAKARTA
Yenny*, Krisna Yetti**,Yusron Nasution***
ABSTRACT
Fluid output in patients undergoing CAPD is influenced by glucose inCAPD fluid which acts as an osmotic agent.
On the other hand the characteristics of the peritoneum indirectly affect ultrafiltration through the rapid or slow
diffusion of glucose from the dialysate into the plasma, thus affecting the difference in osmotic pressure. This study
aims to analyze the role of glucose concentration and peritoneal characteristics of fluid output in patients
undergoing CAPD. The study used Retrospective cross-sectional approach with consecutive data collection methods
sampling . All data are sourced from medical records and patient CAPD diaries from 2005 to 2010. Peritoneal
characteristics are determined based on PET examinations conducted at PGI Cikini Hospital. Measurement of fluid
output was carried out for 7 days based on the patient's CAPD diary, for a period of 1 day to 6 months after PET
examination. The results of the study show different mean output of fluid in the dialysate with different glucose
concentrations and different peritoneal characteristics. T test results showed differences between the average output
of dialysate with a glucose concentration of 1.5% and 2.5% on the day and night (p <0.05) ANOVA test results
showed differences between the mean output between the high transporter with high average transporter and low
average transporter, high average transporters with high transporters , low average transporters with high
transporters ( p <0.05) It can be concluded that glucose concentrations and peritoneal characteristics are equally
responsible for fluid output in patients undergoing CAPD , but the dominant role cannot be concluded.
Keywords: peritoneal characteristics, glucose concentration, output, CAPD
INTRODUCTION
Continuous Ambulatory Peritoneal Dialysis
(CAPD ) is a modality of Peritoneal Dialysis
(PD),which is one of the replacement
therapies for End Stage Renal Disease
(ESRD).12 CAPD is a dialysis technique
using the peritoneal membrane as a dialysis
membrane. Peritoneum classified based on
the Peritoneal Equilibration Test (PET)
examination. PET categorizes peritoneum
into four classifications, namely; high
transporter, high average transporter, low
average transporter and low transporter13, 14.
Glucose in CAPD fluid acts as an osmotic
agent, which results in a difference in
osmotic pressure which affects ultrafiltration
or fluid transfer during CAPD
The difference in osmotic pressure caused
by glucose concentration is one of the
determining factors for fluid transfer across
the peritoneal membrane during CAPD. The
higher the glucose concentration the greater
the ultrafiltration caused.Meanwhile the use
of glucose as an osmotic agent has
advantages and also limitations, because
glucose is not a perfect osmotic agent,
especially for long-term use.On the other
hand the characteristics of the peritoneum
indirectly affect ultrafiltration through the
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
rapid or slow diffusion of glucose from the
dialysate into the plasma, thereby
influencing the difference in osmotic
pressure.
Therefore to achieve a stable fluid balance,
the CAPD fluid glucose concentration and
characteristics peritoneum should be equally
considered. It's just that in Indonesia not all
patients undergoing CAPD have known
peritoneal characteristics.This is because
there are still very few hospitals that conduct
PET examinations.Besides that CAPD
patients are less likely to meet health
professionals than they are with
hemodialysis (HD) patients, so as to obtain
adequate fluid output,generally patients
modify the use of CAPD fluids which is
more hypertonic.The research question
posed in this study is there a more dominant
role between characteristics peritoneum and
glucose concentration to expenditure?
Research methods
This research was conducted in the Renal
unit of PGI Cikini Hospital Jakarta, from
May 10 to June 11, 2010. The design in this
study was crosssectional, with a
retrospective approach.Data were obtained
from medical records and CAPD diaries,
which originated from 2005 to May. 2010,
with a sample of 53 people.The sample in
this study was taken by consecutive method
sampling with inclusion criteria; CAPD
patients that has been tested for PET,uses
CAPD fluid with a glucose concentration of
1.5% and / or 2.5% with a volume of 2 liters
and fluids changes 4 times /day, and having
a CAPD book up to 1 year after the PET
examination date.
Before the requesting approval for the
patient involved in the study, the researcher
provided information related to the
research. Agreement signed patients was
characterized by a consent form and willing
to lend a logbook CAPD for materials
research.After that, it is continued by
recording data from the respondent's CAPD
diary on the recording sheet.The
documented data are: name, date, CAPD
fluid glucose concentration, time of
completion of the CAPD fluid entry, time to
start dialysate,output and fluid balance every
turn.
Record of fluid output is done for one week,
starting (first day) one day after PET
inspection, or the closest date after PET
inspection within one year.Next is recording
the data from the medical record which
includes PET examination results, PET
examination dates, blood sugar levels and
serum albumin.Blood sugar levels used are
the results of laboratory tests, in the same
week,Whereas the results of laboratory tests
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
of serum albumin in the same month output
data from the CAPD diary to be used.
Research result
Table 1. Characteristics of Respondents
Gender (%)
Male 56,6 (30)
Women 43.4 (23)
Age 56.02 ± 12.57
(Mean ± SD) 52,56 - 59,48
95% CI 25 - 78
Min - Max
Blood Sugar
(Mean = SD)
149.17 =
67.09
CI95% 130,68-167,66
Min-Max 72-327
Albumin
(Mean ± SD) 3.31 ± 0.62
95% CI 3.05 - 3.57
Min - Max 2.0 - 4,50
Time after PET
(Mean ± SD) 10.74 ± 31.11
95% CI 2.16 - 19.31
Min - Max 1 - 178
Liquid Expenditures
Morning
(Mean ± SD)
236.75 ±
125.91
95% CI 202.04 -
271.45
Min - Max 14.29 - 721.43
Afternoon
(Mean ± SD)
302.47 ±
757.14
95% CI 260,51 -
344,42
Min - Max 70.00 - 757.14
Afternoon
(Mean ± SD)
233.73 ±
124.07
95% CI 124.07
Min - Max 0 - 707,14
Night
(Mean ± SD)
306.16 ±
167.05
95% CI 260,12 -
352,21
Min - Max 16,67 - 678,57
Cumulative
(Mean ± SD)
1079.10 ±
441.07
95% CI 957,53–
1200,68
Min - Max 16,67 - 678,57
Characteristics of respondents in this study
can be seen in table 1.
Distribution of respondents by sex shows
that most of the respondents are male, that is
equal to 56.6%, with an average age is 56.02
years.The youngest is 25 years old and the
oldest is 78 years old.Blood sugar levels are
above normal value,with the average of
149.17 mg%, where as the mean serum
albumin of 3.31 g / dl CAPD respondents
involved in this study were within a period
of 10.74 days after PET examination(table
1).
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Distribution of respondents based on
Peritoneum characteristics indicate that the
peritoneum characteristics of respondents
are generally average namely the low
average and high average.(Graph 1)
Most of the respondents used CAPD fluids
with a glucose concentration of 1.5%,
especially in the morning and evening.
During the day the distribution of the use of
glucose concentrations of 1.5% and 2.5%
was quite even, while at night the
respondents used more fluids. CAPD with a
glucose concentration of 2.5% (Graph 2)
Most respondents regulates the use of
glucose concentration based on patterns A
and B. The results of the data analysis also
shows a small portion of respondents did
change the pattern, which means replacing
the CAPD fluid glucose concentration of
1.5% to 2.5% or vice versa between 4 times
exchange(table 2).
6%
38%47%
9%
Graph 1
Distribution of Respondents
Based on the Characteristics
of Peritoneum
High High average
Low average Low
0
10
20
30
40
50
60
1.5
0%
2.5
0%
1.5
0%
2.5
0%
1.5
0%
2.5
0%
1.5
0%
2.5
0%
Morning Noon Afternoon Night
Graph 2Distribution of Respondents
Based on the dialysate glucose concentration
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Output fluids at each change occur most at
night, minimal in the afternoon. In the
afternoon, the lowest output of liquid is 0 ml,
which means that ultrafiltration and
absorption during dwell time occur as large,
so that the balance of fluid is 0 ml. While the
highest average expenditure in the afternoon
amounted to 707.14 ml, which means that
during the dwell time 707.14 ml of liquid
from the net ultrafiltration was released as a
drain volume, also called the negative
balance (tabel 1).
The results of the analysis show that there
are differences in mean fluid output between
the four characteristics of peritoneum. The
average fluid expenditure is mostly in the
high transporter, which occurs every
exchanges except during the daytime, while
the average fluid expenditure varies at least
between the high average transporter and the
low transporter. Further analysis showed a
significant difference in mean fluid output
between the four peritoneal characteristics in
the morning and afternoon (p value
<0.05)Significantly different groups are
high transporters with high average
transporters and low average transporters,
high average transporters with high
transporters, low average transporters with
high transporters. The mean fluid output
during the day and night did not show a
significant difference between the four
characteristics of peritoneum(graph 3).
0 200 400 600
High
High average
Low average
Low
High
High average
Low average
Low
High
High average
Low average
Low
High
High average
Low average
Low
Mo
rnin
g *
No
on
Aft
ern
oo
n *
Nig
ht
Graph 3Average Respondent Fluid
Expenditures Based on Peritoneum Characteristics
* p <0,05
Tabel 2 Distribution of Respondents
Based on The Pattern of Glucose Use
Patte
rn
Morni
ng
No
on
Aftern
oon
Nig
ht
Fre
q.
A 1.5 1.5 1.5 1.5 17
B 1.5 2.5 1.5 2.5 14
C 1.5 1.5 1.5 2.5 11
D 2.5 2.5 2.5 2.5 3
E 2.5 1.5 2.5 1.5 1
F 1.5 2.5 2.5 2.5 1
G 2.5 2.5 1.5 2.5 1
Change
pattern 5
Total 53
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
The highest number of respondents'
cumulative liquid expenditure is also seen in
the high transporter(graph 4). .
The results of data analysis on the role of
CAPD fluid glucose concentration variables
with fluid output showed that the mean fluid
output in respondents using CAPD fluid
with 2.5% glucose concentration was greater
than those using 1.5% glucose
concentration. This difference can be seen
every time you change fluids, namely in the
morning, afternoon, evening and night.
Further analysis appears there was a
significant difference between the mean
output of respondents who use CAPD fluid
with a concentration of 1.5% and 2.5% on
the day and night ( p <0.05). The mean
output of fluids in the morning and evening
did not show a significant difference
between respondents with the use of
different glucose concentrations. (tabel 3)
Tabel 3
The results of the correlation analysis of
fluid and blood sugar expenditure showed a
weak relationship in the morning, but in the
afternoon, day and night did not show
closeness, but all had a negative pattern .
While the correlation of fluid output with
serum albumin showed a strong relationship
at night and in the morning, also the overall
pattern was negative . While the correlation
analysis shows that there is no closeness
between the output of fluid and the time after
PET examination, but it has a negative
pattern, which means there is a tendency that
the longer the time after PET examination
the less fluid output.
Discussion
Most of the patients who underwent CAPD
involved in this study were 56.24 years old,
with age range between 25 to 78 years old.
These results illustrate that renal
replacement therapy with CAPD modalities
can be used on all ages. Patients with various
0 500 1000 1500 2000
High
High average
Low average
Low
ml
Graph 4Average Cumulative Expenditures
Based on the Characteristics of Peritoneum
1,50% 229,33 130,56 45 19,46 0,28
2,50% 286,12 95,46 7 36,08
1,50% 243,39 129,26 31 23,22 0,000
2,50% 389,8 147,48 21 32,18
1,50% 220,26 126,55 45 18,86 0,16
2,50% 303,14 83,11 5 37,17
1,50% 243,03 174,61 20 39,05 0,03
2,50% 344,39 152,46 33 26,54
Morning
Noon
Afternoon
Night
Average Respondent Fluid Expenditures Based on the
Dialysate Glucose Concentration
glucose
concentrationMean SD n SE
p
value
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
levels of age can learn to do CAPD, as well
as for elderly patients , if they do not
experience dementia or visual impairment.
But this situation is not an absolute
contraindication, if indeed CAPD is needed
it can still be carried out, for that we need
help from family or other people who can
help patients in doing CAPD at home.
The most commonly used CAPD glucose
concentration by respondents was 1.5% in
the morning, afternoon and evening. CAPD
fluid with a glucose concentration of 2.5% is
quite widely used in the afternoon and most
at night. This is parallel with the description
of the pattern of use of liquid CAPD based
on fluid turnover time which describes dwell
time.In theory, the concentration of glucose
that is generally used is 1.5%, especially in
the morning, afternoon and evening, which
is at dwell time of 4-6 hours. While CAPD
fluid with a glucose concentration of 2.5% is
generally given at night, due to a longer
dwell time , which is 8-10 hours. Hypertonic
CAPD fluids are also used to obtain more
expensed expenses. 4,6
Glucose is a well-known, relatively cheap
and safe osmotic agent, 11 is also a source of
calories, however glucose is not a perfect
osmotic agent. Glucose acting as an osmotic
agent can cause hyperglycemia,
dyslipidemia, obesity, and damage to the
peritoneal membrane in the long term, either
directly or through glucose degradation
products (GDPs). 2 The higher the glucose
concentration there will be more GDPs
formed. 2 GDPs are toxic, formed during
heat sterilization and CAPD liquid storage.
The peritoneum that is exposed to this toxin
in the long term, can cause it changes in
peritoneal morphology which is
characterized by loss of mesothelial cells,
interstitial fibrosis, vasculopathy, and
neovascularization . as a result there is an
increase in the transport of solutes with
small molecular weights and glucose, which
in turn causes a progressive decrease in
ultrafiltration . 4,6,11 Therefore it is
necessary to be careful in determining the
glucose concentration to be used.
The amount of disbursement of the
respondent's fluids , at most at night, was
306.16 ml, the afternoon was 302.47 ml ,
although the number of differences was not
too large . The more amount of fluid output
at night and during the day can be explained
by the use and regulation pattern of glucose
concentration . In the evening and afternoon,
the most commonly used CAPD fluid
glucose concentration is 2.5%, so the
average output of fluid is greater than in the
morning and evening.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
The difference in the expenditure of liquid
which is not too large at night and during the
day, can be due to differences in dwell time
. Dwell time at night ranges from 8-10 hours,
while afternoon4–6 hour. Dwell time affect
net ultrafiltration, Mujais and Vonesh(2002)
showed a decrease in ultra filtration net after
the fourth hour, so that at night with a dwell
time ranging from 8-10 hours, after four
hours ultrafiltration will be reduced but the
liquid absorption continues until the next
CAPD exchanges. This situation can cause
fluid output ( drain volume ) at night to be
not too much.
The study also showed respondents who
used CAPD fluid with a glucose
concentration of 2.5% average expenditure
fluid was greater than glucose concentration
1.5%. This difference is mainly seen during
the day and night. Glucose is an osmotic
agent, causing dialysate fluid to be
hypertonic when compared to blood. This
situation results in differences in the osmotic
pressure between the dialysate in the
peritoneal cavity which is hypertonic and the
blood in the peritoneal capillaries is
relatively hypotonic, thus affecting
ultrafiltration or fluid transfer during CAPD.
5.8
But on the other hand glucose as an osmotic
agent, has a low reflection coefficient value
so that the difference in osmotic pressure
caused by glucose quickly disappears. This
decrease in osmotic pressure occurs because
fast glucose diffuses from the dialysate fluid
into the peritoneal capillary. 2 Therefore the
higher the glucose concentration of CAPD
fluid will be higher and the longer the
difference in osmotic pressure between
dialysate and blood can be maintained, so
that it continues to have an effect on
ultrafiltration. This situation is seen in the
use of CAPD fluid with a 2.5% glucose
concentration that is widely used in the
evening and night , so that the average fluid
expenditure is more.
The results of the data analysis further prove
that glucose concentration plays a role in
fluid output, there is a significant difference
in the mean expenditure of fluid between
dialysates with glucose concentrations of
1.5% and 2.5% at day and night (pvalue
<0.05). But in the morning and evening, the
difference is not too big. This can be caused
by a dwell time more length, which is
influenced by work, social activities or other
activities undertaken in the respondent's
daily life. Although it can be assumed that
dwell time in the morning, afternoon, and
evening ranges from 4 to 6 hours, in this
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
study no deep assessment of the respondent's
dwell time was conducted .
Besides that, when compared with the
results of respondent characteristics based
on glucose concentration, it was seen that in
the morning and evening, the respondents
mostly used CAPD with a glucose
concentration of 1.5%. As previously
explained, ultra filtration net at a 1.5%
glucose concentration will decrease after the
fourth hour . 6.9 The amount of
ultrafiltration net will increase slowly if
there is no reabsorption of the peritoneum,
especially through lymphatic.
Reabsorption of the peritoneum persists and
will reduce intraperitoneal volume
throughout the dwell time . 6 Therefore after
the fourthhour the reabsorption of the liquid
will be greater than the ultrafiltration, thus if
there is an addition of dwell time the end
result is a decrease in the amount of liquid
coming out. The difference in osmotic
concentration caused by glucose is generally
maximal at the onset of PD and decreases
over time, because of the dilution of glucose
by the output and also diffusion from
glucose dialysate into the blood. 2 This
situation is certainly inseparable from the
role of the characteristic peritoneum in
influencing glucose diffusion.
Most of the peritoneum characteristics
involved in this study are average, namely
low average and high average . While the
high and low transporters are far fewer in
number, the results of other studies also
show the same thing even in different
percentages. 8 Based on the characteristics
of the peritoneum, it can be stated, in
general, respondents involved in this study
are ideal for substitution therapy with
CAPD, because high average transporters
and low average transporters provide good
dialysis and ultrafiltration. 4
The mean cumulative fluid expenditure
based on peritoneal characteristics also
shows differences. If it is sorted according to
the most fluid output from is as follows; high
transporter, low transporter, low average and
high average. In general, the highest
expenditure of liquid based on peritoneum
characteristics is low transporter, low
average, high average , and high transporter
. 8 In theory, ultrafiltration on high
transporter is not adequate. 4
High transporters have a large effective
peritoneal surface area or high membrane
permeability, so that the osmotic pressure
difference rapidly reduced due to rapid
glucose diffuses into the plasma. This
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
situation will cause low ultrafiltration. But in
this study, the expenditure of high
transporter fluids is relatively more than the
other types of transporters , either in the
cumulative amount or at each fluid change,
except during the day. This relatively more
expenditure of fluids, according to the
researchers can be caused by several factors
including the role of residual kidney fuction
(RKF).
The research conducted by Konings, et al
(2003) show the volume of ultrafiltration of
the peritoneum is inversely proportional to
RKF, the smaller the RKF the greater the
volume of peritoneal ultrafiltration, which
means the output of fluid was also greater.
When referring to the study , a larger output
of the high transporter can be caused because
it decreases or there is no more RKF left.
This study also shows the estimation of the
fluid output intervals in the range of negative
balance and a positive balance. If this
estimate is compared with theory and
previous research, it may be possible for the
population to find a balance of fluids that
differ significantly in individuals different
from the peritoneal membrane - both high
transporters .
Besides that hypoalbuminemia can also be
the cause of the large amount of fluid
secretion in patients undergoing CAPD .
Based on the results of observations of
researchers on respondents with this type of
high transporter obtained 2 of 3 respondents
experiencing hypoalbuminemia while others
do not know the value of serum albumin. In
high transporters, the protein in the dialysate
is high so that serum albumin levels are low.
Furthermore, patients with
hypoalbuminemia have low oncotic pressure
and ultrafiltration tends to be higher. 2
The average cumulative fluid expenditure in
respondents with the average transporter
peritoneum is the lowest when compared to
other peritoneal transporters, but still in
accordance with the estimated reference of
fluid output.Twardowski ( 1989 ) states that
high average and low average peritoneum
provides good ultrafiltration . 4 This
situation is also seen in this study where the
standard dosage of CAPD expenditure of
fluid in the low average and high average is
not too much different.
Output inthe low transporter is second only
to high transporter. Peritoneum The low
transporter peritoneum has a low
permeability membrane or small effective
peritoneal surface area, so that the osmotic
pressure difference doesnot rapidly reduced
because glucose doesnot quickly diffuses
into the plasma. This situation causes
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
excellent ultrafiltration, but dialysis is poor,
so high-dose CAPD is needed . 4
If again referring to different sources can be
seen in the low transporter, to get the
maximum ultrafiltration it takes a longer
dwell time.6,8This is the reason for this
study that the average fluid expenditure in
the low transporter is relatively almost the
same at the turn of the liquid morning,
afternoon and evening. Whereas at night
more fluid is released because of the longer
dwell time , which is 8-10 hours.
A further analysis of fluid secretion based
on peritoneal characteristics showed a
significant difference in mean fluid output in
the morning and evening (pvalue <0.05). But
during the day and night there is no
difference in fluid expenditure which is
significant between the characteristic types
of peritoneum, as well as the release of
cumulative fluid. The results of this data
analysis when compared with the
characteristics of respondents based on
glucose concentration, it is seen that the use
of glucosa 2.5% is more used in the day and
night. According to researchers the
hypertonic CAPD fluid may play a more
dominant role in fluid output than peritoneal
characteristics. Therefore, further research is
needed to answer this assumption.
The mean blood sugar level in this study was
149.17 mg%. In theory, glucose absorption
that occurs in patients undergoing CAPD
can cause hyperglycemia in patients who
suffer from diabetes or who experience
impaired glucose in tolerance. 13Statistical
analysis shows that there is a strong
relationship between blood sugar levels and
output in the morning, and the overall
pattern is negative. These results indicate
that there is a tendency for higher blood
sugar levels to be less fluid.
The difference in osmotic pressure between
the dialysate in the peritoneal cavity and the
blood in the peritoneal capillary will be
reduced if there is hyperglycemia. Systemic
hyperglycemia can affect fluid secretion
with reduced osmotic gradient differences. 6
Because ultrafiltration depends on the
difference in glucose between the peritoneal
membrane. But further studies need to be
done to see other possible factors that
influence the closeness of the relationship
between blood sugar levels and output.
The mean albumin serum of respondents in
this study was 3.31 g / dl , with ranges
between 2.00–4.5 g / dl . During the CAPD
process one of the physiological elements
which is also wasted through dialysate is
protein, and 75% of the missing protein is
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
albumin . 10 Albumin is a large molecular
weight protein and utilizes large pores ( large
pores ) to move across the peritoneal
membrane. 8 The average albumin release
through dialysate is 9 g / day,
hypoalbuminemia is generally minimal if
protein intake is adequate . 2
Albumin is the main protein in human
plasma 10 with one of its functions
regulating oncotic pressure in blood vessels.
Oncotic pressure acts to maintain fluid in the
blood so that it is in contrast to ultrafiltration.
Further data analysis in this study showed a
moderate relationship between expenditure
of fluid with serum albumin in the afternoon,
but was very weak in the morning, afternoon
and evening and had a negative pattern . This
means that there is a tendency for lower
albumin levels to be more fluid. As stated,
patients who experience hypoalbuminemia
have low oncotic pressureand ultrafiltration
tends to be higher. 2 But further studies need
to be done to see the possibility of other
factors that influence the closeness of the
relationship.
Most of the CAPD daily records of
respondents involved in this study were
within 1 day up to 170 days after the PET
examination, with an average of 10.74 days.
PET is generally examined after one month
the patient underwent a CAPD catheter
implant, or after the patient's condition is
stable. In this study the time after PET
indirectly gave a long description of the
respondents having undergone CAPD,
where the more days after PET examination
meant the longer the patient had undergone
CAPD. In general, peritoneal transport is
stable over time, but studies in a small group
and in a short follow-up period show that in
some patients there is a change in peritoneal
transport . 3 The results of the data analysis
further show that there is no closeness in the
relationship between expenditure of liquid
and time after PET but has a negative
pattern. This means that there is a tendency
for the longer to undergo CAPD, the less
fluid output. This shows that the tendency to
reduce fluid expenditure over time needs to
be further assessed .
Conclusion
The researcher concluded that the
characteristics of the peritoneum and CAPD
fluid glucose concentration equally affected
fluid secretion in patients undergoing
CAPD. The glucose concentration
commonly used is 1.5% with peritoneal
averagecharacteristics. Expenditure offluid
in the use of CAPD with a glucose
concentration of 2.5% more than 1.5%.
There are differences in mean fluid output
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
between respondents with different
peritoneal characteristics, especially
between high transporters and high average
transporters and low average transporters;
high average transporter with high
transporter; low average transporter with
high transporter.. More extensive research is
needed to assess whether there is a more
dominant role between peritoneal
characteristics and CAPD fluid glucose
concentration.
REFERENCES
(2002). Managing fluid balance. April 16,
2010.http://www.pdinterest.ca/files/
sec4fluidassessment.pdf
Blake, P.G., & Dougirdas, J.T. (2007).
Physiology of peritoneal dialysis.
Dalam J.T. Dougirdas, P.G . Blake &
T.S. Ing (Ed). Handbook of dialysis
(hal 323-338). Philadelphia:
Lippincott Wiliams & Wilkins.
Heimburger, O., Wang, T., &Lindholm, B.
(1999). Alterations in water and
solute transport with time on
peritoneal dialysis. Perit Dial Int19
(20) S83–S90, http://www.
pdiconnect.com/cgi/reprint/19/Suppl_2/S83
Kallenbach, J.Z., Gutch,C.F., Stoner, M.H.,
& Corca, A.L. (2005). Review of:
Hemodialysis for nursing and
dialysis personnel (7th Ed.). St Louis
Missouri: Elsevier Saunders.
Khana, R., Nolph., K & Oreopoulos, D.G.
(1993), The essential of peritoneal
dialysis. Dordrecht: Kluwer
Acadedemic Publishers.
Khana, R., & Nolph, K. (2009). Principles of
peritoneal dialysis. Februari 7,2010.
http://www.
kidneyatlas.org/book5/adk5-04.pdf.
Konings, C.J.A.M., Kooman, J.P.,
Schonck, M., Struijk, D.G.,
Gladziwa, U., & Steven J., et al.
(2003). Fluid status in CAPD
patients is related to peritoneal
transport and residual renal function:
evidence from a longitudinal study.
Nephrol Dial Transplant, 18, 797–
803. Mart 8, 2010.
http://ndt.oxfordjournals.org/cgi/con
tent/full/18/4/797
Misra, M., & Khanna, R. (2008).
Mechanism of solute clearens and
ultrafiltrasion in peritoneal dialysis.
Juli 15, 2009. www.uptodate.com.
Mujais, S., Nolph, K., &Vonesh, E.
(2002). Profiling of ultrafiltration.
Kidney International, 62, ( 81), S17–
S22, Juni 17, 2010.
http://www.nature.com/ki/
journal/v62
/n81s/full/4493368a.html
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Parsudi, I., Siregar, P., & Roesli, M.A.
(2006). Dialisis peritoneal. Dalam
A.W. Sudoyo, B. Setiyohadi, I. Alwi,
M. Simadibrata, & S. Setiati (Ed.).
Buku Ajar Penyakit Dalam (hal.592-
595). Jakarta: Pusat Penerbitan
Departemen Ilmu Penyakit Dalam
Fakultas Kedokteran Universitas
Indonesia.
Rang, C., & Murray, R.K. ( 2000). Protein
plasma, imunoglobulin dan
pembekuan darah. Dalam R.K.
Murray (Ed). Biokimia harper
(Andry Hartono, Penerjemah) EGC.
Jakarta
Saxena, R., &West, C. (2006, July–August).
Peritoneal dialysis: a primary care
perspective. Journal of American
Board Family Medicine, 19, (4 ), 380
– 389 Februari 7, 2010.
http://www.jabfm.org
Sharma, A., & Blake, P.G. (2008).
Peritoneal dialysis. Dalam B.M.
Brenner (Ed.). Brenner & Rector’s:
The kidney (hal2007-2031).
Philadelphia: Elsevier Saunders.
Wild, J. (2002). Peritoneal dialysis. Dalam
N. Thomas (Ed.). Renal nursing (hal
207-261). St Louis Missouri:
Elsevier S
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
RELATIONSHIP OF THE MOTHER EDUCATION LEVEL WITH THE
GROWTH OF TODDLERS IN POSYANDU RW 12 PUSKESMAS
KELURAHAN GEDONG JAKARTA TIMUR
IGA Dewi Purnamawati
Nursing Academi Pasar Rebo Jakarta
Email: ig4dewi@gmail.com
ABSTRACT
Toddler is a golden period , a window of opportunity and a critical period for the continuity of the child's growth and
development.. The mother is the closest person to the toddler, the person who is cared for toddlers and who played a
role in making decisions about the child's health condition. The research aims to find the relationship between mother's
education level and the growth of children . The study used an analytic survey with cross sectional approach on 88
respondents obtained by the method of consecutive sampling. The results of chi square analysis with p value> 0.05
showed that there was no relationship between mot her's education level and weight end height growth with a value of
Pvalue = 0.48 and growth of toddler's upper arm ci rcumference with Pvalue = 0.68. This study recommends research
on the analysis of factors that affect toddler growth and development.
Keywords: Growth , Mother’s education, and toddlers
INTRODUCTION
The growth of children under five is an
important thing that must be considered by
parents, society and even by the state. Every
child will go through a growth process
according to their age. Growth monitoring
can be done by parents, health workers,
educators, cadres and other workers who are
interested in child development. Child
growth and development are basically the
same for every child, so knowing the
characteristics and principles of growth and
development will make it easier for parents
to provide growth and stimulation as needed
(Ministry of Health, Republic of Indonesia,
2014). Growth is an increase in physical size
while development is a process where the
child experiences an increase in a variety of
skills and functions. Assessment of a child's
physical growth such as weight and height on
an ongoing basis is very important so that
growth that is too fast or inadequate can be
identified early (Kyle & Carman, 2014).
Growth b Alita requires stimulation,
stimulation is needed to stimulate the basic
abilities of children so that children grow
optimally. Stimulation per grows late should
be done regularly, as early as possible and
continuously by their parents or caregivers of
children (Kemenkes RI, 2014).
Based on the results of Riskesdas (2013)
toddlers who experience very thin conditions
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
are still quite high 5.3 percent, 12.1 percent
thin and 11.9 percent fat, according to WHO
(2010) health problems have been said to be
serious if the prevalence of thinness between
10.0- 14.0 percent and is considered critical
if ≥ 15.0 percent. In 2013 the prevalence of
under - fives was still 12.1 percent, which
means that underweight problems in
Indonesia were still a serious health problem.
In 2013 there were 19.6% undernourished
children consisting of 5.7% undernourished
children and 13.9% undernourished states,
the data stated that the number of
malnourished children under five rose every
year (Hardianti; Dieny & Wijayanti, 2013).
There is still a high nutritional problem for
children under five in Indonesia, so it
requires hard work to reduce health problems
in the community. Damanik; Ekayanti; &
Hariyadi ( 2010 ) in ( Todaro & Smith, 2009)
suggested that WHO has found five
conditions that cause 70% of under-five
deaths including acute respiratory infections,
diarrhea, chickenpox, malaria and
malnutrition, it is estimated that if this trend
continues , then in 2020 this condition will
cause 30% of child deaths worldwide.
Adequate or deviant child growth can be
monitored through measurements of body
weight (height) , height (TB) and upper arm
circumference (LLA) of children. Based on
the Ministry of Health of the Republic of
Indonesia (2014) child growth can be seen
from body weight (body weight) and height
(TB) using the BB / TB table (Directorate of
Community Nutrition 2002) the results will
be categorized whether the child has physical
growth. Fat, Normal, Skinny and Very Thin.
Growth and developmental deviations can
include speech disorders, cerebral palsy,
down syndrome, short stature, hyperactivity
and autism disorders . Factors that influence
children's growth are influenced by internal
and external factors. Internal factors include
race, family, age, sex and genetics, while
external factors include the conditions of the
mother during prenatal, intranatal and
postnatal conditions. One of the postnatal
factors such as socioeconomic family. Socio-
economic includes residence, mother's
education level and family wealth index
(Kemenkes RI, 2014; IDHS 2012).
Changes that occur continuously on people's
behavior are caused by increasing levels of
education. Associated with the quality of
human life, there is a tendency that the higher
level of education is possessed, the more
knowledge will become and the result in an
increase in the quality of life especially in the
health sector (Indonesia Health Profile,
2014).
Based on the 2012 IDHS, maternal education
has an inverse relationship with the risk of
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
child mortality. A high level of maternal
education is generally associated with a low
risk of death, this is because education makes
mothers get better information on pregnancy
and child care. The infant mortality rate is
77% lower in women who have some college
education Compared to children Whose
mothers have low education (15 and 66 kema
tian per 1,000 births). Based on the results of
the survey on the level of maternal education
can reduce mortality in children, researchers
assume that the mother's education is closely
connected with the growth and development
of infants, because the mother will get
information about the growth and
development of children is better than
mother experience and upbringing low.
The Concept of Toddler Growth
1. Definition of Growth
Growth is an increase in the size and number
of cells and intracellular tissue or increase in
physical size and body structure in parts or in
whole and can be measured in units of length
and weight (Kemenkes RI, 2014) .
2. Toddler Growth
The most prominent picture in childhood is
physical growth . During development,
various tissues in the body experience
changes in growth, composition and
structure. Height development in children is
almost entirely due to skeletal growth and is
considered a measure of stable general
growth (Wong. 2008). In newborns up to 6
months the growth of body weight increases
from 140 to 200 grams of birth weight to be
doubled at the end of the first 4 to 7 months.
Weight gain in infants aged 6 to 12 months
gained 85 to 140 grams of birthweight three
times at the end of the first year. At the age
of toddler and pre-school weight gain 2 to 3
kilograms each year. In infants aged 0 to 6
months, height increases about 2.5 cm each
month and ages 6 to 12 months increase
around 1.25 cm and 6 to 8 cm in the 2nd and
3rd year. the body of the child is twice the
length of birth and at the age of 5 years the
body height increases from 5 to 7 , 5 cm
(Wong, 2008).
3. Weight Measurement ( BB ) :
a. Using baby scales.
1)Baby scales are used to weigh
children up to 2 years of age or
while the child is still able to lie
down / sit quietly.
2) Place the scale on a flat table and
not easily sway.
3) Look at the position of the needle
or the number must point to the
number 0.
4) Babies should be naked, without
hats, socks, gloves.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
5) Lay the baby carefully on the
scale.
6) Look at the needle scale until it
stops.
7) Read the number indicated by the
scale needle or the scale number.
8) If the baby continues to move, pay
attention to the movement of the
needle, read the number in the
middle between the movement of
the needle to the right and left.
b. Using the stampede scales.
1) Place the scales on a flat floor so it is not
easy to move.
2) Look at the position of the needle or the
number must point to the number 0.
3) Children should wear thin everyday
clothes, not wear footwear, jackets, hats,
watches, necklaces, and not hold
anything.
4) The child stands on the scale without
holding it.
5) See the needle scale until it stops.
6) Read the number indicated by the scale
needle or the scale number.
7) If the child continues to move, pay
attention to the movement of the needle,
read the number in the middle between the
movement of the needle to the right and
left.
c. Measurement of Body Length (PB) or
Height (TB) and Upper Arm Circumference
(MUAC) :
1) How to measure by lying down.
2) How to measure in a standing
position.
4. Use of Table BB / TB (Directorate of
Community Nutrition 2002 ).
a. Measure the height / length and weigh
the child's weight, according to the
method above.
b. Look at the child's Height / Length
column that matches the measurement
results.
c. Select the Weight column for
male (left) or female (right)
according to the sex of the child,
look for the body weight closest
to the child's weight.
d. From this weight figure, see the
top of the column to find out the
Standard Deviation (SD)
number (BB / TB table in the
appendix)
e. BB / TB Interpretation: Normal:
- 2 SD to 2 SD, Thin: - 2 SD to
- 3 SD, Very thin: - 3 SD and
Fat: 2 SD.
5. MUCH measurement
Lila measurement is an indirect
measurement of muscle mass. The way to
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
do the measurement is by placing the
meter vertically, along the posterior part
of the upper arm to the acromial process
and to the olecranon process half of the
measurement length is the midpoint.
Interpretation of LILA <11 cm in lean
children, .11-14 cm in normal children
and> 14 cm in fat children.
6. Mother's Education
Education in the Big Indonesian
Dictionary (2008) is the process of
changing attitudes and behavior of a
person or group of people in an effort to
mature humans through teaching and
training efforts. According to Arikunto
(2002) the education level category is
divided into two, namely elementary
school to junior high school education
while higher education starts from high
school to university level. Based on the
2012 IDHS, maternal education has an
inverse relationship with the risk of child
mortality. A high level of maternal
education is generally associated with a
low risk of death, this is because
education makes mothers get better
information on pregnancy and child care.
The infant mortality rate is 77% lower in
mothers with tertiary education
compared to children whose mothers
have low education (15 and 66 deaths per
1,000 live births).
RESEARCH METHODS
The design of this research is descriptive
analytic design with cross sectional research
approach . Study cross sectional / cross-
sectional is a type of non-experimental
observational study where Researchers
conducted observations / measurements of
variables at a particular moment. In this
study, researchers wanted to find the
relationship between the independent
variable as a risk factor and the dependent
variable as the effect by taking a momentary
measurement. The independent variable (risk
factor) in this study is the level of mother's
education. The dependent variable in this
study is toddler growth. The reason the
researcher used this design was to identify
the presence or absence of a relationship
between the independent variable (mother's
education level) and the dependent variable
(toddler growth) at the same time as one
measurement using a questionnaire, a scale
and meter.
Population and Sample
Sampling in this study using consecutive
sampling method is to take all the samples
found and meet the specified requirements
until the specified amount is met. The subject
criteria (inclusion criteria) in this study are:
Age of toddlers ie 3-60 months , Mothers
who have toddlers and are willing to be
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
respondents and can communicate well
verbally , while exclusion criteria in this
study are toddlers who come to Posyandu but
age has exceeded 60 months and refused to
be a respondent.
Data analysis
Data analysis in this study is univariate
analysis, the purpose of this analysis is to
describe the characteristics of each studied
variable, which consists of independent
variables covering the level of maternal
education and the dependent variable also
performed univariate analysis which is age,
sex and toddler growth ie BB / TB and LLA
. The second stage is to conduct a bivariate
analysis by looking for the relationship
between the two variables. This analysis was
carried out after univariate analysis and the
characteristics of each variable were known.
The purpose of this analysis is to prove
whether there is a relationship between the
independent variable consisting of the level
of mother's education to the dependent
variable, namely the growth of infants .
RESULTS RESEARCH
The presentation of the results of this study
will be displayed in two stages of
presentation, namely the presentation of the
results of univariate analysis and the results
of bivariate analysis. Univariate analysis
describes a description of the variables
studied including the level of maternal
education, age of children under five, sex of
children under five, BB / TB and LLA.
Table 1. Frequency Distribution of
Mother Education Level for Toddler
Children in Posyandu RW 12, Puskesmas
Kelurahan Gedong, East Jakarta.
No Mother
Education
Level
Frequency Relative
Frequency (%)
1 No school 2 2.27%
2 Elementary
school
11 12.50%
3 Middle
School
24 27.27%
4 High
school
42 47.72%
5 PT 9 10.22%
total 88 100%
From the table above shows the level of
education of mothers of children under five
is the majority graduated from high school,
which is 46.73% of the number of mothers of
children under five 88 who are respondents
in this study. While there are 2.17% of
mothers of children under five who have
never attended formal education. If
categorized as low education level, mothers
of toddlers are around 42.04% mothers of
toddlers with low education and 57.94%
mothers of toddlers with high education. The
low education level here is mothers who
don't go to school, elementary and junior
high school, while mothers with high
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
education levels are mothers who have
graduated from high school /vocational level,
Diploma I, II and III as well as Bachelor.
Table 2. Frequency Distribution of
Mother Educational Levels of Toddler
Children in Posyandu RW 12, Puskesmas
Kelurahan Gedong, East Jakarta.
No Mother
Education
Level
Frequ
ency
Relative
Frequency (%)
1 Low
Education
Level
37 42.04%
2 Higher
Education
Level
51 57.94%
Total 88 100%
The education level of mothers of children
under five in the Gedong region was 57.94%
with high education and low education with
42.04%. Based on the growth and
development factors of a child can be
influenced by external factors, one of which
is the mother factor. The mother factor here
is related to mother's education and mother's
knowledge about caring for her toddler.
Mother's education has an important role in
preventing underweight in toddlers. A
mother can determine how to determine the
parenting style she will choose especially in
choosing food for her nursery ( Damanik;
Ekayanti; & Hariyadi, 2010 ).
Table 3. Distribution of Toddler Sex in
Posyandu RW 012 Puskesmas Kelurahan
Gedong
No Toddler
Sex
Frequency Relative
Frequency
(%)
1 Man 49 55.68%
2 Girl 39 44.31%
total 88 100%
From the table above illustrates the sex of
children under five in RW 012 Kelurahan
Gedong is male as much as 55.4% while the
sex of toddler as many as 44.5%. The sex of
a child's growth also affects the growth of a
child. The growth of girls is faster than boys
of all ages (Wong, 2008).
Table 4. Distribution of Toddler Age
Frequency at Posyandu RW 12,
Puskesmas Kelurahan Gedong, East
Jakarta.
No Toddler
age
Frequency Relative
Frequency
(%)
1 Infants (1
- 12
Months)
24 27.27%
2 Toddler
(13 - 36
Months)
31 35.23%
3 Preschool
(37-60
Months)
33 37.50%
total 88 100%
Based on the frequency table above, it
illustrates that preschool age is prioritized
with 40.21% followed by toddler and infant
age. Infancy is a period of rapid motor,
cognitive and social development with the
baby's mother forming the basis of trust in
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
the world and the basis of interpersonal
relationships in the future. At toddler age is a
time of great physical and personality
development and requires broader social
relationships , and studying the role
standards for that growth of toddler age is
important to always be monitored.
Table 5. Weight / Height Distribution of
Toddler in P osyandu RW 012 Puskesmas
Kelurahan Gedong.
No Toddler
Nutritio
n Status
(BB /
TB)
Freque
ncy
Relative
Frequency
(%)
1 Thin 3 3.41%
2 Normal 84 95.45%
3 Fat 1 1.13%
total 88 100%
Based on the frequency table above the
nutritional status of children under five in
Posyandu RT 012 Puskesmas Gedong
Village a percentage of 3.41% of children
under five have underweight nutritional
status, 95.45% have normal nutritional status
and 1.13% under five have underweight
nutritional status. Weight and height is one
indicator in determining nutritional status,
proportionally normal and healthy toddlers
get older and are followed by weight gain.
Likewise, increasing height increases body
weight and increases the size of a toddler's
upper arm circumference.
Table 6. Distribution of Toddler Upper
Arm Circular Frequency at Posyandu RW
12, Puskesmas Kelurahan Gedong, East
Jakarta.
No Upper
arm
circumfer
ence
Frequen
cy
Relative
Frequency
(%)
1 Thin 1 1.13%
2 Normal 25 28.40%
3 Fat 62 70.45%
total 88 100%
Bivariate analysis is used to analyze the
relationship between the independent
variable and the dependent variable. This
study uses a chi-square test with an alpha
value of 0.05 to find out whether there is a
relationship between maternal education
level and the growth of children under five.
Variables tested by bivariate analysis were:
the level of education of mothers with under-
five growth in the BB / TB and LLA
components.
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Table 7. Analysis of the relationship between the Mother level of education and BB / TB for
toddlers in Posyandu RW 012 Puskesmas Gedong Kelurahan 2017 (n = 88) NO Mother's
Education
Level
Toddler Growth Total
P.
Value BB / TB
Thin
Normal
Fat
N % N % N % N %
1 Low 1 2.7 35 94.6 1 2.7 37 42.04 .478
2 High 2 3,9 49 96.1 0 0 51 58:00
Total
3 3.4 74 95.5 1 1.1 88 100
Table 8. Analysis of the relationship between the Mother levels of education end toddler
LLA in Posyandu RW 012 in Gedong 2017
NO Education
Level
Toddler Growth Total
P. Value
LLA
Thin
Normal
Fat
N
%
N
%
N
%
N
%
0.682
1 Low 0 0.0 11 29.7 26 70.3 37 100
2 High 1 2.0 14 27.5 36 70.6 51 100
total
1 1.1 25 28.4 62 70.5 88 100
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DISCUSSION
This research categorizes mother's
education levels into two namely low and
high education levels. The results of this
study indicate the level of education of
mothers
under children under five in the Gedong
village health center as many as 51 mothers
or
58% have toddlers with normal BB / TB
growth of 96.1%, while mothers with low
education levels are 37 people or 42.04%.
Statistical test results show the value of P
Value = 0.428 so it can be concluded that
there is no relationship with the level of
education of mothers with the growth of BB
/TB toddler. Unlike the case with the results
of research Waqidil and Adini (2014) the
results of the study with the title of the
relationship between the level of education
of mothers with the development of toddlers
aged 3-5 years. The study resulted in a
relationship between mother's educational
level with the development of toddler found
p: 0,000 <α: 0.05. Normal growth is not
only influenced by one factor. Factors that
can affect the growth of children under five,
especially body weight and height are
maternal factors including education and
work status of the mother , family income,
nutritional knowledge, sanitation hygiene,
and health services (Arini, 2018). Unlike
the case with the results of research
conducted by Damanik; Ekayanti; &
Hariyadi ( 2010 ) low maternal education
balitannya chance to experience Stunting
1:27 times compared with infants whose
mother's education level is above junior or
setin g kat. Mother's education plays an
important role in determining the level of
nutritional adequacy. The prevalence of
stunted children as an indicator of
undernourished children is lower in mothers
of higher education levels with any income.
The results of this study indicate the level of
education of mothers under five in the
Gedong village health center as many as 51
mothers or 58% have toddlers with normal
LLA growth of 27.5%, and 70.6%
overweight while mothers with low
education levels of 37 people or 42.04%
have toddlers with Normal LLA growth is
29.7% and Fat is 70.3%. Statistical test
results show the value of P Value = 0.682
so it can be concluded there is no
relationship between the mother's education
level and the growth of toddler LLA.
CONCLUSION
1. Obtained a picture of the age of children
under five and sex of children under five
in Gedong Village where the age of
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
toddlers who come to Posyandu
Kelurahan Gedong is 40.01% is
preschool age ie ages 3 to 5 years. As for
the sex of toddlers most are male with a
percentage of 55.40%.
2. Obtaining overview of education mother
toddler in Gedong village where
education level is most highly educated
mothers with a percentage of 57.63%, ie
at least high school and educated
Bachelor maximum.
3. Obtained a picture of growth in body
weight (BB) , height (TB) and Upper
Arm Circumference in toddlers in
Gedong Village where the growth of
toddlers seen from the height of the
highest body weight is at normal or
around 95.45%.
4. Obtain an overview of the relationship
between mother's education level and the
growth of children under five in the
Gedong Village Health Center, East
Jakarta. This study resulted in no
relationship between maternal education
level with the growth of BB / TB under
five and LLA under five with a P value
of 0, 478 for the relationship of maternal
education level with the growth of BB /
TB and the results of P value 0, 682 LLA
of children under five.
Thank You Note
Thank you to Nursing Academy Pasar Rebo
to all those who have contributed a lot in
doing this.
BIBLIOGRAPHY
Ati , CA ; Alfiyanti, D & Solekhan, A.
(2013). The relationship between
nutritional status and the gross
motor development of children
under five in Tugurejo District
Hospital . Semarang.
Darma KK 2011. Nursing Research
Methodology . Trans media info.
Jakarta
D ahlan, MS (2014). Steps for
Making a Medical and Health
Research Proposal . Jakarta:
Sagung Seto
Hastono, S. (2007). Health Data Analysis
Module . Faculty of Public Health,
University of Indonesia
Judkins-cohn, TM, & Kielwasser-withrow,
K. (2014). Ethical Principles of
Informed Consent: Exploring
Nurses' Dual Role of Care
Providers and Researchers, 45 (1).
http://doi.org/10.3928/00220124-
20131223-03
RI Ministry of Health. (2014). Guidelines
for Early Childhood Development
and Detection .
Kasenda, MG; Sarimin, S & Obnibala, F.
(2015). Relationship of nutritional
status with fine motor development
in preschool children in GMIN
Solafide Kindergarten, Uner
Subdistrict, Kawangkoan
Subdistrict, Minahasa Regency.
ejournal nursing volume 3.
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Resnik, DB (2015). What Is Ethics In
research & Why is it important?
National Institute of
Environmental Health Sciences.
Ministry of Health of the Republic of
Indonesia. Riskesdas Results.
(2013).
www.depkes.go.id/resources/down
load/general/Hasil%20Riskesdas%
202013.pdf.
Sastroasmoro, SC, & Ismael, S. (2011).
Fundamentals of clinical research
methodology , 4th Edition Jakarta:
Sagung Seto.
Ministry of Health of the Republic of
Indonesia. Indonesian
Demographic and Health Survey.
(2012).
www.depkes.go.id/.../profil-
kempuan-indonesia/profil-
kempuan-indonesia-2012.pdf
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
THERAPEUTIC PLAY OPTIMALIZATION IN PEDIATRIC POST
OPERATIVE PAIN WITH LEVINE’S CONSERVATION
MODEL APPROACH
Siti Nurhayati
E-mail: siti.nurhayati@akperpasarrebo.ac.id
ABSTRACT
Surgery still remains in a great number among children each year. Post operative pain is a traumatic
experience that become general problem among children with surgery. Pain treatment, including
farmakologic and nonfarmakologic management is needed. The aim of this study is to provide an overview
of therapeutic play as a nonfarmakologic management of post operative pain with Levine’s Conservation
Model approach. There were five managed cases that discussed in this study, and all of those experiencing
post operative pain problems. The trophicognosis of pain, based on assessment incuding: energy
conservation, structural, personal and social integrity. Children with therapeutic play showed decreased
of pain and adaptation faster. Therapeutic play as theraphy need a good cooperation among health care
provider.
Keywords: therapeutic play, post operative pain, Levine Conservation Model
Preliminary
Children who experience malignancy,
injury, or are born with congenital
abnormalities, and other acute diseases
will experience impaired organ function
and will affect children’s life. In these
conditions surgery is often needed as an
unavoidable option (Bowden &
Greenberg, 2010). The majority of
children experience moderate to severe
post-surgical pain (Baratee, Dabirian,
Yoldashkhan, Zaree, & Rasouli, 2011).
For that we need adequate pain relief,
both pharmacological and
nonpharmacological.
One of non-pharmacological therapy
that can give is playing therapeutic.
Therapeutic games carried out with the
purpose of reducing fear and discomfort
faced by children during the experience
of care, which is usually done by nurses
(Hockenberry & Wilson, 2012). The
study conducted by Athanassiadou,
Tsiantis, Christogiorgos, and Kolaitis
(2009) proved that puppet play in
children aged 4-6 years can reduce
postoperative aggressiveness and
hyperactivity.
Levine's conservation model approach to
pain management in postoperative
children is carried out as an effort to
obtain conservation: energy, structural
integrity, personal integrity, and social
integrity. One of them is conservation
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
through playing therapeutic by storing
energy and reducing unnecessary energy
use such as crying, excessive movement
and changes in vital signs.
APPLICATION OF NURSING
THEORY IN NURSING CARE
Case Overview
Case 1
Y, (1 year 5 months), after the cut stump
operation. Energy conservation: weight
11 kg, height 75 cm , the patient is rather
fussy and a little weak because he is
fasting and no interest to interact.
Conservation of structural integrity:
Consiousness level is composed mentis,
temperature 370C, pulse frequency 105 x
/sec, RR 40 x/sec, moist lip mucosal,
elastic skin turgor, normal bowel sounds,
warm akral, CRT < 2 sec. Conservation
of personal integrity: he is the 1st child,
lives with his parents who always look
after him and the patient is. Conservation
of social integrity: the patient is always
watched by his mother and sometimes
with his father. The family hopes that
An.Y will immediately recover and be
normal like other children.
Trophicognosis is enforced: the risk of
deficit fluid volume, the risk of
nutritional imbalance: lack of body
requirements, pain, and potential
complications of infection.
Interventions that have been carried out
include observing signs of pain scale,
maintaining a comfortable position for
the child, taking care of the perianal with
the mother. Evaluations conducted on
February 22, 2016 were obtained:
deviation of fluid volume did not occur,
nutritional imbalance: less than body
requirements did not occur, pain was
resolved, and infection did not occur
Case 2
RA, children (8 months), with PSARP
surgery on February 23, 2016.
Assessment on February 24, 2016.
Energy conservation: weight 6.8 kg,
height 64 cm, post-surgery children
become fussy and nervous about the pain
scale (FLACC Scale) 4. Eat porridge one
portion, drink gradually. Conservation of
structural integrity: pulse frequency 115
x/sec, RR 36 x/sec, sound of breathing
Ronchi, coughing occasionally.
Conservation of personal integrity The
client lives with his parents, the second
child are twin. Since hospitalized, R
become more fussy, often cry and not
interested to interact with other people.
Conservation of social integrity: the
client is always watched by his mother
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
and sometimes with his father. After the
operation, parents are took turns because
of fussy children. Parents ask for how to
care for it to succeed. Trophicognosis is
found: ineffective airway clearance, risk
of fluid and electrolyte imbalances, pain,
damage to skin integrity, potential
infectious complications, and lack of
knowledge.
Interventions carried out among others
monitor vital signs, observe the scale of
pain, provide distraction techniques,
educate families how to care for children
with post PSARP. Results of the
evaluation on 29 February 2016: the
airway clearance was effective, fluid and
electrolyte imbalances did not occur, the
pain was resolved, damage to the
integrity of the skin had not been
resolved, the infection did not occur, and
lack of knowledge was resolved.
Case 3
AA, (3 years), underwent laparoscopic
herniotomy on March 2, 2016.
Assessment on March 3, 2016 at 09.00;
Energy conservation: weight 12 kg,
height 84 cm , clients appear active and
easy to smile when invited to talk to
anyone. After surgery the child becomes
fussy and agitated on the pain scale
(VAS) 3-4. Postoperative drinking and a
diet free gradually. Conservation of
structural integrity: level of
conciousness was compos mentis,
temperature 36.60C, pulse frequency 110
x/sec, RR 24 x/sec, lip mucosal dry,
elastic skin turgor, normal bowel sounds,
warm akral, <2 sec CRT, vesicular
breath sounds , normal heart sounds (S1-
S2). Conservation of personal integrity:
the client lives with his parents who
always look after him and the client is an
only child. Conservation of social
integrity: When the client studies are
always watched by his mother and
sometimes with his father. Family hopes
for client immediately recovered and
was able to be normal like other children.
Post operation AA is more often seen
being carried by his mother because of
fuss. Trophicognosis: the risk of
deviation from fluid volume, acute pain,
damage to skin integrity and potential
complications of infection.
Interventions include observing
nonverbal reactions from discomfort and
playing therapeutic. Evaluation results:
Devisit fluid volume does not occur, pain
is resolved, damage to skin integrity has
not been resolved, and infection does not
occur.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Case 4
An SZ (9 years 3 months) diagnosis of
open supracondyler fracture of the right
elbow, after ORIF insertion with K-wire.
Assessment (5 April 2016): Energy
conservation: BB 22 kg, TB 135 cm,
client's face looks less relaxed,
occasionally looks grimace, lack of
interest in the surroundings. After
surgery the child becomes fussy and
agitated pain scale (VAS / FACES) 2-3.
Eat a half portion, drink gradually.
Conservation of structural integrity:
regular pulse frequency 110 x / min,
moderate pain. The right hand seen a
fracture wrapped with bandage, no
seepage. Middle finger, ring and little
right can be moved and feel stiff, painful.
Conservation of personal integrity: the
client is cared for by parents, is the
second child of 3 siblings. Conservation
of social integrity: when the client's
assessment is always accompanied by
his father. parents hope their child
recovered quickly and could return to
normal like other children. Enforced
trophicognosis: acute pain, physical
mobility barriers, risk of injury
(contractures) and potential
complications of infection.
Interventions include: conducting a
comprehensive assessment of pain,
teaching deep breathing techniques,
monitoring vital signs, and assessing the
client's ability to mobilize. Evaluation
results: pain is resolved, physical
mobility obstacles are overcome, injury
does not occur, and infection does not
occur.
Case 5
An AD (4 months) laparotomy surgery
release invagination ileotransversum
anastomosis resection, accompanied by
his mother with the main complaint of
bloody bowel movements since 1 day
before entered the hospital. A few days
ago, he vomits with the contents of ASI
(the client gets exclusive ASI). Bloating
and vomiting occur each time the client
is breastfed with a frequency of > 5 times
a day, with an amount that cannot be
predicted by the mother. Since yesterday
the BAB which was originally brown
turned red with thick mucus. When
checking at the clinic, they
recommended to be examined at Cikini
Hospital and said "folding of the
intestine" then referred to RSCM.
Clients receive paracetamol therapy
3x100 mg (k / p), Cefotaxime 3x200 mg,
Metronidazole 3x50 mg, and IVFD
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maintenance D10 15 ml / hour and AS
6% 7 ml / hour.
Conservation assessment results: Energy
conservation: weight 6.5 kg, height 68
cm, client looks uneasy with pain scale
(FLACC Scale), fasting diet status,
general state of moderate pain.
Conservation of structural integrity:
compos mentis awareness, temperature
37.90C, pulse frequency 136 x / sec, RR
34 x / sec, slightly dry lip mucosa, less
elastic skin turgor, normal bowel sounds,
warm acral, CRT < 2 sec, breath sounds
vesicular. Conservation of personal
integrity: the client from birth lives with
his parents who always take care of him
and the client is the second child of two
siblings. Conservation of social
integrity: when the client's assessment is
always attended by his mother, the father
only comes occasionally because he has
to work. The family hopes that. AD
immediately as before. Environmental
assessment: internal: Abdomen has
surgical scars, inserted NGT with solid
green production; external: current AD
was treated at the BCH in the
observation room. Complete blood and
electrolyte results: Hb: 9.82 gr / dl; Ht
30.9%; Leukocytes 13,200; Platelets
460,000, Na:: 134 meq / dl, K: 3.3 meq /
dl; GDS: 135 mg / dl
The hypotheses (nursing plans)
compiled in client related to pain
problems include: Energy conservation:
observe / monitor pain scale signs,
perform pain reduction techniques such
as touch, play / tell stories, singing.
Conservation of structural integrity:
maintain a comfortable position for
children, collaboration in administering
analgesics if needed: Paracetamol 3x150
mg.
On the last day an evaluation was carried
out (organismic response) with the
results: Subjective: the mother said the
child's fever no longer exists, no nausea
and vomiting, the wound was good and
was allowed to go home today by the
doctor; Objective: Energy Conservation:
the client drinks free breast milk, the
NGT drainage is concentrated green,
IVD fluid is stopped. Conservation of
structural integrity: consciousness level
(GCS) 15, warm acral, CRT < 2 seconds,
moist lip mucosa nausea, vomiting
absent, elastic skin turgor, stable
temperature, flat abdomen, supple,
intestinal noises, wound free from signs
of infection and closed clean kassa;
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Analysis: devisit fluid volume; the risk
of nutritional imbalance is less than the
body's needs; pain; potential
complications of infection; Planning:
intervention stopped.
Integration of Theories and Concepts
in the Nursing Process
The Basics and Assumptions of the
Levine Conservation Model have three
main concepts: wholeness (holism),
adaptation, and conservation. Nursing
practice with models and conservation
principles focuses on conserving
patients' energy to achieve health and
recovery (Levine, 1991 in Alligood &
Tomey, 2010).
Wholeness is an open system and
combines its parts into a unit to deal with
changes in their environment.
Adaptation is a process carried out by an
individual in order to maintain the
integrity of his life by synchronizing the
internal environment with his external
environment by considering the patterns
and adaptability of each individual that
varies according to the time (Historicity),
individual character (Specificity) and
level of adaptation (Redundancy) .
Conservation is a product of adaptation.
Through conservation, individuals can
face obstacles, adapt according to their
uniqueness and maintain their integrity.
According to Alligood (2010), the
nursing process based on the Levine
model can be explained as follows:
Assessment, is the stage of collecting
data on changes that occur in patients by
considering conservation principles.
Nurses assess changes in the internal and
external environment of clients that can
hinder their ability to achieve overall
health. The nurse will assess changes in
the following aspects: a. Energy
conservation: a balance between client
energy expenditure and supply; b.
Conservation of structural integrity: a
defense system for the body; c.
Conservation of personal integrity:
client's feelings about self-esteem, and
personality; d. Conservation of social
integrity: a person's ability to participate
in social systems (family, community,
etc.)
Levine recommends trophicognosis as
an alternative nursing diagnosis.
According to Wilkinson and Ahern
(2012), nursing problems that can occur
in patients undergoing surgery include:
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
pain, anxiety, body image disorders,
delay in post-surgical recovery, risk of
infection, intolerant activity, and damage
to skin integrity.
The hypothesis, is a plan for
implementing nursing interventions that
aim to maintain the integrity of the
patient and promote their adaptation to
the current situation. The nurse will
make a hypothesis of the problem and a
solution that can be done, and then it will
become a nursing plan.
Interventions, carried out based on
conservation principles (energy
conservation), structural integrity,
personal integrity and social integrity.
Acute pain due to post-surgical incisions
is usually a collaborative problem that is
addressed, especially by providing
narcotic analgesics. As for independent
nursing interventions such as teaching
patients to divide the incision area while
moving, teach distraction techniques (eg.
by playing therapeutic) and other pain
management (Wilkinson & Ahern,
2012).
Evaluation, is an assessment of the
client's response to the intervention
provided. Evaluation is done by
reviewing the client's response. .
DISCUSSION
Avoid excessive fatigue and maintain
energy balance so that the incoming
energy in accordance with the energy
that comes out, is an effort for energy
conservation. Physiological children by
requiring surgical action cause imperfect
biochemical and metabolic cell work
which ultimately makes working vital
organs such as the heart, kidneys, lungs
and others imperfect so that energy
disturbances arise (Mefford & Alligood,
2011).
From the study of energy conservation to
the five cases, it is found that data
generally shows that clients get a
disruption in energy conservation in the
form of acute pain. Acute pain is an
unpleasant sensory experience arising
from acute tissue damage described in
such a way as to invasive procedures
(NANDA, 2012). In the short term, pain
causes a decrease in oxygen saturation
and a decrease in the work of the heart
which eventually results in
cardiorespiratory disorders.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
The above conditions will affect energy
conservation due to the imbalance of
supplies with needs. But this does not
occur in all five cases. This is due to the
rapid and precise management of pain.
Pain management performed on all
managed clients is to provide therapeutic
play distraction techniques, monitor pain
scale, nonverbal response, vital signs and
provide analgesic therapy. Distraction
works by diverting the focus of the
child's attention to something, so that the
child is expected to "forget" their pain.
The recommended type of game is a
game that can be enjoyed by children on
the bed, because in post-surgical care
children usually experience restriction of
activity until the third day. Magnetic
numbers / letters on board, finger / hand
puppets, drawing / coloring are examples
of games that can be given (St. Louis
Children Hospital, 2014). Therapeutic
games are given starting from playing
dolls, listening to music, blowing
balloons, playing video games, coloring,
and storytelling (James, Nelson &
Ashwill, 2013). In infants, distraction
can be done by touching, swinging and
giving Non Nutritive Sucking (NNS)
(Sahoo, Rao, Nesargi, 2013).
Music therapy is used to help reduce
stress and pain in children. The results
show that music therapy can reduce pain
scores, respiratory rate and pulse and
reduce anxiety in children who are
undergoing lumbar puncture (Nguyen,
Nillson, Hellstrom, & Bengston, 2010).
Studies conducted by Athanassiadou,
Tsiantis, Christogiorgos, and Kolaitis
(2009) prove that puppet play in children
aged 4-6 years can reduce postoperative
aggressiveness and hyperactivity.
The implementation of therapeutic play
was also one of the resident innovation
projects while undergoing practice in the
BCh room at Cipto Mangunkusumo
Hospital. This activity was chosen in
order to carry out a holistic approach to
improve the effectiveness of pain
management. The responsibilities of
nurses in this regard include: ensuring
that patients get appropriate assessment
and management based on evidence-
based nursing, monitoring pain and
managing pain associated with
complications, educating patients and
families, documenting steps for pain
management, and seeking (applying)
standard for post-operative patient care
(Yuceer, 2011).
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Another treatment that is done in dealing
with pain is collaborating with doctors in
administering analgesics. Several types
of analgesics are given to managed
patients with an intravenous route. Oral
analgesics are usually given after the
fifth day or for treatment at home. The
study by Chorney and Kain (2010),
showed that parents and children did not
get the recommended dose of treatment
at home. Therefore, adequate education
needs to be given before patients are
discharged (James, Nelson & Ashwill,
2013). The brain has a pain management
system ("analgesia"). There are several
types of transmitters involved in this
analgesia system, including dopamine,
serotonin and endorphins that have
morphine-like properties. Activating the
analgesia system can suppress peripheral
nerve signals (Hall, 2014). Morphine
receptors are released in the brain due to
feelings of pleasure, happiness and
comfort. This process occurs when
children play therapeutic, so this activity
is effective for reducing pain.
Conclusion
1. Pain is a problem that is always faced
by children after undergoing a
surgical procedure. The provision of
nursing care with the Levine
Conservation model approach to
children with post-surgical pain
shows that this model can be used to
optimize patient adaptability.
2. Therapeutic play has an important role
in handling non-pharmacological pain
in post-surgical children.
Recommendation
The application of the Levine
Conservation model in handling
postoperative child pain shows that
children can optimize their adaptive
abilities. The application of nursing
theory in practice is very helpful in
developing nursing science, especially
child nursing. Therefore nursing services
are expected can consider the
management of nursing care using the
approach of nursing theories.
Reference
Alligood, M.R. (2010). Nursing theory:
Utilization and Application (Fourth
edition). Missouri: Mosby.
Baratee, F., Dabirian, A., Yoldashkhan,
M., Zaree, .F., & Rasouli, M.
(2011). Effect of therapeutic play on
postoperative pain of hospitalized
school age children in pediatric surgical ward. Journal of Nursing
and Midwifery. vol.21, no.72.
Hall, J.E (2014). Guyton and Hall:
Textbook on Medical Physiology.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
edition 12. (editor: Wijayakusumah,
M.D). Jakarta. Elsevier
Hockenberry, M. J., & Wilson, D.
(2012). Wong's clinical manual of
pediatric nursing. (8th). St. Louis:
Mosby Inc.
James, S.R., Nelson, K.A., & Ashwill,
J.W., (2013), Nursing care of
children: principles and practice (4th
ed). St Louis Missouri, Elsevier
Kain, Z.N., Mayes, L.C., Caldwell-
Andrews, A.A., Karas D.E., &
McClain, B.C. (2006). Preoperative
anxiety, postoperative pain, and
behavioral recovery in young
children undergoing surgery.
Pediatrics, 118 (2), 651-658.
Li, H.C.W., Chan, S.S.C., Wong,
E.M.L., Kwok, M.C., & Lee, T.L.I.
(2014). Effect of therapeutic play on
pre- and post-operative anxiety
responses Hong Kong Chinese
children: A randomized controlled
trial. Hong Kong Med J 2014; 20
(Suppl 7): S36-9
Mariyam, Rustina, Y., Waluyanti, F.T.
(2013). Application of Levine
conservation theory in children with
oxygenation fulfillment disorders in
the child care room. Children's
Nursing Journal, 1 (2), 104-112.
Meffort, L. C., & Alligood, M. R.
(2011). Testing a Theory of Health
Promotion for Preterm Infant Based
on Levin 's Conservation Model of
Nursing. Journal of Theory
Construction & Testing.
NANDA International. (2012). Nursing
diagnoses definition and
classification. West Sussex: Wiley-
Blacwell
Potter, P.A., & Perry, A.G. (2012).
Fundamentals of nursing: Concepts,
process & practice. 9th ed. St. Louis.
Mosby Year Book
Sahoo, J.P., Rao, S., Nesargi, S., Ranjit,
T., Ashok, C., & Bhat, S. (2013).
Expressed breastmilk versus 25%
dextrose in procedural, a procedural
double blind randomized controled
trial. Indian pediatr, 50 (2). 194-199
Shields, L. (2010). Perioperative care of
the child: A nursing manual. UK.
Wiley-Blackwell
St. Louis Children Hospital. (2014).
Postoperative care for children.
Online publication accessed March
5, 2016 via the website
http://www.stlouischildrens.org/our
-services/center-cerebral-palsy-
spasticity/postoperative-care-
children.
Tomey, A.M., & Alligood, M.R. (2009).
Nursing Theorists and Their Works.
(6t Ed). St.Louis: Mosby
Yuceer, S. (2011). Nursing approaches
in the postoperative pain
management. Journal of Clinical
and Experimental Investigation.2
(4): 474-478. doi: 10.5799 /
ahinjs.01.2011.04.0100
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
FACTORS AFFECTING DEPRESSION IN HEMODIALYSIS PATIENTS
Yuanita Panma
Akademi Keperawatan Pasar Rebo, Medical Surgical Nursing Department
Email: yuanitapanma@akperpasarrebo.ac.id
Jl. Tanah Merdeka no.16-18, Pasar Rebo, East Jakarta, Indonesia
ABSTRACT
Background: Depression is a common psychological problem faced by hemodialysis patient. Patient with
depression had lower obedience level in dialysis and also lower quality of life. This study aim to identification
factor affecting depression in hemodialysis patient. Methods: A cross sectional design was used with a total of
119 respondents. The bivariate data is analyzed with chi-square, one way anova and kruskal wallis test. The Beck
Depression Inventory (BDI) questionnaire, The Functional Assesment of Chronic Illness Therapy Spiritual
(FACIT Sp12) and The Medical Outcomes Study Social Support Survey (MOS-SSS) questionnaire to measure
depression, spiritual and social support. Results: There is no significant relationship between age, gender,
education, occupation, frequency of hemodialysis, time undergo hemodialysis, and social support with depression.
But there is a significant relationship between spiritual level (p-value 0.001) with depression. Conclusions: Based
on the findings, healthcare team can support spiritual level patient in the hospital, to reduce depression in
hemodialysis patient
Keywords: depression, hemodialysis, spiritual
Introduction
Chronic Renal Failure (CRF) has globally
become a serious problem where the disease
is able to affect the rates of morbidity and
mortality. In 2014, the rate of CRF patients
reached 111.2 per 1000 patients annually,
with a doubled number of mortality
compared to other patient types (United
States Renal Data System, 2016). In
Indonesia, the number of death of chronic
kidney disease patients in 2014 was 2.221
with the cardiovascular-related cause of
death at 59% (Indonesian Renal Registry,
2014).
Hemodialysis is one of treatment for CRF
besides peritoneal dialysis, and renal
ransplantation. In addition to the therapeutic
effect, hemodialysis can also have long-term
effects that can reduce the quality of life of
patients in the form of physical, psychosocial
and spiritual impacts. One of the
psychosocial effects faced by clients is
depression (Iyasere & Brown, 2014).
Depression is a psychological problem that is
often experienced by patients with end-stage
renal failure. Depression is also called
unipolar disorder, which is characterized by a
decrease in mood (loss of passion for activity,
depressed, unable to express feelings of joy)
(Sarlito, 2014). Dialysis therapy carried out
in patients with chronic renal failure causes
several changes including loss of bodily
functions, changes in role in the family, work,
physical strength, sexual function and
thinking ability. This reinforces the concept
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
of loss associated with depression. Besides
physiological changes, weaknesses that
occur, stress due to chronic renal failure, and
the need to undergo dialysis therapy for life
puts the patient at high risk for depression.
The prevalence of depression in advanced
stage CRF patients who undergo dialysis
(39.3%) is higher than the prevalence of
depression in stage 1-5 patients who do not
undergo dialysis therapy (26.5%) and in
patients undergoing kidney transplantation
(26.6%) %) (Palmer et al., 2013). The risk
factors for depression in general according to
Amir (2005) are gender, age, marital status,
geographical, family history, personality,
social stressors, social support, and not
working. Meanwhile, according to Arici
(2014) risk factors for depression are: young
age, female sex, white race, unemployment,
low income, low education level, non-
compliance with dietary restrictions, non-
compliance with Intra Dialytic Weight Gain
(IDWG), diabetes mellitus, stroke,
hypoalbumin, cardiovascular disease, and
other psychiatric disorders, estranged pouse,
social interaction disorder, estranged family
members.
Depression in CRF patients brings many
disadvantages. CRF patients who are
depressed can increase morbidity,
hospitalization and mortality compared to
CRF patients who are not depressed. Besides
depression can also cause non-compliance
with medication, dialysis therapy and low
quality of life (Palmer et al., 2013). A meta-
analysis study conducted by Palmer, et. al.
(2013) showed a strong relationship between
depression and all causes of death with a
relative risk of 1.59 with a moderate level of
heterogenity. CRF patients who experience
depression show low levels of adherence to
medication, dialysis regimens and low
quality of life which ultimately leads to
increased use of health care facilities and
increased mortality and morbidity (Kimmel,
Cohen, & Peterson, 2008).
The high rate of depression in hemodialysis
patients requires ongoing treatment. Early
detection of depression in hemodialysis
patients is an important first step to further
determine what factors influence the
occurrence of depression in hemodialysis
patients. But it has been fully assessed about
factors that have affected depression in
hemodialyis patients.
Methods
The design of this study is a cross-sectional
design, with consecutive sampling. There
were 119 CRF patients being respondent
with the inclusion criteria in this study were
able to communicate verbally using Bahasa
Indonesia and were outpatients who had
received hemodialysis for at least 3 months.
The research was conducted in May 2017 at
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
hemodialysis unit in East Jakarta. The
instrument used were the Beck Depression
Inventory (BDI) questionnaire to measure
depression and The Medical Outcomes
Study Social Support Survey (MOS-SSS).
BDI questionnaire has been translated in
Indonesian language by Waluyo (2014) with
alpha cronbach 0,822. While MOS-SSS
questionnaire has been translate by
researcher with alpha cronbach 0,907. This
study was approved by the research ethics
committee and the head of hospital. Before
the study begin, respondents were being
explained by the researcher, and all the
participants provided written informed
consent.
The data were analyzed using bivariate
analyses. The numerical data were presented
with mean values, with ± standars deviations
when they followed a normal distribution and
median (intequartile range) when they did not
follow normal curve. The normality test used
in this study was Kolmogorov-Smirnow
Independent t-test was used in order to
control the correlation between a quantitative
continous variables which followed the
normal qurve and a qualitative variable with
two categories. Chi Square was used to
control the correlation between two
qualitative variable with two categories. One
way annova used to control the correlation
between quantitative variables with normal
curve and qualitative variables. Kruskal
walis used to control the correlation between
quantitative variables with abnormal curve
and qualitative variables. A p-value lower
than 0.05 were considered as statiscally
significant. To perform the statistical analysis
the IBM SPSS Statistic version 13 (SPSS
Inc., 2003, Chicago USA) software was used.
Results
In this study, the mean age of the patients
was 54.95 years. The majority of the
respondents were males 60 person (50,4%),
senior high-school graduates 49 person
(41,2%), unemployed 88 person (73,6%),
undergoing hemodialysis twice a week 109
person (91,6%) and the mean duration of
hemodialysis was 32.67 months (SD: 32.28).
Characteristics of the respondents are
presented in Table 1. In table 2, majority
woman and man have no depression,
majority respondent with hypertension have
no depression, majority respondent with not
adequate hemodialysis have no depression,
majority respondent wih high school
education have no depression, majority
respondent which have hemodialysis twice a
week have no depression, majority
unemployed respondent have mild
depression.
Table 1.
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Characteristics of Respondents and Hemodialysis Information (N=119)
Characteristic N %
Age
(M= 54.95, SD= 11.61, Min-Max= 27-81 years)
Gender
Female
Male
59
60
49.6
50.4
Education
Elementary
Junior High
Senior High
University
16
19
49
35
13.4
16.0
41.2
29.4
Occupation
Unemployed
employed
88
31
73.6
26.4
Frequency of HD
2 times a week
3 times a week
109
10
91.6
8.4
Dialysis adequacy
Not adequate
Adequate
117
2
98.3
1.7
Depression
Normal
Mild
Moderate
Severe
59
49
8
3
49.6
41.2
6.7
2.5
Spiritual level
Low
High
58
61
48.7
51.3
Time undergoing Hemodialysis
(M= 32.67, SD= 32.28, Min-Max= 3-192 months)
Hemoglobin Level (M= 7.58, SD= 1.49, Min-Max= 5.2-13.1mg/dl)
Inter Dialytic Weight Gain (IDWG)
(M= 2,13, SD= 1,10, Min-Max= 0-5 kg)
Ureum
(M= 59,89, SD= 25,06, Min-Max= 14-155 mg/dl)
Duration of hemodialysis
(M= 4.30, SD= 0,433, Min-Max= 4-5hours)
Quality of Life
(M= 62.51, SD= 1.72, Min-Max= 59.38-65.63)
Note: M= Mean, SD= Standar deviation, n= frequency, %= percentage
Table 2.
Relationship between gender, hypertension, hemodialysis adequacy, education, occupation, frequency of
hemodialysis, access of vascular, and spiritual level with depression (N=119)
Depression Total p-value
Not depression Mild Moderate Severe
n % n % n % n % n %
Gender
Woman 29 49.2 24 40.7 4 6.8 2 3.4 59 100 0.948
Man 30 50 25 41.7 4 6.7 1 1.7 60 100
Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100
Hypertension
Not
Hypertension
20 55.6 15 41.7 1 2.8 0 0 36 100 0.412
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Hypertension 39 47 34 41 7 8.4 3 3.6 83 100
Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100
adequacy
Not adequate 59 50.4 47 40.2 8 6.8 3 2.6 117 100 0.406
adequate 0 0 2 100 0 0 0 0 2 100
Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100
Education
SD 6 37.5 8 50 2 12.5 0 0 16 100 0.082
SMP 7 36.8 10 52.5 0 0 2 10.5 19 100
SMA 24 49 22 44.9 2 4.1 1 2 49 100
PT 22 62.9 9 25.7 4 11.4 0 0 35 100
Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100
Occupation
Unemployed 38 43.2 40 45.5 7 8.0 3 3.4 88 100 0.10
6 Employed 21 67.7 9 29 1 3.2 0 0 31 100
Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100
Frequency of Hemodialysis
2x/week 55 50.5 44 40.4 7 6.4 3 2.8 109 100 0.836
3x/week 4 40 5 50 1 10 0 0 10 100
Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100
Access of vascular
Cimino 49 50.5 39 40.2 6 6.2 3 3.1 97 100 0.940
CDL 8 44.4 8 44.4 2 11.1 0 0 18 100
Femoral 2 50 2 50 0 0 0 0 4 100
Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100
Spiritual level
low 19 32.8 29 50 8 13.8 2 3.4 58 100 0.001
* High 40 65.6 20 32.8 0 0 1 1.6 61 100
Total 59 49.6 49 41.2 8 6.7 3 2.5 119 100
*p<0.05
The bivariate analysis showed in table 3.
The results of the analysis of the relationship
showed there were no significant
relationship between age, gender, education,
occupation, time undergoing hemodialysis,
Hb level, adequacy of hemodialysis,
frequency of hemodialysis, access of
vascular, hypertension, social support and
Intra Dialytis Weight Gain (IDWG) with
depression. Only spiritual variable has
significant relationship with depression.
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Table 3. Bivariate test
Variables Bivariate test p-value
Age One way anova 0.774
Gender Chi-square 0.948
Education Chi-square 0.082
Occupation Chi-square 0.106
Time undergoing hemodialysis Kruskal walis 0.937
Hb level Kruskal walis 0.404
Adequacy of hemodialysis Chi-square 0.406
Frequency of hemodialysis Chi-square 0.836
Access of vascular Chi-square 0.940
Hypertension Chi-square 0.412
Social support Kruskal walis 0.157
Spiritual level Chi-square 0.001*
IDWG Kruskal walis 0.787
*p <0.05
Discussion
In this study, some respondent had mild,
moderate and severe depression, while
majority of respondents were normal.
Previous studies conducted by Waluyo
(2014) obtained an average level of
depression in hemodialysis patients 18.76
(moderate depression). While research
conducted by Septiwi (2011) shows that
more respondents have mild depression
than those with moderate depression.
Majority of respondents had high spiritual
level in this study. This result in line with
study conducted by Spinale, et al (2008)
who found the mean score of spirituality in
hemodialysis patient was high (mean score
17,5 in range 0-20). Spirituality is important
for hemodialysis patients, to make a future
plans for life while they adapted with
hemodialysis therapy, and to faced the
prospect of death (Walton, 2007) . Because
the physical impact of chronic kidney
disease, medication side effects and dialysis
treatment were negatively affect patients
roles and activities and also challenges
patient’s spirituality (Arici, 2014; Mulder &
Sikken-Kersten, 2016).
There were no significant relationships
between age, education and social support
with depression in this study. This result in
line with research conducted by Astiti
(2014), where there is no significant
relationship between age, education, marital
status and family support with depression in
hemodialysis patients.
In contrast to the results of research
conducted by Setiawan and Novianti (2014)
found that there is a significant relationship
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
between the age of respondents with
depression, this is evidenced that in the age
group > 50 years experience high levels of
depression. In line with Nevid, et al (2003)
which states that depression is most
common in elderly patients, this is because
in the elderly there is a tendency to deny that
he has a problem because he may feel he is
not as fresh as before. Depression in the
elderly is also caused because the person
concerned suffers from several physical
illnesses so that they overlap, and then
depression occurs. In this study, more male
respondents suffered from depression than
female respondents. This is in line with
previous studies conducted by Rustiana
(2012). According to Ruli (2008) men are
indeed more susceptible to chronic kidney
failure than women, whereas from
depression women are more susceptible to
depression because women more often
recognize depression than men and doctors
are more able to recognize depression in
women.
In this study, there was significant
relationship between spiritual level and
depression in hemodialysis patient. This
result in line with previous study who found
that spiritual and religious beliefs correlated
with decreased levels of depression (Patel,
2002). Martinez`(2014) also found that poor
mental health and the presence of
psychological stress, sleep disturbance and
psychosomatic complaints were associated
with lower existential and spiritual
wellbeing. The other study conducted by
Davison (2013) found that spiritual is a
significant predictor of mental quality of
life. This can be explained by research
conducted by Kabat-Zinn, et al (1992)
which states that religious practices activate
various parts of the brain, including in the
structure of the frontal lobes. Activation of
the frontal lobes can lead to regulation of
the functioning of the autonomic nervous
system by connecting the frontal lobes and
the limbic, hypothalamic and amygdala
nerve. Religious practices such as
meditation are also related to immune
system. The autonomic nervous system can
reduce blood pressure, speed pulse,
respiration and cortisol levels and are
effective for reducing stress, anxiety and
panic.
Study conducted by Narayaanasamy (2002)
shows that spirituality is coping
mechanisms and also important factors that
contribute to recovery client. The
relationship of spirituality and activity is
explained in the mechanism that includes
central nervous system, neurotransmitters,
endocrine and immune systems. This matter
described when a person experiences stress
then the endocrine or system
Catecholamines consisting of dopamine,
norefinephrine and efinephrine will change
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
impulse stress function in cardiovascular
reactivation due to increase catecholamines,
this will reduce the body's immune system
regulatory reaction. When stress occurs
over a long period of time eating will
potentially produce negative health. That is
why religious practice can improve the
body's response to stress which has a
positive effect on health (Selbold, 2007).
Conclusion
For conclusion, there was significant
relationship between spiritual level and
depression. Based on the findings, as a
nurse we can promote better spiritual level
for the patient and family to reduce
depression in hemodialysis patient.
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3180.2014.1321606
Mulder, A., & Sikken-Kersten, L. (2016).
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Report Of Indonesian Renal Registry.
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THE EVALUATION WITH MODEL CIPPO OF INDONESIAN NURSE
STANDARD COMPETENCIES (INSC) FOR INDUSTRY 4.0
Labora Sitinjak1,2, Burhanuddin Tola 1, Mansyur Ramly3
1 Universitas Negeri Jakarta, 2Akademi Keperawatan Husada Karya Jaya, 3 Universitas Muslim Indonesia
Email: laborasitinjak8@gmail.com
ABSTRACT
This study aims to evaluate the implementation of the INSC and the method of evaluation of research using model:
Context, Input, Process, Product, Outcomes. INSC current set of the year 2009, has not yet been evaluated for nearly
10 years, not to accommodate the new policy post 2009 and have not adapted new technology especially the industrial
revolution 4.0. The results showed that: Aspects of the context of moderate value, determination and implementation of
INSC in line with the expectations of the team's constituents. There are linkages the purpose of the determination and
implementation of INSC to the satisfaction of all stakeholders. Has not yet been adapted with the industrial revolution
4.0. Aspects of inputs include Human Resources with low-value, needs to be adapted, the industrial revolution 4.0. The
budget and facilities with a value of moderate, planned and would be sure but still need efficiency as the impact of the
use of the latest technology. Organizational structure involved with low-value, not to accommodate Regulation No.
90/2017 concerning the team compiling the INSC is the Power of Nursing Council Indonesia and need to be adapted
the industrial revolution 4.0. Planning with moderate value, needs to be adapted planning industrial revolution 4.0.
Design, stages and standard designation INSC with moderate value, still need to be adapted with the industrial
revolution 4.0. Aspects of the process includes the setting, implementation and monitoring of the evaluation of the value
of moderate, yet adapted the industrial revolution 4.0. Aspects of products with low value includes the availability of
Component competencies of Nurses in health care institutions as well as the curriculum available in nursing education
institutions are based on INSC and have not been adapted by the industrial Revolution 4.0. Aspects of the impact of
low-value, satisfaction of stakeholders has not been optimal. Novelty model development implementation and evaluation
renewable INSC against technology and current policies. Researchers recommend CIPPO renewable INSC and
adapted with the industrial revolution 4.0.
Keywords: Evaluation, INSC, Renewable
INTRODUCTION
The INSC 2009 conventional general nursing
competencies, and not demanding digitizing
competence of nurses. When this happens the
fundamental changes that the disruption in the
era of industrial revolution 4.0 which is a new
challenge for the nation and state of Indonesia
and the world. This has implications in the
provision of nursing services. Minister Hanif
(2018) states that a change in the era of big
data digitization with greatly impact on the
character of the work up to the necessary
competencies of workers also changed.
Nursing human resources need to adapt and
anticipate competence of the system as well as
new equipment and work procedures based on
digital technology. Literacy nurses on
digitization and big data is necessary to
improve the competence adapted to the
industrial revolution 4.0. That is INSC need to
be renewed.
Ariani A. P. (2018) stated that nurses
participate has its own challenges in the era of
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globalization and digitization. Nurses today
need to compensate and adapt to the
surrounding environment based on the latest
technology. 4.0. Globalization of the
industrial revolution in the field of nursing is
a phenomenon that continues to roll in the
community. The presence of information and
communication technologies which accelerate
the process of globalization and the process of
working in the nursing field. The fact that
globalization touches to the entire field is
important in human life. Globalization 4.0
digitalization in the industrial revolution
creating challenges and problems that must be
faced, answered and resolved in an effort to
use globalization for the sake of people's lives
better.
Akhirfiarta BT. (2019), said that digital
literation is the ability to understand and use
information from a variety of digital sources.
This means that not only includes the ability
to read, but it takes a process of critical
thinking to evaluate the information found
through digital media. Nurses also require this
capability in the health service. INSC need to
accommodate the competence of nurses due to
digital literacy. The nursing workforce is
prepared for a digital globalization in the
industrial revolution 4.
Research Egbert N et al., (2018) says that
when nurses digital literacy in the various
domains in the advanced level will help to
more easily acquire the skills and other
competencies in life. Nursing services will
experience the efficiency and effectiveness
with high acceleration achieve service goals
when nurses terliterasi literacy and
digitization.
Research Methods
The method in this study is described in the
research design through two activities, namely
science conceptual and empirical drawn
through the data collecting.
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Research design is Described as follows:
Note: INSC: Indonesian Nurse Competency Standards, C: Context, I: Input, Q: Process, P:
Product, O: Outcome. Evaluation design CIPPO of the INSC
Source: Modification from Stufflebeam, 2017
Results of the implementation and results of each of the constituent components are rated
displayed through the following description:
Table 1. Evaluation Assessment Guidelines
Scoring scale Rankings/ratings Description
1. Low Evaluation criteria are not
fulfilled or partially fulfilled all
below 50% of the number of
grains of criteria
2. Moderate Evaluation criteria is met,
≥50% of the number of grains
of criteria
3. High Evaluation criteria are met all
C Gathering information
about the contents and
objectives of INSC
Interpretating
information about the
objectives relevance of
the Nurse Competency
Standards Indonesia
Analyzing information
about the content and
related objectives of
INSC with user
satisfaction Gathering information
about the readiness to
implement INSC
RE
CO
MM
EN
DA
TIO
N
I Analyzing information
about the readiness to
implement INSC
Information interpretation
about the readiness to
implement INSC
implementation of INSC
P Gathering information
about the INSC
implementation process
Gathering information about the results of
INSC implementation
Gathering information
about the impact of
implementation on user
satisfaction INSC
P
O
Analyzing information
about the INSC
implementation
process
Information interpreta-
tion about the INSC
implementation process
Analyzing the
information about the
results of INSC
implementation
Information
interpretation about the
results of INSC
implementation
Analyzing information
about the impact of
implementation on
user satisfaction INSC
Information
interpretation INSC about the impact of
implementation on user
satisfaction
CO
NC
LU
SIO
N
information
Collection
information
Analysis
information
Interpretation
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RESEARCH RESULT
Context
Table 2 Results of Context Evaluation of INSC
Aspects
Evaluated
Evaluation
criteria
Evaluation findings Ranked Decision
L M H
Analyze the
context
INSC
The contents of
the INSC ac-
commodate on-
going regulatory
and adapted to
the industrial
revolution
adapted & 4.0.
INSC has a comprehen-
sive reference, established
based on decision letter of
the Chairman of Indone-
sia's National Nurses Uni-
on. In the content INSC
has not been imaged com-
petencies adapted the
industrial 4.0.
Ѵ Evalua-
tion
criteria
are met
partly:>
50%
L: Low, M: Moderate, H: High, INSC: Indonesian Nurse Standard Competencies
The table above explains that INSC prepared
well through good references and
accommodate the laws, regulations and
policies related to standards of competence at
home and abroad but has not been reflected in
the statement competencies adapted to the
industrial revolution 4.0. INSC determined by
the Board's decision PPNI center and has the
aim of achieving the satisfaction of
stakeholders. Thus the results of the
evaluation context values are moderate.
Input
Table 3 Results of Input Evaluation of INSC
Aspects to be
evaluated
Evaluation criteria Evaluation findings Ranked Decision
L M H
HR in the
establishment and
implemen-tation of
INSC
Nursing HR capable of
digital literacy identity;
Infor-mation, media literacy
& data; learning & self-
development;
communication skills,
collabo-ration & parti-
cipation; tech-nical skills;
Digital
Creation, in-novation &
research
Establish and implement HR
INSC hasn't been able to
meliterasi digital identity;
Information, media literacy &
data; learning & self-
development; communication
skills, collaboration &
participation; technical skills;
Digital creation, innovation &
research
Ѵ Evaluation
criteria is
met: <50%
Budgetary
resources are used
in the Determina
Enough budget with the
latest technology-based
The budget fairly, but not yet
a digital-based management
system for the de-termination
Ѵ Evaluation
criteria is
met:> 50%
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tion and implemen-
tation of INSC
of ef-fectiveness effi-ciency
accelera-tion & & INSC
implementation
The resources of
the facilities used in
the determination
and implementation
of INSC
Sufficient facilities with the
latest technology-based
management
Amenities enough, but not
optimal digital-based mana-
gement to accelerate the
efficiency and effectiveness of
the INSC
Ѵ Evaluatio
n criteria
is met:>
50%
Aspects to be
evaluated
Evaluation criteria Evaluation findings Ranked Decision
L M H
The structure of the
organi-zations
invol-ved in the es-
tablishment &
implemen-tation of
INSC
KTKI have the ability to
literacy digitization
Permenkes not been enacted
Decree No. 90/2017 and has
not adapted to the industrial
revolution 4.0
Ѵ Evaluatio
n criteria
is met:
<50%
Planning the
structure of
organizations
involved in the
creation and
implementation of
INSC
Each of the parties involved
have the deter-mination &
im-plementation planning for
INSC of the industrial
revolution 4.0
Each party involved has the
determination and
implementation planning
INSC but not yet adapted to
the industrial revolution 4.0.
Ѵ Evaluatio
n criteria
is met:>
50%
Design of INSC Explain the description of the
INSC speci-fication for &
each category nurse &
descri-be competen-cies
adapted the industrial revo-
lution 4.0
Description and specification
INSC portrayed by nurses but
yet undefined category
competencies that have
adapted to the industrial
revolution 4.0
Ѵ Evaluatio
n criteria
is met:>
50%
Stages determina-
tion INSC
Stages of the determination
of the appropri-ate
procedures in progress
INSC& adapted the
industrial
revolution 4.0
Stages take place according to
the procedure INSC
determination but not yet
adapted to the industrial
revolution 4.0.
Ѵ Evaluatio
n criteria
is met:>
50%
Standard-setting
INSC
The stan-dard setting of
INSC using the current refe-
rence & adapted the
industrial revolution 4.0
Standard-setting INSC not
accommodated related policies
set out above in 2009 and has
Ѵ Evaluatio
n criteria
is met:>
50%
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
not adapted to the industrial
revolution 4.0
L: Low, M: Moderate, H: High, INSC: Indonesian Nurse Standard Competencies
The table above explains that HR enough but
Commissariat PPNI not participate in the
implementation of M & E Nurse Competency
Standards in Healthcare institutions. SDM not
yet have literacy towards digitalization. HR in
INSC determination has involved the relevant
stakeholders, but has not been involved in the
monitoring and evaluation PPNI
Commissariat INSC implementation in health
care institutions where nurses work so that the
value is low. Budget resources and facilities
are met but not yet adapted to the industrial
revolution 4.0 so that the value is moderate. in
the structure of the organizations involved has
not imposed Health Minister Decree No.
90/2017 and has not adapted to the industrial
revolution 4.0 so that the value is low.
Planning each unit involved in the
organizational structure has the determination
and implementation planning INSC but not
yet adapted to the industrial revolution 4.0 so
that the value is moderate. INSC
determination procedures and implementation
are met but have not yet adapted to the
industrial revolution 4.0, so the value is
moderate. INSC design has made it clear
description and specification INSC in each
category nurse but has not been reflected in
the competencies related to digitalisation, thus
ranking moderate. INSC stages of adoption
and implementation of compliance
procedures, but have not been adapted to the
industrial revolution 4.0, so nilaitnya
moderate. Standard-setting INSC have used a
complete reference at the time but have not yet
adapted to the industrial revolution 4.
Process
Table 4 Results of Process Evaluation of INSC
Aspects
Evaluated
Evaluation criteria Evaluation findings Ranked Decision
L M H
Stages of the
process of
implemen-tation
INSC
Stages of the process of imple-
mentation of appropri-ate INSC
according to Standar
Operational Prosedure &
adapted to digitization
INSC implementation process
stages according to the procedure
but has not adapted to the industrial
revolution 4.0
Ѵ Evaluation
criteria is
met:> 50%
L: Low, M: Moderate, H: High, INSC: Indonesian Nurse Standard Competencies
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
The above table describes the stages of the implementation process INSC according to
the SOP, but have not yet adapted to the industrial revolution 4.0 so that the value is
moderate.
Product
Table 5 Results of Product Evaluation of INSC
Aspects Evaluated Evaluation criteria Evaluation findings Ranked Decision
L M H
INSC Products: Nurse
Competency Standards
in health care
institutions and
curricula in nursing
education institutions
based INSC
There are nurse
competency standards in
nursing care institutions by
INSC and provided
curriculum at every
education category
nursing by INSC and
adapted to the industrial
revolution 4.0
There are nurse
competency stan-dards in
nursing care institutions
by INSC and provided
curriculum in each
category of nursing
education based INSC
but not optimal adapted
to the industrial 4.0
Ѵ Evaluatio
n criteria
is met:>
50%
L: Low, M: Moderate, H: High, INSC: Indonesian Nurse Standard Competencies
The table above explains that INSC
product on health care institutions already
have standards of competence which are
based on INSC and on nursing education
institutions provided curriculum refers to
the optimal INSC but not yet adapted to the
industrial revolution 4.0 so that the value is
moderate.
Impact
Table 6 Results of Impact Evaluation of INSC
Aspects
Evaluated
Evaluation criteria Evaluation findings Ranked Decision
L M H
Stakehol-ders
satisfaction on
the performance
of INSC
Nurses have the
competence managed
to give great
satisfaction to
Stakeholders
Leaders healthcare or nursing
convey that it is not satisfied
with the performance INSC in
improving the quality of
health care in institutions
Healthcare
Ѵ Evaluation
criteria is
met: <50%
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L: Low, M: Moderate, H: High, INSC: Indonesian Nurse Standard Competencies
The table above explains that the implications INSC to satisfaction of stakeholders are still not
optimal, so the value is low.
Discussion
Below is a discussion of the results of the
study as follows:
1. Context
The findings of the evaluation aspects of
the context, INSC prepared well through
good references and accommodate the
laws, regulations and policies related to
standards of competence at home and
abroad but has not been reflected in the
statement competencies adapted to the
industrial revolution 4.0. INSC
determined by the Board's decision PPNI
center and has the aim of achieving the
satisfaction of stakeholders. Thus the
results of the evaluation context values
are moderate. The research result
Halcomb E et al., (2016) says that the
testing and assessment of standards of
competence in continuing to strengthen
and develop competence of nurses in
primary health care. It is very necessary
to improve public confidence in the
quality of nursing services.
INSC is continuous and regular basis
must be investigated and evaluated to be
developed that are adapted to the
development of science and technology
and is capable of responding to global
challenges. INSC expected to raise the
dignity of nursing jobs nursing services
so that people recognized as noble and
scientific work. The nurse caring for the
individual human being in need of a
helping hand and heart services of a
competent nurse. Competent nurses are
nurses who carry out nursing care based
Caring. Caring is the essence of nursing
services. INSC should be able to improve
the health status of the community, nation
and state of Indonesia. Nursing personnel
with the greatest number of health
services are expected to bring up the
quality of service at the institution where
the nurse worked.
2. Input
The findings of the evaluation of the input
aspects, human resources PPNI
Commissioner's pretty but not participate
in the implementation of M & E Nurse
Competency Standards in Healthcare
institutions. SDM not yet have literacy
towards digitalization. HR in INSC
determination has involved the relevant
stakeholders, but has not been involved in
the monitoring and evaluation PPNI
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Commissariat INSC implementation in
health care institutions where nurses
work so that the value is low. Budget
resources and facilities are met but not yet
adapted to the industrial revolution 4.0 so
that the value is moderate. in the structure
of the organizations involved has not
imposed Health Minister Decree No.
90/2017 and has not adapted to the
industrial revolution 4.0 so that the value
is low. Planning each unit involved in the
organizational structure has the
determination and implementation
planning INSC but not yet adapted to the
industrial revolution 4.0 so that the value
is moderate. INSC determination
procedures and implementation are met
but have not yet adapted to the industrial
revolution 4.0, so the value is moderate.
INSC design has made it clear description
and specification INSC in each category
nurse but has not been reflected in the
competencies related to digitalisation,
thus ranking moderate. INSC stages of
adoption and implementation of
compliance procedures, but have not
been adapted to the industrial revolution
4.0, so the value is moderate. Standard-
setting INSC have used a complete
reference at the time but have not yet
adapted to the industrial revolution 4. 0
and yet accommodate the policies set
after the year 2009 until now, so the value
is moderate. Acreditation research results
ANCC (American Nursing Credentialing
Center), 2017 said that the nurse's
competence needs to be evaluated and
accredited continuously. Nurses Council
of Indonesia has been established through
the Minister Regulation No. 90 in 2017,
especially in chapter 8. The function of
the council is the setting, the
establishment and development of
nursing personnel in performing nursing
practice to improve the quality of health
services. The task for the nursing council
registration nursing staff, nursing
personnel conduct training run practice,
develop national standards for nursing
personnel, set standards of practice and
competence standards and enforce
discipline health workers practice nursing
personnel. In this regulation have been
accommodated consistency INSC makers
will monitor and evaluate the
implementation of INSC and discipline
practices nursing personnel. Need to
provide a tool or tools that purpose of this
regulation will be achieved in improving
the health status of the community.
3. Process
The findings of the evaluation aspects of
the process, the stages of the
implementation process INSC according
to the SOP, but have not yet adapted to
the industrial revolution 4.0 so that the
value is moderate. Aspects observed in
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
the implementation process is
consistency in the implementation INSC
start of the discussion, preparation,
determination, dissemination and
implementation as well as monitoring and
evaluation. Discussion process done well
through discussions in the meetings by
INSC maker teams with experts nursing.
After a discussion of the preparation and
adoption INSC done. Determination
INSC occur after discussion in the
national congress as the ultimate legal
power INSC. Socialization was carried
out from the center to the regions.
Monitoring and evaluation processes will
also be something very important in the
process of sustainable development so
that INSC is always renewable. INSC
latest procurement will be able to satisfy
stakeholders. INSC renewable
procurement process will make nurses
carry out the task with confidence and
dignity.
Acreditation research results ANCC
(American Nursing Credentialing
Center), 2017, said that individual nurses
who have successfully completed a
course of education or competence as
well as a certificate of competence, does
not necessarily have the ability or
competence in nursing practice.
Individuals who are successful and
recognized expertise or competence in
nursing are individuals who have
successfully implemented these
competencies in the execution of daily
tasks. These competencies should be
developed and researched in order to
improve the quality of care is continuous.
4. Product
The findings of the evaluation aspect
INSC product on health care institutions
already have standards of competence
which are based on INSC and on nursing
education institutions provided
curriculum refers to the optimal INSC but
not yet adapted to the industrial
revolution 4.0 so that the value is
moderate. INSC has been implemented at
each institution nursing services.
Consistency is the case with the INSC
implementation monitoring and
evaluation directly by every individual
nurse leaders are at work. In the future
these products will be implemented by
council consistently ranging from
manufacture to INSC development.
council consists of: Elements ministry
held government affairs in the health
sector as much as one person; ministry
which held government affairs in the field
of higher education as much as one
person; organization of the nursing
profession as much as two people;
college of nursing as much as two people;
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
association of nursing education
institutions as much as one person;
association of health facilities as much as
one person and community leaders as
much as one person.
Results of research-Qin Fang Wu et al.,
(2014) expressed about the consistency
and effectiveness of achievement of
competence set out in the curriculum.
Likewise, the results of research Ruth S
et al (2018), with the title of Entry-to-
practice public health nursing
competencies: A Delphi method and
knowledge translation strategy in the
journal Nurse Education Today. In this
study are described: Background to
sustain and strengthen the contribution of
nurses in public health services and
society in the 21st century, most still rely
on the quality of nursing education.
Likewise, the results of research Egbert N
et al., (2018) with the title: Competencies
for nursing in a digital world.
Methodology, results, and use of the
DACH-Recommendations for nursing
informatics core competency areas in
Austria, Germany, and Switzerland in the
Journal of NCBI (National Center for
Biotechnology Information). In this
study, submitted that nurses require
understanding or digital literacy: the
ability to live, learn, work, participate and
thrive in a digital society. Humans
become digital literacy which involves
the development of skills, attitudes,
values and behaviors that can be
categorized as: Digital Identity, welfare
and safety, communication, collaboration
and participation, teaching, learning and
self-development, technical capability
information, make data and digital media
literacy and innovation. Digital literacy in
the various domains in the advanced level
will help to more easily acquire the skills
and other competencies in life.
5. Impact
The findings of the evaluation aspects of
impacts, implications INSC to
satisfaction of stakeholders are still not
optimal, so the value is low. Research
results of Silaban G. et al., (2015) in the
journal Public Health Andalas entitled
Draft Competency Based Performance
Appraisal System Emergency Room
Nurse at XX Hospital Medan. In the study
said that some public hospitals (RSU) in
the field still have not meet the standards
Key Performance Indicator (KPI) of IGD,
one is RSU XX Medan. Needed
emergency nurse performance
assessment which is based on
competence, in order to provide the best
performance. Thus competence is
continuous, nurses need to be evaluated
to create optimal satisfaction for
stakeholders.
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Results informant interviews indicate that
the implementation has not been
satisfactory INSC party stakeholders.
Generally, participants said about their
satisfaction level is not optimal. This
shows that the adoption and
implementation of INSC still need to be
improved so that the impact is more
positive for policy makers, users and
stakeholders and other policies that will
benefit the community nursing service
recipients. In particular in the current era
of the industrial revolution 4.0 by
digitizing and big data encourage nurses
adapts itself to the disruption.
INSC model development
From the discussion above authors describe
the novelty of this research is the development
and implementation of INSC pricing model
based on the evaluation Cippo as follows:
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Findings and discussion of the evaluation
results summarized as follows:
1. Context
a. INSC policies need to accommodate
the latest as the foundation for
preparing the contents
b. INSC future needs of renewable and
adapted to the industrial revolution
4.0, digitizing and big data.
c. Availability of nurses who are
competent and have the digital
literacy to meet the expectations of
society and the government.
2. lnput
a. In the aspect of human resources and
organizational structure needs to be
adjusted to the Presidential Decree
No. 90 in 2017 and HR literacy nurses
on digitization.
b. Budget and facilities required in
setting up the implementation of
planned and fulfilled INSC well but
managed digitizing cloned partitions
for efficiency and effectiveness.
c. INSC determination and
implementation planning, design
INSC, stage-setting and standard-
setting INSC INSC pretty good, but
need to be adapted to the industrial
revolution 4.0.
3. Process
Aspects of the process of
analyzing the discussion, preparation,
C: Context Fill INSC-related policies to
accommodate the latest INSC
I: Input Human resources, budget,
facilities, structures involved, planning each involved in the
structure, design, and standard-setting stage INSC
adapted to the industrial revolution 4.0
P: Process INSC implementation process
adapted to the industrial revolution 4.0
P: Product - Nursing education
curriculum refers adapted INSC industrial revolution 4.0
- Standards of competence in health care institutions that have adapted to the industrial revolution 4.0
- Nurse training is continuous on improving the competence of renewable
Nurses always will produce competent
O: Outcome Stakeholders
optimum satisfaction
for the performance
of INSC
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
determination of content, implementation
and monitoring and evaluation INSC.
Implementation stages of discussion, the
preparation, establishment,
implementation and monitoring and
evaluation carried out according to the
procedures in force at the time. The
researchers concluded that this aspect of
the process is at a moderate ratings. All
stages performed well but need to be
adapted to digitization.
4. Product
Standards of competence and curriculum
of nursing education requires competence
statement digitization and need to be
adapted to the industrial revolution 4.0.
5. Impact
a. Impact determination of content
and implementation of INSC have
a positive effect for the institution
of nursing education as the
cornerstone of the establishment
of the learning curriculum
b. Impact determination of content
and implementation of INSC have
a positive effect on the health care
institution as guidelines for the
preparation of job descriptions,
performance measurement
cornerstone of nursing personnel.
c. The level of satisfaction of
stakeholders on the
implementation of INSC not
optimal.
Recommendation
The Council of Nurses INSC Indonesia
needs to improve the quality of the content
establishment, implementation, monitoring,
evaluation and development INSC as follows:
1. Discussion, assessment, dissemination,
implementation, evaluation and
development INSC future will be
coordinated by Council of Nurses
Indonesia in accordance with Presidential
Decree No. 90 in 2017
2. Literacy nurses towards digitization in the
era of the industrial revolution 4.0 needs
to be done through the implementation of
nursing education and nurse competence
in health care institutions
3. Develop and establish and monitor the
implementation of the adapted INSC
industrial revolution 4.0.
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ANCC Acreditation (American Nursing
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PROSIDING The 3rd International Nursing Conference (2019) “Nursing Contribution at Disaster Risk Management: Psychosocial Impact and Learning from Nations”
Application Handbook,
nursecredentialing.org
Ariani A. P (2018), Nurses should be
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