Proceeding - UMY Repository

THE PROCEEDING OF INTERNATIONAL JOINT CONFERENCE CHALLENGES IMPLEMENTATION OF THE ASEAN ECONOMIC COMMUNITY (AEC) IN THE HEALTH SECTOR IN INDONESIA

Reviewers Rose Nanju MN Unisa BN RN (Faculty of Medicine and Health Science Universiti Sarawak Malaysia) Prof. Nursalam ( Airlangga University) Dr.H.Moch. Agus Krisno Budiyanto,M.Kes (Muhamadiyah Malang University) Dr. Ali Haedar Sp.EM ( Brawijaya University)

Grand Surya Hotel 15-16th November 2015

Supported by :

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THE PROCEEDING OF INTERNATIONAL JOINT CONFERENCE: CHALLENGES IMPLEMENTATION OF THE ASEAN ECONOMIC COMMUNITY (AEC) IN THE HEALTH SECTOR IN INDONESIA

Editor: Rose Nanju MN Unisa BN RN (Faculty of Medicine and Health Science Universiti Sarawak Malaysia) Prof. Nursalam ( Airlangga University) Dr.H.Moch. Agus Krisno Budiyanto,M.Kes (Muhamadiyah Malang University) Dr. Ali Haedar Sp.EM ( Brawijaya University)

Cover Designer: Arya Ulilalbab, S.TP., M.Kes. Setting/ Lay out: Ns. Eko Arik Susmiatin, M.Kep,Sp.Kep,J Nian Afrian Nuari,S.Kep,Ns,M.Kep Dwi Setyorini,S.Kep,Ns,M.Biomed Steering Committee by: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

STIKES Karya Husada Kediri STIKES Surya Mitra Husada Kediri STIKES Hutama Abdi Husada Tulungagung STIKES RS Baptis Kediri STIKES Bhakti Mulia Pare FIK Unipdu Jombang STIKES Patria Husada Blitar STIKES Satria Bakti Nganjuk Akademi Kebidanan Dharma Husada Kediri Institut Ilmu Kesehatan Kediri

Printed by: UD. Mitra Abadi Dr. Sutomo 69 Street, Pare, Kediri Telp: (0354) 398912 Email : [email protected]

ISSN: 2477-0639

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COMMITTEE Committee President Ns. Ratna Hidayati, M.Kep., Sp.Mat Committee Vice President Dr. (PH) Sandu Siyoto, S.Sos.,SKM.,M.Kes Secretary I Reni Yuli Astutik, SST., M.Kes Secretary II Agusta Dian Eliana, S.Kep.,Ns.,M.Kep Financial Holders I Efa Nur Aini, S.Kep.Ns.,M.Kep Financial Holders II Sri Mahanani, S.Kep.,Ns.,M.Kep

Ceremonial Committee

Scientific Committee

Publication Committee

Hj. Farida Hayati, M.Kep Neny Triana, S.Pd.,S.Kep.,Ns Ita Eko Suparni, SSiT.,M.Keb Enggar Anggraeni, SST Yuly Peristiowati, S.Kep.,Ns.,M.Kes Ns. Aries Wahyuningsih, S.Kep.,M.Kes Dr. Apin Setyowati, SKM.,M.Kes (Kep) Masruroh, S.Kep.,Ners.,M.Kes Endah Susanti, SST Dian Prawesti, S.Kep.,Ns.,M.Kep Farida, SKM.,M.Kep Ulfa Husnul Fatah, M.Kep Trisnanto, SH.,S.Kep.,Ns.,M.Kes Siti Komariyah, SSiT.,M.Kes

Ns. Eko Arik S, M.Kep.,Sp.Kep.J Dwi Setyorini, S.Kep.,Ns.,M.Biomed Nian Afrian Nuari, S.Kep,Ns, M.Kep Andi Yudianto, S.Kp.,Ners.,M.Kes Sri Banun Titi Istiqomah, SST.,M.Kes Bambang Wiseno, S.Kep.,Ns Novita, S.Kep.,Ns.,M.Kep Erlin Kurnia, S.Kep.,Ns.,M.Kes Eny Masruroh, S.Kep.,Ners.,M.Kep Levi Tinasari, SKM.,M.Kes Titin, SST Erma Herdyana, S.SiT.,M.Kes

Ns. Moch. Maftuchul Huda,M.Kep.,Sp.,Kom Cucuk Suprihartini, STP.,M.Kes Yenny Puspitasari, S.Kep.,Ns.,M.Kes Ns.Sukamto,S.Kep.M.Kes Sandy Kurniajati, SKM.,M.Kes Dr. Suprajitno, SKp., M.Kep Ninik Azizah, SST.,M.Kes Ahmad Wasis S, S.Kep.,Ns.,MSi Yitno, S.Kp.,M.Pd Erni Setyorini, M.Kep Heru Wahyudi, S.Kep.,Ns.,M.Kes Susiani E.,SST.,M.Kes

Accomodation and Transportation Committee Linda Andri M, S.SiT.,M.Keb Basiran, S.Sos Mirthasari Palupi, SST., M.Kes dr. Nanang Muhibuddin

Decoration and Documentation Committee Ahmat Arianto, ST Dwiono Cahyo Susilo Arya Ulilabab, M.Kes Ns. Sujatmiko, S.Kep.,M.Kes

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GREETING FROM COMMITTEE PRESIDENT

On behalf of the committee, it is a great honor me to extend this opportunity to welcome all of you to International Joint Conference with a theme “Challenges Implementation Of The Asean Economic Community (AEC) In The Health Sector In Indonesia.” The International Joint Conference conducted by 10 institution consist of STIKES Karya Husada Kediri, STIKES Surya Mitra Husada Kediri, STIKES Hutama Abdi Husada Tulungagung, STIKES RS Baptis Kediri, STIKES Bhakti Mulia Pare, FIK Unipdu Jombang, STIKES Patria Husada Blitar, STIKES Satria Bakti Nganjuk, Akademi Kebidanan Dharma Husada Kediri, Institut Ilmu Kesehatan Kediri and supported by Akper Pamenang Kediri.I hope you all have wonderful, fulfilling conference and

are able to take great ideas back to your individual program. Through this conference we hope there is transfer knowledge, sharing idea so we can respone the change of global needs across health system . Ladies and Gentlemen, This conference brings together academicians, practitioners, researcher as much as 200 participant from different provinces in Indonesia and different countries such as Malaysia, Filphina. Finally, I would like congratulate those whose selected papers are included in the International proceeding and I also would like to thank to the attendance keynote speaker, expertise, participant and organizing committees of this conference. Thank you very much and enjoy the conference

Committee President

Ns. Ratna Hidayati, M.Kep., Sp.Mat

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INTERNATIONAL JOINT CONFERENCE AGENDA 2015 NO 1

DAY TIME Sunday 07.00-08.00 th 08.00-09.30 15 November 2015

09.30-09.45 09.45-10.30

10.30-11.15

11.15-12.30 12.30-13.15

13.15-14.00

14.00-14.45

14.45-15.15 15.15-16.00

16.00-16.45

ACTIVITY Registration Opening Ceremony National Anthem (Indonesia Raya) Traditional dance Speechs 1) The head of commite 2) The regent head of health department Kediri 3) Prayers 4) Photo session Tea Break Key Note 1 (30‟ presentation, 15‟ discuss) Update Management of Trauma in Pregnancy: Resuscitation priorities in the Implementation of ASEAN Economic Community (AEC) Key Note 2 (30‟ presentation, 15‟ discuss) Update Management of HIV-AIDS in the Implementation of ASEAN Economic Community (AEC) Pray and lunch Key Note 3 Legal aspect of ethical use of foreign labor in Indonesia health filed Key Note 4 Update Management of Stunting in the Implementation of ASEAN Economic Community (AEC) Key Note 5 The learning strategy (include hardskill, softskill, enterpreneurship, and foreign language capabilities health students)to face of ASEAN Economic Community (AEC) inUniversiti Sarawak Malaysia Tea Break and Pray Key Note 6 Update Management of Acute Coronary Syndroma (ACS) in the Implementation of ASEAN Economic Community (AEC) Key Note 7 Disaster Management in the

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RESPONSIBLE EVENT COMMITTEE COMMITTEE

Prof. Dr. Idzwan Zakaria (Malaysia)

Prof. Dr. Wongsa Laohasiriwong (Faculty of Public Health Khon Kaen University Thailand) Head of Province Health Department, Indonesia Sugeng Irianto, MPS.,PhD (Indonesian Representatif WHO) Rose Nanju (Faculty of Medicine and Health Science) Universiti Sarawak Malaysia

Assoc. Prof. Dr. Wasana Ruaisungnoen (Faculty of Nursing KKU Thailand) Sarah Sandy S.M, Phd

NO 2.

DAY TIME Monday 08.00-10.00 th 16 Nopember 10.00-10.15 2015 10.15-11.15 11.15-11.30 11.30-12.30 12.30-

Implementation of ASEAN Economic Community (AEC) ACTIVITY Oral Presentation (session 1) Tea Break Oral presentation (session 2) CLOSING Pray and Lunch City Tour

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(Philippines) RESPONSIBLE EVENT CONFERENCE COMMITTEE CONFERENCE COMMITTEE

TABLE OF CONTENT PROCEEDING OF INTERNATIONAL JOINT CONFERENCE 2015 ORAL PRESENTATION 1 2 3 4 5 6

7 8 9 10 11 12 13 14 15

16 17

18 19 20 21 22

Preparedness Strategies For Healthcare Students In Facing AEC: “The Importance Of Hard Skill, Soft Skill And Foreign Language Competencies” (Rose Ak Nanju Manju) An Update On The Management Of Trauma In Pregnancy: Resuscitation Priorities (Mohd Idzwan Zakaria) Update Management & Emergency Care For Acute Coronary Syndrome (Wasana Ruaisungnoen) Cheers: A Framework For Disaster Response And Management Review Of Related Literature (Sandra Sanches Montano) Update Management Of Stunting In The Implementation Of Asean Economic Community (AEC) (Sugeng Eko Irianto) Personal Hygiene Behavior And Vulvovaginitis Incident On Fertile Women Age In Obstetrics And Gynecology Ward dr. Iskak Hospital- Tulungagung (Yenny Puspitasari, Intan Fazrin) Analysis Motivation In Review Of The Components Employee Participant And Career Development (Ratna Wardani) Strategy On Health Care Protection For The Poor Society In Kediri City (Koesnadi) Cervical Cancer Model On Hela Cell Transplantation Mice (Yuly Peristiowati, Yenny Puspitasari) The Effect Of Elderly Exercise To Cognitive Dimensia Elderly Function In “Mawar”Age Care Facilities (Pslu) Blitar Tulungagung (Prima Dewi Kusumawati) Social Interaction Affect The Recurrence Of Coronary Heart Disease Patient In Poli Jantung RSUD dr. Mohamad Saleh Probolinggo (Nia Sari) The Effect Of Phase I Cardiac Rehabilitation On Activity Tolerance Of Patients With Coronary Heart Disease (Sutrisno) Analysis of The Use Of Personal Protective Equipment (Ppe) To Cleaning Service Work Accident dr. Iskak Hospital Tulungagung (Sandu Siyoto) Affecting Factors Of Community Preparedness At Disaster Prone Areas Kelud Mountain (Novita Ana Anggraini) Correlation Between Anxiety Levels With Dysmenorrhea Incident In Collegians Of Study Program Of Midwifery Advanced Diploma Stikes Karya Husada Kediri (Dwi Ertiana) Difference Of Mothermilk Production Between Massaged Baby And Unmassaged Baby (Brivian Florentis Yustanta) The Difference Of The Effectiveness Drinking Of Ginger And Vitamin B6 For Reduced Nausea And Vomiting Of Pregnancy In Working Area Of Bendo Public Health Center, Pare Sub-District, Kediri District (Wahyu Wijayati, Anis Setyowati) Description Of Preeclampsia Risk Factors In Hospital Pare Kediri (Endah Luqmanasari, Nunik Ike Yunia Sari) Detection Of High Risk Pregnancy In Integrated Antenatal Care (ANC) At Bendo Public Health Services Kediri District (Eka Sri Purwandari, Wahyu Nuraisya) The Risk Factor That Cause The Happening Of Post Partum Haemorrhage In RSUD Pare Kediri (Fitri Yuniarti) Description Of Risk Factors Neonatal Jaudience In The Perinatology Of Pare Hospital Kediri (Dwi Yuliawati, Ita Eko Suparni) The Influence Of Sosiodemografi Factors On The Incidence Cervical Precancerous

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3 4 5 6 7 8

16 21 27 31 35 39 48 54 63

68 73

78 83 88 93 98

23 24 25 26

27

28

29 30

31 32

33

34

35 36 37 38 39 40 41 42 43 44

Lession By Screening With Visual Inspection Acetat Acid (VIA) (Wuri Widi Astuti, Reni Yuli Astutik) The Analysis Of Menopausal Complaints Toward Menopause Anxiety At Pelem Village, Pare Subdistrict, Kediri Regency (Reni Yuli Astutik) Neonatal Outcomes In Women With Preeclampsia At General Hospital Of Kediri District On January-June 2015 (Dintya Ivantarina, Estin Gita Maringga) Correlation Self Appraisal With Pansy‟s Self Identity in 21-35 Years old (Farida Hayati) Analysis Of Intervention Of Sick Day Management In Effort To Create Normoglycemia In Patient Of Diabetes Mellitus Through Family After Discharge (Eko Arik Susmiatin, Rina Dwi Andari) Effect Of Aerobic Exercise With Yoga Relaxation Techniques Combined On The Fatigue Level On Patients With Breast Cancer Undergoing Chemotherapy (Muhammad Taukhid) The Effect Of Social Skill Training For The Game Addict On The Children 10-12 Years Old Of Students Class V State Elementary School (Dina Zakiyyatul Fuadah, Laviana Nita Ludyanti) Coaching Intervention Model To Improve Comfort In Adolesence With Disminore (Dhina Widayati) Mangosteen Peel Ekstracts As Preeclampsia Preventive Therapy On Reducing Oxidative Stress (iNOS And MDA) In Vivo Studies At The Mice Model Preeclampsia (Ratna Hidayati) Slow Deep Breathing Intervention Reduce The Frequency Of Recurrence Of Patients With Asthma Bronchiale (Nian Afrian Nuari) Effect Of Giving Cognitive Support And Emotional Spiritual Quotient (Esq) To Changes Sexual Behavior Patients Hiv/Aids (Joko Sutrisno, Yuly Peristiowati, Alfian Fawzi) The Effect Of Corn Flour Adding Proportion (Zea Mays) Towards Degree Of Provitamin A, Water Degree And Acceptability Of Cake Corn (Rizka Mar‟atus Sholichah, Arya Ulilalbab, Sindy Anneo Maharani) The Relation Between The Consumption Degree Of Energy, Protein, Fe, Folic Acid, Vitamin B12 And Vitamin C Toward Anemia Status For Alcohol Consumers In Jong Biru Village Kediri Regency (Mirthasari Palupi, Enggar Anggraeni) The “Kimcil” Phenomenon: Sexual Knowledge And Safe Sex Behaviour Among Adolescents In Kediri (M. Ali Sodik) Relationship Of Women‟s Self Perception About Menopause With Self Readiness In Facing Menopause In Selosari Kandat Kediri (Shinta Kristianti) Effectivity Progressive Muscle Relaxation Toward Stress At Community Impact Noisy Highway Street In Pare Kediri (Moch.Maftuchul Huda) The Impact Of Psychological Bulllying At School Against Student‟s Confidence On Communication Ability (Dwi Setyorini) Satisfaction Between BPJS Patients And General Patients Towards Health Services At Community Health Center (Yoyok Febrijanto, Sandy Kurniajati) The Importance Of Family Social Support In Improving Self-Care To Elderly (Dian Taviyanda, Heru Suwardianto) Nurse‟s Effort In Prevention Of Phlebitis To Patients In hospital (Kili Astarani, Erlin Kurnia) Parenting Type Of Authoritative Parents Tends To Inhibitmotor Development To Preschool Children (Rina Endah Kristini, Kili Astarani) Relationship Between Smoking Behavior With Sleep Disorders (Insomnia) Of Adolescent Boy (Leny Indrawati, Presca Adi Prayogo) The Influence Of Hip Motion Exercises (Stretching) To Decrease Lower Back Pain In The Elderly Posyandu Wonorejo Country Districts Sumbergempol Tulungagung

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103 108 113 118

223

230

235 244

251 258

265

273

279 287 294 301 308 315 322 329 336 343

45

46

47 48

49 50 51 52 53 54 55 56

57 58 59 60 61

62

63

64 65 66 67

(Ratna Kholidati, Dwi Intan sari) The Correlation Between The Interest And Motivation Of Becoming A Nurse And The Learning Achievement Of The Student Of Diploma III In Nursing Science At Hutama Abdi Husada Health Institute Of Tulungagung (Sri Agustiana) The Effect Of Massage To The Improvement Of Baby‟s Appetit On The Infants Aged 7-12 Months At Desa Aryo Jeding Kecamatan Rejotangan In Kabupaten Tulungagung As At 2015 (Yitno, Dian Fitriana Ulfa) The Effect Of Interleukin-1β Induction On Chondrocytes (Anis Murniati, Siti Zulaikah, Ma'rufah, Rena Normasari, Sri Fauziyah, Ardani Galih Prakosa) Personality Type Relationship With Students Learning Achievement Of Nursing Program Study S1 Stikes Hutama Abdi Husada Tulungagung (Farida, Taufik Muchlison) The Effect Of Meditationand Haemoglobin Levelson Learning Concentration (Indah Rohmawati, Oka Ludianita, Dwi Sixteen Erawati Putri) Management Of Hyperuricemia With Ergonomic Exercise (Anita Rahmawati) Psychoeducational Family Therapy To Improve Family Attitudes Towards Pulmonary Tb Patients (Bisepta Prayogi) 4s‟s Techniques To Physiological And Crying Duration On Newborn (Erni Setiyorini) Early Stimulation Of Children Aged 12-24 Months To The Gross Motor Development (Ika Agustina) Progressive Muscle Relaxation To Improve Quality Of Sleep Neurosis Patient (Nawang Wulandari) Carrot (Daucus Carota) And Simvastatin To Changes In Blood Colesterol Levels Of White Rats (Rattus Norvegicus) With Hyperkolesterolemia (Thatit Nurmawati) Relationship Between Personal Self-Care Ability And Quality Of Life In Patients Undergoing Chronic Kidney Failure In Hemodialysis Installations Of RSUD Mardi Waluyo Kota Blitar (Sandi Alfa WigaArsa) Effectiveness Of Problem Based Learning Model Towards Student Learning Outcomes In Midwifery Care Pregnancy Diploma Program (Nevy Norma Renityas) Relationship Between Knowledge And Attitude With Culture "Tarak" Postpartum Mothers In Wonodadi Blitar (Ning Arti Wulandari) Overview Of Fatigue In Cancer Patients Which Undergo Chemotherapy (Ulfa Husnul Fata) Improving Nursing Students‟ Speaking Skill By Using Realia As The Media (Wahyu Wibisono) Relationship Between Financial Models And Medicine Adherence In Patients With Diabetes Mellitus Inatalation In Outpatient At Rsud Ngudi Waluyo Wlingi (Yeni Kartikasari) The Effect Of Consuming Watermelon Rind Extract (Citrullus Lanatus) Toward The Decreasing Of Blood Sugar Levels On Diabetes Mellitus Patients In Weru - Paciran – Lamongan (Arifal Aris) The Effect Of Giving Common Snake Head (Channa Striata) On Perineal Wound Healing In Postpartum Mother In BPM Ny. Titin s. Mubin Karanggeneng Lamongan (Heny Ekawati) Modisco Supplementary Feedings On The Weight Gain Of Children Under Five Bgm (Yuyun Fitriani, Vivin Eka Rahmawati, Ike Johan) Psycho Education Module To Treat Children With Thalasemia To Improve Their Family Self Care (Ana Farida Ulfa) Improvement Oxygen Saturation With Soak Foot In Warm Water On Diabetic Foot (Diah Ayu Fatmawati, Khotimah,) Comparison Of Propolis And Piper Betle With Honey Topically On Healing SecondDegree Burns White Rat (Rattus Norvegicus) (Herin Mawarti, Muhammad Zulfikar Asumta and Zuliani)

ix

350

357

364 371

378 385 392 399 406 413 420 427

434 441 448 455 462

469

476

483 490 497 504

68 69 70 71 72 73

74 75

76 77

78

79 80

81 82

83 84 85 86 87

88

89

The influence of progressive relaxation to decrease pain For patients of sectio caesarea Surgery in the first and second day (Aris Dwi Cahyono, Wida Wicaksana) The Influence Factors of Caesarean Section Patient Outcomes in Preparation for Clinical Pathways Costing of DRGs (Diagnose Related Groups) (Suryono) Improving Self-Efficacy Using Caring-Based Self-Efficacy Enhancement Intervention Program In Patients With Type 2 Diabetes Mellitus (Christianto Nugroho) Effect Of Reminiscence Therapy Of Older People And Self- Acceptance With Gerotranscendence Theory Approach (Nugrahaeni Firdausi) The Effect Attitude Exercise Given To Decrease Anxiety To Teacher To child the first school (Widhi Sumirat) The Potential of Shalat Tasbeh to Decrease Postprandial Blood Glucose Levels in Patients With Diabetes Mellitus (Mukhamad Rajin, Afifa S., M. Zhahrul Azhar Asumta) Symptom Of Polyuria Decreases Sleep Quality To Patient With Diabetes Mellitus Type 2 (Dian Prawesti, Selvia David Richard) Stimulus Effect Cutaneous (Slow-Stroke Back Massage) To Intensity Of Pain Head In Elderly With Hypertension (Unit Pelayanan Terpadu Pslu Blitar, Tulungagung 2015) (Sukanto, Dinda Wahyuningtyas) Family Duty (Caring) Supportsfulfillment Of Mobility Needs To Elderly With Cerebrovascular Accident (Cva) (Erlin Kurnia, Natalia Yohanes) The Activity Test of Pandan Wangi Leaves Extract (pandanus amaryllifolius Roxb) for Solubility of Calsium Kidney Stones by in Vitro Method using atomic Absorbtion Spectrophotometri (AAS) (Ida Kristianingsih, Dewi Resti Basuki, Siti Mamluk Atul M3) The Effectiveness Of Fluid Ringer Acetate Malat Compared With Ringer Lactate Fluid In Accelerating Time Increase In Blood Pressure In Rats (Rattus Norvegicus) (Ika Rahmawati, Lizete Auxiliadora Costa Malic) Changes In Blood Pressure In Hypertensive Patients Who Consume Tomato Juice (Nurul Hidayah, Arief Bachtiar, Supono) Effectiveness Of Murotal Music Therapy And Kangaroo Method On LBW Baby‟s Feeding Time In The Neonates Ward Of Aura Syifa Hospital (Putri Kristyaningsih, Diah Eliya Humaida) Parent‟s Attitude In Safety And Injury Prevention To Preschool Children (Selvia David Richard, Erva Elli Kristanti) The Effect Of Attitude Toward Behavior, Subjective Norm And Perceived Behavior Control At Dm Therapy Adherence: Study Theory Of Planned Behavior (Sheylla Septina Margaretta, Heru Kurnianto Tjahjono, Falasifah Ani Yuniarti) The Effect Of Bates Methode On Dioptres Decrease Of Low Myopia On Nursing Students At Iik Bhakti Wiyata Kediri (Sri Wahyuni) Lesshealth Maintenance And Environmental Health Behavior Increases Ari Incident To Under-Five-Children (Srinalesti Mahanani, Vitaria Wahyu Astuti) Study Potential Of Local Plant Pumpkin (Cucurbita Moschata Duch) As Traditional Medicinal Plants (Suwanto) The Effectiveness Of Rose Flower (Rosa Chinensis Jacq) Against Candida Albicans Colonies On Jelly (Sda) Media (Erni Dwi Widyana, Tarsikah, Naimah) Effectiveness Of Zamzam Water And Alkali Water Toward Ankle Brachial Indexs, Oxidative Stress And Reduce Hemoglobin A1c In Diabetic Foot Ulcer Patient (Yohanes Andy Rias) The Correlation Between Energy And Protein Consumption Levels With Gross Motor Development Of Undernourished Children Aged 6-24 Month (Yuliana Dwi Diningrum, Arinda Lironika S, Agustina Endah W) Comparison Body Mass Index (BMI), Hemoglobin Concentration (Hb), Energy And Nutrient Intake (Protein, Iron, Vitamin C) Of Female Adolescent (Cucuk Suprihartini,

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511 518 525 532 542 549

556 563

570 577

584

591 598

605 612

619 626 633 640 647

654

661

90 91

92

93

94 95

96

97 98 99 100

101 102

103 104

105

106

107

108

Frenky Arif Budiman) Relationship Body Fat Thickness With Menstrual Cycle Length Students Unusa( Annif Munjidah, Annisa) Relation Of Application Leadership Participative Style Head Of Nursing Services With Employee Job Satisfaction In Asfiyak Graha Medika Clinic, Kencong, Kepung (Bambang Wiseno) The Effect Of Tomato Fruit (Solanum Lycopersicum) Toward The Increase Of Appettite In White Rats (Ratus Norvegicus Strain Wistar) (Experimental Study In Pharmacology Laboratory of Brawijaya University Malang 2015) (Endah Susanti,Yuli Admasari, Fariha, Intan Layla Vinurika) Relation Of Family Role In Fulfilling Requirement Nutrient Child With The Nutrient Status At Child Age Pre School (4-6 Year) In TK Kusuma Mulya Pare kediri (Erna Nurhochim, Febrina Dwi , Yunarti Matilde Ade) The Influencing Bandura‟s Theory Aplication Toward First Pregnant Woman‟s Knowledge About Umibilical Cord Care (Eva Silviana Rahmawati) The Correlation Between The Frequency Of Baby Massage And The Sleep Duration Of Babies Aged 0-18 Months Found At RB Endang Widayat (Maternity Clinic), Located In Sidoarjo. (Fauziyatun Nisa‟) Affecting Factors For The Implementation Of Early Detection Of Cervical Cancer By Visual Inspection With Lactic Acid In Primary Healthcare Centers In Surabaya (Fritria Dwi Anggraini) Effects Of Age And Parity On The Incidence Of Preeclampsia In A Public Hospital District Sidoarjo (Hinda Novianti, Lailatul Khusnul Rizki) Nurse Experiences In Implementing Logotherapy On Low Self-Esteem Client In Dr.Radjiman Wediodiningrat Lawang In Year Of 2015 (Junianto Fitriyadi,Katmini,Nurul Cholifah) Analize Client‟s Demand For The Health Services Which Have Been Percepted By Nurses And Correlated With Nurses‟ Job Satisfaction (Mohamad Hanifudin) Comparison Between Technique Tendon Suture Modified Samu (Ms) And Modified Kessler (Mk) Towards Tendon Suture Strengths (Tensile Strength) Of Broilers Tendon (Gallus) (Nanang Muhibudin, Erni Rahmawati, Moh. Halimi) Literature Review: Analysis Of Risk Factors For Post Partum Depression (Reni Nurhidayah) Influence The Granting Of Water Decoction Of Betel Leaf Against The Whiteness On Young Women (Study at Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare Kediri) (Ulfatin Nafiah, Silfia Sekar Arum, Martha Mai Nggiri) Effect of Exercise On The Road Fast Weight Changes In Adolescent Obesity Smk Bhakti Mulia Pare-Kediri (Vika Taulina Ismanto, Amri Nasus Talan) Influence Of The Traditional Game Congklak About Stress Levels To Pre-School Age Children In The Daycare Kasih Karunia Foundation Pare - Kediri 2015 (Ahmad Wasis Setyadi,Arif Setiawan,Jitro Gideon Liu) The Effect Of Giving Extract Of Clove (Syzgium Aromaticum) Toward Acceleration Healing Of Incision Wound In White Rats(Rattus Norvegicus) (Analytical study in Pharmacology Laboratory of Brawijaya University, Malang) (A.Wasis Setyadi,Nanang Muhibuddin,Syamsul Hudha,Nurul Cholifah) The Relationship Between Parenting Pattern And The Oldest Child‟s Self Care Independence At Preschool Age In The Permata Ibu Kindergarten Gunung Anyar Surabaya (Ainun Qoiriyah, Ika Mardiyanti) The Effects Of Hand Washing And Cutting The Nails Againts Diarrhea In Young Children In Paud Tunas Mandiri Rt.09 Rw.07 Kelurahan Pacarkeling Kecamatan Tambaksari Surabaya (Rukmini) The Effectiveness Of Semi Fowler Position To The Degree Of Spontaneous Perineum Rupture On Primipara And Multipara Maternal At The Working Area Of Puskesmas

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668 675

682

689

696 703

710

717 724 731 738

745 752

759 766

773

780

787

794

Ngadiluwih Kediri. (Susanti Pratamaningtyas) 109 Reproductive Health Counseling Theraphy Towards Sexual Attitudes Of Adolescent At Pgri Talun Highschool Blitar (Levi Tina Sari) 110 Therapeutic Effect Of Acupuncture And Warm Compresses To Decrease Joint Pain In The Elderly (Masruroh, Achmad Dany Ardiansyah) 111 The Correlation Of Emotional Intelegency With The Motivation Of Clinical Practice Result In Stikes Patria Husada Blitar (Maria Ulfa) 112 Effect Of Warm Compresses To The Reduction Of Menstrual Pain (Disminorea) Primer In Adolescent Girls Boarding School In The Village Maftahucfdxl Uluum Jatinom Kanigoro District Of Blitar (Laily Prima Monica) 113 Revitalization Of Posyandu Lansia Through Non-Pharmacological Therapy To Improving Elderly Quality Of Life (Nasrudin, Abdul Ghofar, Indah Mukaromah) 114 Relationship Between Parent‟s Knowledge And The Ability Of Children Preschooler‟s Self Eating (Andi yudianto) 115 Modeling Adaptive Spline Threshold Autoregressive (Astar) Incidence Dengue Hemorrhagic Fever (DHF) In Nganjuk From 2010-2014 (Tutut Pujianto) 116 The Effect Of Stimulation Therapy Group Activities Perception On The Level Of Depression In The Elderly In Pamotan Sambeng Lamogan (Siti Sholikah) 117 Poverty And Lung Tuberculosis In Ponorogo (Sulistyo Andarmoyo) 118 Influence Of Student's Knowledge And Attitude Level About Healthy Life Behavior Toward Garbage Disposing At IIK Bhakti Wiyata Kediri (Zuyyina Fihayati, Endah Retnani Wismaningsih, Ruli Asharil) 119 The Effect Of Classical Music Therapy To Increase Glasgow Coma Scale In Moderate To Severe Traumatic Brain Injury Patients At Mardi Waluyo Blitar Hospital (Christina Dewi P, Riesa Yuni Pangestuti)

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802 809 816 823

830 837 844 851 858 865

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TABLE OF CONTENT PROCEEDING OF INTERNATIONAL JOINT CONFERENCE 2015

POSTER PRESENTATION 1

2 3

4 5 6

7 8 9 10

11

12 13 14

15 16

17 18 19

The Correlation Of Knowledge And Attitude With The Decision-Making Of Bride Couple To Conduct Premarital Check-Up In Work Area Of KUA District Of Pare Kediri (Ira Haslinda, Tintin Hariyani, Linda Andri Mustofa) An Experience In Herb Complementary And Alternative Medicine (Nurul Laili) Literature Review: Partners Of Professional Nursing Students In The Face Of Mea Through Learning Methods IPE (Interprofesional Education) (Sylvie Puspita, Neny Triana) Effectivity Of Beluntas Juice Toward Cholesterol Level In Elderly With Hypercholesterolemia (Efa Nur Aini, Florena Berty Anggraini) The Analysis Of The Health Service Staff For Patient Satisfaction In Gambiran Public Hospital Kediri (Nurdina) The Relation Teenagers' Knowledge About Puberty And Teenagers' Behaviour (13-15 Years) Against Puberty Age In State Junior High School 3 Wates Kediri (Linda Ishariani) The Influence Of The Music Therapy To The Level The Old Age‟s Stress In Bendo Village, Pare Subdistrict, Kediri Regency (Widyasih Sunaringtyas,Vinda Pratiwi) The Influence Of Peer Group Support To Social Interaction Of The Elders (Linda Kristina) Mean Arterial Pressure As A Mortality Predictor On Severe Traumatic Brain Injury Patients (Pria Wahyu Romadhon Girianto) Nurse‟s Role As Care Giver In Implementing Nursing Care Ineffectiveness Airways Breathing In Patient With Asma Bronchiale (Diana Rachmania, Anggita Windu Lestari) Application Of Caring Behavior (Caring) New Students In Satisfaction Of Recognition D3 Nursing Program Institute Of Health Karya Husada Kediri (Neny Triana, Sylvie Puspita) The Analyze Factors Which Is Influence The Occurred Of The Prisoner Anxiety In Prisoners Of Polres Kediri (Ariani Sulistyorini, Lilik Setiawan) The Effect Of Stad (Student Team Achievement Division) In Increasing Social Ability Of Nursing Students In Karya Husada Institute Health Science (Melani Kartika Sari) Relationship Between Independence Learning And Therapeutic Communication Skill With Clinical Competence Learning In Program Studi D III Keperawatan Stikes Karya Husada Kediri (Sutiyah Heni, Ambar Mudigdo, Nunuk Suryani) The Correlation Between The Quality Of Family Planning Services With The Need Unmeet Events (Ita Eko Suparni , Eka Sri Purwandari) Effect Of Using Condoms Events Sexually Transmitted Infection In Prostitutes In Clinic Sexually Transmitted Infections ( STIS ) Gurah Public Health Service Kediri Regency (Lingga Kusuma Wardani) Women's Willingness To Counseling And Testing HIV / AIDS In Tulungagung (Suci Anggraeni) Comparison Of New Born Morbidity Between Pervaginam Breech Labor And Sectio Caesarea With Gluteal Presentation (Linda Andri Mustofa) Analysis Of Related Factors With Incidence Of Depression In Disaster Victims After The Eruption Of Mount Kelud In The Western Village Of Besowo Sub-District

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886 892

898 905 912

919 926 933 940

947

951 958 965

975 981

990 997 1004

20 21 22 23 24 25 26 27 28

29

30 31 32

33 34

35 36 37 38

39 40

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Kenteng Kepung (Didit Damayanti) Risk Screening Of Pre-Eclampsia And Eclampsia In Pregnant Women In Puskesmas Ploso Klaten Regency Kediri (Siti Asiyah) Progressive Muscle Relaxation Therapy Is Effective To Decrease Insomnia To Elderly (Akde Triyoga, Heru Suwardianto) Behavioral Factor Of Drop-Out Family Planning Acceptor According Lawrence Green (Aries Wahyuningsih, Fidiana Kurniawati) Poor Sleep Quality Affects Severe Impairment Of Cognitive Function To Elderly (Dyah Ayu Kartika Wulan Sari, Dian Taviyanda) Individual Characteristics Affect Nurse‟s Performance Based On Kopelman Theory (Aries Wahyuningsih, Evi Philiawati) Disability Decrease Quality Of Life Topatients With Leprosy (Vitaria Wahyu Astuti, Akde Triyoga) The Warm Water Bath Is Effective To Decrease Sleep Disorder (Insomnia) To Elderly (Tri Sulistyarini, Desi Natalia Trijayanti Idris) Contingency Training Role Of Early In The Community To Improve Preparedness Of Tsunami Hazard On The Beach Sidem District Tulungagung 2015 (Siti Nurhasanah) The Study Of Mother‟s Knowledge On Diftheria Disease In Posyandu (Maternal And Child Health Center) Bago Vilage Tulungagung (Yeni Setyo Prastiwi , Azmi Bagus Prayogo) Effect Of Health Education About Circumcision Against Anxiety In Children Who Will Do Circumcision Actions In The District Of Tulungagung Campurdarat (Hadi Santoso) The Corelation Of Body Mass Index (Bmi) With Cardiorespiratory Resistance On Nursing Students Program (Oka Ludianita,Ita Novita Dewi) The Effect Of Giving Date Palm Extract To Againts Constipation That Happen To Postpartum Mother (Ninik Azizah, Suyati ) Giving Effect Of Tablet Fe And Vitamin C On Anemia Event Numbers Decline In Pregnant Women In The Village Peterongan Jombang (Zakiah, Feny Vitiasaridessy, Dian Puspita Yani) The Effect Of Giving Honey Topically For Healing Perineum Laceration On Post Partum Mother (Suyati,Nur Alfi Abidah,Muzayyaroh) The Influenced Of Early Mobilization On The Fundal Height Decreased Of Post Partum Mother At Paviliun Melati Rsud Jombang (Sabrina Dwi Prihartini, Dewi Triloka Wulandari, Siti Roudhotul jannah) Relationship Between Levels Ofspiritual Intelligence To The Level Of Preoperative Anxiety In Patients (Pujiani, Didik Saudin, Ainur Rofiqoh) The Correlation Between The Quality Of Nursing Care With Patients Satisfaction Level In The Inpatient Unit (Edi wibowo S, Mukhoirotin, Sih Anjar K) Playing Therapy Decreases Anxiety (Hospitalization) Of toddler (Rimawati, Srinalesti Mahanani) Relationship Behaviour of Using Personal Protective Equipment (APD), Healthy and balanced Diet And Personal Higiene To Skin Health status of scavengers In TPA Kediri (Indasah, Nur Zuhdana Maula) The Identification Of Families Stress Level With Adversity Quotient In Caring Schizophrenia Family Members In The City Of Kediri (Byba Melda Suhita) Differences Between Contaminated Old Wound Healing Wound Care Using Scours Onion (Allium Cepa L) Compared With Binahong (Anradera Cordifolia) At The White Rat (Rattus Norvegicus) (Nove Lestari) Nutrition On The First 1000 Days Of Life Determinate The Nutritional Status And Development Children (Miftakhur Rohmah) The Effect Cognitive Support And Emotional Spiritual Quotient(Esq) To Immunologist Status Change In HIV/AIDS Patient In Kediri City (Alfian Fawzi ,Yuly

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1074

1081 1088 1095

1102 1109

1116 1123 1130 1137

1144 1154

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43 44 45 46 47 48 49 50 51 52

53

54 55 56 57

58 59

60

61

62

63 64 65

Peristiowati, Joko Sutrisno) Stress Management Techniques Seft (Spiritual Emotional Freedom Tehnique) To Decrease Frequency Of Epilepsy Patients Seizures Tulungagung (Lasman) Perception Differences In Young Women And Men About Pregnancy At Smk Canda Bhirawa Pare Subdistrict Kediri, East Java (Enur Nurhayati Muchsin) The Relationship Of Self Efficacy And Nurse Caring Behavior To Aids Patient In Isolation Ward Of Rsud Eks Karesidenan Kediri (Dodik Arso Wibowo) Strategies For Improving Nutritional Status Of Children Under Five In Communities (Nurwijayanti) Onion And Ginger Extract To Cholesterol Stabilizers In The Blood (Agusta Dian Ellina, Mohammad Irfan Helmi Ramadhan) The Effectiveness Of Sex Education To Knowledge About The Dangers Of Adolescent Premarital Sex (Agus Supinganto, Kurniatillah ) Out Patient Physical Exercise For Heart Failure Patients More Effective In Improving Activity Daily Living Than Functional Capacity ( Erni Tri Indarti, Heru Wahyudi) The Give Of Audio Visual Provision Of Development Language In Pre School Age Children Kosgoro Kabupaten Nganjuk. (Rahayu Budi Utami, Uswatul Ma‟rifah) The relationship Of Increased Body Weight Pregnant Mothers Withnewborn Weight At Home Her Areas Of Public Hospitals(Sujatmiko, Titin Ratnaningsih, Remita Yuli K) Effectiveness Of Bay Leaves Boiled Water Towards Uric Acid Level Of Hyper Uricemia Patients In The Village District Of Pace Joho Nganjuk (Trisnanto, Anggi Ratih Setiorini) The Difference Of The Cateter Installation Skill Result Of The Study Before And After Peer Tutoring To Term Midwifery Students Stikes Satria Bhakti Nganjuk On 2013 (Tutik Handayani, Ike Nurrochmawati, Ambar Dwi Retnoningrum) Correlation Between The Role Of Mother With Adolescent Girls Perception About Menarche (Dewi Taurisiawati Rahayu) Star Fruit Consumption On Blood Pressure In Hypertensive Outpatients At Gambiran Hospital In Inner Disease Poly Kediri (Andayati) Effect of Initiation Of Breast-Feeding Within One Hour Of The Delivery On MaternalInfant bonding In RSUP M. Djamil Padang 2014 (Dewi Susanti) Correlation Of Parenting System With Verbal Development Of Preschool Age Children (Dharma Wanita Kindergarten Sitimerto Pagu Kediri) (Siti Komariyah, Deby Sintyana Dewi) Relationship Between Nutritional Status With Anemia Prevalence At 1 st grade Dharma Husada Midwifery Academy Class 2012 / 2013 (Widya Kusumawati) The Relation Parity And Acceptor Knowledge About The Injection Contraception With Be The Interest To Be Injection Familly Planning Program In Ngampel Village Mojoroto Sub District Kediri City In 2015 (Rofik Darmayanti) The Relationship Between Mother Knowledge With Attitude Of Stimulation Provides Growth In Children Age 1-3 Years (Toddler Phase) ( In IHC Orchid Village Jambean Kras District Of Kediri Regency ) (Erma Herdyana, Indra Saputri) The Corelation Of Knowledge And Behaviour Of Mother‟s Stimulation For Development Of Adaptif Motor 1-3 Years Old In Ngampel Village Kediri (Susiani Endarwati) Relations Of Herb Consumption Withseverity Of Ckd (Chronic Kidney Disease) At The Dahlia And Flamboyan Room Hospital dr. Iskak Tulungagung 2015 (Eny Masruroh) Relation Between Multiple Pregnancy With A Newborn Baby Weight (Nanik Nuraini, Nur Hasanah) The Relationship Between Maternal Communication Skill And Verbal Language Development In Children Aged 3-4 Years (Nur Hasanah ,Nanik Nuraini) The Identification Of Families Stress Level With Adversity Quotient In Caring

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1321 1328 1335

66 67

68 69 70

71

72

73 74 75

76 77

78 79

80

81 82

84

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86

Schizophrenia Family Members In The City Of Kediri (Byba Melda Suhita) Health Education To Parents To Improve Children Personal Hygiene With Moderate Mental Retardation (Dewi Ika Sari Hari Poernomo, Maria Anita Yusiana) The Correlation Between Mother‟s Perception About Exclusive Breastfeeding And Exclusive Breastfeeding In Pajaran Village Peterongan Jombang (Mukhoirotin, Zulfa Khusniyah, Fais Sugiarti) Family Effort In Improving The Compliance Of Patients With Chronic Renal Failure (CRF) Undergoing Hemodialysis (Kurniawati) The Relationship Between Fatigue Level Night Sport With Sleep Quality At Teenagers Futsal Club “ Scholar One” In Sumeleh Futsal Tulungagung 2015 (Suciati,Riki Irawan) Application Of Blended Learning Method Based Learning Ict For Increasing Interest In The Course Of Social Cultural Basis (ISBD) (Sri Banun Titi Istiqomah, Helmi Annuchasari, Arifa Retnowuni) Related Knowledge Of Exclusive Breast With The Frequency Of Breastfeeding Baby Age 0-6 Months (In Posyandu Srikaton, District Ngantru, Tulungagung 2015) (Firsta Sukmawati, Nurhidayati, Sri Agustiana) The Influence Of Giving Health Education About Napza To Change Attitudes At Students In VIII Grade Of Smpn 2 Campurdarat, Tulungagung, 2014 (Surtini1, Amita Audilla) Process Of Social Legitimacy Of Persons With Mental Retardation In Karang Patihan Districts Balong Ponorogo (Siti Noor Farida Layla) Duration Efect Of Treatment And The Family Motivation For Medication Adherence Of Lepers (Ema Mayasari) Effect Of Giving Isoflavone Genistein During The Period Of Pre- Pubescent Vagina Histology , Estradiol Concentration And Ovulation In Female Mice (Mus Musculus L) (Yenny Puspitasari, Byba Melda Suhita) Characteristics Multiple Drugs Resistance Patient That Conversion Cultures At First Months Of Treatment In Dr. Soetomo Surabaya Hospital (Retno Ardanari Agustin) The Correlation Between Age, Women Fertile Couple‟s Knowledge About Cervix Cancer And Their Interest To Have Human Papilloma Virus (HPV) Immunization. (Case Study In RT 02 RW 2 Sidomulyovillage, Semen Distric Kediri Regency) (Betristasia Puspitasari) Self-Care Deficit To Patients With Diabetes Mellitus Type 2 Based On Orem Theory (Desi Natalia Trijayanti Idris, Tri Sulistyarini) Formulation and Characterisation Of Granule Effervescent Cilembu Sweet Potato (Ipomoea Batatas (l). Lamk)Extract With Concentration Variation Of Citric Acid And Sodium Bicarbonate (Dewi Resti Basuki) Midwifes Science Relationship About Early Initiation With Early Initiation Practices In Bps Nganjuk District‟s Nganjuk‟s Regency (Fitria Hari Wibawati, Sri Ngayomi, Titin Ratnaningsih) Do elderly Use Community Health Centers For Outpatient Care? (Gerardin Ranind Kirana, Hari Kusnanto Josef, Mubasyisyir Hasanbasri) Study Of The Needs Of Patient‟s Family Of Palliative Nursing Program Development At Intensive Care Of Ulin General Hospital Banjarmasin (Ifa Hafifah, Iyus Yosep, Anastasia Anna) The Correlation Level Of Education And Mother‟s Age With Mother Attitudes In Face Of Child Down Syndrome At Menarche (In SLB C1 Putera Asih Balowerti Kota Kediri) (Lely Khulafa‟ur Rosidah) The Correlation Between The Motivation Of Becoming A Nurse And The Learning Achievement Of The Students Of Stratum 1 Nursing Science At Faculty Of Medicine Lambung Mangkurat University (Herawati, Naya Ernawati) Progressive Muscle Relaxation Is Effective To Decrease Blood Pressureto Elderly

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1356 1363 1370

1377

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1391 1397 1404

1409 1416

1423 1430

1437

1444 1451

1458

1465

1472

87

With Hypertension (Suprihatin, Dian Prawesti) Relationship Between Nutritional Status With Anemia Prevalence At 1stgrade Dharma Husada Midwifery Academy Class 2012 / 2013 (Widya Kusumawati)

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ABSTRACT PREPAREDNESS STRATEGIES FOR HEALTHCARE STUDENTS IN FACING AEC: “THE IMPORTANCE OF HARD SKILL, SOFT SKILL AND FOREIGN LANGUAGE COMPETENCIES” Rose ak Nanju Manju Email: [email protected]

The ASEAN Economic Community (AEC) shall be the goal of regional economic integration by 2015. AEC envisages four key characteristics, which are a: i. ii. iii. IV.

single market and production base. highly competitive economic region. region of equitable economic development. region fully integrated into the global economy.

The AEC areas of cooperation among the 10 member countries includes human resources development and capacity building; recognition of professional qualifications; closer consultation on macroeconomic and financial policies; trade financing measures; enhanced infrastructure and communications connectivity; development of electronic transactions through e-ASEAN. The aim is to integrate industries across the region to promote regional sourcing; and enhancing private sector involvement for the building of the AEC. The AEC is hoped to transform ASEAN into a region with free movement of goods, services, investment, skilled labour, and freer flow of capital. As such, healthcare students should be prepared to compete in the ASEAN AEC market to fulfil the human resource providence and to be well-prepared in the area of communication, to master several foreign languages in order to cater the free movement of labour force in the region. This means that the healthcare staff will care for people from different part of the world, who speaks different languages. It is expected that the skills of healthcare workers to be at par with others from the other AEC member countries. This includes the soft skills demonstrated along with their hard skills. As we will be facing challenges to compete in AEC and also the global markets, we need to be excellent in our soft skills and also hard skills. Based on the four key areas above, healthcare staff are to be trained to prepare them to challenge the area of healthcare.

Key word: Preparedness; healthcare staff/student; soft and hard skills; communication skills.

ABSTRACT AN UPDATE ON THE MANAGEMENT OF TRAUMA IN PREGNANCY: RESUSCITATION PRIORITIES Assoc Prof Dr. Mohd Idzwan Zakaria Department of Emergency Medicine, University Malaya Medical Centre Email: [email protected] Trauma death in pregnancy is a downward trend in Malaysia. But it is still the leading cause of nonobstetric cause of mortality and morbidity. The main principle of management of trauma in pregnancy is aggressive resuscitation of the mother. Stabilization of the mother ensures a better foetal outcome. Trauma increases risk of spontaneous abortion, preterm premature rupture of the membrane, preterm delivery, abruption placenta and uterine rupture. This lecture concentrates on the maternal physiology and its clinical implication in trauma, some special clinical management considerations and perimortem caesarean section. The supine hypotension syndrome is also discussed here and methods to prevent are also shown. The role of focused abdominal ultrasonography in trauma is also discussed. The teratogenic risk of radiological imaging is discussed and it is then weigh against the importance of treating the mother to ensure the fetus is safe. Peri-mortem caesarean is discussed although its success rate is minimal in our setting. Keyword: Management, Trauma, Pregnancy, Resuscitation

PERSONAL HYGIENE BEHAVIOR AND VULVOVAGINITIS INCIDENT ON FERTILE WOMEN AGE IN OBSTETRICS AND GYNECOLOGY WARD Dr. ISKAK HOSPTAL- TULUNGAGUNG Yenny Puspitasari, Intan Fazrin Nursing Faculty Health Institute Of Health Surya Mitra Husada Email: [email protected] ABSTRACT Personal hygiene behavior is an act of maintaining cleanliness and health of a person's physical and psychological well-being. Someone who have good personal hygiene can prevent disease, such as Vulvovaginitis. The purpose of this research was to determine the relationship of personal hygiene behavior and Vulvovaginitis incident in fertile women age in Obstetrics and Gynecology ward Dr. Iskak hospital-Tulungagung. The study design was observational analytic.The population is fertile women age in Obstetrics and Gynecology ward Dr. Iskak hospital- Tulungagung on 2 - March 27, 2015 as many as 26 respondents with accidental sampling technique with a large sample of 26 respondents. The independent variables in this research was personal hygiene behavior, the dependent variable was Vulvovaginitis incident. Instruments used questionnaires, observation sheets, the statistical test Chi Square α = 0.05.Results of statistical test p value = 0.003 means p <α = 0.05 so that H1 is accepted, then there is a relationship between personal hygiene behavior and Vulvovaginitis incident in fertile women age.Personal hygiene behavior is good and right to prevent the incidence of diseases such as Vulvovaginitis especially in fertile women age, therefore it is necessary to always maintain personal hygiene so that the physical and psychological well-being. Keywords:

personal hygiene behavior, Vulvovaginitis, fertile women age

8

with abnormal conditions , Research at the Obstetrics Gynecology RSCM get data 2% (age 11-15 years), 12% (age 16-20 years) of 223 adolescents who were infected in the pubic area or because Vulvovaginitis (Kurniadi, 2012). Health problems are common genital area in women is flour albus. Abnormal flour albus can be a symptom of Vulvovaginitis. As many as 75% of women in the world have suffered from flour albus at least once in lifetime, and 45% of them may have twice or more times (Pribakti, 2012). Based on the results of a preliminary study that began on October 13, 2014 at Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung, from interviews to 16 women of fertile women age, 9 person declared that they do not not get Vulvovaginitis because most them understand the importance of protecting their genital organs by keeping it clean or perform personal hygiene. Then the 7 person tested positive get Vulvovaginitis marked as vaginal flushing and itching, and accompanied by other signs. It is also influenced by the cleanliness of oneself or one's personal hygiene is not good. Vulvovaginitis can affect women of all ages and it is very common. This can be caused by bacteria, fungi, viruses, and other parasites such as Bacterial vaginosis eg, Candida albicans, Trichomonas vaginitis, etc. Vulvovaginitis can be found as well as the use of various chemicals feminine hygiene products that actually will kill the normal flora in the area of femininity. Environmental factors such as poor hygiene and allergens may also cause the condition Vulvovaginitis (Purwanti, 2011). Humid circumstances on feminine area will further support growth of bacteria or fungi. If someone less attention to the condition of cleanliness, especially in the area of femininity will arise symptoms such as itching in the area of femininity, redness and a burning sensation on the skin, discomfort during or after urination or during intercourse , irritation and discharge abnormal liquid. Condition

Background Study Vulvovaginitis is inflammation of the vagina and vulva that is most often caused by infection with bacteria, fungi, viruses, and parasites. Inflammation of the vulva and vagina is characterized by itching in the pubic area, swelling of the mucous membranes, the amount of mucus from the vagina, redness, burning sensation, irritation, and discomfort on the skin, especially during or after urination (Suparyanto, 2011). Vulvovaginitis is one of the most common reasons why women visit a gynecologist (Leber, 2009). Habitual action in maintaining personal hygiene plays an important role in this case, particularly in maintaining cleanliness. Personal hygiene or cleanliness of the individual is an act to maintain the cleanliness and health of a person's physical and psychological wellbeing (Permatasari, 2012). Kinds of personal hygiene activities including dental care, hygiene skin, toe, nails and hands, including the treatment of genital (Potter, 2005). Cleanliness itself is strongly influenced by individual values and habits. Things that affect them cultural, social, family, education, health and a person's perception of the level of development (Christina et al, 2011). Vulvovaginitis often caused due to bacterial vaginosis. Gardnerella vaginalis is the most common bacterial cause of bacterial vaginosis in women of fertile age. It is mentioned that 50% of active women's sexuality ever get Gardnerella vaginalis infection, but only a few are symptomatic. Approximately 50% was found in users of IUDs and 86% were found along with Trichomonas infections. Estimating the number of patients with bacterial vaginos very difficult since Gardnerella vaginalis can be obtained from the vagina in 30-50% of women who had no symptoms (Juanda et al., 2007). Cohort study conducted by Bradshaw et al in 2013 that is cited in the study Sulistianingsih et al, 2014 stated in 29 health care centers in three states in Australia to get the 11.8% of women with bacterial vaginosis and 17.2% of women

9

abnormal if a polynomial, it smelly or accompanied by itching and pain. In daily life, it is necessary to clean and healthy life, which is intended to avoid germs or bactery, fungi, viruses that cause disease. Reproductive is one of the organs that are sensitive and require special care. Knowledge and good care is a decisive factor in maintaining reproductive health (Ratna, 2010). The main factor of genital health problems Events around the vagina is highly susceptible to infection. Easy infection occurs because it is situated very close to the urethra and anus, so that microorganisms (fungi, bacteria, viruses, and parasites) easily fit into the vagina (Muin, et al, 2013). Therefore, it should be kept in behavior, especially the behavior of healthy and clean life by further improving personal hygiene or an action to maintain the cleanliness and health of a person to realize the physical and psychological well-being.

RESEARCH METHODS The research design used in this study was observational analytic that is looking for a relationship between variables in cross sectional. The populations in this study were all fertile women age who present at Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung which amount 26 respondents. Samples used in this study were fertile women age who meet by the researchers at the time of data collection in Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung that a number of 26 respondents. This research conducted on 2 March 27, 2015. The sampling technique used in this research was accidental sampling is taking respondents in the sample by coincidence, that anyone who by chance met the researchers can be used when a sample of people who happen to be found suitable as a data source. Data processing is done by editing that is by checking the data obtained. Coding is done by giving the code on each characteristic. Then the scoring the results of the research. The next process is data analysis. Analysis of the data was analyzed using Chi-square statistic test techniques with the help of Statistical Product and Service Solutions (SPSS) version 17 to assess the behavior of personal hygiene with the incidence of vulvovaginitis in fertile women age.

RESEARCH PURPOSES GENERAL PURPOSE To determine the relationship of personal hygiene behavior with Vulvovaginitis incidence in fertility women age in Obstetrics and Gynecology ward dr. Isaac hospital Tulungagung. SPECIAL PURPOSE a. To identify personal hygiene behavior in fertile women age in Obstetrics and Gynecology ward dr. Isaac Hospital Tulungagung. b. To identify the incidence Vulvovaginitis in fertile women age in Obstetrics and Gynecology ward dr. Isaac hospital Tulungagung. c. To analyze the relationship between personal hygiene and Vulvovaginitis incidence in fertile women age in Obstetrics and Gynecology ward dr. Isaac hospital Tulungagung.

RESEARCH RESULT CHARACTERISTIC OF RESPONDENT Table 1. characteristic of respondent characteristic Age 20-29 years old 30-39 years old 40-49 years old

marrital status

10

N

%

9 8 9

34 31 35

characteristic Single Married Widow

N 3 19 4

Education Primary school Junior high school Senior high school University

STATISTICS TEST RESULT Table 4 Chi-Square

% 12 73 15

6 8 8 4

Chi-Square Tests Value df

23 31 31 15

Job Jobless 5 Private 13 Entrepreuner 7 Public servant 1 Resource: result of data analysis

Pearson Chi- 11.816 2 .003 a Square Likelihood 14.121 2 .001 Ratio Linear-byLinear 11.180 1 .001 Association N of Valid 26 Cases a. 3 cells (50.0%) have expected count less than 5. The minimum expected count is 1.27.

19 50 27 4

VARIABEL CHARACTERISTICS Table 2. variable characteristics characteristics Personal Hygiene behavior good enough less

N

%

12 11 3

46,2 42,3 11,5

Symmetri Measures

c Valu Approx. e Sig.

Nominal Contingenc by y .559 .003 Nominal Coefficient N of Valid Cases 26

Vulvovaginitis incident Positive 11 42,3 Negative 15 57,7 Resource: result of data analysis

Based on the analysis of statistical test Chi Square (X ²) obtained the value p value = 0.003, so p - value <0.05 then H0 is rejected and H1 accepted meaning there is relationship between personal hygiene behavior and Vulvovaginitis incidence in fertile women age in Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung. With correlation coefficient personal hygiene behavior with Vulvovaginitis that is equal to 0,559 events in the category correlations were in the range (0.40 to 0.599).

CROSS TABULATION Table 3. cross tabulation between personal hygiene and Vulvovaginitis incident personal hygiene behavior Good Enough Less Total

Asymp. Sig. (2-sided)

Positive

Negative Total

n

%

n

%

n

%

1 7 3 11

3,8 26,9 11,5 42,3

11 4 0 15

42,3 15,4 0 57,7

12 11 3 26

46,2 42,3 11,5 100

DISCUSSION Personal Hygiene behavior in fertile women age

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Results of a study of 26 respondents in Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung showed almost half of respondents (46.2%) with good personal hygiene behavior as many as 12 respondents, nearly half of respondents (42.3) have quite personal hygiene behavior as many as 11 respondents, and a small of respondents (11.5%) have less personal hygiene behavior as many as 3 respondents. Personal hygiene behavior according Potter and Perry (2005) is an act of maintaining cleanliness and health of a person's physical and psychological wellbeing. A person said have good personal hygiene when, the person can maintain a healthy body includes cleanliness of the skin, teeth and mouth, hair, eyes, nose, and ears, legs and nails, genitalia, as well as the cleanliness and tidiness of his clothes. According to Potter and Perry behavior of someone doing personal hygiene is influenced by some factors; body image, social practices, the status of socio economic, science, cultural variables, personal choice, and physical condition. According to researchers opinion based on the results of the study showed that nearly half of respondents have good personal hygiene with this case reflects that the respondent was aware of personal hygiene or personal hygiene for themselves, especially in maintaining the cleanliness of the female organs. Due to keep or maintain the cleanliness and health of a person will strive to realize the physical and psychological wellbeing. By having good personal hygiene they're indirectly trying to prevent from diseases, especially diseases associated with female organs.

or get Vulvovaginitis as many as 11 respondents. Vulvovaginitis is an inflammation or infection of the vulva and vagina are often caused by infection with bacteria, fungi, and parasites. Genesis Vulvovaginitis cause irritation and itching. Vulvovaginitis is one of the most common reasons why women visit a gynecologist (Leber, 2009). This can be caused by bacteria, fungi, viruses, and other parasites. Environmental factors such as poor hygiene and allergens may also cause this condition. Vulvovaginitis has signs and symptoms such as; itching, pain and / or a burning sensation and discomfort in the vagina and vulva, and a bright red rash that affects the inside and outside of the vulva, sometimes spread widely in the groin, pubic area, groin and thigh area. It may happend only a few hours or some days, weeks, or months. Based researchers opinion on the results of the study showed positive results fraction of respondents aged 20-29 years occurred Vulvovaginitis. Vulvovaginitis can affect women of all ages. In this study, a small portion of respondents aged 40-49 years as many as five respondents positively. Because of the age influence the perception and mindset of the person, the age will be growing anyway perception and thought patterns. Especially in health, one would have thought that maintaining health is very important. Moreover, when the body has a condition that is not health, then the person should be quick to respond in such conditions, for example with health check yourself into the nearest public health centre or hospital. Ofcourse, it would be better to prevent than cure. Some prevention can be done to prevent a disease, particularly diseases Vulvovaginitis. The most important thing in preventing infection is to always maintain personal hygiene, especially in the female organs well.

Vulvovaginitis incidence in women of fertile age Research result of 26 respondents in Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung showed most respondents (57.7%) results were negative or did not get Vulvovaginitis as many as 15 respondents, and nearly half of the respondents (42.3%) the result is positive

Analysis of Personal Hygiene behavior and Vulvovaginitis incident in women of fertile age in Obstetrics and Gynecology ward of Dr. Isaac hospital

12

Tulungagung.

skin, teeth and mouth, hair, eyes, nose, and ears, legs and nails, genitalia, as well as the cleanliness and tidiness of his clothes. Personal hygiene behavior is very important to maintain cleanliness in the genital organs in order to avoid germs that cause disease. Such as Vulvovaginitis. Vulvovaginitis is an inflammation or infection of the vulva and vagina are often caused by infection with bacteria, fungi, and parasites (Leber, 2009). Factors environmental factors such as poor hygiene and allergens may also cause this condition. Based on the results above it can be concluded that it is true that when someone who has good personal hygiene behavior will mos be negative or be spared from Vulvovaginitis incident.

Results of cross tabulation personal hygiene behavior and Vulvovaginitis incidence in fertile women age in Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung showed 1 respondents who have good personal hygiene behavior but the results positive gets Vulvovaginitis. Based on the data collected in the specific data summary, it can be happen because the respondent did not use pads that are made of materials that do not cause irritation. Respondents themselves also often complained of itching during menstruation and feel uncomfortable with a bandage used. However, respondents continue to use the material that eventually makes irritation and irritation wider. Results of statistical analysis with Chi-square test to determine the incidence of personal hygiene behavior Vulvovaginitis in Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung p value - value = 0.003 (p value <α ie 0.003 <0.05) then H0 rejected and H1 accepted, which means that there is a relationship between personal hygiene behavior and Vulvovaginitis incidence in fertile women age in Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung. With correlation coefficient personal hygiene behavior with vulvovaginitis is equal to 0,559 events in the category correlations were in the range (0.40 to 0.599).

CONCLUSIONS AND SUGGESTIONS CONCLUSION Based on the research that has been done in Poli Obstetrics and gynecology ward of Dr. Isaac hospital Tulungagung 2015 on 26 respondents about personal hygiene behavior and Vulvovaginitis incidence in fertile women age, it can be concluded as follows: 1. Almost half of respondents with good personal hygiene behavior as many as 12 respondents (46.2%) a total of 26 respondents in Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung. 2. Most respondents of Vulvovaginitis incident the result is negative or does not get Vulvovaginitis as many as 15 respondents (57.7%) a total of 26 respondents in Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung. 3. Results p - value = 0.003, (p - value <α ie 0.003 <0.05) then H0 rejected and H1 accepted, which means that there is a relationship between apersonal hygiene behavior and Vulvovaginitis incidence in fertile women age in Obstetrics and Gynecology ward of Dr. Isaac hospital Tulungagung. With correlation coefficient personal hygiene behavior with

According to Iqbal Wahit Mubarak (2011), the behavior is a set of actions / measures in response to someone in doing something and then made a habit because of the value that is believed. Human behavior is basically made up of components of knowledge (cognitive), attitudes (affective), and skills (psychomotor). Personal hygiene behavior according Potter and Perry (2005) is an act of maintaining cleanliness and health of a person's physical and psychological wellbeing. A person said to have good personal hygiene when, the person can maintain a healthy body includes cleanliness of the

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Vulvovaginitis that is equal to 0,559 events in the category correlations were in the range (0.40 to 0.599).

Kurniadi, I.G.A.M. 2012. Pengetahuan Dan Sikap Remaja Putri Tentang Cara Mencegah Dan Mengatasi Keputihan Di Klinik Remaja Kisara PKBI Bali. Jurnal Dunia Kesehatan, Vol. 2 No. 2. Leber, W. 2009. Vulvovaginitis. (http://www.aidsmap.com/Bacteria l-dan Greta Hungson vaginosis/page/1044636/. Diakses tanggal 15 September 2014, pukul 16:01. Mubarak, W.I. 2009. Ilmu Keperawatan Komunitas. Jakarta : Salemba Medika. Muin, M., Salmah, U., dan Sarake, M. 2013. Hubungan Pengetahuan Penyakit Menular Seksual (PMS) Dengan Tindakan Kebersihan Alat Reproduksi Eksternal Remaja Putri Di SMAN Makassar Tahun 2013. Jurnal Kesehatan Masyarakat, Vol. 5 No. 3 Tahun 2013. Permatasari, K.B. 2012. Ketrampilan Dasar Praktek Klinik Dian Husada Personal Hygiene.htm. Diakses tanggal 15 September 2014, pukul 16:03. Purwanti, D. 2011. Penyakit Kandungan. (http//Berbagi Ilmu Bersama Dewi Penyakit Kandungan.com. Diakses tanggal 26 Agustus 2014, pukul 13.50. Potter, A & Perry, G.A. 2005. Buku Ajar Fundamental Keperawatan : Konsep, Proses, dan Praktik, edisi 4. Jakarta ; EGC. Pribakti. 2013. Epidemiologi Penyakit Menular Seksual (PMS). Jakarta : Balai Penerbit FKUI. Ratna, D.P. 2010. Pentingnya Menjaga Organ Kewanitaan. Jakarta : Indeks. Suparyanto. 2011. Wanita Usia Subur. (http://dr.Suprayanto.blogspot.com ). Diakses tanggal 26 Agustus 2014, pukul 13:42.

SUGGESTION Researchers give advice based on research results are as follows: For the respondents, with the participation of responder helped course of this research, directly or indirectly, they can find out a little information about personal hygiene behavior with Vulvovaginitis incident. Thus the respondent should further improve personal hygiene properly. For hospitals, should be able to add information about the behavior of personal hygiene with Vulvovaginitis incidence in fertile women age so that it can be used as a reference for handling the problem neighbor Vulvovaginitis events. Besides it can also add leflat media that contains information about personal hygiene behavior is good and right and also about Vulvovaginitis, so expect the patient or the public know about the information. As well as giving a briefing to the nurse or midwife to suggest to the patient to be examined, especially when signs and symptoms arrise in order to prevent Vulvovaginitis. For further research, for further research are expected to conduct research and develop a topic or issue related to the incidence of Vulvovaginitis in greater depth with variable wider.

REFERENCES Christiana, A., Martono, K., dan Rejeki, S. 2011. Hubungan Antara Vulva Hygiene Dengan Kejadian Servitis Di Desa Sambigede Kecamatan Sumberpucung Kabupaten Malang. Jurnal : Ari Christiana. Djuanda., Ilyas, S., dan Elistiawaty. 2007. 75% Wanita RI Alami Keputihan. (http://www.detiknews.com/index. php/detik. Diakses tanggal 15 September 2014, pukul 16:00.

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AFFECTING FACTORS OF COMMUNITY PREPAREDNESS AT DISASTER PRONE AREAS KELUD MOUNTAIN Novita Ana Anggraini Lecture From Nursing Faculty Health Institute Of Health Surya Mitra Husada Email: [email protected] ABSTRACT Speciality for disaster management needed to loss minimizing affected by its main disaster in preparedness phase. Disaster Preparedness phase include community as initial subjects of disaster management as well as disaster victims till be able to manage disaster at certain limit and expected disaster do not develop to bigger scale. Purpose of the research is to know Affecting Factors of Community Preparedness at Disaster Prone Areas Kelud Mountain. Design of the research used analytic descriptive desain with cross sectional approach. Sampel generated from 360 respondent used cluster sampling technique consisting of village officials, community leader, jangkar kelud community member, health worker and community member at Disaster Prone Areas Kelud Mountain. Result of research data analized using logistic regression method and showed that contributing variable to preparedness is knowledge (OR 1,509; CI 95%), attitude (OR 1,127; CI 95%), nurses role (OR 1,076; CI 95%), and culture (OR 0,856; CI 95%). Information given to community will shape community attitude and behaviour facing disaster preparedness at Disaster Prone Areas Kelud Mountain because in behaviour shaping based knowledge till shape behaviour eternally. Information spreading about disaster preparedness performed by nursing may do collaboration between nurses and jangkar kelud community through community radio so information spreading more comprehensive and targetted. Affecting factors of community preparedness at disaster prone areas kelud mountain is role nursing, knowledge, attitude and culture. Key Word : Preparedness, Disaster, Community

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knowledge and behavior. The importance of the knowledge society towards disaster preparedness aims to change people's behavior in order to be aware of the disaster. But people tend to be less active in the dissemination of disaster for reasons flurry by the job. Lack of public awareness of disaster preparedness will also influence the behavior of the community. Another factor is the availability of health resources, the nurse on duty as educators to empower communities in disaster preparedness. Providing training to the community is also required which is associated with the training of community volunteers for casualty evacuation and rescue training and first aid (WHO, 2011). Therefore, this study was conducted to determine factors - factors that affect the community in the face of disaster preparedness Kelud in Disaster Prone Areas Kelud.

INTRODUCTION Indonesia is part of the path of the Pacific Ring of Fire which is a series of lines of active volcanoes in the world. In a study also showed that the cause of the disaster in Indonesia 60.66% of floods, landslides 63.11%, and 65.57% volcano. Higher percentage obtained volcano it is related to the position or location of Indonesia which is a region pacific ring of fire (Khairuddin, 2011). Mount kelud (+ 1,731 m DPAL) is a strato volcano type which has a crater lake at its peak, located in the border region of Kediri, Blitar and Malang. According to data from the Center for Volcanology and Geological Hazard Mitigation in Bandung, eruption of Mount Kelud recorded history began in 1000 until 1990, the longest interval of intermittent breaks between 65-75 years and shortest 3 years.

METHODS

In Indonesia the center of the disaster is BNPB as the giver of command in collaboration with public, private, and several related sectors including the government and the health sector. The role of the people here as well as perpetrators of early disaster victims must be able to handle a disaster within certain limits in order to prevent disaster into a larger scale.

This study was observational analytic research with cross sectional approach conducted in Disaster-Prone Areas Kelud Blitar in May-June 2013. The subjects were selected using cluster sampling where samples were people living around the mountain lava flow kelud. Retrieving data using a questionnaire given to the people associated with factors that affect preparedness (the nurse's role, knowledge, attitudes and cultural) communities in the face of Kelud. A total of 360 samples were taken in six selected villages and villages through which the lava flows Kelud. Analysis of the data used to see the relationship between factors that influence (knowledge, behavior, culture, the role of nurses, nurse's knowledge and skills of nurses) and community preparedness in the face of a mountain disaster kelud then performed bivariate analysis. Using a statistical test Chi-Square test if they meet and alternatively using Fisher's exact test with a confidence interval of 95% or p≤0,05. As for the multivariate analysis using logistic regression

NAP-DRR 2010-2012 explained that the new paradigm of the implementation of disaster management is directed to the concept of community-based disaster management. Implementation of disaster management-oriented empowerment and self-reliance through community participation, among others, will lead to disaster risk reduction efforts with areas communities in disaster-prone independently and avoid the emergence of a new vulnerability and dependence of communities in disaster-prone areas to outsiders. Karancy (2005) explains that something which can influence community preparedness in the face of disaster is the

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statistical test with a confidence interval of 95% or p≤0.05.

The role of nurse knowledge behavior culltural

RESEARCH RESULT In this study, the respondents were 360 respondents consisting of people living in disaster prone area I, disaster prone area II and disaster prone area III. It is gained from 360 respondents were 60 respondents (16.67%) lived in disaster prone area III, 120 respondents (33.33%) live in disaster prone area II and 180 respondents (50%) live in disaster prone area I. Results obtained demographic data that the average age of the respondents 35 years and a minimum age of respondents 20 years. Characteristics of the sex of the 360 respondents, 269 respondents (74.72%) were male and 91 respondents (25.28%) were female. Based on the characteristics of the educational level of the 360 respondents the majority of respondents are junior high school graduates as many as 124 (34.44%) and a minority of respondent uneducated as many as 8 respondents (2.2%) it is also affected by economic conditions Disaster Prone Areas Mt. kelud. Based on the characteristics of the 360 respondents earning an average income Rp. 500.000, because the majority of people work as laborers on plantations and farmers. the average length of stay is based on the characteristics of long-stay community disaster prone area Kelud is 33 years so that people have experienced at least two times the eruption of Mount Kelud. Data obtained information related to disaster preparedness community with the majority of people getting information from television that 151 respondents (41.94%), while for others that they get information from the local village officials that 17 respondents (4.72%) and total 4 (1.11%) never get information related to disaster preparedness.

Results of bivariate analysis to determine the relationship of each variable (the role of nurses, knowledge, attitudes and culture) towards community preparedness Kelud obtained their significance - each 0,004; 0,000; 0,004; 0.007 to p <0.05 which means there is relationship between the nurse's role, knowledge, attitudes and culture towards community preparedness p <0.25 at Chi-Square test. Test results showed that in a sequence that affects community preparedness is knowledge (OR 1.509), attitude (OR 1,127), the role of nurses (OR 1076) and culture (OR 0.865).

Table 2 Results of Multivariate Analysis Variabel The role of nurse Knowledge Behavior Cultural

p 0,30 0,01 0,01 0,22

OR 1,076 1,509 1,127 0,865

DISCUSSION The Relationship Between The Role of Nurse With Kelud Community Preparedness Results of the analysis showed that the nurse's role is primarily a community nurse can influence community preparedness of disaster-prone areas Kelud with the results of significant value 0,004 less than alpha (5%). Researchers get the results of a survey related to the nurse's role in educating the public showed a majority of the nurse's role is less (62.2%). The theory of the formation of behavior according to Green one that is a supporting factor (enabling factors) in the formation of behavior is infrastructure

Table 1 Analysis results Bivariat Variable

0,004 0,000 0,004 0,007

p-value

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and health resources. Low role of nurses in providing education to the public will have an impact on the information received that could influence the knowledge and behaviors of society towards disaster preparedness.

society in the face of preparedness (Lakhsmi, 2007).

disaster

Based on the theory of Lawrence Green et al (1980) knowledge is a predisposing factor in the formation of behavior. Knowledge in cognitive domain has 6 levels that know, understand, application, analysis, synthesis and evaluation (Notoatmodjo, 2010). In this study the realm desired by the researchers is to know and understand the realm of disaster preparedness in the face of the mountain erupted. The material must be known and understood community with regard to disaster volcano is the type and characteristics of the hazard, early warning self-protection tool should be prepared community in case of volcanic eruption, volcanic eruption hazard material, sanitary water and evacuation route.

Efforts dissemination of information related to disaster preparedness is not only played by health professionals, but also played by non-medical personnel such as government or NGOs. In the region there are Kelud community radio is a community radio anchor kelud an active role in the dissemination of information related to disaster preparedness volcanoes. The data obtained from the survey results relating to the public the information obtained in Disaster-Prone Areas Kelud majority of people get information through TV (41.94%) and radio (40.83%). According Notoatmodjo (2010) health promotion method which is used if the target is public then it should use the method of mass health promotion. For public health promotion methods frequently used one of them the use of electronic mass media, such as radio and television. Efforts dissemination of data obtained proved that although the information obtained from the community health workers less but community preparedness in the face of disaster preparedness has good (54.7%). This research was supported by a study conducted by Runblad et al (2010) conducted on 1,000 respondents that use the radio to educate the public effectively to raise public awareness in the use of clean water in the floods.

The knowledge gained by the society is also influenced by several factors such as socioeconomic, experience, education and age. Knowledge is very closely related to education, where it is expected that the higher education then that person will be more knowledgeable. The result showed that the educational level of the people living in Disaster-Prone Areas Kelud majority is graduated from junior high school (34.44%). Economic status of a person will determine the availability of a facility that is required for certain activities, so that socio-economic status will affect a person's knowledge (Lukman, 2008). Results of this study found that the average income of people living in disaster prone area Kelud Rp. 500.000. Getting experienced before disaster events can also be a lesson for the public to be more careful and community preparedness in facing similar disasters. The experience allows a person become aware and know the result is then called knowledge (Vardiansyah, 2008). The survey results are available to the public in Disaster-Prone Areas Kelud society obtained the average length of stay is 33 years.

Relationship Between Knowledge With Kelud community preparedness Results of the analysis showed that the knowledge society can influence community preparedness of disasterprone areas Kelud with the results of 0,000 p <0.05. The study was supported by the results of research conducted on 100 respondents found that there is a relationship between knowledge and

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simple and very meaningful in life include values - values that exist in society (Williams, 1961). Some cultures are still embraced by society Kelud is “Larung Saji ritual” that each year is still done by local residents is the main people who are in disaster prone area III which is close to the area Kelud. People assume that they should respect the ancestors to be given safety and lush natural grace. The same study also found associated with the trust factor and superstition also gives an influence on the mindset and behavior of the people living around Mount Merapi eruption area. For people who live in the vicinity of the volcanoes, where the caretaker who becomes guardian of the volcano is still more trusted than the government even the choice of caretaker to remain in the area Kinahrejo (one of the areas affected by the eruption of volcanoes) is followed by many people around even the government ask the community for evacuation (Lavigne, et al., 2008).

Relationship Between Behavior With Kelud Community Preparedness Results of the analysis showed that behaviors can influence community preparedness of disaster-prone areas Kelud with the results of 0.004 p <0.05. Behavior is covered person's response to a stimulus or object, both internally and externally so that its manifestations are not directly visible, but can only be interpreted in advance of behaviors covered. Behavior in reality indicate suitability response to certain stimuli (Sunaryo, 2004). Based Rosenberg's theory known as the theory of affective-cognitive consistency in terms of behavior and this theory is also called two-factor theory is focused on the components of cognitive and affective components. In terms of relation with the volcanic eruption disaster preparedness related to preparedness knowledge must be understood by the community in the process of the formation of community behaviors in the face of disaster volcano. The results show the percentage of behaviors and knowledge by results (41.9%) and (49.4%). Other studies related to people's behaviors in the face of floods in North Sulawesi were collected from 125 respondents showed that 48.61% of respondents have a positive behavior, while 51.39% have a negative behavior (Kumajas et al, 2012).

Factors Affecting Community Preparedness Disaster Prone Areas Kelud From the analysis it was found that sequentially factors that influence community preparedness is knowledge (OR 1.509), behavior (OR 1,127), the role of nurses (OR 1076) and culture (OR 0.865). Based on the theory of Lawrence Green there is relationship between the role of nurses, knowledge, behaviors and culture in shaping the behavior of society in the face of disaster preparedness kelud mountain. Health workers who are in community health centers is a nurse who has the task as educators is to promote the health of the community to empower communities in disaster preparedness through the organization or community development.

Relationship Between Culture With Kelud Community Preparedness Results of the analysis showed that culture can influence community preparedness of disaster-prone areas Kelud with the results of 0.007 p <0.05. In the theory of Lawrence Green culture is one of the predisposing factors of the formation and behavior of a person who possesses or believe a certain confidence will affect their behavior in the face of a disease that will affect the health (Green, 2000). Some people also see a different culture, culture is something that is

Knowledge is the most important factor that effect on preparedness because based on the Lawrence Green theory, knowledge is a factor predisposing factors that facilitate or predispose the

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person's behavior. Or cognitive domain knowledge is very important for the formation of one's actions (overt behavior). The results of experience and research that behavior based on knowledge will be more lasting than behavior that is not based on knowledge (Anwar, 2010). Thomas & Znaniecki (1920) in Anwar (2010) asserted that the behavior is the predisposition to do certain behaviors, so the behavior is not only the internal state of psychological pure of individuals (purely psychic inner state), but the behavior is more a process of awareness of the nature of the individual. Another factor affecting the behavior is the behavior to the formation of culture. Unconsciously culture has instilled a steering line our behavior towards various issues. Culture has colored the behavior of members of the community, because of the culture that gives the experience of individuals in society (Anwar, 2010). Therefore health personnel in charge of people's behavior in this case related to disaster preparedness Kelud. As mentioned above that the behavior of the community is strongly influenced by socio-cultural in changing his behavior indirectly also social and cultural change (Notoatmodjo, 2010).

on the cultural aspects of the communities in disaster prone area Kelud.

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CONCLUSION

_____. 2008. Pedoman Penyusunan Rencana Penanggulangan Bencana. Jakarta

Factors affecting the community in the face of disaster preparedness volcanic eruption in Disaster-Prone Areas Kelud are knowledge, behaviors, the role of nurses and culture.

_____. 2010. Pedoman Umum Penyelenggaraan Rehabilitasi dan Rekonstruksi Pasca Bencana. Jakarta

SUGGESTION it is required coordination between health workers with NGOs in the provision of education on disasters through community radio anchor Kelud in order to complete the dissemination of information and on target. For the future research, the cultural factors are expected to further research using qualitative methods as will be explored

_____. 2012. Pedoman Umum Desa/Kelurahan Tangguh Bencana. Jakarta Burke, S., Jeffrey W, Bethel., Amber F B. 2012. Assessing Disaster Preparedness among Latino Migrant and Seasonal

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Farmworkers in Eastern North Carolina. California: Departement of Health Sciences California State University

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Hidayati, D.N. 2011. Kesiapsiagaan Tanggap Bencana Masyarakat Kecamatan Ngancar Kabupaten Kediri Terhadap Ancaman Erupsi Gunung Kelud. Surabaya

Chapman K & Arbon, P. 2008. Disaster Preparedness in the Acute Setting. Australia: Flinders University

IFRC-RCS. 2005. World Disaster Report: Focus on Information in Disasters. International Federation of Red Cross and Red Crescent Societies. Geneva

Claudia and Frances. 2000. Community Health Nursing : Theory and practice 2nd ed : United States Dahlan, S. 2011. Statistik untuk Kedokteran dan Kesehatan. Jakarta: Salemba Medika

Karanci, A N., Aksit, B., Dirik, G. 2005. Impact of a Community Disaster Awareness Training Program in Turkey: Does it Influence Hazard – Related Cognitions and Preparedness Behaviors. Turkey: Middle East Technical University

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Kadarsetia E., Primulyana S., Sitinjak P., Boyson S. U. 2006. Karakteristik Kimiawi Air Danau Kawah Gunung Api Kelud. Jurnal Geologi Indonesia

Douglas, P., Jhonston, D. 2001. Disasters and Communities: Vulnerability, Resilience and Preparedness. New Zealand: Massey University

Khairuddin. 2011. Dampak Pelatihan Pengurangan Risiko Bencana Terhadap Kesiapsiagaan Komunitas Sekolah. Unsyiah Banda Aceh. ISSN 2088-4532

Efendi, F M. 2009. Keperawatan Kesehatan Komunitas. Jakarta: Salemba Medika Greeg and Lopes, R. 2004. Volcanic Worlds: Volcanism in The Solar System. Praxis Press New York

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Kuntz S., Pamela F., Kristine Q., Linda Strong. 2008. Disaster Preparedness White Paper for Community/Public Health Nursing Educators. ACHNE

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Kumajas M., Zaenal K., Kliwon H., Jailani H. 2012. Community Attitudes and Behavior and Its Influence Towards Social Impacts of Flood in TondanoRiver Estuary. International Journal of Civil & Environmental Engineering

Rundbald, G., Olivia K., Paul R H. 2010. Communication, Perception and Behaviour During a Natural Disaster Involving a „Do Not Drink‟ and a Subsequent „ Boil Water‟ Notice: a Postal Questionnare Study. BMC Public Health

Lakhsmi. 2007. A Study to Assess The Knowledge About Disaster Preparedness Among Inhabitans in A Selected Urban Area. Departement of Community Health Nursing. Bangalore

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Lavigne, F., Thouret J.C., Voight B., Suwa., Sumaryono A. 2000. Lahars at Merapi Volcano Central Java : an overview Journal of Volcanology and Geothermal Research Vol 1

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Notoatmodjo, S. 2010. Metodologi Penelitian Kesehatan. Jakarta: Rineka Cipta

Susan and Sharon. 2010. Public Health Nursing and the Disaster Management Cycle : American Red Cross

______. 2003. Pendidikan dan Perilaku Kesehatan. Jakarta: Rineka Cipta ______. 2007. Promosi Kesehatan dan Ilmu Perilaku. Jakarta: Rineka Cipta

Sunaryo. 2004. Psikologi Keperawatan. Jakarta: Kedokteran EGC

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UN/ISDR. 2004. Living With Risk: A Global Review of Disaster Reduction Initiatives. Geneva: United Nations, International Strategy for Disaster Reduction Vardiansyah, Dani. 2008. Filsafat Ilmu Komunikasi Suatu Pengantar. Jakarta: Indeks Veenema, T G. 2006. Expanding Educational Opportunities in Disaster Response and Emergency Preparedness for Nurses. New York: University of Rochester School of Nursing VUSSC. 2005. Introduction to Disastre Management. Virtual University for Small States of The Commonwealth Version 1 WHO. 2011. Regional Case Study on Role of Nurses and Midwives in Emergencies and Disasters. Regional Office for South – East Asia

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ANALYSIS MOTIVATION IN REVIEW OF THE COMPONENTS QUALITY OF WORK LIFE EMPLOYEE PARTICIPANT AND CAREER DEVELOPMENT Ratna Wardani STIKes Surya Mitra Husada Kediri Email : [email protected] ABSTRACT Human resource enough with the quality of being high, professional, in accordance with its function and the task of each personnel is one of indicator the success of hospitals. The purpose of this research is to know the influence of components quality work of life to motivation nurses in RSM ahmad dahlan kediri. Population a total of 85 a nurse with using simple random sampling obtained the total sample 70 nurse. Pearson correlation in use to know the relationship between a components of quality work of life against motivation nurse. Regression analysis a liner with approach stepwise used to know the influence of components quality work of life to motivation nurse. The results of the analysis in knows that has employee participant and career development influential of 44.6% of motivation where employee participant having influence most dominant. Keywords : career development, employee participant, nurse motivation

nurse always faced with demands idealism a profession and often to face a range of kind of problems good friend of the patients and fellow worker. Service nursing in hospital was a factor for the quality of service and citra hospital in the citizens. And also to participate in improve the quality of health services, every nurse should have motivation high that will get a good performance. Motivation work here is a condition / of circumstances that affect someone to keep increasing, direct and maintain his behavior that deals either directly or indirectly with the environment of work. Many factors that can affect motivation nurse in implementing responsibilities are in hospital . The results of the study Alzeira (2010) claim that there was a correlation between components quality work of life to motivation work nurse so far in a hospital Tugu 2010. Of all components quality work of life in the survey pride to institutions has a strong against motivation work. From the description above so research aims to understand the relationship between employee

INTRODUCTION The hospital is an organization that formed specifically for the demands of the needs of people increasingly complex because people begin to realize the importance of health. Thing that since the hospital to give maximum service to the community. (Amriyati, 2003), the demands will increase heavy in the face of the era of globalization now that the change very fast and simultaneously when is not followed the existence of resources improve our mankind hospitals professional and excellent. In the hospital, besides profession doctor, there are also nurse who had an important role in terms of serve and care for the sick directly. Of their duties daily, a nurse often faced in an effort rescue survival or the life someone. (Kuntjoro, 2005), good service not despite the presence of commitment from a nurse to provide good service to the patient. (Soeroso, 2003) In running the role and functions, a nurse are required to have skill, knowledge, and concentration high. In addition nor a

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participant and career development to motivation employees in RSM Ahmad Dahlan Kediri.

the driving force behind working spirit. Strong and the weak motivation a work of labor come determine big or small outstanding achievements. According to Herzberg (Anoraga 2009), system needs the underlying the motivation, and is divided into two parties, namely factor hygiene and factor motivator. Herzberg found that factors that raises satisfaction work different from factors that raises dissatisfaction work. Factors that cause satisfaction work called factor motivator, which includes the contents of work is factor intrinsic from work itself, that includes: responsibility, progress, work itself, accomplishment, recognition. While factors that raises dissatisfaction work called factor hygiene, pertaining to the context of work, and is factor extrinsic from work, includes: administration and health policy, supervisor, salary, personal relationships, and working conditions.

MOTIVATION According to Edwin B Flippo in Hasibuan (2007), motivation is a expertise in driving civil servants and organization to work more good that desire civil servants and organizational goals can be achieved. Thus, motivation work employees are needed in order to increase firm production. The theory Mc Clelland argues in (Hasibuan 2007) that employees have stored potential energy, but how this energy used dependent upon the strength encouragement the motive for employees and the situation that exists. According to this theory is 3 things that motivates someone. First, needs achievement became an propulsion that motivate of work of someone. Therefore, this need drives someone to develop creativity and mobilize all ability and energy to reach work performance maximum. Someone will realize that only on achieving work performance high will be a greater incentive. Second, the need for affiliation be propulsion that will motivate of work of someone. This need including demand is to be accepted in the neighborhood place to work, feeling respected, feeling forward and not to fail, and feelings participate. Hence, motivation someone to fulfill the need by using energy and develop itself in order to finish the job. Third, the need for power became an locomotion motivation to reach chair or notch the best. Competition is an appropriate way to reach this need. Nurse need to continue to be motivated to improve its contribution to because motivation is a source of propulsion that closely related to labor productivity, culture and scores of work in organization. According to ( Anoraga 2009 ), motivation employment is something raising of enthusiasm or impulse. Because of that, motivation of work in psychology commonly called

QUALITY OF WORK LIFE According to Arnold and Feldman (1986) in Anggraeni (2009), claim that the quality of work life intended to create conditions organization that can help development employees to learn. This is proven by the organization as control the role of how employees does its work and provide an opportunity to occupation is to draw and meaningful for employees so as to cause personal satisfaction that can affect the effectiveness of organization. According to Cascio (2003), the role of organization to improve the quality of work life is a business to meet the needs of employees both physical and psychological made up of several components, including: 1. employee participation according to (Cascio 2003), an attempt participation in employees may be done by means form employee involvement, employee participation meeting, and quality improvement teams. 2. Equitable compensation, compensation are related for its

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employees as individuals, because the size of the compensation is size hard work the employees. 3. Job security, according to (Cascio 2003) security employees to work can in achieving by an organization in the form of retire and status employees. 4. Safe environment, Work environment having the effect on labor productivity. If environmental nice and safe it will cause additional burdens for employees. 5. Pride, according to (Cascio 2003) proud to institutions be able to be implemented by means of strengthen the identity and image organization, increase the participation of the community as well as increase the awareness of for the environment. 6. Career Development, according to (Cascio 2003) career development can be conducted by creating education and training evaluation, performance, and position promotion. 7. Wellness, according to Sikula in the Hasibuan (2005 ), to maintain employees of a company provide welfare in the form of compensation indirect for the provision of facilities and services. 8. Conflict Resolution, conflicts take into consideration that there are problems that need to be resolved in a relationship, induce to commit change within one person, grow encouragement in a burden to solve problem until now have not realized that. 9. Communication, according to (Notoatmodjo, 2007), two way communication will easier to understand each other and very help develop relation which is satisfying to both sides by created on good cooperation. According to (Usman 2009), program the quality of work life can be improving communication internal and group, improve coordination, motivation, and capabilities workers.

Thus programs are able to reach vision, mission, nor the purpose of more developed organization. MATERIAL and METHOD This research is research quantitative uses the research correlational with the approach crosssectional. Research methodology quantitative can be defined as research methodology based on philosophy positivism, used to scrutinize in the population or a given sample of, data collection use of the instruments research, data analysis is quantitative/statistics, for the purpose of test a hypothesis that has been set. The conclusion is the last step of the process research of response to formulation problems. This research in doing in RSM Ahmad Dahlan Kediri by the number of a population of 85 nurse. Technique the sample to research this is simple random sampling by the number of sample 70 respondents. Stage data processing in this research include univariate analysis in used to do analysis on each variable so that it can be in know the percentage. Next done analysis bivariate by using correlation analysis Pearson and to test hypotheses, which is there are influence components quality of work life to motivation nurse use linear regression multiple with the approach method stepwise. RESULT AND DISCUSS Univariate Analysis Table 1. characteristic of employees RSM Ahmad Dahlan Kediri Variabel

Freq

Percent

Age < 25 year 25 – 35 year > 35 year Length of service < 6 year

18

21 46 4

29.6 64.8 5.6

55

77.5

>= 6 year 16 Gender Man 19 52 Women Marital Status Married 51 Not married 20 Education D1/D2 8 D3 49 S1 14 Table 1 above can be knows that age employees RSM ahmad dahlan kediri majority exists by the age of 25 - 35 years as many as 46 respondents (64.8 %).To many years working most workers having long works less than six years 55 or 77.5 %. Gender respondents most are women 52 or 73.3 %, with married status almost all respondents married as many as 51 respondents (71.8 %). Education respondents most of them are d3 a total of 49 (69 %). Bivariate Analysis Table 2. Correlations component the quality of work life against motivation work nurses in RSM Ahmad Dahlan Kediri Variabel p-value Career development 0.003 Employee participant 0.000 Safe environment 0.040 Job Security 0.048 From table 2 above of nine components quality of work life with the motivation work nurses in RSM Ahmad Dahlan the quality of only four variable with links with the motivation work nurse, namely career development, employee participant, safe environment and job security. Multivariate Analysis Table 3. The influence of components quality of work life to motivation work nurses in RSM Ahmad Dahla n Kediri Variabel p-value Career development 0.000 Employee participant 0.000 Safe environment 0.124

22.5Job security 0.051 0.609 0.000 Sig (all variables) 26.8R-Square (2 variabel) 44.6 73.3R-square (4 variable) 44.0 In table 3 it can be in know that 71.8career development and employee 28.2participant affect motivation work nurse, while safe environment and job security 11.3has not been affecting the motivation 69.0work nurse because the value of 19.7signifansinya more than 0.05. The influence of fourth variable above to motivation work of 44 % and influence two variable the motivation nurse to work of 46,2 %, while of 53.8 % in stir by the other factors that not in minutely. Of both variable above in know that employee participant having influence the most dominant to motivation work nurses in RSM Ahmad Dahlan Kediri. According to ivancenvich konopaske & matteson in the (ardiansyah 2009) the concept quality work of life widely have been used for increased the motivation work and improving the condition of who has sent down motivation such work. (Cascio 2003) outlines nine components quality of work life consisting of the employee participant, career development, conflict r resolution, communication, wellness, 0.352job security, safe environment, equitable 0.608compensation, and proud. According to 0.245Harvey and Brown (Usman, 2009) 0.235quality of work life need to be created by the Organization to provide balance in employees in carrying out the work and personal life. Of correlation analysis person in table 2, of the nine components quality of work life only four component that has relations with the motivation work nurse. Career development has a enough with the motivation nurse, employee participant had strong ties with the motivation work nurse, while safe environment and job security has a weak with the motivation nurse. Of table 3 in know that of four B variable with links with the motivation 0.408 0.881work nurse, only two variable that has 0.305an effect on motivation work nurses in RSM Ahmad Dahlan Kediri. Employee

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participant is a component quality work of life that has an effect most dominant to motivation work nurse. The involvement of nurse is part of the program motivation derived from facilities and the assumption described by the experts and support relations of persons in work environment. With there is participation nurses will be creating a sense of responsibilities of each individual. In addition the involvement of nurse to a sense of belonging to institutions place the employees work , namely RSM Ahmad Dahlan Kediri. According to (Siagian 2004) employee participant is the way of view as in see the extent to which an employee first will then enclose in determining decisions sendirl iti on that job. It is done to give liberty against the employee to play an active role to institutions place they work. The higher their participant the more higher the responsibility the employees to complete the task in give. Efforts to improve participation nurse can be done by the leader of RSM Ahmad Dahlan by means of follow enclose in the meeting, involving an employee in each meeting, and development of the quality of team. The role of the head room to guide nurse implementing. With the delegation of given to nurses implementing so will increase responsibilities and a sense of belonging to institutions place to work. The second variables that influence the motivation work nurse is career development, this is in accordance with the (Haryono 2011) in studies conducted in Hospital Hermina Bogor. In general career is all forms of work done a during his lifetime to meet the needs of ideal. According to (Cascio 2003), career development can be conducted by creating education and training, performance evaluation, and position promotion. Thus the level of a career in an institution will increased the motivation an employee in his job. With the career development will give benefits can increase satisfaction work,

can dig potential self of an employee, and will raise motivation work. Competitive environment demanding RSM Ahmad Dahlan Kediri to make standard competence nurse through the level of career nursing that the implementation of the quality of service be well maintained. Allowance level career nurse need to be done so that each increase level of a career which also was an improvement competence nurse able to be rewarded in a career that the program more effective level. Thus the level of a career in an institution make employee improve quality of work and services provided to patients more optimal in accordance with standard minimum service. CONCLUSION Of the nine components quality work of life there are two components influential to motivation work nurse namely career development and employee participant. Employee participant into components the most dominant and had strong ties with the motivation work nurses in RSM Ahmad Dahlan Kediri. REFERENCES Amriyati, S. S. (2003). Kinerja Perawat Ditinjau dari Lingkungan Kerja dan Karakteristik Individu (Studi Pada Instansi Rawat Inap Rumah Sakit Umum Banyumas Unit Swadana Daerah). Manajemen Pelayanan Kesehatan, 8-11. Anoraga, P. (2009). Psikologi Kerja (Cetakan ke 5). Jakarta: Rineka Cipta. Ardiansyah, G. (2009). Pendelang Pekerjaankatan Job Mapping sebagai alat bantu dalam desain u . Depok: Skripsi. Program Studi Teknik Industri Fakultas Teknik Universitas Indonesia. Cascio, W. (2003). Managing Human Resources : Productivity,

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Quality of Work Life, Profit (6th Ed). New York: McGraw-Hill. Haryono, Y. (2011). Hubungan Komponen Kualitas Kehidupan Kerja dengan Motivasi Kerja Perawat Pelaksana dan Bidan di Rumah Sakit Hermina Depok. Depok: Skripsi. Fakultas Kesehatan Masyarakat Universitas Indonesia. Hasibuan, M. (2005). Manajemen Sumber Daya Manusia Edisi Revisi. Jakarta: Bumi Aksara. Hasibuan, M. S. (2007). Manajemen Sumber Daya Manusia (Edisi Revisi). Jakarta: Bumi Aksara. Kuntjoro, T. (2005 Vol. 8 No. 3). Pengembangan Manaemen Kinerja Perawat dan Bidan sebagai Strategi dalam Peningkatan Mutu Klinis. Jurnal Manajemen Pelayanan Kesehatan, 149-154. Notoatmodjo, S. (2007). Promosi dan Perilaku Kesehatan. Jakarta: Rineka Cipta. Siagian, S. (2004). Teori Motivasi dan Aplikasinya. Jakarta: Rineka Cipta. Soeroso, S. (2003). Manajemen Sumber Daya Manusia di Rumah Sakit. Suatu Pendekatan sistem. Jakarta: EGC. Usman, J. (2009). Pengaruh Quality of Work Life Terhadap Semangat kerja di Pertamina Eksplorasi dan Produksi Rantau. Jakarta: Tesis Program Pascasarjana Unversitas Terbuka.

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STRATEGY ON HEALTH CARE PROTECTION FOR THE POOR SOCIETY IN KEDIRI CITY Koesnadi Institute Of Health Surya Mitra Husada Email :[email protected] ABSTRACT

In general, a guarantee of Public Health (Assurance) has the goal of increasing access to and quality of health services to the entire community, including the poor in order to achieve an optimal degree of public health effectively and efficiently. This study purposed to determine the strategy on health care protection for the poor society in Kediri. This study was conducted in May to June 2015 using purposive sampling technique. The approach taken in this study used a qualitative approach. This study took place in Kediri. The informants are the patients who went to threat in Kediri. The data showed that a. The services provided by health centers and hospitals according to the informant was good b. according to all informants every patient should have a health ansurance like Jamkesmas, Jamkesda or BPJS. c. The response of users health care are very diverse among them say that using the health insurance may be light d. Almost all informants said that at there were still obstacles they face, for example, when a family member was sick and in need of further treatment, they are still difficult to get a room for treatment because the room is full. e. Almost all respondents want to get legal protection so that they could be treated safety, comfort and reached Keywords: Strategy, protection, health care, the poor of a good quality in itself and the health ministry.Adisasmito (2007) mentions, low health status of the poor due to limited access to health services due to geographical constraints and cost constraints (cost barrier) .In addition, the behavior of people who lack support a clean and healthy lifestyle is also an obstacle for the Government to promote the development of society, especially in the field of health (Adisasmito, 2007). The quality of public health are low due to the public awareness that is low for a healthy life, a means of health infrastructure beyond the reach of community and economic levels of society who are unable to meet the needs of health, become a concern for the developed countries that are members of the United Nations ( UN). Implementation of the constitutional mandate on health insurance of citizens and the implementation of the declaration of the United Nations in

INTRODUCTION Healthy living is a dream for every human being, because the lives of healthy people can carry out their activities with full perfection, both activities in conjunction with the creator God Almighty, and the activities of fellow human beings and their environment to meet their needs. Socioeconomic conditions are very diverse, both in cities and villages, those who worked as civil servants and private employees, as well as company workers and farm laborers, and others. Differences in social and economic strata of society, has also resulted in differences in the degree of health. Poverty is one obstacle to efforts to increase well-being and quality of life. The poverty rate is also the cause of the poor are not able to meet the demand for health services are relatively expensive (Tiyayasih, 2011). However, the high cost of health care is not the only cause

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2000 on the Millennium Development Goals (MDGs) or the Millennium Development Goals, the Government of Indonesia has set a policy on the guarantee and protection of public health, with the enactment of Law No. 40 Year 2004 on National Social Security System (State Gazette of the Republic of Indonesia Year 2004 Number 150, Supplement to State Gazette of the Republic of Indonesia Number 4456) called UU.SJSN, and Law No. 36 Year 2009 concerning Health (State Gazette of the Republic of Indonesia Year 2009 Number 144, Gazette of the Republic of Indonesia Number 5063) called the Health Act. as well as Law No. 24 of 2011 on the Social Security Agency (State Gazette of the Republic of Indonesia Year 2011 Number 116, Additional State Gazette of the Republic of Indonesia Number 5256) called the Law of BPJS. The philosophical foundation of Law No. 40 of 2004 on National Social Security System, as stated in the preamble to weigh states: "a. that everyone is entitled to social security to be able to meet the basic needs of a decent life and improve dignity towards the realization of Indonesian society that is prosperous, just and prosperous; b. that in order to provide a comprehensive social security, the country developed a National Social Security System for all Indonesian people ". Social security in it is of public health insurance philosophy is to bring people of Indonesia a prosperous, fair and prosperous, and the State ensure the implementation of public health insurance, through the National Social Security System. As the providers of public servants, hospital and health centers should implement the law properly. That is, should carry out duties as institutions that provide health services to the community as well as the obligations mentioned above, including the poor have either Jamkesmas card or no Jamkesmas card, domiciled either in Kediri or outside Kediri, if they require health services at the General Hospital

of Kediri, they should be given good service according to the authority given by legislation, and not be rejected on the excuses where the room does not exist, or pay for the drug itself to the reason the office of PT Askes closed on holidays , as the mandate of the Social Security Act and the Regulation of the Minister of Health on the implementation of the guidelines Jamkesmas. The law must be implemented well in order to create the legal law which creates of public welfare with free public health guaranteed in hospitals. Based on the background above, this dissertation take the topic “STRATEGY ON HEALTH CARE PROTECTION FOR THE POOR IN KEDIRI CITY" METHODS Research Design: Qualitative descriptive. Place and Time: This study was conducted in Kediri in May 2015 Population and Sample: The informant as much as 15 people In this study, the data collection methods used by researchers is the depth interviews with informants RESULTS AND DISCUSSION A.Result 1. The characteristics of informants Informants research on health care protection strategies of the poor in Kediri are composed of 15 informants include age, gender, job, holding health cards From these results obtained informant characteristic data are housewives aged between 40 and 67 years. Based on the characteristics of sex are all female. Based on all sex their jobs are housewives. Health cards of the characteristics possessed 9 using Jamkesmas while others use BPJS. From the results of research from day to day care in health centers has improved. But precisely the existing services at the Hospital which according to one informant is still lacking and not very pleasant for the informant.

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The Informant also says that in all health centers and hospitals of all health workers there suggest that poor patients should have a health card such as Jamkesmas, or Jamkesda or BPJS where the cost for the treatment is cheap. Almost all informants said that by using the health card to be cheaper treatment, drug - any drug can be obtained easily and inexpensively. Even the fee can be deducted from the salary of her husband. Obstacles faced by the informant are very wide - range for example, each time going hospitalization rooms, the rooms in the hospital are always full. That's what always made them feel uncomfortable. All informants say he wants to get legal protection for them as medical personnel perform a medical act not in accordance with the procedure. They want the service at the Hospital of the best, comfortable, safe, cheap and affordable.

well as guarantee to obtain medical care from the state.

B. Discussion

Means and facilities to protect the welfare of the community is felt by the poor is very limited. This is because the geographical situation in the region and knowledge of the importance of health is not maximum. And the public perception is still less maximum of the health card itself.

2. Obstacles in the implementation of the protection of public health services for the poor in Kediri. Obstacles encountered in service is not all government regulations and policies known by the poor, as well as the limited means and facilities available, as well as the dedication of health staff in providing services for the poor is not maximized. Low health status of the poor due to limited access to health services due to geographical constraints and cost difficulties. Besides the behavior of people who lack support a clean and healthy lifestyle is also an obstacle for the government to advance the development of society, especially in the field of health (Adisasmito, 2007)

1. The implementation of the protection of public health services for the poor in the city Kediri The results showed that nearly all of the patients who seek treatment either in the clinic or are in the hospital using health cards. And if they do not already have it health staff recommends obtaining the health card immediately

3. The model of the legal protection of poor people in obtaining health services in Kediri

Article 34 paragraph 3 of the 1945 Constitution states that "the State is responsible for the provision of health care facilities and viable public facilities”

"If it is about the protection it will be related to the law, don‟t you , now I also want to like it so that when there will be an error due to actions taken by the health staff as the poor we can be protected" (informants 1)

Indonesian government policy set national social security system aims for the creation of social security including public health insurance, which can be enjoyed thoroughly by the community.

Legal protection is a subjective condition stating the presence of necessity on ourselves a number of legal subjects to quickly acquire a number of sources, to the continued existence of legal subjects that are guaranteed and protected by law, so that its power is organized in the decision making process politically and economically,

Based on the above statement, it can be interpreted that every Indonesian citizen is guaranteed by the state to prosper and unseen, dwelling and its surroundings as

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especially in the distribution of resources, both at the individual and structural rankings (Hadjon, 1987)

2. It is imperative to improve the socialization of all the rules and policies for all medical staff and the public in Kediri.

To obtain legal protection in the health services, the government should be more aggressively again to socialize on the health service, so that people know and are able to apply the program correctly.

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CONCLUSIONS AND SUGGESTIONS Conclusion 1.Poor people who seek treatment at health centers and in hospitals all have already used health cards to obtain health services. 2.Obstacles encountered in service are not all regulations and government policies known by the poor, and there are still many limited structures and infrastructures and the available facilities, as well as the dedication of health staff in providing services to the poor is not maximized.

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3. Strategies that can be used are: · Availability of legislation and government policies is clearly known, understood and performed by health workers and the poor in hospitals and health centers in Kediri. · Availability of facilities and health care facilities for the poor in hospitals and health centers is adequate in Kediri · The availability of human resources in health care services in hospitals and health centers is dedicated to the poor for the health services without discrimination.

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Usman, Sunyoto.2003.Pembangunan dan Pemberdayaan Masyarakat. Pustaka Pelajar, Yogyakarta.

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Capitalist World-Economy, 17301840's. San Diego: Academic Press.

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UU

No 13 Tahun 2003 tentang Ketenagakerjaan Peraturan Menteri Kesehatan Republik Indonesia nomor 03/MENKES/PER/V/2011 tentang Pedoman Pelaksanaan Program Jaminan Kesehatan Masyarakat, Peraturan Menteri Kesehatan Republik Indonesia nomor 631/Menkes/per/ III/2011 Tentang Petunjuk Teknis Jaminan Persalinan

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A HELA CELL-IMPLANTED MOUSE MODEL OF CERVICAL CANCER Yuly Peristiowati, Yenny Puspitasari STIKes Surya Mitra Husada Kediri Email: [email protected] ABSTRACT Cervical cancer constitutes the second leading cause of death to heart disease with a prevalence of 100 to 350 in every 100,000 individuals annually. It is a primary cancer of the cervix (cervical canal and/or portio). Carcinogenesis is a somatic event since the accumulation of genetic and epigenetic changes cause changes in the normal regulation of molecular control of cell proliferation. The purpose of the present study was to develop a cervical cancer model by implanting HeLa cells into immunosuppressed mice. True experiments were conducted with 5 DDY mice of 2 months in age and 2030 gr. in weight obtained from the Integrated Research and Testing Laboratory (LPPT) 4 of Gadjah Mada University. Mice were injected with 0.5 mg/kg of dexamethasone for 7 days to suppress their immunity. Furthermore, 1 ml (8 x 106 per microlite) of HeLa cells was injected intracutaneously into the back of the mice. Mice were observed for nodulation at the injection site. Upon reduction of nodule growth, dissection and histopathological examination were carried out with hematoxylin and eosin (H&E) staining. Results showed that the cutaneous tissue of HeLa cell-implanted mice had largesized cells, greater nuclear volume than that of the cytoplasm and cells losing contact inhibition. The features of HeLa cells implanted into the cutaneous tissue resembled the vaginal cytologic smears of patients with cervical cancer, in which the cells have been washed away from the surface of the tumor or aspirated from the mass through a fine needle. Keywords: Model, cervical cancer, HeLa cells HeLa cells can be used to test antitumor activity, tumorigenic transformation, cytotoxicity, cell biology and bacterial invasion. Morphologically, HeLa cells are epithelial cells invaded by the human papilloma virus (HPV) tope 18. The cells are immortal and highly aggressive, making it easy to invade other cell culture/tissue (Doyle and Griffiths, 2000). Among the grounds for selecting HeLa cells for use in cervical cancer research is that it has the p53 gene that can be induced by the tested compound resulting in cell apoptosis (Desaintes et al., 1999).

INTRODUCTION Cervical cancer is a primary cancer of the cervix (cervical canal and/or portio). Half a million cases are reported annually and the incidence is higher in the developing countries. This is potentially due to non-routine implementation of Pap smear screening programs. In Latin America, subSaharan Africa and Southeast Asia, including Indonesia, cervical cancer ranks second after breast cancer. In Indonesia, it was reported the number of new cases of cervical cancer was 100 in 100,000 women per year or 180,000 new cases aged 45 to 54 years. Additionally, cervical cancer tops the list of 10 most common cancers in women. The course of cervical cancer represents one model of multistep carcinogenesis, beginning from earlystage carcinogenesis to changes in morphology to invasive cancers.

Cervical cancer is caused, among others, by infection with Human Papilloma Virus (HPV), leading to abnormal changes in the cervical cells (Riono, 1999). Human palpillomavirus is a DNA virus infecting human skin and mucous membranes (Desaintes et

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al., 1997). When it infects a cell, the HPV type 18 will express the proteins E6 and E7 (Thierry et al., 1987, cited by Desaintes et al., 1997). These proteins are suppressor proteins that affect cell proliferation and death. E6 binds to p53 to degrade p53 to prevent cells from undergoing apoptosis, while E7 binds to PRB, leading to cells‟ continuous proliferation (Dyson et al., 1989, cited by Desaintes et al., 1997).

hormones that enhance cell growth. Albumin serves as transport protein, lipids as cell growth support and minerals as enzyme cofactor. All the components of RPMI-serum media are to provide the cells with sufficient nutrients in order to survive and proliferate (Freshney, 1987). Furthermore, 1 ml (8 x 106 per microlite) of HeLa cells was injected intracutaneously into the back of the mice. Mice were observed for nodulation at the injection site. Upon reduction of nodule growth, dissection and histopathological examination were carried out with hematoxylin and eosin (H&E) staining.

The purpose of the present study was to develop a cervical cancer model by implanting HeLa cells into immunosuppressed mice. METHODS The present study used the true experiment design with 5 DDY mice of 2 months in age and 2030 gr. in weight obtained from the Integrated Research and Testing Laboratory (LPPT) 4 of Gadjah Mada University. Mice were injected with 0.5 mg/kg of dexamethasone for 7 days to suppress their immunity.

RESULTS 1.

Cervical cancer induction HeLa cell-implanted mice

of

Cancer in the present study was induced by implanting HeLa cells into the back of immunosuppressed mice. Implantation was carried out by injecting 8 x 106 HeLa cells per microlite. Results showed 100% of the mice developed nodules in their skin. Induction of cancer produced local and unmetastatic tumors. Intracutaneous implantation of HeLa cells were aimed at maintaining the cells in place. This situation allowed for nodulation at the implantation site.

HeLa cells obtained from the LPPT 4 of Gadjah Mada University were grown from the liquid nitrogen storage with 70% ethanol. Cells were transferred to a sterile conical tube containing the RPMI 1640 medium. Subsequently, cells were centrifuged at 325 g for 5 min. the pellets were added with the growing medium containing 20% PBS. The cells were then grown in a tissue culture flask and incubated at 37°C in 5% CO2. The confluent cells were subsequently harvested and washed with PBS without Ca and Mg. Cells were released by adding 0.25% trypsin and then 10 ml of RPMI 1640. Cells were centrifuged for 5 min. Furthermore, cells were added with the growing medium 20% PBS to obtain a concentration of 8 x 10 6/100 microlites.

The formed nodules were initially soft in consistency since it contained HeLa cell suspension but it then changed to be hard in consistency on day 3 of implantation.

The medium used in the HeLa cell culture was RPMI 1640-serum since it contains nutrients required by the cells such as amino acids, vitamins, organic salts and glucose, while serum contains

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aspirated from the mass through a fine needle.

Figure 1. Nodules produced by implantation of HeLa cells into the back of mice. It appeared on day 3 of intracutaneous implantation and was hard in consistency.

Figure 3. The features of HeLa cells implanted into cutaneous tissue. Results of H&E staining (1000x magnification) showed cells of similar size with the nuclear volume larger than that of cytoplasm. The cells were not adherent to each other.

The growth of nodules was observed daily for 12 days. Nodules began to appear on day 3 of implantation. It reached the optimum value on day 8 and then began to decline on day 9. 1

DISCUSSION A cervical cancer modeling by intraepithelial implantation of 1.5 x 106 HeLa cells into the skin tissue was made by Marquez-Lemus et al. (2005) into the legs of female nu/nu mice of 34 weeks in age. It was capable of producing tumors appearing on day 15 of implantation without metastasis. The nu/nu (nude) mice are genetically mutated mice to have no thymic glands. Thus, they cannot produce T cells (lymphocytes) that play an important role in the immune system, leading to incapability to generate an immune response. Therefore, nude mice cannot reject a xenograft, or a tissue transplant from other species.

Nodule Volume Curve

0 H1 H2 H3 H4 H5 H6 H7 H8 H9 H10H11H12 K3 K4

Figure 2. The curve of nodule volume produced by implantation of HeLa cells. 2.

Microscopic features of HeLa cells implanted into mice

Results showed that the cutaneous tissue of HeLa cell-implanted mice had largesized cells, greater nuclear volume than that of the cytoplasm and cells losing contact inhibition. HeLa cells implanted into the cutaneous tissue could not form massive tumors. The features of HeLa cells implanted into the cutaneous tissue resembled the vaginal cytologic smears of patients with cervical cancer, in which the cells have been washed away from the surface of the tumor or

The present study used DDY mice of 2 months in age and 20-30 gr. in weight. Mice were intramuscularly (IM) injected with 0.5 mg/kg B.W. of dexamethasone into their thigh for 7 days aimed at depressing their immune system. Dexamethasone is a steroid that depresses the immune system. However, it should not be used excessively since it

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can damage the immune system of mice, leading to death. Of 5 mice used in the study, one was dead after dexamethasone injection. The success rate of the immunosuppression technique used in the study was 100%, as evidenced by the mice‟s appearing relatively weak and losing appetite after dexamethasone injection. However, the immunosuppression was also temporary; thus, naturally the formed nodules would shrink and eventually disappeared.

8 of implantation. This showed that the cells have been subjected to inflammatory process due to stimulation of HeLa cells implanted. Implantation of HeLa cells into the cutaneous tissue caused infiltration of neutrophils to the implantation site, resulting in swelling in the cutaneous layer. A proper intracutaneous implantation was shown by the presence of cells in the cutaneous layer. Cancer cells have a morphology different from that of normal cells (Price 1994). Thus, hematoxylin and eosin (H & E) staining is required on the emerging nodules. In the present study, examination of HeLa cell- implanted skin tissue (nodules) by the use of the H & E staining method indicated largesized cells with pink nuclei and nuclear volume larger than that of the cytoplasm. Cells were not adherent to one another (loss of contact inhibition). HeLa cells implanted into the citaneous tissue could not form massive tumors.

One of the forms of immune response to the implantation of cells is inflammation. In the implantation site, the pre-capilary arterioles will be dilated and the post-capillary venules will be narrowed, thereby increasing the local blood flow. These events may cause swelling and redness typical of inflammation (Campbell, 2004). Swelling and redness can be clearly observed after isolation of nodules. Inflammatory responses are initiated by the presence of chemical signals. The chemical signals derive from the invading organisms/cells. The chemical signals are pro-inflammatory cytokines, such as histamine and serotonin. Histamine produced by circulating leukocytes, called basophils, and mast cells can be found in the connective tissues. In the event of a lesion, these cells stimulate the release of histamine and trigger enlargement and increase in capillary permeability. Leukocytes and cells of damaged tissues secrete prostaglandins which in turn will increase blood flow to the injured site. An increase in local blood flow and capillary permeability will increase macrophage migration to the injured tissue. Furthermore, macrophages, along with neutrophils, will phagocytize dead (necrotic) tissues (Campbell, 2004).

The features of HeLa cells implanted into the cutaneous tissue resembled the vaginal cytologic smears of patients with cervical cancer, in which the cells have been washed away from the surface of the tumor or aspirated from the mass through a fine needle (Price, 1994). Tumor cells have a large prominent nucleus of irregular shape and few cytoplasms (Damjanov, 2000). REFERENCES Campbell, NA., Reece.,J.B Mitchell.,L.G., Biologi, Edisi ke-5 jilid 1, diterjemahkan oleh Wasmen Manalu, Penerbit Erlangga, Jakarta., 2004, hal 75. Damjonov, I.,Histopatologi, di terjemahkan oleh dr. Brahm U. Pendit, cetakan ke-1, Penerbit Medika , Jakarta., 2000, hal 65. Desaintes,C., Goyat, S., Yanif.,M., Thierry, F. Papilomavirus E2 indus p53-independent apoptosis

Nodules formed after implantation of HeLa cells contain tumor cells and cells produced by immune reaction. Results of the present study showed that the optimum termination was observed on days 7 and

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in HeLa cells, Oncogene,1999. 18, 4538-4545. Griffiths, G.D., Leek, M.D. and Gee, D.J. The toxic plant proteins ricinand abrin induce apoptotic changes in mammalian lymphoid tissues and intestine, J. Pathol., 1987.,151,221-229. Marquez-Lemus, V.A., NoguezJuarez,B.M., Salano-Rodriguez, L., Perez Zepata, A.J., RamonGallegos, E., Schneider-

Ehrenberg, O.P and Graue. Wiechers, F. In vivo study of Biological Effects of Photodynamic Therapy on Cervical Cancer, Physica Scripta 2005., 71,1-4. Price, S.A. Patofisiologi: Konsep Klinis Proses-Proses Penyakit , edisi ke-4 buku 1, diterjemahkan oleh Peter Anugerah, 119-120, Penerbit buku Kedokteran EGC., 1994, Jakarta

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THE EFFECT OF ELDERLY EXERCISE TO COGNITIVE DIMENSIA ELDERLY FUNCTION IN “MAWAR”AGE CARE FACILITIES (PSLU) BLITAR TULUNGAGUNG Prima Dewi Kusumawati Institute Of Health Surya Mitra Husada Email:[email protected] ABSTRACT Elderly would decrease of nerve cells in the brain that would lead to dementia in the elderly. Effective ways that could be used by the elderly to decrease aging process. The aim of this study was to determine the effect of Elderly exercise to cognitive dimensia elderly function in “Mawar” age care facilities (PSLU) Blitar Tulungagung.This study design was quasi-experimental approach to One Group Pre Test - Post Test design. The population all dimensia elderly in “Mawar” age care facilities (PSLU) Blitar Tulungagung totaling 15 respondents with a total sampling method obtained a sample of 15 respondents. Results of statistical test Paired Samples T-Test p value 0.027 to 0.027 value <0.05 can be concluded that the H0 is rejected, which means there was influence of elderly exercise cognitive function in dimensia elderly function in “Mawar” age care facilities (PSLU) Blitar Tulungagung.Exercise elderly provides benefits that emotional stress is reduced, the mind is more clear, the relationship between humans and the atmosphere is more relaxed and happy, language skills and memory increases, people become more passionate, more creative and efficient, people feel more healthy because the stress is reduced. Keywords: Exercise Elderly, Elderly Cognitive Function

Statistics, 2010). In the Asia Pacific region, the number of elderly people will increase rapidly from 410 million in 2007 to 733 million in 2025, and estimated to be 1.3 billion by 2050 (Murwani, 2011).

INTRODUCTION The process of aging and being aging is a natural process that everyone experiences (Atum, 2008). Entering old age means setbacks, such as physical deterioration characterized by sagging skin, graying hair, beginning toothless, lessening clear hearing, getting eyesight worse, being slow motion, and not having figure proportional (Nugroho, 2008).

The number of elderly people who are in dormitory of PSLU Blitar Tulungagung around 77 inhabitants, whereas in Mawar dormitory of PSLU Blitar Tulungagung, there were 14 people still in good health. Elder is an old person because of his old age changes the biological, physical, psychological, and social. This change will affect all aspects of life, including health. Therefore, the health for the elders needs special attention while providing motivation for the elderly people can live productively based on their abilities (Health Act No. 36 of 2009 Article 138).

The elderly population in Indonesia in 2006 amounted to approximately 19 million (8.9%) with a life expectancy of 66.2 years, in 2010 amounted to 23.9 million (9.77%) with a life expectancy of 67.4 years and in 2020 is estimated at 28.8 million (11.43%) with a life expectancy of 71.1 years (the Central Bureau of Statistics, 2010). The amount includes the fourth largest after China, India and Japan (the Central Bureau of

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The increasing number of the elderly population will be able to provide a problem - the problem of disease in the elderly. According to the Ministry of Health in 1998, there was 7.2% of the population aged 60 years and older up to cases of dementia. A total of 5% of old age 65-70 years suffers from dementia and will double every 5 year reaching 45% at the age above 85 years (Nugroho, 2008). Dementia is a disorder of memory function that occurs slowly, and can disrupt the performance and daily activities (Atum, 2010).

The purpose of this study is to determine the influence of exercise for cognitive function from elderly people with dementia in the Mawar Dormitory of PSLU Blitar Tulungagung. MATERIAL AND METHOD Research design Based on the research objectives, the design of the study is quasiexperimental. The model used is the pre and post-test without control. Population and Sample Research The design of the study is quasiexperimental design with pre and post test without control. Sampling technique in this research is total sampling where all population can be sampled, and the samples are elderly suffering from dementia amounts to 15 people. Independent variables of this study are elderly exercise while the dependent variable is the cognitive function in elderly dementia. And data analysis uses Paired sample t-test.

Dementia is marked with disturbances of memorizing and learning something new in short term, eloquence interference (difficult to name objects and search for words to speak), wrong about the place, time, person or object, difficult to count, unable to plan, organize, make decisions and other things (Sumijatun, 2005). The results of a preliminary study conducted by researchers at Dormitory of PLSU Blitar Tulungaggung are the number of elderly people 80 and the number of elders in Mawar Dormitory is 15 people. The results of interviews of 15 elderly people in Mawar Dormitory of PSLU Blitar Tulungagung showed that they often perceived in the dormitory and often forgetful when they put something, it is easy to forget the names of fellow elders and often confused when someone asks.

RESULTS 1. Characteristics of respondents a. By age

The way to improve cognitive function for the elders is a group therapy with Reminiscene therapy is beneficial to maintain individual identity and also can improve the cognitive function, because the elders will use his past to defend his opinions and criticism (Johnson, 2005). The other way to improve cognitive function is Brain Gym or sports. It can also use exercise for the elders to inhibit the aging process. Exercise for elders will not only facilitate the flow of blood and oxygen to the brain, but also stimulate both sides of the brain to work (Tammase, 2009).

Figure 1 shows almost all respondents are 60 -74 years (73%) b. Based on Gender

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Figure 2 shows most of the respondents are male (53%)

Dormitory of PSLU Blitar Tulungagung based on the research results of cognitive value before being granted elderly exercise the respondents with the highest cognitive value was as much as seven respondents (47%).

c. based education

According Pudjiastuti (2003), that decrease of the cognitive function ability due to morphological and biochemical, decreased brain weight for the elders due to a reduced content of protein and fat in the brain so that the brain becomes lighter. Axons, dendrites and nerve cell bodies experience many changes; dendrites which serve as a means for communication between nerve cells change to become thinner and lose cell contact between nerve cells, nerve conductivity decreased so that the movement becomes slow.

Figure 3 shows that the majority of the respondents are no schooling (53%) 2. Characteristics of variables a. MMSE before being given elderly exercise

2. Cognitive Function after being given elderly exercise for Elders with Dementia in the Mawar Dormitory of PSLU Blitar Tulungagung The results of the study are after being given elderly exercise for Elders with Dementia found that mild cognitive score as many as 8 respondents (53%). Figure 4 shows that most of the respondents have moderate cognitive function (47%)

There are several ways to cope with the occurrence of dementia in the elderly, both pharmacological and non pharmacological. In this study, we use non-pharmacological means by giving for 15 minutes exerciser for the elders every day for 3 days. In addition, researchers are consistent with the theory stated by an expert who discovered the exercise movements for elders stating that therapeutic exercise for elders conducted over 1 time a day within 15 minutes for 3 days, on a regular basis can reduce the decline in cognitive function (Denisson, 2009).

b. MMSE after being given elderly gymnastics

Figure 5 shows that most respondents have mild cognitive functions (53%)

3. The effect of elderly exercise for the elders with Dementia on Cognitive Function In the Mawar Dormitory of PSLU Blitar Tulungagung based on the statistical test result with Paired sample

Discussion1. Cognitive Function for Elderly people with Dementia before given elderly exercise the Mawar

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t-test p value 0.027 thus obtained 0.027 <0.05 it can be concluded that the H0 is rejected, which means that there is influence of elderly exercise with cognitive function for the elders with dementia in the Mawar Dormitory of PSLU Blitar Tulungagung. The results showed that elderly exercise for the elders is significantly beneficial in improving the cognitive function of elderly people with dementia proved by the meaningful score results in cognitive function after being given elderly exercise.

The result of this study is expected to provide objective information and feedback related to the handling of the elderly people who have dementia to optimize cognitive function by elderly exercise. For elderly people with dementia is expected to do elderly exercise regularly. 3. For Researcher The result of this study is expected to add the knowledge and experience for the researchers themselves in conducting research on elders with dementia, especially in optimizing cognitive function by elderly exercise.

Conclusion 1. It was found that before doing elderly exercise 15 mostly elderly respondents have moderate cognitive functions are seven respondents (47%).

4. For further research The result of this study is expected to be used as a source of information in future research as well as other measures such as cognitive therapy to optimize cognitive function for elderly people with dementia.

2. It was found that after doing elderly exercise 15 respondents mostly elderly people have mild cognitive functions i.e. 8 respondents (53%). 3. Based on the research showed the value of .8667 and a pre-test to post-test value of 1.4000 so that it could be seen an increase in cognitive function before and after treatment 5,333. Whereas the results of statistical test Paired Samples Test using SPSS with = 0.05. P value 0.027 to 0.027 value <0.05 it can be concluded that the H0 is rejected, which means that there is an influence of elderly exercise with cognitive function for elderly people with dementia in the Mawar Dormitory of PSLU Blitar Tulungagung.

Bibliography Dahlan, Sopiyudin. 2008. Statistika Untuk Kedokteran dan Kesehatan. Jakarta : Salemba Medika Dennison, Paul E,. Gail E. Dennison. 2008. Buku Panduan Lengkap Brain Gym. Jakarta : Grasindo Depkes RI. 2008. Pedoman Pembinaan Kesehatan Usia Lanjut Bagi Petugas kesehatan. Jakarta : Direktorat Pembinaan Kesehatan Masyarakat.

Suggestion

Hartati. 2010. Clock Drawing : Asesmen Untuk Demensia. Semarang : Fakultas Psikologi Universitas Diponegoro.

1. For Respondents The result of research on elderly exercise therapy is expected to be used for pre-seniors with dementia and to prevent the occurrence of a more severe degree of dementia. 2. For Elder Dormitory of PSLU Blitar Tulungagung

Jonhson, M.H,. 2005. Developmental Cognitive Neuroscience, Edisi 2. Oxford : Blacwell Publishing

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SOCIAL INTERACTION EFFECT THE RECURRENCE OF CORONARY HEART DISEASE PATIENT IN POLI JANTUNG RSUD Dr. MOHAMAD SALEH PROBOLINGGO Nia Sari STIKes Surya Mitra Husada ABSTRACT

The recurrence is a condition of the patient when arissing the same symptom which is like before dan makes the patient must nurse back. The condition arround or the society that is full of stress with dietary habit that is not healthy can cause someone infected a heart attack. The purpose of this research is for analyze the effect of social interaction on the recurrence of coronary heart disease patients. The kind of this research used quantitative approach with cross sectional design. The data is got by using a questioner paper for social interaction and medical record for recurrence. The totality of the samples that are taken in this research are 57 respondents By “Simple Random Sampling”. This research on February until Juni, 2015. From 57 respondent which is researched, 71,93 % of the respondents gets relapse and 28,07% of the respondents gets relapse over the last month. From 71,935 of the respondents who is relapse, 21,1% has a bad social interaction.The test results of Logistic Regresion with α = 0,05 got the variable result which is influenced significant on recurrence is social interraction (p=0,026). To prevent the recurrence of coronary heart can be done by healthy social interaction in communities.

Key words : Coronary Heart, Social Interraction, Recurrence

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heart disease (CHD), 23.73% of primary hypertension, 18.9% of heart failure, myocardial infarction 7.5% and there are still some other heart disease. From the above results it can be concluded that patients with coronary heart disease continues to grow each year, and CHD is also the largest type of heart disease during 2014 in the Hospital Dr. Mohamad Saleh Probolinggo.

INTRODUCTION Indonesia today has a double burden in the face of disease problems. On one side of communicable diseases are still high even tends to increase, on the other hand non-communicable diseases are generally classified as degenerative disease began to increase. One of the degenerative disease is the leading cause of death is coronary heart disease (CHD). The disease is generally caused by the behavior or unhealthy lifestyle (Notoatmodjo, 2011). Cardiovascular disease (CVD) is the leading cause of death in many develop countries and looks for a rising trend as a cause of death in many developing countries. Coronary heart disease (CHD) is the cause of that need more in-depth attention to the developing countries. Impact of economic progress, the rapid eradication of infectious diseases. As a consequence, on the other hand CHD shifted into the main cause of death in which previous infectious disease is the leading cause of death. High levels of plasma total cholesterol, arterial hypertension and smoking are three major risk factor for CHD. Hipercholesterolemia occupies a very important position because hipercholesterolemia is the only risk factor that can lead to the onset of artherosclerosis. Diet is related to hipercholesterolemia. Diet is one of the main environmental factors causing coronary heart disease through blood cholesterol. The scientific evidence in recent years shows the importance of the role of social factors as determinants of the health status of non-communicable diseases, especially in this case cardiovascular disease (Bulletin of Health Indonesia, 2012). Based on data obtained from cardiac poly Hospital Dr. Mohamad Saleh Probolinggo, it was found that each year the number of patients with heart disease is increasing. The increase in the number of patients with heart disease from 2013 to 2014 increased from 8191 to 10.311 patients or 25.88%. The percentages of 30.73% of heart disease is coronary

MATERIALS AND METHODS RESEARCH This study uses a quantitative approach, using cross sectional design. Social interaction data obtained using a questionnaire. While the variable dependentnya is recurrence outpatient coronary heart disease (CHD). The population in this study were all outpatients coronary heart disease (CHD) in the heart poly Hospital Dr. Mohamad Saleh Probolinggo. On average there are 66 patients a week which will be used as the study population. Samples are taken as many as 57 respondents, with "Simple Random Sampling" technik. Data analysis using logistic regression. RESULTS Characteristics of the subjects in this study include sex, age, education level and occupation. The description of the characteristics of variables as in table 1. Table 1. Characteristics of Research Based on gender, age, education level and occupation. No Karakteristik 1 Sex Male Female 2. Age <50 th ≥50 th Education level 3 SD SMP SMA PT

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N

%

33 24

57,89 42,11

9 48

15,79 84,21

9 8 27 13

15,79 14,04 47,37 22,81

4

5

6

7

Occupation Swasta PNS Tdk bekerja Social Interaction Good Bad Smoking Smoker No Recurrence yes never Total

14 12 31

24,56 21,05 54,39

44 13

77,19 22,81

3 54

5,26 94,74

41 16 57

71,93 28,07 100

Hospital Dr. Mohamad Saleh Probolinggo showed that of the 57 respondents surveyed, 13 respondents (22.81%) had a poor social interaction, and 44 respondents (77.19%) have a good social interaction. Of the 13 respondents who have poor social interaction, the average of them is a man who does not work and aged over 50 years. Social interaction is said to be bad because most of them are rarely interact or cooperate with groups in the community such as for example, Posyandu elderly, spiritual groups, group gathering and so forth. So that they are the elderly tend to be aloof and less interaction with groups in the community, so the majority, or 10 of 13 respondents poor social interaction, they tend to experience stress. According Soekanto 2006, social interaction is the key to all social life. In the absence of communication or interaction between each other then there may be a life together. If only the physical line of sight between each other, can not produce a form of social groups can interact. And the age factor also affects the elderly lazy to interact and cooperate with social groups because they feel he is old, their ability to interact with and adapt to already not optimal due to the aging process.

Based on Table 1 it can be seen that the majority of respondents are male as many as 33 people (57.89%), aged more than 50 years as many as 48 people (84.21%) and have a high school education level as many as 27 people (47 , 37%), most respondents do not work as many as 31 people (54.39%), the majority of respondents have a good interaction as many as 44 people (77.1%), there are three (5.26%) of respondents who have smoking as many as three people, as many as 41 respondents (71.93%) experienced a recurrence. Table 2. Results regression analysis Variabel Social Interaction

of

the

logistic

Sig.

OR

0,026

3,576

Recurrence Outpatient Coronary Heart Disease in Space Poly Heart Hospital Dr. Mohamad Saleh Probolinggo Recurrence is a condition in which the patient's symptoms are the same as before and the resulting patient should be nursed back (Andrew, 2008). Family with full of stress can trigger a heart attack. In people who are susceptible to heart disease in need of attention and recognition of risk factors that exist in people and that immediate action can be taken against these patients in a short time in order to avoid complications that can bring unintended consequences. According to Niven, in 2005 the factors that influence relapse is noncompliance, depression, behavioral patterns, and the individuals themselves.

P value of social interaction = 0.026 <α = 0.05, which means that H0 is rejected. Results of logistic regression test showed no significant influence of social interaction with the patient relapse. And the value of OR = 3.576, which means, the worse the social interaction of a patient then the person is more likely to relapse 3 times greater compared with patients who have good social interaction. DISCUSSION Social interaction outpatient coronary heart disease (CHD) in the heart poly

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Based on the results of a study of outpatient coronary heart disease (CHD) in the heart poly Hospital Dr. Mohamad Saleh Probolinggo found that of 57 respondents surveyed, as many as 41 people (71.93%) experienced a relapse and 16 did not have a relapse or 28.07%. From the results of cross tabulation between respondent characteristics with recurrence as many as 23 respondents (40.4%) who experienced a relapse-sex male, 33 respondents (57.9%) who experienced recurrence over 50 years, 14 respondents (24, 6%) who experienced a relapse are college graduates and 24.6% of high school graduates, and as many as 22 respondents (38.6%) who did not work also experienced a relapse. Conclusion 1. Social interactions in outpatients coronary heart disease (CHD) in the Hospital Dr. Mohamad Saleh Probolinggo showed that 13 respondents (22.81%) had a poor social interaction, and 44 respondents (77.19%) have a good social interaction. 2. Results of statistical test by using logistic regression showed no significant influence of social interaction with the patient relapse. Suggestion 1. Patient and Family Outpatient CHD a. Outpatient coronary heart disease should have to further enhance friendly relations with their peers. b. For families of patients should continue to provide support and keep control of the activities conducted in order to maintain the health of the patient. 2. For Hospital Dr. Mohamad Saleh Probolinggo Can be added to the program of relaxation for people with coronary heart disease, such as the holding of yoga to reduce stress levels and maintain the health of CHD patients. 3. For Educational Institutions Once this study is expected to further research to follow up on other factors that influence relapse patients with coronary heart disease.

4. For researchers Coming Once this study is expected to further research in order to pay more attention to the frequency of recurrence of CHD patients. REFERENCES Albery I.P dan Munafo, M. 2011.Psikologi Kesehatan Panduan Lengkap dan Komprehensif Bagi Studi Psikologi Kesehatan.Yogyakarta : Palmall Arikunto, Suharsimi. 2010. Prosedur Penelitian suatu Pendekatan Praktik. Jakarta : Rineka Cipta Feldman, Robert S. 2012. Pengantar Psikologi (Understanding Psychology). Jakarta : Salemba Humanika. Hidayat, Alimul. 2011. Riset Keperawatan dan Penulisan Ilmiah.Jakarta : EGC Kabo, Peter. 2008. Mengungkap Pengobatan Penyakit Jantung Koroner. Jakarta : Gramedia Pustaka Utama Niven, Neil. 2005. Psikologi Kesehatan Pengantar untuk Perawat & Profesional Kesehatan Lain. Jakarta : EGC Notoatmodjo, Soekidjo.2011. Kesehatan Masyarakat Ilmu &Seni. Jakarta : Rineka Cipta. Ridwan, Muhamad. 2009. Mengenal, Mencegah, Mengatasi Silent Killer Jantung Koroner. Semarang : Pustaka Widyamara. Sugiyono. 2013. Metode Penelitian Kuantitatif Kualitatif dan R & D. Bandung : Alfabeta Supriyono, Mamat.2008. Faktor-Faktor Resiko yang Berpengaruh terhadap Kejadian Penyakit Jantung Koroner pada Kelompok Usia <45 Tahun. Tesis.Semarang : Universitas Diponegoro, 13-34 Soekanto, Soerjono. 2006. Sosiologi Suatu Pengantar. Jakarta : Raja Grafindo Persada. Wilkinson, Greg. 2005.Stres.Jakarta : Dian Rakyat

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THE EFFECT OF PHASE I CARDIAC REHABILITATION ON ACTIVITY TOLERANCE OF PATIENTS WITH CORONARY HEART DISEASE Sutrisno STIKES Surya Mitra Husada Kediri Email :[email protected] ABSTRACT Phase I cardiac rehabilitation program is one of the efforts to achieve a functional level that allows patients to perform their own activity early in preparation to carry out daily activities at home and yet, to prevent unfavorable effects of prolonged bed rest. This program needs to be implemented as soon as possible in patients who have stable hemodynamics since in ICU/ICCU until the time to discharge from the hospital. The purpose of this study was to identify the effect of phase I cardiac rehabilitation toward activity tolerance in patients with Coronary Heart Disease. The design of the research was a quasi experiment design with post test only non-equivalent control group. The sample was 24 respondents. The measurement tools used the Barthel index, six-minute walking test, digital sphygmomanometer and digital oxymeter. The results showed that there is a significant difference in the ability to perform ADL (p value=0.004), but there is no significant difference in systolic blood pressure (p value=0.875), diastolic blood pressure (p value=0.179), SpO2 (p value=0.920), pulse (p value=0.428), and the maximal VO2 (p value=0.220) between the intervention and control groups after being given the phase I cardiac rehabilitation. Further, the ability to perform activities (ADL) of respondents in the intervention group is significantly higher than the control group and the maximal VO 2 values of the intervention group shows a better value than respondents in the control group. It can be concluded that phase I cardiac rehabilitation exercise have an effect on the tolerance activity in patients with CHD. Therefore, nurses as part of a cardiac rehabilitation program team are expected to assist patients in improving their adaptability on tolerance activity. Keywords: phase I cardiac rehabilitation, tolerance activity, coronary heart diseases (CHD) recognized to have the largest proportion causes of death cardiovascular diseases (48%), followed by cancer (21%), and chronic respiratory diseases (12%).

INTRODUCTION Coronary heart disease is a disorder of the coronary arteries due to a block or plaque of atherosclerosis. The term atherosclerosis comes from the Greek meaning intima thickening of the arteries (sclerosis, thickening), and accumulation of lipids (athere, pasta) which characterizes the typical lesions (Lewis, Dirksen, Heitkemper, Bucher, and Camera, 2011). WHO statistics (2012) describes the global mortality estimate of 57 million in 2008, 36 million (63%) are caused by noncommunicable diseases. Risk factors for non-communicable diseases that are

Coronary heart disease is causing the reduced amount of oxygen needed by the myocardium. If the oxygen requirement is not met according to the needs, it will cause myocardial ischemia. Conditions such as this will reduce cardiac contraction and movement disorder if persistent occur which eventually causes hemodynamic changes of the body. Furthermore, the left ventricular function will decrease

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and may reduce cardiac output with reduced stroke volume (the amount of blood ejected each time the heart beats). One result of the decreased cardiac output or low perfusion and decreased peripheral blood flow causes weakness / fatigue in patients (Anderson & McCarty, 2005).

Improve Physical Functioning in Refractory Angina: A Pilot Study. The results showed that after cardiac rehabilitation, patients showed an increase in physical abilities compared with patients in the control group the level of achievement Progressive Shuttle Walk (p value = 0.005) and the total distance (p value = 0.015).

Weak conditions in patients with coronary heart disease requires the patient should reduce physical activity with complete bed rest to reduce the heart's work and the need for oxygen in the body. Bed rest is given to patients with coronary heart disease because of weakness or fatigue caused by the prognosis of the disease. However, total bed rest can increase the activity intolerance in patients. The impact that occurs when the patient does not do early mobilization or physical activity gradually cause bad effects to the physical condition of the body. This is in line with research conducted by Dolansky et al (2010) which says that a physical disability due to heart disease occur because of decreased aerobic capacity and threshold / tolerance to perform physical functions.

Research on cardiac rehabilitation phase 1 has also been carried out in Indonesia by I Made Mertha (2010) with the title PengaruhLatihanAktifitasRehabilitasiJa ntungFase I TerhadapEfikasiDiri Dan KecemasanPasienPenyakitJantungKoro ner Di RsupSanglah Denpasar with the results of data analysis showed that there is a significant influence of exercise activities to increase self-efficacy (p value = 0.001), and to decrease anxiety respondents (p value = 0.001) after the exercise intervention activities. Phenomenon above shows the immense possibilities for patients with coronary heart disease activity intolerance, but because the disease process is also due to the effects of totall bed rest or not carried out his early mobilization after patients got hemodynamically stable condition. Research on the effect of cardiac rehabilitation phase I to increase activity tolerance in patients with CHD has not been widely described in the nursing research in Indonesia. Therefore this research was conducted to determine “The Effect of Phase I Cardiac Rehabilitation on Activity Tolerance of patients with Coronary Heart Disease”.

Management to overcome the negative effect caused by coronary heart disease and to prevent the re-admission of patients to the hospital with the same complaint, the cardiac rehabilitation program can be administered to patients ranging from hospitalization to longterm maintenance program / outpatient. According to The National Hearth Foundation of Australia (2004), cardiac rehabilitation are all measures that are used to help people who suffer from heart disease reactive, achieving life satisfaction and prevent a recurrence of heart disease.

METHOD The research design was quasiexperimental research design with posttest-only non-equivalent control group. The number of samples in thisresearch as many as 24 respondents, the respondents were divided into two intervention and control. The inclusion criteria respondents, namely (1) Patients with a diagnosis of CHD were treated in the ICCU was continued in a regular patient room. (2) Willing to be a

Other studies of cardiac rehabilitation program in patients with coronary heart disease are also carried by Asbury, Elizabeth Webb, Probert, Wright, Barbir, Fox, & Collins, (2012) with the title of Cardiac Rehabilitation to

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responder. (3) Patients are invited smooth communication. While exclusion criteria: (1) Angina that continues/uncontrolled, (2) heart block degree two or three, (3) Patients CHD haemodynamic not stable (systolic> 200 mmHg, diastolic> 110 mmHg, tachycardia/HR> 130x/mnt, hypotension), (4) the ventricular or atrial arrhythmias are severe, (5) Patients with coronary heart disease with complications such as arrhythmias, congestive heart failure (CHF) functional class III-IV, (6) Patients with CHD muskulosketal system problems.

Sistolik Diastolik Frekuensinadi SpO2

116.82 117,53 76.86 81,94 84.79 81,66 97,5 97,5

10.88 11,14 9.09 8,84 10.69 8,18 0,89 0,44

Tabel 1.2 Distribution of respondents by VO2 max and ADL on the sixth day (n1 = n2 = 12) Variabel VO2

Analysis of the data used is the analysis of univariate and bivariate. The statistical test used for bivariate analysis is independent t test test (for normal numerical variables) and test Mann Whitney test (for numerical variables are not normal) (Hastono, 2001).

ADL

Kelompok Intervensi Kontrol Intervensi Kontrol

Mean 19.14 16.86 97.08 87.50

SD 5.20 3.43 5.42 7.54

In the bivariate analysis showed that the values obtained are not significant (p value> 0.05) from the average variable pulse rate, systolic blood pressure, diastolic blood pressure and SpO2 after intervention for five days in both the respondents both intervention and control, it is showed no significant difference between the two groups. On the sixth day ADL measurement values obtained are significant (p value = 0.004), which says there is a significant difference between the intervention group and the group. While the variable VO2 max no significant difference (p value = 0.22) between the intervention and control respondents.

Result Characteristics of respondents or confounding variables in this study obtained. On this research, the mean age of the respondents is at 55.29 years, with the majority of the male sex 18 (75%). History of smoking among respondents obtained more than half of the respondents do not smoke are 14 (58.33%) of respondents, and in this study the majority of respondents have a body mass index of obesity as many as 17 (70.8%) of respondents. Characteristic variable pulse systolic blood pressure, diastolic pressure, SpO2, VO2 max, and data can be seen in Table 1.1 and 1.2

Intervensi Kontrol Intervensi Kontrol Intervensi Kontrol Intervensi Kontrol

Discussion Effect of cardiac rehabilitation phase I of the systolic blood pressure, diastolic blood pressure, pulse rate and SpO2 responder after intervention.

rate, blood ADL Table

Tabel 1.1 Distribution characteristics of respondents based on the average of the mean pulse frequency of blood pressure (systolic and diastolic) and mean SpO2 post intervention and control interventions respondents (n1 = n2 = 12) Variabel Kelompok Mean SD

Results of this research showed a mean systolic blood pressure intervention respondents less than control respondent, it is possible to intervention respondents have started a process of adaptation to the condition of the body because it has given physical activity exercises for five days. So that

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hemodynamic conditions began to change when the body perform physical activity. Physical exercise regularly and continuously will cause the body's adaptive changes. This is consistent with research that studies conducted Stem & Cleary (1982) that regular exercise will lower systolic blood pressure. This research is in line with the literature that suggests that exercise regularly and continuously can provide chronic effects on the body as a decrease in systolic blood pressure through the process of spending Nitrite oksit a potent bronchodilator after four weeks of exercise (Gormley& Hussey, 2005).

In this research, the mean diastolic blood pressure values in control respondents is higher than intervention respondents. It is possible the intervention of respondents have started a process of adaptation to the condition of the body because it has given physical activity exercises for five days. As in systolic blood pressure response. Based on the theory of physical activity exercises if done continuously, the heart muscle and skeletal muscle will experience an increase in employment adaptation to chronic namely hypertrophy. Enlargement of muscle mass from the normal state can be between 300 g and 500 g (Huonker et al, 1996). This can lead to end-diastolic volume will increase, and it will also stoke volume increase heart. So the diastolic blood pressure will decrease. Research conducted Spartaro (1991) also reported a decrease in systolic 8and diastolic 5 respondents who frequently perform regular physical activity. It is possible to occur in the intervention group who had suffered during the given intervention adaptation exercise physical activity.

result analysis found there is no significant difference in mean systolic post intervention in the intervention and control. It showed no difference in the average value of systolic blood pressure was statistically the second respondent. The maximum value of systolic blood pressure in the intervention respondents in the amount of 137.02 mmHg, indicating increase in systolic pressure value is not shown in conditions that endanger the health of the respondent or still within the tolerance limits of the body. It can be said that the cardiac rehabilitation phase I does not cause harmful effects if done in accordance with procedures and strict supervision.

The analysis results obtained p value not significant that the average diastolic post intervention in the intervention and control. It showed no statistically significant difference in mean diastolic blood pressure in both groups. Respondents were given a five-day intervention during physical activity and exercise interventions show the value of the increase in diastolic blood pressure after the intervention. The maximum value of diastolic blood pressure in the intervention respondents were given a physical exercise-based interventions obtained by 76.86 mmHg. This value indicates no increase is so large and endanger the health condition of respondents coronary heart disease. Increasing the value of diastolic blood pressure in intervention respondents during the given intervention is in line with the theory advanced by Gormley& Hussey (2005) that during the

Based on the theory advanced by Gormley& Hussey (2005) acute effect of physical activity was immediate activation of the sympathetic nerves in the heart and blood vessels can release adrenaline in the blood circulation of the adrenal medulla. One of these effects that cause vasoconstriction of blood vessels. Body compensated to accelerate the flow of blood in the body as a result of physical activity also increases the heart rate so it needs a large preload as compensation of increased heart rate. Vasoconstriction necessary for blood flow to be fast to meet the needs of large preload so after load also must be increased.

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movement of the body or physical activity then it will be activated the sympathetic nerves in the body that lead to increase contraktility heart and accelerate the work of fibers Purkinje that serves to accelerate emptying the contents of the heart volume. This causes an increase in diastolic blood pressure in the body.

the left atrium, predicted as the cause of the appearance of atrial fibrillation during cardiac rehabilitation. Exercise physical activity on a regular basis will provide a great benefit to the body of the adaptation process occurs both at the heart organ and the blood vessels in the body. This is consistent with the theory put forward by Kusuma (2003) which says that physical activity (exercise) increases the blood flow is pulsatile increase the production of nitric oxide (NO) which parallel increase production of EDRF (endothelial relaxing factor derive). Coronary blood flow at rest about 200 ml / min (4% of total cardiac output) increased to 350 ml / min (increase of 150 ml / min) while moderate weight training. If the heart rate increases to 10 times only, the coronary blood flow increased to 224 ml / min, which means an increase of 24 ml / min and already exceeds 4 ml / min, as a condition of increased production of nitric oxide. Moderate physical activity (exercise or walking) will increase the heart rate to 110 beats per minute, an increase of 40 times seadainya resting heart rate of 70 beats per minute. Research in the laboratory showed that the increased flow of 4 ml / min was able to produce nitric oxide, which means it is sufficient to stimulate the improvement of vascular endothelial function (Takahashi, 1997). Nitric oxide (NO) is a potent vasodilator that is located in the intima layer (endothelium) of the arteries where the compound is very important for blood vessels to reduce the risk of atherosclerosis.

The analysis results obtained p value not significant mean pulse rate post intervention in the intervention and control. It showed no statistical difference in the average value of the pulse frequency of respondents intervention and control after the intervention. In this reseach, the frequency of the pulse values obtained after exercise increased physical activity among respondents intervention. The increase in the pulse frequency of the respondents intervention is the result of several mechanisms in the body due to the movement of the body or as a result of physical exercise. When the physical exercise increased sympathetic stimulation of the heart organ that affects the heart's electrical system, especially the SA node therefore increasing heart rate/pulse (Gormley& Hussey, 2005). This effect can be seen when the body physical activity are irregular or can be said is the acute effects of physical activity on the body. The increase in the pulse rate that exceeds the maximum limit should feared the presence of an electrical disorders on the heart and can threaten death to the respondent. This will lead to atrial fibrillation according to research conducted by Giaccardi et al, (2011) which said that the incidence of atrial fibrillation was significantly high number of patients who follow a cardiac rehabilitation program that is sorely lacking in exercise intensity physical activity compared with that follows program of physical exercise with moderate intensity. This is due to the large volume of the left atrium and the low effort emptyvalumepemompoaan to

Results of the analysis we found no significant values mean oxygen saturation post intervention in the intervention and control. It showed no significant difference in the average value of the oxygen saturation in both groups post intervention. In this study found an increase in oxygen saturation after cardiac rehabilitation interventions conducted in the respondents

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intervention. It is very useful to respondents to assist in accelerating the healing process of the disease.

Based on the literature it is said that there is one example of respiration also plays a role in increasing the working capacity of the body is the breathing exercise prescription for patients with post-operative cardiac surgery. Peripheral to tolerate the practice of physical activity, many patients require special breathing while working, which could increase lung volume and gas exchange capacity and, consequently improve the distribution and capture systemic oxygen and increase exercise tolerance (McKirnan&Froelicher, 1993).

Based on the literature says the existence of some mechanism of changes in the respiratory system during a physical activity on the body: (1) The dilution air in the dead-space lungs during inspiration as a result of the increased pressure of pulmonary alveolar (PO2), causing vasodilation of the pulmonary arteries that are activated by the receptor Blood vessels are hypoxic. (2) increase in thoracic volume during the development of lung parenchyma during inspiration. (3) an increase in cardiac filling the right side along with an increase in the exploitation of moments of inspiration, this means an increase in venous return and that will increase the ejection volume of the right ventricle and pulmonary systolic pressure. With this change, the efficiency of ventilation and perfusion of the body tissue will be balanced (Gormley& Hussey, 2005). This led to the intervention of respondents experiencing respiratory system of compensation which improves the functional capacity of the lungs can eventually increase the maximum working Traffic from the body.

Effect of Cardiac Rehabilitation Phase I Against Capability ADL and VO2 max Respondents. Results of bivariate analysis of the ability to perform activities of daily living (ADL) in the intervention group and the control group showed a significant difference. In this study, the intervention group get exercise physical activity gradually in accordance with the capacity and condition of the respondents, while the control group without exercise just given bed rest alone. So it can be said that the exercisebased cardiac rehabilitation that physical activity can stimulate the adaptation and improvement of exercise tolerance capability in the intervention group compared with the control group.

In this research, interventionrespondents always increase even improvement of the respiratory system, while at the controls of the respondents there were some respondents who sometimes experience down the value of saturation. On the intervention of the respondents only one of the respondents who experienced a decrease in oxygen saturation, whereas the control of the respondents there were eight respondents who experienced deterioration in oxygen saturation. It is possible the intervention of respondents functional capacity of the lungs had increased as a result of the intervention given the exercise of physical activity compared to control respondent.

Based on the first congress of cardiac rehabilitation in Hamburg in 1977, insists that the need for early mobilization in patients with heart disease (Balady, Fletcher, Froelicher et al, 1994). Phase I is the effort to be done while the patient is still being treated, the main purpose of this phase is to reduce or eliminate the adverse effects of the condition due to total bed rest, to educate early and that the patient is able to perform daily activities independently and safely (Basuni et al, 2009). Another theory says that one of the objectives of rehabilitation of cardiac rehabilitation phase I that patients can perform selfcare and activities of daily life (ADL)

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and domestic work except for up and down stairs (Garrison, 2001).

Physical activity everyday is useful not just to get a healthy body condition but also beneficial to mental health, entertainment in preventing stress.

This study ADL ability intervention group obtained only three respondents who have a value below 100, it indicates that the Barthel index on respondent intervention is better than the control respondents were only two respondents who had ADL value of 100. The results are also consistent with research conducted by Weberg et al (2013) which says that a significantly increased function and physical role, increased ability and endurance to pain on the effects of cardiac rehabilitation phase I, and the disclosure directly from the respondents experienced an increase in physical and mental after following cardiac rehabilitation Phase I. Improved physical function and role, increased ability and endurance to pain due to a cardiac rehabilitation phase I also found in a study conducted by Hsu et al (2011) the research done on post-CABG patients and organ transplants.

Results of bivariate analysis were not significant values between maximal oxygen uptake (VO2 max) in the intervention group and the control. It showed no significant difference VO2 maximum value of both respondents statistically. At respondents intervention lowest value of VO2 max respondents, 11.15 ml / kg / min, which means all respondents have been able to meet the target of cardiac rehabilitation phase I (> 3 MET = 10.5 ml / kg / min), but the respondent control limits bottom of VO2 max is nothing less than the expected target of Phase I of 10:34 ml / kg / min. Physical activity the body will consume the oxygen that will be used as fuel in energy production. One's ability to consume oxygen during physical activity to the formation of energy, until it reaches the maximum value without being able to go up again though with the addition of the intensity of the exercise known as VO2 Max (Astorin, 2000).

Another study said the effect of exercise physical activity on improving exercise tolerance was also carried out by Marzolini et al (2008) who showed that a combination of aerobic exercise and resistance cause changes more evident in physiological adaptations such as muscle strength and endurance, and body composition compared to aerobic exercise alone in patients with coronary artery disease. Physical exercise-based cardiac rehabilitation also reduces overall mortality / cardiovascular disease mortality [RR 0.87 (95% CI 0.75, 0.99) and 0.74 (95% CI 0.63, 0.87), respectively -masing], and hospitalizations [RR 0.69 (95% CI 0.51, 0.93)] in the short term (<12 months of follow-up). Cardiac rehabilitation does not reduce the total risk of MI, CABG or PTCA (Strange, 2011). Numerous studies have also shown that aerobic training increases muscle strength and exercise tolerance in patients after openheart surgery and patients with MiocardInfark (Ueshima et al, 2005).

The gold standard to measure cardiovascular fitness is maximal oxygen consumption (VO2 max). it is defined maximal oxygen consumption as a measure of exercise are achieved by an individual, who at that point of fatigue or symptoms that arise prevent such individuals to exercise more (Garrison, 2001). This is in line with research Belardinelli (1999) who said that clearly defined, measured by exercise tolerance and oxygen consumption as well as a good predictor of prognosis in patients with cardiovascular disease. Based on the theory advanced by Guyton (2007) not only the respiratory system are instrumental in determining a person's VO2 maximum, but there are four systems that determine the

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maximum VO2 is the respiratory system, cardiovascular, biochemical oxygen transport and network systems. The fourth system is interrelated to one another, so that when the respiratory system is in good condition but there are one or more of the three other systems in the state is not good then it can affect the value of a person's VO2 maximum. While the value of a person's VO2 maximum is also determined by a person's posture, between the one and the other will certainly be different if say both equally healthy but have a different body portur. This is in line with research conducted by Nury (2011) which says that the main determinant of the cycle runs in addition to height is leg length measurements when the maximum VO2.

The results also show the benefits of exercise-based cardiac rehabilitation phase I of physical activity that can be done by a nurse if a physiotherapist human resource is not in the hospital. Phase I cardiac rehabilitation nursing in the world can be said to help the patient in the process of adapting to be able to perform daily activities independently, improve the tolerance of the patient's activity. CONCLUSION On this study, the mean age of the respondents is at 55.29 years, with the majority of the male sex 18 (75%). History of smoking among respondents obtained more than half of the respondents do not smoke are 14 (58.33%) of respondents, and in this study the majority of respondents have a body mass index of obesity as many as 17 (70.8%) of respondents. The mean systolic blood pressure of both groups showed similar values and within normal limits. Mean diastolic blood pressure in the control group was slightly higher than in the intervention group and both were within normal limits. The mean frequency of the pulse after the intervention in the intervention group was slightly higher than in the control group and both were within normal limits. The mean SpO2 after the intervention in both groups of equal value.The mean maximal VO2 greater intervention group than in the control group.The mean ADL higher intervention group than in the control group. It was found no significant difference between the systolic blood pressure, diastolic blood pressure, pulse rate, and oxygen saturation after the intervention in the intervention and control. There are significant differences ability to perform ADLs between intervention and control groups on the sixth day. But there was no significant difference between the value of the maximum VO2 intervention and control groups on the sixth day.

This study shows the difference between the value of the maximum VO2 intervention and control groups was not so great can be seen from the average of the two groups is 19.14 ml / kg / min and 16.87 ml / kg / min. From this it was found that the mean maximal VO2 values greater intervention group than the control group. Value of maximal VO2 could be improved on a person, with increasing VO2 maximum, it can be said the maximum working ability of the body to be achieved. This is according to research conducted by Ueshima et al (2004) peak VO2 increased by less than 25% after exercising, especially in patients who have undergone heart valve surgery. This research can provide input that cardiac rehabilitation program that is most important is when Phase I, which in this phase requires the mobilization of patients as early as possible to reduce the undesirable effects of bedrest old (thrombophlebitis, hypotension orthosatik, muscle atrophy, etc. etc.) and knowledge about the disease in order to return later after there is a change of behavior in the control of risk factors that may lead to heart disease occur so do not get heart disease later in life.

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This research requires a socialization programs the Phase I cardiac rehabilitation program based physical activity practice, to accelerate the healing process in patients that could reduce the lenght of stay (LOS) patients. And the need for nurses to give an evaluation of the action exercise physical activity is given to know the development of tolerance to the patient's physical activity. The need to develop therapeutic modalities nursing to overcome the problems associated with the physical activity of the patient's therapy, which can be applied in providing training physical activity in patients requiring early mobilization during hospitalization. And disseminate information about the importance of mobilization as early as possible after the patient's hemodynamic condition stabilized, to reduce the unfavorable effects of total bedrest.

statement for health care professionals from aha. Circulation; 90;1602-1610. Basuni, Radi; Andang, H. Joesoef; Dede, Kusmana.(2009). RehabilitasiKardiovaskular Di Indonesia.J KardiolIndones. 30:43-5. ISSN 0126/3773. Belardinelli, R; Georgiou, D; Cianci, G; Purcaro, A. (1999). Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation; 99:1173-82. Dolansky, M.A., Xu, F., Zullo, M., Shishehbor, M., Moore, S.M., &Rimm, A.A. (2010). Post-Acute Care Services Received by Older Adults Following aCardiac Event: a Population-Based Analysis. Journal of Cardiovascular Nursing, 25,342-249 Garrison, Susan. (2001). Dasardasarterapi&rehabilitasifisik.Jaka rta :Hipokrates. Garrison, Susan, J. (2003). Lippincott Williams and Wilkins Handbook : Handbook of Physical Medicine and Rehabilitation Basics (2nd Edition). LWW, p.172-180. Gormley, John and Hussy, Juliette. (2005). xerciseTheraphy : Prevention And Treatment Of Diseases. Oxford : Blackwell. Giaccardi M, Macchi C, Colella A, Polcaro P, Zipoli R, et al. (2011). Postacute rehabilitation after coronary surgery: the effect of preoperative physical activity on the incidence of paroxysmal atrial fibrillation. Am J Phys Med Rehabil ; 90:308–15. Hastono, P.S. (2001).ModulAnalisis Data.Depok : FKM-UI Heran, B.S; Chen, J.M.H; Ebrahim, S; Moxham, T; Oldridge, N; Rees, K; Thompson, D.R; Taylor, R.S. (2011). Exercise-based cardiac rehabilitation for coronary heart

This research can be a reference to conduct further research that can improve understanding and knowledge of the cardiac rehabilitation program, especially the phase I. Maybe it could be done further research to determine the relationship of drugs and laboratory values (hemoglobin, hematocrit, and others) are influential toward physical activity in a cardiac rehabilitation program phase I. REFERANSI Anderson, S And McCarty, L. (2005). Patofisiologi :KonsepKlinik Proses-proses Penyakit. Edisi 6.Volume 1.Jakarta : EGC Asbury, Elizabeth, Webb, C, Probert, H, Wright, C, Barbir, M, Fox, K, Collins, P. (2012). Cardiac Rehabilitation to Improve Physical Functioning in Refractory Angina: A Pilot Study. Cardiology 2012; 122;170-177 Balady, J.G; Fletcher, B.J; Froelicher, V.F,et al. (1994). AHA medical/scientific statement: position statement: cardiac rehabilitation programs: a

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disease (Review).The Cochrane Library, Issue 7. Hsu, C.J; Chen, S.Y; Su, S; Yang, M.C; Lan, C; Chou N.K et al, (2011). The effect of early cardiac rehabilitation on health-related quality of life among heart transplant recipients and patients with coronary artery bypass graft surgery. Transplant Proc; 43:2714-7. Huoker, M; Halle, M; and Keul, J. (1996).Structure and fungtional adaptation of the cardiovascular system by training.International journal of sports medicine 17, S164-172. I Made Merta (2010). PengaruhLatihanAktifitasRehabili tasiJantungFase I TerhadapEfikasiDiri Dan KecemasanPasienPenyakitJantun gKoroner Di RsupSanglah Denpasar.TesisUniversitas Indonesia. Lewis, Dirksen, Heitkemper, Bucher, Camera. (2011). Medical Surgical Nursin : Assessment and Management of Clinical Problem (Eighth edition,Vol. 1). USA : ELSEVIER Stangl, V, et al, (2002). Coronary atherogenic risk factors in women, Eur Heart J; 23:17381752. Weberg, M, Hjermstad, M.J, Hilmarsen, C.W, Oldervoll, L. (2013). Inpatient cardiac rehabilitation and changes in self-reported health related quality of life – a pilot study. Annals of Physical and Rehabilitation Medicine 56; 342–355. World Health Organization.(2012). World Health Statistics 2012.WHO Library Cataloguingin-Publication Data.

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ANALYSIS OF THE USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) TO CLEANING SERVICE WORK ACCIDENT Dr. ISKAK HOSPITAL TULUNGAGUNG Sandu Siyoto Institute Of Health Surya Mitra Husada Kediri Email : [email protected] ABSTRACT Accident is an event that is unexpected and undesirable. The use of personal protective equipment is one of the factors that cause accidents. Personal protective equipment is a set of tools used by workers to protect all or part of his body against the possibility of any potential hazards in the workplace or work accident. The purpose of this study was to determine the effect of the use of personal protective equipment (PPE) to cleaning service work accident. This study uses a quantitative approach to the observation method. Data were obtained using a questionnaire. The population in this study were all cleaning service in Dr.Iskak hospital Tulungagung as many as 71 people. The sample were 62 people. The sampling technique using Simple Random Sampling. The results of data analysis with logistic regression test is obtained (p = 0.005) (p <0.05). The results of this study concluded there is the influence of the use of personal protective equipment (PPE) to cleaning service work accident. Keywords: Personal Protective Equipment, Work Accident who are at risk. The officer in charge of waste management should ensure that all risks have been identified and rapid protection available. Based on data from the ILO (International Labour Organization) in 2008, each year an estimated 1.2 million workers died from workplace accidents. Meanwhile, citing data in Anggraini Social Security in 2010, there were 98 711 cases. Of that number, 2,191 workers died, and raises a number of 6667 people permanently disabled. The number of claims to be paid for these cases reached more than Rp 401 billion. Press release International Labour Organization (ILO) in 2013 recorded 160 million cases of work-related accidents with about 2 million deaths annually. On April 28, 2014, in the framework of the occupational safety and health worldwide, stating that cases of occupational illness and accidents has risen 337 million and 2.3 million deaths annually. Based on data from the Indonesian Kemenkertrans death rate from workplace accidents and occupational diseases in Indonesia is still very high, the data up to September 2013 recorded 9 workers die per day. Based on the preliminary results of a study conducted on 15 people, no workers wearing full personal protective equipment. 3 people claimed get stabbed needle, two people never exposed to infectious fluids and the first person ever to slip while working. Based on the above, the researcher was interested to study about “Analysis Use of Personal Protective

INTRODUCTION One effort to increase productivity is to provide protection to workers for her work. This protection is given with the intent to obtain assurance worker health and safety so that they avoid accidents. Work accident is an event that is unexpected and undesirable that may disrupt the process that has been set for an activity (Kurniawati, 2013). Hospital as a health care institution with core service activities of preventive, curative, rehabilitative and promotive have positive and negative impacts. The positive impact is the increasing level of public health, while the negative impacts among others are garbage and medical waste or non-medical that can cause disease and pollution that needs special attention. The number of hospitals in Indonesia in 2014 amounted to 2,415 with as many as 296 087 beds and solid waste as much as 376 089 tonnes / day of wastewater as well as 48 985 tonnes / day (Departement of Health, 2014). As a result of accidents and occupational diseases can attack all workers in the hospital, one of them being a cleaning service. Cleaning service has the greatest risk of exposure to hazardous biological substances (biohazard), contact with the disposable medical instruments (disposable equipment) such as used syringes, IV tubes former. That requires safety and health efforts to prevent and control accidents occupational diseases in hospitals. Therefore, protection is very important to prevent injuries for all workers 48

Equipment (PPE) to Cleaning Service Work Accident Dr. Iskak Hospital Tulungagung”. The purpose of this study was to analyze the effect of use of Personal Protective Equipment (PPE) ) to Cleaning Service Work Accident Dr. Iskak Hospital Tulungagung. The benefits of this research are as an input that can be used as measures and efforts to improve occupational health and safety programs to prevent occupational injuries, so as to create a workplace that is safe and convenient for all employees as well as the maximum increase in labor productivity.

mostly male sex a number of 38 respondents (62%) while the female number of 24 respondents (38%).

Figure 3

Characteristics of Respondents According to Education On Hygiene Officer at Dr. Iskak Hospital Tulungagung Based on Figure 3 shows that respondents whose level education most are high school number 28 respondents (45%), junior school of 24 respondents (39%), primary school number seven respondents (11%), whereas that is un educated number of 3 respondents (5%).

RESEARCH METHODS This type of research used in this research is a correlational study with a "cross-sectional" which emphasizes the time measurement / observation of independent and dependent variables only once in a while. The population in this study is all cleaning service at Dr. Iskak Hospital Tulungagung as many as 76 people. The sampling technique used in this study is simple random sampling with a total sample of 62 people. Data were collected through interviews and observations. The study was conducted in March 2015. Data were analyzed using logistic regression statistical tests.

Figure 4 Characteristics of Respondents based on employment status on cleaning service at Dr. Iskak Hospital Tulungagung Based on Figure 4 shows that most respondents are not permanent employee status a number of 52 respondents (84%), while the status of permanent employee number 10 respondents (16%).

RESEARCH RESULT

Figure 1 Characteristics of Respondents by Age At Hygiene Officer at Dr. Iskak Hospital Tulungagung. Based on Figure 1 shows that most respondents are in the age group 21-30 years by 56%, the age group 31-40 years by 26%, and the group of less than 20 years at 18% Figure 5

Characteristics of Respondents According to the marital status of cleaning service at Dr. Iskak Hospital tulungagung Based on Figure 5 shows that the marital status of respondents the most is not / has not been married a number of 35 (56%), while respondents were married a total of 27 (44%)

Figure 2 Characteristics of Respondents by Gender In Cleaning Service in Dr. Iskak Hospital Tulungagung Based on Figure 2 shows that the cleaning service at Dr. Iskak Hospital Tulungagung 49

Table 2 Distribution Gender Against Use of Personal Protective Equipment At the cleaning service at the Dr. Iskak Hospital Tulungagung use of PPE Total Gender Y T Y T N % N % N % Male 16 67 2 58 3 61 2 8 Female 8 33 1 42 2 39 6 4 Total 24 100 3 100 6 100 8 2 In Table 2 shows that the use of personal protective equipment based on sex in the cleaning service at the Dr. Iskak Hospital Tulungagung. Respondents who use PPE men 67% and women 33%. While respondents were not using PPE male some 58% and women 42%. Table 3 Distribution Old Working Against the Use of Personal Protective Equipment At the cleaning service at the Dr. Iskak Hospital Tulungagung Use of PPE Worki Total ng Y T Y T Long N % N % N % <1 1 42 15 39 25 40 Year 0 1-5 1 58 21 55 35 56 Year 4 >5 0 0 2 5 2 4,0 Years Total 2 100 38 100 62 100 4 In Table 3 shows that the use of personal protective equipment based on longer work. Respondents who use PPE with long work <1 year 42% 1-5 years 58%, while those not using PPE long work <1 year 39% 1-5 years 55% and> 5 years 5%. Table 4 Distribution of educational status Against Use of Personal Protective Equipment At the cleaning service at the Dr. Iskak Hospital Tulungagung Use of PPE Total Educat Y T Y T ional N % N % N % Un 1 4 2 5 3 5 educat ed Primar 2 8 5 13 7 18 y School High 10 42 14 37 24 39

Figure 6 Diagram Distribution of Respondents According to Use of Personal Protective Equipment Based on the picture 6 shows that respondents who use personal protective equipment a number of 24 respondents (39%), whereas that does not use personal protective equipment a number of 38 respondents (61%).

Figure 7 Pie Diagram Distribution of Respondents Against Accidents Based on the picture 7 diagram shows that the incidence of occupational accidents in the cleaning service in Dr. Iskak Hospital Tulungagung number of 42 respondents (68%) said they had experienced a work accident, while 20 respondents (32%) claimed to have never had an accident. Table 1 Age distribution Against the Use of Personal Protective Equipment At the cleaning service at the Dr. Iskak Hospital Tulungagung. use of PPE Total Age Y T Y T N % N % N % <20 4 17 7 18 11 18 Year 21-30 1 66 1 47 34 55 Year 6 8 31-40 4 17 1 32 16 26 Year 2 >40 0 1 3 1 2 Years Total 2 100 3 100 62 100 4 8 In Table 1 shows that the use of personal protective equipment based on the age range cleaning service at Dr. Iskak Hospital Tulungagung. Respondents who use PPE age <20 years of a 17%, 66% aged 21-30 years and 31-40 years of age 17%. While respondents who do not use personal protective equipment (PPE) age <20 years some 18%, 21-30 years 47% 31-40 32% and> 40 years of 3%. 50

cleaning service at Dr. Iskak Hospital Tulungagung Accident Total PPE Never Ever N % N % N % Yes 13 65, 11 26,0 2 39, 0 4 0 No 7 35, 31 74,0 3 61, 0 8 0 Total 20 100 42 100 6 100 2 At table 7 above shows the use personal protective equipment against work accidents. Respondents who use PPE and Never crashed some 26%, respondents who use PPE and never had an accident some 65% of respondents who do not use PPE and never had an accident some 74%, while those who did not use PPE and work accident number 35 %. Tabel 8 Results Effect Analysis Using Personal protective equipment against work accidents At a cleaning service at Dr. Iskak Hospital Tulungagung Variables in the Equation St B S. Wa d Si Exp ep E ld f g. (B) a The 1.6 .5 7.9 1 .0 5.23 1 use of 55. 86 88 05 4 PPE Consta .9 3.9 1 .0 .162 nt 1.8 20 23 48 22 a. Variable (s) entered on step 1: The use of PPE. The analysis showed the use of personal protective equipment (PPE) against occupational accidents in the cleaning service at Dr. Iskak Hospital Tulungagung p value = 0.005 (p <0.05) means that there is the effect of the use of personal protective equipment (PPE) against workplace accidents. Respondents who use personal protective equipment are possibly five times to avoid workplace accidents when compared to workers who do not use personal protective equipment and statistically significant as well as related.

School Senior 11 46 17 45 28 45 High School Univer 0 sity Total 24 100 38 100 62 100 In Table 4 shows that the use of personal protective equipment by educational status. Respondents who use PPE school status no amount of 4%, primary school 8%, 42% junior high school, high school 46% . While not using PPE school status does not amount to 5%, SD 13%, 37% junior and senior 37%. Table 5 Distribution Employmentof Status Against the Use of Personal Protective Equipment In the cleaning service at the Dr. Iskak Hospital Tulungagung The use of PPE Emplo Total yee Y T Y T Status N % N % N % Indepe 2 83 32 84 52 84 ndent 0 Depen 4 17 6 16 10 16 dent Total 2 100 38 100 62 100 4 In Table 5 shows the use of personal protective equipment based on employment status. Respondents who use PPE status of nonpermanent employees 83% and the number of permanent employees 17%. While respondents were not using PPE status of permanent employees 84% and 16% permanent staff. Table 6.Distribusi Marital Status Against the Use of Personal Protective Equipment in the cleaning service at the Dr. Iskak Hospital Tulungagung The use of PPE Total Marital Y T Y T Status N % N % N % No / Not 1 50 2 60 3 56 married 2 3 5 Married 1 50 1 40 2 44 2 5 7 Total 2 100 3 100 6 100 4 8 2 In Table 6 shows the use of personal protective equipment based on marital status. Respondents who use PPE status of unmarried 50% and 50% are married. While respondents were not using PPE status is not married some 60% and 40% are married. Table: 7 Distribusi Use of Personal Protective Equipment Against Accidents in

DISCUSSION Use of Personal Protective Equipment (PPE) to the cleaning service in Dr.Iskak Hospital Tulungagung that of 24 respondents (39%) who use PPE while 38 respondents (61%) did not use PPE. Judging from the use of gloves 44% do not use and 56% use, the use of masks 48% do not use and 52% use, the use of apron 51

watertight 95% do not use and 5% use, the use of the shoes 100% use, while the use of hats or headwear 100% do not use. This is due to lack of compliance officers in the use of personal protective equipment as well as the lack of availability of personal protective equipment for the cleaning service. Proved to be only available one spilkit box in one area, while the officer is in one of the area between 6-8 cleaning service. Besides lack of supervision and lack of sanctions for cleaning service make cleaning service negligent in using personal protective equipment. Personal protective equipment (PPE) according to OSHA or the Occupational Safety and Health Administration is a tool used to protect workers from injury or illness caused by contact with hazards in the workplace, whether it is chemical, biological, physical radiation, electrical, mechanical and other , The use of PPE is used to protect the body from harm job can cause illness or accidents and labor can work with more secure because it can avoid the various occupational hazards. Thus, the use of PPE has an important role because it is useful not only for workers, but also useful to the company. The number of accidents on the cleaning service at the Dr. Iskak Hospital Tulungagung is 42 respondents (68%) never had an accident at work, and 20 respondents (32%) have never had an accident at work. Judging from the respondents fell 29% has been dropped and 71% never fall, 24% of respondents had experienced punctured and 76% have never experienced punctured, 44% of respondents had experienced exposure to liquid infectious and 56% of respondents were never exposed to liquid infectious, 40% respondents had spilled hazardous liquids and 60% of respondents have never spilled liquids deadly; 35% of respondents had collided and 65% of respondents had never hit, 31% of respondents never inhaling toxic gases and 69% of respondents never inhaling poisonous gas, 26% of respondents never exposed chemicals and 74% of respondents were never exposed to chemicals. World Health Organization (WHO) defines accident as an event that can not be prepared in advance countermeasures so as to produce a real injury. Classification of accidents due to work according to Labour Organization is based on the type of accident: such as a fall, hit by falling objects, pierced, pinched, movements that exceed the capabilities, contact with hazardous materials or radiation, Other types, including accidents

Data not sufficient or other accidents that have not entered. While classification according to the cause include: machinery, transport equipment, materials, substances and radiation, work environment, other causes that do not include these factions , Results from the analysis of data obtained (pvalue: 0.005) (p <0.05) means the use of personal protective equipment has a significant relationship * with workplace accidents in the cleaning service at the Dr. Iskak Hospital Tulungagung. The results showed that respondents use personal protective equipment (PPE) 5 times to avoid accidents. While workplace accidents influenced by the use of personal protective equipment (PPE) by 18%. Based on the theory of work accidents caused by several factors and one of them is because they do not use personal protective equipment. As for how to prevent accidents by Ramli 2010 is to wear personal protective equipment in earnest without coercion, aware of the importance of workplace safety and comply with the regulations that exist, because 85% of workplace accidents are caused by human factors with unsafe acts , Joseph 2007 study on Factors Related Accidents also mentioned that there is a significant association between the use of personal protective equipment at work accidents with a value of (p: 0.013) (p <0.05). CONCLUSIONS AND SUGGESTIONS From the research that has been done and it can be concluded from the discussion of matters related research about the effect of the use of Personal Protective Equipment (PPE) against occupational accidents in the cleaning service at Dr. Iskak Hospital Tulungagung. Use of Personal Protective Equipment (PPE) to the cleaning service at the Dr. Iskak Hospital Tulungagung of 62 respondents, only 39% were using PPE, while 61% did not use PPE. The number of accidents caused by work in the cleaning service at the Dr. Iskak Hospital Tulungagung of 62 respondents 68% had had an accident at work and 32% have never had an accident while work. The use of personal protective equipment has a significant influence with workplace accidents in a cleaning service at Dr. Iskak Hospital Tulungagung namely with (p-value: 0.005) (p <0.05). With regard to the outcome of research and discussion and conclusion, then the advice that can be given is a cleaning service should be submissive in the use of personal protective 52

equipment to reduce the risk of workplace accidents. Maintain and take care of personal protective equipment has been provided by either. BIBLIOGRAPHY Arikunto, Suharsimi. 2010. Prosedur Penelitian. Jakarta : Rineka Cipta Depnakertrans. 2012. Data Kecelakaan Kerja dan Penyakit Akibat Kerja Menurut Provinsi. Jakarta : Ditjen PPK Depnakertrans. 2014. Sambutan dalam Rangka Hari Keselamatan dan Kesehatan Kerja pada tanggal 12 Januari 2014. Jakarta : Mensosnakertrans Hidayat, Alimul Aziz A. 2011. Riset Keperawatan dan Teknik Penulisan Ilmiah. Jakarta : EGC ILO. 2013. Press release International Labour Organization (ILO) pada tanggal 26 April 2013 Keputusan Menaker Nomor 609 Tahun 2012 Tentang Pedoman Penyelesaian Kasus Kecelakaan Kerja dan Penyakit Akibat Kerja Kurniawati, Dewi. 2013. Keselamatan dan Kesehatan Kerja.Surakarta: Aksarra Sinergi Media Notoadmodjo, S. 2010. Metodologi Penelitian Kesehatan. Jakarta : Rineka Cipta Nuratika, Desi. 2013. Identifikasi Kecelakaan kerja dan Gambaran Penggunaan Alat pelindung Diri pada Petugas Laundry.Skripsi: Jakarta Nursalam. 2011. Pedoman Skripsi, Tesis, dan Instrumen Penelitian Keperawatan. Jakarta : Salemba Medika Ramli, Soehatman. 2010. Sistem Manajemen Keselamatan dan Kesehatan Kerja OHSAS 180001. Jakarta : Dian Rakyat Ramli, Soehatman. 2013. Sistem Manajemen Keselamatan dan kesehatan Kerja OHSAS 18001. Jakarta: Dian rakyat RI, Depkes. 2008. Kesehatan dan Keselamatan Kerja Laboratorium Kesehatan. Jakarta: Depkes RI RI, Depkes. 2011. Pedoman Pencegahan dan Pengendalian Infeksi di rumah sakit dan Fasilitass Pelayanan Kesehatan , Kesiapan Menghadapai Emerging Infectious Diseas.Jakarta: Depkes RI Ridwan.2012. Metode dan Teknik Menyusun Proposal Penelitian.Bandung: Alfabeta

RSUD Dr. Iskak. 2014. Buku Panduan Penggunaan Alat Pelindung Diri (APD): Tulungagung Rukiyah.2013.Undang-Undang Ketenagakerjaandan Aplikasinya. Jakarta: Dunia Cerdas STIKes Surya Mitra Husada. 2013. Buku Panduan Penyusunan Proposal dan Skripsi : Kediri Sugiyono. 2013. Statistika Untuk Penelitian. Bandung : CV Alfabeta Sugiyono. 2013.Metode Penelitian Kuantitatif Kualitatif dan R&D. Bandung: Alfabeta Suma‟mur. 2009. Higiene Perusahaan dan Kesehatan Kerja (HIPERKES) edisi 2. Jakarta : Sagung Seto Undang-Undang Nomor 1 Tahun 1970 tentang Keselamatan Kerja

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AEROBIC COMBINATION WITH RELAXATION YOGA TO FATIGUE LEVELS IN PATIENTS WITH BREAST CANCER UNDER CHEMOTHERAPY PROGRAM Muhammad Taukhid STIKES Karya Husada Kediri E-mail: [email protected]

Abstract Background : Fatigue is feeling tired physically, psychologically, cognitively perceived cancer patients while undergoing therapies for the disease, including chemotherapy. The purpose of this study was to determine differences in the level of fatigue in cancer patients between before and after aerobic exercise combined with relaxation techniques of yoga. Methods : This study used Quasi-experimental design with pre-test – post-test control group in patients with breast cancer in the course of chemotherapy. The sampling methods used purposive sampling. The fatigue level was collected by subjective instruments Pipper Fatigue Scale (PFS), and then analysed by the Independent and Dependent T test, and multivariate analysis used linear regression with a significance value of α <0.05. Results : There were differences in the level of fatigue post-test between the intervention group and the control group with a difference of 1.25 (p = 0.013). History of previous exercise may explain the 17.8% level of fatigue that occurs in patients with breast cancer in the course of chemotherapy, the rest was explained by other variables. Conclusion : There were a decrease in the level fatigue statistically, however clinically the level of fatigue remain the same categories. Keywords : fatigue, aerobic, yoga, breast cancer quality of life and ability of daily activities (Wagner, Cella, 2004). Signs and symptoms of fatigue characteristics are multi-biopsychosocial, so that if two people who experience fatigue, the appearance symptoms will not exactly match.

Introduction Fatigue is an overwhelming exhaustion more than normally, which are not relieved by rest and nutrition intake. Cancer related Fatigue (CRF) associated with cancer process and the side effect of cancer therapy. The incidence of fatigue in the US reaching 95% of all cancer patients undergoing chemotherapy or radiotherapy (Mustian, 2007). Most incidents fatigue that is between 28% -91% suffered by breast cancer patients who undergo therapy (Hofman et. Al, 2007).

CRF are generally influenced by a history of less activity and psychological stress experienced as a result of cancer. Based on the priorities effectiveness against fatigue, Mitchell, Beck, Hood, Moore, Tanner (2007) recommend giving exercise to intervene against fatigue. Suggested exercises include walking, cycling, swimming, resistance training or exercises combined. Nursing interventions that are judged to be effective fatigue management is performed for activity management and energy conservation, one of the interventions which includes relaxation techniques. Escalante and Manzullo (2010) tried to apply the technique combination of

CRF will affect the ability, physical capacity, and quality of life of cancer patients, so they will rely on others for daily necessities such as household activities, transportation, personal needs such as eating and bathing. CRF perceived multidimensional feeling, the dimensions are behaviour, cognitive, psychological and social. Fatigue felt by the majority of cancer patients during therapy may reduce the

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pharmacological and non-pharmacological therapies, among others: energy conservation, regulation of sleep, exercise, relaxation, antidepressants, analgesics, stimulants, anxiolytic and nutritional counseling. The results are 59% of the 140 respondents reported less fatigue.Methods of combination therapy to reduce fatigue have also been made in the research Decker, Cline-Elsen, Galaggher, (1992) and Kim, Kim, (2005), using nursing interventions breath relaxation techniques with yoga positions. The cancer patients were given the intervention reported lowerlevel experience fatigue. Danismaya research results (2008), who did the application of relaxation techniques of yoga in patients with breast cancer, showed a decrease in the level of fatigue on the 5th day of intervention. Research by wahyuni (2012) suggested that the walking exercise program can reduce fatigue levels in breast cancer patients. The above studies indicate that intervention aerobic (walking exercise) as well as the relaxation of yoga is effective in lowering the level of fatigue. However, so far researchers have not found a combination of aerobics with yoga relaxation of the intervention to be effective in lowering the level of fatigue. This study aimed to determine differences in fatigue levels in breast cancer patients in chemotherapy program between before and after the combination of aerobic exercise and relaxation techniques of yoga.

exercise , then the patient rested for 2 minutes , then the patient is asked to perform Shavasana position yoga as a form of relaxation for 8 minutes. Rest breaks given to minimize the discomfort that can be perceived by the respondents. Data were collected by questionnaires for the pre-test and post-test. Analysis of data using frequency distribution, bivariate analysis Independent and Dependent T test and multivariate analysis using linear regression. Most respondents chose to participate in the study and are willing to take measurements and interventions at each residence. All existing identity documents and data in this study have been agreed only use initials, all the information from respondents in the form of a hard copy stored in a locked filing cabinet and the data in the form of soft copy stored in a specific folder is secured by using a password. During participated in the study respondents are treated fairly and impartially , by providing the same treatment , but in a different time . Intervention control group given a combination of aerobic exercise with relaxation techniques of yoga after data collection is complete . RESULT Obtained 34 respondents by sex married women are divided into two groups , namely 17 respondents in the intervention group and 17 respondents as the control group . The mean age of the respondents 51.5 years old, mean body weight 57.71 kg, and the mean fatigue score of 6.04 (95% CI). Table 1 displays the characteristics of respondents

METHODE The research was used Quasi-experimental pre test post test with control design in patients with breast cancer under chemotherapy program at RSUD Kediri and Amelia Hospital Kediri on April until June 2014. Using purposive sampling technique 34 participant were recruited from 110 patients by medical data record and encountered patients at one day care services unit. Aerobic data was collected with observation sheets about exercise time schedule, and fatigue levels data obtained with Pipper Fatigue Scale (PFS). Initially the patient is asked to perform continuous walking for 10 minutes as a form of aerobic

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TABEL 3 Faktor-faktor yang mempengaruhi tingkat fatigue Adjusted R R2 P value R square 0,012* Langkah 1 0,594 0,353 0,311 0,178 0,001* Langkah 2 0,451 0,203 TABLE 1 Characteristics of Respondents

Based on the results of statistical tests, it was found that a significant reduction in fatigue scores between before and after doing a combination of aerobic exercise Variable n (%) with relaxation techniques of yoga in the Occupation intervention group (p = 0.001; α = 0.05). a. Having a Job (14,7) 5 Based on test results, a decrease in fatigue (85,3) b. Jobless 29 scores were significantly also occurred in Education the control group (p = 0.004; α = 0.05). a. Low Education Based on further testing of the level of (does not school, 27 (79,4) fatigue post test between the intervention Elementary, Junior) group and the control group there were b. Higher Education 7 (20,6) significant differences in levels of fatigue (p (High School and = 0.013; α = 0.05). Table 2 shows the Universities) differences in levels of fatigue post test Cancer Stadium between the intervention group and the a. Stadium II 25 (73,5) control group b. Stadium III 9 (26,5) TABLE 2 Differences in levels of fatigue post-test, Therapy History intervention group and the control group a. Nothing 23 (67,6) Mean b. Exist 11 (32,4) Mean± P Different Exercise History SD value (CI 95%) a. None 30 (88,2) Fatigue Levels (11,8) b. Exist 4 intervention 4,3±1,6 Types of chemotherapy drugs 1,25 group 16 (47,1) (0,29-2,22) 0,013* a. Tamoplex Fatigue Levels b. Cyclospamit 11 (32,4) 5,5±1,8 control group c. Doxorubyn 7 (20,6) independent t test *p < 0,05 by cancer therapy undertaken. The feeling will make the patient's physical abilities Based on the test results of multivariate decline. The high level of perceived fatigue linear regression, the level of fatigue in of breast cancer patients, is associated with breast cancer patients under chemotherapy a decrease in daily activities performed by program is influenced by prior treatment patient (Rotonda, Guillemin, Bonnetain, history and a history of previous exercise (p Velten, Conroy, 2013). Therefore, physical <0.05). Also shown in Table 3 the previous exercise becomes one of the main exercise history can explain the fatigue that recommended treatment for patients with occurs in cancer patients under fatigue, so that the patient's ability to chemotherapy program, the rest is independently returned. Physical exercises explained by other variables. ranging from the mild to severe intended to Uji regresi Linier *p < 0,05 allow someone to have regular activities, so Langkah 1 : riwayat terapi, riwayat atihan that the body will be able to compensate for Langkah 2 : riwayat latihan the decrease in the patient's physical Faktor dependen : tingkat fatigue abilities. If a person feels himself psychologically incapable, then his body DISCUSSION will respond to the same thing, so it will be Cancer related fatigue is a feeling of fatigue the condition of the patient's body that appears persistently, along with the increasingly weak. cancer therapy. Fatigue can arise from the Accordingly, in this study interventions that patient's physical condition declined due to can increase the activity of the respondent the disease process, and may also be caused to provide physical fatigue management by

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walking exercise, and psychological management by providing relaxation techniques of yoga. The results in this study showed a difference between level of fatigue before and after applying a combination of aerobic exercise with relaxation techniques of yoga in patients with breast cancer under chemotherapy programs. Chemotherapy is a protocol that is almost used in all cancer treatment. Be aware that chemotherapy is a treatment method using a type of cytotoxic drugs, which is intended to inhibit the regeneration of cells. Inhibition mechanism occurs in all cells of the body, not least on healthy cells or non-cancerous, so it's also a factor that contributed to the decline in patient's physical abilities. important for patients who are undergoing chemotherapy and experiencing fatigue to keep improving activities of daily routine, to compensate for attenuation effects caused by chemotherapy drugs on normal cells. Routine activities such as cooking, sweeping, walking around the house is the method forms of simple aerobic activity that can be done by cancer patients in order to maintain their physical abilities. In accordance with the results of several previous studies which revealed that aerobic exercise (walking exercise) can be beneficial to the fatigue levels of patients who are in treatment programs (Velthuis, Agasi-Idenburg, Aufdemkampe, Wittink 2010; Wahyuni, 2012; Mustian, Sprod, Janelsins, Peppone , Mohile, 2012; Mayo, Moriello, Scott, Dawes, Auais, Chasen, 2014). Decrease in fatigue scores that occurred in the intervention group can explain that feeling of fatigue experienced by cancer patients can be improved by doing aerobic exercise. These types of exercises can strike a balance between the needs and the production of energy needed by the body to improve physical abilities. Aerobics can increase the cardio-respiratory activities that will increase the supply of oxygen to the muscles. The presence of oxygen in the muscles will increase energy metabolism through oxidation of fats, carbohydrates and protein to form a small part Adenotriphosphate / ATP (Hernawati, nd downloaded from file.upi.edu). ATP is the

basic ingredient of energy, so that when production increases it will be directly proportional to the body's ability to perform its duties and functions. Conversely, a decrease in activity (deconditioning) result in the breakdown and loss of enzymes involved in cellular energy production level. The use of oxygen and energy sources become inefficient. Aerobic exercise is conducted into a stimulation for the body to change the reserves of energy sources into the base material of energy. This is consistent with the first and second laws of thermodynamics theory, which states that energy can neither be created nor destroyed; energy can only be redistributed or changed from one form to another (Winningham and Barton-Burke 2000). Aerobic exercise program can be used as an exercise to minimize energy loss in cancer patients whose chemotherapy by using oxygen consumption as an objective parameter in measuring performance. Aerobic exercise showed progress in terms of performance that produces energy despite cancer patients undergoing chemotherapy. Individuals who perform activities would not feel too tired compared to individuals who do not indulge, this is because the energy in individuals whose activities continue to be distributed though the energy used continuously, the opposite situation occurs in individuals who do not perform activities, energy continues to be required but there is no activity undertaken to produce energy anymore. The exercise program can also provide benefits for the psychosocial health of cancer patients, by improving the ability of themselves and the quality of life (Doyle, C., et al., 2006). Physically, history or the patient's ability to perform activities before experiencing fatigue becomes a factor that greatly affect the compensation body when experiencing fatigue. Analysis of the comparison between each of the factors that influence fatigue in this study suggests that a history of activity contributed 17.8% to the occurrence of fatigue in breast cancer patients (Table 3). Meanwhile, the research results also illustrate that yoga relaxation techniques

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also contribute to the score of fatigue respondents. Yoga is useful to provide and increase the sense of calm in respondents feeling after doing a series of exercises. According Shindu (2013) with yoga positions Shavasana (position lying like a corpse / relaxation in total) will take place gentle pressure on the glands that secrete hormones to a more stable, blood circulation becomes more smoothly, the body will describe the tension of his muscles, the mind becomes quieter and more serene sense of being. Relaxation become appropriate method chosen for the management of fatigue caused by the burden of or stress of feeling in the minds of cancer patients. Stress experienced by patients could be due to progressive disease process, the phase of self-acceptance on the patient's health status, or because of saturation in undergoing cancer therapy who repeatedly and for a long time. According to Hans Selye (in the Canadian medical hall of fame, 2013) stress syndrome originated from a situation in which the body is not specifically respond to various stimuli. Under conditions of stress hypothalamus secretes corticotropin releasing hormone (CRH), further to stimulate the pituitary to secrete cortisol and directly or indirectly adrenal secrete adrenocorticotropic hormone (ACTH), GRH, Somatostatin and release factors (releasing) the hypothalamus and pituitary hormones other. Cortisol and ACTH will issue vasopressin and catecholamines, causing an increase in blood pressure and heart muscle contraction. Clinically, this phase will bring a feeling of tension accompanied by signs such as ulcers, high blood pressure and heart attacks.

symptoms that may aggravate tension fatigue does not occur. The results also showed that the level of fatigue also decreased in the control group, who did not get a combination of aerobic exercise with relaxation techniques of yoga. Generally, it can be overcome with fatigue restoration techniques, such as; ensure a proper diet, ensuring a good sleep patterns, adjusting a good lifestyle, understanding the psychological problems associated with fatigue, as well as coping management for the energy loss (Victoria Minister for Health, 2013). Decrease fatigue that occurs in the control group could be acceptable because some respondents have chemotherapy schedules predetermined, so it is difficult to predict the peak of the respondent fatigue. In addition, the distance between the last chemotherapy respondents to the implementation of the research is very varied, there is a direct postchemotherapy and some that have a few weeks after the last chemotherapy. In the opinion of Otti (cited in Danismaya, 2008) that the peak fatigue occurs on day 7 to day 10 after chemotherapy session and will be back at the starting point before the next cycle. So when performed assessments of respondents could not be ascertained were at the height of fatigue or not, because it may just have been a recovery from fatigue experienced conditions. Interventions that have been given during this study is safe and can be done independently by the respondents during the period of chemotherapy. It is based on the absence of a report from the intervention group who runs a combination of aerobic exercise and yoga relaxation techniques that are harmful and harm him. A decrease in fatigue scores in the intervention group was significantly higher when compared with the control group. Fatigue scores are clinically categorized into four categories, namely; a score of 0 for categories not fatigue, the score 1-3 to the category of mild fatigue, fatigue score of 4-6 to the category of moderate and severe fatigue category 7-10 (Pipper, et. al, 1998 and NCCN, 2014). Decline in average scores are statistically obtained either from 0.52 to 1.82 in the intervention group and

Further processing of the situation would lead to a decrease in the secretion of insulin, glucagon and the intake of oxygen in the body. The impact, decrease energy production, while the energy needs in cancer patients who are undergoing chemotherapy are very large. This gap that causes the inadequate energy for the body, causing fatigue. Therefore, cancer patients need to be taught relaxation methods as an effort to adapt to stress, in the hope

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the control group, from the initial score in the range of 6 scores fell in the range of 5 and 4. Fatigue score 4-6 clinically categorized into moderate category, so it can be concluded that the decrease in fatigue that occurs only statistically significant, but clinically decrease in fatigue that occurs still within the same category, or do not decrease. Several other studies also reveal the same thing, that the reduction in fatigue after exercise and relaxation of yoga significantly only shown in the statistical calculation, but not clinically significant difference (Schwartz, Mori, Gao, Nail, King, 2001 Danismaya 2008, Mustian et. al 2009). However, the research results Mustian et. al (2009) added that although not clinically significant changes occur fatigue, cancer patients were given continuous training to observations of three months showed an improvement in quality of life. As well as on the research results Danismaya (2008) further explained that the provision of the relaxation techniques of yoga over three days showed a decrease in fatigue clinically significant, namely from fatigue category of being on the first day become the category of mild fatigue on the fifth day. Exercise and physical activity that exceeds the portion of the ability of cancer patients can also potentially lead to fatigue, thus creating the opportunity to exacerbate fatigue, therefore in this study are still using the criteria of minimal intervention, namely with a frequency of three days a week. Such determination is based on the optimal frequency in adults aerobic ie at least 3 days a week (Whalet, 2006) and the duration of time of at least 10 minutes in a day (Newton cited in CCWA, 2009). While Danismaya (2008) also mentions that a change fatigue of cancer patients given yoga relaxation occurs from the third day of exercise. This study is an initial attempt to determine the effectiveness of the combination therapy which has not found a reference frequency and duration for the implementation of the combination in previous studies, so that some of the above considerations are used to determine the frequency and duration of combined

aerobic exercise with relaxation techniques of yoga for three consecutive days. The results showed a significant influence between the combination of aerobic exercise with relaxation techniques of yoga in cancer patients undergoing chemotherapy, after three days of observation. But according to the law of Thermodynamic III discovered by Rudolf Clausius (in Barton-Burke and Winningham, 2000) stressed that energy can not only be modified in other forms, but also constantly less available for work. Whenever energy is converted, it always takes more energy than the energy expended a system. This theory can be the basis of that intervention provided in this study can not necessarily eliminate fatigue in just three days, because the body needs a continuous supply of energy along with energy use. So that respondents who perform these interventions are also at risk for getting tired because of the energy requirements continuously. However, at least by providing a combination of aerobic exercise with yoga relaxation techniques on an ongoing basis to balance energy needs, can stimulate the aerobic energy metabolism and relaxation of yoga can save energy by minimizing internal stress. According Winningham (in King and Hinds, 2003) about the proposition of rest and activity states that too much / little break will result in fatigue, as well as too much / little activity will also lead to fatigue, so the dynamic balance between activity and rest will minimize fatigue, and otherwise the imbalance of which will aggravate fatigue. In addition, fatigue become a different problem to individuals who have completed cancer therapy. Individuals who are no longer undergo therapy and be considered free of cancer called cancer survivor. Fatigue is still a problem that can interfere with quality of life for cancer survivors significantly. According Servaes, Verhagen, Bleijenberg (2002), 38% of women with breast cancer who have completed cancer therapy still merasakana exhausted after 29 days post-therapy. Fatigue is also still perceived by 1/3 of women with breast cancer 10 years after completion of therapy

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(Bower, Ganz, Desmond 2006). Theory and research conducted in patients undergoing cancer therapy can not be applied in a population of cancer survivors, solutions that can be given in this population is to improve themselves to be able to adapt and perform independently of the fatigue management are still being experienced. CONCLUSION There are differences in fatigue levels in breast cancer patients who received a combination of aerobic exercise with relaxation techniques of yoga. The decline is statistically significant, but clinically no significant changes in levels of fatigue either the intervention group or the control group. Special interventions for fatigue in cancer patients in this study may be one of the nursing interventions, so that nurses can implement it in order of nursing, especially in the area of oncology nursing. Further research is needed, especially regarding intervention to determine the long-term results of the implementation of the intervention. Specific interventions for fatigue in cancer patients so far is not widely held by hospitals that deal with cancer therapy. The results could be used as a basis for interventions against fatigue that occurs in cancer patients in hospitals, both in hospitals and in the center of the regional hospital.

informed choices. CA Cancer J Clin, 56(6): p. 323-53. Escalante P. C., Manzullo F. E. (2009) Cancer-Related Fatigue: The Approach and Treatment. J Gen Intern Med, 24(Suppl 2):412–6 DOI: 10.1007/s11606-009-1056-z Hernawati, (n.d). Produksi asam laktat pada exercise aerobik dan anaerobik. diunduh dari file.upi.edu/Direktori/FPMIPA/JUR._P END._BIOLOGI/.../FILE_2.pdf Hofman M., Ryan L. J., Figueroa-Moeley D. C, Jean-Pierre P., Morrow G. R.. (2007). Jacobsen PB, Hann DM, Azzarello LM, et al. Fatigue in woman receiving adjuvant chemotherapy for breast cancer: characteristics, course and correlates. J Pain Symptom Manage, 22: 277–88 Kim, S.D., & Kim, H.S. (2005). Effects of a relaxation breathing exercise on fatigue in hematopoietic stem cell transplantation patients. Journal of Clinical Nursing, 14, 51–55. King, C. R., Hinds, P.S. (2003). Quality of life: from nursing and patients perspectives, theory and research. 3rd ed. Jones & Bartlett Publisher. Mayo NE, Moriello C, Scott SC, Dawes D, Auais M, Chasen M. (2014). Pedometer-facilitated walking intervention shows promising effectiveness for reducing cancer fatigue: a pilot randomized trial. Clin Rehabil. pii: 0269215514536209. [Epub ahead of print] PubMed PMID: 24917586 Mitchell A. S., Beck L. S., Hood E. L., Moore K., Tanner R. E. (2007). Putting evidence into practice: evidence-based intervenstion cancer and its treatment. Clinical journal of oncology nursing. 11 (1):99-113. Mustian M. K., Morrow R. G., Carroll J. K., Moseley D. C., Pierre P. J., Williams C. G. (2007). Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. The Oncologist, 12:52–67. Doi:10.1634/theoncologist.12-S1-52

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Mustian M. K., Peppone L., darling V. T., Palesh O., Heckler E. C., Morrow R. G. (2009). A 4-week home-based aerobic and resistance exercise program during radiation therapy : a pilot project randomized clinical trial. J support Oncol, 9:158-167. Mustian KM, Sprod LK, Janelsins M, Peppone LJ, Mohile S. (2012). Exercise Recommendations for Cancer-Related Fatigue, Cognitive Impairment, Sleep problems, Depression, Pain, Anxiety, and Physical Dysfunction: A Review. Oncol Hematol Rev. 8(2):81-88. PubMed PMID: 23667857; PubMed Central PMCID: PMC3647480 National Comprehensive Cancer Network. (2014). NCCN clinical practice guidelines in oncology (NCCN guidelines) cancer-related fatigue version 1.2014. NCCN.org. diunduh dari http://www.nccn.org/professionals/phy sician_gls/f_guidelines.asp#supportive Pipper BF., Dibble SL., Dodd MJ., Weiss MC., Slaugther RE., Paul SM. (1998). The revised piper fatigue scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum. 25(4):677-84. PubMed PMID: 9599351 Rotonda C., Guillemin F., Bonnetain F., Velten M., Conroy T. (2013). Factors associated with fatigue after surgery in women with early-stage invasive breast cancer. The oncologist, 18:467475. Doi 10.1634/theoncologist.20120300 Schwartz L A, Mori M., Gao R., Nail M. L., King E. M. (2001) Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Med. Sci. Spsorts Exer.; vol. 33, no. 5:000000. Servaes P., Verhagen S., Bleijenberg T. (2002). Determinants of chronic fatigue in disesase-free breast cancer patients: a cross sectional study. Annal of Oncology,13: 589-590

Shindu P. (2013). Panduan lengkap yoga: untuk hidup sehat dan seimbang. Bandung : Mizan Media Utama. The Canadian medical hall of fame (2013). Dr. hans Seyle. Diunduh dari http://www.cdnmedhal.org/dr-hansseyle Velthuis MJ, Agasi-Idenburg SC, Aufdemkampe G, Wittink HM. (2010). The effect of physical exercise on cancer-related fatigue during cancer treatment: a meta-analysis of randomised controlled trials. Clin Oncol (R Coll Radiol). 22 (3) : 208-21. doi: 10.1016/j.clon.2009.12.005. PubMed PMID : 20110159. Victoria Minister for Health. (2013). Fatigue fighting tips reproduced from the better health channel (www.betterhealth.vic.gov.au). State of Victoria. Diunduh dari http://www.betterhealth.vic.gov.au/Fati gue_fighting_tips.pdf Wahyuni S.I., (2012). Walking exercise programme (WEP) menurunkan cancer related fatigue pada pasien kanker payudara di rsud Ibnu Sina Gresik. Diunduh dari http://journal.unair.ac.id/filerPDF/abstr ak_5631129_tpjua.pdf Wagner, L.I. & Cella D. (2004). Fatigue and cancer: causes, prevalence and treatment approaches. Br J Cancer, 91(5): p. 822-8. Winningham M.L., Barton-Burke, M. (2000) Fatigue in cancer: a multidimensional approach. United Kingdom: Jones and Bartlett Publisher, inc

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COACHING INTERVENTION MODEL TO IMPROVE COMFORT IN ADOLESENCE WITH DISMINORE Dhina Widayati Bachelor of Nursing Study Programe STIKES Karya Husada Kediri Email : [email protected]

ABSTRACT Disminore is one of the most common problems experienced by Adolesence during menstruation. Disminore management can be performed pharmacological and non-pharmacological. In nonpharmacological one of which can be done by a model of coaching intervention through the abdominal stretching. Coaching is one type of intervention in the theory of comfort "Colcaba". This study aims to determine the effect of coaching intervention models to improvr comfort of adolesence with dysmenorrhea. This study design using pre-experimental, with the approach of one group pre-test post-test design. Sample size are 20 respondents gotten by accidental sampling technique. Data were analyzed using the Wilcoxon Sign Rank Test with results ρ value = 0.001 (<α = 0.05), which means there is the influence of coaching intervention models to improve level comfort of adolesence with dysmenorrhea. After the intervention most of the respondents increased comfort, from mild levels to be high. This is because the movement of the abdominal stretching can stimulate the hypothalamus to excite endogenous opioids that produce endorphins, which can reduce pain intensity disminore and increased comfort with a mechanism can make the muscles around the stomach to relax, reduce pain and make the body feel comfortable. Abdominal stretching can be applied in the Schools, especially in the provision of health education and be learning in physical health education. Keywords: abdominal stretching, coaching, comfort

various problems that interfere with and affect the activity of which the symptoms of premenstrual tension (tension before menstruation), mastodinia, mittelschmerz (pain during ovulation) and dysmenorrhea (pain during menstruation). Dysmenorrhea is not a disease but a physical disorder arising from abnormalities of the pelvis are debilitating female. The main manifestations of dysmenorrhea is painful cramping in the lower abdominal area and spread back or surface of the thigh. In the more severe symptoms are often accompanied by nausea, vomiting, diarrhea, dizziness and even fainting. These symptoms cause many women who complained of pain and requires resting (Bobak, 2010). Based on the cause of dysmenorrhea is divided into two primary dysmenorrhea experienced by women who are menstruating prostaglandins cause arising from the work

INTRODUCTION Adolescence starting from age 12 to age 23 years were a period of dynamic development characterized by changes in the physical development of social cognitive and emotional so quickly. The earliest changes at this time that the physical or biological development of one teenager menstruate. At puberty women also experience emotional changes that change as the peak emotional instability emotional development this is caused by an increase in sexual hormone is so rapid (Guyton, 2006). Menstruation or menstruation is physiological changes that occur periodically women and influenced by reproductive hormones. This period is important in terms of reproduction, usually occurs every month between adolescence and menopause (Bieber, 2011). But in menstruation sometimes arise 235

contained in the cervix and uterus. Prostaglandins work increase uterine contractions and the excessive levels will activate the large intestine. Prostaglandins can reduce or inhibit temporary blood supply to the uterus, which causes the uterus deprived of oxygen causing myometrial contractions and pain. Unlike the secondary dysmenorrhea usually experienced by women with certain diseases disorders include endometriosis, pelvic infection, appendicitis and cervical cancer (Anurogo 2011; Prawirohardjo, 2011). In the epidemiological study of approximately 70-90% of cases of menstrual pain occurs when adolescence (Anurogo, 2011). According Wales (2006 quoted of Fatima, 2007), premenstrual syndrome experienced by 50% of women with socioeconomic medium that come to the clinic gynecology and approximately 14% of women between the ages of 15 to 35 years experience premenstrual syndrome very great influence that require them to take a break from school or office. According santoso 2008 dysmenorrhea is the case in Indonesia is of primary dysmenorrhea, dysmenorrhea percentage in Indonesia amounted to 64.25%, which is divided from primary dysmenorrhea as much as 54.89% and in secondary dysmenorrhea as much as 9.36%. According to Hendrik, 2006 as many as 60-75% of young women experience primary dysmenorrhea provided three-quarters of women experience dysmenorrhea pain mild to moderate and a quarter again experiencing severe pain. Fatimah Research 2007 conducted in Semarang, showed that 71.9% of the 154 respondents experienced premenstrual syndrome. About 40% of women aged 14-50 years experiencing premenstrual syndrome. In most of the young girls of primary dysmenorrhea an ordeal is quite disturbing and should be experienced by every month so that young women must be able to seek appropriate solutions to overcome them. Management of the intensity of pain during dysmenorrhea can be done in two ways, namely by pharmacological and nonpharmacological treatment early in patients with menstrual pain primer is to provide medicines penghilangrasa pain and 80% of patients experienced a decrease in pain of menstruation after taking drugs inhibiting prostaglandin (Arifin, 2008; Anurogo , 2011). Some ways nonpharmacologic to relieve

dysmenorrhea that is safe and without side effects include warm compresses, messase, distraction, getting enough sleep, low-salt diet, physical activity / exercise and increased use of diuretics naturally like celery (Bobak et al., 2005) , As according to Woo and McEnerney (2010 in Charles 2012) there is a strategy that New eventto dysmenorrhea with vitamin B1, B6, and vitamin E, magnesium and omega 3, exercise, acupuncture and Chinese medicine. Many researchers say exercise can cope with dysmenorrhea and exercise more safe and contains no side effects due to use of the physiological processes of the body it is supported by the results of the Daley (2008) which states exercise effective in reducing the intensity of primary dysmenorrhea and study of istiqomah 2009 stating motion gymnastics effective in reducing the scale of dysmenorrhea dysmenorrhea. In the exercise the body will produce endorpien produced by the brain and spinal cord that can serve as a natural tranquilizer, causing a sense of relaxed and comfortable (Arifin, 2008). According Thermacare (2010 in the Retna 2011), exercise that effectively lower scale of dysmenorrhea is abdominal stretching exercise to increase muscle strength abdominal flexibility stomach and immune system in certain circumstances, as well as relaxation breathing for relaxation, release tension and improve pulmonary ventilation so that the blood oxygen can lowering the scale of dysmenorrhea (Wong, et al. and Smeltzer 2002). Distraction is a technique used to reduce pain by means of diverting attention for example to sing, pray, tell loudly, and listen to music, music therapy is a way to reduce pain by distracting and thoughts to the music is heard so that the client's awareness of the painful menstruation or dysmenorrhea is reduced , listening to music can stimulate the release of endorphins that can reduce pain and make the mind relaxes (Potter, 2011). Dysmenorrhea arising during menstruation is very influential on the activities of daily living many symptoms resulting decline in immunity and the effect on the emotional level of women when dysmenorrhea not be handled will have an impact on activity disorder menstrual moving backward, infertility, pregnancy is not detected, the infection and the emotional disorders emerging feelings of tension and anxiety that will affect personal skills and 236

emotional changes occur that make girls labile decreased concentration. Therefore, dysmenorrhea symptoms must be addressed in order to avoid harmful impact. According Kolkaba, humans have a comprehensive response to the stimulus / stimuli are complex and a sense of comfort is the result that comes as a response to the stimulus. The context of a sense of comfort as a holistic experience viewed from four aspects: physical, psychospiritual, environmental and social (Tomey and ALIGOOD, 2006). Abdominal Streching provide interventions are expected to provide a sense of comfort in adolescent girls with disminore pain. This study aims to determine the effect of coaching intervention models: abdominal streching towards comfort in adolescent girls with dysmenorrhea.

1 2 3

7 6 7

35 30 35

Amount 20 100 Table 1 shows that nearly half of respondents (35%) aged 13 years and 15 years (35%). 2. The age of menarche. Table 2 Frequency Distribution of Respondents by age of menarche No Age of Frequency % menarche 1 11 years 11 55 2 12 years 6 30 3 13 years 2 10 4 14 years 1 5 Amount 20 100 The data shown in Table 2 shows that most respondents (55%) had menarche at age 11 years. 3. Intensity of pain Table 3 Respondents Frequency Distribution Based on Ordinary Perceived Pain (in days) No Days Frequency % 1 1 9 45 2 1-2 8 40 3 1-3 3 15 Amount 20 100

METHOD This study uses a pre-experimental design with the approach of one group pre post test design. The population is adolesence at SMPN 1 Srengat experiencing disminore. The sample size in this study were 26 respondents through accidental sampling technique. In this study sample will be selected candidate must meet the requirements of the inclusion criteria set by the researchers. Criteria for inclusion in this study are as follows: (1) Young women who experience disminore during menstruation (mild pain, moderate, severe), (2) Young women who did not take analgesics when disminore, (3) Young women ages 13 -15 years with disminore are willing to become respondents. Exclusion criteria included: (1) Young women who have reproductive diseases, such as endometriosis, uterine polyps, ovarian cyst and uterine myoma, (2) Young women who experience pain due to other complications. In this study, the independent variable is the model of coaching intervention: abdominal stretching. The dependent variable in this study is comfort and pain of dysmenorrhea. RESULTS AND ANALYSIS General Data 1. Age Table 1. Frequency Distribution Respondents by Age. No Age Frequency %

13 years 14 years 15 years

Table 3 shows that almost half of respondents (45%) had pain dysmenorrhea for 1 day 4. Efforts Independent Dysmenorrhea Treatment Table 4. Frequency Distribution of Respondents by Management Efforts Disminore No Management Frekuensi % 1 Drug 7 35 2 Jamu 3 15 3 Rest 9 45 4 Other 1 5 Amount

20

100

Table 4 shows that in reducing pain, almost half of respondents (45%) is done with a break. of

Specific Data 1. Level of Comfort Prior to Do coaching intervention: abdominal streching

237

Table 5 Distribution of the frequency of respondents criteria based on pre implementation comfort level coaching intervention: abdominal streching Comfort Criteria Low

Frequenc y 10

causing increased tone of the myometrium resulting in excessive uterine contractions. In general, primary disminore felt pain before menstruation or during menstruation, this pain usually lasts 48 to 72 hours (Anurogo, 2011). This is due on the first day of menstruation has occurred decay of the cells in the walls of the endometrium that stimulate contractions of the uterus, causing pain during menstruation prefix. Characteristics of respondents by self effort in handling disminore, nearly half of the respondents do independent effort to overcome the pain disminore with rest. According Sukarni et al (2013), breaks it is one of the efforts by non-pharmacological pain management. Happy indeed break action carried out adolescent girls who experience disminore at school. However it is less effective, because when girls break takes too long so that it will interfere with the learning process in schools. It is feared that if the break is always used as a way to reduce menstrual pain, will lead to affective and cognitive impairment in subjects abandoned when disminore. If the attempt to self-break is also done in-house, the young women will increasingly think of the pain that is felt, so keep pain disminore. Then it can interfere with daily activities and the young women will increasingly affect disminore perceived pain. Difikirkan something negative then the result will be negative.

% 50%

Medium

4

20%

High

6

30%

Amount

20

100%

Based on the table above the majority (50%) of respondents have a comfort level in the low category as many as 10 respondents. Disminore is pain during menstruation, usually accompanied by cramps and centered on the lower abdomen. Menstrual pain, it can occur vary from mild to severe pain (Prawirohardjo, 2011). Causes of primary disminore influenced by endocrine factors starting from low levels of progesterone in the late phase of the corpus luteum. Hormone progesterone prevents uterine contractility while the hormone estrogen stimulates uterine contractility (Anurogo, 2011). This pain is felt in the moments before or prefix menstruation that occurs due to uterine contractions due to the decay of endometrial cells. Characteristics of respondents by age and menarche, most respondents had ages between 13 to 15 years. Most had menarche at age 11 years. Ie mid teens aged 13 to 15 years old is still prone to menstrual pain or pain disminore, this is because the primary disminore pain began to emerge from six months to two years after menarche (Sukarni et al, 2013). According Anurogo (2011), menarche at an early age can indeed be a trigger of primary disminore. This is because at this period of rapid increases include reproductive function thus affect the occurrence of changes both physical and psychological development. It is also affected because of the reproductive hormone is not yet stable. Table 5 Characteristics of respondents by regular menstrual pain is felt, almost half of the respondents feel pain disminore on the first day alone. According Sukarni et al (2013), the pain inflicted exposed to increased levels of prostaglandins in the endometrium, causing a decrease in progesterone in luteal phase skhir,

2. Level of Comfort After the Forum coaching intervention: abdominal stretching. Table 6 Distribution of the frequency of respondents criteria based on comfort level post implementation of coaching intervention: abdominal streching Criteria Frequency % Low

2

10%

Medium High Amount

11 7 20

55% 35% 100%

Based on the table above half (50%) of respondents experienced a decrease in pain disminore ie mild pain as much as 10 respondents. Disminore is a medical condition that occurs during menstruation or periods that can interfere with activities and require medication which is characterized by pain or 238

pain in the abdomen or pelvic area (Judha et al, 2012). Abdominal stretching is one of the relaxation techniques with gentle exercise that aims to stretch the muscles, especially in the abdomen, so as to make the muscles around the abdomen be relaxed and smooth blood circulation (Nurhadi, 2007). Streching abdominal movement more emphasis on quietness and comfort, which has positive effect on physical and psychological health. If the body in a relaxed state, the body will secrete endogenous opioids that produce endorphins. If we do a physical exercise / sport lightweight body will produce β-endorphin, the hormone most efficacious among other hormone (Haruyama, 2011). Disminore pain occurs due to abdominal muscle strain due to the decay of the cells of the endometrium during menstruation. A decrease in pain scale and increase the perceived comfort of respondents affected by abdominal stretching. These interventions can reduce pain disminore because this movement can stimulate the hypothalamus that can secrete endogenous opioids from the body and produce endorphins. Endorphin is a natural sedative substances derived from the body so as to make the body feel more relaxed and comfortable. Based on research, the majority of respondents feel pain disminore as age of menarche at age 11 years. Ie mid teens aged 13 to 15 years old is still prone to menstrual pain or pain disminore, this is because the primary disminore pain began to emerge from six months to two years after menarche (Sukarni et al, 2013). The primary risk factor disminore yaiti influenced by age of menarche at age less than 12 years old, unmarried, and long periods of time (Anurogo, 2011). Young women whose menarche age gap of more than two years prior to the age now, it would be easy decreased pain intensity disminore. This is because at adolescence there is a process of growth, resulting in peningkatann namely reproductive organs have started to mature and reproductive hormones begin to stabilize. Disminore perceived because girls also started to decrease in physical activity so that more can arrange a lifestyle that is light exercise simply by doing abdominal stretching and more able to avoid other factors that trigger the pain disminore. A person's behavior in health requires knowledge that these young women

will avoid and will not experience stomach pain due to disminore.

3. Effect of coaching intervention: abdominal stretching for Comfort Level With Young Women Dysmenorrhea Cross Tabulation Table 7 Effect of coaching intervention: abdominal stretching of the pre respondents comfort and post intervention Comfort Level Pre Low Medium High Amount

Low Medium High Amount f % f % f% F % 2 10 0 0 0 0 2 10 8 40 3 15 0 0 11 55 0 0 1 5 6 30 7 35 10 50 4 20 6 30 20 100

Based on the table above shows that the respondents perceived comfort level before the intervention is implemented mostly (50%) of respondents have a comfort level in the low category. Once implemented the intervention increased comfort, the majority of respondents have a comfort level in the medium category. Wilcoxon analysis results with significance (ρ) = 0.001 and α = 0.05 where ρ <α then ρ = 0.001 <0.05 means that H1 is accepted, meaning that there is the influence of coaching intervention models: abdominal stretching of the level of comfort in adolescent girls with disminore. Results of research on the impact of coaching intervention: abdominal stretching of the level of comfort in young women with dysmenorrhea in SMP Negeri 1 Srengat, the Wilcoxon test analysis showed that there is an increased comfort after coaching intervention models: abdominal stretching. Significant level (ρ) value = 0.001 and α = 0.05 of the analysis results obtained (ρ) value = 0.001 and α = 0.05 is H1 accepted, it means that there is the influence of coaching intervention models: the streching abdominal increase the comfort by reducing the intensity of pain disminore in adolescent girls in SMP Negeri 1 Srengat. Abdominal stretching is one alternative to reduce pain due disminore. This intervention is a series of movements performed continuously by stretching muscles, 239

especially in the abdomen. Streching abdominal disminore made at the time, and can be done several times until it feels comfortable. Movement is done can be done independently, in groups, or even with the help of an instructor. Streching abdominal goal to help reduce the complaints of abdominal pain during menstruation and to help young women to relax. In accordance with the implementation of the first, starting from the gymnastic movements relaxed sitting position with your left leg straight ahead, then the right leg is bent transverse to the side of the left leg. Inhale while turning the body to the right. Exhale to its conclusion, and then do back in the right direction. Do this several times with the same intensity and in a matter of 2 x 8 count. Movement started from movements easy to difficult (Senior, 2008). This movement can suppress the diaphragm so as to increase the contractility of the heart muscle and lungs so that a smooth blood circulation. In accordance with a second implementation, the body supine sleeping position, then slowly bent left leg is placed on the chest, then the right leg bent, placed on the left leg, the position of the left hand is placed under the left leg. Perform full diaphragmatic breathing until it feels comfortable. Do the same with the other leg and count 2 x 8 count. If we do light exercise / physical exercise the body will release endorphins that reduce pain (Haruyama, 2011). This movement aims to relax the muscles thighs, pelvis, abdomen and back so as to expedite the circulation of blood by pressing the diaphragm so that the contractility of the heart muscle that can later be increased blood circulation and muscles around the stomach becomes more comfortable. In accordance with the implementation of the third, still in the body supine sleeping position, with legs bent. Then slowly lift the abdomen, pelvis, chest with hands remain beside the body. Perform full diaphragmatic breathing until it feels comfortable and is calculated as 2 x 8 count. This movement aims to relax the abdominal muscles, chest, thighs, hips and back so that blood circulation more smoothly so that the body is getting nyerasa relaxed and comfortable. In accordance with the implementation of the fourth, the telengkup sleeping posture, with legs straight back. Then slowly lift the

abdomen and chest with his hands as a pedestal. Perform full diaphragmatic breathing until it feels comfortable and is calculated as 2 x 8 count. This movement aims to relax the abdominal muscles, chest, thighs, hips and back so that blood circulation more smoothly so that the body is getting nyerasa relaxed and comfortable. In accordance with the implementation of the fourth, sitting cross-legged slowly, then save the head and body towards the front with the hand position is straight forward. Do it while a deep breath and count 2 x 8 count. This movement aims to relax the muscles around the stomach and can also suppress the movement of the diaphragm thereby increasing muscle contractility of the heart and lungs so it can be blood circulation and the body feels more comfortable. In accordance with the implementation of the sixth, with relaxed sitting position right leg straight, left leg bent inward. Then the right hand holding the fingertips right leg and left hand is pulled towards the right. Perform a deep breath until you feel comfortable and count 2 x 8 count. Do the opposite and repeat several times until it feels comfortable. The movement of being able to relax the muscles due to cover the thigh, abdomen, waist, pinggung and hands so that the blood circulation throughout the body become more smoothly and the body becomes relaxed and comfortable. Based on the theory that there can be defined that the interventions that have been given to respondents who experienced pain disminore very positive effect on physical and psychological health by using deep breathing and can stimulate the body to release endorphins endogenous opioids that mengkasilkan. Endorphin is a natural sedative that comes from inside the body. If the body relax then we put the body in the correct position and comfortable. Muscles are not tense and do not require so much oxygen and sugar, slow the heart beat, blood pressure drops, breath easier, relaxed body condition, the body can stop the production of hormones adrenaline and all the necessary hormones during stress, so it can reduce pain. Looks very significant difference from the results of the post-test, proving that the abdominal stretching effect on comfort and pain intensity disminore in adolescent girls. But in addition to the therapeutic factors, 240

respondents could set lifestyle and other factors that could cause pain intensity disminore being dropped off by exercising regularly and be able to avoid the factors that trigger increased disminore. In accordance with catherine kolcaba theory, elaborated on the theory of comfort in nursing. Kolcaba linking the three types of comfort with the convenience of four experiences: physical, psychospiritual, environmental and social. It is known that the appropriate assessment of the experience of comfort in the physical context, clients complain of pain scale 6. After Abdominal Stretching combination of six exercises, consisting of paint stretch, lower trunk rotation, hip stretch, abdominal strengthening: curl up, lower abdominal strengthening, and the bridge position to reduce menstrual pain for 10 minutes and evaluated using instruments cheklist comfort behaviors, pain in the client down from the pain scale 6 to 5. During done Abdominal Stretching technique clients are less able to focus on doing stretching exercises abdominal muscles, tend to be relaxed and still thinking pain he felt and the client still grinning withstand pain. Then do the Abdominal Stretching into two, clients seemed more relaxed and feel more comfortable and clients say the pain slightly reduced so that the pain scale fell from 5 to 4. In the evaluation using instruments comfort behaviors checklist after being given the implementation of the second increased value is 0.67 to 0.77. This shows that an increase in comfort. Pain scale clients are included in the category of being so continued action to reduce pain to mild pain that limits scale 1-3. At the time of abdominal stretching techniques third, clients feel more comfortable, and can no longer stand the pain grinning, clients say the pain much less than at the beginning prior to abdominal stretching, pain scale 4 fell to 3. And the score of the instrument balanced ride comfort behaviors checklist to 0.99. The higher the score the higher the level of comfort. Abdominal stretching techniques, effective to reduce pain because the exercises are designed to increase muscular strength, endurance, and flexibility of muscles, which is expected to decrease menstrual pain (dysmenorrhea) in women. This exercise should be done at the time of menstrual pain (Thermacare, 2010).

Abdominal stretching techniques can reduce stress and can increase the production of endorphins that affect pain reduction. Researchers are also using music that clients are more relaxed because the client's psychological state can affect the intensity of pain. In accordance with the theory Kolcaba (2005) in Peterson and Bredow (2010: 259) suggests some assumptions about the comfort among others: 1). Humans have a holistic response to the complex stimulus, 2). Convenience is a holistic expected results related to the discipline of nursing, 3). People are trying to meet the needs of active comfort. Convenience is more than the absence of pain, anxiety, and other physical discomfort. CONCLUSION Comfort level with disminore girls before coaching intervention: abdominal steching, mostly in the low category. Comfort level after doing the coaching intervention: abdominal steching in adolescent girls half of the respondents have a comfort level in the medium category. Coaching intervention: abdominal steching can improve comfort through reduction in pain intensity disminore in adolescent girls.

ACKNOWLEDGEMENT Thanks to the respondents, all participants SMPN 1 Srengat and Emy Nurul Hidayah as a partner in this study.

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dysmenorrhea. The Clinical Advisor. Diperoleh 26 Juni 2015 dari http://proquest.umi.com/pqdweb?index= 6&did=2195246451. Wong, Donna L., Eaton, Marylin Hockenberry, dkk. 2009. Wong buku ajar keperawatan pedriatric. Vol 1. Jakarta: EGC.

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SLOW DEEP BREATHING INTERVENTION REDUCE THE FREQUENCY OF RECURRENCE OF PATIENTS WITH ASTHMA BRONCHIALE

Nian Afrian Nuari Bachelor of Nursing Study Programe STIKES Karya Husada Kediri Email: [email protected] ABSTRACT Asthma is one of the problems that arise for people in various age and number of asthmatics is growing. Exercise have been widely used as complementary therapy people with Asthma Bronchiale. The goal this research is to analize effect of slow deep breathing intervention reduce the frequency of recurrence in patients with Asthma Bronkiale. This study used Pre Experimental Design with One Group Pre-Post Test. The samples in this study used purposive sampling technique with 10 respondents, while the instrument measured the value of PEFR used a flow meter and the frequency of recurrence in patients with Asthma Bronchiale checklist sheet and analyzed using the dependent sample t test (paired t test) with α 5%. The results showed that most respondents (88%) showed PEFR values increased and 60 % of respondents experienced a decrease in the frequency of recurrence of Asthma Bronchial after intervening slow deep breathing. Based on analysis of Paired T Test on PEFR values (p = 0.001) and the frequency of recurrence of asthma (p = 0.003), so it can be concluded that there is effect of slow deep breathing with the frequency of recurrence of Asthma Bronchiale. Slow deep breathing in the lungs causing get plenty of oxygen will flow throughout the body. This supports the activity of the cells and stimulate spending hormone such as endorphins to prevent the recurrence of asthma. Proper asthma management among others are making near-normal lung function, prevent recurrence, control regularly slow deep breathing. Keywords: Slow, Deep, Breathing, Recurrence, Asthma ,Bronchiale treat this disease. (nugroho, 2009). In indonesia is estimated to 17% of the population suffer from asthma in its various forms (sahat, c, 2008). Various studies show that asthma pravalensi in indonesia estimated 3 to 8.0%. For people with asthma in east java in 2003 as many as 21 925 people. To assess the severity of disturbance can be assessed by lung function tests that the inspection checks spirometridan peak expiratory flow (ape). In addition to using spirometry, ape value can be obtained through a simple examination using meter peak expiratory flow (pef meter). Results of pulmonary function tests in patients with asthma, it is known the existence of airway obstruction if fev1 (forced expiration volume first second) / fvc (forced vital capacity) <75% or fev1 <80% predicted value. Monitoring peak ekspiratory flow rate (pefr) is important to assess the weight of asthma, the degree of

INTRODUCTION Asthma is one of the problems for the people who were raised in various ages. Asthma is a chronic inflammatory disease respiratory disorder characterized by episodes of wheezing, difficulty breathing, chest tightness and coughing. According to who, about 100 to 150 million people worldwide are persons with asthma. This number continues to grow as many as 180,000 people every year. In indonesia, the prevalence of asthma is not known for certain, but estimated 2-5% of indonesia's population suffer from asthma (moh, 2006). In 2005 estimated 400 million people worldwide suffer from asthma with added 180,000 annually. The prevalence of asthma morbidity and mortality recently reported increasing worldwide, despite various new drugs continue to be developed and used to 251

diurnal variation, the treatment response when an acute attack, detection of worsening asymptomatic before it becomes serious, the identification of the originator for example exposure to the working environment and the frequency of recurrence of asthma (guidelines for the diagnosis and management of asthma in indonesia, 2003). In the study ambareesha, kondam et al (2012) reported on a study of medical students showed a slow deep breathing can improve pulmonary function (vital capacity, forced vital capacity and peak expiratory flow rate). Proper asthma management among others are making nearnormal lung function, prevent recurrence, control regularly and improve your fitness with exercise or exercise that is recommended (yunus, 2006). Respiratory muscles is one of the interventions in patients with bronchial asthma. Many theories that explain how respiratory muscle training is expected nati can improve lung function one is to slow deep breathing techniques. Slow deep breathing is a yoga practice which concentrates more on breathing and can be applied in patients with asthma. Slow deep breathing is beneficial to increase the maximum oxygen intake, and the circulation of blood to and from the lungs that can improve lung function (nadera, reyna, 2009). Research pramanik, et al. (2009) in adult patients found that respiratory bhastrika pranayamic in adults able to stimulate the frequency and duration of nerve impulses that activate the receptor pulmonary during tidal volume. It was able to increase vasodilation in blood vessels to lower peripheral resistance in the blood vessels so that it can lower blood pressure. , bhargava research results r (1998), shows the slow deep influence on the autonomic nervous changes associated with breathing and increase vagal rhythm and reduce sympathetic changes. The novelty of this study is the implementation of the slow deep breathing is rarely applied by people with asthma and have not done much research in indonesia on slow deep breathing with asthma sufferers in indonesia. Therefore, it was necessary to examine the effect of slow deep breathing is the pulmonary function in patients with asthma and frequency of recurrence of the disease.The purpose of this study was to determine the effectiveness of the method of Slow Deep Breathing in lowering the value of

Peak expiratory flow rate (PEFR) and the frequency of recurrence in patients with Bronchial asthma. METHOD The research design used in this research is to draft Pre Experiment Design One Group PrePost Test. This research was conducted in Puskesmas Bendo Kediri region and time of the study started in January-August 2015. The population in this study were all patients with asthma bronchiale in Puskesmas Bendo in January - July 2015. In this study, researchers set a number of samples of 10 people with a sampling technique by using purposive sampling. PEFR value measuring instruments used in the form of tools and sheet Peakflow meter check list. Frequency of Recurrence Asthma. The instrument used was the observation sheet. Slow deep breathing intervention for 1 month and monitored by researchers. Within a period of 1 month later, researchers conducted a post test to measure the return value of PEFR and asthma relapse frequency. Bivariate analysis was conducted to determine differences in PEFR value and frequency of asthma relapse during the pre-test and post-test with statistical test dependent sample t test (paired t test) with α (standard error) of 5%. RESULT Characteristics of Respondents a.Age Bronchial Asthma frequency distribution of patients by age, can be seen below:

Figure 1. Diagram Frequency Distribution Based Asthma Patients Age in June 2015 Kediri Based on Figure 1 indicates as many as five respondents (50%) had 61-70 years of age, 3 252

respondents (30%) were aged 51-60 years, 10% aged 31-40 years and 10% of respondents aged 41-50 years. b.Gender Bronchial asthma patients the frequency distribution by sex can be seen below:

Figure 4. Diagram Frequency Distribution Based Asthma Patients Body Height in June 2015 Kediri Figure 2. Diagram Frequency Distribution Based Asthma Patients Sex in June 2015 Kediri

Based on Figure 4 shows as many as eight respondents (80%) have a height of 141-150 cm, one of the respondents (10%) have a height of 131-140 cm and 1 respondent (10%) have a height of 151-160 cm.

Based on Figure 2. shows as many as nine respondents (90%) were female and 1 respondent (10%) male sex.

e.Weight

c.Long suffering Bronchial Asthma

40% 60%

1-5 Tahun 6-10 Tahun

Figure 5. Diagram Frequency Distribution Based Asthma Patients Body Height in June 2015 Kediri

Figure 3. Diagram Frequency Distribution Based Asthma Patients Sex in June 2015 Kediri

Based on Figure 5 shows as much as 6 respondents (60%) had a body weight of 31-40 kg, 3 respondents (30%) weight 41-50 kg and 1 respondent (10%) weight 61-70 kg.

Based on Figure 3 shows as many as six respondents (60%) suffered from asthma for 610 years and 4 respondents (40%) suffered from asthma for 1-5 years. d.Body Height

253

2. PEFR value respondents during the pretest and post-test can be seen below:

month, and as many as 1 of the respondents (10%) experienced a frequency recurrence 56x / month. After the intervention Slow Breathing deep as 3 respondents (30%) to not relapse, 3 respondents (30%) had experienced a recurrence frequency 1-2x / month and 3 respondents (30%) experienced a recurrence frequency 3-4x / month. Data Analysis Normality test using Kolmogorov Smirnov test data analysis with statistical tests Paired t test showed that the obtained PEFR p value of 0.001 (p <0.05), which means that there are differences in PEFR values before and after the intervention of slow deep breathing. While the frequency of recurrence of asthma was obtained p 0.003 (p <0.05), which means that there are differences in the frequency of recurrence of asthma before and after the intervention of slow deep breathing.

Figure 6. Diagram PEFR Value during pre and post test on Asthma Patients in June 2015 Kediri Based on Figure 6 shows as many as nine respondents (88%) experienced an increase in the value of PEFR after intervention Slow deep breathing and 1 respondent (12%) did not experience an increase in the value of PEFR after the intervention.

DISCUSSION 1. PEFR Value Analysis in Pre test The result showed that prior to dintervensi Slow Deep Breathing by 5 respondents (50%) has a value of PEFR below 250 l / sec and as one of the respondents (10%) has a value of PEFR 250 l / sec, and as many as four respondents (40%) PEFR above has a value of 250 l / sec. This suggests that in patients with asthma tend to have below normal PEFR value in accordance with a count of the age and height. To assess the severity of a disorder that occurs in asthma can be assessed by lung function tests, namely the examination of spirometry and peak expiratory flow examination (APE). In addition to using spirometry, APE value can be obtained through a simple examination using meter peak expiratory flow (PEF meter). Results of pulmonary function tests in patients with asthma, it is known the existence of airway obstruction if FEV1 (forced expiration volume first second) / FVC (forced vital capacity) <75% or FEV1 <80% predicted value. Monitoring Peak Ekspiratory Flow Rate (PEFR) is important to assess the weight of asthma, the degree of diurnal variation, the treatment response when an acute attack, detection of worsening asymptomatic before it

3.The Frequency Of Recurrence Bronchial Asthma Frequency of recurrence bronchial asthma in pre-test and post-test can be seen below:

Figure 7. Diagram frequency of recurrence during pre and post test on Asthma Patients in June 2015 Kediri Based on Figure 7 shows prior to the intervention as much as 6 respondents (60 %) experienced a recurrence frequency 3-4x / month, a total of three respondents (30%) experienced a recurrence frequency 1-2x / 254

becomes serious, the identification of the originator for example exposure to the working environment and the frequency of recurrence of asthma (Guidelines for the diagnosis and management of asthma in Indonesia, 2003). Mulyadi (2011) states that PEFR study in adults with asthma tend to decrease and male gender are also likely to experience a decrease in PEFR due to the influence of smoking history and others. While the value of PEFR in adults who suffer from lung disease also decreased the most with a value of 50-80%. This is in line with research that people who suffer from respiratory problems such as asthma bronchiale impaired PEFR. The results showed that as many as 8 respondents (80%) have a height of 141-150 cm and as much as 6 respondents (60%) had a body weight of 31-40 kg. PEFR values of the respondents varied according to the height of being owned respondent. This is consistent with Mulyadi (2011) states that the normal PEFR values associated with the individual's height and weight of individuals and PEFR values are also influenced by age, sex, history of respiratory problems and lung disease. It can be concluded that the normal value is affected PEFR weight and height.

applied in patients with asthma. Slow deep breathing is beneficial to increase the maximum oxygen intake, and the circulation of blood to and from the lungs that can improve lung function (Nadera, Reyna, 2009). In normal conditions we put on 10-15% of our ability to breathe every day. Deep slow exercise will increase the amount of blood being exchanged in the lungs. In normal conditions the amount of air entering the lungs in one minute keparu is as much as 16 x 500ml, whereas when doing yoga exercises has increased 4 x 4800 ml. Some of the benefits of yoga breathing is to increase breathing capacity, improve breath control, and increase the supply of oxygen. Pramanik, et al. (2009) in adult patients found that respiratory bhastrika pranayamic in adults able to stimulate the frequency and duration of nerve impulses that activate the receptor pulmonary during tidal volume. It was able to increase vasodilation in blood vessels to lower peripheral resistance in the blood vessels so that it can lower blood pressure. With the stimulus, there will be an increase in lung function and the effect on patient PEFR values. Slow Deep Breathing is an attempt to regulate and control the breath consciously that include setting the length and duration of inhalation and exhalation as well as efforts to hold his breath. With the application of slow deep breathing regulator happen coping mechanisms capable of inhibiting the release of CO2 that stimulate Bohr effect that will increase the amount of catalyst in chemical reactions release of oxygen from hemoglobin, which will accelerate the distribution of oxygen to the tissues. Besides, breathing exercises are also able to increase the use of NO (Nitric Oxcide) which stimulates Guanylil cyclase that activates cGMP and GTP that activates cGMP dependet that stimulates myosin light-chain phospatase activity that causes relaxation of the respiratory tract, causing dilation that can improve lung function measured by the value of Peak expiratory flow rate (PEFR) in patients with Bronchial asthma. Attempts setting of slow deep breathing breath on both inhalation and exhalation can also increase muscle flexibility intercostalis, pectoralis and trapezius resulting in increased levels of O2 in the lung that will improve lung function.

2. PEFR Value Analysis in Post test The result showed that after intervention Slow Breathing deep by 2 respondents (20%) had PEFR values below 250 l / sec and 8 respondents (80%) had PEFR values above 250 l / sec. This is consistent with research Ambareesha, Kondam et al (2012) reported on a study of medical students showed a slow deep breathing can improve pulmonary function (Vital Capacity, Forced Vital Capacity and Peak expiratory Flow Rate). Proper asthma management among others are making near-normal lung function, prevent recurrence, control regularly and improve your fitness with exercise or exercise that is recommended (Yunus, 2006). Respiratory muscles is one of the interventions in patients with Bronchial asthma. Many theories that explain how respiratory muscle training which is expected later can improve lung function one is to Slow deep breathing techniques. Slow deep breathing is a yoga practice which concentrates more on breathing and can be 255

3. The Frequency of Recurrence Analysis Bronchial Asthma in Pre Test

will berbedapada every height and weight (Guyton & Hall, 2001).

The result showed that before intervention Slow Breathing deep as 6 respondents (60%) experienced a recurrence frequency 3-4x / month, a total of three respondents (30%) experienced a recurrence frequency 1-2x / month, and as many as 1 of the respondents (10%) experienced a recurrence frequency 56x / month. Based on the characteristics of respondents by age is obtained as much as 50% of asthma patients aged 61-70 years. Most who develop asthma in adulthood. Based on the Report of the Basic Health Research (RISKESDAS) in 2007 found that the tendency of the prevalence of asthma has a tendency prevalence increases with age. The airways of asthmatics have distinctive properties that is very sensitive to various stimuli. Asthma attacks can occur at any age from children to adults (Sandaru, 2007). Younger asthma patients under age 30 years of about 70% due to hypersensitivity. In patients with asthma who are older, the cause hypersensitivity to non-allergic irritants in the air such as dust, respiratory tract infection, fatigue, changes in weather and excessive emotional expression. Allergic reaction that occurs will stimulate the formation of abnormal IgE antibody in large quantities and these antibodies cause allergic reactions. This is consistent with the findings that most of the respondents have more than 30 years of age with the age in which individuals experience hypersensitivity thus higher recurrence frequency becomes higher. Based on the characteristics by sex obtained mostly female. This is consistent with the results RISKESDAS 2007 which states that the prevalence of asthma there were no differences by sex. The results showed that as many as 8 respondents (80%) have a height of 141-150 cm and as much as 6 respondents (60%) had a body weight of 31-40 kg. Weight and height affect the respiratory muscle strength and lung function, these results are related to the theory that someone who has a high body large it will have the function of pulmonary ventilation is higher than the smallish. Inspiratory and expiratory function is affected by the height and weight as the ability to expand the chest

4. The Frequency of Recurrence Analysis Bronchial Asthma in Post Test The result showed that after intervention Slow Breathing deep as 3 respondents (30%) to not relapse, 3 respondents (30%) had experienced a recurrence frequency 1-2x / month and 3 respondents (30%) experienced a recurrence frequency 3-4x / month. Bhargava (1998), also showed Slow deep influence on the autonomic nervous changes associated with breathing and increase vagal rhythm and reduce sympathetic changes. Results were in line with this study that the autonomic nervous changes that will improve the lung function of patients. Slow Deep Breathing reduce sympathetic activity and give relaxation response. Relaxation of skeletal muscle also increases lung expansion. During slow deep breathing patterns will increase bronchiale increasingly enlarge the blood perfusion to alveoli. It is able to support a controlled breathing patterns and help reduce sensitivity to allergens that come from the environment. This mechanism which can affect a decrease in allergic reactions that may decrease the frequency of asthma relapse. Slow breathing in the deep causes the lungs to get oxygen and oxygen will flow throughout the body. If breathing is done regularly and concentrate, then the wave amplitude frequency bioelectrical energy fields in the body will take place slowly and steadily. This supports the activity of the cells and organs of the body to be in sync and stimulate spending antibodies that work against a variety of sources of disease and stimulate spending hormone such as melatonin, endorphins that calm the nerves and the mind. This is what causes asthma patients bronhiale can avoid repeated asthma attacks because the mind relaxed and stress do not cause the patient could avoid the stressor or allergens trigger asthma attacks. CONCLUSIONS RECOMMENDATIONS

AND

The results showed that the method of Slow deep breathing can affect the value of PEFR and asthma relapse frequency. Slow deep breathing method is able to increase the value 256

PEFR patients with asthma bronchiale and able to reduce the frequency of relapse of patients with asthma. Suggested this method can be applied as one exercise that is easy and inexpensive that can be carried out continuously by patients with asthma bronchiale.

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REFERENCES Ambareesha, kondam et al . 2012. A study to evaluate the effect of vital capacity (vc), forced vital capacity (fvc) and peak expiratory flow rate (pefr) in subjects practicing slow deep . Inter J Cur Res Rev. Vol 04 issue 19 Bhavanani AB , Sanjay Z , Madanmohan. 2011. Immediate effect of sukha slow deep on cardiovascular variables in patients of hypertension. International Journal Of Yoga Therapy [Int J Yoga Therap] . (21), pp. 73-6. Bhargava R , Gogate MG , Mascarenhas JF. 1998. Autonomic responses to breath holding and its variations following slow deep. Indian Journal Of Physiology And Pharmacology [Indian J Physiol Pharmacol] 1998 Oct-Dec; Vol. 32 (4), pp. 257-64. Black, Joyce & Hawk, Jane. 2005. Medical Surgical Nursing; Clinical Management For Positive Outcome. St.Louis: Elsvier.Inc. Camalia, S.Sahat.2008. Pengaruh senam asma terhadap kekuatan otot pernafasan dan fungsi paru pasien asma di RSU Tangerang. Thesis.Universitas Indonesia Dabhade AM ,Pawar BH , Ghunage MS , Ghunage VM. 2012. Effect of slow deep (breathing exercise) on arrhythmias in the human heart. Elsevier Country of Publication: United States NLM ID: 101233160 Depkes RI. 2003. Pedoman diagnosis dan penatalaksanaan asma di Indonesia Guyton & Hall . 2001. Buku Ajar Fisiologi Kedokteran. Jakarta : EGC, hal 14, 119, 120, 122, 124, 126

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EFFECT OF GIVING COGNITIVE SUPPORT AND EMOTIONAL SPIRITUAL QUOTIENT (ESQ) TO CHANGES SEXUAL BEHAVIOR PATIENTS HIV/AIDS Joko Sutrisno*, Yuly Peristiowati**, Alfian Fawzi*** STIKes Surya Mitra Husada Kediri Email: [email protected] ABSTRACT HIV is a health problem that threatens Indonesian and many countries around the world. Currently no country is free from problem HIV (Djuanda, 2011). Increases Case HIV/AIDS in the world , including in Indonesian, is one thing that soulder be a concern of many patients. One thing is considered to be a source of spread HIV/AIDS is a ryski sexual behavior . Risk Sexual Behavior a sexual activity ,especially those associated with vaginal and anal intercourse by individuals with sexual partners so that it becomes vulnerable to contracting sexually transmitted diseases as HIV/AIDS. One of the efforts to suppress the increase of HIV cases is chages in the sexual behavior of the sufferer so it does not infect other people who are stilln healthy . This result before and after intervantion Cognitive Support an ESQ Support Sexual behavior research before treatment to 80% commit sexual behaviors that lead to the spread of HIV / AIDS and after treatment 36% perform sexual behavior that causation to the transmission of HIV / AIDS. obtained from analysis Wilcoxon p value ,035 ≤ α 0:05 proved to effect cogntive support and increase to Emotional Spiritual Quotient (ESQ) expected sexual behavior patient HIV IDS. So the they will be more motivated to live better and carry out useful activities and get closer God ,Chages and Behavior an attitude positive and treatment are rutinely expected to increase Quality of life and status of people living with HIV /AIDS. Keyword : Cogntive Support, Emotional Spiritual Quotient (ESQ) , Sexual Behavior mother -to-child HIV NTRODUCTIONand positive ( 4.1 % ) MSM ( Men Sex Men ) ( 2.5% ) (Ditjen PP & PL Kemenkes RI, 2013). Based on the data obtained from the Dr. ISKAK Hospital Tulungagung known that the patients with HIV / AIDS in 2006 was 35 people , 2007 is as much as 42 , Year 2008 is as many as 62 people , 2009 was as much as 96 , Year 2010 is a total of 103 people , 2011 is as much 107 , 2012 is as many as 144 people , in 2013 was as much as 152 people . Based on the data obtained from space chrysanthemums during the last 5 months is known that in September 2013 is as many as 11 people , in October are as many as 26 people , November is as many as 17 people , December is as much as 4 people . While the month of January 2014 is as much as 7 people (medical record RSUD Dr. Iskak Tulungagung, 2013). The role of health care in the prevention and control of disease HIVdilakukan through outreach to the community ,

INTRODUCTION Globally an estimated 42 million people living with HIV/AIDS, They are composed 38,6 million adult, 50% of whom were women (19,2 million) and under 15 year (3,2 million) (WHO, 2007).according to report case of HIVAIDS from April to Juni 2013 in Indonesian the prevalence of report AIDS as many as 320 people . The highest percentage of AIDS in the age group 30-39 years ( 33.8 % ) , followed by the age group 20-29 years ( 28.8 % ) and the age group 40-49 years ( 11.6 % ) . The ratio of AIDS among men - men and women is 2 : 1.Jumlah highest AIDS were reported from South Sulawesi ( 80 ) , East Nusa Tenggara ( 76 ) , Lampung ( 50 ) , Banten ( 31 ) and Southeast Sulawesi ( 25 ) .Persentase highest AIDS risk factor is sex risk in heterosexual ( 78.4 % ) , the use of nonsterile syringes to IDUs ( 14.1 % ) , from

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mentoring high-risk groups and behavior change interventions communities, HIV testing and counseling services, Harm Reduction services, treatment and periodic inspection of sexually transmitted diseases (STDs), blood safety donors and other activities that support the eradication of HIV (Notoadmodjo, 2003). Besides, awareness of the self in people with HIV to not do things - negative things like sex uncomfortable still be done. One attempt was made to change the attitudes and behavior of people with HIV are giving cogntif support in the form of provision to people living with HIV and their family members, in addition to information also given motivation, psychological assistance, and providing spiritual guidance (Rasmun, 2004). Dihapkan by administering cogntif supportdapat change the attitudes and behavior of people with HIV become positive attitude and behavior, so that all activities undertaken will memotvasi HIV patients to improve their quality of life. Positive behavior will result in an increase in the immune system of HIV patients, which is indicated by elevated levels of CD4. Based on the above phenomenon, the researcher interested in conducting research with title “Effect Of Giving Cognitive Support And Emotional Spiritual Quotient (Esq) To Changes Sexual Behavior Patients Hiv/Aids”

Cognitive Support and Emotional Spiritual Quotient (ESQ) in Kediri City . c) Analysis Effect Of Giving Cognitive Support And Emotional Spiritual Quotient (Esq) To Changes Sexual Behavior Patients Hiv/Aids in kediri city METHODS This Research use methods Quasi Eksperimental using a study design One Group Pretest - Posttest Design. This research with population 20 Patient HIV/AIDS in groups Kelompok Dukungan Sebaya (KDS) in kediri. The sample used in this study are same 18 patients with HIV/AIDS in groups Kelompok Dukungan Sebaya (KDS) in Kediri City . a) Inclusion Criteria The inclusion criteria as follows : Patients with HIV / AIDS yang incorporated in peer support groups ( KDS ) in Kediri Patients who have HIV / AIDSyang incorporated in peer support groups ( KDS ) in Kediri which is a group at risk of transmitting HIV / AIDS . All Patients Patients with HIV / AIDSyang incorporated in peer support groups ( KDS ) in Kediri using ARVs regularly . b) Exclusion Criteria The exclusion criteria as follows : Patients with HIV / AIDSyang hospitalized in the Hospital ( in the condition of the drop ) Patients with HIV / AIDSyang cared for in the home are not conscious

OBJECTIVE DAN BENEFITS Objective Research 1. General objective Know Effect Of Giving Cognitive Support And Emotional Spiritual Quotient (Esq) To Changes Sexual Behavior Patients Hiv/Aids in kediri city . 2. Special Objective a) Identification of diffrent Behavior on Patient HIV/AIDS before Giving Cognitive Support and Emotional Spiritual Quotient (ESQ) in Kediri City . b) Identification of diffrent Behavior on Patient HIV/AIDS after Giving

This sampling used is Purposive Sampling methode namely sampling of members of the population in accordance with the criteria that have been known. This Independent Variabel to giving Cognitive Support and Emotional Spiritual Quotion Variabel Dependen. Changes Sexual Behavior Patients Hiv/Aids.

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KDS formed to the concerns and needs of fellow sufferers of HIV / AIDS in gaining support on an individual basis. KDS can provide a comfortable and safe place to interact, exchange ideas and information where solving an issue for people living with HIV, the preservation of confidentiality, and apart from a sense of isolation and remove the stigma and discrimination of people with HIV / AIDS.

Data Analysis Data analysis techniques were used to examine the Influence of Cognitive Support and ESQ Against Changes in sexual behavior in patients HIVpada Peer Support Groups (KDS) in Kota Kediridengan using test T-Test included the testing of nonparametric yaituuntuk compared between the two groups of related data with a level of confidence α = 0.05. In the calculation process aided by the help of Statistics Programme For Social Sience (SPSS) For Windows. To Wilcoxon Test Drawing conclusions hypothesis test results are:

KDS support given in the form of motivation both in patients and in the patients' family. This support is done * with the establishment of peer support groups (KDS) Friebdship plus in the town of Kediri, in which a container to provide support, motivation, and increased knowledge of HIV. KDS dilakuan activities, among others, performed once every month regular meetings that discuss permasalaha- Sesma problems that occur in people with HIV. The problems are discussed from their physical health, regularity of taking antiretrovirals, as well as problems concerning the psychological condition of people living with HIV. In addition to discussing the problems also are donors movement of partners involved This form of material assistance, as well as moral support and increased knowledge by giving counseling. KDS's presence in the city kediri provides many benefits for people with HIV. They can meet with friends - friends who have suffered the same so that they do not feel alone and lonely in the fight against the disease.

1. If p ≤ α = 0.05 means that H0 is rejected and H1 accepted meaning There Influence of Cognitive Supportdan ESQ Against Sexual Behavior Change in Patients HIVpada Peer Support Groups (KDS) in Kediri If p> α = 0.05 means that H0 is 2. accepted and H1 rejected, which means not There Influence of Cognitive Supportdan ESQ Against Sexual Behavior Change in Patients with HIV Peer Support Group (KDS) in Kediri RESULT Peer Support Groups (KDS) in the town of Kediri is a group that is potentially in assisting people living with HIV to the fullest. Therefore, its existence is need for support from the community and from the government. Empowerment of the KDS in the town of Kediri should try as much as possible to help people living with HIV in problem solving and provide motivation and good memberikandukungan moral, and spiritual. Expected with the implementation of science and technology for the people who carried on by STIKes Surya Mitra Husada Kediri can increase KDS role in pemberikan troubleshooting solutions for people with HIV / AIDS both physical problems, psychological and spiritual and efforts to combat HIV / AIDS in the town of Kediri.

PLHIV who are members of the Peer Support Groups (KDS) Friend Ship Plus in Kediri town of 100 people, they are composed of at risk groups such as female sex workers, drug users, Homo sex and also housewives. Until now recorded in Kediri in 2014, there were 456 patients in which 354 were patients and 102 HIV is AIDS. Of the total HIV / AIDS mother tumah ladder ranks second after the WPS (Women Sex Workers). Data from the Regional AIDS Commission Kediri record number of 69 people with HIV / AIDS is a housewife.

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KDS Friendship Plus was established on October 28, 2007 which has a secretariat at the Jalan Banjaran Gg. Carik No. 71B Kediri, E.mail: [email protected]. KDS organizational structure Friendship Plus chaired by Yudho, secretary / treasurer sister Mira, Division Kolif women and children, brothers and sisters Narmi Services Access Division

27% married unmarried 73%

Figure 5.3 Characteristics of respondents by marital status at KDS group Friendship Plus Kediri April 19 s / d 25 April 2015

Identifikation characteristic of responden a. Characteristics of Respondents by Gender

d. Characteristics of Respondents Based on ARV Consumption e.

47% 53%

Male

20%

routine consumption

Women 53% 27%

Figure 5.1 Characteristics of respondents by Gender at KDS group Friendship Plus Kediri April 19 s / d 25 April 2015 Figure 5.1 Characteristics of respondents by Gender at KDS group Friendship Plus Kediri April 19 s / d 25 April 2015

Variabel Of Research a. Identification of Sexual Behaviour HIV / AIDS before Intervension Cognitive support and Emotional and Spiritual Support

employee

27%

13%

7%

33%

No Consumption

Figure 5.4 Characteristics of respondents by consumption of drugs in the group of KDS Friendship Plus Kediri April 19 s / d 25 April 2015

b. Characteristics of Respondents by Job

20%

concumtion no routine

teacher 20%

entrepren eur WPS/Muci kari

Transmissi on 80%

Figure 5.2 Characteristics of respondents by job group KDS Friendship Plus Kediri April 19 s / d 25 April 2015

preventio n

Figure 5.5 Characteristics of respondents by sexual behavior Before treatment at KDS group

c. Characteristics of Respondents by Married Status

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Friendship Plus Kediri April 19 s / d 25 April 2015

decisions requires information that is relevant, useful, accurate and true. 1.2 Identification of diffrent Behavior on Patient HIV/AIDS after Giving Cognitive Support and Emotional Spiritual Quotient (ESQ) in Kediri City . sexual behavior after treatment at KDS group Friendship Plus Kediri 67% to prevention or 33 % transmission deseases

b. Identification of Sexual Behaviour HIV / AIDS after Intervension Cognitive support and Emotional and Spiritual Support

33% transmission 67%

Cognitive can be enhanced by changes in beliefs, emotions and behaviors. Another way to approach health social cognitive behavioral example is the effort to find ways of behavior related to health started from the consideration of people - those on health also take preventive measures depends directly on the outcome of confidence or health assessment (Herawani, 2012). social support from family members, close friends, tetanga. Social support as cognitive consisting of knowledge, information, verbal or non-verbal advice, real help or action is given by the familiarity of social and emotional benefits or have the effect of behavior on the part of the recipient. 1.3 Analysis Effect Of Giving Cognitive Support And Emotional Spiritual Quotient (Esq) To Changes Sexual Behavior Patients Hiv/Aids in kediri city . proven to exist effect of Cognitive and Emotional and Spiritual Support support to changes in sexual behavior patient HIV –AIDS dengan nilai P Value ,,035 ≤ α 0:05 proved effect cogntive support and increase to Emotional Spiritual Quotient (ESQ) expected sexual behavior patient HIV IDS. Cognitive is the acquisition, structuring and use of knowledge covering every mental behavior associated with the understanding of consideration, information management, problem solving, gaps and beliefs (Nurbani, 2008). So the they will be more motivated to live better and carry out useful

prevention

Figure 5.6 Characteristics of respondents by sexual behavior after treatment at KDS group Friendship Plus Kediri April 19 s / d 25 April 2015 c. Analysis Effect Of Giving Cognitive Support And Emotional Spiritual Quotient (Esq) To Changes Sexual Behavior Patients Hiv/Aids in kediri city proven to exist effect of Cognitive and Emotional and Spiritual Support support to changes in sexual behavior patient HIV –AIDS dengan nilai P Value 0,035 ≤ α 0:05 proved effect cogntive support and increase to Emotional Spiritual Quotient (ESQ) expected sexual behavior patient HIV IDS DISCUSSION 1.1 Identification of diffrent Behavior on Patient HIV/AIDS before Giving Cognitive Support and Emotional Spiritual Quotient (ESQ) in Kediri City . Sexual behavior Before treatment at KDS group Friendship Plus Kediri to transmission deseases 80% or prevention 20% According Herawani (2012), Cognitive Function Support (Information) that is as raw material for the decision, which everyone in any time will take the right

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activities and get closer God ,Chages and Behavior an attitude positive and treatment are rutinely expected to increase Quality of life and status of people living with HIV /AIDS.

Darwis, S. D. 2003. Metode Penelitian. Jakarta : EGC. DepKes, RI. 2005. Profil kesehatan Indonesia 2005. Dibuka pada website : http.//www,depkes.co. id. Pada tanggal 6 januari 2008).

CONCLUTION AND REKOMENDATION Conclution 1. From the research for a while it can be concluded that the provision of cognitive support and ESQ treatment in patients with HIV / AIDS Kelompok Dukungan Sebaya (KDS) Friendship Plus Kediri can be received well by respondenm, and respondents calls for this therapy regularly and continuously 2. This results of the identification characteristics of respondents by sex 53% male, 33% self-employed by occupation, by married status 73% did not / not married, based on consumption of 53% routine ARV ARV consumption, based on examination of 57% Normal CD4 levels and based blood tests 3. Sexual behavior research before treatment to 80% commit sexual behaviors that lead to the spread of HIV / AIDS and after treatment 36% perform sexual behavior that causation to the transmission of HIV / AIDS.

DepKes, RI. 2010. Riset Kesehatan Dasar. Jakarta : Badan penelitian dan pengembangan kesehatan Kementrian Kesehatan RI. 2010.

Djuanda, Adhi. 2011. Ilmu Penyakit Kulit dan Kelamin. Jakarta : Balai Penerbit FKUI. Ditjen PP & PL Kementerian Kesehatan RI. 2013. Laporan Perkembangan Situasi HIV & AIDS Di Indonesia Triwulan 2 Tahun 2013. Jakarta. DinKes Jawa Timur, 2013. Hawari, D. 2004. Al Qur‟an : Ilmu Kedokteran Jiwa dan Kesehatan Jiwa”. Edisi III (Revisi). Yogyakarta: PT. Dana Bhakti Prima Yasa. Herawani, 2012.Pendidikan Kesehatan Dalam Keperawatan. Jakarta : EGC.

5.1 Recomendation 1. Giving to cognitive support and ESQ in maintenance support odha and giving motivation support aand guidance both morally and spiritually to be able increases prevention ODHA in order to increase its life expectancy and Quality of live. 2. It should be further analysis to determine the effect of treatment on sexual behavior ODHA and improving the mental status and addiction to sexual habit.

Halim, M.S & Atmoko, W.D. 2005. Hubungan Antara Kecemasan Akan HIV/AIDS Dan Psychological WellBeing Pada Waria Yang Menjadi Pekerja Seks Komersial. Jurnal Psikologi. 15 : 17 - 31. Kurniawati, 2006. Coping Stres Pada Orang Dengan HIV/AIDS (Sebuah Studi Kasus). Skripsi. Surabaya : Fakultas Psikologi Universitas Airlangga.

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Lazarus, R.S & Folkman, S. 1984. Stress, Appraisal and Coping. New York : Spranger.

A.Aziz, Alimul Hidayat. 2010. Metode Penelitian Keperawatan Dan Teknik Analisis Data. Jakarta : Penerbit. Salemba Medika.

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Mandal, 2010. Penyakit Infeksi. Jakarta : Erlangga Medical Series.

Umar Zein, 2006. 100 Pertanyaan Seputar HIV/AIDS Yang Anda Ketahui. USU Press, Medan.

Nihayati, A. 2012. Dukungan Sosial Pada Penyandang HIV/AIDS Dewasa. Skripsi. Surakarta : Fakultas Psikologi Universitas Muhammadiyah Surakarta.

WHO, 2007. Pencegahan AIDS melalui promosi kesehatan : Masalah yang sensitif. Bandung : Penerbit ITB.

Notoatmodjo, Soekidjo. 2003, Pendidikan dan Perilaku Kesehatan. Jakarta : Rineka Cipta. Notoatmodjo, Soekidjo. 2007. Metodologi Penelitian Kesehatan. Jakarta : Rineka Cipta. Nursalam, 2008. Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan. Jakarta : Salemba Medika. Nugroho, P. 2009. Coping Stres Pada Orang Dengan HIV dan AIDS. Skripsi. Malang : Fakultas Psikologi Universitas Muhammadiyah Malang. Nurbani, F. 2008. Dukungan Sosial Pada ODHA. Skripsi. Jakarta : Fakultas Psikologi Universitas Gunadarma. Phillips, K.D. 2007. Social Support, Coping, and Medication Adherence Among HIV-Positive Women with Depression Living in Rural Areas of the Southeastern United States. AIDS PATIENS CARE and STDs. 21 : 667 - 680. Rasmun, 2004. Stres, Koping dan Adaptasi. Sagung Seto. Jakarta : EGC. Sugiyono, 2011. Metode Penelitian Kuantitatif Kualitatif Dan R&D (Edisi Revisi). Bandung : CV. Alfabeta. Stuart & Sunden, 2002. Principles and practice of psychiatric nursing sixth edition. St.Louis Missouri : West Line Industrial Drive.

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RELATIONSHIP OF WOMEN’S SELF PERCEPTION ABOUT MENOPAUSE WITH SELF READINESS IN FACING MENOPAUSE IN SELOSARI KANDAT KEDIRI. Shinta Kristianti Prodi Kebidanan Kediri Poltekkes Malang Email: [email protected] ABSTRACT Perception is interpretation process about something pass through seeing, hearing, and feeling sense. Menopause is the last of menstruation which is experienced by woman which still influenced by reproduction hormone, which will seem to uncomfortable thing in running life. It needs self readiness physically and psychologically in facing menopause. Purpose of this research was knowing the relation of self perception of 45th-55th years old woman about menopause with self readiness in facing menopause in Selosari Kandat Kediri. The research design was analytic survey with cross sectional time approach. The research was implemented in June 2014 with population 45th-55th years old woman in Selosari Kandat Kediri, sample was taken from population were 79 respondents. The instrument was questionnaire. The data analysis by Fisher Exact Statistic test. Women who had negative perception with ready category contains of 49 women (62,03 %), women who had positive perception with readiless category contains of 0 women (0 %). It was gotten from accumulation value of ρ account < ρ table (0 < 0,05). This research will show that there was relation of self perception of 45 th-55th years old woman about menopause with self readiness in facing menopause in Selosari Kandat Kediri. Health staff have to give counseling about menopause in local area. Keywords: Perception, Menopause, Readiness

BACKGROUND Women have a complex body. They experience a life with a process of development of anatomical, physiological, and reproduction, beginning in childhood, then grew into adolescence and adulthood. At the same time, growing and developing organs as well as a perfect woman. The most typical and distinctive of the women is the reproductive system. This is due to all of the processes that formed the reproductive system since women still fetus to grow up. Perfection was marked by the beginning of menstruation and from that moment all the organ anatomy, physical, and reproductive work together to enhance the female reproductive function. The process continues until the expiration of productive women, when menstruation stops permanently (Kasdu Dini, 2005). In general, people prefer to use the term "menopause", although the term is not appropriate, because menopause is only a momentary occurrence, namely the last menstrual bleeding. The most appropriate use is climacteric, the period of transition from the

reproductive phase to the phase of aging caused by the declining function of the generative (Baziad, 2003). Climacteric is a phase that women pass down the aging process and stop fertility. Menopause is a life after the last menstruation. Because it is the phase of life premenopausal women before menopause (Benson, 2008). Menopause occurs at that age varied, occurring on average menopause age 45-50 years, at present there is a tendency, for the occurrence of menopause at an older age of menopause for example in 1915 is said to occur at the age of 44 years, while in 1950 the menopause occurs at age approaching 50 years. According Manuaba (1999) the average menopause occurs at age 45-50 years with a clinical picture of normal menstruation stops. Most women begin experiencing symptoms in their 40s and reached its peak at the age of 50 years. Most experienced symptoms for less than 5 years old and about 25% over 5 years (Sibagariang, 2010). In the course of his life a woman who reaches the age of about 45 years, 287

aging ovaries, so it is unable to meet the hormone estrogen (Manuaba, 2009). Some of the changes that occur in the body due to lack of the hormone estrogen are: hot flashes (hot flushes), vertigo, sweating a lot, paresthesias (disorders skin feeling like tingling), spinal pain, muscle pain, depression, insomnia, vaginal discharge, and menstrual disorders (Sibagariang, 2010). In addition, the symptoms of menopause often acute and long-anxiety effect, such as cardiovascular disease and osteoporosis. Emotionally, menopause may indicate the timing of major change when women have the opportunity to make the assessment of the life he had been through, she may have to adapt to the changing role within the family and society, and have to face changes in the body and in life expectancy. Changes in physical, social, and emotional life, as well as psychological changes in women to make menopause become one of the biggest shake-up and self-analysis for some women. Menopause is an event that is very individual, with a variety of problems due to the "middle age" that accompany so how every woman receives and undergo a physical change is highly variable (Andrews, 2009). Such a situation can occur when individuals are not ready to face the climacteric, menopause, and senium (Manuaba, 2009). As a result of physical changes that can last longer and can affect the way women face other stresses that may arise at the same time. It‟s to very easy to blame the menopause for all the physical and emotional disturbance experienced by women in their ages. This assumption could be wrong, but it is true that the area of a woman's life that can always be managed by women suddenly become difficult to manage. Some women require treatment and other therapies, in addition to hormone replacement therapy, to help them cope with some aspects of their lives. Some women who arise in midlife is better treated using other therapies, not only hormone replacement therapy (Andrews, 2009).

METHODOLOGY The research design was analytic survey with cross sectional time approach. The research was conducted in June14 with population 45th-55th years old woman in Selosari Kandat Kediri, sample were 79 respondents was taken by purposive sampling. Independent variable of data from this study was women‟s self perception about menopause. Dependent variable was self readiness. The instrument was questionnaire, and the data analysis by Fisher Exact Statistic test.

RESULT Women’s Self Perception Women about Menopause The survey showed that 62,03% of clients had negative perceptions Table 1. Frequency Distribution Women‟s Self Perception Women about Menopause No.

Perception

f

%

1.

Positive

30

37,97

2.

Negative

49

62,03

Total

79

100

Self Readiness in Facing Menopause The survey showed that 100% ready in facing menopause Table 2. Frequency Distribution of Women‟s Self Readiness

RESEACH OBJECTIVES The objective of this research was anallyzing women‟s self perception about menopause with self readiness in facing menopause.

No.

Readiness

f

%

1.

Ready

79

100

2.

Not Ready

0

0

79

100

Total

288

Relationship of Women’s Self Perception about Menopause with Self Readiness in Facing Menopause

covers everything that broaden the knowledge of themselves and the world in which they live (Team Developer Education FIP-UPI, 2007). Based on the research results of Umi Rizky The majority of respondents were women aged Sari in 2009, most of the respondents have less 45-55 years who have a negative perception of knowledge about menopause with negative the category is ready to face menopause as perceptions of menopause complaints by 25 many as 49 people (62.03%) people. Sufficient information about menopause have a positive impact on the Table 3 Correlatios Analysis Result reaction of the respondents in facing menopause. Based on the above explanation, Readiness Ready Not Total ρ the perception is the process of interpretation Ready Value of a person through the senses of sight, taste, Perception f f% % f % and hearing. So what is seen from others, feel 30 37,97 0 0 30 37,97 Positive 0 the symptoms before menopause, and obtain information from others about menopause may 49 62,03 0 0 49 62,03 Negative lead to the perception of oneself. Negative 79 100 0 0 79 100 Total perception may also be caused because the mother has not feel the menopausal symptoms. Based on the results of data processing by One can understand the information in the Fisher Exact test statistic ρ value is 0, the error surrounding circumstances. Mothers who have level of 5% (0.05) the obtained values of 0.05 low knowledge, information held too little. ρ table. This means that ρ value <ρ table (0 The higher the knowledge, the higher the <0.05). With these results H0 is rejected and it absorption rate of the information so that the can be said that there is a correlation self information acquired can be well understood. perception women age 45-55 years of Conversely the lower knowledge, the patterns menopause the readiness self in face of thought to be low so that the absorption rate Menopause. of the information also becomes less. Low knowledge may also lead to a negative DISCUSSION perception. Self Perception of Women’s Women about Menopause

Self Readiness in Facing Menopause The distribution of respondents by readiness in facing menopause is entirely categorized as ready as many as 79 people (100%). This is supported by research Atik Ismiati the year 2010, the distribution of respondents by readiness of menopause largely categorized ready. A person who ready can control depression, anxiety, and emotional disorders in the face of the problems of menopause (Sukarni, 2013).

Perception of Self Female Age 45-55 Years of Menopause Perception of the respondents in this study are categorized into two, namely the perception of positive and negative. Respondents said to have a positive perception if the total score > mean and have a negative perception if the value of the mean total score ≤ Mean. The results showed that more than half of the respondents self perception of women aged 45-55 years of menopause is negative as many as 49 people (62.03%).

Based on the above explanation, the readiness defined as a state of the mother to prepare her to face menopause, both physically and psychologically. The period of this change will be passed well, if the woman is able to adapt to new conditions as they arise. A woman approaching menopause should always think positive that the condition is something that is natural, in order to be able to prepare themselves to face the menopause.

Soenaryo (2004) stated that the perception of the individual can realize and understand about the state of the environment in the surrounding areas as well as on the state of the individual concerned. This is consistent with the theory that perception is an experience that is generated through the senses of sight, hearing, and smell (Setiawati, 2008). In the broadest sense, both formal and informal education 289

menopause and establish confidence if the information that many around. Mothers who have a low probability of knowledge increasingly narrow social life because they only relate to those around her house, so it has little understanding and not much in touch with mothers who have high knowledge that allows mothers do not obtain information or insight about the menopause. Conversely, the lower the knowledge is not necessarily the more negative perceptions of menopause, when obtaining information or insight a little around.

Relationship Self Perception Women Age 45-55 Years of Menopause the Self Readiness in Facing Menopause Results of this analysis showed that there was no connection Self Perception Women Age 45-55 Years of Menopause the Readiness Self in Face Menopause in Hamlet Village Nglarangan Selosari Kandat Subdistrict Kediri. It was found that respondents who have a negative perception is more prepared to face menopause as many as 49 people (62.03%) and respondents who have a positive perception of the category is ready to face menopause as many as 30 people (37.97%). According to the perception of the process of extracting the information that is preparing to respond (Grace H, 2009). Thus, it is necessary to study how much information about the woman's climacteric owned, perception of stress experience, who relied on for a dependent, and ask for help (Bobak, 2004). Of course, support from family members, to make it more expedient to face attitude that menopausal women (Harmanto, 2006). There should also foster reading craze that has extensive knowledge about life. It would increase confidence that the larger (Santoso 2009). If you experience symptoms that make you feel uncomfortable, then you should consult with health professionals (Astikawati, 2006). This is supported by research Atik Ismiyati in 2010, that there is a correlation between the level of knowledge about menopause with the preparedness of menopause in premenopausal mothers in Housing Sewon Asri Yogyakarta. Seeing the existing data can be explained there are some things that cause this hypothesis is accepted, the perception appears to be no reaction from the person to prepare for the menopause. A person's perception was correlated with readiness in the face of menopause. It is influenced by pegetahuan. Knowledge varies greatly affect research. Though knowledge has nothing to do with the perception of menopause and menopause preparedness. The higher the knowledge, the higher the absorption rate of the information so that the information acquired can be well understood. Conversely the lower knowledge, the patterns of thought to be low so that the absorption rate of the information also becomes less. The higher the increasingly positive perception of knowledge about

Other studies above also states that there is a relationship of knowledge about menopause with menopause preparedness. Perceptions arise because of the knowledge of a person. This shows the perception that emerged resulted readiness in the face of menopause, so it does not interfere with the role of the individual. Therefore, in this study, low knowledge is not necessarily less prepared to deal with menopause. Many mothers who have a negative perception, prepared better to face the menopause. Here also the necessary support so that more families can accept the fact, as well as consultation with a health worker if you feel uncomfortable in dealing with the symptoms of menopause.

CONCLUSION It conclude that more than half of the respondents had negative perceptions of menopause and all respondents are ready to face menopause. There is a relationship selfperception of women aged 45-55 years of menopause with readiness in facing menopause. REFERENCES 1. Andrews, Gilly. 2009. Buku Ajar Kesehatan Reproduksi Wanita. Jakarta: EGC 2. Astikawati, Rina dan Amalia Safitri. 2007. Simple Guide Menopause. Jakarta: Erlangga 3. Azwar, Saifuddin. 2005. Sikap Manusia Teori dan Pengukurannya Edisi Ke 2. Yogyakarta: Pustaka Pelajar Offset

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5. Benson, Ralph C. 2008. Buku Saku Obstetri dan Ginekologi Edisi 9. Jakarta: EGC 6. Bobak, dkk. 2004. Buku Ajar Keperawatan Maternitas. Jakarta: EGC 7. Fakultas Ilmu Komputer, Universitas Indonesia. 2008. http://www.kamusbesaronline.com. Diakses jam 16:39, tanggal 7 Maret 2014. 8. Hardjito, Koekoeh. 2012. Pengantar Biostatistika. Jawa Timur: Forum Ilmiah Kesehatan 9. Harmanto, Ning. 2006. Ibu Sehat dan Cantik dengan Herbal. Jakarta: PT Elex Media Komputindo 10. Heffner J., Linda dan Danny J. Schust. 2005. At A Glance Sistem Reproduksi Edisi Kedua. 11. Hidayat, A. Aziz Alimul. 2007. Metode Penelitian Kebidanan dan Teknik Analisis Data. Jakarta: Salemba Medika 12. ___________________. 2009. Metode Penelitian Kebidanan dan Teknik Analisis Data. Jakarta: Salemba Medika 13. Ilmi, Nuril dan Titin E..N. 2012. Hubungan Persepsi Menopause dengan Kecemasan Menopause. Sidoarjo 14. Irianti, Indah dan Nina Herlina. 2010. Buku Ajar Psikologi untuk Mahasiswa Kebidanan. Jakarta: EGC 15. Ismiati, Atik. 2010. Hubungan Tingkat Pengetahuan tentang Menopause dengan Kesiapan Menghadapi Menopause Pada Ibu Premenopause. Surakarta. 16. K. Sukarni Icesmi dan Margareth ZH. 2013. Kehamilan, Persalinan, dan Nifas Dilengkapi dengan Patologi. Yogyakarta: Nuha Medika 17. Kasdu, Dini. 2005. Solusi Problem Wanita Dewasa. Jakarta: Puspa Swara 18. Mahfoedz, I. 2011. Teknik Menyusun KTISkripsi-Tesis-Tulisan dalam Jurnal Bidang Kebidanan, Keperawatan dan Kesehatan. Yogyakarta: Fitramaya

19. Manuaba, Ida Ayu C., dkk. 2009. Memahami Kesehatan Reproduksi Wanita Edisi 2. Jakarta: EGC 20. Muaris, Hindah. 2003. Makan sehat dan Lezat di Masa Menopause Sarapan. Jakarta: PT Gramedia Pustaka Utama 21. Notoatmodjo, Soekidjo. 2010. Metodologi Penelitian Kesehatan. Jakarta: Rineka Cipta 22. Nugroho, NSK. 2008. Transformasi Diri Memberdayakan Diri Melalui Hipnoterapi. Jakarta: PT. Gramedia 23. Nursalam.2009. Konsep Dan Penerapan Metodologi penelitian Ilmu Keperawatan Pedoman Skripsi, Tesis, dan Instrumen Penelitian Keperawatan. Jakarta: Salemba Medika 24. Pusat Data dan Informasi Kementrian RI. 2013. Gambaran Kesehatan Lanjut Usia Di Indonesia. Jakarta: Buletin Jendela Data dan Informasi Kesehatan 25. Rahmat H, Dede. 2009. Ilmu Perilaku Manusia Pengantar Psikologi untuk Tenaga kesehatan. Jakarta: TIM 26. Rosenthal, M. Sara. 2009. Pedoman untuk Wanita Revolusi Terapi Hormon. Yogyakarta: B. First. 27. Santoso, Hanna dan Andar Ismail. 2009. Memahami Krisis Lanjut Usia Uraian Medis dan Pedagogis-Pastoral:Jakarta: Gunung Mulia 28. Setiawati, S dan A.C Dermawan. 2008. Proses Pembelajaran dalam Pendidikan Kesehatan. Jakarta: TIM 29. Sibagariang Ellya, Eva, dkk. 2010. Kesehatan Reproduksi Wanita. Jakarta: TIM 30. Sugiyono. 2010. Statistika untuk Penelitian. Bandung: Alfa Beta 31. Sujianti dan Chandra Ayu Dhamayanti. 2012. Buku Ajar Psikologi Kebidanan. Jakarta: TIM 32. Sunaryo. 2004. Psikologi Keperawatan. Jakarta: EGC

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SMOKING BEHAVIOR WITH SLEEP DISORDERS (INSOMNIA) OF ADOLESCENT BOY IN JEPUN VILLAGE, SUBDISTRICT TULUNGAGUNG

Leny Indrawati 1, Presca Adi Prayogo 2 STIKes Hutama Abdi Husada Tulungagung Email: [email protected] Abstract Smoke and insomnia has hand in glove relevance. Even smoking is not predictor‟s the one only divides insomnia, but then nicotine which consists in smoke can cause stress on sympathetic nerve and parasympathetic nerve, so causes that person will make a abode to awake. To the effect this research which is to identify corelation between smoking behaviour with sleep disorder (insomnia) of adolescent boy in Jepun Village, Tulungagung‟s district Tulungagung‟s Regency. This observational method utilize analytic method. Executed research at Jepun‟s subdistrict Tulungagung on 17 th February – 17th March 2015, by use of research design “Cross Sectional”. This observational population is all adolescent boy which smoke, technics sampling utilizes purposive sampling with sample 47 striplings. For research it utilizes statistical quiz formula corelation Spearman-Rho. Base observational result, gotten that smoking behaviour of adolescent boy at Jepun‟s subdistric, Tulungagung‟s Regency at 2015, which is stripling with weight level smoker 43 persons (91,5%), Lightweight smoker 4 persons (8,5%) and insomnia on adolescent‟s Jepun‟s subdistrict boy which weight insomnia 43 (91,5%), lightweight level of insomnia 4 persons (8,5%). From statistical quiz result corelation Spearman-Rho gotten p = 0,000 < a = 0,05 therefore h0 refused and h1 accepted, its mean available Relationship smoking behaviour with sleep disorders (insomnia) on adolescent boy at Jepun, Tulungagung‟s District / Regency. Progressively heavy behavioural smoking on stripling, therefore getting weight too insomnia level on that adolescent. Expected adolescent one smoke at a swoop experience insomnia will stop to smoke than insomnia that their suffering can get over or minimal dwindling level acuted. Keyword: Smoking Behavior, Sleep Disorders (Insomnia), Adolescent Boy

INTRODUCTION

cardiovascular disease, cancer, fertility disturbing, born less months, Death or absent from work or school. Adolescent who smoking, growth and development of his lungs immediately affected would be the smoking immediately. The other effect of smoking is can cause insomnia. Nicotine in cigarettes classified stimulants. Stimulants are substances which gives a refreshing effects as well as caffeine and cocholate. Efect from nicotine is more stronger, evidenced with Research of Punjabi and his colleagues in 2006 examined the effects of nicotine on the sleep patterns of someone. (Prasadja, 2009). Smoking And Insomnia has a close

The international research conducted US Census Bureau, International Data Base of 2004 as reported by From Cureresearch, Saturday (05/01/2010) Indonesian people of 2004 amounted to 238 452 million, as many as 28 053 million people in Indonesia the affected insomnia or approximately 11.7 % . This Data just based indications are generally not take into account genetic factors, culture, environment, social, and ras. It can continue to grow as living style changes. (www.health.com downloaded on February 5, 2012) Consequences of smoking can increase incidence of respiratory tract infections differences, cough, asthma, sinusitis, 336

relationship. Although smoking is not the only predictor for insomnia, but nicotine contained cigarettes cause tension on Sympathetic nerve and parasympathetic nerve, causing the person would stay awake. In fact, when someone sleep, all nerves and human organ in relaxation, even Heartbeats was throbbing slow. On this essentially condition, man who can not sleep or experiencing insomnia is a condition where the someone nerves still continues work (contracts) when the person wants to review highly feel sleepy or relaxes nerve-the nerve to review a rest. Then, substances that can cause the triggering of the dopamine hormone for example is the caffeine in coffee, nicotine in cigarettes, and the alcohol in alcoholic beverages. (downloaded www.eMedicine.com on March 9, 2012) The data is justified Posted Dr. dr. Nurmiati Amir, SpKJ admitted that Indonesia Population About 10 Percent Paid From having trouble of sleep. Normal time for adult for a review of sleep is 6-7 hours. But the most of patients with Insomnia sleep 3-4 hours only. "Insomnia is a one medical condition frequently encountered but not diagnosed so no treated well," as Dr. dr. Nurmiati SpKJ in Event Management Comprehensive Insomnia press conference at the Novotel Mangga Dua Square, Jakarta, Saturday (05/01/2010) . According to her, if the Condition Continues to left unchecked, can reduce quality of life of sufferers so the impact triggering accidents. So it takes behavioral therapies and medications to review deal with insomnia. (www. health. com to download on February 5, 2012). Based on the findings of research carried Posted Health Center Tulungagung Tulungagung subdistrict Jepun during the month of April 2012 in at works region, the findings showed that smokers largest are young men in the Tulungagung district. There are 47 teenagers (80, 49%) of the results of research findings is a smoker (PHC Data Jepun, 2013). Based on the reason, researchers ALSO

addition to experience, as well as many of the adolescents that already smoke, researchers are interested in a review examining Relations the smoking behavior of young men age 15-23 years with Disorders Sleep Patterns (insomnia) in the Jepun village of Tulungagung subdistrict

METHODS In carrying out the research, researchers using the design study "observational" study namely on the research object is a moment. Research and observation on independent and dependent variables from the object of research conducted in conjunction in limited time, means that the object is not researched or continuously observed over specific time periods. That study was based on location Jepun Village Tulungagung subdistrict So the population of the research is some teenagers in the Jepun Village of Tulungagung subdistrict. Based the Data, the details of the study population was 47 Paid adolescence. Acumulated data of this study uses instrument label form interview and kuesionar then regrouped includes tabulation in accordance with drawn sub variables. In analyzing the relationship smoking behavior with sleep disorders (insomnia) at Young Men in the Jepun Village of the District / Tulungagung 2015 using Computer Assisted SPSS (Statistical Product and Service Solution Version 16 Windows) By type Rho-Spearman statistical test. To determine the relationship is p value ≤ α of 0.05 means that H0 is rejected, H1 accepted and Means stated there is relationships smoking behavior with sleep disorders (Insomnia) in young men in rural Jepun, If the value of p > α 0.05 means that H0 is accepted, and H1 rejected Means stating there is no relationships smoking behavior with sleep disorders (Insomnia) in young men in rural Jepun.

337

RESEARCH RESULT A. General Data 1. Characteristics of respondents by age male population in villages Jepun subdistrict / district Tulungagung. Based on Research findings showed that respondents that amounts of the 47 teenagers, mostly big respondents aged 1823 years (85%). 2. Characteristics of respondents by job man in the village Jepun subdistrict / Tulungagung From the research findings showed that respondents that amounts of the 47 teens, teens work in Jepun village sub-district / Tulungagung, Most big teenager not work (70%). B. Special Data 1. Smoking Behavior on young men in the village of Jepun.

Age

The mid teens (15-18) Late Teens (18-23) Total

Smoking Behavior Mild Moder Weight ate F % F % F % 4 8,5 0 0 8 17

12

25, 5

0

0

0

0

35

74, 5

35

74, 5

4

8,5

0

0

43

91, 5

47

100

most the weight smokers there are 43 teenagers. b.

Based on the study findings showed that respondents that amounts of the 47 teenagers. 18-23 year-old big portion Already Namely Heavy smokers as much as 35 teenagers.

Job

Smoking Behavior Mild

Total

Moder ate

Weight

∑

Smoking level

%

Frequency (F)

Percentage (%)

Lightweight

4

8.5

30

Medium Weight

0 43

0 91.5

33

70

Period

47

100

47

100

F

%

F

%

F

%

Work

0

0

0

0

14

30

14

Not Working

4

8, 5

0

0

29

61,5

Total

4

8, 5

0

0

43

91,5

c.

a.

Based on the study findings showed that respondents that amounts of the 47 teens, from the data that is most are not working behave smoke weight by 29 teenagers.

Based on the study findings showed that respondents that amounts of the 47 teens, 338

Total ∑ %

b. 2. Sleep Disorders (Insomnia) IN young men in the village of Japan a

Insomnia level

Frequenc y (F)

Age

The mid teens (15-18)

Percentage (%)

Light weight Medium

4 0

0

Weight

43

91.5

Period

47

100

Late Teens (18-23) Total

8.5

Mild

∑

%

F 4

12

25,5

0

0

0

35

74,5

35

74,5

4

8, 5

0

0

43

91,5

47

100

Sleep Disorders (Insomnia) Light weight

Me diu m

F %

F % F

%

F

%

4 8,5

0 0

0

4

8,5

Medium

0

0

0 0

Weight

0

0

Total

Mode Weight rate % F % F % 8, 0 0 8 17 5

0

Heavy

Total

c. Jobs

Lightwei ght

Total

Based on the study findings showed that respondents that amounts of the 47 adolescents, aged 18-23 years most big insomnia weight that's been experiencing as many as 35 teenagers.

. Smoking Behavior

Insomnia

4 8,5

0

0

0

0

0

0 0 43

91,5

43

91,5

0 0 43

91,5

47

100

F 0 4

Insomnia Moder ate % F % 0 0 0 8,5 0 0

F 8 35

4

8,5

43

Mild

Work Not Working Total

0

0

Weight % 17 74, 5 91, 5

Based on the study findings showed that respondents that amounts of the 47 adolescents, small portion that not working with experience lightweight insomnia 4 adolescents (8.5%), Weight experiencing insomnia that work at 8 teenagers (17%) and most big that not work with Insomnia weight experienced by 35 adolescents (74.5).

Based on the study findings showed that respondents That amounts Of the 47 adolescents, adolescents experiencing Insomnia Most big weight of 43 teenagers.

3. Relationship smoking behavior with Sleep Disorders (Insomnia) in young men 339

Total ∑ %

8 3 9 4 7

17 83 100

in the village of Jepun subdistrict / Tulungagung.

problem. There are many phenomena today we can see that teens especially teenage boys already to do smoke or being a smoker. Smoking behavior also influenced Work factors, base on Posted Theory * According Sitepoe (1997) that smoking For teenagers, especially teenage boys has become commonplace and can proud For them, even many of those who already become Active smokers. In Indonesia, children younger Starting smoking due to several factors, including the influence of the others, Peer Pressure, Want to customize the Self, Work. Work problem in Someone smoke Become Habits Should smoking be done BECAUSE WITH MORE Someone Becomes Quiet even Cigarettes contained Chemicals such as nicotine stimulates the brain The order The smoker feels Smart. ON findings The study was conducted Posted Research shows that teens are smoking more Final compared WITH the midle. Based on Theory The older teenagers Age The Ripe and Ready ACCEPT trials and matters would be faced, because that Posted Should End teen CAN anticipate Smoking behavior. Based on the findings of research done Turns that in adolescents Final MORE CAN precisely Many Are Becoming Heavy smokers caused Smoking habits Already Long And Difficult to review in the High-Level avoid even more against smoking dependence. Facts on the differences of some researchers believe that adolescents That Works interaction will be more spacious, so the potential for a review Posted affected his social environment, whereas adolescents who do not work have less Insights The affected area so it does NOT ABOUT Dangers And Lack Knowledge of the smoking. Based on Well then teenWorking and NOT Work have Heavy smokers Behavior. B. Sleep Disorders (Insomnia) ON Teens Based on Table 4.4 it is known that adolescents CAN The Insomnia weight of

Based on the study findings showed that respondents that amounts of the 47 young men in rural Jepun, adolescent smokers The Weight And Insomnia weight totaled 43 (91.5%), The lightweight smokers and insomnia Lightweight 4 (8.5%) C. Research Statistics Test Results Obtained Spearmanrho value of p = 0.000, while α = 0.05, p ≤ α It‟s mean H0 is rejected, H1 accepted and there is Relation between Smoking Behavior with Sleep Disorders (Insomnia) at Young Men in the Jepun village of the District / Tulungagung 2015.

DISCUSSION A. Smoking Behavior on young men Based on Table 4.1 the study findings showed that 47 Respondents who are heavy smokers of 43 (91.5%), with lightweight smokers 8,5% (4 orang). From the Data indicate that Of the 47 young men in the village of Jepun the majority is weight smokers. Based covers cross-tabulation table 4.2 Of the 35 respondents aged 18-23 years are weight smoker. Under cross-tabulation table covering 4.3 between the smoking behavior of teenage boys work in Rural Jepun Tulungagung 2015 showed that of the 33 teens who do not work there are Lightweight smokers behaves 4 teenagers, and behave in weight smokers are 29 adolescent smokers. Based on The Smoking behavior is influenced Posted factors Age, base on Posted Theory According to Hurlock (1999) that the age of youth smoking used on as emblem maturity. more teen age old who has a psychological that more on mature from a younger age, so increasingly age somebody, Ready The accept trials are also hearts and various 340

43 teenagers (91.5%). Clearly seen that 91.5% there are 43 young smokers in Jepun village experience Insomnia Sleep Disorders Weight. From the findings include cross-tabulation tables 4.5 BETWEEN THE Age of teenage boys with Insomnia in the village of Jepun Tulungagung 2015 showed that most adolescents aged 18-23 years big weight's been experiencing Insomnia That is a total of 35 adolescents (74.5%). From the findings include cross-tabulation table 4.6 BETWEEN Insomnia WITH Works teenage boys in the village of Jepun Tulungagung 2015 that shows that do not work as many as 39 teenagers and there are 35 adolescents (90%) that have trouble sleeping weight As well as the four teens (10%) Lightweight who have trouble sleeping. Based on the level of Insomnia The affected Age factors, Supported WITH Theory * According to the Theory Noorkasiani And S.Tamher (2009) that the Age of factors affecting the psychology of man, The More age can increasing of problem Should think so hard to review Night's Sleep. Based on the level of Insomnia What factors influenced the work.In Posted in Support BY Theory * According Noorkasiani And S.Tamber 2009 that states Insomnia Often Occur ON Work that has activity until hours or work to be done as soon as possible, thereby ALSO Student Very Often Less sleep in because The Many tasks. ON findings The study was conducted Posted Research shows that teens End more likely to have insomnia than middle teens. In Researchers WITH Increasingly Age The Many problems Should think so hard to review Night's Sleep. Facts on the differences of some researchers argue that the initial theory According WITH include cross tabulations BETWEEN THE work with Insomnia at young men in the village Jepun Tulungagung 2015 That shows the percentage of insomnia weight, ON

adolescents who worked more big of juvenile who is NOT ON works. Researcher advise review go to Bed Late BECAUSE can disturb activities the next day. C. Relationship Smoking Behavior WITH Sleep Disorders (Insomnia) Based on the data Table 4.7 obtained young smokers in Jepun Village, District / Tulungagung as much as 47 teenagers. ON teenager who have Weight smokers And weight Insomnia totaled 43 teenagers (91.5%). ON Above analysis founded Statistics Test Results Obtained Spearman-rho value of p = 0.000, while α = 0.05, BECAUSE p <α then H0 rejected and H1 accepted. Its mean there is Relation between Smoking Behavior with Sleep Disorders (Insomnia) ON Teens in Jepun subdistrict / Tulungagung. Effects Of Tobacco OR Cigarette Giving stimulation Lighter depression, fishing Disorders Power, insomnia, feeling, Thinking process, behavior and psychomotor functions. When compared to other addictive substances Cigarette very big effect, so dependence To Cigarette hard to break review of Sleep (Roan, 1979: 33). Proven smoking behavior can cause insomnia, Where Rafknowledge (2004: 58) states that one thing that can cause insomnia is nicotine. Nicotine is a stimulant in Cigarettes. Nicotine is a stimulant substance that function to review the working suppress nerve, Sympathetic Nerve Namely And the parasympathetic nerve to review contracting OR Fixed Work. * According to the researchers Smoking is Associated WITH Proven Sleep Disorders (insomnia) that experienced by young men in the village of Jepun Tulungagung. Increasingly Heavy smoke teenager more Tougher Sleep Disorders (insomnia) that experienced. And conversely more Lightweight Smoking behavior, The Light also Sleep Disorders (insomnia) that experienced. 341

It initials accordance BY results include cross-tabulations Relations BETWEEN Smoking Behavior WITH Sleep Disorders (Insomnia) AT Young Men in the village of Jepun subdistrict / Tulungagung That shows that, of the respondents That amounted to 47 young men in rural Jepun, juvenile who Weight smokers And Insomnia Weight amounted to 43 persons (91.5%) and The light smokers and insomnia Lightweight 4 persons (8.5%).

for a student to continue the review of research WITH Methods more Better. With Adding materials research A more complete and latest accordance BY Advancement of Science That The longer Increasingly Evolving as well as Research Methods The DIFFERENT degree of difficulty compared with what has been done Posted researchers BIBLIOGRAPHY Alghifari, Abu. 2003 Teen Fashion Victims. Bandung: Mujahid.

Conclusions and Suggestions From the findings of this study concluded that: 1. Smoking behavior of young men in the village Jepun, District / Tulungagung 2015, are teenagers who are heavy smokers are 43 persons (91.5%). 2. Level Insomnia ON young men in Jepun Village, District / Tulungagung CAN teenager who weight Insomnia are 43 (91.5%). 3. There is a relationship between the behavior of smoking with Disorders Sleep Patterns (insomnia) at adolescents boy in the Village of Jepun, District / Tulungagung 2015. As the Researchers suggestion : 1. For Respondents CAN expected increase understanding ABOUT Smoking behavior, and Insomnia so CAN stop smoking, smoking resulted CAN BECAUSE Jazz hospital diseases such as lung, heart, cancer, and Insomnia. 2. For Health workers should MORE improve health education To the young men in particular, in order to determine the impact of cigaret and BE MORE Maintaining healthy And Environment there around. 3. For Educational Institutions are expected to multiply literature of smoke that relation Sleep Disorders (insomnia) so that young people in rural Jepun CAN anticipate the danger posed smoke . 4. For Further Research papers WITH the research, is expected to be an inspiration

Anonymous. May 31, 2009. 10 Country WITH Paid Smokers World's Largest http://nusantaranews.wordpress.com. Accessed 6 April 6 April accessible .......... .......... Wake up, A.P. Attitude 2008. Wisely For Smokers. Jakarta: Indocamp. Budiarto. 2001. Biostatistics for a review of Medicine and Public Health. Jakarta: EGC. Bustan, M.N. 2000. Epidemiology of Infectious Diseases NO. Rineka Copyright: Jakarta. Ministry of Health. 2008. The Indonesia Health Profile 2007. Jakarta: Ministry of Health of the Republic of Indonesia. Hidayat, Aziz Alimul. 2006. Introduction to Basic Human Needs. Jakarta: Salemba Medika. Hurlock, Elizabeth. 1999. Developmental Psychology. Jakarta. PT Gramedia. Listiani, Amelia SS 2007. The Secrets of Sleep Well Tonight. Jakarta: Interaksara. Notoatmodjo, Soekidjo. 2005. Health Research Methodology. Jakarta: PT. Rineka Reserved.

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343

THE INFLUENCE OF HIP MOTION EXERCISES (STRETCHING) TO DECREASE LOWER BACK PAIN (LOW BACK PAIN) IN THE ELDERLY POSYANDU WONOREJO COUNTRY DISTRICTS SUMBERGEMPOL TULUNGAGUNG 2015 Ratna Kholidati 1, Dwi Intan sari 2 STIKes Hutama Abdi Husada Tulungagung Email: [email protected]

Abstract Agingis a biological process that isunavoidable. This phase i scharacterized for some decline inphysical activity and psychological and ageaggravate lowerback pain, as happens decrease the body's functions, especially bone elastic and onenonpharmacological treatment of lower back pain is the physical exercise such a ship motion exercises (stretching) which include slight and easy exercise. The goal in this research is know the influence of hipmotion exercises (stretching) to decrease low back pain in the elderly in the village Elderly IHC Wonorejo Sumbergempol Tulungagung subdistrict. The design used in this study is Quasy-experiment by comparing the results of pre test and post test. The study population was all elderly people of lower back pain in the Village Elderly IHC Wonorejo Kecamatam Sumbergempol Tulungagung on March 8, 2015, March 10, 2015 and March 14, 2015. Samples were taken with total sampling technique with a number of 32 respondents in accordance with the inclusion criteria. Retrieving data using observation sheets, and the data were analyzed with statistical test Wilcoxon Signed Rank Test. From the results of the study showed that there is influence of hip motion exercises (stretching) to decrease low back pain in the elderly in the village Elderly IHC Wonorejo Sumbergempol Tulungagung sub district indicated by the value of ρ=0,000<α =0,05. Therefore from these results we can conclude that the elderly experience lower back pain (low back pain) can be done physically exercises (stretching) to reduce lower back pain (low back pain) in the elderly.

Keywords: Elderly, Lower BackPain, Hip motion exercises (Streching).

have been hit by lower back pain (Paliyama, 2004). The more we age, the level of perceived pain and the number of elderly with lower back pain increased with age, especially over 65 years. And the average low back pain experienced by both sexes, but an outline of women into the higher incidence of the Low Back Pain (LBP). One of the things that cause this is menapouse. Menapouse cause women produce less estrogen that one of its functions is to maintain bone density. When these hormones are produced, and slightly less than the body needs, the risk of Low Back Pain (LBP) to be larger that is aggravated by heavy work or sitting too long (Jayson, 2002). Based on data from the Central Statistics Agency (BPS) in 2011, the number of elderly in Indonesia reached 18.96 million people. Of these 11.16% of which are in East Java province or region ranked number two highest

INTRODUCTION Aging or growing old is a biological process that is unavoidable. The aging process occurs naturally, it can cause physical problems, mental, social, economic, psychological. Potentially causing any circumstances that tend to the health problems of mental health in general and specifically in the elderly (Sumosadjuno, 2005). Stage elderly is a condition that must be faced by every human being, this stage is characterized by the presence of some decline in physical activity and psychological (Prawitasari, 2004). Age is a factor that aggravate the occurrence of lower back pain, so it is usually suffered by older people due to a decrease fungsi¬-function body, especially the bones so it is no longer elastic like the time when young. But as is often found young people

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number of lansianya after Central Java (Indonesia National Media, 2009). According to the WHO in 2011, In the UK reported the prevalence of low back pain in a population of approximately 16.5 million per year. And in the United States 60-80% reported experiencing lower back pain or Low Back Pain. Epidemiological data regarding low back pain in Indonesia does not exist, but an estimated 40% of the population of East Java island aged over 55 years had suffered from back pain, the prevalence in males 18.2% and 13.6% in women. Incident based on patient visits to several hospitals in Indonesia ranging between 3-17% (Sadeli & Tjahjono, 2011). According RISKESDAS (Health Research) in 2013, the prevalence of joint disease diagnosis based health workers (Health Workers) in Indonesia and 11.9 percent based on the diagnosis or symptoms of 24.7 per cent. Prevalence based diagnosis of health workers (Health Workers) Bali's highest (19.3%), followed by Aceh (18.3%), West Java (17.5%) and Papua (15.4%). Based on the data in Posyandu in November 2014 in the village Wonorejo districts sumbergempol tulungagung district, unknown number of elderly who recorded 61 elderly people and there are 35 elderly people, or about 22% of elderly with low back pain. Biologically elderly population is a population that is experiencing the aging process continuously. Which is characterized by declining physical endurance is increasingly vulnerable to disease that can cause death. This is due to changes in the structure and function of cells, tissues and organ systems. Most elderly who frequent complaints are pain in the lower back area (Hutapea 2005). Pain is an inconvenience in the development of events will mempenga ruhi various components in the body. The impact of pain can affect the physical, behavioral, and influence on daily activities. Although the pain is usually handled through the use of drugs, some technical nonpharmacological may also help control the pain: masasse, nerve stimulation with electrical transcutaneous (transcutaneous electrical nerve stimulation (TENS)), peng use of hot or cold compresses, meditation, hypnosis, and stretching , These techniques are generally safe, easily available, and can be

done at home or in an environment of acute care facilities (Stanley, 2006). In the treatment of back pain there are several actions that can be done in relieving back pain either by physical training or exercise pinngul motion. This exercise is not only to relieve pain, could be to merileksasikan muscles in the lower back due to regular physical exercise or sport back muscles will be more flexible and relaxed so it would be free to move and the pain can be reduced (Davies, 2007). Stretching (stretching) not only for athletes, but also for active people require stretching to relieve them from the pressure of stiff muscles. A number of researchers have shown that the more we age, the elasticity of the muscles will decrease, and stretching helps maintain flekbisilitas and assign physical appearance. If done correctly and regularly, stretching would be nice (Burke, 2001). Provision of hip motion exercises / stretching can help to reduce the time of the pain. Because it will automatically train the pelvic muscles become supple (aqila smart, 2010). Based on the description above, the researchers interested in conducting research "The influence of hip motion exercises (stretching) to decrease lower back pain (low back pain) in the elderly posyandu wonorejo country districts sumbergempol Tulungagung". METHODS The study design used quasyexperiment with using one-group pre-post test design. characteristic of this type of research is the use of a causal relationship by engaging a group of subjects. Group of subjects was observed before the intervention, and then observed again after the intervention (Nursalam, 2003). Population in this research is all elderly Posyandu Wonorejo In Sumbergempol Tulungagung subdistrict to 56 people. In this study the samples used all elderly low back pain (low back pain) at Posyandu village districts Wonorejo sumbergempol Tulungagung total of 32 respondents, with the inclusion and exclusion criteria. In data collection that is used for measuring instrument research was the observation sheet.

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The research was conducted on the 8th of March, 10 March and 14 March 2015 in the village of Wonorejo Elderly IHC Sumbergempol Tulungagung subdistrict. In analyzing the effect of hip motion exercises (stretching) of the lower back pain in elderly Elderly In Village Wonorejo IHC Tulungagung subdistrict Sumbergempol 2015, using statistical test of Wilcoxon Signed Rank test. If the p value <0.05 was said to be significant

namely the null hypothesis (Ho) is rejected, then H1 accepted meaning stated there Effect of hip motion exercises (stretching) of the lower back pain in the elderly, while p value ≥ 0.05, the null hypothesis is accepted and H1 rejected the means no Influence claims no hip motion exercises (stretching) to decrease low back pain in the elderly.

RESULT AND ANALYZE 1. Low Back Pain Before Exercise Motion Hips (Stretching) (Pre-test). Table 1 Distribution of Respondents Frequency Measurement Based on Lower Back Pain (Low Back Pain) Prior Following Hip Motion Exercise (stretching). Number

Low Back Pain

Frequency

Procentase (%)

1 2 3

Weight Moderate Light Summary

16 13 3 32

50% 40,6% 9,4% 100%

Based on Table 1 above it can be seen that out of 32 respondents before given

stretching half experiencing severe back pain as many as 16 people (50%).

2. Low Back Pain After Exercise Motion Hips (Stretching). Table 2 Distribution of Respondents Frequency Measurement Based on Lower Back Pain Prior Following Hip Motion Exercise (stretching). Number

Low Back Pain

Frequency

1 2 3

Weight Moderate Light Summary

0 22 10 32

Based on the table 2 above can be seen that out of 32 respondents after given motion exercises Hips (Stretching) most experienced moderate pain as many as 22 people (68.8%). Results of statistical test Wilcoxon Signed Rank Test in getting the value ρ = 0.000 where ρ <0,05 so that Ho rejected

Procentase (%) 0% 68,8% 31,2% 100%

and H1 accepted which means there is significant influence between the administration of Motion Exercise Hips (Stretching) The Lower Back Pain (Low Back Pain) In elderly In elderly Posyandu Wonorejo village Sumbergempol Tulungagung.

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Researchers agree with the above theory, that hip motion exercises (stretching) can reduce the level of lower back pain in the elderly. Stretching not only performed in the elderly but can be done by all ages.

A. The results of lower back pain before hip motion exercises (stretching). From the results of this study in elderly hip motion before training (stretching) at Posyandu Village Wonorejo Sumbergempol Tulungagung subdistrict, of 32 respondents showed that respondents who experienced light of low back pain are 3 (9.4%), moderate of Low Back Pain were 13 (40.6%) and weigh of Low Back Pain as much as 16 (50%) of the data is mostly elderly people experience lower back pain (Low Back Pain) total weight 16 people (50%). In the treatment of back pain there are several actions that can be done in relieving back pain either by physical training or exercise pinngul motion. This exercise is not only to relieve pain, could be to merileksasikan muscles in the lower back due to regular physical exercise or sport back muscles will be more flexible and relaxed so it would be free to move and the pain can be reduced (Davies, 2007). Researchers agree with the above theory, that hip motion exercises (stretching) done regularly can help to reduce pain in the lower back and free to indulge and pain can be reduced.

C. The Effect of Exercise motion analysis Hips (Stretching) The Lower Back Pain On Elderly Results of statistical test Wilcoxon Signed Rank Test in getting the value ρ = 0.000 where ρ <0,05 so that H0 rejected and H1 accepted which means there is significant influence between the administration of Motion Exercise Hips (Stretching) The Lower Back Pain (Low Back Pain) In Elderly In elderly Posyandu Wonorejo village Sumbergempol Tulungagung subdistrict 2015. In the treatment of back pain there are several actions that can be done in relieving back pain either by physical training or exercise pinngul motion. This exercise is not only to relieve pain, could be to merileksasikan muscles in the lower back due to regular physical exercise or sport back muscles will be more flexible and relaxed so it would be free to move and the pain can be reduced (Davies, 2007). In accordance with the results obtained by researchers and theory shows the influence of lower back pain before being given a hip motion exercises (stretching) and given setelahh hip motion exercises (stretching). This proves that the given hip motion exercises (stretching) in the elderly can reduce lower back pain (low back pain). Means the provision of motion exercises / Hips (stretching) no effect on low back pain (low back pain) in the elderly.

B. The results of lower back pain after hip motion exercises (stretching). From the results of this study in elderly hip motion after training (stretching) at Posyandu Village Wonorejo Sumbergempol Tulungagung subdistrict, of 32 respondents showed that respondents who experienced low back pain (Low Back Pain) light as much as 10 people (31.2%) and lower back pain (Low Back Pain) was as much as 22 (68.8%) of the data is mostly elderly people experience lower back pain (Low Back Pain) was as much as 22 people (68.8%). Stretching is not only in the show for the athletes, but also for active people require stretching to relieve them from the pressure of stiff muscles. A number of researchers have shown that the more we age, the elasticity of the muscles will decrease, and stretching helps maintain flekbisilitas and assign physical appearance. If done correctly and regularly, stretching would be nice (Burke, 2001).

CONCLUSIONS Based on the results of the study the effects of exercise hip motion (stretching) of the lower back pain (Low Back Pain) in elderly Posyandu Wonorejo Village District of Sumbergempol Tulungagung 2015 can be inferred from the 32 respondents in the analysis by using statistical test of Wilcoxon Signed Ranks Test with a value of ρ = 0.000, meaning that ρ <α = 0.05, so that H0 rejected H1 accepted and that means no influence 346

Granting Motion Exercise Hips (Stretching) With Lower Back Pain Decline In Elderly In Rural Elderly IHC Wonorejo Sumbergempol Tulungagung subdistrict 2015.

Pain (Online).( http://innappni.or.id. Accesed on 26th october 2014). Ismiati Cahyo, dkk. 2010. Posyandu & Desa Siaga. Yogyakarta : Nuha Medika

ACKNOWLEDGEMENT Nursing education institutions should equip students with knowledge about handling nonfarma-psychology lower back pain in the elderly, which can later be equipped nurses in applying science and knowledge to the people, especially the elderly. The result is expected as fill material for both increased insight and knowledge and skills perawata in increasing knowledge about how to lose lower back pain in the elderly, efforts are made to improve education and health promotion activities to the public.

Malcolm. 2003. Seri Kesehatan Bimbingan Dokter pada Nyeri Punggung. Jakarta : Dian Rakyat.

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Yuflihul. 2010. Pengaruh Latihan Gerak Pinggul (Stretching) Terhadap Nyeri Punggung bawah pada Lansia Di Dusun ketejer Desa Suka Makmur Kecamatan Gerung Kabupaten Lombok Barat NTB. Ebook‟Yuflihul Kharir. Accessed on 28th october 2014.

Hidayat, A.Aziz Alimul. 2007. Riset Keperawatan dan Teknik Penulisan Ilmiah. Jakarta: Salemba Medika. Idyan, Z. 2008. Hubungan Lama duduk Saat Perkuliah an dengan Keluhan Low Back

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(The Coreelation Between The Interest and Motivation of Becoming A Nurse And The Learning Achievement of The Student of Diploma III In Nursing Science at Hutama Abdi Husada Health Institute Of Tulungagung Sri Agustiana STIKes Hutama Abdi Husada Tulungagung Email : [email protected] Abstract The objective of this research are to investigate : ( 1 ) the correlation between the interest and the learning achievement, (2) the correlation between the motivation and the learning achievement, (3) the simultaneous correlation between the interest, motivation and the learning achievement.The method for this research was an observational analytical with the correlation design. The research started from December 2009 up to Agust 2010. The population, were all student semester IV ( fourth ) with total 91 student and all student semester VI ( sixth ) with total 121 students. As well as independent variable in this research were interest and motivation of becoming a nurse. The data at the research were gathered by using quetionnaire and document analysis. The data were then analyzed by using the multiple correlation technique of analysis.According to the result from analysis data and discussion which done by using significant 1% shows : (1) there is signification correlation between the interest and the learning achievement as indicated by r count > r table ( 0,764 > 0,159 ) with ρ = 0,000, (2) There is significant correlation between the motivation and the learning achievement as indicated by r count > r table ( 0,632 > 0,159 ) with ρ = 0,000 ; (3) there is simultaneous correlation between the interest, motivation and the learning achievement as indicated by Fcount > Ftable ( 103,58 > 4,74 )The result can be conclude that the research place founded students which have high interest and motivation to become a nurse, the academic achievement also high, the students which have moderate interest and motivation to become a nurse, the academic achievement also moderate. For the students to become a nurse, the academic achievement is fairly. This is caused by, the support from parent is strong but interest and motivation not come from their self. For the academic institution, better increase the learning achievement for student by way at improve and increase the quality teaching process, fulfill tool and infrastructure, as well as adequate human resources. Keyword : Interest, Motivation, Learning achievement INTRODUCTION The right choice for high school graduates who are interested and motivated to get a job is to continue their education to higher education such as Diploma III. One lane professional education in the health sector is education of Nursing Diploma III program. In the late, interest of the students entering the Diploma Nursing education tends to decrease. It can be seen from the data STIKes Hutama Abdi Husada Tulungagung, the number of applicants in the year 2006/2007 as many as 152 people, as many as 139 people in 2007/2008, 2008/2009 115

people and as many as 111 people in 2009/2010. One contributing factor is the lack of interest and motivation of students. STIKes Hutama Abdi Husada Tulungagung D-III Study Program of Nursing is the formal educational institutions that educate students to become professional nurses. To determine the success STIKes Hutama Abdi Husada Tulungagung as a professional educational institution needs assessment of students‟ academic achievement. Cumulative Performance Index (IPK) is a number that indicates the achievement of students from the

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first semester till the final semester. Predicate graduation Nursing D-III program in STIKes Hutama Abdi Husada Tulungagung as follows: IPK 2.00 to 2.75 predicate satisfying, IPK 2.76 to 3.50 VERY satisfying, IPK of 3.51 to 4.00 cumlaude. Student interest and motivation essential to achieve something to be desired. Students who have an interest and high motivation to become a nurse, then academic achievement is also high. But in reality, many students who are not interested in becoming a nurse. Though graduates of the Diploma of Nursing has a pretty good prospect. To achieve a high cumulative grade point it is necessary interest and motivation to become a nurse. Therefore it is very important to identify: whether there is a relationship between the interest and motivation to be a nurse with the Learning Achievement (in Students of D-III Nursing Program in STIKes Hutama Abdi Husada Tulungagung). The purpose of this research is to analyze the relationships between interest in learning achievement; analyzing the relationship between motivation and academic achievement; analyze the relation interest and motivation and learning achievement.

Husada Tulungagung totaling 297 students. The sampling technique using the Stratified Random Sampling. Stratified Random Sampling is a sampling technique by means of stratification of the list of all units of the population. The sample in this research is the Students of D-III Nursing Program in semester IV and VI. Forth semester students numbered 60 people. Sixth semester students numbered 79 people. Data were collected using a questionnaire. Questionnaire to gauge interest consists of 10 questions and questionnaires for measuring motivation consists of 17 questions. The answer choices are strongly agree, agree, undecided, disagree and strongly disagree. Whereas, this measure is used to obtain data learning achievement is a document in the form of student achievement scores such the last semester of IPK. Hypothesis test uses multiple correlation test. Double correlation is a number that indicates the direction and strength of the relationship between two independent variables together. Double two-variable correlation formula is: √

METHODS The research design used in this study was observational analytic correlational design. Reasons for using analytic observational design correlational design is to determine the relationship between the independent variables (interest and motivation to be a nurse) and the dependent variable (the learning achievement). This research is cross sectional. Dependent and independent variables were taken simultaneously with one observation. This research was conducted in STIKes Hutama Abdi Husada Tulungagung D-III study program of Nursing. This study was conducted from December 2009 to August 2010. The population in this study were all students of Nursing D-III STIKes Hutama Abdi

Testing the significance of the multiple correlation coefficient can use the Ftest with the formula: ( )( The calculation results are then compared to the price of Ftable (4.78). If the Fcount larger than Ftable then H0 rejected and H1 accepted. This means there is a significant relationship shared between the interest and motivation and academic achievement. RESULTS AND ANALYSIS Results of this study consisted of general data and specific data. General data include age and gender. While specific data consists of the

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)

interest to be a nurse, be a nurse motivation and learning achievement. The frequency characteristics of respondents by sex female 80 people (58%), while the male gender as many as 59 people (42%). The frequency characteristics of the respondents according to the age of students 15-20 years as many as 46 people (33%), and 21-25 years as many as 93 people (67%). Data student interest in becoming a nurse showed seven respondents (5.04%) have high interest, 88 respondents (63.31%) had moderate interest, and 44 respondents (31.65%) had a low interest. Data student motivation to be a nurse showed 6 respondents (4.32%) have high interest, 104 respondents (74.82%) had moderate interest, and 29 respondents (20.86%) had a low interest. Data student achievement shows three respondents (2%) had a performance index is very high, 79 respondents (57%) had a grade point well, and 57 respondents (41%) had a grade point enough, and no one has the less IPK. The correlation of student‟s interest in learning achievement of D-III study program students of Nursing STIKes Hutama Abdi Husda Tulungagung in 2010 showed there is correlation. This is indicated by the test results with the Pearson product moment correlation values obtained rcount > rtable is 0.764 > 0.159 (p = 0.000). While the relationship between motivation and learning achievement of D-III study program students of Nursing of STIKes Hutama Abdi Husda Tulungagung in 2010 also showed there is correlation. This is indicated by the test results with the Pearson product moment correlation values obtained rcount > rtable is 0.632 > 0.159 (p = 0.000). Data from multiple correlation test the correlation interest and motivation to be a nurse and learning achievement in the study program Student Nursing D-III STIKes Hutama

Abdi Husda Tulungagung in 2010 as in the following table: Correlation

Value

r1

0,764

r2 r3

0,632 0,777

Multiple Correlation Test Fcount = 103,58 Ftable = 4,78 significant

The table shows that there is a significant correlation between interest and learning motivation and academic achievement. With a standard error of 1%, the price of the F table = 4.78 and the price of the F count = 103.58. F count larger than F table (103.58 > 4.78). Then H0 is rejected and Ha accepted. This means that there is a significant relationship between interest and motivation and academic achievement. DISCUSSION 1. Relationship between Interests and Learning Achievement According to the theory Sandjaja (2005) that an activity will be performed or not is dependent once by a person's interest towards the event. This means that interest is very dependent on the values that make a person have a choice in life. Interest is the psychological aspect of a person to pay high attention to certain activities and encourages concerned to carry out such activities. With the support element of learning that support the learning process, it will facilitate the learning activities of students. Students with high interest will arise in the spirit of high achievement. While low interest will cause the students are not interested in learning. The results showed no significant relationship between interest to be a nurse and academic achievement. The value of rcount > rtable is 0.764 > 0.159 (p = 0.000). Students who have an interest in being in the category of enough about 88 people (63.31%) as

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well as academic achievement and also quite good. These results indicate the suitability of theory and research results showed that the higher a person's interest to be a nurse, then the learning achievement also increased. 2. Relationship between Motivation and Learning Achievement According to Hamalik (2008), that motivation is the energy change in a person who is characterized by the emergence of feelings and reactions to achieve the goal. Motivation is the driving factor in the self-learning students. Motivation is very important in improving student achievement. Students are highly motivated will seek to learn at any time. Instead students who have low motivation, it is also low learning motivation. This makes them lazy to learn, easily discouraged, and dependent on others. The results showed no significant relationship between motivation to be a nurse and academic achievement. The value of rcount > rtable is 0.632 > 0.159 (p = 0.000). Students are highly motivated as much as 50% with excellent academic achievement. Students who have the motivation was as much as 74% with good learning achievement. And only 26% of students have enough learning achievement. Based on theory and the results showed that students who have high motivation, the achievement of high academic achievement as well. While students who have low motivation, then the achievement of learning is also small. 3. Relationship between Interest and Motivation with Learning Achievement According Poerwodarminto (1990) learning success is the mastery of knowledge or skills developed by each subject and shown in the form of test scores. Learn to show some change in behavior as a result of exercise, or interaction with the environment. Interest and motivation has an important

role in the learning process. Interest and high motivation will strengthen a person to achieve what is desired. Students who have an interest and motivation to become a nurse more enthusiastic about learning and acquiring learning achievement. This is in accordance with the opinion of Sardiman (2007) that the learning process goes smoothly accompanied by high interest to learn. The results showed no significant correlation between the collective interest and motivation to be a nurse and academic achievement. Prices Fcount > Ftable is 103.58 > 4.78. From the description it can be concluded that the interest would influence the motivation to learn. And the higher the motivation, the better academic achievement. Meanwhile, the lower the interest, the motivation will decline thus affecting the academic achievement as well. CONCLUSIONS From the results of research and discussion, it can be concluded that: there is a correlation between interest in becoming a nurse with the achievement of students with rcount > rtable table is 0.764 > 0.159 (p = 0.000). There is a relationship between motivation to be a nurse with the achievement of students with rcount > rtable table is 0.632 > 0.159 (p = 0.000). And there is a significant relationship shared between the interest and motivation to be a nurse with student achievement, as shown by Fcount > Ftable (103.58 > 4.78). Suggest that can be given are: education institutions, should improve learning achievement of the students to improve their motivation. In addition, the organization of the learning process should be supported by adequate infrastructure. Creating a conducive learning environment, and improve the quality of teaching and learning processes. For students, should be able to follow the teaching and learning process in accordance with the provisions stipulated. Students need to increase interest and motivation to learn

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to achieve optimal learning. In addition to outstanding students awarded. Suggestions for researchers, this study can be used as a reference implementation of future studies.

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Sukmadinoto dan Syaodik Nana, 2009. Metode Penelitian Pendidikan. PT. Remaja Rosdakarya. Swansburg. 2001. Pengembangan Staff Keperawatan. Jakarta: EGC.

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THE EFFECT OF BABY MASSAGE TO THE IMPROVEMENT OF BABY’S APPETITE ON THE INFANTS AGED 7-12 MONTHS AT ARYOJEDING, REJOTANGAN, TULUNGAGUNG 2015 Yitno1, Dian Fitriana Ulfa2 STIKes Hutama Abdi Husada Tulungagung Email: [email protected] Abstract Currently many infants less appetite. Physiotherapy is a very large role in helping the growth process is the optimal infant massage, which is one of the benefits is that it can increase appetite and weight. The aim in this study was to determine the effect of massaging babies aged 7-12 months to increase appetite in the village of Aryo Jeding Rejotangan Tulungagung subdistrict. The method in this study using the analytical method. by using the design study "Pre Experimental (one group pretest-posttest)". The study population was all infants aged 7-12 months were enrolled in the Village District of Aryo Jeding Rejotangan that meet the criteria for inclusion and exclusion criteria as much as 20 respondents, and respondents who have been actually have criteria as a sample. For this study using the formula Willcoxon Signed Rank Test. Based on the results of the study Effects of Infant Massage Ages 7-12 Months Against Increased Appetite held on 23 – 28 February 2015 showed that 20 respondents before massaging all have less appetite, whereas after massaging all have normal appetite. From the statistical test result obtained Willcoxon Signed Rank test P = 0.00 <α = 0.05 then H0 is rejected and H1 accepted, meaning that there Effect of Infant Massage Ages 7-12 Months Against Increased Appetite in the village of Aryo Jeding Rejotangan Tulungagung subdistrict Year 2015. From this it can be concludedthat all infants aged 7-12 months experienced a lack of appetite so that the importance of infant massage physiotherapy done to improve the baby's appetite so as to achieve optimal growth according to age. Keywords : Infant Massage, Infant Appetite, Baby. PRELIMINARY Infancy is the golden period and also as the critical period of people development. It‟s said to be a critical period because at that time the baby is very sensitive to the environment and it‟s said to be golden because infancy lasted a very short and can not be repeated, if during these infants suffered malnutrition and don‟t get optimal treatment, the effect was lost generation, the lost generation (Department of Health). Infancy is divided into 2 (two) periods, neonatal period and post-natal period. Neonatal period starts from the age of 0-28 days, while the post-neonatal period starting from the age of 29 days - 11 months. Babies are individuals who are

weak and need adaptation process. Difficulty process of adaptation will cause the baby get weight loss, developmental delay, behavioral irregular even to death (Mansur, 2009). Physiotherapy has very big role in helping the optimal growth and development, so that it will form a quality generation. Infant massage is a form of physiotherapy that has positive effect on the growth and development of infants beside giving supplementary feeding (Roesli, 2001). According Roesli (2001) infant massage therapy is the oldest known human touch and the most popular. Infant massage is a form of stimulus / tactilekinesthetic stimulation is accompanied by stimulation of verbal communication as the

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embodiment of love affection of parents to the baby who have benefits for the baby. Infants are massaged by their parents will have a tendency to increase appetite or weight, good emotional and social relationships. In 2011 the number of babies in Indonesia are 4.3726 million inhabitants of toddlers 21,805,008 or 20.05% (Ministry of Health Indonesia, 2011). In Indonesia the implementation of infant massage in rural communities still held its role by consider traditional birth attendants (TBAs). Because they consider traditional birth attendants better understand and proficient to do infant massage has been practiced for centuries. (Roesli, 2010). Based on the results of RISKESDES in 2013 about the nutritional status of infants in the East Java, namely the prevalence of underweight children with Zscore <-3.0 SD. The prevalence by province and national. One of indicator to determine the child should be treated in the management of malnutrition is a very thin. The prevalence of very thin nationally in 2013 is still quite high at 5.7% severe malnutrition and malnutrition 13.9%, there is an increase compared to the year 2010 are poor nutrition and malnutrition of 4.9% and 13.0% in 2007 malnutrition 5,4% and 13.0% malnutrition. Over all prevalence of malnutrition and malnutrition increase in 2013. Generally, malnutrition is one of the terms of the disease-Protein Energy Malnutrition (MEP), that is a disease caused by lack of energy and protein. Depending on the degree of energy-protein deficiency that occurs, then the manifestation of the disease was different. MEP is often termed mild malnutrition. Whereas marasmus, kwashiorkor (often also termed malnutrition or HO), and marasmik-kwashiorkor include as heavy MEP. Infant who get malnutrition is a threat for future generations. This infancy is a growth and development period that‟s very rapid. If during these infants suffered malnutrition and do not get optimal treatment then the impact is lost generation. Physiotherapy has very big role

in helping the optimal growth and development, so that it will form a quality generation. Infant massage is a form of physiotherapy that has positive effect on the growth and development of infants beside giving supplementary feeding (Roesli, 2001). In the book Guidelines for Infant Massage (Utami Roesli 2005) mentioned that one of the benefits of touch therapy or massage can improve appetite and weight. If these actions are taken on a regular basis and in accordance with the procedures and techniques of baby massage, therapy could be beneficial for the baby. The positive influence of massage or touch on growth and development process of infants and children has long been recognized by humans. Infant massage can started after the baby is born, that‟s sure the younger infants should not be massaged as in infants. Touch and infant massage is done slowly and gently so the baby feel comfortable and make appetite to be great (Billy, 2005). Baby massage therapy has several benefits, there are make comfortable, stimulate blood circulation and increase energy, enhance endurance baby, reducing stress and make babies sleep better, can build love with parents (Roesli, 2009). Besides the benefits, there are also disadvantages among infants who were not massaged, that is the babies who do not gain weight, more slowly than the babies were massaged. And also have irregular sleep patterns than babies who massaged (Roesli, 2010). Baby massage is one of touch language and massage in baby after birth could provide guarantees for sustainable body contact that can sustain the feeling of safety in baby. Touch will also stimulate blood circulation and will add energy as waves of fresh oxygen will be more sent to the brain and througho ut the body (Roesli, 2001). Notice of the phenomenon, researchers interested in conducting the study titled "The Effect of Baby Massage Ages 7-12 Months To Increased Appetite In Aryo Jeding, Rejotangan, Tulungagung 2015".

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RESEARCH METHODS The study design is a strategy as guide the researchers guide on the whole process of research (Nursalam, 2007). In this study use "pre-experimental (one group pretest-posttest)". This study was done by giving a pretest (initial observations) before given the intervention, after the intervention is given, then given posttest (concluding observations) (Aziz, 2008). This design is also no comparison group (controls), but it already made the first observation (pretest) which allows researchers can test the changes after the experiment (Setiadi, 2007). Population is all subject or object with particular characteristics that will be studied. Not only the object or subject being studied but all the characteristics or properties owned by the subject or the object. (Aziz, Alimul, 2003). The population in this study were all infants aged 7-12 months were enrolled in Aryo Jeding, Rejotangan, Tulungagung there are about 20 babies. Sampling technique used in this study is purposive sampling technique, sampling based upon a something purpose. (respondents were chosen correctly - does have criteria as a sample) (Aziz Alimul, 2003). Instruments / measuring instruments used in this study is the observation sheet, that is a worksheet to observe and measure the level of achievement. (Aziz Alimul, 2003). Analysis using the Wilcoxon Signed Rank Test. If the results of the analysis showed p value <α (0.05) is said to be significant, the null hypothesis (H0) is rejected, then accepted H1 means that states there Effect of Baby Massage 7-12 Months Against Increased Appetite In Aryo Jeding, Rejotangan, Tulungagung 2015.

RESEARCH RESULT 1. Identification Appetite Before Massaging Table 1. Description of the appetite data before Massaging in infants aged 7-12 months. No 1 2 3 4 5 6

Age 7 8 9 10 11 12

Min

Max

Mean

SD

5 6 7

6 7 8

5,67 6,33 7,25

0,577 0,577 0,500 0,707 0,447 0,577

7 9 9

8 10 10

7,50 9,20 9,67

Source: Observation Research 2015 Based on the results of the study showed that from 20 respondents, 3 respondents aged 12 months has value average appetite as much as 9,67. 2. Identification of Appetite After Massaging Table 2. Description of the appetite data after Massaging in infants aged 7-12 months. No Age Min Max Mean SD 1 7 6 7 6,67 0,577 2 8 7 8 7,67 0,577 3 9 8 9 8,25 0,500 4 10 9 10 9,50 0,707 5 11 10 11 10,20 0,447 6 12 11 12 11,67 0,577 Source: Observation Research 2015 Based on the results of the study showed that from 20 respondents, 3 respondents aged 12 months has value average appetite as much as 11,67. 3. Analysis of The Effect of Baby Massage 7-12 Months Against Increased Appetite Table 3. Decription data of the effect of baby massage in Infants 7-12 month to increase appetite Data Age Before After

7 5,67 6,67

8 6,33 7,67

Rata - rata 9 10 7,25 7,50 8,25 9,50

Source: Observation Research 2015

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P 11 9,20 10,2 0

12 9,67 11,6 7

0,026

and regulated by the close interaction between the digestive tract, adipose tissue and the brain. Decrease in appetite is called anorexia, while polyphagia (or "hyperphagia") is increased eating. Appetite is said to be good / normal when the feeding process in order to meet the nutritional needs of the body, especially the energy balance running optimally (Arali, 2008). From the results above the researchers think there is compatibility between theory and the results of research, conducted massage is an attempt to add increased baby‟s appetite to obtain optimal conditions during the infant period.

Based on the table above shows that of the 20 respondents on average appetite before and after massaging have test results Willcoxon Signed Rank Test showed that the value of P = 0.026 (P <α = 0.05), which means there Effect of Baby Massage Ages 7-12 month Against Increased Appetite In Aryo Jeding, Rejotangan, Tulungagung, 2015. DISCUSSION A. Identification Massaging

Appetite

Before

The results showed, the baby‟s appetite before massaging from 20 respondents aged 7-12 months on average have less appetite than normal. Lack of appetite / lost will cause in weight loss that is undesirable and some other impacts, it cause strongly influenced by the eating procces disorders (physiological) and psychological influences (Arali 2008). Based on AKG nutrient deficiencies because of poor eating quality can cause various disorders of growth process and endurance. From the result above the researchers found a compatibility between theory and the results of research, massaging regularly will increase the appetite. This is accordance with Roesli‟s opinion (2005) which said that the benefits of baby massage can increase weight, growth and endurance. B. Identification Massaging

of

Appetite

C. Effect of baby massage 7-12 Months Against Increased Appetite

After

The results showed, the baby‟s appetite after massaging from 20 respondents aged 7-12 months have an average appetite approaching normal figures. Appetite is the desire to eat food, feel hungry (srimulyati, 2003). Appetite exists in all higher forms of life, and the function is to regulate intake energy sufficient to maintain metabolic needs

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Based on data analysis to determine the effect of massage infants aged 7-12 months to increased appetite with statistical test Willcoxon Signed Rank Test p value = 0.026 where p = 0.05, so that H0 rejected and H1 accepted, which means there Effect of Infant Massage Ages 7 -12 Months Against Increased Appetite In Aryo Jeding, Rejotangan, Tulungagung 2015. The correlation above is supported by the theory from Roesli (2009) infant massage can increase the intestinal peristaltic and increase in vagal tone (the brain's neurons to-10), which can lead to increased levels of the enzyme absorption gastin and insulin, it can increase appetite and absorption food becomes better so that weight‟s baby who appetite and massaged are increase than the baby who are not massaged. In this study, the importance of infant massage is proven effect to increase the appetite for optimal growth of the baby during this time. This is supported by research from Laurentina Fitriany & Novita Nurhidayati In Clinic Physiotherapy Handicamp International Wedi Klaten 2007, entitled Effects of Infant Massage Against Increased

Appetite Baby Age Above 6 Months, stating that babies are massaged increased vagal tone (the brain's nerve to 10) that will lead to increased levels of absorption gastin enzymes and insulin. Thus, food is absorbed better so the appetite massaged baby more than who are not massaged. CONCLUSIONS AND SUGGESTIONS A. Conclusion Based on the results of research at in Aryojeding, the respondent Rejotangan, Tulungagung can be conclude that from the 20 respondents were analyzed using statistical tests Willcoxon Signed Rank test with p <α = 0.05, so that H0 rejected and H1 accepted, which means there Effect of Baby Massage Ages 7 -12 Months To Increased Appetite In Aryo Jeding, Rejotangan, Tulungagung 2015. B. SUGGESTIONS 1. Suggestions for Development of Science The result is expected as input to add knowledge and skills of nurses in increased appetite. The efforts made to improve baby massage and health promotion to the public. 2. Suggestion for Program Development Educational institutions should give education for their students that is knowledge about the effect of baby massage to increase appetite. Knowledge about the effect of baby massage to increase the appetite will be the provision of nurses in applying science and knowledge to the community. BIBLIOGRAPHY Arikunto, Suharsini. 2006. Prosedur Penelitian Suatu Pendekatan Praktki. Yogyakarta : PT. Rieneka Cipta Alimul, Aziz. 2007. Metode Penelitian Dan Teknik Analis Data. Jakarta : Salemba Medika

.2003. Riset Keperawatan dan Teknik Penulisan Ilmiah. Jakarta : Salemba Medika Laporan Riskesdes RI. 2013. http : //www. DRiskesdes.co.id diakses 05 . Januari 2015 jam 09.47 Depkes RI, 2006.Pedoman Umum Pemberian Makanan Pendamping ASI (MP-ASI) Lokal. Jakarta. http://www.depkes/makananpenda mpingASI.com , diakses tanggal 13 Januari 2015 jam 20.07 Prabantini, Dwi. 2010. Makanan Pendamping ASI. Yogyakarta : CV ANDI OFFSET Hidayat, A. 2007. Metode Penelitian Kebidanan dan Teknik Analis Data. Jakarta : Salemba Medika Ikatan Dokter Anak Indonesia. 2010. Indonesia Menyusui. Jakarta : Badan Penerbit IDAI Maharani, Sabrina.2009. Pijat Bayi dan Senam Sehat Untuk Bayi. Jogjakarta : Kata Hati Mansur, H. 2009. Psikologi ibu dan anak untuk kebidanan. Jakarta : Salemba Medika Notoadmojo, Soekidjo. 2003. Ilmu Kesehatan Masyarakat. Jakarta : Rineka Cipta . 2003. Pendidikan Dan Perilaku Kesehatan. Jakarta : Rineka Cipta. Nursalam, 2005. Asuhan Keperawatan Bayi dan Anak. Jakarta : Salemba Medika. .2003. Metodologi Penelitian Kesehatan. Jakarta : Salemba Medika. , 2008. Pendidikan Dalam Keperawatan. Jakarta : Salemba Medika Rahayu.2010. Faktor Yang Mempengaruhi Pengetahuan Pijat Bayi. Jakarta : Trubus Agriwidya Rahmat, Mohamad.2003. Biostatistik Aplikasi pada Penelitian Kesehatan. Jakarta : Buku Kedokteran EGC Roesli, Utami. 2009. Pedoman Pijat Bayi. Jakarta : Trubus Agriwidya. . 2008. Pedoman Pijat Bayi Prematur Dan Bayi Usia 0 – 3 bulan. Yogyakarta : Trubus Agriwidya.

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Rosalina, Ina. 2007. Fisiologi Pijat Bayi. Jakarta : Trikarsa Multi Media. Soetjiningsih.1995. Tumbuh Kembang Anak: Jakarta : Penerbit Buku Kedokteran EGC.

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THE EFFECT OF INTERLEUKIN-1Β INDUCTION ON CHONDROCYTES

Anis Murniati 1, Siti Zulaikah 2, Ma'rufah 2, Rena Normasari 3, Sri Fauziyah 4, Ardani Galih Prakosa 5 1

(Department of Nursing, STIKES Hutama Abdi Husada, Tulungagung, Indonesia) 2 (Department of analitical medicine, AKMAL, Malang, Indonesia) 3 (Department of Pathology, Faculty of Medicine, University of Jember, Jember, Indonesia) 4 (Department of Fisiology, Faculty of Medicine, UNISMA, Malang, Indonesia) 5 (Department of Fisiology, Faculty of Medicine, Brawijaya University, Malang, Indonesia) e-mail: [email protected] Abstract IL-1β is a glycoprotein molecule produced and secreted in an inactive form called pro-IL-1β. IL1β stimulates the synthesis and activity matrikmetalloproteinase (MMPs), one of which is MMP13 and it also synthesis the other enzymes that cause cartilage degradation. IL-1β has the ability to suppress the synthesis of type 2 collagen, proteoglycans and inhibit TGF-beta serves to stimulate the proliferation of chondrocytes. Chondrocytes are cells contained in avascular tissue, synthesize all the elements contained in the cartilage matrix. The changes that occurred during the chondrocytes in vitro conditions also occur in the body of patients with osteoarthritis (OA). This research is a true experimental by using post-test only control group design, The aim of this research is to know the changes of chondrocytes and secretion of MMP-13 after being given recombinant human IL-1β. The result showed chondrocytes become hypertrophic, the cells swollen and the secretion of MMP-13 increased, the results are analized used un-paired t test obtained (p = 0.000), there are differences in the secretion of MMP-13 between groups were given IL-1β with a group were not given IL-1β. Chondrocytes induced IL-1β to produce MMP-13 and type X collagen which shows dedifferentiation toward hypertrophic phenotype. Stimulation of IL-1β activates several MAPK kinase (MAPKK) will then phosphorylates and activates MAPK, p38, c-jun N-terminal kinase (JNK) and extracelullar signal-regulated kinase (ERK) which will translocate into the nucleus. Next, MAPK phosphorylates and activates several transcription factors (ATF-2, c-jun, Elk-1 and Ets-1) that play a role in the transcription of MMP will further increase in the expression of Nuclear factor kappa B (NFkB) and activator protein 1 (AP- 1) and the secretion of proinflammatory cytokines occurs stimulation were able to induce chondrocytes to synthesize the MMPs and stimulates the normal chondrocytes becomes hypertrophic Keyword : IL-1β induction,chondrocytes, hypertrophic, MMP-13 ability to induce chondrocytes and synovial to synthesize MMPs, IL-1β has the ability to suppress the synthesis of type 2 collagen, proteoglycans and inhibit TGF-beta which serves to stimulate the proliferation of chondrocytes (Alejandro, 2011). Chondrocytes which were induced by IL-1β produce proteins that are not found in cartilage that produce collagen type I and III. It also produces alkali phosfatase, osteonectin, MMP-13 and type X collagen

Introduction IL-1β is one type of cytokine that plays an important role in the inflammatory response associated with the infections and diseases related to the immune system. IL-1β is a glycoprotein molecule produced and secreted in an inactive form called pro-IL1β. IL-1β stimulates the synthesis and activity of matrikmetalloprotein and other enzymes that cause cartilage degradation. IL1β is a pro-inflammatory cytokine, has the

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which shows dedifferentiation toward hypertrophic phenotype. It could be used as a marker chondrocytes osteoarthritis (OA) (Prasadam et al, 2010). The morphology of hypertropic chondrocyte has characteristics that drastically increased cell volume, chromatin core spread, a number of glycogen particles visible existing in the cytoplasm. In cytoplasm there are many rough endoplasmic reticulum, Golgi apparatus and lysosomes shape becomes very large. Chondrocytes synthesize the matrix metalloproteinases (MMPs) to break down the collagen type 2 and aggrecan. MMP has a workplace in a matrix surrounded by chondrocytes (Felson, 2008). Stimulation of cytokines to injury can stimulate matrix remodelling, but the over stimulation of IL1β can increase matrix degradation. TNF induce chondrocytes to synthesize prostaglandins (PG), nitric oxide (NO), and other proteins that have an effect on the synthesis and degradation of matrix. NO which were produced will inhibit the synthesis aggrecan and improve the process of protein breakdown on the network (Felson, 2008). Cartilage have a slow metabolism, with the change of matrix slow and orderly balance between synthesis and degradation. However, in the early phases of development OA has a very active metabolism (Felson, 2008). At the onset of OA, chondrocytes are stimulated to release aggrecan and collagen type two which is inadequate to the cartilage and joint fluid. Aggrecan in cartilage will often run out and braid collagen will easily loosened (Felson, 2008). The complex of matrix articular cartilage composition make chondrocytes difficult to replicate in the severe damage of collagen. During the early stages of OA, chondrocytes in vivo respond to structural changes in the surrounding cartilage matrix by proliferate and synthesize matrix proteins, proteinase, and the anabolic and catabolic factors.The changing nature of OA chondrocytes reflected fibrillation, depletion matrix, grouping the cells and changes in the quantity, distribution, or the composition of the matrix proteins. Evidence

of phenotypic modulation is shown in the increase of collagen type I, III, hypertrophic chondrocytes, collagen type X and the others chondrocytes differentiation (Felson, 2008). Mechanism of IL-1β in stimulating normal chondrocytes changes into chondrocytes that have a phenotype such as OA is to interact with the receptor, and then activate MAPK signaling and activate the transcription factor through AP-1, NFkB to stimulate MMPs that causes degradation of matrix degradation. In OA, the process of the matrix extracellular degradation by matrix metalloprotein (MMPs) faster than endogenous inhibitors of MMPs, it‟s called tissue inhibitors of metalloproteinases (TIMPs), which inhibit the degradation of matrix extracellular, this happens because the pathogenesis of OA, chondrocytes secrete proinflammatory cytokines, one of which is IL -1β (Nagase et al, 2010). This will exacerbate OA cytokines by stimulating excessive secretion of matrix degradation thus complicate treatment. Based on the above, the researchers wanted to know the role of IL-1β to changes either in the form of chondrocyte cells and secretion of MMP13. This study is expected to be the initial research for the development of therapeutics through the blocking of IL-1β or MMP-13. Materials and Methods This research is a true experimental by using post-test only control group design, The aim of this research is to know the changes of chondrocytes and secretion of MMP-13 after being given recombinant human IL-1β. It using random sampling technique. The experimental group was treated with human IL-1β recombinant and the control group was not induced by IL-1β then observed and measured the cells form and secretion of MMP-13. Each treatment was repeated 3 times. Material Cell line (Clonetics ™ Nhac-kn LONZA), Dulbeco's Modified Eagle's Medium (DMEM), Growth medium (Clonetics ™ CGM ™ BulletKit ™ LONZA), medium differentiation (Clonetics

365

™ CDM ™ BulletKit ™ LONZA), Chondrocyte ReagentPack ™, sodium alginate, a solution of CaCl2, NaCl solution, a solution of Na citrate, H2O, fetal calf serum (FCS), phosphate buffered serum (PBS), and fetal bovine serum (FBS). IL-1β human recombinant (Biolegend, California, Cat No. 579 402 ) 10 ng / ml (Mathew, 2001). Material for measurement type II collagen is collagen type II (R & D) antibody-coated 96-well plates (Bioassay Technology Laboratory, Shanghai. Cat no. E0717Hu), materials measurement of MMP13 is a microwell plate coated with monoclonal antibody to human MMP-13 ( Abnova, Taipei, Cat no.KAO182) 96 well, Biotin-Conjugate anti-human MMP-13 polyclonal antibody, Streptavidin-HRP, MMP-13 Standard, lyophilized, Assay Buffer Concentrate 20x (PBS with 1% Tween 20 and 10% BSA ), sample Diluent, Wash Buffer Concentration 20x (PBS with 1% tween 20), substrate solution and stop solution. Cell culture Thawing process, the chondrocyte cell line grown in sterile conditions in a laminar air flow (LAF). Thawing cell cryopreserved at a temperature of 37 ° C to melt. The culture medium (chondrocyte cell growth medium bulletkit TM LONZA) 1 ml was added to the medium containing the chondrocyte cryovial then dissolved transferred into 25 cm 2 culture flask already containing medium. Cell chondrocytes then cultured in a humidified incubator 37 ° C, 5% CO 2 until the cells attached to the base flask cultures after 2 days the cells were washed with serum free media and the culture medium was replaced with fresh medium, the cells were allowed to grow up to form a monolayer of fibroblast-like cell and achieve confluency 80-90%. The process of subculture, a culture that has reached confluency 80-90% then subcultured using reagentPack TM chondrocyte subculture reagents. If 90% of the cells had detached, trypsinisasi process was stopped by adding 6 ml of room temperature trypsin neutralizing solution (Lonza) and transferred in a 15 ml

falcon tube and centrifuged at 1000 rpm for 10 minutes.Obtained pellets (solid phase) which is the chondrocyte cells. Furthermore, the cells were collected for diredeferensiasi become mature chondrocytes cells. Redifferensiasi process, prechondrocyte cells can dirediferentiation into chondrocyte cells cultured in suspension by means of alginate bead. To ensure that cells cultured chondrocytes was carried out using a measurement of collagen type 2 medium then replaced with elisa media which is containing IL-1β dose of 10 ng / ml for the group treated incubated 24 hours later was measured MMP-13, a group that was not given IL-1β also measured MMP 13, before it is taken cell culture medium was observed with a microscope to see the changes in cell morphology. Measurement of MMP-13 by ELISA After preparing all reagents and samples to be measured, samples were taken from the medium, add 50 mL sample diluent into the sample well, add 50 mL biotin conjugate at all well, cover with adhesive films after incubation at room temperature for 2 hours in microplate shaker 400 rpm. After 2 hours of opening the cover, aspirated and washing all well with wash buffer, washing is done 3 times, aspirated and dried with a tissue. Then add 100 mL of streptavidin-HRP diluted at all well, cover with adhesive films after incubation at room temperature for 1 hour at 400 rpm shaker mikroplate. After 1 hour open the cover, aspirated and washing all well with washing buffer, washing is done 3 times, aspirated and dried with tissu. added 100 mL of TMB substrate solution at all well and incubation at room temperature for 10 minutes, keep it away from light. Add 100 mL of stop solution into each well shaken gently until it forms a uniform color (± 1 hour). ELISA results read by ELISA reader at a wavelength of 450 nm. Calculation multiplied by 2 as the dilution factor. Result Culture in the flask after thawing observed every 2 days when replacing medium. Observations using light

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microscope to see the development of the cell. After reaching confluency 80% in the flask, the cells were transferred into 24-well culture plate and the medium was changed every 2 days, the cells were allowed to grow until it reaches confluency 8090%. Chondrocyte cells that are too long are planted in monolayer tend to undergo dedifferentiation. Chondrocyte cells that round will lose the properties of phenotype and morphologic change into fibroblast like chondrocyte (chondrocyte similar to fibroblasts) (Figure 1 (B)). In these circumstances, markers such as collagen type 2 in chondrocytes will go down or not generated so as to restore the properties of chondrocytes, should redifferentiation for 3 weeks using alginate bead. Fibroblast like chondrocyte not produce collagen type 2, while physiologically chondrocytes producing collagen type 2 so as to ensure chondrocyte phenotype results redifferentiation have normal chondrocytes, the measurement of collagen type 2 (De Ceuninck, 2004). As a comparison measurement of collagen type 2 of the culture medium DMEM-10% FCS without cells, fibroblast like cell culture medium before redifferentiation and medium of chondrocyte cells after redifferentiation (Figure 1 (A)). Measurements by ELISA.

light microscope magnification of 400x, chondrocytes culture transformed nature into fibroblast like cells (B) before diredifferensiasi, forms flattened, elongated, translucent white color, arrows indicate cells undergoing changes resemble fibroblasts.

collagen type 2 concentration (ng/ml)

100 80 60 40 20 0

b

a

a

DMEM-10% Chondrocytes Chondrocytes FCS (without cells before cells after cells) differentiation differentiation Medium

Figure 2. The concentration of collagen type 2 chondrocyte cell culture medium, measurements using ELISA method. Medium DMEM-10% FCS without chondrocyte cells, collagen type 2 concentration of 15.3 ng / ml, DMEM medium chondrocyte cells that change into fibroblast like cell morphology (B), the measurement results of type 2 collagen concentration of 15.6 ng / ml and DMEM medium chondrocyte cells after diredifferensiasi (C), collagen type 2 concentration of 77.9 ng / ml. The results (Figure 2) used as a benchmark further treatment is administration of IL-1β and incubated 24 hours. After incubated 24 hours later seen with microscope and got a few cells undergo hypertrophy (Figure 3).

(A) (B) Figure 1. Cell culture chondrocytes day 8 in medium DMEM-10% FCS seen with a light microscope magnification of 400x, chondrocytes reached confluency 80%, rounded cell shape, fluorescent yellow light (A) and chondrocyte cell culture day 11 in medium DMEM-10% FCS, seen with a

367

chondrocyte cell cultures after induction of IL-1β, the medium is taken 24 hours after induction of IL-1β.The average concentration of MMP-13 cell culture chondrocytes without induced IL-1β of 1.422 ng / ml, the cell culture chondrocytes induced IL-1β amounted to 7.947 ng / ml. Examination by ELISA method. Analysis and discussion The role of IL-1β in chondrocyte morphology Observation of cell shape chondrocytes in group induced IL-1β and were not induced differences morphology that is at chondrocytes were not induced IL-1β cells are round and small whereas in the group induced showed morphological chondrocytes transformed into hypertrophy, cell shape enlarged ( figure 3). IL-1β is a proinflammatory cytokine, has the ability to induce chondrocytes and synovial to synthesize MMPs, IL-1β has the ability to suppress the synthesis of type 2 collagen, proteoglycans and inhibit TGF-β that serves to stimulate the proliferation of chondrocytes. IL-1β is a cytokine that plays a role in the inflammatory process (Alejandro, 2011). This is consistent with most previous research that states in cultured chondrocytes induced IL-1β to produce proteins that are not found in cartilage that produce collagen type I and III. Chondrocytes induced IL-1β also produces alkali phosfatase, osteonectin, MMP-13 and type X collagen which shows dedifferensiasi toward hypertrophic phenotype (Prasadam et al, 2010). Hypertrophy occurs due to IL-1β interacts with the receptor and activate signal MAPK and work to activate the transcription factor through AP-1, NFkB to stimulate spending MMPs that degrade the matrix and release cytokines, stimulates cells to the dedifferensisasi so chondrocytes undergo changes in phenotype become hypertrophic.

(A) (B) Figure 3. Comparison of morphological between normal chondrocytes with IL-1β induction chondrocyte. Redifferentiation chondrocyte cells in medium (Clonetics ™ CDM ™ BulletKit ™ LONZA), was observed using inverted microscope with a magnification of 200x. (A). showed morphological normal chondrocytes in alginate beads and medium redifferensiasi. (B). Morphology shows chondrocytes that have been induced by IL1β for 24 hours, chondrocytes undergo morphological changes become hypertrophic, dilated cell shape. This morphological change one marker has become OA chondrocytes. The arrows indicate cells undergoing hypertrophy. Results of measurements of the concentration of MMP-13 in the group induced and not induced as follows: MMP-13 concentration (ng/ml)

10

*

8 6 4 2 0 IL-1β (-)

Sample

IL-1β (+)

The role of IL-1β in chondrocyte in the secretion of MMP-13 Changes in chondrocyte metabolism driven by the presence of pro-inflammatory

Figure 4. Comparison of concentrations of MMP-13 cell culture chondrocytes without induced IL-1β and MMP-13 concentration

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mediators. One of the pro-inflammatory mediators potential and play an important role in the pathogenesis of OA is IL-1β, IL1β has the ability to stimulate chondrocytes for the synthesis of MMP (Aigner et al, 2006; Roman, 2006; Weber, 2010).). In this study showed that the induction of IL-1β increases the secretion of MMP-13 significantly compared to the group that was not induced (Figure 4). Induction of IL-1β activates several transcription factors such as NF-kB, AP-1, c-jun terminal kinase (JNK) and p38 MAPK. Activation of NF-kB is able to induce some of the target gene transcription works on the inflammatory process, immune system, cell proliferation, cell cycle and apoptosis. NF-kB activation may induce several MMP genes, one of which MMP-13, so that the OA increased MMP-13. Results of the study says the average concentration of MMP-13 in normal chondrocytes 1.422 ng / ml, while the IL-1βinduced chondrocyte average concentration is 7.947 ng / ml. SPSS test results un-paired t test obtained (p = 0.000), there are differences in the secretion of MMP-13 between groups were given IL-1β with a group who were not given IL-1β which analyzed data from 3 repetitions. These results are consistent with the theory and research Alejandro (2011) which states that the induction of IL-1β stimulates the synthesis and activity of matrix metalloprotein (MMPs) and other enzymes that cause cartilage degradation. IL-1β is a pro-inflammatory cytokine, has the ability to induce chondrocytes and synovial to synthesize MMPs, IL-1β has the ability to suppress the synthesis of type 2 collagen, proteoglycans and inhibit TGF-β that serves to stimulate the proliferation of chondrocytes. Another study by Shan (2004) explains that the induction of IL-1β can decrease the expression of transcription factors after 6 hours of induction. Experimental research models of OA, MMP-13 expression correlated with the pathological chondrocytes undergo hypertrophic differentiation in the

development of OA. Immunostaining results on research Kobayashi et al (2005) found an increase in MMP-13 in OA chondrocytes and expressed also type X collagen which is hypertrophic marker. In severe conditions found to co-localization of MMP-13 and type X collagen in the areas adjacent to the destructive lesion. Conclusion IL-1β causes morphological changes in chondrocyte cells become larger and stimulates increased secretion of MMP-13. The statistic result significantly different between the secretion of MMP-13 induced IL-1β group.

Acknowledgement We thank you for your input and discussion with Prof.Dr.dr.Handono Kalim, Sp.PD., KR so as to complete the research properly. Reference Afif., Nebbaki, Fatima, Hassan, M. Kapoor, Benderdour, Nicolas Duval, Jean-ierre Pelletier, Johanne Martel-Pelletier., Fahmi H. Egr-1 contributes to IL-1- ediated downregulation of peroxisome proliferator-activated receptor g expression in human osteoarthritic chondrocytes. Arthritis Research & Therapy. 2012, (14): 69. Alejandro M. Florian. IL-1 and it's role in osteoarthritis. Open Journal Of Medicine. 2011.1 (1): 3 Weber, P. Wasiliew, andM. Kracht, Interleuk in-1 (IL-1) pathway, Sci Signal, 2010 3 (105), cm 1 Conaghan, f. 2008. Osteoarthritis National clinical guideline for management in adults careAnd. Eds Birrel et al. Royal College of Physicians andrews place: london. (11): 319. De Ceuninck F. Lesur C. Pastoureau. Caliez A. Sabatini M. Culture of chondrocytes in alginate beads. Methods in molecular medicine. vol.100: Cartilage and

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osteoarthritis, vol 1: Cellular and mollecular tools eds Sabatini et al. 2004: .15-22 Felson MD. David T. Osteoarthritis of the knee. The New England Journal. NEJM. 2008 (354): 841-848. Firestein, GS Budd, RC Gabriel, SE McInnes, IB and O'Dell, JR Cartilage and Chondrocyte. Textbook of Rheumatology. Ed. by Firestein et al. Elsevier Saunders. Philadelphia. Vol.9. 2013. 97115. Jeremi, Christin. Role of inflamation in the pathogenesis of OA. Therapeutic advances in Musculoskeletal dissease. Therapeutic Advances in Musculoskeletal Diseases. 2012. (6): 2034 Malemud, CJ Matrix metalloproteinases (MMPs) in health and disease: an overview. Bioscience, 2006. (11): 1696-1701. Mathew. And Brinckerhoff, C. transcriptional Regulation of Collagenase (MMP1, MMP13) Genes in Rheumatoid. Res Arthritris 2001. (4): 157164 .. Nagase H and Y. Okada. Proteinases and matrix degradation. (Eds) Kelley WN, Harris ED, Ruddy S, Sledge CB. Textbook of rheumatology. Philadelphia, Saunders, WB. vol. 6. 2013: 323-41. Nagase H, Visse R, Murphy G. Structure and function of matrix metalloproteinases and TIMPs. Biochim Biophys Acta. 2010.1803 (1): 55-71 Roman-Blas andSA. Jimenez.NF-kB as a potential therapeutic targets in

osteoarthritis and rheumatoid arthritis. Osteoarthritis and Cartilage. 2006 (14): 839-848 Tesche, F; Miosge, N. New aspects of the pathogenesis of osteoarthritis: the role of fibroblast-like chondrocytes in late stages of the disease. HistolHistopathol. 2005. (20): 329-337 Tetlow LC. Adlam DJ. Woolley. Matrix metalloproteinase and proinflamatory cytokine production by chondrocytes of human cartilage osteoartritic. Arthritis Rheum. 2001 (32): 585-594 T. Aigner, S. Soeder, andJ. Haag, IL-1beta and BMPs - interactive players of cartilage matrix degradation and regeneration, Eur Cell Mater, 2006, (12), 49-56 T Kobayashi, K Notoya, T Naito, S Unno, A Nakamura, JM Pelletier, JP Pelletier. Pioglitazone, a Peroxixome Proliferator-Activated Receptor gamma Agonists, Reduce the Progression of Experimental Osteoarthritis in Guinea Pigs. Arthritis & Rheumatism, 2005 (52 ), 479-487. Wu QQ. Zhang Y. Chen. 2002. Mechanoregulation of chondrocyte proliferation, maturation and hypertropy. Exp Cell Res. (3). 383-391. Z. Shan, K. MasukoHongo, S. Dai, H. Nakamura, T. Kato, an d K. Nishioka, A Potential Role of 15Deoxy-Δ 12,14 -prostaglandin J2 for Induction of Apoptosis in Human Articular Chondrocyte Arthritis, The Journal of Biological Chemistry, 2004. 279 (36)

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THE RELATIONSHIP PERSONALITY TYPE WITH STUDENTS LEARNING ACHIEVEMENT OF S1 NURSING PROGRAM GRADE II STIKES HUTAMA ABDI HUSADA TULUNGAGUNG Farida1, Taufik Muchlison 2 STIKes Hutama Abdi Husada Tulungagung Email: [email protected] Abstract Student achievement can be seen from the Grade point semester and grade point average (GPA). Many people are found learning achievement in the form of a high GPA, only those who possessed Intelligence Questions (IQ) is high, but the level of IQ is not the only factor that determines the success of a person, because there are other factors that influence the personality. This study aims to determine the relationship with the Personality Type of Student Learning Achievement Study Program S1 Nursing Level II STIKes Hutama Abdi Husada Tulungagung. The experiment was conducted in February to March 2015. This type of research using correlation design with cross sectional approach. All students study population is S1 Nursing Program Level II STIKes Hutama Abdi Husada Tulungagung and samples are Most students study program S1 Nursing II STIKes Hutama Abdi Husada Tulungagung using simple random sampling technique as many as 54 people. Collecting data using questionnaires and personality type card study results, the data were analyzed with used Chi Square test. The results of the 54 students mostly exstovert personality and get a very good learning achievement as many as 17 people (58%). Statistical test Chi Square test obtained value ρ = 0.032 <α = 0:05 so that H0 is rejected and H1 accepted, where there is a relationship between personality type S1 Nursing Program students study the level II STIKes Hutama Abdi Husada Tulungagung. This study shows that there is a relationship between the type of personality to the achievement of students, therefore creating an atmosphere or a supportive learning method in accordance with the type of personality could increase the achievement of students. Keywords: Personality, Academic Achievement, Student Student in relation with education, is a subject that has the potential to develop a pattern of life, and become the object of the whole form of activity and creativity, so it is expected to show the quality it has to obtain satisfactory academic achievement. Learning achievement is a benchmark used to measure student‟s ability to understand the material and awarded after student get learning in an institution and within a certain period in the form of value (Naam, 2009). The value of student achievement called Performance Index (IP). Grade distinguished on their GPA (IPS) and a grade point average (GPA). The calculation of grade point average at the end of the semester, by calculating the

PRELIMINARY Education is a necessity for humans. Every man needs education until whenever and wherever he is because without education, we will be difficult to develop and even backward. Education is divided into formal education, non-formal and informal. Formal education is pursued through education in schools such as Elementary School / equivalent, Junior High School / equivalent, Senior High school / equivalent and Universities. Non-formal education is obtained from the institute courses, training institutes and similar educational unit. Informal education acquired in the family and society (Yusniati, 2008).

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values that have been entered in the semester. GPA is used as an input evaluation study of student success and academic sanctions (Diknakes, 2014). Learning achievement in the form of a good GPA/IPK is very important for students because it will increase the chances of getting a scholarship and affect the work that can be obtained in adulthood. Many people give opinion that to reach learning achievement in the form of a high GPA/IPK, everybody must have a high Intelligence Questions, Intelligence Questions is a provision that would make it easier to learn and in turn will produce optimal learning achievement. However, the level of Questions Intelligence is not only the one that determines a person's success, because there are other factors that influence (and Melissa Lim, 2012). Intelligence Questions (IQ) accounted for only 20% for success, while 80% is the contribution of other factors. There are other factors which influence learning achievment. They are external factor that include family circumstances, teacher/lecturer, teaching proccess and social motivation and internal factors include aptitude, motivation, intelligence, physical health and personality. From this, it is stated that a person's personality is one of the factors that influence achievement (Goleman, 2007). A study entitled "The relationship with the Personality Type Academic Achievement at the Faculty of Medicine, University of Riau 2006", personality types studied are personality type A, type B personality, and personality type AB. The final conclusion, there is a relationship between personality type with academic achievement in students of the Faculty of Medicine class of 2006 University of Riau (Lusiana, 2009). The study documentation in STIKes Hutama Abdi Husada Tulungagung on S1 Nursing Program level 1 academic year 2013/2014 in getting the data that the percentage of students who earn GPA/IPK below 3.0

is 46%, while the percentage of students who earn GPA/IPK value over / equal to 3.0 is 54%. From these data it can be concluded that there are still many students who have GPA/IPK less than satisfactory, if it continues, it will be a negative impact (S1 Prodi Academic Unit of Nursing, 2014). The negative impact that may arise when low GPA/IPK is, the students will feel insecure and difficult to make competition with other students who are superior in getting scholarships and jobs and will certainly interfere with future students. In the long run, the quality of the institution will also decrease. It will lead to the decline in the interest of the registrant or high school students / equivalent to study at the institution. To prevent it, it needed a proper solution (Arifin, 2009). Alternative solutions that can be used by teachers / lecturers is to change strategy centered learning teacher (Teacher Center Learning) with teacher always gives lecture become a Student Center Learning and the teacher as a facilitator train students for a discussion group and seminars. This is according to the student is extroverted because it is easily sociable, optimistic and talkative, is also appropriate for students who are introverted personality who has a shy nature, difficult to express their opinions and pessimistic because of the learning strategy is a student who has an introverted personality can learn speak his mind and increase self-confidence (Naisaban, 2005). Based on the above, researchers interested in conducting research titled “The Relationship Personali ty Type with Students Learning Achievement of S1 Nursing Program Grade II STIKes Hutama Abdi Husada Tulungagung” RESEARCH METHODS The design of this research used design correlation with cross sectional approach. Cross sectional design is study design or he observed measurements carried out

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simultaneously at a time or all the time (Hidayat, 2007). The population in this study is all students study program S1 Nursing Grade II STIKes Hutama Abdi Husada Tulungagung. The sample in this study is the majority of students study program S1 Nursing Grade II STIKes Hutama Abdi Husada Tulungagung as much as 54 students, with the inclusion and exclusion criteria. Measuring tool wear data collection questionnaire research that has been in the validity and reliability and Card Study Results (KHS). The research was conducted on 24 February to 4 March at STIKes Hutama Abdi Husada Tulungagung. Analysis of data Personality Type Relationship with Student Learning Achievement Program S1 Nursing II STIKes Hutama Abdi Husada Tulungagung, using statistical test Chi Square. If the p value <0.05 was said to be significant, the null hypothesis (H0) is rejected, then H1 accepted meaning stated there Personality Type Relationship with Student Learning Achievement S1 Nursing II program, while p value ≥ 0.05 then the null hypothesis is accepted and H1 rejected, which means that states there is no relationship with the Personality Type of Student Learning Achievement Program S1 Nursing II

Source : Research 2015

RESULTS

3. The relationship personality type with students learning achievement of s1 nursing program grade II STIKes Hutama Abdi Husada Tulungagung Tabel 3 The relationship personality type with students learning achievement of s1 nursing program grade II STIKes Hutama Abdi Husada Tulungagung.

Based on table 1 above it can be seen that most students S1 Nursing Study Program II STIKes Hutama Abdi Husada Tulungagung have extroverted personality types as much as 29 people (54%). 2. Student Learning Achievement Study Program S1 Nursing II STIKes Hutama Abdi Husada Tulungagung. Table 2 Distribution of the Student Learning Achievement Program S1 Nursing II STIKes Hutama Abdi Husada Tulungagung. No 1 2 3

Learning achievement Enough Good Excellent Total

F

%

12 18 24 54

22,22 % 33,33 % 44,45 % 100%

Source: Research, 2015 Based on the table 2 above can be seen that almost half of the students of S1 Nursing II STIKes Hutama Abdi Husada Tulungagung learning achievement is excellent / very good to have as many as 24 people (44.45%).

1. Personality Type Student S1 Program Nursing Grade II STIKes Hutama Abdi Husada Tulungagung Table 1 Personality Type Student S1 Program Nursing Grade II STIKes Hutama Abdi Husada Tulungagung No Personality Frequency Procentage 1 Introvert 25 46,3 % 2 Ekstrovert 29 53,7 % Total 54 100%

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Learning Achievment Excelle Enough Good nt F % F % F % 12, 16,6 16,6 96 Introvert 9 9 7 7% 7% % 31, Ekstrover 5,56 16,6 1 47 3 9 t 7 % 6% % 44, 1 22,2 1 33,3 2 45 Jumlah 4 2 2% 8 3% % Source : Research, 2015 Personal Type

Based on Table 4.3, students who have introverted personality types with excellent achievement is as much as 7 (12.96%) and students who have personality types extrovert with an excellent / very good achievement is as much as 17 people (31.47%), concluded that nearly half of respondents who have a very good learning achievement is the respondents who have extroverted personality types as much as 17 respondents (31.47%). Results of statistical test ChiSquare obtained ρ = 0.032, while α = 0.05 for ρ <α then H0 rejected and H1 accepted. Meaning There is Relationship Between Personality Type Learning Student Achievement Program S1Grade II STIKes Hutama Abdi Husada.

active, happier working group, easy expression and prefers to interact with many people at once. There are many factors that can affect a person's personality type. Stephen and Timothy (2008) reveals there are several factors that can affect a person's personality that include heredity, environmental and situational conditions. And F.G. Robbins (in Suryabrata, 2006) also suggests there are five factors that form the basis of personality, namely nature, prenatal environment, individual differences, the environment, and motivation. Researchs believe the theory and the facts above, the environmental factors are among the factors that determine an individual's personality type, especially in a campus environment that demands a Prodi S1 Nursing student to master the theory and clinical practice in the field. Maybe that's why Prodi S1 Nursing student who has type kepribadin more extrovert than the extrovert personality type. 2. Student Learning Achievement Grade II Stikes Hutama Abdi Husada The result in table 2 show that out of 54 respondents grade II have different learning achievement. From the data obtained show of 54 students, almost half of the respondents had excellent/ very good learning achievement as much as 24 respondents (45%). Learning achievement is a change in behavior skills, or abilities that can grow over time and not due to the growth process, but the learning situation. Embodiment forms of the results of the learning process can be either talk or writtensolving and problem-solving skills as well as directly measured or assessed using a standardized test (Sobur, 2006). Learning achievement is not only influenced by Intelligence Questions course, there are many

DISCUSSION 1. Personal Type Students Grade II STIKes hutama Abdi Husada Tulungagung The result of the research shows that from 54 respondents have different personality type. Based on Jung (Sunaryo, 2004) reveal that there are two types of human personality is introverted and extroverted personality types. Table 1 shows that of the 54 students, most have a personality type ekstovert totaling 29 students (54%). According to Jung (in Sunaryo, 2004) this personality type tend to be happy with someone, confident (sometimes to excess),

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factors that influence it. According to Ahmadi (in Septiarini, 2011) factors that affect the process and the learning outcomes of students in school, can be broadly divided into two parts, namely internal factors (factors physical health, physiological, intelligence, motivation, interests and personality) and external factors (family circumstances, teachers and teaching, teaching tools, social motivation, environment / opportunities and curriculum). Researchers give opinion from the theory and the facts above, the learning achievement is not only influenced by Intelligence Questions course, there are many factors that affect the learning achievement one of which is the motivation and interest, with the motivation and strong interest then someone will be active in learning so that it will get the value learn a great achievement.

The results are consistent with the theory Ahmadi (in Septiarini, 2011) which states that personality is one of the factors that influence learning achievement. Learning achievement with excellent category are mostly owned by students with personality types extrovert, according to personality traits ekstovert active, friendly, confident, happy to discuss and bold expression so as to encourage them to provide achievement of optimal (Sunaryo, 2004). Researchers agree with theory above as characteristic personality types ekstovert be one of the factors that can improve learning achievement because it has characteristics of social skills, express their opinions and provide counseling / solutions to public health problems. It is also supported by a previous study conducted by Lusiana (2009) on the Relationship of Personality Types with Academic Achievement at the Faculty of Medicine, University of Riau Force 2006 ", personality types studied are personality type A, type B personality, and personality type AB. With results of the research, there is a relationship between personality type with academic achievement in students of the Faculty of Medicine class of 2006 University of Riau. In common with this study is equally aims to determine the relationship of the type of personality and academic achievement. Differences of this study with previous studies is if the previous study examined are personality types A, B and AB, but this study examined are introverted and extroverted personality type. Based on this research and the results of previous studies, the researchers concluded there is a correlation between the type of personality and academic achievement, thus the personality type is affecting the students to get a good learning performance,

3. Relations with the Personality Type of Student Learning Achievement Program S1 Nursing II STIKes Hutama Abdi Husada The results in Table 3 obtained a student who has an introverted personality type with a very good achievement is as much as 7 (12.96%) and students who have personality types extrovert with a very good achievement is as much as 17 people (31.47%), it can be concluded that nearly half of the respondents who have a very good learning achievement is the respondents who have extroverted personality types as much as 17 respondents (31.47%). Statistics Chi Square test results in Table 4 was obtained p value = 0.032, while α = 0.05 for p <α then H0 rejected and H1 accepted. That is no relationship between personality type and Achievement of Student Learning Nursing Program S1.

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therefore, the institution is expected to choose the method of learning that suits the type the personality of each student in order to obtain optimal performance.

c. For further Researcher Further research is needed to look for a more complete supporting data about personality types and learning achievement, so as to develop further research in order to better.

CONCLUSIONS AND SUGGESTIONS A. Conclusions From the result of the research, it shows almost half of 54 students have personality type extrovet with excellent / very good learning achievement 17 students (31,47%) and value ρ = 0,032, so it can concluded there is relationship between personality type with learning achievement of S1 Nursing Program Grade II STIKes Hutama Abdi Husada Tulungagung.

BIBLIOGRAPHY Arifin, Z. 2009. Evaluasi Pembelajaran, Prinsip, Teknik, Prosedur. Bandung: PT. Remaja Rosdakarya. Diknakes. 2014. Pedoman Kegiatan Akademik Program S-1 Keperawatan. Tulungagung: STIKes Hutama Abdi Husada. Goleman, D. 2007. Emotional Intelligence (Terjemahan). Jakarta: PT. Gramedia Pustaka Utama Grafindo Perkasa. Hidayat, A.A.A 2007. Metodologi Penelitian Keperawatan dan Teknik Analisa Data. Jakarta: Salemba Medika. Lim, P.S. & Melissa, N.A.L.Y. 2012. Big Five Personality Predictors Of Post-Secondary Academic Performance. Pertanika Journal Social Science & Humanika, 4 , 973 - 988. Lusiana. 2009. Hubungan Tipe Kepribadian dengan Prestasi Akademik pada Mahasiswa Fakultas Kedokteran Universitas Riau Angkatan 2006, diunduh tanggal 25 Desember 2014 dari ejournal.unri.ac.id.index.php/JI K/ article/download/672/665.pdf. Naam, S. 2009. Hubungan Konsep Diri dengan Prestasi Akademik Mahasiswa S1 Keperawatan Semester III Kelas Ekstensi PSIK FK USU medan. Universitas Sumatera Utara, Fakultas Kedokteran. Diunduh tanggal 23 November 2014, dari http://repository.usu.ac.id/bitstre am /123456789/14291/1/09E00579

B. Suggestions 1. For Development Program a. S1 Nursing Program With this research, educational institutions can be expected to develop a program to create a mood or learning support method according to personality type S1 Nursing Program students grade II STIKes Hutama Abdi Husada Tulungagung. 2. For Develompment Science a. For Educational Institution For educational institutions can be expectated to provide more reference books about personality and academic avhievement. b. For Development Nursing Science It‟s expected to further develop nursing science in the field of education, especially it can be the basic to determine the student's education strategy which has introverted and extroverted personality, and further advance the science of nursing research in enhancing the value of learning achievement.

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Naisaban, L. 2005. Psikologi Jung, Tipe Kepribadian Manusia dan Rahasia Sukses dalam Hidup (Tipe Kebijaksanaan Jung). Jakarta: PT. Grasindo. Septiarini, N. 2011. Hubungan Tipe Kepribadian dengan Indeks Prestasi pada Mahasiswa Program A Di Fakultas Keperawatan Universitas Sumatera Utara. Fakultas Kedokteran, Universitas Sumatera Utara. Diunduh tanggal 26 Desember 2014, dari http://repository.usu.ac.id/handle /123456789/26923. Robbins, Stephen P. dan Timothy A. Judge. 2008. Perilaku Organisasi Edisi ke-12. Jakarta: Salemba Empat. Sobur, A. 2006. Psikologi Umum. Bandung: Pustaka Setia. Sunaryo. 2004. Psikologi untuk Keperawatan. Jakarta: Penerbit Buku Kedokteran EGC. Suryabrata, S. 2006. Psikologi Kepribadian. Jakarta: Rajawali Pers. Yusniati. 2007. Manusia dan Masyarakat Pelajaran Sosiologi untuk SMA/MA. Jakarta : Ganesha Exact.

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THE EFFECT OF MEDITATION AND HAEMOGLOBIN LEVELS ON LEARNING CONCENTRATION Indah Rohmawati 1, Oka Ludianita 2, Dwi Putri Sixteen Erawati 3 1 Prodi DIII Nursing STIKes Hutama Abdi Husada Tulungagung 2 ,3 Prodi SI Nursing STIKes Hutama Abdi Husada Tulungagung Email: [email protected] Abstract Producing quality graduates is the hope of all the educational institutions, for it during the course of one's physical condition must be healthy and not anemic. In addition concentration is necessary for the student to learn the material provided can be absorbed. Good concentration is when a being in the alpha state, this can be accomplished one of them when students are trained meditation. The research objective is to prove the effects of meditation and haemoglobin levels on learning concentration. Analytical research type experimental design with randomized controlled trials (RCT) and carried for 28 day. population Nursing student in Prodi DIII STIKes Hutama Abdi Husada Tulungagung fourth semester amounted to 74 students, with a purposive sampling technique obtained 56 samples, the distribution of control and experimental group (trained meditation) done with Proportionate cluster random sampling technique. Practice meditation conducted for 28 days. HB levels were measured using Cyanmethemoglobin, learning concentration to use Bourdon Wiersma test. The technique of data analysis use independent t test. There is a statistically significant effect of meditation on the learning concentrations, seen from a p-value of 0.000 for speed, p 0.006 for accuracy, and p 0.000 for constancy. There is no statistically significant effect of Haemoglobin levels on learning concentrations, seen from the p-value of 0.933 for speed, p 0.126 for accuracy, and p 0.670 for constancy, this is because in this research was not found samples had higher levels of HB less than normal Keywords: Meditation, Learning Concentration, hemoglobin levels (HB)

INTRODUCTION Learning quality one can be seen from the starting measuring student achievement through the cumulative achievement index (CPI). One can achieve the expected achievement when in the process of learning to concentrate. Various attempts have been made to improve student learning concentration eg improvement of instructional media, improving the quality of lecturers as well as the improvement of facilities and infrastructure supporting learning, but the fact still be obtained Students who are not able to concentrate, including the Students in STIKes Hutama Abdi Husada Tulungagung. Concentration learning is centralizing power of thoughts and acts on an object to be examined with flush or set aside everything that has nothing to do with the object being studied

(Surya, 2009). One of the tools for measuring the concentration of learning is Bourdon Wiersma Test, including speed, accuracy and constancy.Categorized group concentration measurement results using standard norm values Wieghted Scores (WS). Rate of speed is the quality of attention that is manifested by the cumulative number of seconds in completing the test material. The ability of perception is to describe the precision strike group specified point. Based on the level of vigilance recorded figures shortest and longest completion of the test, is used as the determination of constancy completion of work Someone who has the HB levels lower than the normal value or mangalami anemia can mangalami thought process disorder, decreased concentration, 378

memory, intelligence and ultimately the learning achievement of children is low (Yuriastien E, Prawitasari D, Febry AB, 2009). H B is a protein that is rich in iron. HB most important function is the transport of oxygen and carbon dioxide (Muttaqin, 2008). To determine whether a person is deprived of blood or not, can be determined by measuring hemoglobin levels. Determination k Adar hemoglobin can be defined in various ways, including a method t allquist, Sahli, oxyhemoglobin method, or a method sianmethemoglobin. But there anya h 2 an acceptable method in hemoglobinometri clinics, ie oxyhemoglobin, and sianmethemoglobin. Limit of normal levels of HB strongly influenced by age, sex, and height of residence from sea level (Hand W and Haribowo USA, 2008). The normal value of hemoglobin of male approximately 14-18 gr am / dL, while women 12-16 gr am / dL (Asmadi, 2008). Values above can be different on each - each laboratory but not would be too far from the value above. There is also a laboratory which does not distinguish between men or women by men or older women. Good concentration is when a being in the alpha state (relaxed without stress is marked by the opening of 88% subconscious mind (Olivia, 2007). Meditation can make our brain waves to the alpha state (Sukmono, 2013). Exercise regular meditation can help improve our ability to change with the brain consciousness lowering the brain waves of a beta, alpha, theta to delta (Mustajib, 2010). M anfaat meditation among others improve confidence and selfcontrol, m Enhancing the ability to focus the mind, sera can m engeluarkan hormone endorphin (Rodenbeck, 2007). E ndorphins can be generated when the condition of the wave g o no (Brainwave) are in phase between alpha and theta. Endorphins not only makes feeling refreshed and energized. Endorphin substances can also improve concentration and memory (Mustajib, 2010). Rehearsal meditation within a period of 8 weeks was found to

alter brain structure, based on analysis of magnetic resonance imaging (MRI) research results from Sara Lazar researchers from Psychiatric Neuroimaging Research Program MassachusettsGeneral Hospital found the density of the substance of gray (gray matter) increased in the hippocampus that are important to the process learning, memory, awareness, compassion and introspection, as well as a decrease in the density of gray substance in the amygdala, which plays an important role in anxiety and stress, (Sukmono, 2013). The point of all this depends on the student, unable or unwilling to control yourself to stay focused on what is being learned. The research objective is to prove the effects of meditation and haemoglobin levels on learning concentration. Hypothesis 1) there is the effect of meditation on learning concentration of , 2 ) there is no effect of HB levels on learning concentration METHODS This research analytic experimental design with random control trial (RCT). do in STIKes Hutama Abdi Husada Tulungagung Jl. Dr. Wahidin Sudiro Husodo Tulungagung. population in this research is Student of diploma III Nursing STIKes Tulungagung III level II semester of academic year 2013/2014 which amounted to 74 students. Samples partly Student of diploma III Nursing level II, III semester of 2013/2014 academic year who meet the inclusion criteria, namely the status of active students, willing to become respondents, as well as the exclusion criteria are sick more than 1 week. Samples numbered 56 students. Meditation is done for 28 days was conducted from May 31 s / d July 2, 2014, primary data collection (HB levels and learning concentration) was made on July 3, 2014 obtained through examination of the levels of HB and assessment of learning concentration, both in the control group (not trained in meditation) and the treatment group (trained meditation). The level of HB manner using a spectrophotometer Cyanmethemoglobin

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collaboration with the laboratory Enggal Saras Tulungagung, while learning concentration was measured using an instrument Bourdon Wiersma test. Data analysis techniques, the characteristics of the sample data continuous are described in n, mean, SD, minimum and maximum. Katagorikal data sample data characteristics are described in n and percentage (%). To determine 2 sample

unpaired have average values different statistically tested with independent t test RESULT A description of the characteristics of the respondents using univariate analysis. The univariate analysis aims to determine the number and percentage of respondent characteristics. Here are the data about the characteristics of respondents who became research subjects

Table. 1 Characteristics of Respondents Research Gender Number (n) Man 18 Female 38 amount 56 HB levels Number (n)

Percentage (%) 32.1 67.9 100 Percentage (%)

≥ 18 g / dL 12- 18 g / dL

10.7 89.3

Based on Table. 1 it is known that 38 (67.9%) of the respondents are female, meaning that many study subjects were female. Judging from the level of HB 89.3% of the study subjects had higher levels of HB 12 to 18 g / dL. Description of the research variable data to the data katagorikal didiskripikan in n and percentage (%), for

6 50

continuous data analysis presented in the form of minimum, maximum, mean and standard deviation. Presentation data variable research (Data c ontinuous) This aims to determine the average scores HB levels and learning concentration compared with a maximum score of assessment, as follows:

Table. 2 Description of the variable data research HB levels, the concentration of study and meditation status N Minimum Maximum Mean SD HB levels meditation group 28 13.2 18.6 15.9 1.60 Speed meditation group 28 3.9 12 8.9 2.44 Accuracy meditation group 28 0 15 2.4 3.30 Constancy meditation group 28 0.1 8 1.4 1.71 HB levels of the control group 28 13.5 19.6 15.9 1.70 Speed control group 28 6 14 11.4 1.98 Accuracy control group 28 0 20 5.7 5.10 Constancy control group 28 1.4 15.5 5.8 3.75 Speed group HB levels normal 50 3.9 14 10.1 2.59 Accuracy group HB levels normal 50 0 20 4.4 4.71 Constancy group HB levels normal 50 0.1 15.5 3.6 3.68 Speed group HB levels above normal 6 6.4 12 10.2 1.98 Accuracy group HB levels above normal 6 0 4 1.3 1.51 Constancy group HB levels above 6 0.2 9.2 3 3.44 normal Valid N (listwise) 56

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Granting the status of Meditation Not Meditation Meditation amount Table 2 shows that the participants on the assessment of the levels of HB score the average and maximum values The same good level of HB control group as well as the levels of HB treatment groups. As for the concentration of study in the treatment

n 28 28 56

% 50 50 100

group receive an average score and the maximum value is better when compared with the control group. Judging from the status of meditation partially of respondents do meditation as many as 28 respondents (50 %)

Table. 3 Independent T Test results about different of learning concentration between groups of not meditation and meditation Concentration Group n Mean SD t p speed Not meditation 28 11.4 1.98 4,10 0,000 Meditation 28 8.9 2.44 Accuracy Not meditation 28 5.7 5.10 2,86 0,006 Meditation 28 2.4 3.30 constancy Not meditation 28 5.8 3.75 5.61 0,000 Meditation 28 1.4 1.70 Table 3 shows that there is a mean learning concentration difference between the 2 groups of student, mean differ significantly because better for the group meditation. Judging from the p value of 0, 000 for speed, value of p 0.006 for the

accuracy and value of p 0,000 for constancy. Thus the p-value is smaller than the value of α (5%) or 0.05 means that there is effects meditation with learning concentration.

Table 4 Independent T Test results about different of learning concentration between the study group with HB levels <18.1 and HB levels > 18.1 Concentration Group n Mean SD t p Speed HB > 18.1 6 10.2 1.98 0.08 0.933 HB < 18.1 50 10.1 2.59 Accuracy HB > 18.1 6 1.3 1.51 -1.55 0.126 HB < 18.1 50 4.4 4.71 Constancy HB > 18.1 6 3 3.44 -0.43 0.670 HB < 18.1 50 3.6 3.68 Table 4 shows that the mean difference the concentration of learning between the two groups, the mean was not significantly different. Judging from the p-value 0.933 for speed, the p-value 0.126 for accuracy, and the p-value 0.670 for constancy thus the p-value is bigger than the value of α ( 5 % ) or 0.05 means that there no effect of HB levels with a learning concentration

DISCUSSION The effects of meditation on learning concentrations Concentration learning is centralizing power of thoughts and acts on an object to be examined with flush or set aside everything that has nothing to do with the object being studied, (Surya, 2009). This concentration can be developed through practice, Hakim (2004). For example, through the practice of

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meditation. Meditation is a conscious process to focus a lot of attention to the course (Suryani, 2006) Meditation done right means not just sit still and thoughts still wander anywhere will be able to generate positive effects such as increased concentrations of learning. To so do your meditation correctly needs to be done regularly practice meditation. In this study, the treatment group doing the meditation exercise for 28 days with a long time of 30 minutes a day in STIKes Hutama Abdi Husada Tulungagung. With the practice of meditation on a regular basis, it is expected the students have become accustomed

meditative under any circumstances, including in the learning process or while working on a questionnaire Bourdon Wiersma test. This is in line with the opinions Ada (2013) that the benefits of meditation is the harmony of mind, which is not cleaved by the ghost of the past and worries about the future. Students who are already doing the meditation exercise while working on a questionnaire Bourdon Wiersma test students' attention is concentrated on what is being done, and stop trying to do several things simultaneously ignoring the various factors that do not favor, for example, the noise from the atmosphere outside the classroom, the number of tasks from other academic subjects which must be resolved, and others. Their minds remain concentrated on what is happening at the moment, they are doing today is working on a questionnaire Bourdon Wiersma Test and not think about what had happened either failure which can lead to depression or feeling useless and success that can lead to a sense of fun that excessive and taste arrogant, and not thinking about what's coming, which made them anxious, fear and stress, what matters is currently done with the best. It can be shown from the average value listed in Table 2 that the value of the average speed of 8.9 seconds treatment groups included in good criteria, while the control group 11, 4 seconds is included in the criteria of

sufficient treatment group means faster and better in completing the questionnaire Bourdon Wiersma Test compared with the control group. Judging from the treatment group had a mean accuracy of 2.4 included in the criteria good enough and the control group had a mean of 5.7 is included in sufficient criteria, which means a more accurately treatment groups, fewer mistakes in cross out or does not answer the questionnaire Bourdon Wiersma Test when compared with the control group. Judging from the mean value constancy treatment group had a mean of 1.4 included in good criteria and a control group that has a mean of 5.7 is included in sufficient criteria, which means the treatment group had a better constancy in work on the problems when compared with the control group. All of these conditions can be achieved if the student is able to control and calm the mind and emotions. So according to researchers meditation is not just sitting still for practice concentration, but more important is the control of our thoughts and emotions in all situations. That is meditation just as the means to achieve a meditative (tranquility). This is in accordance with the opinion of Krishna (2003) that meditation is a way of life which is the basis of life for a person to become meditative. "When it has reached the level of meditative, we like having the on off button in terms of emotion". In this case for example when working on a questionnaire Student Test Bourdon Wiersma, Students who do meditation will be able to control his emotions so much faster in the work on the problems, more constant and more accurate. Based on Table 3 obtained the data that the p-value of 0.000 for the speed, p 0.006 for accuracy, p 0.000 for constancy. Thus the p-value is smaller than the value of α (5%) or 0.05 means there studying the effects of meditation with concentration. According to researcher Sara Lazar of Psychiatric Neuroimaging Research Program at Massachusetts General Hospital of the results of research

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mentioned that the practice of meditation within a period of 8 weeks was found to alter brain structure, based on analysis of Magnetic Resonance Imaging (MRI) find the density of the substance of gray (gray matter) increased in the hippocampus is important for learning, memory, awareness, compassion and introspection, as well as a decrease in the density of the substance of gray in the amygdala, which plays an important role in anxiety and stress (Sukmono 2011 ). Results of research at North Western University also proved that when someone is learning something, the brain "reward" themselves by producing endorphins. In other words, learning and memory, will be easier to do if there are quite a lot of endorphins in our brain, a condition that can occur when the brain is at the right waves (Mustajib, 2010) In line with the opinion attributed to the results of research, learning concentration of students in the treatment group is better when compared with the control group it can be caused because by giving the meditation practice, although only 28 days using music alpha meditation, when doing questionnaire Bourdon Wiersma Test, students can organize brain waves in the alpha state, because according Sukmono (2011) meditation is one way to regulate brain wave patterns, meditation can make our brain waves to the alpha state. In this study, researchers did not see directly how a brain wave conditions while working on a questionnaire Students Bourdon WiersmaTest. Researchers only observe the effects of the alpha brain waves. If the student is able to make his brain waves in a state of alfa, the endorphins will be released. According Rodenbeck (2007) one of the benefits of meditation is to produce endorphins, further Sukmono (2011) explains that the hormone endorphin will be issued when our brainwaves in the alpha state. Mustajib (2010) also mentions that endorphin substances can also improve concentration and memory. That is why at the moment working on questionnaires Bourdon Wiersma test

Students who are already doing the meditation exercise can focus or concentrate on what he was doing compared to students who do not do meditation for 28 days, in addition to the student who has been doing the meditation exercise may not experience anxiety and stress and have fun juice that makes them relax. The effects of HB level on learning concentrations Physical health, healthy condition and fit for example no deficiencies of HB levels (anemia) affect the concentration of one's learning. HB carries oxygen to all body tissues, then decreasing levels of HB will result in decreased oxygen levels, including to the brain. Oxygen deficiency is certainly going to affect the amount of energy produced (energy being a little), and the need for energy to be able to concentrate decreased. According Astawan (2008) that one of the effects of anemia is

that it can decreases the ability of to concentrate Based on the table 1 in getting the data that 50 respondents (89.3%) of the 56 respondents had higher levels of normal HB and 6 (10.7%) had levels above normal HB. Based on Table 4 obtained the data that different from the mean concentration of learning, to speed and constancy mean did not differ significantly better in the group with high levels of HB normal or groups that had higher levels of HB above normal, but for accuracy mean significantly different, because it more closely to the group which has HB levels above normal with a mean value of 1.3 is smaller when compared with the group who had higher levels of normal HB. Judging from the p value of 0.933 for the speed, p 0.126 for accuracy and p 0.670 for constancy thus the p-value is bigger than the value of α (5%) or 0.05 means that there is no effect HB levels on the learning concentration Associated with the above theory, basically the result of this study are consistent with above theory even though the levels of HB proved not to have

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significant effect with the learning concentrations, but still supports the theory above, it is in because the results of the study are not found respondents who had higher levels of HB below normal (<11 g / dL) were included in the criteria of anemia that can decrease the learning concentrations. So since this study only groups with higher levels of normal and above normal HB and did not have HB respondents who had levels below the normal functioning as a comparison that can not prove that the HB levels has an effect on learning concentrations. In addition to not finding respondents who had higher levels of HB below normal, to support research that the levels of HB does not affect the learning concentrations, also the discovery of the mean levels of HB were similar between the treatment group and the control group, this can be evidenced in Table 1 that the level of HB between the treatment groups and the control group had the same mean is 15.9 g / dL, whereas the concentration of learning both the speed, accuracy and constancy has a mean and maximum score better in the treatment group compared with the control group. If levels of HB proved either directly with the learning concentration, this is because there are other factors that lead to increased learning concentration and in this study is meditation. meaning that although between the treatment group and the control group had a mean level of HB same, but because of the treatment group was given meditation exercise for 28 days so that an increase of the concentration of learning CONCLUSIONS a. There is a statistically significant effect meditation on the learning concentration, Viewed from a p-value of 0.000 for speed, for accuracy` p 0.006 and p 0.000 for constancy b. There is statistically significant no effect HB levels on the learning concentration Viewed from a p-value of 0.933 for the speed, p 0.126 for accuracy and p 0.670 for the constancy, this is because in this study was not

found samples had levels HB less than normal REFERENCES Ada, M., 2013. The time for silence, peace, and healing. [Online] Available at: http://www.baliusada.com/index.p hp?option=com_content&task=vie w&id=141&Itemid=46 [Accessed 17 September 2013]. Asmadi, 2008. Technical Procedural Nursing: Concepts and Applications Basic Needs Client. Jakarta: Salemba Medika. Astawan, M., 2008. Efficacy Colorful food. Jakarta: Gramedia Pustaka Utama. Hakim, T., 2004. Effective Learning. Jakarta: Puspa Swara. Handayani W dan Haribowo A.S, 2008. Textbook Nursing with Hematologi.Jakarta System Disorders: Salemba Medika. Mustajib, A., 2010. The Secret Powerful Brain Therapy. Semarang: Wahyu Media. Muttaqin, A., 2008. Textbook Nursing with Respiratory System Disorders. Jakarta: Salemba Medika. Olivia, F., 2007. Helping Children Have Memories Super. Jakarta: Elex Media Computindo. Rodenbeck, C. 2007. Meditation series Guidelines To Be Healthy For Busy People. Batam: Karisma Publishing Group. Scandinavia, C. R., 2004. Cognitiv Scanner Function, Function and Parameterization. [On line] Available at: http://www.crs.dk/function.html. [Accessed May 26, 2014]. Sukmono, RJ, 2011. Boosting Intelligence brain with meditation. Jakarta: Vision Media.

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Solar, H., 2009, into a human learner. Jakarta: Elex Media Komputendo. Suryani, L. K. 2006. Meditation Candle. Jakarta: Yayasan Obor Indonesia.

Yuriastien E, Prawitasari D, Febry AB, 2009. Games Intelligence Therapy for Infants and Toddlers. Jakarta: Revelation Media

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MANAGEMENT OF HYPERURICEMIA WITH ERGONOMIC EXERCISE Anita Rahmawati . Program Studi Pendidikan Profesi Ners, Stikes Patria Husada Blitar [email protected]

ABSTRACT Hyperuricemia has been increased because of the lifestyle change. Hyperuricemic metabolism will produce highly purine rate called uric acid. Exercise will reduce that highly purine rate. Ergonomic gym exercise will also reduce blood pressure, heart rate, respiratory rate, and will give comfortable of sleep. The purpose of this research was to learn the significance between ergonomic exercise and uric acid rate on client with hyperurisemic. The study was pre experiment with One Group Pretest Posttest design. The sample was hyperuricemia elderly client in posyandu lansia which fulfill the inclusion criteria. The respondents ergonomic exercise in every day for two weeks and uric acid rate was measured before and after research. The data was served in the frequencydistribution table and analysed with normality test using Kolmogorov-Smirnov and Paired Sample T-test with significancy α ≤ 0,05. The results shown that the urid acid level was decrease (uric acid mean and standart deviation for pretest 7,06 ± 0,85 and post test 3,94±1,84). Paired sample T-test analysis found different significant value (p=0,000). Ergonomic exercise can be one of intervention to decrease uric acid rate for hiperuricemia. Key word: hyperuricemia, ergonomic excecise, urid acid level, elderly Introduction Uric acid had been known since two-thousand years ago and be well known as one of the oldest disease. In order to human time life improvement, the incidence of the disease is getting increased because of bad life style, include uncontrolled eating pattern. Uric acid is a crystal-shaped that become the end of purine metabolism (derivative from nukleoprotein), so uric acid is the latest product of purine metabolism which usually cannot tolerate highly. Everyone have uric acid in their body because in every normal metabolism process always produce uric acid. In the other hand, highly uric acid rate coming from many triggers like food or everything in which contain purine. Fortunately, our body contribute about eighty-five percent purine derivatives for daily need. It means that purine demand from food only about fifthteen percent (Hesen, 2009). Hyperurisemic incident all over the world is nominally vary, estimated between 2,3%-17,6% while gout

incident between 0,16%-1,36%. In USA the prevalence number of client with asymptomatic hyperurisemic from general population is about 2%-13%. In the hyperurisemic study on the hospital there are higher prevalence between 17%-28% because of disease and drug influent. In Indonesia, hyperurisemic prevalence is about 24,3% on male and about 11,7% on female (Indriawan, 2009). Many people in Indonesia that life with hyperuricemia doesn`t aware their condition except their symptoms lead to be severe. Uric acid could be relieved in the way to make the rate normally with control of the consumption of meal and prevent the food with higher purine rate. In addition, neither drinking water nor exercise could be useful to increase the circulation so that can excrete excessive purine in our body. One of the exercises that useful for hyperurisemic client is the ergonomic gym exercise. In some places there are many ergonomic gym exercise groups, e.g. MASUSEI

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(Yayasan Masyarakat Suka Senam Ergonomik), East Bekasi Gym Groups, and many more, which a large number of their member had given the testimony that stated if the gym exercise could be useful to control many diseases like migraine, vertigo, gout, and diabetes mellitus. Ergonomic gym exercise is not the same as yoga or other fitness that are more complex. Actually, the exercise movement use general movement from our daily activities and every person would be able to do this exercise. Even this exercise is used by everyone, there is no pain either during exercise activity or after exercise is finished. Because hyperurisemic client is susceptible with pain on their joint so the exercise must have simple and no tiring movement. The important thing is continuity and consistency on doing this exercise (Khairumi, 2012). General purpose in this research was to learn the effectiveness of ergonomic exercise toward uric acid rate on hyperurisemic client and the specific purpose was to measure uric acid rate on hyperurisemic client before ergonomic exercise, to measure uric acid rate on hyperurisemic client after ergonomic exercise and to analyse the effectiveness of ergonomic exercise toward uric acid rate on hyperurisemic client. . RESULT Tabel 1

Method The study was pre experiment with One Group Pretest Posttest design. The sample was hyperuricemia elderly client in posyandu lansia which fulfil the inclusion criteria. Respondents act in every day ergonomic exercise for two weeks and uric acid rate was measured before and after research with easytouch GCU. The sample were taken based on inclusion criteria: first stage hyperurisemia (hyperurisemia client which was not followed with symptom like continues severe pain, arthritis, tofi/tofus and able to do ergonomic exercise. Exclusion criteria was respondents who did not do routine ergonomic exercise. Ergonomic exercise process in this research base on instrument SOP (Standar Operasional Prosedur) had created by researcher base on ergonomic exercise by Wratsongko (2009). While in ergonomic exercise process, the researcher was helped by two enumerator for observed respondent exercise movement by observational sheet. The data was served in the frequency-distribution table and has analysed with normality test using Kolmogorov-Smirnov and Paired Sample T-test with significancy α ≤ 0,05.

The Frequency Distribution of responden based on age, sex, job, education, purine dietary and BMI

No description 1. Age : 45 - 59 years old 60 - 74 years old 75 - 90 years old 2. Sex: Male Female 3. Job: Housewife Had rest private 4. Educational: Junior High School Senior High School University

F frequency 1 14 1 7 9 3 11 2 10 4 2

% percentage 6,2 87,6 6,2 43,7 56,3 18,8 68,7 12,5 62,5 25,0 12,5

Purine Dietary: Intermediate

9

56,3

5.

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High

7 1 12 3 16

6.

BMI Thin Normal Fat Total Tabel.2

43,7 6,2 75,0 18,8 100

The average level of uric acid in Hyperuricemia client before and after Ergonomic Exercise Uric acid level Mean

Std. Deviation

7,06 3,94

0,85 1,84

Before exercise After 2 week exercise paired sample T-test

0,000

DISCUSSION Uric Acid Level on Hyperuricemia Client Before Ergonomic Exercise The mean of uric acid level for Respondent before had done ergonomic exercise 7,06 mg/dl. The majority of respondent had intermediate purine dietary (56,3 %). This condition was the same as experimental result which had done by Setyoningsih and Darmono (2009) in RSUP Dr.Kariadi Semarang that shown if purine intake was the predominant risk factor for hyperuricemia. In this research Male more susceptible than female, but in female hyperuricemia incident would be higher after menopause because estrogen help uric acid to be excreted before menopause. Uric acid disease more frequent in erderly and less in people before 60 year age (Kertia, 2009). Sex distribution of hyperuricemia client in experimental group slightly increase on female and majority of them have uric acid level higher than male respondent. The effect of elderly age and menopause was considered as the cause of why uric acid level on female respondent relatively higher than male. There were correlation between uric acid level with menopause and water consumption (Fajarina, 2011) Body mass index (BMI) was one of the measurement of nutrition status. The result of BMI respondent in this

research majority found on normal BMI. Based on the research done by Choi et al., in Pramudya (2009) found that between dietary factor and gout risk factor were not depend on Body Mass Index (BMI). This was strengthen by research in Sokaraja, Banyumas where found if there were no correlation between uric acid level and BMI (Kumalasari, 2009). Uric Acid Level on Hyperuricemia Client After Ergonomic Exercise After sixteenth respondent had done ergonomic exercise routinely for two weeks, uric acid level decrease from 7,06 mg/dl to 3,94 mg/dl. Hyperuricemia was a condition where uric acid level in the blood higher more than normal (male about 3,5 - 7 mg/dL, female about 2,6 - 6 mg/dL) so uric acid would be accumulated in body tissues formed crystal on joint (Sari, 2010). Almost all of the experimental group respondent who are firstly hiperuricemia then to be normal after ergonomic exercise routinely for two weeks but there were one of experimental group respondent have increase in uric acid level. From the process ergonomic exercise observation, this respondent always stopped her movement while in sit movement because unable to retain pain and heat. In hyperuricemia client or

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food intoxication will fell like burnout (Sagiran, 2009).

Conclusion 1. The average uric acid level hyperuricemia client before ergonomic exercise was 7,06 mg/dl. 2. The average uric acid level hyperuricemia client after ergonomic exercise was 3,94 mg/dl, 3. There were an effect of ergonomic exercise toward uric acid level hyperuricemia client. Based on paired sample t-test shown p value p= 0,000

Influence Ergonomic Exercise Toward Uric Acid Level on Hyperuricemia Client Based on paired sample t-test p= 0,000 shown that there were significant different uric acid level between before and after ergonomic exercise. According to Wratsongko from Indonesian Ergonomic Gym& Health Care, purpose of doing ergonomic exercise was a part of prevention and rehabilitation from every disease. There are five principal movements in this ergonomic exercise that had benefit in each of the movement. In first movement, stand upright with straight vision make the body relax, two arms twist backwards maximally to optimalize nerve function on pleksus brakialis in stimulate nervus system on lungs, hearts, hepar, stomach, and intestines so that metabolism would be optimal too. Those movements were followed by stand on tiptoes to increase stimuli sensory nervous system and to increase uric acid excretion flow in where that uric acid accumulated more on tiptoes joint. The second movements were bend our body frontward with our hand hold on foot ankle to our back joint, elbow, thigh and knee until feeling drawled or pulled. This step could bent ligament and muscle on the joint and increase blood circulation so the uric acid flow that accumulated on joint could fast too. The third movements were to help the optimally from renal function in uric acid excretion. In the fourth movements two hands grasp foot ankle to give relaxation effect on sympathetic nerve system so that relaxation of the circulation wall would be happening. The fifth movements were the most important movement in reduce uric acid level because those could burn uric acid, fat, and toxin in our body, strengthen low back area and renal function (Isran, 2012).

Acknowledgement This study had no control group and so can not be clear whether the reduction in the level of uric acid caused by ergonomic exercise or by other factors. Various confounding factors that may reduce the uric acid level was not investigated in this study. Refferences Cole, J.R. dan Azmi. 2010. Inilah Senam Ergonomik dan Manfaatnya. http:Zonajurnal.com. 15 Maret 2013 (10:30) Hensen dan R. Tjokorda. 2007. Hubungan konsumsi Purin dengan Hipersemia Pada Suku Bali di daerah Pariwisata Pedesaan. http://ejournal.unud.ac.id/abstrak.p df. 17 Maret 2013 (14:10) Indriawan, I. 2009. Penyakit Asam Urat. http:repository.unikom.ac.id/repo/s ector/kampus.13 maret 2013 (11.10) Isran. 2012. Pedoman Sehat Tanpa Obat dengan Sholat dan Pijat. Kawan Pustaka. Jakarta Khairumi. 2012. Senam Penderita Asam Urat. Kertia, N. 2009. Asam Urat. Bentang Pustaka. Jakarta. Kumalasari, T. Saryono. I. Purnawan. 2009. Hubungan Indeks Massa Tubuh dengan Kadar Asam Urat Darah pada Penduduk Desa Banjaranyar Kecamatan Sukoraja Kabupaten Banyumas. Jurnal Keperawatan Soedirman (The Soedirman Journal of Nursing). 4(3):119-124.

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Notoatmodjo, S. 2010. Metode Penelitian Kesehatan. Jakarta: Rineka Cipta. Nucleus Precise News Letter Edisi – 1). Asam Urat atau Gout.www.mirbrokers.com/.../New sletter%2070%20Edisi%201%20%20Asam%20Urat%20310120111. pdf. 13 maret 2013 Setyoningsih, R dan Darmono. 2009. Faktor-faktor yang Berhubungan dengan Kejadian Hiperurisemia pada Pasien Rawat Jalan RSUP dr.Kariadi Semarang. Skripsi. Fakultas Kedokteran Universitas Diponegoro Semarang.

Sari, M. 2010. Sehat dan Bugar Tanpa Asam Urat. Cetakan ke-1. Araska Publisher. Jakarta. Sagiran. 2007. Mukjizat Gerakan Sholat. Qultum Media. Jakarta. Tenggara. J. 2009. Elderly Exercise – Olahraga Untuk Lanjut Usia, Bagian I. FKUI-RSCM. Jakarta Wratsongko, M. 2006. Pedoman Sehat Tanpa Obat. Elex Media Komputindo. Jakarta. Weaver, A.L. 2008. Epedemiology Of Gout. Cleveland Clinic Journal OfMedicine. 75 (5):9-12.

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PSYCHOEDUCATIVE FAMILY THERAPY UNTUK MENINGKATKAN SIKAP KELUARGA TERHADAP PASIEN TB PARU (Psychoeducational Family Therapy To Improve Family Attitudes Towards Pulmonary TB Patients) Bisepta Prayogi STIKes Patria Husada Blitar Email: [email protected] ABSTRACT Tuberculosis(TB) remains a major global health problem. This leads to poor health among millions of people every year and is now ranked second leading cause of death from infectious disease world wide, after the Human Immunodeficiency Virus (HIV). The objective of this study was to analyze the effectivenes of family therapy psycoeducative to to improve family attitudes of patients with pulmonary tuberculosis. This study used quasy experiment pre-post test control group design. Total sample was 32 respondents taken using purposive sampling, the sample divided into experiment and control group. The data were analyzed by Paired T Test, and Independent T Test, with significance value of 0.05. Paired T Test analysis showed that psychoeducative family therapy had effect on increasing family attitude of towards pulmonary TB patients (p =0,000). Psychoeducative family therapy improved family attitudes. Keywords: psychoeducative family therapy, attitudes of family, Pulmonary TB Patients __________________________________________________________________________ prevalence of pulmonary tuberculosis in Indonesia 730,000 cases or 297 cases per 100,000 population. According to WHO tendency of new cases of pulmonary TB in Indonesia increased that in 2000 there were 430,000 cases of pulmonary tuberculosis and in 2012 there were 460,000 new cases (WHO, 2013). TB eradication in Indonesia has been implemented since 1969 through the National Program Tuberculosis Eradication Program (P2TB) by the Ministry of Health, and since 1995 further intensified by means of treatment strategies using Directly Observed Treatment Short course (DOTS) recommended by WHO. But in reality after running 9-10 years of DOTS, treatment success rate has yet to reach the target set by the Ministry of Health is able to cure 85% of TB patients with Acid Resistant Bacteria (BTA) (+) were treated. From global surveillance results have been reported TB germ resistance against Anti-Tuberculosis Drugs (OAT) in patients with TB for one type of OAT (DR-TB Drug Resistant-TB) by 12.6% and for more than 2 types of OAT (MDR TB, Multi-Drug Resistant TB) of 2.2% (Depkes, 2002).

INTRODUCTION Tuberculosis (TB) remains a global health problem. The most recent estimate that there are 8.6 million new TB cases in the world in 2012 and 1.3 million deaths from TB (just under 1.0 million among HIVnegative people and 0.3 million deaths associated with HIV-TB). Most of these TB cases and deaths occur among men. In 2012, there were an estimated 2.9 million TB cases and 410,000 deaths among women, as well as the estimated 530,000 cases of dan74.000 death in children. The actual number of TB deaths could be reduced given that most could be prevented if people can use health services for diagnosis and appropriate treatment. The program of short-term treatment of first-line drugs available and can cure about 90% of cases for decades (WHO, 2013). Indonesia take on fourth place in the world for the number of TB cases after India, China, and South Africa. In 2012 there were 460,000 new cases of TB in Indonesia or 185 per 100,000 population. There are about 67,000 deaths from pulmonary tuberculosis or 27 people per 100,000 population. The

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At the national level, East Java is one contributor to the invention of the number of pulmonary tuberculosis patients under the second highest in West Java Province. In 2012, the figure Case Detection Rate (CDR) of 63.03% with the number of new cases (positive and negative) as many as 41 472 people and as many as 25 618 new smearpositive cases. These conditions are still far from the target CDR stipulated that 70% (east java public health office, 2013). Data in the East Java Public Health Office in 2012 showed the results of treatment of TB patients can be seen from the cohort of patients in 2011. The number is calculated by summing the new smear positive TB patients with the final results of treatment to heal and complete treatment is divided with smear-positive TB patients treated in cohort same period and multiplied by 100%. The results of treatment in East Java showed a pretty good number, because it has achieved treatment success rate of over 90%. Only 9 (nine) districts / cities that have not yet reached a success rate of 90%. Target 2014, a treatment success rate of 90% can be achieved by 100% of districts / cities (East Java Public Health Office, 2013). In 2012 the number of new cases in Blitar is 180 cases per 100,000 population. The mortality rate of pulmonary TB in Blitar is 17 people per 100,000 population. Of the 104 patients with pulmonary tuberculosis treated, the number of people who recover is 80, meaning that the level of success in the treatment of pulmonary tuberculosis in Blitar is 80%, whereas the target is 90% success rate. Cure rate in Blitar reached 76.92% of the target of 85%. Data of patients drop out as much as 5 patients (4.8%). The figure is still within the target of <5% (East Java Public Health Office, 2013). To improve discipline and prevent non-adherent patients in the treatment program needs the support of the family. The support given to family members who suffer from pulmonary tuberculosis in the form of psychosocial support which could be a positive support to any activity undertaken. By providing information to families about the disease and advise on effective coping mechanisms, psychoeducation program reduces the tendency of clients to relapse and reduce the effects of this disease on other family (Townsend, 2009) .Berdasarkan

research conducted by Sulistiowati (2012) that psycoeducative family therapy effective in enhancing the ability of families both psychomotor and cognitive in treating patients with pulmonary TB disease. Based on evidence based practice, psychoeducation is a therapy that is used to provide information to families to improve their skills in caring for their family members, it is expected that the family will have a positive coping to stress and load experienced (Goldenberg & Goldenberg, 2004). In the family psychoeducation there are 5 sessions: identification of problem, client care, stress management, load management family, community empowerment. Thus, one alternative solution to optimize the support is to use psychoeducative family therapy. Psychoeducative family therapy with means to facilitate local social structures (families, groups, and communities) are likely defunct so as to re-provide effective support to the needy related stressful life experiences. MATERIALS AND METHODS The design of this study was Quasi Experiment with pre and post test control group design. The Population was pulmonary TB patients and families (PMO) in the city of Blitar. The sampling technique used purposive sampling with a sample 16 respondents of treatment group and 16 respondents of control group. The independent variable was Psycho Educative Family Therapy, while the dependent variable is the attitude of pulmonary TB patient's family. Instruments used: 1) The questionnaire to collect demographic data of respondents including sex, age, education, occupation, marital status, religion, income, relationship with the PMO patients, the number of families and family-type, 2) questionnaire to measure the attitude of the family. The data collected then processed and analyzed using statistical test Paired t Test, and Independent t test with significance level p≤0,05.

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RESULT

This chapter describes the results of research, which includes: 1.

The effectiveness of psycho educative family therapy to family attitudes Statistical test results in the group treated with Paired T Test p = 0.000, which showed no change attitudes before and after treatment, the control group Paired T Test results p = 0.333 showing no change in attitude. Statistical test results Independent T Test after intervention was obtained p = 0.000 in both groups showing that there is a significant influence on attitudes between the treatment group and the control group (see table 1). Table 1. The effect of psycho educative family therapy to family attitudes

N SD Mean

Treatment Pre Post test Test 16 16 4,195 2,872 28,44 34,38 Paired T Test p=0,000

Control Pre Post Test Test 16 16 3,074 3,146 21,13 21,19 Paired T Test p=0,333

Difference (∆) Treat Control ment 16 16 3,492 0,25 5,94 0,06 Independent T Test p=0,000

DISCUSSION 1.

The effect of psycho educative family therapy to family attitudes. Most respondents in the treatment group were 9 respondents (56.3%) before being given psychoeducative family therapy have a negative attitude. Attitude is the response of someone who is still closed to a stimulus or object. Components of attitude consists of the trust (confidence), the idea and the concept of an object, the emotional life or emotional evaluation of an object and a tendency to act. According to Wright & Leahay (1994) trust is a sub category of assessment which is something underlying ideas, opinions and assumptions are owned by the family. Changes in the domain knowledge is an intermediary changes in attitudes and behavior. In the affective domain is facilitated family to share the experience of caring for a family member suffering from pulmonary tuberculosis and provide family support.

The attitude of the family treatment group on average have increased from the previous negative to positive. In the first session found a problem that most of the patient's family or the PMO did not want to help remind patients to take medication time. If the family does not help remind patients when to take medication, patients forget to take medication for a very large. This is then followed up, especially in the second session of therapy. In the second session is given psychoeducation about the attitude that should be done by the family (PMO), and the roles of the family in the treatment program undertaken by the patient. Improved attitudes in the treatment group this may occur because of the continuous interaction between researchers and respondents during the study. Attitudes can be influenced by one's personal experience, the attitude is formed when a personal experience involving emotional factors. The attitude of the family in the control group there were 1 rise respondents and 15 respondents remain. Respondents who experienced an increase in the value of the attitude though not obtain the intervention can be caused, because the respondents still interact socially with others, such as health care workers, other family or those that are considered important.

CONCLUSIONS AND SUGGESTIONS Conclusions Psychoeducation can improve the attitude of the family (PMO) patients suffering from pulmonary tuberculosis in Blitar through the provision of psychoeducation about the care of patients with pulmonary TB. Suggestions For nurses can be used as a study to consider the psychoeducational family therapy as an alternative solution in order to optimize treatment program at psien pulmonary tuberculosis. Provide activities that are psychologically based on the family of pulmonary tuberculosis in an effort to improve medication adherence. Family is expected to cooperate with the health care

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team in monitoring the development of the

Tuberkulosis.www.googlescholar.com . diakses pada tanggal 21 November 2012.

condition of patients with pulmonary tuberculosis, and provide optimal support to family members suffering from pulmonary tuberculosis.

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Sulistiowati, ni made dian. (2012). Effect of family psyco-education therapy for family capability in caring the family member with mental disorder. Proceeding of international nursing conference, the association of indonesian nurse education center

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The Effectiveness of 4s’s Techniques To Physiological And Crying Duration Of Newborn Erni Setiyorini Pediatric Nursing STIKes Patria Husada Blitar Blitar, Indonesia 085645646666 and email:[email protected] Abstract For a hospital birth, there are numerouse routine procedures, such as injection, blood sampling procedures and many other which can administered. The procedures made newbon uncomfortable by pain then have impact to short and long term. Newborn express their pain in defferent ways. Previous study have shown that newborn who experience many painful procedures may show changes to their behaviour in later childhood. The purpose of this study was determine the effect of 4s‟s techniques on physiological responses and duration of crying after venous blood sampling. We conducted a prospective, post test only control group design. Newborn consist of 46 samples, were divided into 2 group, 23 samples control group with 1s‟s technique and 23 samples treatment group with 4s‟s technique. The data collected by accidental sampling at November 2014 by observation sheet. Data Analysis used T-Test and Wilcoxon Signed Rank Test. Result showed that 4S‟S technique had effect on physiological responses on pain (heart rate with p=0,004, respiratory rate with p=0,000, temperature with p=0,000) and on duration of crying with p=0,001).The 4s‟s technique decrease pain on newborn with physiological responses indicator and decrease length of crying. Keyword: The 4s‟s technique, physiological response, crying duration, newborn INTRODUCTION For a delivery in hospital, newborn administered on various procedures resulted in pain, discomfort, or noxious stimulation. These include general procedural pain, such as blood sampling procedures, injection. Normal newborns experience painful procedures as a component of routine care. Haouari and Coworkers (1995) estimate that every newborn undergoes at least one heel stick or venipuncture. procedure and that over 1 in every 10 newborn have two or five injections or blood taken for testing. Based on data obtained from Ngudi Waluyo Wlingi Hospital, from January to September 2014 there were 1385 births and 942 term infants. From these data a 100% gain venous blood sampling procedures (Data Register RS Ngudi Waluyo Blitar, 2014). Differences in pain management in neonates have evolved over three

decades. Perception early to said that the development of neuroanatomical and neuroendocrine in pain response neonates less than complete, accompanied by fears of analgesia that can potentially damage the respiratory system (Lippmann et al, 1976, Rackow et al, 1960). Anand and Craig suggested that reported neonatal pain behavior as nonverbal. Some neonatal pain assessment methods based on different combinations of indicators of physiological, biochemical and behavioral pain (Khurana, Hall and Anand, 2005). Newborns demonstrate autonomic/ visceral, motor and state behavior changes in relation to venipuncture. Pain in infants will respond by crying and moving the entire body. One of them through facial expressions, crying, movements arm, leg movements, breathing patterns, and stimulation status, so the assessment

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suggested the response in newborn using observations a sign of behavioral and physiological responses (Wong et al, 2009). Some procedure of inventions that repeated pain early in life can interfere with the development of the central nervous system permanently (Hatfield, Meyers and Messing, 2012). Physiological studies indicate that the experience of pain and stress very early to have immediate consequences in newborn. Assessment and treatment of pain is a complex subject and a challenge when the individual was still a baby. Reviews conducted by Page (2004) shows the long-term physiological consequences of pain, including changes in the central nervous system and changes in responsibility of neuroendokrin and the immune system. Wati (2004) explains that the pain experienced by the baby raises three effects: the immediate, short term and long term. Soon experienced the effects of newborn is the emergence of a sense of fear, anxiety, sleep and wake disorders, decreased food consumption, increased production of stomach acid. Short-term effects can cause immunological disorder (the body's defense), delayed healing, impaired formation of emotion, while the longterm effects on memory formation of pain, growth retardation, changes in response to pain. Pain management in neonates has not been a major concern for health workers; this is caused by the inability of the baby to convey pain, fear of negative side effects used anlgesics, a mistake to interpret the expression of pain in newborn as an expression of fear, health workers concern for priority disease management (Hockenberry & Wilson, 2007). Darcia Narvaes a psychologist explains her opinion about continues crying on newborn. According her the methods of letting a baby cry is dangerous because it can caused brain cell death of newborn. The mechanism is when the newborn is stressed, they release cortisol, a hormone that can

cause the death of brain cells. While, at birth, new baby's brain develops 25% and growing very fast their first year (Kartikawati, 2011). From interviews with nurses in Edelweiss, intervention was given after invasive procedure in newborn, there was no specific treatment. Generally soon after a blood drawn, then the baby would be returned to its original position, which is only swaddling (1S s) and they were not considered when the baby stops crying, sometimes can be immediately stopped crying, sometimes prolonged duration of crying. Various methods are used to treat pain in newborn with pharmacological and non pharmacological. Preferably non pharmacological interventions on minor invasive procedures because the side effects are minimal (American and Canadian Academy of Pediatrics, 2000). One non pharmacological methods that can be applied in dealing with infant pain is 4s's technique. The initial concept of physical intervention techniques adapted from 5s's composed of swaddling, side-stomach position, shushing, swinging and sucking. Based on concept that newborn lost fourth trimester. They not yet ready living at wide world, they still missing lived on mother whomb. The swaddling almost similar with mother whomb, gaved warm temperature. Side-stomach position help their gastrointestinal and gaved support. Shushing like sound of mother artery near whomb and giving message that mother here, available for newborn. Swinging (when baby at mother whomb about 9 month, they living at amnion fluid and every movement giving sensation to baby, like shaking). Sucking giving comfort affect on newborn, like position at whomb they sucking their thumb. The research conducted by Dr. Harrington (2010) states that most babies who get physical intervention 5s's stop crying within 45 seconds, while receiving a sugar solution were still crying 2 minutes after vaccination invasive procedures (Gupta,

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2012).One of reason we did dot apply sucking paciffier in this research because of pacifier use may be associated with early breast weaning or may be a marker of breastfeeding difficulties; therefore, it should be avoided until breastfeeding is well established (Sexton and Natale, 2009). The 4s's technique research I did before also showed that the 4s's technique influenced physiological pain responses (heart rate and oxygen saturation), while the respiration rate showed no difference in the control group and the treatment group (Setiyorini, 2015). Wintiyah (2014) studied of applications of the 4s's technique for the crying duration of newborn showed that the 4s‟s technique influenced on duration of crying babies with p value: 0,001. Based on background above, the researchers interested in conducting research on the effect of 4s's technique on physiological responses (HR, RR, temperature) and crying duration of newborn post venous blood sampling procedures.

dependent variables was physiological responses (heart rate, respiratory rate and temperature) and crying duration of newborn. Data analysis with T-Test and Wilcoxon Signed Rank Test. RESULT AND ANALYSIS RESULT General data Table 1 Characteristics of samples 4s‟s technique Characteristics F % Type of birth Normal 7 30,4 Cesarean 16 69,6 Gender of newborn Male 8 34,8 Female 15 65,2 Specific data Table 2 The effect of 4s‟s technique on physiological responses (HR, RR, temperature) post venous blood sampling procedures. Gro Min Me Ma Stat up ima an xim isti l al c test Heart 4s‟s 115 12 138 rate tech 3,8 niqu 2 p=0 ,00 e Con 100 13 162 4 trol 4,8 6 40 42, 48 Respi 4s‟s ration tech 78 p=0 niqu rate ,00 e 0 Con 38 47 60 trol Temp 4s‟s 36, 36, 37,3 eratur tech 6 99 p=0 e niqu ,00 e 0 Con 36 36, 37 trol 67

METHODS The research design was quasy experiment with post test only of control group. The population of this research was newborn at Edelweis Room at Ngudi Waluyo Wlingi Hospital with venous blood sampling procedure. The data was collected on November 2014. The inclusion criteria were: newborn first day aged, weight ≥2500 gram, not in illness, apgar score of 7-10, not using infusion, first blood sampling procedure, newborn crying during and after blood sampling procedure. A samples of 46 newborn was taken by accidental sampling, which were divided into 23 newborn with treatment 4s‟s technique (swaddling, side-stomach position, shushing, swinging) and 23 newborn with 1s‟s technique (swaddling) as control group. The independent variable of this study was the 4s‟s technique (swaddling, side-stomach position, shushing, swinging). While the

Table 3 The effect of 4s‟s technique on crying duration newborn post

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C f 7 16 10 9

venous blood sampling procedures Grou Min Me Max Stat p imal an imal istic test Cryi 4s‟s 8 20, 40,5 tech seco 32 ng 6 dura niqu nd sec seco tion e ond nd p=0 Cont 13,1 30, 50,1 ,001 rol 2 14 2 seco sec nd ond

According table 2, the results showed that the average heart rate on treatment group was lower than the control group, but heart rate in both groups remained in the normal range. The decrease in heart rate was one indicator that the intensity of pain experienced on newborn treatment group has decreased compared to the control group. Respiration rate showed that the treatment group was lower than the control group. This data also as the indicator of decreased pain on newborn. Statistic test showed that the 4s‟s technique affected on newborn respiratory rate with p value=0,000. While the temperature of the treatment group had an average higher than the control group, but still on normal range temperature. After delivery, in addition to breathing and circulatory adaptation, the newborn must take control of body temperature. Getting too warm was as likely as getting too cold, so parents must continue to monitor, touch and feel their baby to ensure baby was not too hot or too cold, because both over chilling and overheating are SIDS risk factors and could impact the health and well being of infants (Williams, 1996). Temperature deviations were key signs of illness. Variation temperature on newborn affected by external factors. Fransson, Karlsson dan Nilsson (2005) on they studi emphasises the importance of close physical contact with the mothers for temperature regulation during the first few postnatal days. According this research temperature on treatment group had an average higher than control group but still on normal range. The 4s‟s technique given more time to newborn contact with caregiver than 1s‟s technique. Normal temperature for infants and children is usually higher than the normal adult temperature. At birth, heat-regulating mechanisms are not complete developed, so a marked fluctuation in body temperature may occur during the infant‟s first year of life (The Brookside Associates Medical

ANALYSIS Characteristics of newborn Based on Table 1, most types of labor experienced by mothers of newborn was cesar both the control and treatment groups most of newborn with female gender. Biological factors in genetic variations causing different types of neurotransmitters and receptors in moderate pain. There were limited data that gender also influence the behavior of pain, the female gender had an increased expression of behavior in response to acute pain compared to male babies. Unknown gender differences associated with pain processes and expressions of pain (Fuller, 2002; Guinsburg et al, 2000 on Rollman GB, Abdel-Shaheed J, Gillespie JM, Jones KS, 2003). The effect of 4S’s technique on the physiological responses (HR, RR, Temperature) on newborn post venous blood sampling procedures. Venous blood sampling procedure is one of routin procedures has effect pain. Pain is stressor for newborn. During and soon after pain procedure infant responses by physiological, behavioral and physic. Hockenberry & Wilson (2007) states that the interpretation of pain through physiological responses which are vital signs, variations increased heart rate, rapid and shallow respiration and oxygen saturation decreased.

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one only senses an the 4s‟s technique involving various senses.

Education Division, 2007). Beside that, when newborn got pain procedures, they are responses by behavioral, its also produced calor. The result of changed physiological responses supported by Harvey Karp research by recondition on womb mother. Swaddling made newborn restrict room and stopped extreme movement, giving message that time to sleep. Side-stomach position, newborn after delivery have morro reflex and they felt almost fall when got surprising stimuly. Fast method to calm baby at stress condition by side-stomach position. Shushing with sound of mouth “ssssshhhhh” near ear baby as loud as their crying sound. This sound almost same with artery mother. Swinging is rocking movement at our arms, this movement not more than 1 until 2 inchi from side to side. Stimulation by used many of senses such as sight, hearing and touching more efective for decrease pain than used just one of senses.

CONCLUSION There was an effect of the 4s‟s (swaddling, side-stomach position, shushing and swinging) to physiological responses (heart rate with p value=0,004, respiratory rate with p value=0,000 and temperature with p value=0,000) and the 4s‟s technique effect on crying duration newborn post venous blood sampling procedures with p value=0,001. ACKNOWLEDGEMENT The limitation of this research was on samples, we didn‟t control the first condition on newborn, newborn hungry or not, newborn felt cold or hot, felt comfortable or not and another factors influenced newborn prolonged to crying. REFERENCES Barr RG, et al. Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken-baby syndrome in mothers of newborns: a randomized, controlled trial. Peds.2009;123:972-80St. JamesRoberts I: Distinguishing between infant fussing, crying and colic: How many phenomena? in Lester B, Barr R, eds:Colic and Excessive Crying, Report of the 105th Ross Conference on Pediatric Research, 1997, 3-14.

The effect of 4S’s technique to crying duration on newborn post venous blood sampling procedures Table 3 showed that crying duration on treatment group shorter than control group. There was an effect the 4s‟s technique on crying duration of newborn post venous blood sampling sith p value=0,001. The cries of the newborn were a reaction to external and internal stimuli. Bradelton, 1962 at McCarrol and Fariz, 2010 conducted that cries is responses of need, such as changes of temperature, hungry, pain and discomfort. Short crying duration support phsychosocial development children on formatting senses trust versus mistrust. Ignored crying baby caused disturbance at future phsychosocial development (Wong, 2009). Infants normally cry about 1 to 3 hours a dat. The reason for a newborn to cry when hungry, thristy, tired, lonely or pain. It is also normal for a baby to have fussy period in the evening. Physical intervention to reduce pain by involving various senses is more effective than the

Fransson AL1, Karlsson H, Nilsson K.2005. Temperature variation in newborn babies: importance of physical contact with the mother. http://www.ncbi.nlm.nih.gov/pub med/16244210. acess at October 30, 2015. Gupta S.2012. The 5s’s: Easing Baby pain after vaccine shots. http://thechart.blogs.cnn.com/201 2/04/16/the-5-ss-easing-babypain-after-vaccine-shots/.

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Hatfield LA, Meyers MA, Messing TM. 2012. A systematic review of the effects of repeated painful procedures in infant: is there a potential to mitigate future pain responsivity?. http://dx.doi.org/10.5430/jnep.v3n 8p99. acess at October 30, 2015. Haouari N, Wood C, Griffiths G, Levene M. The analgesic effect of sucrose in full term infants: a randomised controlled trial. BMJ. 1995 Jun 10;310(6993):1498–1500. [PMC free article] [PubMed] Henry P.R, Haubold K and Dobrzykowski T.M. 2004. Pain in the Healthy Full-Term Neonate: Efficacy and Safety of Interventions. http://www.medscape.com/viewar ticle/481612 acess at Nopember 2015. Hockenberry MJ & Wilson D.2007. Wong’s nursing care of infants and childrens (8th ed). St. Louis: Mosby Elsevier. Karp H.2012.Happiest baby on the block. Gramedia: Jakarta. Kartikawati D.2011. Buku ajar dasar – dasar kegawatdaruratan. Jakarta: Salemba Medika. Khurana S, Hall R.W, Anand KJS. 2005. Treatment of Pain and Stress in the Neonate. http://neoreviews.aappublications. org/content/6/2/e76. acess at October 30, 2015. Medical Education Division, Brookside Associates .2007.Lesson 4: vital signs. http://www.brooksidepress.org/Pr oducts/Nursing_Fundamentals_II/ lesson_4_Section_1A.htm. acess at october 15, 2015. Page GG.2004. Are there long – term consequences of pain in newborn in newborn or very yaoung infants. http://www.ncbi.nlm.nih.gov/pmc /articles/PMC1595204/#citeref38. Acess at October 30,2015.

Rollman GB, Abdel-Shaheed J, Gillespie JM, Jones KS. 2003. Does past pain influence current pain: biological and psychosocial models of sex differences. http://defiant .ssc.uwo.ca/faculty/ rollmanpdfs/60_2004%20Rollma n%20et%20al%20%20Past%20pa in%20Eur%20J%20 Pain.pdf . acess at October 30, 2015. Setiyorini E. 2015. The effect of 4S’s technique to physiological and behavioral responses on newborn. Proceeding Book The 1st International Nursing Confrence STIKes Hang Tuah Surabaya, June 6, 2015. Sexton S and Natale R. 2009. Risk and benefits of pacifiers. http://www.aafp.org/afp/2009/041 5/p681.html acess at October 15, 2015. Wintiyah.2014. Pengaruh Swaddling, side position, sushing dan swinging (4S’s) terhadap durasi tangisan bayi paska prosedur pengambilan darah di Ruang Edelweis RS Ngudi Waluyo Wlingi. Skripsi. STIKes Patria Husada Blitar. Wong DL, dkk. 2009. Buku Ajar Keperawatan Pediatrik, Ed. 6, Vol.1. Alih Bahasa Agus Sutarna dkk. Jakarta: EGC. Williams SM, et al. 1996.Sudden Infant Death Syndrome: Insulation from Bedding and Clothing and its Effect Modifiers. International Journal of Epidemiology; 25, 366-75.

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THE EFFECT OF EARLY STIMULATION IN CHILDREN AGE 12-24 MONTH OF GROSS MOTOR DEVELOPMENT IN THE CORNER INFANT HEALTH CARE 1 VILLAGE CORNER DISTRICT DISTRICT PONGGOK BLITAR Ika Agustina STIKes Patria Husada Blitar email:[email protected] Abstract Growth and development is a process that occurs in life. Development stage in children is a series of regular growth from one stage of development to the stage of development of generally applicable. The aim of this study was to determine the effect of early stimulation of children aged 12-24 months against gross motor development at IHC Corner 1 Corner Village District of Ponggok Blitar. The study design used is a preexperimental with one group pre-post test design. The sample from this study were 20 infants in the IHC Corner Village Corner Ponggok District of Blitar. The sampling technique used was total sampling. The analysis in this study used paired samples t test and assisted by using SPSS program. The results showed an increase in the percentage of gross motor development of children before and after the early stimulation that motor development with the appropriate category of 7 respondents, or 35% to 16 respondents or 80%. While the dubious category of 13 respondents or 65% after stimulation given to 4 respondents or 20%. In addition, there were no children who have a distorted gross motor development. Based on statistical test sample paired t test showed p value = 0.024 <= 0.05, indicating the effect of early stimulation on the development of gross motor toddlers. The results of this study were expected to be used as a reference for monitoring the implementation of the stimulation and early detection to toddlers KEYWORDS: Early stimulation, development of gross motor Toddlers Age 12-24 Months children who have little or no stimulation(Soetjiningsih, 2008). In the process of gross motor development at age 12-24 months, namely walking, standing without holding, walking backward and kicking a ball, a child required special stimulation to encourage children to dare to do the stage of development in accordance with his age. An important role in stimulating the development of children is to train children especially gross motor development. Someone children must be trained to perform motor development in order to avoid delays (Hurlock, 2008). Unknown approximately 80% of the number of children who have

INTRODUCTION Growth and development is a process that occurs in living organisms. The process of growth and development of children have occurred since conception until the end of adolescence. Every organ and function have different growth rates. Development in children is a chain and orderly growth of one stage of development to the stage of development of generally applicable (Fida and Maya, 2012). One of the factors that affect growth and development are stimulated. Stimulation is essential in growth and development. Children who are purposeful and regular stimulation will grow faster than

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developmental disorders also have difficulty in setting the body's balance. This body balance adjustment problems related to the vestibular system or systems that regulate the balance in the body. If not treated immediately, this difficulty will be taken continuously by the children to school and when they will cause problems in the gross motor (Monks, 2004). Blitar town has about 3,817 children aged 0 to 1 year, about 1,840 children aged 1 to 2 years, approximately 4,687 children ages 3 to 5 years. This means that children aged 0 to 6 years as many as 15 939 have been growing and developing well or perhaps even risky. On 13 April 2008 the City Health Office Blitar cooperate with ties pediatrician Indonesia (IDAI) East Java and the division of child development and adolescent part of a community health center RSU Dr Sutomo Surabaya hold events early detection of child development mass (DDTKA-mass) in the City Blitar with a pre-screening questionnaire method development (KPSP) (ejournal.umm.ac.id). Based on the results of secondary data conducted in IHC Corner 1, were not in accordance with the toddler stage of its development (doubtful) in Infant Health Care Corner 1. Thus the phenomenon the authors wanted to examine the effect of early stimulation of children aged 12-24 months against gross motor developments in Infant Health Care Corner 1. Based on the results of secondary data conducted in IHC Corner 1, were not in accordance with the toddler stage of its development (doubtful) in IHC Corner 1. Thus the phenomenon the authors wanted to examine the effect of early stimulation of children aged 12-24 months against gross motor

developments in Infant Health Care Corner 1. The research problem were: "How is the effect of early stimulation of children aged 12-24 months against gross motor development at Infant Health Care Corner 1 Corner Village District of Ponggok Blitar? The aim of the study was to find out the effect of early stimulation of children aged 12-24 months against gross motor development. While the specific objectives were (1)Identify gross motor development in children aged 12-24 months before it was given early stimulation. (2) Analyze the effect of early stimulation of children aged 12-24 months against gross motor development. The theoretical benefits of the research was expected to increase the understanding and ability in the growth and development of children by providing the fulfillment of love, grindstones and good parenting to children so that children can grow and develop in accordance with his age level. The practical benefit was it was expected to improve the implementation of the stimulation and early detection to infants through cadre's to give an example of stimulating the development of the baby in the family. MATERIALS AND METHODS Design of this study was preexperimental with one group pre-post test design.The subjects were all children aged 12-24 months in Infant Health Care Corner 1. The Sampling technique used total sampling. The independent variable was early stimulation. The dependent variable was gross motor development. The analysis

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in this study used paired samples t test and assisted by using SPSS program.

Based on the results of the research showed that 20 toddlers, 65% or 13 children under five gross motor development before early stimulation in the category of dubious then after given early stimulation gross motor development of infants to 80% or 16 children in the appropriate category. Of the 20 infants, showed an increase in the percentage of gross motor development of children before and after the early stimulation that the motor development of the appropriate category from 35% to 80%. In addition, there were no children who have a distorted gross motor development. Based on statistical test sample paired t test showed p value = 0.024 <= 0.05, indicating the effect of early stimulation on the development of gross motor of toddlers.

RESULT AND ANALYSIS RESULT Characteristics of respondents listed in the table below. Table 1. Respondents No 1

Characteristics

Of

Characteristics Age

f

%

12 - < 15 month 15 - < 18 month 18 - < 21 month 21 - < 24 month

8 2 3 7

10 15 15 35

f 12 8

% 60 40

Table 2.Gender No Gender 1 Man 2 Female

Table 3. Toddler Nutrition f Toddler nutrition

No

Eating a day 3X

20

Table 4. History Of Toddler No History of toddler f 1 2

Nothing

Exist

18 2

ANALYSIS Gross Motor Development Of Children Aged 12-24 Months Before Early Stimulation Based on the results of research conducted in Infant Health Care 1 Corner Village District of Ponggok Blitar, showed that from 20 children aged 12-24 months, 13 respondents or 65% growth of gross motor development of infants before early stimulation in the dubious category. While 7 respondents, or 35% gross motor development of infants before early stimulation in the category appropriate. The gross motor development in infants who still doubt category could be due to the lack of stimulation in infants by parents, because when seen from the common data that includes nutritional research toddlers 100 % children got balanced nutrition. While based on a history of the disease 90% children under five do not have a history of the disease, while

% 100

% 90 10

Table 5. Gross Motor Development Of Infants Before Early Stimulation No Category f % 1 7 35 Corresponding 2 13 65 Doubtful 3 0 0 Diverge Table 6.Gross Motor Development Of Infants After Early Stimulation No Category f % 1 16 80 Corresponding 2 4 20 Doubtful 3 0 0 Diverge

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70% parenting authoritatively. There were no complications of childbirth. It could be concluded from the general data not obtained it leads to the development of children who are not good. Lack of stimulation was done to a child's development could be caused by lack of knowledge of mothers on the stimulation of the development as well as ways or methods of doing so in infants. Lack of knowledge of the respondents attributed to the lack of information and experience in providing stimulation mother (Notoatmodjo, 2010). Information about the development of sufficient stimulation would increase knowledge and ultimately encourage motor development of children. It was appropriate according to the source who said that the information would have an influence on the knowledge. With less get a true and accurate information will make the respondents do not have a good understanding of the method for stimulation in children. Mothers tend to did not deliver stimulation could significantly help the development of gross motor baby (Notoatmojdo, 2011). The young age of the baby is still considered to be particularly vulnerable should be taught something so she just gave the need for affection and only quieted the baby so that it grows naturally. The assumption that gross motor development will progress automatically to the child's age, is a false assumption (Fida and Maya, 2012) If the mother has a good knowledge not necessarily also able to provide a good development for toddlers. Good and bad behavior is also influenced by the environment, human, social, economic, cultural and others.

Gross Motor Development In Children Aged 12-24 Months After Early Stimulation Based on the results of research conducted in Infant Health Care Corner 1 Corner Village District of Ponggok Blitar, that of 20 children aged 12-24 months, 16 respondents or 80% gross motor development of infants after early stimulation in the appropriate category and 4 respondents or 20% of children under five in the category dubious. A lack of compatibility with KPSP gross motor development could be attributed to the success of the stimulation of the progress made and supported by the fulfillment of the basic needs of children, grindstones, compassion and parenting that have been carried out by the mother. While 4 respondents or 20% children still in the category of dubious because at the time there is a post assessment toddler in a state of less healthy or sick, fussy so as it affects the assessment. Based on the results, 90% of infants were exclusively breastfed 0-6 months and 100% children immunized complete. Physical needs-biomedical (FOSTER) include food or nutrition is the most important needs, basic health care, including immunizations, breastfeeding, weighing babies or children who regularly, treatment when sick, and others, board or adequate housing, hygiene individual, environmental sanitation, clothing and physical fitness, recreation, and others. With the fulfillment of basic needs to children who either course will encourage the improvement of gross motor development of infants. Toddlers become nutritional needs were met and that their immune stimulation can be done well.

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The results showed 70% parenting toddlers apply authoritative style. Meeting the needs of emotion or affection (ASIH) is the affection of his parents (father, mother) will create a close bond (bonding) and a trust basis (basic trust). The need for mental stimulus (Sharpen) is the forerunner in the process of learning (education and training) in children. Mental stimulation (Sharpen) was develop the mental development of psychosocial namely intelligence, skills, independence, creativity, religion, personality, moralethical, productivity, etc. If the fulfilment of love, grindstones and custody can be met by either the stimulation given to children under five will be successful. Some stimulation given to children aged 12-24 months are for children who are still babies (unable to walk), which could be trained include crawling, standing exercises, throwing, and so on. Mother invites toddlers to play and induce mothers to crawl or take a ball or throwing objects. As for children who can walk, a mother can train some movements, for example: running, climbing stairs, climbing chair, spinning, and so on. Up and down the couch at home are also sometimes given to help the development of gross motor skills of children. Mothers taking children play involving these movements and the children are always under the supervision of a parent while doing so. So that early stimulation is given able to improve gross motor development in children according to age levels (Fida and Maya, 2012).

gross motor development of children before and after the early stimulation that motor development with the appropriate category of 7 respondents, or 35% to 16 respondents or 80%. While the dubious category of 13 respondents or 65% after stimulation given to 4 respondents or 20%. In addition, there were no children who had a distorted gross motor development. Statistical test results obtained paired sample t, p value = 0.024 to p value = 0.024 <= 0.05, indicating the effect of early stimulation on the development of gross motor toddlers. An increase in gross motor development in infants, indicating early stimulation was a good method to improve gross motor development in infants. The most important period in the development of the child was the toddler, because at this time the basic growth that will influence and determine the next child development. In infancy, the development of language skills, creativity, social awareness, emotional, and intelligence to walk very fast and create a foundation for further developments (MOH RI, 2006). In child development are critical times, in which the necessary stimulation or stimulation useful for developing potential, that require attention. Stimulation of the parents, in addition to aid development, the aim was also to detect whether a child develops motor properly or not, whether in accordance with the task of development of the child's age at the time. Early detection was crucial in order to provide solutions or anticipate when gross motor development of the child was not the appropriate stage of its development, although it is still important to remember that each child must be different. If the developing

Effect Of Early Stimulation With Gross Motor Development Based on the results of the study showed an increase in the percentage of

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gross motor normal and optimal, this certainly will be supporting the child's level of self-confidence, health, and happiness together (Soetjiningsih, 2012 ).

Fida dan Maya. 2012. Pengantar Ilmu Kesehatan Anak. Yogyakarta: D-Medika Hidayat, Alimul. 2007. Metode Penelitian Kebidanan dan Teknik Analisa Data. Jakarta: Salemba Medika

CONCLUSIONS From the research and data analysis showed following results: 1. The development of gross motor skills of children aged 12-24 months before early stimulation majority of respondents in a dubious category at 65%. 2. The development of gross motor skills of children aged 12-24 months after early stimulation almost entirely of respondents in the appropriate category at 80%. 3. The results of the analysis with paired sample t test showed p value = 0.024 <= 0.05 so that it could be stated that early stimulation influence on gross motor development of children aged 12-24 months.

Hurlock, 2008. Perkembangan. Erlangga. Jakarta: Trans Info Media

Martiningsih,wiwin.Pengaruh Stimulasi terhadap Perkembangan Anak Sebagai Tindak Lanjut DDTK Masal Pasca pencatatan Recor Muri di Kota Blitar. Online diakses pada tanggal 11 September 2014 (http://www.ejournal.umm.ac.id/ index.php/.../1138 umm scientific journal) Monks. 2004. Psikologi Perkembangan. Yoyakarta: Gadjah Mada University Press. Notoatmodjo, Soekidjo. 2010. Metodologi Penelitian. Jakarta: Rineka cipta

REFFERENCES

Notoatmodjo, Soekidjo. 2011. Metodologi Penelitian. Jakarta: Rineka cipta

Arikunto. 2010 . Prosedur Penelitian. Jakarta: PT Rineka cipta

Nursalam,2011. Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan. Jakarta: salemba Medika

Cahyaninsih, Sulistyo. 2011. Pertumbuhan Perkembangan Anak dan Remaja. Depkes

Psikologi Jakarta:

R.I.2006. Pedoman Pelaksanaan Stimulasi,Deteksi, dan Intervensi Dini Tumbuh Kembang Anak . Jakarta: Depkes RI.

Nursalam. 2008. Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan. Jakarta: salemba Medika Soetjiningsingsih. 2012. Tumbuh Kembang Anak. Jakarta : EG

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THE EFFECT OF PROGRESSIVE MUSCLE RELAXATION TO IMPROVE THE QUALITY OF SLEEP OF NEUROSIS PATIENT Nawang Wulandari Program Studi Pendidikan Profesi Ners, STIKes Patria Husada Blitar [email protected] ABSTRACT Neurosis is a psychic reaction with typical anxiety. Anxiety may cause physical imbalance such as the increase of blood pressure, insomnia, muscle tension and palpitations. Muscle tension and sleep difficulties are common anxiety response symptoms experienced by the society. Progressive muscle relaxation therapy is a relaxation of the tightening and relaxing movement on the muscles of one particular body part at a time to provide physical relaxation. The muscles are tightened and relaxed in a series of movement. This study aimed to determine the effect of progressive muscle relaxation to improve the quality of sleep of neurosis patients. Pra-experimental research design with One Group Pre-Post Test with purposive sampling was conducted with the number of samples was 13 respondents. This study used a questionnaire to measure sleep quality while to measure the improvement of the quality of sleep used PSQI questionnaire, and the data were analyzed used bivariate analysis using the T-test. The result of the quality of sleep before and after the therapy on the treatment was p 0.000. It means there was some effect on progressive muscle relaxation therapy to improve the quality of sleep neurosis patient, so the hypothesis could be accepted. From the results, it could be concluded that the progressive muscle relaxation therapy could be used to improve the quality of sleep of neurosis patients. Keywords: Progressive Muscle Relaxation, Sleep Quality, Neurosis

INTRODUCTION Neurosis is a mental disorder in which the psychological condition of the client are in fear and anxiety chronic, people put more pressure on the perceived negative emotions to the subconscious, where it affect the feelings, thoughts, behavior and health of the body of a person who experienced it. Individuals who in the span of life have positive thoughts to the events in his life will develop a positive emotional response. Likewise, individuals who have negative thoughts toward an event experienced always use the negative thoughts and irrational when the stressor appear¹. This is an impact on physical and psikis² one of neurosis. Anxiety can cause physical imbalance such as increased blood pressure, insomnia, muscle tension and palpitations. While the psychological imbalances that can arise for example

difficulty concentrating, confusion, loss of control and imbalance social1. Based on the results of basic medical research (Riskesdas) Indonesia in 2013, the prevalence of emotional disorders as many (6%)2. Among a variety of mental disorders, neurotic disorders (anxiety neurosis) is a mental disorder that is most widely found in the community that is 2-4%3. In Blitar City particularly in Puskesmas Kepanjen Kidul Blitar there are 35 clients with a diagnosis of neurosis who visit every month, and there are no further interventions to address them. The prevalence of anxiety increased in line with the course of the disease and symptoms. Anxiety can provide the signs and symptoms of the complaints expressed subjectively or that can be observed with the observation that consists of the physical, cognitive, social

413

and psychological behavior. Muscle tension and difficulty sleeping is a response to the anxiety that is often experienced clients. Several factors can affect sleep as physical, psychological, social and environmental. Changes in the physical, psychological, social and environmental results in reduced time of sleep. Psychotherapy more effective than medical therapy in the long-term evaluation, as psychotherapy aimed at helping the patient or family to change the pattern of cognitive, behavior that is based on a deep understanding of the problems experienced by patients and their family. Progressive muscle relaxation therapy can be applied to clients with anxiety neurosis. Relaxation exercises aimed to distinguish the feelings experienced during be straightened muscle groups and compared when the muscles in a state of tension. By knowing the location and feel the muscles tense then the client can feel the loss of tension as one response to anxiety more clearly where therapy is progressive muscle relaxation can stimulate spending chemicals endorphins and enkephalins and stimulate signaling the brain that causes the muscles to relax

RESULTS AND ANALYSIS Table 1. Characteristics of Respondent Variabel Age (Year)

and improve blood flow to the brain. Progressive muscle relaxation can make the mind feel calm, relaxed and easier to sleep4. The aim of this study was to determine the effect of progressive muscle relaxation therapy to improve the quality of sleep neurotics in Puskesmas working area Kepanjen Kidul Blitar. METHODS This research was a quantitative research used Pre Experimental with PrePost Test design. The population in this study was all neurotics in Puskesmas Kepanjen Kidul Blitar as 35 people. The Sampling technique used in this research was purposive sampling as 13 respondents. The instrument to measure sleep quality used PSQI (The Pittsburgh Sleep Quality Index) questionnaires. The implementation of the entire study takes 6 weeks. 5 weeks were use for the implementation and one week of therapy were use to evaluate the quality of sleep after therapy. The data analysis used consisted of univariate and bivariate analyzes. In univariate analisis used statistical test Paired t-test.

s by Age Mean SD 45,15 9,998

Min 31

Max 58

Table 2. Characteristics of Respondents by Sex, Occupation, Education, and Marital status Variable Category Ʃ n % Sex Male 6 42,9 Female 7 53,8 Wrking Privately 6 42,9 Occupation Farmer 1 7,1 Not Work 6 42,8 Married 11 78,6 Marital Status Single 2 14,3 SD 3 21,4 Education SMP 6 42,9 SMA 4 28,6

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Most of the respondents were female gender. This type of work, the respondent is working privately, to the marital status of the majority of the respondents were married as many as 11 people. And for the respondent's educational level is junior high school.

Table 3 Distribution of Neurotics Sleep Quality Before and After Intervention Sleep Quality Paired t-test. Interven N si St. Deviasi Min-Max Mean 95% CI Pre 13 17,15 1,519 15-19 16,24P 0,000 18,07 Post 13 13,38 2,022 10-16 12,1614,61 the quality of sleep neurotics on the average was 17.15 before the intervention, after the intervention has been changed into 13.38. Sleep quality score before and after progressive muscle relaxation with a p-value of 0.000 (p value <0.05). ANALYSIS Neurosis Patients Sleep Quality Before Given Progressive Muscle Relaxation Therapy In Puskesmas Kepanjen Kidul Blitar. The results showed that the average quality of sleep neurotics before given progressive muscle relaxation therapy was 17.15. Poor sleep quality could be anxiety, fear and worry that excessive respondents experienced a decline due to the condition of the disease or health status, environmental conditions and other psychological conditions. In addition, some factors trigger a decrease in the quality of sleep is also associated with diet, habits of the use of drugs to help you sleep and daily activities were performed. In this study, the majority of respondents, namely private work as a maker of craft that demands high job completion precipitate stress that impact on the fulfillment of sleep. Emotional stress causes the stress that often leads to frustration so that the individual would have difficulty to start sleeping or otherwise. Smoking habits performed by male respondents were also concerned with the difficulty to start sleeping, this was because nicotine causes an increase in time awake. Nicotine has a half-life of about 1-2 hours so that individuals who smoked more than one cigarette in a few hours before sleep will have difficulty to start sleeping.

In this study, the average sex of the respondents in the treatment group was women. Women 2-3 times more prone to anxiety than men, this was because women were putting emotion. So that in times of stress, the more untouched emotion, aspects that impact on their health5 conditions. Neurosis Patients Sleep Quality After Given Progressive Muscle Relaxation Therapy In Puskesmas Kepanjen Kidul Blitar. The average score of PSQI respondents after being given progressive muscle relaxation therapy was 13.38. The average score of sleep quality decreased from before therapy, where the average quality of sleep 17.15. This shows that the average decrease in score indicates improvement in sleep quality. The assessment of quality of sleep by PSQI based on a score of 7 components include appraisal quality of sleep subjectively, sleep efficiency, sleep duration, the accuracy of sleep, a history of the use of drugs to help you sleep, things disturb of sleep, the perceived impact associated with sleep problems. The sum score of PSQI would describe the quality of sleep in which a high score indicates bad sleep quality6. Progressive muscle relaxation was part of a relaxation therapy that was used as a coping skill that teaches clients when and how to do relaxation and comfort under

415

conditions that can cause anxiety. This therapy was done with motion tightens and relaxes the muscles on one body part at a time to give a feeling of physical relaxation. Progressive muscle relaxation showed benefit in reducing the tensions that will fix various physiological and psychological symptoms. The stress response was part of a closed feedback path between the muscles and the mind. Assessment of the stressors lead to muscle tension which sends stimulus to the brain and make feedback path7. Relaxation exercises was one of self-management techniques that are based on the workings of the sympathetic and parasympathetic nervous system. Muscle relaxation would inhibit the pathway by activating the parasympathetic nervous system works. Physiologically the body, to produce endogenous to inhibit pain impulses generated by the perceived tension. Consists of endogenous endorphins and enkephalins, when the body remove these substances then one effect was to relieve tension be perceived8. The relaxation response occurred because parasympathetic autonomic nervous system activity raphe nuclei, causing changes that can control the activity of the autonomic nervous system in the form of a reduction in oxygen function, frequency of breathing, pulse rate, muscle tension, blood pressure, as well as alpha waves in the brain so it was easy to fall asleep. Neurosis patients sleep quality before and after progressive muscle relaxation therapy in Puskesmas Kepanjen Kidul Blitar. The results showed that there were differences in sleep quality scores neurosis patients with p 0.000 (α <0.05), which means that there is the effect of progressive muscle relaxation therapy against in this study, the average patient has decreased the quality of sleep before therapy. This was caused by the various conditions experienced by respondents include family conditions, relationships

with family members, delinquency, a relationship with a spouse, loss of loved ones and so on. Someone who were experiencing anxiety would lead to an imbalance in terms of physical vital signs, eating disorders, sleep patterns and tensions musle9. Sleep disorders are perceived them difficult to start sleeping, easily awakened at night and did not get a good sleep quality that impact on their daily activities. Progressive muscle relaxation were done by the respondents in a full concentration in which respondents were asked to distinguish between feelings experienced when the muscle groups be limp and compared when the muscles in a state of tension, and given the suggestion in the form of comfort to the respondents feel the relaxation maximum turned out to show a benefit in reducing tension and anxiety respondents experienced even a few respondents who feel the maximum relaxation stated doze off because of perceived convenience. Therapy was well done and full of concentration would improve a variety of physiological and psychological symptoms because it could create a state of relaxed and effective in improving sleep. Another opinion that some of the techniques that could be done to increase the need for sleep quality and quantity was bootzin methods and methods of relaxation, but the approach were the most widely used relaxation is progressive muscle relaxation. Progressive muscle relaxation was based on the mechanism of action of progressive muscle relaxation in influencing the need for sleep, which occurs the relaxation response (Trophotropic) that stimulates all the functions which works opposite to the sympathetic nervous system in order to reach a state of relaxation and calm. This relaxed feeling would be forwarded to the hypothalamus to produce Corticotropin Releasing Factor (CRF), which would stimulate the pituitary gland to increase the production of several hormones, such as βEndorphin, enkephalin and serotonin10. The relaxation response occurred because the activity of the parasympathetic

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autonomic nervous system so that the raphe nuclei caused changes that can control the activity of the autonomic nervous system in the form of a reduction in oxygen function, frequency of breathing, pulse rate, muscle tension, blood pressure, as well as alpha waves in the brain so it is easy to fall a sleep. Sleep was one of the basic requirements relating to the maintenance and restoration of health that allows the body and mind continue to function optimally. During the period of sleep the brain would process the long-term memory, integrate new information as well as tissue repair brain and nerve cells and plays a role in the biochemical processes. Less quality sleep was very harmful and affect the well-being of the negative impact on the function of physiological, psychological and work of someone11. Progressive muscle relaxation could make the mind feel calm, relaxed and easier to sleep4.

3. Hawari,D. (2007). Pendekatan Holistik pada Gangguan Jiwa Skizofreni. Jakarta: FK-UI.

CONCLUSIONS Based on the research results, it could be concluded that there were significant progressive muscle relaxation therapy to improves the quality of sleep neurotics in Puskesmas Kepanjen Kidul Blitar

7. Bebbington, P.E., Brugha, S., Meltzer, H et al. 2000. Neurotic Disorders and The Receipt of Psychiatric Treatment. Journal Psychological Medicine, 30(1369-1376).

ACKNOWLEDGEMENT Limitation research in the implementation of this study has limitations that technical issues such as location of residence respondents in 7 villages so it takes a long time. And the samples used only involve one group and no control group REFFERENCE 1. Stuart, G.W. 2009. Principles and Practice of Psychiatric Nursing (9th edition). St. Louis: Mosby 2. Badan Penelitian dan Pengembangan Kesehatan Departemen Kesehatan RI. 2007. Laporan Nasional Riset Kesehatan Dasar. www. riskesdas. litbang depkes. go.id. diakses tanggal 2 Februari 2015.

4. Conrad, A., Roth, W.T. 2007. Muscle Relaxation Therapy for Anxiety Disorders: It Works But How?. Journal of Anxiety Disorders, 21 (243–264). 5. Kaplan & Sadock. 2007. Sinopsis Psikiatri: Ilmu Pengetahuan Psikiatri Klinis Jilid 1. Jakarta: Bina Rupa Aksara. 6. Bush, L.A., Armento, E.A., Weiss.J.B et al. (2012). The Pittsburgh Sleep Quality Index in Older Primary Care Patients With Generalized Anxiety Disorder: Journal Psychometrics and outcomes following cognitive behavioral therapy Psychiatry Research, 199 (24–30). www.elsevier.com/locate/psychres

8. Smeltzer,S.C & Bare,B.C. (2002). Buku Ajar Keperawatan Medikal Bedah Brunner & Suddart edisi 88.Jakarta: EGC. 9. Stuart, G.W & Laraia, M.T. 2005. Principles and Practice of Psychiatric Nursing (7th edition). St. Louis: Mosby. 10. Ramdhani, N & Putra, A.A. 2008. Pengembangan multimedia relaksasi. Yogyakarta: bagian psikologis klinis fakultas psikologi UGM. 11. Riegel, B., Weaver, T.E. (2009). Poor Sleep and Impaired Self-Care: Toward a Comprehensive Model Linking Sleep, Cognition, and Heart Failure Outcomes. Eur J Cardiovasc Nurs, 5(337-344).

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12. Varcolis, E.M. 2006. Psychiatric nursing clinical guide: assesment tools and diagnosis. Philadelphia. W.B Saunders Co. 13. Keliat, B.A, Akemat. 2010. Model Praktik Keperawatan Profesional Jiwa. Jakarta: EGC.

14. Colten, R., Harvey., Altevogt, M.B. (2006). Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: The National Academic Press. 15. Iyus, Y. (2007). Keperawatan Jiwa. Bandung: Refika Aditam

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The Comparison of effectiveness between carrot (Daucus Carota) and Simvastatin to Changes in Blood Cholesterol Levels of white rats (Rattus Norvegicus) with Hyperkolesterolemia Thatit Nurmawati Pendidikan Ners, STIKes Patria Husada Blitar email: [email protected] Abstract High level blood cholesterol can impact on diseases. Carrot known with high beta carotene able to reduce blood cholesterol levels. The aim of the research was to determine the comparison effectiveness between carrots and simvastatin on cholesterol levels in hypercholesterol rats. The type of the research was experiments used randomized control-group pretest - post test design. The samples were divided into simvastatin and carrots treatment groups, each of 8 rats. Hypercholesterolemia by administering highcholesterol diet. Treatment using raw carrots with 1.25cc dose for 3 days. Measurement of cholesterol levels using Touch Essay data analysis with Willcoxon and Mann-Whitney. The results showed decreased cholesterol simvastatin groups as much as 12.5% (P = 0.069> α = 0.05), and the treatment group as much as 37.5% (P = 0.208), but the statistical test showed no effect of carrots on blood cholesterol levels. While the effectiveness of the results between treatment and control group (P = 0528> α = 0.05), indicating no effect to decreased levels of good cholesterol and a control group treated group. No effect on decrease in cholesterol levels could be caused by factors of betacarotene absorption easier if you boil carrots. Additionally only 3% beta-carotene in raw carrots was released during digestion. Keywords: levels-cholesterol, hypercholesterolemia, carrots, beta-carotene

INTRODUCTION No contagious diseases become a leading cause of death globally . Data WHO (world health organization) shows that of the 57 million deaths that occurred in the world in 2008, as many as 36 million or nearly two- thirds were caused by no contagious diseases. Several cases of no contagious disease including hypertension, coronary heart disease, diabetes mellitus, stroke, cancer and chronic respiratory diseases (Bulletin of the window and Health Information , 2012). Based on a sample of 1.5 % 300,000 heart diagnosed by a doctor , as much as 0.5 % on the interview with the doctor , 0.3 % had signs and symptoms of heart disease and as many as 0:13 % had heart failure The coronary heart disease become one of the major cause of death caused by narrowing of the lumen of blood vessels of the heart or often called atherosclerosis (Kabo 2008) The emergence of

atherosclerosis triggered by a buildup of cholesterol in the blood (hypercholesterolemia). Cases of atherosclerosis increase if there are factors - risk factors that can be changed include high diit , hypertension, diabetes mellitus, smoking, obesity, and stress (Brunner and Sudart, 2000). In addition, there are other factors that cannot be changed among others ras, sex, ages and genetic (Mutaqqin, 2009). High-fat diet can cause hypercholesterolemia by triggering the accumulation of cholesterol (Muttaqin, 2009). Cholesterol is a nutrient or component of the complex fat needed by the body as one of the highest sources of energy and also is the manufacture of sterol (Nurwahyuni, 2006). Cholesterol is divided into HDL (high destiny lipoprotein) cholesterol is the type that contains a lot of protein and LDL (low destiny lipoprotein) cholesterol is the type with a lot of fat. When excess levels of

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LDL will settle on the walls of the arteries that can lead to narrowing until closing. Therefore, an increase in LDL is one of the oxidants in the body (Fikri, 2009). Then attempt to decrease cholesterol levels in the blood is expected to reduce cases of atherosclerosis. Therefore, researchers wanted to use herbs. Herb is a plant or plants that have the purpose or value in the treatment because it contains an active substance that is useful for therapeutics. Advantages of herbal plants which lack side effects, processed naturally without chemicals, easily available and affo (Iklan Pos, 2014). One of plants used is carrots (Daucus Carota) Plant carrots (Daucus Carota) is no stranger to the world community, because always there regardless of the season. The community has many cultivate as plantation that profitable. Plant carrots (Daucus Carota) is an annual herb, can be consumed as vegetables, juices and even for snacks. Besides the price is relatively affordable, Carrots (Daucus carota) have low side effects (Cahyono, 2006). Based on the results of the study showed that the consumption of raw carrots every morning can lower blood cholesterol up to 11% (Julianti, Nurjanah and Soetrisno, 2009). This is because there is a compound in carrots beta-carotene. Based on research Parwata (2010) serves as an antioxidant beta carotene which has the ability to reduce free radicals, especially singlet O2. Taking beta-carotene derived from carrots are safe and will not give toxic effects to 100,000 IU per day. This is in contrast to the excessive synthetic beta carotene have potential risks as prooxidan (Muchadi, 2009). The walls in carrots also contain pectin, which is a type of dietary fiber, which is water-soluble (Soluble dietary fiber). This type of fiber acts to lower cholesterol levels and blood sugar (Vallerie, 2009). Higher beta-carotene in carrots is still raw, but the absorption of betacarotene more easily if the carrots boiled first (Muchadi, 2009). Also based on laboratory test results MOH nutritional composition of ingredients in raw carrots

more than in cooking and presentation of other (MOH, 1995). Based on research in carrots (Daucus Carota) contained beta carotene 7.6 mg, alphakarotin 3.4 mg, vitamin E 465 mcg, Vitamin B1 69 mcg, Vitamin B2 53 mcg, nocotamide 500 mcg, acid pentofanat 270 mcg, Vitamin B6 270 mcg, phosphoric acid 26 mcg, 0.7 mg vitamin (Rozaline, 2006). Therefore, the researchers want to do research on the effectiveness of the carrot (Daucus Carota) on cholesterol levels in rats (Rattus norvegicus).Research Question Are there any potential differences in cholesterol reduction in white rat Rattus norvegicus after carrots compared with simvastatin? METODS Independent variable : processing of carrots, carrots dose and duration of administration. Dependent variable : decrease in blood cholesterol levels. The design of this study was true experiment using pretest posttest control group design. The sample is based on a formula Federer, the (t-1) (n-1) ≥15, t is the treatment group, n is the number of samples per treatment group. Then the number of samples in each treatment is 8 of rats. Cholesterol levels obtained by measuring the blood of rats before treatment carrots. The provision of a diet high in cholesterol (egg yolk duck, goat oil, lard, flour) in feed. Treatment of carrot (blended), filtered and then administered by sonde. Measurement of blood cholesterol levels by taking from the tail end. Analysis of the data used was Kruskal Wallis statistics to examine differences in the speed of cholesterol reduction using 95% confidence level used by SPSS 17. RESULTS AND ANALYSIS This study aims to determine the differences decrease blood cholesterol levels by using the carrot (Daucus carota) were given to rats (Rattus norvegicus) after administration of a diet high in cholesterol. During the study, there was no samples droup-out, complications or serious side effects.

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cholesterol levels of white rats treated group before being given a raw carrot is greater than in the control group were also not given the treatment by a margin of 6 mg / dl. Table 2 also shows the results of research in the form of cholesterol after N Weight Pre Post o (gr) ∑ % ∑ % treatment in the treatment group and the 1 100-150 1 6.25 9 56.25control group. From these results indicate 2 160– 200 12 75 2 12.25that high cholesterol levels in the treatment 3 210– 250 3 18.25 5 31.25group was 349 mg / dl. While the lowest was 137 mg/ dl. Value - average cholesterol treatment group mice who had Based on table 1, before treatment been given a raw carrot was 185.25 mg /dl. 75% weigh 160-200 grams. While the In the control group the highest cholesterol percentage of weight loss with 6:25 level is 218 mg / dl and the lowest smallest 16% of rats. Body weight of rats cholesterol levels of 117 mg / dl. Value after treatment given change of weight average cholesterol levels after the control range 100-150 gr changed from 6:25% group given cholesterol drug was 169.75 increase to 56.25%. weight gain also mg / dl. After calculating the average occurred in the range of 210-250 g of obtained - average cholesterol levels of 18:25% increase to 31.25%. However, for white rats after the treatment group was the range of 100-150 g decreased from given raw carrots is greater than the 75% to 12.5%. cholesterol levels of mice white given cholesterol drug therapy with a difference The Distribution Of Cholesterol Levels of 15.5 mg/dl. From the comparison of the Of Rats On Pre And Post Treatment difference between the average - average Table 2 The distribution of cholesterol results from before and after treatment levels of rats on pre and post treatment Simvastatin showed that an increase in average Daucus (mg/dl) (mg/dl) differences - cholesterol rats from the No Sample Pre Post Pre Postdifference between the previous average of 141 162 100 154 1 1 138 1506 mg/dl to 15.5 mg / dl. Of the difference 2 2 207 167 3 3 132 165 112 218could be concluded that a change in 4 4 171 168 100 150cholesterol levels between before and after 5 5 147 137 164 117treatment. Distribution Of Rats Weight On Pre And Post Treatment. Table 1. Distribution of rats weight on pre and post treatment.

6 7 8

6 7 8 Median

150 159 100 145.75

168 174 349 185.25

131 179 153 139.75

145 209 207The Distribution 169.75Of Rats On Pre

Based on the table 2 cholesterol treatment group had the highest cholesterol levels 207 mg / dl and the lowest cholesterol level is 100 mg / dl. Value average cholesterol levels of white rats in the treatment group before being given a raw carrot was 145.75 mg / dl. While the control groups were not given the treatment had the highest cholesterol levels 179 mg / dl and the lowest cholesterol level is 112 mg / dl. Value - average cholesterol levels of white rats control group was 139.75 mg / dl. After tabulation of data obtained average - average

Of Cholesterol Levels And Post Simvastatin

Treatment Table 3 The distribution of cholesterol levels of rats on pre and post simvastatin treatment Simvastatin Pre Post No Sample (mg/dl) (mg/dl) 141 162 1 1 2 2 138 150 3 3 112 218 4 4 100 150 5 5 164 117 6 6 131 145 7 7 179 209 8 8 153 207

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Median Average range Α P : 0.069

139.75

169.75 30

Based on Table 3 the results before and after drug administration cholesterol in the control group obtained average - average before being given treatment was 139.75 mg / dl and the average - average after being given treatment with the drug was 169.75 mg / dl. Based on the above tabulated results are an increase in the average - average cholesterol levels before and after treatment of cholesterol drug delivery. While based on the data of the table is a decrease in cholesterol levels before and after treatment as much as 12.5% of all samples. Changes in cholesterol levels before treatment was 164 mg / dl after being given the drug treatment of cholesterol dropped to 117 mg / dl. But based on statistical result obtained P = 0.69 in other words P> α = 0.05 which means acceptable and there is no effect of cholesterol drugs against cholesterol test animals white mice. The Distribution Of Cholesterol Levels Of Rats On Pre And Post Daucus Carota Treatment Table 4 The distribution of cholesterol levels of rats on pre and post Daucus carota treatment Daucus Carota No Sample Pre Post (mg/dl) (mg/dl) 1 1 100 154 2 2 207 167 3 3 132 165 4 4 171 168 5 5 147 137 6 6 150 168 7 7 159 174 8 8 100 349 Rata rata 145.75 185.25 Average range 39.5 α P : 0.208 Based on Table 4 in the treatment group obtained average - average before being given a raw carrot was 145.75 mg / dl and the average - average after given

raw carrots increased to 185.25 mg / dl. Based on these results it can be concluded there is an increase in the average average cholesterol levels before being given a raw carrots and after given raw carrots. However, based on the table there is also a decrease in cholesterol levels 37.5% of the total number of samples treatment groups. Among rats No. 2 with cholesterol levels of 207 mg / dl to 167 mg / dl, the mice no 4 with cholesterol 171 mg / dl changed to 168 mg / dl and no rat 5147 mg / dl changed to 137 mg/dl. Different things also occur in mice No. 8 is characterized by an increase drastic of cholesterol before treatment of 100 mg / dl increased to 349 mg / dl. But based on statistical results available P = 0.208, in other words P> α = 0:05 so that it can be concluded that there was no effect on cholesterol levels of raw carrots test animals white mice. Cholesterol Mice After Treatment In The Treatment Group And The Control Group Table 5 Cholesterol mice after treatment in the treatment group and the control group Post Post No Sample control treatment (mg/dl) (mg/dl) 162 154 1 1 2 2 150 167 3 3 218 165 4 4 150 168 5 5 117 137 6 6 145 168 7 7 209 174 8 8 207 349 α P : 0.528 Based on the table 5 after the test statistics on the results of the effectiveness of the provision of raw carrots and giving cholesterol drugs obtained P for 0528. because the value P> of the α = 0.05, then the hypothesis is rejected, which means there is no influence. it can be said that there is no effect of raw carrot to decrease cholesterol levels either the control group or the treatment group.

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DISCUSSION Carrots are one of the root vegetables that are rich in bioactive compounds. Carrots has become a major vegetable and is commonly known as and carotene content (Sharma, et al, 2012). Carotene as an antioxidant dampen singlet oxygen and prevent lipid peroxidation, the effect resembles the effects of vitamin E and vitamin C in protecting DNA and membranes from oxidative attack endogenous (Robbins, et al., 2004; General, 2013).Carotene acts as an antioxidant to prevent a chain reaction generated hydroxyl radicals thus preventing disconnection chain fatty acids in membranes and prevents the formation of disulfide bonds (-SS) the protein so it does not lose its biological activity for the formation of energy (Mayes, 2002). Carotenoids are lipophilic so that play a role in cell membranes to prevent lipid peroxidation. β carotene is a compound that can give electrons (electron donor) to free radicals or oxidants so that a stable radical compounds (Meyes, 2002; General, 2013). β carotene is known as an excellent antioxidant, due to its ability to quench singlet oxygen and peroxyl radical scavenger (Agung, 2013). he results showed no difference in each treatment to reject the hypothesis. Probably due to the levels of β carotene contained in carrots is still very low. This is in line with research Heber and Lu (2000), which shows that at the same concentration of various carotenoid compounds, β carotene will have lower antioxidant activity. The addition of carotenoid intake can increase the concentration of lipoprotein carotenoids In addition there is also a pectin carotene in carrots. Pectin is able to decrease absorbance bile acid but only slightly lowering cholesterol (Leveille, 1966) pectin binding bile acids and increased spending that is then wasted with feces. Bile acid binding by pectin causes bile acids out of the enterohepatic cycle. Decrease the amount of bile acids cause liver uses cholesterol in the blood as a precursor of bile acids. Increased faecal bile acid or cholesterol is lost can result in

decreased plasma cholesterol and increase the turnover of cholesterol biosynthesis in animals (Linder, 1992). Will tetepi on the results of this study showed no pectin high cholesterol absorption capability. Pectin levels in carrots is very small, about 7.4% There is no difference in treatment can be influenced metabolism in rats of different bodies. When the number of calories derived from food is less than energy expended the endogenous savings will be issued (Ganong, 2002). Food absorption there may be differences in each individual and therefore contributes to increased levels of cholesterol (Haryanti, 1997). The conditions allowing the mice to spur the production of stress hormones epinephrine, norepineprin, corticotropin and glucocorticoids that activates hormone-sensitive lipase that breaks down triglycerides, triglycerides and free fatty acids increase. The stress hormone causes the active genes in fat cells that can multiply and thrive. Comparative Analysis Of Cholesterol In Pre And Post Control Group Based on the results of data processing showed that there were decreases in cholesterol levels before and after treatment as much as 12.5% of the test animals, but based on statistical result obtained P = 0.69 in other words P> α = 0.05 which means acceptable and there is no effect of cholesterol drugs against cholesterol test animals white mice. It is possible researchers used the lowest dose in the study. The dose used was 0144 mg. based on research results Venesa et al (2013) volume required is 10 mg simvastatin medications for cholesterollowering effect in rats. In line with the research Unneyputty (2013) the dose of simvastatin to rats of 0.18 mg / day / 200 gr BB. Another possibility rat cholesterol level changes caused by the activity of the rats based on the observations of researchers, rats experienced enough activity. Because of the activity on a regular basis can improve HDL cholesterol and pressing total cholesterol and LDL cholesterol and triglycerides burn to lose weight. In addition to food activity also

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affects changes in cholesterol levels. foods that contain a lot of cholesterol, trans fats and high in saturated fat such as cheese, lard, beef brain and viscera increase cholesterol levels in the blood. Stress experienced by the rats within lasts long enough will destroy the balance of body functions so that it can raise cholesterol and blood pressure (Wijayakusuma. 2008). Comparative Analysis Cholesterol Levels Of Mice In The Treatment Group Before And After Given Raw Carrots Based on the results of data processing are cholesterol-lowering amount of 37.5% of the treated group of mice. But based on statistical results obtained P = 0.208, in other words P> α = 0:05 so that it can be concluded that there was no effect on cholesterol levels of raw carrots test animals white mice. There may be because of the absorption of white mice terhadapa raw carrots. This is in line with research Muctadi (2009) argued that a higher content of beta carotene in carrots is still raw, but the absorption of carotenoids easier if carrots boiled first. Raw carrots have tough cell wall makes the body can only convert less than 25% beta-carotene into vitamin A. Based Rukmanan (2006) Carrots can be eaten in various ways, but only 3% of beta carotene in raw carrots is released during the digestion process takes place, this can be increased to 39% through cooking and add palm oil. Comparative Analysis Cholesterol Levels Of Mice In The Treatment Group And The Control Group Based on the results of a statistical test the effectiveness of the provision of raw carrots and giving cholesterol drugs obtained P for 0528. The P value> of the α = 0.05, then the hypothesis is rejected, which means there is no effect, it can be explained that there was no effect of cholesterol-lowering both the control group and the treatment group. This is caused due to the timing of therapy is only 3 days. According to research conducted Vanese et al (2013) cholesterol changes which occurred in the first week can also

be caused due to environmental stress, and changes in the type and pattern of food suddenly. As soon as rodents can adapt to food, metabolism lasted well so that cholesterol in the blood can go down by itself CONCLUSION The results of this study had demonstrated that there were no effect of Daucus carota on high levels cholesterol white rats (Rattus norvegicus) ACKNOWLEDGEMENT The sample size is the least. Time research to short treatment so alteration not maximal REFERENCES Anonymous, 2004. Carrot. http://en.wikipedia.org/wol.iki/carrot. online diakses tanggal 6 mei 2015 Biokimia Harper Edisi 25 Robert k.Murray; Daryl k.Granner ; Peter A.Mayes and Victor w.Rodwel, 2003 EGC. Fikri F. 2009. Memahami, Mendeteksi Bahaya Kolesterol. Arr-Ruzz Medi: Jakarta Iklan Pos. 2014. Sehat dengan herbal. Jakarta: Iklan Pos Julianti, Nurjanah dan Soetrisno. 2009. Bebas Hipertensi dengan Terapi Jus. Jakarta: Gramedia Pustaka Utama Kabo. 2008. Mengungkap Pengobatan Penyakit Jantung Koroner. Jakarta: Gramedia Pustaka Utama. Nurwahyuni A. 2006. Efek Kolesterol Daun Sambung Nyawa TerhadapKolesterol LDL dan Kolesterol HLDL Darah Tikus Diabetik Akibat Induksi Streptozotozin. Skripsi Universitas Negeri Semarang Rozaline. 2006. Terapi Jus dan Sayur. Jakarta: Puspa Swara Smeltzer ,Suzane C Buku ajar keperawatan medikal – bedah, Brunner & Suddarth edisi 8 vol.2 Jakarta. Uneputty, Yamlean dan Kojong. 2013. (Annona Potensi Infusan Sirsak muricata L) terhadap kadar

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kolesterol darah tikus putih jantan (Rattus Norvwgicus). Vanessa, Purwijantiningsih dan Aida. 2013. Pemanfaatan minuman serbuk instan kayu manis (Cinnamomum Burmanii BI) untuk menurunkan kadar kolesterol total darah pada tikus putih (Rattus Norvwgicus). Wijayakusuma H. 2008. Ramuan herbal penurun Kolesterol. Jakarta: Pustaka Bunda.

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THE CORRELATION OF PERSONAL SELF-CARE ABILITY AND QUALITY OF LIFE IN PATIENTS UNDERGOING CHRONIC KIDNEY DISEASE IN HEMODIALYSIS INSTALLATIONS OF RSUD MARDI WALUYO BLITAR Sandi Alfa Wiga Arsa STIKes Patria Husada Blitar Email : [email protected] Abstrac : Chronic kidney disease is condition occurs if the patient could survive only with help of hemodialysis machine. In this state, the patients not only have to survive alone but also to achieve a certain level of their welfare. This quality of life should be maintained in management of clinical nursing for these patients. Self-care ability is one of the factors that is considered to have a relationship with the quality of life for chronic kidney disease patients. As many as 30 patients were being respondents to this research by filling out a questionnaire of personal care ability and quality of life that is modified from KDQOL-SF v 1.3. The data were analyzed using Spearman rho correlation with SPSS version 17. The results showed p value: 0.008 and rs: 0.473. This means that the correlation was strong and had positive correlation directions between self-care ability and quality of life for the patients of chronic kidney Disease. If the level of the self-care ability is higher, they will have a better quality of life. With the increasing number of the patients who can conduct a personal self-care ability will increase the contentment, or socalled a psychic satisfaction, because of the fulfillment of the requirement for a good life for both of external requirements and their perception. In addition, this satisfaction will drives an individual to gives a good value for their quality of life. Keywords : quality of life , self-care, chronic kidney disease. INTRODUCTION Along with the development of globalization era, Indonesia is one of the developing countries that are now executing to develop in every sector including health. Riskesdas 2007 in SKN 2009 show an increase in cases of noncommunicable diseases (such as cardiovascular diseases and cancer) are quite significant; making Indonesia has a double burden. Chronic kidney disease is one of the non-communicable diseases is quite rapid development rate of sufferers. Kidney failure is a clinical condition characterized by the irreversible decline in kidney function, to a degree requiring kidney replacement therapy which remains, in the form of dialysis or kidney transplantation (Aru W Sudoyo et al, 2009). Peritoneal dialysis, hemodialysis and kidney transplantation is the treatment given to patients with chronic kidney failure. Hemodialysis is a treatment that has been chosen by patients with chronic kidney failure. Hemodialysis is used for patients with end stage kidney failure or acute disease patients requiring dialysis short time (Nursalam & Fransisca, 2006).

Hemodialysis can extend life without clear boundaries, this action will not change the natural history of the underlying kidney disease, and does not restore kidney function, and patients will continue to experience a number of problems and complications (Smeltzer & Bare, 2004). The quality of life of patients will gradually decrease over the course of the disease experienced. Where a person perceives himself departed with normal living conditions / ideal to hazardous conditions or without health that need dialysis to stay alive. One of the factors that are considered researchers affect the quality of life is the ability to self-care, which is a form of business to meet the needs of these patients in order to survive. Based on the Report of Indonesian Renal Registry in 2010 by the Association of Nephrology Indonesia (PERNEFRI). Shows the number of new hemodialysis patients and hemodialysis patients were still active in 2007, 4977 new patients a number of people, in 1885 the number of active patients; In 2008 new patients a number of 5392 people, in 1936 the number of active patients; In 2009 new

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patients a number of 8193 people, 4707 active patients; In 2010 the number of new patients 9649 and 5184 active patients (PERNEFRI, 2010). Based on preliminary survey dated January 11, 2012 at Mardi Waluyo Hospital Hemodialysis installation Blitar, from 2009 to 2011 patients continues to increase. Currently available 8 daily dialysis machine and this machine is never empty. The number of patients on hemodialysis installation Mardi Waluyo Hospital amounted to an average of 14 people every day who do dialysis. Hemodilisa engine number and business hours only in the morning and afternoon shift considerably less installation space because according to data Mardi Waluyo Hospital hemodialysis there are still 45 patients with chronic renal failure have not been able to obtain dialysis services here. In addition to therapy with hemodialysis, patients with chronic renal failure should be able to adapt to the circumstances that happened. Restrictive diets will change the patient's lifestyle and perceived as a nuisance and undesirable for many patients with chronic renal. Because food and beverages is an important aspect of socialization, patients often feel excluded when with other people because there are only a few food choices are available to him (Aru W Sudoyo et al, 2009). In addition, patients with chronic kidney failure who receive hemodialysis actions undergone many changes in many aspects of life. According to Mercedes-Moreiras (2011) the first aspect that changes is welfare, where the progressive state of renal worsening will reduce also the functions of other organs, such as restrictions on food, diet control, decreased sexual function, and others, make the patient feel things that he liked to be limited, so that the change in subjective well-being of himself. Second, is the self-image, problems such as discoloration of the skin, body odor, reduction urinary function, and others can make patients assess themselves negatively and using feelings of inferiority. This limits the feeling of social and family relationships that can bring introversion.

The third is the fulfillment of basic needs, where the frequency of dialysis can damage and limit the patient's lifestyle. On the other hand the feeling of inferiority accelerates physical deterioration, passivity, ignorance and dependency, which can often be left with the help of another person, the family and social environment. The last aspect that changes are the mental attitude, anxiety is always present at all times in the life of the patient because every day faces the risk of death. Anxiety causes stress, somatization, obsessive attitude, depression, aggression and so on. With various changes in various aspects of the person's going to do something on his own in maintaining the life, health and welfare, called Dorothea Orem as care themselves. The ability of daily self-care activities was important for health. There are eight elements of universal self care needs identified include air intake, water intake, food intake, elimination function, activity / rest, social interactions, precautions against the dangers of life, and live a normal life. With self-care (non-medical factors) that have been pursued and action hemodialysis (medical factors) capable slow down progression to kidney failure, are important factors in the morbidity and mortality of patients with chronic renal failure. Of the two factors of medical and non-medical has been done, the patient will perceive himself about his position in life. Perception and self-assessment of the patient's health status is called MercedesMoreiras (2011) as the quality of life. Quality of life is very important in the clinical management of patients at this time, because the patient is not just hoping to survive alone, but hopes to achieve a certain level of prosperity. Improving the ability of self-care for patients with chronic kidney failure is needed to increase quality of life of these patients. Improved quality of life will greatly affect the life expectancy in patients with renal failure. Based on the above, it is necessary and important to know the correlation of selfcare ability and quality of life of patients with chronic renal failure receiving

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hemodialysis action in Hemodialysis Installation General Hospital of Mardi Waluyo Blitar. The research problem in this research was: How is the correlation of self-care with the quality of life of patients with chronic renal failure in Hemodialysis Installation Mardi Waluyo Hospital Blitar. The general objective of this research was to explain the correlation of self-care ability and quality of life of patients with chronic renal failure receiving hemodialysis action in Hemodialysis Installation General Hospital of Mardi Waluyo Blitar. While the specific objectives of this research were: 1) Identify the ability of self-care patients chronic kidney disease, 2) Identify the quality of life of patients chronic kidney disease, 3) analyze the relationship between the ability of self-care patients with chronic renal failure with the quality of life in the Installation Hemodialysis Hospital Mardi Waluyo Blitar. Theoretical benefit of this research was to add the treasures in the science of nursing intervention on arrange patients with chronic renal failure receiving hemodialysis action, practically this study can be used as one way to improve the quality of life of patients with renal failure receiving hemodialysis action.

version 1.3. Data analysis Spearman's Rho with p ≤ 0:05.

using

RESULT Table 1 Value quality of life and self-care of patients with chronic renal failure Quality of Life

Self care Mean

12.9333

73.8300

Std.

1.96404

9.87980

Range

8.00

38.50

Minimum

8.00

48.20

Maximum

16.00

86.70

Deviation

Table 2 Value of correlation between selfcare with the quality of life of patients with chronic renal failure Spearman rho Probabilty (p

Correlation

value)

Coefficient (rs)

0,008 METHODS The research design was correlational to assess the correlation of self-care with the level of quality of life in patients with chronic renal failure who received the action hemodialysis, research carried out in the installation Hemodialysis Regional General Hospital Mardi Waluyo Blitar, on on 5 - May 19, 2012, with a population of 42 patients still undergoing regular hemodialysis, the sampling technique was total sampling. The independent variable was the ability of daily self-care of patients with chronic renal failure and the dependent variable was the quality of life of patients with chronic renal failure receiving hemodialysis action. Data collection tool in this study was questionnaire self-care ability and questionnaire SF KDQOL modified

0,473

Based on the table above, obtained probability value of 0.008. Because the pvalue ≤ 0.05, it means that there is a significant correlation between self-care ability and quality of life. The value of the correlation coefficient obtained from the SPSS statistical test is rs: 0.473 which shows a positive correlation coefficient with a sufficient degree of correlation. It can be concluded that the relationship was strong and positive relationship between the ability of self-care with the quality of life of patients with chronic renal failure who receive hemodialysis action in Hemodialysis Installation Mardi Waluyo Hospital Blitar.

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DISCUSSION AND ANALISIS Self Care Nursing independent (self-care) by Dorothea E. Orem was an implementation of the activities initiated and conducted by the individuals themselves to meet the need to maintain life, health and wellbeing according to the circumstances, either healthy or sick. Based on this study the ability of self-care acquired by 6 people in the category ability of self-care partial was only some of these patients can meet the needs of self-care daily, and the majority of respondents included in the ability of self-care self-sufficient, as many as 24 people with a sense could be said of these patients does not need any help at all in meeting the needs of daily self-care. From the data tabulation of data obtained minimum value of self-care was at the 8 and the maximum value obtained was 16. While in the category of total or require full assistance in fulfilling the needs of daily self-care, was not found in research in Hemodialysis Installation Mardi Waluyo Hospital Blitar. Actually, necessary of self-care by Dorothea E. Orem learned and influenced by individuals themselves, the environment, health and nursing. Self-care was the first step by individuals that take place on an ongoing basis according to the circumstances and its existence, good health and perfection. Self-care independent universally assumed as the ability to meet life daily care that have been identified to the respondents in this study through questionnaires include moderately air intake, moderate intake of water, moderate intake of food, the fulfillment of the functions of elimination, balance between activity and rest, fulfillment activities and social interactions, precautions against the dangers of life, and is able to live a normal life. Disappearance category abilities self care total respondents possible because the respondents themselves quickly adapt to the circumstances they were experiencing now, the everyday environment where they often come face to face with renal failure patients other and share experiences

neighbor of self-care that must be done, the self-awareness of their health status was also greatly contributes to the patient's ability to self-care, and health education on self-care given by nursing staff in hospitals Hemodialsa Installation the Mardi Waluyo. Quality of Life Quality of life is the perception person about the individual how assess their own health. It is influenced by several factors, medical and non-medical interconnected. Pain, or effect to one's physical area, has an impact to the psychological condition of people and relationships. MercedesMoreiras uses the term Health-Related Quality of Life because it is defined formally as when the physical, emotional and social reasonable or are expected to be affected by a medical condition or treatment. The concept of Health-Related Quality of Life (HRQOL) shows the impact of a disease or medical action against the physical symptoms, functional status, and mental and social functioning. Agus Yuono in 2000, the quality of life decreases with increasing age, patients with terminal renal failure young age will have a better quality of life because typically have better physical condition. Male gender have a lower quality of life than in women, and the longer undergoing hemodialysis the lower the quality of life of patients. Etiology or cause of chronic kidney disease nephrotic diabetic disease has a poorer quality of life than patients for other reasons (Bergstrom, 1985 in Agus Yuono 2000). Based on the research quality of life of patients with kidney failure in Hemodialysis Installation Mardi Waluyo Hospital Blitar very varied, with the acquisition of a minimum value is 48.2 and the maximum value obtained 86.7. The average value of the quality of life obtained from 30 respondents was 73.83. Assessment of quality of life particularly a maximum value of 100, the number 100 can be said to approach the quality of life of patients with chronic renal failure, the better. Age, education, the last ever taken of respondents do not have a meaningful role. Age and educational status does not

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guarantee a person's past can assess and perceive a state of pain they experienced well. According to Mercedes Moreiras quality of life is affected by the physical, psychological and social relations. Based on research conducted Agus Yuono (2000), a precursor of diabetes mellitus disease has a significant role in the quality of life. In this study did not prove so because the number of patients with chronic renal failure in this study the majority had hypertension predecessor disease. In the grouping of sex, women have a better quality of life than in males with a minimum value the quality of life in women is 68.20, the minimum value of the quality of life in men 48.20, while the maximum value obtained in women was 86.7 and 86.4 in men. The difference between the quality of life gained men and women, may be because men are usually more active in the work, and make a living for his family so that the male has a standard priority higher quality of life compared with patients female. As a result the quality of life of men will get lower when compared to women. Quality of life of respondents undergoing hemodialysis 120 months long enough to dominate the minimum value of the quality of life to appear as much as 4 respondents in the four lowest value and 4 respondents in moderate values. This can caused initial adaptation period or tolerance of a patient with chronic renal failure undergoing hemodialysis the first time both psychologically and physically. In a previous study conducted by Agus Yuwono in Hemodialysis Unit of Hospital Dr. Kariadi (2000) shows the nutritional status, etiology, and the number of comorbid affect the quality of life, whereas sex, duration of HD and age do not have a meaningful relationship. Research results Kusman Ibrahim (2009) revealed that there were significant differences between the quality of life by gender and other accompanying health problems, whereas there was no significant difference in the quality of life of patients according to age, education level, and the longer undergo hemodialysis. Each research area has different factors that have a significant

relationship with quality of life. As in this study, a factor that has not been previously studied the ability of self-care that turned out to have quite a significant relationship in the quality of life of patients with chronic renal failure. Relationship between Self-Care Ability with Quality of Life From the statistical test using Spearman's rho correlation test with SPSS version 17 is the result p value of 0.008. Because the value of p <0.05 then the H1 is accepted it means there was a significant correlation between self-care ability and quality of life. The value of the correlation coefficient obtained from the SPSS statistical test was rs: 0.473 correlation coefficient that shows the correlation between the levels of self-care with the quality of life considerably. Positive values obtained in the correlation coefficient have a meaning, the higher the self-care ability the higher the quality of life of patients with chronic renal failure in Hemodialysis Installation Mardi Waluyo Hospital Blitar. The ability of self-care was an implementation of the activities initiated and does by individuals themselves to meet the need to sustain life, health and wellbeing in accordance with the state of both sick and healthy, the results of this study show the ability of self-care that was owned patients with chronic renal failure have a encouragement or motivation of its own to live with what happened to him today. With more and more patients could perform independence in self-care could improve satisfaction, or can be called psychic satisfaction for the fulfillment of their needs, both externally and perception needs. And satisfaction was what drives an individual gives good value for itself in the quality of life. CONCLUSIONS Self-care ability of patients with chronic renal failure who receive hemodialysis action in Hemodialysis Installation Mardi Waluyo Hospital Blitar with an average value of 12.93 which if considered to be in an independent category. The average value of the quality of life that was 73.83,

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Moreiras, Mercedes P. 2011. “Assessment of Health-Related Quality of Life:TheCinderella of Peritoneal Dialysis?”,accesed on February 192012(http://www.hindawi.com/journals) Nursalam. 2008. KonsepdanPenerapan MetodologiPenelitianIlmuKeperaw atan.Jakarta:SalembaMedika. NursalamdanFransisca B.B. 2006.Asuhan KeperawatanpadaPasiendengan GangguanSistemPerkemihan. Jakarta. SalembaMedika. Nursalam. 2003. KonsepdanPenerapan MetodologiPenelitianIlmuKeperaw atan.Jakarta:SalembaMedika. O‟Callaghan, C.A. 2007. At Glance SistemGinjal, Terjemahan Elizabeth Yasmine,edisikedua.Jakarta: Erlangga. PerhimpunanNefrologi Indonesia (PERNEFRI). 2010. Report of Indonesian RenalRegistry 2010. Smeltzer, Suzane C and Bare, Brenda G.2001.BukuAjarKeperawatan MedikalBedah Bruner &Suddarth, Terjemahan :AgungWaluyo. Jakarta: EGC Saryono.2010. Kumpulan Instrumen PenelitianKesehatan. Bantul: NuhaMedika.UnitPenelitidan PengabdianMasyarakat. 2009.

getting closer to the 100 it can be said the quality of life of patients with chronic renal failure, the better. There was correlation between self-care ability and quality of life with a p-value: 0.008 and rs: 0.473 ACKNOWLEGEMENT The limitations of the study using a questionnaire that is sometimes the answer given by the sample did not show real state. In addition to assessing the quality of life of patients with chronic renal failure can be changed according to time with the psychological and emotional state of patients when assessed. REFFERENCES AgusYuono. 2000. UniversitasDiponegoro Semarang. KualitasHidupMenurutSpitzer pad PenderitaGagalGinjal Terminal yang MenjalaniHemodialisis diUnit Hemodialisis RSUP Dr. Kariadi Semarang. ArifMuttaqindanKumala Sari. 2011. AsuhankeperawatanGangguanSist emPerkemihan.Jakarta: SalembaMedika. Alligod, Martha R and Tomey, Ann M. 2006.Nursing Theorists and Their Work, Seventh Edition. Greenville, North Carolina: Mosby Elsevier. Aru W. Sudoyo., dkk. 2009. IlmuPenyakit. Dalam, Edisi V Jilid II. Jakarta: InternalPublish. AwiMuliadi W.2011. GagalGinjalKronik (Chronic Renal Failur) TahapAkhir.accessed on January 17 2012. (www.infodokterku.com)

Draft SKN 2009.Accessed March 122012 .(http://www.depkes.go.id/SKN20 09.pdf) Jonathan Sarwono, StatistikItuMudah: PanduanLengkapuntukBelajarKom putasiStatistikMenggunakan SPSS 16PenerbitUniversitasAtma Jaya Yogyakarta,2009 Kidney Disease Quality of Life Short Form (KDQOL-SF ™), Version 1.3.A Manualfor Use andScoring.Accesed on March 20 2012. (http://www.rand.org)

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THE EFECTIVENESS OF PROBLEM BASED LEARNING MODEL DEPEND ON LEARNING OUTCOMES STUDENT IN COURSE PREGNANCY ON OBSTETRICAL CARE ON DIPLOMA PROGRAM Nevy Norma Renityas Program Studi D3 Kebidanan STIKes Patria Husada Blitar [email protected] ABSTRACT The changes in a Health education system must be done for better education. Midwifery care in pregnancy is health education courses in midwifery department. In order to get the optimal result of education, it is required an innovative learning models. There are many models of learning innovation such as example problem based learning. Based on the consideration above, researchers want to analyze the effectiveness of Problem Based Learning depend on learning outcomes student in course Pregnancy on Obstetrical Care learning Diploma Program. This research was done in STIKes Patria Husada Blitar on 25 February until March 8 th 2015. This research used quantitative approach, quasy experimental. The population and the sampel was the students in the third semesters in the total amount of 38 student divide into 2 groups in random. The control group was discussion group in the amount of 18 people. Problem based learning group (experimental group) consists of 20 people divided into 4 groups, each group consists of five people. The Independent Variable was Problem Based learning while the Dependent Variable was learning outcomes. The results of the research showed there was a significant difference with different test results using a t-test ( t:-5,46) between learning outcomes using problem based learning model and class group discussion on pregnancy midwifery care courses. The problem based learning model is more effective than group discussions. Keywords: Problem Based Learning, Learning Outcomes, Pregnancy on obstetrical Care INTRODUCTION Day by day, the problems faced by many people tend to be increased. It makes the competition to gain something also getting tougher. The Demands and challenges in world worked always changes especially healthy.In this case , a change in a system of health education must be changes more beter. Lecturer is very important in the change, one of the changes that can be made by the lecturer is a change in the learning process. Midwifery pregnancy is a health education course of obstetrics.In Course Pregnancy

on obstetrical care the student is expected to get the optimal learning. Lecturers have an important role in the learning process. The lecturers have to be creative and innovative in their lessons. During this time, the methods used lecturer in the learning process of pregnancy care in addition to conventional methods, there are also some student-centered methods include a method in a class discussion. The method is performed by a group discussion presented in front of the class. STIKes Husada Patria is one of the health institutions in the district blitar. Based on

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observations in the classroom, especially learning model that can be applied to the the second class of the third level can be real world, especially learning healthy in identified problems that occur. These course pregnancy on obstetrical care. problems can be stated as follows: Based on consideration above, the 1. The low pregnancy test scores researcher want to analyze of effectiveness midwifery care, especially the subject of model problem based learning depend matter of pregnancy care. In the academic on learning outcomes student in course year 2011/2012 due to the limit value of pregnancy on obstetrical care on program midwifery pregnancy is 75. Students who diploma get test scores 75 as much as 40% and students who scored <75 as much as 60%. 2. Inappropriate method chosen and METHOD applied. In the implementation of learning, This research was done in STIKes lecturers less attention to the learning Husada Patria Blitar, on February 25process but more attention on the end March 8 2015, this research used result. quantitative approach, experimental quasy. 3. Difficulty students to answer the The Population and sample in this study question and less interaction between other was the third semester students in total students. amount 38 students, divided into 2 groups, Discussion class model was good for choice in random. Discussion groups course pregnancy on obstetrical care on (control) in the amount 18 people,Problem program Diploma. But the researchers tried Based Learning (experimental to use problem based learning model in group)consist of 20 people were divided STIKes Patria Husada. into 4 groups. Each group consist 5 people. If the learning process was well ,student The independent variable was Problem participation has also increased. I hope the Based Learning, dependent variable was learning outcomes will be increased. The learning outcomes. researchers trying to apply problem-based RESULT AND ANALYSIS The Difference of Learning Outcomes depends on Learning group discussion Model and PBL in Course Pregnancy On Obstetrical care On Program Diploma This Research used 38 sample. 18 people for group discussion and 20 people for Problem Based Learning Group. Table 1 The Difference of Learning Outcomes depends on Learning group discussion Model and PBL in Course Pregnancy On Obstetrical care On Program Diploma

no 1 2 3 4 5 6 7

interval 35-40 41-45 46-50 51-55 56-60 61-65 66-70 Jumlah

Group discussion 2 4 8 3 1 0 0 18

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frequensy % 11.11 22.22 44.44 16.67 5.56 0.00 0.00 100

PBL 0 0 3 6 7 2 2 20

% 0 0 15 30 35 10 10 100

Primery Source The Difference of Learning Outcomes depends on Learning group discussion Model and PBL in Course Pregnancy On Obstetrical care On Program Diploma The data table consideration above can show that higher value on Group Problem Based Learning. Group discussion not show that the higher value for the learning outcomes in course pregnancy on obstetrical care. And it show that PBL more effective to increase learning outcomes.

Diagram 1 The research of The Difference of Learning Outcomes depends on Learning group discussion Model and PBL in Course Pregnancy On Obstetrical care On Program Diploma From the histogram considered above higher value show on PBL student. And the student in group discussion not show that have higher values. It show that PBL more effective than group discussion. ANALYSIS PBL was a adult learning. Adult Learning was learning based on considered a problem learning in contextual problem thus stimulating student to learning, this model give student more motivating for learning(Claire, et all, 2001) in learning outcomes show that there was different learning participation student depend on PBL model and group discussion. The statistic result show that P=0,014, it means there was different PBL and Group discussion. The research result show that PBL give Good indicator amount of 9 people than group discussion amount 4 people. Indicator least once on PBL nothing, in group discussion indicator least once amount 4 people. This was due because the participation learning on PBL show good quality to expression opinion in course Pregnancy obstetrical care. The contribution expression opinion was very important. It show in participation chart amount 20 people just 1 doubters in expression opinion. In Group discussion 4 people doubters that opinion. Many things effect participation learning accept student consentration. Other affect was technical factor from learning model. The research show that learning model affect the

participation. In PBL based on considered adult learning it means actif to find more experience with learning source, which centered student, if the adult learning used give more motivating for student learning. Group PBL consist tutor, chairmain, and members. The tutor excite, motivating the members to think critical and to pay attention. Chairman members also officiate set a time (Saptono, 2003; karim, et all 2007;Sudjana,2004; Suradjiono, 2004) Effectivenss of Model PBL show that member name Riski Dwi A(score 5) from PBL group have good participation be compared ST widatul jannah have enough participation (score 3). The name of members veni antikasari from Group PBL have least participation (score 2). Not beter than tika epiana from group discussion have good participation (score 4). But the outline Model PBL more effective to increase participation learning. The research show that any different mean and median, learning outcomes PBL between group discussion. Learning Outcomes mean with PBL more higher than learning outcomes group discussion.The statistic result show (t:0,00)signivicants. About that same in the teory that show learning outcome get from

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the effort to find mastery knowledge and basic skiil in various in life aspect, so it seems in individualism about the used values attitude, knowledge and basic skill change attitude quantitatively. To change learning outcomes more better, must to used good learning model, like a problem based learning. This learning model demand the student to more active than before in learning process. PBL was outanding factors to influence learning outcomes(sudjana,2004). The result show that any difference significant from learning outcomes.In Group discussion show learning outcome score 46-50 amount 8 people. And PBL amount 4 people. Altough this score not good but it show that PBL more effective than group discussion. In half score 60 point show that PBL amount 7 people and group discussion amount 1 people. Higher scre getting Group PBL amount 4 people. And than group discussion nothing at all for getting higher score. CONCLUSIONS Any different significant with different result test used t-test (t:0,00) between learning outcomes PBL with group discussions in course pregnancy on obstetrical care. It show that PBL more better than group discussions. And in fact that PBL more efective to increase learning outcome. ACKNOWLEDGEMENT The limitation of this study was the researcher cannot controll the confounding factor that can influence the result. REFERENCES Alimul, A. 2007. Metode Penelitian kebidanan & Tehnik Analisa data. Jakarta: Salemba Medika. Ali Muhammad. 2004. Dasar-dasar Proses pembelajaran. Bandung: Sinar Baru Algesindro Bondan, D. 2011. Mengembangkan softskiil siswa melalui pembelajaran Matematika berbasis masalah. Skripsi Pendidikan

Matematika Universitas Negeri Yogyakarta.(Unpublished) Claire, Major, Palmer. 2001. Assessing the effectiveness of Problem Based Learning in Higher Education. Cambridge: Cambridge University Press. Depkes. 2002. Komunikasi efektif . USAID IBI. Duch, B. 1995. Problem A Key Factor in PBL. England. Evan, G. 2001. Problem based Instruction In M Orey(edt) Emerging Prespective on Learning Teaching And Technology. Hastuti Noer, Rosyidin, Fadiawati Noor, Hasnundiyah Neni. 2011. Mengembangkan Soft skill siswa melalui pembelajaran matematika berbasis masalah. Prosiding Seminar nasional pendidikan MIPA. Bandar Lampung Helen, V. 2001. Varney Pocket Midwives in Endah Pakaryaningsih(edt). Jakarta:EGC. Ign M. 1995. Penilaian hasil belajar Siswa di sekolah. Yogyakarta : Konisius. Karim, S, Noor Suheniana. 2007. Penerapan pendidikan pembelajaran berbasis masalah untuk meningkatkan penguasaan konsep fisikan serta mengembangkan ketrampilan berpikir tingkat tinggi dan ke Cakapan ilmiah. Proposal Hibah Kompetitif UPI. 2007. Bandung: Tidak Diterbitkan. Limbong thabitha. 2008. Gambaran karakteristik penderita abortus inkomplit Di RSU Daerah Kota Mamuju. Jurnal media Kebidanan Poltekkes Makasar. Manampiring, A. 2008. Prevalensi Anemia dan tingkat kecukupan zat besi pada anak sekolah dasar di desa Minahasa. Lapran penelitian untuk penelitian Dosen Fakultas Kedokteran Sam Ratulangi. Manado. Mandriwati, GA. 2008. Asuhan Kebidanan Ibu Hamil. Jakarta: EGC

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Muhson Ali. 2009. Peningkatan Minat Belajar dan pemahaman masalah melalui penerapan Problem based learning. Jurnal pendidikan Volume 39 No 2 november 2009 hal 171-182. Nana, S. 2005. Dasar-dasar Proses belajar mengajar. Bandung: Sinar Baru Algesirdo. Prawirohardjo, S. 2003. Ilmu Kebidanan. Jakarta: PT Bina Pustaka Sarwono. Pusat Pendidikan Tenaga Kesehatan. 2003. Asuhan Kebidanan kehamilan. Jakarta. Purwanto. 1990. Evaluasi Pendidikan. Bandung: Lembaga Penelitian IKIP Bandung Pusdiknakes. 2001 Buku Asuhan antenatal. WHO:JHPEG. ……………... 2001. Konsep Asuhan Kebidanan. WHO: JHPEG RSUD. Dr. H. Soemarno Sosroatmodjo . 2010. Standard Pelayanan Medik Obstetri dan Ginekologi. Departemen kesehatan Kuala Kapuas. Rustam M. 1998. Sinopsis Obstetri. Jakarta:EGC. …………. 2000. Sinopsis Obstetri Jilid II deteksi dini adanya komplikasi hal 290300. Jakarta: EGC;. Sabrina, Junaidi Edy, Hannah Fadhilah. 2010. Farmakoterapi “Anemia”. Program studi Farmasi & Komunitas Sekolah Farmasi Institut Teknologi Bandung. Saifudin, Bari, Abdul. 2002. Panduan Praktis Pelayanan Kesehatan Maternal dan Neonatal.WHO:JHPEG Sagala, S. 2007. Konsep dan Makna Pembelajaran. Bandung : Alfabeta Saptono, R. 2003. Is Problem based Learning (PBL) a better approach for engginerring education?CAFEO-21 (21st Conference of the Asian Federation Of Engginering Organisation). Yogyakarta 22-23 Oktober 2003.

Subagyo, Suharto Agung, Winarsih Dyah. 2011. Hubungan antara anemia dalam kehamilan dengan kejadian BBLR di RSUD Dr Soeroto Ngawi tahun 2011.Ponorogo. Sudjana, D. 2004. Model Pembelajaran Pemecahan Masalah. Bandung: Lembaga penelitian IKIP Bandung. Sudjana, N. 2005. Dasar-dasar Proses belajar mengajar. Bandung: Sinar Baru Algesirdo. Sugiyono. 2012. Metode penelitian Pendidikan (pendekatan kuantitatif, Bandung: kualitatif, R&D). Alfabeta. Sunarto, Santoso Heru, Nugroho Heru, Sunarko Heru. 2012. Hubungan kejadian anemia kehamilan dengan kejadian perdarahan post partum di Poned Ngawi. Jurnal penelitian kesehatan suara Forikee Volume III no 2 April 2012. Suprihatiningsih. 2009. Faktor-faktor yang berhubungan dengan komplikasi kehamilan pada Ibu hamil. Jurnal Kesehatan Metro SaiWawai Vol II No 1 Edisi Juni 2009. Suprijono, Agus. 2009. Cooperative earning Teori dan Aplikasi PAIKEM. Yogyakarta: Pustaka Pelajar. Suradijono, SHR. 2004. Problem Based Learning Apa dan bagaimana Makalah Seminar”Penumbuhan Inovasi Sistem Pembelajaran Pendekatan Problem Based Learning Berbasis ICT (Information & Communication Technology)” Yogyakarta: 15 Mei 2004. Sweet B.R. 1997. Mayes Midwifery. Jakarta: EGC Varney. 1997. Varney Midwifery. Jakarta: EGC Wiknjosastro, H. 2002. Ilmu Kebidanan. Jakarta: PT Bina Pustaka Sarwono. Wildan, Moh. 2008. Dokumentasi Kebidanan. Jakarta: Salemba Medika Yuni Kusmiyati, Puji Heni, Sujiyanti. 2008. Perawatan ibu Hamil. Yogyakarta: Fitramaya.

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THE CORRELATION OF KNOWLEDGE AND ATTITUDE WITH "Tarak" CULTURE OF POSTPARTUM MOTHERS IN WONODADI BLITAR Ning Arti Wulandari, Zaenal Fanani. STIKES Patria Husada Blitar Abstract Indonesia is a multicultural society. Each region has a different culture that is embraced by the trust from the previous generation."Tarak" on postpartum mothers is a habit of not eating chicken dishes, meat, eggs and certain other foods, fearing the wound did not heal and their infants vomiting after breastfeeding. Cultural aspect is very important to facilitate in providing nursing care. The purpose of this research was to identify correlation between knowledge and attitude with a culture of "tarak" in the postpartum mothers at Wonodadi Blitar. The design of this research was crossectional with a sample of 40 mothers in the postpartum at Wonodadi Blitar taken by Consecutive sampling with inclusion criteria: maternal postpartum phase of letting go. The variable in this research was the knowledge, attitudes about postpartum maternal nutrition and culture "tarak". The instruments used questionnaire. The result by Spearman rank analysis showed no correlation between postpartum maternal nutritional knowledge of the culture of incontinence with a value of ρ = 0, 658, correlation between attitude and cultural behavior "tarak" with the value ρ = 0.01. eventhough the level of knowledge of mothers of postpartum in nutrition was good but it did not guarantee that the mother did not follow the culture of "tarak", this is in accordance with Manurung (2012) that culture is not only influenced by the knowledge but also a strong belief. While the attitude is a feeling that followed the tendency to act so that the attitude of postpartum mothers have a correlation with the "tarak". Therefore, the role of nurses is very important in reconstructing the culture of "tarak". Key Word: Knowledge, attitudes, culture "Tarak", postpartum mothers

Background Post partum period called postpartum or puerperal period is a period or time since the baby was born and the placenta comes out until the next six weeks, accompanied by the restoration of the organs associated with the content, which changes as injury and other related During childbirth ( Suheri . Et al , 2008) . While the purpose of the provision of care during childbirth, according Saleha (2009), among others maintains the health of mother and baby, detect problems; write your health education and providing family planning services. Maternal care community is very important in this regard. In nursing theory, saw man should nurse holistic in providing nursing care.

Differences in cultural values is also part of a holistic human Indonesian society is a multicultural society. Each region has a different culture that is embraced by the trust from previous generations. Many people who believe in the culture of previous generations because the culture was obtained from parents who think they have more experience. With this belief they are convinced that the behavior he does will bring positive results and beneficial to their health. Not all treatments are performed based on the heritage can be fully accepted, could have carried out such treatments provide less favorable health outcomes for mother and baby (Manurung, 2009). Behavior or habits that harm eg nursing mothers are prohibited from eating foods that fishy eg fish, eggs and others because the baby will

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sweat odor. Postpartum mothers are prohibited nap. Post partum mothers had to sleep sitting or half-sitting for fear of bad blood rose to the eye (Mubarak et al, 2012). Based on the preliminary research conducted in September 2012 in the Cempaka (space Ruling) Hospital Ngudi Waluyo Wlingi obtained 15 of the 22 mothers postpartum do not want to eat chicken dishes, meat and eggs because their parents forbid fearing the wound did not heal and their breastfeeding infants vomiting. Based on interviews with the head of the room, the nurse had provided health education about the importance of nutrition to patients‟ post-partum mothers. Some elements involved in the sociocultural according to Mubarak, et al (2012) among other things: knowledge, belief, art, morals, law, customs and abilities as well as custom made by the community. Knowledge has a profound influence on health. Likewise, related public confidence about the care of the sick is very influential on the public health level. Culture is the behavior resulting from human perception, behavior that would be stronger if it is based on the powerful stance anyway. Medeleine Leininger developed the concept of transcultural nursing, bringing the role of cultural factors in nursing

practice into the discussion on how to provide nursing care according to need. According Leinenger (1978) transcultural nursing is a nursing service berfocus on the behavior of individuals or groups, as well as the process to maintain or improve health behavior and the behavior of physical pain and psikokultural provided to clients in accordance with the cultural background (Tommey and Alligood, 2006). Swasono Statement (1998) in Manurutng (2009) argue that there are some people kepercayaaan value associated with post partum care, with knowledge of the cultural aspect is important to be known by health workers to facilitate the approach to providing health care. This of course requires special attention to overcome. According to nursing theory leineinger medeline there are several strategies are in use in providing nursing care, among others maintaining the culture, the culture of negotiation and change the culture (Tommey and Alligood, 2006). From the description above, the researchers wanted to identify how the correlation between postpartum maternal nutritional knowledge and attitude to culture "incontinence" in postpartum mothers in Wonodadi Blitar

METHODS The research design used cross sectional, which connects between knowledge and culture "incontinence" and attitude with a postpartum mother culture "incontinence" in the mother postpartum. Knowledge in this research was knowledge about postpartum maternal postpartum maternal nutrition, attitude in this research is the attitude of postpartum mothers in meeting their nutritional culture whereas "incontinence" was the behavior not eats tempeh, tofu, egg, chicken, meat/ goat, fish freshwater and saltwater fish. The sample in this research was 40 people listed in the postpartum maternal health centers Wonodadi. The sample in this research were drawn in a way convenient sampling with inclusion criteria postpartum mothers who are already in the phase of letting go, the mother and the baby does not have a particular disease and do not have allergies to certain foods. This research was conducted from September 26 to October 6, 2014. RESULTS AND ANALYSIS RESULTS Postpartum maternal characteristics in Blitar Wonodadi as many as 40 people as in the table below:

Table 1 Postpartum maternal characteristics in Wonodadi -Blitar

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characteristics of Respondents Age ≤ 20 years 21-30 years 31-40 years 41-50 years Education Elementary School Junior High School Senior High school Prioriy to Primipara Multipara Occupation Housewife Privat employees

3 16 20 1 7 18 15 14 26 36 4

Information about postpartum maternal nutrition No Ever

Table 2

30 10

Table 3 above shows that 43 % of respondents have a good attitude towards nutrition postpartum mothers and 20 % of 8% respondents had a very bad attitude 40% towards the fulfillment of postpartum 50% maternal nutrition. 2% Table 4 Frequency distribution of " Tarak " culture in postpartum mothers 17% 45% 38% Culture " Tarak " Frequ percen tage ency (%) 35% 9 23% 65% Do not follow the culture of " Tarak " 90% Following some cultures " 5 13% 10% Tarak " Following culture " Tarak" 26 64% overall %

75% 25% Based on Table 4 above shows that the majority of 64 % of respondents follow the culture of “tarak” and only 23 % who do not follow the culture of “Tarak”

The frequency distribution of knowledge about postpartum Table 5 maternal on postpartum maternal nutrition

Pengetahuan Good Sufficient

f

Frekuensi 15 25

The correlation between postpartum maternal nutritional knowledge of the culture of Tarak" postpartum mothers

Persentase (%) Culture 37% " tarak " 63%

Table 2 above shows that most respondents Followin have sufficient knowledge of as many as g culture 25 people ( 63 % ) " Tarak " overall Table 3 Frequency distribution attitude postpartum maternal postpartum Followin maternal nutrition in meeting g some cultures attitude frequency percentage " Tarak " (%) 43%Do not 17 Good 15 38%follow Sufficient 8 20%the Bad culture of

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Knowlegdement Good Sufficie nt

Total

N 1 6

(%) 40

N 1 0

(%) 25

N 2 6

(%) 65

2

5

3

8%

5

12

7

18

2

5

9

23

" ρ

0,658

have sufficient knowledge anyway, it was evident that one of the factors affecting the level of knowledge is education. In addition to educational information is also Table 5 above shows that the Spearman greatly affect a person's knowledge. Based rank test results obtained value of ρ = 0658 on Table 1 of the 40 respondents 75% had which means that there is no correlation never received information about with postpartum “tarak “ culture . postpartum maternal nutrition. The correlation between with a postpartum Table 6 Information could be received from maternal nutrition of“tarak” culture in the media or health workers, in this postpartum mothers. case the role many are nurses. Therefore Wonodadi PHC nurses "Tarak” Attitude Total ρ should provide health education Culture Bad Not Good particularly on postpartum maternal good nutrition. N % N % N % N % Following 1 3 3 8 8 2 2 65 Postpartum Maternal Attitude In culture " 5 8 0 6 Meeting Nutrition Tarak " overall Table 3 shows that postpartum 0,01 mothers who have a good attitude as much as 43%. According Following 0 0 4 1 1 3 5 12 Notoatmodjo (2010) knowledge, some 1 thoughts, beliefs and emotions play cultures " an important role in determining the Tarak " attitude intact. These results strongly support the theory tersbut, of the 17 Do not 0 0 1 3 8 2 9 23 respondents who have a good follow the 0 attitude, 12 have a good knowledge culture of " anyway. According to the theory Tarak” Anwar (2007) health communication using the design principles of teaching is one of the efforts to foster an Table 6 above shows that the Spearman attitude. The theory is supported by the rank test results obtained value ρ = 0.01 , results of this research, based on table 1 which means that there were correlation postpartum mothers who never get between attitudes in nutrition with a information about postpartum maternal postpartum mother " tarak"culture nutrition as much as 75%. Information obtained through communication poses. Knowledge About Nutrition Maternal Communication is the exchange of Postpartum Maternal Postpartum With thoughts, feelings and opinions and give Cultural "Tarak" advice in which occur between two or more people work together. Table 2 shows that most respondents Communication is also an art to compose (63%) have sufficient knowledge about and deliver a message in a way that is easy postpartum maternal nutrition. One's so that others can understand. Therefore, knowledge according Notoadmodjo (2010) health professionals, especially nurses play could be affected by several external an important role in changing attitudes in factors, namely, education, information meeting the nutritional postpartum and experience. Based on Table 1 of the 40 mothers. Providing health education respondents were educated terakir SPM as through the media and attractive method is many as 18 (45%) of the 18 respondents 15 the right way to make it easier to who have enough knowledge. While respondents were educated last 7 SD whole understand the postpartum mother and " Tarak

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motivated to apply. If the postpartum mother can understand very well it will form a good attitude as well. Of a good attitude will have a tendency to behave well. “Tarak " Culture Of Mother Postpatum Indonesian society is a multicultural society. Each region has a different culture that is embraced by the trust from previous generations. Many people who believe in the culture of previous generations because the culture was obtained from parents who think they have more experience. With this belief they are convinced that the behavior he does will bring positive results and beneficial to their health. Culture is the behavior resulting from the perception of cultural manusia.Masyarakat Wonodadi Blitar have in providing care to mothers postpartum, one of which is the culture of "tarak". Culture "incontinence" behavior is not consuming all kinds of proteins, among others; do not eat meat beef or mutton, chicken, eggs, tempeh, tofu, fish, freshwater and marine fish. Blitar Wonodadi community considers consume meat, chicken, eggs, fish, freshwater and saltwater fish will lead to the failure of wound healing. While consuming tempe and tofu would result in accumulated dirt eye on breastfeeding infants. Culture "tarak" adopted Wonodadi Blitar society is very contradictory to the theory Widasari (2009) which says that the fulfillment of adequate protein will help the healing process. Based on Table 4 shows that 26 respondents (65%) followed tarak overall culture, which means did not take all of the above proteins. While 5 respondents (13%) follow some cultures continence which means do not consume any animal protein? According to nursing theory leineinger medeline there are several strategies are in use in providing nursing care, among others maintaining the culture, the culture of negotiation and change the culture (Tommey and Alligood, 2006). Based on the theory Wonodadi PHC nurse can provide nursing care to negotiate a culture at 65% of respondents who follow the culture of "tarak" as a whole by providing

knowledge that protein is essential for wound healing and nutrition to the baby. While the 13% who follow some cultures "tarak" could be given nursing care to maintain the culture or the culture of negotiation because although postpartum mothers do not consume animal protein, the protein needs met mothers of vegetable protein. Correlation Between postpartum maternal nutritional knowledge of the culture of “tarak” Based on Table 5 shows that the test results obtained with the Spearman rank ρ value > 0.05, which means that there was no correlation between postpartum maternal nutrition to the culture of “tarak" . Some elements involved in the sociocultural according to Mubarak , et al ( 2012) among other things : knowledge , belief , art , morals , law , customs and abilities as well as custom made by the community . Knowledge has a profound influence on health. The theory is not in accordance with the results of this research , 65 % of respondents who follow the culture of " tarak " overall , 40 % have a good knowledge of postpartum maternal nutrition . Such conditions show that other elements , namely trust, tradition and habits Wonodadi community was very strong against the culture of " incontinence . Wonodadi public confidence towards “tarak “ culture strong need special attention . According Leinenger (1978 ) transcultural nursing is a nursing service berfocus on the behavior of individuals or groups , as well as the process to maintain or improve health behavior and the behavior of physical pain and psikokultural provided to clients in accordance with the cultural background ( Tommey and Alligood , 2006) . According to the research most of respondents who embrace the culture of “tarak " have a good level of knowledge about postpartum maternal nutrition , so that according to nursing theory transkultur cultural negotiation not only to individuals but also families who care for postpartum mothers . Negotiations

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culture can be done by providing counseling to families or even society at large about the importance of postpartum maternal nutrition. Correlation Between Attitude In Meeting With Postpartum Maternal Nutrition Culture “Tarak” Based on Table 6 shows that the test results with rank Spearman ρ value < 0.05 , which means that there was a correlation between attitudes in meeting with a postpartum maternal nutrition culture " tarak " . According B.Karr Snehandu (1983 ) in Notoadmojo (2010 ) or the resultant behavior was the result of the stimulus ( external factors ) and response ( internal factors ) in the subject or The person who behaves . While culture was the behavior resulting from human perception . According to the theory lawrence Green in Notoatmojo (2010 ) said that behavior to own some of the factors that influence it , among others praktor predisposing factors that allow and amplifier factors . Predisposing Factor of behavior such as knowledge, attitudes, beliefs, beliefs , values , traditions and so on . The theory was in accordance with the results of this research , 65% of postpartum mothers who embrace the culture of " tarak " overall 38 % had a very bad attitude and 8 % had a bad attitude towards the fulfillment of postpartum maternal nutrition . Based on the results of the research 75 % had never received information about postpartum maternal nutrition. This is consistent with the theory that some of the factors that facilitate the occurrence of behavior was the facility in infrastructure or health behaviors. Therefore, the role of health personnel on duty at the health center Blitar Wonodadi very important to negotiate on the culture of “tarak " . It was also proven from the results of this research of 65 % of respondents who follow incontinence culture overall 40 % had good knowledge about nutrition postpartum mothers and 20 % of respondents have a good attitude towards the fulfillment of nutrition , but they still

behave " tarak " . This was because the huge belief in the culture of “tarak“ in Wonodadi Blitar . Conclusions 1. There were no correlation between postpartum maternal nutrition to the culture of " tarak " postpartum mothers in Wonodadi Blitar 2. There were correlation between attitudes in meeting with a postpartum maternal nutrition culture " tarak " postpartum mothers in Wonodadi Blitar ACKNOWLEDGEMENT The instrument not yet passed by validity and reliabily test. We cannot control honesty of respondent because of researcher little interaction with them during resesearch and may they not yet belief with us.

REFERENCE Azwar, saiffudin.2007. Sikap Manusia,teori dan pengukurannya. Yogyakarta.Pustaka pelajar Depkes RI. 2009.Pedoman Pelaksanaan Kelas Ibu Hamil. Jakarta. Dirjend Bina Kesehatan Masyarakat Manurung, Yunani Dewi. 2009. perawatan Post Partum Menurut Perspektif Budaya Jawa. Sumatera Utara. Universitas Sumatera Utara (skripsi) Mubarak, dkk. 2012. Pengantar dan Teori Ilmu Sosial Budaya Dasar Keperawatan. Jakarta: EGC Notoatmodjo, Soekidjo. 2010. Promosi kesehatan teori dan aplikasi. Jakarta: Rineka Cipta

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Nursalam. 2008. Konsep dan Penerapan Metodologi penelitian Ilmu Keperawatan. Jakarta: Salemba Medika Saifudin dan Yusuf. 2010. Nikmatnya seks islami. Hal. 116. Yogyakarta: pustaka Marwa (Anggota IKAPI). (ebook online) Saleha, sitti. 2009. Asuhan Keperawatan pada Masa Nifas. Jakarta: Salemba Medika Suherni, dkk. 2009. Perawatan Masa Nifas. Yogyakarta: Fitramaya Supatemi Yeni (2013). Struktur budaya dan sosial ibu post partum berdasarkan pendekatan teori keperawatan

transkultural medeleine leininger di kecamatan wonotirto. Stikes Patria Husada Blitar. (Skripsi) Syaifudin A, dkk. (2006). Buku Acuan Nasional Pelayanan Kesehatan Maternal dan Neonatal. Jakarta: YBPSP Tommey and Alligood. (2006). Nursing Theorist and Their Work. Philadelphia USA: Mosby. Wong,D.L, Hockenberry M, Wilson,D, Winkelstein,M.L, & Schwartz, P.(2002). Buku Ajar Keperawatan Pediatrik Wong, Ed 6, Vol I.Alih Bahasa Agus Sutarna. Jakarta:EGC.

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OVERVIEW OF FATIGUE IN CANCER PATIENTS WHICH UNDERGO CHEMOTHERAPY Ulfa Khusnul Fata Nursing Study Program of STIKes Patria Husada Blitar Jl. Sudanco Supriyadi 168 Blitar, Jawa Timur Email: [email protected] Abstract One of the side effects of chemotherapy in cancer patients is fatigue. Fatigue is a feeling of tired, exhausted, or lack of energy that can that may take in several days, weeks, or months. The purpose of this study was to identify fatigue on cancer patients which undergo chemotherapy. The population of this study was adult cancer patients that undergoing chemotherapy in the Dharmais Cancer Hospital Jakarta. The research method was descriptive with a sample size of 95 respondents. The sampling technique used consecutive sampling. The data collection used questionnaires by respondents and accompanied by the researcher. The result of this study showed that 53 (55.8%) of respondents experienced mild fatigue, and 42 (44.2%) of respondents experienced severe fatigue. Fatigue in cancer patients undergo chemotherapy often causes by physical and psychological problems. The predisposing of fatigue in patients undergoes chemotherapy including cancer burden, treatments of cancer, nutritional problems, infections, and psychological factors including depression, anxiety, and stress. Therefore, identification of the causes of fatigue is needed to prevent more severe fatigue in cancer patients undergo chemotherapy. Keywords: cancer, chemotherapy, fatigue The experience of fatigue in 90% cancer patients at some point during the course of their illness and it has been noted to worsen when cancer treatment begins (Barnes & Bruera, 2002; Escalante et al., 2001; Yeşilbalkan, ȌU., Karadakovan, A., & Gőker, E., 2009). Diminished performance status and the presence of disease-related symptoms often cause fatigue before treatment with chemotherapy (Grant, Golant, Rivera, Dean, & Benjamin, 2000; Yeşilbalkan, ȌU., Karadakovan, A., & Gőker, E., 2009), but fatigue also can be worsened by pain, anemia, sleep disturbance, and nutritional, mood, and activity issues (National Comprehensive Cancer Network [NCCN], 2008; Yeşilbalkan, ȌU., Karadakovan, A., & Gőker, E., 2009). Patients who experience severe and persistent fatigue have a truly impaired quality of life, as this condition affects their social activities, leisure time, work and responsibilities (Romito et al. 2011).

BACKGROUND Fatigue is a common symptom in patients with cancer (Piper et al. 1998 ; Yeşilbalkan, ȌU., Karadakovan, A., & Gőker, E., 2009). According to The National Comprehensive Cancer Network (NCCN), Cancer Related Fatigue (CRF) is a “distressing persistent, subjective sense of tiredness or exhaustion related to cancer treatment that is not proportional to recent activity and that interferes with usual functioning” (Mock et al., 2007, p.1 ; Given, B., 2008). Compared with fatigue experienced by healthy individuals, cancer related fatigue is more severe, more distressing, and less likely to be relieved by sleep or rest (Kwak, SM., et al., 2011). The incidence of fatigue among patients with cancer is well-documented, with 75%-99% of patients who undergo chemotherapy describing it as increasing with every cycle (Nail & Jones, 2001 ; Kuchinski, AM., Reading, M., Lash, AA. 2009).

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Factors contributing to fatigue are surgery, chemotherapy, pain, sleep disturbance, anemia, gastrointestinal disturbance, and emotional distress (Anderson, N.J., & Hacker, E.D, 2008). Fatigue has a significant impact on the overall quality of life. In the fatigue study, of the 419 patients with cancer who participate in a telephone interview, 78% experienced fatigue during the course of their treatment. Fatigue adversely affected patients in their daily lives more than did pain (61% vs 16%). The fatigue study involved a telephone survey of 379 patients with cancer who had previously received chemotherapy. Seventy-six percent of the patients reported experiencing significant fatigue at least a few days each month during their most recent chemotherapy cycle (Errihani, H, & Tazi, EM, 2011). Until now, overview of fatigue overview in cancer patients undergoing chemotherapy still necessary to developed in Indonesia. Therefore, based on the description above, author interested in conducting research on the description of fatigue incancer patients undergoing chemotherapy. The general purpose of this study was to describe of fatigue in cancer patients undergo chemotherapy in inpatient unit and ambulatory short of care Dharmais Cancer Hospital Jakarta. Whereas the specific purposes of this research are: 1) indentifyng fatigue in cancer patients undergo chemotherapy, 2) identify the age, Hb, stage of cancer, types of chemotherapy, cycles of chemotherapy, sex, type of cancer, pain, sleep quality, nausea and vomiting, anxiety, depression, physical activity in cancer patients undergo chemotherapy.

Schwartz Cancer Fatigue Scale which is a questionnaire to assess fatigue in cancer patients. Researchers identify potential respodents with medical records that are ajusted to the inclusion and exclusion criteria. Then, the questionnaires filed out by respondents with assisted by researchers. Data analysis was to know the description of fatigue in cancer patients undergo chemotherapy. RESULT Table 1. Distribution of respondents by age and hemoglobin levels in the Dharmais Cancer Hospital, June 2013 (n = 95) Varia ble

Mea n

Medi an

SD

Age

45,5 4

46,0 0

10,1 02

10,8 81

10,6 00

1,37 98

Mi n– M ax 21 65

95% CI 43,4 8; 47,5

Hb 6.3 – 13, 8

10,5 99 ; 11,1 6

Table 1 describe the results of the analysis of the mean respondents age in this study was 45,54 ± 10,102 years (95% CI: 43,48 ; 47,49) with the age range of 21 – 65 years. While the average level of haemoglobin range of 6,3 g/dl -13,8 gr/dl. Table 2. Distribution of respondents by sex and types of cancer in the Dharmais Cancer Hospital, June 2013 (n = 95) Variable Frequency Percentage Gender Male 26 27,4 69 72,6 Female

RESEARCH METHODS This study was descriptive. The sample was cancer patients undergo chemotherapy at the Dharmais Cancer Hospital Jakarta in 2013 and the number of sample was 95. The samplin methode used consecutive sampling with inclusion and exclusion criteria. Instruments used in this research was Questionnaire Revised

Types of cancer Ca Mammae KNF LNH Ca Kolon 449

37 13 10 6 5 4

38,9 13,7 10,5 6,3 5,3 4,2

Variable Ca Ovarium Ca Cerviks Another

Frequency 20

stadium 3 of 52 respondents (54.7%). The following analysis data result obtained types of chemotherapy combination of FAC as much as 29 respondents (30.5%), and nearly half undergo cycles of chemotherapy more than 4 reaching 28 respondents (29.5%). Table 4. Distribution of respondents by pain, sleep quality, nausea and vomiting in the Dharmais Cancer Hospital, June 2013 (n = 95) Variable Frequency Percentage

Percentage 21,1

Table 2 describe the distribution of respondents were female as much as 69 respondents (72.6%), as well as the distribution of respondents by types of cancer is breast cancer by nearly half as much as 37 respondents (38.9%) Table 3. Distribution of respondents by stadium of cancer, types of chemotherapy, and cycles of chemotherapy in the Dharmais Cancer Hospital, June 2013 (n = 95) Frequenc Percentag Variable y e Stage of Cancer Stage 1 Stage 2 Stage 3 Stage 4 Types of chemoterapy FAC Cisplatin Paxus Lain-lain Cycles of chemotherap y Cycle 1 Cycle 2 Cycle 3 Cycle 4 Cycle > 4

2 27 52 14

2,2 28,4 54,7 14,7

29 12 4 50

30,5 12,6 4,2 52,6

9 13 27 18 28

9,5 13,7 28,4 18,9 29,5

Pain Nothing Mild Moderate Severe Sleep Quality Good Bad

13 29 45 8

13,7 30,5 47,4 8,4

17 78

17,9 82,1

11 11,6 Nause and 33 34,7 Vomiting Normal 37 38,9 Mild 11 11,6 Moderate 3 3,2 Severe Worse / Very severe Table 4 descibe the distribution of respondents by level of pain was obtained almost half of the respondents experienced moderate pain as much as 45 respondents (47.4%), and nearly all respondents are poor sleep quality as much as 78 respondents (82.1%). The frequency distribution by nausea and vomiting showed that nearly half of respondents had experienced nausea and vomiting in the category were as much as 37 respondents (38.9%). Table 5. Distribution of respondents by anxiety, depression, and physical activity in the Dharmais Cancer Hospital, June 2013 (n = 95) Variable Frequency Percentage

Table 3 describe the distribution of respondents standium of cancer was 450

Variable Anxiety Normal Borderline Abnormal Depression Normal Borderline Abnormal Physical Activity Pasif Minimal active Active

DISCUSSION Describe of Fatigue in Cancer Patients which Undergo Chemotherapy The research result showed that nearly half (44.2%) of respondents experienced severe fatigue. Fatigue is common symtom experienced by cacer patients and cancer survivor. Fatigue may be defined as a distressing, persistent, subjectives sense of tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. Fatigue is multidimensional symtom because it ecompasses physical, mental, and emotional aspects. Patients can experience fatigue anywhere along the spectrum of cancer care (Escalante & Manzullo, 2009). Several factors play the occurence of fatigue, however, no specific pradictivefactors have been indentified in the literature. Age is consedired a predictive factor though the evidence is conflicting. Younger patients, les that 34 years do better that older patients. Similarly, men men over 75 years of age were found to experience 11 time more fatigue thant their younger counterparts (Narayan & Koshy, 2009).

Frequency Percentage 34 35 26

35,8 36,8 27,4

59 20 16

62,1 21,1 16,8

33 42 20

21,1 44,2 34,7

Table 5 showed that almost half of respondents experienced a borderline anxiety as much as 35 respondents (36.8%), and almost were not experience depression as much as 59 respondents (62.1%). The frequency distribution of respondents by physical activity showed that nearly half of the respondents included in the category of activity minimal as much as 42 respondents (44.2%).

The mean age of respondents was 45,54 years old with the age range 21-65 years. It was consistent the theory that older people had of higher of fatigue than younger. The age effect on the incidence of fatigue because the higher a peson‟s age, the ability to regenerate cells wil decrease. It was may lead to the incidence of fatigue in cancer patients receiving chemotherapy. CONCLUSIONS 1. The result of the study showed that the mean age was 45,54 years old with the age range 21-65 years old. While the mean of heamoglobin level was 10.881 with the lowest value was 6.3 g/dl and the highest was 13.8 g/dl. 2. Overview the majority gander of respondens (72.6%) were women. The types of cancer was almost half of teh respondents (38.9%) were breast cancer, and the most (54.7%)

Table 6. Distribution of respondents fatigue in the Dharmais Cancer Hospital, June 2013 (n = 95) Variable Frequency Percentage Fatigue Mild 53 55,8 fatigue 42 44,2 Severe fatigue

Table 6 showed that almost half of the respondents experienced severe fatigue that was 42 respondents (44.2%).

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were stage 3. The types of chemotherapy were received almost a half of respondent (30.5%) was a type of FAC chemotherapy combination. 3. Almost a half (44.2%) of respondents experinceing mild fatigue and almost a half (47.4%) of respondents had moderate pain. Sleep quality of respondent (38.9%) experienced mdoerate nausea and vomiting. REFFERENCES Anderson, N.J., & Hacker, E.D. (2008). Fatigue in Women Receiving Intraperitoneal Chemotherapy for Ovarian Cancer: A Review of Contributing Factors. Clinical Journal of Oncology Nursing, 12(3), 445-454. doi: caac.20073 [pii]10.3322/caac.20073 [doi] Errihani, H, & Tazi, EM. (2011). Evaluation and Management of Fatigue in Oncology: A Multidimensional Approach. Indian Journal of Palliative Care / May-Aug 2011 / Vol-17 / Issue-2. Escalante, C.P., & Manzullo, P.J. (2001). Cancer-Related Fatgiue: The Approach and Treatment. Journal of General Internal Medicine, 24, 412416. Given, B. (2008). Cancer-Related Fatigue: A Brief Overview of Current Nursing Perspectives and Experiences. Clinical Journal of Oncology Nursing Volume 12 Number 5. Kuchinski, AA., Reading, M., & Lash, AA. (2009). Treatment-Related Fatigue and Exercise in Patients with Cancer: A Systematic Review. Medsurg Nursing. Vol. 18/No.3. Kwak, SM., et al. (2011). The relationship between interleukin-6, tumor necrosis factor-α, and Fatigue in terminally Ill Cancer Patients. Palliative Medicine 26(3) 275-282). Narayanan, V., & Koshy, C. (2009). Fatigue in cancer: A review of literature. Indian Journal of Palliative Care, 15(1), 19-25. Romito, et al. (2011). Is Cancer Related Fatigue more strongly correlated to

haematological or to psychological Factors in cance patiens?. Support Care Cancer (2008) 16.943-946. Yeşilbalkan, ȌU., Karadakovan, A., & Gőker, E. (2009). The Effectiveness of Nursing Education as an Intervention to Decrease Fatigue in Turkish Patients Receiving Chemotherapy. Oncology Nursing Forum Vol. 36, No. 4.

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IMPROVING NURSING STUDENTS’ SPEAKING SKILL BY USING REALIA AS THE MEDIA Wahyu Wibisono STIKes PATRIA HUSADA BLITAR Jln. Sudanco Supriyadi no.168 Blitar E-mail: [email protected] Telp: 085649587182

ABSTRACT English become the most important things in facing the issue of ASEAN ECONOMIC COMMUNITY (AEC) especially in the health sector since english is one of the international language use in asean. So, preparing medical employees with English become a great issue to be solved. This study was intended to apply realia as the media to improve students speaking skill. The research design used in this study was collaborative Classroom Action Research. The collaboration was done with one English teacher of STIKes Patria Husada Blitar. This Classroom Action Research was implemented in one cycle only which involved four stages namely planning, implementation, observation, and reflection. To know how far the implementation of realia as the media in teaching writing were successful, the researcher gained the data in the form of students‟ involvement during teaching learning activity and speaking score in role play. To get those data, the researcher used several instruments; those were observation checklist, field notes. The finding of this study showed that by using realia as the media, the students could speak and communicate much better than before when they were taught by using other speaking instructions. In terms of the students‟ individual writing product, in preliminary study, the number of students who passed the minimum passing grade (64) was only 2 students (9.09%). On the other hand, in Cycle 1, all of the 22 students (100%) could pass the minimum passing grade (64). The improvement of students‟ writing skill was due to the use of realia as the media in teaching speaking which consisted of several activities for the students so that they were enthusiastic in joining the class. In addition, it was suggested for the lecturers and/ or teacher to apply and modify this technique in their classes. Keyword: realia, speaking skill

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English become the most important things in facing the issue of ASEAN ECONOMIC COMMUNITY (AEC) especially in the health sector since english is one of the international language use in asean. So, preparing medical employees with English as early as possible will be a the best way to face the challenge. STIKes Patria Husada Blitar is a medical college located on Jln. Sudanco Supriyadi 168 Blitar. There are two departments in this college: the nursing department and the midwifery department. Based on the curriculum book of STIKes Patria Husada Blitar, English is a compulsory subject which should be taken by the students. This college provides English courses for the students which focus on the English for Academic Purposes (EAP) (Panduan Pendidikan Ners dan Bidan STIKes Patria Husada Blitar, 2011). This course focuses instruction on skills required to perform in an English-speaking academic context across core subject areas generally encountered in a university setting. In this EAP course, the students will be taught vocabulary, grammar, and also the four skills (reading, writing, speaking, and listening) of English, but the English will be tied up to meet the specific needs of the students, in this case is English for medical purposes. There are six English courses in the nursing department and one English course in the Midwifery Department (Panduan Pendidikan Ners dan Bidan STIKes Patria Husada Blitar, 2011). Based on the researcher‟s experience in dealing with the students in STIKes Patria Husada Blitar, the EFL students frequently get difficulties in English. Among those difficulties, speaking is considered to be difficult by the students. Based on the observation, the students had low motivation and were not interested in the class. They felt that speaking was a difficult activity. Moreover, the teaching learning process was still insufficient in the classroom. The first things which need to be solved was the teacher‟s technique in

teaching writing because teacher played an important role in managing the class so that students would not get bored and also feel excited on having a writing class. Next, the condition of the teaching learning process in the class should be changed into more cooperative atmosphere between teacher and students and among students and not competitive atmosphere in order to create a conducive teaching learning process in speaking class. In this research, the researcher is interested in using realia as the media in teaching speaking since he considered that realia would be more effective than other previous techniques which had been used in speaking class. Realia is considered to be effective in teaching speaking of nursing students because the nursing students were often exposed to the real objects of medical instruments so that by using realia, it is expected that students‟ motivation in speaking will increase. Furthermore, they will also get benefit in writing and practicing, so that they will get both the speaking process and the practicing process. In this research, realia were used as the media in teaching speaking of procedure text. In order to increase the understanding the concept of realia, many experts have already made a definition of realia. Celce-Murcia & Hilles (1988) state that realia is objects of any origin used to illustrate vocabulary and structure in the L2. Furthermore, realia is concrete objects and the paraphernalia of everyday life (Zukowski-Faust, 1997). The examples of realia are objects such as coins, tools, and textiles that do not easily fit into the orderly categories of printed material. In education, realia are objects from real life used in classroom instruction, so by using realia students are exposed to the real objects. A realia gives students the opportunity to use all of their senses to learn about a given subject, and is appropriate for any grade or skill level. A realia provides language learners with multisensory impressions of the language which, as Rivers (1983) notes, is "learned

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partly at least through seeing, hearing, touching, and manipulating" items. Interaction with authentic materials aids in contextually grounding instruction by bringing students into contact with language as it is used in the target culture in order to meet actual communication needs. The use of realia, then, can enhance linguistic and cultural comprehensibility, which are both prerequisites for real language learning. Realia has advantages and disadvantages. Jones (1994) explains the advantages of realia. First, realia which deals with real things with which one will interact in life is the best learning situation possible. Second, real objects are plentiful and available everywhere. Third, real items can be observed and handled, providing concrete learning experiences for the student. Fourth, dealing with realia motivates the learner. Fifth, realia can be used as part of the evaluation system. The last is realia learning can be extended through the use of displays. On the other hand, realia also has disadvantages. First, real things are not always readily available. Second, realia are not always practical for use in the classroom (size of a real object may be too large for instance a submarine or too small for instance a single human cell for classroom study). Realia such as live animals, certain electrical and mechanical equipment, etc., can represent potential hazards for the learner and the teacher. Real objects often are expensive. Realia need to maintain original structure (while some realia can be dismantled, many others cannot be, e.g., cutting open a person to see how the heart functions.). Third, affective learning is unpredictable through realia. Fourth, if left sitting around the classroom, realia can be a distraction. The last is storage and retrieval can create problems. The researcher decided to choose realia as the media in teaching writing because the nursing instruments were available and easy to be found in this college so that teacher and students were found any obstacles in finding and using the realia.

METHOD The research is designed using classroom action research which is intended to solve a particular problem encountered by a teacher in the teaching and learning process, especially in the teaching speaking. According to Harmer (2001), action research is the name given to a series of procedures which is engaged by teachers to improve aspects of their teaching, and to evaluate the success and suitability of certain activities and procedures. Burns (1999) also states that a major focus of action research is on concrete and practical issues of immediate concern to particular social groups or communities. Based on the statements above, classroom action research is the research that is held by the teacher in the class and school where he/she teaches by improving the process and teaching practices. A classroom action research design is suitable as the research design in this study because the researcher is an English teacher who often finds some problems faced by the students in mastering the lessons. The students have difficulties in speaking. Moreover, the researcher tries to solve the problem. It is in line with the basic point of the classroom action research that is to propose a strategy, technique, or media in the teaching and learning process to overcome the students‟ problem in mastering a particular subject. In this research, the researcher proposes using realia as the media in teaching speaking. Realia is considered to be suitable in this research because realia has never been implemented as the media in teaching speaking in this college. The previous studies proposed by Darojat (2011) and Rokhmawati (2011) show that realia can improve students‟ writing skill. In conducting the research, the researcher worked collaboratively with one collaborator who was involved from the beginning up to the end of the process of the research activity in arranging the lesson plan, instructional material, teaching learning activities, the action, and evaluation. Before starting the

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research activity, the researcher and the collaborator discussed all of the things related to the process in order to meet the same perception about the strategy being implemented, the procedure of the teaching and learning process being carried out, how to collect the data using the instruments, and how to score the students‟ test using the scoring rubric. In this research, the researcher acted as the practitioner who taught speaking by using realia, whereas the collaborator acted as the observer who observed the implementation of the action in the classroom. During the process of implementing the strategy, the collaborator observed the students‟ activities by using observation checklist and field notes. At the end of the teaching and learning process, the students were to make role play. After implementing the strategy, the teacher and the collaborator conducted reflection or discussion. In this session, the researcher and the collaborator analyzed the data from observation checklist, field notes, and the result of the test, in order to find out whether the criteria of success in use are achieved or not. Finally, the researcher and the collaborator drew the conclusion. Based on the conclusion, the researcher and the collaborator discussed and solved the problems continuously until they reach the standard. The original plan would be revised and would be changed into a new cycle until the criteria of success have been achieved.

presenting the research findings in Cycle 1.

FINDINGS The result of the research deals with how to improve the students‟ ability in speaking using realia as the media. It contains the research findings of the implementation of the classroom action research which cover the students‟ involvement during the implementation of the action and students‟ speaking ability, the results of the observation checklist, and the field notes. To know the students‟ problem in speaking, the data in preliminary study are provided before

In relation to the students final scores in preliminary study, based on table 3.7, it could be seen that 11 students or more than a half students got E, 9 students got D, and 2 students got BC.

The Students’ Speaking Score in the Preliminary Study All of the students score for each aspect in speaking could be seen in Table 3.6 below. In this table, no students were in the level of excellent. Most of the students‟ writing products on procedure text were in the level of fair. Table 3.6 The Level of Students ’ Speaking Score in all Aspects in Preliminary Study STUDENTS SPEAKING SCORE Level Pronu Grammar Vocab Fluency nciatio ulary n 0 Excellen 0 0 0 t 1 1 1 1 Very 3 4 3 6 good 12 16 17 12 Good 6 1 1 3 Fair Poor Total 22 22 22 22

In brief, the table 3.6 the level of students speaking score in each aspect could be seen in that the students‟ speaking score were mostly in the level of fair. Table 3.7 Students’ Final Score of Speaking in Preliminary Study Grade Score Number of studens A 84-100 0 AB 77-83 0 B 71-76 0 BC 64-70 2 C 56-63 0 D 41-55 9 E 0-40 11 Total 22

Moreover, after being analyzed, based on Table 3.7, the researcher found out that there were only 2 students who passed the passing grade BC (64); the rest of the students (20 students) did not pass the passing grade. The number of the students who passed and did not pass the

457

Comp rehen sion 0 1 4 15 2

22

Table 3.14 The Level of Students ’ Writing Score in all Aspects in Cycle 1

minimum passing grade could be seen in Table 3.8.

STUDENTS WRITING SCORE Level Pronunc Gram iation mar 3 0 Excellent Very 14 10 good 4 12 Good 1 0 Fair 0 0 Poor 22 22 Total

Table 3.8 Students’ Final Score of Procedure Text in Correlation with the Minimum Passing Grade in Preliminary Study Score >64 <64 Total

Number of Students 2 20 22

Category Passed did not pass

Vocab ulary 2 17 3 0 0

Fluency

22

2 16 4 0 0

Comprehen sion 0 3 19 0 0

22

22

In brief, the level of students speaking score in each aspect in Cycle 1 could be seen in table 3.14. In this table, the students had already made some improvement compared to the scores in preliminary study. It could be seen that the students‟ speaking score were increased, mostly in the level of very good. Table 3.15 Students’ Final Score of Procedure Text in Cycle 1 Grade A AB B BC C D E

Figure 3.8 Percentages of Students Final Score in Preliminary Study

In brief, it can be seen from the figure 3.8 showing the diagram of the percentage of students‟ final score in preliminary study. In this figure, it could be seen that 90,91% of the students did not pass the minimum passing grade of the score 64(BC), while only 9,09% of the students had passed the minimum passing grade of 64 (BC).

Score 84-100 77-83 71-76 64-70 56-63 41-55 0-40 Total

Number of Students 3 3 13 3 0 0 0 22

In relation to the students‟ final scores in Cycle 1, based on table 3.15, it could be seen that 3 students got score A, 3 students got AB, 13 students got B, and 3 students got BC. The diagram of this finding can be seen in Figure 3.15.

The results of the research and development correspond to the research questions as mentioned in the following sections.

Moreover, after being analyzed, based on table 3.15, the researcher found out that all of the students had already passed the passing grade BC (64). The number of the students who passed and did not pass the minimum passing grade could be seen in Table 3.16.

The Result of Students’ Speaking Score on cycle 1 All of the students score for each aspect of the speaking could be seen in Table 3.14. In this table, the students‟ made some improvement compared to the scores in preliminary study. There was no student in the level of poor. Most of the students‟ speaking score were in the level of fair very good.

Table 3.16 Students’ Final Score of Procedure Text in Correlation with the Minimum Passing Grade in Cycle 1 Score >64 <64 Total

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Number of Students 22 0 22

Category Passed did not pass

6

In brief, it can be seen from the figure 3.16 showing the diagram of the percentage of students‟ final score in Cycle 1. In this figure, it could be seen that all of the students or 100% passed the minimum passing grade of the score 64(BC). Based on the result of the students‟ speaking score, there was a great improvement of the students‟ average score from the students on the preliminary study to the students‟ speaking score on the Cycle 1. The average score on the preliminary study was 44,3 and the average score of the students‟ on the first cycle was 76,3. It means that there was a 32 point of average score improvement. In the preliminary study, there were only 2 students who achieved the score above the criteria of success. Meanwhile, in the Cycle 1, all of the students had already passed the minimum score of the criteria of success that is 64 or BC. For detailed information about the improvement of the students‟ score in Cycle 1 compared to the score in the preliminary study can be seen in Table 3.1

4

5

68

96

-

-

64

64

-

-

2

22

9,09%

100%

90,91 %

0

0%

Table 3.18 The Students’ Improvement in each Aspect of Writing Stage Preliminary Study Cycle 2 Aspect Writing

of

Content Organization Vocabulary Grammar Mechanics

Table 3.17 The Students’ Speaking Improvement in Cycle 1. N Preliminary Cycl Percentage PreAspects o Study e1 Cycle 1 Study 1 Average 44,3 76,3 Score 2 Min Score 33 69 Max Score Criteria of Success Achieving Criteria of Success

20

Based on the students‟ scores on table 3.17, it can be concluded that the implementation of the process writing approach in the Cycle 1 met the criteria of success. The average score was 76.3. There were no students who got score under 64. The lowest score in the first cycle were BC which were acquired by 3 students, 13 students got score B, 3 students got score AB, and 3 students got score A. The student‟s lowest score was 69 and the highest students‟ score was 96. The data above showed that the students‟ achievement in their speaking had achieved the criteria of success. There was also an improvement in terms of the aspect of speaking. For detailed information about the students‟ improvement in speaking of each aspect can be seen in Table 3.18.

Figure 3.16 Percentages of Students Final Score in Cycle 1

3

Not Achieving Criteria of Success

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Mean

Min Score

Max Scor e

Mean

Min Score

Max Score

2,11 2,34 2.20 2.25 2.23

1,5 1,5 1,5 1,5 1,5

4 3 4 4 4

3,89 4 4 3,68 3,14

2,5 3,5 3,5 3,5 3

5 5 5 4,5 4

Based on the score of the students‟ final score in Cycle 1, it can be concluded that the implementation of the strategy on the first cycle had met the criteria of success. The average score of the Cycle 1 was 76,63. In addition, all of the students or 100% of the students had reached the criteria of success. DISCUSSIONS The realia were designed to achieve the objective of teaching speaking. The objective was that the students were able to make a droleplay based on the realia used. In this case, realia was very useful because it helped

the students to arrange the sequence of steps on how to use/operate something into correct order. It was confirmed by many experts, for instances, Doff (1995) states that the use of real conditions using the target language items helps the students absorb the point faster and memorize them longer. Meanwhile Kreidler (1971) mentioned that realia can be used to teach fast drill of the tenses. In this activity, medical instruments are excellent aid. To help the students practice with imperative sentence, the using of medical instruments can help a lot rather than just teach them theoretically. Furthermore, Celce-Murcia and Hilles (1998) also suggested that realia can be used in conjunction with storytelling and role play techniques to contextualize the grammar lesson, as well as facilitate memory and learning. Moreover, Soames (2008) mentioned some advantages of the implementation of realia. First, using realia stimulates the mind, and is one way of encouraging creativity by involving the senses. Second, realia saves time, as recognition of an object is immediate and so cuts out the need for lengthy explanations and drawing funny pictures on the board. Third, bringing realia into the class is a great icebreaker, and serves as a useful tool to prompt conservation. Forth, using realia will generate interest and help create an atmosphere conducive to learning. The last, realia breathes life into new vocabulary, and the chances of the students remembering the new words. The teaching of speaking consisted of pre, whilst, and post activities. In the pre speaking stage, the researcher activated the students‟ background knowledge by using brainstorming. Brainstorming activity helps the students to collect ideas, viewpoints, or ideas related to the topic being discussed. This was in line with Raimes (1983) who states that brainstorming is an activity to produce words, phrases, ideas as rapidly as possible without concerning for appropriateness, order or accuracy. In this part, the teacher asked the students to mention medical instruments they usually

used in nursing standard operating procedure. This activity is essential to promote creativity and tolerate for collecting many possible answers. After the students were familiar with some medical instruments, the teacher decided to continue to the next activity. The teacher asked some questions to the students related to the terms of the part of the medical instruments used in nursing standard operating procedure. It was proposed to make the students familiar with the vocabulary and give chance for the students who have known the terms before to share the information with other friends. After that, the teacher presented the model of speaking of nursing SOP. It was about the procedure of “how to check blood pressure”. The teacher explained the model of nursing SOP so that the students understand it. By presenting a model, the students could understand the form of writing they were supposed to speak. Brown (2001) stated that by reading and studying a variety of relevant types of text, students can gain information insight both about how they should write and about subject matter that they may become the topic of their writing. This finding is parallel with the idea stated by Eanes (1997) that the activities or strategies in the prewriting stages should help students to develop their background knowledge and organize thoughts. The teacher and the students discussed the model together. Through the discussion, the students could comprehend the how to speak and what to speak. However, the teacher should give guidance by asking some questions so that the students had good understanding of the model. Therefore, presenting the model becomes an effective way to facilitate the students to transfer their ideas. The next activity was group task. In this action, the teacher asked the students to make a group of four. Their task was; first, observe/practice with the realia in term on how to operate the realia. Second, make a draft about procedure

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Realia to Improve Students‟ Speaking Ability in Procedure Text”. In this research, the researcher used realia to improve students‟ speaking ability, because realia is real object that can be used as a medium in teaching learning process and most of students are interested in it. In this research, the researcher used many kinds of realia. In the first cycle, the researcher used candles, bar of match and candle holder. Then, in the second cycle, she used a water faucet, a soap, and a towel. In third cycle, she used pencils and sharpener. The result of research shows that realia used in teaching speaking procedure text with the ninth grade of students MTs Mathalibul Huda Jepara in The Academic Year of 2010/2011 can improve students‟ speaking ability. In terms of the realia being used, there was a difference between this study and another previous study. Both previous research by Darojat (2011) and by Rokhmawati (2011) took the MTs N students as the object of the study, while in this research, the researcher will take the fifth semester students of nursing department. Rokhmawati (2011) used household appliances and stationary such as candles, match, candle holder, water faucet, soap, towel, pencils and sharpener, while in this research the researcher used the medical equipment which is used in the nursing Standard Operating Procedure such as thermometer, stethoscope, sphygmomanometer, etc because nursing students are expected to be able to use those kind of tools in their profession. To know whether the teaching and learning process had achieved the objectives or not, it was necessary to conduct evaluation. The result of the evaluation should be led to the improvement on students‟ speaking score. In this study, there was a significant improvement on students‟ speaking skill compared to the teaching and learning process of speaking before applying realia as media. The result of the analysis on the students‟ final product on speaking showed that the students‟ skill in speaking

paragraph on how to operate the realia. Then, they exchange their draft to other group. After that, they did peer revising. The students should give comments or suggestions to their friends‟ draft. It was intended to train the students in giving feedback to their friends‟ draft for correctness in term of content, organization, and grammar. Brown (2001) states “peer editing is a true sharing process”. Through this strategy, the students learn to be better writers and better readers. Besides, it enabled them to have close relationship with each other. However, the teacher should give intensive guidance. The fact showed that some of the students reluctant to ask for the teacher‟s help though they found difficulties in accomplishing the task. So, the teacher should proactively help the students without waiting for the students to raise questions. After getting the feedback from their friends and the teacher, the next stage was rewriting. In this stage, the students revises their draft based on their friends‟ and the teacher‟s feedback. The last stage was the postspeaking activity. In this stage, the students were given a chance to make a role play. The role play activities could be done by asking the students to present role play in front of the class Referring to the previous relevant studies in the use of realia to improve students‟ English skill, the finding of this study showed the same result as Darojat (2011). He implemented realia to teach writing procedure texts. The results of the study revealed that the implementation of realia as media to teach writing procedure texts is effective in improving the students' writing ability of the ninth grade students of MTs N Liwa in writing procedure texts. Besides, the results of the study showed that the students were enthusiastic, motivated, and actively involved in teaching and learning process using realia as media in the teaching and learning process. Another research that supports realia is effective to be used in language teaching was done by Rokhmawati (2011) entitled “The Use of

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had improved significantly from preliminary to cycle 1. Before the action was implemented, the mean score of students was D or 44.3. After the strategy had been implemented, the mean score of the first Cycle 1 became B or 76.3.

the problem faced by the students in a certain class and certain topic. This study focused on the effort to improve the students‟ ability in speaking in term of on how to do something/how to operate some modern appliances. As the result, it had been successful. Based on the research findings, some suggestions, particularly for the teachers and/or lecturers who want to apply this approach in their speaking classes, and for the next researchers who want to conduct similar study, are proposed to improve the quality of the teaching and learning process in the future. Firstly, the result of the research will be advantageous for STIKes Patria Husada Blitar. As has been discussed previously, this study provides an alternative approach in teaching and learning writing that can be used for the lecturers in solving their students‟ problem in speaking. However, the lecturers should be more aware in the time management, particularly in handling students-teacher conference otherwise it would spend much time. To make the time effective, it would be much better if the lecturers could manage the meetings less than five meetings. Additionally, since the students are not accustomed to be actively involved in the class activities, the lecturers should give activities that can stimulate students‟ cooperativeness and activity. Secondly, based on the effectiveness of the implementation of realia as a media to teach speaking, it is suggested that the English teachers implement the strategy as an alternative strategy in English instruction and create the students-centered instruction. In addition, in applying this strategy, the teacher should be active in monitoring the students and proactively give effective guidance to the students. Furthermore, the teacher should be creative in the teaching and learning process so that the students will never feel bored. Furthermore, in implementing the strategy, the teachers should be aware of the following considerations. First, the teacher should clarify their instructions and explanations

CONCLUSION AND SUGGESTION This chapter presents the conclusion and the suggestion in reference to the research finding and discussions presented in the previous chapter. The conclusion deals with the students‟ improvement in speaking and the using of realia as the media in teaching and learning process of speaking. In addition, the suggestions are directed to English teachers and further researchers who want to continue to do research in the same field in the future. Conclusion Referring to the findings of this study, realia can be an effective media in the teaching of speaking. The realia can improve the students‟ ability in speaking and the students‟ involvement in the teaching and learning process. In this study, the students‟ speaking scores was significantly improved in Cycle 1 compared with those in Preliminary study. The number the students who got score above 64 (BC) as the minimum passing grade set by the researcher was also improved from the Preliminary study to Cycle 1. The data showed that the students‟ participation in Cycle 1 is categorized as very good because most of the students involved actively in the teaching and learning process. Most of the students participated actively in the teaching and learning process, such as: paying attention to the teacher‟s explanation, answering the teacher‟s question, making a group, making a draft, giving comments to their friends‟ draft, revising draft, and making a role play. Suggestion This study proposed realia as media to improve the students‟ ability in speaking. It was conducted to overcome

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more and more since it is still hard for non English students to understand instructions in English. Second, during the process, it is better for the teacher to use modeling for providing examples of how the students should speak, and pronounce. Third, the teacher should give intensive guidance to the students in each stage of the speaking process when the students do the task. The last, there must be a sufficient number of dictionary in the class in order to help the students find the appropriate words that they used in their

speaking. It is a must because inability of the students to organize the ideas was mainly caused by the insufficient vocabulary they already mastered. Finally, further researchers who are interested in the same field of the study, it is suggested that they apply this strategy. They can propose realia as media to help the students learn how to describe something/someone. Besides they can investigate the research about the effectiveness of realia in the teaching of vocabulary

REFERENCES Celce-Murcia, M. & Hilles, S. 1998. Techniques and Resources in Teaching Grammar. Hongkong: Oxford University Press Darojat, Muhammad. 2011. Using Realia to Improve the Ability of the Ninth Graders of MTs N Liwa Lampung Barat in Writing Procedure Texts. Unpublished S2 Thesis. Malang: Graduate Program State University of Malang. Jones, Anthony S.D.,& The Black River Group. 1994. The Expert Educator. Fond du Lac WI: Three Blue Herons Pub Rivers, W. 1981. Teaching Foreign Language Skills. Chicago: The University of Chicago Press Tim Penyusun Kurikulum STIKes Patria Husada. 2011. Panduan Pendidikan Ners dan Bidan STIKes Patria Husada Blitar. Blitar: STIKes Patria Husada Zukowski-Faust. 1997. What is meant by Realia? Arizona: AZ-TESOL Newsletter

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THE CORRELATION OF FINANCIAL MODELS AND MEDICINE ADHERENCE IN PATIENTS WITH DIABETES MELLITUS INATALATION OF OUTPATIENT AT RSUD NGUDI WALUYO WLINGI Yeni Kartika Sari, Nanang Yudhi Prasetyo, Wiwin Martiningsih STIKes Patria Husada Blitar Email:[email protected] Abstract Medication adherence in patients with Diabetes Mellitus is important in achieving treatment goals and effective in preventing some of the complications of Diabetes Mellitus. Patients with chronical diseases such as Diabetes Mellitus whose treatment requires a long time even a lifetime to note about the social economy, especially how patients pay for treatment. The purpose of this study was to determine the correlation between financial models and medicine adherence in patients with diabetes mellitus of Outpatient in RSUD Ngudi Waluyo Wlingi.This study was a type of nonexperimental research design and analysis of cross sectional. This study was conducted in 68 patients with Tipe 2 Diabetes Mellitus at Outpatient RSUD Ngudi Waluyo Wlingi, in Nopember 2014, the samples were taken by accidental sampling technique. The correlation score of medication adherence with financial models was analized using Spearman Rank test. It was found that there were correlation between financial models and medicine adherence in patients with diabetes mellitus by p value 0,000. It was important to improve health education about medicine adherence and how to acces financing to support their treatments. Key words: medicine adherence, financial models diabetes. The number of diabetics in urban areas of Indonesia in 2003 was 8.2 million people. While 5.5 million people in rural areas. It is estimated that 1 of 8 people in Jakarta have diabetes. The high count of patients in urban areas is partly due to lifestyle (Prapti Utami, 2009). Based on data obtained in Outpatient of Ngudi Waluyo Wlingi hospital that the average patient visits during 2009 was 259, in 2010 the average patient visit was 278, in 2011 the average patient visit was 300 and in 2012 the average patient visit was 295. Then in 2013, 33 visit patient was new patient and 311 visit patient was the old patients. In 2014

Introduction Diabetes mellitus is a disease characterized by high blood sugar levels. Basically, this is because the body lacks insulin substance produced by the pancreatic gland. Disadvantages here could be the lacking amount of insulin that, or the insulin is quite but it works less well. Diabetes mellitus is a chronic degenerative disease / not curable but blood sugar levels can be stabilized to normal (Sukarjdi, 2009). According to WHO Indonesia ranks fourth largest number of diabetics in the world. In 2000 there were approximately 5.6 million people in Indonesia who have

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until September, the average patient visits were 354. It is estimated that there are still many people (about 50%) who have not been diagnosed with diabetes mellitus in Indonesia witch was only two-thirds of diagnosed people who have undergoing treatment, both non-pharmacologic and pharmacologic. From the undergoing such treatment is only one-third are well-controlled (PERKENI 2011 ). Whereas patients with diabetes mellitus if it does not receive appropriate treatment will have a negative impact on the patient's own form of occurrence of various complications. Which it will further increase the burden of medical expenses that should be covered by the patient.

Based on this condition, noncompliance of diabetes mellitus patients maybe due to socioeconomic related factors. In patients with chronic diseases such as diabetes mellitus whose treatment requires a long time and even a lifetime must note about the social economy, especially how to finance patient treatment. If the patient is in lower economic level or do not know about the existence of the system of financial model dedicated to him, the patient will tend to disobey in the treatment. Based on research of Isa and Baiyewu in Ramdani, 2012, showed that lower quality of life in patients type 2 diabetes is influenced bybsocio-economic factors that is associated with financial problems or financial availability to support their The lower treatment. of socioeconomic status is also associated with poor adherence in patients with diabetes mellitus (Faradhilah, 2014). Medication adherence in patients with Diabetes Mellitus is important in achieving treatment goals and effective in preventing some of the complications of Diabetes Mellitus. Patients with chronical diseases such as Diabetes Mellitus whose treatment requires a long time even a lifetime to note about the social economy, especially how patients pay for treatment, (Putri, 2008).

Various studies have shown that generally patient compliance in the treatment of chronic diseases is low. The research involving outpatients showed that more than 70% of patients do not take medication according to the right dose (Basuki, 2009). According to a WHO report in 2003, the average compliance of patients on long-term therapy for chronic disease in developed countries is only 50%, whereas in developing countries, the number is even lower (Asti, 2006). From the analysis of some of the opinions of experts known that medicine adherence is influenced by many factors. These factors include economic factors. Estimates that there are states that 20% of hospitalization as a result of noncompliance of patients to treatment (Sarafino, 2013)

There were various financial models at Ngudi Waluyo Wlingi hospitasl such as general financial, BPJS and Jamkesda. Based on observation there, the 80% of 354 visit of diabetes mellitus patient to September choosen BPJS as financial models and a lot of patients who used a general financial and

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Jamkesda moved to BPJS financial models.

analyzed by Spearman rank test with significance level ≤ 0.05

Based on the above description of the importance of sustainable financial models to support the treatment of patients with chronic diseases such as diabetes mellitus, the researchers were interested to know the correlation of Financial Models and Medicine Adherence in Patients with Diabetes Mellitus Inatalation in Outpatient at RSUD Ngudi Waluyo Wlingi.

Result and Analysis The Gender of Respondents Table 1 The Distribution of Respondent‟s Gender In Outpatient of Ngudi Waluyo Wlingi Hospital, November 2014 Gender Male Female Total

The general purpose of this research was to explain the correlation between Financial Models and Medicine Adherence in Patients with Diabetes Mellitus Inatalation in Outpatient at RSUD Ngudi Waluyo Wlingi While the specific purposes of this study were: 1) Describe the financial model of diabetes mellitus patient in Outpatient of Ngudi Waluyo Wlingi hospital. 2) Describe the medicine adherence of diabetes mellitus patients in Outpatient of Ngudi Waluyo Wlingi hospital. 3) Analyze the relationship between financial models and medicine adherence in patients with diabetes mellitus inatalation in Outpatient at RSUD Ngudi Waluyo Wlingi.

Amount 25 43 68

Procentage 37% 63% 100%

The Employment of Respondents Table 2 The Distribution of Respondent‟s Employment In Outpatient of Ngudi Waluyo Wlingi Hospital, November 2014 Employment House wife Private Job Farmer Pentionary Teacher Government emp Total

Jumlah 19 15 7 23 3 1

Prosentase 27,9% 22,1% 10,3% 33,8% 4,4% 1,5%

68

100%

The Education Of Respondents Table 3 The Distribution of Respondent‟s Education in In Outpatient of Ngudi Waluyo Wlingi Hospital, November 2014

Method This research was non-experimental research with cross sectional method. The sample in this research was 68 people who suffer from diabetes mellitus who visited the Outpatient of Ngudi Waluyo Wlingi hospital with accidental sampling technique The independent variable of this research was financial model while the dependent variable was the medicine adherence. The data were

Education Elementary Junior High Senior High Diploma/ bachelor Total

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Amount 21 18 17 12

Procentage 30,9% 26,5% 25% 17,6%

68

100%

happens because the ongoing financing needed when the level of compliance to be achieved successful therapy with either (WHO 2003), in which the BPJS patient is no guarantee continued their threatment. While on public patients there was a possibility of high socio-economic status so that they could pay for their treatment, because the sustainable financing needed if the level of medicine adherence to be achieved works so well (WHO, 2003). From the results of the research obtained from the data that there were 22 people who have a moderate level of compliance in which 13 people were patient with public financial models. In addition to socio-economic factors that could affect adherence, the majority of respondents (8 people) answered yes when asked if they feel that therapy was complicated, this means that factors associated therapies such as the duration, the treatment regimen, previous treatment failures , changes of treatment, the unfavorable effects of the drug, side effects, and the availability of medical support to deal with them was a prominent factor in influencing medicine adherence (Takiya et al, 2004). While in the BPJS financial model there were 9 people with moderate adherence and the majority of respondents (4) have the same answer with 8 respondents of public financial models. The result also showed that there were 6 people have low adherence level and most of them (4 patient) are public financial models that were commonly influenced by socioeconomic factors which socioeconomic status were low also associated with poor adherence in patients diabetes mellitus

Cross-tabulation financial model with medication adherence of Diabetes mellitus patients Table 4 Cross Tabulation Financial Model with medicine adherence of Diabetes mellitus patientsIn Outpatient of Ngudi Waluyo Wlingi Hospital, November 2014

Financial Model BPJS General Spearman Rank

Medication Adherence High 37 3 0,000

Moderate Low 9 2 13 4

The above table shows that there was a correlation between financial model with medicine adherence in diabetes mellitus patients, with the results of analysis using SPSS 16 software with Spearman Rank test P value of 0.000 was obtained, and in this case of course P value less than 0.05. Discussion Based on the research results could be obtained that the majority of respondents, 40 people have a high compliance rate (58.8%), 22 with moderate compliance rate (32.4%), six people had a low compliance rate (8.8%). It could be obtained from the study also that patients with diabetes mellitus using BPJS were 48 people (71%), and patients who use public financing were 20 people (29%). The 40 people who have a high density of as many as 37 people (92.5%) were respondents who use BPJS financial model, while 3 people (7.5%) are respondents who use public financial model. This

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(Faradhilah, 2014). Whereas in BPJS patients there are 2 people who have low level of adherence in which the majority of them answered yes when asked if they sometimes forgets to take medication. It was appropriate with that some of the factors related to clients adherence affected factors was reportedly forgetfulness (WHO, 2003), besides of course also due to the lack of motivation of the client to perform the treatment, as well as the level of education of the patients were low (elementary shool), considering education can affect the level of patients' knowledge about the importance of regularity of taking the drug, it was appropriate because education were a process of changing attitudes and code of conduct of a person or group and also mature human effort through the efforts of the teaching and training (Meliono Irmayanti, 2007). From the results of this study showed that BPJS patients have a high compliance rate of more than patients who used public financial model in which of the 48 respondents who used as 37 respondents (77.1%) have a high compliance rate. While in public financial model patients from 20 respondents there were 3 respondents (15%) had a high compliance rate. This condition occurs because BPJS patients had availability of financing for access to treatment, while the public financial model patient not necessarily guarantee the availability of financing because it depend on the social economic status. At the level of moderate compliance there were more BPJS patient than public client that was 13 respondents (65%) and in BPJS patients from 48 respondents have 9 respondents (18.75%) with high levels of complianc. It was a

fact that there were other factors that affect adherence in this case that were relevant with therapy factor. At the low level of medicine adherence the amount of public patient are more than BPJS patient where from 6 low adherence respondents, 4 of them were public financial models, this condition could be happens because in public patients not necessarily guarantee the availability of sufficient financial access to treatment, while BPJS patients have other factors affecting adherence that were factors related to the client them self. Conclusion There were correlation between model of financial model with medicine adherence in diabetes patients in Outpatient of Ngudi Waluyo Wlingi Hospital with α significance value of 0.000. Acknowledgement Among patients with a number of public financial and BPJS patients in this study is not the same

REFFERENCES Asti, Tri. 2006. Kepatuhan Pasien : Faktor Penting dalam Keberhasilan Terapi. Info POM, Vol. 7, No. 5, diakses Januari 2011 dari (http://perpustakaan.pom.go.id /Koleksi/Buletin%20Info%20P OM/0506.pdf) Basuki, Endang. 2009. Penatalaksanaan diabetes mellitus terpadu. Jakarta: Balai Penerbit FKUI. Irmayanti, Meliono, dkk. 2007. MPKT Modul 1. Jakarta: Lembaga Penerbitan FEUI.

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PERKENI, 2011.Konsensus Pengelolaan Dan Pencegahan Diabetes Mellitus Tipe 2 Di Indonesia Putri, 2008, Analisis Efektivitas Biaya Penggunaan Antidiabetik Kombinasi pada Pasien Diabetes Melitus Tipe 2 Rawat Jalan Di RSU Pandan Arang Boyolali. Skripsi, Universitas Muhammadiyah Surakarta. Surakarta, tidak dipublikasikan Ramdani, Deri. 2012. Gambaran Kualitas Hidup Berdasarkan Karakteristik Pasien DM Tipe2 Di Rumah Sakit Umum Pusat Hasan Sadikin. (http://www.academia.edu/.../b ab 1 pendahuluan). Di akses tanggal 9-10-2014 Ramdani, Deri. 2012. Manajemen Berkas Dan Isi Rekam Medis. (http://www.academia.edu3275 264./Management Berkas dan Isi Rekam Medis). Di akses tanggal 10-10-2014 Sukardji, Kartini. 2009. Penatalaksanaan diabetes mellitus terpadu. Jakarta : FKUI Surya, Faradhilah Adi. 2014. Hubungan Tingkat Kepatuhan Minum Obat Penderita DM Tipe2 Terhadap Kadar Hba1c.(http://www.scribd.com/

doc/234158166/HubunganTingkat-Kepatuhan-MinumObat-Penderita-DM-Tipe 2Terhadap-Kadar-Hba1cSkripsi). Di akses tanggal 1010-2014 Sarafino, E.P. 2013.Health Psychology: Biopsychosocial Interaction, Second Edition. New York: John Wiley & Sons, Inc. Soegondo, Sidartawan. 2009. Hidup secara mandiri dengan Diabetes mellitus, kencing manis, sakit gula. Jakarta : Penerbit FKUI. Takiya, 2004. Meta-analysis of interventions for medication adherence to antihypertensives. Annals of Pharmacotherapy, 38(10), 1617-1624. (www.theannals.com/content/3 8/10/1617.full)diakses 18 september 2014. Utami, Prapti.2009.Solusi Sehat Mengatasi Diabetes.Jakarta:Agromedia Pustaka. WHO, 2003. Adherence to Long Term Therapies Evidence for Action. (Online) (http://apps.who.int/medicine docs/en/d/Js4883e/) diakses 7 oktober 2014

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THE EFFECT OF CONSUMING WATERMELON RIND EXTRACT (CITRULLUS LANATUS) TOWARD THE DECREASING OF BLOOD SUGAR LEVELS ON DIABETES MELLITUS PATIENTS IN WERU - PACIRAN - LAMONGAN Arifal Aris, S.Kep, Ns, M.Kes.

Nursing Program of STIKES Muhammadiyah Lamongan ABSTRACT Diabetic is a cronic disease that characterized by hyperglycemic. This disease is a problem that often occurs in the society, with their high blood sugar levels. One way to control blood sugar levels is by pharmacological and non-pharmacological. One of the ways is using the essence of watermelon rind juice/extract (Citrullus Lanatus), because rind extract of watermelon contains citrulline that produces nitric oxide, which nitric oxide is capable of lowering blood glucose. The purpose of this research is to know the effect of watermelon rind extract (Citrullus Lanatus) toward the decreasing of sugar levels of diabetic patients in Weru, Paciran, Lamongan. The method used in this research is quasy eksperimental using pre test and post test design. Population in this research is all diabetic patients in Togosadang Health Center, Weru, Paciran, Lamongan at October. The population is 31 patients with the sample is 28 patients. The sampling technique used is simple random sampling. The instrument is Glukotest. The method to analyze the data is using paired t-test with α = 0,005. The result of this research is that the patients in treatment group given watermelon rind extract get decreasing in their blood sugar levels attaining 10 of them(71,4%) anf they who get increasing in ther blood sugar levels reaching 4 of them (28,6%). But in the control groups not given watermelon rind extract do not get decreasing on their blood sugar levels, none of them (100%). It measured using paired t tets α 0,05 with significan 0,000 (p < 0,05). From this result, we can conclude that there is effect of consuming watermelon rind extract to the diabetic patients in Weru to decrease their blood sugar levels.. Based on the result of this research, it can be concluded that to control blood sugar levels is by combining pharmacology medicine with herbal medicines, one of the ways is by using watermelon rind extract (Citrullus lanatus). Key words: watermelon rind extract (citrulus lanatus), blood sugar levels, diabetic.

diabetics in the world currently reached 200 million and is estimated to increase more than 330 million in 2025. The reasons for this increasing are the raising of life expectancy and doubled high population growth with increased rates of obesity linked with urbanization and dependence on processed foods. In the United States, 18.2 million people with diabetes (6.3% of the population), almost one-third of them are unaware that they have that illness. (Corwin, 2009)

1. INTRODUCTION Diabetes is derived from Greek word which means 'drain or divert' (siphon). Mellitus from Latin word which means sweet or honey. Diabetes mellitus (diabetic) can be defined as an individual that drains much urine volume with high glucose level. Diabetes mellitus is a disease characterized by hyperglycemia with the lack of absolute insulin or the decreasing in the relative insensitivity of cells to insulin. Based on the current epidemiological evidence, the number of

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Diabetes mellitus is a disease that is not contagious which its‟ pravelence increases from year to year. Diabetes mellitus often referred to as 'The Great imitator', because this disease contaminates all organs of the body and causes many complaints. The symptoms vary widely and can occur gradually, so the patient will not aware of the changes such as they drink more often, urinate frequently or even lose their weight. (Andi D, P, 2007) According to data of the Health Ministry in 2008, there were 5.7% of Indonesia's population (about 12 million people) suffer from diabetes mellitus and 11% of that amount is a group of prediabetes. In the projection of 2030, it is estimated that the number will rise into more than 21 million people (Hidayati, 2009). Likewise, people with diabetes mellitus in the Surabaya also continues to rise, it can be said that the diabetic currently reaches 180,000 people, 6% of society on that region, while in Lamongan about 200,000 or 12% of the population allegedly affected by diabetes mellitus (Nur and Ayi 2008). Based on the data obtained from Puskesmas Tlogosadang Paciran, it is found 360 people who have tested their blood sugar levels in January to September 2014, 212 of them (58.84%) have a normal blood sugar levels and 148 of them (41.16%) have abnormal blood sugar levels. Based on the initial survey conducted in September 2014 in Weru Paciran, it got 10 people suffering from diabetes mellitus, 7 of them or 70% with a high blood sugar levels. Of all the people to be sampled for this survey, 10 people did not do additional therapies or alternative treatments for lowering their blood sugar levels. From these data it can be concluded that the problem of blood sugar levels of diabetic is still high or can not be controlled. There are some factors that could affect the success in controlling blood sugar levels are diet, stress, drugs, environment, sports, elucidation about diabetes mellitus and the role of the

family in motivating them and supervising their diet. Diabetes mellitus is already known widely as a disease characterized by the increasing of blood sugar levels, and can occur because of hereditary factors. Therefore, the treatment of diabetes should be conducted as early as possible, in order to prevent the occurrence of various complications. The treatment of diabetes can be with chemical drugs or with natural drugs. To avoid the consequences of the use of diabetes medications that can harm health if consumed in a long term that can cause undesirable adverse effects on health is by controlling blood sugar levels. To control the blood sugar levels is by combining pharmacology drugs and herbal medicines. One of the ways is to eat watermelon (Citrullus lanatus), especially its‟ rind (the white one), the process is simple and has no side effects that is safe to eat for health. Watermelon is a plant of tropical and subtropical Afrika. Gurun Kalahari is the central of its divergence. Recently, this plant has grown rapidly in many other countries such as China and the United States. Watermelon is a crop that grows vine and require sunlight. Watermelon is favored by many people from infants to adults, because this fruit is really sweet and its color is red or yellow that is quite tempting to make everyone who see it keen to savor. Watermelon contains a lot of water which is about 92% of its containt so it will taste delicious when it is consumed by the time we feel thirsty. Unripe watermelon can be used as a vegetable in making food. While the watermelon rind can be used as raw material for making candied or pickled while the seeds are used to make kwaci. (Khomsan, 2009). In Indonesia, watermelon‟s seeds are commonly consumed as snack and known as kwaci. The fruit is eaten as a dessert or dishes laid outon the table. Mozambik of watermelon is further processed, for example, a traditional alcoholic beverage made of its extract.

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Some people use this plant and its fruit for animal feed, even just a few that do that. One respondent showed that the consumption of watermelon is able to be used as a medicinal treatment. In his watermelon‟s leaves opinion, maceration is able to cure earache, while the flesh is able to cleanse the bowels and has the effect of watermelon afrodifiak. Kind of watermelon in this research is varied consisting white, yellow, and red flesh watermelon. In his research, Sugiyanta expect that the watermelon rind contains citrulline producing nitric oksida. Nitrad oxide is capable of lowering blood glucose and triglyceride mice with diabetic. Researcher explained that citrulline is useful for nitrad oxide systems of human that has a high potential as an antioxidant and vasodilation and dilating blood vessels to increase blood flow to the tissues that need it. (Trufus, 2013). From the description above, one of the ways to control blood sugar levels is by combining pharmacology medicine with herbal medicines, one of which is by consuming watermelon rind (Citrullus lanatus). The researcher is interested in examining the effect of watermelon rind to decrease blood sugar levels of diabetic patient in Weru, Paciran, Lamongan.

Table 1 The distribution of respondents characterized by gender in the treatment group.

Table 1 shows that nearly all respondents with diabetes mellitus in treatment group are women with the amount of 12 respondents (85.7%). The (14.3%) is male with the amount of 2 respondents. (2) Characteristics by gender in the control group. Tabel 2 The distribution of respondents based on gender in the control group.

Table 2 shows that the majority of respondents with diabetes mellitus in control group are female with the amount of 9 respondents (64.3%), and the reaming is male (35.7%) with the amount of 5 respondents.

2. RESEARCH METHOD The design of this study uses Quasy Experimental using Pre-Test and PostTest Design. The population of this study is all diabetes patients in Weru who come to Puskesmas Tlogosadang, Paciran, Lamongan in October. The amount of the population is 31 people. The sample of this study is 28 people taken using simple random sampling. The instrument used is Glukotest.

2) haracteristics based on Age (1) Characteristics treatment group.

by

age in

the

Table 3 The distribution of respondents by age in the treatment group

3. RESULT General Data 1) The characteristics based on Gender. (1) Characteristics by gender in the treatment group

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respondents ger rising on their blood sugar levels (28, 5%). 2) Blood sugar levels In the control group.

Tabel 6 The distribution of blood sugar levels in the control group Based on Table 3, it can be explained that 6 respondents aged 50-59 (42.8%) and one respondent aged <40 (7.1%). (2) Characteristics based on age in the control group Table 4 The distribution of respondents by age in the control group

Table 6 shows that the blood sugar levels in the control group given watermelon rind extract/juice are 14 respondents. No one got decresing on their blood sugar levels (100%) 3) Comparison of Blood sugar levels In Treatment and Control Group. Tabel 7 The comparison of data distribution on blood sugar levels between treatment group and control group.

Based on Table 4, it is explained that 7 respondents aged 50-59 (50%) and no one aged <40. Particular Data 1) Blood sugar levels In The Treatment Group. Table 5 The data distribution of Blood sugar levels in the treatment group

Table 7 shows the differences between blood sugar levels in the treatment group and the control group given watermelon rind extract/juice of 14 respondents. Ten patients in treatment group given watermelon rind extract got their blood sugar levels decreases (71.4%) and 4 participants got their blood sugar levels increases (28.6%). On the other hand, 14 patients in the control group not given watermelon rind extract did not get decreasing on their blood sugar levels (100%). It is supported by the results of the test using SPSS 16.0 using t test sample independent with significance 0.00

Table 5 shows that the blood sugar levels of the patients in the treatment group given watermelon rind juice/extract are 14 respondents. Ten respondents get decreasing on their blood sugar levels (71.4%), and 4

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where α = 0.05. Then H0 is rejected, it means that there are differences in blood sugar levels among respondents who given watermelon rind extract and them who were not on the diabetes mellitus‟ patients in Weru, Paciran, Lamongan.

regularly consumed, at least, in seven days to obtain maximum results. 2. Blood sugar levels In the Control Group The results in table 4.6 shows that blood sugar levels in the control group who were not given watermelon rind extraxt is 14 people and all the respondents get decreasing on their blood sugar levels (100%). Based on the results, it can be concluded that all patients who were not given watermelon rind extract did not experience changes in their blood sugar levels. It is because the control group was given no treatment. Based on the observations, many respondents are less active in controlling their blood sugar levels, such as the lack of regular exercise, do not eat properly. There are several factors that can affect the success in controlling the levels of blood sugar, such as: diet, stress, family roles, medicine, environment, and sport (Guyton, 2007). Thus, maintaining the body to stay healthy is very salient. Some of the ways to do that are by maintaining a proper diet, exercising regularly, and keeping the mind to avoid stress.

4. DISCUSSION The discussion of this study is in accordance with the purpose of the research, statistical result and the effect of watermelon rind juice to decrease blood sugar levels on diabetes mellitus‟ patients in Weru, Paciran, Lamongan in the year of 2015. They are as follows: 1. Blood sugar levels In the Treatment Group The results written in Table 4.5 shows that the blood sugar levels of diabetic patients in the treatment group given watermelon rind extract are 14 people, 10 patients got decreasing on their blood sugar levels (71.4%) and 4 patients stayed the same in their blood sugar levels (28.6%). Based on the data above, it can be concluded that the majority of patients after consuming watermelon rind juice got decreasing on their blood sugar levels. According Trufus, (2013) white watermelon rind extract contains citrulline producing nitric oxide; nitric oxide is capable of lowering blood glucose and triglycerides of diabetics. In addition, citrulline is useful to nitric oxide system in human body and it is very potential as an antioxidant and vasodilation. It dilates blood vessels to increase the blood flow in the body and distribute it to the tissues that need it. The levels of citrulline in watermelon rind reached 24.7 mg, more than the flesh that only 16.7 mg. Citrulline in watermelon red fleshy (7.4 mg) is less than the citrulline of yellow-fleshed watermelon (28.5 mg). Thus, watermelon rind juice has qualitative benefits as herb because it has been used as a medicine to lower blood sugar levels in diabetes mellitus‟ patients. Watermelon rind extract/ juice should be

3. The differences between Blood sugar levels In Treatment Group and Control Group Table 4.7 shows the differences between blood sugar levels in the control group and the treatment group given watermelon rind extracts. It shows that 10 diabetic patients get decreasing on their blood sugar levels (71.4%) and 4 diabetic patients did not experience the same (28.6%). Whereas in the control group, the diabetic patients who were not given watermelon rind juice, all of them did not get decresing on their blood sugar levels (100%). Based on the data above, it can be claimed that all participants, diabetic patients, who consumed watermelon rind juice got decreasing on their blood sugar levels. According to Trufus (2013), white watermelon rind extract

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contains citrulline-producing nitric oxide. Nitric oxide is able to lower blood glucose and triglycerides of diabetes. Whereas in the control group, all the patients were not given watermelon rind juice and they did not get any level changes on their blood sugar levels. It is caused that the control group were not given the treatment. The factors that could affect the success in controlling the levels of blood sugar are diet, stress, family roles, medicine, environment, and sport (Guyton, 2007). By studying the theories and the results described above, watermelon rind extract can influence to the decreasing of blood sugar levels in diabetes mellitus‟ patients in Weru, Paciran, Lamongan. Thus Sari watermelon rind can be used as an alternative medicine for lowering blood sugar levels.

medical personnel or medical team, but also the whole individual should take a part. To facilitate the information about the effect of consuming watermelon rind extract on diabetic patients, it is needed to be held counseling to the patients and their family. 5.2.2 For Health Institutions By the development of the effect of watermelon rind juice to decrease blood sugar levels in diabetes mellitus‟ patients, this research is hoped to be able to support the research as additiona existing theories. 5.2.3 For Other Researcher To conduct further research, the other researcherscan use larger number of respondents with more accurate method. They are also able to study using other influences such as diet, reducing stress, medicines, comfortable environment, regular exercise, and role of family to motivate and supervise the diabetic patients in their diet to eat fruit and vegetables regularly with low sugar.

5. CLOSING 5.1 Conclusion After analysing the data and see the results of the analysis, the researchers can draw some conclusions as follows: 1) There is reduction on the blood sugar levels of diabetic patients in the group given watermelon rind extract in Weru, Paciran, Lamongan. 2) There is no reduction on the blood sugar levels of diabetic patients in the group not given watermelon rind extract in Weru, Paciran, Lamongan. 3) There are differences on the blood sugar levels between group given watermelon rind extract and the group not given the extract of watermelon rind in Weru, Paciran, Lamongan.

DAFTAR PUSTAKA Andi, Dyah Pratiwi. (2007). Epidemologi dan Isu Mutakhirnya http// wordpress.com/2007/12/10/. Diakses: tanggal 10 Oktober 2012. Corwin, E. J. (2009). Buku Saku Patofisiologi. Jakarta: EGC. Davey, Patrick. (2005). At Glance Medicine. Jakarta: Erlangga. David, Rubenstein. (2005). Lectura Notes on Clinical Medicine, Ahli Bahasa Annisa RahmaniaJakarta: Erlangga. Guyton, Athur C. (2007). Buku Ajar Fisiologi Kedokteran. Jakarta: EGC. Hasim.(2012). Etika Dalam Melakukan Penelitian Eskperimen.https://hasim319.w ordpress.com/2012/05/12/.

5.2 Suggestion Based on the above conclusions, there are some efforts that need to be considered: 5.2.1 For Nursing Profession To overcome the increasing of blood sugar levels is not only done by the

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Diakses: tanggal 23 Desember 2014. Hidayat, A Aziz Alimul. (2007). Edukasi Penting Untuk Kendali Pravelensi Diabetes.http://www.jurnal medika.com-192-edukasipenting-untuk-kendalikan pravelensidiabetes.html.Diakses tanggal 10 oktober 2012. Hidayat, A Aziz Alimul. (2007). Metode Penelitian Keperawatan dan Teknik Analisa Data. Jakarta: Salemba Medeka. Hidayat, A Aziz Alimul. (2007). Riset Keperawatan dan teknik penulisan ilmiah. Jakarta: Salemba Medeka. Khomsan, P. A. (2009). Rahasia Sehat Dengan Makanan Sehat. Jakarta: PT Kompas Media Nusantar. Kowalak, Jenifer P. (2011). Buku Ajar Patofisiologi. Jakarta: EGC M.N. Bustan. (2007). Epidemologi penyakit tidak menular, edisi tiga. Jakarta: EGC Nur dan Ayi.(2008). DM tertinggi, tren Narkoba Naik. http://www.Jawapos.go.id. Diakses tanggal 08 oktober 2012. Notoatmodjo, Soekidjo. (2005). Metode Penelitian Kesehatan Edisi Revisi. Jakarta: Rineka Cipta

Nursalam. (2008). Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan, Jakarta: Salemba Medika Nursalam. (2003). Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan: Pedoman Skripsi, Tesis dan Instrumen Penelitian Keperawatan. Jakarta: PT Salemba Medika Prince, Sylvia Anderson. (2005). Patofisiologi: Konsep Klinis Proses-Proses Penyakit. Jakarta: EGC Robbins, H.B. (2008) Buku Ajar Patologi Volume 2. Jakarta: EGC Sidartawan, Soeganda. (2004). Penatalaksanaan Diabetes Mellitus Terpadu. Jakarta: FKUI Suharsimi, Arikunto. (2002). Prosedur Penelitian Suatu Pendekatan Praktek. Cet.13. Jakarta: PT Rineka Cipta Tjokroprawiro, Askandar. (2004). Hidup Sedat dan Bahagia Bersama Diabetes, Jakarta: Gramedia Pustaka Utama. Trufus.(2013). 100 Plus Herbal Indonesia Bukti Ilmiah dan Racikan vol 11. Bandung: PT Trubus Swadaya.

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THE EFFECT OF GIVING COMMON SNAKE HEAD (CHANNA STRIATA) ON PERINEAL WOUND HEALING IN POSTPARTUM MOTHER IN BPM NY. TITIN S. MUBIN KARANGGENENG LAMONGAN Heny Ekawati Stikes Muhammadiyah Lamongan Email: [email protected] ABSTRACT Perineal wound is a wound caused of the birth canal laceration well as in episotomy or not, at the time of birth the fetus. One of the way for fast perineal wound healing is gived common snakehead. The aim study for knowing the effect of giving Common Snakehead (Channa Striata) On Perineal Wound Healing In Postpartum Mother. The design of the study uses Quasy Experimental. The population is all of postpartum mother in BPM Ny. Titin S. Mubin, Amd. Keb in February to April 2014. The sampling technique uses consecutive sampling. Sample are taken by 30 respondents to include inclusion criteria. The research data is taken using observation sheets and SOP. Processing data using editing, coding, and tabulating, and then analyzed using the mann whitney test with a significance level α = 0,05. The result showes almost entirely or 80% perineal wound healing fast category experienced of postpartum mother is given common snake head (Channa Striata). While, almost entirely or 86.7% perineal wound healing slow category experienced of postpartum mother not given common snakehead (Channa Striata). The results of statistical tests obtained results are the effect of giving common snakehead (Channa Striata) on wound healing of the perineal with a value of Z = 3598 and with a significance level of 0.000 (p <0.05). The conclusion, giving common snakehead can used as alternative for perineal wound healing. Key word : postpartum mother, wound perineal, given common snakehead

indications such as (1) a large baby, (2) abnormal head position, (3) Birth buttocks, (4) extraction forceps are difficult, (5) shoulder dystocia (Saifuddin, 2008). Meanwhile, according to Varney (2007), perineal laceration can be classified as follows: 1) the degree: laceration involving the vaginal mucosa, posterior fourchette and perineal skin. 2) Second degree: laceration that resulted in the vaginal mucosa, posterior fourchette, perineal skin and muscles of the perineal. 3) Degree three: Lacerations involving the vaginal mucosa, posterior fourchette, perineal skin, perineal muscles and the external anal sphincter. 4) Degrees Four: Lacerations involving the vaginal mucosa, fourchetter posterior perineal skin, perineal muscles, external anal sphincter, rectum and anterior wall. In the wound healing process in addition to new mothers require proper wound care, also require nutrition mainly albumin and protein. When albumin and protein requirement is rarely met in the wound healing process of the tissue cells of the body will be hampered in building and replacing the cells in

INTRODUCTION Childbirth is the process of spending the products of conception that can live in the uterus through the vagina from the outside world (Wiknjosastro, 2005). Childbirth is a normal process that occurs at the expense of the fetus at term gestation (37-42 weeks), was born spontaneously with the presentation in the back of the head that lasted 18 hours, with no complications for both the mother and the fetus. (Prawirohardjo, 2002). However perineal laceration occurred in nearly all first births and not infrequently also in the next delivery. Perineal wound is a wound in the perineal because of the birth canal laceration well as episiotomy and delivery of a fetus (Wiknjosastro, 2005). The cause of perineal injuries can be caused by two factors: 1) Maternal factors: maternal factors such as (1) parturition precipitatus are not controlled and are not helped, (2) The patient is not able to stop pushing, (3) parturition hastily resolved to urge Excessive fundus, (4) edema and fragility of the perineal. 2) Indication of the fetus: fetal

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the wound tissue perineal wound healing process lasts so long. In Indonesia ancestral herb for healing after childbirth is still widely used, even by modern society in this way has not been widely used. For example, perineal sutures for wound healing, traditional societies use common snakehead to be consumed daily in order to accelerate the process of wound healing of the perineal. However, meeting the needs of albumin and protein by using a fish cork has not been widely used, but according to the study conducted by prof. Dr.. Ir. Eddy Suprayitno MS, fish cork containing albumin is high enough so that it can accelerate wound healing of the perineal and the rapid wound healing can prevent the occurrence of infections (Kordi, 2010). In the community itself is still a lot of mothers who experience postpartum perineal wound healing delays, where the 7th day after the wound is still there crusta, no adhesions at the turn of the bandage, no scarring, no signs of infection, inflammation and granulation are still not visible, the former wound is not good (Pusdiknakes, 2003). Based on data from the World Health Organization (WHO) in 2009 there were 2.7 million cases of rupture of the perineal at birth mother. This figure is estimated to reach 6.3 million by 2050, along with the high midwife midwifery care that do not know well. In the 26 million Americans who experience maternal perineal rupture, 40% had rupture of the perineal because of the negligence of the midwife. In Asia rupture of the perineal is also a considerable problem in the community, 50% of the incidence of rupture of the perineal in the world occur in Asia. The prevalence of maternal experiencing perineal rupture in Indonesia in the age group 25-30 years is 24% while at the maternal age of 32 -39 years by 62%. The results of the initial survey conducted by researchers for one week in BPM Ny.Titin S. Mubin, Amd.Keb.Lamongan Karanggeneng there were 10 mothers who experience postpartum perineal wound. Of the 10 mothers there are 7 people or 70% of new mothers experience a delay in wound healing of the perineal and 3 people or 30% of puerperal women have experienced in the wound healing process. Based on the data in the above description, that the majority of new mothers experience a delay in wound healing of the perineal.

Physiologically perineal wound will begin to improve within 6-7 days postpartum. As for some of the factors that affect wound healing of the perineal are internal factors and external factors. Internal factors that affect the healing of the perineal include: (1) Nutrition. Nutritional factors, especially protein will greatly affect the wound healing process perinium because the network is in desperate need of protein turnover. Protein requirements will be needed in the process of wound healing lacerations of the birth canal, because this protein serves as a building block cells that have been damaged. When this protein needs are lacking in wound healing process the tissue cells of the body will be hampered in building change cells and tissue in the birth canal laceration wound healing process lasts so long (Kartika, 2008). (2) Personal hygiene or vulva hygiene. If personal hygiene maintained in less postpartum mothers will lead to an infection (Moya, 2003). Personal hygiene or lack of personal hygiene can also slow healing, it may cause foreign objects such as dust and germs (Smeltzer, 2002), (3) maternal condition. If the condition of a healthy mother, then the mother can take care of themselves well. (4) Descendants, (5) age, (6) hemorrhage, (7) hypovolemic, (8) local edema factor, (9) nutritional deficit, (10) oxygen deficit, and (11) over the activity. While external factors affecting the perineal wound healing include: (1) Environment. Support from family, where the mother will always feel the protection and support and advice, especially parents in caring for hygiene after childbirth. (2) Tradition. sutures for wound healing after surgery, using a traditional community fish or fish cork curse to be consumed daily in order to accelerate the process of wound healing stitches. (3) Knowledge. If the mother's lack of knowledge thereof problems of food consumed wound healing will take a long time (4) Socio-economic, (5) Handling officer, (6) Network Management, (7) Drugs (Smeltzer, 2002). Impact of delay in the first perineal wound healing is infection, which affected locheaperineal conditions and moisture will greatly support the proliferation of bacteria which can cause infection in the perineal. The second occurrence of complications, the emergence of infection in the perineal can propagate in the gallbladder or in the birth canal that can result in the emergence of

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infectious complications and bladder infections in the birth canal. And the third is the occurrence of postpartum maternal death, treatment of complications that can lead to a slow death in women post partum physical condition is still weak postpartum mothers (Ambarwati, 2008). To accelerate wound healing of the perineal there are many ways, such as through improved nutrition by eating foods high in calories and high in protein. Common sources of protein are meat, milk, bread, cereal, eggs, fish, nuts, and seeds (Boyle, 2008). According Kordi (2010), catfish (Channastriata) is one kind of fish that contain albumin and protein are high enough. Protein and albumun very function as a builder substance cells that have been damaged, so that wound healing will take place faster. With a high content of protein and albumin, common snakehead could potentially be used by the public for the wound healing process, especially postoperative wounds, burns and after childbirth. For the role of nurses is expected to help provide counseling to new mothers on how to optimize the perineal wound healing by encouraging the fish to consume common snakehead. Because many factors affect the perineal wound healing researchers interested in conducting research on nutrition, which is intended to improve nutrition by researchers is "Giving Nutrition Improvement With Common Snakehead (Channastriata)".

S. Mubin, Amd. Sumberwudi 2014. No

Keb

Village

Age

Jumlah Prosentase Responden (%) 1. < 20 thn 5 16.7 2. 20 – 30 thn 15 50 3. > 30 thn 10 33.3 Total 30 100 Sources Primary Data: Study Pebruari-April 2014 Based on the above data shows that of the respondents who experienced a postpartum mother's perineal wound most or 50% aged 20-30 years and a fraction or 16.7% were aged <20 years 2) Characteristics of respondents by level of education Table 2.Distribution of Respondents by Education Mothers Experiencing Postpartum The perineal wound in BPM Ny.Titin S. Mubin, Amd. Keb Village Sumberwudi 2014. No

Education

1. 2. 3. 4.

PrimarySchool Junior High School High School College

Juml ah 4 4 17 5

Prosent ase (%) 13.3 13.3 56.7 16.7

Jumlah 30 100 Sources Primary Data: Study Pebruari-April 2014 Based on the above data shows that of the respondents who experienced postpartum maternal perineal wound over part or education high school and 56.7% or 13.3% fraction education elementary and junior high school

METHODS This study uses Quasy-Exsperimental. In this study population was 300 respondents and the sample in this study consisted of 30 respondents 15 respondents control group and the treatment group of 15 respondents. The sampling method used in this study is Consecutive sampling. RESULTS 1. The General Data 1) Characteristics of respondents by age Table 1. Distribution of Respondents by Age Mothers Experiencing Postpartum The perineal wound in BPM Ny.Titin

3) Characteristics of respondents by Jobs

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Table 3. Distribution of Respondents by Mother Employment Ruling scarred perineal in BPM Ny.Titin S. Mubin, Amd. Keb Village Sumberwudi 2014. No Jobs Jumlah Persentase (%) 1. Farmer 3 10 2. Employee 9 30 3. Merchant 8 26.7 4. Don‟t 10 33.3 work Jumlah 30 100 Sources Primary Data: Study Pebruari-April 2014 Based on the above data shows that of the respondents who experienced a postpartum mother's perineal wound almost half or 33.3% do not work and a small portion or 10% are farmers.

1) The Perineal Wound Process of Control Group

Diagram 1. The perineal wound Healing process of control group in BPM Ny.Titin S. Mubin, Amd. Keb Desa Sumberwudi Tahun 2014

1. 2. 3.

Jumlah

Cepat Lambat 13.3%

perineum Wound Healing Process

Based on the above data shows that respondents that new mothers in the control group was 86.7% or almost entirely wound healing process is slow and categories perineal fraction or 13.3% wound healing process perineal fast category. 2) The Perineal Wound Healing Process of Intervention Group Diagram 2. the perineum wound healing process of intervention group n BPM Ny.Titin S. Mubin, Amd. Keb Desa Sumberwudi Tahun 2014

Persentase (%) 46.7 36.7 16.7

Frekuensi

Parity

86.7%

Frekuensi

14 12 10 8 6 4 2 0

4) Characteristics of respondents based on parity Table 4.Distribution of Respondents by Parity Mothers Experiencing Postpartum The perineal wound in BPM Ny.Titin S. Mubin, Amd. Keb Village Sumberwudi 2014. No

Healing

Primipara 14 Multipara 11 Grandemultip 5 ara Jumlah 30 100 Sources Primary Data: Study Pebruari-April 2014 Based on the above data shows that of the respondents who experienced a postpartum mother's perineal wound partially or almost 46.7% had 1 child (primiparous) and a small portion or 16.7% had> 2 children (grandemultipara).

14 12 10 8 6 4 2 0

80 % Cepat Lambat 20 %

Properineum Woun Healing Process

Based on the above data indicate that respondents puerperal women in the treatment group or 80% almost entirely wound healing process faster and categories perineal fraction or 20% of the wound healing process is slow perineal category.

2. Data Special

3) Effect of Commond snake head ( Channa striata) The Perineal

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turnover (Boyle, 2008). 2) Personal hygiene or vulva hygiene affect wound healing of the perineal, if personal hygiene maintained in less postpartum mothers will lead to an infection (Moya, 2003). 3) The condition of the mother. Maternal health condition both physically and mentally, can lead to long recovery. If the condition of a healthy mother, then the mother can take care of themselves well. 4) Age: Age is closely related to wound healing, because the older person will decrease the speed of wound healing. Faster wound healing occurs at a younger age than in older people. People who are already advanced in years can not tolerate stress such as tissue trauma or infection (Smeltzer, 2002). The result showed that the cause of the slowdown in the perineal wound healing than the control group because it was not given fish cork, they also undertake to abstain from foods that lack nutritional needs are met, lack of attention to personal hygine so easy to breed bacteria and cause infection, and lack of activity. These factors led to the possibility that the perineal wound healing process in the control group lasted longer. In the treatment group were given fish cork 12 respondents showed rapid wound healing perineal categories namely wound healing perineal<7 days, the average wound healed on days 5-7. Nutrition is one of the key wound healing. Puerperal women are encouraged to eat with a balanced diet, enough carbohydrates, proteins, fats, vitamins and minerals (Suherni, 2009). One source of protein that can be obtained from fish cork that can aid in wound healing, it is because the catfish can increase endurance. Common snakehead meat contains high protein and albumin. In addition, common snakehead meat also contains a complete amino acid, as well as micronutrients zinc, selenium, and iron. Other content in fish flesh is alisin cork, allyl sulfide, and furostanol glycosides that can help repair damaged tissue in the wound, so that wound healing can take place more quickly (Suprayitno. E, 2003). Above theory in accordance with the results of research in Ny BPM. Titin S. Mubin Amd. Keb sumberwudi Karanggeneng Lamongan village where the results of statistical tests indicate that there is the effect of common snakehead (Channa striata) on wound healing of the perineal. Providing methods to improve nutrition in the form of a

Wound Healing In BPM Ny.Titin S. Mubin, Amd. Keb 2014. Diagram 3 Effect of Common Snakehead (Channa Striata) the Perineum wound healing in BPM Ny.Titin S. Mubin, Amd. Keb Tahun 2014

proses Penyembuhan Luka

25 20 15

Perlakuan Kontrol

10 5 0 0

20

40

jumlah responden Z = -3.598 dan = 0.000

Based on the above data shows that in the control group perineal wound healing process is slow category, where the wound healed after day 7. Whereas in the treatment group respondents puerperal women perineal wound healing process including fast category, where the wound is healed before day 7. Based on the results of statistical tests using the Mann Whitney in SPSS version 16 with the results obtained Z = -3598 and where Ho is rejected, which means there is the effect of common snakehead (Channa striata) on wound healing of the perineal in BPM Ny.Titin S. Mubin, Amd. Keb 2014. Granting common snakehead (Channa striata) can accelerate wound healing of the perineal in postpartum mothers. DISCUSSION In the control group was given fish without cork 13 respondents indicated category perineal slow wound healing wound healing perineal> 7 days, the average wound healed at day 14-21. There are several factors that can affect the perineal wound healing include: 1) Nutrition. Nutritional factors and nutrients, especially protein will greatly affect the wound healing process in the perineal because the network is in desperate need of protein

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fish cork in hopes of repairing damaged tissue in the wound, so that wound healing can take place more quickly. CONCLUSIONS RECOMMENDATIONS

DayaIkanGabus.Edisi 1. Yogyakarta: ANDI Moya J, Morison. (2003). Manajemen Luka. Jakarta: EGC Prawirohardjo, Sarwono. (2002). PelayananKesehatan Maternal dan Neonatal.CetakanKelima. EdisiKetiga. Jakarta: BinaPustaka Pusdiknakes. (2003). Asuhan Kebidanan Post Partum. Jakarta: Pusdiknakes Saifuddin, Abdul Bari. (2008). Buku Acuan Nasional Pelayanan Kesehatan Maternal Dan Neonatal. Jakarta: YBPSP Smeltzer, Suzanne C, dkk. (2002). Keperawatan Medikal Bedah, Edisi 8 Vol 1, Jakarta: EGC Suherni. (2009). Perawatan Masa Nifas. Yogyakarta: Fitramaya Varney, Helen. (2007). Buku Ajar Asuhan Kebidanan Edisi 4. Jakarta: EGC Wiknjosastro, Hanifa. (2005). Ilmu Kandungan. Jakarta: YBPSP

AND

1. Conclusions There is the effect of common snakehead (Channa striata) on wound healing of the perineal in BPM Ny.Titin S. Mubin, Amd. Keb 2014. 2. Recommendation Giving common snakehead can be used as an alternative to accelerate wound healing of the perineal in postpartum mothers. REFERENCES Ambarwati. (2008). Asuhan Kebidanan Nifas. Yogyakarta: Mitra Cendekia. Boyle, Mauren. (2008). Pemulihan Luka: Seri Praktik Kebidanan. Jakarta: EGC. Kordi, M. Ghufran H. (2010). PanduanLengkapBisnisdan Budi

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THE INFLUENCE OF PROGRESSIVE RELAXATION TO DECREASE PAIN FOR PATIENTS OF SECTIO CAESAREA SURGERY IN THE FIRST AND SECOND DAY Aris Dwi Cahyono, Wida Wicaksana Akademi Keperawatan Pamenang Abstract After the effect of Sectio Caesarea anesthesia has finished, they will feel pain on body organ where surgery is done. There are two methods to decrease pain of Sectio Caesarean surgery by using medicines and using progressive relaxation technique. The purpose of this research is to identify the influence of progressive relaxation to decrease pain for patients of Sectio Caesarea surgery in Maternal Room General Hospital of Kediri Regency in 2014. Research design was Pre-Post Test Experiment. The populations 38 patients of post section caesarean surgery in the first and second day. Sample used purposive sampling and consisted of 9 respondents. Data analysis was implemented by comparing pain scale pre and post intervention and being analyzed as descriptive. Research result showed that pre-intervention, value of mean was 5,66 with standard deviation 1, and post-intervention, value of mean was 4,66 with standard deviation 1,5. Analysis result showed a decrease of mean value 1 and standard deviation 0,54. There was influence of progressive relaxation to decrease pain for patients of Sectio Caesarea surgery. It is hoped for medical staffs to use progressive relaxation technique as one of chosen therapies to decrease pain scale beside of medicines. Key words : Progressive Relaxation, Pain, Post Sectio Caesarean Surgery.

technique is to focus on a muscle activity in a sustainable manner by identifying the tense muscles then lowers the tension by doing relaxation techniques to get a feeling of relaxation (Murphy, 1996). In Indonesia, the percentage of Caesarea Sectio big enough. In government hospitals in the year 2008 the average labor with Sectio Caesarea by 11%, while at the Private Hospital could be more than 30%. And recorded from 17 665 birth rate there is 35.7% 55.3% of mothers giving birth to the process of sectio caesarea. In East Java, Regional General Hospital Dr. Soetomo as the largest referral hospital in East Java was found that the incidence of labor with Sectio Caesarea in 2008 was 1478 cases (23.3%) of the total 6335 deliveries (Yudhoyono, 2008). Meanwhile, according to a preliminary study conducted at the maternity ward Kediri District Hospital on 19 November

Background Sectio Caesarea is an act of delivery of a fetus that has been able to live together with the placenta and membranes are transabdominal through the uterine incision. In the operation process used anesthetic so that the patient does not feel pain during surgery. But after the operation is completed and the patient began to realize and react to the anesthesia wears off, the patient will feel pain in the body that had surgery. Many women complain of pain in stitches, this complaint is actually reasonable because the body is experiencing injuries and healing can not be perfect, especially if the wound is relatively long and deep. However, there are two methods to reduce pain in a natural scale postoperative Sectio Caesarea mother is in Pharmacological and non-pharmacological drug use one of them with progressive relaxation techniques. Progressive relaxation

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2013 was recorded incidence Sectio Caesarea deliveries on average each month in 38 patients. This increase is allegedly due to improved techniques and facilities, the operation lasted more aseptic, anesthetic techniques improved, comfort pasectio caesarea higher operating, and the length of the short growing and can choose the date of birth as you wish (Roeshadi, 2006). Nevertheless Caesarea operation does not mean free of risks or problems. Research by Hillan about pain post Sectio known that on days 1-2 clients still experiencing pain in the wound, and even almost half of women lasts until they return home, and even about 32% of patients who performed the cesarean is still experiencing pain in injuries, and often pain in the wound after returning gain weight thus requiring analgesics. Steer, 2004 stated that relaxation is a method of transfer of nonpharmacological pain that is often used in the UK. Steer in the study reported that as many as 34 women using relaxation, by induction of relaxation for 15 minutes can significantly reduce the sensory component of pain. Pillips added that the emotional component of pain is also reduced so that the effect of exacerbating anxiety was also reduced due to the impact of the relaxation (Mander, 2004). Relaxation can be used in episodes of acute and chronic pain to reduce pain. Usually it takes 5-10 training sessions before a client can effectively minimize pain. Patients who already know about the relaxation techniques may just need to be reminded to use such techniques to reduce or prevent the pain. The basic aim of relaxation is to help people to relax, and thus improve the various aspects of physical health. Besides, there are also some other benefits, which lead to inner peace, reduced anxiety, lower heart rate, reduce blood pressure, a greater resistance to disease, mental health getting better and better memory. Many patients and health teams tend to view drugs as the only method to relieve pain, but many non-

pharmacological nursing activities that can assist in the relief of pain. One of them is progressive relaxation, nonpharmacological methods of pain relief that has a very low risk. Although such action is not a substitute for drugs, such action is necessary to shorten episodes of pain that lasts only a few seconds or minutes. Based on the above description researchers interested in conducting “The Influence Of research on Progressive Relaxation To Decrease Pain For Patients Of Sectio Caesarea Surgery In The First And Second Day” in the Maternity Room of the District General Hospital Kediri.

Formulation of the Problem Based on the description of the background of the problem, it can be formulated research problem, namely “Is there a The Influence Of Progressive Relaxation To Decrease Pain For Patients Of Sectio Caesarea Surgery In The First And Second Day in the Maternity Room of the District General Hospital Kediri?”

Purpose 1. General Purpose To determine differences in the level of pain in patients with postoperative Sectio Caesarea before and after being given the progressive relaxation technique in Maternity Room General Hospital of Kediri. 2. Special Purpose a. Identify the level of pain before the progressive relaxation in patients with postoperative sectio caesarea in the first and second day. b. Identify the level of pain after doing the progressive relaxation in patients with postoperative sectio caesarea in the first and second day. c. Analyzing the influence of progressive relaxation to decrease postoperative pain in patients

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sectio caesarea in the first and second day.

3 4 5 6 7 8 9 Mean Median Modus stand. Dev

Research Design The research design used in this research is the design of preexperimental design One group pretestposttest, which in this design there is no comparison group (control, but most do not already made the first observation (pre-test) that allows researchers can test changes occurred after the experiment. Pre test test 01

Treatment

X

4 5 5 7 6 5 7 5,66 6 6 1

Based on the table shows that out of 9 respondents surveyed 11.11% or 1 respondent experienced pain with pain scale 4, 33.33% or 3 respondents experiencing pain with pain scale 5, 33.33% or 3 respondents experiencing pain with pain scale 6 and 22.22% or 2 respondents experiencing pain with pain scale 7. the mean 5.67, median 6, 6 mode and standard deviation 1.

Post

02

The independent variable in this study is a progressive relaxation. The dependent variable in this study is the reduction of postoperative pain in patients Sectio Caesarea. The study population was 38 patients with postoperative sectio caesarea experiencing pain in the first and second day. In this study, samples taken part sectio caesarea postoperative mothers who experience pain in the first and second day as many as 9 respondents. In this study, the sampling technique used was purposive sampling, where the technique of determination of sample by choosing among a population sample in accordance with the desired researchers in accordance with the criteria. The data analysis was done through descriptive analysis, the observation of the frequency table. Frequency table consists of a column - a column that contains frequencies and percentages for each category.

2. Pain scale respondents action after progressive relaxation techniques Code Scale Pain 1 5 2 4 3 4 4 4 5 3 6 7 7 5 8 3 9 7 Mean 4,67 Median 4 Modus 4 Stand. Dev 1,5 Based on the table shows that out of 9 respondents surveyed 22.22% or 2 respondents experiencing pain with pain scale 3, 33.33% or 3 respondents experiencing pain with pain scale 4, 22.22% or 2 respondents experiencing pain with pain scale 5 and 22.22% or 2 respondents experiencing pain with pain scale 7. The Mean Value 4.6, 4 Median,

Research Result 1. Respondents pain scale before action is taken progressive relaxation techniques Code Pain Scale 1 6 2 6

513

mode 4 and the Standard deviation of 1.5. 3. Analysis of the effect of progressive relaxation in patients with postoperative sectio caesarea in Maternity Room General Hospital District Kediri. Resp. Decrease Before After Number pain scale 1 6 5 1 2 6 4 2 3 4 4 Tetap 4 5 4 1 5 5 3 2 6 7 7 Tetap 7 6 5 1 8 5 3 2 9 7 7 Tetap Mean 5,66 4,67 1,5 Median 6 4 1,5 Modus 6 4 1 Stand. 1 1,5 0,54 dev. Based on the results of research conducted it appears that there is a decrease pain scale by the respondents, the descriptive statistical tests obtained prior to action relaxation techniques mean value of 5.66, the median value of 6.00, the value of 6:00 mode, and standard deviation of 1. After the action is obtained the mean 4.67, median values of 4.00, 4.00 value mode, and standard deviation of 1.5. Value indicates a decrease in the mean value of 1.5, the median value of 1.5, the value of mode 1 and a standard deviation of 0.54 so that H0 is rejected and H1 accepted. It showed no effect of relaxation techniques on a scale decrease postoperative pain in patients sectio caesarea on the first day and the second in the Maternity Room General Hospital of Kediri.

Discussion 1. Pain scale before the patient is given the actions of progressive relaxation techniques. Pain scale before being given a progressive relaxation technique that measures of 9 respondents surveyed in the last 2 weeks Mean pain scale score was 5.6, median 6, 6 mode and standard deviation 1. Pain is an uncomfortable feeling, whether mild or severe. Pain is defined as a condition that affects a person's existence is unknown and if someone ever experienced (Tamsuri, 2007). According to the International Association for the Study of Pain (IASP), pain is an emotional experience unpleasant feelings as a result of actual or potential damage, or describe the condition of the occurrence of damage. According to the researcher scale of perceived pain patients in the Maternity Room District General Hospital Kediri is influenced by several things including the age and experience of sectio caesarea operation. Showed that of the majority of respondents aged 20-30 years and 2 respondents had never undergone surgery sectio caesarea. It can be concluded that the different scale of perceived pain patients due to surgery sectio caesarea experience before. 2. Pain scale after the patient is given the actions of progressive relaxation techniques. The scale of the pain that is felt after the patient is given the actions of progressive relaxation techniques, decreased pain skla into Mean Value 4.6, 4 Median, Mode 4, the standard deviation is 1.5. Progressive relaxation technique is to focus on a muscle activity by identifying the tense muscles then lowers the tension by doing relaxation techniques to get a feeling of relaxation (Murphy, 1996). It is also based on the theory of the

514

gate control, explaining that the pain that occurs in a person due to certain stimuli such as surgery can be blocked when the interaction between the pain stimulus and the stimulus to the fibers that transmit sensations of pain blocked on the circuit gate resistor, this reversal can be done through distraction or by the action of relaxation (Sutherland, 2005). According to researchers pain scale decline in respondents influenced surgery sectio caesarea experience and capabilities of different respondent in conducting progressive relaxation techniques are taught. So with relaxation techniques is expected patients assisted by nurses can use it as an action to lower the scale of pain experienced, in addition to using the drug.

different respondents in performing relaxation techniques are taught, so the impact on respondents' perceived pain scale. So the difference in results or the effect of relaxation techniques performed in this study indicate that the need for health workers to improve the ability to analyze the factors that affect pain scale and improve skills in using the techniques of progressive relaxation as one alternative to reduce the pain scale for patients other than use drugs. Conclusion 1. Pain scale measures a patient prior to relaxation techniques obtained a mean value of 5.6, the median 6, 6 mode and standard deviation 1.

3. Progressive relaxation influence on reducing postoperative pain in patients sectio caesarea on the first day and the second in the Maternity Room General Hospital District Kediri. Based on the results of the study showed a decrease in the pain scale sixth respondent after given action relaxation techniques, to obtain penurunkan mean values of 1.5, 1.5 median, mode 1, and standard deviation of 0.54 means that there is a decrease in the pain scale of respondents. The factors that affect pain scale include age, gender, culture, anxiety and past experiences and progressive relaxation techniques. Progressive relaxation is an effective way to rest the muscles through an appropriate manner, followed by mental relaxation and mind (Davis, 2005). According to researchers, the differences decrease pain scale on each individual is different. That is because many factors ranging from differences in age, experience sectio caesarea operations, and the ability of

2.

The scale of the patient's pain after the relaxation techniques implemented measures showed that the mean value of 4.6 median value of 4.00 mode value of 4.00 and a standard deviation of 1.5.

3.

Patient pain scale before and after the implemented measures showed a decrease in mean values of 1.5 median value of 1.5 mode value of 1 and a standard deviation of 0.54. There dilakukanya influence action relaxation techniques to decrease pain scale figures on maternal postoperative sectio caesarea in Maternity Room General Hospital District Kediri.

Suggestion 1. For health agencies Progressive relaxation technique is one of the nursing treatment that is easy and inexpensive can be selected to be applied to nursing actions for clients with problems of pain. 2.

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For educational institutions Relaxation techniques are one option for clients with problems of

3.

4.

pain, so it can be entered into the laboratory skills of students in the achievement of competence.

Farrer,

For the general public Mothers with post Sectio Caesarea expected to apply relaxation techniques as a nonpharmacological therapies that are safe and easy to reduce pain.

Astuti, Puji. (2010), cermin Dunia Kebidanan. www.cermin dunia kebidanan.com (download ) Notoatmojo,

Notoatmojo,

(2003).

soekidjo. (2005). Metodologi Penelitian Kesehatan. Jakarta : PT Rineka Cipta.

Notoatmodjo, S. (2010). Metodologi Penelitian Kesehatan , Ed.Rev 1 .Jakarta : PT Rineka Cipta

Reference Potter, P.A & Perry, A.G.(2005) Fundamental Keperawatan Konsep, Proses Dan Praktik, Jakarta: EGC

Nursalam.

Smeltzer, S. C, & Bare.(2001). Buku Ajar Keperawatan Medikal Bedah. Jakarta. EGC Smeltzer, S. C, & Bare.(2002). Buku Ajar Keperawatan Medikal Bedah. Jakarta. EGC Torrance, C & Serginson. E (1997). Surgical Nursing. Bridgend, Midglanmorgan:WBC Book Manufactured. Ltd A. (2007). Konsep Penatalaksanaan Nyeri.jakarata : EGC

soekidjo. Metodologi

Penelitian Kesehatan. Jakarta : PT Rineka Cipta.

For further research This study can be used as a source of information for further research pengembangkan. Future studies may consider factors that affect pain scale such as age, experience sectio caesarea operations and the ability of respondents to do relaxation techniques taught.

Tamsuri,

Hellen. (2001).Pearawatan Maternitas.Edisi 2 : ECG.Jakarta

Dan

Cuninghamm. F.G, (2007) Obstetri William, vol ipenerbiy buku kedokteran egc, Jakarta

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(2003). Konsep dan Penerapan Metodologi Keperawatan. Jakarta : Salemba Medika

THE INFLUECING OUTCOME FACTORS OF CAESAREA SECTIO PATIENTS IN PREPARATION FOR THE CLINICAL PATHWAYS COSTING OF DRGS AT PARE – KEDIRI HOSPITAL Suryono Akademi Keperawatan Pamenang Pare, Jl. Mahakan No. 05 Pare- Kediri, Email [email protected] Abstract Clinical Pathway is a concept of comprehensive service to plan the patient that are using standard of medical service and Nursing care during hospitalization. Research design is correlational approach observation with secondary input variables including Hb, age, class of service, indication, medicine, wound care, and nutrition. The output variables are LOS (Length of Stay), cost, wound, mobilization, and complication using statistical analysis with multiple linear regression. Populations in this study were all patients hospitalized with caesarean section at Pare Hospital, Kediri, east Java, Indonesia. Multiple linear regression analysis showed that Hb variable positive correlate to the LOS(r=0,136). Antibiotic variables also showed positive correlation with the hospital cost (p=0,041). From multiple logistic regression analysis, wound care is more influenced (B=161,98) to wound healing process, mobilization and complications more than another variables. This result can be used for early basic to arranged clinical pathway at caesarean section patient with some consideration such as age, infant indications, nutrition, antibiotic combinations, wound care, diabetic mellitus, prolonged delivery, and hypertension with complications. Key words : Clinical pathway, caesarean section

mobilization and complications of caesarean sectio patients at Delivery Room Pare Kediri Hospital. The benefits of this research can be used as the initial data for the hospital to arrange Clinical Pathway. 1. Framework Concept Scheme 3.1 research conceptual framework

Background On July 1st, 2007 the Ministry of Health of Indonesia has introduced Diagnosis Related Groups (DRG's INA) which will be used as the basis for a claim payment insurance patient hospital. But the government in implementing the INA DRG's not give the basis for calculating the financing so detailed yet clearly the cost of each component of health care. As a basis for determining the cost of health insurance services can be used Clinical pathway (theoretical cost driver). Clinical pathway is one component of the DRG system casemix consisting of codefication and action procedures and the calculation of costs. Clinical pathway into something that should be developed by each hospital, where the insurance company or the government would require hospitals to provide quality health services at a reasonable cost(Yunita,2009). Formulation of the problem in this study are the factors that affect the LOS, costs, wound healing time, mobilization and complications of caesarea sectio patients in maternity room Pare Kediri hospital. While the goal of this research is to identify factors that affect the LOS, costs, wound healing time,

Hypothesis: there is influence of the characteristics (Hb, age, class of service) indication, medicine, doctor, nurse intervention, and nutrients to the LOS, costs, wound healing time, infusion time off , catheters time off and complications. 3.Researchmethods The study design: a correlational approach "observational" using retrospective secondary data aims to identify factors - factors that affect patient outcomes caesarea sectio. The population in this study were all hospitalized 518

patients with cesarea sectio in the General Hospital of Pare Kediri. While the independent variables examined included the data Hb, age, class of service, indications, medications, nutrition, the actions of doctors, nurses, and LOS include the dependent variable, the cost, time healing wounds, immobilization time, and complications. 4.Research result The result showed that the distribution of respondents mother who gave birth by cesarea sectio mean age was 31.1 years. The general status of the mother when viewed from the maternal haemoglobin concentration was 9.4 mg%. The majority of respondents in this study using a class of service insurance as 74 respondents (92.5%). Most caesarea sectio conducted with mothers indicated that 59 (73.8%). The majority of doctors use amoxicillin antibiotic injection and oral amoxcillin 48 (60%), wound care nurse performed, a majority of only 1 x during care after surgery 64 (80.8%). While the lenght of stay (LOS) of respondents found that the average patient is treated for 4.8 days. The total cost incurred respondents means is 3.910.000 rupiah. Majority of the wound healing time for 7 days, as many as 64 respondents (80%), the distribution of respondents by the ability start to mobilize, a majority on the first day of 52 respondents (65%). 1) The Influencing Factors To LOS a. The Influence of Age and Hb The relationship between LOS and age shows with a low correlation (r = 0.241) and a positive pattern means that the older have higher of LOS . Statistical test results found relationship/significant influence of maternal age with LOS (0.031) (Table 4.1).

The mean of hospitalization long days patients with poor insurance is 4.85 or 5 days. Patients with Health Insurance the mean of hospitalization is 4 days, while in the general patient have 4 days of hospitalization. Statistical results test obtained p = 0.437, which means it can be concluded there was no effect of financing sources with LOS. While the average long day of hospitalization of caesarea sectio patients with an indication is 4.95 days. Statistical test results obtained value of p = 0.067, meaning there is no influence between caesarea sectio with a long day of hospitalization. The mean long days of hospitalization patients with amoxicllin injection therapy and oral amoxicillin is 4.92 or 5 days. The mean of patients with amoxicillin injection therapy and oral cipro is 4.25 days of hospitalization, cipotaxim injection therapy and oral amoxicillin has average of 4.60 days, while in patients with therapy oral cipro and cipotaxim injection means 4.85 days. Statistical test results obtained value p = 0,470 which means there is no influencing between medicine therapy with LOS. The mean long days of hospitalization patients with one time wound care is 4.44 days, patients with wound care 2 times the average length of stay was 6.13 days and patient with three times wound care the average is 9 days. Statistical test results obtained p = 0.000, which means there is significant influence between the LOS wound care. The mean of long days of hospitalization caesarea sectio patients with nutritional/ dietary high-calorie highprotein is 4.75 days, while the dietary highcalorie high-protein-low salt means was 5.80 days. Statistical results test obtained value of p = 0.019, meaning there is influence between nutrition/diet with long days of hospitalization. (table4.2).

Table 4.1. Correlation and regression analysis of age and Hb with LOS

Table 4.2. Distribution The mean LOS According Class Service

a. The Effect of Nursing Class, Caesarea Sectio Indication, Medicine, Wound care and Mutrition To LOS. 519

0.822, which means there is no class effect with the cost of hospital care. The mean cost of hospital patients on caesarean sectio with an indication of the capital is 3.950.000 rupiah 797,642.991 rupiah. While the mean with baby indication is 3.800.000 rupiah - 297,905.704 rupiah. Statistical results test obtained value of p = 0.275, meaning there is no influence between patients caesarean sectio with hospital cost. The Mean hospital costs patients with amoxicillin injection therapy and oral amoxicillin is 3.770.000 rupiah -. 231.590.4 rupiah ,-. Patients with amoxicillin injection therapy with oral ciprofloxacin the means days of hospitalization is Rp. 4.010.000,-, 359.290.6 rupiah, cipotaxim injection and oral amoxicillin its average 3.920.000 rupiah 860.610.9 rupiah whereas in patients with therapy cipotaxim injection and oral ciprofloxacin means 4.390.000 rupiah,1.346.163.5 rupiah. Statistical test results obtained p = 0.041, which means there is the influence of medicine therapy with hospital costs. The Mean hospital costs in patients with wound care one time is 3.940.000 rupiah, 756.545.9 rupiah, in patients with wound care 2 times the average cost of hospital is 3.770.000 rupiah, - and wound care 3 times its average 4,020.000 rupiah -. Statistical test results obtained p = 0.690, which means there is no significant influence of the wound care with hospital costs. The mean of hospital cost patients caesarea sectio with nutrition / dietary highcalorie high-protein is 3.870.000 rupiah - with a standard deviation of 636.348.4 rupiah while the high-calorie high- protein low salt diet means is Rp 4.430.00 with a standard deviation of 1380550.6 rupiah. Statistical test results obtained value of p = 0.088, meaning there is no influence between nutrition/diet with long days of hospitalization (Table 4.4). Table 4.4. Distribution The mean cost of hospital According Class Service

2) The Influential Factors To Cost a. The Influence of age and Hb The relationship of age with the cost of the hospital showed a low correlation (r = 0.105) and a positive pattern means that the older the higher cost of RS. Statistical results test found no significant effect (p = 0.000) between age and hospital costs. While the relationship haemoglobin with hospital cost shows a low correlation (r = 0.078) and a positive pattern means higher Hb levels will make higher hospital costs. Statistical results test found no significant effect (p = 0.000) between Hb with hospital costs(Table4.3). Table 4.3. Linear Regression Results The effect of age and Hb Against Hospital Costs

b. The Effect of Nursing Class, Caesarea Sectio Indication, Medicine, Wound Care and Nutrition Mean hospital costs patients with poor insurance is 3.920.000 rupiah -. Patients HI (Health Insurance) the average cost is 3.610.000 rupiah - while the general patient means is 3.770.000 rupiah - 174.300,281 rupiah. Statistical test results obtained p = 520

b. The Effect of Nursing Class, Caesarea Sectio Indication, Medicine, Wound care and Nutrition for Wound Healing Time Average time of wound healing patients with poor insuranc is 8.08 days. For Health Insurance Patients mean of wound healing time is 7 days, whereas in the general patient means also 7 days. Statistical test results obtained p = 0.455, which means there is no influence of the class of service with the wound healing time. Average time healing wounds of patients caesarea sectio with an indication is 8.19 days. While the baby with indication means is 7.48 days. Statistical results test obtained value of p = 0.166, meaning there is no effect between the caesarean sectio indication with wound healing time. Average time of wound healing in patients with amoxcilin injection therapy and oral amoxicillin is 8.15 days. Patients with amoxicillin injection therapy and oral cipro have mean of long days of hospitalization is 7.00 days, cipotaxim injection and oral amoxicillin its average 7.67 days, while in patients with therapy oral cipro and cipotaxim injection means 8.15 days. Statistical results test obtained p = 0.639, which means there is no influence of medicine therapy with wound healing time. Average time of wound healing in patients with wound care one time is 7.16 days, patients with wounds care 2 times the average hospitalization time is 11.33 days wound healing and wound care 3 times its average 12.00 days. Statistical results test obtained p = 0.000, which means there is significant influence between the wound care and healing time. Average time of wound healing with means dietary high-calorie high-protein is 10 days. Statistical results test obtained value of p = 0.090, there is no difference or effect between nutrition / diet with wound healing time (Table 4.6). Table 4.6. Mean Distribution According Wound Healing Care Class, Indication, Medicine, Treat Wounds and Nutrition

3) The Influential Factors of Wound Healing Time a. The Influence of age and Hb The relationship of age with wound healing time showed a low correlation (r = 0.204) and a positive pattern means that the older have longer of the wounds healing time. Statistical results test found no correlation/significant influence of maternal age and the healing time of wound (0.069). The relationship of haemoglobin with wound healing time showed a low correlation (r = 0.085) and a positive pattern means higher Hb levels will have longer of healing time wounds. Statistical results test found no correlation/significant effect (p = 0.453) between Hb with wound healing time (Table 4.5).

Table 4.5. Correlation and regression analysis of age and Hb with Wound Healing Time

521

(60%). On the results of statistical tests on wound care obtained p = 0.000, which means there is significant influence between the wound care wound healing time. (Table 4.8). Table 4.8. Mean Distribution According Wound Healing Care Class, Indication, Drug, Wound Care and Nutrition

4) The Influencing Factors of Patient Mobilization To Caesarea Sectio In Delivery Room Pare Kediri Hospital. a. The Influence of age and Hb The results test found no statistically significant relationship between maternal age at the time of wound healing (0.069). Likewise, the results of statistical tests between Hb with wound healing time no significant effect (p = 0.453) (Table 4.7.). Table 4.7. Logistic regression analysis with age and Hb Wound Healing Time

5) The Factors that influence the occurrence of complications a. The Influence of age and Hb The test results found no statistically significant relationship between maternal age with complications (p = 0.061). Likewise, the results of statistical tests between Hb with complications no significant effect (p = 0.453). More can be seen in Table 4.9.

c.

The Effect of Nursing Class, Indication, Medicine, Wound Care and Nutrition Results of the analysis of the majority of the average wound healing time for 7 days occurred in treatment classes HI 1 (100%) and General 5 (100%), and indication of babies were 19 (90.5%), antibiotics that used a combination of injection and amoxcicilin oral ciprofloxacin 4 (100%), wound care one time as many as 62 (96.9%) and with dietary highcalorie high-protein were 62 (82.7%). While the wound healing time will be longer (median 12 days) in patients with wound care 2 x 13 (86.7%), three times as many as 1 (100%) and dietary high-calorie high-protein-low salt 3

Table 4.9. Logistic regression analysis of age and Hb with Time Mobilization

Effect of Nursing Class, Indication, Medicine , Wound care, and Nutrition Results of the analysis do not occur the majority of complications in the treatment of class HI 1 (100%) and General 5 (100%), and indication of babies were 19 (90.5%), which used a combination of antibiotics oral ciprofloxacin and amoxcicilin injection 4 (100% ), wound care one time as many as 62 522

(96.9%) and with dietary high-calorie highprotein were 62 (82.7%). Statistical result test of complications with treatment classes obtained p = 0.444; indication p = 0.162; antibiotics p = 0626; nutritional value of p = 0.083; which means there is no effect between treatment classes, indication, antibiotics and nutrients with the occurrence of complications. While the wound care obtained p = 0.000, which means there is significant influence between patient wounds with complications (Table 4.10]. Table 4.10. Distribution of Respondents According to the Class Care and Occurrence of Complications

0.12 days associated with maternal hemoglobin concentration and increased LOS related to wound care. While the cost of the regression line equation hospital = Rp 3.582 million + Rp 170,200.2 * antibiotics, which means that we can predict hospital costs by using variable antibiotics, which is the relationship shown significant positive relationship hospital costs will rise by Rp. 3.582.000 - with regard to antibiotics used. More can be seen in Table 4.11. Table 4.11. Results of Multiple Linear Regression Analysis LOS and Costs

Constant Hb Wound care Antibiotic

LOS 1,45 Days 0,12 1,82

Hospital cost Rp 3.582.000,-

-

Rp 170.200,2

-

From the results of multiple logistic regression analysis, it turns out the variables that significantly affect the wound healing time was wound care and nutrition. It also looks interaction between the wound care nutrition with P Value = 0,000. Thus the final model is the model with interaction. Of the three variables, the variables that most influence on the LOS is variable nutrient (Exp B = 178.89). While the results of the analysis of mobilization, it turns out the variables that significantly affect only the mobilization of the wound care alone, with Exp B = 7.475. However found the interaction between patient wound with class of service in their influence on the mobilization (p Value = 0.002). On the results of the analysis of complications, wound care only significant effect on the incidence of complications. But in these complications did not reveal any interaction between age, wound care and nutrition in their influence on complications (0.094), but the wound care among the three most effect on the incidence of complications (Exp B = 161.98). (Table 4.12.)

Furthermore, multivariate analysis of the dependent variable for the scale of numerical data (LOS and Hospital cost) using multiple linear regression analysis to predict the value of LOS and hospital cost by using independent variables. As for the scale of categorical data the dichotomous (wound healing time, mobilization, and complications) using multiple logistic regression analysis. Terms of independent variables that can be continued in a multiple linear regression analysis and multiple logistic regression is if the value of p Value <0.25. LOS on the dependent variable, the regression line equation obtained LOS = 1.45 + 0.12 * Hb + 1.82 * wound care, which means that we can predict LOS using variables Hb and wound care, where the relationship shown is positive relationship which means the LOS will rise by

Table 4.12. Results of Linear Regression Analysis & Logistics Double Wound Healing Time, Mobilization and Complications.

523

responses (60%). Selection of antibiotic combination is among the most inexpensive price compared to other types of antibiotics. Wound care nurses do a majority of just 1 time for treated after surgery as many as 64 respondents (80.8%). Because the healing process epithelialization on day 2-3 then it is not advisable to open the wrapping on that day so that enough nurses to do it once, for the next patient enough control to poly outpatient. Diet given to the majority of respondents was 93.8% dietary high-calorie high-protein. . This diet is best to expedite the healing process in post-cesarea mother's condition, because in addition to the calories for the recovery of the general health status of the mother, the protein to aid in cell regeneration (Sugeng, 2004) Results of research on the distribution of the dependent variable length of stay (LOS) of respondents obtained a mean of 4.8 days. The total cost incurred respondents means is 3.910.000 rupiah. Majority of the wound healing time for 7 days, as many as 64 respondents (80%) with the indicator does lift the seam during the control patients in poly outpatient. The majority of respondents have been mobilized since the first day of 52 respondents (65%). Immediate mobilization gradually very useful to help the healing of wounds. Mobilization is useful for preventing thrombosis and embolism (Novita, 2007). Other findings of 64 respondents (80%) had no complications, and complications as much as 20% in the form of caesarean section wound that has not healed up to the 12th day. In accordance with the theory of short-term complications in cesarea sectio deliveries is happening escape of stitches, bleeding, haematuria and infection, while in the long run will occur sepsis. May undergo surgical wound dehiscence (wound is open back) and infections. Local causative factor in dehiscence no bleeding, wound infection, suture less good and less good surgical technique (Potter and Perry, 2006). 2} The Influential Factors To Length Of Stay Patient Caesarea Sectio In Delivery Room Pare Kediri Hospital Statistical results test found no significant relationship between maternal age with Length Of Stay (LOS) (p = 0.031). However, the relationship of age with LOS showed a low correlation (r = 0.241). From the age variable linear regression analysis found a positive

5. Discussion 1) Overview Patient Characteristics Input of Caesarea Sectio The result showed that the distribution of respondents mother who gave birth to the caesarea sectio the average age was 31.1 years. The age of the theoretical or technological advances health is still relatively old safe from the standpoint of the health of the mother's reproductive system both for normal childbirth or caesarea sectio. While respondents mean Hb levels of 9.4 mg%. Hb is relatively small under normal indicator in women (10 mg%). Hb levels correlated with the distribution of blood supply to the wound area, which in turn affects the healing process, both the caesarea sectio and the wound healing process of the reproductive system of women after pregnancy and childbirth (Sylvia, 2006). Class of service selected respondents using the majority of insurance as many as 74 respondents (92.5%). However, based on patient rights and obligations of hospitals, health workers shall not discriminate treatment of patients, including based on the class of service. Which may be different only hospital facilities are provided, so that the logic does not affect or relate to the healing process. While the distribution characteristics of the client based on the indication does the majority of caesarea sectio is an indication of the mother as many as 59 respondents (73.8 This indication is also not relevant to the healing process, so long as it is detected or treated early. Doctors in Pare hospitals majority prescribe antibiotics oral amoxicillin and amoxicillin injection, as many as 48 524

correlation, which means that the older the respondent, the longer days of hospitalization. These results are consistent with the theory that with increasing maternal age, disruption of cellular repair mechanisms (Wahyudi, 2000) thereby increasing the long days of hospitalization. From the analysis of patient variable wound was found that these variables proved significant effect on the long days of hospitalization in the mother post caesarea sectio , this means that there are differences among the three intervals do LOS wound care. In accordance with the results of the mean LOS of 4.8 days, whereas in the fourth day of new mothers are given care of the wound, which subsequently allowed to go home and outpatient care enough if the observation is currently visible injuries wound care improves. The provision of care wound on the fourth day post caesarean sectio is to adjust the theory where sterile wound healing process that has entered the stage of epithelialization is around the third and fourth days (Potter and Perry, 2006). Nutritional factors also affect the long days of hospitalization in the mother post caesarea sectio (P = 0.019). This situation is consistent with the theory that with good nutrition, the recovery process is also good that the mother would sooner go home from the hospital (Sugeng, 2004). For further when analyzed with multiple linear regression equation regression line LOS = 1.45 + 0.12 * Hb + 1.82 * wound care, which means that we can predict LOS using variables Hb and wound care, where the relationship shown is a significant positive relationship LOS will rise by 0.12 days associated with maternal hemoglobin concentration and increased LOS related to wound care. The results are consistent with the theory that hemoglobin levels correlated with the distribution of blood supply to the wound area, which in turn affects the healing process, both the caesarea sectio and the wound healing process of the reproductive system of women after pregnancy and childbirth (Sylvia, 2006). 3) The Influence Factors To Cost Statistical test results found no significant relationship between maternal Hb with Length Of Stay (LOS) (p = 0.000). Of linear regression analysis, the association of Hb with hospital costs patterned positive means higher

Hb levels higher hospital costs, but the strength is relatively low relationship (r = 0.078). These results are consistent with the results of the analysis on the dependent variables LOS, where the dependent variable LOS also negatively correlated with haemoglobin. LOS is closely related to the cost of the hospital, the higher LOS greater the cost to be incurred hospital patients. In the analysis of the cost of hospital care class p value = 0.822 which means there is no significant impact to the cost of hospital care class. Statistical test results indicated cesarea sectio with hospital costs obtained p = 0.275 ,. But unlike the analysis of the antibiotics used in hospital costs, which gained statistical test result obtained p = 0.041, which means there is the influence of drug therapy with hospital costs. The findings are consistent with the more expensive antibiotics are used, meaning the higher the costs incurred hospital patients. But not relevant to the results obtained in the analysis of antibiotics with LOS. From the analysis of patient variable wound was found that this variable was not shown to significantly affect the cost of posthospital maternal caesarean sectio (p = 0.690). While nutritional factors do not affect the cost of post-hospital maternal SC (p = 0.088). Nutrition assist in the recovery of the mother post caesarea sectio, so the LOS and costs decreased. For further when analyzed with multiple linear regression equation regression line hospital costs 3.582.000 rupiah = 1 + 170,200.2 rupiah * antibiotics, which means that we can predict hospital costs by using variable antibiotics, which is the relationship shown significant positive relationship Hospital costs will rise by Rp. 3.582.000, - associated with antibiotic use. The results are consistent with the fact that a combination of antibiotics prescribed by a doctor, will determine the size of the hospital costs. A positive relationship between the cost of the hospital with antibiotics on the results of this study in accordance with the theory, which serves antibiotics against microorganisms so that no infection (Sulistia, 2005). 4) The Influential Factors of Wound Healing Time The test results found no statistically significant relationship between maternal age at the time of wound healing (0.069). While the results of the statistical test between Hb with wound healing time no significant effect 525

(p = 0.453). In the statistical analysis of treatment classes obtained p = 0.440, which means there is no class effect of treatment with wound healing time. While the analysis does indication caesarean sectio, obtained p = 0.280, which means there is no indication does influence between SC with wound healing time. Selection of a combination of antibiotics also has no effect on wound healing time (p = 0.626). The wound care proven effect on wound healing time for patients in Pare hospitals post caesarea sectio (p = 0.000). In accordance with the results of the mean LOS of 4.8 days, whereas in the fourth day of the new mother is given once a wound care, which subsequently allowed to go home and outpatient care enough if the observation is currently visible injuries wound care improves. The provision of care wound on the fourth day post caesarea sectio is to adjust the theory where sterile wound healing process that has entered the stage of epithelialization is around the third and fourth days. Therefore, the opening of the bandage before the third day is not allowed because it can disrupt the network epithelialization process (Potter and Perry 2006). Results of statistical analysis on the nutritional value obtained p = 0.083, meaning there is no influence between nutrition / diet with wound healing time. To further after analyzed by multiple logistic regression was obtained variables that significantly affect the wound healing time was wound care and nutrition. It also looks interaction between the wound care nutrition with P Value = 0,000. Thus the final model is the model with interaction. Of the three variables, the variables that most influence on wound healing is nutritional variables (Exp B = 178.89). The results are consistent with the theory, where the frequency of hospitalization injuries most a little showing the wound well, considering the patient wound made to wait after three-four days post c that adapts to the theory so as not to interfere with the process of epithelialization wounds as a caesarea with positive wound healing process and to further patients for outpatient treatment (Perry and Potter, 2006). 5} The Influencing Factors of Mobilization Patient To Time Caesarea Sectio In Delivery Room Pare -Kediri Hospital.

The age factor does not significantly influence the mobilization time (p = 0.507). Similarly, hemoglobin (p = 0.453), grade of treatment (p = 0.174), indicative caesarean sectio (p = 1.000), antibiotics (p = 0.440), and nutrition (p = 0.468) did not affect the mobilization time. Wound care factors proven to affect the mobilization of maternal time post caesarea sectio in Pare hospitals (p = 0.001). The indirect effect of the action is to help the patient wound healing process so that patients are motivated for immediate mobilization. Immediate mobilization gradually be very useful to assist wound healing irritation. Mobilization is useful for preventing thrombosis and embolism. Conversely if too early mobilization can influence wound healing (Novita 2007). To further after analyzed by logistic regression, it turns out the variables that significantly affect only the mobilization of the wound care alone, with Exp B = 7.475. However found the interaction between patient wound with class of service in their influence on the mobilization (p Value = 0.002). The results are consistent with the theory, where the frequency of hospitalization injuries most a little showing the wound well, considering the patient wound made to wait after three-four days post SC that adapts to the theory so as not to interfere with the process of epithelialization wounds as a sign of positive wound healing process and to further patients for outpatient treatment (Perry and Potter, 2006). 6) The Influence factors that affect the occurrence of complications of Caesarean section Patients In Delivery Room Pare Kediri Hospital. The age factor proved to be no significant effect on the occurrence of complications (p = 0.061). Likewise, the Hb factor (p = 0.453), grade of treatment (p = 0.444), indication (p = 0.162), medicine (0626), and nutrition (p = 0.083). Only the factor hospitalization proven effect on the occurrence of complications in patients in hospitals Pare post caesarean sectio (p = 0.000). To further after analyzed by logistic regression, it turns out the variables that significantly affect the occurrence of complications is simply wound care alone, with Exp B = 161.98, and there were no interaction between age, wound care and 526

nutrition in their influence on complications (0.094). 6. ImplicationsResearch In this study, patients with complications of caesarean section wound healing time so that the average 9-12 days of hospitalization (LOS) for 9 days because obstetric doctors in Pare hospitals do not allow patients go home if the wound is still wet (in case of complications in the postoperative wound) , so that the wound care needs to be performed 2 times. This usually occurs in patients with an indication of entrance is indicative of a mother with diabetes mellitus, prolonged labor and with high blood pressure that affects the cost increase in caesarea section patients to Rp 4.43.000, -. The variable class of service as a source of financing in this study did not affect the outcome of patients sectio, so that in accordance with the Law on Consumer where there is no difference in terms of the provision of care services that lead to the healing process of patients in hospitals, except the room facilities were acquired, so the cost issued approximately Rp. 3.61.000, -. Based on these images we can conclude the preparation of Clinical Pathway restrictions on caesarea sectio patients in terms of age at least patients aged 25-31 years, because it affects the patient LOS factors to be 4 days, while the diet given was High-calorie high-protein and the time required for wound healing is 7 days and 1 day mobilization. Antibiotics are used can be used is a combination of amoxicillin and oral amoxicillin injection, wound care enough 1kali done after the patient is allowed to go home because the incision is dry (no complications in the wound) and outpatient treatment at the time determined by the treating physician. Indication of incoming patient is an indication that the baby does not affect the relative length of stay because usually the mother was discharged so that the total costs needed by patients is approximately 3610.000 rupiah. 7. Limitations Research a. Secondary data nutrients in Pare Hospital Delivery Room just shows the type but can not reflect the amount of intake that is acceptable to the patient. b. The analysis carried out in one direction and a stage that can not be identified properly. Further research

is advisable to use Path analysis for the perfection of research analysis. c. Collecting data in this study is only done in Pare Hospital so that these results can not be generalized. 8. Conclusion Factors that proved influential on maternal LOS post caesarea sectio in hospitals Pare was wound care and nutrition, factors that proved to affect the cost of post caesarea sectio hospital in the mother's age, Hb, and medicine. While the wound care factors shown to affect the wound healing time. Wound care factors also proved to be an effect on the time of mobilization, in addition to wound care and nutritional factors are also shown to influence the occurrence of complications in patients with post caesarea sectio in Pare hospitals. 9. Suggestions To determine the cost efficiency in the preparation of Clinical Pathway for caesarea sectio patients in Pare hospitals to consider is the age factor, Hb, class of service, indications, wound care, antibiotic use, nutrition and complications. Of the 7 (seven) factors are more influential to the cost is ranging from nutrition, wound care, indications, and Hb, further factor of antibiotics used and age. References Baker, J. J. (1998). Activity Based Costing and Activity Based Managemet for Health Care. Gaithersburg, Maryland, Aspen,inc. Cate , S, BHsc 2005, „Clinical pathway in the emergency department : Successful implementation of „Adut Patients who are Febrile Following Chemotherap‟pathway‟, Australian Emergency Nursing Journal vol. 8, pp. 27-34. Cheah, J 2000, „Development and Implementation of Clinical Pathway Programme in Acute Care General Hospital in Singapore‟, International Journal for Quality in Health Care, Vo. 12, pp. 403-12. Firmanda, D 2006, „ Penyusunan Clinical Pathway untuk Case-Mix‟, in Pertemuan Penerapan Coding System dan Software Case-Mix Rumah Sakit di Indonesia, Direkturat Jendral Bina Pelayanan Medik Depkes RI, Hotel

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IMPROVING SELF-EFFICACY USING CARING-BASED SELF-EFFICACY ENHANCEMENT INTERVENTION PROGRAM IN PATIENTS WITH TYPE 2 DIABETES MELLITUS ChristiantoNugroho S.Kep.Ns.,M.Kep Akper Pamenang Pare and Dsn. Sindurejo-Ds. Kunjang-Kec.Ngancar-Kab.Kediri Email: [email protected]

ABSTRACT Introduction: Patients with diabetes mellitus (DM) tend have impaired coping mechanisms, one of which being low self-efficacy.The purpose of the present study was to demonstrate the effects of caring-based SEEIP on the improvement in self-efficacy in patients with type 2 diabetes. Methods: The study used a quasi experiment design, in which the experimental group was given caring-based SEEIP intervention, while the control group received routine care given by doctors and nurses.Samples were 17 participants of Prolanis(Program PengelolaanPenyakitKronis, or Chronic Disease Management Program) selected by a simple random sampling technique. The independent variable was caring-basedSEEIP and the dependent variable was self-efficacy of patients with type 2 diabetes. Data were collected using questionnaires, which were then analyzed using paired t-test and independent t-test, while confounding variables were analyzed using multiple linear regression.Results: Results showed that caring-based SEEIP had effects on improving self-efficacy of patients with type 2 diabetes with a p-value of 0,000 (α < 0.05), meaning that there was a significant difference before and after the caring-based SEEIP intervention.Discusion:When an individual thinks that he or she is God‟s perfect creature, the individual would maintain his or her body well. Caring-based SEEIP had effects on improving self-efficacy of patients with type 2 diabetes mellitus. Future researchers could develop this concept for other diseases. Keywords: Caring-based SEEIP, self-efficacy, type 2 diabetes mellitus INTRODUCTION

Diabetes mellitus (DM) is a group of metabolic diseases with characteristic increase in blood glucose level (hyperglycemia). Often times DM patients accept diabetes diagnosis difficult, when especially they knows their life are regulated by diet and drugs (Kai G.Kahl, 2014). DM patients will be negative attitude when during treatment, negative attitude toward the disease and treatment will be cause to DM management failure, this may affect patients of life quality and social skills (Soegondo, 2011). That introduction survey results are diabetes patients in Kediri District has less DMSES self efficacy (46-58%) and PTES (30-37%). Diabetes independently Selfmanagement that effective is gotten if the

individual has knowledge, skills and selfefficacy to perform DM. behavior management. one way to improve selfefficacy by applying SEEIP (Self Efficacy Enhancement Intervention Program) based Caring in DM patients. This the purpose research was to prove the influence SEEIP caring based on the increase in selfefficacy in patients with type 2 diabetes. Someone who has only the knowledge, attitudes, and specific skills in the absence of self-efficacy are high, indicating a belief that he was able to do something, it is unlikely that someone would commit such acts or behavior (Edberg, 2010). Based previous research Wu, et. Al (2011) stated that the program SEEIP have an influence on self-efficacy. 525

Damayanti (2012) also states the same thing that self-efficacy enhancing intervention program in DM patients,This program increase self-efficacy patient to do self-care. SEEIP is one the techniques of learning to improve self-efficacy to patients who adopted the cognitive theory of social (social cognitive theory, SCT) proposed by Bandura comes from four main sources of influence, among other things: (1) performance accomplishments, (2) vicarious experience ( 3) verbal persuasion, (4) somatic and emotional state (Bandura, 1997). Meanwhile, to support awareness of himself and others we add model of caring by Jean Watson with 10 caritasnya values of humanity, trust-hope, sensitivity terdahapyourself and others, a relationship of trust and mutual help, expression of positive and negative, systematic problem solving methods, teaching and learning through interpersonal relationships, support, protection, mental, physical, social, cultural and spiritual environment, human needs and the strength of the existential phenomenological (Alligood, 2014)

RESULTS Patients withtype 2 diabetes mellitus identification is Self Efficacy Table1. Differences Self Efficacy type 2 diabetes patients are before and after treatment to treatment group and control group of Diabetes group in BPJS branch Kediri, Kediri,District in April-May 2015. Treatment Control (n = 17) (n = 17) Variabel M M p P (SD) (SD) Self Efficacy (DMSES) Pre–Post 1 -21,706 ,000 -,029 ,868 (12,572) (,717) Pre – Post 2 -28,382 ,000 -,235 ,399 (13,563) (1,120) -6,676 ,000 -,206 Post 1 – Post 2 ,130

METHODS Design research uses quasiexperimental, by the experimental group were given intervention based SEEIP Caring, while control group received routine maintenance carried out by doctors and nurses. Samples were some participants Prolanis (Chronic Disease Management Program) amounted to 17 people chosen by simple random sampling. SEEIP-based independent variable is the dependent variable is Caring and Self - Efficacy Patient DM Type 2. Data were collected using a questionnaire DMSES and PTES, then analyzed using paired t-test, independent ttest, while confounding variables using multiple linear regression.

Table1. to refer in treatment groups show that Self Efficacy(DMSES &PTES) has a p value is <0.000, α<0.05, its which means that any significant changes before and after SEEIP based Caring. In contrast to control group showed that Self Efficacy (DMSES &PTES) has a p value greater with α<0.05, which means are not change before and after SEEIP based Caring.

(4,334) (,532) Self Efficacy (PTES) Pre – Post 1 -25,471 ,000 ,294 (16,164) (1,213) Pre – Post 2 -27,000 ,000 ,118 (15,996) (1,269) Post 1 – Post 2 -1,529 ,001 -,176 (1,463) (1,185)

526

,332 ,707 ,548

Table2. Self Efficacy type 2 diabetes patients is identification in the treatment group and control group after to do SEEIP indiabetes group in BPJS branch in Kediri, Kediri in April-May 2015. Treatment Control Variabel p (n=17) (n=17) M (SD) M (SD) Self Efficacy (DMSES) 55,06 55,06 1,000 Pre (13,236) (13,236) 76,76 55,09 ,000 Post 1 (13,579) (5,483) 83,44 55,29 ,000 Post 2 (13,815) (2,984) Self Efficacy (PTES)

Pre Post 1 Post 2

66,59 (16,086) 92,06 (1,345) 93,59 (1,805)

73,00 (17,288) 72,71 (16,744) 72,88 (16,733)

Correlation characteristics Respondent with Self Efficacy Table

3.Correlation variables are in research diabetic groups in the region of the branch BPJS Kediri in Kediri, in April-May 2015.

Post – 1 (T2) T Col. (p) (vif) Self Efficacy (DMSES) Group ,000 1,787 Age ,935 1,547 Gender ,068 1,431 Therapy ,842 1,376 Work ,066 1,895 Education ,031 4,709 Sick ,517 1,302 Complication ,609 1,069 DMSES PRE ,000 3,230 Self Efficacy (PTES) Group ,000 1,597 Age ,842 1,633 Gender ,922 1,430 Therapy ,325 1,339 Work ,036 1,842 Education ,147 3,513 Sick ,243 1,222 Complication ,967 1,062 PTES PRE ,000 2,046 Variabel

,271 ,000 ,000

The results analysis show that Self Efficacy (DMSES & PTES) in pre ( do not do SEEIP based Caring) the difference was not significant, and after SEEIP showed results that Self Efficacy (DMSES & PTES) on post1 (T2), post2 (T3) has a value p value = 0.000, α> 0.05, which means that self-efficacy were not significant differences between treatment and control groups. While seeing a change in the treatments group are mean number self-efficacy show DMSES post 1 (76.76%) and post 2 (83.66%) in both categories that were previously pre (55.06%) in medium category and self efficacy PTES post 1 (92.06%) and post 2 (93.59%) in both categories that were previously pre (66.59%) in the medium category. This differs significantly from results of self-efficacy to control group are lean to remain medium category.

F (p)

,000a

,000a

Post – 2 (T3) t Col. F (p) (vif) (p) ,000 ,621 ,161 ,972 ,091 ,086 ,285

1,787 1,547 1,431 1,376 1,895 4,709 1,302

,934 ,000

1,069 3,230

,000 ,943 ,831 ,241 ,052 ,183 ,191 ,810 ,000

1,597 1,633 1,430 1,339 1,842 3,513 1,222 1,062 2,046

Test analysis results are f (p value 0,000, α <0.05), which means together variable (group, age, gender, treatment, employment, education, duration of illness, complications, pre dmses and PTES) significantly affects the self efficacy and the t test analysis on the variable group, dmses and pre PTES (p value 0,000, α <0.05) which shows that the variable group and self efficacy in pre influence on self-efficacy, but variables (age, sex, treatment, employment, education, duration of illness, complications) has a p value greater than α, which means these variables individually have no effect on selfefficacy. These results are also supported by the analysis of collinearity shows the value of vif<10 thus concluded variable (group, age, gender, treatment, employment, education, duration of 527

,000a

,000a

illness, complications, self-efficacy pre) does not occur multikolinearitas or does not happen a strong correlation with self efficacy.

similarity with the observer's own self. The more people who are observed to have a resemblance to him, the greater the potential for self-efficacy that will be contributed by this factor. While helping individuals gain confidence in healing, positive thinking. The more people have a strong belief and positive thinking, then the self-efficacy would be optimal. Verbal persuasion is persuasion that other people verbally or by yourself (self-talk) that can be used effects how people act or behave. Individuals under the influence or the suggestion that he was able to overcome the problems to be faced. Someone who confidence always given and the drive to recover and be able to control the disease, it will show behavior to try to recover and control, vice versa. This factor nature may come from outside or within the individual himself. The influence that can be given by the giver of persuasion is a sense of trust to the grantor of persuasion and believed that he was able to manage his illness. The same time through verbal persuasion helps to appreciate the power of existentialphenomenological namely appreciate and realize that the life-death-suffering is a blessing from God and believe in the possibility of the magic / miracles of healing from God and recalling that the individual is a creature cipataan God's most perfect and continue loved by God. Emotional arousal is generating positive emotions so that people have the confidence to perform a particular action. Emotional condition (mood) also affect a person's decision-making related to his self efficacy. Emotional state that accompanies the individual when he was doing an activity will affect a person's self-efficacy. Emotion is meant strong emotions such as fear, stress, anxiety and joy. These emotions can increase or decrease one's self efficacy. At the same time dividing issues with other individuals, which help the individual that he has friends and relatives who always supported him.

DISCUSSION The results show that significantly affect Caring based SEEIP Self Efficacy patients with type 2 diabetes, is evidenced by the significant changes after treatment with the value Self Efficacy (DMSES & PTES) has a value of value <0.000, α <0.05, which means that the significant changes before and after SEEIP (table 1) and supported the existence of differences between treatment and control groups, namely Self Efficacy (DMSES & PTES) on post1 (T2), post2 (T3) has a value of value = 0,000, α> 0 , 05 which means that self-efficacy were no significant differences between treatment and control groups (Table 2). This situation is caused by a program-based Caring SEEIP given to patients with type 2 diabetes mellitus include Performance Accomplishments which recalls the accomplishments or experience the best ever achieved by the patient in the past in controlling diabetes. Good performance in the past experienced by the patient will make increase the expectation of efficacy, while the experience of failure will decrease the efficacy of the individual. At the same time it helps the individual to have a sense of love, care, trust, hope, sensitive, positive thinking, creative problemsolving, the best learning experience, and confidence to cure both to themselves and to others. Vicarious experience is the experience gained from others or emulate their behavior to get what others get. Selfefficacy will increase if observing the success that has been achieved by others, whereas the self-efficacy would decrease if individuals observing someone who has the equivalent of his Traffic failure. Given the influence of these factors on the selfefficacy is based on the observed 528

This is consistent with the results of the study conducted by Wu, et. Al (2011) which states that the program SEEIP have an influence on self-efficacy. Damayanti (2012) also states same thing that self-efficacy enhancing intervention program in patients with DM, the program enhances patient self-efficacy in performing self-care. Potter and Perry (2009) stated that confidence of the patient's health can be a powerful motivation to take actions that can reduce the disease or reduce the severity. The role of nurses as educators took part in providing the knowledge and motivation to patients. Trento, et.al (2004) in Atak, Gurkan and Kose (2006) explained that the health education group problem solving increase knowledge about diabetes and improve the decision making lifestyle changes to manage the disease. Similarly, Anderson, et al (1995) in Atak, Gurkan and Kose (2006) conducted a study on the effects of health education about DM, with health education about disease management obtained a change of psychosocial and skills where someone with type 2 diabetes develops keyakinananya about coping psychology DM called confidence DM. Research nyut et al (2010), which conducts research on self-efficacy, self care and control blood sugar result that the provision of education can improve self efficacy 62% and 30% self-care behavior. Self-efficacy is the belief in one's ability to organize and execute courses of action required to manage a situation that will occur (Bandura, 1994). It is also supported by results of Table 3. on other factors that affect selfefficacy, ie the t test analysis on the variable group, dmses and PTEs pre indicates that the variable group and self efficacy in pre influence on self-efficacy, but variables (age , gender, treatment, employment, education, duration of illness, complications) has a p value greater than α, which means these

variables individually have no effect on self-efficacy. These results are also supported by the analysis concludes variable collinearity (group, age, gender, treatment, employment, education, duration of illness, complications) do not occur or do not occur multikolinearitas strong correlation with self efficacy. Results were showed statistically many female respondents, but there is no relationship between gender and selfefficacy, means that men and women have the same ability in solving various problems or to cope, and to behave as expected. Men and women possess the same confidence in their ability to behave as expected to manage the disease. Age of respondents average 47 years, the results not statistically significant relationship of age with self-efficacy this is due to the older respondents have complications or comorbidities that will further reduce the function of the physical so that patients do not feel able to do the treatment himself with such good though sport, whereas in the adult respondents were more likely to focus on perjaan and household. The average education level of respondents junior high school graduates, according to the results of this study that education level was not associated with self-efficacy can be interpreted that the higher the education level of respondents do not guarantee good self efficacy. The level of education is high on the respondents in this study is a formal education in general not describe specific education about DM, but respondents with higher education should be easier to understand and accept the information that helps in improving efficacy of himself. Based on current experience researching, there are some respondents who are well educated and know how to correct diabetes management, but is still difficult melaksanakannnya a variety of reasons including the one about exercise and diet DM. The average respondent has a job, 529

according to the results of this study that the job no association with self-efficacy, it is because the working conditions can be a source of stressors that can reduce a person's ability to solve problems. Stress conditions is one of the risk factors that can aggravate the condition of patients with diabetes mellitus type 2, which will have an impact on the decline in selfefficacy in the management of his diabetes. Long experience DM is mean of respondents two years, the results of this study there was no significant relationship between old suffering from diabetes with self-efficacy, due to the length of experience DM will happen much damage to cells and body functions so more easily appeared a variety of physical disorders and metabolic or in other words complications have occurred. someone with komlikasi will experience a variety of disorders and limitations that can cause low self efficacy of patients. The above results differ from test analysis f in Table 3. stating jointly variables (group, age, gender, treatment, employment, education, duration of illness, complications, pre dmses and PTEs) significant effect on self-efficacy. This suggests that there are factors other than the four elements of self efficacy which affect self-efficacy in individuals, although these factors do not stand alone but affects together, are consistent with the theory Bandura (1977) states in addition to the four sources of efficacy and process information can be also influenced by the characteristics of the individual and the environment. Ideally, self-efficacy strengthened through a variety of experiences related and will influence subsequent behavior. Someone will decide to behave based on reflective thinking, the use of knowledge in general, and the ability to perform an action.

based Caring can improve Self Efficacy in patients with type 2 diabetes mellitus. RECOMMENDATIONS Application of Caring based SEEIP can be applied to health care institutions to develop an integrated system of services and provides the means for the Center Self Efficacy Restoration as an effort to increase confidence in type 2 diabetes patients in the care of her. Caring based SEEIP program can be applied to cases of other chronic diseases that require treatment eg patients with hypertension, stroke, kidney failure, and in palliative care. REFERENCES ADA, 2012. Diagnosis and Classification of Diabetes Melitus. Diabetes Care, II(1), p.35. Alligood, Martha R., 2014. Nursing Theorist and Their Work. 8th ed. United Satates of America: Elsevier. Atak, N. Gurkan,T. & Kose,K., 2006. The effect of education on knowledge, self management behaviour and self efficacy of patient with type 2 diabetes. Australian journal of advanced nursing , pp.66-74. Bandura, A., 1977. Self-efficacy: Toward a unifying theory of behavioral change. New York: Psychological Review. Bandura, A., 1994. Self-efficacy. 1st ed. New York: Academic Press. Bandura, A., 1997. Self-Efficacy: The exercise of kontrol. New York: Academic Press. Damayanti, S., 2012. Analisis Praktik Residensi Keperawatan Medikal Bedah: Penerapan teori adaptasi Roy pada pasien dengan gangguan sistem endokrin. Jakarta: Universitas Indonesia. Edberg, M., 2010. Buku Ajar Kesehatan Masyarakat; Teori Sosial dan Perilaku. Jakarta: EGC.

CONCLUSIONS Application of SEEIP (Self Efficacy Enhancing Intervention Program) 530

Kai G.Kahl, Ulrich, Christoph, Conrad, Marie, Michael, Peter., 2014. Depression, anxiety disorder, and metabolic sydrome in a population at risk for type 2 Diabetes Melitus. Brain and Behaviour, pp.1-7. Patricia A Potter, A.G.P., 2009. Buku Ajar Fundamental Keperawatan. Jakarta: EGC. Sandhi W.Nyut, Nopporn H, Nawarat S, Thiltipat R., 2010. self-efficacy, self-care behaviour and glycemic kontrol among type-2 diabetes patients attending two private clinic in yangon,myanmar. Southeas Asian J Trop Med Public Health, pp.943-51. Shu-Fang V.W, Mei-chen L,Shu-Yuan L, Yu-Ying L, Tsae J.W, Heng H T., 2011. Effectiveness of a selfefficacy program for persons with diabetes: A randomized kontrolled trial. Nursing and Health Science, pp.335-43. Soegondo, S., Rudianto,P., Subekti, I., Pranoto, A., Arsana, P.M., et al.., 2011. Konsensus pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia 2011. Jakarta: PB Perkeni.

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EFFECT OF REMINISCENCE THERAPY OF OLDER PEOPLE AND SELFACCEPTANCE WITH GEROTRANSCENDENCE THEORY APPROACH IN JOMBANG INSTITUTION AND GERIATRIC OF PUHJARAK COMMUNITY HEALTH CENTER KEDIRI Nugrahaeni Firdausi Akademi Keperawatan Pamenang Kediri Email: [email protected] Introduction: Aging process is a natural phenomenon. Aging process is change to physical, social, psychological, moral and spiritual to older people. That change can to effect low self-acceptance. Older people of low self-acceptance will correlated with high depression level. This research purpose was analyse effect of reminiscence therapy to self-acceptance older people with gerotranscendence theory approach in Jombang Institution and Geriatric of Puhjarak Community Health Center Kediri. Method: This research used a quasy experiment two groups with non randomized pretest-posttest control group design approach. This research sampling technique used purposive sampling, so 28 samples got to selected was based on inclusion and exclusion criteria. This research independent variables was elderly self-acceptance and the dependent variable was the reminiscence therapy. The instrument used data collection of selfacceptance questionnaire from modification psychological well-being questionnaire Ryff (1989). Data were analyzed using paired t test and t test independent. Result: The results showed that treatment group in Jombang Institution, there was increasing acceptance older people with p= 0.001, whereas the control group was p= 0.021. Value pretest was self-acceptance between treatment and control group showed p= 0.139, and the posttest value was p= 0.000. The treatment group was Puhjarak Community Health Center Kediri, there was increase self-acceptance older people p= 0.001, whereas the control group was p= 1.000, between value were pretest self-acceptance treatment and control group to show p= 0.226, and the posttest value was p= 0.000, differences between value were posttest self-acceptance treatment group in Jombang Institution and Geriatric of Puhjarak Community Health Center Kediri p= 0.854, and the value control group was p= 0.017. Discussion: Reminiscence therapy can increase self-acceptance in the older people through gerotrancendence theoretical approach, but older people acceptance effected age were too, stay nursing homes long time, history life, sadness, environmental, and social support. Suggestion for next researcher expected can do qualitative research about selfacceptance older people and respondents are strict controls observing and environmental research so to give maximum results. Keywords:

self-acceptance older people, reminiscence therapy, theory

gerotranscendence

INTRODUCTION Increasing degree of health and well-being of the population at this time will have an effect on the increase in life expectancy in Indonesia (Kemenkes RI, 2013). The Central Statistics Agency (BPS) reported that life expectancy in 2010 was 69.43 (with the percentage of the elderly population is 7.56%) and in 2011 to 69.65 years (with the percentage of the elderly population is 7.58%).

Number of older people in the province with the highest percentage of three contained in Yogyakarta (13.04%), East Java (10.40%), and Central Java (10.34%). Changes in physical, social, psychological, moral and spiritual occur in the older people can lead to negative self-acceptance (Mariana, 2014). The research of Tika & Saifuddin (2013) showed that of 54

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older people, found 31 (59.6%) older people have enough self-acceptance, and 3 (5.8%) older people have less selfacceptance, while the data collection showed that two out of three people (66.67%) in the Jombang institution had a lack of self-acceptance, and one (33.33%) had self-acceptance well, the same data was also obtained on Geriatric of Puhjarak Community Health Center Kediri, from three older people, single people (33.33%) of older people had enough self-acceptance, one person (33.33 %) had less self-acceptance, and one person (33.33%) had good selfacceptance. Gerotransenden theory is a theory explaining the aging process, in this process the thought patterns of the older people will become more extensive and cosmic (Jonson & Magnusson, 2001). Thorstam in Thorsen (1998) mentions that gerotransenden is a universal phenomenon that occurs in any process of aging. The research of Tornstam (1994, 1997a, b, 1999, 2003), quantitatively demonstrate that the gerotransenden theory positively correlated with age, but in fact, only about 20% of the population. achieving a high degree of gerotranscendence without difficulty (Tornstam, 2011). Johnson & Magnusson (2001) mentions that changes to the natural aging process is described by the gerotransenden theory an awareness in old age toward wisdom. Gerotransenden sign is divided into three levels, the cosmic level, the level of self, and the level of the individual and social relations (Tornstam in Jonson, 2001). At the level of self, gerotransenden theory outlines the developments associated with the aging process (Wadensten, 2005). Older people who do not have self-acceptance will view themselves as depressed, too boast of his past, or use a self-defense mechanism to deal with change associated with increasing age itself (Sari & Nuryoto, 2002). Reminiscence therapies currently used as a therapy for treatment of depression in the older people, while

the influence of the reminiscence therapy to improve self-acceptance has not been done. The using of reminiscence therapy by motivating the older people to remember the ability he has, whether biological, psychological, social, spiritual, and cognitive, so the limitations due to the aging process can be minimized (Syarniah, 2010). Elderly will become more focused on the needs of others, and obsession with body switch with self-acceptance which results in life satisfaction (Tornstam, 2011). This research purpose was analyse effect of reminiscence therapy to self-acceptance older people with gerotranscendence theory approach in Jombang Institution and Geriatric of Puhjarak Community Health Center Kediri.

METHOD This research used a quasy experiment two groups with non randomized pretest-posttest control group design approach, with research time was 4 weeks in Jombang Institution and Geriatric of Puhjarak Community Health Center Kediri. This research sampling technique used purposive sampling, so 28 samples got to selected was based on inclusion and exclusion criteria. Twentyeight samples were in Jombang Institution divided into two groups, 14 samples were treatment group, and 14 samples were control group. Puhjarak Community Health Center was divided into two, each 14 samples were treatment group, and 14 samples were control group. This research independent variables was elderly self-acceptance and the dependent variable was the reminiscence therapy. The instrument used data collection (pretest and posttest) of self-acceptance questionnaire from modification psychological well-being questionnaire Ryff (1989), which contains 14 questions. Format attitude scale questionnaire self-acceptance is a Likert

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scale. In the questionnaire of selfacceptance, there are four possible answers, Strongly Agree, Agree, Disagree and Strongly Disagree. This measure are items favorable (item number 1, 2, 5, 6, 8, 12, and 13) and items unfavorable (item number 3, 4, 7, 9, 10, 11, and 14). Score 4 for Strongly Agree, 3 to Agree to Disagree 2, and 1 for Strongly Disagree, while for item unfavorable scoring is the opposite. Assessment questionnaire is indicated by a score of acceptance of yourself, better when the score 43-56, acceptance of self-sufficient when the score 29-42, and the acceptance of self-less when the score 14-28. Instruments for the independent variable reminiscence therapy is SAK. Retrieval of data held in Jombang Institution and Geriatric of Puhjarak Community Health Center Kediri in March 2015, while the process of research carried out on April 23, 2015- May 16, 2015. The respondents determined in accordance with the criteria of the sample and sampling techniques. Respondents who have been selected will be given an explanation about the purpose and benefits of research. Respondents that had been collected was then given an explanation of the technical guidelines of treatment research/SAK in accordance with the group (treatment or control) in order to obtain informed consent from each respondent. Pretest is done by using a questionnaire form self-acceptance, so the initial score obtained before the intervention. Scores of self-acceptance questionnaire obtained from questionnaires acceptance modification of psychological well being questionnaires Ryff (1989). The data collection process is assisted by observers who have studied and understand the research activity. Respondents in the treatment group was given the research activities in the form of reminiscence therapy as much as six sessions, the first session that activities

reminiscing childhood with 2 meetings, the second session in memory of adolescence with 2 meetings, third session in memory of adulthood with two meetings, fourth session in memory of a family with one meeting, the fifth session of reminiscing elderly period with 2 meetings, and the sixth session is the evaluation of the achievement of self-integrity. Implementation of the reminiscence performed with a duration of 20-30 minutes, every meeting held 3x/week, was done 2 days in a period of 4 weeks. The final assessment carried out by the end of the 4th week, performed on all groups using a questionnaire form self-acceptance back to find out the scores after the intervention. Respondents in the control group was not given any intervention, just doing everyday actions of each respondent, but after the study ended, the control group will also be given the same treatment as the reminiscence of older treatment group before. Data were analyzed using paired t test to determine the difference before and after implementation of an intervention and t test independent to determine the comparison between the groups treated and untreated.

RESULT AND DISCUSSION Results of observations about the characteristics of survey respondents which include gender, age, marital status, and length of stay in Jombang institution or longer follow Geriatric of Puhjarak Community Health Center Kediri will be described below.

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Tabel 1 Respondent characteristics in Jombang institution or longer follow Geriatric of Puhjarak Community Health Center Kediri April-May 2015 Jombang Institution Geriatric of Puhjarak CHC No Characteristic Treatme Total Control Treatme Control s nt group group nt group group Gender f % f % f % f % Ʃ % 1. Male 3 21,4 3 21,4 1 7,1 1 7,1 8 14,3 2. Female 1 78,6 11 78,6 1 92,9 1 92,9 48 85,7 1 3 3 Amount 1 100 14 100 1 100 1 100 56 100 4 4 4 f % F % f % f % Ʃ % Age (year) 1. 60-65 4 28,6 1 7,1 4 28,6 3 21,4 12 21,4 2. 66-70 2 14,3 1 7,1 4 28,6 5 35,7 12 21,4 3. 71-75 8 57,1 12 85,7 6 42,9 6 42,9 32 57,1 Amount 1 100 14 100 1 100 1 100 56 100 4 4 4 Bartlett‟s test p=0,848 of Sphericity % f % f % f % Ʃ % Marital status f 1. Married 2 14,3 1 7,1 4 28,6 5 35,7 12 21,4 2. Widow 1 71,4 11 78,6 9 64,3 8 57,1 38 67,9 0 3. Widower 2 14,3 2 14,3 1 7,1 1 7,1 6 10,7 Amount 1 100 14 100 1 100 1 100 56 100 4 4 4 Ʃ Length of f % f % f % f % % stay 1. < 3 month 0 0 1 7,1 0 0 0 0 1 1,7 2. 3 month –1 4 28,6 1 7,1 6 42,9 6 42,9 17 30,4 year 3. 1-5 year 8 57,1 6 42,9 8 57,1 8 57,1 30 53,6 4. > 5 year 2 14,3 6 42,9 0 0 0 0 8 14,3 Amount 1 100 14 100 1 100 1 100 56 100 4 4 4 Characteristics of respondents in Jombang institution and Geriatric of Puhjarak Community Health Center majority are female, are in the age range 71-75 years old, a widow, length of stay in Jombang institution is in the period of 1-5 years, and longer follow Geriatric of Puhjarak Community Health Center also within 1- 5 years for respondents who are older people in the Geriatric of Puhjarak Community Health Center.

Results of the assessment of self-acceptance older people in Jombang institution in the treatment group and the control group before and after reminiscence therapy can be seen in the following table:

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Tabel 2 Assessment of self-acceptance older people in Jombang institution in the treatment group and the control group before and after reminiscence therapy of the April-May 2015 Self acceptance Treatmen group Control group Pretest Posttest Pretest Posttest F % f % f % f % Well 0 0 12 85,7 0 0 1 7,1 Enough 12 85,7 2 14,3 13 92,9 13 92,9 Less 2 14,3 0 0 1 7,1 0 0 Amount 14 100 14 100 14 100 14 100 Mean±SD 32,14±2,742 50,14±4,258 34,07±3,832 37,36±3,003 Mean difference 18 3,29 Wilcoxon signed p=0,001 p=0,021 rank test The results showed that after is marked by the return of past memories treatment reminiscence therapy, selfand conflicts (Butler, 1996). acceptance older people in the treatment Implementation of therapy have a group experienced a significant positive influence in improving selfimprovement after reminiscence acceptance in the older reminiscence therapy. Older people before people. implementation reminiscence therapy Increased self-acceptance in the more focus on the lack of theirselves and treatment group after treatment desire to change the past, after the reminiscence therapy still not up on all reminiscence therapy become more the respondents, there are two categories grateful and accept all its shortcomings of respondents who have enough selfas a gift from God that must be grateful. acceptance despite given reminiscence At the level of self gerotransenden therapy, there are respondent 2 and 6. perspective, there is a change of Self acceptance on respondents 2 and 6 rationality eolder people obsession with does not increase significantly in both body switch with self-acceptance and categories, although there is an increase become more focused on the needs of in the value of her acceptance. others, resulting in life satisfaction. SelfRespondent 2 are aged 75 years old, a acceptance is an introduction to personal widow, and lived in Jombang institution abilities and accomplishments for 7 years. Interviews showed that themselves, along with the acceptance of during the research process that the limitations of self (Corsini, 2002). coincided with the arrival of the students Reminiscence therapy carried by practice makes respondent 2 motivating the elderly to recall remembered her grandchildren that are capabilities, whether biological, outside Java were sorely missed, so psychological, social, spiritual, and make respondent 2 feel sad. Pannes in cognitive, so the limitations due to the Hurlock (1978) argued that a person aging process can be minimized. who receives him is someone who is not Memories, in the Gerotransenden troubled by itself, does not have the perspective seen as an important element burden of feeling of self, so it has plenty in the development process of the older of opportunity to adapt to the people, because contribute in developing environment. an identity and a sense of reality through The research of Tornstam (1994, memories (Tornstam in Wadensten, 1997a, b, 1999, 2003), quantitatively 2006). Butler (1996) illustrates that demonstrate that the gerotransenden people of all ages reviewing their past in theory positively correlated with age, various ways in life. Remembering the but in fact, only about 20% of the past is a normal developmental task that population, which reached a high degree

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of gerotransenden without difficulty (Tornstam, 2011). Gerotransendence process towards this, some people may be hampered by a variety of reasons, one of which is retained hope. Self-acceptance older people besides influenced by reminiscence therapy is also affected by age, adaptation to the environment and circumstances in the individual's own personal self. Respondent 6 is a 60-year-old, widow, and the length of stay in Jombang institution is 3 years. Respondent 6 said that during the process of research, respondents still work as usual and maintain good relations with friends, but from observation during the research process, respondent 6 is not too interact with other. Other respondents said that respondent 6 did not like to associate with other, because of differences in the background. Hurlock (1980) explains that the attitude or response from the environment to form an attitude towards oneself (self attitude), the individual who received the appropriate attitude and fun of their environment tend to receive him. Baltes & Baltes in Newman & Newman (1979) said that the adaptability make an important contribution for older people to achieve successful aging. This is because successful aging strategies involve older people who used to accept the changes that happened to him. Other factors that lead to self-acceptance is the age of maturity, according to Akçakoca in Ceyhan and Ceyhan (2011), age may affect the level of self-acceptance on a person, the more a person's age, the higher the level of acceptance of himself. Implementation of reminiscence therapy in improving selfacceptance in the older people through gerotransenden theoretical approaches do not all give good results, but is also influenced by the history of one's life that should help understand and provide coherence of life (Tornstam, 2005).

Increased of self-acceptance older people in the treatment group after reminiscence therapy in accordance with previous studies, the research Moral et al (2013), which indicates that the reminiscence therapy given positive effect in improving the psychological well being of older people in the posttest and follow-up, with self-acceptance as one dimension of psychological well being. This is supported by the observation of memories during therapy in Jombang institution group, which showed that out of 14 respondents, all of them participated in the therapy with enthusiasm. The respondents recalled independently after listening to instructions and rules of conduct. Results of the evaluation showed activity of all respondents score more than 3 per session, which indicates that in following the activities, the respondents can be followed with enthusiasm and complete from start to finish. The evaluation results are supported by previous studies that the use of reminiscence therapy can motivate the elderly to remember the ability he has, whether biological, psychological, social, spiritual, and cognitive, so the limitations due to the aging process can be minimized (Syarniah, 2010). Memories in the gerotrancendence perspective seen as an important element in the development process of the older people, because contribute in developing an identity and a sense of reality through memories (Tornstam in Wadensten, 2006). In the process of gerotransenden changes materialistic and rational view of the world becomes more cosmic and transcendence, which is usually accompanied by an increase in life satisfaction. At the level of self-change view of themselves and the physical retrospect and acceptance of, the individual and social relationships occur selectivity against superficial relationships, while at the cosmic level changes the feeling that grew into a part

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of the universe. This perspective changes resulted in a lot of thought back to childhood, a period that was revised and understood in a new way (Tornstam, 2005). Reminiscence therapy given significant influence in increasing acceptance in the older people, but increase self-acceptance in the older people is also affected by age, length of stay, and an environment that is not observed in this study. Kelompok kontrol yang tidak mendapatkan terapi kenangan, sebagian besar responden lanjut usia mengalami peningkatan penerimaan diri, dan terdapat satu responden lanjut usia yang mengalami peningkatan penerimaan diri yang signifikan, yaitu pada kategori cukup meningkat menjadi kategori baik, yaitu pada satu responden (7,1%). Peningkatan tertinggi terdapat pada responden 9, yaitu dari penerimaan diri kategori cukup menjadi penerimaan diri kategori baik. The control group that did not receive therapy memories, most respondents increased self-acceptance, and there is an respondents who experienced a significant increase selfacceptance, which is in the category increased to a category quite well, which is on one of the respondents (7.1% ). The highest increase contained in the respondent 9, which is quite a category of self-acceptance into either category of self-acceptance. Respondent 9, aged to 75 years, widow, and the length of stay in Jombang institution is 3 years. Observed during the research activities underway indicate that the respondents in the control group who did not receive therapy during the study period memorable stay abreast of daily activities in Jombang institution. In the second week, the student practices of some institutions do gerontik nursing practice, and the existence of these students can not be controlled optimally in this study. Ryff (1989) says that

social support is one of the factors that influence the high and low levels of psychological well being of individuals, with self-acceptance is one dimension of psychological well being. Observation and extracting information to clients that support this theory is the data obtained that the respondent 9 during the study period was very pleased with the visit of the students, the respondent 9 can talk and express their feelings to the students companion, every day someone accompany, as a granddaughter. The participation of students practice that can not be controlled optimally in this study, because the study period coincides with the time gerontik nursing practice students from several institutions. It is also consistent with research Masyithah (2012) who said that there is a significant relationship between self-acceptance and social support for patients with poststroke. The data obtained from the study in the control group showed that the cause of the increase in the older people acceptance in Jombang institution influenced by social support factors that are not observed in this study. Results of the assessment of selfacceptance differences in Jombang institution between the treatment group and the control group can be seen in the following table:

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Tabel 3 Assessment of self-acceptance differences in Jombang institution between the treatment group and the control group in April-May 2015 Self acceptance Pretest Postest Treatment Control group Treatment Control group group group Mean± SD 32,14±2,742 34,07±3,832 50,14±4,258 37,36±3,003 Mean difference 1,93 12,78 t test independent p=0,139 Mann whitney p=0,000 Results of self-acceptance older people in the treatment group and the control group before being implemented reminiscence therapy indicate that the level of self-acceptance older people between the treatment group and the control group was no difference value of acceptance between the two groups before being implemented reminiscence therapy, showed the data homogeneous, and among the treatment group and the control group there was no difference between the two background prior to the reminiscence therapy. Strict control is needed on research, because many factors can affect self-acceptance in the oder people, such as self-understanding, realistic expectations, the absence of environmental barriers, social behavior accordingly, the absence of emotional stress, memories of success, good selfidentification good, self perspective, parenting good childhood, and selfconcept steady (Hurlock, 1974). Results of the assessment of selfacceptance elderly in the treatment

group and the control group after reminiscence therapy showed that there are differences in the value of selfacceptance significant between treatment groups who received reminiscence therapy and a control group that did not receive reminiscence therapy. Moral et al (2013), explained that the therapy has positive effect in improving the psychological well being of older people in the post-test and follow-up, with acceptance of ourselves as one dimension of psychological well being. Acceptance of self-assessment results indicate conformity with the results of previous studies showing that reminiscence therapy can increase selfacceptance in the older people. Results of the assessment of selfacceptance in Geriatric of Puhjarak Community Health Center in the treatment group and the control group before and after reminiscence therapy on can be seen in the following table:

Tabel 4. Assessment of self-acceptance older people in Geriatric of Puhjarak Community Health Center in the treatment group and the control group before and after reminscence therapy of the April-May 2015 Self acceptance Treatment group Control group Pretest Posttest Pretest Posttest f % f % f % f % Well 0 0 12 85,7 0 0 0 0 Enough 14 100 2 14,3 13 92,9 13 92,9 Less 0 0 0 0 1 7,1 1 7,1 Jumlah 14 100 14 100 14 100 14 100 Mean±SD 36,21±3,867 49,71±5,980 34,29±3,361 34,29±3,292 Mean difference 13,5 0 Wilcoxon signed p=0,001 p=1,000 rank test

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Results of the assessment of selfacceptance in Geriatric of Puhjarak Community Health Center in the treatment group before and after the implementation of the reminiscence therapy showed that there is a significant increase in self-acceptance after reminiscence therapy. Reminiscence therapy of an activity that aims to learn about theirselves, in the perspective of gerotransenden aims to develop, reorganize, change of identity, and perception of the world (Tornstam, 1999b). Results of the assessment of selfacceptance in Geriatric of Puhjarak Community Health Center in the treatment group before and after the implementation of the reminiscence therapy showed that there is a significant increase in self-acceptance after reminiscence therapy. Reminiscence therapy of an activity that aims to learn about yourself, in the perspective of gerotransenden aims to develop, reorganize, change of identity, and perception of the world (Tornstam, 1999b). Increased self-acceptance in the treatment group is not maximized, there are two respondents increased acceptance, but did not arrive at either category, despite an increase in the value of self-acceptance, that the respondents 11 and 14. Respondent 11, 62 years old, a widow, and a long follow Geriatric of Puhjarak Community Health Center is 1 year. Respondent 11 said that the time of her life in old age, respondent 11 was not able to enjoy her old age in peace, because they still have to take care of her grandchildren were entrusted by his parents who worked as Labor Indonesia, when returning home, a job taking care of grandchildren is always wait. Respondent 14 was 60 years old, married, long followed Geriatric of Puhjarak Community Health Center is 3 years, said that in her old age still have to support themselves busy, although her husband also worked odd jobs. Kalimaftika & Saifuddin (2013) stated that the activity increases fatigue

that can affect the older people selfacceptance. The process towards gerotransenden hampered or stopped, can cause psychiatric symptoms including depression, anxiety, fear of death, hate and a feeling that life has been stolen, that for some people commit suicide is the final breakout (Jung in Tornstam, 2011). Results of observations during the study showed that all respondents were keen to follow the activities of the 14 respondents, all of them participated in the presence of 100%. All respondents recount memories of the good old days with an enthusiastic from the start of operations until the activity is over, even respondent 9, 10, and 13 show the objects memories of the past that still exist, such as the gramophone, tools knitting and embroidery equipment. Results of the evaluation showed activity of all respondents score more than 3 per session, which indicates that in following the activities, the respondents can be followed with enthusiasm and complete in accordance with SAK. Respondents 4, 6, and 13 said that the memory of the good old days to make happy, accept aging as an advantage that can motivate to live better longer. This is consistent with previous studies that show that reminiscence therapy significantly improved psychological well being in the treatment group compared with the control group (Jo Chiang et al., 2009). Reminiscence therapy given significant influence in increasing acceptance in the older people, but increase selfacceptance in the older people is also influenced by the activities and environments that can not be strictly controlled in this study. Results of the assessment of selfacceptance in Geriatric of Puhjarak Community Health Center in the control group during the pretest and posttest showed that the respondents' level of self-acceptance still remains as the pretest, which means there is increasing acceptance during the pretest and

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posttest. This means that the background in the treatment group and the control group before implementation reminiscence therapy is the same background. Observed during the study showed that the respondents in the control group perform daily activities as usual, and actively participates in older people in Geriatric of Puhjarak Community Health Center every month. Low self-acceptance in the older people if left untreated will cause a negative impact, as expressed by Kalimaftika & Saifuddin (2013), that self-acceptance older people is low will correlate with high rates of depression in the older people. Older people who have low selfacceptance will easily fall in depression conditions and limitations due to the aging process can not be minimized. Results of the assessment of selfacceptance older people in the treatment group and the control group before the reminiscence therapy showed that there was no difference in the value of acceptance between the two groups before treatment reminiscence therapy. Strict control is needed on research, because many factors can affect selfacceptance in the older people, such as self-understanding, realistic expectations, the absence of environmental barriers, social behavior accordingly, the absence of emotional stress, memories of success, selfidentification good, self perspective, parenting good childhood, and selfconcept steady (Hurlock, 1974). Results of the assessment of self-acceptance older people in the treatment group and the control group after therapy performed a memorable show differences in the value of selfacceptance significant between treatment groups who received reminiscence therapy and a control group that did not receive reminiscence therapy. This is consistent with previous studies, that there is an increased

psychological well being, that selfacceptance is one of the dimensions after treatment reminiscence therapy (Afonso et al., 2011). Meiner and Lueckenotte (2006) describes the therapeutic use of memories with the motivation and discussion on the older people about past experiences that experienced and problem solving efforts undertaken at the time, so as to develop the identity and rationality elderly. Effect of reminiscence therapy of the most significant role in increasing selfacceptance in the older people. Results of the assessment of self-acceptance differences in Geriatric of Puhjarak Community Health Center between the treatment group and the control group can be seen in the following table:

541

Tabel 5. Assessment of self-acceptance older people in Geriatric of Puhjarak Community Health Center between the treatment group and the control group after reminiscence therapy of the April-May 2015 Self acceptance Pretest Postest Treatment Control group Treatment Control group group group Mean± SD 36,21±3,867 34,29±3,361 49,71±5,980 34,29±3,292 Mean difference 1,92 15,42 Mann whitney p=0,226 p=0,000 is support from the surrounding Results of the assessment of environment. Memories in the self-acceptance differences in the gerotransendence perspective seen as an control group aged between Jombang important element in the development institution and Geriatric of Puhjarak process of the older people, because Community Health Center at the time of contribute in developing an identity and the posttest show that there are a sense of reality through memories. differences in the value of selfGerotransenden processes associated acceptance among older people control with age, but in fact, this process can group. Such differences may be caused hampered by various things, such as by environmental factors that may affect expectations restrained, life crisis, grief, the acceptance of older memories that and the environment. The results are present in addition to therapy when showed that the effect of therapy the study took place, and less can be remains the most significant controlled optimally. reminiscence therapy in increasing selfThe existence of students as one of acceptance older people, because they social support can affect self-acceptance can be trained themselves independently elderly, this is in accordance with the by the respondents without having to statement of Hjelle and Ziegler (1981), wait another supporting role. that acceptance would be better if there CONCLUSIONS RECOMMENDATION

AND

Conclusions Implementation of reminiscence therapy can improve the acceptance of older people in the treatment group compared to the control group in Jombang institution and Geriatric of Puhjarak Community Health Center. In the control group there was an increase in Jombang institution self-acceptance because of the lack of strict controls on the environment during the process of the study. Self-acceptance older people in Jombang institution and Geriatric of Puhjarak Community Health Center between the treatment group and the control group before implementation reminiscence therapy showed homogeneous values. Memories as an important element in the development

process of the older people in developing identity and a sense of reality. Implementation of reminiscence therapy in improving self-acceptance in the older people through gerotransendence theoretical approaches do not all give good results, but is also influenced by the history of life, including life crisis, grief, and environment should help understand and provide coherence of life. Comparison of self-acceptance older people in the treatment group in Jombang institution and Geriatric of Puhjarak Community Health Center provide equally good effect in improving self-acceptance older people. The value of selfacceptance that differ between the older

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people control group in Jombang institution and Geriatric of Puhjarak Community Health Center posttest when

implemented due to lack of control over the environment.

Recommendation Jombang institution as the residence of the older people and Geriatric of Puhjarak Community Health Center as implementing health care for the older people is expected to use the reminiscence therapy as a way to increase self-acceptance in the older people. Nurses can use the reminiscence therapy to improve self-acceptance in the older people so that limitations due to aging can be minimized.

Researchers then expected to conduct qualitative research on selfacceptance in the older people and social support affects self-acceptance. Observing strict control of the survey respondents and the environment so as to provide maximum results should be done. Older people can independently use reminiscence therapy as an alternative way to increase self-acceptance older people.

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of gerotranscendence in a cultural gerntological and post modernist perspective‟, Norwegian Journal of Epidemiology, 8(2), pp.165 – 176 Topaz, M., Jordan, M.T., Mackenzie, M 2014, „Construction, deconstruction, and reconstruction: the roots of successful aging theories‟, Nursing science quarterly, Vol. 27(3) 226–233 Tornstam, L. 1999, „Gerotranscendence and the functions of reminiscence, Journal of Aging and Identity, 4(3):155-166 Tornstam, L 2011, „Maturing into gerotranscendence‟, Journal of Transpersonal Psychology, 43(2), 166–180 Undang-Undang Republik Indonesia Nomor 13 tahun 1998 tentang kesejahteraan lanjut usia Videbeck, S.L. 2008, Buku ajar keperawatan jiwa, Edisi Bahasa Indonesia, EGC: Jakarta Wadensten, B., & Carlsson, M 2003, „Theory-driven guidelines for practical care of older people, based on the theory of gerotranscendence‟, Journal of Advanced Nursing, 41, 462-47 Wadensten, B 2005, „Introducing older people to the theory of gerotranscendence.‟ Blackwell Publishing, 2(5), pp.381 – 389 Wadensten B., & Carlsson, M 2007, „The theory of gerotranscendence in practice: Guidelines for nursing – part III‟, International Journal of Older People Watt, L.M. & Cappeliez, P 2000, „Integrative and instrumental reminiscence therapies for depression in older adults: intervention strategies and treatment effectiveness‟, Aging & Mental Health, Vol 4(2), 166± 177

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THE EFFECTS ATTITUDE EXERCISE GIVEN TO DECREASE ANXIETY TO TEACHERS TO CHILD THE FIRST TIME SCHOOL

Widhi Sumirat Akademi Keperawatan pamenang The success of educating in socialization can be seen from the ability of the individual to adapt oneself to various situations. This research is experimental study with pretest-posttest control group design. Giving attitudional guidance to children when they interact with the teacher using positive conditioning was aimed at lowering children‟s anxiety. The data was collected using questionnaire and observation, in order to obtain data connected to the characteristic of the children, school components, and anxiety indicators towards the teacher. The sample used in this study are all the population which comprised of 16 children, divided randomly into the experimental group consisted of 8 children, and the control group also with 8 children. The result of the analysis showed that the decrease of anxiety towards the teacher in experimental group was higher than that of the control group. Conclusion, giving attitudional guidance to children with anxiety towards the teacher could lower the children‟s anxiety Keywords: attitudional guidance, anxiety towards the teacher, children on their first day at school

INTRODUCTION Socialization is the process whereby an individual‟s standards, skills, motives, attitudes and behaviors are shaped to conform to those regarded as desirable and appropriate for his or her present or future role in society. Socialization process of education takes place throughout one's life through a learning process that guided and supervised. The learning process can take place within the family through the role of parenting and school environment through teaching and mentoring role of teacher. The success of the educational process of socialization can be seen from a person's ability to make adjustments yourself. One common problem that parents often complained about the ability of self-adjustment of the first children to school is school refusal with anxiety when in a school environment. The results of preliminary studies conducted in March 2011 in the working area of preschool education in kindergartens and elementary UPTD Wates Subdistrict average anxiety problems were recorded from 30 children 13.3%, which is 3.3% of children with anxiety when interacting with teachers. Handling is done in this case school teachers to the child's anxiety problems, has not been well standardized. Provision of training with a positive attitude conditioning in children who experience anxiety

when interacting with teachers, is expected to reduce his anxiety. METHOD The study design was experimental with a pretest-posttest control group design. The exercise is an independent variable and attitude toward teachers anxiety as the dependent variable. Engineering data collection using questionnaires and observation, which aimed to obtain data related to child characteristics, components and indicators of school anxiety about the teacher. The sample used in this study using the entire population of 16 children, which were randomly divided into study group and control group of 8 children 8 children. The results were analyzed using descriptive analysis. Exercise attitude given to children for two weeks with three times the assessment of indicators of anxiety about the teacher that is before treatment, 1 week after treatment and 2 weeks after treatment. Assessment conducted on the study group by providing a positive sign on the indicators of anxiety to the child's teacher can be maintained for 5 minutes and then also the child is given food or a toy he likes, while the control group given no training but observation of indicators of anxiety attitude toward teachers is still being done with the assessment the same study group. Score assessment of indicators of

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Table. 2 Respondent’s Father Characteristics in Study Group and Control of Preschool Education in Kindergartens and Elementary UPTD Wates Subdistrict, June 2011

anxiety about the teacher who determined if the child is able to retain four (4) attitudes toward teachers 'anxiety decreased until the end of the study assessed children do not worry, children are able to maintain a three (3) attitudes toward teachers' anxiety decreased until the end of the study assessed the child mild anxiety, children are able to maintain one or two (half) attitude decreased anxiety for teachers until the end of the study assessed the child and the child's anxiety was not able to maintain four (4) attitudes toward teachers' anxiety decreased until the end of the study assessed the child serious anxiety.

N o 1

RESULT AND DISCUSS Result Table. 1 Respondent Characteristics in Study Group and Control of Preschool Education in Kindergartens and Elementary UPTD Wates Subdistrict June 2011 N o 1

2

3

2

Group

Respondent Characteris tics Age (year) <6 ≥6

2(50%) 6(50%)

2(50%) 4(100%) 6(50%) 12(100%)

Gender Male Female

6(50%) 2(50%)

6(50%) 12(100%) 2(50%) 4(100%)

Study (n=8)

Control (n=8)

Birth Grade Single child 3(37,5%) 5(62,5%) Eldest child 1(100%) 0(0%) Middle 1(100%) 0(0%) child Youngest 3(50%) 3(50%) child

Total 3

4

8(100%) 1(100%) 1(100%)

Responden t’s Father Characteri stics Age (year) 20 – 25 26 – 30 31 – 35 36 – 40

Group Study (n=8)

Control (n=8)

Total

0(0%) 0(0%) 6(66,7%) 2(28,6%)

0(0%) 0(0%) 3(33,3%) 5(71,4%)

0(0%) 0(0%) 9(100%) 7(100%)

1(20%) 3(75%)

4(80%) 1(25%)

5(100%) 4(100%)

4(57,1%)

3(42,9%)

7(100%)

0(0%)

0(0%)

0(0%)

Work Status Work None

7(50%) 1(50%)

7(50%) 1(50%)

14(100%) 2(100%)

Income (million) None <1 1

1(50%) 0(0%) 7(58,3%)

1(50%) 2(100%) 5(41,7%)

2(100%) 2(100%) 12(100%)

Education grade Elementary First secondary school High secandary school University

Characteristics of respondent‟s father in the study group and the control group of Preschool Education in Kindergartens and Elementary UPTD Wates Subdistrict, are in the age range 31-35 years, high secondary school, work, and income more than 1 million.

6(100%)

Characteristics of respondent in the study group and the control group of Preschool Education in Kindergartens and Elementary UPTD Wates Subdistrict, are in the age range is more and equal to six years, male, and birth grade of single child.

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Table. 3 Respondent’s Mother Characteristics in Study Group and Control of Preschool Education in Kindergartens and Elementary UPTD Wates Subdistrict, June 2011

o 1 2 3

No 1

Respondent’s Mother Characteristics Age (year) 20 – 25 26 – 30 31 – 35 36 – 40 Education grade Elementary

2

First secondary school High secandary school University

3

4

0

0%

0

0%

8

100%

8

100%

0 (0%) 0 (0%) 8 (61,5%) 0(0%)

1 (100%) 2 (100%) 13 (100%) 0(0%)

Assessment of the level of anxiety towards the teacher in study group and control before treatment are in the level of severe anxiety.

1 (33,3%) 1 (25%) 5(62,5%)

2 (66,7%) 3 (75%) 3 (37,5%) 0 (0%)

3 (100%) 4 (100%) 8 (100%) 1 (100%)

N Levels of N Anxiety o

3 (50%) 5 (50%)

6 (100%) 10 (100%)

5(50%) 2 (66,7%) 1 (33,3%)

10(100%) 3 (100%) 3 (100%)

1 (100%)

5(50%)

5(50%) 1 (33,3%) 2 (66,7%)

Table. 5 Assesment of Level Anxiety Towards The Teacher in Study Group and Control After 1 Week Treatment

1 2 3 4

Characteristics of respondent‟s mother in the study group and the control group of Preschool Education in Kindergartens and Elementary UPTD Wates Subdistrict, are in the age range 31-35 years, high secondary school, not work, and no have own income.

None Mild Anxiety Moderate Anxiety Severe Anxiety

1 2 3 4

544

8

100%

5

62,5 %

0

0%

3

37,5 %

Table. 6 Assesment of Level Anxciety Towards The Teacher in Study Group and Control After 2 Weeks Treatment

N o

Before Treament Study Control

After 1 Week Treatment Study Control (n=8) (n=8) N % N % 0 0% 0 0 0 0% 0 0

Assessment of the level of anxiety towards the teacher in study group and control after 1 week treatment, study group are in the level of moderate anxiety level, and control group 5 ( 62.5 % ) are in moderate level and 3 ( 37.5 % ) are in severe anxiety.

N

Table. 4 Assesment of Level Anxiety Towards The Teacher in Study Group and Control Before Treatment

N

(n=8) % 0% 0%

1 (100%) 2 (100%) 5 (38,5%) 0(0%)

None

NLevels of Anxiety

N 0 0

control (n=8)

3(50%)

1

Total

(n=8) % 0% 0%

Study (n=8)

Work Status Working

Income (million) None <1

4

Group

None Mild Anxiety Moderate Anxiety Severe Anxiety

N 0 0

Levels of Anxiety

None Mild Anxiety Moderate Anxiety Severe Anxiety

After 2 Weeks Treatment Study Control (n=8) (n=8) N % N % 0 0% 0 0% 0 0% 1 12,5 % 7 87,5 7 87,5 % % 0 0% 1 12,5 %

Assessment of the level of anxiety towards the teacher in study group and control after 2 weeks treatment, study group 1 ( 12.5 % ) are in level mild anxiety and 7 ( 87 , 5 % ) are in moderate anxiety, and control group 7 ( 87.5 % ) are in moderate anxiety , 1 ( 12.5 % ) in severe anxiety.

Table. 8 Median Score of Level Anxciety Towards The Teacher in Study Group and Control Before, After 1 and 2 Weeks Treatment Before

Level N sNof Anxi o ety

Table. 7 Level Anxiety Towards The Teacher in Study Group and Control Before, After 1 dan 2 Week Treatments Leve N lsNof Anxi o ety 1 Non e 2 Mild Anxi ety 3 Mod erat e Anxi ety 4 Seve re Anxi ety

Before Stud i N % 0 0 % 0 0 %

Kont rol N % 0 0 % 0 0 %

0 0 %

0 0 %

8 10 0 %

8 10 0 %

After Treatment 1 Week Studi Kontr ol N % N % 0 0 0 0 % 0 0 0 0 % 8 10 0 %

0 0 %

5 62 ,5 %

3 37 ,5 %

After Treatment 2 Week Studi Kontr ol N % N % 0 0 0 0% % 1 12 0 0% ,5 % 7 87 7 87,5 ,5 % %

0 0 %

1 None 2 Mild Anxi ety 3 Mode rate Anxi ety 4 Sever e Anxi ety Median

After 1 Week Treatment Stud Cont Stud Cont y rol y rol Sc N Sc N Sc N Sc N or or or or e e e e 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

After 2 Weeks Treatment Stud Contro y l Sc N Sc N or or e e 0 0 0 0 1 1 0 0

0

0 0

0 23

8 15

5 15

7 18

7

32

8 32

8 0

0 12

3 0

0 4

1

4

8 4

8 3

8

8

8

8

3

2

3

Median score of level anxiety towards the teachers in the study group and the control group before treatmeant is 4. Median score of level anxiety towards the teachers in the study group and the control group after 1 week treatmeant is 3. Median score of level anxiety towards the teachers after 2 weeks treatment, in the study group is 2, and control group is 3.

1 12,5 %

Assessment of the level of anxiety towards the teacher in study group before treatment are in the level of severe anxiety, after 1 week treatment are in the level of moderate anxiety level, and after 2 weeks treatment 1 ( 12.5 % ) are in level mild anxiety and 7 ( 87 , 5 % ) are in moderate anxiety Assessment of the level of anxiety towards the teacher in control group before treatment are in the level of severe anxiety, after 1 week treatment 5 ( 62.5 % ) are in moderate anxiety and 3 ( 37.5 % ) are in severe anxiety, and after 2 weeks treatment 7 ( 87.5 % ) are in moderate anxiety , 1 ( 12.5 % ) in severe anxiety.

Table. 9 Assesment of Children’s Age in Study Group and Control Between Anxiety Towards The Teacher After 2 Weeks Treatment, June 2011 Study Group Levels of Anxiety After 2 Weeks Treatme nt

None Mild Anxiety Moderate Anxiety Severe Anxiety Total

Control Group Levels of

545

None

Age (year) <6 ≥6 0(0%) 0(0%) 0(0%) 1(100%)

Total

2 (28,6%) 0(0%)

5 (71,4%) 0(0%)

0(0%) 1 (100%) 7 (100%) 0(0%)

2 (25%)

6 (75%)

8 (100%)

Age (year) <6 ≥6 0 (0%) 0 (0%)

Total 0 (0%)

Anxiety After 2 Weeks Treatme nt

Mild Anxiety Moderate Anxiety Severe Anxiety Total

0 (0%)

0 (0%)

2(28,6% ) 0 (0%) 2 (25%)

0 (0%) 5 7 (71,4%) ( 100%) 1(100%) 1 (100%) 6 (75%) 8 (100%)

Table. 10 Assesment of Children’s Gender in Study Group and Control Between Anxiety Towards The Teacher After 2 Weeks Treatment, June 2011 Study Group Levels of Anxiet y After 2 Weeks Treat ment

None Mild Anxiety Moderat e Anxiety Severe Anxiety Total

Control Group Levels of Anxiet y After 2 Weeks Treat ment

None Mild Anxiety Moderat e Anxiety Severe Anxiety Total

5 (71,4%)

2 (28,6%)

0(0%)

0(0%)

6 (75%)

2 (25%)

Gender Male Female 0(0%) 0(0%) 0(0%) 0(0%)

Study Group Level s of Anxi ety After 2 Week s Treat ment

Assesment of children‟s age in study group and the control between anxiety towards the teacher after 2 weeks treatment, is levels of anxiety happening of children less than 6 years of age is 28.6 % , smaller than the above age children and equal to 6 years ( 71.4 % ).

Gender Male Female 0(0%) 0(0%) 1(100%) 0(0%)

Table. 11 Assesment of Children’s Birth Grade in Study Group and Control Between Anxiety Towards The Teacher After 2 Weeks Treatment, June 2011

None Mild Anxi ety Mode rate Anxi ety Sever e Anxi ety Total

Total 0(0%) 1 (100%) 7 (100%)

Control Group Level s of Anxi ety After 2 Week s Treat ment

0 (0%) 8 (100%) Total 0(0%) 0(0%)

5 (71,4%)

2 (28,6%)

7 (100%)

1(100%)

0(0%)

6 (75%)

2 (25%)

1(100 %) 8 (100%)

None Mild Anxi ety Mode rate Anxi ety Sever e Anxi ety Total

Singl e 0 (0%) 0 (0%)

Birth Grade Eldes Midl t le 0 0 (0%) (0%) 0 0 (0%) (0%)

3 (42,8 %)

1 (14,3 %)

0 (0%)

1 (14,3 %)

Youn gest 0 (0%) 1 (100 %) 2 (28,6 %)

Total Total 0 (0%) 1 (100 %) 7 (100 %)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

3(37, 5%)

1(12, 5%)

1(12, 5%)

3(37, 5%)

8(100 %)

Singl e 0 (0%) 0 (0%)

Birth Grade Eldes Mid t dle 0 0 (0%) (0%) 0 0 (0%) (0%)

Youn gest 0 (0%) 0 (0%)

Total 0 (0%) 0 (0%)

4 (57,1 %)

0 (0%)

0 (0%)

3 (42,9 %)

7 (100 %)

1 (14,3 %)

0 (0%)

0 (0%)

0 (0%)

1 (100 %)

5(62, 5%)

0(0% )

0(0 %)

3(37, 5%)

8(100 %)

Assesment of children‟s birth grade in study group and the control between anxiety towards the teacher after 2 weeks treatment, is levels of anxiety going on greater than of single child and a youngest is almost three times compared to the eldest and middle child.

Assesment of children‟s gender in study group and the control between anxiety towards the teacher after 2 weeks treatment, is levels of anxiety is happening in male 71.4 % , higher than female (28.6 %) .

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Table. 12 Assesment of Father’s Income in Study Group and Control Between Anxiety Towards The Teacher After 2 Weeks Treatment, June 2011

Study Group Levels of Anxiety After 2 Weeks Treatm ent

None Mild Anxiet y Moder ate Anxiet y Severe Anxiet y Total

Control Group Levels of Anxiety After 2 Weeks Treatm ent

None Mild Anxiet y Moder ate Anxiet y Severe Anxiet y Total

Parent’s Income (million) Father None ≤1 >1 0 0 0 (0%) (0%) (0%) 0 0 1(100 (0%) (0%) %)

0 (0%) 1(100 %)

1 (14.3 %)

1 (14.3 %)

5 (71,4 %)

7 (100 %)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

1 (12,5 %)

1 (12,5 %)

6 (75% )

8 (100 %)

Parent’s Income (million) Father None ≤1 >1 0 0 0 (0%) (0%) (0%) 0 0 0 (0%) (0%) (0%)

Table. 13 Assesment of Mother’s Income in Study Group and Control Between Anxiety Towards The Teacher After 2 Weeks Treatment, June 2011 Study Group

Total

Level s of Anxi ety After 2 Week s Treat ment

None Mild Anxiet y Moder ate Anxiet y Severe Anxiet y Total

Control Group Total Level s of Anxi ety After 2 Week s Treat ment

0 (0%) 0 (0%)

1 (14.3 %)

2 (28,6 %)

4 (57,1 %)

7 (100 %)

0 (0%)

0 (0%)

1 (12,5 %)

2 (25% )

1 (100 %) 5 (62,5 %)

1 (100 %) 8 (100 %)

None Mild Anxiet y Moder ate Anxiet y Severe Anxiet y Total

Parent’s Income (million) Mother None ≤1 >1 0(0%) 0 0 (0%) (0%) 1 0 0 (0%) (14,3% (0%) ) 4(57,1 1 2 %) (14,3 (28,6% %) )

Total 0 (0%) 1 (100%) 7 (100%)

0(0%)

0 (0%)

0 (0%)

0 (0%)

5(62,5 %)

1 (12,5 %)

2 (25%)

8 (100%)

Parent’s Income (million) Mother None ≤1 >1 0 0 0 (0%) (0%) 0 0 0 (0%) (0%)

Total 0 (0%) 0 (0%)

5 (71,4% )

2 (28,6 %)

0 (0%)

7 (100%)

0

0 (0%)

1 (100%)

1 (100%)

5(62,5 %)

2(25 %)

1(12,5 %)

8(100 %)

Assesment of mother‟s income in study group and the control between anxiety towards the teacher after 2 weeks treatment, is levels of anxiety happening of mother no income greater than who earn more than 1 million and nearly three times the mothers who earn less than and equal to 1 million.

Assesment of father‟s income in study group and the control between anxiety towards the teacher after 2 weeks treatment, is levels of anxiety happening to fathers who earn more than 1 million more than who earn less than and equal to 1 million and none .

Discuss 1. Analysis Decrease Levels of Anxiety Toward The Teachers Results of the assesment of levels anxiety towards the teachers to child the first time school before and after 1 and 2 weeks treatment,

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showed that decrease anxiety scores towards the teachers. Anxiety to child at the school occured, because of the attitude and behaviors of teachers less friendly, unfriendly and incompetent (Astuti et al, 2010). According to Hurlock (2006), fear or anxiety to child may be influenced by the intelligence, gender, socioeconomic status, physical condition, social relationships, birth grade and personality. Negative perceptions to pre-school child has it happened because the development of cognitive, social, emotional and moral child not develop optimally, then habituation positive through exercise posture by giving food or toys are preferred, and in accordance with the child's development, can reduce attitudes and beliefs of children not good. (Freud; in Singgih and Yulia (2003)). Decrease of levels anxiety towards the teachers in the study group occurred because of the effect attitude exercise, that is positive conditioning to reduce the situation is less fun and also a process of maturation, while decrease of levels anxiety towards teachers in the control group occurred as a result of maturation of child and also through the process of imitating or equate themselves with friends. Age characteristics of child influence to develop intellectual, so that child can ability to perceive a stimulus that is received will be carefully and appropriately. Perception child positive, and a less pleasant experience which can lead to anxiety. Gender characteristics of child influence to interests and values, in which the interest and value of boys is higher than women. Birth grade characteristics of child influence to social and emotional develop. Characteristics of parents, influence to the role and to take care of the child. Anxiety towards the teacher to child the first time school, because age of parents in the range of young adult, and elementary education. Thats can influence to the understand and ability to take care of the child. Parents does not meet the principles of mental health, less aware of their responsibilities and domestic tranquility can not be realized, while the father has not been wise. Anxiety towards the teacher to child the first time school, because the competence of teachers not good. According Singgih and Yulia (2008), the teacher is the central figure at the school environment, and guide who learn of the develop personality. The successful achievement of tasks and obligations lies in the relationship

that is conducive that could be created with full communication of affection, respect, sincerity and the warmth of the teacher to the child. Favorable relations requires the ability to understand the students, the culture, and the corresponding value of child development. 2. Analysis The Effects Attitude Exercise Given To Decrease Anxiety To The Teachers To Child The First Time School Results of the assesment of median scores in the study group and the control group after 1 and 2 weeks of treatment, showed that difference. Decrease median scores in both groups after 1 week of treatment, and after 2 weeks of treatment of control group did not experience a decrease in median scores. Decrease of median score that is indicate to given attitude exercise for 2 weeks have an effect of levels anxiety towards teachers to child the first time school. According to Hurlock (2006), emotional development of child depends on factors ripening (maturation) and learning factors, of which the most important of the two is a factor of learning because it can be controlled. Process Children's learning process can be through trial and error, imitating, likening herself, conditioning and training. Hurlock (2006) also says that child really like the safe environment that is conducive. This environment can be created through the control of the environment by making the experience unpleasant emotions (reward). Exercise attitude is very helpful to reduce the anxiety towards the teacher to child the first school. Children initially had trouble adjusting in school or have a less pleasant experience when interacting with teachers, there will be insecurity, lack of confidence and calm. CONCLUSION AND RECOMENDED Conclusion 1. Results of the assesment of levels anxiety towards the teachers to child the first time school before and after 1 and 2 weeks treatment, showed that decrease anxiety scores towards the teachers. Decrease of levels anxiety towards the teachers in the study group occurred because of the effect attitude exercise, that is positive conditioning to reduce the situation is less fun and also a process of maturation, while decrease of levels anxiety towards teachers in the control group occurred as a result of maturation of child and also through the

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process of imitating or equate themselves with friends. 2. Results of the assesment of median scores in the study group and the control group after 1 and 2 weeks of treatment, showed that difference. Decrease median scores in both groups after 1 week of treatment, and after 2 weeks of treatment of control group did not experience a decrease in median scores. Decrease of median score that is indicate to given attitude exercise for 2 weeks have an effect of levels anxiety towards teachers to child the first time school. Exercise attitude is very helpful to reduce the anxiety towards the teacher to child the first school. Children initially had trouble adjusting in school or have a less pleasant experience when interacting with teachers, there will be insecurity, lack of confidence and calm.

http.Upi.Adu/Direktori/FIP/Jurnal PGTK. (sitasi Juli 2011) Frogratt, W. (2006). Free From Stress: Panduan Mengatasi Cemas. Bhuana Ilmu Populer. Jakarta Gunawan, Ary. (2000). Sosiologi Pendidikan. Jakarta. EGC http//en wikipedia org/wiki/Cognitive Behavior Therapy, 2008 Hurlock, Elizabeth B. (2006). Perkembangan Anak. Jilid 1. Jakarta. Erlangga Kearney, Silverman. (1996). Defined Refusal Behavior. Kecamatan Wates. (2010). Profil Kecamatan. Kediri. Pemerintah Kabupaten Kediri Mulyatningsih, Rudi., Sunu P., Kuswadi Y., Manik R. (2006). Bimbingan Pribadi Sosial Belajar. Jakarta. Grasindo Nelson. (2000). Ilmu Kesehatan Anak. Volume 1. Editor Richard E.Behrman, Robert M Kliegman, Ann M Arvin. Editor edisi Bahasa Indonesia A Samik Wahab Edisi 15. Jakarta. EGC Noorlaila, Iva. (2010). Panduan Lengkap Mengajar PAUD. Yogyakarta. Pinus Book Pbulisher Notoadmodjo, Soekidjo. (2002). Pendidikan dan Perilaku Kesehatan. Jakarta. Rineka Cipta. Notosoedirdjo. Moeljono., Latipun. (2007). Kesehatan Mental Konsep dan Penerapan. Cetakan V. Malang. Universitas Muhammadyah Press Ramalah, Savitri. (2003). Kecemasan Bagaimana Mengatasi Penyebabnya, Edisi 1. Jakarta. EGC Remschmidt, Belfer. (2004). Goodyer. Facilitating Pathways Care, Treatment and prevention In Child and Adolecent Mental Health. Spinger medizin verlag. Berlin Hiedelberg Semiun, OFM. (2007). Psikologi Untuk Keperawatan. Jakarta. Grasindo Singgih, D Gunarsa., Yulia Gunarsa. (2003). Psikologi Perkembangan Anak dan Remaja, Jakarta, Gunung Mulia Singgih, D Gunarsa., Yulia Gunarsa. (2008). Psikologi Perkembangan Anak dan Remaja, Jakarta, Gunung Mulia Sudiyanto. (2007). Bimbingan Teknis Psikoterapi CBT, FK UNS Sunaryo. (2002). Psikologi Untuk Keperawatan. Jakarta. EGC Sunaryo. (2004). Psikologi untuk Keperawatan. Jakarta. EGC

Recomended 1. Create a positive environment when dealing with children with problems of adjustment at the begin of school, the first of at least 2 weeks 2. Do development and assessment of teacher competence on a regular basis to stimulate increased understanding and ability of teachers to master the competence. REFERENCE Abdullah, Mulat Wigan. (2006). Sosiologi Untuk Anak SMP Semester VII. Jakarta. Grasindo Astuti, Endang Sri., Rosminingsih., Retno Widajati., Tuti Sukarni dkk. (2006). Bahan Dasar Untuk Pelayanan Konseling pada Satuan Pendidikan Jilid I. Jakarta. Grasindo Baron, Robert A., Donn Byrne. (2007). Pembentukan Sikap Melalui Sosial Learning and Social Comparison Dan Dipengaruhi Faktor Eksternal Atau Internal. Journal Komunika Volume 10 Nomor 1 Oktober 2007 Bernstein, Bettina E. Separation Anxiety and School Refusal Treatment and Management. http.// emedicine.medscape.com/article (sitasi tahun 2000) Collins, Mallary M., Fortenal. (1992). Pendekatan Positif. Cetakan I. Diterjemahkan oleh Kathleen Sri Wahdani. Jakarta. Gunung Mulia. Ernawulan,Syoiodih. Makalah Perkembangan Perilaku Sosial Anak Pra Sekolah.

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Thabirajah, et.al. (2008). Understanding School Refusal: a handbook for proffesionals in educational health and social care. Jessica Kingsley. London Thalib, Syamsul Bachri. (2010). Psikologi Pendidikan Berbasis Analisis Empiris Aplikatif. Jakarta. Kencana Tim Pengembang Ilmu Pendidikan, FIP-UPI. (2007). Ilmu dan Aplikasi Pendidikan. Bandung. Intima Wong, Donna L.. (2008). Buku Ajar Keperawatan Pediatrik Edisi 6 Volume 1. Alih Bahasa Agus Sutarna dkk. Jakarta. EGC

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STIMULUS EFFECT CUTANEOUS (SLOW-STROKE BACK MASSAGE) TO INTENSITY OF PAIN HEAD IN ELDERLY WITH HYPERTENSION (Unit Pelayanan Terpadu PSLU Blitar, Tulungagung 2015) Sukanto1, Dinda Wahyuningtyas2 STIKes Hutama Abdi Husada Tulungagung [email protected] Abtract Hypertension is systolic blood pressure greater than or equal to 140 mmHg and diastolic blood pressure greater than or equal to 90 mmHg One of the risk factors that lead to this unstability is aging process so that the primary clinical symptoms of headache. One of the non-pharmacological ways to cope with this pain is by applying cutaneus stimulation with slow-stroke back massage method. The mechanism of cutaneous stimulation using the principle of gate control theory and the theory of endorphins. The purpose of this study was to determine the effect of cutaneous stimulus (Slow-Stroke Back Massage) to the intensity of headache in the elderly with hypertension. The design used is to one group pretest-posttest. The research began February 23th until March 7th, 2015. The sample of this study were elderly people aged 55 to 80 years using purposive sampling technique were 30 elderly. The data collected by observation. The results of the 30 respondents before given stimulus cutaneous mostly experienced moderate pain is there are 21 (70%) of respondents, and after given stimulus cutaneus a small portion experienced mild pain is there are 7 (23.3%) of respondents. According of Wilcoxon Signed Rank test that p value (0.000) <α (0.05), then H 0 is rejected and H1 accepted that there is effect of cutaneous stimulus (Slow-Stroke Back Massage) to the intensity of headache in the elderly with hypertension.This research showed that administration of cutaneous stimulusis very effective in order to reduce the intensity of headache. Then of the cutaneous stimulus (slow-stroke back massage) can be used as an alternative option toreduce the intensity ofheadachein patients with hypertension. Keywords

: Slow-Stroke Back Massage, Headache Intensity,Hypertension, Elderly

referred to as 'The Silent Disease' or hidden disease. (Hartono, 2012). WHO (World Health Organization) said that cardiovascular disease is the largest cause of death in the population aged 65 years or older with more number of deaths in developing countries. Based on the data Lancet (2008), the number of hypertensive patients world wide continues to increase. In India, the number of hypertensive patients reached 60.4 million people in 2002 and an estimated 107.3 million people in 2025. In China, 98.5 million people have hypertension and increased to 151.7 million in 2025. In the the other in Asia, there were 38.4 million people with

PRELIMINARY Indonesia will experience an increase in the number of elderly population the 21st century. High increase in the number of elderly who have the potential to cause various problems both from the aspect of social, economic, cultural, and health (Nugroho, 2000). Health problems of aging occur on various body systems such as hypertension. Hypertension is one of the most deadly diseases in the world, because the disease can cause complications such as heart failure and stroke. Hypertension is a condition in which a person's blood pressure to rise which systolic blood pressure / diastolic exceeds 140/90 mmHg. It is often

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hypertension in 2000 and is predicted to be 67.4 million people in 2025. Data patients with hypertension in Indonesia reach 17-21% of the population and mostly undetected. In general, more women than men suffer from hypertension. It is closely related to diet, especially salt intake, which is generally higher (Muhamaddun, 2010). Based on the results of a preliminary study conducted by researchers at UPT PSLU Blitar, obtained the data in October 2014 there are many elderly suffer from hypertension. For the last 2 months there are 56,25% as many as 45 elderly people who suffer from hypertension of the total elderly. While the prevalence of hypertensive patients who experience headaches as many as 30 elderly ie 37.5% of the elderly who are 80 elderly. (UPT PSLU Blitar in Tulungagung, 2014). The impact of hypertension that can lead closed blood vessels (vasoconstriction), there by resulting in a decrease in cardiac output. If there is a decrease in cardiac output, the tissues of the body will experience a shortage of nutrients and O2. As cardiac compensation will increase to meet the needs of network contraction resulting in increased hydrostatic pressure of the blood vessels. Stiffness and increased hydrostatic pressure causes the lowest threshold of pain the brain blood vessels easily touched (hit), and the sensation of head pain will be felt hypertension. According Marlia (2009) general treatment of hypertension that is pharmacological and nonpharmacological. One of the actions complementary or non-farmacologist in reduce symptoms of hypertension like help to reduce the perception of pain or provide comfort in nursing is the Massage and touch sensory integration techniques that affect the activity of the autonomic nervous system (Potter and Perry, 2006). Relaxation is very important to helps clients to improve comfort and free themselves from the fear and the stress of illness and pain

experienced endless (Potter & Perry, 2005). Based on the above phenomenon, researchers are interested to knowing and proving there any influence cutaneous stimulus (Slow-Stroke Back Massage) to the intensity of headache in the elderly with hypertension in UPT PSLU Blitar in Tulungagung 2015. RESEARCH METHODS The design study is using a one-group pre-post test design. characteristic of this type of research is the use of a causal relationship by engaging a group of subjects. Group of subjects was observed before the intervention, and then observed again after the intervention (Nursalam, 2003). The population in this study were all elderly with hypertension in UPT PSLU Blitar in Tulungagung as many as 45 elderly. In this study sample used mostly elderly people who suffer from hypertension with headache in UPT PSLU Blitar in Tulungagung that meet the criteria desired by the researchers, the number of respondents are 30 people. In collecting data is used observation and interview for measuring instrument research. This experiment was held on February 23 until March 7, 2015 in Unit Pelayanan Terpadu PSLU Blitar in Tulungagung. In analyzing the effect of the stimulus effect of cutaneous (SlowStroke Back Massage) to the intensity of headache in the elderly with hypertension in UPT PSLU Blitar in Tulungagung 2015, using the Wilcoxon Signed Rank test statistic Tes.Bila p value <0.05 was said to be significant, the hypothesis 0 (Ho) is rejected, then H1 accepted meaning stated there Effect of stimulus effect of cutaneous (SlowStroke Back Massage) to the intensity of headache in the elderly with hypertension, while p value ≥ 0.05, hypothesis is accepted and H1 rejected, which means no cutaneous stimulus effect Effect (Slow-Stroke Back

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Massage) to the intensity of headache in the elderly with hypertension.

moderate pain respondents.

is

7

(23.3%)

of

3. The Result of statistical test From the data obtained, the next test statistics using the Wilcoxon Sign Rank T-test and showed sig. (2-tailed) less than 5% (p = 0.000) <( = 0.05), thus the results obtained H0 rejected and H1 accepted meaning there is effect, cutaneous stimulus effect (Slow-Stroke Back Massage) to the intensity of headache in the elderly with hypertension in UPT PSLU Blitar in Tulungagung.

RESULTS 1. Initensity Head Pain Before Awarded Stimulus cutaneous (Slow-Stroke Back Massage). Table 1. Distribution of frequency intensity characteristic of the headache before it is given stimulus cutaneous (slow-stroke back massage) in UPT PSLU Blitar in Tulungagung on 23 February -7 March 2015. No. Categori Frequen Prosenta es cy se (%) 1 No pain 0 0% 2 Less pain 9 30 % 3 Moderate 21 70 % pain 4 Hard pain 0 0% Jumlah 30 100 %

DISCUSSION A. The results Head Pain Intensity Stimulus Before Giving cutaneous Stimulus (Slow-Stroke Back Massage)

Source : Penelitian tahun, 2015 Table 1 above shows that out of 30 respondents largely there are 21 experiencing moderate pain (70%) of respondents. 2. Head Pain Intensity Stimulus Provided After cutaneous (SlowStroke Back Massage). Table 2. Distribution of frequency characteristics of headache intensity after cutaneous stimulus is given (slowstroke back massage) in UPT PSLU Blitar in Tulungagung on 23 February -7 March 2015. No. Categories Freque Prosentase ncy (%) 5 16,7 % 1 No pain 2 Less pain 18 60 % 3 Moderate 7 23,3 % pain 4 Hard pain 0 0% Jumlah 30 100 % Source : Penelitian tahun, 2015 Table 2 above shows that of the 30 respondents, some small experience

565

From table 1 the data obtained that before given stimulus cutaneous (slowstroke back massage), of 30 respondents mostly experienced moderate pain that is there are 21 (70%) of respondents, 9 (30%) of respondents experienced mild pain and 0 (0%) respondents did not complain of the pain. Pain is everything that someone says about the pain and occurs whenever someone has told that he felt pain (Potter and Perry, 2005), so that each individual will perceive pain in different ways depending on other factors that affect pain such as experience past, anxiety, culture, age, the placebo effect (Smeltzer & Bare, 2008) and the meaning of pain and coping style (Potter & Perry, 2006) and also factors of disease. Based on the above theory and fact, researchers believe that pain is a natural response of the body to respond to the presence of an abnormality in the body system. This happens because the response to pain that is felt by each of the indivitu vary depending on factors other causes such as age, anxiety, culture, the placebo effect, the meaning of pain and coping styles. Response to pain that is felt by the client begins with a decrease in the body's organ systems,

especially that of blood vessels that can lead to atherosclerosis, resulting in a decrease in cardiac output may increase the hydrostatic pressure of the blood vessels arises sensation of pain. The individual response to pain through three phases: activation starts when the first individual receiving pain stimuli to the body reacts to pain include muscular and emotional responses. The second stage is the stage of reflection, at this stage the pain that arises very great but brief. And the third stage is the stage adaptation, if pain lasts longer then the body will adapt to a pain, so that individual responses to pain vary. It was also evident from the research data that showed that before being given cutaneous stimulus of 11 respondents aged 75-90 years old, all experienced moderate pain that is there are 11 (100%) of the respondents, and of the 19 respondents who suffer from mild hypertension, almost all of which pain was that there were 17 (89.5%) of respondents.

the attributes certainly the experience of pain is that pain is an individual (Potter & Perry, 2003) so the response that occurs after treatment can not be compared with others. Mechanisms of pain reduction can be explained by the gate control theory, the pain intensity lowered by blocking the transmission of pain at the gate (gate), and the endorphin theory, namely the decrease in pain intensity was influenced by increased levels of endorphins in the body. With stimulus cutaneous (slow-stroke back massage), can stimulate the fibers A beta are numerous in the skin and responds to a light massage on the skin so that the impulse delivered more quickly. This makes the stimulation comes from the dominant impulse input A beta fibers so that the gate closes and pain impulses can not be transmitted to the cerebral cortex to be interpreted as pain. In addition, the descending control system will also react by releasing endorphinyang is the body's natural morphine that block pain transmission and perception of pain does not occur (Potter & Perry, 2005). Cutaneous stimulus correct use can reduce the perception of pain and helps reduce muscle tension that can increase pain, decreased pain intensity, anxiety, blood pressure, and heart rate were significantly (Mook E, 2003) Referring to the theory and the above facts the researchers found the presence of nursing actions such as the provision of cutaneous stimulus (slow-stroke back massage) for 10 minutes on the subject of the research, the intensity of the headache that is felt client can be decreased. This occurs because of the influence of the fibers A that can block the transmission of pain impulses and also the presence of endorphins which are natural morphine in the body so it can reduce the intensity of the headache that is felt by the client. It was also supported by research data shows that before being given cutaneous stimulus of 11 respondents aged 75-90 years old, all experienced moderate pain that is there are 11 (100%) of the respondents

B. The results Head Pain Intensity Stimulus After Giving cutaneous Stimulus (Slow-Stroke Back Massage) Cutaneous stimulus (slow-stroke back massage) for 10 minutes on the subject of the study show the results as listed in Table 2, which shows that of the 30 respondents, some small experience moderate pain there are 7 (23.3%) of respondents, 18 (60 %) of respondents experienced mild pain and 5 (16.7%) of respondents did not complain of pain. According to the theory explained that pain is a condition such as an unpleasant feeling, is very subjective because the feeling of pain is different for each person in terms of scale or the level, and only the person who can explain or evaluate the pain they experienced (Alimul, 2006). Decrease in pain intensity value of each individual is different even though the stimulus that causes pain and was given the same treatment. It is associated with one of

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and after a given stimulus cutaneous nearly half experience moderate pain that is there are 5 ( 45.5%). And of the 19 respondents who suffer from mild hypertension, almost entirely experiencing moderate pain that there were 17 (89.5%) of the respondents and after a given stimulus cutaneous nearly half experience moderate pain that is there were 5 (26.3%)

atherosclerosis, loss of elasticity of the connective tissue and a decrease in vascular smooth muscle relaxation, which in turn lowers the ability of distension and tensile strength of blood vessels. Consequently, the aorta and large arteries diminished ability to accommodate the volume of blood pumped by the heart (stroke volume), resulting in decreased cardiac output and increased peripheral resistance (Rohaendi, 2008). Increased pressure may touch peripheral blood vessels around it so sensation the pain felt by the individual. Management of nonpharmacological measures can be taken to reduce the intensity of headache is the stimulus cutaneous (slow-stroke back massage). Mechanism of this technique is with gate control theory, the pain intensity lowered by blocking the transmission of pain at the gate (gate), and the endorphin theory, namely the decrease in pain intensity was influenced by increased levels of endorphins in the body. With stimulus cutaneous (slowstroke back massage), can stimulate the fibers A beta are numerous in the skin and responds to a light massage on the skin so that the impulse delivered more quickly. This makes the stimulation comes from the dominant impulse input A beta fibers so that the gate closes and pain impulses can not be transmitted to the cerebral cortex to be interpreted as pain. In addition, the descending control system will also react by releasing endorphins which are the body's natural morphine that block pain transmission and perception of pain does not occur (Potter & Perry, 2005). Based on theory and the facts above, the researchers argue that the stimulus cutaneous the elderly who experience headache very effective in order to reduce the intensity of the headache that is felt client, it looks at the differences in the intensity of headache in the elderly with hypertension before and after stimulus cutaneous ( slowsroke back massage). This stimulus can dilate blood vessels, muscles become relaxed, can stimulate the fibers A and

C. The results of the analysis of cutaneous Stimulus Effect (SlowStroke Back Massage) Against Pain Intensity Head On Elderly with Hypertension Based on the results of statistical tests Wilcoxon Sign RankT-testdengan α = 0.05 was obtained p value = 0.000. Thus the p value (0.000) <α (0.05), then Ho is rejected. From the analysis above, it can be concluded that the stimulus cutaneous (slow-stroke back massage) has an influence on the intensity of headache in the elderly with hypertension. According to the theory, explained that the sympathetic nervous system stimulates the blood vessels in response to emotional stimuli. The adrenal glands also stimulated, resulting in additional activity vasoconstriction. The adrenal medulla secretes epinephrine causes vasoconstriction. The adrenal cortex to secrete cortisol and other steroids, which can strengthen the vasoconstrictor response of blood vessels. Vasoconstriction leading to decreased blood flow to the kidneys, causing release of renin. Renin stimulate the formation of angiotensin II, a vasokonstriktorkuat, which in turn stimulate the secretion of aldosterone by the adrenal cortex. This hormone causes the retention of sodium and water by the kidney tubules, causing an increase in intravascular volume, all these factors tend to trigger a state of hypertension. For consideration gerontology, functional and structural changes in the peripheral vascular system responsible for blood pressure changes that occur in the elderly. These changes include

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stimulate endorphin pengeuaran of the body so as to block the transmission of impulses to be transmitted to the brain (cerebral cortex). It was also reinforced by research data from Sumartini and Grhasta Dian Perestroika which showed that this stimulus can reduce pain intensity and can also stimulate the hormone endorphin which Brazilians of morphine naturally from the body, so the pain that arises can be neutralized resulting in a decrease in the intensity experienced by individuals. It was also proved by the research data shows that before being given stimulus cutaneous majority of respondents experiencing moderate pain that is there are 21 (70%) of respondents, and after a given stimulus cutaneous small proportion of respondents experienced moderate pain that is there are 7 (23.3%) of respondents , And from a small portion of respondents who experienced a mild pain that is there are 9 (30%) of respondents, having given no cutaneous stimulus large majority of respondents who experienced a mild pain that is there (60%) of respondents. Thereby providing a stimulus cutaneous (slowstroke back massage) can be used as an alternative option to reduce the intensity of headache in the elderly with hypertension in non pharmacological relatively no side effects.

hipertensi PSLU Tulungagung Blitar 2015. SUGGESTION 1. For Developers Sciences Nursing education institutions should equip students with knowledge of non-pharmacological treatment in the elderly who suffer from hypertension with symptoms of headache, which later can be equipped nurses in applying science and knowledge to the people, especially the elderly. 2. For Developers Program The result is expected as fill material for both increased insight and knowledge and skills nursing in increasing knowledge about how to lose headache in the elderly, efforts are made to improve education and health promotion activities to the public. SOURCES Arikunto,S. 2005. Prosedur Penelitian Suatu Pendekatan Praktek.Edisi Revisi keempat. Jakarta : Rineka Cipta. Arikunto, Suharsini. (2000). Prosedur Penelitian Suatu Pendekatan Praktek. Jakarta :PT. Rineka Cipta Ahmad, H.A.2002.Ilmu Penyakit Dalam.jilid I. Jakarta : Galia Indah. Azwar, S.2006.Metode Penelitian.Yogyakarta : Pustaka Pelajar Darmojo, B. 2006. Buku Ajar Geriatri (Ilmu Kesehatan Usia Lanjut) Edisi Ke-3. Jakarta : Balai Pustaka FKUI. Hidayat, A.Aziz Alimul. 2007. Riset Keperawatan dan Teknik Penulisan Ilmiah. Jakarta: Salemba Medika. Hutapea, R. 2005. Sehat dan Ceria di Usia Senja. Jakarta: Rineka Cipta. Kusyati, E. 2006. Keterampilan dan Prosedur Laboratorium Keperawatan Dasar. Jakarta : EGC. Mansjoer, Arief.2001 Kapita Selekta Kedokteran, Edisi 3. Jakarta : Media Aesculapius FKUI. Mardi Mario.2009.Rahasia Hidup Sehat dan Efesien. Jakarta : Gramedia Pustaka Utama

CONCLUSIONS AND SUGGESTIONS CONCLUSION Based on the results of the study the influence of stimulus cutaneous (Slow-Stroke Back Massage) to the intensity of headache in the elderly with hypertension in UPT PSLU Blitar in Tulungagung, 2015 can concluded from 30 respondents with analyzed by using statistical test of Wilcoxon Signed Ranks Test with a value of ρ = 0.000, meaning that ρ <α = 0.05, so that H0 rejected H1 accepted and that means the stimulus effect of cutaneous (SlowStroke Back Massage) to the intensity of headache in the elderly with UPT

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Maryam, dkk.2008. Mengenal Usia Lanjut Dan Perawatannya. Jakarta : Salemba. Midyuin, 2010. Rancangan Penelitian cross sectional. http://dhinierha.blogspot.com/2009/r ancangan-penelitian-crosssectional.html.tanggal 30 November 2014. Mok, E; Chin Pang Woo. 2004. The Effects of Slow-Stroke Back Massage on AnxietyandShoulder Pain InElderly Stroke Patients.http://www.sciencedirect.co m/science, Diakses 30 October 20014 Notoatmojo, S. 2003. Metodologi Penelitian Kesehatan. Jakarta : Rineka Cipta. Notoatmojo, S. 2002.Pendidikan dan Perilaku Kesehatan. Jakarta : Rineka Cipta Nugroho, W. 2000. Keperawatan Lanjut Usia. Jakarta : EGC. Nursalam, 2003. Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan : Pedoman Skripsi, Tesis dan Instrumen Penelitian Keperawatan. Jakarta : Salemba Medika. Nursalam dan Pariani,S. 2003 . Pendekatan Praktis MetodoLogi Riset Keperawatan. C.V. Jakarta : Sagung Seto. Potter, Patricia A; Anne Griffin Perry. 2005. Buku Ajar Fundamental Keperawatan: Konsep, Proses, dan Praktik Edisi 4 Volume 2. Jakarta : EGC. Sabri,luknis dan Sutanto Priyo Hastono. 2008. Statistik Kesehatan.Jakarta: Rajawali Pers Sarwono, Jonathan.2000.Analisis Data Penelitian. Yogyakarta : CV Andi Offset Smeltzer, Bare. 2002. Buku Ajar Keperawatan Medikal Bedah Brunner & Studdarth. Jakarta : EGC. Sugiyono, 2009 . Metode Penelitian Kuantitatif Kulalitatif dan R&D. Jakarta : CV Alfabeta. Suharsono.2004.The Dance Of Minds. Kementrian Kesehatan RI. Jakarta

Suparman, 2005 . Jurnal Cermin Dunia Kedokteran No.146 . Jakarta. Surewati.2003.Ilmu Penyakit Dalam Jilid 3. Jakarta : Graha Ilmu Stanley M, Patricia GB. 2006. Buku Ajar Keperawatan Gerontik Edisi 2. Jakarta: EGC. Syarifudin B. 2009. Panduan TA Keperawatan dan Kebidanan dengan SPSS. Yogyakarta : Grafindo Litera Media Tamsuri, Anas.2006. Konsep dan Penatalaksanaan Nyeri. Jakarta : EGC. .

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The Activity Test of Pandan Wangi Leaves Extract (pandanus amaryllifolius Roxb) forSolubility of Calsium Kidney Stones by in Vitro Method using atomic Absorbtion Spectrophotometri (AAS) Ida Kristianingsih1, Dewi Resti Basuki2, Siti Mamluk Atul M3 FAKULTAS FARMASI INSTITUT ILMU KESEHATAN BHAKTI WIYATA KEDIRI Email: [email protected] Abstract Pandanus amarylliflius Roxb.folium has been used from generation to generation as kidney stones medicine. Mursito (2001) in his book said thaPandanus amarylliflius Roxb folius has flavonoid as one of the constituents. In accordance with Pramono (1986), one of the kidney stones medicine mechanisme is by forming dissolvable calcium-flavonoid complex. The experiment was purposed to know whether water extract of Pandanus amarylliflius Roxb folium contains flavonoid and could dissolve calcium contained in kidney stones. Kidney stones as subject were homogenized its fitrated sefted using a mess 45, and then to test of qualitatively analized chemically. Pandanus amarylliflius extracted with water and get analized qualitatively with Wilstatter Test. The kidney stones divided into seven group, each of them soaked in aquadest, Calcusol 1,2%, solution, Pandanus amarylliflius Roxb. Folium extract 0,625%, 1,25%, 2,5%, 5% and 10%,during ±5 hour with temperature ±37°C. Quantitative analize with Atomic Absorption Spectrophotometer was done to the solution after soaking. Qualitative analysis of kidney stones calcium shows positive results. Flavonoid qualitatif analysis with Wilstatter Test shows possitive results of flavonoid with carmine colours. Atomic Absorption Spectrophotometer data analysis by One Way Anova shows significant differentiation the amount of dissolved kidney stones calcium in aquadest negative control and 1,2% Calcusol as positive control are 0,3812 ± 0,0027 ppm and 1,4053 ± 0,0051 ppm; The0,625%, 1,25%, 2,5%, 5% and 10%, Pandanus folium extract could dissolved kidney stones calcium 1,4590 ± 0,0065 ppm, 2,8419 ± 0,0078 ppm, 2,5909 ± 0,0176 ppm, 2,9439 ± ,00740 ppm, 5,4445 ± 0,02562 ppm. The experiment results shows that water extract of Pandanus amarylliflius Roxb.,. Leaves contains flavonoids and could dissolve calcium in kidney stones. The experiment results shows that water extract of Pandanus amarylliflius Roxb., folium contains flavonoids and could dissolve calcium in kidney stones Keyword : Pandanus amarylliflius Roxb., kidney stone, calcium, Atomic Absorption Spectrophotometer

causing turbidity or urine becomes concentrated. The next result of blockage in the drain from the kidney to the bladder which can disrupt the smooth flow of urine. If the urine is obstructed exit of the kidney, there will be accumulated of urine in the kidney. In addition, it can also lead to infection due to the emergence of bacteria or viruses from the bladder. Accumulation of urine in the kidneys and infection that lasts a long time will lead to a decrease

INTRODUCTION The people considers that the used of traditional medicine was safer than chemical medicine, so that they prefer to used traditional medicine to cure many diseases. They are usually consumed in the form of stew, steeping, or directly consuming that are considered nutritious (Anonim, 2008). Kidney stones were one of the health problems in the urinary system, because the body is dehydrated, its

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in the physiological function of the kidneys. Traditional medicine used empirically is pandan wangi (Pandanus amaryllifolius Roxb). it used by the community as a laxative medicine kidney stones. The people used it hereditary and based on their experiences used boil water of pandan wangi leaves to treat kidney stones. One of the laxative mechanism drug by dissolving kidney stones are calcium kidney stones. Pandan wangi leaves, according Dalimartha (2000) contains flavonoids. In his research, Pramono (1986), states that the mechanism of dissolution of calcium kidney stones with the possibility of the formation of complexes between ionic calcium kidney stones with a hydroxy group carbonyl flavonoids contained in traditional medicine. Rahardjo study (2003) showed that infusion of pandan wangi leaves can dissolve calcium kidney stones. Some results phytochemical screening of pandan wangi contains alkaloids, saponins, flavonoids, tannins, and a dye. These flavonoids can be extracted with ethanol 70%. Ethanol can be used to sum up the relatively high polarity substance until relatively low. Pandan wangi leaves ethanol extract is obtained through maceration which are a method that is suitable for compounds that do not withstand heating to high temperatures and is often used for extracting the ingredients which floured smooth simplicia (Voigt, 1994). Preparations of infusa can only sum up the substances that are polar, penyarian this way produce pollen that is unstable and easily contaminated by bacteria and fungi, therefore the juice obtained must not be stored for more than 24 hours. Another disadvantage is the cause swelling of the cell so that the active ingredient will be firmly attached to the bulbs. While the dosage forms in addition to the extract can be stored for longer also can be used repeatedly.

Method 1. Processing of simplicia Pandan Wangi Leaves plants grow away from water sources and harvested during the dry season. The leaves are taken is growing 8 strands of shoots up to 8 strands of the base and than its were cut 10 cm from the base of the leaf. Leaves were disorted and washed with flow of water. The leaves are allowed to dry with air flow and Its not exposed to direct sunlight. 2. Preparation of pandan wangi ethanol extract Pandan Wangi Leaves were dried under shade and then were powdered with a sieve number 8 made extrac. Extraction using 170 g (10 parts) simplicia pandan wangi leaves by maceration with ethanol 70% as much as 1.275 ml (75 parts). Maceration performed for 5 days with stirring twice a day. Maserat obtained from filtration was collected. The remaining pulp macerated again 2 days, filtered and collected to obtain 1700 ml (100 parts). Maserat obtained evaporated with a rotary evaporator at a temperature of not more than 500C, until a thick consistency is formed future. The Extract is made by weighing 10 grams of pandan wangi leaves extract is dissolved in 100 ml of solvent (DMSO and distilled water). 3. Treatment of kidney stones disease Kidney stones are made of powder by means of crushed using a mortar and sieved with a mesh size 45. After sifted powder kidney stones washed with distilled water and dried flows. 4. Preparation of calcusol 1.2% (a therapeutic dose of 1 day) Calcusol as a positive control, six capsules calcusol (3 x daily therapeutic dose of 2 capsules) is opened and its contents weighed 2.4 grams gained weight. The powder is then dissolved in distilled water to 200 ml (volume one drink)→ levels of 2.4 g / 200 ml = 1.2%

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dilute with water as much, whipped and left. Red to orange color is given by the flavonoids, dark red color is given by the flavonol or flavonon, green to blue color is given by the aglycone or glycoside.

5. Test the identification of calcium kidney stones in vitro Test identification of calcium kidney stones by using chemically qualitative inorganic analysis. Powder kidney stones included a test tube and reacted with detection reagents:

7. Grouping and treatment of test subjects Kidney stone test subjects were divided into seven groups. The first group, a negative control, were given distilled water, kelompak II, the positive control, given calcusol solution 1.2%. Group III to VII consecutive extract fragrant pandan leaves grading 0.625%, 1.25%, 2.5%, 5% and 10% . The seventh group of test subjects are treated as follows, as much as 50 mg powder kidney stones soaked with 5 ml of the test solution as specified above in the tube and placed in a water bath with a temperature of 370C for 5 hours and shaken every half hour for one minute. After 5 hours the filter with filter paper, the filtrate obtained was analyzed by atomic spectrophotometer to determine the solubility of calcium.

a. Carbonic Kidney stones are already included in the test tube was added HCl 10%, when gas formation means CO3 (+). b. Calcium Kidney stones are already included in the test tube was added 3 ml of HCl 10%, then heated and added saturated ammonium oxalate through the tube wall (not shaken), the white precipitate like fog means calcium (+). c. Oxalate Kidney stones are already included in the test tube was added 1 ml of HCl 10%, then bring to a boil and coupled with MnO2 tip of a spoon. If the gas arises, then oxalate (+). d. Phospat Kidney stones are already included in a test tube add 4-5 drops of HNO3, then heated until the powder kidney stones

8. Preparation of standard curve Making the standard curve begins with a calcium stock solution of 1000 ppm. Laruatn stock calcium prepared by dissolving 2.497 grams of CaCO3 in 100 ml of HCl 1M and added distilled water up to 1000 ml. Solution standard curve then pipette 10 ml and 100 ml plus aqudest. This solution is called the working standard solution with a concentration of 100 ppm. Of the working standard solution is then diluted to obtain a standard solution standard with konsentrasi1 ppm, 2 ppm, 3 ppm, 4 ppm, and 5 ppm. 1 ppm standard solution prepared by diluting 1mI 100 ppm calcium solution using distilled water to 100 ml Calculation: V1 x C1 = V2 x C2 Description : V1 = volume solution of working stones CaCO3

6. Qualitative test pandan wangi leaves extract with test method Wilstatter a. Preparation of experiments Take the equivalent of 10 grams of extracts of plant material. Whipped repeatedly with hexane until the extract is colorless. Discard the hexane phase. Mix the residue with 10 ml of 80% ethanol and then filtered to filtrate into 2 equal parts a lot (A, B). A tube is used as a control. b. Test wilstatter "cyanidin" Tube supplemented with 0.5 mL of concentrated HCl, then add 3-4 slices of magnesium. Observe the color change occurring within 10 minutes. If the stain is weak, the solution is taken in half and added to 1 ml of octyl alcohol. Then

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C1 = concentration of CaCO3 working standard solution (100 ppm) V2 = volume of standard solution (100 ml) C2 = concentration of standard solution (1 ppm, 2 ppm, 3 ppm, 4 ppm, 5 ppm) Standard solution 2 ppm, 3 ppm, 4 ppm, 5 ppm created using the same way.

Atomic spectrophotometer set the conditions for the determination of levels of calcium. The condition of the tools used are: Lamp current: 7.5 Ma Wavelength: 422.7 nm Oxidant: Air 3 kg / cm²; 15 l / min Fuel: Acetylene; 1.1 kg/cm²; 2l/ min Once the conditions are appropriate tools, raw absorbance readings performed and samples.

Figure 1. Standard Curve Profile A. Randemen Pandan Wangi Leavesextract Extract Method Used In This Study Is Maceration. Simplicia dry powder pandan wangi leaves used a 170 g. Extraction solvent ethanol 70% as much as 1700 ml. Do as much as 3x. Extraction results are collected and then evaporated with a boiling water bath until thick extract obtained. And is calculated on the weight of crude drug extract randemen early. Randemen extracts = the total weight of the extract obtained x 100 ml Simplisia initial weights

9. Sample Preparation A sample of the filtrate results immersion kidney stones filtrate samples diluted with distilled water immersion results with distilled water, pandan wangi leaves extract 0.625%, 1.25%, was diluted 10 times is done by taking a 1 ml sample was then added to 10 ml of distilled water. Samples pandan wangi leaves extract 2.5%, 5% and 10% diluted 50 times by taking a 1 ml sample was then added to 50 ml of distilled water. 10. Preparation tool

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Table 1. Results randemen extract Replication

initial Weight (g)

1 2 3

170,0003 170,0002 170,0001

Weight extrac (g) 17,0230 17,0180 17,0220

Average

B. Results Making Fragrant Extract (Pandanus Amarillifolius Roxb.)

Randement extract 17,023 17,018 17,022 17,021

C. Results Qualitative Test Method Flavonoids With Wilstatter Assay was done by qualitative chemical. Begins by weighing 10 grams of extract. Then extract that has been weighed mixed with hexane in a separating funnel. The mixture is shaken repeatedly until the extract is colorless. Hexane phase discarded, the residue is added 10 ml of 80% ethanol, filtered and the filtrate was divided into two parts as much (A and B).

- The weight of the powder herbal P.Wangi leaves: 170 grams - The volume of ethanol 70% : 1700 ml - Weight viscous extract : 17.021 grams - Percentage randemen: % Randemen = weight extract thick x 100 the weight of powder % Randemen = 10.012%

Table 2 Results of the qualitative examination of flavonoids Tube A B

treatment _ added 0.5 ml HCl concentrated, then added 3-4 magnesium.

D. Qualitative Results Of Kidney Stones Before the identification test of calcium, then the kidney stones crushed and sieved with a mesh size of 45. Tests conducted in vitro method of qualitative inorganic chemical analysis. Kidney stone powder reacted with calcium reagent identification, ie carbonate solution, a solution of calcium, oxalate solution, and a solution of phosphate. observed deposition of calcium compounds are formed.

result Negatif control Old red its showed that contain flavonoid

E. Levels of Measurement Results Samples with AAS Soaking kidney stones with pandan wangi leaves extract distilled water negative control and positive control calcusol, levels of 0.625%, 1.25%, 2.5%, 5% and 10%, carried out for 5 hours at a temperature of 37°C and every 30 minutes done shaking for 1 minute. After soaking for 5 hours, filtrate screening results were analyzed dissolved calcium content using atomic absorption spectrophotometer

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Table 3. Results of the qualitative examination of calcium kidney stones NO 1

2

3

4

Treatment

Result

Carbonat Assay Kidney stone powder + HCl 10% Calcium Assay Kidney stone powder + 3 ml of HCl 10%, heated + NH4 oxalate saturation through the wall of the tube (do not shake) Oksalat Assay examination Sulfate Kidney stone powder + 1 ml of HCl 10%, boil + tip of a spoon MnO2 Phospat Assay idney stone powder + 3 ml of HCl 10%, heated + NH4 oxalate saturation through the wall of the tube (do not shake)

CO3

+

A white precipitate is formed like a fog

+

Arising gas

+

Pale yellow

-

Table 4 Results of measurements of samples with SSA Sample

Neg control.Aquades Pos. control Calcusol 1.2% P.Wangi extract 0.625 P.Wangi extract 1.25% P.Wangi extract 2.5% P.Wangi extract 5% P.Wangi extract 10%

Absorbance

0.0382 0.1162 0.1204 0.2258 0.2066 0.2335 0.4241

Concent ration (ppm) 0.3813 1.4046 1.4597 2.8426 2.5907 2.9436 5.4442

Dilution factor

Concentration of sample (ppm)

10 10 10 10 50 50 50

3.813 14.046 14.597 28.426 129.535 29.436 272.21

Figure 2. Histogram test solutions versus the average Ca dissolved by atomic absorption spectrophotometer, the results of immersion calcium kidney stones with the test solution for 5 hours

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In this case, the researchers only identify the elements which generally form kidney stones among other things carbonate, calcium, oxalate, and phosphate. However, the most important element in this study is calcium. For qualitative analysis of calcium, carried out by first adding calcium powder with 10% HCl. The addition of 10% HCl aims to dissolve the calcium. Selection of HCl 10% based on the theory that most of the compounds in the form of calcium kidney stones of calcium oxalate. This is evident in the analysis of oxalate which showed positive results. Calcium oxalate is only soluble in strong mineral acid HCl 10% so selected that a strong mineral acid as the solvent of calcium oxalate. After the addition of 10% HCL and heated, then the solution was added ammonium oxalate. Calcium analysis results are as follows: CaCl2 + (COONH4) 2 Ca (COO) 2 + 2NH4Cl The addition of ammonium oxalate solution causes the formation of a white precipitate such as fog (+). The above reaction shows that the subject of kidney stones were used in this study contains calcium. Flavonoid qualitative analysis carried out by Wilstatter Test. This analysis aims to determine the content of flavonoids in pandan wangi leaves extract used in the study. Flavonoida are polar compounds that can form complexes with metal ions. Wilstatter In tests, the addition of magnesium as the metal ion. In literature, it is mentioned that the test is done by extracting the equivalent of 10 grams of plant material. and added hexane until colorless. The purpose of the addition of hexane is to attract chlorophyll that can interfere during the examination of flavonoids. Then, the hexane phase discarded, the residue mixed with 10 ml of 80% ethanol. This filtrate concentrated HCl plus 0.5, then added 34 magnesium metal. Results can be seen after 10 minutes. From this test get a deep red color that identifies a class of flavonoid compounds flavonols.

RESULT AND ANALYSIS Pandan wangi used in this study was obtained from Purwodadi. This study begins with the identification of pandan wangi will be used. This step aims to ensure that the plants used are not wrong and actually comes from Pandanus amaryllifolius Roxb species. The extraction method used in this research was maceration with ethanol 70% as solvent. Ethanol are neutral, can inhibit the growth of mold and bacteria, non-toxic, can be mixed with water at any ratio, and the time required for a concentration of less (Depkes, 1986). So it is expected these solvents can obtain optimal active substances because it can attract active substances that dissolve in water or in alcohol. The amount of 70% ethanol used in this maceration is 10 times the weight of crude drugs. Pandan wangi leaves extract made with a series of levels of 0.625%, 1.25%, 2.5%, 5% and 10%, the selection is based on a series of levels of study Rahardjo with levels of 10% proved to have an influence on the solubility of calcium kidney stones. For further research then made a different dosage forms that extracts fragrant pandan leaves with lower levels, and whether the dosage form of the extract has an effect on the solubility of calcium kidney stones. Kidney stones before it is treated with fragrant pandan extract, than it washed with distilled water flowing and dried. Afterwards, kidney stones crushed and then sieved with a sieve mesh size of 45. The purpose of the washing is done to remove impurities that exist in kidney stones. While sifting is done so that the size of the kidney stone that is used uniformly. To determine the content of calcium in the kidney stones were used then conducted a qualitative analysis of the chemical calcium. One purpose of this study was to determine the effect on the solubility of fragrant pandan extract calcium kidney stones in vitro, therefore, needed kidney stones contain calcium as one of the constituent components.

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Quantitative analysis of the solubility of calcium kidney stones is done by adding 50 mg powder kidney stones each into 7 groups. The seventh group include: 5 ml of distilled water as a negative control, 5 ml calsusol 1.2% as positive control, and sample each 5 ml pandan wangi leaves extract 0.625%, 5 ml pandan wangi leaves extract 1.25%, 5 ml pandan wangi leaves extract 2.5%, 5 ml pandan wangi leaves extract 5%, and 5 ml pandan wangi leaves extract 10%,. Soaking carried out for 5 hours at a temperature of ± 37 ° C and every minute is done shaking for 1 minute. After soaking for 5 hours, 7 groups filtered using filter paper. In this study, used Calcusol positive control because it is a traditional medicine that kidney stones proven efficacious and have been determined by a doctor. As for the negative control used is distilled water. The use of negative control aims to look at the possibility of dissolution of calcium for treatment during soaking and shaking. Selection of atomic absorption spectrophotometer is based on the ability to measure levels of metals with high accuracy and low detection limit. Atomic absorption spectrophotometer can detect calcium metal to levels of 0,002 ppm. Analysis of calcium in fragrant pandan extract made with flame atomization at a wavelength of 422.7 nm, air oxidant 15 l / min, acetylene fuel 2 l / min. A wavelength of 422.7 nm is the wavelength of maximum spectral calcium. A mixture of air-acetylene flame temperature required to reach about 2300 ° C. The high temperatures needed to melt, evaporate, then mengatomkan calcium metal which has a melting point of 838 ° C and a boiling point of 1440 ° C. Before measuring the absorbance of the sample prior measurement of the absorbance of standard solutions. Absorbance measurement standard solutions aimed at obtaining the raw curve equation used to calculate the level of calcium in the sample extract fragrant pandan leaves.

Standard curve of standard solution absorbance measurement results can be seen in Table 4. Before the measurement of absorbance, sample first made sample dilution. The sample dilution due to high calcium in the sample. Absorbance measurement results show the sample absorbance after being diluted. The concentration of dissolved calcium in the sample before dilution can be calculated by multiplying the dilution factor with the concentration of calcium measured. Atomic absorption spectrophotometer analysis results processed using descriptive statistical methods to determine whether a data Explore each sample has a normal distribution and homogeneous variants. Explore normal distribution in statistics ditujukkan with the ratio between the value of skewness and kurtois and strandart error no more than ± 2. Variant data are expressed homogeneous when its significance is greater than 0.05%. Explore the results of the analysis show that the data were normally distributed and had homogeneous variant. Analysis of the One Way ANOVA statistical method performed to see whether there are differences in the data from each sample and whether it is a significant difference or not. Methods One Way Anova been a parametric analysis method for data with one free variable that is first of the two treatments and unpaired. Calcium solubility data analysis using One Way ANOVA showed significance value less than 0.05 (sig. <0.05). Sig. <0.05% indicates that there is a difference in the average value of the solubility of calcium kidney stones in distilled water negative control, positive control calcusol 1.2% and pandan wangi leaves extracts of each level. To find out which groups that have an average difference of dissolved calcium, and if the difference is significant, the use of comparative analysis with the Tukey HSD method. In the analysis of Tukey HSD average significant difference between

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samples is shown with significance value of less than 0.05. Significance value obtained from the comparison of the average solubility of calcium each sample in Tukey HSD analysis is less than 0.05. it can be said that the average solubility of calcium in distilled water negative control, positive control Calcusol 1.2%, and the pandan wangi leaves extracts from each of the different levels of meaning or difference is real or significant. It is marked on the Mean Difference column contained an asterisk (*). The amount of calcium dissolved in pandan wangi leaves extract and the percentage increase of the negative control and a positive control Calcusol distilled water of 1.2% can be seen in Table V. Comparison between the negative control and a positive control calcusol distilled water of 1.2% indicates that the ability to extract fragrant pandan leaves 2 , 5% calcium kidney stones dissolve the lower 2.5909% and 84.3663. Aquadest comparison with the negative control and positive control Calcusol 1.2% indicated that the ability of pandan wangi leaves extract 0.625%, 1.25%, 5% and 10% are able to dissolve calcium kidney stones with each percentage increased, 282.6381 ± 3.8265, ± 645.3675 102.2272, 672.1198 ± 109.4855, 287.4315 ± 1327.9916, although a less capable but wandan pandan wangi leaves extract 2.5% still has the potential to dissolve calcium kidney stones because Tukey HSD analysis results showed significant differences between calcium dissolved in a pandan wangi leaves extract 2.5%. Histogram test solutions versus the average Ca dissolved by atomic absorption spectrophotometry, results immersion calcium kidney stones with the test solution for 5 hours. Histogram relationship between the test solution with the amount of dissolved calcium indicates that the higher the concentration of the extract, the amount of dissolved calcium also higher. Flavonoids contained in the extract to

form soluble complexes with calcium so that an increasing number of flavonoids would increase the amount of dissolved calcium. Research pandan wangi leaves extract effect on the solubility of calcium kidney stones in vitro results that pandan wangi leaves extract content of 0.625% to 10% can dissolve calcium kidney stones. ability to dissolve calcium kidney stones caused by the flavonoids in pandan wangi leaves extract. This study is the first step to determine the ability of pandan wangi leaves extract kalsim in dissolving kidney stones. Further studies need to be performed in vivo to determine the ability of pandan wangi leaves extract in dissolving calcium kidney stones.

CONCLUTION The experiment results shows that water extract of Pandanus amarylliflius Roxb.,.folium contains flavonoids and could dissolve calcium in kidney stones REFERENCES 1. Anonim. 2008. Sediaan Galenik. Jakarta: Departemen Kesehatan RI 2. Anonim. 1979. Vademekum Bahan Obat Alam. Jakarta: Depkes RI 3. Anonim. 2008. Buku Pintar Tanaman Obat. Jakarta: Agromedia, 16-17. 4. Cahyono. 2009. Bagaimana Cara Mencegah dan Mengatasi Batu Ginjal. yogyakarta 5. Dalimartha, Setiawan. 2000. Atlas Tumbuhan Obat Indonesia. Jilid I. Trubus Agriwidya. Jakarta. 103104 6. Gandasoebrata, R. 1968. Penuntun Laboratorium Klinik. Jilid I. Dian Rakyat. Jakarta. 186187 7. Gandjar, Ibnu, Gholib. 2007. Analisis Kimia Farmasi. Yogyakarta

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20. Voigt, R. 1994. Buku Pelajaran Teknologi Farmasi. Di Terjemahkan Noerono, S. edisi V. 551-564. Gadjah Mada University Press. Yogyakarta

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THE EFFECTIVENESS OF FLUID RINGER ACETATE MALAT COMPARED WITH RINGER LACTATE FLUID IN ACCELERATING TIME INCREASE IN BLOOD PRESSURE IN RATS (RATTUS NORVEGICUS) Ika Rahmawati¹, Lizete Auxiliadora Costa Malic² Nursing Major Faculty of Health Science Institut Ilmu Kesehatan Bhakti Wiyata Kediri Abstract Dehydration is described as a state of disturbed fluid balance that can be caused by various types of disease. One of the signs and symptoms of dehydration is a decrease in blood pressure. Dehydration occurs due to loss of water more than on the water inlet. Fluid administration is one of the measures taken to overcome the problem of dehydration. Ringer Acetate Malate fluids containing electrolytes are balanced with concentrations similar to those found in human plasma. Ringer Lactate fluid is a crystalloid liquid that is widely used in fluid therapy. The levels of sodium in the crystalloid solution called Ringer Acetate Malate is more similar with the plasma of the human body than Ringer lactate therefore Ringer Acetate Malate more isotonic than Ringer Lactate. Acetate metabolism also obtained 3-4 times faster than Lactate. Experimental animals used in this study were white rats (rattus norvegicus) totaling 14 samples. This study aims to determine the effectiveness between the administration of Ringer Acetate Malate fluid compared with Ringer Lactate fluid in accelerating time increase in blood pressure in rats. Type of research is quantitative research, design true eksperimental approach pra test- post test group design. Data collection using observation. Data were analyzed by Independent T Test statistical test to determine differences in Ringer Acetate Malate fluid and Ringer Lactate fluid in rats. Based on the survey results revealed that the increase in blood pressure in rats by administration of Ringer Acetate Malate fluid there is an increased and accelerated the volume of urine produced by the average amount of 0.3625 cc in less than 2 hours. While Ringer Lactate for fluid administration in increasing blood pressure and accelerate time amount of urine produced volume is 0.275 cc within 2 hours or more. The results of statistical tests using Independent T Test found the difference between giving Ringer Acetate Malate fluids with Ringer's Lactate with values obtained α = 0.017. Conclusions from this study that there is a difference between giving fluids Ringer Acetate Malate with Ringer Lactate fluid in accelerating time increase in blood pressure in rats. Increased blood pressure more quickly by providing fluid Ringer Acetate Malat than using fluid Ringer Lactate. Key Words : Ringer Acetate Malate, Ringer Lactate, Blood Pressure

584

dehydration if fluids and electrolytes are not replaced either through oral rehydration solution Salts (ORS) or through intravenous fluids (15). Children are smaller (toddlers) are more susceptible to dehydration due to the composition of body fluids large, immature kidney function, and inability to meet their own needs independently (independent) (7). The main goal of fluid therapy Ringer Acetate Malat (RAM) is in lieu of extracellular fluid, prevents dehydration, prevent hypotension, correcting fluid and electrolyte deficiency rapidly (rehydration therapy) and to prevent nutritional deficiencies (5). Based on the amount of fluid lost dehydration can be categorized into 3 among others: without dehydration, mild dehydration moderate, and severe dehydration. Diarrhea without dehydration children appear unconscious, not sunken eyelids, lips and tongue wet, skin turgor back quickly, in this case can be given ORS as much as 5 to 10 ml/kg. On being discovered signs of mild dehydration sunken eyes, children restless or cranky, thirsty to drink with gusto, pinch back by slow stomach. In this case the child should get as much ORS 75 ml/kg administered over 3 hours by monitoring the progress of hydration. In the severe dehydration, the child looks unconscious, sunken eyes, can not drink or drink lazy, the abdominal skin pinch the return is very slow. In this situation the child must be hospitalized and receive intravenous fluids 100ml / kg for 6 hours in infants aged under 12 months and 3 hours for children older than 12 months (13). RAM solution is different from the solution of Ringer Lactate (RL), where lactate is mainly metabolized in the liver and a small portion of the kidney , while acetate is metabolized in almost all tissues of the body, especially in muscles. The RAM solution containing electrolytes are balanced with concentrations similar to those found in human plasma. This solution can be used for handling fluids in the perioperative haemostasis and can be used to replace the volume of provisional intravasal (9) . Based on the above, the researchers are interested in doing research on the effectiveness of the liquids Ringer Acetate Malat compared with Ringer Lactate fluid in accelerating time increase in blood pressure on the White Rat (Rattus norvegicus) .

INTRODUCTION Dehydration is a condition that disturbed fluid balance that can be caused by various diseases (7). Dehydration occurs due to loss of water (output) more than on the water inlet (input) (13). Discharge is usually accompanied by an electrolyte (9). Dehydration caused by diarrhea is the leading cause of death in infants and toddlers (7). Data from the World Health Organization (WHO) in 2004 in the WHO (2009), showed diarrhea is the second leading cause of child deaths in the world with 1.5 million children die each year from this disease. In the United States, dehydration occurs around 7 % in patients older than 65 years who were hospitalized with an average length of 14 days and occurs in 82 % of febrile patients being treated at home. Dehydration is one of the main reasons elderly patients taken to the emergency room (8). Data in Indonesia obtained from the emergency department of the Department of Internal Medicine RSUPNCM in 2000-2001 where as many as 45% of elderly patients who were brought to the emergency room, suffering from dehydration. Dehydration occurs more frequently in adolescents (48.1 %) compared to adults (44.5%) (3). Based on the results of research conducted by Ella (2007), entitled Relationship diarrhea with dehydration Genesis Figures show pediatric patients with diarrhea in Dr H. Adam Malik of the 39 samples analyzed, 76.9 % found dehydrated mild or moderate and 23.1 % severe dehydration . Based on these data we can see that the incidence of diarrhea with dehydration in children is still quite high. Based on data taken in hospital emergency rooms Gambiran Kediri, morbidity of diarrhea with dehydration in January to October 2014 to reach 184 cases. In acute diarrhea with severe dehydration, blood volume is reduced so that it can have negative consequences in infants and children the symptoms include shock of hypovolemic (heartbeat becomes rapid, rapid pulse, blood pressure decreases, the patient becomes weak, decreased consciousness, diuresis decrease), disruption electrolyte, acid-base balance disorders, and acute renal failure (9). During episodes of diarrhea, water and electrolytes (sodium, chloride, potassium, and bicarbonate) is lost through liquid stools, sweat, urine and breathing. Death can follow severe 585

Table 3 Production of urine production period

METHODS This type of research is quantitative research, experimental, quasi-experimental research design with the approach of the pre test and post-test group design . In both groups started with the pre-test, and after the treatment is completed held back measurement (post-test) (13). Animals used in this study is the White Rat (Rattus norvegicus) totaled 14 tails are male 2-3 months old weighing 200300 g and get the same nutrients. Selection of male rats so that there are no hormonal influences and pregnancy. This study used rats as an animal is widely used as experimental animals, easy to obtain, have a quick response, give an idea scientifically that may occur in humans, and are relatively inexpensive.

Age

1 2

2- 2,5 months

6 8

Percentage (%) 42,85 57,14

14

100

Frequency

2,6 -3 months Total

No

DISCUSSION After collecting data using observation sheet is then processed, interpreted and analyzed according to the variables studied. The effectiveness of fluid Ringer Acetate Malat against time increase in blood pressure in rats (Rattus norvegicus) Results of the study increase in blood pressure in rats obtained Ringer's acetate malate fluid is a liquid that is effective in accelerating the production of white rat urine so that a white rat blood pressure increase becomes faster. It can be seen from the increase and acceleration of volume of urine produced by the average number of 0.3625 cc in less than 2 hours . With fluid administration of Ringer's acetate malate in the amount of 2 cc and using a 3 cc syringe (14) . Theoretically RAM fluid is isotonic fluids similar to body fluids (1). This RAM fluids containing electrolytes are balanced with concentrations similar to those found in human plasma. RAM is an isotonic balanced electrolyte solution which can adjust to human plasma by not ignoring physiology important electrolytes in it. RAM is different from the solution of Ringer Lactate (RL), where lactate is mainly metabolized in the liver and a small portion of the kidney, while acetate is metabolized in almost all body tissues, especially in muscle (1). Acetate metabolism also obtained 3-4 times faster than lactate. Ringer Acetate malate has been widely available in many countries. This liquid is particularly indicated as a replacement for the acute fluid loss (resuscitation), such as diarrhea, dengue fever, burns/shock hemoregik. In lieu of fluid during a surgical

Sample Characteristics Frequency Distribution Based Weight Loss Weight

200-250 1 grams 260-300 2 grams Total

Frequency

14

Percentage (%)

4

28,57

10

71,42

Fluid

Based on Table 3 shows the results of urine output with fluid administration of Ringer acetate malate is the average number of 0.3625 cc in less than 2 hours (40 minutes to 1 hour), while the average of urinary production for Ringer Lactat is 0.275 cc within 2 hours or more.

Based on Table 1 shows the characteristics of the sample based on age can be explained that the mice age 2,6-3 months as much as 8 samples (57.14 %) and 2-2.5 months old as 6 samples (42.85 %) . Table 2

urine

Rate urine Duration of urine output production RAM 0,3625 cc < 2 hour (40 1 minutes s.d 1 hour) 2 RL 0,275 cc 2 hours/more

No

RESULT Table 1 Sample Characteristics Frequency Distribution by Age No

and

100

Based on Table 2 shows the characteristics of the sample by weight can be explained that the white rat body weight 260300 grams by 10 samples (71.42 %) and body weight of 200-250 grams of 4 samples (28.57 %).

586

procedure, fluid loading time of induction of regional anesthesia, priming solution in action cardiopulmonary bypass, and is also indicated in acute stroke complicated by dehydration (6). The benefits of fluid loading at the time of induction of anesthesia, for example, demonstrated by studies Ewaldsson and Hahn (2001) which analyzed the effect of 350 mL of RAM quickly (within 2 minutes) after the induction of general anesthesia and spinal against volume kinetic parameters. This study shows the provision of RAM can prevent arterial hypotension induced central hypovolemia is common after general anesthesia/spinal. According to Hahn and Drobin (2003) RAM does not encourage cell swelling, because it can be given in acute stroke, particularly if there is suspicion of cerebral edema. For obstetric cases , Onizukka et al (2009) tried to compare the effect of rapid infusion of Ringer Lactate Ringer Acetate Malat with against the maternal and fetal metabolism and acid-base balance in 20 patients who underwent combined spinal and epidural anesthesia before seksiosesarea . This study shows giving Ringer Acetate Malat better than Ringer 's lactate for the 3 parameters above , because it can improve neonatal lactic acidosis (a condition common in babies born to mothers who experienced pre-eclampsia or eclampsia) . Based on the results of the study, administration of fluid Ringer Acetate Malat is effective compared to administration of Ringer's lactate liquids which time the rats increased blood pressure becomes faster as measured from the white rat urine production quicker and more.

administered intravenously or subcutaneously. Fluid Ringer lactate abbreviated as "LR" , "RL" or "LRS, where lactate is mainly metabolized in the liver. Ringer Lactate is a fluid hipotonis where absorption in the human body a little longer. At neurotraumatologi, hypotonic fluid such as Ringer 's lactate should be avoided because of the risk of edema cerebral (1). According to the conclusions of researchers on Ringer's lactate for fluid administration can increase blood pressure in rats but it takes a little longer because of the white rat urine production and a little too long. The effectiveness of fluid Ringer Acetate Malat compared with Ringer Lactate fluid in accelerating time increase in blood pressure in rats (Rattus norvegicus) Results of research in accelerating a rise in blood pressure in rats showed that more effective use of fluid Ringer Acetate Malat in accelerating time increase in blood pressure in rats compared with fluid Ringer Lactate, this is evidenced by statistical tests using T Test Independent of the declared value Asymp sig 0.017. Ringer Acetate Malat an isotonic balanced electrolyte solution which can adjust to human plasma by not ignoring the physiology of important electrolytes in it (1). RAM solution is different from the solution of Ringer Lactate (RL), where lactate is mainly metabolized in the liver and a small portion of the kidney, while acetate is metabolized in almost all tissues of the body, especially in muscles. Acetate metabolism also obtained 3-4 times faster than lactate (6). RAM is an isotonic solution is a solution similar to the body fluids. The RAM solution containing electrolytes are balanced with concentrations similar to those found in human plasma. This solution can be used for handling fluids in the perioperative haemostasis and can be used to replace the volume of provisional intravasal (9). The difference with a solution of Ringer Lactate (RL) which is now frequently used in resuscitation purposes is that the RAM containing anions acetate and malate metabolism which has a role as a precursor bicarbonate, will neutralize acidosis hyperchloraemic (1). Ringer's lactate is fluid hipotonis with blood and intended for intravenous administration. This liquid can also be administered subcutaneously. Fluid Ringer

Ringer Lactate fluid administration effectiveness over time increase blood pressure in rats (Rattus norvegicus) Results showed there was an increase in blood pressure in rats by administration of Ringer's lactate fluids but not too significant because urine production takes a little longer. It can be seen from the increase and acceleration of volume of urine produced by the average number of 0.275 cc within 2 hours or more. With Ringer's lactate for fluid administration in the amount of 2 cc and using a 3 cc syringe (14). In theory Ringer lactate fluid is a liquid hipotonis with blood. Administration may be 587

lactate abbreviated as "LR", "RL" or "LRS, where lactate is mainly metabolized in the liver (1). Solution Ringer Lactate is often used for fluid resuscitation after blood loss due to trauma, surgery, or burns. Previous, was used to induce the production of urine in patients with kidney failure. Another use is a common treatment of renal failure in small animals, where a solution is given subcutaneously instead of intravenously. Managing fluid in this way allows the solution to be given to the animals quickly and not require the presence of blood vessels. The liquid is then slowly absorbed from under the skin into the blood stream of animals. Solution Ringer Lactate used as a by-product of the metabolism of lactate in the liver to overcome acidosis, which is a chemical imbalance that occurs with fluid loss of acute renal failure . Ringer Lactate is not suitable for maintenance therapy because the sodium content (130 mEq /L) is considered too high, especially for children, and the potassium content (4 mEq / L) is too low, given the need for daily electrolytes (1). Thus the researchers conclude that the fluid Ringer's acetate malate and fluid Ringer's lactate can be used to speed up the increase in blood pressure in rats but more effective in the resuscitation fluid is a liquid malate Ringer's acetate.

REFERENCES 1. Braun, B. 2011. Manfaat isotonisitas ringerfundin vs hiponatremia pada ringer laktat dan ringer asetat (hipotonis). Germany : KoTM FVT 2. Ewaldson Carl Arne, Hahn Robert G. 2005. Anesthesiology. American Society of Anesthesiology 3. Gustam, Hardinsyah, Dodik Briawan. 2012. Faktor Risiko Dehidrasi pada Remaja dan Dewasa. Skripsi Institut Pertanian Bogor 4. Hahn. 2010. Volume kinetics for infusion fluids. Anesthesiology 5. Hartanto WW., 2012. Terapi cairan dan elektrolit perioperatif. SMF/Bag. Farmakologi Klinik dan Terapeutik/ Fak. Kedokteran Universitas Padjadjaran. Bandung : FK Unpad 6. Hartanto R V. 2007. Perbedaan perubahan konsentrasi natrium plasma antara preload 20 cc/kgbb ringer laktat dibandingkan dengan preload 20 cc/kgbb ringer asetat malat. S.Ked [thesis]. Semarang: Universitas Diponegoro 7. Huang. L.H, Anchala, K.R, Ellsbury, L. George, S.C. 2009. Dehydration. Available from : http://emedicine.medscape.com (accessed 15 Juni 2012)

8. Friedman J.N, Goldman R.D, Srivastava R, and Parkin PC. 2004. Development of a Clinical Dehydration Scale for Use in Children Between 1 and 36 Months of Age. The Journal of Pediatrics

CONCLUSIONS 1. Giving Fluid Ringer Acetate Malat effective to speed up the increase in blood pressure in rats (Rattus norvegicus). It can be seen from the increase and acceleration of volume of urine produced by the average number of 0.3625 cc in less than 2 hours. 2. Giving Fluid Lactate Ringer effective in increasing blood pressure in rats (Rattus norvegicus) but it takes a little longer. It can be seen from the increase and acceleration of volume of urine produced by the average number of 0.275 cc within 2 hours or more. 3. Fluid Acetate Ringer Lactate Ringer's Malat and liquid can be used to speed up the increase in blood pressure in rats but more effective in the resuscitation fluid is a liquid malate Ringer's acetate. This is evidenced by statistical tests using the Test T Independent stating Asymp sig value of 0.017.

9. Latief S A, Suryadi K A, Daclan M R. 2009. Analgesia regional. Dalam: Latief S A, Suryadi K A, Daclan M R, editor. Petunjuk praktis anestesiologi. Edisi ke-2. Jakarta : Bagian anestesiologi dan terapi intensif FK UI 10.Nursalam. 2013. Metodologi Penelitian Ilmu Keperawatan. Edisi 3. Jakarta : Salemba Medika 11.Notoatmodjo, 2005. Metodologi penelitian kesehatan. Edisi ketiga. Jakarta : Rineka Cipta 12.Plaiser, A. 2010. Plasma Water as Tool in the Assessment of Dehydration in Children with Acute Gastroenteritis. Eur J Pediatr 13.Suraatmaja. 2010. Keseimbangan cairan dan elektrolit tubuh. Jakarta : Sagung Seto 14.Rusdi, Budipramana V.S. 2010.

Perbandingan pemberian ringer laktat dan ringer asetat dalam meningkatkan 588

kadar laktat darah pada iskemia hepar akibat ligasi vena porta (studi eksperimental pada kelinci) [Karya akhir penelitian]. Surabaya : Bagian bedah FK-UNAIR/RSU dr.Soetomo 15.WHO, 2009. Pelayanan kesehatan anak di rumah sakit pedoman bagi rumah sakit rujukan tingkat pertama dikabupaten/kota. WHO dan Departemen Kesehatan RI. Jakarta.

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EFFECTIVENESS OF MUROTAL MUSIC THERAPY AND KANGAROO METHOD ON LBW BABY’S FEEDING TIME IN THE NEONATES WARD OF AURA SYIFA HOSPITAL Putri KristyaningsihI, Diah Eliya HumaidaII Nursing Major Faculty Of Health Science Institut Ilmu Kesehatan Bhakti Wiyata Kediri Abstract Kangaroo method is a treatment method for low birth weight (LBW) or premature baby, by doing skin to skin contact between mother and the baby. Music therapy is the use of music as therapy equipment to repair, maintain, develop physical mental and emotional health. While murotal music therapy is a technique that used to cure a disease by using the verses of the Holy Al-Quran. The design of this study is pre-experimental post only design. The sample are 24 babies that were stayed in Neonate Ward of Aura Syifa Hospital Kediri. This study use the inclussion and exclussion criterias to determine the samples. The sampling technique that is used in this study is purpossive sampling. The data collected by using the observation sheet, statistical test that used is Kruskal Wallis with ρ ≤ 0,05. From the test, the p value is 0.000, which means this study‟s result is statistically significant. The result showed that baby‟s feeding time on kanggaroo method group is 18 to 22 minutes time span, on murotal music therapy group is 14 to 16 minutes, on control group is 13 to 16 minutes. From the study we can conclude that kangaroo method is more effective to increase baby‟s feeding time. Kangaroo method is more effective because the kangaroo method using skin to skin contact technique between mother and baby, hence the baby can feel more comfort and baby‟s feeding time becomes longer. Keywords : Kangaroo Method, Murotal Music Therapy, Baby‟s Feeding Time

tension reflective and measured quantitatively and qualitatively by a computer-based (8).

INTRODUCTION Low birthweight infants (LBW) is baby newborn‟s weight less than 2500 grams regardless of gestational age (6). LBW consists of LBW preterm or and fullterm or post-term with growth retardation in the uterus (4). LBW with preterm pregnancy, usually experienced a complications. While the LBW with full-term pregnancy commonly are the organs are mature so it is not too problematic in treatment (1).

According to the Indonesian Demographic and Health Survey (14), Indonesia infant mortality rate is 34 per 1,000 live birth. The amount is higher than the Millennium Development Goals (MDG's) by 2015, a target which is to reduce infant mortality rate of 25 cases per 1,000 live births. One of the main causes of infant mortality is LBW infants, about 29% (13).

Murotal music therapy can accelerate the healing, it has been proven by some experts, as has been done by Ahmad al Khaidi, Director of Islamic Medicine Institute for Education and Research in Florida, the results of these studies show a positive results, that listening to the verses of the Holy Al-Quran have a significant effect in reducing the nervous

According to the World Health Organization (WHO) in 2007, in developing countries, nearly 70% of 5 million neonatal deaths and 17 of the 25 million deliveries per year give birth to babies with low birth weight (less than 2500 grams). Each year, an estimated 20 million babies are born with low birth

598

therapy can also affect the baby‟s feeding time and which one is more effective between kangaroo method and murotal music therapy to increase the length of breastfeeding in infants LBW is not known yet. That is why researchers interested in studying the effectiveness between kangaroo method and murotal music therapy in increasing LBW baby‟s feeding time. The research was done in Aura Shifa Hospital. Aura Syifa Hospital is a hsopital taht focus on mother and child treatment.

weight (LBW). The main cause of this case can be due to the preterm or prematurely born or impaired growth during unborn or Intra Uterine Growth Retardation (IUGR) (12). The prevalence of LBW in Indonesia ranged from 2 to 17.2%, and its donates about 29.2% of Infant Mortality Rate (IMR). The high morbidity and mortality rates of low birth weight infants remains a major problem. The value of Infant Mortality Rate (IMR) in Indonesia is 34% and the incidence of low birth weight (including preterm birth) in Indonesia reached 29% where the incidence of low birth weight is a health issue first and as a contributor to death in the perinatal period, followed by asphyxiation 27% and sepsis 5.4%. It is estimated that the incidence of premature and low birth weight in Indonesia is diminishing but it is still quite high at 52% per 100 live births (1).

METHODS The research used the Pre-experimental Post Only design with control design, this study uses a therapy for the respondents and the aim is to search whether there is an influence between the therapies, so we can conclude the effect after we give the therapy (5). Sampling technique that used in this study is purpossive sampling technique, is a technique by choosing he sample among a population appropriate with the researcher‟s desire (aim and problem of this study), so that the sample can represent the characteristics of the population that has been known previously (9). And using inclussion criterias that have been determined by researchers (the baby did not experience severe respiratory problems, the babies do not experience Hiperbilirubin, no congenital abnormalities, the mother is willing to participate, Moslems for murotal music therapy group).

In East Java, LBW is still the highest cause of neonatal deaths, in 2001 amounted to 36.23% and in 2002 amounted to 34.72%. Based on preliminary studies that researchers do in Aura Syifa Hospital during the last 5 months from July, June, August, September and October, the incidence of babies of low birth weight are born normal and operations by 33% or 164 in 2014 with a range of weight 1900 grams to 2500 grams of number 492 births. There are some data from previous research, the effect of kangaroo method and murotal music therapy affect the baby with low birth weight, but whether the kangaroo method and murotal music

RESULTS AND DISCUSSION RESULT

Table 1. Frequency Distribution Characteristics of Respondents Based Weight LBW babies in Neonatal Space Aura Shifa Hospital Kediri No. 1 2 3

Baby‟s weight 1000-1500 grams 1600-2000 grams 2100-2500 grams Total

Frequencies 3 4 17 24

599

Precentage (%) 12,5 16,7 70,8 100

Table 2. Frequency Distribution of Respondents by Old Time Breastfeeding At LBW infants in Neonatal Space Aura Shifa Hospital Kediri No .

Baby‟s weight

14-15 minute s

16-17 minute s

18-19 minute s

20-21 minute s

22-23 minute s

4

0

0

0

1

1

3

0

0

0

7

1

1

4

2

12

4

1

4

3

1000-1500 grams 1600-2000 2 grams 2100-2500 3 grams Frequencies 1

Total

24

Table 3. Frequency Distribution of Respondents by Old Time Breastfeeding At Each group of LBW babies in Neonatal Space Aura Shifa Hospital Kediri N o

Group

Kangaroo method Murotal 2 music therapy 3 Control Frequencies 1

14-15 minute s

16-17 minutes

18-19 minute s

20-21 minute s

22-23 minute s

0

0

1

4

3

5

3

0

0

0

6 11

2 5

0 1

0 4

0 3

Based on table 1, the characteristics of respondents by weight can be explained that LBW infants of low birth weight infants are the most dominant is the gram weight of 2100 -2500 as many as 17 samples (70.83%).

Total

24

therapy 14-17 minutes there are 8 samples and the control group 14-17 8 minutes also 8 sampled. To identify significant differences in the length of feeding time, the data were statistically test, using Kruskal Wallis Test (10). Fromthe test we get p value 0.000, where the signifcant level is p <0.05, it means that H1 is accepted,it is more effective to use kangaroo and murotal music therapy to increasing baby‟s feeding time.

Based on table 2, LBW infants feeding time according to the weight that the weight can be explained 1000-1500 long feeding time 14-15 minutes 22-23 minutes 4 samples and 1 sample. 16002000 weight long feeding time 14-15 minutes 1 minute 16-17 samples and there are 3 sample. While weight 21002500 long feeding time 14-15 minutes 7 samples, two samples of 16-19 minutes, 20-23 minutes there were six samples.

DISCUSSION Effect of Kangaroo method on LBW baby’s feeding time

Based on table 3, the distribution of feeding time each group is known for a kangaroos feeding time range from 1823 minutes 8 samples, murotal music

The result showed that the kangaroo method is the most effective method to increase the feeding time on baby with LBW in Aura Syifa Hospital. The time

600

for feeding on respondents range from 18 to 22 minutes is proved by the value of Mean Rank 60.50, with baby weight from 1000 to 1500 grams is 1 sample and weight 2100- 2500 grams are 7 samples.

Weight 1600 to 2000 grams are 3 samples and weight 2100 to 2500 grams are 5 samples. Murotal music therapy gives great effect if played to the baby, it was revealed by Dr. Nurhayati (dalam 9), according to her research, 48-hour-old baby whom played Quranic verses from the tape recorder showed a response to smile and be quieter. Murotal therapy consists of sentences that written in Al-Quran, played for 15 minutes that can provide psychological impact towards the positive, this is because when murotal played will be translated by the brain which will give rise to a sense of comfort and calm (11).

For the babies, kangaroo method useful for reducing consumption of calories, prolong the baby's sleep time, improve bonding between the baby and mother, causing a calming effect that lowers the stress (marked with cortisol levels low), reducing the incidence of nosocomial infections, serious illnesses or lower respiratory infections , body temperature more quickly reach 36.5oC temperature, heart rate and respiratory rate relative in the normal range, reduce stress on the baby, baby's behavior becomes better, which would seem baby alert, cry less, more frequent breastfeeding, increasing the baby weight (2). For mothers, kangaroo method is useful to facilitate breastfeeding and implementation of the early breastfeeding, increase milk production, improve mother‟s selfesteem, improving the bonding and affection of a mother with a baby and provide psychological influences in the form of serenity in the mother and family (7).

Music murotal can increase the breastfeeding time but not too significant, music murotal may be less significant in influencing suckling time on LBW infants due to the timing of the music therapy murotal possibility of sound frequencies less according to the condition of each child, but still can be used daily for therapy supporters. Effectiveness between kangaroo method and murotal music therapy to the baby’s feeding time Statistically, it was found that the length of feeding time in LBW baby in the Aura Syifa Hospital more effective using kangaroo method and murotal music therapy compared to control group, it was proved by the results of statistical tests Anova Non parametric Kruskal Wallis test stating Asymp sig value is 0,000.

According to the conclusions based on research studies that have been done kangaroo method is more effective because the baby directly touch the mother so the baby can be more comfort and familiar, it can affect baby‟s suckling time. This is supported by the theory of the Kangaroo method above. Effect of Music Therapy Against Murotal Long Time Feeding in Infants LBW

Kangaroo method is a simple way to care for newborns and use the mother's body temperature to warm the baby. The baby is naked, wearing only a diaper and a hat, and the baby is placed vertically / upright in the chest between mother‟s breasts, naked chest, then covered (7). While Murotal is one of the music that has a positive influence for the hearing. Murotal therapy can accelerate healing, it has proved by various experts as it has

The results showed that there is an effect of music therapy for abbay feeding time at Aura Syifa Hospital. The data showed that music theray can influence baby‟s feeding time but not too significant. It is from the result of statistical test Mean Rank at 27.02. With time for breastfeeding from 14 to 16 minutes.

601

done Ahmad al Khadi, president of the Islamic Medicine Institute for Education and Research in Florida, USA. In the seventeenth annual conference of the American Medical Association, US missuori region, Ahmad Al-Qadi made a presentation on the results of his research with the theme of the influence of the Koran on the perspective of human physiology and psychology. Results of these studies showed positive results that listen to the verses of the Quran have a significant effect in reducing the tension cord is reflective and the results recorded and measured quantitatively and qualitatively by a computer-based tool (8).

minutes. while the control group breastfed longer time between 13-16 minutes. Feeding time 13-14 minutes 1 samples, 15 samples of 5 minutes and 16 minutes of 2 samples. Kangaroo method is the most effective method because it is influenced by the technique of skin to skin between the mother and the baby so the baby can feel comfort and calm.

Refferences 1. Depkes, Asuhan Neonatal Esensial: Paket Pelatihan Pelayanan Obstetri Dan Neonatal Emergensi Komprehensif (PONEK), Jakarta,2008

This study shows that both of them can be used to increase the feeding time, but the most effective is to use the Kangaroo method than using Murotal Music Therapy. This is possible because the kangaroo method has several advantages such as there is direct contact or skin to skin between the baby with the mother that the baby gets a sense of comfort and calm while in the mother's arms. Kangaroo method is a settlement in a state where medical technology and obstetrics extremely limited or no tersediannya for LBW care as in developed countries.

CONCLUSSION RECOMMENDATIONS

2. Fatmawati, S, Andi, 2013. Pengaruh Perawatan Metode Kanguru Terhadap Fungsi Fisiologis Bayi Prematur Dan Kepercayaan DiRI Ibu Dalam Perawatan Bayi. Jurnal Keperawatan Soedirman, vol 8, no 3. Palu 3. Gusmiran, 2005, Rugyah Terapi Religi sesuai sunnah Rasullah SAW, Jakarta: Pustaka Marwa 4. Messak, Rima.2012. BBLR. Fakultas Kedokteran Universitas Nusa Cendana. (http://www.scribe.com diakses tanggal 8 Desember 2014 pukul 23.11 WIB)

AND

5. Nursalam, 2013. Metodologi Penelitian Ilmu Keperawatan: Pendekatan Praktis Edisi 3. Jakarta: Salemba Medika

Conclussion From the research that has been done, the kangaroo method is the most effective method to increase the baby‟s feeding time with the time span of 18-23 minutes. For feeding time 18-19 minutes 1 sample, 20-21 minutes 4 samples, and 22-23 there were 3 samples so that all amounted to 8 samples. Murotal music therapy itself has a span of 14-16 minutes. Long feeding time 14 minutes 2 samples, 15 minutes 3 samples and 3 samples with long feeding time 16

6. Proverawati.A, dan Sulistyorini, C. A, 2010. Bayi Berat Badan Lahir Rendah, Jogjakarta: Nuha Medika 7. Rahardjo,Kukuh. Marmi. 2014. Asuhan Neonatus, Bayi, Balita, dan Anak Prasekolah.Yogyakarta: Pustaka Pelajar

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8. Remolda, P.2009. Pengaruh ALQuran pada manusia dalam prospektif Fisiologi dan Psikologi. (http://www.theedc.com. Tanggal akses24 Oktober 2014)

12. Uhudiyah,Uut dkk. 2003. Perawatan BBLR dengan Metode Kanguru. Jakarta. Perkumpulan Parinatologi Indonesia (Perinasia) 13. WHO. Perinatal Mortality. Report No: WHO/FRH/MSM/967. Genewa: WHO 2004

9. Saryono. 2010. Metodelogi Penelitian Kesehatan. Yogyakarta: Mitra Cendekia Press.

14.

10. Sugiyono, 2007. Stastistika Untuk Penelitian.Bandung: CV ALFABETA IKAPI 11. Sunarto, Achmad.(Eds), 1999. Terapi Penyakit Dengan AlQur‟an dan Sunnah. Pustaka Amani: Jakarta

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, Data Kematian Maternal dan Perinatal tahun 2006 dan 2007 KIA, Jakarta 2008. (http://ejournal.umm.ac.id/index .php/keperawatan/issue/view/22 6/show/toc)

THE EFFECT OF ATTITUDE TOWARD BEHAVIOR, SUBJECTIVE NORM AND PERCEIVED BEHAVIOR CONTROL AT DM THERAPY ADHERENCE: STUDY THEORY OF PLANNED BEHAVIOR Sheylla Septina Margaretta1, Heru Kurnianto Tjahjono2, Falasifah Ani Yuniarti3 Institut Ilmu Kesehatan Bhakti Wiyata Kediri

Abstract Diabetes Mellitus cause physical complications that can aggravate the psychological pressure. Provision of education is one of the four main pillars of the management of DM. Educational Theory of Planned Behavior-based DM is an education with individual approach that includes support and guidance DM therapy at home which aims to improve treatment adherence DM. In education TPB has been given to people with diabetes are among antesenden TPB The Attitude Toward Behavior, Subjective Norm and Perceived Behavior Control which would contribute significantly to the compliance behavior therapy with DM. To identify a number of antesenden ie Attitude Toward The Behavior, Subjective Norm and Perceived Behavior Control described in TPB to behavior therapy adherence DM. This study used data analysis method that includes the step of measurement and interpretation of the value of Attitude Toward The Behavior, Subjective Norm and Perceived Behavior Control according to the principles Theory of Planned Behaviour (TPB), the next step performed statistical tests include test bivariate correlation third antesenden TPB attitude towards compliance DM therapy performed on 34 sempel with sample selection using purposive sampling. The results on the F test probability value (sign) 0.000> 0.05, so it can be concluded that the Attitude Toward The Behavior, Subjective Norm and Perceived Behavior Control unacceptable influential in predicting the intentions of people with diabetes to comply with therapy DM, with variable Attitude Toward The Behavior showed a stronger effect than any other variable that is obtained by value ttest (sign) 0.033> 0.05 and the value of the regression coefficient β attitude and subjective norm is positive, it indicates that this variable has a strong correlation with DM therapy adherence. R2 values obtained from the results of the three variables simultaneously perceived by 70.4% effect on DM therapy adherence. The three antesenden TPB ie Attitude Toward The Behavior, Subjective Norm and Perceived Behavior Control DM attitude towards compliance with therapy showed that all three received antesenden influential in predicting intention to comply with DM DM therapy. TPB-based education so highly can be used to improve coping and treatment adherence penyadang DM.

Keywords: Educational DM, individual coping, compliance DM and Theory of Planned Behavior.

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million people die of infectious diseases every year, which is 63% of global deaths in the world (WHO, 2013) 5. In 2035 is expected to rise DM 14,152.2 thousand people or 6.7% of the population of Indonesia soul (IDF, 2013)6. Boss, M & Cjarles, A., (2013)7 shows that in North Africa DM complications ranged from 8.1% to 41.5% in retinopathy complications, 21% to 22% complications arise albuminuria, 6.7% to 46 , 3% complications nephropathy and 21.9% to 60% neuropathic complications arise. American Diabetes Association

INTRODUCTION Theory of Planned Behavior (TPB) or the theory of planned behavior is one theory of learning for educational use in the patient's interpersonal approach. This theory was developed by Ajzen 1967. This theory includes three things namely; beliefs about the likely outcomes and evaluation of the behavior (behavioral beliefs), beliefs about the expected norm and motivation to meet these expectations (normative beliefs), as well as beliefs about the factors that can support or hinder behavior and awareness of the strength of these factors (control belief ) (Nursalam, 2013)1. Many studies use TPB approach to look at the human intention, one study conducted by Tjahjono, HK et al, (2013) 2 who has studied the intention of management students Muhammadiyah University of Yogyakarta in IT-based entrepreneurship. In addition to viewing the intention TPB can be used to view human behavior as the research that has been done by (Zoellner et al, 2012)3 concluded that the educational approach can decrease intentions TPB in sugar consumption. Research conducted by

8

(ADA) (2014) menganjuran treatment to be followed with diabetes include diet planning, exercise and regular activity, drugs control, and follow the educational program DM. Education given to people with diabetes should be done continuously and progress must be observed by health workers (Soegondo 2009)9. Researchers have found that satisfaction with the quality of the interpersonal relationship between patients and health workers were significantly associated with treatment compliance DM (Sherbourne, 1992 in St. Paul, S et al., 2001)10, so it is necessary to educate health workers using interpersonal approach to patients with the aim of achieving therapeutic success DM. The provision of education to people with diabetes by strengthening the three basic beliefs of TPB are: behavioral beliefs, normative beliefs and beliefs control is expected to provide confidence, the intention (intention) to accept the conditions and the intention to recover so as to improve therapy adherence DM.

4

Rashidian & Russel (2012) also concluded the use of TPB are very helpful in the intention (intention) in understanding a doctor's prescription, so that it can be concluded TPB is a theory of effective learning in the field of health one of them in the provision of health education. In the health sector needs to approach interpersonal between nurses and patients in the delivery of education communication (Ajzen, 1988, in Nursalam 2013)1. Provision of education is one of the important part of diabetes management. These diseases include the category of non-communicable diseases in the world's biggest killer, no less than 36

HYPOTHESIS In general it can be said that the better the attitude and subjective norms toward a behavior, and large semkain perceived

613

H3:

The behavior of people with diabetes to comply with therapy DM significantly influenced by subjective norm with diabetes to comply with therapy DM Perceived behavior control is a condition where people believe an action it easy or difficult to do (Dharmmesta, 1998)11.

behavioral control, the stronger the intention of the individual to perform an action (Dharmmesta, 1998)11. Based on the above, the proposed hypothesis as follows: H1: Behavioral therapy to comply with DM DM jointly influenced significantly by the attitude toward the behavior, subjective norm and perceived behavior control is in keeping with DM DM therapy. Gordon Allfort in Setiadi (2003)12 proposed a definition menganai attitude toward the behavior is a mental and terms in connection with readiness to respond, organized through experience and influence that lead to behavioral or dynamic. If we analogy with the attitude towards compliance with DM DM therapy mean attitude towards compliance DM DM is studying the tendency to evaluate the therapeutic results either liked or disliked consistently. Based on the above, the researcher took hypothesis as follows: H2: The behavior of people with diabetes to comply with therapy DM significantly influenced by the attitude toward the behavior of people with diabetes to comply with therapy DM Subjective norm as social factors indicate the perceived social pressure to perform or not perform an action or behavior (Dharmmesta, 1998)11. Subjective norm formed of normative beliefs and willingness to obey the wishes of others that are considered important. Normative beliefs regarding the condition that the individual or group of important referents will agree or disagree with the execution behavior. The strength of each normative beliefs generated through the motivation of the person to follow referents and estimates of subjective norm is obtained by summing the results of all referents pentin). Based on the above, the researcher took hypothesis as follows:

11

Ajzen in Dharmmesta (1998) have stated that perceived behavior control effect on intent or directly on the behavior itself. Based on the above, the researcher took hypothesis as follows: H4: The behavior of people with diabetes to comply with therapy DM significantly influenced by the perceived behavior control people with diabetes to comply with therapy DM. METHODS Data analysis method used in this study includes the step of measurement and interpretation of the value attitude toward the behavior, subjective norm and perceived behavior control according to the principles Theory of Planned Behaviour (TPB), the next stage of statistical tests include test bivariate correlation third antesenden TPB attitude towards compliance with therapy DM , The research model form shown in Figure A below: Attitude Toward The Behavior (X1) Subjective Norm

(X2) Perceived Behaviour Control (X3)

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Therapy adherence DM (Y)

In this study, researchers used multiple linear regression analysis model. Formula of multiple linear regression model as follows:  Y =β1X1 + β 2X2 + β 3X3 Where:  Y =the dependent variable (adherence therapy DM)  X1 = Independent 1 (Attitude Toward The Behavior)  X2 = Independent 2 (Subjective Norm)  X3 = Independent 3 (Perceived Behavior Control)  β 1, 2, 3 = coefficient of regression

approach ( holistic) which is based on the framework of the adaptation system, consisting of 33 questions covering compliance with DM in terms of diet, medication, and exercise control. The answer from the compliance questionnaire using Likert scale with a scale of 1: TP (never), 2: JR (rarely), 3: KD (sometimes), 4: SR (often), 5: SL (always). This research was conducted in the village of Wajak Lor, District Boyolangu, Tulungagung, East Java in March 2015 by all people with diabetes in the village Wajak Lor, District Boyolangu, Tulungagung Java Tumur some 78 people. This study using purposive sampling or sampling with inclusion criteria set by the researchers. With sample calculation sample of 34 people. Criteria for inclusion in this study were DM willing as a respondent, can read and write, aged 15-70 years, with at least one elementary school, do not have other concomitant diseases eg heart disease. This study has been declared worthy of ethics on October 6, 2014 by the Research Ethics Committee of the Faculty of Medicine and Health Sciences University of Muhammadiyah Yogyakarta.

Questionnaires spreadsheet of the data belief DM therapy made using the Theory of Planned Behavior approach made by researchers based on the results of discussions with experts Prof. Heru Kurnianto Tjahjono. Retrieved 28 instrument consists of variable beliefs (bi) is the variable that is the strength of your belief that by keeping DM therapy will gain certain benefits, variable evaluation (ei) is the variable that indicates to you whether to comply with the DM therapy will provide good benefits , variable normative beliefs (ni) is the variable that indicates that family / friends (group referents) advise you to adhere to the DM therapy, motivational variables (mi) is the variable of motivation to carry out compliance DM therapy with suggestions of family / friends (a group referent), variable access to the controls (ci) is an assessment you that in order to comply with the DM therapy is easy and not difficult, belief variables control (pi) that is your belief based on experience about the sources of opportunities such as information and facilities necessary to comply with the DM therapy with 5 answers that strongly agree, agree, neutral, disagree, strongly setuju.Sedangkan DM therapy adherence attitude measurement using a questionnaire developed by the research Hidayat (2013)13 based on the Concept System Model Betty Neuman's developed that overall human

RESULTS AND DISCUSSION Correlation The Attitude Toward Behavior, Subjective Norm and Perceived Behavior Control Compliance Behavior Therapy Against Persons with DM in the village Wajak-Lor, BoyolanguTulungagung 2015 Variabel β t Sig. F.Sig R Attitude Toward The Behavior Subjective Norm Perceived Behaviour Control

,532

2,233 ,033

,381

1,758 ,089 0.000 0.444

-,341

-2,008 ,054

1) Attitude Toward The Behavior Based on t test analysis significance value of 0.033 is smaller than the probability of error of 0.05. It concluded that compliance with therapy is significantly influenced by

615

2

the DM Attitude Toward The Behavior DM 2) Subjective Norm Based on t test analysis significance value of 0.089 is greater than the probability of error of 0.05. It can be concluded that the therapy compliance with DM was not significantly affected by Subjective Norm DM. 3) Perceived Behavior Control Based on t test analysis significance value of 0.054 is greater than the probability of error of 0.05. It concluded that compliance with diabetes treatment significantly influenced by Perceived Behavior Control DM. 4) From the table above it can be seen that the independent variable is the attitude toward the behavior, subjective norm and perceived behavior control simultaneously and significantly affect the dependent variable DM compliance with therapy that is indicated by the significance of 0.000 is smaller than the probability of error is 0.05, it can be said that the F-test reject Ho and accept Ha proposed that compliance with DM therapy jointly influenced significantly by the attitude toward the behavior, subjective norm and perceived behavior control is felt with DM. 5) From the above calculation is obtained Adjusted R2 = 0.444, or 44.4%, this means that the variations in treatment adherence (Y), which can be explained by the regression equation was 44.4% influenced attitude toward the behavior, subjective norm and perceived behavior control while the rest to 55.6% influenced by other variables that are outside the equation. Patient compliance is a health care concept that affects all areas of health nursing, including the handling of Diabetes

Mellitus. Attempts to change a behavior health improvements are constantly a component of compliance that requires a health education (Society of Endocrinology Indonesi, 2006)14. Health education is a process of dynamic change in behavior. Changes in behavior is not just a material transfer process but change happens awareness of individuals, groups or communities (Mubarak et al, 2007)15. According to Edelman and Mandle (2002) in Widiastuti (2012)16 health education purpose is to make people achieve optimal health levels through its own actions. Education is an effective strategy and the potential to reduce the risk of complications for patients with Diabetes Mellitus so as to reduce the economic cost of diabetes care. Patients with diabetes who understand the condition will be responsible for the compliance of DM therapy (Jenhani, M., et al., 2005)17.Edukasi would be more effective if nurses understand the theory of learning required. Educational process applied in this study is education DM using the theory of planned behavior (Theory of Planned Behavior / TPB). Correlation tests were conducted attitude toward the behavior, subjective norm and perceived behavior control simultaneously and significantly influence the behavior of people with DM variables in complying with Diabetes Mellitus therapy that is directed by the significance of 0.000 is smaller than the probability of error is 0.05, it can be said that the test F unity hypothesis is accepted that compliance behavior in keeping with DM DM therapy jointly influenced significantly by the attitude toward the behavior, subjective norm and perceived behavior control with DM. The results support the first hypothesis that explains that the behavior of people with

616

diabetes to comply with therapy together DM influenced significantly by the attitude toward the behavior, subjective norm and perceived behavior control with DM. So it can be explained that the better or the positive attitude of people with diabetes to compliance therapy and subjective norms are positive ie a willingness DM to follow the advice of people they consider important such as family and friends, as well as more easily control behavioral perceived in this case is a assessment of therapy that are not considered difficult and beliefs based on the experience of the sources of information and opportunities such as health facilities will encourage greater the behavior of people with diabetes to comply with therapy DM. Of the t-test results it can be said that the attitude toward the behavior has a significant value for 0,033 is smaller than probilitas error of 0.05. It can be concluded that the behavior of people with diabetes to comply with therapy DM significantly influenced by the attitude toward the behavior of people with diabetes to comply with therapy DM. Results of the study received the second hypothesis. This is because autonomy in being owned by people with diabetes to comply with therapy DM is high. It shows that the decision to comply with the DM therapy involves a lot of internal factors such as personality, perception, motivation and so forth. Objective norm variable has a value of greater significance than the 0,089 error probability of 0.05. It can be concluded that the behavior of persons with DM DM ntuk adhere to therapy was not significantly affected by the subjective norm to comply with DM DM therapy. Results of this study contradicts the third hypothesis. So it can be explained that family and friends are considered important role has no role or lower for people with diabetes to comply with

therapy DM. This can be caused by the decision to adhere to the therapy prescribed by his own behavior. Perceived behavior control variable has a value signikasi for 0,054 is greater than the error of 0.05. It can be concluded that the behavior of people with diabetes to comply with therapy DM was not significantly affected by the perceived behavior control people with diabetes to comply with therapy DM. The research result is in contrast to the fourth hypothesis. So it can be explained that the condition reality assessment of therapy is not considered difficult and beliefs based on experience about the sources of opportunities such as information and health facilities do not affect people with diabetes to comply with therapy DM, it is due to that raised still feel the difficulty adhere to therapy for life should be they live as well as information sufficient experience which is felt less so influence the behavior of people with diabetes who tend to be non-compliant in the implementation of DM therapy. Determian coefficient of the test results are Adjusted R2 = 0.444, or 44.4%, this means that the variations in treatment adherence (Y), which can be explained by the regression equation was 44.4% influenced attitude toward the behavior, subjective norm and perceived behavior control while the rest to 55.6% influenced by other variables that are outside the equation. This is in line with research conducted by (Trinh et al, 2012)18 learning theory TPB assessed effectively be a useful model to explain physical activity in patients with cancer of kidney, development interventions physical activity based on TPB effective in promoting physical activity in patients with cancer of kidney and can be important in the improvement of health. It can be concluded that the attitude toward the behavior, subjective norm and perceived behavior control influential in predicting the behavior of people with diabetes to comply with therapy DM.

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Sugar sweetened Beverage Consumption. Journal J Nuert Educ Behav. 2012 March; 44 (2): 172-177, doi. 10.1016 / j.jneb.2011.06.010 4) Rashidian and Russel (2012). General Practitioners' Intentions and prescribing for Asthma: Using the Theory of Planned Behavior to Explain Guideline Implementation. Journal Int J Prev Med. 2012 January; 3 (1): 17-28. PMCID: PMC3278865 5) WHO. (2013). Diabetes Mellitus 2013. WHO accessed on December 24, 2013 fromwww.who.int?mediacenter/factsheet s/f3312/en/ 6) IDF. (2013). Global Burden, accessed October 1, 2013 from http://www.idf.org/diabetesatlas/5e/theglobal-burden 7) Bos. M., and Cjarles A. (2013). Prevalence and complications of diabetes mellitus in Northern Africa, a systematic review. Bos and Agyemang journal BMC Public Health, 13: 387, December 24, 2013 diakse of http://www.biomedcentral.com/14712458/13/387 8) The American Diabetes Association (ADA). (2014). Diabetes Standards of Medical Care inDiabetes. Volume 37, Supplement 1, January 2014 9) Soegondo, S., (2009). Integrated management of diabetes mellitus. Jakarta: Central diabetes and lipid Dr Cipto Mangunkusumo and School of Medicine, in collaboration with WHO and Ministry of Health RI 10) Paul S. Ciechanowski, M.D., M.P.H. et al. (2001). The Patient-Provider Relationship: Attachment Theory and adherence to treatment in diabetes. Am J Psychiatry. 158: 29-35. doi: 10.1176 / appi.ajp.158.1.29 11) Dharmmesta, B.S. 1998 Theory Of Planned Behavior In Research Attitude, Intention and Consumer Behavior, Journal of Urban. No. 18 / VII / 1998. 12) Setiadi, N.J. 2003. Consumer Behavior: Concepts and Implications for Strategy

CONCLUSION 1)

2)

3)

4)

5)

The first hypothesis test results showed that the attitude toward the behavior, subjective norm and perceived behavior control simultaneously significant influence on treatment adherence behavior with DM. The second hypothesis test results showed that the attitude toward the behavior significantly in people with diabetes to comply with therapy DM The third hypothesis results showed that significantly subjective norm no significant effect on the behavior of people with diabetes to comply with therapy DM. The fourth hypothesis test results show that perceived behavior control is significantly no significant effect on the behavior of people with diabetes to comply with therapy DM. From the test results are determian coefficient Adjusted R2 = 0.444, or 44.4%, this means that the variations in treatment adherence (Y), which can be explained by the regression equation was 44.4% influenced attitude toward the behavior, subjective norm and perceived behavior control while the rest of 55.6% is influenced by other variables that are outside the equation.

REFERENCES 1)

2)

3)

Nursalam (2013). Methodology of Nursing Research. Salemba Medika: South Jakarta Tjahjono, HK, et al. (2013). Students intentions IT.Jurnal Yogyakarta-based Entrepreneurship Business Strategy vol 17, no 1, p 17-27. Zoellner, et al. (2012). Exploring the Theory of Planned Behavior to Explain

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and Marketing Research, First Edition, First Printing, Pernada Media. Bogor. Hidayat, F. (2013). Coping relationship Individuals With Compliance Levels for People with Diabetes Mellitus As Persadia Member RSMM Branch Bogor Perkeni (2011). Consensus management and prevention of type 2 diabetes mellitus in Indonesia 2011. Jakarta: Indonesian Society of Endocrinology Mubarak., Et al (2007). Health Promotion An Introduction to Teaching and Learning in Education. Yogyakarta: Graha Science. Widiastuti (2012). Structured Educational Effectiveness Based Theory of Planned Behavior and Quality of Life Empowerment Against Coronary Heart Disease Patients Pondok Indah Hospital in Jakarta. Thesis. University of Indonesia Jenhani, M., Gaha, K., Nabouli, R., et al. (2005). Effectiveness of patient education on glycemic control insulin patiend treated in general practice. Diabetes Metabolism, 376-381 Trinh et al, (2012). Correlates of physical activity in a population-based sample of kidney cancer survivors: an application of the theory of planned behavior. Trinh et al. International Journal of Behavioral Nutrition and Physical Activity 2012, 9:96

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STUDY POTENTIAL OF LOCAL PLANT PUMPKIN (CUCURBITA MOSCHATA DUCH) AS TRADITIONAL MEDICINAL PLANTS SUWANTO Biology Department, Faculty of Sciences, Institute of Health Sciences Kediri Email: [email protected] Abstract The times will change the paradigm of society on effective medicinal plants, even does not recognize the effectiveness of medicinal plants that exist around, nowadays many types of diseases that attack the human body, one being the issue of global terms is diabetes this can be caused by genetic factors and environment. With the various types of diseases that attack the body, the work done by the sick patient is treated in a modern rather than through traditional medicine. Indonesia country rich in biodiversity, one of which is the pumpkin (Cucurbita moschata Duch) which is the local plant as a traditional medicinal plant. Part of the pumpkin plants can be utilized, such as fruit pulp, seeds, leaves and flowers as a cure diseases, among others, anti diabetes mellitus, anti-cancer, healing of burns, prostate, and bladder intestinan and some other diseases. Medicinal plants pumpkin contains active molecules that can be used as a traditional medicine such as; fruit pulp, seeds, flowers, and its leaf. The nutrient content of yellow squash plant parts such as; Protein, vitamin A, beta-carotene, potassium, vitamin C, unsaturated fatty acids, phosphorus, phytoestrogens, selenium, fiber, cucurbitacin E, calcium, zinc, other vitamins and minerals. Keywords: Traditional medicine, Cucurbita moschata Duch, Nutrition. Introduction Indonesia country rich in biodiversity, one of which is a pumpkin that is the local plant as a traditional medicinal plant. More than 200 species of medicinal plants that can be used for health, the effective of medicinal plants for the benefit of society as a treatment to 75% [1]. In 1985 WHO (World Health Organization) predicts that about 80% of the world population has been utilizing medicinal plants (herbal medicine, phytotherapy, phytomedicine or botanical medicine) for primary health [2]. The times will change the paradigm of the public about the effectiveness of medicinal plants, even does not recognize the effectiveness of medicinal plants that is around, now many types of diseases that attack the human body, one being the issue of global terms is diabetes mellitus this can be influenced by genetic and environment. With the various types of diseases that attack the body, the work done by the sick patient is treated in a modern rather than through traditional medicine, because

people generally prefer something instant and recover quickly from his illness treatment, can not see the negatives of modern medicine. Modern medicine can cure the disease on the body but through a process that is rather long, and the result does not cause negative dapak. The proof of our ancestors utilizing medicinal plants so that her immune system strong is not easily attacked by the disease. Modern medicine can cure the disease on the body but through a process that is rather long, and the result does not have a negative impact. The proof of our ancestors utilizing medicinal plants so that the body resistance is strong is not easily attacked by the disease. Traditional medicine should be returned to the old days, when treating diseases by utilizing our existing plants around the plant is believed to treat disease. Medical tradition left by our ancestors must be guarded and applied to health. Medical tradition of a society can not be separated from local culture. Perception of the

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concept of illness, healthy, and varieties of plants used in traditional medicine are formed through a process of socialization that have historically been trusted and believed to be true. Traditional treatment is all treatment efforts by other means outside of medicine based on knowledge that is rooted in a particular tradition [3]. Medicinal plants known to contain many different types of antioxidants. The study of medicinal plants in China shows the content of flavonoids, lignin, bisbenzyl, coumarine, and terpenes. Flavonoid pigment is an aromatic compound found in green plants and includes compounds chalcone, flavanone, flavone, biflavonoid, dihydroflavonole, anthrocyanidine, and flavonole. Mexico also reported that in many medicinal plants used for the treatment of various diseases such as infections, arthritis, heart disorders, headache, fever, asthma. After analysis of bioactive components, it turns out many medicinal plants contain antioxidants that ranged from 27 to 972 mol Trolox equivalents per gram of dry weight.. However, in addition to antioxidants, the results of research conducted by the researchers that the compounds contained in plant pumpkin serves as diabetes [4] [5], inhibition of tumor growth, wound healing, hypoglycemic effect and hypolipidemic, [6] [7] [8] [9]; antifungal, antibacterial and anti-inflammatory activity, antioxidant effects, and prevent the growth of, and reduce the size of the prostate, antihypertensive [5] [10]. Pumpkin plants usually cultivated in dry land and only as a secondary crop when approaching dry season. Pumpkin plants included in the family Cucurbitaceae [11]. The plants are annual crops that are spreading (vine) by means of a flat-shaped tool holder. The plants are annual crops that are spreading (vine) by means of a flat-shaped tool holder. pumpkin stems are strong enough and a length of 12 m, the surface of the trunk contained fur / hair ness rather sharp and triangular rod shape, the surface dark green stems [12]. Pumpkin plant leaves is a single leaf which has a compound leaf. The leaves along the stem and leaves rounded

shape, the color of the leaf surface dark green and dark green no white spots. While the flowers of pumpkin is uniseksual monoecious reddish yellow. Pumpkin plants can be grown in lowland and highland. While the ideal altitude is between 0 m - 1500 m above sea level [13][14]. Pumpkin is a family Cucurbitaceae, pumpkin plants classified as fruit-bearing crops [11]. Pumpkin plants consisting of 130 genera and 800 species are cultivated around the world, so these plants are very general and is known by many people. Some of which include plant pumpkins are squashes, gourds and melons [15][16][17][11]. In this paper was delivered on plant morphology local pumpkins, the content of the plant pumpkin, pumpkin potential of local plants as a cure for diabetes and potential of local plants pumpkin as an anti cancer. Morphology of Pumpkin Plant pumpkin as a vegetable and medicinal plants, these plants grow spread and classified in types of crops that will soon die after fruiting. Pumpkin plants has been widely cultivated in countries such as Africa, America, India, China, and Yougoslavia [13][10]. Pumpkin plant can be classified as follows[18]: Kingdom : Plantae Divisi : Spermatophyta Sub divisi : Angiospermae Kelas : Dicotyledonae Ordo : Cucurbitales Familia : Cucurbitaceae Genus : Cucurbita Spesies : Cucurbita moschata Duch. Pumpkin is an annual plant that is spread or propagate by intermediaries who shaped flat toolholder as shown in (Figure 1). Strong enough and long stem and on the surface of the rod are hair ness rather sharp. Leaf width (10-25 cm up to 13-35 cm), and on the surface there are green leaf innocent and there is also green but there are white patches on the surface of the leaf, flower have five petals and five sepals [19].

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Source: [12] b

a

c

Figure 1. Morphology of pumpkin (Cucurbita moschata Duch) Description : (a) stem and petiole; (b) Spots on the green leaf of pumpkin; (c) parts of flower consist of 5 sepals and 5 petals

Pumpkin shaped fruit flat round, oval, round egg upside down, bottles, elongated oval, round, long, and a bokor with lots of grooves (15-30 groove) as shown in (Figure 2). Large fruit and the colors vary (although the fruit is old but the color of the fruit still young green because of fruit pumpkin has not been picked in the stalk so that the chlorophyll in the fruit is still

a

e

there, while the fruit has been harvested yellow whitish because of fruit pumpkin after being picked from stems and stored so that the chlorophyll in the fruit is not there). Thick thick flesh of about 2 to 3 cm and slightly sweet taste. Weights pumpkin fruit an average of 3-5 kg, for large-size pumpkin can weigh up to 20 kg per fruit

b

c

f

g

d

h

Source: [14] Figure 2. Variations fruit shape pumpkin (Cucurbita moschata Duch) Description: (a) Round flat; (b) Oval; (c) Round egg; (d) Bottle (e) Elongated oval ; (f) Round; (g) long; (h) Bokor.

The content of pumpkin Pumpkin contains the active molecule in the flesh of the fruit, seeds, flowers, and its leaf, the content of the parts of the plant pumpkin, among others, proteins, petida, polysaccharides, sterols of the aminobenzoic acid, vitamin A, vitamin C,

[20]; all parts of pumpkin plants can be utilized, such as seeds and skin of the pumpkin as a tapeworm treatment, part of the interest can be used as a healing of burns and healing sore throat [21]. The contents of pumpkin flower as follows;

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Tabel 1: The content of pumpkin flowers [21]. Nutrient Proximate Water Energy Protein Total lipid (fat) Carbohydrate, by difference Mineral Calcium (Ca) Iron (Fe) Magnesium (Mg) Phosphorus (P) Potassium (K) Sodium (Na) Vitamins Vitamin C, total ascorbis acid Thiamin Riboflavin Niacin Folate, DFE Vitamin B-12 Vitamin A, RAE Vitamin A, Vitamin D (D2+D3) Vitamin D Lipid Fattt acid, total saturated Fatty acids. Total monousaturated Fatty acids, total polyunsaturated Cholesterol

Unit

Value per 100 gram

g kcal g g g

95.15 15 1.03 0.07 3.28

mg mg mg mg mg mg

39 0.70 24 49 173 5

mg

28.0

mg mg mg µg µg µg IU µg IU

0.042 .0.075 0.690 59 0.00 97 1947 0.0 0

g g

0.036 0.009

g

0,004

Mg

Pumpkin seed oil is generally dominated by oleic (± 50%), linoleic (± 30%) and palmitic acid (± 15%) phytosterol, [22] the content of the seeds is beneficial for people affected by hypertrophy. Phytosterol the seeds can act as a cure prostate. Pumpkin seed oil contains vitamins A, D, and E. Vitamins A and E are antioxidants that function as

0 inhibitors of free radicals that can mencega cancer diseases, especially cancer of the prostate. pumpkin seeds proven to aid in the prevention of prostate disease and cancer and small intestine and seeds contain a lot of potassium, calcium, magnesium, phosphorus, Zonc and selenium, all the content of the seed used to treat intestinan and bladder.

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Tabel 2. Nutrient in pumpkin [21] Nutrient Unit Energy KJ Carbohydrate g sugars g Dictary fiber g Fat g Saturated g Monounsaturated g polyunsaturated g Protein g Vitamin A µg Beta-carotene µg Thiamine (vit. B1) mg Riboflavin (vit. B2) mg Niacin (vit. B3) mg Pentothenic Acid (B5) mg Vitamin B6 mg Folate (vit. B9) µg Vitamin C mg Vitamin E mg Calcium mg Iron mg Magnesium mg Phosphorus mg Potasium mg Sodium mg Zinc mg Potential local plant pumpkin as an anti cancer.

The term cancer in medical science is the abnormal growth of cells. Cancer cells grow in an uncontrolled way, and cause malignant cancer that attacks on nearest parts of the body. Cancer cells, did not spread to other parts of the body via lymph or blood flow, called metastasis. All tumors are not cancerous in nature; there are some benign tumors, benign tumors do not invade nearby tissue, and spread to other parts of the body. More than 200 types of cancer has been identified that harm the human body. Has identified that the factors that influence the increase of cancer that attacks the body such as smoking, radiation exposure, obesity, lack of physical activity, environment, psychology. More than 5-10% of cancer diseases caused by hereditary factors. Cancer can be diagnosed using

Value per 100 gram 109 6.5 136 0.5 0.1 0.05 0.01 0.01 1.0 369 (46%) 3100 (29%) 0.05 (4%) 0.110 (9%) 0.6 (4%) 0.298 (6%) 0.061 (5%) 16 (4%) 9 (11%) 1.06 (7%) 21 (2%) 0.8 (6%) 21 (2%) 44 (6%) 340 (7%) 1 (0%) 0.32 (3%) biochemical tests, and advice from a doctor. Chemotherapy, radiation therapy and surgery is the procedure adopted for the treatment of cancer. Of the procedure for the treatment of cancer can be menimbuklan negative impacts, the use of medicinal plants for treating cancer diseases are safer than treatment with chemotherapy. [23]. Medicinal plants are the main source for the treatment of cancer, medicinal herbs have anti-cancer compounds. Some herbs have been known to cure and control of cancer include pumpkin plants. [21] [24] that plant pumpkin as a medicinal plant has many nutritional content such as; Protein, vitamin A, beta-carotene, potassium, vitamin C, unsaturated fatty acids, phosphorus, phytoestrogens, selenium, fiber, cucurbitacin E, calcium, zinc, other vitamins and minerals, etc.. Pumpkin plants are not only used as prevention of cancer disease but can be

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used for healing several diseases. All parts of pumpkin plant organs such as flower, leaves, roots, and seeds have benefits for disease treatment. The organs of these

Cucurbitaceae showed anti-cancer activity which inhibits the oxidation of blood, isolated from polymorphonuclear cells and mononuclear cells. Anti-cancer potential of the seed extract of Cucurbitaceae Telfairia occidentalis showed significant activity with other extracts [25]. The following results can be seen in Table 3.

plants can be useful as an anti-cancer drug plants. It was reported that the family Cucurbitaceae have potential anti-cancer. Telfairia occidentalis seed extract of Table 3. Anticancer activity of crude extract occidentalis against HeLa cells [25]. Extract GI50(µg/mL) Crude extract 171.3±1,24 Hexane 14.6±1.22 Dichloromethane 25.0±0.57 Ethyl acetate 43.3±0.73 Butanol 55.3±0.57 Aqueous 51.3±0.83 Doxorubucin (µM) 0.61±0.003 µM

and fractions of seed of Telfairia LC50 (µg/mL) 244.0±1.29 72.6±1.16 81.3±1.52 88.6±1.38 78.3±1.15 92.0±1.18 7.80±0.80 µM

TGI (µg/mL) 216.4±3.23 21.6±1.05 46.3±1.04 3.60±0.30 µM

Note: Data are represented as mean ± SEM of three independent experiments; Values in the table are concentrations of extract/fraction expressed as μg/mL; GI50 = Concentration of the drug causing 50% growth inhibition of the cells; TGI = Concentration of the drug causing total growth inhibition of the cells; LC50 = Lethal concentration of the drug that killed 50% of the cells. Potential local plant pumpkin as antidiabetic. Diabetes mellitus is one of the oldest diseases known to man, is derived from the Yunani language which means that the sweet urine. This is illustrated from the

usual symptoms of this disease that appears on urination in large quantities and sugar. Medically can be defined as a metabolic disorder caused by a deficiency of the hormone insulin resulting in blood glucose can not be stored and utilized by the body's cells become energy [26]. There are various types of diabetes mellitus, but there are two main types of diabetes mellitus type 1, a said disease diabetes mellitus when fasting glucose levels ≥ 126 mg / dl or 2 hours after eating ≥ 140 mg / dL but less than 200 mg / dL, the glucose tolerance is said to be weak [27]. Diabetse mellitus type 1 is a disease of hyperglycemia due to absolute lack of insulin. People with this disease must receive insulin replacement. Diabetes mellitus type 1 is usually found in people

who are not fatter aged less than 30 years, by comparison the men slightly more than women. Incidence of type 1 diabetes mellitus peaking in adolescence or early age, eat out often called juvenile diabetes. However, it turns out type 1 diabetes can occur at any age [28]. Diabetes mellitus type 1 is thought to arise as a result of autoimmune destruction of β cells of the islets of Langerhans which is triggered by the environment. Autoimmune attack can occur after a viral infection for example mumps, rubella, sitomegavirus chronic, or after exposure to drugs or toxins (eg class of nitrosamines found in preserved meats). At the time of diagnosis of diabetes mellitus type 1 is being established, found antibodies to the cells of the islets of Langerhans in the majority of patients. Causes a person to produce antibodies against the cells of the islets of Langerhans is unknown. Any of the possibilities is that there is an environmental agent that antigenic change pancreatic cells to stimulate the formation of autoantibodies. It may also be that

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individuals who have diabetes mellitus type 1 have in common antigens between β cells pangkres them with viruses or certain medications, so the immune system fails to recognize that these cells are the pancreatic cells themselves [28]. Diabetes mellitus type 2 is a type of diabetes mellitus are more common, many sufferers compared with type 1 diabetes mellitus. Patients with type 2 diabetes mellitus reach 90-95% of all patients with diabetes mellitus population. Generally, people older than 45 years, but lately people with diabetes mellitus type 2 has not been revealed clearly. Genetic and environmental factors influence is large enough to cause the occurrence of diabetes mellitus type 2, among others, obesity, a diet high in fat and low in fiber, and lack of physical activity [29]. Individuals who suffer from type 2 diabets millitus still resulting in insulin, but there insentivitas cells to insulin. There may be a genetic link between obesity and prolonged stimulation of insulin receptors. The prolonged stimuli on these receptors can cause a decrease in the number of insulin receptors found on cells. It may also be individuals who suffer from diabetes mellitus type 2 produce insulin autoantibodies associated with insulin receptor, inhibiting access to the insulin receptor, but does not stimulate the activity of the carrier. The reason is what makes diabets mellitus type 2 is also called noninsulin-dependent diabetes mellitus (NIDDM), because insulin still produced by pancreatic β cells [28]. The prevalence of diabetes mellitus is expected to double by 2030 compared to 2007. During this time the treatment has been done for people with diabetes is insulin injections and oral drug delivery antidiabetic have side effects such as headache, dizzy, nausea, and anorexia as well as relatively inexpensive so many people are trying to control blood glucose levels in the traditional way using materials nature such as herbal plants [30]. The research states that a medicinal pumpkin plant (Cucurbita moschata) as antidiabetes mellitus as follows: [17] polysaccharide extract of Cucurbita

moschata cause significant inhibition at concentrations of α-glucosidase with 0.70.9 mg / ml.[31] powder on the species Cucurbita moshata have hypoglycemic properties of type 2 diabetes mellitus. [32] polysaccharide capable of lowering blood glucose concentration, increase serum insulin improve glucose in mice were given treatment using alloxan will then damage the cells β pangkreas in mice, therefore, can cause diabetes mellitus, alleged that the polysaccharide has antioxidant properties that protect cells β pangkreas. The results showed that among the proteins extracted, globulins constitute the most abundant class of storage proteins in all five species selected. Citrullus lanatus and Cucurbita moschata presented the highest levels of globulin (275.34 and 295.11 mg/g dry matter, respectively). The results of electrophoresis showed that all species possess acidic and neutrals albumins and globulins, with molecular weight of protein subunits ranging from 6.36-44.11 kDa for albumins, 6.5-173.86 kDa for globulins and 6.5-49.66 kDa for glutelins. The 6.36 kDa of albumin subunit protein and the 6.5 kDa of globulin subunit protein were present in all the species. The oral glucose tolerance test showed that the globulins of the seeds of all species except Cucumeropsis mannii caused significant drop in blood sugar (88 – 137.80%, compared to the controls, p<0.05). These findings showed that the selected Cucurbitaceae seeds contained globulins with significant anti-hyperglycaemic activity. It is therefore highly encouraged to pursue investigations towards development of peptide-drugs and/or phytomedicines from these bioactive proteins which could be used as affordable alternative therapy against DM [33]. Conclusions Indonesia country rich in biodiversity, one of which is a pumpkin that is the local plant as a traditional medicinal plant. More than 200 species of medicinal plants that can be used for health, the effectiveness of medicinal plants for the benefit of society as a treatment to 75% [1].

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Pumpkin contains the active molecule in the flesh of the fruit, seeds, flowers, and its leaf, the content of the parts of the plant pumpkin, among others, proteins, petida, polysaccharides, sterols of the aminobenzoic acid, vitamin A, vitamin C, [20]. Pumpkin plants as medicinal plants can be used to control cancer, [21] [24] that plant pumpkin as a medicinal plant has many nutritional content such as; Protein, vitamin A, beta-carotene, potassium, vitamin C, unsaturated fatty acids, phosphorus, phytoestrogens, selenium, fiber, cucurbitacin E, calcium, zinc, other vitamins and minerals. The pumpkin plants as medicinal plants can be used as antidiabetic, [17] polysaccharide extract of Cucurbita moschata Duch cause significant inhibition at concentrations of α-glucosidase with 0.7-0.9 mg / ml. [31] powder on the species Cucurbita moshata have hypoglycemic properties of type 2 diabetes mellitus. [32] polysaccharide capable of lowering the concentration of blood glucose, serum insulin increases glucose repair in rats given the treatment using alloxan then will destroy pancreatic β cells in mice, therefore, can cause diabetes mellitus, that polysaccharides have antioxidant properties that protect cells of the pancreatic β. Acknowledgement Thank you, I thank the rector of the Institute of Health Sciences Kediri, head of research institutions and community service IIK kediri which gives the opportunity and motivation to the author, so I can finish the scientific papers. Refrences [1] Yamada, H. 2008 Whistler award lecture. International Carbohydrates Symposium. Oslo, Norway.

Lokakarya tentang Penelitian Praktek Pengobatan Tradisonal. Badan Penelitian dan Pengembangan Kesehatan, Deparetem Kesehatan Republik Indonesia. Ciawi, 14-17 Desember 1988. [4]

[5] Manal, K. A. 2006. Effect of pumpkin seed (Cucurbita pepo L.) diets on benign prostatic hyperplasia (BPH): chemical and morphometric evaluation in rats. World Journal of Chemistry 1 (1): 33-40. [6]

Fu, C., Shi, H. and Li. Q. (2006). A review on pharmacological activities and utilization technologies of pumpkin. Plant Foods for Human Nutrition, 61: 70-77.

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Inngjerdingen, M., Inngjerdingen, K. T., Patel, T. R., Allen, S., Chen, X. Y., Rolstad, B., Morris, G. A., Harding, S. E., Michaelsen, T. E., Diallo, D. and Paulsen, B. S. 2008. Pectic polysaccharides from Biophytum petersianum Klotzsch, and their activation of macrophages and dendritic cells. Glycobiology, 18: 1074-1084.

[8]

Košťálova, Z., Hromádková, Z., Ebringerová, A., Polovka, M., Michaelsen, T. E., Paulsen, B. S. 2013. Polysaccharides from the Styrian oil-pumpkin with antioxidant and complement-fixing activity. Industrial Crops and Products, 41: 127-133.

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Asgary Sedigheh, Moshtaghian Seyyed Jamal, Setorki Mahbubeh, Kazemi Somayeh4, Rafieian-kopaei Mahmoud, Adelnia Azadeh6 and Shamsi Fatemeh, 2011. Hypoglycaemic and hypolipidemic effects of pumpkin (Cucurbita pepo L.) on alloxan-induced diabetic rats. African Journal of Pharmacy and Pharmacology Vol. 5 (23): 26202626.

[2] Dorly. 2005. Potensi Tumbuhan Obat dalam Pengembangan Industri Agronomi. Bogor: ITB. [3]

Jia, W., Gao, W. and Tang, L. 2003. Antidiabetic herbal drugs officially approved in China. Phytotherapy Research, 17: 1127-1134.

Sosrokusumo, P. 1989. Pelayanan pengobatan tradisional di bidang kesehatan jiwa. Dalam: Salan, R., Boedihartono, P. Pakan, Z.S. Kuntjoro, dan I.B.I. Gotama (ed.).

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[10] Ashok Sharma, Ashish K. Sharma, Tara Chand, Manoj Khardiya, Kailash Chand Yadav. 2013. Antidiabetic and Antihyperlipidemic Activity of Cucurbita maxima Duchense (Pumpkin) Seeds on Streptozotocin Induced Diabetic Rats. Journal of Pharmacognosy and Phytochemistry. Vol. 1 (6): 108-116. [11] Weng, Y., and Sun, Z. (2012) Major Cucurbit Crops. In Wang, Y., Behera, T. K., Kole, C. Genetics, Genomics and Breeding of Cucurbits St. Helier, Science Publishers. [12] Suwanto. 2015. Potential of Local Food Pumpkin ( Cucurbita moschata Duch ) as Diversification of Rice to Food Security. International Conference on Life Sciences and Biotechnology. Exploration and Conservation of Biodiversity. Biology Department, Faculty of Mathematics and Natural Sciences, The University of Jember. [13] Dietmar, F. 2005. Extract of Pumpkin Seeds Suppresses Stimulated Peripheral Blood Mononuclear Cell Invitro. American Journal of Immunology (1): 6-11.

Botanicae Horti Agrobotanici Cluj, 39: 34-40. [17] Song, Y., Zhang, Y., Zhou, T., Zhang, H., Hu, X. and Li, Q. 2012. A preliminary study of monosaccharide composition and α-glucosidase inhibitory effect of polysaccharides from pumpkin (Cucurbita moschata) fruit. International Journal of Food Science & Technology, 47: 357–361. [18] Hutapea, J. R. 1994. Labu Kuning (Cucurbita moschata Duch). CCRCFarmasi UGM. Yogyakarta. [19] Agbagwa, I. O., B. C. Ndukwu, and S. I. Mensah. 2007. Floral biology, breeding system, and pollination ecology of Cucurbita moschata (Duch. Ex Lam) Duch. Ex Poir. Varieties (Cucurbitaceae) from part of the Niger Delta, Nigeria. Turk. J. Bol. 31: 451-458. [20] Yadav, N., Morris, G., Harding, S. E., Ang, S. and Adams, G. G. (2009). Various non-injectable delivery systems for the treatment of diabetes mellitus. Endocrine, Metabolic & Immune Disorders-Drug Targets, 9: 1-13.

[14]Yuliani, S., E.Y. Purwani, S. Usmiati, dan H. Setiyanto. 2004. Penelitian Pengembangan Teknologi Pengolahan Pangan Berbasis Sagu, Sukun dan Labu Kuning: Kegiatan Penelitian Pengembangan Teknologi Pengolahan Berbasis Labu Kuning. Laporan Akhir. Balai Besar Litbang Pascapanen Pertanian, Badan Litbang Pertanian, Departemen Pertanian.

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[15] Huang, G., Tan, J., Tan, X. and Peng, D. 2011. Preparation of polysaccharides from wax gourd. International Journal of Food Sciences and Nutrition, 62: 480-483.

[23] Mushtaq Ahmed, Muhammad Imran Khan, Muhammad Rashid Khan, Nawshad Muhammad, Amin Ullah Khan1 and Rahmat Ali Khan1. 2013. Role of Medicinal Plants in Oxidative Stress and Cancer. Journal Scientific Reports, 2 (2): 1-3.

[16] Noelia, J., Roberto, M. M., de Jesus, Z. J. and Alberto, G. J. 2011. Chemical and physicochemical characterization of winter squash (Cucurbita moschata D). Notulae

Abasalt Hosseinzadeh Colagar, Omolbanin Amjadi Souraki. 2012. Review of Pumpkin Anticancer Effects. Journal Quran Med.1(4): 7678.

[22] Radovich, T. 2011. Farm and Forestry Production and Marketing profile for Pumpkin and Squash (Cucurbita spp.). Permanent Agriculture Resources. USA, pp. 2-12.

[24] Johnson, E. J., and Johnson, T. J. 1996. Economic plants in a rural Nigerian market. Economic Botany, 30: 375-381.

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[25] Jude E. Okokon, Ashana Dar Farooq, M. Iqbal Choudhary, Bassey S. Antia. 2012. Immunomodulatory, Anticancer and Anti-inflammatory Activities of Telfairia occidentalis Seed Extract and Fractions. International Journal of Food Nutrition and Safety, 2(2): 7285. [26] Clark, Marie. 2004. Understanding Diabetes. England: John Wiley & Sons‟s Ltd. [27] Sukandar. 2008. ISO Farmakoterapi. Jakarta: PT. ISFI Penerbitan. [28]

Corwin, E.J. 2009. Buku Saku Patofisiologi. Jakarta: Penerbit Buku Kedokteran EGC.

[29] Direktorat Jenderal Bina Kefarmasian dan Alat Kesehatan Departemen Kesehatan RI. 2005. Pharmaceutical Care Untuk Penyakit Diabetes Mellitus. Jakarta. [30] Okky Meidiana Prameswari, Simon Bambang Widjanarko, 2014. Uji Efek Ekstrak Air Daun Pandan Wangi

Terhadap Penurunan Kadar Glukosa Darah dan Histopatologi Tikus Diabetes Mellitus, Jurnal Pangan dan Agroindustri, 2 (2): 16-27. [31] Chen, Z., Wang, X., Jie, Y., Huang, C. and Zhang, G. 1994. Study on hypoglycemia and hypotension function of pumpkin powder on human. Jiangxi University of Traditional Chinese Medicine, 25, 50. [32] Li, L., Fu, F., Yukui, R., Guanghui, H. and Tongyi, C. 2005. Effects of protein-bound polysaccharide isolated from pumpkin on insulin in diabetic rats. Plant Foods for Human Nutrition, 60, 13-16. [33] Clautilde Mofor Teugwa, Thaddée Boudjeko, Bruno Tugnoua Tchinda, Pascaline Chouadeu Mejiato and Denis Zofou, 2013. Anti-hyperglycaemic globulins from selected Cucurbitaceae seeds used as antidiabetic medicinal plants in Africa. Jornal BioMed Central Complementary and Alternative Medicine 13 (63): 2-8.

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THE EFFECTIVENESS OF ROSE FLOWER (ROSA CHINENSIS JACQ) AGAINST CANDIDA ALBICANS COLONIES ON JELLY (SDA) MEDIA Erni Dwi Widyana, Tarsikah, Naimah Poltekes Kemenkes Malang Email: [email protected] Abstract Approximately 90% of women in Indonesia have the potential to experience fluor albus. Fluor albus is mostly caused by Candida albicans. C.Albicans is a fungus that often causes infections on people. Herbal medicine is one alternative that can be used as a raw material for anti fungi medication of C. albicans. The purpose of this study was to determine the effectiveness of rose flower (Rosa Chinensis Jacq) against Candida albicans colonies. This research was an experimental laboratory with "Posttest Only Control Group Design", using four repetitions with a concentration of 7.5%, 10%, 12.5%, 15% and 17.5%. The hypothesis test used was One-way ANOVA (Analysis of Variance) with a significance level of 0.05. Analysis at 7.5% concentration, the growth of the colonies was 148.75 CFU/ml; at 10% concentration, the growth of the colonies was 123 CFU/ml; at 12.5%, the growth of the colonies was 86 CFU/ml, at 15%, the growth of the colony was 29 CFU/ml; at 17.5 %, the colony growth was 0, so it can be concluded the higher concentration of rose extract, the lower number of Candida albicans colonies. Rose extract (Rosa chinensis Jacq) is effective in inhibiting the growth of the Candida Albicans fungus with Minimal Killing Levels of 17.5%. Further studies on toxicity test on rose extracts (Rosa chinensis Jacq) against Candida albicans are expected. Keywords: Rose flower (Rosa Chinensis Jacq), Candida albicans

Introduction Fluor albus is a very common symptom experienced by many women. About 90% of women in Indonesia have the potential to experience fluor albus. Research data on women's reproductive health shows that 75% of women in the world suffer from fluor albus at least once in their lifetime, 45% of them would experience this twice or more (Yatim, 2005). Fluor albus is divided into physiological and pathological. Physiological fluor albus occurs before ovulation, before and after menstruation or as hormone influence on pregnancy, while the pathological factor occurs due to vaginal infection, Trichomonas vaginalis infection, candida albicans fungal infection, reproduction malignancy or caused by foreign bodies in the birth canal. Candidiasis is the most frequent cause. The infection often

happens on the vulva and results in ithciness. The fungal attacks the cells in vaginal tract and vulva skin cells. About 15% of women are infected, but the symptoms of fluor albus and itching occurs in 3% to 5% of women. Candida albicans is one of the organisms function as normal flora in human bodies and is not dangerous. But C.albicans is also one of the funguses that cause infections on people. It is usually a local infection such as oral and vaginal infection (Manuaba 2008). Candida albicans is a facultative anaerobic organism that is capable of cell metabolism in both the anaerobic and aerobic atmosphere. This fungus grows at a temperature of 280C - 370C and at a pH of about 4.5-6.5. Candida albicans will have fermentation process in an aerobic or anaerobic condition, which will ferment glucose, maltose and

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sucrose which will then produce acid and gas (Simatupang, 2008). Treatment for fluor albus due to infection caused by Candida fungus usually starts with avoiding or eliminating predisposing factors before medication with chemical drugs. Medical treatment with chemical drugs does give satisfactory results, but it has side effects such as fever, vomiting, muscle spasms, and hypotension. Herbal medication is one alternative that mostly people choose when they are reluctant to use medical treatment using chemical drugs, so that it is necessary to do research on the medicinal herbs (Riskillah, 2010). Herbs that can be used as a natural ingredient for treating fluorine albus among others are turmeric, ginger, pomegranate, papaya fruit, yellow flowers, hibiscus, kembang pukul empat flower, and rose flower (Fitzania, 2010). Rose (Rosa chinensis Jacq) contains vitamin C, B, E and K. Its atsiri oil also contains geraniol, limonene, citrate substance, citronellol, linalol, nerol, eugenol, feniletilalkohol, farnesol, gallic acid and nonilal-dehida. The result of the research conducted by Tripathi (2002) states that gallic acid content on roses has antifungal effect against 17 kinds of fungi in concentrations of 3%. Yi Zhong Cai, et.al (2005) mentions that rose flower (Rosa chinensis Jacq) contains a lot of hydrolyzable tannins, flavonoids and anthocyanins. Flavonoid found in rose is about 41 mg / 100 g dry. Flavonoids, tannins and antioxidant activity found in roses can inhibit the growth of bacteria and fungi (Sigh, et.al 2009).

treatment group were given extracts of rose flower (Rosa chinensis Jacq). Sampling The samples used were vaginal Candida albicans from Microbiology Laboratory of the University of Brawijaya cultured in a petri dish with SDA medium (Sabouraud dextrose Agar), using four repetitions for each extract concentration of roses (Rosa chinensis Jacq) which are 7.5%, 10%, 12.5%, 15%, 17.5%. Data Collection and Instrument Stage 1 Make rose extract (Rosa chinensis Jacq) using maceration method by providing 500g of fresh rose petals, dried in room temperature. Once dried, mash them using the blender then weigh them. Put 100gr of dry sample into an Erlenmeyer glass with the size of 1 liter, soak with methanol to a volume of 900 ml (3 times), then whisk until thoroughly mixed (± 30 min) and allowed to stand one night to settle. Take the top layer of the mixture of ethanol with active substances that have been drawn up and put in the 1 lt evaporation flask. Attach the evaporation tube on evaporator and fill up the water bath with water. Let methanol solution separate from the existing active substance in the flask. Wait until methanol flow stops dripping from the container flask (± 1.5 to 2 hours for 1 flask). Put the result into a plastic bottle and store it in the freezer. Stage 2: Rose Extracts Test (Rosa chinensis Jacq) against Candida albicans colonies. 1) Pre-test. It is conducted to find out the concentration of flower petals extract. On this test, the killing ability of each extract with concentration of 5%, 7.5%, 10%, 12.5%, 15%, 17.5% with a ratio of (1 cc of aquabidest:100) x concentration of the extract. 2) 65 grams of Saboraud Dextrose Agar powder is added to 70 ml of distilled water; stir and cover it with

Method This research was an experimental research laboratories using dilution Tube Test to determine the effects of roses antifungal (Rosa chinensis Jacq) against Candida albicans in Vitro. It used "Posttest Only Control Group Design" with colonies of Candida albicans

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aluminium foil and sterilize with autoclave together with the instruments used for 15 minutes with the temperature of 121ºC. 3) First layer of liquid Saboraud Dextrose Agar is poured into sterilized petri dish and let it to become solid 4) Take 1 ml of 1 ml Candida albicans culture using heated osche above spiritus lamp until it is getting heated then let it cool 5) Give 0.1 ml rose petal extract (Rosa chinensis Jacq) with concentration of 7.5%, 10%, 12.5%, 15%, 17.5%. 6) Do a full streaking on Saboraud Dextrose Agar media as much as 10µ1 7) Petri dish is incubated for 24 hours in incubator with temperature of 37º 8) Calculate the growth (Colony Counter) using Total Plate Count (TPC) method 9) Repeat the experiment as much as 4 times.

Minimum Killing Level is the lowest concentration of an antimicrobial that can kill fungi (characterized by the absence of bacteria growth in SDA medium) or colony growth of less than 0.1% of the number of colonies on initial inoculum (original inoculum / OI) in SDA medium by one ose streaking (Dzen et al., 2003). The results of streaking on SDA medium can be seen in figure 1.

Result And Analysis Table 4.1 The result of Candida albicans colony calculation on Pre-test Concentration 5% 7.5% 10% 12.5% 15% 17.5%

The number of growing Candida Albicans colonies 193 151 128 77 29 0

From table 1 it can be seen that a concentration of 5% is able to inhibit the growth of Candida albicans colonies. With a concentration of 17.5% there is no growth of Candida albicans colonies. Test Result of the Growth of Candida Albicans

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(c)

(b) %

(a)

(d)

(e)

Figure 1. Candida Albicans growth on many rose extract flower with jelly media Source: Primary Data Caption: (a) Growth of colonies of Candida Albicans with concentration of 7.5% (b) Growth of colonies of Candida Albicans with concentration of 10% (c) Growth of colonies of Candida Albicans with concentration of 12.5% (d) Growth of colonies of Candida Albicans with concentration of 15% (e) Growth of colonies of Candida Albicans with concentration of 17.5% The result of descriptive analysis about the data of the number of Candida albicans colony growth

at a concentration of 7.5%, 10%, 12.5%, 15% and 17.5% can be seen in the following table:

Table 2. Calculation Results of the number of Candida albicans colonies in each concentration Concentration Repetition I II III IV Average

The number of growing Candida Albicans colonies 7.5% 10% 12.5% 15% 17.5% 149 127 96 31 0 149 115 70 26 0 146 115 62 25 0 151 123 86 29 0 148,75 123 86 29 0

Based on the observation in Table 2, it was found out that by the increasing concentration of rose petals extract, the number of colonies that grow on the SDA (Saboraud Dextrose Agar) is also increasingly reduced. 7.5% concentration resulted in the largest and most dense growth of fungal colonies, that is 149 CFU/l.

Meanwhile, at a concentration of 17.5%, there is no growth of Candida albicans colony. From the result of isolated Candida albicans colony growth and calculation, the killing ability minimum level of rose extracts can be determined. That is, on the SDA with colony growth <0.1% of the original

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inoculum. The minimum killing level of rose extracts in this treatment was 17.5%. Prior to statistical analysis to determine mean differences of each rose extract concentration, normality and homogeneity tests were conducted.

Table 4 The result of Homogeneity test: Levene One Way ANOVA on the number of

Candida Colonies Concentration

Normality Test Results Normality test results on the number of Candida albicans colonies of each rose (Rosa chinensis Jacq) petals extract concentration with Shapiro-Wilk test can be seen in Table 3.

7.5% 10% 12.5% 15%

The number of Candida Albicans Colonies () 0.572 0.224 0.768 0.650

The Results of Variant Data Analysis on the Number of Candida albicans Colonies in average number of Candida Albican colonies (CFU/ml)

7.5% 10% 12.5% 15%

The number of Candida Albicans Colonies  Average ± SD Levene 148.75 ± 2.062 0.692 120.00± 6.000 78.50± 15.351 27.75 ±2.754

Homogeneity test results in Table 4 shows the value of> 0.05 ( = 0.692), which indicates that the data is homogeneous, so that the One-Way ANOVA test requirement is met, which should be in a normal distribution and the variance should be the same

Table 3 The Results of the ShapiroWilk normality test on the number of Candida albicans Colonies Concentration

albicans

The results Shapiro-Wilk normality test as shown in Table 3 shows that the value of> 0.05, so the significance of all the data on the number of colonies of Candida albicans at each concentration is at normal distribution.

160 140 120 100 80 60 40 20 0 7,5% 10% 12,5% 15% 17,5% rose extract concentration

Homogeneity Test Results Homogeneity test of the average number of Candida albicans colonies at each rose petals (Rosa chinensis Jacq) extract concentration were tested with Levene test using One Way ANOVA.

Each Concentration Graph 1 Average Number of Colonies of Candida albicans in Each Concentration

Graph 1 shows the significant reduction in the number of colonies in with rose extract provision, wherein the more number of extract concentration the less number of Candida albicans colonies were grown.

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Table 5. Results of ANOVA test on Total Colonies of Candida albicans in Each Concentration Concentration

N

(X)

SD

F



7.5% 10% 12.5% 15% 17.5%

4 4 4 4 4

148.75 120.00 78.50 27.75 .00

2.062 6.000 15.351 2.754 .000

270.439

0,000

chinensis Jacq) has anti-fungal potency against Candida albicans.

Based on Table 5 it can be concluded that H1 is accepted which means that there are significant differences in the various concentrations of rose extracts (Rosa chinensis Jacq) between concentrations of 7.5% to 17.5%. From ANOVA test results in table 5 and graph 1, it can be concluded that the more concentration of rose petals extract, the less number of growing Candida Albicans colonies. This shows that rose extracts (Rosa

LSD (Least Significance Difference) Test Results on the Number of Colonies of Candida albicans in each concentration. After ANOVA test, it was followed by LSD Post Hoc Test to determine which groups are different and which groups did not differ significantly in the number of colonies of Candida albicans.

Table 6. Mean Difference Test Result using LSD Post Hoc Test on Dependent Variables in Each concentration. Concentration Group (I) 7.5%

10%

12.5%

15%

17.5%

*

Group (J) 10% 12.5% 15% 17.5% 7.5% 12.5% 15% 17.5% 7.5% 10% 15% 17.5% 7.5% 10% 12.5% 17.5% 7.5% 10% 12.5% 15%

Mean Difference (I-J) 28.750* 70.250* 121.000* 148.750* -28.750* 41.500* 92.250* 120.000* -70.250* -41.500* 50.750* 78.500* -121.000* -92.250* -50.750* 27.750* -148.750* -120.000* -78.500* -27.750*



Remark

0,001 0,000 0,000 0,000 0,001 0,000 0,000 0,000 0,000 0,000 0,000 0,000 0,000 0,000 0,000 0,001 0,000 0,000 0,000 0,001

Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different Significantly different

The mean difference was significant at <0.05

From Table 4.6 above it can be seen that there are differences in the

concentration of each extract of rose petals with the average number of

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Candida albicans colonies ( = 0.000,  = 0.001, <0.05).

albicans poliferation. Flavonoids have antifungal effect which is very effective in inhibiting cell growth (Orhan D., 2009). Biological flavonoids activities were done by destroying the cell wall of Candida Albicans consisting lipid and amino acid which react with alcohol groups on a flavonoid compound that will break down the cell walls and the compound can enter the fungi cell nucleus. Furthermore, in the fungi cell nucleus, this compound will contact the DNA in Candida albicans fungi cell nucleus and through differences in polarity between the lipids making up the DNA with alcohol groups on flavonoid compound, there will be a backlash that would damage the lipid structure of the DNA of the Candida albicans. The activity of flavonoids is due to their ability to form complexes with the extracellular proteins which is soluble with cell walls, so that microorganisms cannot attach and invade the host cell. Lipophilical flavonoids may also damage microbe membrane. Flavonoid compounds also inhibit topoisomerase II enzyme work on microorganisms associated with microorganism proteins (Melderen, 2002). DNA gyrase is one of the of topoisomerase II class of enzyme, DNA gyrase twists the strands of DNA and decipher DNA strands. The more lipophilic a flavonoid, the more ability to destroy the bactery cell wall (Cowan, 1999). Tannin contained in rose extract believed to have the same mechanisms as other phenolic compounds in inhibiting and killing the growth of fungi and bacteria and can react in an inactivation function way of genetic material (Branen, 1993). Tannin can also form complex compounds that are irreversible with proline, a complete protein which has the effect of inhibiting the synthesis of proteins to inhibit cell wall. Tannin also has the ability to inhibit reverse transcriptase enzyme from the microbial cells. In addition, Tannin can also

Analysis Rose extracts have antifungal effect against Candida Albicans that can be seen in table 1 showing that the higher the concentration of rose extract used, the smaller the number of colony growth of Candida albicans. It can also be stated that the higher the concentration of the rose extracts the higher antifungal effects. The result of One-Way ANOVA statistical test on Table 5 obtain F count = 270.439, with a value of = 0.000, it is significant with α <0.05, so that <0.05 then H1 is accepted, which means that there are differences between the mean value of colonies of Candida albicans of each extract concentration rose (Rosa chinensis Jacq). Test results in Table 6 on LSD Post Hoc Test which showed a highly significant difference from all group of rose extract concentration which shows <0.05. Rose extract has anti-fungal effect against the Candida albicans fungus which is caused by active substances that are soluble in methanol flavonoid. Suitable with Yi Zhong CAI, et.al (2005) research which states that are hydrozable content of tannins, flavonoids and anthocyanins in roses. There are 17 types of flavonoids that have been identified and 7 types of flavonoid which has not been identified at the roses, and there are 15 types of anthocyanins which are mostly classified as monoglicocides or diglicocides, cyanidin, pelargonidin and peonidin (Mikanagi, et.al, 2000). Roman I, et al, (2013) in his study also states that roses contain ascorbid acid compounds, polyphenols, flavonoids and antioxidant activity. The content of vitamin C in rose is about 0.51 g / 100 g of dried roses, flavonoid about 41 mg / 100 g dried roses, and citric acid approximately 3.34 g / 100 g of dried roses (Arthur A, 2012) .Vitamin C contains in roses decrease Candida

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inhibit the C-14 demethylase enzyme which is also a catalase enzyme, which serves to spur ergosterol. Ergosterol forms a major component of the plasma membrane of fungi. With the disruption of this enzyme function then it cannot synthesize ergosterol normally. This causes plasma membrane structure does not form properly and the function is disrupted (Deacon, 1997). Eukaryotic cell plasma membrane such as C. Albicans cell has an important role in osmotic regulation, nutrient absorption, excretion and cell wall biositesis. Aside from being a major component of the plasma membrane, ergosterol is also involved in the formation of chitin, which is one component of the polysaccharides cell wall and has a very important role in germination. Thus, inhibition of the formation of the plasma membrane ergosterol C. albicans of cells also mean inhibition of reproduction (Albert et al, 2002). In addition to the number of cells, the cell mass can also be used as a measure for the growth of the C. albicans fungi. Dawes and Sutherland (1992) state that the growth of single cells (including fungi) can be interpreted as an increase of cell mass. The results of this study indicate that the concentration of 7.5%, 12%, 12.5%, 15% rose extract cannot affect or inhibit cell mass accretion. This happens because the compounds in roses at these concentrations have not been able to get through the cell walls. At a concentration of 17.5% it can affect C. albicans cell mass accretion, which means interfering with metabolism, so there is no increase in the number of the colonies at this concentration.

Killing Level of rose extracts (Rosa chinensis Jacq) against Candida albicans was 17.5%. Acknowledment The Author would like to thank the Health Polytechnic of Malang, Microbiology Lab of FK UB, and many people who have contributed to this current study. References Braner, LA. 1993. Antimicrobial in Food. Marcel Dekker, Inc, New York. Crowan, MM. 1999. Clinical Microbiology Review-Plant Products Antimicrobial Agent.Ohio Departement of Microbiology, Miami Universiti, Vol.4, No.2, P.564-582, (Online).http://smccd.net/accounts/ case/ref/564.pdf. diakses tanggal 5 November 2013 Deacon., J.W. 1997. Modern Mycology.Blackwell Scientific Publication. London Dzen, S.M., dkk. 2003. Bakteriologi Medik. Banyumedia Publishing. Malang Fitzania. 2012. Toga Sehat. Cara Mengatasi Keputihan secara Alami. http://www.togasehat.com/2012/0 3/cara-mengatasi-merawatkeputihan-secara.htmlFitzania. 2010. Bunga Mawar Sebagai Obat Herbal.http://fitzania.com/bungamawar-sebagai-obat-herbal/ Lin-Sen Qing, et.al., 2012. Identification of Flavonoid Glycosides in Rosa Chinenses Flower by Liquid Chromatography-tandem Mass spectrometry in Combinatoin with 1 3 C Nuclear Magnetic Resonance. Journal Chromatogr A.: 1247: 130-137. http;//j.chroma/2013 Manuaba, IBG. 2008. Gawat Darurat Obstetric-Ginekologi Dan Obstetric-Ginekologi Sosial Untuk Profesi Bidan. Jakarta: EGC.

Conclusion Rose extract (Rosa chinensis Jacq) is effective in inhibiting the growth of Candida Albicans fungus. The higher concentration of rose extract, the higher growth declining of Candida Albicans fungus. Minimum

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Orhan, D, et.al., 2009. Antibacterial, Antifungal and Antiviral Activies of Some Flavonoid.Microbiological Research.165 (20100. 496-504. http://www.Sciencedirect.com Prawirohardjo, S. 2008. Ilmu Kandungan. Jakarata: Yayasan Bina Pustaka. Prayetni, 2001.Asuhan Kebidanan Pada Ibu Dengan GangguanReproduksi. Jakarta: Pusdiknas Depkes RI. 2010. Candida Riskillah, A.G. Albicans.Faculty of Medicine – University of Riau. Pekanbaru, Riau. © Doctor's FiLez.(http://www.DoctorsFilez.tk Roman I, et.al. 2013. bioactive Compounds And Antioxidant Activity Of Rosa Canina L. Biotypes From Spontaneus Flora of Transylvania.Chemistry Central Journal. 7:73. http;//Journal.chemintrycentral.co m/content/7/73. diakses tanggal 5 November 2013 Sigh, Sheena, Robbins N, Zaas A, Scheel WA, Perfect JR, Cowen, LE. 2009. Hsp90 Governs Echinocandin Resistance in the Pathogenic

Yeast Candida albicans via Calcineurin. Research Article. Tersedia dalam journals.plos.org/plospathogens/ar ticle?id=10.1371/journal.ppat.100 0532 Simatupang, Maria Magdalena.2009. Candida Albican. Departemen Mikrobiologi. Fakultas Kedokteran UniversitasSumatra Utara. Tersedia dalam http://repository.usu.ac.id/bitstrea m/123456789/1935/1/09E01452.p df Tripathi G, Wilshire C, Macaskill S, Tournu H, Budge S, Brown AJB. Gcn4 co-ordinates morphogenetic and metabolic responses to amino acid starvation in Candida albicans.MBO J. 2002 Oct 15; 21(20): 5448–5456. Yatim, F, 2005. PenyakitKandungan. Jakarta: Pustaka Populer Yi-Zhong CAI, et.al, 2005. Phenolic Antioxidants (Hydrolyzable, Tannis, Flavonols and Anthocynins) Identified by LCESI-MS and MALDI-QIT-TOF MS From Rosa Chinensis Flowers. The University of Hong Kong.

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EFFECTIVENESS OF ZAMZAM WATER AND ALKALI WATER TOWARD ANKLE BRACHIAL INDEXS, OXIDATIVE STRESS AND REDUCE HEMOGLOBIN A1C IN DIABETIC FOOT ULCER PATIENT Yohanes Andy Rias Departement of Medical Surgical, Collage of Nursing, Bhakti Wiyata Institute of Health Sciences, Indonesia E-mail: [email protected] Abstract DFU that can affect oxidative stress so result in an imbalance between oxidants and antioxidants mechanisms. The imbalance can be affected by water consumption such as zamzam water and alkaline water. it can be neutralize acidic conditions in the body, the cells used for hydration, and removing toxins and produce insulin efiseien. We have carried out this study in diabetic foot ulcer patients to evaluate the effect of Zamzam water be compared Alkaline water on their oxidant antioxidant status, glycemic control, vascularization (Ankle Brachial Indexs) and lipid profile as long as 61 day. The patients were randomly divided into two groups each drank one liter/day of water for 61 day; one group received alkaline water while the other drank zamzam water. This study was a experimental design with purposive sampling and than pre and post test controlled grups design. Results after two months of water consumption were compared with their corresponding baseline values in the same groupusing paired t-test. Statistical significance was set at p<0.05. Regarding these results, based on the results of research that correlated with a literature review, it can be concluded that Zamzam water and alkaline water can affected by ABI, reduce hemoglobinA1c, and blood glucose, but no significant influence on TBARS, MCH, ESR. Further research is needed in this area to confirm the results and explore the mechanism behind HbA1c lowering effect produced by zamzam water and alkaline water compared and hystology of pancreas organ. Keyword: zamzam water, alkali water, ankle brachial indexs, oxidative stress, hemoglobin a1c, diabetic foot ulcer

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Introduction Diabetes Mellitus (DM) is a disease of carbohydrate metabolism disorders include chronic caused by a deficiency of insulin hormone in relative or absolute terms with complications of diabetic foot ulcers 1,2. Diabetic foot ulcer (DFU) is a neurological disorder as a result of tissue damage (neuropathy) and vascular in the limbs, finally amputation and affect quality of life 3,4,5 . The results of an international consensus on the management and prevention DFU of some countries such as the UK, DFU incidence of 7.4%, Netherlands 2.1%, Sweden 3.6% and 5.8% in the United States of participants DM 6,7. DFU incidence in developing countries reached 2-4% higher than in developed countries 8. The increase in participants DFU in Indonesia has not been registered with the clear, but can be seen from the increase in the prevalence of DM. World Health Organization (WHO) released that people with diabetes in 2000 amounted to 8.4 million people and is predicted to increase to 21.3 million in 2030. Based on these figures can be predicted total of people with diabetes who have DFU with the level of risk of 25% to 5.3 million 9. According to Profiles and Information Services in Dr. Moewardi Surakarta Hospital (2006) be found 13.968 people with DM during of 2005 and than increased in 2006 to 15.365 patients, of which suffer from DFU in 2005 amounted to 362 patients and increased in 2006 to 487 patients. Data in the surgical Ward at Dr. Saiful Anwar Malang Hospital, stated that the DFU increased as much as 11.8% of the 118 cases in the first 6 months to 132 cases in the second 6 months of 2011 10. Data acquired in PKU Muhammadiyah Unit II there were 29 patients with DFU in 2012, 40 patients with DFU in 2013, and in 2014 (January to March) there are 8 DFU patients who underwent inpatient treatment 1 1 . DFU treatment serves to prevent and minimize the acute and chronic

complications related to oxidative stress 12,13 . Oxidative stress is an imbalance between oxidant and antioxidant which are caused by excessive exposure to prooxidants or deficiency of antioxidant mechanisms 14,15,16. Oxidative stress can be minimized by increasing the antioxidant defense mechanisms and than one of which is alkaline water 14, 16, 17. Alkaline water containing components such as negative oxidation reduction potential, hydrogen dissolved and pH > 7, so that reported to reduce oxsidative stress and to improve the glycemic control 17,18,19. Alkaline water has the same charateristic with Zamzam water. Zamzam water is natural water comsumed by millions of muslim and has been found to be alkaline so that rich in many minerals and is potential antioxidant agent 20, 21. Therefore, this study was designed to investigate the effect of 61 day alkaline water (pH 8) compared with Zamzam water (PH 7,9) ingestion on oxidantantioxidant status, glycemia control, ankle brachial index and lipid profile in diabetic foot ulcer patients. Materials and Method Study Design and Measurement Instrument This study was a experimental design with purposive sampling and than pre and post test controlled grups design. Independent variabel are zamzam water and Alkaline water. Dependent variabel are oxidant-antioxidant status, glycemia control and lipid profile in diabetic foot ulcer patients. Measurement Instrument among others water sample, patient, blood collection, laboratory analysis, ankle brachial index protocol and statistical analysis. The subject of the research is diabetic fot ulcer patients by exclusion criteria: patients of the following criteria were excluded from research 1. Age more than 60 2. HbA1c less than 7%

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3. Diabetic foot ulcer grade IV or major cardiac problem 4. Patients not pleasure in the follow up periodically Water sample were obtained from NWCC from Sunan Ampel Surabaya and Air Kangen (pH 8). Each patients in both grup was instructed to drink 1 liter/day for 61 day. The research was conductade in all aspects releted to research ethics according to decleration of Helsinki. At the first time visit, baseline investigation among others ingestion on oxidant-antioxidant status, glycemia control and lipid profile in diabetic foot ulcer patients. The patients were divided into one of two groups through simple randomization walk in method and than the above investigations were repeated again at the end of the study. After explaining about the research objects and emphasizing on the information confidentiality and obtaining agreement from the patients, the required information was collected from the samples. The data was analyzed by the analitic software. Results after two months of water consumption were compared with their corresponding baseline values in the same groupusing paired t-test. Statistical significance was set at p<0.05.

their baseline levels in the group of patients who received zamzam water as well as alkaline water. Table 2 summarizes the baseline and final levels of fasting blood glucose and hemoglobin A1c (HbA1c) of all patients. The group of patients who drank Zamzam water and alkaline showed a significant decline in HbA1c and than all parameters in the lipid profile were not changed significantly in both groups. Table 3 summarizes the results on blood urea, serum creatinine, uric acid and calcium. A significant rise in serum creatinine and uric acid was encountered in the group given Zamzam water. ESR, HCT, and MCH dan MCV, ABI has infuence (table 4). Tabel 1 Antioxidant capacity, TBARS and Superoxide dismutase Zamzam Water

Alkaline Water

Antioxidant capacity TBARS Superoxide dismutase

0,001 0,771 0,028

0,002 0,819 0,011

Tabel 2 baseline and final levels of fasting blood glucose and hemoglobin A1c (HbA1c) Parameter Blood glucose HbA1c

Result Analysis of the data shows that the diabetic foot ulcer patients average age was (56.87±8.17), the minimum age was 28 and the maximum age was 59. Most of the samples were women (54.3%). There was no significant difference between the two groups of patients in sex distribution and duration of diabetes and great DFU. Chemical composition of Zamzam water and alkaline water samples, used in this research, is shown in Table 1 summarizes the baseline and final levels of serum antioxidant parameters and TBARS for both groups of diabetic foot ulcer patients included in the research. At the end of the two months water consumption, serum total antioxidant capacity, and superoxide dismutase were significantly higher than

p-value

Parameter

p-value Zamzam Water

Alkaline Water

0,041 0,010

0,038 0,009

Table 3 summarizes the results on blood urea, serum creatinine, uric acid and calcium Parameter Urea Creatinin Uric acid Calcium

p-value Zamzam Water

Alkaline Water

0,064 0,026 0,010 0,044

0,049 0,022 0,019 0,011

Tabel 4 summarizes ESR, HCT, and MCH dan MCV and ABI Parameter ESR HCT MCH

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p-value Zamzam Water

Alkaline Water

0,532 0,118 0,477

0,617 0,118 0,319

MCV ABI

0,010 0,008

0,018 0,008

Discussion Zamzam water teatment fasting glucose result is not decreasing, which means, however HbA1c levels decreased significantly. The decrease in HbA1c in our study could be due to combination of the insignificant decrease in blood glucose and the enhancement of antioxidant power 21 . Since HbA1c is a predictor of cardiovascular risk in people without diabetes21, 22. Alkaline water contains many hydrogen molecules that can stimulate glucose uptake by cells. Alkaline water also have the ability to decrease the effects of antioxidants and free radicals in the body, thus preventing complications and reducing ROS 18,19. Based on the theory of the antioxidant power can be reduced in water electrolysis such as alkali water and zamzam water. Furthermore, electrolyzedreduced water has been reported to enhance human lymphocyte resistance to the DNA strand breaks induced by H2O2 in vitro21,23. The antioxidant power of Zamzam water could be due to its alkaline pH and/or to its richness in many minerals needed for antioxidant enzymes activity. The other interesting finding in this study is the significant decrease in HbA1c following 2 months ingestion of Zamzam water in type 2 diabetic patients 21. Unexpectedly, there was‟t a corresponding decrease in fasting blood glucose in these patients. This seems to be conflicting with the previous finding of a significant lowering effect of glucose produced by alkaline water in animals18, 21,24. The effect of a decrease in glucose levels is consistent with research Jin et al (2006), where the glucose levels in the mice decreased after the administration of alkaline water for 12 weeks. There is a decrease in blood sugar and HBA1c significantly after consuming alkaline water for 6 days25. Diabetes mellitus, antioxidant defense and cellular repair systems will be stimulated in response oksidatif challenge26... Sources of oxidative

stress that occurs derived from the increased production of free radicals due to auto oksidasi glucose, weight reduction in the concentration of antioxidants low molecular network, and the disruption of activity enzymatic antioxidant defense. Significance of oxidative stress pathology of the disease is often uncertain. Therefore oxidative stress and impaired antioxidant defenses. Diabetes mellitus is a privilege that occurred since early in the disease. In addition, oxidative stress also has contribute to the deterioration and the development of events complications26. The excess superoxide radicals, there will be a reaction with nitric oxide generating radical peroxynitrite which are cytotoxic. Inhibition radical peroxynitrite formation will keep function vasodilation of blood vessels, played by nitric oxide. In endothelial cells, ascorbic acid affects the enzyme nitric oxide synthase that superoxide radicals as a side-product formation of nitric oxide can pressed. Another mechanism is the ability of ascorbic acid reduced or oxidized form in inhibiting the entry of glucose via the GLUT transporter into the cell so as to reduce interference vasodilation dependent endothelial cells 26. Simple checks that can be performed for the detection of PAD is to assess the Ankle Brachial Index (ABI). This can happen due to the narrowing formed slowly and has been formed to find out the necessary collateral and peripheral vascular system examination, segmental blood pressure measurements (at each extremity), vascular doppler ultrasonography inspected and checked on each patient's ABI. ABI values have a sensitivity of 95% and a specificity of 99% PAD significant compared using angiography. Meanwhile, according to ABI value in determining the PAD has a sensitivity of 91% and specificity of 86% 27,28,29 . According to Framingham Heart Study said 20% of patients with PAD symptoms of diabetes, and PAD itself as a major risk factor for amputation, especially for patients diabetes 30. Conclusion

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Regarding these results, based on the results of research that correlated with a literature review, it can be concluded that Zamzam water and alkaline water can affected by ABI, reduce hemoglobinA1c, and blood glucose, but no significant influence on TBARS, MCH, ESR. References 1. Bryant, R & Nik, D. (2007). Acute and Chronic Wound Current Management Concept. St.Louis: Mosby Elservier. 2. Maidina, TS., Djalaludin, Alfi Yasmina (2013). Corelation HBA1c levels with the incidence of diabetic foot ulcer in patients with diabetes mellitus. Periodic medikal journal vol 9 No 2. September 2013: 211-217 3. Foley, L. (2007). Where to the Diabetic Foot Ulcer. Retrieved September 12, 2013,http://www.awma.com.au/journal/ library/1502_03.pdf. 4. Firman, A., Indah W., Dadang, R. (2012). Quality of Life of Patients Diabetic Ulcers In Serang District General Hospital in 2012 5. Souza, D., et al. (2013). Quality Of Life and Self-Esteem of Patients With Chr onic Ulcers. Retrieved January 02, 2014. From Acta Paul Enferm journal 26(3):283-8. 6. Jeffcoate, W.J., Harding, K.G. (2003). Diabetic Foot ulcer: a Review. Retrieved September 12, 2013, From http://www.epodiatry.com/diabeticfoot.htm 7. Handayani, T.W. (2010). Management influence Depression with Yoga Breathing Exercises for Diabetic Ulcer Healing Process Development in Aceh Government Hospital. Thesis, Faculty of Health Sciences, University of Indonesia. Jakarta. 8. Misnadiarly. (2005). Diabetic Foot Problems and Countermeasures effort. http: //www.honson_kaki diabetic.htm. downloaded dated October 1, 2013 9. Society of Endocrinology Indonesia. (2006). Consensus: Management and Prevention of Type 2 Diabetes Mellitus in Indonesia. PERKENI: Jakarta.

10. Wijanarko, Yeni. (2012). Relations Knowledge Level About Diabetes Type II Diabetes Foot Care With Diabetic Foot Ulcers incident in RSU Dr. Saiful Anwar Malang. Thesis UB, Malang. 11. Rias.,Yohanes Andy (2014). Development A Model of The Structured Discharge Planning Conservation for Individual and Family Self Management of Diabetic Foot Ulcer. Thesis UMY, Yogyakarta 12. Elmarakby AA, Sullivan JC (2012) Relationship between oxidative stress and inflammatory cytokines in diabetic nephropathy. Cardiovasc Ther 30: 49-59. 13. Tiganis T (2011) Reactive oxygen species and insulin resistance: the good, the bad and the ugly. Trends Pharmacol Sci 32: 82-89 14. Pitocco D, Zaccardi F, Di Stasio E, Romitelli F, Santini SA, et al. (2010). Oxidative stress, nitric oxide, and diabetes. Rev Diabet Stud 7: 15-25 15. Reuter S, Gupta SC, Chaturvedi MM, Aggarwal BB (2010) Oxidative stress, inflammation, and cancer: how are they linked Free Radic Biol Med 49: 1603-1616. 16. Wei W, Liu Q, Tan Y, Liu L, Li X, et al. (2009) Oxidative stress, diabetes, and diabetic complications. Hemoglobin 33: 370-377. 17. Huang KC, Yang CC, Lee KT, Chien CT (2003) Reduced hemodialysisinduced oxidative stress in end-stage renal disease patients by electrolyzed reduced water. Kidney Int 64: 704714. 18. Jin D, Ryu SH, Kim HW, Yang EJ, Lim SJ, et al. (2006) Anti-diabetic effect of alkaline-reduced water on OLETF rats. Biosci Biotechnol Biochem 70: 31-37. 19. Kim, K.-H. Jung, Y.-K. Uhm, K.-H. Leem, H.-K. Kim (2007) Preservative effect of electrolyzed reduced water on pancreatic β-cell mass in diabetic db/db mice. Biological and Pharmaceutical Bulletin, 30 (2007), pp. 234–236

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20. Shomar B (2012) Zamzam water: concentration of trace elements and other characteristics. Chemosphere 86: 600-605. 21. Bamosa Abdullah., et al (2013). Zamzam Water Ameliorates Oxidative Stress and Reduces HemoglobinA1c in Type 2 Diabetic Patients. J diabetes Metab 2013, 4:3. Retrieved September 12, 2014. http://dx.doi.org/10.4172/21556156.1000249. 22. Santos-Oliveira R, Purdy C, da Silva MP, dos Anjos Carneiro-Leão AM, Machado M, et al. (2011) Haemoglobin A1c levels and subsequent cardiovascular disease in persons without diabetes: a metaanalysis of prospective cohorts. Diabetologia 54: 1327-1334 23. Lee MY, Kim YK, Ryoo KK, Lee YB, Park EJ (2006) Electrolyzedreduced water protects against oxidative damage to DNA, RNA, and protein. Appl Biochem Biotechnol 135: 133-144 24. Kim MJ, Jung KH, Uhm YK, Leem KH, Kim HK (2007) Preservative effect of electrolyzed reduced water on pancreatic beta-cell mass in diabetic db/db mice. Biol Pharm Bull 30: 234-236. 25. Jin, S.-H. Ryu, H.-W. Kim, E.-J. Yang, S.-J. Lim, Y.-S. Ryang, et al.(2006) . Anti-diabetic effect of alkaline-reduced water on OLETF rat Bioscience, Biotechnology, and Biochemistry, 70 (2006), pp. 31–37 26. Setiawan, Bambang., Eko suharto (2005). Role of Oxidative Stress and Antioxidants on Diabetes Mellitus. Periodic medikal journal vol 55, No 2. Jakarta. 27. Mangiafico, R.A., Sarnataro, F., M angifico, M. 2006. Impaired cognitive performance in asymptomatic peripheral arterial disease: relation to C-reactive protein and D-dimer levels. Age and Ageing 35: 60–65 28. McDermott, M.M., Liu, K., Criqui, M.H., Ruth, K., Goff, D., Saad, M.F., Wu, C., Homma, S., and Sharrett, R. (2005). Ankle Brachial Index and

Subclinical Cardiac and Caritid Disease. American Journal of Epidemiology.162:33-41 29. Guo, X., Li, J., Pang, W., Zhao, M., Luo, Y., Sun, Y., (2008). Sensitivity and Specificity of Ankle-Brachial I ndex for Detecting Angiographic Stenosis of Peripheral Arteries. Circ J . 72:605-610 30. American Diabetes Association. (2003). Peripheral Arterial Disease in People with Diabetes. Diabetes Care .26:3333-3341.

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THE CORRELATION BETWEEN ENERGY AND PROTEIN CONSUMPTION LEVELS WITH GROSS MOTOR DEVELOPMENT OF UNDERNOURISHED CHILDREN AGED 6-24 MONTH Yuliana Dwi Diningrum, Arinda Lironika S, Agustina Endah W Clinical Nutrition Program, Department of Health, State Polytechnic of Jember Email : [email protected] Abstract Gross motor skill is an important aspects of children‟s development pattern. The period of rapid development occurs in children aged 6-24 months. Children need energy and protein for optimal growth and development. Nutrient consumption effect children‟s developmental disorder preceded by declining nutritional status. The prevalence of children‟s malnutrition increased from 17.9% (2010) to 19.6% (2013). To determine relationship between the level of energy and protein consumption with gross motor development of under nourished children. This was done using quantitative method with an analytic observational study with cross sectional design. The subjects were 48 malnourished children aged 6-24 months and their parents, male and female, who attended Puskesmas Sumbersari. Denver II was used to obtain gross motor development of children, a 2 x 24 hour food recall was used to obtain data on energy and protein consumption levels, whereas the data on nutritional status were measured by weight and age of the children. Data were analyzed with Spearman's rank and Chi-Square test. The findings shows no association between the energy consumption levels (p = 0.467) and protein consumption levels (p = 0.258) with the development of gross motor skills. Meanwhile, there were a significant correlation (PR = 11.2; CI = 95%: 2381-52683; p = 0.002) between the mother's occupation with gross motor development of children. The level of energy and protein consumption do not have a significant correlation with gross motor development of undernourished children. However, mothers who are not working have 11.2 times the odds of having a child with normal gross motor development. Keywords: Consumption of Energy, Consumption Of Protein, Gross Motor Development

future of human resources is still much undernourished. Riskesdas 2013 showed, the prevalence of malnutrition among children by indicators BB/U in Indonesia provides an overview fluctuating from 18.4 percent (2007) decreased to 17.9 percent (2010) and then increased again to 19.6 percent (in 2013 ). Meanwhile, the prevalence of undernourished children less according to indicators BB/U in East Java province in 2010 that is 12.3%. Cause of the high prevalence of malnutrition in person is the consumption of nutrients that do not conform to the body's needs. Nutrient consumption is not directly affected by the availability of household food and nurture the mother of the child. Parenting include how mothers

INTRODUCTION The economic growth of a country is very important as an indicator of the success of the economic development of a country. Human resource factors contribute to efforts to accelerate economic growth. Human resources is driving the nation's economy in creating innovation and creativity in the face of AEC (Asean Economic Community) 2015. One of the obstacles encountered, most likely derived from the quantity and quality of their human resources. Until today, Indonesia is facing a double burden of nutrition problems where malnutrition is still a major problem in the field of nutrition and health. Children as the

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feed, how mothers care for, maintain the health and hygiene of children and mothers as well as how the affectionate mother to her child. Status of malnutrition that occurs in a long time can cause brain damage, pain, muscle weakness and decreased physical growth that could affect the development of strength and gross motor skills children2. The period of rapid development occurs in children aged 6-24 months, so it‟s often referred to as the golden period once the critical period. Golden period can be achieved if at this time, the child can obtain the substances in accordance with the needs for optimal growth and development. Conversely, when children don‟t get food that suits their nutritional needs, the golden period will be turn into a critical period that will interfere with the growth and development, both now and adulthood3. The gross motor is movements of the body that require balance and coordination among part of the body, or in other words is a movement that uses the large muscles, some or all of the body, such as walking, running, jumping, sitting, kicking, climbing, etc.4. Gross motor is the largest area of the development of children under three years of age5. Gross motor development requires energy and protein intake that is sufficient to supply nutrients to the brain and throughout the body to support physical activity involving large muscle. Therefore, the intake of nutrients such as energy and protein in children need to be considered. Energy is the main ingredient for the movement of the body. To perform gross motor activities such as stomach, crawling, standing, walking, and running, it takes quite a lot of energy supply because it involves a mechanism that emit high energy 6. 7 . Effect of nutrient consumption for child developmental disorder preceded by declining nutritional status. Nutritional status is a state of the body caused by the consumption of food and nutrients utilization. Effect of nutrient consumption for child developmental disorder preceded by declining nutritional status. Nutritional status is a state of the body caused by the

consumption of food and use nutrients. Nutritional status is influenced by the amount and type of food consumed and utilized in the body. If the intake of food in the body can lead to malnutrition impaired8. Lack of nutrients in food causes impaired growth in children which in turn will affect the development of the entire herself9. Disorders of nutrition in children can be caused by food rearing of children by mothers who pralakteal feeding or giving complementary foods too early there is even too late, and the number and quality of complementary foods are often inadequate given2. Physical growth disturbance due to the insufficiency of certain nutritional requirements can affect the development of gross motor skills of children, especially energy and protein needs. Energy and protein used for the formation of body tissues, strengthen bones and muscle movement, development of brain function and a power source to support gross motor activities, because children aged 6-24 months in the learning phase to train motor skills requires the consumption of energy and protein in accordance with needs body. Based on the problems, it‟s necessary to study the correlation between energy and protein consumption level with gross motor development undernourished children aged 6-24 months. METHODS This was an analytic observational study with cross sectional design that researchers conducted observations at the same time between the independent variable is the level of energy and protein consumption with the dependent variable is gross motor development undernourished children aged 6-24 months10. This study was conducted in Posyandu at working area of health centers Sumbersari Lumajang during 2 months from July to August 2015. The subject is the whole undernourished children aged 6-24 months who following the weighing Posyandu in August 2014 that is 48 children. The sampling technique using total sampling is a sampling technique in which the number

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of samples is equal to the population, because the population in this study is less than 100 then the entire population of the sample. Data was collected by interviews, direct observation and measurement. Primary data such as identity data of mothers and children was obtained by interview, the child's weight is obtained by anthropometric measurements using the steelyard, nutritional status obtained by Growth Chart WHO-NCHS, the level of energy and protein consumption is obtained by 2x24 hours food recall and gross motor development of children obtained by examination using form DDST II11,12. While secondary data obtained from the recording and reporting of the health status of children in 2014 in the Department of Health Lumajang. The level of energy and protein consumption categorized by the provision of more/above sufficiency when energy consumption and protein levels ≥119%, normal if levels of energy and protein consumption is 90-119%, mild deficiency if the level of energy and protein consumption is 80-89%, moderate deficiency if the level of energy and protein consumption is 7079% and severe deficiency if the level of energy and protein consumption is <70% 13. The categories gross motor development derived from a form DDST II with the normal criteria, if the interpretation of the test results there is no delay and or at most one warning (caution) and the suspect or the suspect is no delay when the interpretation of the test results obtained

two or more warnings (caution) and one or more delay (delay). Gross motor development tests carried out re-testing 1-2 weeks later to eliminate momentary factors such as fatigue, fear and others who can influence the development of the test results11. The data were analyzed using univariate and bivariate statistical test that is chi-square and Spearman's Rank test with significance level (0.05). If the significance or probability values less than or equal to 0.05, then the variable is declared relate significantly. RESULT Characteristics Of Respondents Children who become subjects an average aged 14.77 ± 5.26 months, the age of the youngest and oldest age is 6 months to 24 months. While the gender distribution of subjects are mostly child-sex male (60%). The average age of mothers was 28.12 ± 7.11 years with the youngest age is 16 years old and the oldest is 45 years of age. Then categorized by median age into young adulthood ie mothers aged <31 years and older adulthood ie mothers aged ≥ 31 years. Mother's education includes elementary school, junior high school and Bachelor. While this type of work mothers categorized into two categories: work (civil servants, private employees, factory workers and others) and doesn‟t work as a housewife (Table 1).

Table 1. Distribution of Characteristics of Respondents Characteristics of Respondents Mother : Age (years) < 31 ≥ 31 Level of education Elementary school Junior High School High School College (D3,S1)

Frequency Distribbution (n=48) n

(%)

32 16

67 33

7 17 17 7

14.6 35.4 35.4 14.6

656

Pekerjaan Working Housewife Children : Age (month) 6-12 13-18 19-24 Gender Male Female

12 36

25 75

16 2 10

33 46 21

29 19

60 40 weight (Energy / kg) with ideal weight undernourished children by age can be seen on the Growth Chart WHO-NCHS. Based on the table 2 can be seen that most of the energy consumption levels of undernourished children (83.3%) fall into the category of "severe deficiency" and a small portion (4.2%) belong to the category of energy consumption level "Normal". While the level of protein intake of most undernourished children (35.4%) fall into the category of "severe deficiency" and a small portion (6.2%) belong to the category of "Over/Above sufficiency".

Levels of Energy And Protein Consumption The level of energy and protein consumption is the total energy and protein consumed compared to figures Nutritional Adequacy of energy and protein are recommended. The level of energy sufficiency in RDA per kg body weight (Energy/kg) for children aged 6 months, accounting for 92 kcal, aged 7-11 months in the amount of 81 kcal and the age of 1-2 years in the amount of 86 kcal. While the level of adequacy of the RDA of protein per kg of body weight (protein/kg) for children aged 6-24 months is equal to 2 grams14. In this study, the subject has focused on undernourished children so that the level of energy and protein sufficiency is calculated by multiplying the energy and protein sufficiency in AKG per kg body

Gross Motor Development of Children Table 3 shows that most children have a normal gross motor development as many as 37 children (77.1%) and gross motor development that seems to be a delay as many as 11 children (22.9%).

Table 2. Distribution of Energy and Protein Consumption Levels Of Children

Category Severe deficiency Moderate deficiency Mild deficiency Normal Above sufficiency Jumlah

Level of Energy Consumption n % 40 83.3 3 6.2 3 6.2 2 4.2 0 0

Level of Protein Consumption n % 17 35.4 9 18.8 10 20.8 9 18.8 3 6.2

48

48

657

100

100

Table 3. Distribution of Gross Motor Development Status Of Children Gross Motor Development Categories Suspect Normal Jumlah Relationships Between Characteristics of Mother With Gross Motor Development of Children There are 31 children (64.6%) had mothers with low education levels but gross motor development of children is normal and only one child with suspected gross motor development although highly educated mothers. Conversely, women who are just as housewives (75%) had normal gross motor development of children with a total of 32 children (66.7%) and only 4 children (8.3%) that allegedly contained delays in gross motor development. Chi Square test showed that there was no significant relationship between age and maternal education with gross motor development of children (p> 0.05). However, there is a relationship between the mother‟s jobs with gross motor development of children (PR = 11.2; CI = 95%: from 2381 to 52,683; P = 0.001). Mothers who don‟t work or as a housewife has 11.2 times the chance of having a children with normal gross motor development (Table 4).

n 11 37 48

(%) 22.9 77.1 100

Relationship Between Levels Of Energy And Protein Consumption With Gross Motor Development Of Children Most of children (62.5%) have levels of energy consumption by category of severe deficiency but have normal gross motor development, only 20.9% of children who are suspected delayed gross motor development. Spearman's rank test, showed that there is no significant correlation (p> 0.05) between the level of energy consumption with gross motor development of children and has a positive correlation with the direction of force is very weak correlation (r = 0.108) (Table 5). Meanwhile, severe protein deficiency also occurs in the majority of children (25%) but the gross motor development is normal, only about 10.4% or as much as five children who have alleged delay in gross motor development. Statistical test using Spearman's rank showed no significant correlation (p> 0.05) between the levels of protein consumption with gross motor development of children and has a positive correlation with the direction of force is very weak correlation (r = 0.167) (Table 5).

Table 4. Relationship Between Characteristics Of Mothers With Gross Motor Development Of Children

Characteristics Of Mothers

Age (years) < 31 ≥ 31 Total Level of Education Low High

Gross Motor Development Of Children Suspect Normal % n % n

Total

PR (CI 95%)

p

8 3 11

16.7 6.2 22.9

24 13 37

50 27.1 77.1

32 16 48

66.7 33.3 100

1,444 (0.326-6.401)

0.628

10 1 11

20.8 2.1 22.9

31 6 37

64.6 12.5 77.1

41 7 48

85.4 14.6 100

1,935 (0.207-18.068)

0.562

658

Total Occupation Working 7 14.6 5 10.4 Housewife 4 8.3 32 66.7 Total 11 22.9 37 77.1 *) The chi square test, significant (p <0.05)

12 36 48

25 75 100

11,2 (2.381-52.683)

0.002*

Table 5. Relationship Between Levels Of Energy And Protein Consumption With Gross Motor Development of Children

Consumption Levels

Energy Severe Deficiency Moderate Deficiency Mild Deficiency Normal Total Protein Severe Deficiency Moderate Deficiency Mild Deficiency Normal Above Sufficiency Total

Gross Motor Development Of Children Suspect Normal % n % n

Total

10 0 1 0 11

20.9 0 2 0 22.9

30 3 2 2 37

62.5 6.2 4.2 4.2 77.1

40 3 3 2 48

83.4 6.2 6.2 4.2 100

5 2 3 1 0 11

10.4 4.2 6.2 2.1 0 22,9

12 7 7 8 3 37

25 14.6 14.6 16.7 6.2 77.1

17 9 10 9 3 48

35.4 18.8 20.8 18.8 6.2 100

p

r

0.467

0.108

0.258

0.167

mother then she will learn to be more responsible for the children and their families. Age aging also causes more and more experience and information about health and nutrition of family6. Parental education is one important factor in child development due to good education, then parents can receive any information from outside about how to care for the child properly. The higher the person's level of education, the more easily receive information. Conversely, lack of education will hinder the development of a person's attitude and acceptance new information10. Absence of relationship with the mother's education and gross motor development of children, because the mother is highly educated does not necessarily have a good awareness about nutrition and child development. If one does not often seek or obtain information on nutrition and child development, the

DISCUSSION Relationships Between Characteristics Of Mother With Gross Motor Development of Children Most of mothers (67%) aged less than 31 years and are highly educated only about 14.6%. Meanwhile, if viewed from the mother's jobs, there are about 75% of mothers who don‟t work or as a housewife. While the majority of children aged 13-18 months and more male (60%) rather than female (40%). The results showed that there was no association between maternal age and education level with gross motor development of children. This is in contrast with the theory that maternal age affects children's development. The older the mother, the parenting patterns in feeding and health practices, is better. This is understandable because the older the

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knowledge of it is also not so affect the upbringing of children16. The relationship between maternal employment with gross motor development of children in this study due to the mother who does not work to have more free time to care for her child. Work is generally a time-consuming activity to support life in the family while the housewife will have more leverage in order to know all their activities. Parents who do not work can provide a good stimulation because the mother has plenty of time to care for their children, including providing stimulation with a frequency of more intensive 17. Mother's role in the growth and development of children is very important because children are still very dependent on his mother 18. Advances in the development of more effective, coordinated, and controlled when getting instruction, interaction and support from the adults around them living 19. According to the theory, stimulating factor holding important role in the development of the child. Stimulation is the stimulation that comes from the outside environment of the child. Children who are purposeful and regular stimulation will grow faster than children who have little or no stimulation 11. Research conducted by Brown and Pollit (1996) that malnutrition in early human life does not give a direct impact on human development in the future because there are some other factors that play a role such as the environment, social, economic, health status, and most importantly, stimulation 20.

Gross motor development is skills in balancing her child from crawling to walking and running. To perform the movement takes enough energy corresponding nutritional adequacy rate by age 9. The nutritional status or the fulfillment of nutritional needs is one of the factors that influence the development. If little or no nutritional needs are met, it can inhibit the development of children22. Lack of energy occurs when energy intake through food is less than energy expended, so that the body will have the energy imbalance. As a result, the weight is less than the weight seharusnya.Tingkat consumption is determined by the quality and quantity of dishes. Food quality reflect the nutrients needed by the body are found in foodstuffs, while the quantity of food reflects the amount of each nutrient in a food. It said consumption or inadequate nutrient intake where the body will get good nutrition health condition, in terms of both quality and quantity. By contrast, consumption of poor quality and quantity will give health conditions of malnutrition or deficit 23. The results are consistent with research conducted Hasyuti (2011), showed no association with energy intake gross motor development of children. This can be caused by factors other than nutrient intake, the magnitude of genetic factors and environmental factors can also affect gross motor development of children. According Soetjiningsih (2014), some of the factors that influence the development of, among others, genetic, maternal nutrition during pregnancy, stimulation, parenting.

Relationship Between Level of Energy Consumption With Gross Motor Development of Children The results showed that there was no relationship between the level of energy consumption with gross motor development of children (p> 0.05). This is in contrast with the theory that energy is the key ingredient for the movement of the body. Energy is one of the results of the metabolism of carbohydrates, proteins and fats. Energy serves as an energy for metabolism, growth, temperature regulation and physical activity 21.

Relationship Between Level of Protein Consumption With Gross Motor Development of Children The results showed that there was no correlation between consumption level of protein with gross motor development of children (p> 0.05). This is in contrast with the theory that the protein is a precursor to the neurotransmitter that supports brain development. Good brain function depends on the capacity to absorb and process control informasi.Perkembangan motor is the development of physical movement

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through the nerve center, nerve, and muscle coordinated 18. Proteins can also be used as fuel when the body's energy needs are not met by carbohydrates and fats 26. Protein function for growth, when the body lacks protein function of energy substances to produce energy or forming glucose takes precedence. When glucose or fatty acids in the body are limited, the cells are forced to use protein to form glucose and energi.Glukosa needed as an energy source of brain cells and the nervous system. Breakdown of body protein to meet energy needs and glucose will eventually lead to muscle weakness, coordination of brain cells and the nervous system 7. Lack of protein can further affect gross motor development of children. From the research results can be seen, most children have high levels of protein intake deficits and have a habit of eating foods that are not complete sources of protein such as tempe and tofu. Food sources of complete protein like chicken and fish eggs are also consumed, but in small amounts. Thus, although the amount of protein-containing foods consumed only slightly but the types of food sources of protein (essential amino acids) is good as fish, eggs, milk, formula, it can support the development of children's brain function and muscle. Animal food contains a higher quality protein because it is easily used by the body and have a complete amino acid composition 13. The results are consistent with research conducted Hasyuti (2011), which indicates that there is no association between protein intake with gross motor development of children. Although the protein intake of children less but parents diligently practice their gross motor skills so that children have a normal gross motor skills. According soetjiningsih (2014), that the mother's role in providing stimulation greatly affect the development of motor anak.Stimulasi will optimize the potential of genetic owned subsidiary. A conducive environment will encourage the development of physical and mental well being, while the less supportive environment that will lead to the

development of children under genetic potential. CONCLUSION Most children aged 6-24 months with undernourhised status have this level of energy consumption (83.3%) and protein consumption level (35.4%) are included in the category of severe deficiency but have normal gross motor development. The level of energy and protein consumption was not significantly associated with the development of gross motor skills. However, when seen from the majority of mothers who do not work or sit at home tend to have 11.2 times the odds of having a child with gross motor development is normal. Non-fulfillment of the consumption of energy and protein only manifest in the nutritional status of children is lacking and not to cause delays in gross motor development of children. REFERENCES 1.

2. 3.

4. 5.

6.

7.

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Kemenkes RI. 2013. Laporan Hasil Riset Kesehatan Dasar Indonesia 2013. Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan. Amin, dkk. 2004. Kumpulan Diskusi Pakar Gizi. Jakarta: LPI dan UNICEF. Depkes RI. 2006. Pedoman Umum Pemberian Makanan Pendamping Air Susu Ibu (MP-ASI). Jakarta. Kurniasih, Imas. 2010. Permainan Interaktif untuk meningkatkan kecerdasan anak. Jakarta: Gramedia. Marimbi, Hanum. 2010. Tumbuh Kembang, Status Gizi, dan Imunisasi Dasar Pada Balita. Yogyakarta : Nuha Medika. Husaini M, Anwar. 2009. Peranan Gizidan Pola Asuh dalamMeningkatkan KualitasTumbuh KembangAnak. Jakarta: Departemen Kesehatan RI. Sumarmi, Sri. 2012. The Development of Motion in Early Childhood. Proseding Education Sport Profesionals Conserving Local

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Wisdom and Progressing Future. pp. 534-539. ISSN 978-979-19764-2-8 Almatsier, S. 2009. Prinsip Dasar Ilmu Gizi. Jakarta: PT Gramedia Pustaka Utama. Depkes RI. 2007. Pedoman Tata Laksana Kurang Energi Protein Pada Anak di Puskesmas dan di Rumah Tangga. Jakarta: Bhakti Husada. Notoadmodjo, Soekidjo. 2010. Metodologi Penelitian Kesehatan. Jakarta: Rineka Cipta. Soetjiningsih. 2014. Tumbuh Kembang Anak edisi 2. Jakarta: EGC. Gibson, R. S. 2005. Principles of Nutritional Assesment. New York: Oxford University Press Inc. Widyakarya Pangan dan Gizi. 2004. Angka Kecukupan Gizi Bagi Orang Indonesia. Jakarta : Persagi Hardinsyah, Tambunan V. 2004. Kecukupan Energi, Protein, Lemak dan Serat Makanan. Dalam Angka Kecukupan Gizi dan Acuan Label Gizi. Jakarta: LIPI, Deptan, Bappenas, BPOM, BPS, Menristek, PERGIZI PANGAN, PERSAGI dan PDGMI. Kementerian Kesehatan RI. 2014. Peraturan Menteri Kesehatan RI Nomor 75 Tahun 2013 Tentang Angka Kecukupan Gizi Yang Dianjurkan Bagi Bangsa Indonesia. Jakarta: Direktorat Bina Gizi. Notoatmodjo, Soekidjo. 2005. Pendidikan dan Perilaku Kesehatan. Jakarta: Rineka Cipta. Nursalam.2005. Asuhan Keperawatan Bayi dan Anak.Jakarta: Salemba Medika. Hurlock, E. B. 2008. Psikologi Perkembangan Anak: Suatu Pendekatan Sepanjang Rentang Kehidupan. Jakarta: Erlangga.

19. Santrock, J.W. 2007.Psikologi Perkembangan. Jakarta: Erlangga 20. Desmika W,dkk. 2012. Hubungan Antara Status Gizi Dengan Perkembangan Motorik Kasar Anak Usia 1 – 5 Tahun Di Posyandu Buah Hati Ketelan Banjarsari Surakarta. Jurnal Universitas Muhammadiyah Surakarta. 21. Institute of Medicine. 2005. Dietary Reference Intake for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. A Report of the Panel on Macronutrients, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Washington, DC: National Academies Press. 22. Hidayat, A. Azis Alimul. 2008.Pengantar Ilmu Kesehatan Anak Untuk Pendidikan Kebidanan. Jakarta: Salemba Medika. 23. Sediaoetama.2010. Ilmu Gizi Untuk Mahasiswa dan Profesi.Jakarta: PT Dian Rakyat 24. Hasyuti, Nur. 2011. Faktor-Faktor Yang Berhubungan Dengan Status Perkembangan Motorik Kasar Baduta Usia 6-18 Bulan Di Kabupaten Jeneponto Tahun 2011. Jurnal. Universitas Hasanuddin. 25. Malla, M. Akil. 2002. Gizi Untuk Perkembangan Kecerdasan Anak Dini Usia, Buletin PADU, Jurnal Ilmiah Anak Usia Dini, Edisi 02, Oktober. 26. Winarno, F.G. 2008.Kimia Pangan dan Gizi. Jakarta: Gramedia.

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RELATIONSHIP BODY FAT THICKNESS WITH MENSTRUAL CYCLE LENGTH STUDENTS UNUSA Annif Munjidah.* Annisa ** Universitas Nahdlatul Ulama Surabaya, Jl. Smea 57 Surabaya Email: [email protected] Abstract Factors affecting the menstrual cycle in women are: age, psychological, physical (heredity, nutritional status, and environment) and drugs. So far, the study on the menstrual cycle is only seen from the factors of nutritional status through the upper arm circumference and BMI (Body Mass Index). This prompted researchers to conduct a study on the menstrual cycle length from nutritional factors as seen from body fat thickness. This study aims to analyze the relationship between thick body fat with menstrual cycle length on the students.The study used an observational analytic with cross sectional approach. The population was all of the students in the first level of DIII Midwifery Department of Nursing and Midwifery Faculty of UNUSA who have regular menstrual cycles and do not take anti-depressant drugs / contraceptive device. The sample was mostly students with simple random sampling. The total of the sample was 72 people. Analysis test was done by a moment product (alpha 0.05). The result of the study showed that the average students have 29,7 body fat thickness or fat and have regular menstrual cycles on average. There was a relationship between the body fat thickness with menstrual cycle length of the first level students of DIII Midwifery Department of Nursing and Midwifery Faculty of UNUSA. The conclusion of this study is the thicker of the student‟s body fat had the longer of their menstrual cycles. For the health workers, they can provide counseling on female adolescents about reproductive health especially menstruation and the risk of fat in the body. Keywords: body fat thickness, menstrual cycle length

INTRODUCTION Every month regularly a woman bleeds from the tool implies this event called menstruation. According Wiknjosastro (2002) menstruation is periodic and cyclic bleeding from the uterus that accompanied the release (desquamation) endometrium. Menstrual event the result of cooperation between the hypothalamus, pituitary, ovary and uterus for reproduction (Hypotalamus ovarial pituitary axis). Results of the embodiment of cooperation is the first time the system is characterized by the occurrence of menarch (first menstrual period), ie at the age of 12-13 years. Because menarch only influenced just by the hormone estrogen so

that menstruation during this period occurred irregularly until it reaches the age of 18 years, after which it should have a regular menstrual cycle. The menstrual cycle length is time from the first day of menstruation until the arrival of the next menstrual period. While the menstrual cycle length is the distance between the start date of menstruation last until the beginning of the next menstruation. Length of the normal menstrual cycle, or is regarded as a classic cycle is 28 days, but the variation is quite large. According Wiknjosastro (2002) mentions that women cycle regularly with intervals of 26-32 days. The difference in length of a woman's

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menstrual cycle is one of the problems that often arise, among which the difficulty of determining the proper interpretation of labor in pregnant women, and also raised concerns about a woman because of her menstrual not come on time. There are several factors that affect the menstrual cycle include age, stress, drugs consumed and the nutritional status (Cunningham, 2006). This is supported by Arisman (2010) which states that menstrual disorders may also becaused by problems with nutritional disorders. Ali Baziad (2003) suggests women who weigh more frequently impaired in ovarian function. In obese women showed supraadrenal excessive glandular activity, characterized by increased production of the hormone testosterone, as well as an increase in the ratio androstendion estrone / estradiol which will affect the hormonal processes of the menstrual cycle. Fatty tissue of the body can also affect estrogen in the body, because the granulosa cells and the fatty tissue that can changed androgen into estrogen. The nutritional status of a person can be measured either by measuring the thickness of body fat. Barasi (2010) anthropometric measurements can be done by measuring body mass index (BMI), body circumference , and skinfold thickness. Through thick body fat measurements we can estimate the total amount of fat in one's body is to measure the 4 parts of the body including part of the biceps , triceps , supskapular , and suprailiaka . Almost all aspects of nutrition research potentially has drawbacks, but some can be eliminated through the process of planning and design studies carefully through measurements made repeatedly ( Barasi : 2010 ). So far research about the length of the menstrual cycle in Prody DIII midwifery FKK Unusa only limited nutritional factors as seen from the body circumference and body mass index ( BMI ) , for the researcher interested in conducting research on the length of the menstrual cycle of nutritional factors in particular of thick body fat . From the above data for researchers raised questions about how the menstrual cycle length in women who have more or less nutritional status is calculated by measuring the thick of body fat. Based on this background , the authors are interested in knowing the relationship between body fat thick with menstrual cycle length on the first level students Prodi D - III Midwifery School of Nursing and Midwifery FKK ) Unusa.

METHODS This study use an observational analytic design with cross sectional approach by examining the relationship between body fat thick with menstrual cycle length. The length of the menstrual cycle is taken regular menstrual cycles for at least 6 months back and then measuring the thickness of body fat using a Skinfold Kalliper. The population is all students of first level in Prodi D-III Midwifery FKK Unusa who have regular menstrual cycles and not taking anti-depressant / KB for 88 people and the sample used is mostly first level students Prodi D-III Midwifery FKK Unusa who have cycles irregular menstruation and not taking anti-depressant medication / KB with a sample size of 72 people. Using simple random sampling Collecting data directly using questionnaire insrumen about menstrual cycle that contains a record date of menstruation within the last 3 months. As for the variable fat thickness researchers conducted direct measurements are then entered into the formula The research was conducted in Prody DIII Midwifery FKK Unusa. While the implementation time was conducted in September 2014 till March 2015. Statistical tests were chosen to determine the relationship of body fat thick with the menstrual cycle lenght which uses Product Moment Correlation or with the help of a computer through SPSS RESULT This research has been conducted on first level students DIII Midwifery School of Nursing and Midwifery (FKK) Nahdlatul Ulama Universuty of Surabaya (UNUSA) the located at Jl. SMEA No: 57 Surabaya. UNUSA is development of Stikes Yarsis through permit the establishment of the University by the Director General of Higher Education on 2nd July 2013. Starting in academic year 2013/2014 Prody DIII Midwifery courses UNUSA using competency-based curriculum which is guided by the national curriculum (Kurnas) Data retrieval research conducted by administering questionnaires to a variable length of menstrual cycle, while the variable thickness of body fat by measuring the thickness of fat on the biceps, triceps, sub-scapula and supra illiaka. The number of samples in the study of

669

72 people who had been through the sampling process using simple random sampling. a. Characteristics of respondents according to age and education Table 1 Frequency Distribution of Age Students First Level Prodi D - III Midwifery School of Nursing Midwifery Unusa No Age (years) 1 < 18 2

>18 Total

Frequency 2

Persentage (%) 2,8

70

97,2

72

100

Source : primary data 2015 According to the table 1 is known that almost all ( 79.2 % ) respondents aged over 18 years b. Distribution of respondents by a long menstrual Characteristics of respondents by a long period will presented in the following table : Table 2. Frequency Distribution longer menstrual respondents in Prodi D - III Midwifery School of Nursing Midwifery Unusa. No

Frequency

1

Menstrual (day) <6

1

Persentage (%) 1,4

2

6-8

64

88,9

3

>8

7

9,7

72

100

Total

Based on Table 3 is known that almost all ( 79.2 % ) students have a normal menstrual cycle length Descriptive statistical test results menstrual cycle length and thick of body fat below are presented the results of the descriptive statistical test on the menstrual cycle length and thickness of body fat Table 4 Results of the analysis of menstrual cycle length with a thick body fat Variabel Cycle body fat thickness

Short

0

0

2

Normal

57

79,2

3

Long

15

20,8

Total

Median 31,0 29,0

SD 3,4 6,1

Min 23 17,6

Mak 39 50,4

P 0,039

Source : Primary Data 2015 The above data shows that the average menstrual cycle at 30.64 students with the shortest cycle of 23 days and the longest 39 days.While the body fat thickness on average 29.79 students have thick fat with fat thick smallest details and most large 17.65 50.42 Based on the statistical test using Product Moment Correlation with the 0.05 significance level of p values obtained for the thickness of body fat with menstrual cycle length is 0,039. Then Ho is rejected because t is greater t table is 0.039 <0.05. This means that there is significant correlation between the body fat thickness with menstrual cycle length on the first level students Prodi D - III Midwifery School of Nursing Midwifery Unusa

Source : primary data 2015 Based on the table 2 is known that almost all ( 88.9 % ) of respondents have a longer period for 6-8 days c. Characteristics of respondents according to the length of the menstrual cycle. Distribution of respondents based on the length of the menstrual cycle. Table 3 Frequency Distribution of respondents menstrual cycle length in Prodi D III Midwifery School of Nursing Midwifery Unusa No Cycle Frequency Percentage (%) 1

Mean 30,6 29,7

2. DISCUSSION a. Body fat thickness Based on table 4 showed that the average respondent had thickness body fat 29.79%. Of the 72 respondents obtained the smallest thickness of fat which is 17.65% and 50.42% thickeness. Thick body fat or body fat (BF) is the result of the calculation of the percentage of the sum of thickness of body fat which then entered into the formula. The percentage of the mean value of 29.79% body fat means that the average respondent entered the category of fat or grease. Whereas the minimum percentage value obtained for 17.65% means that there were respondents who fall into the category of normal. And the highest percentage yield of 50.42% means that no respondents were categorized as obese.

72 100,0 Source : Primary Data 2015

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d.

This is consistent with the theory Indriyati Etty (2010) that subcutaneous fat thickness measurement is typically used to estimate the amount of fat in the body. Meanwhile, according to Sirajuddin (2011) fat can be measured in absolute terms (in kg) and relative (%) of the total body weight. The amount of body fat varies greatly determined by gender and age. Skinfold thickness is a measure of body fat content because about half of the total body fat reserves are directly under the skin . Measurement of thickness of skin folds is one of the important methods for determining body composition and body fat percentage and body to determine how anthropometric nutritional status . Whereas from Table 4 there are some respondents who have body fat ( % BF ) overweight and obese it indicates that the nutritional status of the respondent excess , the age of the respondents were still teenagers have activities that moderate to mild , with a diet that is fond of eating fatty foods makes fat easily buried . According to Andriani , Wirjatmadi ( 2012) the cause of obesity because of factors : physical activity , consumption of high fat foods or , genetic , social, economic , hormonal , and the ability of the body. b. Menstrual Cycle length Based on the results in Table 4 the average respondent has a menstrual cycle length of 31 days. With the shortest cycle of 23 days and the longest cycle of 39 days. The menstrual cycle in a woman may be different - different. Several factors can affect the length of the menstrual cycle, according to Bobak (2005) including the woman's age, psychological factors and physical factors, while according to Erna Francin (2005) other factors affecting such factors nutritional status, and according to Adele (2002) medicines can also affect the length of the menstrual cycle Based on the results in Table 1 almost all respondents (97.2%) aged > 18 years. This age is an age that is already showing a regular menstrual cycle or regular or have entered the reproductive age is between 18-40 years in contrast to women aged under 18 years whose menstrual cycles are still not regularly so hard to do the assessment of the menstrual cycle right becaused immature reproductive organs so that the possibility of her menstrual cycle unovulatoir, while the women aged over 40 years is likely to have menstrual cycles anovulation is becaused small number of follicles in the ovaries that interfere with the menstrual cycle (Winkjosastro, 2002)

The relationship the thickness of body fat with menstrual cycle length Based on the results, t is greater than t table is 0.039> 0.05 means that there is significant correlation between the thickness of body fat with menstrual cycle length on the first level students Prodi D-III Midwifery FKK Unusa. In women with thickness body fat has a greater potential to have a menstrual cycle length is longer. With analysis that over the length of the menstrual cycle due to an increased amount of estrogen in the blood due to the increased amount of body fat. Known as menstrual cycle by hormones estrogen dependent mechanism. At the beginning of the menstrual cycle lasts estrogen and progesterone levels drop and that would send a signal to the hypothalamus for secrete GnRH which will produce hormones FSH and mature follicle De Graff is called negative feedback. Whereas if the amount of estrogen in the blood at the beginning of the menstrual cycle is certainly a negative feedback effect is not the case or there is a delay to wait until the estrogen levels decrease and the menstrual cycle that occurs will be longer Lailiyana (2010 ) states that the condition of obesity associated with the process of change androgen into estrogen . The hypothalamus stimulates increased secretion of LH hormones and occurs hyper androgenism . Another mechanism is the follicle maturation disorder due to an increase in LH and testosterone levels are low. The level of estrogen is influenced by the high and low levels of androgen in the body , because the androgen is a hormone that is needed by the body ( suprarenal , ovaries ) to produce estrogen . Enzymes needed to convert androgens into estrogens are aromatase and networks have the ability to changes androgens to estrogens is granulosa cells and fat tissue . Increased androgen levels in the blood will interfere with the function of the hypothalamus and suppress GnRH . The result is disruption of sexual development , and the direct suppression of the gonadotropins both at the level of the hypothalamus and pituitary . In this case the LH more clearly influenced from the FSH . This means that an increase in androgens circulating in the blood will disrupt the harmony between the hypothalamus , pituitary and ovaries . The above in accordance with the theory Ali Baziad (2003 ) which suggests that the

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shortage / excess fat tissue will facilitate the occurrence of metabolic disorders of sex hormone . Women who have too much fat tissue are not only advantages but also androgen excess estrogen especially estrone / estradiol. Obese women with normal menstrual cycle testosterone levels lower than that experienced amenorrhea. In women with a low-fat diet menstrual cycle length increased by an average of 1.3 days, long menstrual rise average of 0.5 days and the phases follikuler increased by an average of 0.9 days ( Lailiyana : 2010 ) as well as by Erna Francin ( 2005) that in particular the number of women who are anovulatory will increase if the weight increases. Another mechanism is follicel maturation disorder due to the increase LH and testosterone levels are low. How fat which will cause anovulatory cycles is not known for certain , it is clear that diet and weight greatly affects the menstrual function . Whereas a high intake of fat effect on steroid hormone levels , proven low-fat diet prolong the cycle, menstrual days and extend the length of the follicular phase ( Francin : 2005)

Baziad,

Ali. 2003. Pemeriksaan Dan Penanganan Amenorea. Editor Endrokrinologi ginekologi. Jakarta: Cipta Karsa Bobak, IM, Lowdermilk DL, Jensen MD. 2005. Buku Ajar Keperawatan Maternitas (Maternity Nursing) Edisi 4. Maria A Wijayarti dan Peter Anugrah (penerjemah). 2005. Jakarta: EGC Brenna, I. Mayer H. 2004. At a Glance Nutrisi. Jakarta: EGC Cunningham. 2006. Obstetri William. Edisi 21 Volume 1. Jakarta: EGC Daru, Wijayanti. 2009. Siklus-haid-kesehatanwanita. http://www.pustakasehatwordpress.c om/tag/kesehatan-wanita. tanggal akses 15 Desember 2014 Djaeni, Achmad S. 2012. Ilmu Gizi Untuk Mahasiswa Dan Profesi Cetakan X. Jakarta: Dian Rakyat Francin, Erna, dkk. 2005. Gizi Dalam Kesehatan Reproduksi. Jakarta: EGC Indriati, Etty. 2010. Antropometri Untuk Kedokteran, Keperawatan, Gizi, Dan Olahraga. Yogyakarta: PT. Citra Aji Parama Kurniawati, Sari. 2012. KTI: Hubungan Berat Badan Dengan Siklus Menstruasi Pada Mahasiswa. Surabaya: digilib Unusa. http//digilib.unusa.ac.id. Akses 17 Desember 2014 Kusmiran, Eny. 2011. Kesehatan Reproduksi Remaja Dan Wanita. Jakarta: Salemba Medika Lailiyana, dkk. 2010. Buku Ajar Gizi Kesehatan Reproduksi. Jakarta: EGC Muchtadi, Deddy. 2009. Pengantar Ilmu Gizi. Bandung: Alfabeta Murti, Bhisma. 2011. Validitas Dan Reliabilitas Pengukuran. Surakarta: Fakultas Kedokteran. Universitas Sebelas Maret Surakarta Sirajuddin, Saifuddin. 2011. Penuntun Praktikum Penilaian Status Gizi Secara Biokimia Dan Antropometri. Makassar: Laboratorium Terpada Fakultas kesehatan Masyarakat Universitas hasanuddin. Supariasa, I Nyoman. 2009. Penilaian Status Gizi. Jakarta: EGC Wiknjosastro, Hanifa. 2002. Ilmu Kebidanan. Edisi III. Cetakan VI. Jakarta: YBPSP

CONCLUSION Based on the results of 72 respondents about the relationship of body fat thickness with menstrual cycle length in Student Level I in Prodi D - III Midwifery Unusa FKK can be concluded as follows : 1. Students Prodi D levels I - III Midwifery Unusa FKK average has a body thickness 29.79, thats fat 2. Students Prodi D levels I - III Midwifery Unusa FKK average have regular menstrual cycles 3. There is a relationship between the thickness of body fat with menstrual cycle length Level I students Prodi D - III Midwifery FKK Unusa REFERENCES Adele. 2002. Buku Saku Perawatan Kesehatan Ibu Dan Anak. Jakarta: EGC Anindita, Galuh. 2012. KTI: Gambaran FaktorFaktor Penyebab Ketidakteratutan Siklus Menstruasi Pada Mahasiswi Yarsis. Surabaya: Digilib Unusa. http//digilib.unusa.ac.id. Akses 17 Desember 2014 Arisman. 2010. Buku Ajar Ilmu Gizi: Gizi Dalam Daur Kehidupan. Jakarta: EGC Barasi, Mary E. 2010. At a Glance Ilmu Gizi. Jakarta: Erlangga

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Wirjatmadi, Andriani. 2012. Peranan Gizi Dalam Siklus Kehidupan. Jakarta:

Kencana Prenada Media Group

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R E L A T I O N O F A P P L IC A T I O N L E A D E R S H IP P A R T IC IP A T I V E S T Y L E HEAD OF NURSING SERVICES WITH EMPLOYEE JOB SATISFACTION IN ASFIYAK GRAHA MEDIKA CLINIC, KENCONG, KEPUNG Bambang Wiseno STIKes BHAKTI MULIA PARE – KEDIRI Email: [email protected] Abstract The purpose of the study was to analyze the relationship participative leadership style head of service with employee job satisfaction in Asfiyak Graha Medika Clinic Kencong, Kepung. The method used is the cross sectional correlation. Total populations of 11 respondents were taken for samples with total sampling technique. Independent variables are the application of participative leadership style and the dependent variable is job satisfaction. Data collection using questionnaires and data analyzed were using Spearman's rank with significance 0.05. The results showed that the application of participative leadership style the head of nursing services mostly (54.54%) good criteria. While the level of job satisfaction mostly (54.54%) in the moderate level. Data analysis results obtained that rho -0314, it can be concluded that there is no correlation with the application of participative leadership style on employee job satisfaction. Research there was no correlation with in the application of participative leadership style and job satisfaction. This can be caused by many factors including the physiological factor need, that‟s evidenced by low levels of employee satisfaction at the fulfillment of physiological needs. Application of participative leadership style had no effect on all aspects of employee satisfaction. Satisfying physiological needs a dominant factor in perceived lack of employees, because it is not affected by the physiological needs participative leadership style but by institutional policy in the salary system. Key words: Leadership, Participative, Job satisfaction, Employer.

Leaders should be aware and able to evaluate the leadership style that is used in order to optimize the functioning of all parts for employee satisfaction and progress of the institution. Work behavior is influenced by leadership style will have an impact on employee performance. Employee satisfaction affects and is affected employee performance determined leadership style superiors.

INTRODUCTION Leadership in an organization is a decisive factor on the success of the organization in achieving its objectives. A leader must be able to direct their subordinates to achieve organizational goals. The leader who they are not aware of the style leadership themself that‟s will result in a subordinate's performance is affected, may have a negative impact on the progress of the organization.

GENERAL PURPOSE Analyzing there a relationship application of participative leadership style head of nursing care with job satisfaction of employees in Kencong, Graha Medika Clinic Asfiyak, Kepung, Kediri.

Based on preliminary studies in Clinical Asfiyak Graha Medika, Kencong, Kepung, after the head of nursing services fill leadership style assessment instrument inclination, identified that‟s the head of nursing services tend to use a participatory leadership style of leadership. In addition to the assessment, also obtained a statement from an employee who said that the head of the field service often invites a discussion with a subordinate when there is a problem. These employees proud with the action although the decision remains with the authority of the leadership.

PROBLEM The success of an institution is influenced by many factors, one of which is the leadership style of a leader. If the leader is able to create an effective working environment that allows employees basic needs are will influence the level of employee satisfaction. Which in turn will employees optimal working to provide the 675

best service. Based on the above, it is made of a formulation of the problem is there a relationship application of participative leadership style head of nursing care with job satisfaction of employees in Graha Medika Clinic Asfiyak, Kencong, Kepung, Kediri.

employees who work at the clinic Asfiyak Graha Medika, Kencong, Kepung, Kediri total as 10 people.

Criteria For Sample All employees at the clinic Asfiyak Graha Medika, Kencong, Kepung, Kediri used as a sample with the following criteria: 1) The inclusion criteria Namely the general characteristics of the study subjects from a target population that is affordable and will be examined (Nursalam, 2008). In this study were included in the criteria for inclusion are: 1. Employees who work at the clinic Asfiyak Graha Medika, Kencong, Kepung, Kediri. 2. Long working more than 6 months. 3. Employees of at least high school education 2) Exclusion criteria In this study there was no exclusion criteria for the samples used were all employees at the clinic Asfiyak Graha Medika, Kencong, Kepung.

RELEVANCE Consumer satisfaction is the end result of a service and it is determined by the optimal performance of employees. The performance of employees will go well if employees get satisfaction in work and vice versa. Employee satisfaction will be achieved if their basic needs are met as physiological needs, safe, comfortable, affection, cherished and selfactualization, even if those needs are met only partially and with different levels of each requirement. All leadership style has advantages and disadvantages. But in terms of employee satisfaction, participative leadership style which is a combination of authoritarian and democratic leadership style which employers will be able to create a conducive work environment. A pleasant working environment, mutual respect and appreciation can create good work habits so that the performance of employees increased at the same time will bring a satisfactory working conditions for employees.

The sampling technique and sample size This study uses "total sampling" which examines all employees who work at the clinic Asfiyak Graha Medika, Kencong, Kepung, total as 10 people. If the number of members of a population of 10, the number of members of the sample is 10 (Krejcie and Morgan, 1970) cited by (Sugiyono, 2010).

RESEARCH DESIGN This study uses correlation design with cross sectional approach is research or processing of the relationship between two variables in a group or subject to observation or measurement variables at the same time based on the state status at the time of the study variables. Research that emphasizes the result of a measurement or observation of the independent and dependent variable data only once at the time of data collection. Correlation analysis was then performed by comparing the proportions between the variables of observation results.

DATA COLLECTION AND DATA PROCESSING Data collection Is a process approach to the subject and the process of collecting the required characteristics of subjects in a study (Nursalam, 2008). In this study used a questionnaire to all the variables as a data collection instrument. The process of data collection The stages of data collection in this study are as follows: 1) The preparation phase The tools used for data collection of this research is a questionnaire that contains superior capabilities in participative leadership style and employee satisfaction questionnaire.

Sampling Design The population is taken all employees who work at the clinic Asfiyak Graha Medika, Kencong, Kepung, Kediri as many as 10 employees. The sample in this study were all 676

2) Phase of implementation Before giving questionnaires to the respondents, the respondents were given an explanation purposes of research as well as requests for willing respondents. 3) Data collection phase Gave questionnaires to respondents to fill and collect the data that has been filled respondents.

organization to be able to compete with other health services to provide excellent service. 2) Time The research process carried out since late September 2012 with the commencement of preparation of proposals and for the technical implementation of the plan will be carried out field research in December 2012.

Data Collection Instrument Research instruments are the tools used for data collection. Data collection independent and dependent data used is a questionnaire which a number of written questions that are used to obtain information from respondents. In this study, a questionnaire used is closedended question, which means that the questionnaire used had supplied the answer so that the respondent can just choose from the available answers.

Data Processing And Data Analysis Data processing Data were collected from questionnaires rareprocessed through the following steps: 1) Editing Editing is reviewing and examining data collected by: 1. Check the completeness of the data, if there is a lack of contents or page it is necessary dikembali-right or repeated to the respondent. 2) Check the various data fields. 2) Scoring Scoring put a value on the part that needs to be assessed. Independent variables, parameters used is the application of participative leadership style with the statement of the respondent. Scoring in a statement: No :0 Yes :1 The value of each respond of all statements summed and divided by the number expected, then multiplied by 100% and the result is a percentage By criteria according The Good : ≥ 76% Enough : 56-75% Less : ≤ 55% The dependent variable, the parameters used are employee satisfaction with satisfaction the statement. Scoring: Extremely Dissatisfied :1 Dissatisfied :2 Satisfied enough :3 Satisfied :4 Very satisfied :5 Results are calculated as the independent variable in the category: Height : ≥ 76% Moderate : 56-75% Low : ≤ 55%

The independent variable Instruments for the independent variable in this study using a questionnaire containing the application of participative leadership style created by the author. The independent variables have tested the validity and reliability by using Pearson correlation, is said to be valid if the correlation of each statement of the total score ≥ 0.3 and is said to be invalid when the correlation of each statement to a score of ≤ 0.3. Pearson correlation formula: ∑ √* ∑

(∑ (∑ ) +*

)(∑ ∑

) (∑ ) +

Reliability test using Cronbach Alpha, Alpha reliability if the total score ≥ 0.6 of the statement and said no reliability when Alfa ≤ 0.6. A questionnaire designed by the researchers to obtain data on the independent variables have tested the validity and reliability, and the results are valid. The place and time 1) Place Research will be conducted at the clinic Asfiyak Graha Medika, Kencong, Kepung. The choice of location is done intentionally (purposive) with the consideration that the clinic Asfiyak Graha Medika, Kencong a new private clinics should develop the

Data Analysis 677

The collected data are systematically analyzed and presented in tabular form. Based on the data collected is then used statistical Spearman Rank two ordinal scale variables (nonparametric) was conducted to determine the relationship between the application of participative leadership style with employee satisfaction. Spearman Rank Correlation formula Further data processing results can be interpreted with the results calculated rho, if rho count > rho table means Hi acceptable and if rho count < rho table means Hi rejected.

54.54% 36.36%

Note: 9.09% Application of Participatory Leadership Style

Good = 6 Responden Enough = 4 Responden Less = 1 Responden

RESULTS AND DISCUSSION Education respondents

Older respondents work

Criteria Employee Satisfaction Total High Moder Low ate Frek Σ % Frek Σ % Frek Σ % Fr Σ % ek Goo 0 0% 3 27.2 3 27.2 6 54.54 Criteria d 7% 7% % Appication of Enou 2 18.18 2 18.1 0 0% 4 36.36 Participatory gh % 8% % Leadership 0 0% 1 9.09 0 0% 1 9.09 Less Style % % 2 18.18 6 54.5 3 27.2 1 100 Total % 4% 7% 1 % Analysis by Uji Spearman‟s Rank, rho count = - 0.314 rhoSpearman‟s tabel = 0.618

DISCUSSION From the data obtained during the study as described and summarized above, it can be further described as follows: Identification of the application of participative leadership style Based on the results of the research showed that the participative leadership style adopted by the 678

head of the nursing care field most (54.54%) either. In theory it is mentioned that the participative leadership style is a combination of authoritarian and democratic style in which the role of leader and subordinate balanced in problem solving and decision making (Faiz and Siti Saleha, 2009). Leaders give subordinates the opportunity to participate in decisionmaking and participate actively in the development of the institution. The tendency of the head of the field of nursing care lead by using a participatory leadership style is already appropriate to apply this time. This encourages subordinates to participate in problem solving and maturity level of the subordinates was to high with a two-way communication. Participative leadership allows employees are more ready to accept responsibility for a solution, objectives and strategies where they are empowered to develop institutions. Work experience of employees of all working time criteria assess the applicability of participative leadership style most (54.54%) good and a fraction (36.36%) enough. According Swansbrug (cited by Nursalam 2009), more than 80% of the time used for communication manager. In this case, the length of work affects the interaction between superiors and subordinates that lasted for the better, so that superiors and subordinates will be more receptive and gives message. Superior subordinate relationship is to facilitate the discussions to make decisions.

the level of employee satisfaction mostly at moderate levels. Shows that employees feel less satisfied in their work to obtain the fulfillment of physiological needs in particular. This may be because of the lack of attention the company in meeting the financial needs of employees. Matters relating to the financial problems is the policy of the company, so the company needs to reconsider the system of pay and rewards in the form of materials to meet the physiological needs. The highest satisfaction scores according to the fulfillment of basic needs there are in the affection. This is because employees are fulfilled compassion in working both leaders and coworkers. Employees have the opportunity to communicate well and get a chance also to participate troubleshoot problems that occur in the workplace. Job satisfaction has significance both for the employees and the company. Job satisfaction will create a positive state of the working environment within the company, where it is the capital as contribute in improving the quality of care. Analysis of the application of participative leadership style relations with employee satisfaction. Based on the data processing according to the results obtained rho Spearman Rank count = 0.314, while for the table rho = 0.618. Concluded rho count
Identification of employee satisfaction Based on the results of the research indicate that employee satisfaction majority (54.54%) exist at the level of medium and small proportion (27.27%) at low levels and (18:18%) at high levels. Satisfaction according to need fulfillment theory explained that the satisfaction will be achieved if fulfilled what he needed. All humans have a need for a common basis where the level of physiological needs is the dominant factor for human life must be met first before the need for a higher level (Nursalam, 2009). Financial fulfillment of employees in work is one aspect to meet the physiological needs. After the calculation is based on a sequence of basic needs A.Maslow, showed a very low value of employee satisfaction on the issue followed physiological needs and safety needs convenient and self-actualization. This causes 679

the work to get their physiological needs. Judging from the order stated that the basic needs physiological needs are basic needs are greatest that must be met first before other needs. Participatory leadership style that carried the head of nursing services is generating employee satisfaction on the basic necessities of affection and esteem. This means that there are aspects of the physiological needs that affect employee satisfaction. The application of participative leadership style will be able to generate the maximum satisfaction and balance of all the basic needs of employees when the study all aspects of needs ranging from physiological needs to selfactualization needs are met. This may be achieved when balanced by institutional policy in the basic needs of employees in the form of payroll and reward accordingly. This is why no correlation application of participative leadership style with employee satisfaction. Leadership boss who apply participatory leadership style has nothing to do with the job satisfaction of employees despite the participative leadership style has been applied properly. Employees only get satisfaction on a small part of their basic needs are met and not fully to their basic needs. For that institutions must pay attention and organize management so that the basic needs of employees are met so that the employee satisfaction can be met, particularly the financial needs of employees who will indirectly affect the fulfillment of physiological needs. Provision of education and employees' salaries in accordance with the increase in regular employment and the provision of additional incentives should be considered to be given. Performing employees need to be given a reward in the form of promotion or promotion of further education. This would increase the motivation and performance of employees so that job satisfaction would be better employ

m?articleid=1554523&show=pdf pada tanggal 22 Oktober 2012. Anonymous. Critical Values of the Spearman Rank Order Correlation Coefficients: The rs Tables diakses melalui http://www.ace.upm.edu.my/bas/5950/Spe arman%20Rho%20Table.pdf pada tanggal 16 Februari 2013. Choi Sang Long and Lee Yean Thean. (2011). Relationship Between Leadership Style, Job Satisfaction and Employees‟ Turnover Intention: A Literature Review. Research Journal of Business Management, Volume 5: 91-100. diakses melalui http://scialert.net/abstract/?doi=rjbm.2011. 91.100 pada tanggal 22 Oktober 2012. Hidayat, A.A Azimul. (2009). Metode Penelitian Keperawatan dan Tehnik Analisa Data. Jakarta: Salemba Medika. Huber Diane L. (2006). Leadership and Nursing Care Management. 3rd Edition. Philadelphia: Saunders. King, Laura. (2010). Psikologi Umum Sebuah Pandangan Appreciative View. Jakarta: Salemba Humanika. Nursalam. (2008), Manajemen Keperawatan Aplikasi Dalam Praktik Keperawatan Profesional, Edisi 2, Jakarta, Salemba Medika. Mangkunegara Prabu. (2005). Evaluasi Kinerja SDM. Bandung: Refika Aditama. Marquis, Bassie L. (2000). Leadership Roles and Management Function in Nursing. Theory and application. 3rd Edition. Philadelphia: Lippincott. Prayetno S. (2012). Peranan Kepemimpinan dalam meningkatkan produktifitas kerja di Rumah Sakit PINPAD Bandung. diunduh melalui http://portal.kopertis3.or.id/handle/123456 789/617 pada tanggal 19 Oktober 2012. Psychological Bulletin. (2001). The Job Satisfaction JobPerformance Relationship: A Qualitative and Quantitative Review. An American Psychological Assosiation Sari Diana. (2008). Manajemen Pemasaran Usaha Kesehatan. Jogjakarta: Citra Cendekia. Satrianegara, Saleha. (2009). Organisasi dan Manajemen Pelayanan Kesehatan Serta Kebidanan. Jakarta: Salemba Medika. Suarli. (2002). Manajemen Keperawatan. Jakarta: Erlangga.

REFERENCE Ali,

Mohammad. (2006) "A study of relationship between managers' leadership style and employees' job satisfaction", Leadership in Health Services, Vol. 19 Iss: 2, pp.11 – 28. Emerald Group Publishing Limited diakses melalui http://www.emeraldinsight.com/journals.ht

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Sugiyono. (2010), Statistik Nonparametris. Bandung: Alfabeta.

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THE EFFECT OF TOMATO FRUIT (SOLANUM LYCOPERSICUM) TOWARD THE INCREASE OF APPETTITE IN WHITE RATS (RATUS NORVEGICUS STRAIN WISTAR) (Experimental Study in Pharmacology Laboratory of Brawijaya University Malang 2015) Endah Susanti*Yuli Admasari*Fariha Nurlia*Intan Layla Vinurika STIKES Bhakti Mulia Pare Abstract Health problems that found among preschool / kindergarten children are decrease of the child's appetite that getting increased. Food that served by mothers should contain a number of nutrients as well as vitamins, minerals, and fiber such as tomatoes fruit. The objective of this research was to analyze the effect of tomato juice toward the increase of appetite in white rats (Ratus Novergicus Stain Wistar). Methode. The research design was a true experimental with approach method of pretest-posttest control group. The population was white rats (ratus novergicus stain wistar), with sample amount to 20 rats, used technique of purposive sampling . The data collected through observation. Result. The research results in the control group were increase of average weight 0.12 g - 0.37 g and average portion of eating 0.04 g - 0.86 g. While in the treatment group, the increase of average weight 0.63 g 5.33 g and average portion of eating 0.04 gr - 3.14 gr. Analysis of paired samples t test obtained result: the value of sig (2-tailed) : 0,000 and: 0.05, <, so H0 was rejected and H1 was accepted, that meant there was effect of tomato fruit (Solanum lycopersicum) toward appetite of white mice (ratus novergicus stain wistar), with the strength of the effect 95% and a positive effect direction. Conclusions. The people who have pre-school age children to give tomatoes fruit every day with the goal of improving the child's appetite in order that the growth and development of the child can develop properly. Keywords: Tomato fruit, appetite

INTRODUCTION Indonesia has been succeeded in reducing the poverty rate, as measured by the indicator of USD 1.00 per capita per day, become a half. The progress of the poverty level has not reached maximally in an effort to further reduce the poverty rate, as measured by the national poverty line and from the current level of 13.33 percent (2010) to target 8-10 percent in 2014. Poverty is closely associated with malnutrition in infants, it is associated with the consumption of foods derived from parents. Malnutrition in infants can also be caused by parents who do not care or mother are too busy in working and caregivers handed over to the food intake so that child nutrition is not controlled. 682

Children in preschool age represents a period of relatively rapid growth and develop. Various health problems found among children in preschool / kindergarten, including the lack of optimal physical growth. Difficulty eating is a symptom of various diseases or disorders of body functions, is not a form of diagnosis or the certain disease. Appetite disturbances commonly experienced by children aged 4-6 years (Santoso, 2012). Decrease of the child's appetite that getting increased related to increasing interaction with the environment, they are more susceptible to diseases, especially infectious diseases, both acute and chronic, worm infections and so on. At the age of 4-5

years in addition to the reduced appetite due to illness also because of other factors such as time / opportunity to eat because of busy learning or play (Sunarjo, 2013). Data of UNICEF in 2013 estimated that less child's appetite can lead to more than 21.6 million children have malnutrition, and 216 510 suffering from severe malnutrition. The incidence of more than 100 / 100,000 population per year occur in the region of South Asia, Central Asia, Southeast Asia and in the southern part of Africa, and of these 70-80% of cases occur in ASIA (WHO, 2013). Data RISKESDAS 2013 in Indonesia malnutrition 5.7%, lack of nutrition 13.9%, while in East Java as much as 40.6% of the population consume food below 70% of the Nutrition Adequacy Score (AKG) is recommended in 2014. The situation is much common in school-age children (41.2%), teenagers (54.5%) and pregnant women (44.2%) (Riskesdas, 2013). According to data from Health department of Kediri regency, malnourished in 2013 as much as 5.49% of the existing toddlers. Meanwhile, based on a child's weight are carried out during 2014, there were children below the red line as much as 5.70% (Dinkes Kab. Kediri, 2013). Based on preliminary studies conducted on December 10, 2014 in TK Dharma Wanita Plaosan II District of Wates, Kediri regency by conducting interviews to 10 parents of children, known that there are 8 children (80%) experienced decreased appetite, 1 child (10%) had a lust eat fickle sometimes increases sometimes decreases and 1 child (10%) had a good appetite. Of the eight children who experience reduced appetite due to a sick child, the busyness of play in children who are stillin pre school age. In general, a factor which is the cause of difficult in eating can be divided into 3 groups namely nutritional factors, factors of disease / disorder of organic and interference factors / psychological disorders. Effect of lost or decreased appetite seems to be the major cause trouble eating in children. This can influence appetite ranging from mild (decreased appetite) to severe (no appetite). The display of appetite disorders in children 683

include refusing food that given, buying time while eating, choosing foods. In a heavy difficulty in eating and long lasting will impact on the health and the growth and develop of the child. If prolonged disruption will affect the health and the growth and development of children. Additionally appetite has close relation to body weight. Most people with disorders of appetite followed by weight loss quite dramatically, so has the weight below normal. No ideal weight can cause lifeproblems and threaten the children. These disorders are difficult to overcome, in addition it is difficult to didiagnosa the cause, also no conventional medicine to increase appetite, but only the effect of the drug. Appetite disorders can cause a phenomenon depending on the type and amount of nutrients that are lacking. If the child just does not like certain foods such as fruits or vegetables would occur a deficiency of vitamin A. If you just want to drink milk alone will occur iron deficiency anemia. If the deficiency of calories and protein will occur Protein Energy Deficiency (KEP) (Gunarso, 2011: 72). The government programs that carried out by physical examination, it may even be required investigation. In the heavy situation may be the cause not only one factor (multi-factors) beside that it conducted the provision of vitamin B 12 and an increase in additional nutrition in children when coming to posyandu. Correcting nutritional deficiency states that are found. As far as possible given in the form of food, if it it is imposible then it given in the form of medicines (Widodo, 2013). In addition, it is better that the food served at home by mothers, contains nutrients and a number of vitamins, minerals, and fiber such as tomatoes fruit. Giving tomato juice 1 hour before meals is expected to be done every day to improve the

child's appetite because in tomatoes fruit there are many substances that can increase appetite. In addition tomato juice also feels fresh and liked by children. Tomatoes contain an alkaloid solanine (0.007%), saponins, folic acid, malic acid, citric acid, bioflavonoids, proteins, fats, sugars (glucose and fructose), adenine, trigonelin, kholin, tomatin, minerals (Ca, Mg, P, K , Na, Fe, sulfur, chlorine), vitamins (B1, B2, B6, C, E, A, Lycopene, niacin), carbohydrates, histamine, fiber, phytonutrients substances. Tomato juice contains vitamins and minerals that are complete enough. 100 grams of tomato juice will obtain 7 mg calcium, phosphorus 15 mg, iron 0.9 mg, sodium 230 mg, and 230 mg of potassium. Vitamin that contained in 100 grams of tomato juice is vitamin A (1,050 IU), vitamin B1 (0:05 mg), vitamin B2 (0.03 mg) and vitamin C (16 mg). Tomatoes have a slightly sour taste makes appetite increased. sour taste of tomato fruit comes from citric acid. Efficacious increase appetite by multiplying the discharge of saliva. Regular consumption of tomatoes help treat the anorexia disease (loss of appetite). The best of processed tomatoes are in the form of juice. drink tomato juice one hour before meals can improve appetite. Old and ripe tomatoes naturally always alkaline smells and tastes slightly sour, That's because tomatoes have salt minerals. Minerals that stimulate the circulation of saliva, so increasing the feeling of hunger while allowing food to be digest properly (Dewi, 2012). Based on the description above, researchers interested in conducting research about "The Effects of Tomato fruit (Solanum Lycopersicum) toward the increase of appetite in white Rats (Ratus Novergicus Stain Wistar) at the Pharmacology Laboratory of Brawijaya University Malang ". METHOD OF RESEARCH In this research use true experimental research design with the post-test design with the election for attempting to reveal the influence of tomato fruit (Solanum 684

Lycopersicum) toward increase appetite in White Rats (Ratus Novergicus Stain Wistar). The design of of this research using pretest posttest control group that is a grouping of the members of the control group and the experimental group, was CONDUCTED randomly, then performed a pretest (01) in the two groups and followed by intervention (X) in the experimental group. After some time conducted posttest (02) in both groups. The population in this research is the White Rats (Rattus norvegicus strain Wistar). Samples as many as 20 rats by using technique of purposive sampling Instrument of data collection for the independent variable is the observation (check list) is used to determine steps of giving the tomato fruit therapy, while the dependent variable is the observation (check list). Analytical is conducted through bivariate analysis with statistical test Indepedent samples t-test (t test for paired samples). In the calculation process aided by the help of Statistics Programme for Social Science (SPSS) Version 17. RESULT OF RESEARCH Effect of Increased Appetite towards Weight Table Effect of eating portion towards Weight of White Rats in Pharmacology Laboratory of the Brawijaya University , 6 - 12 July 2015 Increase average of Increase average of meals portion (gr) weight (gr) Sample Treatment Treatment Control Control group group group 0,5 1 ml 2 ml group 0,5 1 2 ml ml ml ml 1 0,57 2,92 1,90 3,14 0,12 3,71 1,47 1,37 2 0,04 2,59 2,55 2,31 0,18 1,22 1,80 1,57 3 0,86 2,51 2,82 1,90 0,35 1,27 0,96 0,80

4 5

0,67 0,51

2,08 2,86 2,29 2,55 2,16 3,06

0,55 0,37

1,08 3,00 2,02 2,51 0,63 5,33

Based on the above table it is known that in the control group, there are increase in the average portion of the meal a maximum of 0.86 g / day with an average increase in maximum weight of 0.55 g / day, in the group treated with a dose of 0.5 ml increase in the average portions reaches a maximum of 2.59 g / day with a maximum weight gain of 3.71 g / day, in the group treated with a dose of 1 ml, increase in the average portion of the meal reaches a maximum of 2.86 g / day with a maximum increase of weight gain, 3,00 g / day and in the group treated with a dose of 2 ml increase in the average size of the meal reaches a maximum of 3.14 g / day with an increase of maximum body weight 5.33 gr / day. Based on the research results, it concluded that in the control group an increase in the average portion of the meal is slow, so that the increase in the average weight is slow too. While in the treatment group there is an increase in the average portion of the meal that increased so that the increase in the average weight also be faster . Analysis of Data Analysis of white rats’ weight Table Test results of two pair samples T test . Effect of Tomato Fruit (Solanum Lycopersicum) towards weight of white rats' (Ratus novergicus Stain Wistar) in Pharmacology Laboratory of Brawijaya University Malang. Variable

The average score of weight in control group and an average score of weight in treatment group

Sample

20



0,05

Significant Value ( ) .002

Based on the analysis table of white rats' weight, are known the results of data analysis using paired samples t-test on white rats' weight, the control group and the treatment 685

group obtained result of sig (2tailed) : 0,002 and taraf kesalahan ( ) : 0,05, jadi < so H0 is rejected and H1 is accepted, meaning that there is influence of tomato fruit (Solanum lycopersicum) towards body weight of white rats (ratus novergicus stain wistar) in the Pharmacology Laboratory of Brawijaya University Malang. The value of paired samples T-test was 5.97 untill 44.82 means that the power of influence was 95% . Results of the analysis was positive means that the more often children consume tomatoes, the appetite will also be improved with weight that increasing too , and vice versa if it never consumed tomatoes then the child may experience a shortage of appetite, characterized by less weight increase. Analysis of white rats’ meals portion Table Test results of two pair samples T test . Effect of Tomato Fruit (Solanum Lycopersicum) towards meals portion of white rats' (Ratus novergicus Stain Wistar) in Pharmacology Laboratory of Brawijaya University Malang. Variable

The average score of meals portion in control group and an average score of meals portion in treatment group

Sample



Significant Value ( )

20

0,05

.000

Based on the analysis of meals portion, are known the result of data analysis using paired samples t test on white rat‟s weight, the control group and the treatment group obtained result of sig (2-tailed) : 0,000 dan: 0,05, jadi < so H0 is rejected and H1 is accepted, meaning that there is influence of tomato fruit (Solanum lycopersicum) towards meals portion of

white rats (ratus novergicus stain wistar) in the Pharmacology Laboratory of Brawijaya University Malang. The value of paired samples T-test was 18,9 until 25,9 means that the power of influence was 95%. Results of the analysis was positive means that the more often children consume tomatoes, the appetite will also be improved characterized by the increase of meals portion and vice versa if it never consumed tomatoes then the child may experience a shortage of appetite, characterized by less of meals portion. DISCUSSION Identification of weight and meals pattern of white rats (Ratus Novergicus Stain Wistar) in control group Based on the the research results showed that the 5 white rats in the control group gained weight over 7 days with an average of 0.12 g - 0.37 g, while the increase of meals portion with an average of 0.04 gr 0.86 gr , Disorders of appetite is a clinical disorder that is important but often ignored (Grilo and Mitchell, 2010). This problem is actually a trivial thing, but often becomes major problem, especially in children (Manikam and Perman, 2010). According to Waugh and Lask (2010), 25% -45% of children who develop normally experience impaired appetite whereas children who are late development, this figure reaches 80%. If this disorder is not overcome immediately, it can cause serious problems. One of the problems caused by the lack of appetite is the failure of the fulfillment of nutritional needs. If this continues be ignored, it can cause health problems and child development. The normal work of various organs also severely disrupted in the event of a nutritional deficiency. In addition, the appetite is closely related to weight. Most people with disorders of appetite followed by weight loss quite dramatically, so has the weight below normal. Not ideally the child's weight can lead to various problems.

686

Effect of lost or decreased appetite seems to be the major cause of trouble eating in children. This can influence appetite ranging from mild (decreased appetite) to severe (no appetite). the views of mild disorders such as milk bottles often left over, time to drink breastfeeding is reduced (previously 20 minutes to become 10 minutes), eat often leftovers or just a little or pull out and spouts food in the mouth. While the more severe disorders such as child shut his mouth or do not want to eat and drink at all (Judarwanto, 2014: 64). According to the researchers, the lack of child's appetite can result in not ideally the child's weight. In the long term, disturbances of appetite can also be life-threatening. These disorders are difficult to overcome, in addition because it is difficult to diagnose the cause, nor the conventional drugs that work directly to improve appetite. Lack of appetite will influence on the growth and development. Decreased of child's appetite is increasing, related to the increasing interaction with the environment, they are more susceptible to diseases, especially infectious diseases, both acute and chronic, worm infections and so on. At the age of 4-5 years, the decrease of appetite beside because of ill also because other factors such as time / opportunity to eat because of busy playing. Identification of weight and meals pattern of white rats (Ratus Novergicus Stain Wistar) in treatment group Based on the the research results showed that the 5 white rats in the treatment group with a dose of 0.5 ml experiencing increased weight for 7 days with an average of 1.08 g - 3.71 g, the group treated with 1 ml dose experienced a average weight gain of 0.63 g - 3.00 g and the treatment group

with a dose of 2 ml experience increase the average weight of 0.80 g - 5.33 g. As for the meal portions showed that 5 white rats in the control group experienced an increase in the meals portion for 7 days with an average of 0.04 g - 0.86 g, the treatment group with a dose of 0.5 ml portions increase an average of 2, 08 gr - 2.92 g, the treatment group with a dose of 1 ml , increase the average portion of the meal 1,90 gr - 2,86 g and the treatment group with a dose of 2 ml experience increase meals portions in average of 1.90 gr - 3,14 gr. Difficulty of eating that heavy and lasting for along time will impact on the health and growth and development of the child. The symptoms depend on the type and amount of nutrients that are lacking. If the child just does not like certain foods such as fruits or vegetables would occur a deficiency of vitamin A. If you just want to drink milk alone will occur iron deficiency anemia. If the deficiency of calories and protein will happen protein-energy malnutrition (PEM). Difficulty of eating is a symptom of a natural inability to meet nutritional needs. the causes of difficulty eating may be a disease, but may also be a lot of factors involved. the appropriate nutritional efforts should be made to improve impact of difficulty of eating towards the growth-development and nutrition disorders. Efforts should be made to eliminate / treat the cause. It may take a multidisciplinary approach. Tomato (Solanum lycopersicum syn. Lycopersicum) is a plant of the family Solanaceae, native plants of Central and South America, from Mexico to Peru. Tomato represent a plant with short life cycle, can grow as high as 1-3 meters. Tomatoes are a close relative of the potato (Fakriana, 2014: 62). Tomatoes contain an alkaloid solanine (0.007%), saponins, folic acid, malic acid, citric acid, bioflavonoids, proteins, fats, sugars (glucose and fructose), adenine, trigonelin, kholin, tomatin, minerals (Ca, Mg, P, K , Na, Fe, sulfur, chlorine), vitamins (B1, B2, B6, C, E, A, Lycopene, niacin), carbohydrates, histamine, fiber, 687

phytonutrients substances. Tomato juice contains vitamins and minerals that are complete enough. 100 grams of tomato juice will obtain 7 mg calcium, phosphorus 15 mg, iron 0.9 mg, sodium 230 mg, and 230 mg of potassium. Vitamin contained in 100 grams of tomato juice is vitamin A (1,050 IU), vitamin B1 (0:05 mg), vitamin B2 (0.03 mg) and vitamin C (16 mg). Tomatoes have a slightly sour taste makes appetite increased. Tomato fruit sour taste comes from citric acid. Efficacious to increase appetite by multiplying the discharge of saliva. Based on the research materials contained in tomatoes, has its benefits, one to increase appetite. Sour taste in tomatoes derived from citric acid content, causing tomatoes tasted fresh, so it can increase appetite. Tomatoes are rich in mineral salts which stimulates the flow of saliva. This mineral is useful to stimulate the appetite and make food easily digested. Regular consumption of tomatoes to help treat the disease anorexia (loss of appetite). According to researchers, the tomatoes can be said fruits that contain lots of fiber so good for consumption, especially in children. Drink the tomato juice one hour before meals can improve appetite. Old and ripe tomatoes naturally always smells alkaline and tastes slightly sour, That's because tomatoes have salt minerals. Minerals that stimulate saliva flow, thereby increasing hunger. Increased appetite of children will affect the growth and development of the child itself, which with good nutrition fulfillment, then the growth and development of the child would be ideal and in accordance with age, so it is expected to increase the nation generation that strong and healthy. Influence of tomatoes fruit (Solanum Lycopersicum) towards appetite of

white rats (Ratus Novergicus Stain Wistar) Based on the data analysis result of white rats' weight in control and treatment group using paired samples t-test on white rats' weight, the control group and the treatment group obtained result of sig (2tailed) : 0,002 and taraf kesalahan ( ) : 0,05, jadi < so < H0 is rejected and H1 is accepted, meaning that there is influence of tomato fruit (Solanum lycopersicum) towards body weight of white rats (ratus novergicus stain wistar). While for meals portion known that the data analysis result about meals portion of white rats in control and treatment group using paired samples t test in white rats weight in control and treatment group obtained result of value  < so H0 is rejected and H1 is accepted, meaning that there is influence of tomato fruit (Solanum lycopersicum) towards meals portion of white rats (ratus novergicus stain wistar) in the Pharmacology Laboratory of Brawijaya University Malang. White rats or mice are native animals in Asia, India and Western Europe. This type is now found all over the world due to the introduction by humans (Sari, 2012: 22). Mice are animals that live together, stay indoors during cold weather and moved outside during spring and summer, the forms of wild, live outside in all their lives, and caged animals, continue to research, testing, teaching, pet and luxury (Isroi, 2010: 23). Tomato (Solanum lycopersicum), there are two kinds, namely tomato fruit and tomato vegetable. The difference lies in the shape and thickness of the skin. If the tomato fruit, the shape is slightly oval and thick skin. In contrast, tomato vegetable are round and thinner skin. Tomato fruit is usually used as a fresh salad, and consumed directly without the need to be cooked first. This tomato type is more durable than tomato vegetable. Tomato vegetable usually used as a cooked vegetable mixture, and can not be durable (Restu, 2011: 22). Sour taste in tomatoes fruit derived from the content of citric acid that causes the tomatoes tasted fresh, so it can increase 688

appetite. Tomatoes are rich in mineral salts which stimulates the flow of saliva. This mineral is useful to stimulate the appetite and make the body to digest food, and also increase hunger while allowing food to digest properly (Dewi, 2012: 40-42). The urge to eat is influenced by the hunger and appetite. Appetite is a situation that encourages a person to satisfy the desire to eat. Appetite is regulated by the hypothalamus, especially in the lateral hypothalamus and ventro medial nuclei. Stimulation of the lateral hypothalamus will lead to increased appetite while stimulation of ventro medial nuclei would be the opposite effect. When viewed in terms of child nutrition, eating is an attempt to meet the individual needs of the various nutrients (nutrients) for various purposes related to the metabolism of the need to preserve life, maintain health and for growth and development. Eating is an education in order that children accustomed to eating habits that good and right and also to get satisfaction and enjoyment for children and for the giver, especially mothers. For children, eating is a complex behavior with a skill that must be learned gradually. Appetite is closely related to weight. Most people with disorders of appetite followed by weight loss quite dramatically, so has the weight below normal. Not ideally the child's weight can lead to various problems. If this nutritional disorder continues in the long term it can cause various health problems. In addition to its association with nutritional needs, appetite also closely related to weight. Lack of appetite in child can lead to not ideally the child's weight. In the long term, disturbances of appetite can also be life-threatening. These disorders are difficult to overcome, because it is difficult to diagnose the cause, nor the conventional drugs that work directly to

improve the appetite but from the side effects of the drug According to the researchers tomato fruit is a fruit that contains a lot of benefits for humans, one of which is to increase appetite. Tomatoes have a slightly sour taste makes appetite increased. Tomato fruit sour taste comes from citric acid. Efficacious to increase appetite by multiplying the discharge of saliva. Based on the research materials contained in the tomato has its benefits, such as to increase appetite. Sour taste in tomatoes is derived from citric acid content, which causes the tomatoes tasted fresh, so it can increase appetite. Tomatoes are rich in mineral salts which stimulates the flow of saliva. This mineral is useful to stimulate the appetite and make food easily digested. Regular consumption of tomatoes to help treat the disease anorexia (loss of appetite). The best of processed tomatoes are in the form of juice. drink tomato juice one hour before meals can improve appetite. Old and ripe tomatoes naturally always alkaline smells and tastes slightly sour, That's because tomatoes have salt minerals. Minerals that stimulate the circulation of saliva, so increasing the feeling of hunger while allowing food to be digest properly.

689

Conclusion The increase of weight and meals portion in the control group showed that the 5 hite rats had increased weight for 7 days with an average of 0.12 g - 0.37 g while the increase of meals portion wint an average of 0.04 gr - 0, 86 gr. The increase of weight and meals portion in the treatment group for 7 days showed that 5 white rats at a dose of 0.5 ml had increased of weigh an average of 1.08 gr - 3.71 gr, a dose of 1 ml had increased of weight an average of 0 , 63 gr - 3.00 gr and a dose of 2 ml had increased of weight an average of 0.80 gr - 5.33 gr. As for the meal portion showed that 5 white rats had increased of meal portion an average of 0.04 gr - 0.86 gr, 0.5 ml dose the increase of meals portion an average of 2.08 gr- 2.92 gr, a dose of 1 ml had increased of meals portion an average of 1.90 gr - 2.86 gr and a dose of 2 ml had increased of meal portion an average of 1.90 gr - 3.14 gr. The data analysis result about white rats' weight obtained value sig (2-tailed) : 0,002 and: 0,05, so < so H0 is rejected and H1 accepted, meaning that there is influence of tomato fruit (Solanum lycopersicum) toward weight of rats white rats ( ratus novergicus stain wistar). While the data analysis results about meals portion of white rats obtained value sig (2-tailed) : 0,000 dan: 0,05, jadi < so H0 is rejected and H1 accepted, meaning that there is influence of tomato fruit (Solanum lycopersicum) toward the meals portion of white rats (ratus novergicus stain wistar) in the Laboratory of Pharmacology, University of Brawijaya, Malang Suggestion It expected that the results of research conducted in the laboratory of pharmacology, University of Brawijaya malang can provide information to the public about the importance of improving the child's appetite to meet the nutritional needs of children every day, especially in children who are having 690

problems appetite by providing alternative options that easy and inexpensive. In the community, especially with children of pre-school age to give tomato fruit every day to improve the child's appetite so the development of the child can develop properly. The results of research that conducted in the laboratory of pharmacology, University of Brawijaya Malang is expected to provide information to the holder of a nutrition program to improve services to the public in order to achieve good nutrition so that the nourishment of children can be met every day by providing alternative options that are easy and inexpensive. One way is by providing counseling services in the villages about the importance of improving the child's appetite, especially at pre-school age children. It is expected that the research conducted in the Pharmacology laboratory of Brawijaya University can be applied by the kindergarten teachers to give understanding to the students about the importance of tomato fruit in order to overcome the problems of the child's appetite decreased, by providing alternative options that are easy and inexpensive. For kindergarten teacher could provide tomato juice at least once a week and it expected can increase appetite of child in order that the child development issues can be resolved. It expected that results of research conducted in the laboratory of pharmacology, University of Brawijaya Malang can add knowledge and skills of researchers about the effect of tomato fruit to increased appetite, so after a plunge in the community in the future can be applied directly. Results of research that conducted in the laboratory of pharmacology, University of Brawijaya is expected to provide benefits as a reference for further

research and add a variable on further research about the effect of tomato fruit to increased the appetite white rats (ratus novergicus stain wistar).

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MDA Dalam Darah Tikus Wistar (Rattus norvegicus) yang Diinduksi Aktivitas Fisik Maksimal. (Tesis). Program Pasca Sarjana Ilmu Biomedik Universitas Udayana.

DAFTAR PUSTAKA Agusman. 2012. Upaya Dietetik Dalam Mengatasi Kesulitan Makan Pada Anak. Dalam Samsudin dan Aryatmo Tjokronegoro, Eds. Gizi dan Tumbuh Kembang. Jakarta: Balai penerbit FKUI.

Judarwanto. 2014. Mengatasi Kesulitan Makan Anak. Jakarta : Puspaswara Publisher.

Arikunto. 2011. Prosedur Penelitian Suatu Pendekatan Praktik. Jakarta: Rineka Cipta. Aviram, M., Dornfeld, L., Rosenblat, M., Volkova, N., Kaplan, M., Coleman, R., Hayek, T., Presser, D., dan Fuhrman, B.S 2010. Pomegranate Juice Consumption Reduces Oxidative Stress, Atherogenic Modifications to LDL, and Platelet Aggregation : Studies in Human and in Atherosclerotic Apolipoprotein E-deficient Mice. Available from : http://www.ajcn.org. Dewi. 2012. Khasiat dan Manfaat Tomat. Surabaya: Stomata. Fakriana.2014.Buah dan sayur. Magelang: Azka Pustaka. Gunarso. 2011. Anoreksia pada Anak: Aspek Psikologis. Dalam Naskah Lengkap Pendidikan Kedokteran Berkelanjutan Ilmu Kesehatan Anak ke XXXI. Jakarta, Universitas Indonesia. Grilo dan Mitchell. 2010. The treatment of Eating Disorders: A Clinical Handbook. New York: The Guildford Press.

Manikam dan Perman. 2010. Pediatric Feeding Disorder. Journal of Clin Gastroenterol. Ngatidjan.

2010. Laboratorium Toksikologi. Uji Toksisitas.

Notoatmodjo.

2010. Metodologi Penelitian Kesehatan. Jakarta: Rineka Cipta.

Nursalam.

2011. Penerapan Metodologi Penelitian Ilmu Keperawatan. Jakarta: Salemba Medika. Nursalam. 2014. Metode Penelitian Ilmu Keperawatan. Jakarta: Salemba Medika. Restu. 2011. Tomat, Usaha Tani dan Penanganan Pasca Panen. Yogyakarta: Kanisius. Riskesdas.

Isroi . 2010. Pemberian Ekstrak Kulit Terung Ungu-Antosianin (Solanum melongena L.) Menurunkan 692

Metode Dalam Metode

2013. Riset Kesehatan Dasar. Jakarta: Badan Penelitian dan Perkembangan Kesehatan. Kementerian Kesehatan RI.

Samsudin.

2011. Penggunaan Rasional Prepovat Vitamin Mineral dan Merangsang Nafsu Makan. Dalam : Sri Nasar dan Sukarti Agusman eds. Berbagai Aspek tentang Vitamin dan Mineral pada Tumbuh Kembang Anak. Jakarta: Balai Penerbit FKUI.

Santoso. 2012. Kesehatan dan Gizi. Jakarta: Rineka Cipta. Sari. 2012. Pelatihan Fisik Berlebih Menurunkan Konsentrasi dan Motilitas Spermatozoa Tikus Putih (Tesis). Denpasar: Universitas Udayana. Sugiyono. 2010. Statistika Nonparametris. Bandung : Alvabeta. Sunarjo. 2013. Kesulitan Makan Pada Anak. Dalam Makalah Lengkap Pendidikan Kedokteran Berkelanjutan Ilmu Kesehatan Anak ke XXXI. Jakarta, Universitas Indonesia

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Waugh dan Lask. 2010. Treatment of Childhood Eating Difficulties and Disorder, The Treatment of Eating Disorders. Widodo. 2013. Pemberian Makanan, Suplemen dan Obat pada Anak. Jakarta: EGC.

RELATION OF FAMILY ROLE IN FULFILLING REQUIREMENT NUTRIENT CHILD WITH THE NUTRIENT STATUS AT CHILD AGE PRE SCHOOL (4-6 YEAR) IN TK KUSUMA MULYA PARE KEDIRI

Erna Nurhochim * Febrina Dwi * Yunarti Matilde Ade STIKes BHAKTI MULIA PARE – KEDIRI Email : [email protected] Abstract Nutrient status represent the expression one aspect or more than nutriture a individual. Family role related to nutrient status child for example role in accomplishment of requirement nutrient as according number sufficiency nutrient. This research aim for the relation of family role in fulfilling requirement nutrient child with the nutrient status at child age pre school (4-6 year) in TK Kusuma Mulia Pare Kediri year 2012. Desain used in this research is desain Non-Eksperimen form the Cross sectional. By using Total technique Sampling obtained by sampel as much 34 responder. Instrument used sheet kuesioner for the variable role family and observation sheet for the nutrient status child, its result is analysed with the statistical test Spearman Rank. Result. Result of research show the characteristic family role that is more than good family role responder that is as much 18 responder (52,9%), while characteristic of nutrient status child show almost entire good nutrient status responder that as much 29 responder (85,3%). Analysis result statistical test indicate that the value signifikansi p 0,000 < 0,05 and correlation coefficient equal 0,436 meaning H 0 refused, its meaning there is relation of family role in fulfilling requirement nutrient child with the nutrient status at child age pre school (4-6 year) in TK Kusuma Mulia Pare Kediri year 2012. Improvement of nutrient status in conducted through improvement of parent role in child mothering specially in accomplishment requirement nutrient child as according to sufficiency number, others as health worker better always give the counselling hit various role which must be conducted for to support the nutrient status of child. Keyword : Family Role, Nutrient Status, age pre school (4-6 year)

preschool (age 3-5 years) used as one indicator the level of well-being of the community. The problem is still there children including preschool age children (3-5 years) less nutritional status as well as bad. In 2010 there were 3,000,292 toddler in East Java and the weighed at posyandu 2,072,539 toddler (69,08%), which means the percentage of a toddler weighed at Posyandu (D/S) has not been reaching the target of 80%. Among all a toddler who weighed there 1,476,234 Toddler (70,8%) toddler who ride weight his body, however the coverage has not met the target of 80%. The total number of Toddler Red down the line (BGM) still 42826 toddler (2,07%) of

INTRODUCTION Background Nutritional status is an expression one or more aspects of the nutriture an individual in a variable (Hadi, 2002) as quoted Akhmadi (2011). The problem of nutritional status in Indonesia still dominated the problem less energy protein (KEP), the problem of Anaemia Due To Disorders Of Iron, Iodine Deficiency (GAKY), Vitamin A deficiency (KVA) and the problem of obesity is mainly in big cities (Supariasa, 2002). The problem of nutritional status It is important to note as a matter of public health (Notoatmodjo, 2007). Therefore the nutritional status of the child ages 689

the entire toddler who weighed (Health OfficeJatim, 2010). In Kediri Regency in 2009 also It brings the number of malnutrition by as much as 54 children Toddler (0.05%) with the death of four children the total amount of toddler toddlers in Kediri Regency as much 112,548 child health Office (Kab. Kediri 2008,2009,2010).

water supply NET qualified health, and various actions other preventive as well as curative role namely treatment immediately appropriately If the child is suffering from a specific disease (Supariasa,2002). In this case because the old man is a component the family consists of a father and mother, and is the result of a bond a valid marriage. Parents have the responsibility for educate the nurturing and guiding his son to reach the stage of (anonymous, 2010). The impact of the the nutritional status of the poor and the less is the child vulnerable to disease infection even death. Considering this problem then within the lower order. nutritional status less and worse in children the school then need to do various the effort. The Government sought food security through the efforts of stabilize the price and supply of materials staple or basic food (nine staple) that affordable communities (Notoatmodjo, 2007). No less importantly through an increase in the caregiving fua in person in particular in the the fulfillment of children's nutritional intake accordingly with a number of nutritional adequacy (RDA). For that health workers should always provide guidance regarding the variety of roles that must be implemented to support status child nutrition as advocate regular visits to every posyandu month, preventive efforts in order fulfillment children are not developing as well as curative action executes (treatment) if the child is sick. Based on the exposure of problems in above, then the researcher is interested in doing research with formulated in the title of the study "The role of the family in Relation Meet The Nutritional Needs Of The Child with the nutritional Status in Children Ages Pre School (4-6 years) in kindergarten Kusuma Mulia Pare Kediri

A preliminary study undertaken researchers on February 6, 2012 in kindergarten Kusuma Noble Pare Kediri, from 10 preschool age children who made the observation there are 4 children with the condition was fat more bodies, 2 children look small and skinny, and the remaining 6 looks normal in terms of his physical condition. From the study the preface indicates that There are conditions of different children. From the study the preface indicates that There are conditions of different children. The preface indicates that. The high incidence of malnutrition is less In addition there is the bad or anything to dowith social factors and the economy, too related to the level of the Ministry of health. According to the Call and Levinson (1871) as quoted Supariasa, et al. nutritional status, nutritional factors influenced in food, there is not the giving of food outside the family buying power family, eating habits, the maintenance of health and the physical and social environment. Indirect causes are lack of family food security the quality of maternal and child care, the Ministry of health and sanitation the environment. Lack of child care associated with lack of role people parents in parenting. The role of the parents that have to do with nutritional status of the child, among others, the role of in fulfillment of the appropriate nutritional intake. with a number of nutritional adequacy (RDA), role in weighing a toddler in routine at posyandu, role in give the ASI, a role in the keep your child's health through personal hygiene for example application handmade soap wash, remove stool not just any place, the provision of a healthy home,

RESEARCH OBJECTIVES General Purpose Know the role of the family relationship in meeting the nutritional needs of the child with the nutritional status in children ages pre

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School (4-6 years) in kindergarten Kusuma Mulia Pare Kediri.

child so that the nutritional status of children pre-school age (4-6 years) can goes well

Special Purpose 1. Identify the role of the family in meeting the nutritional needs pre school age children (4 to 6 years) in the TK Kusuma Mulia Pare Kediri.

THE TYPE AND DESIGN OF THE RESEARCHE

2. Identify the nutritional status on pre school age children (4 to 6 years) in the TK Kusuma Mulia Pare Kediri.

This kind of research used is a type of analytic research karelasional. Research methods analytic is a research method conducted with the main purpose to make the connection or the analytic about a situation objectively (Notoatmojo, 2003). Research korelasional analytical review the relationship between the variables. Researchers can search, describes an relationships, estimates, and test based on the theory that there is a (Nursalam, 2008). In this research the research design used is NonExperimental form of Cross sectional. Cross sectional is a research to study the dynamics of the

3. Analyze the relationship role the family in fulfilling nutritional needs of the child with status nutrition in pre-school age children (4-6 year) in kindergarten Kusuma Mulia Pare Kediri THE BENEFITS OF RESEARCH 1. For Researchers Add new insights about the the role of the family in relation meet the nutritional needs of the child with the nutritional status in children aged pre school (4-6 years). As In addition to trained researchers do research on existing problems. 2. For Research As a reference and input in order to Research places can be applying the standard of service considering the relationship the role of the family in fulfilling nutritional needs of the child with status nutrition in pre-school age children (4-6 year) 3. For Educational Establishments STIKes His Holiness Bhakti Prodi DIII Obstetrics This research is expected to be Add literature library as a suggestion to enrich science the reader's knowledge of particular about the role of family relationships in meeting the nutritional needs in children pre school age (4-6 years). 4. for the Respondents Add insight and knowledge about family in meeting the nutritional needs

correlation between risk factors with effect, by means of the approach, observation or data collection While at one time (Point Time Approach) (Notoatmodjo, 2010)

RESULTS : GENERAL DATA Frequency Distribution Based On Age Of Respondent

0; 3; 8,8% 0,0%

< 20 Tahun

31; 91,2% 20-35 Tahun

From the diagram above I note 4. that and the 34 respondents obtained almost all 691

respondents aged 20-35 years i.e. as many as 31 respondents (9l, 2%), a tiny fraction of respondents age as many as 35 year > 3 respondents (5.5%). Frequency Distribution Based On Parent Education

9; 26,5%

5; 14,7%

18; 52,9%

11; 32,4%

0; 3; 0,0% 8,8%

Baik

Cukup

Kurang

From diagram 4.4 above known that from 34 responder got more than semi role responder good family that is counted 18 responder ( 52,9%) and some of is small responder role of family less counted 5 responder ( 14,7%) Nutritional Status In Children Ages Pre School

22; 64,7% SD From the diagram above 4.2 Note that of the 34 respondents obtained more than half of the respondents HIGH SCHOOL educated i.e. as many as 22 respondents (64,7%), small portion respondent Education JUNIOR HIGH SCHOOL as much as 3 respondents (8.8%).

1; 1; 3; 2,9% 2,9% 8,8%

Disfribusi Frequency Based On Jobs

0; 0; 0,0% 0,0%

29; 85,3% 10; 29,4%

Lebih

From the diagram above 4.5 known that of the 34 respondents obtained almost all respondents nutritional status well that is as much as 29 respondents (85,37%), fraction of respondents more nutritional status as much as 1 respondents (2.9%). post infection does not occur 4 respondents (18.2%).

24; 70,6% Swasta

Baik

PNS

From diagram 4.3 above note that of the 34 respondents obtained the majority of respondents work IRT i.e. as many as 24 respondents (70.6%), almost half of the respondents the work of the civil servants as much as 10 respondents (29,4%).

The Role Of The Family In Relation Meet The Nutritional Needs Of The Child With The Nutritional Status In Children Aged Pre school KINDERGARTEN Kusuma Mulia Pare Kediri.

SPECIAL DATA The Role Of The Family In Fulfilling Nutritional Needs

Based on Table 5.1 above in mind that the role of the family in fulfilling children's nutritional needs good criteria as many as 18 respondents (52,9%) of a total of 34 respondents. 692

From the diagram it is known that from 4.1 34 respondents was obtained by partial large respondents aged 20-35 years that is as many as 31 respondents (91,2%). Age is the age of the individual who calculated from the moment born until birthday time (Notoatmodjo, 2003). Getting older age mom is getting construction in use koping against problems facing the young, the aged mother then not enough his maturity, it is as a result of less experience and lack of maturity of the soul (Nursalam, 2008).

Analysis Of Results Of Statistical Tests Research Based on statistical tests Spearman obtained results p: 0.010 meaning rating 0.000 p 0.05 then H1 < accepted H0 is rejected which means there is a connection among families in meeting the nutritional needs of children with nutritional status on pre school age children in kindergarten Kusuma Mulia Pare Kediri in 2012, with the value of the koefisiensi entry 0.436 in the category of being. In This research koefesiensi categories were is 0.40 0.599.

According to the opinion of the researchers that based on the research results obtained most respondents roles good family in meeting the nutritional needs of children, it is influenced many factors associated with the condition respondents. One of them is a factor age, as a person's age will affect many at least a person's knowledge, the more mature age the parents also extensive knowledge so that the role of the family to meet children's nutritional needs can be lasting well that is for example a parent who was more mature and knowledgeable about nutrition will can support the nutritional status of the child the better.

DISCUSSION Identification Of The Role Of The Family In Meet Nutritional Needs Based on the results of the study are known that of the 34 respondents obtained more than half the respondents to a role good family that is as much as 18 respondents (52,9%), almost half respondents to the role of the family is quite a total of 11 respondents (32.4%) and a small portion of the respondent's role families less as much as 5 respondents (14.7%)

From the diagram it is known that from 4.2 34 respondents was obtained by partial great HIGH SCHOOL educated respondents that is as many as 22 respondents (64.7%). The more the growing education a person makin easy person to search for information. Education is high then a person will tend to get information, either from the person or other mass media. The more many of the incoming information is increasingly many are also knowledge gained about health. Instead the less education will hamper the development of a person towards a new knowledge (Nursalam, 2008). Family owned education especially mom and dad did opinion researchers this may give impact on the mindset of and his knowledge so that the effect on the application of knowledge He has to his son including knowledge about nutrition

The role is a dynamic aspect from the position of a person, in a person carrying out the rights and obligations in accordance with its position then the person in question runs a the role of the (Yasyin, 2004) Parents has a very important role in meeting the nutritional needs of the child (Sulistijani, 2003). According to the researchers these research results shows almost half respondents to the role of the family is good, it is shows parents very role in the fulfillment of nutrition at his son. Should any parent can perform its role in maximum exposure to their children, especially role in the fulfillment of nutrition that is by giving needs the consumption of foods containing nutrients.

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so fulfillment of nutrition do families make an impact on the nutritional status of the child From diagrarn 4.3 Note that from 34 respondents obtained the majority of the respondents IRT work as many as 24 respondents (70.6%). The level of the economy will also affect the role of the mother against the fulfillment of the nutritional status of children. When mother is busy working to meet the needs of his family, then the role of the mother in meeting nutritional needs children will not be optimally viewed from in terms of time but in terms of the material mom more plays to buy materials foods that contain nutrients (Soetjiningsih, 2002).

substances nutrition will also be disrupted. Baby be better and healthier nutrition, more likely to have mental and intellectual abilities more good and has an age of hope the life and times of a more productive high (FNB-NAS)

According to researcher jobs give parents held the influence on the level of economic the family, as if the work parents are good and well established then the economy will be good, in this case families will be able to buy ingredients foods that contain nutrients can adequate nutritional needs his son so that the impact on nutritional status in children.

The Role Of The Family In Relation Meet The Nutritional Needs Of The Child With The Nutritional Status In Children Aged Pre school KINDERGARTEN Kusuma Mulia Pare Kediri.

According to researchers from the fact and the above theory of research results There is a majority of the respondents criteria of good nutritional status, it is because one of the factors the role of family it brings his son is the role of the family in fulfillment of nutritional needs, it This should always be improved to in order to support his son's nutritional status do not experience interference.

Based on statistical tests Spearman obtained as a result p = 0.010 meaning rating 0.000 p 0.05 then H1 < accepted H0 is rejected which means there is a connection the role of the family in fulfilling nutritional needs of children with nutritional status on pre school age children in kindergarten Kusuma Mulia Pare Kediri in 2012, with a value of koefisiensi 0.436. The strength of the correlation of the results of this analysis of 0.436 belongs to the category being. Based on Table 5.1 Note that of the 34 respondents most respondents to the role of the family in meet the needs of child nutrition criteria quite as much as 11 respondents (32.4%) good nutritional status is obtained 10 respondents (29,4%) and nutritional status less 1 respondents (2.9%). According to sunita ( 2009 ) , daily food were chosen in good will give all the nutrients needed to normal body function .But if food not chosen in either of body to be deprived of substances nutrition essential certain .Essential substance is the nutrients that must be imported from food .If grouped there are three

The identification of nutritional Status in children Pre School Age Based on the results of the study are known that of the 34 respondents obtained most respondents nutritional status well that is as much as 29 respondents (85,3%), nutritional status more as much as I respondents (2.9%), nutritional status is less as many as 3 of the respondents (8.8%), the status of malnutrition is as much as I respondents (2.9%). Nutritional status is a State of health individuals or peace that is determined by the degree of physical needs will be energy and substances other energy that has not been retrieved. From Food and food that his physical impact can be measured in Anthropometry (Suhardjo, 2003). The achievement of a good nutritional status, supported by the consumption of food contain enough nutrients and safe to be consumed. In case of health problems, then was-faatan 694

function the nutrients in the body includes: ( 1 ) giving energy , ( 2 ) growth and maintenance body tissues , ( 3 ) set up bodily process .Assessment nutritional status of can be implemented by directly or indirectly , the measurement of indirectly can be implemented in three ways that is survey of food consumption , vital statistics and factors ecology .While measurement at regular can directly implemented through the measurement of anthropometry , biochemistry , clinical and biofisika ( supariasa , 2002 ) . According to researchers from the results obtained the result is no link the role of family needs child nutrition with status of nutrition in children pre school in kindergarten kusuma noble pare kediri in 2012.This is because the role of family applied by the to his son concerning meeting the needs of child nutrition can make a difference in nutritional status of one is girded his son but that this research result indicates that the better the role of family in fulfilling nutritional requirements the more good too nutritional status of one is girded children and vice versa.

koefesiensi entry in the category were is 0.40-0.599.

BIBLIOGRAPHY Nursalam. (2008). Konsep dasar Penerapan Metodologi penelitian IImu Keperawatan: Pedoman Skripsi, Tesis dan Instrumen Penelitian. Jakarta:Salemba Medika. Notoatmodjo. (2003). Pendidikan dan Perilaku Kesehatan. Jakarta: Rineka Cipta. Notoatmodjo. Soekidjo. (2007). Kesehatan dan llmu Jakarta: Rineka Cipta.

Promosi Perilaku.

Notoatmodjo. 2010. Promosi Kesehatan (Teori dan Aplikasi). Jakarta: Rineka Cipta. Soetjiningsih(2003). Tumbuh Kembang Anak, ECG, Jakarta: Supariasa. (2002). Penilaian Status Gizi.Jakarta : EGC, Hal 27 – 31.

CONCLUSION 1. the respondent had Obtained the role of the family in the category of good that is as much as 18 respondents (52,9%) of a total of 34 respondents. 2. Obtained the majority of the respondents i.e. good nutritional status as much as 29 respondents (85,3%) of a total of 34 respondents. 3. Obtained result p: 0.010 meaning value p 0.000 0.05 then accepted H1 < H0 is rejected, meaning no relationship role of the family in meeting the nutritional needs of children with nutritional status in children of pre-school age in kindergarten Kusuma Mulia Pare Kediri in 2012, with a value of koefisiensi 0.436 included in the category of being. The value of the

Sunita. (2009). Prinsip Dasar Ilmu Gizi. Jakarta : Gramedia Pustaka Utama. Suharjo. (2006).Perencanaan Pangan dan Gizi. Jakarta:PT.Bumi Aksara. Soeparmanto. (2007). Pedoman Pelaksanaan Stimulasi Deteksi dan Intervensi Dini Tumbuh Kembang Anak. Jakarta: Depkes RI. Soetjniningsih. (2002). Tumbuh Kembang Anak, Bab Penilaian Pertumbuhan dan Perkembangan. Fakultas Kedokteran Universitas Udayana . Bali:EGC. Yasyin, (2004). Pengertian Tumbuh Kembang Anak. 695

http://www.anneahira.com/pengertia n-tumbuh-kembang-anak.htm Diakses tanggal 30 September 2011.

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THE CORRELATION BETWEEN THE FREQUENCY OF BABY MASSAGE AND THE SLEEP DURATION OF BABIES AGED 0-18 MONTHS FOUND AT RB ENDANG WIDAYAT (MATERNITY CLINIC), LOCATED IN SIDOARJO. Fauziyatun Nisa’ Universitas Nahdlatul Ulama Surabaya, Jl. Smea 57 Surabaya Email : [email protected]

Abstract The high sleep disturbance and the quality of sleep which has not been fulfilled by a baby can result in the unoptimal growth and development. Massage stimulation is very important because it can make a baby comfortable and result in a long sleep duration or tight sleep which may bring a positive effect for their growth and development. Therefore, the purpose of this study was to analyze the correlation between the frequency of baby massage and the sleep duration of babies aged 0-18 months found at RB Endang Widayat (Maternity Clinic), located in Sidoarjo. The design of study was analytic cross sectional. The population involved all mothers having children aged 0-18 months who have come to the clinic mentioned above for baby massage. Twenty samples were taken by using purposive sampling technique. The instrument used to collect the data was a checklist. Moreover, the data were analyzed by using Spearman‟s Rank test with the significance level α = 0.05. The result of study showed that nearly half of the respondents (45.0%) had low frequency in giving baby massage, whereas half of them (50.0%) had short sleep duration. Furthermore, the analysis using Spearman‟s Rank test showed that ρ = 0.000 which meant that ρ < α so that H0 was rejected showing that there was a correlation between the frequency of baby massage and the sleep duration of babies aged 0-18 months found at the maternity clinic. The conclusion of study was that if baby massage was done more frequently, babies would have longer sleep duration. Therefore, the health workers should suggest the mothers to apply baby massage more often to increase the health of babies for the optimal growth and development.

Keywords: baby massage, sleep duration.

2006). Certainly, it is something that should be noted for better growth and development. Achieving optimal growth and development is the result of the interaction of a variety of interrelated factors, namely genetic factors, environment and behavior, as well as useful stimulation. The baby's brain grows three times that of the current state of birth or 80 % of the adult brain in the first year. This condition only occurs once in a lifetime.

INTRODUCTION Sleep is a basic requirement for optimal growth and development for a baby. Mothers with babies aged less than two years often complain about their baby‟s fussiness while sleeping at night, causing them to have sleep disorder. This sleep disorder can be fatal if it occurs in babies or children such as sleep talking (somniloqui), fussiness, restlessness in sleep causing frequent body movement, waking up often, and other sleep disorders in babies (Rini S

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Hence, for maximum growth and development, babies need sufficient rest. (Atmaji, 2005) Quality of sleep affects the development of babies because with good sleep, they will grow into well-developed children. Babies who are active and grow normally usually have sufficient time to sleep. (Wong, 2000) Sleep is an unconscious condition in which an individual can be awakened by appropriate sensory stimuli. Sleep not only gives the body a chance to rest, but it also provides an opportunity to improve the process of metabolism, namely the processing of nutrients into energy. Sleep cannot be interpreted only as a silent and meaningless activity because it has an important role in our daily lives (Hidayat, 2006). 70 % of babies have a habit to sleep "through the night" at the age of three months, 85% at 6 months and 95% at the end of the first year (Rudolph, 2002). Baby sleep pattern usually appears at the age of 3 or 4 months. At the age of 4 to 6 months, babies will be affected by the surrounding environment and will stay awake if they are angry and exhausted (Dowshen, 2001). Sleeping with good quality and quantity will promote the development of babies. Children of the same age will usually have approximately the same sleep interval. Nevertheless, we should remember that each person is a unique individual with different needs, including the need for sleep. (Anonymous, 2006) According to the research done by Sekartini in Indonesia in 2004, among 80 children aged less than three years, 41 of them or 51.3% experienced sleep disorders. Based on research with 385 respondents in five cities, Jakarta, Bandung, Medan, Palembang and Batam, 44.2% of the children had less than 9 hours during nighttime sleep, waking up at night more than three times, and long awake at night more than an hour (Widianto 2005). Meanwhile, according to (Sari Perdiatri, 2006), the prevalence of sleep disorders in children was approximately 30% - 35%. In Beijing, China, the prevalence of sleep disorders in children aged 2-6 years wais

23.5%. Sleep disorders in children are often undetected by parents and not dealt properly. Complaints that are usually expressed by parents include irregular sleep habits, less or excessive sleep, waking up at night, and sleepiness during the day. Children under three years who have troubled sleeping at night on a regular basis show symptoms of anxiety, such as changes in emotion and behavior. Some disorders may exhibit more severe disorders, such as sleep apnea syndrome and sudden infant death syndrome. From the preliminary study conducted by the writer at RB Endang Widayat located in Sidoarjo the data describing babies receiving massage in February, March, and April showed an average of 32 babies. Based on the result of interviews with the mothers in early May 2014, of 5 babies aged 0-18 months, 4 babies had troubled sleeping or have not fulfilled good quality of sleep, shown in Table 1.1 below: Table 1.1 Data of sleep quality of babies

aged 0-18 Months Sleep quality of babies aged 0-18 months Criteria ∑ Babies Percentage Unfulfilled 4 80 Fulfilled 1 20 Source: Primary data of the writer, May 2014 Table 1.1. concluded that 80 % of the babies have not fulfilled the quality of sleep because of waking up more than 3 times in one night, fussiness, and crying. Thus, the problem revealed from this research was the high incidence of sleep disorders/sleep quality that has not been fulfilled by the babies. Factors that may affect the baby‟s sleep are environment, physical exercise, nutrition, diseases, and massage stimulation (touch) (Turcin, 2000; Hidayat, 2006; Perry and Potter, 2006; Saputra 2009, Ria, 2012). One of the factors that can affect a baby to sleep is the lack of massage stimulation (touch). Baby massage is a fun way that will create a feeling of comfort for

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the baby. Stimulation (touch) in the form of massage is important because it will make the baby more comfortable, cause the baby to sleep longer/ tight to generate positive effects for the growth and development. The above factors can also lead to physiological and psychological balance disorders. The physiological effects include the decrease in daily activities, tiredness, weakness, poor neuromuscular coordination, the slow healing process and decreasing body immune, whereas the psychological effects include more emotionally instability, anxiety, no concentration, cognitive abilities and lower combination with his experience (Turcin, 2000; Soedjatmiko, 2006; Saputra, 2009). The ways to help a baby sleep better are by bathing them with warm water, giving quiet activities, such as reading stories, singing lullabies or listening to a quiet music before sleeping. In addition, there is also a form of stimulation to help baby sleep tight, namely baby massage, a movement, like a game, applied to babies to stimulate growth and development and the ability of optimal baby‟s movement (Sutini, 2008). In order to maintain good sleep pattern for babies in daily life, it is necessary for health workers to provide health education for the mothers, especially whose babies experience sleep disorders. To provide the babies with stimulation (touch) or baby massage, they can ask health workers to do it. However, it will be better if the mothers can do it by themselves at home by following the steps of baby massage written on leaflets or flipchart provided by health personnel, so that babies can obtain sleep with quantity and quality appropriate with their needs for optimal growth and development.

this research involved all mothers having babies aged 0-18 months providing massage for their babies at RB Endang Widayat, Sidoarjo, totaling 32 people. The samples used in this study were some of the mothers having babies aged 0-18 months receiving baby massage at RB Endang Widayat, Sidoarjo. In this research, the samples were taken using non-probability sampling in which not all subjects had the same opportunity to take parts in this research. The technique used was purposive sampling based on certain considerations made by the researcher, based on the characteristics of the population that have been previously known (Notoatmodjo, 2012). The analysis was performed analytically to determine the correlation between the two variables (frequency of baby massage and sleep duration of babies aged 0-18 months) using tabulation. Once the data were collected and the completeness was examined, the researcher performed the analysis using Spearman Rank test when ρ <α (0.05), H0 was rejected which meant that there was a correlation between frequency of baby massage and sleep duration of babies aged 0-18 months found at RB Endang Widayat, Sidoarjo. RESULT From the collected data, it showed that the frequency distribution of respondents by frequency of baby massage was as follows: Table 5.2 The frequency Distribution of respondents by frequency of baby massage done at RB Endang Widayat, Sidoarjo in July 2014 frequency Percentage of baby Frequency (%) massage High 15,0 3 40.0 Moderate 8 Low 9 45.0 Jumlah 20 100 Source: Primary data taken in July 2014

METHODS The type of this research was analytic purposed to find out the correlation between frequency of baby massage and sleep duration of babies aged 0-18 months. Based on the time, the design of the study was cross-sectional, in which the independent and dependent variables were observed at the same time. Population in

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Based on Table 5.3 it can be seen massage with moderate frequency, 50.0 % that among 20 respondents, it was found had ideal sleep duration, while 9 that nearly half (45.0%) of the Variable respondents having babies receiving baby ρ Independent Dependent massage with low frequency. (Significance) Description a. Sleep duration of babies Table 5.3 Frequency distribution of respondents by sleep duration at RB Endang Widayat, Sidoarjo in July 2014

(free) Baby massage (Frequency)

DISCUSSION 1. Baby massage

Table 5.4 A cross tabulation between frequency of baby massage and sleep duration of babies aged 0-18 months at RB Endang Widayat Sidoarjo in July 2014

High Moderate Low Total

-

Ideal n (%) 1 (33,3%) 4( 50,0%) -

5 5 (25,0) (25,0)

Less n (%) 1 (12,5%) 9 (100,0%) 10 (50,0)

Correlated

Based on the statistic result shown in table 5.6. using Spearman rank test, it showed ρ = 0.000 and significance level α = 0.05. From this result, we can conclude that ρ < α, then H0 was rejected which meant that there was a correlation between frequency of baby massage and sleep duration of babies aged 0-18 months at RB Endang Widayat, Sidoarjo.

b. The correlation between frequency of baby massage and sleep duration of babies aged 0-18 months

Sleep duration of babies

0,000

Table 5.5 Results of analysis using Spearman Rank test

Based on Table 5.4 it can be seen that among 20 respondents, it was found that half (50.0%) of respondents had babies with less sleep duration.

More n (%) 2 (66,7) 3 (37,5)

Sleep duration

respondents providing baby massage with low frequency, 100.0 % had less sleep duration.

Sleep Percentage duration of Frequency (%) babies More 5 25,0 Ideal 5 25,0 Less 10 50,0 Total 20 100 Source: Primary data taken in July 2014

Frequency of baby massage

(bound)

Total n (%) 3 (100,0) 8 (100,0) 9 (100,0) 20 (100,0)

Source: Primary data taken in July 2014 Based on Table 5.5, it showed that among 2 respondents providing baby massage with high frequency, 66.7 % had more sleep duration, 4 respondents providing baby

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Based on Table 5.3, it showed that among 20 respondents, nearly half (45 %) providing baby massage with low frequency was ≤ 2x / month. 40 % provided baby massage with moderate frequency totaling 3-4 times each month, and 15 % provided baby massage with high frequency, namely ≥ 5 times each month. Based on the fact occurring in the community, most of the parents provided massaging for their babies regularly every week or month, as seen in the research done by Louren and Novita (2007), stating that the implementation of baby massage in the community in general was 1-2 times / month for (40 %), 3-4 times / month (40 %), > 5 times / month (10 %). Massage is not only an artistic touch stimulus to the baby, but it also has become an alternative medication to improve the health of babies. Baby massage can be started immediately after the baby is born, as the parents wish. Starting massage faster and

more routinely in doing massage will bring greater advantages for the babies (Roesli, 2005). Based on Table 5.1, it showed that by the age of the respondents, 20 % having babies aged 0-3 months, 10 % having babies aged 3-6 months, 15 % having babies aged 6-9 months, 10 % having babies aged 9-12 months, 45% having babies aged 12-18 months. In short, most of babies in this research were at the age between 12-18 months. According to the Field (1998) Harley (2003), therapeutic massage as a part of alternative treatment has just been newly invented. This massage will provide greater benefits if done regularly since childbirth until the age of 67 months. In addition, it can be done easily because the procedure of baby massage is easily done with few exercises. According to Utami (2005), any individual can apply the techniques and stages of massage appropriate with the age. The reasons that affect the mothers to provide her babies with massage are to make their babies healthy, to increase appetite, easy to do, to avoid tiredness, which lead to one goal, namely to provide the health for their babies (Lulu, 2010). The result of interviews conducted by the researcher reveals that most mothers provide massage for their babies because of the fussiness resulted from unhealthy condition. Others claim that it was the scheduled time for massage. Moreover, they provide massage because the babies‟ activities are not normal as before. According to Ria (2012), massage can smooth the flow of oxygen to the brain via the bloodstream, so the baby becomes more concentrated when playing and doing activities in daily life. As a result, babies massaged regularly will have an impact on their activities and better body condition. The result of interviews shows that many mothers no longer frequently and regularly provide massage for their babies appropriate with the babies‟ age because they think that it was not so necessary. They think that as the babies grow older, physical condition will be stronger, and consequently the baby can be more resistant in sick condition. It can affect the results of the low-frequency massage, considering

that most of the babies in this research aged between 12-18 months. Most parents are still afraid to do this massage at home for fear of something undesirable after massage. They believed that baby massage requires special techniques which cannot be done by any person. They prefer to take their babies to health professionals, such as midwives, and traditional baby masseurs. Natural touch on baby is actually the same with this massage. If this activity is done regularly in accordance with the correct procedures and techniques, it can be therapeutic treatment to bring benefits to the baby you love. In addition, the touch improves social development. A study done to babies who receive massage when they are four weeks old and after shows that they are more responsive during supervision at home over a period of twelve weeks. Moreover, touch and massage will speed up the bond of love between parents and a baby if they are done by parents on a regular basis. In relation with emotional development, a touch done by the parents is a basis for the development of communication, which will foster mutual love. Moreover, the baby will feel safe because he / she feels the love and protection from the parents (Roesli, 2008). 2. Sleep Duration Based on Table 5.4, it showed that among 20 respondents, 50 % of the babies had sleep duration less than their needs. While 25 % of the babies had good sleep duration fulfilling their needs, and 25 % had sleep duration more than their needs. Given the importance of sleep for the baby's development, the need for sleep must be totally fulfilled so as not to adversely affect the development. One method to meet these needs is massage. Babies receiving massage will be able to sleep well (Roesli, 2005). Massage will support the dilation of blood vessels which increases blood circulation. Smooth blood circulation will require more O2 in the bloodstream. The increasing O2 needs to be sent throughout the body, including to the brain which needs more O2 that stimulates circulation and respiration system to be

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better. This process will increase the hours of sleep in babies (Nuviala, 1992). Based on supporting data from interviews with the baby's mother, it showed that their babies sleep more quietly and not too fussy. This is in line with the opinion of Roesli (2005) that massage can increase serotonin level which will produce melatonin, which plays a role in sleep and make sleep longer and well at night. Serotonin will also increase the capacity of cells receptors to bind the glucocorticoid (adrenaline, a stress hormone). This process leads to decreased level of the hormone adrenaline (stress hormone) so that the babies treated with massage will appear more quiet and without fussiness. In short, massage done more regularly and often will make sleep more restful and deeper with all hormonal process in the body when the baby is asleep.

the environment. Noisy and non-conducive environment will affect the sleep duration. In this study, environmental factors are not controlled which brought effects to the sleep, whereas the internal factor is the health of newborns. According to the interviews, some of the babies were in a state of illness, such as fever, influenza. Such condition affected the sleep. The habit of drinking milk before bed will also affect the baby in sleep. Milk contains alpha protein that can increase the level of Tryptophan. Tryptophan is a precursor of the hormone melatonin and serotonin, which serve as the connecting nerves (neurotransmitters) as well as custom regulator (neurobehavioral). In addition to an effect on patterns of consciousness, perception and pain also affect sleep pattern (Widianto, 2006). In this research, most babies had a habit of drinking milk before bed. It certainly also affects the quantity of sleep. According to (Roekistiningsih 2010) the age factor also affects the increase of quantity of sleep. As the age grows older, the quantity of sleep will decrease. This research was dominated by the babies aged 12-18 months so that age factor caused the babies to have less sleep duration.

3. Correlation between frequency of baby massage and sleeping duration of babies aged 0-18 months Based on the result of a cross tabulation table 5.5, two babies possessed by the respondents who did massages with high frequency had good sleep duration (66.7%). Four babies of the respondents who did the massage with moderate frequency (50.0%) had sufficient sleep duration, whereas 9 babies of the respondents who did the massage with low frequency (100.0%) had less sleep duration. In short, the higher the frequency of the regularity of the massage is done, the better the sleep duration experienced by the babies.. From table 5.6, the result of the analysis using Spearman Rank test and SPSS (Statistical Product Service) for Windows with significance level α = 0.05 obtained the value of ρ = 0.000 which meant that ρ <α, so that H 0 was rejected. It showed that there was a correlation between frequency of baby massage and sleep duration of babies aged 0-18 months. However, there were several factors in this research that affect the baby‟s sleep so that the results were not as expected. Those factors include internal and external factors. External factors include

CONCLUSION 1. Most babies of the respondents found at RB Endang Widayat, Sidoarjo received massage with low frequency. 2. Most babies of the respondents at RB Endang Widayat, Sidoarjo had sleep duration less than their needs. 3. There was a correlation between frequency of baby massage and sleep duration of babies aged 0-18 months at RB Endang Widayat, Sidoarjo . REFERENCES Anonime. 2010. Pengaruh Baby Massage terhadap Kuantitas dan Kualitas Tidur Bayi Usia 0-6 Bulan di Surabaya. www.digilib.unimus.ac.id. Diakses pada tanggal 16 Mei 2014.

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Potter et all. 2006. Basic Nursing+Mosby‟s Nursing Skill 2.0. Elsevien Science Health Science Division. Rafknowledge. 2004. Insomnia dan Gangguan Tidur. Jakarta: PT. Elex Media Komputindo. Rahayu. 2013. Pengaruh Pemberian Pijat Bayi terhadap Penurunan Gangguan Tidur pada Bayi Usia 24 Bulan di Posyandu RW III kec.Dukuh Pakis Surabaya. Karya Tulis Ilmiah. Rudolph, AM, Robert K , et all. 2002. Fundamental of Pediatric. USA: Third Edition, the Me Graw Hill Componies. Inc. Roekistiningsih, dkk. 2010. Pengaruh Pemijatan Terhadap Peningkatan Kuantitas Tidur Bayi Usia 4-6 Bulan di Kelurahan Sumbersari Kecamatan Lowokwaru Kota Malang.. Skripsi. Roesli, Utami. 2005. Petunjuk Praktis Menyusui. Jakarta: Trubus Agriwidya. Schanberg, S. And T. Field,. 1986. ”Sensory Deprivation Stress and Suplemental Stimulation in the Vat Pup and Preterm Human Neonate”, Child Development 5-8. Schanberg, S.,et al. 1989. ”Maternal Deprivation Stress and Growth Suppression. In Advance in Touch. New Implication in Human Dvelopment.” Pediatri Round Table. USA Siobhan, S. 2010. Bayi Tidur Lelap. Jakarta: Erlangga Soedjatmiko. 2006. Pedoman Praktis Pemijatan Bayi. Tanggerang: PT. Karisma Publishing Group. Turner, Nayakkara. 2005. The Smoothing Art of Baby Massage. Landsdowne Publishing. Ubaya, RL. 2010. Hubungan Pijat Bayi dengan Kualitas Tidur Bayi Usia 12 Bulan di Desa Keto Sari kec. Singorojo kab.Kendal. Skripsi. Utami, Roesli. 2008. Pedoman Pijat Bayi. Depok: Trubus Agriwidya Widianto, S. 2005. Pentingnya Tidur Nyenyak Bagi si Kecil. http://www.pikiran

Arikunto. 2006. Prosedur Penelitian. Jakarta: Rineka Cipta. Depkes RI. 2009. Stimulasi Deteksi Intervensi Dini Tumbuh Kembang Anak. Jakarta. Dinas Kesehatan. Conny, Tanjung MF, Rini Sekartini. 2006. Masalah Tidur pada Anak. Sari Pediatri: vol 2(3): 138-142.2. Field, TM, et al. 1986. Tactile/ Kinesthetic Stimulation Effect on Preterm Neonates. Pediatric Jurnal. Gichara, J. 2006. Mengatasi Perilaku Buruk Anak. Tanggerang: PT. Kawan Pustaka. Ikatan Dokter Anak Indonesia. 2008. Tumbuh Kembang Anak dan Remaja Edisi 2. Jakarta: Sagung Seto. Lopez-Cifra Herminia, et al. 1999. The role of Touch in Stress Recovary. In Johnson & Johnson Media Comunications. Hongkong: MediMedia Asia. Lourentina-Novita. 2007. Pengaruh Pijat Bayi Terhadap Peningkatan nafsu Makan Bayi Usia Diatas 6 Bulan di Polklinik Fisoterapi Handicamp International Wedi Klaten. Karya Tulis. Luluk, Nur. 2010. Faktor-Faktor yang Mempengaruhi Ibu Dalam Pelaksanaan Pijat Bayi di Dusun Papahan Kelurahan Papahan Kecamatan Tasikmadu. Jurnal Maternal Volume 3 edisi Oktober 2010. Notoatmodjo, S. 2010. Metodelogi Penelitian Kesehatan. Jakarta: Rineka Cipta. Notoatmodjo, S. 2005. Metodelogi Penelitian. Jakarta: Rineka Cipta. Nursalam. 2008. Konsep dan Penerapan Metodelogi Penelitian Ilmu Keperawatan, Pedoman Skripsi, Thesis, dan Instrumen Penelitian Keperawatan. Jakarta: Salemba Medika. Nuviala, 1992. Effect of Physical Training on Hematological Parameters in Young Swimmers. Sangre (bare), 37:363-367.

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rakyat.com/htm. Diakses tanggal 8 Angustus 2014. Wong, DL, Whaley. 2000. Nursing Care of Infant and Children 5 th. St Louis: Mosbys Year Book. Inc.

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AFFECTING FACTORS FOR THE IMPLEMENTATION OF EARLY DETECTION OF CERVICAL CANCER BY VISUAL INSPECTION WITH LACTIC ACID IN PRIMARY HEALTHCARE CENTERS IN SURABAYA Fritria Dwi Anggraini UNUSA, FKK, Prodi D III Kebidanan – Jl. Smea 57 Surabaya Email : [email protected] Abstract Cervical cancer detection program through an examination of the IVA has been implemented in all health centers in Surabaya since 2010. Target of this program are 80 % womans and the target examination at least 25 people per month, but the achievement only 3-4 people per month. The purpose of research is to analyze the factors that affect the implementation of IVA‟s programs in healthcare centers in Surabaya . Research conducted observational analytic cross sectional approach. The population was responsible for IVA program at the health center (52 people) by total sampling. Data was collected through interviews and observation using a structured questionnaire. Analyzed using T test track with the program VPLS ( Visual Partial Least Square ). The results showed IVA program by parent centers in the city of Surabaya 57.7 % and 51.9% of communication less, the attitude of the respondents 55.8% positive/supportive IVA program , character health centers provide less at 53.8% support , understanding of the standard and target 51.9% less understand. Based on the test results showed that the communication model of the structure, characteristics and health centers responsible attitude directly affects the implementation of the VIA program , while managing and understanding of the standard target indirectly influence the IVA program implementation through communication and attitude. Taken together these five factors influence the implementation of the IVA program with a contribution of 82.7% which is the most influential variable is communication. Suggested DKK establish clearly that the IVA is mandatory and impose targeted SPM to all healthcare centers, as well as improving the provision of resources and commitment through regular supervision. Puskesmas are advised to develop a strategic plan and conduct internal monitoring as well as discussions and refressing on IVA program information . Keywords : Early detection of cervical cancer, program implementation, Primary Healthcare Center

In Indonesia The incidence of cervical cancer continues to increase each year with increased ± 15,000 cases, and 7493 of them ended in death because nearly 70% of new cases are found already in a state of advanced stage. The high incidence of cervical cancer in Indonesia is the highest incidence of cervical cancer in world. Most cases in Indonesia are found in East Java. From the report of POSA (Poli Onkologi Satu Atap) at Dr.Soetomo Hospital, obtained cases reached 2,879 cases in 2011 and 3780

INTRODUCTION Cervical cancer is a malignant disease of the cervix (cervical) caused by HPV (Human Papilloma Virus). Throughout the world, the disease is a type of cancer that affects most to two women after breast cancer, but became the first cause of death of women due to cancer. The incidence of nearly 20 million people per year and 90 % of which occur in developing country like south Asia, Southeast Asia, central and Southern America and East Africa.1

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in 2012, every day discovered 8-10 new cases and in the last 3 years (20102012) the number increased of new patients cervical cancer in a row in 1263, 1758 and 1691 the number of deaths 40 cases.5 Cervical cancer is preventable and treatable if it was found/detected at an early stage. WHO recommends that all women who are sexually active to early detection as the key to successful cancer control program is the effective screening and penanganaan as early as possible. Methods of early detection of cervical cancer screening can be done through a Pap smear test and visual inspection with acetic acid (VIA). Provincial Health Office of East Java began moving examination of cervical cancer screening by health centers since 2007, but has not been implemented optimally, andthen in 2010 City Health Office (DKK) Surabaya coordinate with related sectors as well as the networking of cancer to early detection program for cervical cancer according to Kepmenkes No. 796/Menkes/VII/2010 and assigned to the entire parent community health centers. The program began in the city of Surabaya, Malang, Gresik and Kediri, then will be expanded to all districts/cities in East Java. Activities include outreach to the community and early detection of cervical cancer by the method of IVA. 2 Based on preliminary surveys were obtained by the author through interviews with Primary Health Care Sie KIA DKK Surabaya as the holder IVA program and 4 people in primary IVA program officer, obtained in 20102011dari 62 PHC parent, this program is only implemented by 23 (37%) health center inspection coverage of 20.4% of the target has been done counseling, instead of the entire target. In 2012 DKK Surabaya set the Minimum Service Standards (SPM) examination parent IVA to all health centers in Surabaya region that inspection coverage of at least 25 patients/month for each health center. In 2011-2012,

these programs increased to 56 health centers but only three health centers that reach the target SPM while 53 health centers are below the minimum target coverage defined by an average of 7-8 people coverage/month/community health centers, community health centers and 6 others 0% coverage and has not carried out the search and follow-up of these achievements. 2 Based on the background described above, the writer can formulate problem less optimal implementation of the program of early detection of cervical cancer in the clinic, it is evident from the lack of civic education activities as well as the low coverage in health centers IVA examination which is still far below the target of both the target SPM. Can be said that the implementation of the program for early detection of cervical cancer through examination IVA in the clinic is not optimal but not yet carried out a search and follow-up of these achievements, for it is important to analyze the factors which imfluence to the implementation of programs for early detection of cervical cancer in Primary Healthcare Centers in Surabaya RESEARCH METHODS Research conducted is observational analytic with cross sectional approach. Research analysis unit primary health centers that have been implementing the program IVA, population are executing program officer at the health center for 52 people with total sampling. The independent variable (independent) consisting of communication, availability of resources, health centers support characteristics, attitudes/disposition executor, an understanding of the standards and policy targets. The dependent variable (dependent) is the implementation of programs for early detection of cervical cancer through IVA examination. Data collected through interviews and observation by using a structured 711

questionnaire. Tests were carried out by using the program SEM (Structural Equation Modeling) with alternative models of structures using VPLS (Visual Partial Least Square) because the sample size is relatively small (n <100), using a significance level of 5% (p <0.05) through the analysis of the structural model (Inner Model) and the measurement model (Outer Model). RESULT AND ANALYSIS IVA Programme Implementation in Primary Health Center (PHC) Implementation of cervical cancer early detection program conducted by health centers include the preparation, execution and reporting records. Table 1. Implementation of the program IVA IVA program at primary health center in Surabaya, 2013 Implementation Frequency Percentage Good 22 42,3 Less 30 57,7 52 100,0 total Table 1 shows that the implementation of the health center in the early detection of cervical cancer program largely unfavorable 57.7%. Management of the implementation of cervical cancer early detection program includes the preparation (data collection, estimationtarget mapping, the estimated needs), implementation (inspection scope extension and IVA), as well as recording and reporting.5 Preparation is an examination of needs analysis which includes the analysis starts from the needs of the target, the estimated needs, as well as mapping of target clients according region. Based on the interview respondents can be seen that 82.7% PHC has drawn up a budget plan based on estimated needs tools and means, even 90,3% has appointed executor who examinations and counseling before hand. Associated with the target, 69.1% had health centers estimate the number

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of its target audiences in the region that is the number of women aged 30-50 years who are married, but less preparation of which 80.9% health centers do not perform the mapping target, as well as for cooperation/coordination with cadre/public figures related counseling IVA obtained 69.2% did not do it during preparation. Mapping and cooperation, are two important things the preparation of the IVA program because of the large number of targets including in every region at Surabaya city with a high population density, to facilitate the access of women to achieve IVA inspection services by grouping the corresponding parts of the region began to extension up to examination. According to Azwar, preparation is a supporting factor that has important role in helping implementing organizing various activities that have been plan.16 Associated with the implementation of education and examination, targeted examination of almost all health centers (86.5%) had right that is not limited only to women in the region working alone and 55.8% health centers also do referrals for suspected cases of cancer to a more complete facilities. But the number of IVA inspection coverage in the clinic is very far from their intended target because only six health centers that reach the target SPM, even 26 health centers (50%) had never achieve the set SPM target of DKK. It‟s also associated with the implementation of the extension of the inspection IVA, because there are 52 health centers only 32.7% of primary care clinics routinely conduct counseling and scheduling execution while others is nothing. Inspection of IVA is a relatively new thing for the community, for the efforts of extension and add insight is the main thing to be able to empower and mobilize people in order they want to do the inspection, and this should be done right on target, scheduled and involve cooperation with the

volunteer/community leaders in order to reach the entire target. Recording has been carried out, but not all of those use the same format, even the majority (36.5%) health centers say that there is no specific format for reports from health centers from official health center. All health centers have reported the implementation of the IVA, but not exhaustive, including outreach activities that have been done, but rather focused on the coverage of the examination IVA, 55.8% health centers do not report regularly every month, when it should be recording and reporting regularly every month with the format that has been set, Implementation of health centers in the program of early detection of cervical cancer 57.7% largely unfavorable, especially in the aspect of preparation (cooperation cadres and mapping targets), as well as the coverage extension and inspection activities. The Target program of IVA is very large and bigger, therefore the preparation field includes mapping, advocacy and socialization, building atmosphere, mobilization of communities and partnerships across programs and across sectors is also needed, for the cadre of health plays a role in motivation and mapping the client either to follow counseling and motivation in conducting the examination. IVA examination is actually a long technique enough to find, but to set a new health center program in place since 2010, moreover, although required but this program is the flagship program so that most health centers are expected to prioritize the implementation of the main programs that can not be fulfilled.

the Head of City Health Centre and implementing programs in the clinic include socialization (source, schedule, method), clarity and consistency. Table 2 Communications of implementation IVA at primary health center in Surabaya, 2013 Comunication Frequency Percentage Good Less

27 25

48,1 51,9

Total 52 100,0 The results showed that the communication program of early detection of cervical cancer 51.9% in health centers has not been implemented properly. Communication in this study is the delivery of information/dissemination of the IVA between DKK Surabaya to the Head of Primary Health Center and implementing programs in the clinic include socialization (source, schedule, method), clarity and consistency. The results showed that communication about cervical cancer early detection program in Primary Health Center 51.9% have not done well, especially in the aspect of clarity and operational guidelines for the program must be implemented by all the primary health centers. IVA program executive coordinator at the health center has received information about IVA program either from the Head of the health center or from DKK, provision of implementation and the target remains unclear. Clarity of information is very significant in implementing a policy program in the clinic. Communication is a vital factor that focus on standards and objectives clarity, accuracy and consistency of communication implementers (similarity) is communicated and various resources. program should be clearly understood by the executor, because of a vague understanding of the policy making implementation will not run as expected. Van meters and van

Communication of Implementation in IVA Program Communication in this study is the delivery of information/dissemination of the IVA between DKK Surabaya to 713

horn states if the communication is delivered properly it will have an impact on the disposition/attitude of a midwife in implementing the program because the standard of clarity, consistency and accuracy goals. 6 Disposition/attitude implementor of IVA Programme Disposition/attitude in this regard is implementing in response to cervical cancer early detection program to the task and the response/support in the implementation of cervical cancer early detection programs, including the willingness and responsibility and tendency accept/support program implementation IVA or otherwise. Table 3 The attitude of implementor IVA program at primary health center in Surabaya, 2013 Sikap Frequency Percentage Positive/suport Negative/ Not support

29

55,8

23

44,2

Total 100,0 52 Table 3 shows that the person in charge of the program/implementor majority (55.8%) positive support for early detection of cervical cancer program. The attitude of implementor accepting reject of the executive program (Primary health Cenrters/PHC) will greatly affect the success of public policies. Disposition maintain consistency between the goals set out what the policy makers and implementers. implementor 78.8% of respondents agreed that an IVA is an important program to reduce the incidence of cervical cancer and 53.8% agree that it is the duty and responsibility of health centers in particular respondent who is in charge IVA program in the clinic. Related finding to this run optimally 44.2% of respondents agreed that implementation depends heavily on the support and compensation of DKK, even 73% of

respondents stated that the IVA program not required as long as there are no sanctions or rewards for the health centers linked to whether or not the implementation program. success of the program or policy implementation is the attitude of workers toward acceptance and support for the policies or the support that has been set. Characteristics Supports of Primary Health Center for Implementation in IVA Program Characteristics of support include how big the carrying capacity of an organization to the implementation of the program, among others include the bureaucratic structure, the rules in the form of standard operating procedures (SOP) and patterns of organizational structure includes the arrangement and implementers responsible IVA program and the details of the task. Table 4 Characteristics of support ofIVA program at the health center in Surabaya, 2013 Characteristics PHC Frequency Percentage Positive/suport 24 46,2 Negative/ Not support 28 53,8 52 100,0 Total Implementation of this program relatively lack of supporting, evidenced in 57.7% of City Health centre there is no specific agenda for monitoring the implementation and increase efforts to improve the coverage, and 82.7% said there was no direct supervision of DKK and supervision only based on reports alone. Implementor understanding about Standards and targets of IVA Program Implementor understanding about standards and targets in this study is the understanding and the tendency of the implementor of the standards and policy targets to be achieved by the IVA program.

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Table 5 Implementor understanding of the standards and targets IVA program in PHC Hospital Surabaya, 2013 Percentage understanding Frequency Percentage 44,2 44,2 GoodBaik 2323 55,8 55,8 LessKurang 2929 100,0100,0 5252 TotalTotal The table shows that the standards and targets of the program of early detection of cervical cancer is 55.8% less understanded. The results showed that the standards and program goals early detection of cervical cancer is 55.8% less understood. It was Obtained that 88.5% of respondents consider/approve that IVA program is not a program but the principal is an excellent program, so it does not have to be done by all health centers. 34.8% of them feel that the target number is too big and difficult to achieve by the clinic, even 50% do not agree that this program is charged on all health centers, it is thought to be due to the many existing programs in health centers and community health centers program targets are still subject has not been achieved. IVA program officer at the health center has a different perception and less precise about IVA program, especially concerning the status and targets to be by the achieved health centers linked to the program objectives. understanding of the policy objectives IVA program. According to Van Meter and Van Horn, standards and policy targets must be clearly and correctly understood by the person in charge of the program, to the precision and clarity of communication become an important factor in understanding improper information because it can affect the attitudes/disposition implementor in implementing a program. 8

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Resources (personnel/HR, funds, facilities and infrastructure) in the IVA Program Resources are anything that is used to facilitate the implementation of cervical cancer early detection program in order to be effective, include financial resources (funds) and nonfinancial resources, personnel (HR), facilities and infrastructure. Table 6 Categories availability of resources at IVA program in City Health Centre area of Surabaya, 2013 Resources Frequency Percentage Good 27 51,9 Less 25 48,1 52 100,0 Total Resources in the implementation of IVA program in PHC Surabaya majority (51.9%) complies with the standards that exist in the IVA service guide implementation IVA program. Resources in the implementation of IVA program in PHC Surabaya largely complies with the standards that exist in the IVA service guidelines IVA program implementation, particularly in human resources and infrastructure is needed. Infrastructures that are in the form of equipment and material health advocates such as speculum, bed ginecology, stick Watten and so on are all available adequate and feasible because the tools and materials that are standard are already to be there in the clinic regardless of the program IVA, but for infrastructure activities counseling is still very minimum, only 21.3% health center that has a banner on IVA and 34.7% when the leaflets that provide counseling. The achievement of policy objectives must also be supported by the availability of human resources, funding and infrastructure. In IVA program with optimal GCC is not yet available due to the absence of funds from the special fund operasinal maing DKK for each clinic. According Winarto resource availability is a decisive factor performance of a policy. Implementor must obtain the proper

resources for the program to run smoothly. Although the policy has clear standart and target, but if resources are not adequate or are not used properly, the policy will not be implemented.

Table

7 Analysis of independent variables affect the implementation of the results of the t test based on the model independent t Result variables statistic Communication 4,83 significant Attitude 2,35 significant implementor

The Influence of Communication, Attitude of implementor, Characteristics suport of the Executing Program, Resources and Understanding of Implementor about Standard and Targets With Implementation of IVA Program Model testing done in 2 stages, based on test results obtained from the first phase, there are several indicators that are not valid on each variable, then the invalid indicator aren‟t allow in testing model stage II and obtained the following results.

characteristics suport of the PHC Resources

2,53

significant

0,83

Understanding of Implementor

1, 45

Not significant Not significant

Based on the structure of the model can be analyze the effect of each variable on the implementation. Chart 1 and table 7 shows that of 5 variables associated with implementation of the obtained three variables direct and significant impact on the implementation of that row is communication with a correlation coefficient of 0.529 characteristics executing agencies with correlation coefficient of 0.317 and attitudes with correlation coefficient 0.259 three significant because the test value T > 1.96, while the standard variable and objectives and resource variables do not directly affect the implementation because of the value of T <1.96. In the path analysis using VPLS obtained no free variables (exogenous) of implementation can be a dependent variable (endogenous) for other variables. On such models are based on a theoretical framework van meters obtained models with 3 endogenous variables (variables that are subject arrows) that is communication, attitudes, characteristics and implementation of executing agencies with R2 respectively as follows. On the theory of Van Meter and Van Horn, not only the variables that can affect the implementation, but also between independent variables affect each other and it can not be ignored.

Chart 1. Model influence between variables (inner model) and a significance test to test T

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Table 8 Analysis affecting factors for the implementation of the results of the t test based on the model Variable Eksogen (independent) - Communicatio n - Dispotition/At titude implementor - Characteristics suport of PHC - Resources - Understanding of Implementor about standart and targets - Resources - Communicatio n - Characteristics suport of PHC - Resources - Understanding of Implementor about standart and targets - Resources - Communicatio n

Variable Endogen (dependent)

RSquare (R2) model

Implementation 0,82

Attitude implementor

0,69

effect on the implementation by the attitude and communication. Implementation model on the total value of R square = 0.827 donation means all the factors together affect the implementation of 82.7%, while 17.3% are influenced by other factors not examined. The results showed that of the 5 variables 3 variables obtained direct and significant impact on the implementation of the large influence of successive communications, health centers support characteristics and attitudes. Communications 57.8% influenced by the resources and understanding of standards and policy targets, the characteristics of the support of 26.9% was influenced by the health centers as well as the communication standards and targets, while the attitude of 69% is jointly influenced resources, communication and executive support characteristic. This follows implementation of the theoretical framework proposed by Van Meter and Van Horn : Understanding of standart and targets

Communication

0,57

Characteristics suport of PHC

0, 26

Communication

Resources

Characteristics suport of PHC

Implementation of Early Detection Ca Cervic with IVA Program

Dispotition/At titude implementor

Based on this antarakomunikasi influence, attitudes, characteristics of the implementing agencies, resources and standards and targets for program implementation IVAoleh health center in the city of Surabaya can be described as follows :

The independent variable that does not directly affect the implementation of the IVA program can not be ignored because these variables can affect other independent variables, in other words independent variables affecting the implementation either directly or indirectly. Communication, community health centers and support characteristics together attitudes directly influence IVA program implementation, in addition to the standard target resources and indirect

Understanding of standart and targets

Communication

717 Resources

Characteristics suport of PHC

Implementation of Early Detection Ca Cervic with IVA Program Dispotition/A ttitude implementor

Results of this study confirm the theory of the theory implementation according to Van Meter and Van Hornyang describe the implementation of a policy directly influenced by the attitudes and karakterristik executing agency, it is in line with that obtained in IVA program implementation in Surabaya. While communication is described in theory as an indirect factor proved to have a significant direct effect on the implementation, and even have the most influence over the implementation of which is 50.3%. This is because communication is an important factor that can affect the tendency of the character and attitude of the implementing health center where both factors are important factors in implementation. Van Meter and Van Horn explained that the policy can be implemented properly if there is effective communication between the executive program with the target group.6 Communication plays a role in the implementation of the program the largest in Surabaya IVA. Results of research on the respondent's answer, IVA program is perceived not as a program that should be undertaken by all health centers, but the target SPM 25orang/month only focused on areas awarness/high risk of cervical cancer are health centers in the areas they are regional localization. It describes the differences in perception between DKK and health centers on whether compulsory IVA program, the target set and the target goal IVA program. According to George Edward, the information is not given or received clearly and consistently will lead to differences in perception/ understanding between regulators with the implementor of policy objectives. This difference in perception ineffectiveness impact on performance in the first implementation in a relatively new program is set, therefore communication is the first step of the success of a policy.11

Attitude formation and increased support for community health centers which are important factors that directly influence the implementation and both are also influenced by communication. understanding will create a resistant implementing the program and this can make implementations will not run as expected.11 According Taibi Kahler (Kahler Communications), communication is not just information delivery activities, but efforts to influence and reinforce perceptions and attitudes in accordance with the desired objectives. Communication is an important factor, especially on the clarity of standards and goals, the implementers of communication accuracy and consistency (similarity) is communicated and various resources. Understanding by individuals who are responsible for policy implementation is crucial, hazy understanding will create a resistant implementing the program and this can make implementations will not run as expected.9 Resources and understanding of the standard target funds also affects the implementation of the policy. Attitudes and support for community health centers for IVA program less than the maximum because of the absence of clear provisions as well as compensation for the provision of adequate resources. Unavailability of funds allocated specifically for programs IVA as well as the absence of compensation for follow-up in the form of reward for Primary Health Center successful and panishment for those who do not implement creates a perception that the target program is not mandatory to achieve, especially targeted program targets a very wide so that the necessary cooperation with various parties and it requires optimal resources. Standards and targets vague/unclear whether its programs are required or not, and what the target standards to be achieved will lead to 718

barriers in communication. Neither of resources, provision of resources not only on the infrastructure and human resources, but rather what is needed in the implementation of the program including funding. Unavailability of resources as well as the optimal standard and targets vague/unclear about a program and cause distortion/barriers both in the communication process and the implementation of a policy. 6

Acknowledgement and Refferences 1. World Health Organization. Comprehensive Cervical Cancer Control. A Guide to Essential Practice. Geneva : WHO, 2007. 2. Kepmenkes RI Nomor 796/Menkes/SK/VII/2010. Pedoman Teknis Pengendalian Kanker Payudara dan Kanker Leher Rahim. 2010 3. Canavan TP, Doshy NR. Cervical Cancer. Situs American Family Physician. www.aafp.org 2002. . Accessed dated January 2, 2013 4. Holowaty P et al. Natural History of dysplasia of the uterine cervix. Journal of the National Cancer Institute. 2005 5. Benedet JL, Ngan HYS, Hacker NF. Staging Classifications and clinical practice guidelines of gyneecologic cancers. Int J Gynecol Cancer. 2000 6. Dwiyanto,Indiahono. Kebijakan Publik Berbasis Dynamic Policy Analisys;Gava Media: Yogyakarta,2009. 7. Subarsono. Analisis Kebijakan Publik Teori dan Aplikasi. Penerbit : Pustaka Pelajar, Yogyakarta. 2012. 8. Winarno, Budi. Kebijakan Publik, Teori dan Proses. Medika Press: Yogyakarta, 2008 9. Agustinus, Leo. Dasar-Dasar Kebijakan Publik. Alfabeta, Bandung, 2008 10. Solahuddin Kusumanegara, Model dan Aktor dalam Proses Kebijakan Publik, Penerbit Gava Media, Yogyakarta, 2010. 11. Ekowati Mas Roro Lilik, Perencanaan, Implementasi dan Evaluasi Kebijakan atau Program. Pustaka cakra. Surakarta. 2009 12. Juanim. Analisis Jalur dalam Penelitian. Fakultas Ekonomi UNPAS. Bandung.2004 13. Ghozali Imam. Structural Equation Modeling dengan Alternatif Partial Least Square. UNDIP. Semarang.2011. 14. Nurjazuli. Paradigma Baru dalam Analisa data Penelitian SEM

CONCLUSION 1. Communication on the implementation of the program IVA majority less well, especially in terms of clarity of information, responsible for majority of positive attitude/support IVA program, characteristic of most of the health centers majority less support in the organizational structure, understanding of the standards and program goals majority less particular about state statutes and program targets to be achieved. 2. Implementation IVA program by Primary Health Center in Surabaya, majority less than in the mapping target, counseling and scope of the examination. 3. Communication, characteristics and attitudes support health centers responsible for their respective programs directly affect the implementation of IVA program. 4. Resources and understanding of the target standard indirect effect of the implementation of IVA program. 5. Communication, attitude, characteristic of the support of community health centers, resources and understanding of the target standard jointly IVA affect the implementation of the program with a prediction of 80.7% which is the most influential variable communication.

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15.

16.

dengan VPLS. UNDIP. Semarang. 2012. Gibson, James L. John M. Ivancevich J.H. Donelly Jr.Organization. Organisasi Perilaku, Struktur dan Proses. Jakarta: Erlangga Azwar Azrul, Pengantar Administrasi Kesehatan Edisi ketiga. Bina Rupa Aksara. Tangerang, 2010.

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EFFECTS OF AGE AND PARITY ON THE INCIDENCE OF PREECLAMPSIA IN A PUBLIC HOSPITAL DISTRICT SIDOARJO Hinda Novianti*. Lailatul Khusnul Rizki** UNUSA, FKK, Prodi D III Kebidanan – Jl. Smea 57 Surabaya Email : [email protected] Abstract One of the complications in pregnancy that could have an impact on maternal neonatal mortality is preeclampsia. Until now, the exact cause of preeclampsia is not known. The purpose of this study was to determine the effects of age and parity on the incidence of preeclampsia. The study design was cross-sectional analytic approach. Entire population Pregnant women and maternity hospitals in the delivery room of Sidoarjo by 450 people from January to March 2015, samples were taken using simple random sampling of 150 respondents. The independent variables were maternal age and parity, the dependent variable was the incidence of preeclampsia. The research instrument used secondary data from medical records. Then the data is processed with the process of editing, coding, processing and cleaning, were analyzed using univariate, bivariate and multivariate analysis with multiple logistic regression. Results of the research that has been conducted using the chi-square test for variables of age obtained Pearson chi-square value of 24.093 and p = 0.000> 0.05 of the proceeds Ho is rejected, and the variable parity performed using chi-square test of Pearson chi-square didapatkannilai 8.687 and p = 0.000> 0.05 from the results of Ho rejected. From the multiple logistic regression multivariate analysis showed calculation results Nagelkerke R 0234 square connotes age and parity variables simultaneously able to explain 23.4% of variations in the risk of preeclampsia. In conclusion there is the effect of age on preeclampsia, and there is also the effect of parity against preeclampsia. Keywords: Age, parity, pre-eclampsia actually can be prevented with technology and cost is relatively low while in poor countries around 25 to 50 % women who die fertile caused because the other thing about pregnancy, childbirth, and postpartum (Saifuddin, 2006). The maternal mortality in east java is still high. Based on the report from districts in 2013 obtained such an amount 107 / 100,000 live births. Cause of death is bleeding 23,19 %, eklamsi of 39,38 %, infection of 6,17 % and others of 31,26 %. Preeklamsi / eklamsi is still the leading cause of death (Profile health east java, 2010). The maternal mortality higher on woman who has age extreme less than 20 and more than 35 years (Cunningham, 2006). Bobak (2005) said about 85 % preeklamsi happened in pregnancy first.Of parity 3-2 is of parity

INTRODUCTION Pregnancy is a process physiological takes place in the body a woman. Even though it is a process physiological a lot of disorder that usually accompanies pregnancy that can lead to the high death maternal, one disorder was preeclamsi (Prawirohardjo, 2008) Based on SDKI (2012), on the average a number maternal mortality rate (MMR) noted until 359 per 100,000 live births. It it expresses that the maternal mortality rate (MMR) have increased from 2007 which reached 228 per 100,000 live births. Mortalitas and morbidity in pregnant women and maternity s a big problem good in developing countries and in poor countries, in developing countries more than 50 percent of maternal mortality

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the safest in terms of the incident preeklamsi and risk up in grandemultigravida. Preeklamsi is syndrome specific pregnancy of reduced perfusi organs due to vasospasme and activation endothelial, proteinuria is significant sign preeklamsi, came across proteinuria 300 mg / 1 (Cunningham, 2006 ). The etiology of the preeklamsi could not be known in exact currently, but there are several factors affecting the preeklamsi namely primigravida / nulliparitas, age mother extreme ( 20 th and 35 th ), family history ever preeklamsi / eklamsi, kidney diseases and hypertension that has lived since before pregnant obesity, diabetes mellitus, disease the trophoblast (70 % occurs in cases molahidatidosa. About 85 % preeklamsi happened in pregnancy first. Of parity 3-2 is of parity the safest in terms of the incident preeklamsi and risks rose again in grande multigravida (Bobak, 2005) . According to Cunningham (2006) age safe to pregnancy and childbirth is 23-35 years. Maternal mortality on pregnant women and delivery at the age of under 20 years and after age 35 it increased, because women who have age less than 20 years and more than 35 years was assumed more susceptible to the preeklamsi. In addition pregnant women whose age ≥ 35 years there has been a change of the network tools content and the birth canal not pliable again and more risky to happen preeklampsi.

was most expectant mothers and maternity the maternity hospital in Sidoarjo of 150 people. By using probability sampling, where each subject has an equal opportunity to be selected or not selected as samples. And sampling techniques using Simple Random Sampling, namely with how to create a lottery in accordance with the medical record number. The independent variable in this study the age and parity, and the dependent variable is the preeklampsia. The research instrument used is the patient's medical record. Data processing with editting, scoring, coding, and tabulating. To find out whether there is influence of age and parity of events preeklampsia, then the analysis of the data using Analysis Test bivariat Chi nature of (X²) The proximity of relationship between the free variables with variables are bound is determined based on the value of the Odds Ratio (OR), OR if ≥ 1 risk factor influential means positive against preeclampsia. While multivariate analyses using logistic regression analysis model used to analyze the relationship of the dependent variable independent variable categories that dichotomy and test whether the probability of occurrence of a bound variable can be predicted by its independent variables. RESULTS OF RESEARCH Characteristics of respondents based on age Table 5.1 Frequency distribution of respondents according to age of pregnant women and maternity hospital in Sidoarjo.

METHOD Design research used is analytic, which design research arranged to analyse, define the connection between variables age, of parity and the chain preeclampsia. By using the method approach “cross sectional” that was between the independent variable ( age and of parity and dependent variable this story preeclampsia ) measured at the same time. The population in this research is all expectant mothers and maternity the maternity hospital in Sidoarjo of 450 people. In this study, the sample used

No

1

Age

Frequency

Persentage(%)

At 46 30,7 risk 2 Not at 104 69,3 risk Total 150 100 Source : Secondary data, March 2015

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The results in table 5.1 shows that of the 150 respondents most have an age not at risk (69,3%) Characteristics of respondents based on Parity Table 5.2 Frequency distribution of respondents according to parity of pregnant women and maternity HOSPITALS in Sidoarjo.. No Parity Frequency Persentage (%) 54,7 1 At risk 82 2 Not at 68 45,3 risk Total 150 100

Cross-tabulations between age, parity and incidence of preeclampsia Table 5. 4 Cross-tabulated against age influences the incidence of preeklampsia Preeklampsia Not Age

PE

PE

Not at risk

72

32

At risk

12

34

46

84

66

150

Total

Total 104

Tabel 5.5 Cross-tabulated against parity influences the incidence of preeklampsia

Source : Secondary data, March 2015 .

The result in table 5.2 shows that of the 150 respondents most have parity at risk (54,7%).

Preeklampsia

Characteristics of respondents based on preeklampsia Tabel 5.3 Frequency distribution of respondents according to preeklampsi of pregnant women and maternity hospital in Sidoarjo

Parity Not at risk At risk Total

Not PE

PE

Total

47

21

37

45

82

84

66

150

68

No Preeklampsi Frequency 1 2

Yes No Total

66 84 150

Persentage 44 56 100

Source : Secondary data, March 2015. The result in table 5.2 shows

that of the 150 respondents most have not preeklampsia (56%).

Bivariat Analysis Tabel 5.6 Bivariat analysis results on the influence of age and parity of events preeklampsia Independen ce variable

Dependence variable

Pears on Chi Squar e

P value

Age

Events preeklamp sia Events preeklamp sia

24.09 3

< 0.001

8.687

0.003

Parity

Source : Secondary data, March 2015. Table 5.6 shows that the age of the mother and Parity have correlation with the incidence of Preeklampsia in Sidoarjo HOSPITALS. Based on table 5.6 can be concluded that age has a strong positive influence of events preeklampsia with a value of p = 0000; p < 0.05. Variable Parity has a strong positive influence of events

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preeklampsia the value of p = 0.003; p < 0.05.

14.5% of the variations to the risk of the occurrence of preeclampsia.

Multivariat Analysis Table 5.7 The results of the multiple logistic regression multivariate analysis the influence of age and parity of events preeklampsia.

DISCUSSION The influence of Age against Preeklampsia. Based on the results of research on table 5.6 influence of age and parity of events preeklampsia in Sidoarjo hospital April 2015 obtained results that age had significant effects against the Genesis preeklampsia the value of p < 0.05. Based on Table 5.4 percentage of data shows that the age of the mother with preeklampsia at the age of the mother at risk IE < 20 years and > 35 years more 34 people (i.e. 73,9%) compared with age not at risk (20 – 35 years) that as many as 12 people (26.1%). Results from research that has been done using the chi-square test obtained the value of pearson chi-square = 0.000 24.093 and nilaip > 0.05 the results of Ho denied and Ha accepted then it can be inferred that there was significant influence between the age factor with the risk of the occurrence of preeklampsia, it is possible most of the mother's age is the age of reproduction (20-35 years old). Mothers aged between 20-29 is the age of the lowest contributor to deaths of mothers and babies, while the mother of the younger or older had a great risk, pregnancy of the mother by age 16 years an increase in the risk of going preeklamsi, age 35 are at risk > high and 40 have risk > is very high (Benson and Martin, 2009). Based on the OR = 95% CI 5588 and means high risk age pregnant women have the opportunity of experiencing time Genesis 5588 preeklampsia compared to pregnant women of reproductive age. Value OR > 1, then it means mother's age was a risk factor occur preeklampsia, it is the same with research by Afni Sucita official (2013) where the value of p = 0.015 that means there is a relationship between age with preeclampsia. Apriliani research (2008) stating there is a

Variable

Confidence Interval 95 % Exp (B/OR)

B

Konstanta

0.304

Age

5.588

1.191 1.721

Parity

2.117

0.750

N Observation Nagelkerke R Square

p valu e

0.00 0 0.00 0 0.04 3

150 0.234

Source : Secondary data, March 2015 Interpretation of the results of the analysis are as follows : age at risk will increase the risk of occurrence of 5588 preeklampsia times (OR = 5588, CI 95%; p < 0.001), whereas the risk parity would increase the risk of the occurrence of preeklampsia 2117 times (OR = 2117, CI 95%; p = 0043). From multiple logistic regression multivariate analysis shows the calculation result Nagelkerke R square 0234 meaning variables age and parity simultaneously capable of explaining 14.5% of the variations to the risk of the occurrence of preeklampsia, and the rest by other variables not examined. Results from research that has been done using the chi-square test for the variable age obtained the value of pearson chi-square 24.093 and value p = 0.000 > 0.05 from those results Ho denied, and parity variables performed using chi-square test obtained the value of pearson chi-square 8.687 and value p = 0.000 > 0.05 of the Ho results denied. From multiple logistic regression multivariate analysis shows the calculation result Nagelkerke R square 0234 meaning variables age and parity simultaneously capable of explaining

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significant relationship between age with preeklampsia events (p = 0.02). The study found the proportion of mothers who are in high risk age category (< 20 years and > 35 years) and suffered preeklampsia 5588 times more than that do not suffer from preeklampsia, compared to mothers who are in low-risk age requirements (20 – 35 years). Based on statistical analysis using the chi square test, found the existence of a significant relationship between the age of mothers with preeklampsia events. Its meaning, mother aged < 20 years and > 35 years had a tendency to experience preeklampsia compared with mothers aged 20 – 35 years. Previous studies also find that there is a relationship (p = 0.00) between mothers who have age on high risk category with preeklampsia and value OR of 3.73. In another study also obtained that mothers who are in high risk age category have a risk of 5.089 times preeklampsia compared to mothers who are in the category of lowrisk age (Gafur et all, 2011). Preeclampsia is a collection of symptoms that arise on pregnant women, maternity and during parturition. Clinical symptoms in the form of hypertension and proteinuria arising due to pregnancy induced Endothelial Activation and when vasospasme gestational age above 20 weeks (Cunningham, 2010). Preeklampsia is one of the penyulit in pregnancy which causes severe pain, long-term disability, and death in the mother and fetus. Based on the research that has been done is found from the birthing mother obtained 26 94 people (27.7%) of mothers who experienced preeclampsia. According to the researchers these figures are fairly high incidence of preeclampsia. This incident could have been caused by many factors such as maternal age and parity. Reproductive age from a woman is 20 – 35 years. Reproductive age this is the safest period for pregnancy and childbirth because of the risk at the age of onset of complications during

pregnancy. Age under 20 years and above 35 years of age, also known as high risk for experiencing complications during pregnancy. At age < uterine size is 20 years old, has not yet reached the size of a normal for pregnancy, so the probability of disorders in pregnancy like preeklampsia become larger. At age > 35 years occurred a degenerative process resulting in functional and sruktural changes that occur in the peripheral blood vessels are responsible for changes in blood pressure, making it more susceptible preeklampsia (Strom, 2011) Research conducted by Rozikhan (2007) brings about the relationship between the ages < 20 years with preeklampsia, but there is no relationship between the ages > 35 years with Genesis preeklampsia. Inversely proportional to Rozikhan, research conducted El-Gilany (2012) found that there is no relationship between the mother's age < 20 years with preeklampsia, but there is a significant relationship between the age of the mother > 35 years with Genesis preeklampsia. The influence of Parity against Preeklampsia. Based on the results of research on table 5.6 influence of age and parity of events preeklampsia in Sidoarjo hospitals April 2015 obtained results that age had significant effects against the Genesis preeklampsia the value of p < 0.05. Based on Table 5.5 shows that the percentage of mothers with parity data preeklampsia on parity of mothers at risk i.e. primigravida and grandemulti more IE 45 people (54,9%) compared to the parity is not at risk (multigravida) i.e. as many as 37 people (45.1%). Results from research that has been done using the chi-square test obtained the value of pearson chi-square = 0.000 p value and 8.687 > 0.05 of the results Ho denied and Ha was accepted then it can be inferred that there was significant influence between factors of risk parity with the occurrence of preeklampsia, the

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results it is possible there are still many respondents that have parity parity is ideal (multigravida) it justifies this research results. Based on the analysis of value OR = 2117 and CI 95%, meaning that expectant mothers have the opportunity grandemultigravida and primigravida 2117 times experienced preeklampsia compared with expectant mothers multigravida. Value OR > 1, then it means mother's parity is the occurrence of risk factors preeklampsia, the this is not consistent with research conducted by Mayang Sari (2013) of factor factor associated with preeklampsia on pregnant women in poly Kesdam Hospital obstetrics where there is no relationship between the parity with the preeklampsia events (p = 0,858) (OR = 0,563) while the research of Nurmalichatun (2013) there is a significans relationship between the parity with the preeklampsia events (p = 0.01). The ideal of parity was 2-3, mothers who have children > 5 have a tendency to experience problems in pregnancy (Siswosudarmo and Ova, 2008:82). On a preeklampsia primigravida has a tendency to occur two times greater (JNPK-KR, 2009:188). Preeklampsia more common in first pregnancies compared with the next pregnancy. This is because in the first pregnancy of the formation of blocking antibodies against antigens of the placenta is not perfect, that the more perfect in the next pregnancy. In theory, the more at risk to experience primigravida preeklampsia than a multigravida because preeklampsia usually arises in women who first exposed vilus korion. This happens because the imunologik mechanism on women the formation of blocking antibodies conducted by HLA-G (human leukocyte antigen G) against antigens of the placenta has not been formed completely, so that the process of implantation of the trofoblas to the desidual the mother being distracted. Primigravida is also susceptible to stress

in the face of labor that will stimulate the body to secrete cortisol. The effect of cortisol is to improve the response of sympathetic dystrophy, so precipitation heart and blood pressure will also increase (Yie et all, 2008). Preeklampsia is a disease with clinical symptoms in the form of hypertension and proteinuria arising due to pregnancy induced Endothelial Activation and when vasospasme gestational age above 20 weeks. 1.2 Preeklampsia is one of the penyulit in pregnancy which causes severe pain, long-term disability, and death in the mother, fetus and neonates. SUMMARY On the basis of the results of the study it can be concluded that there is an influence of Age pregnant women and maternity against Preeklampsia Events in Sidoarjo hospitals. There is the influence of Parity of events Preeklampsia in Sidoarjo hospitals. BIBLIOGRAPHY 1. Bobak. 2005. Buku Ajar Keperawatan Maternitas (edisi 4). Jakarta: EGC. 2. Cunningham, F. G,dkk. 2006. Obstetri William Volume 1-2 edisi 21. Jakarta: EGC. 3. Depkes RI. 2006. Buku Panduan Praktis Pelayanan Kesehatan. Jakarta: YBP Sarwono Prawirohardjo. 4. Dinas Kesehatan Kabupaten Sidoarjo. 2013. Profil Kesehatan Kabupaten Sidoarjo 2013. Sidoarjo: Dinas Kesehatan Kabupaten Sidoarjo. 5. Gitasari, T. 2008. Hubungan Usia Ibu dan Umur dengan Kejadian Preeklamsi pada Ibu Hamil di RSUD DR. M Ashari Pemalang. Semarang, Poltekes. 6. Hoetomo. 2005. Kamus Lengkap Bahasa Indonesia. Jakarta: Mitra Pelajar. 7. Kriyantono. 2006. Teknis Praktis Riset Komunikasi. Jakarta: Prenada Media Group

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8. Lestari, A. 2010. Hubungan Karakteristik dengan Pengetahuan Ibu Hamil Tentang Preeklampsia di RSUD Kota Semarang Tahun 2010. Semarang, Universitas Muhammadiyah Semarang. 9. Mardanis. 2004. Metode Penelitian Suatu Pendekatan Proposal. Jakarta: Bumi Aksara 10. Prawirohardjo, S. 2008. Ilmu Kebidanan. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo. 11. Rochjati, P. 2003. Skrining Antenatal pada Ibu Hamil. Surabaya: Pusat safemotherhood. 12. Siswosudarmo, R. 2008. Obstetri Fisiologi. Yogyakarta: Pustaka Cendekia.

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NURSE EXPERIENCES IN IMPLEMENTING LOGOTHERAPY ON LOW SELF-ESTEEM CLIENT IN DR.RADJIMAN WEDIODININGRAT LAWANG IN YEAR OF 2015 Junianto Fitriyadi*Katmini*Nurul Cholifah STIKES BHAKTI MULIA PARE KEDIRI Email: [email protected] Abstract Logotherapy is kind of a psychotherapy type which is first developed by Viktor E. Frank. It means prioritizing the meaning of life as its central theme. The meaning of life itself is the main motivation of man to reach a meaningful life. In this study, the researcher applied a qualitative research with phenomenological approach. Then, data collection methods used in-depth interview technique, it was conducted for 3 participants who execute logotherapy in low self-esteem client. For data analyzing technique, the researcher used Interpretative Phenomenological Analysis (IPA). The results analysis of this research was obtained from experiences of nurse in implementing logotheraphy on the low self-esteem client, it is one of way to recovery client with the process to rediscover the meaning of life that had a negative value, rejection, lack of interaction, reduced activity, and communication disorders. The steps of logotherapy on the low self-esteem started from the approach process till giving of positive reinforcement of the principles of therapeutic communication. There were suporting factors of logotherapy was derived from the adaptive ability of the client, the personal ability therapists, and family education. While obstacle factors came from psychiatric clients and the lack of family support. Self-rated or personal assessment of nurse to the result logotheraphy was determined by the therapist's own assessment that used some aspects of assessment, including; affective, cognitive, and psychomotor. After doing observed, the researcher saw many clients of low self-esteem in a psychiatric hospital. Then, logotherapy is expected can be one of accurate solution as the recovery way of increasing self-esteem. Key words : logotherapy, low self-esteem, nurse.

motivation of the client's life with low self esteem. According to the World Health Organization (WHO), the number of sufferers of the disorder in the world in 2001 was 450 million people and nearly one in three of the population in South East Asia have experienced impaired neuropsychiatric. Currently that amount is estimated to be already on the rise, from 220 million inhabitants of Indonesia, there are about 50 million or 22 percent, had severe psychiatric disorders (Yosep, 2011). Based on a preliminary study in a mental hospital (RSJ) Dr. Radjiman Wediodiningrat. Lawang, the number of new sufferers in 2014 reach 2270 sufferers, it has increased when compared to the new sufferers in 2013, amounting to as much as 2244 sufferers. The total number of patients in the RSJ Lawang in the 2014 reach 5138 sufferers, both sufferers of mild psychiatric disorders as well as the soul. Most patients come from East Java region, particularly the area of

INTRODUCTION Mental health is one of the directions of vision health. Mental disorders occur in the era of globalization and free competition at this time tended to increase. Stressful life events, such as the loss of a loved one, the breakdown in social relations, unemployment, problems in the marriage, economic hardship, the pressure in the job, and sufferers of the disorder increases the risk of discrimination. The increase in the number of sufferers of disorders of the soul will continue to be a problem and a challenge for health workers, particularly nurses who work in mental health services. Human resources (medical personnel) of very high quality are expected to address the matter (Sulistyawati et al, 2005). The nurse's dilemma in dealing with mental disorders treated in mental hospitals, namely the difficulty of establishing a therapeutic Adaptive communication, particularly in finding the meaning of life with low self esteem. So the difficulty nurses to determine interventions in increasing the 724

Malang, Lamongan, Gresik, Sidoarjo, East Java region and others. Some measures of nursing nurse has done to improve therapeutic communication techniques that are adaptive in changing client self-esteem. One of the actions taken by the nurse's soul in finding the meaning of life with low self esteem is the implementation of logotherapy. Logotherapy or commonly referred to as the meaning of life is something that is considered important, true, and coveted as well as give special value to someone so deserving made goal in life. Nurses see many clients do not have a response to the life, so as a professional health worker, nurse explores the spiritual aspects of reality in logotherapy to help clients find the meaning of life in every situation which belonged to clients. Based on the phenomenon and the problems, the authors are interested in knowing more deeply and analyze about the pegalaman of the soul in the discharge nurse logotherapy clients with low self esteem.

logotherapy, the logos meaning significance (meaning) and spiritual (spirituality), while "therapy" is healing or treatment (Bastaman, 2007). According to Frankl in Bastaman (1996) says that the purpose of logotherapy is helping individuals or humans to find the meaning of life and its purpose in any situation including in situations that are not fun. The method and clinical applications of logotherapy addressed by Frankl in Bastaman (2007), among others: 1. Paradoxical Intention The technique of paradoxical intentiton basically utilize the ability of taking distance (self detachment) and the ability to take a stand (to take a stand) against the conditions of the self and the environment. 2. Dereflection Dereflection leverages the capabilities of transcendence of the self that exists in every adult man. It means the ability to free themselves and no longer paying attention to the conditions that are uncomfortable to later devote attention to other things that are positive and beneficial. 3. Medical ministry This approach leverages the ability to take a stand (to take a stand) toward self and environmental conditions is not possible anymore. This approach is the realization of the values be (attitudinal positions values) as one of the sources of life meaning. The main purpose of the method of medical ministry helping someone find the meaning of pendeitaannya (Meaning in our Suffering). 4. Existential Analysis This method is the therapist help the sufferer neurosis noogenik and those who experience the emptiness of life to find out for yourself the meaning of his life and was able to set life goals are more clearly.

Research Objectives This research aims to find out and analyse the experience of nurses in performing soul logotherapy (meaning life) clients with low self esteem in Radjiman Wediodiningrat RSJ Lawang. As for the specific purpose of this research, including: 1. Describe the nurse's understanding of the soul about logotherapy clients low selfesteem 2. Describe how to implement measures or logotherapy by nurses in clients with low self esteem 3. Describe the factor endowments and barrier nursing inhabitants in performing client logotherapy low self esteem 4. Determine selfrated or assessment results from the implementation of personal logotherapy by nurses in clients with low self esteem

RESEARCH METHODS Design Research The design on this research is qualitative research, that is research using naturalistic approach to search and find understanding or understanding of the phenomenon of what is experienced by the subject by way of

THE CONCEPT OF LOGOTHERAPY Logotherapy was introduced by Emile Victor Frankl, a doctor of the nervous and mental disease experts (neuro psychiatrist). The term is derived from the Greece of 725

description in the form of words and language with a specific context background and nature (Moleong, 2010). The approach used in this study is Phenomenology, that is a strategy of research in which the researcher identified therein the fact of human experience about a particular phenomenon (Creswell, 2010). This exploratory characteristic research and there is no treatment to the subject and not made for at ujikan. Aims to describe (expose) the important events that occur in a systematic and more emphasis on factual data (Nursalam, 2011). In this study researchers trying to understand about the phenomenon experienced by nurses in performing soul logotherapy on clients with low self-esteem who is hospitalized in a mental hospital (RSJ) Radjiman Wediodiningrat Lawang. The data used in the strive comes from an examination of the object describing the phenomenon about the experience of nurses in performing logotherapy (meaning life) clients with low self esteem, either in the form of expression, a way of thought, action, viewpoints, as well as clinical data that supports against the problem.

self-esteem and who implement logotherapy clients with low self esteem. Criteria For Sample Sample criteria used in this study are : 1. Any nurse caring for clients with low self esteem in the space Pavilion 2. Every nurse who became participants are nurses who were or had been carrying out on clients of logotherapy, low self esteem and daily interaction with the client. 3. Nurses selected as participants are who understand the process of implementation of logotherapy and have quite a long experience in the field of nursing (senior). In this study a sample of researchers have determined the following considerations: 1. Qualitative Research phenomenological approach uses a small number of individuals (Dempsey, 2004). 2. determination of the number of this sample depends on the fulfillment of needs in research objectives and representativeness of the substance of the data obtained. The sample should be representative of the whole concept is needed in the definition of the term. Research on Place and Time This research was conducted in the space Pavilion Radjiman Wediodiningrat RSJ Lawang, Malang and timing of this research have been implemented starting April 29, 2015 until 8 may 2015. The interviews were conducted separately on each participant and time can be adjusted with the schedule agreed upon between researchers with participants.

Populations and Samples Population The population is all of the subject that meets the criteria specified (Nursalam, 2011). The population in this research is the whole soul nurses carry out client on logotherapy, low self esteem, in the space Pavilion Radjiman Wediodiningrat RSJ, that is as many as 12 people.

Methods of Data Collection Data collection methods that will be used in this research was interview semiterstruktur (semistructure interview) that are included in the technique of deep interview indept interview or followed by activities of the recording (recording). As for the stages in the interview are as follows: 1. Preparation phase Before the interview, the researcher has determined the characteristics partispan, Contracting, time and place with participants who have signed the inform consent or request approval partsipan

Sample The sample consists of the most affordable population that can be used as a subject of research (Nursalam, 2011). The sampling technique in this study by using purposive sampling (sampling aims) which is based on a consideration of certain specified researchers according to purpose (purpose) Research (Sugiyono, 2008). The sample in this research are used as much as the 3 senior nurses, who has many clients deal with low 726

against the implementation of data capture with in-depth interview techniques. 2. Stage of implementation of the Interview Researchers introduce themselves and explain the intent and purpose of the research. Notify the back about the confidentiality of participants. When the interview process, researchers acted as a neutral, impartial means on a conflict of opinion, events. 3. The closing Stages After you have finished implementing a process of interviews, then researchers say thank you. The researchers checked the validity and quality of the data or carry out interviews or complement existing records.

has been agreed upon by the participating organizations and researchers about the time and place of execution. Table 1. Schedule the time and place of execution of the interview Participant Time Place P1 29 – 30 Pavillion on the April 2015 RSJ Lawang P2 06 – 07 Mey Pavillion on the 2015 RSJ Lawang P3 07 – 08 Mey Pavillion on the 2015 RSJ Lawang Implementation of data capture with indepth interviews conducted on each participant for approximately 40 minutes. Data retrieval on the participants include understanding the nurses soul about logotherapy on clients low self-esteem, how to nurse or soul in the discharge of logotherapy, factor endowments and a barrier to implementation of logotherapy clients low self-esteem, as well as private nurses or assessment selfrated soul against the results of the implementation of logotherapy clients low self-esteem.

Analysis of Data Steps in data analysis in this study by using Interpretative Phenomenological Analisys (IPA) as written by Smith (2009 : 79-107), with the following stages : 1. Reading and re-reading 2. Initial noting 3. Developing emergent themes 4. Searching for connection across emergent themes 5. Moving the next cases 6. Looking for patterns across cases

1. Nurse's Understanding of The Soul About Logotherapy Clients Low SelfEsteem Statements of participants (P1, P2, and P3) about the nurse's understanding of the soul about logotherapy clients low selfesteem. Following various statements from the participants :

RESULTS The Characteristics of Participants Participants are taken is mental nurse researcher working on the RSJ Lawang, with a record never carry out procedures of logotherapy, especially in clients with low self esteem. Participants totaled three people with a background of nursing education, nursing job as inhabitants, with the difference of the position in the same room. Participants first (P1) is a nurse who has worked at RSJ Lawang for 23 years and has been implemented since the beginning of logotherapy in RSJ lawang. On the second participant (P2) is a nurse who has worked at RSJ Lawang for 17 years, during which it has implemented logotherapy as one of its intervention. On the third participant (P3) is a nurse who has worked in 32 years during the Lawang RSJ, and has been held since the beginning of logotherapy in RSJ Lawang. Below are described the interview schedule

Table 2. Keywords and Categories of understanding Nurses Soul About Low Self Esteem No. Keyword Categories 1. a. Not useful The negative b. Worthless assessment a. Is not considered The rejection b. Not recognized c. Excommunicated 2. a. Lone. Less interaction b. Indifferent c. Lazily hang out get out of the room 3. a. Lazy work. Decreased 727

4.

b. No spirit (activity) c. Do not want to a. No response

activity 3. Communication disorders 4.

Table 3. Keywords and Categories of Understanding Nurses Soul of Logotherapy No. Keyword Categories 1. a. Therapy The recovery effort 2. a. Looking for The process of b. Dig finding 3. a. The meaning of The meaning life 4. a. Beneficial Worth b. Useful

5.

Theme 1 : Logotherapy clients low selfesteem is an attempt the recovery process to rediscover the meaning of life in order to make life more worth, done on a client that has a negative assessment, experienced rejection, lack of interaction, activity decreased, as well as the disruption of communication. 2. The Steps in Implementing Nurse Logotherapy on Clients With Low Self Esteem The following statement from the various participants (P1, P2, and P3) about the nurse's understanding of the soul on its way or step in execute logotherapy on clients with low self esteem. Table 4. Keywords and Categories of The Soul About How Nurses Understanding or Step in The Exercise of Logotherapy With Clients Low Self-Esteem No. Keyword Categories 1. a. Community Approach relations b. Mutual trust c. Understand the characters d. Introduction 2. a. Give the Education Explanation (therapy)

b. Explain the topic c. Inform a. Facilitate (determine the Attitude) a. Look for points Of feelings b. Dig the meaning a. Resigned to God b. Sincere a. Coaching ability b. Invite coding c. Creating works a. Give praise b. Give Appreciation c. Say thanks a. Java language b. Indonesian Language c. The language of Madura a. Eye contact (staring at your Opponent talk) b. Lip Languages c. Tone of voice a. Dealing b. A balanced Position c. Do not Overshadow a. Politely b. Manners c. Attention d. Wait e. Painstaking

Facilitator

Exploration

Spiritual orientation Development potential Positive reinforcement

Types of language

Body gesture

Convenient position

The attitude

Themes : the way or step execution of logotherapy in clients "low self esteem" starts from the process approach, education, facilitating, exploration of feelings, spiritual orientation, development potential, and the granting of positive reinforcement, using the principles of therapeutic communication considering the kind of body language, gesture, comfortable position and attitude of the therapist.

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3. Factor Endowments and The Factors Restricting Implementation of Logotherapy Clients Low Self-Esteem The following statements expressed by participants (P1, P2, and P3) on the supporting factors and the factors restricting implementation of logotherapy clients low self-esteem :

5.

a. Exile from family Lacking family b. Family does not support accompany c. is not considered (in the family

Themes : Factors supporting the implementation of logotherapy clients low self esteem comes from the adaptive capabilities of the client, the therapist's personal abilities, and parenting families, whereas an inhibitor factor comes from the psychological abuse of clients and the lack of family support.

Table 5. Keywords and Categories of factors Supporting the implementation of Logotherapy in low self esteem No. Keyword Categories 1. a. Answer the Cooperative appropriate client questions b. Directional Talk c. Follow the referrals therapist d. Poise 2. a. The view focus Good eye b. Look toward the contact therapist 3. a. Painstaking Skills for therapist therapists b. The resilient therapist c. The therapist patient 4. a. Family Attention Family (See) parenting b. Family affection c. Granting roles in the family

4. Private Nurse Assessment Against The Results of The Implementation of Logotherapy With Low Self Esteem The following statements of participant (P1, P2, and P3) about how to do a personal assessment of the implementation of nurse logotherapy clients low self-esteem : Table 7. Keywords And Categories in The Soul Against The Nurse's Personal Assessment of The Results to Implementation of Logotherapy Clients Low Self-esteem No. Keyword Categories 1. a. Ask the client Interview b. Ask other medical personnel c. Ask the client to another 2. a. Assess how to Appearance dress observation b. Assess how to dress up 3. a. Observe the work Observation of b. Do not confine behavior themselves 4. a. Noting the Documentation development notes b. Write the SOAP c. Record the results of therapy 5. a. The talk therapy The evaluation results b. Correction of errors

Table 6. Keywords and Categories of Factors Restricting Implementation of Logotherapy in Low Self Esteem No. Keyword Categories 1. a sullen Face. Verbal b. Crying response c flat Expression 2. a. Tense Anxiety b. Afraid c. Concerned d. Anxious 3. a. Client is offended Sensitive b. Irritability 4. a. Quietly Passive b. Indifferent c. Does not respond 729

c. Contract therapy next time a. Open b. Interact c. Not indifferent d. Want to hang out e. Respond to action a. Know the date, day, month, year b. Find out actual news (tv) a. Exercise routine (badminton) b. Active hobby c. Clean your own room d. Join the race (the race handwashing)

DISCUSSION 1. The Notion of Logotherapy in Clients With Low Self Esteem Based on the participants ' statements against his understanding of logotherapy in clients with low self esteem, referring to an attempt by the process of recovery, to find back a meaning to his life. Logotherapy was described as a pattern of psychology or Psychiatry which recognizes the existence of a spiritual dimension in human beings besides the physical dimension and psychological abuse, and contended that the meaning of life and a passion for meaningful is the primary motivation of human beings in order to achieve the desired level of life meaningful (Bastaman, 2007). The following will be shown in brief statements at the reveal by mental health nurses, among others : P1: ".....life is useless, worthless life, aloof behavior, did not want to come out of her room, and when on the invite communication no response and feedback..... " P2: ".............low self esteem it a negative perception against yourself, i.e., feel worthless and are not considered. The behavior of the indifferent or lazy…..” P3: "….feeling useless, because there is a reason, for example, was excommunicated from the family and social reasons, and so arises the feeling indifferent and unwilling to interact with others, and choose to be alone….” Based on fact and theory obtained, logotherapy clients low self-esteem, concentrates on the process of excavation and discovery of the meaning of life on a client that has a negative judgment against him. The negative assessment of the client's low self esteem is shown by behavior that is considered himself worthless and useless. In addition people with low self esteem will diminish its interaction, they will behave indifferent, aloof, and lazy to get along. Then its activity will decrease, for example not always vigor and lazy-malasan, its communication is also experiencing a disturbance, indicated by his behavior that does not respond to the words of others.

Affective assessment

Cognitive assessment

Psychomotor Assessment

Theme : Private nurses or assessment Selfrated soul against the results of logotherapy clients low self-esteem is determined by means of the assessment of its own therapists use some aspects of the assessment, including the aspect of cognitive, affective, and psychomotor. Data Validation Results Researchers use the data in the form of the validity of the method of triangulation of sources and techniques, i.e. the source of the other participants and techniques of observation directly on the participants. the results data from the deep by participants as compared with the results of interviews with other nurses who also handle clients low selfesteem diruangan the same and also compared to the results of the observations made by the researchers themselves. Based on the results of interviews with other interviewees expressed explanation as well as provide a record of the results of the interviews of each participant (P1, P2, and P3) obtained the conformity and equality, as well as data of mutual support with the results of the in-depth interviews that have been conducted on participant researchers (P1, P2, and P3). While the results of observation on PI, P2, and P3, also showed data consistent with answers at the time of the interview. 730

uniqueness that exists on each individual and applying it on the steps of logotherapy.

2. Mental Health Nursing Techniques in Performing Logotherapy on Clients With Low Self Esteem Based on statements from participants about his understanding of the way or step execution of logotherapy in clients with low self esteem are identified from the two sub themes, namely, the process of the implementation of the principle of the use of logotherapy therapeutic communication as a means of communication. Step activities therapist according to Elisabeth Luke in Fabry (1997), including : 1) Keep the familiar relationships and taking the distance over the symptoms, 2) Modification Of attitude, 3) The reduction of complaints or symptoms, 4) Orientation to find the meaning of life. The following will be shown in brief statements at the reveal by mental health nurses, among others : P1: "...give or direct to a new meaning. On the last stage or session, the therapist to convince clients to develop their personal potential and give a compliment achievement.... " P2: "...dig up information the positive side of all issues that are being faced by the client, at the next stage, I direct clients to determine attitudes and find new meaning from his life, helping clients to addressing the problem, and resigned over the will of God ...." P3: "...start looking for points or themes from the feeling of the deepest feelings and dig client to problems faced by clients, while directing the client's attitude to perform acceptance and resignation to all problems faced by me only as facilitators, and then on the final stage I give an explanation on the client to develop their potentialities already owned clients, engage and train the creative and work to fill in spare time ...." The process of implementation of logotherapy can be implemented flexibly and not get hung up on the stage of its implementation because the individual problems and characteristics of logotherapy, client facing differences in characteristics, therapists need to understand any of the

3. Factors Supporting The Implementation of Logotherapy in Clients With Low Self Esteem Based on statements from participants about his understanding of factor endowments and a barrier to implementation of logotherapy in clients with low self esteem are identified from the two sub themes namely, factor endowments which include the adaptive capabilities of the client, the therapist's personal abilities, and parenting families. Factor endowments include the adaptive capabilities of the client, the therapist's personal abilities, and parenting families. the following will explain the factors supporting the implementation of logotherapy, among others : 1) The adaptive ability is reflected from a client that cooperative 2) The ability of personal therapist is able to understand and put myself to be able to propitiate the client so that the client can have a sense of trust and open. 3) The giving of love, attention, and the granting of a role in the family Factors restricting implementation of logotherapy is derived from the client's own psychiatric condition, and lack of support from the family of clients. 1) Psychiatric Conditions here include a verbal response from clients that are less good, anxiety, excessive client condition client is sensitive, and the passive clients 2) Excessive anxiety of clients 3) The condition of sensitive and passive clients 4) The lack of support from the family against the conditions experienced by the client. 4. Private Nurse Assessment Against The Results of Logotherapy in Clients With Low Self Esteem Personal assessment the nurse's soul against the results of the implementation of logotherapy is determined by means of an assessment therapist myself, and this aspect of the assessment that must be met, namely, cognitive affective assessment aspects, and psychomotor. The following will explain 731

participant statements about private nurses or assessment selfrated soul against the results of the implementation of logotherapy. a. Assessment Techniques Self-assessment of nurses against the implementation of logotherapy was done on a client with low self esteem is by interview, be it to the client itself, to his friends or clients during treatment in the RSJ Dr. Radjiman Wediodininhgrat Lawang, and to other medical officer also participated in the daily care of the client, this interview was done so that the therapist can get to know the client's response directly against the results of logotherapy the validation is performed, and as the interviews to the client's own friends and other medical officers, this is to monitor the development of clients and the effectiveness of implementation of logotherapy has done. b. Aspect of The Assessment Personal assessment the nurse's soul against the results of logotherapy in clients with low self esteem is determined with some aspects of the assessment, which includes : assessment of cognitive, affective, and psychomotor 1) Affective assessment can be done by way of assessing the client's attitude began to open, and willing to interact with its environment. 2) Cognitive assessment that is done at the client's low self-esteem that gets done by way of logotherapy meniingkatkan common knowledge, in order to stimulate serotonin as a neurotransmitter in the brain cell activity, be it directly or indirectly. 3) Assessment of psycomotoric can be seen from its activities such as cleaning his own room, and active in the morning sports activities every day.

interaction, activity decreased, as well as the disruption of communication. Implementation process starts from the process approach of logotherapy, then education, further facilitate and explore, then spiritual orientation, development potential, and the granting of positive reinforcement. The principle of communication used i.e. therapeutic communication that include the type of language used, it should be noted that the body gesture, a comfortable position between the client and the therapist, as well as the attitude that must be owned by a therapist logotherapy. Factors supporting the implementation of logotherapy clients low self-esteem include the adaptive capabilities of the clients shown with cooperative clients, and a good eye contact between therapist and client. Next his own, the last factor endowments i.e. parenting from the client's own family. The factors restricting implementation of logotherapy clients low self esteem comes from the client's own psychology, which includes verbal response, anxiety, excessive, condition sensitive, passive and clients against the therapists, as well as a lack of support from the family. Personal assessment of nurses using the method of direct observation, interview both the appearance as well as behavior, then with documentation in writing, and the latter with an evaluation of the overall results to correct for logotherapy. Spects of assessment in the results of logotherapy uses three criteria, i.e. criteria that includes affective attitude towards client interaction and keterbukaannya during treatment. Then the criteria of cognitive peilaian that include the client's ability to understand common knowledge and actual news is often observed by the client. The last assessment criteria, namely the assessment of psychomotor activity that includes clients in performing daily activities after obtaining logotherapy, for example sport or active in following activities held regularly in a mental hospital.

CONCLUSION Logotherapy clients low self-esteem is an attempt the recovery process to rediscover the meaning of life in order to make life more worth, done on a client that has a negative assessment, experienced rejection, lack of

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pada Remaja Awal (12-15 Tahun) di Desa Kambeng Kecamatan Slahung Kabupaten Ponorogo. Pare: STIKes Bhakti Mulia (tidak dipublikasikan).

Sugiyono. 2008. Metode Penelitian Administrasi. Bandung: Alfabeta.

Bastaman. 2007. Logoterapi: Psikologi untuk Menemukan Makna Hidup dan Meraih Hidup Bermakana. Jakarta : PT.Raja Grafindo Persada. Depkes RI. 2007. Riset Kesehatan Dasar 2007. Jakarta: Balitbangkes Depkes RI Depkes RI. 2013. Riset Kesehatan Dasar 2013. Jakarta: Balitbangkes Depkes RI Fitria, Nita. 2010. Prinsip Dasar dan Aplikasi Penulisan Laporan Pendahuluan dan Strategi Pelaksanaan Keperawatan (LP dan SP) untuk Diagnosis Keperawatan Jiwa Berat bagi Program S-I Keperawatan. Jakarta: Salemba Medika. Kanine, E. 2011. Pengaruh Terapi Generalis dan Logoterapi Individu Terhadap Respon Ketidakberdayaan Klien Diabetes Melitus di Rumah Sakit Provinsi Sulawesi Utara. (Tesis). Jakarta: FIK UI. Koeswara. 1992. Logoterapi :Psikoterapi Viktor Frankl. Yogyakarta: Kanisius. Maryatun, Sri. 2011. Pengaruh Logoterapi Terhadap Perubahan Harga Diri Narapidana Perempuan dengan Narkotika Di Lembaga Pemasyarakatan Kelas IIA Palembang. (Tesis). Jakarta: FIK UI Nursalam. 2011. Konsep dan Penerapan Penelitian Ilmu Metodelogi Keperawatan, Edisi 2. Jakarta: Salembe Medika. Stuart, G.W & Laraia, M.T. 2005. Principles and Practice of Psychiatric Nursing. (7th ed.). St.Louis: Mosby. Stuart, G.W & Sundeen. 1995. Principles and Practice of Psychiatric Nursing. (5th ed.). St.Louis: Mosby Stuart, G.W. 2009. Principles and Practice of Psychiatric Nursing. (9th ed.). Canada: Mosby, Inc

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COMPARISON BETWEEN TECHNIQUE TENDON SUTURE MODIFIED SAMU (MS) AND MODIFIED KESSLER (MK) TOWARDS TENDON SUTURE STRENGTHS (TENSILE STRENGTH) OF BROILERS TENDON (GALLUS) Nanang Muhibuddin* Erni Rahmawati* Moh Halili STIKES BHAKTI MULIA PARE KEDIRI Email : [email protected] Abstract Acute trauma at the arms, wrists, or fingers often cause the tendon rupture which certainly needs strong and effective suture. Therefore, the researcher is going to compare the strengths between tendon suture Modified Samu technique and Modified Kessler technique. This research design applied true experimental design through Pasca test in the first analysis and Prepost test for the second analysis. The samples of this research were 30 broilers which were categorized in inclusive and exclusive criteria by using simple random sampling. The first analysis was to test the strength of tendon suture Modified Samu and Modified Kessler Technique, while the second analysis was to test the effectiveness of tendon suture Modified Samu and Modified Kessler Technique. The data were collected through observation sheets which were suited to the checklist then analyzed through Mann–Whitney U-Test. After the research was conducted, tendon suture Modified Samu was 90% stronger than Modified Kessler technique, however, the Modified Kessler Technique was 90% more effective than Modified Samu technique. Based on Mann–Whitney U-Test in þ < α (0,05) degree of suture strength, the score of þ 0,02 was < 0,05, while the suture effectiveness, the score of þ 0,02 was < 0,05. Regarding the results, it showed that Ho was rejected and H1 was accepted. It meant that there was significance difference of the suture strengths and the suture effectiveness between tendon suture Modified Samu technique and Modified Kessler technique of broilers. Regarding the difference, it is expected for the readers especially orthopedic surgeon to be able to use new technique which is Modified Samu in coordinating the tendon which got rupture. Key words: suture technique, suture strength, suture effectiveness.

finally result in impaired function of the related fingers, it can even occur rupture again (Rizal, 2010). The success in the implementation of orthopedic surgery, especially in the tendon grafting, depending on the suture technique, which is used. However, the use of the suture technique should pay attention to the situation, the conditions and the shape or size of the tendon itself (Surya, 2004). From the research results of E. Surya D. Pohan, 2004, obtained a connection gap in average load 1,269 kgf. While the results of the measurement of the difference in circumference or diameter of the tendon, before and after healing sewn on average 0.75 mm. Where these studies using rabbit as a model. From the preliminary study researchers concluded strength of the

1. Background One of the complicate problems in orthopedic surgery is to restore the normal function of the finger with tendon rupture. Trauma of sharp on the arm, wrist and on the fingers often cause tendon rupture, both flexor and extensor tendons. The success of tendon graft surgery and rehabilitation is influenced by many factors. Among these factors which are highly instrumental is the kind of trauma tendon, torn tendon sheath, the tendon nutrition, shape and traumatic suture techniques, material and size of the threads and postoperative immobilization of the related finger . The handling of tendon rupture that is not optimal will result in tendon adhesion with surrounding tissue that will interfere with tendon gliding, that

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tendon on the broiler, before doing the surgery / grafting was 1,450 kgf. Various experimental studies and clinical trials, previously concluded that early mobilization of the tendon that has been spliced, would decrease the occurrence rate of tendon adhesion with the surrounding tissue, and repair the tendon gliding. However, early mobilization will cause the connection gap (gap formation) larger, which facilitates the occurence of rerupture. Connection gap is too large, and the rerupture of the tendon that has been spliced, indicating a malfunction suture, it is influenced by suture techniques, material and size of the threads as well as biological and mechanical capabilities of the tendon, in the early stages of healing tendon. In the first 2 weeks post-grafting, tendon suffered softening phase, where early mobilization in this phase, increase the possibility of rerupture. After the 3rd week, it gradually becoming more and more powerful connections (Sun, 2004). According to Rizal (2010) that the increase in gap connections provide poor clinical outcome. One target of the connecting tendon to repair or maintain the gliding function. In tendon grafting, the addition of a connection circle has effect on the gliding and then affecting mobilization after grafting. Early mobilization in connection tendon, stimulate the surgeons hands to do research, in order to get a strong tailoring techniques, while avoiding the occurrence of a gap larger connection, which facilitates the re-rupture. Where, Kesler modification technique is often used to compare with other techniques because according Siverkiold Modified Kessler technique has advantages, such as the use of 4.0 prolene yarn classified as small thread so that the addition of the connection circle minimal (4.10 mm). See the advantages - advantages that exist in Modified Kessler technique, the researchers wanted to compare the results of his findings on the tendon suture technique namely Samu Modification Techniques (SM), which will be compared with Kessler Modification Techniques (KM)

Research benefits Theoretical benefits 1. Add a contribution in surgery 2. Being a new alternative materials that better at connecting tendons. 3. Understand the technique of grafting tendons. Practical benefits 1. For institution Provide information about the techniques to sew the tendons that provide optimal results, so that in surgery, especially orthopedic surgery can be used as guidelines on how or techniques to sew the tendon.

2.

3.

4.

For nursing profession Nurse or other surgeons can choose tendon suture technique that can provide good therapy in the treatment of tendon rupture. For Public / Clients who experiencing Tendon Rupture Help clients in order that the fingers or extremities which experience ruptured tendon, return to normal function and prevent the occurence of rerupture of the tendon. For researcher By conducting this research, researchers can increase knowledge about techniques of sewing the tendon. Researchers also can improve the knowledge of researchers in applying science that has been obtained by researchers directly into the environment. While for other researchers can be used as a reference or as consideration for the next study.

Research Design The research design used true experimental design in the form of post-test on analysis (I) and prepost tests on the analysis (II), with two treatments towards broiler with the preparation of the flexor tendons, spliced with Samu Modification techniques and Kessler modification technique. Use this kind of research,

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because researchers want to compare the strength of the tendon suture using a suture technique of Samu Modifications and Kessler Modifications, by using broiler as test animals. Therefore, in terms of methods and data analysis, this study facilitate researchers to control the counfounding factor and bias due to sample homogeneity. in addition, it also facilitate researchers in the analysis of data because the amount of samples that conducted treatment, can be determined from the initial amount in the same period of time.

Based on diagrams 2 is known that sample of 10 broilers 100% or all broilers have gender of male, which then from the 10 broilers were divided into two treatment groups, namely Samu Modification technique and Kessler Modification technique, respectively 5 broilers. These data are in accordance with the inclusion and exclusion criteria in intake of sample. c. Frequency Distribution based on Weight

General Data 1. Analysis (I) a. Frequency Distribution based on age

0% 100%

0% 100%

Jantan 1500 gram

5 Minggu

Diagram 1 Frequency distribu-tion based on age of research sample in analysis (I)

Diagram 3 Frequency distribu-tion based on weight of research sample in analysis (I)

Based on diagrams 1 is known that sample of 10 broilers 100% or all of the 5-week-old broiler, which then, from the 10 broilers were divided into two treatment groups, namely Samu Modification technique and Kessler Modification technique, respectively 5 broilers. These data are in accordance with the inclusion and exclusion criteria in intake of sample.

Based on diagrams 3 is known that sample of 10 broilers 100% or all of broilers have a weight of 1500 gram , which then, from the 10 broilers were divided into two treatment groups, namely Samu Modification technique and Kessler Modification technique, respectively 5 broilers. These data are in accordance with the inclusion and exclusion criteria in intake of sample. 2. Analysis (II) a. Frequency Distribution based on age

b. Frequency distribution based on gender 0% 100%

30% Jantan

70%

Diagram 2 Frequency distribu-tion based on gender of research sample in analysis (I)

5 Minggu 6 Minggu

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Diagram 4 Frequency distribu-tion based on age of research sample in analysis (II) Based on diagrams 4 is known that sample of 20 broilers 70% or 14 broiler were 5-week-old and 30% or 6 broilers were 6-week old, which then, from the 20 broilers were divided into two treatment groups, namely Samu Modification technique and Kessler Modification technique, respectively 10 broilers. These data are in accordance with the inclusion and exclusion criteria in intake of sample.

c. Frequency Distribution Based on Body Weight

30% 70% 1400 gram 1500 gram

Diagram 6 Frequency distribu-tion based on body weight of research sample in analysis (II)

b. Frequency Distribution Based on Gender

Based on diagrams 6 is known that sample of 20 broilers 70% or 14 broilers have a weight of 1400 gram and 30% or 6 broilers have a weight of 1500 gram, which then, from the 20 broilers were divided into two treatment groups, namely Samu Modification technique and Kessler Modification techni-que, respectively 10 broilers. These data are in accordance with the inclusion and exclusion criteria in intake of sample.

0%

100% Jantan

Diagram 5 Frequency distribu-tion based on gender of research sample in analysis (II) Based on diagrams 5 is known that sample of 20 broilers 100% or all broilers have a gender of male, which then, from the 20 broilers were divided into two treatment groups, namely Samu Modification technique and Kessler Modification techni-que, respectively 10 broilers. These data are in accordance with the inclusion and exclusion criteria in intake of sample.

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Specific Data 1. Analysis (I) a. Formation of connection gap Samu Modification (SM) Table 1 Measurement result of the formation of tendon connection gap with Tendon Suture Technique of Samu Modification (SM) The formed gap Load (Kg)

1 2

0,1

0,7

3

0,1

0,5

4

0,1

0,6

5

0,1

0,6

6

0,1

0,6

7

0,1

0,5

8

0,1

0,7

9

0,1

0,6

10

0,1

0,5

0,1

0,6

6

0,1

0,5

7

0,1

0,6

8

0,1

0,7

9 10

0,1 0,1

0,4 0,5

The above table shows that the gap that formed in Kessler Modification (KM) techniques is largely formed on the load to 600 grams.

No Gap (cm) 0,1

5

0,6 c. Strength of Tendon Suture technique Samu Modification (SM) Table 3 Result of strenght Assessment of the tendon Suture with Samu Modification (SM) tendon suture techniques

1

Tendon Terputu s Pada Beban (Kg) 1,1

2

1,1

1,1

3

kuat

3

1,2

1,2

3

kuat

4

1,1

1,1

3

kuat

5

1,2

1,2

3

kuat

6

1,1

1,1

3

kuat

7

1,1

1,1

3

kuat

8

1,2

1,2

3

kuat

9

1,1

1,1

3

10

0,9

0,9

2

kuat cukup kuat

N o

The above table shows that the gap that formed in Samu Modification (SM) techniques is largely formed on the load to 600 grams. b. Formation of connection gap Kessler Modification (KM) Table 2 Measurement result of the formation of tendon connection gap with Tendon Suture Technique of Kessler Modifikasi (KM) in group (B)

Strengt h (kgf)

Scor e

Categor y

1,1

3

kuat

The formed gap NO Load (Kg)

1

Gap (cm) 0,1

2

0,1

0,6

3

0,1

0,7

4

0,1

0,6

The above table shows that the strength of the tendon with Samu Modification (SM) techniques, mostly including in strong category.

0,6

d. Strength of Tendon Suture technique Kessler Modifica-tion (KM)

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Tabel 4 Result of strenght Assessment of the tendon Suture with Kessler Modification (KM) tendon suture techniques

No

Tendon Terputus Pada Beban (Kg)

Strength

Score

1 2

5 weeks 5 weeks

1400 1400

0,4 0,5

3

6 weeks

1500

0,5

4

5 weeks

1400

0,5

5

5 weeks

1400

0,5

6

5 weeks

1400

0,4

7

6 weeks

1500

0,5

8

6 weeks

1500

0,5

9

5 weeks

1400

0,5

10

5 weeks

1400

0,5

Category

(kgf)

1

1

1

2

2

1

1

2

3

1

1

2

4

0,9

0,9

2

5

1

1

2

6

1,2

1,2

3

7

1

1

2

8

0,9

0,9

2

9

1

1

2

10

1

1

2

cukup kuat cukup kuat cukup kuat cukup kuat cukup kuat Kuat

The above table shows that the diameter of the tendon before sewn in the treatment group of Samu Modification (SM) techniques, most of diameter 0.5 cm. 2) Diameter Post Test Samu Modification (SM) technique Table 6 Result of Diameter Change Assessment in Post Test of Samu Modification (SM) Techniques

cukup kuat cukup kuat cukup kuat cukup kuat

Formation of Adhesion

1

Diameter after 3 weeks (Post Test) SM 0,6

2

0,7

S

3

0,7

S

4

0,7

S

5

0,7

S

6

0,5

T

7

0,7

S

8

0,7

S

9

0,7

S

10

0,7

S

No The above table shows that the strength of the tendon with Kessler Modification (KM) techniques, mostly including in strong enough category. Analysis (II) a. Technique of Samu Modification (SM) Samu 1) Diameter of Pre Test Modification (SM) technique Table 5 Result of Diameter Change Assessment in Pre Test of Samu Modification (SM) Techniques

No

Age

Weight (g)

Description S : little T : None

Diameter beforet (cm)

743

SM S

The above table shows that the diameter of the tendon after sewn in the treatment group of Samu Modification (SM) techniques, most of diameter 0.7 cm.

Kessler Modification (KM) Techniques

3) Effectiveness of Samu Modification (SM) Suture Technique Table 7 Result of Effective-ness Assessment of Samu Modification (SM) Techniques No 1

Selisih Diameter Score (Cm) 2 0,02

2

0,02

2

3

0,02

2

4

0,02

2

5

0,02

2

6

0,01

3

7

0,02

2

8

0,02

2

9

0,02

2

10

0,02

2

category cukup efektif cukup efektif cukup efektif cukup efektif cukup efektif efektif cukup efektif cukup efektif cukup efektif cukup efektif

Diameter before suture (Cm)

No

Age

Weight (g)

1

5 weeks

1400

0,4

2

5 weeks

1400

0,5

3

6 weeks

1500

0,5

4

5 weeks

1400

0,5

5

5 weeks

1400

0,4

6

5 weeks

1400

0,5

7

6 weeks

1500

0,5

8

6 weeks

1500

0,5

9

5 weeks

1400

0,5

10

5 weeks

1400

0,5

The above table shows that the diameter of the tendon before sewn in the treatment group of Kessler Modification (KM) techniques, most of diameter 0.5 cm. 2) Diameter Post Test Kessler Modification (KM) technique Table 9 Result of Diameter Change Assessment in Post Test of Kessler Modification (SM) Techniques Diameter after 3 weeks No (post test) KM

The above table shows that the effectiveness of tendon sutures with Samu Modification techniques (SM), largely in category of quite effective. b. Technique of Kessler Modification (KM) 1) Diameter of Pre Test Kessler Modification (KM) technique Table 8 Result of Diameter Change Assessment in Pre Test of

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Formation of Adhesion

1

0,5

KM T

2

0,7

S

3

0,6

T

4

0,6

T

5

0,5

T

6

0,6

T

7

0,6

T

8

0,6

T

9

0,6

T

6

0,01

3

Efektif

10

0,6

T

7

0,01

3

Efektif

8

0,01

3

Efektif

9

0,01

3

Efektif

10

0,01

3

Efektif

Description S : little T : None The above table shows that the diameter of the tendon after sewn in the treatment group of Kessler Modification (SM) techniques, most of diameter 0.6 cm.

The above table shows that the effectiveness of tendon sutures with Kessler Modification techniques (SM), largely in category of effective.

3) Effectiveness of Kessler Modification (SM) Suture Technique Table 10 Result of Effective-ness Assessment of Kessler Modification (KM) Techniques n A ( n A 1) 2

U A n AnB U A 10 x10

U A 100

10 (10 1)

2. Comparison of Tendon suture strength between Samu Modifikasi technique (SM) and Kessler Modifikasi technique (KM) Table 11 Comparison of Tendon suture strength bet-ween Samu Modifikasi technique (SM) and Kessler Modifikasi technique (KM)

 RA  145

Kel. Score Rank Kel. Score Rank SM KM 1 3 15,5 1 2 5,5 2 3 15,5 2 2 5,5 3 3 15,5 3 2 5,5 4 3 15,5 4 2 5,5 5 3 15,5 5 2 5,5 6 3 15,5 6 3 15,5 7 3 15,5 7 2 5,5 8 3 15,5 8 2 5,5 9 3 15,5 9 2 5,5 10 2 5,5 10 2 5,5

2

110  145 2

U A 10

Different of No Score Diameter (Cm) 1 0,01 3

Category

2

0,02

2

3

0,01

3

Efektif cukup efektif Efektif

4

0,01

3

Efektif

5

0,01

3

Efektif

= 145

RA

nA (nA 1) U B nAnB RB 2 10 (10 1)  65 U B 10 x10 2 110  65 U B 100 2 U B 90

745

RB

= 65

3. Comparison of tendon suture effectiveness between Samu Modification technique (SM) with Kessler Modification technique (KM) Table 12 Comparison of tendon suture effectiveness bet-ween Samu Modificati-on technique (SM) with Kessler Modification technique (KM)

Based the table above assessment found the number of ratings for the strength of tendon connection in Samu Modification techniques (SM) = 10 whereas the Kessler Modication technique (KM) = 90 Based on the count above shows that the ratings strength of tendon suture in the technique of Samu Modification (SM) tthat is smaller than the techniques of Kessler Modification (KM) that is value of UA is smaller than UB (10 < 90) thus the used one to compare with the U table is UAtheone with value 15. Based on the table 4.3 in Chapter 4 with n1 = 10 and n 2 = 10, obtained value of U table = 19. In fact the value of U calculation is bigger than U table (10 < 19). So that Ho is rejected and H1 is accepted that meaning there is significant difference in tendon suture strength between Samu Modifikasi modification technique (SM) dengan technique of Kessler Modification (KM). Based on the statistical test of Mann-Whitney U-Tesusing SPSS 11,5 with significant level of α (0,05), for comparison of tendon suture strength Samu Modification (SM) with Kessler Modifica-tion (KM) obtained value p 0,00. In reality p < α (0,00 < 0,05), sho that Ho is rejected and H1 is accepted that mean there was a significant difference or comparison in the tendon suture strength between Samu Modification technique (SM) with Kessler Modification technique (KM).

Kel . SM 1 2 3 4 5 6 7 8 9 10

Scor e

Ran k

2 2 2 2 2 3 2 2 2 2

5,5 5,5 5,5 5,5 5,5 15,5 5,5 5,5 5,5 5,5

Kel . KM 1 2 3 4 5 6 7 8 9 10

R A= 65 U B nAnB RA

Scor e

Ran k

3 2 3 3 3 3 3 3 3 3

15,5 5,5 15,5 15,5 15,5 15,5 15,5 15,5 15,5 15,5

RB

= 145

nA (nA 1) 2

B

10 (10 1)  145 U B 10 x10 2

U B 100 U B 10

110  145 2

ase d on the

abo

ve asse ssment table, obtained that a number of ranks for suture effectiveness of Samu Modifi-cation (SM) = 90, while in Kessler Modification techni-que (KM) = 10 Based on the above calculation showed that the ranks of tendon suture effectiveness Kessler Modification technique (KM) is smaller that the Samu Modification technique (SM) namely value of U B is smaller that value of U A (90 < 10) thus the one used to compare with U table is UB with value 10. Based on

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formation of a gap connections that mostly formed on the load to 600 grams, if we compare it with the strength of the tendon in a preliminary study in which the power of the tendon without sewing, mostly 1,450 Kgf, we can conclude that the formation of gap connection in the tendon with Samu Modification techniques (SM) almost 50% of the tencon strength before sutured. This is due to the suture technique Samu Modification (SM) are not too many punctures / suture so it does not facilitate the re-occurrence of rupture, so the formation of a gap to be minimized. One target of the tendon connection is to repair or maintain the function of the tendon gliding. the more minimal of gap tendon connection that is formed, the better the tendon gliding function because no tissues are out of the tendon gap. Samu Modification (SM) Techniques, in this study is enough to prove that this technique produces a strong connection, it can be seen from the formation of gaps when compared with Kessler Modification (KM) technique, the stronger ones is technique of Samu Modification (SM). The formation of the gap connection, this will affect the strength of the tendon suture. The earlier formation of the gap connection the morereducing the strength of the tendon suture. One that affects the formation of this gap is the early mobilization of tendon that has been spliced, with early mobilization, the movement of the tendon will be more maximized so that if the suture of the tendon is not strong, the tendon will be easy to form a gap, when the gap has been formed, it can reduce the strength of the tendon suture. In addition to reducing the strength of the tendon suture, gap formation will facilitate the occurrence of adhesion or a new tissue that will obstruct the process of the tendon gliding, gliding tendon when disturbed, the function of tendons that rupture and have sutured will not be optimal.

the table 4.3 in Chapter 4 with n1 = 10 dan n 2 = 10, obtained value of U tabel = 19. In fact the value of U calculate is bigger that U table (10<19). It mean that there is significant changes or signi-ficant in effectiveness of the tendon suture between tech- nique of Samu Modification (SM) with technique of Kessler Modification (KM). Based on the statistical test of Mann-Whitney U-Test using SPSS 11,5 with significant level of α (0,05), as for the comparison of tendon suture effectiveness between Samu Modification technique (SM) with Kessler Modification technique (KM) obtained value of p 0,00. Where p < α (0,00 < 0,05), so that Ho is rejected and H1 is accepted, meaning that there was significant difference or comparison in the tendon suture effectiveness between Samu Modification technique (SM) with Kessler Modification technique (KM). Discussion 1. Formation of tendon connection gap with Samu Modification (SM) technique Based on Table 5.1 can be known that of all samples that exist in the treatment group Samu modification techniques (SM) most of the gap formed on the load to 600 grams and a small portion is formed on the load to 700 grams. According to Surya (2004), there are several things to be considered, to make the connection tendon is strong and not easy in the formation of a gap that is the smooth way of work (gentle) and fine instrument. By looking at Surya opinion above, as a nurse or surgeon, especially orthopedic , should pay attention to way of good work and the selection of appropriate instruments in surgery. Techniques of Samu Modification (SM) is a new technique that gives quite optimal results, it can be seen on the

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tendon connection is formed, the better the tendon gliding function because no tissues that out of the tendon gap. Sutures should be strong enough to withstand the movement during the early mobilization without damaging the structure of tissue, in the tendon that could inhibit the healing process of the

2. Formation of tendon connection gap with Kessler Modification (KM) technique Based on Table 5.5 can be known that of all samples that exist in the treatment group Kessler modification techniques (KM) most of the gap formed on the load to 600 grams and a small portion is formed on the load to 400 grams. According to Rizal (2010) that the increased of tendon connections gap, provide poor clinical outcome. At tendon grafting, the formation of gap has effect on adhesion formation in the tendon, so it will affect the function of tendon gliding. This Kessler Modification (KM) suture technique, according to the researchers is too many punctures / suture that surrounds the tendon rupture so that allow the occurence of rerupture, in addition, the technique of Kessler Modification (KM) use the more yarn that technique of Samu Modification (SM). Besides mobilization also influence the formation of the connection gap in the tendons that larger so as to facilitate rerupture in the tendon connection. One that affects the formation of this gap is early mobilization of tendon that has been spliced, with this early mobilization, the movement of the tendon will be maximized, so that if the tendon suture is not strong, the tendon will be easy to form gap, when the gap has been formed, it can reduce the strength of tendon suture. In addition to reducing the strength of the tendon suture, the gap formation will facilitate the occurrence adhesion or new tissue that will disturb the process of the tendon gliding, when the tendon gliding is disturb the functionof the tendons that rupture and have sewn will not be optimal. While the purpose of suturing or grafting tendons is splicing the ends of a ruptured tendon in such a way so as to allow the healing process occurs. One target of the connecting tendon is to repair or maintain the function of the tendon gliding. the more minimal gap

tendon itself.. If we compare it with the technique of Samu Modification (SM), suture technique of Kessler modification (KM) is less powerful, it can beseen in the formation of a gap in the group of Kessler Modification (KM) technique which is a small portion is formed on the load of 400 grams, while in the group of Samu Modifications (SM) technique, most of small gap if formed at the load of 700 grams. This proves that the formation of the gap connection of Kessler Modification (KM) technique is less powerful than suture techniques of Samu Modification (SM). early gap that formed on Kessler Modification (KM) techniques, can also be influenced by the size of the thread that used is large enough, which is in thisresearch, the technique of Kessler modification use proline threads 4.0 and 6.0, while the techniqueof Samu Modification only use proline threads 6.0 that certainly smaller than threads used in the technique of Kessler Modification (KM). 3. Strenght of tendon suture in Samu Modification (SM) technique Based on Table 5.3 can be known that of all samples that exist in the treatment group Samu modification techniques (SM) mostly including in strong category. In addition to the smooth workings (gentle) and fine instrument , in the process of surgery should be using a magnifying glass. This is to provide optimal results in grafting tendons (Rizal, 2004). According to Surya (2004) tendon suture strength is determined by several factors: the type of yarn, thread strength and technique or

748

type of suture. By subject, tendon suture technique is satisfactory is the maximum tensile stregth but not damage the tendon micro-circulation and able to prevent or reduce the occurrence of a gap, easy to perform, allowing early mobilization that controlled and do not interfere with the tendon gliding. According to investigators, suture strength, including resistance to prevent tendon rupture suture connection (tensile strength) and the ability to prevent a connection suture gap (gap formation). Tendon suture strength is influenced by the material or materials of suture, the size of the thread and suture techniques that used. At this time material and size of the suture can be performed standardization, while the suture techniques has developed rapidly. With the discovery of a wide variety of suture techniques that diverse, each researcher reported advantages of their suture technique. Ideally a suture technique has a good suture strength, the connection gap is small and has a small diameter connection, so it does not interfere with tendon gliding. in the technique of Samu Modifications (SM) uses a proline thread 6.0 with roun bodiet needle inte round shape and a pointed tip. The thread size is very small, so making it easier for the surgeon in the connecting of tendons. In addition Samu modification techniques (SM) are not too many punctures or suture, so it does not facilitate the occurrence of a tear in the tendon. In this study, researchers used a tendon rooster as a sample because the rooster has a high mobility of the hens, the tendon is certainly much smaller than the size of the human tendon, so researchers conbsider-ed the technique of Samu Modification (SM) includes in a powerful technique because the tendon size is relatively small. This Samu Modified (SM) suture technique is able to provide optimal strength, certainly when Samu modification techniques (SM) is applied to the tendon that is larger in particular the human tendons will provide a more optimal strength. From the other side,

suture technique Samu Modification (SM) is a sutures technique that are arguably not difficult, it is suitable for the profession of nurse or surgeon, especially the surgical orthopedics in the handling of tendon rupture, and therefore this is not difficult, this technique is not too time-consuming long enough , so as to provide comfort for the nurse or other surgeons. So far the techniques used in the treatment of tendon rupture takes quite a long time so that the possibility could occur more severe complications such as lack of fluid volume caused by bleeding during a long processof surgery. 4. Strenght of tendon suture in Kessler Modification (KM) technique Based on Table 5.4 can be known that of all samples that exist in the treatment group, Kessler Modification techniques (KM) mostly including in strong category. Suture technique Kessler Modification (KM) with epitenon sutures, is one tendon suture technique , the most preferred of the surgeon, and often used as a standard of comparison, with a range of new techniques that will be researched, the Kessler Modification (KM)technique is using 2 types of threads namely threads proline 4.0 and proline 6.0 (Surya, 2004). Sutures strength include resistance to prevent the broken off tendon sutures connection, (tensile strength) and the ability to prevent the occurence of suture connection gap (gap formation) (Rizal 2010). According to researchers the Kessler Modification techniques (KM) in this study as a comparison with Samu Modification techniques (SM) that is certainly Kessler Modification techniques (KM) possessed certain positive side. Almost entirely, tendon sutures strength is affected by the lack of a puncture / sutures in the tendon. Besides, early mobilization is also very influential on the strength of the tendon sutures, due to the new tendon performed surgery then often undergo

749

mobilization will cause a malfunction of suture. It is caused by the occurence of tendon connection gap (gap formation) caused by frequent early mobilization. Gap connection tendon, which is too large and occurence of re rupture in the tendon that spliced, indicating the function of sutures, it is influenced by the technique of tendon sutures, material and size of the thread, and the ability of biological and mechanical of the tendon in the early stages of tendon healing, as described by Surya at the above the Kessler Modification (KM) technique using two types of threads namely proline threads 4.0 and 6.0, where proline thread 4.0 is large enough so that facilitates the tear in the fibers of tendon that may cause the re-rupture. In addition to the size of the thread used that influence the strength of the tendon suture technique is early mobilization can accelerate the formation of the connection gap, so the tendon that had been sutured have possibility could experience rupture again. However, early mobilization is also has very important role in preventing the adhesion, because with early mobilization, tendon that has been stitched or spliced avoid the occurrence of adhesions between tissues that are not yet ripe with tissue in the surrounding of the tendon so it will disturb the glidding process or the movement of the tendon. In this research, the mobilization performed to the the tendon that has spliced, in the form of the load continuously, it will provide action and tendons are interested to form a gap, even experience rupture again. The action that fucntion as an early mobilization, where the technique of Kessler Modification (KM) experienced the gap formation at the load average of 600 grams and disconnected in the load average of 1000 grams or 1 kg, so it can be said that the strength of Kessler Modification (KM) technique on this research is include in category of quite strong because of the strength of the technique is 1 Kgf, it is slightly different from Samu Modification (SM)

techniques, that includes in category of strong because the formed strength in this research is 1.1 kgf. 5. Diameter of Tendon Pre - Post Technique of Samu Modifikasi (SM) Based on Table 5.7 can be known that of all samples that exist in the treatment group, Samu Modification techniques (SM) most has different of pre post diameter 0,2 cm. Tendon suturing techniques, which has a slim shape tendon connection, it will not disturb the process of the tendon gliding in the tendon sheath, while the shape of the protruding connection will disturb the tendon gliding process (Surya, 2004). The formation of tendon diameter caused by the formation of tendon connection gap. The greater the gap tendon connection is formed, the larger the diameter of the tendon is formed, this is due to the release of tissue, from the tendon gap, thus forming a new tissue outside of the tendon. In the sutures technique Samu Modification (SM), there are changes in the tendon of 0.2 cm before and after sutured because in the technique of Samu Modification (SM) there is a little puncture / sutures so allowing the occurence of adhesion to the tendon. The more adhesion is formed, the sutures technique is not effective, because adhesion will affect the tendon gliding, so the tendon function is not back to normal. In addition to the size of the thread used that influence the strength of the tendon suture technique, the early mobilization can accelerate the formation of the connection gap, so the tendon that had been spliced has possibility could experience hte rupture again. However, early mobilization is also has very important role in preventing the adhesion, because with early mobilization tof endon that has been stitched or spliced avoid the occurrence of adhesions between tissues that are not yet ripe with tissue in the surrounding of the tendon so it will disturb the gliding process or the movement of the

750

tendon. In this research, the mobilization that provided tothe tendon that has been spliced in the form of providing the load continuously, it will give action and tendons are interested to form a gap, even experience rupture again. In this research, the difference of tendon before and after sutured, is assessed in the analysis (II), the analysis is to identify the leffectiveness level of sutures techniques. As we know that function is as shortening the muscle tendon, the tendon moves to point to the bottom of the foot. This is the action that allows a person to stand on one's feet, run, jump, walk normally, and to go up and down stairs, in addition to the function is to bend and stretch the tendon all joints and muscles to hold the bone. Without tendons, muscles will just be a large gathering in the field and will not be able to move. So the greater the adhesion, the more interrupted the process of gliding or the movement of the tendon. If that happens then the function of the tendon will not be optimal. In this research adhesion that formed in Samu Modification techniques (SM) is quite large when compared with Kessler Modification technique (SM). The good splicing of the tendon will either be able to restore the continuity of the tendon without causing adhesions or adhesions between the tendosn with tissue surrounding the tendon, and form of connections that could hinder the tendon gliding. The success of tendon grafting surgery, and rehabilitation or tendon healing process, especially the formation of adhesions, which was instrumental is the torn of tendon sheath, sutures techniques and mobilization. The more severe the tendon tear, the more possibility the formation of adhesion in tendon that has been sutured.

tendon prepost test 0,2 cm so that includes in category of quite effective. The effectiveness or success in the implementation of orthopedic surgery, especially in the tendon grafting, depending on the sutures technique, which is used. However, the use of the sutures technique should pay attention to the situation, the conditions and the shape or size of the tendon itself (Surya, 2004). In this research Samu Modification techniques (SM) includes in category of quite effe0ctive in connecting tendons so that it can be used in surgery, especially orthopedic surgery. The effectiveness of this sutures technique is assessed from the formation or changes in diameter. The tendon sutures technique is said to be effective if the change in diameter before and after sutured is minimal, so as to prevent the adhesion formation in the tendon. The formation of tendon diameter was one caused by the formation of a connection. The bigger the gap connection is formed, the greater the possibility of adding diameter are formed. This is caused by the discharge of immature tissue from the tendon itself and formed adhesions or adhesions with existing tissues around the tendon. In this research, the suture technique of Samu Modification (SM) includes in category of effective, that if we compare it with Kessler Modification technique (KM), the result is Kessler Modification technique (KM) is more effective. According to researchers it happened because in this research, the sample used was roaster with its tendon size is much smaller than the size of a human tendon, so that the thread that used should use a smaller size. However, Samu Modification techniques (SM) has a its own advantage that an atraumatic and simple techniques making it easier for the nursing profession or other surgeons to do so. Considering the tendon rupture cases that including the critical cases , then requiring critical action that is fast and precise, so that for the researchers, this Samu Modification techniques (SM) is

6. Effectiveness of Samu Modification (SM) suture technique Based on Table 5.7 can be known that of all samples that exist in the treatment group, Samu Modification techniques (SM) most has different in

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suitable as an alternative in handling cases of tendon rupture.

physiological and adequate, the fine instrument , workplace is free of blood, suture material that is unreactive, strong, not delayed, it can easily be made the tight suture, tendon suture technique is strong and does not cause a blockage of blood flow and does not disturb the tendon gliding, does not injure the blood vessels around the tendon, treatment by a specialist or surgeon, good lighting and assistants who can well-cooperated (Surya, 2004). According to the researchers, the technique of tendon sutures Kessler Modification (KM) is an effective technique in tendons grafting, this is caused by the minimal adhesion formation due to changes or additions diameter tendon which is minimal, so many surgeons, especially surgical orthopedic using this technique, in addition to many researchers are also using this technique as a comparison technique with other techniques, this is because the technique of Kessler Modification (KM) is include in effective category.

7. Diameter of Tendon PrePost technique of Kessler Modification (KM) Based on Table 5.10 can be known that of all samples that exist in the treatment group, Samu Modification techniques (SM) most has different of pre post diameter 0,1 cm. Various experimental studies and clinical trials previously concluded that early mobilization of the tendon that has been spliced, would decrease the occurrence of tendon adhesion with the surrounding tissue and will repair the tendon gliding. However, early mobilization will cause the connection gap (gap formation) greater that facilitates re-rupture (Surya, 2004). Changes in diameterwhich is formed on the tendon with Kessler Modification techniques (KM) is quite minimal, this is caused by the closing or lack of tendon gap connection that are formed, making it impossible to grow new tissue in the surrounding tendons and reduce the formation of tendon adhesion, and does not disturb the tendon gliding. Thus Kessler Modification technique (KM) is very safe to use in surgery, particularly orthopedic surgery, because in this research the Kessler Modification technique (KM) including in effective category, this is due to the minimal change in the diameter of the tendon.

9. Comparison of suture tendon strength between Samu Modification (SM) technique and Kessler Modification (KM) technique From the research ranking the strength of the tendon connections in Kessler Modification technique (SM) = 10, while Samu Modification techniques (SM) = 90, so the technique of Samu Modification (SM) is stronger than the Kessler Modification technique (KM). Statistical tests to prove the significance of this comparison value þ <α (0.00> 0.05), which means that H1 is accepted meaning that there are significant comparisons on the strength of the tendon sutures between Samu Modification techniques (SM) with Kessler Modification technique (KM). According to Surya (2004) tendon suture strength is determined by several factors: the type of yarn, thread strength and technique or type of suture. By subject, tendon suture technique is satisfactory is the maximum tensile

8. Effectiveness of Kessler Modification (KM) suture technique Based on the table 5:10, it is known that of all samples that exist in the treatment group Kessler Modification techniques (KM), most of the difference tendon in test prepost 0.1 cm so include in effective category. The basic principle for the success or effectiveness of the technique of tendon sutures, is a surgical technique atraumatic which include: the way of work is smooth (gentle), the use of a magnifying glass, incision that

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stregth but not damage the tendon micro-circulation and able to prevent or reduce the occurrence of a gap, easy to perform, allowing early mobilization that controlled and do not interfere with the tendon gliding. sutures strength include resistance to prevent the rupture of tendon sutures connection (tensile strength) and the ability to prevent occurence of gap connection sutures (gap formation) (Rizal 2010). In this study found a significant difference statistically in the strength of sutures (tensile strength) between techniques of Samu Modification (SM) and technique of Kessler Modification (KM) where the technique Samu Modification (SM) is stronger than in technique of Kessler Modification (KM), because in Samu Modification techniques (SM) are not too many punctures / sutures in the tendon, while the Kessler technique Modification (KM) there are more puncture / sutures of the tendons so that can facilitate rerupture of the tendon that has been spliced. Researchers can not compare these results with other studies, since the amount of literature study, the researchers did, no one has to compare these two techniques in particular, but when we see the results of technique Kessler Modification (KM), in this study the strength of sutures in average of (1 kgf) and the connection gap formed at average loads (0.6 Kg) obtained result that is smaller, compared to the results of other researchers such as D. Pohan. This is caused by two things: In this study, researchers used a method cyclic loading and intermittent, in this study, researchers use the tendon rooster as a model, while in the study D. Pohan using rabbit tendon as a model. In vivo force that received by the spliced tendons , at the time of passive motion postoperative is relatively small force repeatedly (cyclic). In this research the force applied to the connection on Samu Modification technique (SM) and Kessler Modification technique (KM) is a force that is both continuous and progressive until the sutures broke back,

the situation is somewhat different from the actual circumstances occur as explained above. This invivo research in the animal experiments and clinical trials to look at the advantages and disadvantages of Samu Modification technique and Kessler Modification technique, have never reported the results, but the results of this study on these two techniques, can be used to maintain the connection sutures tendons of fingers, which will be conducted early mobilization with passive movement, because passive movement requires tendon resistence force of 0.1-0.9 kgf. Based on these results, obtained that tendon sutures strength is greater than the tendon force resistence in passive movement, in which the sutures strength of Modification Samu technique average of 1.1 kgf, and Kessler Modification technique average of 1 kgf. These different sutures strength is caused by Samu Modification techniques (SM) which is atraumatic, causing granulation tissue and connective tissue, which is less, so that the possibility of adhesion can be eliminated. Granulation tissue and connective tissue, have contributed in terms of adhesion formation, which in the end inhibit movement while conduct early mobilization. In addition, the technique of Samu Modification (SM) has a knot on both sides of the tendon that prevents sutures become loose or even release, thus minimizing the gap formation that is formed. The Kessler Modification (KM) technique which criss-cross has a tendency to disturb the vascularization intratendon. 10. Comparison of the Tendon suture effectiveness of Samu Modification technique (SM) with Kessler Modification technique (KM) Based on the research the ranking of the effectiveness of Samu Modification technique (SM) = 90, while Kessler Modification technique (KM) = 10, so that the technique of Modification Kessler (KM) is more effective than Samu Modification

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technique (SM). Statistical tests to prove the significance of the comparison of this both technique is þ <α (0.00 <0.05). Which means that H1 is accepted that there are significant comparisons on the level of effectiveness of tendon suture technique between Samu Modification (SM) with Kessler Modification (KM) Besides suturing technique, a lot of things that affect the success of tendon grafting surgery, however there are three factors that play an important role, namely: Strength of tendon sutures, postoperative mobilization, good nutrition tendon (Surya, 2004). Comparative effectiveness on the research is considered of great small changes in the diameter of the tendon, before and after connected with these two techniques. The Technique of Kessler Modification (KM) is more effective than the technique of Samu Modification (SM), this is due to the changes in diameter that are formed on the Kessler Modification technique (KM) is minimal, if compared with the technique of Samu modification, because in the technique of Kessler Modification (KM) formed a minimal gap at the connection of the tendon, so it does not allow growth of new tissue around the tendon that will form adhesions. The effectiveness of different suture is caused by the Kessler technique Modification (KM), the formation of adhesions or adhesions are less or minimal cause granulation tissue and connective tissue that is a little more so the possibility of adhesion can be eliminated. Granulation tissue and connective tissue has a contribution in terms of adhesion formation, which in the end inhibits movement while early mobilization. Almost completely, the healing tendon that has been sutured for the cellular response of the essence, because the penetration or capillary pressure on the tendon. This is also going to cause adhesion, or adhesions that prevention efforts are needed, in an effort to tendon healing process, so that the results of the tendon connection can

function properly. Gliding or movement of the tendon can be restrained because adhesion, caused by the pull of the tendon in the first 3 weeks of healing, inflammatory reaction caused by infection or sutures that are not sterile and circulatory disorders from the tendon base. The effectiveness of different suture techniques is caused by Samu modification techniques (SM) is more atraumatic that causes granulation tissue and connective tissue is fewer so the possibility of adhesion can be eliminated. Granulation tissue and connective tissue has a contribution in terms of adhesion formation, which in the end inhibits movement during early mobilization. In addition, the technique of Samu Modification (SM) has a knot on both sides of the tendon that prevents suture become loose or even release, thus minimizing the gap formation that is formed. Kessler Modification Techniques (KM) which criss-cross has a tendency to disturb the vascularization of intratendon. Conclusion 1. The formation of Tendon connection gap with technique of Samu Modification (SM) By using the test load continuously and progressively, obtained the data gaps that formed, most of the load to 600 grams, because Samu modification techniques (SM) are not too many punctures / Suturing. 2. The formation of Tendon connection gap with technique of Kessler Modification (SM) By using the test load continuously and progressively, obtained the data gaps that formed, most of the load to 600 grams, because Kessler modification techniques (SM) are not too many punctures / Suturing. 3. The strength of tendon suture with technique of Samu Modification (SM) Strength of Samu Modification techniques mostly 1.1 Kgf, and includes in category of quite strong, because there are too many punctures / suturing.

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greater that in the Kessler Modification technique.

4. The strength of tendon suture with technique of Kessler Modification (KM) Strength of Samu Modification techniques mostly 1.1 Kgf, and includes in category of quite strong, because there are too many punctures / suturing. 5. Diameter of Tendon Pre-Post technique of Samu Modification (SM) Difference in tendon diameter prepost Samu Modification (SM) mostly of 0.2 cm, because too many punctures / suturing. 6. Efektiveness of the suture technique of Samu Modifikasi (SM) Technique of Samu Modification (SM) mostly include in category of quite active because change in diameter which is little bigger 7. Diameter OF Tendon Pre - Post technique of Kessler Modification (KM) Difference in tendon diameter prepost Kessler Modification (KM) mostly of 0.1 cm, because not too many punctures / suturing. 8. Effectiveness of Kessler Modification (KM) suture technique Kessler Modification Techniques (KM) mostly categorized as effective, because of the minimal changes in tendon diameter. 9. Comparison of Tendon Suture strength between Samu Modification technique (SM) and Kessler Modification technique (KM) The suture of Samu modification technique (SM) is stronger than the Kessler Modification technique (KM), because in the technique of Kessler Modification (KM) there are a lot of punctures or suture so that it facilitate the occurence of re-rupture. 10. Comparison of Tendon Suture strength between Samu Modification technique (SM) and Kessler Modification technique (KM) The suture of Kessler modification technique (KM) is more effective than the Samu Modification technique (SM), because the adding of tendon diameter in the technique of Samu Modification is

Suggestion For Institution Based on the research result, this study suggested The technique of Samu Modification (SM) can be used as an alternative to surgery, especially orthopedic surgery. For nursing profession Considering the results of research on the strength of suture technique Samu Modification (SM), which includes in the category of strong and quite effective, it is recommended for nurses or other surgeons to use these techniques in surgery, especially orthopedic surgery.. For Researcher The researcher hope this research can be improved, such as the use of test animals, the structure of the tendon is more like a human, such as monkeys and so on.

REFERENCES

Agus. ( 2010). Macam – macam Ayam, http://ahmadhambali86.blogspot.co m/ . Diakses tanggal 27 Oktober 2012 jam 12.30 WIB. Arikunto. (2006). ProsedurPenelitian Suatu Pendekatan Praktek, Jakarta: Rineka Cipta. Erkadius. (2004). Ilmu Bedah, Padang : Universitas Andalas. Hambali. (2010). Pemilihan benang jahit bedah untuk luka operasi, http://easthomas.blogspot.com/201 0/11/pemilihan-benang-jahit-bedahuntuk-luka.html#ixzz2I6sCxLVp . Diakses tanggal 27 Desember 2012 jam 12.30 WIB. Hidayat. (2007). Statistik untuk Penelitian Kesehatan dengan Aplikasi

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Program R dan SPSS, Yogyakarta : Pustaka Rihana.

Surya. (2004). Ilmu Bedah Kedokteran, Semarang : Undip.

H. Carleston. (2000). Trauma Tendon, http://wwwtahukahandaarok.blogspot.com/2012/02/traumatendon-tangan.html . Diakses tanggal 3 November 2012 jam 12.30 WIB. Notoatmodjo. (2002). Metodologi Penelitian Kesehatan, Jakarta: Rineka Cipta. Notoatmodjo. (2009). Metodologi Penelitian Kesehatan, Jakarta: Rineka Cipta. Nursalam. (2003). Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan, Jakarta: Salemba Medika. Nursalam. (2008). Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan, Jakarta: Salemba Medika. Rizal. (2010). Ilmu Bedah Kedokteran, Padang : Universitas Andalas. Sabiston. (1995). Perawatan Medikal Bedah, Jakarta: Buku Kedokteran EGC. Setiadi. (2007). Konsep dan Penulisan Riset Keperawatan, Yogyakarta: Graha Ilmu. Sodera dan Saleh. (2000). Kapita Selekta Kedokteran, Edisi III, Jilid I, Jakarta : Media Aesculapeus. Sudigdo,(1995). Statistika untuk Penelitian, Bandung : Alfabeta Sugiyono. (2010). Statistika untuk Penelitian, Bandung : Alfabeta

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LITERATURE REVIEW: ANALYSIS OF RISK FACTORS FOR POST PARTUM DEPRESSION Reni Nurhidayah STIKes BHAKTI MULIA PARE-KEDIRI Email: [email protected] Abstract The transition to a new parent, lead to stress of new role especially felt by the mother. A mother passing the psychological adaptation period from taking in to letting go, a variety of factors that occurred during the adaptation process can be confounding factor that finally stimulated maladaptive response is commonly called postpartum depression. Postpartum depression has a high prevalence in community. Study conducted on 90 mothers in the postpartum hospital X in Medan 43.3% of respondents experiencing postpartum depression. The high prevalence of postpartum depression is influenced by many factors. Demographic factors such as age, marital status, parity, education level and economic status take a role as one of stressor that contribute to postpartum depression. In addition, psychosocial factors such as family support also be a determining factor to stimulating postpartum depression. The aims of this article is to explore the factors that take a role in increased incidence of postpartum depression. Analyses were performed with a literature review to see how much these factors contribute to postpartum depression. Results from the literature review shows that maternal age, parity, socioeconomic status and educational level of the mother only has a less significant contribution to post-partum depression. Whereas social or family support factors and prenatal anxiety or psychological problems during pregnancy has a major contribution to the emergence of post-partum depression. Keyword: Factors, depression, post-partum

infant morbidity due to disturbances in the relationship between mother and baby. Various problems in the transition period and the impact of postpartum depression made into one of the serious psychological problems faced by new parents, especially mothers (Epifanio, Genna, De Luca, Roccella, and La Grutta, 2015). Postpartum depression has a high prevalence in the community. Results of research conducted Epifianio et al (2015) showed 75 pairs new parentsin Parlemo and Trapani Italy, 20.8% of mothers experience postpartum depression, while 5.7% from a father who experience postpartum depression within the first month of birth. High rates of postpartum depression in mothers is also supported by research done on the first day postpartum at the Chaim Sheba Medical Center, Israel,

BACKGROUND The transition period being a parent is a complex psychological process of development. Birth causes changes in the personal and the changes in family patterns. Changes in lifestyle, sleep patterns, recreation, patterns of relationships in the family and identity become characteristic of the transition period. Both parents must be able to adjust both in terms of identity, family changes and the ability to care for children. Inability adaptation during this period gave new problem called postpartum depression. Postpartum depression cause various impact. Mother's inability to care her own baby cause bonding problems of mother and baby. Problems in the process of breastfeeding is unavoidable impact of postpartum depression. Postpartum depression will improve maternal and

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showed 40.4% of 89 mothers experience postpartum depression (Shlomi Polachek, Huller Harari, Baum, & R, 2014). While in Indonesia, a study conducted on 90 mothers in the postpartum hospital X Medan 43.3% of respondents experiencing postpartum depression (Yusdiana, 2011). Some results of these studies showed high rates of postpartum depression in the community. The high prevalence of postpartum depression is influenced by many factors. Demographic factors such as age, marital status, parity, education level and economic status take a role as one of stressor that contribute to postpartum depression. In addition, psychosocial factors such as family support also be a determining factor for the emergence of postpartum depression. Perinatal depression or anxiety is also regarded as one of the important predisposing factor for the emergence of postpartum depression. Various factors contribute to each other increase the incidence of postpartum depression (Shlomi Polachek et al., 2014).

in low levels have increased reactivity manifestations include emotional tension, focus decreases, crying and upset and always afraid to do something. Manifestations of postpartum depression in a fairly heavy level include persistent sad, low self esteem, strained, decreased appetite, difficulty sleeping, feeling lonely, emotional instability, confusion, neglect of children and even the idea of suicide (Epifanio et al., 2015). Postpartum depression requiring fast and precise handling, as it not only affects the health of the mother but also the baby's health. Further effects of postpartum depression is the increased morbidity for mother and baby. Research conducted by Paul et al (2012) showed maternal morbidity is increased in women with postpartum depression. But the most widely morbidity experienced by their babies. The disruption of breastfeeding in mothers with postpartum depression causes the baby had serious diseases such as pathological Hiperbilirubin. Postpartum depression will lower oxytocin levels that would reduce breastfeeding. Thus postpartum depression will affect the health of the mother and baby. Etiology of postpartum depression has not been identified until now, but the research on risk factors has improved a lot. Growing epidemiological studies show that postpartum depression occurs when there are specific risk factors that become a major stressor. But further study showed that postpartum depression occurs when there are several risk factors that accumulate into a stressor. The risk factors include demographic factors, psychosocial and perinatal history of depression. Demographic factors including age, parity, economic status, marital status, local traditions. Support families in particular husband's support also takes the role of psychosocial factors in increasing the incidence of postpartum anxiety or depression. History of stress or anxiety during pregnancy either at the beginning or end of the trimester also increases the risk of the incidence of

AIM The aims of this article to explore the factors that take a role in the increased incidence of postpartum depression. Analyses were performed with a literature review to see how much these factors contribute to stimulated postpartum depression. LITERATURE Postpartum depression is a continuation of postpartum anxiety where mood becomes unstable that lasted 10 days until 4 weeks postpartum. Postpartum depression is a psychological problem that is quite a lot going in the community, but less recognized by public. Postpartum depression makes the new mother has not been able to take a role in caring for children after more than 10 days postpartum (Basri, Zulkifli, and Abdullah, 2014). Postpartum depression

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postpartum psychological disorders. Various predisposing factors are considered to contribute significantly to the onset of anxiety or depression postpartum (Epifanio et al., 2015). One demographic factors affecting postpartum depression is age. Age who are at risk of experiencing postpartum depression is a young age (<20 years) and elderly (> 35 years). This is because, at a young age lack of experience and mood disorders are still common difficult adaptation to the new role that trigger the onset of parenting stress. While old age is a risk of gestational age contributed to stimulated perinatal anxiety. Pregnant women with older age are more focused on the risks they face during pregnancy and childbirth. This is exactly what contributes to cause anxiety or depression prenatal (Wahyuni, Murwati, & Supiati, 2014). The second demographic factors that increase the risk of postpartum depression is parity. Primiparous believed to have suffered postpartum depression tendency level of the multiparous. This is attributed to the lack of experience primiparity in adapting to a new role as a parent. The transition period to become parents will bring confusion for primiparous so can cause stress of parenting. Parenting stress would be a specific stressor thus increasing the risk of the emergence of postpartum depression (Wahyuni et al, 2014). The third demographic factors contribute to postpartum depression is the mother's education. Low education is rated as one of the risk factors of postpartum depression. This is associated with a lack of knowledge and limitations of the use of information that would result in low postpartum maternal skills in adapting to her new role. Limitations that will have an impact on the increased risk of postpartum depression (Wijayanti, Wijayanti, & Nuryanti, 2013). The next demographic factor is family income. Low family income seen

as one reason for the emergence of postpartum depression. Lack of family financial capabilities would make the mother more anxious in thinking of ways to fulfill the needs of the newborn. Anxiety lead the mother into a postpartum depression if she can‟t handled well (Basri et al, 2014). In addition to demographic factors, psychosocial factors also contribute significantly to the emergence of postpartum depression. The main psychosocial factors that lead to the emergence of depression is family support. Families support have a major impact for the mother postpartum because the family is the primary support system mother in adapting to her new role. If the family support inadequate, then the problem will lead postpartum depression occurs (Urbayatun, 2010). The last factor considered to contribute to the emergence of postpartum depression is a history of prenatal anxiety or depression. Prenatal anxiety or depression is stressfull life event for postpartum mothers. The prenatal anxiety or depression will accumulate and make postpartum mothers become more vulnerable and sensitive to adaptation the roles changes (Shlomi et al, 2014). DISCUSSION The first is the age demographic factors (age <20 years and > 35 years) increase the risk of postpartum mothers experience depression. The prevalence of postpartum depression occurs in young mothers. Age is considered to contribute to increase the risk of postpartum anxiety or depression because at a young age the greater possibility of mood disorders. In addition, postpartum mothers at a young age have the skills that are lacking in managing the emotions associated with the changes that occur postpartum. The lack of skills is considered to contribute to the onset of postpartum depression (Wijayanti, Wijayanti, & Nuryanti, 2013). Australian study also says that

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too young mothers, the risk of experiencing prenatal and postpartum depression will also increase (Yelland, Sutherland, & Brown, 2010). Research conducted in Blora showed that the incidence of postpartum depression experienced by the largest age group at risk, 83.33% of mothers with young age (under 20 years) experience postpartum depression, followed by 41.67% of mothers with older age (over 35 years) experiencing postpartum depression (Wijayanti et al., 2013). Meanwhile different results presented by Wahyuni et al (2014) showed statistical result pvalue = 0.470 (α = 0.05), which means age at childbirth not contribute substantially in postpartum depression. Results were in accordance with the concept of the developmental tasks of young adulthood, the time when the case of adjustment to the changes of new life and new hope. Young adults have the ability to take responsibility, the role and make a new commitment (Wahyuni et al, 2014). From literature above, the results is still a debate until now how much the mother's age affects postpartum depression. Parity is second factor that assessed as having a role in postpartum psychological adaptation. Primiparous judged to be the vulnerable groups who experience postpartum depression, because of the transition to the role of new parents is a stressful condition. This transition can disrupt the pattern of family routine, changing priorities and increased responsibility. Changes in fulfill the needs of newborns with lack of experience resulted in the emergence of parenting stress would trigger postpartum depression (Epifanio et al., 2015). According to research Wijayanti (2013) postpartum depression in primiparous mothers 17.4% higher than multiparous mothers. This is confirmed by various studies conducted that the primiparous more vulnerable to postpartum depression. However, research Basri (2014) showed different results that multiparas also has the same risk of postpartum depression with

primiparous. This is related to the increase in child then also increased economic burdens and responsibilities, triggering the onset of anxiety or depression postpartum (Wahyuni, Murwati, & Supiati, 2014). Economic status into third demographic factors that predispose to postpartum depression. Economic status increases the risk of postpartum depression according to Yelland et al (2010) which states that a low income family became one of the predisposing factors of postpartum depression. Low income families will complicate the financial willingness with increasing child. So that both long-term expenses and short-term will be amended. Research conducted Basri (2014) explains that 52.8% of respondents who experienced postpartum depression comes from the weak economic group. Maternal education factors stimulated postpartum depression is still being debated. Low education is believed to be one factor in the emergence of postpartum depression. This is because mothers with low education, have lacking of knowledge and skills in adapting to the roles changes (Yelland et al., 2010). Wijayanti (2013), shows that respondents with low levels of education more vulnerable to postpartum depression. However, the results of different studies presented by Wahyu (2014) and Basri (2014) which states that higher education will increase the risk of postpartum depression. From the results, the data that 57.7% of respondents who experienced depression originating from the higher education level. The same thing was also mentioned by Shlomi (2014) that the level of higher education will lead to high psychological problems postpartum. This is because the high self ideal and too much exposure to the information, so that it actually makes postpartum mothers confused when carrying out the role as the gap between theory and reality.

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In addition to the above demographic factors, family support that take a role to stimulated postpartum depression has been studied. Family support plays an important role in the prevention of postpartum depression, because family support is a support system for postpartum mothers. Good family support will make postpartum mothers feel appreciated, cared so this will reduce feelings of depression and helplessness that arise after birth. Social support can include emotional support, financial, information and awards. With the support system that effective then it will be easier postpartum mothers in developing adaptive coping to adapted the role changes (Ayu & Lailatushifah, 2010). Research conducted Ayu (2010) shows that there are very specific negative relationship between husband support to occurrence of postpartum depression. This means, the lower the husband support induced higher rate of postpartum depression. Similar research in Jogjakarta, shows that social support (family) has a contribution of 29.7% in causing postpartum depression in mothers primipara (Urbayatun, 2010). The last factor that trigger postpartum depression is a prenatal psychological problem. Events that occur during pregnancy and childbirth also become one of the major risk factors for postpartum depression. The main risk factor is a history of prenatal anxiety or fear during pregnancy becomes a major risk factor for postpartum depression. Research conducted by Shlomi et al (2014), shows that the existence of a consistent relationship between anxiety during pregnancy can stimulated postpartum depression. Anxiety include fear of childbirth, fear of life the healthy baby and fear during childbirth, distrust in the face of labor and lack of confidence in caring for the baby later. Some of it will accumulate and cause anxiety prepartum. Prepartum unresolved anxiety will be stressfull life events that will accumulate and will weaken the ability of coping postpartum mothers

(Paul, Downs, Schaefer, Beiler, & Weisman, 2012). Various risk factors contribute to the onset of postpartum psychological problems from maternal age at delivery, maternal education level, economic status, parity history, family support and a history of prenatal anxiety or depression. Regardless of the pro and contra of whether or not large these factors in causing anxiety and postpartum depression, proper prevention is important to prevent the effects of anxiety and postpartum depression on maternal and infant health. Conclusion Anxiety or depression postpartum become one of the most common postpartum problems. Various risk factors can lead to the emergence of this postpartum psychosocial adaptation problems. Family support and a history of prenatal anxiety or depression is believed to bring a significant contribution in the incidence of postpartum depression or anxiety. While maternal age, parity, education and economic status have a role in the emergence of postpartum psychological adaptation problems although there are still debated of some of the research results. Improper handling in overcoming postpartum depression is believed to improve maternal and fetal morbidity, such as the interruption of breastfeeding. REFERENCES Ayu, F. R, & Lailatushifah, S. N. F. (2010). Dukungan suami dan depresi pasca melahirkan. Jurnal FPSI Mercubuana, 2. Basri, A. H, Zulkifli, A, & Abdullah, M. T. (2014). Efektivitas psikoedukasi terhadap depresi postpartum di RSIA Sitti Fatimah dan RSIA pertiwi Makasar Junrnal Kesehatan Masyarakat Universitas Hasanudin, 7. Epifanio, M. S., Genna, V., De Luca, C., Roccella, M., & La Grutta, S.

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(2015). Paternal and Maternal Transition to Parenthood: The Risk of Postpartum Depression and Parenting Stress. Pediatr Rep, 7(2), 5872. doi: 10.4081/pr.2015.5872 Paul, I. M, Downs, D. S, Schaefer, E. W, Beiler, J. S, & Weisman, C. S. (2012). Postpartum anxiety and maternal-infant health outcome. American Academy of Pediatric, 2147, 1218-1224. doi: 10.1542/peds.2012-2147 Shlomi Polachek, I., Huller Harari, L., Baum, M., & R, D. Strous. (2014). Postpartum anxiety in a cohort of women from the general population: risk factors and association with depression during last week of pregnancy, postpartum depression and postpartum PTSD. Isr J Psychiatry Relat Sci, 51(2), 128134. Urbayatun, S. (2010). Dukungan sosial dan kecenderungan depresi postpartum pada ibu primipara di daerah gempa Bantul. Humanitas, VII, 114-122. Wahyuni, S, Murwati, & Supiati. (2014). Faktor internal dan eksternal yang mempengaruhi depresi postpartum. Jurnal Terpadu Ilmu Kesehatan, 3(2), 106-214. Wijayanti, K, Wijayanti, F. A, & Nuryanti, E. (2013). Gambaran faktor-faktor resiko postpartum blues di wilayah kerja puskesmas Blora. Jurnal Kebidanan, 2(5). Yelland, J, Sutherland, G, & Brown, S. J. (2010). Postpartum anxiety, depression and social health: finding from a population-based survey of Australian women. BMC Public Health, 10, 1-11. Yusdiana, D. (2011). Kejadian stres pasca trauma pada ibu post partum dengan secsio sesaria emergenci, partus pervaginam dengan vakum dan partus

pervaginam normal. Jurnal Keperawatan Indonesia, 14.

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INFLUENCE THE GRANTING OF WATER DECOCTION OF BETEL LEAF AGAINST THE WHITENESS ON YOUNG WOMEN (Study at Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare Kediri) Ulfatin Nafiah * Silfia Sekar Arum * Martha Mai Nggiri STIKES BHAKTI MULIA PARE - KEDIRI Email : [email protected] Abstract Whiteness was all fluid dispensing tool genetalia was not blood. If no alert can lead to pathological so that needs to be prevented. One way of using the betel leaves. The leaf was very effective as an antiseptic, it can eradicate the fungus candida albicans and reduces the secretion of vaginal fluid. The goal of research to know how the granting of water decoction of betel leaves against a white teenager daughter in Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare Kediri. Pre design research experiments model one group pretest - posttest design. Entire population of young women with vaginal discharge at Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare Kediri a number of 50 people with a sample of 35 respondents taken with purposive sampling technique, analyzed by Wilcoxon test. Result. Result of the research there is influence the granting of water decoction of betel leaf against the whiteness in young women (p = 0,000 < 0,05 then H0 denied). This is due to water decoction of betel leaf contains antiseptic that can kill microbes in the form of bacteria or fungi. It was concluded that the betel leaf is effective in curing and preventing pathological whiteness. It is expected that the respondents are already experiencing vaginal discharge using herbal betel as an alternative treatment. Keywords : vaginal discharge, betel leaf, teens

experience vaginal discharge, either physiological or pathological (Saputri, 2012). The number of women in the world who have experienced vaginal discharge about 75%, while in Indonesia for more than 70% experienced disease whiteness (Triyani, 2013). According to the Demographic Survey (MOH, 2010) cases as many as 200 cases of vaginal discharge, but only about 95 cases are experiencing vaginal discharge with itching. Whiteness problem is often not noticed by women who suffer, but if not addressed can lead to serious problems (Cahyani, 2012). Research in East Java showed 75% of young women suffer from vaginal discharge at least once in their lifetime,

INTRODUCTION Whiteness is all discharge genital apparatus which is not blood. Whiteness not a disease, but a symptom manifestation of nearly all illnesses content (Suparyanto, 2011). These conditions exist that are physiological and some pathological nature. Under normal circumstances, the vagina will produce a colorless liquid (transparent), odorless, and not too much, without a burning sensation or pain. While the pathological vaginal discharge is abnormal discharge due to vaginal infection, excessive mucus in the form of white or yellowish with odor, itching and pain during sexual intercourse. Women of childbearing age are a high risk group in 752

45% may experience vaginal discharge twice or more (Ubay, 2012). Based on research Cahyani (2014) in Pondok Pesantren Lirboyo Kediri of 10 female students (girls), 6 female students (60%) experienced a vaginal discharge with details two female students (33.3%) had pathological albus flour and 4 female students (66.7% ) non-pathological. Based on preliminary studies at Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare Kediri obtained from 20 young women who have experienced pathological vaginal discharge as much as 8 girls (40%) while the remaining 12 girls (60%) did not have pathological vaginal discharge. Whiteness pathological often caused by an infection, one of which bacterial vaginosis. Epidemiological studies indicate that bacterial vaginosis is the most common cause with the incidence rates (40-50% of cases of vulvovaginal candidiasis, 80-90% of cases are caused by candida albicans, 5-20% of cases are caused by trichomoniasis trichomoniasis vaginalis, (Haryadi, 2011). The main cause whiteness pathological is infectious (fungi, bacteria, parasites and viruses). The indirect causes are the lack of maintenance of the appliance genitalia such as the lack of washing behavior vagina properly, using the rinse excessively, use underwear that does not absorb sweat, rarely change underwear, not frequently changing pads. Teenagers are one of the groups at risk of whiteness pathological as it pertains to the cleanliness of the vaginal area that is bad (Suparyanto, 2011). This arises because of the lack of knowledge about vaginal discharge so that the behavior of personal hygiene is also bad. The impact of whiteness if not addressed is that it can cause more serious health problems (MOH, 2010). Health problems include

infection Chlamydia, Herpes simplex virus infection, fungal infection Candida sp, HPV viral infections, bacterial infections Neisserea gonorrhoeae (Suparyanto, 2011) Given the problems it is in order to reduce the incidence of whiteness required precise handling. Many ways to do that is in addition to medical treatment, it may also be herbal. Nowadays, the development of treatment has led back to nature (Back to nature) because traditional medicine has been proven to be safe and does not cause side effects such as chemical drugs. In addition to herbal basic materials can generally be obtained easily, cheaply and efficiently. One of the herbs that can be used to prevent pathological whiteness is of the betel plant species. Betel leaf extract (piper battle L) is very effective as an antiseptic, can eradicate the fungus candida albicans and can reduce the secretion of fluid in the vagina. Based Lestari (2010) green betel leaves boiled water can be used to clean the female pubic region. This method is able to care for and avoid vaginal discharge due to phenol (karvakrol) and fenilpropan (eugenol and kavikol) in a green betel leaf essential oil that serves as an antiseptic (bactericide and fungicide very strong). You do this by taking 10 betel leaves and then boiled with two liters of water for five minutes, wait until the warm boiled water, use boiled water to wash the area of femininity regularly three times a week (Revina, 2014). Based on the above, researchers are encouraged to conduct research with the title: "The Effect of Water Betel leaf decoction against Whiteness at Young Women in Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare 2015".

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Based on Table 4.1 are known almost all respondents whiteness before granting boiled water betel leaf is categorized pathologically as many as 28 respondents (80%).

METHODS The research design used in this research is the design of pre experiment that is a design study where there is a deliberate treatment by the investigator. Pre experimental models selected in this study are: one group pretest-posttest design. The population in this study were all young women with vaginal discharge in Pesantren Putri Nurul Huda Singgahan Pelem Pare, sample as many as 35 respondents with purposive sampling technique sampling

Whiteness After Giving Water Betel leaf decoction Table 4.2 Distribution Frequency Discharge After Giving Water Betel leaf decoction at Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare Kediri

Data collection instruments The instrument used was questionnaire. Questionnaire used to ask about the signs and symptoms of vaginal discharge before and after administration of betel leaves boiled water. Analytical done In bivariate analysis with statistical test of Wilcoxon. In the calculation process aided by the help of Statistics Programme for Social Science (SPSS) version 17.

f

%

1

Patologis

1

2,9

2

Fisiologis

27

77,1

3

Normal

7

20,0

35

100

Total

Based on table 4.2 in mind almost all respondents whiteness after giving betel leaves boiled water belongs to the category of physiological as many as 27 respondents (77.1%). Effect of Water Betel leaf decoction against Whiteness In Young Women Cross Tabulation Table 4.3 Effect of Water Betel leaf decoction against Whiteness at Young Women in Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare

RESULT Whiteness Before Giving Water Betel leaf decoction Table 4.1 Distribution Frequency Discharge Before Giving Water Betel leaf decoction at Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare Kediri

Whiteness (Post) No.

Whiteness (Pre)

No.

Whiteness (Before Giving Water Betel leaf decoction)

f

%

1

Patologis

28

2

Fisiologis

3

Normal

Total

No.

Whiteness (After Giving Water Betel leaf decoction)

f %

f

1 Patologis

1 3,6

80,0

2 Fisiologis

7

20,0

3 Normal

0

0,0

35

100

Total

754

Total

Patologis Fisiologis Normal %

21 75,0

f % 6 f21,4

% 28

100

0 0,0

6

85,7

1 14,3

7

100

0 0,0

0

0,0

0 0,0

0

0

1 2,9

27 77,1

7 20,0

35

100

Based on the table 4.3 in mind the majority of respondents from pathological conditions turn into physiological as many as 21 respondents (75%) and a small portion turned to normal as many as six respondents (21.4%), while almost entirely of physiological conditions remain physiologically as many as 6 respondents (85.7%) and only a small proportion that drops to normal as many as 1 of the respondents (14.3%). In order to prove the significance of the relationship between the two variables tested by Wilcoxon Signed Ranks Test.

Whiteness is any discharge from the vagina besides blood, may be secretions, transudation, or exudates from organs or lesions in the genital tract. Normal vaginal fluid excess, so just include excessive secretion and transudation, excluding exudate. The fluid source can be derived from the secretions of the vulva, vaginal fluid, cervical secretions, secretions of the uterus, fallopian tubes or secretion, which is affected in ovarian function (Mansjoer, 2011). Mamafia (2009) cited by Ardiani (2013) reveals some trigger discharge is less personal hygiene, use of cleaners that are not healthy, bacteria, fungi, parasites and viruses. If before granting boiled water betel leaves almost all respondents whiteness including pathological category, this can be caused by various factors. One is due to lack of experience in dealing with this problem. Lack of experience could have been caused by the age of the respondents were relatively young. Based on the survey results revealed almost half of the respondents including the mid teens. It can be interpreted that at this time the respondent has not been able to recognize the signs or symptoms of pathological vaginal discharge. These conditions in turn continues so until the pathological condition. Another factor may be caused by lack of education of the respondents. Based on the survey results revealed most respondents educated courses. This indicates that the respondent is not as people with higher education or special education in the health sector so that information and knowledge about whiteness is also lacking. As a result, the practice of personal hygiene genital apparatus could have unfavorable

Table 4.4 Analysis Wilcoxon Signed Ranks Test at Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare Kediri No. 1. 2. 3.

Variabel Betel leafWhitenenss n = 35 α = 0,05

Z 4,919

P 0,000

Based on the table above 4.4 is known to have the effect of betel leaves boiled water to discharge in Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare Kediri (p = 0.000 < 0.05 then Ho is rejected, meaning that no effect of boiled water betel leaves to whiteness young woman at Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare Kediri DISCUSSION Whiteness Before Giving Water Betel leaf decoction Based on Table 4.1 are known almost all respondents whiteness before granting boiled water betel leaf is categorized pathologically as many as 28 respondents (80%).

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continues to onset of pathological vaginal discharge.

in women who menngunakan betel leaves boiled water. With state of the pubic clean of microbes, bacteria and fungi can also reduce the vaginal secretions caused as a sign of microbial bacteria and fungi.

Whiteness After Giving Water Betel leaf decoction Based on table 4.2 in mind almost all respondents whiteness after giving betel leaves boiled water belongs to the category of physiological as many as 27 respondents (77.1%). In order to reduce the incidence of whiteness required precise handling. Many ways to do that is in addition to medical treatment, it may also be herbal. Nowadays, the development of treatment has led back to nature (Back to nature) because traditional medicine has been proven to be safe and does not cause side effects such as chemical drugs. In addition to herbal basic materials can generally be obtained easily, cheaply and efficiently. One of the herbs that can be used to prevent pathological whiteness is of the betel plant species. Betel leaf extract (piper battle L) is very effective as an antiseptic, can eradicate the fungus candida albicans and can reduce the secretion of fluid in the vagina. Betel leaf contains phenols (karvakrol) and fenilpropan (eugenol and kavikol) that serves as an antiseptic (bactericide and fungicide very strong) (Lestari, 2010). If almost all respondents whiteness after giving betel leaves boiled water including physiological category then this is due to the role of betel leaf in cleaning the woman's pubic area. Boiled water betel leaf contains phenols (karvakrol) and fenilpropan (eugenol and kavikol) that serves as an antiseptic. The use of betel leaves boiled water to wash the genital area of women will kill microbes, bacteria and fungi. This can reduce the risk of contracting sexually transmitted diseases

Effect of Water Betel leaf decoction against Whiteness In Young Women According to the table 4.4 is known to have the effect of betel leaves boiled water to discharge in adolescent girls in Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare (p = 0.000 < 0.05 then Ho is rejected, meaning that no effect of boiled water betel leaves to whiteness in young woman at Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare). One of the herbs that can be used to prevent pathological whiteness is of the betel plant species. Betel or Piper betle L., is a medicinal plant that grows in Indonesia and is known by the name of betel (Sumiati & Elya, 2012). Betel leaf extract (piper battle L) is very effective as an antiseptic, can eradicate the fungus candida albicans and can reduce the secretion of fluid in the vagina. Based Lestari (2010) green betel leaves boiled water can be used to clean the female pubic region. This method is able to care for and avoid vaginal discharge due to phenol (karvakrol) and fenilpropan (eugenol and kavikol) in a green betel leaf essential oil that serves as an antiseptic (bactericide and fungicide very strong). If the results showed no effect of betel leaves boiled water to discharge in adolescent girls, the results of this study prove the effectiveness of betel leaf in curing and preventing the onset of pathological vaginal discharge. When women experience a pathological vaginal discharge then it is possible that in the reproductive organs have been infected by 756

microbes, bacteria, fungi and viruses. Evident from the results seen most of the respondents of pathological conditions turn into physiological as much as 21 respondents (75%) and even some small changes to normal as many as six respondents (21.4%) even from physiological no small part to normal. According to the researchers use boiled water betel leaves can reduce vaginal discharge. Results of this study are quite encouraging because if the calculated value of its effectiveness in the healing of pathological to normal by 21.4%, and the effectiveness of the healing of normal physiological conditions become 14.3%.

providing advice to patients or clients with complaints of vaginal discharge. The trick is to wash the feminine area 3 times in one week with a dose of 10 betel leaves boiled with 2 liters of water for 5 minutes. Further research should also conduct a similar study with a sample of this study with more or with a variety of other design models. Should educational institutions through reviewing or re-examination. If the results are relevant to this study, it deserves to be published. Moreover worth also compiled into a handbook or technical manual healing of pathological vaginal discharge with betel leaf decoction and marketed so that it can be used as a healing whiteness technical guidelines by the public.

CONCLUSION Almost all respondents whiteness before granting betel leaves boiled water including pathological category. Almost all respondents whiteness after giving betel leaves boiled water including physiological category. There is the influence of betel leaves boiled water to discharge in adolescent girls in Pesantren Putra Putri Nurul Huda Singgahan Pelem Pare (p = 0.000).

REFERENCE Agoes, A. 2010. Tanaman Obat Indonesia. Jakarta : Salemba Medika Ardiani & Triyani. 2013. Hubungan Pemakaian Pembersih Vagina Dengan Kejadian Keputihan Pada Remaja Putri. Bidan Prada : Jurnal Ilmiah Kebidanan, Vol. 4 No. 1 Edisi Juni 2013

SUGGESTION Should respondents who had experienced vaginal discharge using betel as an alternative herbal treatment. Technically way is used for washing the feminine area 3 times in one week with a dose of 10 betel leaves boiled with 2 liters of water for 5 minutes. It is hoped that the research fields make the results of this study as one of the alternative suggestions that can be given to students or young women in overcoming pathological vaginal discharge. It is hoped that midwives make the results of this study as a reference in

Arikunto, Suharsini. 2012. Prosedur Penelitian Suatu Pendekatan Praktik. Jakarta: Rineka Cipta . Blankast, Ariev. 2008. Mengatasi Keputihan dengan Herbal. http://gealgeol.com Barns. 2013. Manfaat dan Khasiat Daun Sirih Hijau untuk Kesehatan. http://obatpenyakitkankerpayudara. net Cahyani. 2012. Asuhan Kebidanan Gangguan Sistem Reproduksi Ny. D P1A0 Umur 27 Tahun dengan 757

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Manuaba, 2011. Ilmu Kebidanan, Penyakit Kandungan dan Keluarga berencana untuk Pendidikan Bidan. EGC. Jakarta. Mansjoer. 2011. Kapita Selekta Kedokteran Jilid I. Jakarta. Media Aculapius. Notoatmodjo.2010. Pendidikan dan Perilaku Kesehatan. Jakarta. Rineka Cipta.

2008. Flour Albus Keputihan. http://enitauho.com

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Farida. 2010. Efikasi Sabun Ekstrak Sirih Merah Dalam Mengurangi Gejala Keputihan Fisiologis. Majalah Kedoteran Indonesia

Revina. 2014. Menghilangkan Keputihan Obat Alami. Dengan http://bidanku.com

Herlina. 2012. Personal HygieneKebutuhan Dasar Manusia II. Ciamis : Program Studi Keperawatan Fakultas Ilmu Kesehatan Universitas Galuh

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Hermawan. 2007. Pengaruh Ekstrak Daun Sirih (Piper betle L.) terhadap Pertumbuhan Staphylococcus aureus dan Escherichia coli dengan Metode Difusi Disk. Surabaya : Fakultas Kedokteran Hewan Universitas Airlangga

Sastroasmoro & Ismael. 2010. DasarDasar Metodologi Penelitian Klinis. Jakarta : Sagung Seto Sugiyono. 2013. Metode Penelitian Kuantitatif Kualitatif. Bandung: Alfabeta.

Kusuma, Sri Adi Sumiwi, Ellin Febrina, Ami T. 2009. Pengembangan Sirih Merah (Piper crocatum) Sebagai Herbal Terstandar untuk Mengatasi Keputihan terhadap Trichomonas vaginalis. Bandung : Departemen Pendidikan Nasional Universitas Padjadjaran Fakultas Farmasi

Sumiati dan Elya. 2012. Uji Pendahuluan Efek Kombinasi Antijamur Infus Daun Sirih (Piper Betlel.), Kulit Buah Delima (Punica Granatuml.), Dan Rimpang Kunyit (Curcuma Domesticaval.) Terhadap Jamur

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EFFECT OF EXERCISE ON THE ROAD FAST WEIGHT CHANGES IN ADOLESCENT OBESITY SMK BHAKTI MULIA PARE-KEDIRI Vika Taulina Ismanto* Amri Nasus Talan* STIKES BHAKTI MULIA PARE - KEDIRI Abstract Obesity is a nutritional problem for everyone, including adolescents because in addition to problems in the field of ksehatan also interfere with performance. Factors associated with this excess hádala nutrition and lack of physical activity include brisk walking exercise. The purpose of this study was toanalyze the effect of brisk walking exercise to accelerate weight loss in obese adolescents SMK Bhakti Mulia Pare 2015. Pre-experimental design used the model "one group pretest-posttest design". The population is all obese adolescents in SMK Bhakti Mulya Pare 30 obese adolescents with a sample of 30 respondents taken with total sampling technique. The independent variable is the dependent exercise brisk walking and weight changes were measured with scales. Data were analyzed by 2 independent samples T-test (two independent sample t test). The survey results revealed before exercise brisk walking, low body weight 58 kg and 97 kg with the highest average of 69.23 kg and after exercise brisk walking, low body weight is 56 kg and the highest was 94 kg with an average of 67.07 kg and no way exercise influence quickly to changes in body weight obese adolescents (p value = 0,000 <α, then Ho is rejected and H1 accepted). This is due to beneficial physical exercise to burn fat so you lose weight. It was concluded that the beneficial physical exercise to burn fat in the body. It is recommended that obese people keep doing physical activity with regular exercise. Keywords: Exercise brisk walking, weight changes, Teens

In Indonesia in 2013 recorded prevalence of adult male population obesity as much as 19.7%. The lowest prevalence there are in East Nusa Tenggara (9.8%) and highest in the province of North Sulawesi (34.7%). Sixteen of the province with the prevalence of obesity is above the national prevalence was Aceh, Riau, Central Sulawesi, Bangka Belitung, East Java, Yogyakarta, North Maluku, Indonesia, North Sumatra, the Riau Islands, West Papua, Bali, East Kalimantan, Papua, North Sulawesi and Jakarta (Riskesdas, 2013). According to the research of Dr. DamayantiRusliSjarifDr, SpA (K) of the FKUI/RSCM along with his colleagues in 2012 to do research in 10 cities, namely Malang, Pasuruan, Kediri Regency, Mojokerto, Jombang, Kediri, Indonesia, Surabaya, Tulungagung, Blitar and with

LatarBelakang In adolescence occur rapid growth accompanied by physiological and mental changes. Adolescents generally grow in height and weight (Anwar, 2006). The original uniform growth, suddenly has increased rapidly (Sayogo, 2006). During puberty, there is the addition of more fat in young women with body fat of approximately 22% compared to 15% in men (Sayogo, 2006). While it's ideal body is craving every people including teens (PurwatiRachmawany in 2005). Instead of body fat or obseitas tend to be avoided. Said to be obese or obese (IMT > 25-27 for light and heavy for 27 >) while the normal (IMT 18.5-25), thin lightweight (IMT 17.0-18.5), and (IMT < 17) skinny weight which can be seen based on the time Index of the body (IMT) (Supariasa, 2011). 759

the subject of elementary school students. The results showed a prevalence of obesity in children of 17.75 percent in Malang, Pasuruan, Kediri Regency 7.1 percent 13.2 percent, 25 percent, MojokertoJombang 24.3%, Kediri 2.1 percent, 4 percent, Mojokerto Surabaya 11.4 percent, Tulungagung, Blitar and 11.7 percent 5.3 per cent (Dzakiyah, 2013). Meanwhile, preliminary results of a study of adolescent obesity in SMK Bhakti Mulya Pare Kediri of 35 adolescents found obese teen thirteen (37,1%), the rest there are 22 teens (62,9%) which included no obesity. Among the 10 teenagers who had the interview from a group that says obesity does not have the hobby of sports such as football, swimming, running, walking, badminton and pedaling the bike. As for the groups that obesity has a hobby outside of those activities, such as playing games, too, studying with sibu likes to sleep and tend to be less motion. Cause factor obsesitas occurred because of the inefficient provision between calorie consumption with energy needs, namely the existence of excess calorie consumption too compared to the needs or energy consumption. The excess energy in the body is stored in the form of fat. In normal circumstances, fatty tissue is deposited in a certain place among them in the network and the inside network subcutan curtain intestines (Notoatmodjo, 2010:199). Notoatmodjo (2010) also describes the impact of obesity, the patients tend to suffer from cardiovascular disease, hypertension and diabetes mellitus. Farid (2007) revealed that in order to prevent obese theoretically performed by setting weight and reduce body mass index (IMT). Therapy should be directed to the family, especially if you want to change the pattern of eating. The role of parents in directing the behaviour of a good meal is very healthy and plays a major role. Lifestyle is very important to be altered, watch TV and video games is absolutely must be reduced, walk or exercise

(exercise) shall be conditioned for at least 20-30 minutes per day. Based on the above problems then the teens who have experienced the problem of overweight (obesity) should be sought to the greatest extent possible regulate or limit your intake of nutrients. Activities such as exercise or sports should also be conducted on a regular basis. Diit settings precisely to do with carrying out consultation to experts. Based on the background of the above then the researchers interested in conducting research on "effect of Exercise Way quickly to acceleration of Teen Obesity weight loss in SMK Bhakti Mulya Pare Kediri by 2015". Research Objectives 1. General purpose Analyze the effect of exercise way quickly to acceleration of teen obesity weight loss in SMK Bhakti Mulya Pare Kediri by 2015 2. Special purpose a. Identify teen obesity weight loss prior to exercise brisk walking in SMK Bhakti Mulya Pare Kediri by 2015. b. Identify teenage obesity after weight do brisk walking exercise in SMK Bhakti Mulya Pare Kediri by 2015. c. analyze the effect of exercise way quickly to acceleration of teen obesity weight loss in SMK Bhakti Mulya Pare Kediri by 2015.

Research Methods The research method is a way of gaining the truth of science or problem solving (Notoatmodjo, 2010). Research methods the research include the design, framework, population, sample and sampling techniques, identification of

760

variables, procedures of data collection and data processing The design is the design of the research is compiled in such a way that it can lead researchers to be able to obtain answers to the questions the research (Sastroasmoro& Ismail, 2010). The research design used was the design of the experimental pre model "One Group Pretest – Posttest Design" (Sugiono, 2011). The population in the study are all adolescent obesity in SMK Bhakti Noble Pare Kediri 30 teenage obesity. The samples used in this study in this study are defined as many as 13 respondents. the sample is still influenced by the criteria of inclusion and exclusion. Sampling is the process of selection of the population to be able to represent the population. The sampling technique is the ways that a sampling, in order to obtain a sample that is truly in accordance with the keseluruan subject of research (Nursalam 2008). This research uses the total sampling samplingsampling is by taking the entire subject of research). Research instrument is a device or facility used by researchers in collecting data in order to make his work easier and the result is better, in the sense of more carefully, complete and systematic, and thus more easily processed (Arikunto, 2006). In this study, to measure weight using scales. Data analysis techniques were used to test the weight difference before and after the exercise test using T 2 Free Samples (Two Independent Samples T Test) with α = 0.05. In the process the calculations helped by using Statistics assistance Programe for Social Science (SPSS) version 5.

Age Of Respondent 16 ; 53% Women 14 ; 47%

Men

Diagram 5.1 frequency distribution based on Teen age in SMK Bhakti Pare Noble 2015 Based on diagram 5.1 known to most respondents included early teens (13-16 years) that as many as 16 (53,3%) respondents. 2. Frequency distribution of respondents based on gender

Gender Of Respondent 7 ; 23% Women Men 23 ; 77%

Diagram 3.2 Characteristics of respondents based on Gender in SMK Bhakti Pare Noble 2015 Based on diagram 5.1 known to the majority of the respondents are women-sex as much as the 23 respondents (70.7%).

Special Data 1. Teen Obesity Weight before Exercise brisk walking Table 5.1 Teen Obesity Weight before Exercise brisk walking

RESULTS General Data 1. Frequency distribution of respondents based on age

N Weight Before Exercise

761

30

Std. Minimum Maximum Mean Deviation 58

97

69,23 10,695

brisk walking

DISCUSSION

Of research results are known before the exercise brisk walking, minimum or lowest weight is 58 kg and 97 kg with the highest average weight 69.23 kg with standard deviation of 10.695. 2. Teen Obesity weight loss After Exercise brisk walking Table 5.2 Teen Obesity weight loss After Exercise brisk walking in SMK Bhakti Pare Noble 2015 N Weight Before Exercise brisk walking

30

Std. Minimum Maximum Mean Deviation

56

94

67,07 10,161

From the results of the study known after exercise brisk walking, minimum or lowest weight was 56 kg and the highest is 94 kg with an average of 67.07 kg with standard deviation of 10.161.

3. Analysis and Interpretation of Research Results Table 5.5 Analysis T Test 2 Paired Samples Influence Exercise brisk walk against Teen Obesity weight changes No.

Variable

1.

BB Before-After Exercise Brisk Walking N = 30 α = 0,05

2. 3.

t

p

7,323

0,000

Based on table 5.5 revealed the influence of exercise brisk walk against teen obesity weight changes in SMK Bhakti Mulya Pare Kediri (p value = 0.000 < α, then Ho denied and H1 are accepted). 762

1. Teen Obesity weight loss prior to Exercise Based on table 5.1 known before exercise brisk walking, minimum or lowest weight is 58 kg and 97 kg with the highest average weight 69.23 kg with standard deviation of 10.69. According to the Teen Doctor Ties Indonesia (IDAI), obesity is the State of the body mass index (IMT) teens who were above 95 percentile on the graph grows flower teen appropriate sex. The Center for Disease Control (CDC) US categorize as 'overweight'. The CDC argued that a teenager categorized obesity if experiencing overweight above 95 percentile with greater body fat proportion than other body components. According to CDC obesity when BMI above 95 percentile and overweight among the 85 percentile up to 95 (Farid, 2007). According to the above provisions for obesity among 85 percentile up to 95 is on teens ages 13-16 years old are on standard deviation between 11.1 up to 12.3 (Supariasa, 2009). Obesity occurs due to an inefficient provision of energy needs with calorie consumption of excess calories too compared to the energy consumption. The excess energy in the body is stored in the form of fat. In normal circumstances, a network of fat deposited in a certain place among them in the network and the inside network subcutan curtain intestines (Notoatmodjo, 2010:199). If the results of the study before exercise brisk walking obtained standard deviation of 10.69 then it can be said that the respondent was in fact obesitasnya level is at a category approach to obesity. However in the physical appearance of these adolescents already classified as obese teens. This is due to the current

teenage eating habits tend to consume fatty foods and less consumption of vegetables or fruits. Automatically with less physical exercise can cause the teens tend to store excess energy in the form of body fat. Physically the body body will look great, physical motion tends to be sluggish. Generally teenagers currently less physical activity because of the rare form of sport, and children's games to teens currently different from teenagers. This form of the game at this point tend to smell like computer games and other games. Automatically declining physical activity, on the other hand the intake of nutrients at the moment tend to excess because of economic conditions supported the parents the better. The behavior of living like this is already widespread among adolescents. Though therefore impact global problems in teenagers today are likely to be overweight.

If after having exercise brisk walking average weight with a standard deviation of 10.161 then it shows respondents are at normal weight ranges for teens ages 13-16 years (according to the age of most of the respondents were aged 13-16 years). However, with standard deviation the 10.161 was nearing the minimum threshold of obesity is 11.1 up to 12.3 for ages 13-16 years old.This weight for adolescents currently belongs to quite ideal given the current teen activity generally is less physical and more motion activity seated or work and play in front of the computer. For the students at this time rarely among those working weight helps parents. Generally they have in everyday physical activity learning, playing games in front of the computer, if saturated with dilanjutnya see TV shows and it's just about done. This resulted to the buildup of fat in the body. Through the activities of the street quickly then the fat burning process will occur from within the body. Slowly but surely this will be able to lose weight. The average weight loss of 69.23 down became a 67.07, so there is a decrease of 2 kg within 1 month. Decrease of 2 kg within 1 month can already be said that physical exercise brisk walking has its positive effectiveness for weight loss efforts. So in this case it can be said that the physical exercise fast effective way to lose weight school-aged children.

2. Teen Obesity weight loss After Exercise Based on table 5.2 note after exercise brisk walking, minimum or lowest weight was 56 kg and the highest is 94 kg with an average of 67.07 kg with standard deviation of 10.161. Physical activity or sport is a series of regular physical motion and planned to keep the motion (which means sustaining life) and improve the ability of motion (that means improving the quality of life), for example walking, cycling and running. As hatnya meals, motion (sports) is the continuous nature of life needs; This means that sport as a tool for sustaining life, maintain and nurture health, cannot be left out. As with any meal, olahragapun will only be able to be enjoyed and beneficial to the health of those who do sports activities (Proverawati&Rahmawati, 2012).

3. Influence of Exercise brisk walk against Teen Obesity weight changes Based on table 5.5 revealed the influence of exercise brisk walk against teen obesity weight changes in SMK Bhakti Mulya Pare Kediri (p value = 0.000 < α, then Ho denied and H1 are accepted). In principle for patients with obesity have to do physical activity by 763

exercising regularly. Should be kept to one hour of physical activity such as brisk walking every day, besides try to do sports ragajaln fast, running, swimming, cycling, structured for 20 minutes at least 3 times a week. The sport may be selected for patients with obesity is the path, up the stairs, running, cycling and swimming (Hasdianah, 2013:69). Brisk walking is stepping forward with a motion without a connection is dropped to the ground. Every time step the front foot must touch the ground before the rear foot leaves the ground. While stepping one foot must be on the ground, then the legs should be straight not bent knee and footstool in an upright position. Elements in motion way fast is discipline, morale, cohesiveness, oomph, neatness and durability. A quick hike is usually carried out in the field or on the road. When supplies will be brisk walking is shoes and carrying a drinking place. Regular walk will increase the body's metabolism. In addition to a number of calories wasted by foot, the excess calories are stored in the body will join the burn, then weight gain didn't happen. On the results of this study indicate the influence of exercise brisk walk against teen obesity weight changes, then this result proves the truth of the theory say that physical exercise is beneficial for fat burning. So with brisk walking physical exercise fat burning will occur in the body as a result of excess nutrient intake per day. On the study of weight loss brings about 2 kg, on the students of SMK Bhakti noble pare, then if followed regularly and continuously will mmbuat teens are at a normal or ideal weight. But keep in mind that this weight will quickly change or grow less nutrition intake controls when done, so will the fat buildup from happening again. Therefore, in line

with the process of physical exercise brisk walk then it should still regulate nutritional intake not to excess. CONCLUSION Based on the results of the study before exercise brisk walking, minimum or lowest weight is 58 kg and 97 kg with the highest average weight 69.23 kg with standard deviation of 10.695. After the exercise the way fast, minimum or lowest weight was 56 kg and the highest is 94 kg with an average of 67.07 kg with standard deviation of 10.161. There is the influence of exercise brisk walk against teen obesity weight changes in SMK Bhakti Mulya Pare Kediri (p value = 0.000 < α, then Ho denied and H1 are accepted). Advice It is expected that adolescents who are obese to lose weight immediately by way of carrying out physical exercise can walk, run, climb stairs tau cycling for 1 month at least 3 times in 1 week of practice.It is expected that SMK Bhakti Mulya Pare Kediri applying physical exercise to his protégé especially who are obese with a walk, run, climb stairs or biking at least 1 times in 1 week of practice. It is expected that the results of this research can be used as documentation in the library and the development of the health sector is primarily about the influence of exercise brisk walk against teen obesity weight changes.Researchers can then use this research study as one of the research relevant to his research. REFERENCE Abied.

2009. RemajadanCiri-Cirinya. http://meetabied.wordpress.com

Ariyadi. 2009. DefinisiOleh http://hidupsehatt.com

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Raga.

Farid.

2007. ObesitaspadaAnak. http://www.majalah-farmacia.com

Fitrianti. 2010. MotivasiPenderita Diabetes Mellitus Tipe II dalamMengikutiKegiatanOlahraga padaAnggotaPersatuan Diabetes Indonesia (Persadia) CabangPekalongan. Semarang :FakultasIlmuKeolahragaanUnivers itasNegeri Semarang Hasdianah, SanduSiyoto, YulyPeristyowati. GiziPemanfaatanGizi, Diet danObesitas. Yogyakarta :NuhaMedika Hira.2011. ManfaatOlahragadalamMelawan 7 Penyakit.http://www.anneahira.co m Proverawati&Rahmawati. 2012. PHBS (PerilakuHidupBersihdanSehat). Yogyakarta :NuhaMedika Sastroasmoro&Sofyan Ismail. 2010. DasarDasarMetodologiPenelitianKlinis. Jakarta : CV SagungSeto Selamihardja. 2007. Diet dan Olahraga bagi Penderita Diabetes. http://cuek.wordpress.com/ Sugiono. 2011. MetodePenelitianKuantitatif, Kualitatifdan R & D. Bandung :Alfabeta

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INFLUENCE OF THE TRADITIONAL GAME CONGKLAK ABOUT STRESS LEVELS TO PRE-SCHOOL AGE CHILDREN IN THE DAYCARE KASIH KARUNIA FOUNDATION PARE - KEDIRI 2015 Ahmad Wasis Setyadi*Arif Setiawan*Jitro Gideon Liu STIKes BHAKTI MULIA PARE – KEDIRI Email : [email protected] Abstract Pre-school age children in daycare will experience psychological problems, one of them stress. A traditional method was believed to reduce the stress children were congklak game. The purpose of this study was to analyze the influence of the traditional game congklak against stress levels to pre-school age children. The study design used pre-experimental "one group pretest-posttest design". The population of pre-school age children in Kasih Karunia Foundation-Kediri Pare as many as 65 children with a sample of 32 respondents taken with total sampling technique. Traditional games congklak independent variables and the dependent child's stress level was collected by checklist. Data were analyzed using the Wilcoxon test of Marked rating. From the analysis found most respondents stress level before the game congklak including phase V (weight control) that 22 respondents (68.8%), after almost half of the respondents included stage IV (by weight) of 15 children (46.9%) and no traditional games congklak influence on the level of stress in children pre-school age (p value = 0,000 <α, 0,05 hence Ho refused and H1 accepted. This was due to the game congklak then the child feel comforted so forget the psychological burden. It was concluded that the traditional game congklak effective to reduce stress levels at pre-school age children in daycare. It is recommended that daycare apply congklak game to his children. Keywords: traditional games congklak, stress, pre-school age children

"Orchid Room" RSUD Ambawara" with sample amount to 60 children and methods of quantitative non-experimental with design of correlation study, the incidence of children in stress stage I as much as 63.33% stress stage II as much as 10% , stress stage III as much as 5%, and not stress 21.67%. Subsequent research by Siti Aizah, Sui Erna Wati entitled "Efforts to Reduce Stress Levels of Hospitalization with Activity of Coloring Pictures at Children Aged of 4-6 Years in Orchid room of RSUD Gambiran Kediri". The research results showed the stress level of hospitalization before being given activity of coloring picture, severe stress as much as 13 children (42%), mild and very severe stress respectively of 9 children (29%), and none of the children experience mild stress. after given the activity of coloring pictures, respondents who experienced mild and moderate stress respectively of 13 children (42%), severe stress as much as 5 children (30%), and none of the respondents who experienced very severe stress. The analysis showed p value of 0.000 (P <0.05) there are differences in the level of stress before and after being given activity of coloring in children aged 4-6 years who experienced a hospitalization. The existence of a significant difference from

INTRODUCTION children in preschool age are also referred to as the early days of children, stretching from late infancy (18 or 24 months of birth) to approximately 5 or 6 years (Santrock in Hapsari, 2010). Along with theactivities of parents, sometimes children are invited to the workplace. However, the presence of activity in the workplace lead to less attention to the child. Finally the parents prefer to leave their children to daycare. On the other hand the child in this period generally begin to learn "more independent (self-sufficient) and take care of themselves, develop skills of school readiness (following orders, identifying letters), and spend hours playing with peers" (Santrock in Hapsari, 2010). Related to the problem, not infrequently cause negative effects such as stress. Almost four million children in the world are experiencing stress (Rahmawati, 2007). In Indonesia, an estimated of 35 per 1000 children experiencing stress (Sumaryoko in Apriliawati, 2011). The prevalence of anxiety when the child in hospitalization reaches 75% . Research of Sari & Sulisno (2012) with the title: " Correlation of mother's Anxiety with Child Anxiety When child in Hospitalization, in h

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the average child who experienced severe stress and then decreased to levels of mild stress to moderate stress, it can be concluded that the coloring activity can reduce stress levels of hospitalization of children aged 4-6 years in the Orchid Room RSUD Gambiran Kediri. While the results of preliminary studies on stress in preschool age children in daycare that is Yaysan Kasih Karunia Pare Kediri obtained from 10 children there are 4 children (40%) identified in stress, the rest there are 6 children (60%) identified had no stress. The presence of such stress can be caused by various factors. Like adults, children can also experience stress even more susceptible to stress than adults. The causes of stress in children can come from various sources. Sources of stress in children can come from family, school or relationships with other children. There are some experiences that occur in children that can cause stress, such as the ill family member, death of loved ones, changing schools and others. Another research states that the causes of stress in children can occur because left alone by their parents, and when he first time entered the school (Suwardi in Unimus, 2012). The stress experienced by children are generally the same as those experienced by adults, only the mechanisms of stress that occurs in both age groups are not the same. Children generally know, gain and experience stress that inherited directly from the environment, especially the family environment. In contrast to adults, most of the stress experienced by children as a result of the inability in the socialization with the environment although then the environment can create stress conditions get worse. Therefore, children are highly vulnerable to stress especially ifthey were in the midst of family that experiencing stress (Noviekayati in Unimus, 2012). The effects of stress experienced by children in preschool age as stated Dadang Hawari (2008), to the power of thought is decreasing / forgetful, and often complain of headaches or dizziness). Expressions of tense face , mouth and lips feel dry. throat as if there is obstacle so difficult to swallow. The respiratory system is disrupted, also lead to asthma (asthma bronchiale). The cardiovascular system such as cardiac and vascular or cardiovascular disrupted, peripheral blood vessels (peripheral) narrowed so that it feels cold and numb. Besides the body feels hot (subfebril) or otherwise feels cold. Nausea and painful digestive system. Urinary

system disrupted so the frequency to urinate more often than usual. Based on the problem above, to reduce the stress on children in daycare, there are at least fun thing for children. Child's world is filled with a world of play and it will always be fun. Therefore one of the games that need to be given is a game of congklak. Congklak is known by different names from region to region. In Java, this game is known as dakon, dhakon or dhakonan. In Lampung, the game is called dentuman tamban. In Sulawesi, called Mokaotan, Maggaleceng, Aggalacang and Nogarata (Bois, 2011). This game has been known for a long time ago, for our society so that the possibility of rejection is relatively small. Besides, the game is also relatively cheap (economically), practical, and not harmful for children. In conditions of children in day care, the risk of a child is injured by this game is also very small so there is no reason for a place of research to rejects this game. Based on the above background, researchers interested in conducting research about "The Effects of Traditional Games Congklak against Stress Levels in children of Pre-School Age in Daycare of Yayasan Kasih Karunia Pare Kediri 2015.”

METHODE OF RESEARCH Design is all that needed in the planning process and implementation of research. The research design used is pre-experimental design with the design of "One group pretest-posttest design" In this research the variables in the analysis is a game of congklak and stress levels of children in pre-school age. Population in this research are children in preschool age in Daycare of Yayasan Kasih Karunia Pare Kediri. This study used a total sampling that is sampling technique when all members of the population used as a sample as much as 32 respondents. The research instruments used Childhood Concern survey that contains 28 questions. Analytical analysis is conducted by statistical tests of induction (inferential) nonparametric. Selection of statistical tests is determined based on the purpose and scale analysis of data from each variable. Effect of Traditional Games Congklak against Childhood Stress Levels in Pre-School age children analyzed using the Wilcoxon test with a rating Labelled of α = 0.05. In the calculation process

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is assisted using Statistic assistance programe for Social Science (SPSS) Version 17.

Analysis and interpretation of the research result

RESULT OF THE RESEARCH

Tabel 5.3 Hasil Analisis Wilcoxon Pengaruh Permainan Tradisional Congklak terhadap Tingkat Stres pada Anak Usia Pra Sekolah di Tempat Penitipan Anak Yayasan Kasih Karunia Pare-Kediri Tahun 2015

Stress levels of children in preschool age Before the game of Congklak Table 5.1 Descriptive Stress Levels of children in Preschool age before the game Congklak in Yayasan Kasih Karunia Pare Kediri 2015 No. 1 2 3 4 5 6

Stres level before the game Congklak Stres Stage I Stres Stage II Stres Stage III Stres Stage IV Stres Stage V Stres Stage p VI Total

f

%

0 0 1 7 22 2 32

0,0 0,0 3,1 21,9 68,8 6,3 100

No. Variable z p 1. Stres level before – -4,264 0,000 after 2. the game Congklak 3. N = 32 α = 0,05 Based on Table 5.3 is known that there is effect of traditional games congklak toward the stress level of children in pre school age in daycare of Yayasan Kasih Karunia Pare Kediri (p value = 0.000 <0.05, then Ho is rejected and H1 accepted that meaning there is effect of the traditional game congklak toward stress levels of children in pre-school age in daycare Yayasan Kasih Karunia Pare Kediri).

Based on the table 5.1 is known that stress level of most respondents before the game congklak including stage V (weight controlled) as many as 22 respondents (68.8%).

DISCUSSION Stress level of children in pre school age before the game Congklak

Stress levels of children in preschool age After the game of Congklak

Based on the research results is known that the stress level of most respondents before the game congklak including stage V (weight controlled) as many as 22 respondents (68.8%). Stress in children of preschool age are caused by the interaction between the individual and the environment, creates a perception gap between the demands coming from a situation rooted in biological systems, psychological and social of person (Binus, 2013). Related to the problem, not infrequently cause negative effects such as stress. Stress is a stimulus or situation that cause distress and creates physical and psychological demands on a person (Sriati, 2008). Therefore, children in this age need to get attention from their parents. Meanwhile along with the activity of parents, sometimes children are invited to the workplace. However, the activity in the workplace lead to less attention to the child. Finally the parents prefer to leave their children in daycare. The research results showed that the strss level of children ini pre school age before the game congklak are mostly in stage V (weight

Table 5.2 Descriptive Stress Levels of children in Preschool age after the game Congklak in Yayasan Kasih Karunia Pare Kediri 2015 No. 1 2 3 4 5 6

Stres level after the game Congklak Stres Stage I Stres Stage II Stres Stage III Stres Stage IV Stres Stage V Stres Stage VI Total

f

%

0 0 6 15 11 0 32

0,0 0,0 18,8 46,9 34,4 0 100

Based on table 5.2 are known the stress level of respondent almost a half after the game congklak including stage IV (severe) as many as 15 children (46.9%).

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controlled). This is due to the position of children that are in daycare such as Yayasan Kasih Karunia Pare Kediri , then the child feel less get attention and affection from their parents even though on the other hand the child comforted by the atmosphere play with other children. At a certain moment where there is a conflict for example quarrel with friends, a fall or other adverse situation, then the child feel not getting protection from the parents which is where most wanted by the child. Situations like this will bring the child feels himself less affection and protection of their parents. Mentally, the psychological effect on the child's level of stress. Therefore, the level of stress including in high enough at the stage V (weight controlled). Besides, in this period, the child's activity is quite high with happy children running here and there, playing around and mingle, causing the child vulnerable to mental fatigue. Such stress will appear on the attitudes of children that tend often moody, less communicative and sometimes with negative coping.

The research results showed that the stress levels of children in pre school age after the game congklak nearly a half are in stage IV (severe), this condition can also be influenced by various factors, including external factors or the environment, that is the child play congklak with friends. The atmosphere of playing generally well-liked by child because the child is synonymous with play. Whatever the form of the child's game, the fun would have a positive influence on children's mental. Congklak is one form of traditional games that have been popular since our ancestors. This game does not require heavy energy, free from the risk of accidents so that children feel happy and can forget his inner conflict. Influence of Traditional Games Congklak against Stress Levels of children in pre school age in daycare of Yayasan Kasih Karunia Pare Kediri 2015 Based on the research results rknown that there is influence of traditional games congklak toward stress levels of children in preschool age in daycare of Yayasan Kasih Karunia Pare Kediri (p value = 0,000 <α, 0,05 then Ho is refused and H1 is accepted, meaning that there is influence of traditional games congklak toward the strss level of children in pre-school age in daycare of Yayasan Kasih karunia Pare Kediri). Congklak It is a traditional game that known by various names throughout Indonesia. Usually in a game, a kind of mussel shells used as seed congklak and if no, sometimes used also seeds of plants (Mulyani, 2013). This games congklak can bring the following benefits: a training tool for the management or financial management, training of a skill and careful, mental training of sportsmanship, fair, familiar with others and establish familiarity, and train the child's motoric (Neorita, 2012), This research was supported also by the theory of Carmichael in the Association For Play Therapy where play as therapy can be applied as a treatment of choice in mental health, school, agency, developmental, hospital, residential, and recreational settings, with clients of all ages. The presence influence of traditional games congklak toward stress levels of children in pre-school age caused by the decrease in the frequency of children with stress category V and IV before and after the game congklak. This difference was also significant based on the results of statistical analysis. This is due to the game congklak the children feel entertained. The

Stress level of children in pre school age after the game Congklak Based on the research resultsis known that the stress level of respondents almost a half after the game congklak including stage IV (severe) as many as 15 children (46.9%) this shows a decrease compared to befor the game congklak. Stress can go down influenced by many factors including the environment that could affect stress (Saefullah, 2010). Environment, such as playing one of the game that is game congklak, besides bringing benefits as a training tool for the management or financial management, training of a skill and careful, mental training of sportsmanship, fair, familiar with others and establish familiarity, and train the child's motoric and also brings a sense of fun. The world of children is a world full of games and it is always be fun. Pleasant situation will forget the mental and psychological burden so that it can reduce stress and anxiety for the child (Neorita, 2012). In addition, there are also some types of that decrease stress in the game congklak namely (1) Playing recreation in this case for (fun) to play spontaneous and unstructured (2) The game is structured in a way to monitor the conduct game congklak, so that children regularly do game congklak.

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existing theory explains that the game will make the child regardless of the tension and stress they experienced because of the conduct of the game, children will be able to divert the pain in game and relaxation through pleasure doing game. This condition is unconsciously through activities of play congklak, emotions and feelings that are in themselves can be removed, so can create a positive coping. This positive coping is characterized by a positive behaviors and emotions. The condition will help in reducing the stress experienced by children. Play therapy, help children become more responsible for behaviors that do, develop new solutions and creative to problems that children are facing, develop respect and understanding for others, learn to express emotions, developing empathy and respect for thoughts and feelings others learn to perform new social skills and relationship skills with family, developing a better confidence about the ability that children have. Decreasing stress is more common in children with the female gender. The results showed the majority of children experience stress stages V (weight controlled) but after the game congklak only half of the girls that experience stress stages IV (severe). This shows children are more easily stressed, but with the game congklak, more stress level has decreased. At the level of stress a child, can be influenced by gender, in this research the male sex easier decreasing levels of stress with the game congklak compared to women. The analysis showed after the game congklak, in boys the majority of the stress stages IV (severe). While the majority of female stress stages V (weight controlled). This is due to the boys generally have a stronger mentally than girls. Therefore, with a little game then it can immediately forget about the problems being faced Differences of age that significant for example children, teenagers, adults up to the elderly may influence significantly but in this

stress level after the game congklak including stages IV (severe), due to various factors, including external or environmental factors. There is influence of traditional game congklak toward the stress level of children in pre-school age in daycare of Yayasan Kasih karunia Pare Kediri (Wilcoxon with p value = 0.000 < 0.05, then H1 is accepted and H0 is rejected, meaning that there was an effect of traditional game congklak toward stress level of children in preschool age . SUGGESTION Parents are expected to increase attention to their child at the time of togetherness with game congklak or other games that, so can reduce thestress levels of their child. It is expeted that the Yayasan Kasih karuania Pare Kediri apply the game congklak to their children so can reduce the stress levels of pre-school age children. Nurses can use the traditional game congklak as one of the suggestions to the daycare to reduce stress levels. It expected that the results of this research can be used as documentation in the library and the development of the health sector, especially on the influence of the traditional game congklak toward stress levels of preschool age children. The further researchers can use this research as one of the research that relevant to their research.

DAFTAR PUSTAKA Anisa, I. 2010. Menanamkan Kedisiplinan Kepada Anak Usia Prasekolah (http://ichacha-ichadudul.blogspot.com , diakses pada tanggal 9 Januari 2015 jam 16.16 WIB) Apriana. 2009. Hubungan Pendidikan Anak Usia Dini (Paud) Dengan Perkembangan Kognitif Anak Usia Prasekolah di Kelurahan Tinjomoyo Kecamatan Banyumanik Semarang. Semarang : Program Studi Ilmu Keperawatan Fakultas Kedokteran Universitas Diponegoro

study all respondents still considered the age of the children so that problem solving to reduce stress levels better, thus it can be concluded that the stress on children did not affect by the age of the respondents (see Table 5.2.1 general data). CONCLUSION Stress level of most respondents before the game congklak including stages V (weight controlled), This is because children are in daycare. Almost half of the respondents the

Apriliawati. 2011. Pengaruh Biblioterapi terhadap Tingkat Kecemasan Anak Usia Sekolah yang Menjalani Hospitalisasi di

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Rumah Sakit Islam Jakarta. Jakarta : Universitas Indonesia.

2012. (http://ejournals1.undip.ac.id/index.php Diakses , tanggal 10 Desember 2014 jam 14.05WIB)

Arikunto. 2009. Manajemen Penelitian. Jakarta : Rineka Cipta. Depkes

Setiawan & Saryono. 2010. Metodologi Penelitian Kebidanan DIII, DIV, S1 dan S2. Yogyakarta : Nuha Medika

RI. 2006. Pedoman Pelaksanaan Stimulasi, Deteksi dan Intervensi Dini Tumbuh Kembang Anak di Tingkat Pelayanan Kesehatan Dasar. Jakarta : Dekpes RI.

Siti Aizah, Sui Erna Wati. 2014. Upaya Menurunkan Tingkat Stres Hospitalisasi dengan Aktifitas Mewarnai Gambar Pada Anak Usia 4-6 Tahun di Ruang Anggrek RSUD Gambiran Kediri. Kediri : Universitas Nusantara PGRI Kediri

Bois. 2009. Congklak, Permainan Tradisional Indonesia. (https://budayangeblog. wordpress.com. Diakses tanggal 11 Desember 2014 jam 22.48 WIB) Evo. 2014. Permainan Tradisional Congklak dalam Pembelajaran Matematika. (http://makalahlaporanterbaru1.com , diakses pada tanggal 10 Desember 2014 jam 13.17 WIB).

Sriati, A. 2008. Tinjauan Pustaka tentang Stres. Jatinagor : Universitas Padjadjaran Fakultas Ilmu Keperawatan Sugiyono. 2011. Metode Penelitian Kuantitatif, Kualitatif dan R & D. Bandung : CV Alfa Beta.

Fahlevi 2008. Penilaian Perkembangan Anak. (http://usebrains.wordpress.com . Diakses tanggal 9 Januari 2015 jam 13.17 WIB)

Suparyanto. 2011. Stres, Penangganan dan Pengukuran. (http://dr-suparyanto.com , Diakses tanggal 14 Januari 2015 jam 20.08 WIB)

Hasanah, Nunung, erik dan andri. 2011. Artikel Penjaskes Permainan tradisional ( Unimus. 2012. Hubungan antara Stres p ada congklak). http://andasites.com , diakses Anak Usia Prasekolah dengan Enuresis pada tanggal 10 Desember 2014 jam di RA Al Iman Desa Banaran Gunung 13.14 WIB) Pati Semarang. Mulyani, S. 2013. 45 Permainan Tradisional (http://mydocumentku.com Diakses , Anak Indonesia. Yogyakarta: tanggal 10 Desember 2014 jam 20.10 Langensari Publishing WIB) Pradana, M.I. 2014. Interaksi Sosial pada Anak Periode Late Childhood yang Bekerja. www.gunadarma.ac.id, diakses pada tanggal 10 Desember 2014 jam 13.14 WIB)

Wordpres. 2009. Perkembangan Anak Usia Pra Sekolah. (http://forbetterhealth. files.wordpress.com, Diakses tanggal 9 Januari 2015 jam 15.56 WIB)

Saefullah. 2010. Bagaimana Cara Mengatasi Stres dan Patah Hati. Bandung : Pustaka Reka Cipta Sari & Sulisno. 2012. Hubungan Kecemasan Ibu dengan Kecemasan Anak Saat Hospitalisasi Anak. Jurnal Nursing Studies, Volume 1, Nomor 1 Tahun

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THE RELATIONSHIP BETWEEN PARENTING PATTERN AND THE OLDEST CHILD’S SELF CARE INDEPENDENCE AT PRESCHOOL AGE IN THE PERMATA IBU KINDERGARTEN GUNUNG ANYAR SURABAYA Ainun Qoiriyah, Ika Mardiyanti Faculty of Nursing and Midwifery Nahdlatul Ulama University of Surabaya Surabaya, East Java Email : [email protected] Abstract Self-care is the effort of preventing the occurrence of health problems. The parents who are too over protective and worried about their child‟s abilities will inhibit the child's independence in solving each of their problems. This research is purposed to find out the relationship between parenting pattern and the oldest child‟s self-care independence at the preschool age in the Permata Ibu Kindergarten Gunung Anyar Surabaya. The design of this research was an analytic with cross sectional approach. The population was all parents and their oldest children in 2015 whose age was 5-6 years as 48 parents and 48 oldest children. The 43 respondents were taken as the samples by using probability sampling in which simple random sampling technique was applied in this research. The independent variable was parenting pattern, whereas the dependent one was self-care independence. The instrument of the research used to collect the data was questionnaire. Moreover, they were analyzed by using Kruskal-Wallis statistic test with the significance level α = 0.05. The result of the research showed that nearly half of the respondents (30.2%) applied a democratic parenting, whereas most of the children (62.8%) were independent in performing self-care. Furthermore, the result of Kruskal-Wallis test showed that ρ = 0.004 < α = 0.05 means that H0 was rejected and it showed that there was a relationship between parenting pattern and the oldest child‟s self-care independence at the preschool age in the Permata Ibu Kindergarten, Gunung Anyar, Surabaya. In conclusion, the parents with a democratic parenting can make the oldest children to be independent in performing self-care. Hence, they are expected to be able to choose an appropriate parenting pattern and train their children‟s safe-care independence since the early age through their daily activities. Keyword : Parenting Pattern, The Oldest Child‟s Self Care Independence, Preschool Age

1.

to the culture, power and wealth, besides the oldest child is usually expected to be an example for his/her younger siblings. Parents have higher demands and expectations of the eldest child, so he/she can be more independent in carrying out its activities (Puspitaningrum, 2012). The child's independence to perform self-care is an effort to prevent the onset of health problems or problems due to development of the child (Herlina, 2013). If the child asks for a help and the attitude of parents who always want

Introduction Childhood is an important period in growing process of self-reliance, so understanding and the opportunity that is given by parents to children in promoting independence is very crucial (Marini, 2008). Child care independence is characterized by the ability to perform simple daily activities, like eating without being fed, able to put on his/her own socks and shoes, and other activities without depending on others (Nakita, 2005). The oldest child (the eldest son) in this case is seen as the heir

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to protect and feel anxiety to the child's ability is still maintained, it can inhibit the child's independence in solving any problems that face him/her (Hawari, 2007). In one research found that 33.8% of mothers claim their oldest child is smarter in the class, and only 1.8% of the oldest child who admits their child is at the bottom in the class. That research was conducted on 12,000 respondents in the United States. The fact showed that the parents will be harsh if their eldest child gets bad score at school. Whereas on the second child and next, their attitudes are more lenient. In the research it was also proved that the oldest child generally has better academic achievement and higher IQ scores than the second and so on. The leader of the researcher, Joseph V argued that in fact the level of intelligence is not influenced by the order of birth, but rather to the treatment of parents to children. It could be due to the oldest child treated more disciplined and also gets assistance in learning to have better school achievement and that is also interesting from this survey that parents act firmly on the oldest child as they try to build a reputation. After the parents feel tough on his oldest child, next they tend to be more lax to him/her. Susan Whitebourne, a professor of psychology at the University of Massachusetts said that parents‟ assertive parenting on their oldest child was due to bear the burden and the expectations of them (Nakita, 2005). Based on the research that has been conducted by Nayla Muchsinati (2007) Faculty of Psychology at State Islamic University of Malang on the relationship of birth order in the family with the independence of early childhood in Medina kindergarten Malang was obtained that in general the independence of early childhood in Medina kindergarten Malang was quite various, namely 23% high independence, 54% medium independence, and 23% low independence. The analysis also showed

that there was a relationship between birth orders in families with early childhood independence, which was indicated with the presence of significant differences in independence if it was seen from the the birth order of the child in a family. The results also showed that the oldest child was more independent than the middle child, and the last child was more independent than the middle child and the oldest child had an almost equal degree of independence to the last child. In addition to the research above, there was a research that discussed about the parenting patterns to their children, and based on the research conducted by Joko Tri Suharsono et al in 2009 about the relationship of parenting patterns on social skills of preschool children in Pertiwi kindergarten, North Purwokerto showed that the child cared by an authoritarian parenting: 1 child had good social skills (5.3%), 7 children had enough social skills (36.8%), while children who had less social skills as 11 children (57.9%). Children with permissive parenting have good social skills was as 4 children (17.4%), quite social skills was as 10 children (43.5%), and less social skills was as 9 children (39.1%) while children are nurtured with a democratic parenting more than half had good social skills which was 27 children (79.4%), while children who had enough social skills and lack were as 3 children (8.8%) and 4 children (11.8%) and the results of the study can be concluded that there is a relationship between the parenting pattern on the preschool children‟s socialization skills in Pertiwi kindergarten, North Purwokerto. Based on the preliminary studies conducted in Permata Ibu kindergarten Gunung Anyar Surabaya, it is found that the result of interviews with six parents who have oldest child at preschool age, 4 of them said that they were not bear to see their children performed daily activities by themselves, in addition they also said that if their children did selfcare independently, the results were not

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clean and untidy and it also required a long time then the parents should immediately took an action to help their children. While 2 of them told their children were quite independently to perform self-care with little direction, they said that their oldest child had been trained independently because he/she had a young sister/brother so the oldest child could be an example for her/him and sometimes help keep her/him. The efforts that can be done are to train children‟s care independence as early as possible regardless of their birth order of children in families by giving their children the same opportunity and involving them in a variety of specific activities aimed at improving their independence of self-care children (Mulyani, 2005). Other efforts to do is to teach and give responsibility to them, such as making a schedule of daily activities from waking up in the morning to sleeping at night. Children's ability to manage their time would have a positive impact, they are able to be discipline and responsible to themselves. Giving positive reinforcement to the child's independence will motivate them to be able to do more to make themselves independent (Herlina, 2013).

2.

the data used Kruskal Wallis statistical test with α = 0,05.

3. Result The result of the research of parenting pattern on the oldest child‟s self-care independence will be described in the following table: Table 1 The Frequency Distribution Based on Parenting Pattern of the Oldest Child at The Preschool Age in the Kindergarten of Permata Ibu Gunung Anyar Surabaya in 2015 Parenting pattern Authoritarian Democratic Permissive Situational Total

Frequency 12 13 11 7 43

Percentage (%) 27,9 30,2 25,6 16,3 100

Based on the table 1 above almost half (30.2%) of the respondents used a democratic parenting pattern. Table 2 The Frequency Distribution Based on The Oldest Child‟s Self-Care Independence at Preschool Age in The Kindergarten of Permata Ibu, Gunung Anyar Surabaya in 2015

Research Methodology The purpose of this research was to understand the relationship between parents‟ parenting and the oldest child‟s self-care independence at preschool age in the kindergarten of Permata Ibu, Gunung Anyar Surabaya. This research is a quantitative research with correlation descriptive design with cross sectional approach. The population of the research was all parents with their oldest child of Permata Ibu Kindergarten Gunung Anyar Surabaya in 2015 whose age was 5 to 6 years as 48 parents and 48 students, whereas the number of the samples was 43 respondents. The sampling was a probability sampling with simple random sampling technique. The study was in June 2015. Analysis of

Self-care independence not independent quite independently independent Total

Frequency

Percentage (%)

0

0

16

37,2

27 43

62,8 100

Based on the table 5.2 above, most (62.8%) of the respondents had performed self-care independently.

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Table 3 Cross Tabulation of The Relationship between Parenting Pattern and the Oldest Child‟s Self-Care Independence at Preschool Age in the Kindergarten of Permata Ibu Gunung Anyar Surabaya in 2015 N Paren o ting patter ns

Self-care independence Not Quite Indepe Tota indepe Indepe ndent l ndent ndentl y n% n% n% ∑% 1 Author 0 0 1 8,3 1 91, 1 1 itarian 1 7 20 0 2 Demo 0 0 3 23, 1 76, 1 1 cratic 1 0 9 30 0 3 Permi 0 0 9 81, 2 18, 1 1 ssive 8 2 10 0 4 Situat 0 0 3 42, 4 57, 7 1 ional 9 1 0 0 Total 0 0 1 37, 2 62, 4 1 6 2 7 8 30 0

According to the table 5.3 above shows that the 12 respondents of 43 respondents who used an authoritarian parenting pattern was almost entirely (91.7%) independent in performing selfcare, from 13 respondents who used a democratic parenting pattern was almost entirely (76.9%) independent in it, the 11 respondents who used a permissive parenting was almost entirely (81.8%) quite independent in it, while 7 respondents who used a mixture parenting was majority (57.1%) independent in it. Statistical test result was done by using Kruskal Wallis test. Calculation used SPSS 16 for windows with a significance level α = 0.05, it was obtained that value ρ = 0.004 and α = 0.05. It means that ρ <α, then Ho was rejected. It means that there is a relationship between Parenting Pattern and the Oldest Child‟s Independence in

self care at the Preschool Age in the Permata Ibu Kindergarten, Gunung Anyar Surabaya. 4. Discussion 4.1 Parenting Pattern Parenting pattern has an important role in educating children, especially at the preschool age. Based on the result of the research in Permata Ibu Kindergarten, Gunung Anyar Surabaya in the table 5.6, it was obtained that almost half (30.2%) of the 43 respondents which are 13 persons used a democratic parenting. This result shows that quite a lot of parents who used a democratic parenting in educating the children. Democratic parents get more warm, and the child is given the freedom to conduct his activities but he remains under the supervision of the parent, besides the parent disciplines a child by advising him/her, explaining the aims and the objectives, giving understanding and trying to steer him/her rationally so it is possible for the child to become a person who is more responsible, confident and has a good character. Baumrind in Judy et al (2012) which states that parents with democratic parenting always behave rationally that they always underlays their behavior on the ratio or thoughts. Parents are also realistic on the child‟s ability, give freedom on the child to choose and act something and their approach to the child is in a subtle way. This parenting will produce independent child characteristics, have self-controlled and have good relationship with friends. The distribution data of parenting pattern of the oldest child in the Permata Ibu kindergarten showed that not all mothers apply a democratic parenting to their children but they also used an authoritarian, permissive and situational parenting pattern. Almost half of parents (27.9%) also used an authoritarian parenting which was as 12 people, while a minority of parents used a permissive parenting (25.6%), which was 11 people and the situational parenting (16.3%) was as 7 people.

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Based on the data obtained from fulfilling the questionnaires, parents who applied authoritarian parenting to their children tend to be a little pushy towards their children with a good intention and scared them with the bad things that would happen if they did not want to listen to their advice. The result also showed that an authoritarian parenting is also quite widely used by parents of the oldest students in the kindergarten of Permata Ibu. Parents who used an authoritarian parenting had an adequate high of force control, strict in applying the variety of rules and very disciplined in educating their children. If parents used this parenting well for a positive purpose, it is possible that the life of the children at the preschool age could be more disciplined and obedient to their parents. According to Dariyo (2007), this authoritarian parenting lays parents as a control of all children‟s activities. Children will always be under parental control. They will not be given the freedom to do everything that they want. Parents do not hesitate to apply hard rules so that their children become obedient. Parents think that the rule is stable and unchanged; it is often that the parents do not like the actions of children who protest, criticize, or deny them. The result showed that a minority of parents used a permissive parenting (25.6%) was as 11 people and the situational parenting (16.3%) was as 7 people. The permissive parenting indicates that the freedom given by parents to their children is very exaggerated, but with a little guidance given, usually parents do not want to take a risk it seems that they let and always understand things done by their children, but sometimes the affection given is too excessive, parents give more help and do everything that their chidren desire so it is possible that the child will be spoiled. While in the situational parenting which is a mixture of a democratic, authoritarian and permissive parenting is freer in applying any rules

at home and sometimes they also do not have to bother to supervise them, parents can also be flexible to their children. Gunarsa (2008) states that in a permissive parenting, parents provide too much freedom to their children. Parents tend not to prohibit or require anything. This parenting is strongly opposed to the authoritarian parenting. If in the authoritarian parenting puts the parents as a control / central in the family, so in the permissive parenting the child becomes the control in the family. Parents simply act as "policemen" who supervise, reprimand, and probably scold. Parents are unusual to get along with their children, their relationship is not familiar and feels that their children should know themselves. Dariyo (2007) states that a situational parenting is a mixture of democratic, authoritarian, and permissive parenting. Parents do not use special parenting. Parents sometimes use different parenting in certain times. Parents are more flexible to their children and adjust parenting with the children's condition.

4.2 The Oldest Child Self-Care Independence at The Preschool Age Based on the result of the research on the oldest child at the preschool age in the Permata Ibu Kindergarten, Gunung Anyar Surabaya, in Table 5.7 shows that a large majority (62.8%) of the 43 respondents have been independent in performing self-care. This result indicates that every parent wants his/her oldest child to be able to do his/her selfcare by himself/herself without depending on others. The oldest child at the preschool age is appropriate for learning responsibility by exercising his/her independence through daily activities. Hurlock in Agus, et al (2012) states that the oldest child is usually given the responsibility by parents to assist in taking care of and supervising younger

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siblings, and is required to give a good example to his/her younger siblings, consequently the oldest child tends to adhere to the regulations that exist around it. Therefore, the oldest child is possible to reach self-independent sooner than younger siblings. Most of the oldest child at the preschool age in the Permata Ibu Kindergarten Gunung Anyar Surabaya has been self-independent in performing self-care. It can be seen from the result child‟s of questionnaires that the independence of self-care can be shown from the children who are able to take a shower and wash their own hands, wear and undress themselves, feed themselves without being fed, go to school by themselves without getting accompanied by their parents and they are able to keep their own luggage by themselves. The researcher‟s statement is in accordance with Wulandaru (2012) that in 5-6 years old children must be able to interact with others and begin to abide by the rules, can control their emotions, may be responsible, able to maintain their safety by themselves, accustomed to protecting the environment, show an attitude of independence, discipline and self-confidence.

5.8 shows that among 43 respondents, the 12 respondents who used an authoritarian parenting are almost entirely (91.7%) independent in performing self-care, from 13 respondents who used a democratic parenting was almost entirely (76.9%) of the respondents perform their own selfcare themselves, from 11 respondents used permissive parenting is almost entirely (81.8%) of the respondents are quite independent in it, while 7 respondents who use a mixture parenting was majority (57.1%) of the respondents were independent in it. The child‟s self-care independence taught by many parents will have a positive impact for children's health. In addition, it has the rights and obligations of parents as the primary responsible for educating their children. Children need the opportunity, support and encouragement from parents and families as well as the surrounding environment to be able to live independently. Therefore, parents need to teach independence as early as possible in accordance with the child's ability. According to Supartini (2004) things that the parents done when the child is sick, does not want to eat, sad, cries, acts aggressively, or is lying, in this case, a parent is required in order to be better prepared to carry out the role of parenting to the children so they have the life skills and can build independence optimally in the adulthood.

4.3 Relationship between Parenting pattern and The Oldest Child’s SelfCare Independence at The Preschool Age The research result of the relationship of parenting pattern with self-care independence of the oldest child at the preschool age was done by using Kruskal Wallis correlation test at the significance level α = 0.05. Calculation was done by using SPSS 16 for windows and it was obtained that the value ρ = 0.004 and α = 0.05, ρ <α so that H0 was rejected, it means that there is a relationship between parenting pattern and the oldest child‟s self-care independence at the preschool age in the Permata Ibu Kindergarten, Gunung Anyar Surabaya. Based on the cross-tabulation table

Based on the result of the research, it showed that among 43 respondents there were 12 respondents who used authoritarian parenting and 13 respondents who used democratic parenting are almost entirely (91.7%) and (76.9%) independent in performing self-care. It shows that many parents of the oldest child at the preschool age in the Permata Ibu Kindergarten Gunung Anyar Surabaya used an authoritarian and democratic parenting. In the authoritarian parenting pattern, parents tend to be disciplined, firm, tight and

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stressed their child‟s adherence to the rules of their children made without giving an explanation. Parents will be emotional when their children did somthing that was not in accordance with the parent‟s desire. That makes the child will obey, obey with their parents, disciplined and self-independent in performing self-care. Children who are grown up with this parenting although they look disciplined and independent in their daily life, feared to be unhappy, paranoid or always in fear, easy to be sad and depressed, happy to be out of the house when the parents do not apply this parenting wisely for a positive purpose, Indrawati (2006) states that the authoritarian attitude used by parents in parenting, will cause a significant psychological disorder in children's lives. According to Riyadi (2009) authoritarian parenting pattern does not mean that it can not be used in parenting and making the children‟s independence, it can be used when in a state of forced or critical for the children‟s health if the child does not want to listen. While in the democratic parenting, parents who behave democratically prioritize more to the child, always gives guidance to him/her with guidance and explanation while providing limit and control to him/her so it can encourage him/her to be more confident and independent, especially in the term of performing self-care. Children need the opportunity, the support and encouragement of their parents to be independent. Parents also play a role as a nanny, so a proper parenting is needed to foster the child's independence. According to Agus‟ research et al (2012), parents with a democratic parenting greatly stimulate the child's independence, the role of parents as mentors who pay attention to the activities and needs of children, especially in terms of interaction in the neighborhood and at school.

4.4 Limitations of Research The process of collecting data by using questionnaires has weaknesses to be filled dishonestly by respondents so the results are less able to represent qualitatively. Questionnaire made by researchers themselves who are still unknown the level of validity and reliability as well as researchers should make a visit to the home of the respondents because the research period that coincides with the school vacation schedule so it takes a long time. 5. Conclusion It is concluded that parents with a democratic parenting pattern can shape the oldest child of preschool age to become independent in self-care. Parents are expected to choose an appropriate parenting and train their child‟s self-care independence since an early age through daily activities. References : Agus, Riyanti, Puspito, Rini (2012) Kemandirian Remaja Berdasarkan Urutan Kelahiran. Sumenep, Jurnal Dosen Prodi Pendidikan Matematika STKIP PGRI Sumenep. Alimul, A. Azis (2006). Pengantar Kebutuhan Dasar Manusia : aplikasi Konsep & Proses Keperawatan. Jakarta, Salemba Medika. Bali Post (2011). Membentuk Anak Mandiri. www.balipost.co.id. Artikel diakses tanggal 22 Januari 2015. Chairini, Nurul (2013) Faktor-Faktor yang Berhubungan Dengan Stres Pengasuhan Pada Ibu dengan Anak Usia Prasekolah di Posyandu Kemiri Muka. Jakarta, Skripsi Prodi Ilmu Keperawatan Universitas Islam Negeri Syarif Hidayatullah. Desmita (2009). Psikologi Perkembangan. Bandung, Rosda. Edwards, C. (2006) Ketika Anak Sulit Diatur : Panduan Orang Tua Untuk Mengubah

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Nakita (2005) Anak Sulung : Harapan Orangtua. Tabloid Nakita http://www.tabloidnakita.com/read/1902/anak-pertamaselalu-lebih-pintar . artikel diakses tanggal 27 Mei 2015. Hapsari, Citra Widi (2008). Perbedaan Kematangan Emosi Berdasarkan Urutan Kelahiran (Birth Order) Pada Remaja. Semarang, Skripsi : naskah-publikasi04320137.pdf, artikel diakses tanggal 1 Februari 2015. Herlina (2013). Hubungan Pola Asuh Keluarga Dengan Kemandirian Perawatan Diri Anak Usia Sekolah Di Kelurahan Cisalak Pasar Kecamatan Cimanggis Kota Depok. Depok, Skripsi Program Studi Magister Ilmu Keperawatan Peminatan Keperawatan Komunitas Universitas Indonesia. Indrawati, Maya dan Wido Nugroho (2006). Serba Serbi Bijak Mendidik dan Membesarkan Anak Usia Pra-Sekolah. Jakarta, Prestasi Pustaka. Marini (2008) Penerapan Pola Asuh Orang Tua dalam Menumbuhkan Kemandirian Pada Anak Usia Balita di Lingkungan UPTD SKB Kota Cimahi. Cimahi, 08030056-Rini-Marini.pdf Artikel diakses pada tanggal 27 Mei 2015. Muchsinati, Nayla (2007). Hubungan Urutan Kelahiran Dalam Keluarga Dengan Kemandirian Anak Usia Dini Di TK Madinah Malang. Malang, Skripsi : Fakultas Psikologi Universitas Islam Negeri Malang. Mulyani, Yani dan Juliska Gracinia (2005). Belajar Di Rumah Untuk Anak Usia Pra-Sekolah. Jakarta, Elex Media Computindo. Notoatmodjo, Soekidjo (2012). Metodologi Penelitian Kesehatan. Jakarta, Rineka Cipta.

Nursalam (2013). Metodologi Penelitian Ilmu Keperawatan : Pendekatan Praktis Edisi 3. Jakarta, Salemba Medika. Parker (2005). Menumbuhkan Kemandirian Dan Harga Diri Anak. Alih Bahasa : Bambang Wibisono. Jakarta, Prestasi Pustakaraya. Perry, Potter (2005). Buku Ajar Fundamental Keperwatan. Jakarta, EGC. Putra, Febri Yunanda (2012). Hubungan Pola Asuh Orangtua Dengan Tingkat Kemandirian Personal Hygiene Anak Usia Prasekolah Di Desa Balung Lor Kecamatan Balung Kabupaten Jember. Jember, Skripsi Program Studi Ilmu Keperawatan Universitas Jember. Riyadi, Sujono dan Sukarmin (2009). Asuhan Keperawatan Anak. Yogyakarta, Graha Ilmu. Shochib, Moh. (2010). Pola Asuh Orang Tua Dalam Membantu Anak Mengembangkan Disiplin Diri, Edisi Revisi. Jakarta, Rineka Cipta. Shodiq, Muh. (2014) Pengaruh Pola Asuh Orang Tua dan Pergaulan Terhadap Kesadaran Anak Dalam Beribadah. Salatiga, Skripsi Program Studi Pendidikan Agama Islam Negeri STAIN Salatiga. Sholihatul, Afiyatus (2011). Kemandirian Anak Usia Dini. Surabaya, http://blog.elearning.unesa.ac.id diakses tanggal 4 Februari 2015. Soetjiningsih, Christiana Hari (2012). Seri Psikologi Perkembangan : Perkembangan Anak Sejak Pertumbuhan Sampai Dengan KanakKanak Akhir. Jakarta, Prenada. Sosiawan, Edwi Arief (2013). Psikologi Komunikasi. http://edwi.dosen.upnyk.ac.id. Artikel diakses tanggal 1 Februari 2015.

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Walgito, Bimo. (2010). Bimbingan dan Konseling (Studi dan Karier). Yogyakarta, Andi. Wikipedia (2015) Sulung. Wikipedia Bahasa Indonesia, Ensiklopedia Bebas, http://id.wikipedia.org/wiki/Sulung Artikel diakses tanggal 27 Mei 2015. Winarti (2011). Pengaruh Pola Asuh Orang Tua Terhadap Pembentukan Akhlak Anak Usia 7-12 Tahun Di Ketapang Tangerang. Jakarta, Skripsi : Fakultas Dakwah dan Ilmu Komunikasi Universitas Islam Negeri Syarif Hidayatullah.

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Wulandaru, Wening. (2012). Bunda, Sekolah Pertamaku : Panduan Islami Mencetak Anak Unggul. Solo, Tinta Medina.

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THE EFFECTIVENESS OF SEMI FOWLER POSITION TO THE DEGREE OF SPONTANEOUS PERINEUM RUPTURE ON PRIMIPARA AND MULTIPARA MATERNAL AT THE WORKING AREA OF PUSKESMAS NGADILUWIH KEDIRI Susanti Pratamaningtyas Health Ministry Health Polytechnique Malang ABSTRACT Semi Fowler position is the most often suggested position for second phase by setting pillow under knee, arm and back. Parity can influence a spontaneus rupture perineum because the perineum area net structure in multipara has different elasticity. The purpose of the research was to analyze the effectivity of Semi Fowler position to the degree of rupture perineum to primipara and multipara maternal. The research design was using a pre experiment post test only design where its independent variable was semi fowler position and its dependent variable was a spontaneus rupture perineum to primipara or multipara by using wilcoxon mann-whitney u-test statistic test. The population and sample of research consisted of 15 primipara intrapartum and 15 multipara intrapartum. The result of statistic test showed that U1 = 47.5 and U2 = 177,5 in which U1 was used as the account value. So Utest = 47.5 and this score then was compared with U table ( for n1 = 15 and n2 = 15 it showed that Utabel =56). The conclusion of the AsUtest < Utable so that h0 was rejected and h1 was accepted. research was the effetivity difference of a semi fowler position of spontaneus rupture perineum to primipara and multipara intrapartum maternal. The straining position influenced to the process of intrapartum, so the straining position could indirectlyinfluence a rupture perineum. Keyword : a semi fowler position, rupture perineum, primipara, multipara (NICE, 2007) and (2) the active second stage is defined as the emergence of fetal, contraction of emergence with the finding that cervical fully dilated or any other signs that the cervix is fully dilated, active maternal effort after full cervical dilatation confirmed, without any emergence contractions (Helen, 2010), the third stage begins as soon as the fetus is born and ends with the birth of the placenta and fetal membranes. The third stage is also known as a stage of separation and placenta expulsion. (Sarwono Prawirohardjo 2008). Stage IV is after the birth of the placenta and ends two hours after that (JNPK-KR, 2008). Labor is determined by several factors such as power, passage, passanger, psychology (Lipincott, Williams, 2005). The percentage of direct maternal causes of death in East Java in 2011 is bleeding

Background In the delivery process, there are opening and thinning of the cervix processes including process of descent into the birth canal that happens in full-term pregnancy which is 37-42 weeks without any complications to the mother and fetus (Saifuddin, 2006). The progress of labor and birth takes place in four stages (Ladewig, 2006). Labor is divided into some stages and the first stage is when opening takes place from zero to the complete opening which is divided into a latent phase and active phase (JNPK-KR, 2008), and the second stage of labor begins when the cervix is fully dilated, and ends when the baby is born (Hellen, 2010). Second stage of labor is divided into (1) the passive second stage that is defined as findings of full cervix dilatation before or without unconscious delivery contractions

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(29.35%); pre-eclampsia (27.27%); infection (6.06%); heart (15.47%); others (21.85%) (East Java Provincial Health Office 2012). The main cause of bleeding is atonic uterus ruptured while the perineum is the second leading cause of almost happened at every birth pervaginan (Sumarah. 2009). An estimated 85% of maternal experience the birth canal laceration (Aprilia, Yessie. 2010). Women who give birth vaginally or less perineal trauma (Vicky, Chapman, 2006). Rips through the birth canal usually caused by an episiotomy, spontaneous perineal laceration, trauma forceps or vacuum extraction, or by extraction version, how to strain, and labor leaders are wrong (Sarwono, 2009). According to the WHO in 2009 there was 2.7 million cases of rupture of perineum on maternal. This figure is expected to reach 6.3 million in 2050, along with the high midwife who do not know the good midwifery care (Rithy, 2010). In America 26 million mothers who experienced a rupture perineum, 40% of them experienced a rupture perineum because of the negligence of the midwife 20 million of which is maternal. And this will make the costs for the treatment of approximately 10 million dollars per year (Heimburger, 2009). According to research in Australia, every year 20,000 birth mother will experience perineal rupture is caused by ignorance of midwives about midwifery care is good. In Asia rupture perineum is also a considerable problem in the community, 50% of the rupture of the perineum in the world occur in Asia (Campion, 2009). The prevalence of mothers who experienced a rupture perineum in Indonesia in the age group 25-30 years is 24% being in the maternal age of 32-39 years by 62% (Alin, Parlin.2011). The study from the Center for Research and Development (Research) Bandung, which conducts research from 20092010 in several provinces in

Indonesia found that one in five mothers who have ruptured perineum will die of 21.74% (Siswono, 2003). Perineum rupture caused by several factors, one of which is the position strain. Selection strain current position comfortable for pregnant women and multigravida primigravidae make Mother's anxiety is reduced, the duration of the second stage is shorter, and episiotomy or perineal rupture and aid delivery less (Helen, 2010). The impact of the mother's perineum rupture among others, the occurrence of infection in the wound sutures which can propagate in the gallbladder or in the birth canal that can result in the emergence of complications of bladder infections or infections in the birth canal. It also can occur because of the opening of blood vessels bleeding that does not close completely so that bleeding occurs continuously. Strain position can be selected among others the mother supine position (supine), the lithotomy position, oblique or lateral position, a squatting position (squatting), and semi fowler position. At the first time until now, the majority of caregivers attending births by placing the mother is supine or lithotomy (Anik, maryunani. 2010). The setting position can provide mechanical advantage or disadvantage to the delivery mechanism by altering the effect of gravity, the relationship between the parts of the body that is essential for the progress of labor and affect the overall degree of rupture of perineum. Keep in mind that the position of women giving birth can affect the length of the delivery process. Mothers who are more engaged and select the position of their own choosing will experience the birth process shorter and the pain is mild, it is in accordance with the opinion of Nikodem (1995) that studies have shown that allowing mothers maternity to choose a position on the

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second stage of labor has many advantages such as lack of perineal trauma, more easily meneran and Apgar score 1 minute and 5 minutes better. Therefore, health care providers should explain to maternal and maternal companion that can decide themselves felt most comfortable position for himself. The role of health care providers is to give support to the mother in choosing any chosen position, suggest alternatives if the selected position for himself endanger the mother and for the baby(Anik,maryunani.2010). According to Dr. Dwi Rahmiati Hasyar position most commonly applied in various maternity hospitals (RSB) or midwives practice independently (BPM) in all over the country are on their backs (supine), which has the disadvantage that one of them is increasing the pressure on the perineum which can increase tear and degree episiotomy while in the semi-Fowler position of> 50% for this position enough to make the mother comfortable but has the drawback that is approximately equal to the lithotomy position that is by the patient sits with his back leaning against a pillow, legs bent and thighs opened to the side. Other positions are slanted position used in the second stage of labor is about <40% but the obstacles complicate tilted position midwife to assist the delivery process. In a sense, hard to monitor the baby's head, held, as well as directed. Midwives will have trouble when performing episiotomy, while in a squatting position used <10% in the second stage of labor positions. Weakness in the squatting position can potentially make your baby's head injury as well as complicate the monitoring of opening and other labor actions eg episiotomy. In a systematic review evidence relating to the position of the alternative second stage, Gupta & Hofmeyr (2004) concluded that meneran would be more effective if the mother is in an

upright position, and is related to the duration of the second stage is shorter, episiotomy and aid delivery more a little. Based on preliminary studies conducted in health centers Kediri district Ngadiluwih conducted on 21 s / d February 28, 2014 obtained four deliveries, two birth mothers and two labor primiparous multiparous mothers. Results obtained 3 of them did not rupture perineum and one of them suffered spontaneous rupture perineum. Based on the description above, researchers are interested in conducting research on the degree of perineal rupture associated with strain position. Therefore the researchers chose to study with the title " The Effectiveness of Semi Fowler Position to the Degree of Rupture Perineum Spontaneus on Primipara and Multipara in maternal at Working Area Puskesmas Ngadiluwih Kediri ". It is hoped this can help health workers, especially those related to the aid delivery process to assist the mother in choosing straining position, as well as help birth mothers find a comfortable position. So as to reduce complications during childbirth in the second stage. Reseach objectives Determine the effectiveness of semi fowler position to the perineum rupture spontaneously in maternal primiparous and multiparous in Puskesmas Ngadiluwih Kediri. Methodology This study was a comparative analytical study design is research that attempts to explore how the phenomenon occurs. This study design using pre-experimental design post test only design that is in the draft absolutely no control. The draft can be described as follows:

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experiment

Ruptur Perineum

Post test

X

Mother in lab or

O2

Results 1. Rupture of perineum on Primipara Maternal with Semi Fowler Position in Puskesmas Ngadiluwih Kediri. Rupture of the perineum on primiparous maternal using semi fowler position can be seen in the table below: Ruptur Perineum 1. Unrupture

n 7 4

26,67

3. Grade II

3

20,00

4. Grade III

1

Total

15

n

Primipa ra

1

Multipa ra

7

Persentase (%) 46,67

2. Grade I

Tidak % 6,67

I n

II %

2 13,33

n

III %

n

9 60,

Jumlah %

3 20,0 0

46,67

4 26,67

3 20,

100,00 Table 1.1 Perineum Rupture on primiparity Maternal with Semi Fowler Position

Table 4.1 Explained about the results of the degree of rupture of the perineum primipara maternal who birth to semi fowler position that is largely primipara maternal with semi fowler position perineum ruptured grade II as many as 9 people. 2. Rupture of the perineum Multipara Maternal with Semi fowler Position in Puskesmas Ngadiluwih Kediri. Rupture of the perineum on multipara maternal using semi fowler position can be seen in the table below:

1 0

Table 1.2 Rupture of the perineum Multipara Maternal with Semi Fowler Position Table 1.2 shows that the majority of multiparous maternal not experienced spontaneous perineum rupture as many as seven people.

Ruptur Perineum 1. Unrupture

n 1

6,67

2. Grade I

2

13,33

3. Grade II

9

60,00

4. Grade III

3

20,00

15

100,00

Total

Persentase (%)

Based on table 1.3, perineum rupture on primiparous and multiparous maternal using semi fowler position that was on primipara maternity who

797

1 0

3. The Effectiveness Semi Fowler Position to Spontaneous Rupture Perineum On Primiparity and Multipara Maternal Table 1.3 The Effectiveness Semi Fowler Position To Spontaneous perineum rupture On Primiparity and Multipara Maternal

6,66

n

1 6 , 6 6

% 50,0 0 1 5 50,00 5

experienced spontaneous perineum rupture grade II were 9 people. While on maternity multiparous largely perineum ruptured as many as seven people. Then to determine the effectiveness semi fowler position on the degree of spontaneous perineal rupture in primiparous and multiparous maternal used Mann Whitney U-Test with α: 0.05 Obtained results U test smallest value = 47.5. This value is then compared with U tabel (for n1 = 15 and n2 = 15 obtained U tabel value = 56). Because Utabel> Utest then H0 is rejected and H1 accepted, meaning that there are different degrees of spontaneous rupture of the perineum between semi fowler position on primiparous and multiparous maternal.

experienced by the mother feels heavier and increasingly lose concentration when meneran so there rupture perineum. If the uncomfortable feelings such as stress can be removed then the delivery process can be perceived as a process that is happy and proud that the concentration of mother to meneran increased. This can lead to increased concentration of the birthing process becomes more secure, comfortable and smooth so as to minimize the perineal tears (Desinta, 2008). Based on research conducted by Roslena (2013) that there is a relationship between the position of parturition with spontaneous perineal rupture in normal childbirth at Mother and Child Hospital in Banda Aceh. Research data in table 4.2 in accordance with the results of Fika and Farida (2008) about the level of parity relationship with the occurrence of spontaneous perineal rupture in Puskesmas Mergangsan is very low. So that the results obtained are of 186 primiparous birth mothers who experienced a rupture which is the highest degree perineal ruptures II as much as 66.67%, ruptured perineum level I as much as 18.82%, third degree perineal rupture is 1.61% and there is a fourth-degree perineal rupture ie as much as 0.53%, so as much as 87.63% of maternal primiparous experienced spontaneous rupture perineum. The research results are compared with theory and previous research found that the equation of> 85% maternal primiparous experienced spontaneous rupture perineum, and most of the largest spontaneous rupture perineum II grade. The high incidence of rupture of the perineum in primiparous due to unpreparedness mother in the face of labor due to lack of information from the midwife and the preparation in the face of labor. Various things can be done to prevent rupture of the perineum that is done from the moment the pregnancy process by teaching and motivating mothers to pregnancy exercise and massage the perineum so that mothers

Discussion 1. Rupture of the perineum primiparous Maternal with Semi Fowler Position Table 1.2 explained that the results of the degree of perineum rupture on maternal with semi fowler position on primipara maternal is mostly primipara maternal with semi fowler position ruptured perineum grade II as many as 9 respondents. According to Liu (2008) 85% of first births always accompanied perineal tears. Perineal tears relationship with parity is due to soft tissue damage. Damage to the birth canal is usually more pronounced in women because the network on primipara denser and more resistant than multiparous women. On delivery will take place emphasis on soft birth canal by the head of the fetus. With intact perineum in primi will easily occur perineal tears, because the perineum in some women less able to withstand the strain during childbirth (Bobak, 2005). To avoid severe rupture in particular by leading the delivery properly, preferably semi fowler position or lying on his side (Winkjosastro,2005). In terms of psychological, primiparous birth mothers tend to feel anxious, afraid, worried in the face of the delivery process. Uncomfortable feelings such as stress can make the pain 798

feel more relaxed and perineal muscles to be flexible during the delivery process takes place, so that communication on maternal more easy because it has been trained. Moreover, the competence of midwives in attending births less in accordance with the standards of a normal delivery care (APN) that is set so that the midwife must improve their competence in attending births with a lot of practice and learn from what is obtained from friends midwife who has done childbirth assistance in accordance with the standard APN. Midwife should respond when an episiotomy is done on maternal multiparous so as not to rupture perineum III grade, so that the capital cost of labor becomes more efficient. In observations conducted by researchers that when there is rupture of the perineum to grade III midwife who perform perineal suturing whereas in theory mentioned midwife does not have the authority to suturing grade III. Supposedly the event of rupture of the perineum to grade III should be referred to the hospital and treated by a physician. 2. Rupture of the Perineum Multipara Maternal with semi Fowler Position Based on the results of research conducted on 15 respondents who use the multiparous maternal with semi fowler position showed that the majority of maternal multiparous not ruptured perineum 46.67% (7), and only 6.66% (1) who have rupture of perineum grade III. It can be concluded that the amount of maternity multiparous ruptured perineum using semi fowler position is quite high, as much as 53.33%. According Bobak (2005) perineal rupture occurs in less than multiparous primiparous. Parity can affect spontaneous perineal rupture due to the network structure of the perineal area on different multiparas elasticity. Rupture of the perineum always happen and often repeated in the next delivery (Sarwono, 2005). According Yuliatun (2009) Another cause is the state of the pelvic floor muscles are more elastic

than primiparous multiparous so that the incidence of perineal tears is more common in primipara. It is supported by the results of research Fika and Farida (2008) about the level of parity relationship with the occurrence of spontaneous perineal rupture in Mergangsan health centers showed that of the 395 respondents mostly multiparous maternal not ruptured perineum as many as 82.07% (119 people), and there is a third degree perineal rupture as much as 25% (1). Another study of Lisa (2008) the support that number of maternal multiparous many as 161 people are 91 people who suffered a ruptured perineum (56.5%) were most also experienced a rupture grade I-II as many as 70 people (43.5%) and who do not have rupture of 70 people(43.5%). There are similarities between the studies that have been done with the theory and previous studies showed that the majority of maternal multiparous not ruptured perineum due to maternal multiparous own experience of giving birth so that the state of the pelvic floor muscles in multiparas more elastic than primiparous. Maternal Multiparous majority being a housewife to do daily activities such as mopping the floor with a squat position, and taking care of their children so that the state of the perineum is more elastic. But on maternal multiparous there is still a ruptured perineum grade III due to the possibility of other factors, namely: the state of the perineum, fetal weight, distance delivery with the last pregnancy, and sometimes uncooperative patient during childbirth because the leadership feel the pain of contractions. So not only on maternal primiparous but also on maternal multiparous by way of a midwife and information given on the preparation in the face of labor semi fowler Position. 3. Effectiveness Against Spontaneous Perineum Rupture On Primiparity and Multipara Maternal Based on the table above 4.3 on a ruptured perineum on primiparous and

799

multiparous maternal using semi fowler position is on maternity primipara who experienced spontaneous rupture perineum as much as 93.33%. Most ruptured perineum grade II by 60% (9), and maternity primiparous who ruptured perineum grade III that is as much as 20% (3). While on maternal multiparous who experienced spontaneous perineum rupture as much as 53.33%. Most did not rupture perineum as many as 46.67% (7), and there are mothers who have perineum rupture grade III by 20% (3). From the results of research and data analysis by Wilcoxon Mann Whitney Utest with α: 0.05 Utest obtained value (47.5) is smaller Utabel (56), thus H0 is rejected, which means that there are differences in the degree of spontaneous perineal rupture in maternal primiparous and multiparous. According Bobak (2005) incidence greater degree apparent rupture occurred in primiparous because it has not been passed by the baby, still intact perineum, vulva closed, pervoratus hymen, vagina narrow with ruggae so that the muscles of the perineum has not stretch. Factors that affect risk rupture of perineum spontaneous namely parity effect on the elasticity of the perineum so that the more the number of parity increasingly elastic as well perineum her, the size of the fetus / infant, relief / management of delivery includes an error in holding the perineum, the way strain maternal and labor positions are wrong, and the last factor is malpresentation and malposition of the fetus that is the location of latitude or breech (Handerson, 2006). Another cause is the state of the pelvic floor muscles are more elastic than primiparous multiparous so that the incidence of perineal tears are more prevalent in primigravida. At the time of delivery speed led the birth of the baby's head should be controlled because of the birth of the head that can cause sudden severe laceration to the anal sphincter (Yuliatun 2009). The birth canal to be flexible in women who exercise. Outdoor sports is recommended because it can flex the

birth canal and the surrounding muscles (Simkin, 2008). Kegel exercises are performed during pregnancy has the advantage that it can make the elasticity of the perineum (Nursalam, 2010). According to research by Tuty Octaviany (2010) that the weakness of semi fowler position in strain is this position lead to fatigue and stiffness in the back, especially when prolonged labor process. The results of the analysis of statistical tests performed by Heny, et al (2008) showed no difference in the degree of rupture of perineum at delivery who use semi fowler position or another position. Based on research conducted Suwarni Lis (2004) showed in primiparous likely to rupture perineum almost doubling of incidence in this study multipara. The result according to research conducted Purwati, et al (2011) about the relationship of maternal age, parity, and head circumference the incidence of rupture of the perineum in hospitals Banjarnegara which suggests that there is a significant relationship between parity with rupture of the perineum.The results of this study are also consistent with studies conducted by Dian Lestari in May 2004 on the scientific work entitled "Factors Factors That Cause Rupture of perineum at Normal Delivery". At found as many as 78% of ruptured perineum while in multiparous who have never given birth more than once found a 52% rupture of the perineum. There are similarities between research, theory, and past research on the degree of spontaneous perineal rupture in maternal primiparous and multiparous is on maternity primiparous perineum rupture incidence greater than in maternal multiparous. From these results parity has an important role in the incidence of ruptured perineum, but not only parity of other factors also affect the rupture of the perineum as a large baby, how to wrong strain , delivery is fast, cooperation between mother and helper were not good, and competence owned midwife in making aid delivery in accordance with the standard APN.

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In Pregnancy Pregnancy Trimester III Against the perineum tear Mrs. Kala Inpartu I In BPS Sumberpucung Regional Health Center. Accessed on June 27, 2014 Liu, D. 2008. Manual Labor (Labour Ward Manual) Edition 3. Jakarta: EGC Manuaba, et al. 2008. Intensive-Emergency Obstetri- Gynecology & Obstetrics Gynecology Midwife Social Professions. Jakarta: EGC Mardialis. 2010. Methods An Approach Proposal. Jakarta: Earth Literacy Notoadmodjo, Soekidjo. 2010. Health Research Methodology. Jakarta: Rineka Image Oxorn, et al. 2010. Obstetrics Pathology and Physiology of Labor. Jakarta: Andi Offset Adriana, Eva. 2011. Relationship Parity With the incidence of rupture perineum In Vk dr Ansari Banjarmasin. Banjarmasin accessed on 2 June 2014 Purwanti, Sri et al. 2011. KTI Relationship Between Age, Parity, Circle Head With perineum rupture incidence Banjarnegara In Hospital. (www. Scribd.com) accessed on June 27, 2014 Raybum, W. 2003. Obstetrics & Gynecology. Jakarta: Widya Medika Rukiyah, et al. Midwifery Care II Delivery 2009. Revised Edition. Jakarta: EGC Science, Blackwell. 2005. Handbook of Labor. Jakarta: EGC Setiawan, et al. 2010. Midwifery Research Methodology. Jakarta: Nuha Medika Simkin, Penny. 2005. Handbook of Labor. Jakarta: EGC Sugiyono. 2010. Statistics For Research. Bandung: Alfabeta Sumarah, et al. 2009. Community Midwifery. Jakarta: EGC Suririnah. 2008. Book Smart Pregnancy & Childbirth. Jakarta: Gramedia Pustaka Utama Varney, H. 2007. Textbook of Midwifery Care volume 1. Jakarta: EGC Wiknjosastro, H. 2007. Surgery Obstetrics. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo Wiknjosastro, H. 2007. Obstetrics. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo William, et al. 2007. The Baby Book,

References Ambar, Dwi. 2010. Textbook of Midwifery Care Normal Delivery. Jakarta: EGC Armi. 2006. Fundamentals of Obstetrics. Padang: Andalas University Press Asep, Saefudin, et al. 2009. Basic Statistics. Bogor: Grasindo Bobak, et al. 2005. Textbook Maternity Nursing. Jakarta: EGC Chopra, D., 2006. Medical Beginnings: A Holistic Guide Pregnancy & Birth. Bandung: Kaifa Christine, Handerson. 2006. Textbook of Obstetrics concept. Jakarta: EGC Dahlan, Sopiyudin. 2008. Statistics For Medical And Health Ed 3. Jakarta: Salemba medika East Java Provincial Health Office. 2012. Indicators of Minimum Service Standards (MSS) Health In District / City East Java Province. Surabaya: East Java Provincial Health Office. Firman, et al. 2010. Obstetrics Physiology Science Ed 2. Jakarta: EGC Frasher, Diane. 2011. Textbook Midwives Ed Myles 14. Jakarta: EGC Hacker, N. 2004. Essential Obstetrics and Gynecology Ed 2. Jakarta: Hippocrates Hakimi, M. 2003. Physiology and Pathology of Labor. Jakarta: Yayasan Medika Esentia Handerson, C. 2006. Mayes Midwifery A Text Book For Midwife Thirthteenth Edition. London: Bailliere Tindall Heny, et al. 2008. Medical Journal Vol 6 No 1: Effect of Position Mom In Labor Against the perineum Trauma In Regional Maternity Hospital Malang. Hapless National Network of Clinical Training-RH. Reference Books, 2008. Normal Delivery Care: Essential Care, Prevention and Mitigation Immediate Complications of Childbirth and the Newborn. Jakarta: Ministry of Health of the Republic of Indonesia Johnson, R. 2005. Textbook of Midwifery Practice. Jakarta: EGC Jones, Barlett. 2004. Anatomy And Physiology For Beginners. Jakarta: EGC Licha, Firha. KTI 2009. Effect of Exercise

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Everything You Need To Know About Your Baby From Birth To Age Two. Jakarta: Porch Sciences of the Universe. Williams, Lippincott. 2005 Nursing Mother-Newborn Ed 3. Jakarta: EGC. ________________. 2005. Learning Guide: Nursing Mother-Newborn. Jakarta: EGC. Yessie, Aprilia. 2010. Hipnosentri: Relaxed, Comfortable, And Safe During Pregnancy and Childbirth. Jakarta: Gagas Media. Yuliatun, Laili. 2008. Pain Treatment Delivery Method Non Pharmacology. Malang: Bayumedia Publishing

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(REPRODUCTIVE HEALTH COUNSELING THERAPHY TOWARDS SEXUAL ATTITUDES OF ADOLESCENT AT PGRI TALUN HIGHSCHOOL BLITAR) Levi Tina Sari Program Studi D3 Kebidanan STIKes Patria Husada Blitar [email protected] Abstract The nature of teenagers who always want to find out new things, especially about sex will lead to a negative attitude if not accompanied by a good knowledge and from the right source, maturity for adolescents is psycho social even more severe, if the attitude toward casual sex less it will open opportunities for premarital sex or sex also called free (free sex), abortion, sexually transmitted diseases purpose of this study was to determine the influence of reproductive health counseling on adolescent sexual attitudes. The study design used was quasi experiment, the pretest and posttest design with non-equivalent group. The total sample of 58 respondents were given treatment KRR counseling. Univariate analysis with frequency distribution and bivariate to know the differences with the Mann-Whitney test. The results showed that before treatment is given as much as 55.2% do not have an attitude of support, but after being given treatment proved that 53.4% had a supportive attitude. Mann-Whitney test result adolescent reproductive health counseling effect on the attitude of a teenager with a p-value of 0.0005. Adolescent reproductive health counseling influence the change in attitude conducive to not have sex outside of marriage. Therefore, it is expected that the school always gives guidance and counseling KRR routinely in high school. Keywords: reproductive health counseling, sexual attitudes, adolescent

2010, the number of Indonesian teenagers aged 10-24 years about 67 million or 29% of the total population (BPS, 2013). The number of teenagers that nearly a third of the population of Indonesia is capital to create the next generation of quality that is needed to build a nation Currently, reproductive health remains a public health problem in Indonesia is quite large scale. It can be seen from the data and facts on some components of reproductive health, which is a matter of reproductive health in adolescents. Adolescent reproductive health problems in addition to the physical impact, can also affect the mental and emotional state of the economy and social welfare in the long term. The long-term impact not only affect the teens themselves, but also on families, communities and nations in the future. Adolecents, there are accelerated adult positively and

INTRODUCTION Reproductive health received special attention globally since he raised the issue at the International Conference on Population and Reproductive health received special attention globally since he raised the issue at the International Conference on Population and Development at Cairo UEA since 1994. Indonesia agreed definition of reproductive health since 1996 which is a state of complete physical, mental and social as a whole, not merely free of disease or infirmity in all matters relating to the reproductive system and its functions and processes (BKKBN,2005). According to the World Health Organization (WHO) is a teenage male or female population aged 10-19 years (BKKBN, 2005; UNHCR, 2012). The current composition of the juvenile population in the world reached around 1.3 billion (UNFPA, 2009). Based on the results of the population census of 802

negatively. Adolescents who experienced a accelerated maturation and mature in a positive way that is adolescent who say young age but has a pattern of thought and positively behavior as adults. Whereas adolescents are experienced a accelerated maturation negatively that is adolescent who are still said to be a young age, but the mindset has been like an adult but has the mindset and negative behavior. This is followed by the media revolution is open to the diversity of lifestyles and career choices. These developments resulted in increased vulnerability of adolescents to various diseases, especially related to sexual and reproductive health, including the growing threat of HIV / AIDS due to sexual behavior. (Suryoputro et al., 2006). Many teenagers consider fair sex behavior that appear vulgar and flare, this indicates that quite a lot of irregularities sexual behavior among adolescents (Tauhid, 2005). Psychosocial maturity for adolescents is even more severe, if less knowledge of sex education will open up opportunities for premarital sex or sex is also called the free (free sex), abortion, sexually transmitted diseases. Children's knowledge about sex education generally obtained from people who are older or from friends of the same age with dirty jokes, often resulting in incorrect assumptions or negative emotions (Syamsu, 2002). Adolescent Reproductive Health Survey Indonesia (SKKRI, 2007), stating adolescents aged 15-24 years of knowledge about reproductive health is still low, 21% of girls do not know at all the changes that occur in boys during puberty. Adolescents knowledge of the fertile period is still relatively low. Only 29% of women and 32% of men gave the correct answer is that a woman has a great chance of becoming pregnant in the middle of the menstrual period cycle. As a result of not obtaining reproductive health information from the right source can be bad. The problem that arising today

among adolescents they are at risk for a number of reproductive health and social issues, namely delinquency, unemployment, premarital sexual behavior, Napzah and HIV / AIDS. One method to influence the attitude of Adolescents reproductive health in order to achieve an optimal manner counseling. This method by directing counselees to understand and face the real life situations that can make a decision based on that understanding to the happiness of his life. The purpose and goal of counseling is to provide conditions that facilitate the change voluntarily. Therefore, the young people can have a good knowledge about HIV / AIDS and can have a good attitude and positive behavior to avoid early marriage, drugs and HIV / AIDS. METHODS The design used in this study is a quasi experiment with using pretest and posttest design with non-equivalent group. Counseling therapy conducted at PGRI High school Talun Blitar. Counseling performed a total of once only conducted for 12 days, every day counseling as much as 5 students / student. Sampling technique in this research used a totally sampling. The collection of data using questionary attitude where to see how much the attitude of the respondents in adolescent reproductive health. Overall research in the form of multiple choice questionnaires and questionnaires that are directly carried out by the respondent. The data analysis research, to univariate uses a unique frequency distribution and bivariate know the difference between pre and post using Mann-Whitney. RESULTS AND ANALYSIS The results obtained by adolescent sexual attitudes in the experimental group between pretest and posttest there was significant changes compared to the comparison group. From the results of the experimental

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group pretest, the attitude of the respondents who have an attitude in favor of just 44.8%, after getting counseling be 53.40%. For more seen in the table below : Table 1. Results of numerical characteristics of the respondents in PGRI High school Talun Blitar No. 1.

2.

3.

4.

5.

characteristics respondents Gender a. Man b. Female Age a. 16 years b. 17 years c. 18 years Ever get information about adolescent reproductive health: a. Yes b. No If so, the information can adolescent reproductive health at first from : a. Health workers b. Magazine c. Electronic media d. Friends Haved date : a. Yes b. No

Amount

(%)

27 33

45 55

4 31 25

25 52 42

57

95

3

5

28

47

0 9 20

0 15 33

52 8

87 13

The control group a. Doesn‟t support b. Support

The experimental group a. Doesn‟t support b. Support

Preete st ∑ %

Posttes t ∑ %

3 8 2 2

2 7 3 3

6 3 3 7

6 5 3 5

3 9 2 1

6 5 3 5

It is known from the above table that the experimental group after being supportive counseling for sexual behavior by 33 respondents , whereas there was no change it in the comparison group. Analyzed data were using Mann- Whitney Test showed that adolescent reproductive health counseling effect on adolescent sexual attitudes with p-value 0.0005. Counseling with face to face activities, conducted intentionally , involves two parties , namely are conselor and counselees. Counselors are those who help and those who assisted counselee is aimed at enlightening the counselee to better understand himself he himself, knowing the situation, look at the various alternatives to solve the problem and decide his choice (Akhmadi, 2013). Therefore, counseling on reproductive health carried out can shape the attitudes of the students. The focus of counseling is to help an individual or group of individuals to achieve goals intrapersonal and interpersonal, overcome personal shortcomings and difficulties of development, making decisions and planning for change and development, and improve physical and mental health and happiness achieve collective happiness. Attitude is a feeling of support or partiality (positive) or less support or impartiality (negative) on a specific object. An attitude of readiness to react to an object in a certain way, it can be said that readiness is a potential tendency to react or act only when individuals are exposed to a stimulus that calls for a response. From the research it is evident that most of the students are already getting information about reproductive health from health officials, the

Table 2. Numerical results pretest posttest sexual behavior of adolescent who get counseling and get counseling adolescent reproductive health PGRI High School Talun Blitar

Variable

3 9 2 1

4 5 5 5

804

electronic media and friends before being given counseling. Thus, therapy can be solidified counseling a person to be supportive attitude some positive things in sex and drugs.

Implikasinya terhadap Kebijakan dan Layanan Kesehatan Seksual dan Reproduksi. Jurnal Makara, Kesehatan, Vol.10, No. 1: pp 2940. UNFPA. (2009). Adolescent Sexual and Reproduktive Health Toolkit For Humanitarian Settings: A Companion to The Interagency Field Manual on Reproductive Health in Humanitarian Setting.

CONCLUSION The formation of new behavior began in the cognitive domain, where the subject knew beforehand the stimulus in the form of material giving rise to new knowledge on the subject and subsequently cause a response in the form of inner attitude and pose a further response in the form of action related to a particular object.

UNHCR, UNFPA. (2012). Women‟s Refugee Commission, Save the Children: Adolescent Sexual and Reproductive Health Programs in Humanitarian Settings.

ACKNOWLEGEMENT Research on the effect of counseling on adolescent sexual attitudes, there are some drawbacks which time only one month of research, counseling therapy is given only once face to face, this is because when the students constrained midterms. It is hoped further research may provide therapeutic counseling face-to-face at least 5 times so that the attitude of teenagers obtained can be maximized REFFERENCES Ahmad & Mubiar. (2013). Dinamika Perkembangan Anak dan Remaja: Tinjauan Psikologi Pendidikan dan Bimbingan. Bandung: Refika aditama. BKKBN. (2005). Remaja dan Kesehatan Reproduksi. Jakarta : BKKBN. BPS, BKKBN, & Kemenkes. 2013. Survei Demografi dan Kesehatan Indonesia 2012 Kesehatan Reproduksi Remaja. Jakarta. Suryoputro, A., Ford, J. Nicholas., & Shaluhiyah. (2006). Faktor-Faktor yang Mempengaruhi Perilaku seksual Remaja di Jawa Tengah:

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THE CORRELATION OF EMOTIONAL INTELEGENCY WITH THE MOTIVATION OF CLINICAL PRACTICE RESULT IN STIKES PATRIA HUSADA BLITAR MARIA ULFA Program Studi D3 Kebidanan STIKes PATRIA HUSADA BLITAR email: [email protected]

ABSTRACT The result of clinical practice is the scoring of any medical action which is done by the student during the clinical practice session. Midwivery academy is academy which used 40% theoritical and 60% practice in the lesson. Factors determine the result of the study is affected by intrinsic and extrinsic factor; emotional quotient and motivation.The objective of was this study is to investigate correlation of Emotional Quotient and Motivation with the Student Result of Clinical Practice in Asuhan Kebidanan III STIKes Patria Husada Blitar. This study was observational analitic using cross-sectional approach. The sampel was 36 3rd grade students in D III midwivery on STIKes Patria Husada Blitar, using exhaustive sampling. The dependent variable was the students result of clinical practice in asuhan kebidanan III, while the independent variables was emotional quotient and motivation. The data was collected using two closed questionnaires which has been pretested for validity and reliability. The total item correlations were > 0,20 and Cronbach Alpha > 0,60. The data was analyzed using multiple linear regression model. This study showed that there was a positive relation between the Student Result of Clinical Practice in Asuhan Kebidanan III and Emotional Quotient (b = 0,27; p = 0,010), and motivation (b = 0,69; p = 0,001). Emotional Quotient and motivation variables was able to explained 88,7 % of the variation in Student Result of Clinical Practice in Asuhan Kebidanan III ( R2 = 0, 887; p < 0,001). The conclusion of the research showed that there was a relation between emotional quotient and motivation with the student result of clinical practice in asuhan kebidanan III. Emotional quotient and motivation can increase student result of clinical practice in asuhan kebidanan III Keywords: Emotional Quotient, motivation, Student Result practice . Clinical practice is a form of real experience for students to learn how to interact with clients . Because clients come from a variety of ethnic, religious and social status , it requires attention and sooth ourselves . Learning outcomes are the results that have been obtained by students from the experiences and practices are followed during learning in the form of cognitive , affective , and psychomotor(Dimyati, 2006).

INTRODUCTION An academy of midwifery education institutions that use the learning method with 40 % theory and 60 % practice , so as to determine the success of the learning process is not only of value theory but also visits of skill or clinical practice midwifery care given(Depkes RI, 2006). Once the student has passed the learning in the classroom , the student is ready to be deployed on land practices for implementing clinical 816

From the acquisition of learning outcomes in clinical practice STIKes Husada Patria Blitar last 2 years has decreased Acquisition value III clinical practice of midwifery care in D III Midwifery courses begin the academic year 2007/2008 to 2009/2010 academic year , which demonstrated the value tends to decrease. Some efforts have been made by the institutions in an effort to improve learning outcomes from the implementation of the lab skills on each - each Prasat obstetrics , test each Prasat any rate increases , debriefing before the students went to the practice field , the results are still not changed. In midwifery education , emotional intelligence needed to prepare midwifery students in the world of work in which a midwife should have the ability to motivate and empathy toward others because of the midwifery profession is closely in contact with the public, especially women. Given the emotional intelligence , there is the ability to motivate , midwifery education in itself , serves as the driving motivation of the achievement of a student achievement obstetrics. Motivation can determine whether or not the goals that the greater the motivation will be even greater learning success . Someone who is a big motivation will be enterprising , persistent seem unwilling to give up , keen to read books to improve his performance to solve the problem . Instead they yamg motivation is weak , seemed indifferent , easily discouraged , his attention is not focused on the lesson , like disturbing the class , often leaving lessons will decline as a result of student achievement . If this is not observed , not helped , the student will fail in learning . Therefore, the teacher

as the person who membelajarkan students , should be concerned with the problem of this motivation . Teachers must be willing and able to motivate students who are low learning motivation , and increase the motivation of students who already have motivation (Friedman, 2004 : 112). The dividing line between emotion and motivation is very thin . For example, fear ( fear) is emotion , but also a motive driving behavior. Because when people are afraid that people will be encouraged to behave towards a specific goal (goal -directed ) . We are goal -directed behavior is colored by emotion . Tomkins argued that the emotions it raises the energy for motivation . Further stated that the motive or impulse ( drive ) only provide information about temporary needs . For example impulse tells us that food was needed , as well as water and so on (Walgito, 2004 : 55). Through a preliminary study conducted, the results of interviews on some privately practicing midwives who had been a mentor practice student midwifery STIKes Patria Husada Blitar obtained information that some students praktikan less able to provide health counseling persuasive to patients and have less desire to skillfully perform the target - target of their competence, other than that they are also less sensitive to the feelings of patients and they are less able to socialize with people around practice. From this information, it can be concluded that the majority of midwifery student lacks the ability to motivate, empathy and the ability to build social relationships well. Whereas those three things are the most important thing that must be owned by a student midwife midwifery as a candidate, because they will be the

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health care community, especially women. Ability to motivate, to empathize and build social relationships with both form part of emotional intelligence in addition to the ability to recognize and control emotions. While the scope of the lecture itself, much needed motivation to learn that can be caused by emotional intelligence of each - each student. As expressed by Walgito (2004: 55), that the emotions it creates energy for motivation. And are associated with impulse (drive) is emotion, which creates energy for the boost, so that the motivational power. In regard to the importance of emotional intelligence and motivation to learn in order to improve the learning outcomes of clinical practice and have never done the research on pragram studies D III Midwifery STIKes Patria Husada Blitar , the authors interested in studying " The relationship of emotional intelligence and motivation with the learning outcomes of clinical practice midwifery care III students D III STIKes Husada Patria Blitar ".

and Cronbach alpha > 0.60 ie 0.94 as many as 24 items . The items - items that drop is number 2. The trial for the 20 items of the questionnaire motivation , otherwise qualified reliability which the total item correlation > 0.20 and Cronbach alpha > 0.60 ie 0.93 as many as 19 items . The items - items that drop is number 9. Table 4.1 Reliability Test Results

B. Description of Research Subjects Table 1 Distribution Frequency characteristics of the respondents

METHODS This study is observational analytic cross sectional (cross - sectional ) . This research carried out in d III Midwifery Program STIKes Husada Patria Blitar in February 2012. The sample consisted of 36 students of level III D III Midwifery Studies Program STIKes Husada Patria Blitar using exhaustive sampling . The instrument used was a questionnaire

Characteristics of the sample (data ) on Penalitian relationship of emotional intelligence and motivation to learn the results of midwifery care III clinical practice midwifery students STIKes Husada Patria Blitar in table 2 below : Table 2 Table sample characteristics ( continuous data )

RESULT AND ANALYSIS A. Reliability Test Results Based on trial results for the 25 items of the questionnaire of emotional intelligence , otherwise qualified reliability where correlations > 0.20

Based on research data in Table 4.3 shows that the average emotional intelligence , motivation and learning outcomes respectively ( 85.75 ) , ( 74.34 ) , ( 78.14 ) .

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C. Hypothesis Testing 1. Frequency Distribution From Table 3 showed that emotional intelligence has a significant correlation with learning outcomes . It also occurred in the motivation that has signifika correlation with learning outcomes . Figure 4 presents a scatter diagram and the regression line on the relationship of emotional intelligence Figure 1 shows that of the 36 subjects , the average value ( mean) 85.75.

Figure 4 shows there is a positive correlation between emotional intelligence and learning results of clinical practice . Students of high emotional intelligence tend to get better learning results .

Figure 2 shows that of the 36 subjects , the average value ( mean) 74.39 .

Figure 3 shows that of the 36 subjects , the average value ( mean) 78.14 .

Figure 5 shows there is a positive correlation between motivation and learning outcomes of clinical practice . Students who have high motivation tend to get better learning results .

1. Analysis Bivariat Table 3 Correlation emotional intelligence and motivation with learning outcomes

2. Analysis Multivariat

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Results of the study the relationship of emotional intelligence and motivation to learn the results of midwifery care III clinical practice midwifery students STIKes Patria Blitar Husada described in Table 4. Table 4 Results of multiple linear regression analysis on emotional intelligence and motivation with learning outcomes

model is statistically significant (p <0.001). 2. 1.

Table 4 shows the results of multiple linear regression analysis linking the value of the learning outcomes of clinical practice with emotional intelligence and motivation. The analysis showed every 1 point increase emotional intelligence scores 0.27 points scores will improve learning outcomes. In other words every increase of 10 points score of emotional intelligence will improve learning outcomes 2.7 points on a scale of 100. This shows that there is a positive relationship and statistically significant on emotional intelligence by learning outcomes (b = 0.27; p = 0.010). The analysis showed every 1 point increase motivation score will improve learning outcomes scores 0.69 points. In other words every increase of 10 points score of motivation will improve learning outcomes 6.9 points on a scale of 100. It shows there is a positive relationship and statistically significant motivation to learning outcomes (b = 0.69; p = <0.001). Variable emotional intelligence and motivation to learn is able to explain the variations in learning outcomes of 88.7 percent (R2 = 0, 887). The overall

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ANALYSIS Emotional intelligence with learning outcomes clinical practice midwifery The results are consistent with research Goleman (2009), that emotional intelligence influence on student success in learning. According to Table 4.5, each 1 point increase emotional intelligence scores 0.27 points scores will improve learning outcomes. In other words every increase of 10 points score of emotional intelligence will improve learning outcomes 2.7 points on a scale of 100. This shows that there is a positive relationship and statistically significant on emotional intelligence by learning outcomes (b = 0.27; p = 0.010). Learning outcomes will be obtained not only pay attention to intellectual intelligence of students, but also their emotional intelligence. Intellectual intelligence alone does not give the preparation the students to face the turbulence, opportunities or difficulties difficulties in implementing clinical practice. With emotional intelligence, the individual is able to know and respond to their own feeling well and able to read, the face of feelings - feelings of others effectively. Students with welldeveloped emotional intelligence, can effectively appreciate the value of the object - faced through the expression of feelings and can express it appropriately. Students will also be able to solve the problem - the problem that occurred in the area of clinical practice. For example, a student suffered severe anger or depression will still be able to get up and feel happy, if it has the form of the current

compensation - when happy (Goleman, 2009). Emotional intelligence and are able to recognize themselves and academic social environment will affect the learning outcomes to be obtained. This is consistent with a report from the National Center for Clinical Infant Programs (1992) stated that success in school is not predicted by a collection of facts a student or her ability to read, but by the size - the size of the emotional and social themselves have an interest, know the behavior which is expected of others and how to control impulses to do bad, is able to wait, follow the instructions and referring to the teacher for help and expressing needs - needs while hanging out with friends (Goleman, 2009). Research that is consistent about the relationship between emotional intelligence with the results of this study has been carried out by Amalia SW (2004), entitled "Relationship between Emotional Intelligence with Achievement at a second grade student SMU lab school in East Jakarta" found no relationship low between emotional intelligence and achievement the study (r = 0.25). Based on the results of research conducted by Qurniyawati (2009) entitled "Emotional Intelligence Relationship with Student Learning Achievement in Program D IV Midwifery Strip FK UNS Regular School Year 2008/2009", there is a significant relationship with the positive direction between emotional intelligence and learning achievement (p <0.05). Results - the results showed that children - children who are trained in the early childhood emotions - a child will be able to develop the ability of social kertampilan future, these skills can help them in their interaction with

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their surroundings. In reaching a feat, in students one of which is also affected by emotional disorders. Feelings of anxiety, anger, or depression have difficulty learning, people - people who are stuck in a state - this state also encountered difficulties with information efficiently absorb or mitigate them properly. In this sense of emotional intelligence is the primary skill, ability which deeply affects all other abilities, either facilitate or inhibit the ability - the ability (Goleman, 2009). 2. Learning Motivation And Learning Outcomes Of Clinical Practice Midwifery Motivation can essentially help in understanding and explaining the behavior of individuals, including the behavior of individuals who are learning (Uno, 2011). The statement was supported by the results of this study. According to Table 4.5 each increase of 1 point score of motivation will improve learning outcomes scores 0.69 points. In other words every increase of 10 points score of motivation will improve learning outcomes 6.9 points on a scale of 100. It shows there is a relationship posirif and statistically significant motivation to learning outcomes (b = 0.69; p = <0.001). From the results above, it can be explained the relationship between motivation to learn the results of clinical practice because motivation is a powerful incentive for individuals or students conducting clinical practice. The urge to learn, then the potential will obtain better results (Sardiman, 2007). A person who entered the field of health education when coupled with high motivation will display high spirit and always prioritize its activities to

kepetingan learn so as to obtain optimal results or achievements. This is in line with what was said Sardiman (2007) that students with a strong motivation will have more energy for learning activities. Otherwise lack motivation or low then there is no or less zeal in learning activities so that the results obtained are less than the maximum. Lack of motivation can be grown in various ways such as giving replay, adding value and giving feedback (feedback), created competition, reward (reward) or punishment (punishment). Line research on the relationship between motivation and outcome of this study has been conducted by Dedi I (2006), entitled "Relationship Motivation and Achievement in Madrasah Aliyah Sukarame Tasikmalaya" relationship was found (r = 0.50). Based on the results of research conducted Nabhani (2007), entitled "Relationship Between Interest and Motivation to Learning Achievement in Students of Nursing Academy PKU Muhammadiyah Surakarta Year 2007", also stated there was a significant relationship with the positive direction between motivation and academic achievement (r = 0.56). The role of positive motivation-a collection of enthusiasm, passion and confidence in achieving the feat. Motivation is the impulse contained within him and comes from outside themselves, and urge the cause, directing, and organizing behavior to do a job. People - people who are used to motivate themselves tend to be more productive and effective every mngerjakan any (Goleman, 2009). 3. Emotional intelligence and learning motivation and learning

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outcomes of clinical practice midwifery Emotional intelligence and motivation to learn simultaneously positively and significantly related to the learning outcomes of clinical practice midwifery care. Together - the same emotional intelligence and motivation to learn is able to explain the variations in learning outcomes of clinical practice midwifery. Based on the multiple linear regression statistical calculation results of the variables emotional intelligence and motivation are able to explain variations in learning achievement of 88.7% (R2 = 0, 887; p <0.001). From the results it can be said that there are emotional intelligence and motivation to learn to relate to the competence of clinical practice midwifery care. Thus the simultaneous variables emotional intelligence and motivation to learn can explain the learning outcomes of clinical practice midwifery care. Results of this study supported previous research conducted by the research of Saifuddin Z (2010) with the title "The relationship between interest, motivation and emotional intelligence with learning achievement in Student Prodi D III Physiotherapy Polytechnic mentioned that Surakarta" the relationship between the interest, motivation and emotional intelligence with student achievement, then the interest, motivation and emotional intelligence highly supportive learning achievement. It can be concluded that there is a weak correlation between interest and learning achievement (r = 0:17, ρ = 0.184). moderate correlation between motivation and learning achievement (r = 0:34, ρ = 0.008). There is a moderate correlation between emotional intelligence and

learning achievement (r = 0491, ρ = 0.000). In international research Arockiam L and Selvaraj C. (2011) A Study on the relationship between emotional quotient and Recollection and retention in e-learning provides the results of emotion and motivation is the most significant driving force behind the maximum results for students to move in a certain direction. Students who do not have the motivation to learn and the level of the relatively immature emotional intelligence might be inclined to see the results of clinical practice is negative, due to the success in this environment requires a greater degree of self-discipline, independent business, maturity, time management skills, and a positive attitude , Given the research linking emotional intelligence and motivation in clinical practice with intrinsic personal characteristics such as self-discipline, self-direction, and maturity, as well as extrinsic motivator, it becomes more important to change the power of thought which demands extra cognitive, emotional, and physical resources. Skills in this practice requires a strong sense, self-awareness and personal understanding. It also requires good problem solving, skills and confidence firm to conduct a follow up to the task. A study of the concept of emotional intelligence showed that characteristics such as self-perception, maturity, and selfactualization will motivate the forces that led to the students involved and academic success and get the appropriate assessment. CONCLUSION Based on the analysis and discussion that has been stated in the previous chapter, it can be concluded as follows:

1. There is a positive relationship and a statistically significant correlation between emotional intelligence and learning results of clinical practice midwifery (b = 0.27; p = 0.010) 2. There is a positive relationship and statistically significant between motivation and learning outcomes of clinical practice midwifery (b = 0.69; p = 0.001) 3. Variable emotional intelligence and motivation are able to explain variations in learning achievement of 88.7% (R2 = 0, 887; p <0.001). SUGGESTION 1. For Education To manage emotional intelligence in order to improve the motivation of learners, to carry out tests of emotional intelligence and motivation to determine the extent of readiness of students in conducting clinical practice midwifery care. The existence of a minimum value as a condition for implementing clinical practice at the practice field. With emotional intelligence and motivation to learn are both expected outcomes of clinical practice students are also increasingly baim as the results in this study. 2. for Students To develop emotional intelligence and motivation as well as play an active role in achieving the learning outcomes of students clinical practice and develop strategies to clinical practice midwifery care.For Further Research. 3. For Further Research Expected to conduct further research on the factors influencing

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the emotional intelligence and motivation to learn because of the results of this study indicate.

. 2006. Kurikulum pendidikan diploma III kebidanan. Jakarta: Departemen Kesehatan Sardiman. 2007. Interaksi dan motivasi belajar mengajar. Jakarta: PT Raja Grafindo Perkasa Slameto. 2003. Belajar dan faktor – faktor yang mempengaruhi. Jakarta: Pt Rineka Cipta Uno H. 2011. Teori motivasi dan pengukuran. Jakarta: Bumi Aksara Winardi J. 2001. Motivasi & pemotivasian dalam manajemen. Jakarta: PT Raja Grafindo Persada Arockiam L and Selvaraj C. 2011. A Study on relationship between emotional quotient and recollection and retention in e-learning. http://www.enggjournals.com/ ijcse/doc/IJCSE11-03-12077.pdf. 27 desember 2011 Dobbins T. 2011. The relationship between emotional intelligence and attitudes toward computer-based instruction of postsecondary hospitality students. http://scholar.lib.vt.edu/ejourn als /JCTE/v26n1/behnke.html . 28 desember 2011

REFFERENCES Arikunto S. 2002. Prosedur penelitian suatu pendekatan praktek. Jakarta: Rineka Cipta Dimyati dan Mudjiono. 2006. Belajar dan pembelajaran. Jakarta: Rineka Cipta Goleman D. 2009. Emotional intelligence. Jakarta: Gramedia Pustaka Utama Hamalik O. 2011. Proses belajar mengajar. Jakarta: PT Bumi Aksara Mubayidh M. 2006. Kecerdasan dan kesehatan emosional anak. Jakarta: Pustaka Al-Kautsar Mudjiman H. 2006. Belajar mandiri (self – motivation learning) Cetakan I. Surakarta: LPP UNS dan UNS Press Murti B. 2010. Desain dan ukuran sampel untuk penelitian kuantitatif dan kualitatif di bidang kesehatan Cetakan II. Yogyakarta: Gadjah Mada University Press Purwanto N. 2007. Psikologi pendidikan. Bandung: Remaja Rosdakarya DepKes. 2005. Standar pembelajaran praktik kebidanan. Jakarta: Departemen Kesehatan

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THE EFFECTIVENESS OF WARM COMPRESSES TO THE REDUCTION OF PRIMER MENSTRUAL PAIN (DISMINOREA) IN ADOLESCENT GIRLS Laily Prima Monica STIKes Patria Husada Blitar Email : [email protected] Abstract Giving a warm compress both given during menstruation and menstrual pain experienced (disminorea) primer, helps to stretch the muscles of the uterus to contract when menstruation and blood flow. Pre - experimental research design. The population in this study was 234 girls boarding school in the village Maftahul Uluum Jatinom Kanigoro District of Blitar. The sampling technique used purposive sampling. The research was Conducted on 30 July 2015 in the Maftahul Uluum Jatinom Kanigoro District of Blitar boarding school. The statistical test used Wilcoxon Sing Rank Test and was assisted using SPSS for windows. The result showed a decrease in the percentage of menstrual pain scale (dysmenorrhoea) primer before and after being given a warm compress that pain scale was from 60% to 20%. Then, there was the increase in scale of menstrual pain (dysmenorrhoea) primer on mild pain scale that was from 33.3% to 66.7% and there was no pain on a scale from 0% to 13,3. Based on statistical test obtained Wlicoxon Signed Rank Test p value = 0.004, so the p value = 0,004 <α = 0.05, meant that there were effect of a warm compress to decrease menstrual pain (dysmenorrhoea) primer in adolescent girls. Warm compresses is one method that can reduce the pain that occurs when disminorea in adolescent girls. Keyword : Warm compress, menstrual pain (disminorea) primer. belly down before and during menstruation and often nausea hence the term dysmenorrhoea is only used if the menstrual pain so painfull, forcing the patient to rest and leave, for a few hours or a few days (Wiknjosastro, 2005). The use of warm compresses is a way to eliminate or decrease the pain that is in a non-pharmacological without side effects. Warm compresses can relieve ischemia by reducing uterine contractions and expedite blood vessels so that it can relieve pain by reducing tension, improve blood flow and reduce pelvic vasocongestion (Bobak, 2005). In epidemiological studies in the adolescent population (aged 12-17 years) in Amerikaa union, klein and Litt disminorea reported a prevalence of 59.7 percent. And those who complain of pain, 12 percent severe, 37 percent moderate and 49 percent dull pain. The study also reported that disminorea causes 14 percent of young women are often

Introduction Menstruation is the periodic bleeding of the uterus that begins about 14 days after ovulation. Mestruasi cycle is a complex sequence of events which affect each other and occur simultaneously in the endometrium, to the hypothalamus, pituitary and ovary. (Bobak. 2005). Menstruation can sometimes cause pathological risk when associated with impaired activities of daily living. At the time of menstruation, women sometimes feel pain, the nature and degree of pain varies. The condition is called dysmenorrhoea, namely the state of severe pain and can interfere with daily activities. Because this disorder is subjective, difficult to assess the weight or intensity. Although the frequency of dysmenorrhoea is quite high and the disease has long been known, until now this pathogenesis has not been solved satisfactorily. Hence almost all women experience discomfort in the

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absent from school. Conditions in Indonesia may be said 90 percent of women have experienced disminorea (Anugoro, ditto. 2011). The results of the initial survey conducted in Pondok Pesantren Putri Maftahul Uluum Ds. Jatinom district. Kanigoro Kab. Blitar based on the register for the last three months there were 8 students who break due to dysmenorrhea. The results of interviews of 10‟ boarding school students found that eight of the students experiencing abdominal pain each period and two people sometimes experience it. When two people said that how to cope with taking pain medication, five people with rest, squat, and never use eucalyptus oil. Based on the results of these interviews, researchers interested in conducting research on the effectiveness of warm compress to decrease primer menstrual pain (dysmenorrhoea). The purpose of this research was to determine the influence of a warm compress to decrease menstrual pain (dysmenorrhoea) in adolescent girls in Pondok Pesantren Putri Maftahul Uluum Ds. Jatinom district. Kanigoro Kab Blitar. The benefit research for writers was expected to increase insight and knowledge of researchers on research, especially regarding the effect of warm compresses to decrease menstrual pain (disminorea) primer adolescent girls. For midwifery services could be used as an intervention to implement midwifery care, especially for young women in an effort to reduce menstrual pain (disminorea) primer during menstruation. For educational institutions could be used as reading material for the development of science and literature especially in the field of health and was expected to become information for all those who need to support the skills and pengetahuan. For other researchers could provide information and basic data for further research on the concept of pain and the influence of warm compresses against reduction of menstrual pain (disminorea) primer.

METHOD This research used a preexperimental approach with One-group pre-post test design. The population in this study was all young women who have experienced menstruation and experienced primary menstrual pain (dysmenorrhoea) in the village Uluum Maftahul Jatinom Kanigoro Blitar boarding school .The respondents were 15 young girls. The sampling technique used purposive sampling. In this study, the instrument used a check-list as SOP and observation sheets to determine the effect of the interventions. The data collection methods used observation. This study used a statistical test Wilcoxon signed rank test with SPSS. RESULT AND ANALYSIS A. GENERAL DATA Table 1. Characteristics of respondents girls in boarding school in the village Jatinom Maftahul Uluum Kanigoro District of Blitar on 30 July to 5 August 2015 (in which n = 15). No f % Age 1 1 6,7 10-12 2 13-15 5 33,3 3 16-19 9 60 No 1 2 3

No 1 2 3 4

∑ Education

15 f

100 %

Elementary School Junior High Sc Senior High Sc

0

0

1 14

6,7 93,3

∑

15

100

Duration 1-2 days 3-4 days 5-6 days > 7 days

f 13 2 0 0 15 f 3 12 15

% 86,7 13,3 0 0 100 % 20 80 100

f 11 2 2 0

% 73,3 13,3 13,3 0

∑

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No 1 2

Information Yes Never

No 1 2 3 4

∑ Information Source Never get Midwife, Nurse Media Friend

No 1 2

∑

15

100

Analgesic Consumption Yes No

f

%

0 15 15

0 100 100

∑

No Pain 0 13,3 Dull Pain 33,3 66,7 Moderate 60 20 Pain Severe Pain 6,7 0 Very Severe 0 0 Wilcoxon signed rank test: p value = 0,004

B. SPECIFIC DATA Table 2 Distribution of the frequency of menstrual pain scale (disminorea) primary girls before being given a warm compress on the boarding school in the village Jatinom Maftahul Uluum Kanigoro District of Blitar on 30 July to 5 August 2015 (in which n = 15) No Pain Scale f % 1 No Pain 0 0 2 Dull Pain 5 33,3 3 Moderate Pain 9 60 4 Severe Pain 1 6,7 5 Very Severe 0 0 Pain ∑ 15 100

DISCUSSION Based on the results of research conducted in accordance table 4.7 in boarding school in the village Jatinom Maftahul Uluum Kanigoro District of Blitar, showed that 15 respondents got the whole (100%) of the respondents of young women experience menstrual pain (disminorea) primary with nearly half (33.3 ,%) in the mild pain scale before being given a warm compress, most (60%) on the pain scale was before warm compresses, and a small portion (6.7%) in severe pain scale before warm compresses. Intensity of pain was an idea of how severe the pain felt by the individual, very subjective measurements of pain intensity. The possibility of the same intensity perceived very differently by two different people. This situation was influenced by various factors, such as age, sex, socio-cultural background, environment and experience (Andarmoyo, 2013). Based on the research results according to table 4.1 showed that majority (60%) of respondents of young women aged 16-19 years and almost all (93.3%) of respondents are studying high school. Age and education greatly affects a person's pain scale because it affects the readiness of respondents in facing menstruation and disturbances that arise. Readiness itself more associated with psychological factors. Pain can be caused or aggravated by psychological state. Often after marriage disminorea lost and rarely settled after childbirth (Judha, et al. 2012). By the age of 16-19 years old and studying high school student are teenagers who should already have sufficient

Table 3 Distribution of the frequency of menstrual pain scale (disminorea) primary girls after being given a warm compress on the boarding school in the village Jatinom Maftahul Uluum Kanigoro District of Blitar on 30 July to 5 August 2015 (in which n = 15). No Pain Scale f % 1 No Pain 2 13,3 2 Dull Pain 10 66,7 3 Moderate Pain 3 20 4 Severe Pain 0 0 5 Very Severe 0 0 Pain ∑ 15 100 Table 4 Comparison of the frequency distribution scale menstrual pain (dysmenorrhoea) primary girls before and after being given a warm compress on the boarding school in the village Jatinom Maftahul Uluum Kanigoro District of Blitar on 30 July to 5 August 2015 (in which n = 15) Pain Scale % Scale % Scale Before After Warm Warm Compresses Compresses

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experience and information about menstrual pain (disminorea) during menstruation every month, but in reality only silence young women just because they know they are experiencing menstrual pain only lasts short only 1-2 days during menstruation. Because painful menstruation (disminorea) primer happens on the first day or before the first day of menstruation due to the emphasis on the cervical canal (cervical) and will usually disappear over the next day of menstruation (Judha, dkk.2012 ). While nearly all (86.7%) of women respondents have menstrual period on day 1-2 and all (100%) of the respondents not take antipain / analgesic or do an alternative way to help cope with menstrual pain / disminorea they experienced. This may because of lack of information on reproductive health, especially on painful menstruation (disminorea) primer which almost all (80%) of respondents have never heard or received information about menstrual pain (disminorea) primer along with ways to overcome the pain. Based on the results of research conducted according to table 4.8 in the boarding school in the village Jatinom Maftahul Uluum Kanigoro District of Blitar, that of the 15 girls gained a small portion (20%) on a scale of moderate pain, the majority (66.7%) of respondents girls on mild pain scale, and little else (13.3%) on a scale of no pain after being given a warm compress. Warm compress is to give a sense of warmth to patients to reduce pain by using a liquid that serves to dilate blood vessels and increase local blood flow, and reduce muscle tension. Whereas during menstruation endometrial cells release the hormone prostaglandin F2 alpha which may increase the amplitude and frequency of uterine contractions and lower abdominal cramps (Bobak, 2005). Not only decrease the pain, warm compress can also stimulate the brain to release endorphins that cause respondents experienced a sense of comfort when given a warm compress. Based on the results of the study showed a decrease in the percentage scale menstrual pain (dysmenorrhoea) primer before and after

being given a warm from 60% to 20%. Then, the increase in scale of menstrual pain (dysmenorrhoea) primer on mild pain scale from 33.3% to 66.7% and no pain on a scale from 0% to 13.3%. This shows a decrease of pain scale from hingh to low. Based on statistical test Wlicoxon Signed Rank Test was obtained p value = 0.004, so the p value = 0,004 <α = 0.05, indicating the effect of a warm compress to decrease menstrual pain (dysmenorrhoea) primer in adolescent girls. Warm compress is a method that can reduce pain when dismenorea come. Thus these actions are expected to the young women to make them not to leave school activities and other activities due to menstrual pain experienced (disminorea) primer so that the activities can be run well. CONCLUSION The research and data analysis had following results: a. Painful menstruation (dysmenorrhea) Before being given a warm compress nearly half (60%) on a scale of moderate pain, almost half (33.3%) on a scale of mild pain and a small portion (6.7%) in severe pain scale. b. b. Menstrual pain (dysmenorrhoea) primer in young women after giving a warm compress get large proportion (66.7%) on a scale of mild pain, a small portion (20%) on a scale of moderate pain, and little else (13.3%) on the scale painless. c. In accordance with data analysis using statistical test of Wilcoxon Signed Rank test showed p value: 0,004, where it was demonstrated that administration of warm compresses affect the decreasing primer painful menstruation (dismenorea). ACKNOWLEDGEMENT The limitations of this study are researchers could not definitively determine a person's pain because pain is subjective. In addition, the classification of primary and secondary dismenorhea require further medical examination. REFERENCES

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Andarmoyo, Sulistyo. 2013. Konsep & Proses Keperawatan Nyeri. Yogyakarta: ar-ruzz media. Anurogo, dito. 2011. Cara jitu mengatasi nyeri haid. Yogyakarta: ANDI Bobak. 2005. Buku Ajar Keperawatan Maternitas Edisi 4. Jakarta : EGC Judha, dkk. 2012. Teori Pengukuran Nyeri & Nyeri Persalinan. Yogyakarta: Nuha Medika. Wiknjosastro, Hanifa. 2005. Ilmu Kandungan. Jakarta : Yayasan Bina Pustaka Sarwono Prawirohardjo.

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THE EFFECT OF STIMULATION THERAPY GROUP ACTIVITIES PERCEPTION ON THE LEVEL OF DEPRESSION IN THE ELDERLY IN PAMOTAN SAMBENG LAMONGAN Siti Sholikah Stikes Muhammadiyah Lamongan Email: [email protected] Abstract Depresion is a mood disorder characterized by feelings of sadness excessive empty feeling worthless, hopeless, feels like a failure until three is the idea of suicide. The purpose of rescarh to identify the influence rescarh before and after therapy perceptions stimulation group activity level of depression in the elderly. Rescarh design uses pre-experimental methods to design a pretest-posttest group in which no comparison group (control). A sample of 45 patients who met the inclusion criteria with a random sampling technique. This analysis rescarh using testing techniques and data collection Mc Nemar with orientation task Activity Group Therapy (TAK) Perception of stimulation and Observation Sheet. The results of this Rescarh is depressed patients were given the activity level of group therapy most 45 patients 25 individuals (56.8%) could to decrease depression. So based on the calculation results obtained p = 0.000 (p <0.05), the HO is rejected and H1 accepted many significant effects on the administration of TAK perception stimulation level of depression in the elderly in rural area Pamotan Sambeng Lamongan Regency. The rresults are expected to provide awareness of the benefits of group therapy activities for health care, educational institutions and other research. Keyword :Stimulation Therapy Group Activities, Depression, Elderly.

1.

factors, 2) predisposes factors, it means factors behind people experiencing a mental disorder so that they become more easier to get mentally ill because since they were born or during their growth, their personality and their coping mechanism is not optimal, 3) Sensitivity and fragility factors, these factors are the result of the interaction between the heredity factors and the influences of environment toward them. Innate factors can be biological and hereditary.

Introduction

Mental health is a balanced state of a person's soul, which he could organize and execute its function in society. Quantification of people tendency of the increasing of mental disorders causes for concern. Almost 50% of Indonesian experiences mental disorders (Siti Sa'idah 2007). Mental health disorder is a public and social health problem in the world that increases from year to year. Nearly 1% of Indonesian suffers from psychotic during their lives (Sulistyowati, 2007).

According to the WHO in 2000, approximately 450 million adults of the world's population are mentally ill. According to data from the health department in 2009, the number of people with mental disorders in Indonesia currently reaches more than 28 million people with 11.6 % categorized into mild mental disorder and 0.46 % categorized into severe mental disorder.

Slamet (2007) stated that the cause of the abnormal behaviour and mental disorders are not that simple, but it is related to the complexity of personality development. Mental disorders generally have many causes (multicasual) and related to what existed before the disorder appears in some cases, such as 1) heredity, people with heredity of mental disorder experience higher tendency to suffer this illness than people who do not have a hereditary

The process of aging is a process of the disappearance of tissues‟ ability to

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reproduce/replace their selves and maintain their normal function, with the increasing of life expectancy certainly has an impact of declining their function of elderly. That decreasing of their function can lead to many problems in the elderly, such as lack of support and role of the family. Those will be able to aggravate the problems of the elderly enabling to lead to the depression (Nugroho, 2007).

he/she has a high risk of suffering from depression too because of the genes passed down from parents to their children (Mc Kenzie, 1999). 2) Chemical structure of the brain and body, those hold a big role in controlling one‟s emotions. On the depressed people, it is found that there were changes in the chemical structure (Kompas, 2008). 3) Age, youth and adolescents may experience depression more (Wilikson, 1995). 4) Gender, women are twice more often experiencing depression if compared to men, it is because women get difficulties to communicate their problems to others (pease, 2001). 5) Lifestyle, many bad habits and unhealthy lifestyle can lead to many kinds of diseases where those diseases can trigger anxiety and even depression (Hendrananata, 2004). On the other hand, psychological factors that affect depression are: 1) Personality, one personality who tends to have negative thoughts and pessimistic personality types experiences introvert depression (Retnowati, 2000). 2) Mindset, someone who has negative view toward themselves vulnerable to get depression (Mc William, 2008). 3) Selfesteem, low self-esteem can lead to depression (Maslow, 2008). 4) Stress, losing someone who you love so much can trigger recurrent stress which can cause depression (Mackenzie, 1999).

According to the World Health Organization (WHO), it estimates that the depression prevalence of elderly in the world ranges from around 8-15%. The result of meta-analysis of countries in the world, elderly that get depression prevalence is 13.5% with a ratio of women and men 14.1: 8.6 and elderly who get depression prevalence undergoing treatment is approximately 30-45%. Depression is a mood disorder indicated by excessive feelings of sadness, melancholy, feeling worthlessness, feeling empty, hopeless, and feeling failed all the time till having idea of committing suicide (Joseph, 2007) Based on the central Bureau of Statistics (BPS) East Java, the number of elderly aged 60 years in the year of 2007 is 4.209.817 people consisting 1.811.995 men and 2.397.882 women. Population census in the year of 2013 shows that the number of elderly aged 60 years is 141.373 people, while based on an initial survey done by the researchers on 4 October 2014 in Pamotan, Sambeng, Lamongan, there are 50 elderly in that village, 10 of them are given questions using the Geriatric Depression scale Yesavage short form obtained six (60%) of people showing the symptoms of moderate depression, and 4 (40%) of them experiencing mild depression. From the initial survey, the researchers can find the problem that there are still many elderly who experience moderate depression in Pamotan, Sambeng, Lamongan.

From all factors mentioned above, family support becomes the most important factor that plays salient role on the depression level of elderly. Poor family claimed elderly as the cause of the problem resulting in rejection, while the elderly actually are very dependent on their family so that when they do not get support from their family it can affect the psychological conditions of elderly. Depression according to PPDG111 (2001) is divided into three levels, namely mild depression, moderate depression and severe depression. The difference between the three of those depressions lies in the complex that includes the number, shape and severity of symptoms found.

Factors that can affect depression include Physical and Psychological Factors. Physical factors consist of: 1) Genetic factors, these factors described that if one‟s family is suffering from severe depression,

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Depression of elderly is mainly caused by feelings of sadness, helplessness and pessimism, which is associated with an affliction that can be an attack shown to yourself or a deep feeling (Nugroho, 2008). The management of nursing with depression can be provided with a therapeutic modality that one of them is Therapeutic Activity Group/ Group Activity Therapy (TAK).

is pre-test as the first observation which allows researchers to examine the changes that occur after the experiment (Soekidjo Notoatmojo, 2010). Population in this research is 50 elderly, while the sample is partially patients‟ post laparotomy operation who met the inclusion criteria with a number of 45 elderly. Independent variabel of this research is the perception stimulation group activity therapy, while the dependent variable is the depression level of elderly. The data collection used observation sheet and the analysis of this study used Mc Nemar test.

Group activity therapy is very effective to change behavior because in a group there will be interaction of one to each other that can affect them. In the group will form a social system interaction to each other and become a place to the client to practice new adaptive behaviors to improve long maladaptive behavior (Christopher, 2007). TAK is divided according to the client's nursing problems, one of them is TAK Perception Stimulation. TAK Perception Stimulation is perception stimulation group activity therapy that uses the activity, perceives a variety of stimuli associated with the experience or life to be discussed in the group. The results of group discussions can be either an agreement or a perception of alternative problem solving (Keliat, 2006).

3.

1. Characteristics by Gender Table 1 The Characteristics Frequency Distribution of Patients Experiencing Increased Level of Depression based on their Gender in Pamotan, Sambeng, Lamongan on February 2015

Based on the description above, the researchers are interested in doing this research to determine the extent of the perception stimulation group activity therapy‟s effect of elderly depressed levels, in order to assist clients in handling health problems faced through the implementation of nursing care in the form of Group Activity Therapy (TAK).

No Gender

Frequency Percentage

1

Male

27

61,4

2

Female

17

38,6

Total

44

100

Table 4.1 explains that most of patients that experience increased level of depression are male with a number of 27 patients (61.4%) and female patients experiencing increased level of depression are 17 (38.6%).

The purpose of this research is to analyze the influence of group activity therapy of perception stimulation on the depression level in the elderly in Pamotan, Sambeng, Lamongan. 2.

The Result of the Study a. General Data

2. Characteristics by Age Table 2 The Characteristics Frequency Distribution of Patients Experiencing Increased Level of Depression based on their Age in Pamotan, Sambeng, Lamongan on February 2015.

Research Method

The research design used in this study is pre experiment using one group design pretest-posttest. In this design, there is no comparison group (controls), but there

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Experiencing Increased Level of Depression Based on Religion in Pamotan, Sambeng, Lamongan on February 2015.

No

Age

Frequency Percentage

1

60-74 y.o.

16

36,4

2

75-90 y.o.

14

31,8

3

>90 y.o.

14

31,8

No

Religion

Frequency Percentage

44

100

1

Moslem

44

100

44

100

Total

Total Table 2 explains that most of patients experiencing increased level of depression are them who are in the age of 60-74 years with a number of patients are 16 people (36.4%) and them who are in the age of 7590 years with a number of patients are 14 people (31.8%).

Table 4 shows that almost entirely Moslem patients with increased level of depression with a number of 44 patients (100%). 5. Characteristics by Marital Status Table 5 The Characteristics Frequency Distribution of Patients Experiencing Increased Level of Depression Based on Their Marital Status in Pamotan, Sambeng, Lamongan on February 2015.

3. Characteristics by Education Table 3 The Characteristics Frequency Distribution of Patients Experiencing Increased Level of Depression Based on Their Latest Education in Pamotan, Sambeng, Lamongan on February 2015. No

Education

Frequency Percentage

1

Kindergarten

10

2

Elementary School

31

70,5

3

Junior High School

3

6,8

4

Senior High School

0

0

Total

22,7

No

Marital Status

Frequency

Percentage

1

Married

27

61,4

2

Widower

17

36,6

44

100

Total

Table 5 shows that most of the patients getting increased level of depression are they who were married with a number of 27 patients (61.4%) and 17 other patients (36.6%) were widower. b. Special Data

44

100

1. Patients who get increased level of depression in pamotan, sambeng, lamongan before giving TAK perception stimulation session I identification positive things on themselves.

Table 3 shows that the majority of patients with increased level of depression are patients from Elementary school with a number of 31 patients (70.5%), and patients from Junior high school with a number of 3 patients (6.8 %%).

Table 6 The Distribution of Depression Level before Giving Activity Group Therapy Session I Identification Positive Things on themselves in Pamotan, Sambeng, Lamongan on February 2015.

4. Characteristics by Religion Table 4 The Characteristics Frequency Distribution of Patients

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No Session 1

Frequency Percentage

1

Capable

0

0

2

Incapable

44

100

44

100

Total

activity therapy is by entering all the data got into table. Table 8 The effect of TAK Perception Stimulation (Session 1) on The Depression Level in the Elderly in the Pamotan, Sambeng, Lamongan on February 2015

Table 6 shows that before giving group activity therapy session I, all patients, 44 patients (100%) have not been able to reduce the level of depression. 2. Patients who have increased level of depression In Pamotan, Sambeng, Lamongan after giving TAK perception stimulation Session 1 Identification positive things on others.

Table

6

Session 1

Frequency Percentage

1

Capable

25

56,8

2

Incapable

19

43,2

44

100

Total

N

P

Note

Identifiying positive thing of themselves

44 0,000 There is impact

Table 8 shows that here is influence TAK perception stimulation session 1 toward the depression level. These results were supported by Mc Nemar statistical test with p = 0.000 (p <0.05), which means there are significant group activity therapy on the level of depression on the elderly in Pamotan, Sambeng, Lamongan.

The Distribution Level of Depression After Activity Group Therapy Session 1 Identification positive things on others In Pamotan, Sambeng, Lamongan on 2015

No

Session 1

4.

Discussion 1. The Patients‟ Level of Depression before being given Activity Group Therapy session 1 Identification of Positive thing of themselves.

Table 6 shows that patients of depression in Pamotan, Sambeng, Lamongan before being applied group activity therapy session 1 are 44 patients (100%). All of them have not been able to reduce their depression.

Table 7 shows that the majority of depressed patients who were able to identify positive things on themselves are 25 patients (56.8 %%) and depressed patients who have not been able to identify positive things on themselves are 19 patients (43.2%).

According to a quote from stuard and Sundeen (2006), group can be a tool of therapy. The group is a unique social system which can be defined and studied. Group is a collection of individuals who have a relationship between one to the others, have a type of interdependence, and have the same goals and norms.

3. The effects of TAK Perception Stimulation toward the Depression Level of Elderly Session 1 Identification Positive thing of themselves In Pamotan, Sambeng, Lamongan. In accordance with the analysis of data, after collecting the data, to calculate the effect of perception stimulation group

Activity group therapy is a group of psychotherapy conducted by the patients all together by discussion led or directed by a therapist or a trained mental health worker

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(Guideline Rehabilitation Mental Patient Mental Hospital in Indonesia Joseph, 2007). Group therapy is a psychological treatment that is performed in groups to provide stimulation for patients with impaired interpersonal (Joseph, 2008).

enhancing the ability to communicate and provide feedback. Socializing can boost the awareness of relationship emotional reaction toward the action and generate communications for the progress of affective and cognitive function. Decreased depression TAK is aimed to identify positive things on themselves, appreciate the positive things of others and set goals of realistic life. TAK is expected to stimulate the perception of clients' response to various stimuli in life becomes adaptive and rehabilitative in which those who have been cured medically, but still need to be prepared to the function and the ability of independent and social preparation in the community.

The inability of increased level of depression patients to decrease their depression is because of not applying activities group therapy. TAK can provide a stimulus for patients with impaired interpersonal by conducting a group of patients discuss each other and led or directed by a therapist or trained mental health worker.

According to Keliat Budiana 2005, there were 3 sessions of TAK Perception Stimulation of depression, they are: 1. Identifying the positive things of themselves; 2. Appreciating positive things of others; 3. Setting the realistic life goals.

2. Level of Depression Patients After being given Activity Group Therapy Session 1 Identification the Positive thing of themselves Table 4.9 shows that 44 patients with the progressive increase in depression in Pamotan, Sambeng, Lamongan after being given TAK perception stimulation session 1. It indicates that the majority of patients with a number of 25 patients (56.8%) were able to identify positive things by themselves.

It is indicated by the progressive increase of depression before being applied the group activity therapy sessions 1 and after group activity therapy sessions 1. From these results it can be concluded that the stimulation group activity therapy is influenced by the level of depression of the patients so this activity therapy should be given to the patient in order to accelerate the healing process.

In the group activities therapy, there are several phases and one of them is group work phase. In this phase, the group has become a team. The group became stable and realistic (Keliat, 2004). At the end of this phase, the group members realize increased productivity and capabilities with confidence and independence (Joseph, 2007).

3. The effect of TAK Perception Stimulation Session 1 Identification Positive Things of Themselves on the Level Depression in Elderly

It deals with the objectives that the client knows the importance of self-respect, and the client can also identify positive things by themselves. Clients are trained to perceive the stimulus provided or stimulus they experienced. The clients‟ capabilities are evaluated and improved in each session. With this process, it is expected that the response of the clients in stimulating becomes adaptive.

Table 4.9 shows the result of the data tested using Mc Nemer Test, SPSS version 18.0 can be explained that there is effects of the implementation of group activity therapy perception stimulation toward the level of depression in the elderly, session 1: Identification of positive things of themselves, with value of p=0.000 (p<0.05), whichh means that there are significant perception stimulation group activity therapy on the level of depression

This is in accordance to the general purpose of group activity therapy that is

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in the elderly in Pamotan, Sambeng, Lamongan.

session 1 to the patient has not been able to reduce depression. 2. The level of depression of elderly after giving perception stimulation TAK session 2 to the depressed patients are able to reduce the level of depression by means of Identification of positive things of themselves. 3. There is an effect of perception stimulation TAK session 1 identifying positive things of themselves to the level of depression of elderly in the Pamotan, Sambeng, Lamongan. It is supported by the data analysis using Mc Nemar test with significance level α of 0.05 and p = 0.000. The result shows that there is a relationship between giving perception stimulation group activity therapy toward the level of depression of elderly.

Group activity therapy is a group of psychotherapy conducted by the patients to discuss between one to another led or directed by a therapist or mental health worker who have been trained (Rehabilitation Manual of Mental Patient Mental Hospital in Indonesia in Joseph, 2007). Psychological group therapy is conducted in groups to provide stimulation for patients with impaired interpersonal (Joseph, 2008). It deals with the general purpose of TAK that is to enhance communication and feedback. Getting socialized, improving awareness of relationship emotional reaction toward the action, and motivating for the advancement of the cognitive and affective functions. It is also in accordance with the specific purpose of TAK which is to enhance identity, channelize emotions constructively, and improve interpersonal relationship skills. TAK also has a rehabilitative function in which those who have been cured medically but need to be prepared in the ability to the function and social preparation in the community.

b. Suggestion This study is expected to provide input for the nursing profession about the effect of group activity therapy (TAK) of perception stimulation toward the level of depression of elderly.

6.

Thus the Activity Group Therapy can provide a positive stimulus for patients having increased level of depression that aims to identify positive things of themselves, appreciate the positive things of others, and set the realistic life goals. TAK perception stimulation of depression is an attempt to the patients to reduce depression, both physically and mentally in order to think and behave in a constructive without harming clients and families and the surrounding environment so that they can run a better life.

5.

References

Alimul, Aziz, (2003). Riset Keperawatan dan Teknik Penulisan Iimiah. Salemba Medika, Jakarta. Arikunto Suharsimi (2006). Prosedur penelitihan suatu pendekatan praktik, Rineka Cipta , Jakarta. Azizah L. H. 2011. Keperawatan Jiwa (Aplikasi Praktik Klinik). Edisi I. Yogyakarta: Graha Ilmu. Badan

Penelitian dan Pengembangan kesehatan DEPKES RI. 2008. Laporan Nasional Riset Kesehatan Dasar 2007. DEPKES RI Depkes RI (2001), Pedoman penggolongan dan diagnosis gangguan jiwa di indonesia III,(PPDG III), Direktorat jendral pelayanan medis, Jakarta Diktat Keperawatan Jiwa Tim Keperawatan Jiwa. 2009. STIKES Muhammadiyah Lamongan.

Conclusions and Recommendations

a. Conclusion 1. The level of depression of elderly before applying TAK of perception stimulation

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Dinas

Kesehatan Lamongan. 2013. Proyeksi Jumlah Penduduk Kabupaten Lamongan dari Hasil Sensus Penduduk tahun 2010. Lamongan: Dinkes Lamongan Hawary, Dadang.(2001). Manajemen stress, cemas dan depresi. Jakarta : FKUI Hawary, Dadang. (2002). Demensi religi dalam praktek psikiatri dan psikologi. Jakarta : FKUI Hawari, D. 2007. Sejahtera Di Usia Senja Dimensi Psikoreligi pada Lanjut Usia. Jakarta: Balai Penerbit FKUI. Hidayat, A. A.A.(2007). Riset Keperawatan Dan Teknik Penulisan Ilmiah, Edisi 2. Jakarta : Salemba Medika Hidayat A. Aziz Alimul. 2006. Pengantar Kebutuhan Dasar Manusia : Aplikasi Konsep dan Proses Keperawatan. Jakarta: Salemba Medika. . 2007.Metode Penelitia n Kebidanan dan Teknik Analisa Data. Jakarta: Salemba Medika. Ibrahim, Ayub sani. (2007). Depresi aku ingin mati. Jakarta: CV Ref graphika Iqbal, Wahid. 2009. Keperawatan Gerontik. Jakarta: EGC. Iyus, Yosep. (2007). Keperawatan Jiwa. Retika adhitama : Bandung Jurnal Ilmiah Kesehatan Diagnosis No 06 Vol 4–(2014). http://unud.ac.id Keliat, Budi Anna, (2006). Keperawatan jiwa (Terapi Aktivitas Kelompok). EGC, Jakarta. Keliat, Budi Anna.2006.Peran Serta Keluarga Dalam Perawatan Klien Gangguan Jiwa. Jakarta: EGC Keliat, Budi Anna. 2012. Keperawatan Jiwa: Terapi Aktivitas Kelompok. Jakarta: EGC. Ma‟mun M. Y, 2002. Buku Saku Psikoterapi II, Gajah Mada University Press, Yogyakarta

Mubarak, Wahit Iqbal, dkk : (2009). Ilmu Keperawatan Komunitas, Konsep dan Aplikasi. Jakarta : Salemba Medika Notoatmojo,Soekidjo.(2005). Metode Penelitihan Kesehatan. PT. Rineka Cipta, Jakarta. Nursalam, (2008). Konsep Dan Penerapan Metodelogi Penelitihan Ilmu Keperawatan: Pedoman Skripsi Tesis, Institusi Penelitihan Keperawatan. Salemba Medika Jakarta. Sugiono. (2006). Statistika Untuk Penelitihan. Alfabeta : Bandung Sulistiyowati. (2005). Konsep Dasar Keperawatan Kesehatan Jiwa. Jakarta : EGC. Yosep, (2008). Catatan Ilmu Kedokteran Jiwa, Fakultas Kedokteran Universitas Airlangga, Surabaya. Wahjudi nugroho. (2008). Keperawatan gerontik dan geriatrik. Jakarta : EGC Wahjudi nugroho. (1992). Keperawatan lanjut usia. Jakarta penerbit buku kedokteran. Jakarta : EGC

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POVERTY AND LUNG TUBERCULOSIS IN PONOROGO Sulistyo Andarmoyo1 S1 Nursing of Health Sciences Faculty of Muhammadiyah University of Ponorogo Email: [email protected] Abstract Lung Tuberculosis (TB) is an infectious disease directly affects the lungs caused by tuberculosis bacteria (Mycobacterium Tuberculosis). One of main causes of the increasing of burden of TB is poverty in various groups of people, such as in developing countries. This study aims to determine how the relationships of poverty and the incidence of lung tuberculosis in Ponorogo regency. This research method used observational of case control approach where the population and the sample were men and women who visited Health Centers in the region of Ponorogo Regency Health Office either outpatient or inpatient during the study period, adjusted to the criteria of the study. The results of the study showed that poor respondents had risk of lung tuberculosis infection were 2.2 times greater than non-poor respondents (OR = 2.2; CI = 95 %). Suggestions can be submitted are necessary effort and commitment of strong political support, by the support of broad public participation, including the private sector of the health in solving tuberculosis. Key words: Poverty, Lung Tuberculosis WHO estimates that in 2011 there were 8.7 million new cases of tuberculosis (13 % are co-infected of HIV) and 1.4 million people died of tuberculosis (WHO, 2012). In a WHO report in 2013 estimated that there are 8.6 million cases of TB in 2012 where 1.1 million people (13 %) of whom were TB patients of HIV-positive (Kemenkes RI, 2014). In Indonesia lung TB disease is a major problem of public health. Based on economic calculations using the indicator of DALY (Disability Adjusted Life Year) introduced by the Word Bank, TB is 7.7 % of the total disease burden in Indonesia, this figure is higher than in other Asian countries that only 4 %. In 1995, the results of the Household Health Survey showed that tuberculosis is the third cause of death after cardiovascular diseases and respiratory infections in all age groups, and it is number one of the group of infectious diseases. In 1999, WHO estimated that each year 583,000 new cases of tuberculosis caused the deaths about 140,000. Roughly estimated per 100,000

Introduction Tuberculosis is an infectious disease directly caused by the bacteria of the Mycobacterium group named Mycobacterium Tuberculosis (Kemenkes RI, 2014), is that an acidresistant aerobic bacillus transmitted through the air (airborn) (Asih & Effendy, 2004). Tuberculosis can affect all organs and all age groups. Nonetheless lung is the organ most frequently affected by Tuberculosis (Kemenkes RI, 2012). Tuberculosis (TB) continues to be a health problem in the world, especially in developing countries. Although the anti-tuberculosis drugs (OAT) has been found and vaccination Bacillus Calmette Guerin (BCG) has been implemented, TB still not been eradicated all (Depkes, 2012). In developing countries, the death of TB is 25 % of all deaths, actually it is preventable. An estimated 95 % of TB cases and 98 % of TB deaths in the world occur in developing countries; with 75 % of TB patients are productive age group (15-50 years).

851

population of Indonesia there are 130 new patients with BTA-positive tuberculosis. It is estimated that in 2004, every year there were 539,000 new cases and 101,000 deaths of people. Based on the data of World Health Organization (WHO) in 2007 stated that the number of tuberculosis patients in Indonesia about 528 thousand inhabitants and it was in the top three world after India and China. The latest report of WHO in 2009 recorded that ranked Indonesia decreased into the fifth position with the number of tuberculosis patients were 429 thousand people. Indonesia is among of the top 10 countries of patients with lung tuberculosis cases in the world. According to WHO (2012) in the report of the Global Report 2011 that the prevalence of tuberculosis was estimated 289 cases per 100,000 population, the incidence of tuberculosis 189 cases per 100,000 population and a mortality rate 27 cases per 100,000 population. Patients with highest lung tuberculosis are in the productive age group (15-50 years), around 75 %. Adult tuberculosis patients are expected to lose an average of 3-4 months work, so it resulted in loss of household income about 20-30 %. If someone died of TB, he would lose revenue about 15 years. In addition to adverse economic, tuberculosis is also having a devastating effect, namely ostracized by the society (stigma) (WHO, 2012). Based on Riskesdas in 2010 in East Java, the prevalence of TB on ≥15 years was 0.628 % and suspected tuberculosis was 1,843 %. Lung tuberculosis patients used medical facilities through public health centers were 44.2 %. While cases of lung TB in Ponorogo, based on data from the Health Center of Ponorogo in 2014 the

discovery of new cases of tuberculosis with BTA (+) were 300 people, with the number of men was 202 people and women was 98 people (Dinkes Ponorogo, 2015). One of the main cause of the increasing of TB problem is poverty in various groups of people, such as in developing countries (Kemenkes RI, 2014). WHO (2003) mentioned 90 % of patients with lung tuberculosis in the world attacked weak or poor socio-economic groups. The mortality of lung tuberculosis is about 3 million people every year. This situation is largely or almost 75 % found in developing countries with low socioeconomic (Alsagaff, H. & Mukty, A. 1995). Based on the study above, researcher is interested in studying the relationships between poverty and the incidence of lung tuberculosis in Ponorogo. The method of the study This study is a type of observational study using case control design. Research was conducted in several health centers in the Health Center of Ponorogo. Samples were taken by using simple random sampling method. Data was collected by interview, to determine the amount of family income in 1 month. Data analysis used the chi -square test.

852

The Results and the Discussions Tabel 1 Distributions of Respondents according to age, Sex, level of education, and occupation history Variabel

Cases (suffered of lung TB ) Total %

Control (not suffered of lung TB ) Total %

Total

Total

%

Age 15 - 55 years 56 - 80 years Total

22 8 30

73,33 26,67 100

18 12 30

60 40 100

40 20 60

66,7 33,3 100

Male Female Total

21 9 30

70 30 100

19 11 30

63,3 36,7 100

40 20 60

66,67 33,33 100

Level of education Low High Total

20 10 30

66,67 33,33 100

18 12 30

60 40 100

38 22 60

63,33 36,67 100

20 10 30

66,67 33,33 100

24 6 30

80 20 100

44 16 60

73,33 26,67 100

Sex

Occupation Employed Unemployed Total Source: Primary data, 2014

Based on table 1 above it can be seen that the age of majority in the case group and the control is the age group 15-55 years where 22 people (73.33 %) are in the group of cases and 18 people (60 %) are in the control group. By sex showed that most sex is male, where in the case groups are 21 persons (70 %), while the control group are 19 people (63.3 %). Based on the level of

education can be seen that the highest level of education is low where in the case group are 20 people (66.67 %), while the control group are 18 people (60 %). Based on work history can be seen that the highest employment history is employed where in the case group are 20 people (66.67 %), while the control group are 24 people (80 %).

Tabel 2 Social Economic condition and the incident of lung tuberculosis Control Variabel Cases (TBC) (not TBC) N N % % 1 . Social economic condition - Poor (< UMR) 21 70 17 56,7 - Not poor (> UMR) Total Source: Primary data, 2014

9

30

13

43,3

30

100

30

100

853

OR

P

2,2

0,038

Based on the above results can be seen that the poor respondents (< UMR) have more increased risk of lung tuberculosis infection 2.2 times than not poor respondents (> UMR) (OR = 2.2; CI = 95 %).

sanitation does not fulfill health requirements. One of factors not less important in the fight against tuberculosis is low socio economic status and less earnings, because the treatment of lung tuberculosis requires continuity of treatment in the long term, so it requires a considerable cost (Tjiptoherijanto, P. & Soesetyo, B., 1994).

The discussions and the results Based on the results of the study showed that respondents with income levels of less (poor) have greater increased risk of lung tuberculosis infection 2.2 times than the respondents of higher income level (not poor) (OR = 2.2; CI = 95 %). This is suited by research of Fitriany, E. (2012), it showed that there was a correlation study of family income level (p - value = 0.002, OR = 3.169), the incidence of tuberculosis in Health Center of Ketanggungan. According to King (2008), the heads of families who have incomes under the minimum wage will consume foods not fitted by nutrient levels, by the needs of every member of the family, so they have a poor nutritional status and it will make them easier for infectious diseases including lung tuberculosis. In terms of the types of house constructions have just less income, so the construction of houses owned did not fulfill health requirements that will easily transmite lung tuberculosis. As we know that the good house for patients with lung tuberculosis is a house has enough ventilation, which allows sunlight enters to the house so it can kill the bacteria of mycobacterium tuberculosis. This is caused the germs Micobacterium Tuberculosis is a very sensitive germ to heat, sunlight andultraviolet rays. Direct exposure to the sun causes most of the bacteria will die within a few minutes (Kemenkes RI, 2014). Economic status is one of the main factors causes the development of tuberculosis germs in Indonesia, it is due to low income of per capita family, lack of nutrition and housing environment and

The conclusions and suggestions The results of the study showed that there is relationships between poverty and the incidence of lung tuberculosis, poor respondents have a greater risk of lung tuberculosis infection 2.2 times than nonpoor respondents (OR = 2.2; CI = 95 %). Lung tuberculosis is a threat of national problems, try letting the development of tuberculosis in a country as well as let the rampant poverty in the country. To deal with lung tuberculosis and poverty impact required the commitment and strong political effort, by the support of broad public participation, including the private sector and health. References Aditama, T. Y. (2005) Tuberkulosis dan Kemiskinan. Majalah Kedokteran Indonesia. Volume: 55, Nomor: 2, Pebruari 2005 Alsagaf, H dan Mukty, A. (2005). DasarDasar Ilmu Penyakit Paru. Surabaya: Airlangga University Press. Asih, N.G.Y & Effendy, C. (2004). Keperawatan Medikal Bedah: Klien Dengan Gangguan Sistem Pernafasan. Jakarta, EGC. Atmosukarto & Soewasti S. (2000). Pengaruh Lingkungan Pemukiman dalam Penyebaran Tuberkulosis. Jakarta: Media Litbang Kesehatan, Vol. 9 (4), Depkes RI. Depkes RI. (2007). Pedoman Nasional Penanggulangan Tuberkulosis, cetakan kedua, 2007. Jakarta: Depkes RI. Dinkes Ponorogo, (2015). Laporan Penemuan Pasien TB per UPK

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Kemenkes RI, (2012). Pedoman Pencegahan dan Pengendalian Infeksi Tuberkulosis Di Fasilitas Pelayanan Kesehatan. Jakarta. Direktorat Bina Upaya Kesehatan Fitriani, E. (2012). Faktor Resiko yang berhubungan dengan kejadian Tuerkulosis Paru. Semarang. Unnes Journal of Public Health Kemenkes RI. (2014). Pedoman Nasional Penanggulangan Tuberkulosis, Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan, Jakarta: Kemenkes RI. Prabu, Faktor Resiko TBC, Desember 24 2008, http://putraprabu.wordpress.com/ 2008/12/24/faktor-resiko-tbc/, diakses tanggal 19 Juni 2014. Rab, T. (1999). Ilmu Penyakit Paru, editor Sandy Qlintang, Jakarta: Hipokrates Tjiptoherijanto, P. & Soesetyo, B. (1994). Ekonomi Kesehatan, Rineka Cipta, Jakarta. WHO, (2012). “Global Tuberculosis Report 2012”. World Health Organization 20 Avenue Appia, 1211–Geneva–27, Switzerland. Tersedia di www. who.int/- tuberkulosis. diakses pada tanggal 25 Mei 2014.

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INFLUENCE OF STUDENT'S KNOWLEDGE AND ATTITUDE LEVEL ABOUT HEALTHY LIFE BEHAVIOR TOWARD GARBAGE DISPOSING AT IIK BHAKTI WIYATA KEDIRI Zuyyina Fihayati, Endah Retnani Wismaningsih, Ruli Asharil Institut Ilmu Kesehatan Bhakti Wiyata Kediri Abstract Educational institution is primary target which should be practicing Healthy life behavior such as washing hand with soap, eating healthy food and beverage, healthy latrines, and disposing garbage into garbage can. These behavior where strongly influenced by individual's level of knowledge and attitude. This study aimed to analyze the influence of student's knowledge and attitude level about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri. This research was a cross sectional study, number of sample determined by cluster sampling technique. Data were analyzed by multiple linier regression in order to determined the most influenced variable toward garbage disposing. The result showed that 58,18 % respondents has moderate knowledge, and 71,82 % respondents has good attitude about healthy life behavior. the multiple linier regression result test showed that the most influenced variable toward garbage disposing was attitude with p value 0,011 < 0,05 mea nwhil e knowledge has no influence (p value 0,944 > 0,05). From this research, it‟s known that attitude has most influence toward garbage disposing. Keyword : Knowledge, attitudes and garbage disposing.

INTRODUCTION

important basic domain in the formation of individual practice (Notoatmodjo, 2007).

Health behavior particularly healthy life behavior (PHBS) are important factor which influence individual and community health status. Through KEPMENKES RI No.1193/MENKES/X/2004, government has established healthy life behavior vision 2010. Healthy life behavior are a set of behavior which practiced based on awareness as the learning results to enable individual or family to self assist in health area and actively participated in achieving community health (Pusat Promosi Kesehatan, Depkes RI 2006).

In the educational institution (campus, school, pesantren, seminar, padepokan, etc), primary target have to practice behavior that can created a healthy life behavior‟s instititution, including washing hand with soap, eating healthy food and beverage, healthy latrines, and disposing garbage into garbage can, do not smoke, do not do drugs, alcohol, psychotropic and other addictive substances, do not spit in public area, eradicate mosquito nest, (Kementrian Kesehatan RI, 2011).

Healthy life behavior is a health behavior that closely related to individual behavior. Wherein the formation of the behavior is strongly influenced by individual knowledge. Knowledge or cognitive is an

Health educational institution (school) is a education major with health background which aimed to develop reliable health workers that not only reliable handling their clients but also always practice healthy life behavior in 865

daily life, in order to increase their productivity and also being a role model for their community. To achieve those target, students (prospective health workers) have to prepared –as early as possible- in to being competence resources, productive, and have healthy life behavior.

2.Specific Purpose a. Describing respondent‟s characteristics based on sex and age. b. Analyzing the influence of student's knowledge about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri. c. Analyzing the influence of student's attitude level about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri. d. Analyzing the influence of student's knowledge and attitude level about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri. e. Analyzing the most influencing variable (knowledge and attitude) toward garbage disposing at IIK Bhakti Wiyata Kediri.

There are 3 faculties at Institut Ilmu Kesehatan (IIK) Bhakti Wiyata Kediri, that are Public Health Faculty (now known as Faculty of Health Science), Faculty of Medical Dentistry, Faculty of Pharmacy. Total students of IIK Bhakti Wiyata are 1783 student, which divided into 11 study program. Interview result from fifteen students (randomly choose) showed that all of them ever disposed garbage at public area (not in the trash can). Based on that observation researcher want to analyze about the influence of student's knowledge and attitude level about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri.

BENEFIT OF RESEARCH 1. Benefit for Institution This research can be udes as additional literature available in the development of science particularly about healthy life behavior in the health educational institiution, also can be used as teaching materials and assessment in the community. 2. Scientific Benefit The result of this research can be used as additional health promotion literature, particularly about healthy life behavior in the health educational institiution as the reference for the next research 3. Benefit for Student As the knowledge and motivation for the student to be more active –even as role model- in practicing healthy life behavior particularly about garbage disposing.

Based on those reason, the problem formulated as : are there influence of student's knowledge and attitude level about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri Research Purpose 1.General Purpose Analyzing influence of student's knowledge and attitude level about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri

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RESEARCH METHOD Data was conducted at IIK Bhakti st th Wiyata Kediri from June 1 to 6 2014.

level about healthy life behavior toward garbage disposing. Data Analyzing a Data analyzed technique was used software application. The variable was statistically tested using Multiple Linier Regression to assest the influence of student's knowledge and attitude level about healthy life behavior and which variable has more influence toward garbage disposing at IIK Bhakti Wiyata Kediri.

Research Design This research was a quantitative approach, using cross sectional study that is a study where observation of risk factor variable and effected variable or independent variable and dependent conducted at the same time (Notoatmodjo, 2010). Population Population of this research was all student of IIK Bhakti Wiyata Kediri. Total population were 1783 student.

RESULT AND DISCUSSION Characteristic of the Respondent The Characteristic of the respondent is showed in the table below: Table 1. Characteristic of the Respondent

Sample Sample is part of population that will be researched or half of total characteristics of population (Nursalam, 2003). Total sample in this research was 330 student, which divided into 11 cluster.

No 1 2

Variable of the Research Independent variable are variable which was the cause or change dependent variable. Independent variable of this research were knowledge and attitude about healthy life behavior. dependent variable are variable which was the effect or have been changed by independent variable. Dependent variable of this research were garbage disposing.

Characteristic

Frequ-

Percen-

ency

tage (%)

Male

153

43,33

Female

149

56,67

Age

< 20

181

54,85

(years)

≥ 21

149

45,15

Sex

* Primary data, 2014

Based on the Table 1, it‟s known that 56,67% respondent were female and 54,85% were 21 years old or older. Variable’s Characteristic Student‟s level of knowledge about healthy life behavior is showed in the table below: Table 2. Student‟ s Knowledg e Level

Instrument of the Research This research used questionnaire as the instrument to conduct the data. The questionnaire consist of independent and dependent variables in the educational institution which measured by assessment of the student's knowledge and attitude

No

Knowledge

Frequency

Level 1 2

Low

3

(%) -

Moderate

192

58,18

High

138

41,82

Total

330

100

* Primary data, 2014

867

Percentage

Based on the Table 2, it‟s known that 58,18% of respondent have moderate knowledge level about healthy life behavior.

behavior toward garbage disposing at IIK Bhakti Wiyata Kediri is showed in the below: Table 5. Multiple Linier Regression Test Result

Student‟s level of attitude about healthy life behavior is showed in the table below: Table 3. Student‟s Attitude Level No Attitude Level Frequency

Standa Unstandari zed Coefficient

Persentage

Model

Low

-

-

2

Moderate

93

28,18

3

High

237

71,82

Total

330

100

B 1.7

tant)

84

* Primary data, 2014

Penge

.00

Based on the Table 3, it‟s known that 71,82% of respondent have high attitude level about healthy life behavior, which mean that IIK Bhakti Wiyata‟s Student have positive attitude about it.

tahu-

3

Frequency

disposing

Sikap

10

3,03

2

Moderate

269

81,52

3

High

51

15,45

Total

330

100

Beta

.176

10.1

.000

48 .046

-.004

-

.944

.071

.12

.050

.140

2.55

.011

Based on Table 5, it‟s known that there was no i nfl ue nc e of st ude nt 's knowl e dge l e ve l about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri (Sig = 0,944). There was an i nfl ue nc e of st ude nt 's a t t it ude le ve l about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri (Sig = 0,011). From the Multiple Linier Regression Test result, it‟s known that garbage disposing were influenced by student's knowledge and attitude level about healthy life behavior (Sig = 0,039).

(%)

Low

Erro

*Primary data, 2014

Percentage

1

cient

an

Student‟s practice about healthy life behavior particularty garbage disposing is showed in the table below: Table 4. Student‟s Practice Garbage

Sig.

r 1 (Cons

No

t

Coeffi

Std.

(%) 1

rized

*Primary data, 2014

Based on the Table 4, it‟s known that 81,52% of respondent have moderate practice of garbage disposing, which mean that IIK Bhakti Wiyata‟s have not always dispose their garbage into garbage can.

Notoatmodjo (2003), although individual has high educational background, it does not certify that he/she also have knowledge about disease and how to prevent it, because their knowledge are only at the level of know and not yet at the level of understanding, applying, analyzing, or evaluating the material

Characteristic of the Influence Between Variables The influence of the student's knowledge and attitude level about healthy life 868

related about the possible effect.

st ude nt 's a t t i t ude l e ve l about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri 4. Based on the result, it can be conclude that there was an i nfl ue nc e of st ude nt 's knowl e d ge a nd a t t it ude l e ve l about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri. 5. Based on the result, it can be conclude that student‟s attitude has more effect than student‟s knowledge toward garbage disposing at IIK Bhakti Wiyata Kediri.

From the result and, it can conclude that knowledge level also has influence toward garbage disposing. Festinger (1957), other than knowledge, bad habits and culture also influence individual in practicing a behavior. Culture of a group in the community usually are heritable which also formed attitude and perception toward health. Ratna (2010), cultural practice is an act that must made as habits by learning. So although an individual has a higher education, it‟s not certify that he/she will have practice health behavior.

Suggestion 1. IIK and BEM should made rule about garbage disposing and give strict sanction or punishment to students whom violate the rule so the student will be a competence health worker and have a good healthy life behavior. 2. IIK should adding garbage can and place it at the hall, cafeteria, and parking lot. 3. IIK should place poster which appeal the student to dispose the garbage in to the can. . REFFERENCE

Despite of that, student‟s attitude has more effect than student‟s knowledge toward garbage disposing at IIK Bhakti Wiyata Kediri. Attitude is the readiness and willingness to act and not the implementation of particular motive. Notoatmodjo (2010), Attitute is not an act but presdipotition of a behavior (closed behavior). Sani (2011), Attitude is a readiness to act as the reaction and appreciation toward the object. Basically, the attitude of most IIK Bhakti Wiyata‟s students showed good correlation toward garbage disposing.

Festinger, L. 1957. A theory of cognitive dissonance. California: Stanford University Press

Conclusion 1. Based on the result, it can be conclude that most of the respondent were female and 21 years old or older. 2. Based on the result, it can be conclude that there was no i nfl ue nc e of st ude nt 's knowl e d ge l e ve l about healthy life behavior toward garbage disposing at IIK Bhakti Wiyata Kediri. 3. Based on the result, it can be conclude that there was an i nfl ue nc e of

Kementerian Kesehatan RI, 2011. Profil Kesehatan Indonesia 2010. http://www.depkes.go.id/downloads/ PROFIL_DATA_KESEHATAN_IND ONESIA_TAHUN_2011. pd f. Diakses 21 Desember 2013 Notoatmodjo, S. 2007. Promosi kesehatan & ilmu perilaku. Jakarta: Rineka Cipta.

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Notoatmodjo, S. 2003. Pendidikan dan Perilaku Kesehatan.Jakarta : Rineka Cipta Nursalam. 2011. Konsep Dan Penerapan Metodologi Penelitian Ilmu Keperawatan Pedoman Skripsi Tesis Dan Instrumen Penelitian Keperwatan. Jakarta : Salemba Medika Proverawati, A. & Rahmawati, E. 2012. Perilaku hidup bersih & sehat (PHBS). Yogyakarta : Nuha Medika. Sina,Seni Susanti dkk. 2010. Sikap Terhadap Perilaku Hidup Bersih Dan Sehat Pada Mahasiswa Stikes Citra Husada Mandiri Kupang Tahun 2010. Jurnal dipublikasikan Stikes Citra Husada Mandiri Kupang. Santoso, Slamet Iman. 2005. Beberapa Segi Pendidikan (Pembinaan Watak Tugas Utama Pendidikan). Jakarta : Penerbit Universitas Indonesia. Sani, Fahrudin Nasrul.2011. Hubungan tingkat pengetahuan sehat - sakit dengan sikap mahasiswa Universitas Muhammadiyah Surakarta tentang perilaku hidup bersih dan sehat. Jurnal dipublikasikan Universitas Muhammadiyah Surakarta

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THE EFFECT OF CLASSICAL MUSIC THERAPY TO INCREASE GLASGOW COMA SCALE IN MODERATE TO SEVERE TRAUMATIC BRAIN INJURY PATIENTS AT MARDI WALUYO BLITAR HOSPITAL Christina Dewi P, Riesa Yuni Pangestuti Nursing Major Faculty of Health Science Institut Ilmu Kesehatan Bhakti Wiyata Kediri Email: [email protected] Abstract Brain injury begins with brain function are accompanied intersitial hemoragic which may cause interruption of the continuity of the patient's brain and aggravating circumstances that can reduce the level of consciousness, causing death. Music therapy as a nursing intervention that can be performed by nurses as sensory stimulation can improve the awareness and potential for rehabilitation in patients with brain injury. This study aims to determine the effect of music therapy on the increase in the Glasgow Coma Scale in patients with moderate-severe brain injury. This study uses a pre-experiment design with One-grouph-pre-post test design and the technique accidental sample obtained 10 respondents in the bougainvillea and the ICU in Mardi Waluyo Hospital Blitar. Descriptive analysis with paired simple test illustrates that classical music therapy after an increase in Glasgow coma scale significantly to patients moderate to severe brain injury is Pvalue = 0.000.Conclusions from this study that there is the influence of classical music therapy to increase the Glasgow Coma Scale in patients with moderate to severe brain injury in Mardi Waluyo Hospital Blitar. Based on the research results suggested that the provision of classical music therapy can be applied in hospitals, especially in patients with brain injury. Keywords: Glasgow Coma Scale and classical music therapy

According to Djohan(3), music therapy is musical activities to resolve the various problems in the aspect of physical, psychological, cognitive and social needs of individuals with physical disabilities. With the incidence of such and a high mortality rate, the need for therapy assistant in addition to primary therapy to overcome the problem of severe traumatic brain injury, music therapy is one of nursing interventions as stimulation to patients which are expected to have an impact on the recovery and patients healing.

INTRODUCTION Brain injury is a traumatic disruption of brain function with or without interstitial bleeding in the brain substance without followed by the dissolution of continuity of the brain (1). According to Iavagnilio(2) , in the United States, the incidence of brain injury each year reached around 500,000 cases. Of these cases, 10% died before arriving at hospital. Who arrived at the hospital, 80% were classified as mild brain injury, and 10% were moderate and the rest of the brain injury is severe traumatic brain injury. Incidence of brain injuries mainly occur in the productive age group between 15-44 years.

Soo et al(4) states, music can also give effect to the improvement of health, reduce stress. Music is effective to reduce anxiety and increase positive feelings in medical-surgical patients.

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Music influence the mechanism of action of the autonomic nervous system, hormonal, so it can indirectly influence but patients who are given music therapy will feel more relaxed and calm. Some research about the benefits of music therapy for human health above has been developed in various countries, especially in Europe and America.

about 20 minutes and then respondents GCS was observed 10 minutes later. The results of Glasgow coma scale observation score before therapy compared to after the classical music therapy. After getting permission from the head of the nursing hospitals Mardi Waluyo Blitar, research conducted in the bougenvill room and the ICU Mardi Waluyo Blitar hospital to conduct preliminary studies, determine the sample, the sample in measuring the value of the Glasgow coma scale early before therapy classical music then conducted music therapy for 20 minutes by using earphones every patient and 10 minutes after the music therapy measured again the value of the Glasgow coma scale later on the observation sheet compared between Glasgow coma scale score after the therapy with classical music.

In Indonesia, the research conducted by Asrin et al(5) found that music therapy can be influential to improve the level of consciousness with severe traumatic brain injuries. During the theraphy session each respondents shows positive changes on physical response and psychosocial which the response are the present of the tears, the movement of the fingers and toes, the movement in the area around the jaw and attempt to open the eyelids. The same thing also stated by Novita(6) in his study where the music can reduce the stimulation of the sympathetic nervous system, where the response is to lower tensions that arise neuromuscular activity, increase the threshold of awareness, decrease the activity of adrenaline.

The population in this study were all patients with moderate to severe brain injury in hospitals Mardi Waluyo Blitar in February - March 2015. Samples taken in this research is 10 respondents, using minimal sample with accidental technique(8). Inclusion criteria are willing to become a respondent, moderate brain injury patients with GCS ≥9 <12, severe traumatic brain injury patients with GCS> 3 <8, had stable vital signs with a period of hospitalization more than 1 day, aged 12 - 80 years, and patients diagnosed with moderate to severe brain injury either due to traffic accidents, direct trauma or penetrating trauma.

In Mardi Waluyo Blitar hospital, during the past year (January 2014 - December 2014), the average number of traumatic brain injury patients each years is 101 patients in the bougenvill room and in the ICU which are consist of light brain injury (45 patients), moderate brain injury (24 patients), severe traumatic brain injury (32 patients). Based on the above writer is interested in conducting research on the influence of classical music therapy to increase patients Glasgow coma scale in moderate to severe brain injury in Mardi Waluyo Blitar hospital.

This study was conducted in the ICU and bougenvill room of Mardi Waluyo Hospital from 16 February until 16 March 2015. The primary data obtained directly from Glasgow coma scale observations of each patients before and after classical music therapy. The secondary data were getting from documentation and patients medical

RESEARCH METHOD The study used pre-experimental design with pre-post test desaign(7). In this study, Glasgow coma sclae observation was done before music therapy. The respondent accept the music therapy for

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records in the ICU and bougenvill room of Mardi Waluyo Blitar Hospital.

of brain injury, vital signs and initial Glasgow Coma Scale. Results of this analysis also illustrates the mean, confident interval, Glasgow Coma Scale score after classical music therapy. The following results are :

RESULT AND DISCUSSION Result A. Respondents characteristic

The analysis of the respondent characteristics in this study illustrates the distribution of respondents by age, sex, cause

Tabel 1 : Respondent distribution frequency in the moderate to severe traumatic brain injury at Mardi Waluyo Blitar hospital Characteristic

n

%

Age : Early adolescence (12 - 16 years) Late adolescence (17 - 25 years) Early adulthood (26 - 35 years) Late adulthood (36 - 45 years) Early elderly (46 - 55 years) Late elderly (56 - 65 years) Elderly (>65 years) Total

1 1 3 2 1 1 1 10

10 10 30 20 10 10 10 100

Gender : Male Female Total

9 1 10

90 10 100

Brain injury causes : Accident Penetrating trauma Direct trauma Total

7 3 10

70 30 100

-

-

5

50

5 10

50 100

-

-

10

100

Vital sign (Blood pressure) Low : - Blood pressure : < 90/60 mmHg Normal - Blood pressure : 90/60 mmHg-130/90 mmHg High - Blood pressure : >130/90 mmHg Total Vital sign (temperature) Low : - Temperature : < 36,5 0C Normal - Temperature : 36,50C-37,50C

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High - Temperature : > 37,50C Total Vital sign (Heart rate) Low : - Heart rate : < 60x/menit Normal : - Heart rate : 60-100x.menit High : - Heart rate : >100x/menit Total Vital sign (Respiratory rate) Low : - RR : < 12x/menit Normal : - RR : 12-20x/menit High : - RR : >20x/menit Total Early GCS 9-12 (Moderate traumatic brain injury) 3-8 (Severe traumatic brain injury) Total

10

100

-

-

8

80

2 10

20 100

-

-

-

-

10 10

100 100

4 6 10

40 60 100

(Resource : primary data from april 2015) respondents (70%), and direct trauma are 3 respondents (30%).

Based on Table 1 it can be seen that the age distribution of respondents majority who suffered brain injury moderate - severe in Mardi Waluyo Blitar hospital is in the age group of early adulthood are 3 respondents (30%), and minorities are at the age of early adolescence 1 respondents (10 %), late adolescence 1 respondent (10%), early elderly 1 respondent (10%), late elderly 1 respondent (10%), elderly 1 respondent (10%).

From the data above it can be seen that for the characteristics of the vital signs of the respondents are for blood pressure who are in the category of high blood pressure are 5 respondents (50%), and 5 respondents are in the category of normal blood pressure (50%). The majority temperature of the respondents are in a safe rate that is 36,50C - 37,50C number of 10 respondents (100%). For the majority of the heart rate, 8 respondents (80%) have normal heart rate and 2 respondents (20%) have high heart rate. All of the respondent was showed high respiratory rate.

Based on gender, the respondent who have sex male are 9 respondents (90%) and the female 1 respondent (10%). While the distribution of the characteristics of the causes of brain injury moderate to severe can be classified into accidents by 7

Distribusi untuk skala Glasgow Coma Scale responden dapat di kategorikan menjadi 2 yaitu pada skala Glasgow Coma Scale 9-12

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(COS) terdapat 4 responden dengan persentase 40% sedangkan untuk Glasgow Coma Scale 3-8 (COB) terdapat 6 responden dengan persentase 60%.

The distribution of the respondents Glasgow Coma Scale can be classified into moderate traumatic brain injury (GCS 9-12) there are 4 respondents (40%) and severe traumtaic brain injury (GCS 3-8) there are 6 respondents (60%).

B. Main variable Tabel 2 : Respondents Glasgow coma scale frequency before and after interventions in the day 1 until day 3 at Mardi Waluyo Blitar hospital

No resp ond en

Pr e

GCS

01

10

Moderate

Level of conscio usness (qualita tive) Stupor

02

7

Severe

03

Glasgow Coma Scale (GCS) post score Day 1 Day 2 Day 3 Sess Sess Sess Sess Sess Sess ion ion ion 1 ion 2 ion 1 ion 2 GCS 1 2

Level of consciousne ss (qualitative)

10

10

11

12

12

13

Light

Somnolen

Coma

7

7

8

9

9

9

Moderate

Stupor

10

Moderate

Stupor

10

10

10

11

11

11

Moderate

Stupor

04

6

Severe

Coma

6

6

6

7

8

8

Severe

Coma

05

7

Severe

Coma

7

8

9

9

9

9

Moderate

Stupor

06

7

Severe

Coma

7

7

7

8

8

9

Moderate

Stupor

07

11

Moderate

Stupor

11

11

11

12

12

12

Moderate

Somnolen

08

11

Moderate

Stupor

11

11

11

12

12

12

Moderate

Somnolen

09

4

Severe

Coma

4

5

5

5

6

7

Severe

Coma

10

5

Severe

Coma

5

5

5

6

7

7

Severe

Coma

(Resource : primary data from april 2015) Tabel 3 : Descriptive test (mean, confident interval, Pvalue) of the respondents Glasgow Coma Scale before and after intervention from day 1 until day 3 at Mardi Waluyo Blitar hospital

N

Mean

GCS pre

10

7,8

GCS post

10

9,7

(Resources : primary data from april 2015)

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Confident Interval 95 % Lower Upper 5,9903

9,6097

8,1528

11,2472

Pvalue

0,000

Based on the table 2 can be interpreted that the Glasgow coma scale before and after therapy were given classical music a significant increase, it can be seen on the Glasgow coma scale in each column of respondents are pre - post for 3 days has increased significantly. The mean increase in scale of the Glasgow coma scale after being given music therapy was 1 - 3 points.

2. Glasgow coma scale after the classical music therapy at Mardi Waluyo Blitar hospital From the distribution of the data obtained, the respondents with moderate brain injury that changed the GCS to be a mild brain injury as much as 1 respondents with initial GCS score 10 to 13, 3 respondents with initial GCS score 10-11 to 11-12, of respondents with brain injury weight amounted to 6 with 3 of them have increased GCS to moderate brain injury, but 3 of them still suffered severe brain injury but still increased GCS points. This is consistent with the Rihiantoro et al(9) which states that a coma patient's hemodynamic status is also controlled by the central nervous system, especially in the medulla oblongata, sensory stimulation is an action to raise awareness and potential for rehabilitation in comatose patients. Stimulation activities may include stimulation of the sensory sight, hearing, smell, taste, touch and kinestesia. 3. Analysis of test result paired with simple test of the effect of classical music therapy to increasing Glasgow coma scale for moderate-severe traumatic brain injury at Mardi Waluyo Blitar hospital Analysis of test results paired with a simple test of the influence of classical music therapy to increase patients Glasgow Coma Scale for moderate to severe brain injury in Mardi Waluyo Blitar hospital of test data obtained (pvalue = 0.000) with (α = 0.05), therapy Classical music is very influential to improve the Glasgow Coma Scale in patients with moderate to

Based on table 3 can be seen that from the data collected have been performed the data analysis processing of the results of this study showed that the mean of the respondents amounted to 10 with pre GCS classical music therapy can be interpreted by 7.8 and for GCS post classical music therapy can be interpreted by 9.7 whereas for the t value with CI = 95% for GCS pre classical music therapy at 5.9903 (lower) and 9.6097 (upper) and CI 95% for GCS post classical music therapy at 8.1528 (lower) and 11.2472 (upper). The analysis of the level of significance to the respondent (pvalue = 0.000). Discussion 1. Glasgow coma scale before the classical music therapy at Mardi Waluyo Blitar hospital In this study, respondents were selected in moderate brain injury patients (GCS ≥9 <12) and severe traumatic brain injury patients (GCS> 3 <8). Respondents in this study there were 4 respondents diagnosed with a brain injury was the range of scores (GCS 10-11) and 6 respondents were diagnosed with severe traumatic brain injury and for severe traumatic brain injury with the range of scores (GCS 4-7).

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severe brain injury. The responses of the physical and psychosocial well showed positive changes in the present of the tears, the movement of the fingers and toes, the movement of the jaw area as well as efforts to open up and move the eyelids, moaning and talking distracts. This is according to research conducted by Asrin et al(5) found that music therapy can be influential in raising awareness of the status of severe head injury patients and achieve the physical and psychosocial responses. Music is organized auditory stimuli consisting of melody, rhythm, harmony, timbre, form and style. Classical music is often a benchmark of music therapy, because it has a wide range of tone and tempo dynamic(10). This shows that when respondents listening to music, waves transmitted through ossicels in the middle ear and cochlear fluid running through to the auditory nerve and stimulates secrete endorphins. Endorphins have a relaxing effect on the body. The effect of music is lowered stimulus of the sympathetic nervous system. Response arising from a decrease in the activity is reduce the activity of adrenaline, decreased neuromuscular tensions, increase the threshold of consciousness(11).

2. The identification results after classical music therapy is one of the respondents to the initial GCS score 10 (COS) increased GCS up to 13 (COR), 3 respondents with initial GCS score 10 and 11 (COS) only increased GCS points that have high levels of awareness (qualitative) stupor into somnolence. While 3 respondents with initial GCS 7 (COB) increased GCS to 9 (COS), but there were 3 respondents severe traumatic brain injury with initial GCS score 4 to 7, initial GCS score 5 to 7 and the value of the initial GCS 6 to 8. 3. There is a very significant difference in Glasgow Coma Scale for brain injury patients with moderate to severe (pvalue = 0.000) and (α = 0.05). It can be concluded that there is the influence of classical music therapy to increase the Glasgow Coma Scale in patients with moderate to severe traumatic brain injury at Mardi Waluyo Blitar hospital. REFFERENCE 1. Muttaqin, Arif. 2011. Buku ajar asuhan keperawatan klien dengan gangguan persyarafan. Jakarta : Salemba medika,

CONCLUSION 1. Identification prior to classical music therapy has a range of scores (GCS 10-11) to moderate brain injury as much as 4 responders and the range of scores (GCS 4-7) for severe traumatic brain injury as much as 6 respondents.

2.

Iavagnilio, C.L. (2011). Traumatic brain injury : improving the patient‟s outcome demands timely and accurate diagnosis. Journal of Legal Nurse Consulting, 22 (3), 3 – 9.

3.

Djohan. (2011). Terapi musik : teori dan aplikasi. Penerbit Galangpress : Yogyakarta, Soo, K.D. et al. (2011). Effect of music therapy on mood in stroke patients. Yonsei Med Journal, Vol 52 (6),

4.

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5. Asrin, Mardiyono & Saryono. (2007). Pemanfaatan terapi musik untuk meningkatkan status kesadaran pasien trauma kepala berat, Jurnal Keperawatan Soedirman (The Soedirman Jurnal of Nursing)(2). No.2. Hlm 102106, 6. Novita, Dian. (2011). Pengaruh Terapi Musik Terhadap Post Operasi Open Reduction Internal Fixation (ORIF) di RSUD Dr. H Abdul Moeloek Provinsi Lampung. Tesis, Universitas Indonesia, Jakarta diakses 07 September 2013 http://lontar.ui.ac.id-is.html, 7. Nursalam. (2013). Konsep dan penerapan metodologi penelitian keperawatan. Jakarta : Salemba Medika,

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Sugiyono. (2010). Statistika Untuk Penelitian Edisi Revisi. Bandung : Alfa Beta, 9. Rihiantoro, Tori., Nurachman, E., Hariyati. (2008). Pengaruh terapi musik terhadap status heodinamika pada pasien koma di Ruang ICU sebuah rumah sakit di Lampung. Jurnal Keperawatan Indonesia (12) No.2, Juli 2008 Hlm 115-120, 10. Nurrahmani. (2012). Kamus musik. Yogyakarta : Kanisius, 11. Sarayar, C., et al. (2013). Pengaruh musik klasik terhadap penurunan tekanan darah pada pasien pra-hemodialisis di ruang Dahlia BLU RSUP. Prof.Dr.R.D Kandou Manado. E-journal keperawatan (e-Kp)(1). No.1. Hlm 1-7.

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THE CORRELATION OF KNOWLEDGE AND ATTITUDE WITH THE DECISION-MAKING OF BRIDE COUPLE TO CONDUCT PREMARITAL CHECK-UP IN WORK AREA OF KUA DISTRICT OF PARE KEDIRI

Ira Haslinda*, Tintin Hariyani**, Linda Andri Mustofa*** Advanced Midwifery Study Program STIKES Karya Husada Kediri Email: [email protected]

ABSTRACT

Premarital check up is the preparation efforts pregnancy and early detection of a disease that could endanger the mother and baby. Many people do not know about the purpose, benefits and procedures of premarital check-up. This resulted in a low number of bride and groom couples who do premarital check-up. There are several causal factor, namely the lack of knowledge, because not a lot of counseling and information about premarital check-up. This results in negative attitudes toward premarital check-up. The objective of this research was to know the correlation between knowledge and attitude with the decision-making of bride couple to conduct premarital check-up. Data collection was conducted in KUA Pare Kediri, which was held in July-August 2015. The design used analytic with approach of cross-sectional. The population was all couples bride. The sample amounted to 58 respondents. Samples were taken by technique of simple random sampling. The independent variables in this research were knowledge and attitude. The dependent variable was the decision to conduct premarital check-up. The data collection used questionnaire sheet. The data analysis used statistical test of Chi-Square with significance level of 0.05. The research results of knowledge and attitude with the decision to conduct premarital check-up, from the Chi-Square test results obtained there was a correlation between knowledge and attitude with the decision to conduct premarital check-up. While the closeness correlation were low, with contingency coefficient of 0.35. The increasing number of knowledge that gained about premarital check-up it will have an impact on the mindset, which resulted in a couple brides to be positive. With good knowledge and positive attitude, the bride and groom couples willing to do premarital check-up. Keywords: knowledge, attitude, decision making to conduct Premarital Check Up

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To increase the number of brides who do premarital check-up, the need for an increase in promotion and health education activities related to the importance of premarital checkup on the prospective bride and groom by health personnel. It aims to improve knowledge and attitudes pair bride and groom, so that there will be an increasing number of brides who do premarital check-up. Premarital check-up is intended as a preparation for the pregnancy and to produce offspring that are free of disease and disability.

INTRODUCTION The fundamental requirement in a marriage, one of which is for the function of reproduction and genetics that produce offspring (Gardiner and Kosmitzki, 2005). Descendants expected that generation of intelligent and free of disease and disability are not only physically but also spiritually. To mendapatkanya need for early skirining associated with decreased disease, chronic and infectious that can affect reproductive health in this case related to the effort to have offspring. Premarital Check Up is a preventive measure to detect reproductive health and genetics. Premarital Check Up contains a set of laboratory tests to ascertain the health status of both the prospective bride. From the results of the study in China found brides who followed the premarital health examination (Premarital Check-up) that is equal to 63.4% (Heketh, 2003: 277-279). According to the study conducted in Central Java showed that 89% of brides do not do premarital medical examination (Premarital Check-up) (Ulfah, 2008). Decision making the bride and groom to make premarital medical examination (Premarital Check-up) voluntarily remains low this is due to several factors. Of all the factors that have been investigated it was found that a low knowledge greatly affect the decision making the bride and groom to do premarital check-up. Bride and groom couples ignorance about how the procedures of examination, the type of inspection as well as the main one is related to the benefits of premarital check-up resulted bride and groom couples are reluctant to do pemarital check-up (Notoatmodjo, 2007: 140). Attitude is one that supports the bride and groom couples do premarital check-up. Positive or negative attitude of the couple bride bride influence the decision to conduct premarital check-up or not (Nojoadmojo, 2007: 124).

METHODS Design used is cross sectional analytic approach. The study population is all couples bride and groom in the working area of KUA Pare. Samples were taken by simple random sampling technique. The independent variable in this study is the knowledge and attitudes as well as the dependent variable is the decision making the bride and groom to do premarital check-up. Data collection will be done with the questionnaire sheet. Analysis of data using statistical Chi-Square test with significance level of 0.05. RESULTS General Data Characteristics Based Ever Presence Respondents to Information About Premarital Check Up

It is known that from 58 respondents, the majority of respondents were never informed about premarital check-up as many as 33 respondents (57%).

Characteristics of Respondents Based Sources of Information About Premarital Check Up

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Characteristics of Respondents by Sex

It is known that from 58 respondents, half of the respondents received information about premarital check-up from others as many as 14 respondents (50%).

It is known that from 58 respondents, half of the respondents were female as many as 29 respondents (50%).

Characteristics of Respondents by Age It is known that from 58 respondents, nearly half of respondents last high school education as many as 28 respondents (48%). Characteristics of Respondents by Income Level

Characteristics of Respondents by Education Level

It is known that from 58 respondents, the majority of respondents have an income of RP1.339.750 ≤ as many as 41 respondents (70%).

Specific Data Distribution Knowledge

It is known that from 58 respondents, the majority of respondents aged> 35 years as many as 32 respondents (55%).

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of

Respondents by

Level of

No

Level of Knowledge

Freque ncy

Percenta ge (%)

1

Less

24

41

2

Enough

16

28

3

Good

18

31

Total

58

Nearly half of the respondents have a good knowledge of conduct premarital check-up as much as 16 respondents (27.6%). And a small portion of respondents have less knowledge did premarital check-up as much as 14 respondents (24.1%).

100

Based on the results of statistical tests chi-square correlation value obtained by the decision-making knowledge to do Premarital Check Up, the result x2 count = 10.9 is greater than x2 table = 5.991 (10.9> 5.991) where Ho is rejected. With contingency coefficient value of 0.35. It means that there is a relationship between knowledge of the decision of the bride and groom to conduct premarital check-up in the working area of KUA districts Pare with the relationship low.

Of the 58 respondents, nearly half of the respondents have less knowledge as many as 24 respondents (41%). Distribution of respondents by attitude No

Attitude

Frequency

Percentage (%)

1

Negative

26

45

2

Positive

32

55

58

100

Total

Relationship Between Attitude With Decision Making Of the 58 respondents, the majority of respondents have a positive attitude as many as 32 respondents (55%).

N o

Attitud e

Distribution of Respondents by Decision Making

Of the 58 respondents, the majority of respondents chose to do Premarital Check Up as many as 38 respondents (66%). Relationship Between Knowledge With Decision Making No.

Knowledg e

1

Less

2

Enough

3

Good Total

Decision Making Do Do Not Premarita Premari l Check tal Up Check Up 14 10 (17,2) (24,1) 12 4 (20,7) (6,9) 16 2 (27,6) (3,5) 38 20 (65,5) (34,5)

1 2 24 (41,4) 16 (27,6) 18 (31) 58 (100)

Total

No

Decision Making

Frequen cy

Percentage (%)

1

Do Premarital Check Up Do not Melakukan Premarital Check Up Total

38

66

20

34

58

100

2

Total

Decision Making Do Do Not Premarital Premarital Check Up Check Up

Negati ve Positiv e Total

12 (20,7) 26 (44,8) 38 (65,5)

14 (24,1) 6 (10,4) 20 (34,5)

26 (44,8 32 (55,2 58 (100)

Nearly half of respondents have a positive attitude do premarital check-up as much as 26 respondents (44.8%). And a small portion of respondents have a negative attitude not

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conduct premarital check-up as much as 14 respondents (24.1%). Based on test results obtained chi-square value of the correlation attitude with the decision to do Premarital Check Up, the result x 2 count = 7.9 greater than x2 table = (7.9> 3,841) where Ho is rejected. With a contingency coefficient of 0.35. It means that there is a relationship between the attitude of the bride and groom's decision to conduct premarital check-up in the working area of KUA districts of Pare with the relationship low.

Respondents feel the need for premarital checkups and considers it important health himself and partner. Besides the positive attitude of the respondents is likely due to the requirement before the wedding to attach the results of the current marriage registration at KUA. So without knowing much about the benefits and purpose of premarital check-up candidate besikap pengatin positive and agreed to conduct premarital checkup. Decision To Perform Premarital Check Up According to the results of the study showed that of the 58 respondents, the majority of respondents chose to do Premarital Check Up as many as 38 respondents (66%). Decision making is the process of choosing an alternative way of acting with an efficient method according to the situation. Decision-making can be seen in relation to the process, namely that a decision is the final state of a process that is more dynamic (Salusu, 2005: 87). The bride and groom a good decision that is where the bride is willing to participate actively to conduct premarital check-up. The decision to conduct premarital bride kebanyaakan based because marriage at the KUA requirements that require the bride to attach the results of premarital check-up when performing marriage registration. So many brides decide to conduct premarital check-up. In the process of making one's decision to conduct premarital check-up or not, can be affected by several factors. Relationship Between Knowledge And Attitude With Decision To Perform Premarital Check Up Based on the results of statistical tests chi-square correlation value obtained by the decision-making knowledge to do Premarital Check Up, the result x2 count = 10.9 is greater than x2 table = (10.9> 5.591) where Ho is rejected. More information is obtained it will affect knowledge bride and groom couples resulting in the decision to conduct premarital check-up. Based on test results obtained chi-square value of the correlation attitude with the decision to do Premarital Check Up, the result x2 count = 7.9 greater than x2 table = (7.9> 3,841) where Ho is rejected.

DISCUSSION Knowledge The survey results revealed that of the 58 respondents, nearly half of the respondents have less knowledge as many as 24 respondents (41%). Some studies have noted that certain demographic factors have an effect on the bride and groom to participate in Premarital Check Up. These factors include gender, age, place of residence, education, and income bride. Besides the awareness, knowledge and attitudes towards Premarital examination Check Up (Wang, 2013). Knowledge can be obtained by means of traditional and modern. In the knowledge that there are three domains of cognitive, affective and psychomotor. Differences in the ability of a person to receive information depengaruhi by several things, for example the level of education, income, local culture etc. Knowledge of the respondents were less because not many counseling related to premarital check-up. So not many respondents know what the purpose, keutungan and losses premarital check-up and how the examination procedure. So the effect on the decision to do the bride and groom couples premarital check-up. Attitude According to the research that has been conducted shows that of the 58 respondents, the majority of respondents have a positive attitude as many as 32 respondents (55%). Attitude is the assessment (can be opinion) a person to a stimulus or object (Nojoadmojo, 2007: 124). A positive attitude can be shown by the respondent he received well and proactively with counseling about premarital check-up. It is also willing to conduct premarital check-up because of his own conscience.

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A positive attitude and negative attitude of someone who decided based on the results of social interaction with the environment. It influenced the development of the mindset that one can determine the attitude of a thing, which is to be negative or positive. A positive attitude bride and groom couples may influence the decision to conduct premarital check.

up with melibatka health workers as partners. 3. For Educational Institutions Improve and develop the results of further research and is expected to be an additional literature to enrich the existing literature. 4. For Further Research In order to develop the existing research by using a larger sample, should be tested the validity and reliability of the questionnaire so the results are valid and can be used as material for further research.

CONCLUSION 1. Almost half of the respondents have less knowledge as many as 24 respondents (41%). 2. Most of the respondents have a positive attitude as many as 32 respondents (55%). 3. Most of the respondents chose to do Premarital Check Up as many as 38 respondents (66%). 4. Based on the results of statistical tests chisquare correlation value obtained by the decision-making knowledge to do Premarital Check Up, the result x2 count = 10.9 is greater than x2 table = 5.991 (10.9> 5.991) where Ho is rejected. Contingency coefficient of 0.35. It means that there is a correlation with low cohesion between knowledge and decisionmaking for the bride and groom couples do premarital check-up in the working area of KUA Pare. 5. Based on the results of statistical tests chisquare value obtained correlation attitude with the decision to do Premarital Check Up, the result x2 count = 7.9 greater than x2 table = (7.9> 3,841) where Ho is rejected. Contingency coefficient of 0.35. It means there is a low correlation with the closeness between the attitude of the bride and groom couples decision to conduct premarital checkup in the working area of KUA Pare.

BIBLIOGRAPHY A. Wawan dan Dewi. (2011). Teori dan Pengukuran Pengukuran Pengetahuan, Sikap dan Perilaku Manusia. Yogyakarta: Pustaka Pelajar. Hal 1618, 34, 35-37 Atoillah, Ibnu. 2012. Pemeriksaan Kesehatan Pra Nikah Dalam Perspektif Hukum Islam. Jawa Tengah: universitas negeri sunan kalijaga. Hal 5 Chiroma, Magaji. 2014. Premarital Medical Examination Is A Panacea To The High Rate Of Parental Mortality In The Society A Reflection On Its Implication Toward Children Up Bringing : An Islamic Jurispicidence Perspective. Vol. 25. Journal of Law, Policy and Globalization. IISTE. Hal 50 Gu, Yaming. 2014. Factors Influencing Voluntary Premarital Medical Examination In Zhejiang Province, China: A Culturally-Tailored Health Behavioral Model Analysis. China: BMC public health. Hal 2, 3, 5 Notoatmodjo, Prof. Dr. Soekidjo. (2002). Metodologi Penelitian Kesehatan. Jakarta: Rineka Cipta. Hal 122, 123, 126 Wang, Peigang. 2013. Factors Influencing The Decision To Participate In Medical Premarital Examinations In Hubei Province, Mid-China. China: BMC public health. Hal 2, 4,5

SUGGESTION 1. For Health Officer mainly Midwives From the research that has been conducted local midwife can give the bride and groom couples counseling on the importance of premarital check-up as an effort to prepare for pregnancy. 2. For Officers KUA Can be used as inputs in improving the existing program about premarital check-

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LITERATURE REVIEW PARTNERS OF PROFESSIONAL NURSING STUDENTS IN THE FACE OF MEA THROUGH LEARNING METHODS IPE (INTERPROFESIONAL EDUCATION) Sylvie Puspita (STIKes Husada Jombang)* Neny Triana (STIKes Karya Husada Kediri)* * *Email : [email protected]

ABSTRACT Background : Selection of appropriate learning methods for nursing students is one thing that is important in the face of MEA (masyarakat ekonomi asean). Interprofesional learning method is a method of learning that prepares students of nursing as a professional partner other health team. With the application of IPE learning method is expected to improve the health care of patients. Objective: This study aimed to determine the effectiveness of the application of IPE in improving nursing students komnikasi and cooperation with other health team and the factors that become obstacles in the implementation of the IPE. Methods: Perform a search on Proques article about articles related to IPE learning method in nursing with the keyword "IPE" found 519 articles published in 2000-2015 and then with the keyword "IPE in education nurshing found 315 articles then we enter into 20 articles . Results: IPE provide a positive impact on both the students and teachers. Students are required to be someone who can appreciate other professions and work together in a professional manner. Diving instructor IPE learning process becomes more aware of the characteristics of students and more menikamati course of the learning process. The existence of barriers in the learning process IPE is a big challenge for every department of this include differences in the curriculum of each study program and bagamana how to set the time for the IPE. Keywords: IPE, Nursing Students, MEA

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Background IPE learning methods mrupakan methods that are widely used in the medical faculty of nursing is no exception. In the face of the MEA and the demands of society the higher will be the good service requires education providers need to print professional nursing graduates who could become partners and other health team. IPE is an approach to the educational process two or more different disciplines collaborate in the teaching-learning process with the aim of fostering interdisciplinary / interprofessional interactions that enhance the practice of their respective disciplines. (ACCP, 2009). By dimasukkanya IPE IPE in nursing education curriculum is expected to be a learning method that aims to prepare nursing students become nurses ready to work professionally with other healthcare teams that are useful for improving the health care of patients. IPE implementation requires a high commitment between programs of study, one of the obstacles of implementing IPE is how to manage the implementation of the IPE. This is because each program has a curriculum of study respectively. (Buring et al, 2009). The participation of lecturers in the implementation of the IPE is how to manage the process of implementing IPE nets, mengidentfikasi conflict and participate in the process berjalanya discussion. By following a process of discussion berjalanya professors could direct how the students in developing critical thinking skills. (Brimble, 2008; Race & Pickford, 2007; Macauley & Billings, 2011). Definition IPE There are several definitions of the IPE, to make it easier to use the five definitions of some of the theories that we

then conclude. IPE is a strategy used to facilitate students to improve collaboration, communication, and skills in working with other health team. (Henderson, O'Keefe & Alexander, 2010; National League for Nursing (NLN), 2012). IPE is when there are two or more professional students who studied together to solve the patient's problem. IPE is a deliberate attempt to bring together two or more professions to work together to improve health care (Palaganas, 2012). IPE is the cooperation carried out by nurses, doctors, midwives in order to face the global demands to improve the comprehensive care of the patient (Begley, 2009). IPE is a learning method that aims to reduce the difference between the profession which led to poor patient care and professional work (Areskog, 1988; Carpenter, 1995; McMichael & Gilloran, 1984; Ryan & McKenna, 1994). According to the World Health Organization, 2010 explained that IPE is crucial to learning methods aimed at preparing health personnel in meeting and responded pasiean needs to be a professional service. IPE is an approach to the educational process two or more different disciplines collaborate in the teaching-learning process with the aim of fostering interdisciplinary or interprofessional interactions that enhance the practice of their respective disciplines. (ACCP, 2009). Purpose or benefit IPE IPE useful for the improvement of patient care because in IPE occur profeional exchange information about the patient's condition. In the process of IPE is not only a process of understanding the role of each profession but also assessment and patient care decision-making. (Barrett, Greenwood, & Ross, 2003; Patsios & Carpenter, 2010). IPE aims to train students to work together in collaboration with other health care team to prepare students for the world of work after

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graduation. It emerged from each health profession so comes IPE (IPEC Expert Panel, 2011). IPE has the benefit of improving the quality of patient care. IPE during an exchange of knowledge that is beneficial to the patient. The World Health Organization (WHO, 2010) has been promoting IPE as' an important step in preparing a "collaborative practice-ready" health workforce better prepared to respond to public demand health care professional. method By searching through proquest article related to IPE. Search is done by typing the keyword "IPE" appears as 1,288. Our second type of IPE to limit the year 2010-2015 appears as many as 519 articles. Because we want to do on nursing education we type the keyword "IPE in nurshing Educatian" with the range of 2010-2015 as many as 315 articles mncul and finally we select as many as 20 articles. Table conclusions of 20 articles Tipe Qualitative penelitian Observational Quasi experimental

Jurnal

Lokasi

Nursing journal Journal of nurshing education American journal of public health American Journal of Pharmaceutical Education Journal of Allied Health Nurse Education in Practice Springer Publishing Company Journal of Physical Therapy Education USA New york

n=5 n = 10 n=5 n=1 n=2 n=1

n=2 n=6 n=4 n=2 n=1 n = 10 n=1 n=1

Australia n Canada n New Zealand

n=5 n=3

Discussion Implementation of IPE learning model is one model that is appropriate for dealing with the public tntutan will peayanan optimal health in the face of the MEA. With the implementation of good IPE expected to avoid overlapping jobs or roles in patient care so that patients will not get the same information. (Bennett et al, 2011 ;. Freeth, 2007). In the implementation of the IPE there are challenges or obstacles most often encountered. The one challenge is time. This happens because of different curriculum of each program of study so it is difficult to determine the exact schedule for the implementation of the IPE. (Buring et al., 2009). Other barriers that are usually encountered is inadequate because the number of students and the capacity of the room is not balanced. The challenges in the implementation process IPE is how can mutual respect between professional opinion and discard bad or degrading prangsangka other professions. (Barnes, Carpenter & Dickinson, 2000; Cragg, Jelley, Burrows & Dyer, 2013; Hind et al., 2003). The obstacles in the implementation of the IPE there are also benefits one of which is to be implemented learning model IPE will establish good cooperation with skeatholder that will produce graduates who are professionals in collaboration (Poore et al., 2014). In the American national accreditation body perananan disebutan that the importance of nurses in the service to the patient so requires nurses can work together as partners with a team of other health professionals. It menjeaskan that IPE importance in the learning process. IPE could be described as a

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means of connecting education institutions with health services. This is because the learning model can IPE meningkingkatkan health services. But in the implementation of IPE is need for a strong commitment by each program of study considering different curriculum, teaching schedules and lack of budget in the implementation of IPE. To evaluate IPE based on 20 articles that we get then we use some of the questions: 1. What is the main purpose of the learning process IPE? 2. How is the process of implementation of the IPE? 3. What are the obstacles in the implementation of the IPE? 4. How to overcome obstacles in the implementation of the IPE? Result Based on article 20 we get a conclusion to answer the following questions. 1. What is the main purpose of the learning process IPE? With the IPE learning process is expected to cultivate an attitude of concern for the students to learn about the professional manner in cooperation with other health care team, and supported by a professional and experienced facilitators between academic and clinical facilitators in the process of IPE. (Anderson & Thorpe, 2008). IPE also had a positive impact on the change in the attitude of the facilitator is more appreciative of other professions, teachers enjoyed a role during the learning process, the positive feedback from students, memottivasi students during the process of IPE. Mahasiswan educated using IPE reported that having a better understanding about cooperation in a professional manner that benefits patients and friends in other professions to be

comfortable. (Acton Shapiro, 2008). Benefit from a collaborative approach is supported in a study by Lumague and colleagues (2006). Summative assessments and goals module combines done IPE is how patient management strategies for treating patients with the professional manner in accordance with their respective sciences. 2. How is the process of implementation of the IPE? Basically the process of implementing IPE has four important components, namely McFadyen et al. (2005): 1) Teamwork and Collaboration Learning with other health care team will make more effective mahasiswaa, good communication and how mutual respect among health professionals that will ultimately improve patient care. 2) Negative Professional Identity Dispel the idea that "I do not need belejar with other health care team and the patient's problem I can handle sendri" it is the purpose of the implementation of the IPE. 3) Positive Professional Identity Foster the idea that learning together will make me become a better communication, I would be able to solve the problems of patients is much better to work together and I will be more professional in their work. 4) Roles and Responsibilities The function of the nurse is as partners that give a thought for the good of the patients and I also had to get the knowledge of other health care team. According interprofessional Education Collaborative (IPEC) there are 4 main competencies in the process of implementing IPE, namely:

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1) The values and ethics roles and responsibilities in collaborative practice 2) The communication interpfofesional 3) Cooperate in patient care Childs (1987) notes that there are 4 Elmen should diperhatiakan in the implementation process IPE: 1) Faculty Faculty have peraanan important in settings where arranged by the faculty IPE ranging from human resources, made a commitment between courses. 2) Curriculum Design and model of curriculum used by each study program is the responsibility of the faculty. Faculty plays a major role in modifying the curriculum to incorporate aspects of IPE including philosophy, organization, main tasks, competence programs, and program evaluation. In the process of implementation of the IPE should be able to create a conducive susana, innovative and an atmosphere of professional cooperation in solving problems of the patients. Through simulation, the health professions students have the opportunity to actively carry out professional work, receive feedback, and reflect on their performance and others in key areas. Students can experience the practice from the perspective of their discipline or can assume the role of other health professionals, which promotes a deeper understanding of how each profession contributes to the delivery of care. (Smith & Roehrs, 2009). 3) Structures When making the experience IPE, IPE the ultimate goal of the implementation is designing for students to actually provide care together in a supervised environment

and health care must be a priority. Active participation dalalam implementation of IPE and contribute or lead the planning meeting interprofessional cases are examples of activities that will provide training in the skills of the team proved. The clinical performance evaluation should include appropriate aspects of a student's mastery of competencies construct because the foundation for effective team-based care. 4) Students Students generally have a positive response to the IPE (Dubouloz, Savard, Burnett, & Guitard, 2010). These findings are consistentwith previous studies showing that students who reported prior experience with IPE had significantly more positive attitudes towards interprofessional team (Curran, Sharpe, Forristall, & Flynn, 2008). However, a later study by some of the same authors (Curran, Sharpe, Flynn, and Button, 2010) shows that the introduction of IPE curriculum for undergraduate education appears to have no significant effect on attitudes toward IPE elongated or interprofessional teamwork. Students must be responsible for learning and performance include the concept of IPE and help to see their important role in promoting teamwork and collaboration in their practice settings in the future. 3. What are the obstacles in the implementation of the IPE? According to WHO the lack of health workers spread around the world 4.3 million health workers that this is a barrier to health in the future. Unequal distribution of health workers who are in the territory of rural and urban occur in developing countries. WHO in this case provide a

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solution that is by promoting education IPE as the main learning model in order to produce graduates who can immediately work together professionally. The American interprofessional Health Collaborative (AIHC), explains that implementing IPE requires a shared commitment because it requires institutional support, leadership, vision and mission in order to be able to walk IPE.One of the obstacles that occur in the process of implementing IPE dalah differences in the academic calendar, curriculum design, no commitment enough of the teaching process related IPE, the lack of funds in the process to support the IPE, and there are many institutions that have Prodi health workable IPE ,By collaborating and working in partnership with families and other professionals, IPE team can identify problems as they jointly respond according to its competence to provide appropriate intervention. The benefits to patients and their families is that they have easy access to services (Mann et al., 2009). IPE in the implementation process, there are several obstacles, namely: 1) Institutional Barriers Time is an issue, such as courses that have a different curriculum and how to schedule and allocate time for each study program to jointly carry out the IPE is difficult, usually because of the workload (Buring et al., 2009). 2) Barriers professional Another challenge of the IPE is able to appreciate how other professions, if this can not be done would be a failure to appreciate their respective roles. 4. How to overcome obstacles in the implementation of the IPE? One obstacle in IPE is not able to appreciate the other professions. Ignorance of other professions can be prevented by

better communication. One solution is to combine the experience of learning where educators from specialist profession run sessions where they share knowledge that will benefit all involved with students of various professions. According Buring et al., 2009, described that there are 5 strategies used to develop the IPE in education and practice, namely: 1) Communicate and disseminate the competence of IPEC 2) Develop interprofesional and resources in the implementation of IPE 3) Strengthening research on IPE 4) Apply the IPE at new school 5) The existence of policies that support the implementation of the IPE either in funding or facilitating the process of IPE. Conclusion IPE learning method is an effective method for mememui public demand health care professionals and the demand for MEA. this is because the institution to equip students with IPE to produce students who are ready to collaborate and communicate professionally with other health care team in entering the world of work

Referenssi Annette Grady Greer, Maria C. Clay (2010) : Interprofessional Education Assessment and Planning Instrument for Academic Institutions . Journal of Allied Health, Fall 2010, Vol 39, No 3 Pt 2 (Special Issue). Brenda Flood, Wendy McKinstry, Rehab, Philippa Friary, Suzanne C. Purdy (2014) : Cultivating Interprofessional Practice in New Zealand : An Inter-Sectorial Approach to Developing

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Interprofessional Education. Journal of Allied Health, Fall 2014, Vol 43, No 3 . Carlson Elisabeth a, Pilhammar Ewa b, WannHansson Christine (2011) : The team builder: The role of nurses facilitating interprofessional student teams at a Swedish clinical training ward. Nurse Education in Practice 11 Courtney West, Michael Veronin, Kare Landry, Terri Kurz, Bree Watzak, Barbara Quiram6 and Lori Graham (2015). Tools to investigate how interprofessional education activities link to competencies. Medical Education Online. Cheryl L. Addy, Teri BrowneElizabeth W. Blake, Jennifer Bailey (2013) : Enhancing Interprofessional Education: Integrating Public Health and Social Work Perspectives. American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1 Deborah Poling, PhD, RN, FNP-BC, CNE; and Mary Kiersma, PhD, PharmD (2013) : A Unique Interprofessional and MultiInstitutional Education Series. Educational Innovations. Dori Taylor Sullivan, Nelda S. Godfrey (2012) : Preparing Nursing Students to Be Effective Health Team Partners Through Interprofessional Education. Creative Nursing, Volume 18, Issue 2, 2012 Elizabeth Susan Anderson, Lucy Nichola Thorpe and Marilyn Hammick (2011) : Interprofessional staff development: Changing attitudes and winning hearts and minds. Journal of Interprofessional Care H.V. Gilbert John : The Status of Interprofessional Education in Canada. Journal of Allied Health, Fall 2010, Vol 39, No 3 Pt 2 (Special Issue). Irma Ruebling, MA, PT, Charlotte Royeen, PhD, OTR/L (2010) : Saint Louis University Interprofessional Education Program. Journal of Allied Health, Fall 2010, Vol 39, No 3 Pt 2 (Special Issue) Jenn Salfi, Patricia Solomon, Dianne Allen, Jennifer Mohaupt, and Christine Patterson (2011) : Overcoming All Obstacles: A Framework for Embedding

Interprofessional Education Into a Large, Multisite Bachelor of Science Nursing Program. Journal of Nursing Education · Vol. 51, No. 2, 2012. Kerry Hood, Robyn Cant , Julie Baulch , Alana Gilbee , Michelle Leech , Amanda Anderson, Kate Davies (2013) : Prior experience of interprofessional learning enhances undergraduate nursing and healthcare students‟ professional identity and attitudes to teamwork. Nurse Education in Practice 14 (2014) 117e122. Lisa Norsen, PLinda L. Spillane (2011) : Partnering in Interprofessional Education to Design Simulation Programs to Promote Collaboration and Patient Safety. Creative Nursing, Volume 18, Issue 3, 2012. Lynne Gaskell , Susan Beaton (2009) : Interprofessional work based learning within an MSc in Advanced Practice:Lessons from one UK higher education programme. Nurse Education in Practice 10 (2010) 274–278. M. Uden-Holman, PhD, Susan J. Curry, PhD, Loretta Benz, MSW, and Mary Lober Aquilino, PhD, MSN (2012) : Public Health as a Catalyst for Interprofessional Education on a Health Sciences Campus. American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1. Neocleous Ari ,(2014). Interprofessional Education : How Can it Enhance Learning?Whitireia Nursing and Health Journal 21/2014 Pages 23–28. Reeves Scott, Goldman Joanne, Burton Andrea, Brenda Sawatzky-Girling : Synthesis of Systematic Review Evidence of Interprofessional Education . Journal of Allied Health, Fall 2010, Vol 39, No 3 Pt 2 (Special Issue). Sarah Shrader, PharmD,* and Caroline Griggs, PharmD CandidateSouth Carolina College of Pharmacy, MUSC Campus, Charleston, South Carolina (2014) : instructional design and assessment Multiple Interprofessional Education Activities Delivered Longitudinally Within a Required Clinical Assessment Course. American Journal of Pharmaceutical Education 2014; 78 (1) Article 14

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Susan C. Sommerfeldt, Sylvia S. Barton , Paulette Stayko , Steven K. Patterson 3, Jan Pimlott (2010) : Creating interprofessional clinical learning units: Developing an acute-care model Nurse Education in Practice 11 (2011) 273e277 Shauna M. Buring, PharmD, Alok Bhushan, PhD, Amy Broeseker, PhD, Susan Conway, PharmD,Wendy DuncanHewitt, PhD, Laura Hansen, PharmD,and Sarah Westberg, PharmD (2009) : Interprofessional Education: Definitions, Student Competencies, and Guidelines for Implementatio American Journal of Pharmaceutical Education 2009; 73 (4) Article 59. .

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THE ANALYSIS OF THE HEALTH SERVICE STAFF FOR PATIENT SATISFACTION IN GAMBIRAN PUBLIC HOSPITAL KEDIRI

Nurdina Institute Of Health Surya Mitra Husada Kediri Email : [email protected] ABSTRACT The purpose of the research is as follows: 1) Analyze the factors that affect the service of health workers and the most dominant factor in the Gambiran Public Hospital Kediri, 2) analyze the factors that affect patient satisfaction and factors which is the most dominant in the Gambiran Public Hospital Kediri,3) to analyze the influence of the quality of health care personnel to patient satisfaction and the size of the effect on the Gambiran Public Hospital Kediri. The research location was in the Gambiran Public Hospital Kediri. Allocation of the study period of 10 months was conducted from June 30 2013 to March 23, 2014. This study uses research approaches explanation (explanatory research) with the survey method. The study populations were inpatients the Gambiran Public Hospital Kediri who are treated in class 3, class 2, class 1 and class VIP. While the sample is part of a smaller population with the following criteria: 1) patients were hospitalized at least 3 days and hospitalized at least twice in Gambiran Hospital, 2) the Age of patients between 19 years to 65 years, 3) Minimum patients educated graduate Primary School, 4) Patients with residence in the former residency Kediri. The number of samples used was 284 respondents consisting of grade 3 as many as 93 respondents, 80 respondents in grade 2, grade 1 were 59 respondents and VIP class of 52 respondents. The analytical method used in this study is multiple regressions. Based on the research results, it can be concluded as follows: 1) the factors of quality health services consisting of variable waiting room that is representative (X3), ease of service medical support (X6), ministry of information (X8) and accuracy and standard medical measures (X9) showed a significance level α = 5%, while the variable X1, X2, X4, X5, X7 and X8 showed non significant. While the most dominant variable is a variable ease of medical services (X6) that is equal to 32.30%, 2) patient satisfaction indicates that the variable Satisfaction with medical services (Y2), Satisfaction with public services (Y3) , Satisfaction with employee attitudes (Y5) and Satisfaction with hospital costs (Y7) shows the level of real significance that the value of α = 5%, while the variable satisfaction with the services administration (Y4) and Satisfaction with the attitude of a paramedic (Y6) showed non significant , while variable Y2 indicate the most dominant variable that is equal to 39.50%. 3) The effect of service to health professionals individually has a significant effect, whereas the effect of service for patient satisfaction is 51.50%. Key-words: Service, health service staff, patient satisfaction and efficient health with emphasis on healing and recovery efforts are carried out in harmony and integrated with efforts to improve and implement referral and prevention of health-related agencies. It must be realized that the main purpose of the activities in the hospital is to serve patients and their families in various forms of service. People assume that getting quality health care is a right for everyone (Marpaung, 2010). This spurred the hospital for a serious attempt to improve the quality

I.INTRODUCTION 1.1.Background The hospital is an integral part of the overall health care system that was developed through health development plan. In the hospital consists of several supporting elements, such as medical doctors, paramedics, medicines and employees as the manager of the hospital. The hospital is an integral part of the whole system of health care services. The hospital has the task of carrying out the effective

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of health services provided. Service of health workers is a form of service to be professional and is an integral part of the health care system that is based on science and nursing shaped tips service. Health care is organized every effort individually or jointly within an organization to maintain and promote health, prevent and cure disease and restore the health of individuals, families, groups and or society (Anwar, 1995). Quality health care is referring to the level of excellence in health care creates a feeling complacent each patient according to the average level of satisfaction of the population, as well as the needs and demands, the more perfect the satisfaction, the better the quality of health services. As well as in the other party in accordance with the procedure of implementation of standards and codes of professional conduct that has been established (Anwar, 1995). Simply, there are three basic requirements that must be held for the so-called good health services, namely: 1. In accordance with the needs of users of the services. A good health service is in accordance with the needs of users of the services. 2. Can be reached by those in need. Affordable here means not only in terms of distance or location but also in terms of financing. 3. In accordance with the principles of science and medical technology. In other words, a good health care is the health services of assured quality (Sari, 2004). Health care workers in hospitals to provide good service facilities mean patients and their families are satisfied with the services provided by the hospital. Satisfaction is a function of the difference between the perceived and expected performance. Patient satisfaction is the perceived level of satisfaction of patients and families to health services and is one of the indicators of hospital performance. If the patient shows good things about health care, especially nursing and patient indicated by the positive behavior, then we can draw the conclusion that the patient was satisfied with the service (Purnomo, 2012). Long and Green (1994) found that nurses have a unique contribution to the satisfaction of patients

and their families. Valentine (1997) stated that the nursing service and nurse behavior is a factor that affects the patient's satisfaction. Soejadi (2006) says, the patient is the most important individual in the hospital and consumer products target in the hospital. Within a decision process, consumers are patients; it will not stop just up the process of receiving the service. Patients will evaluate the service received. The results of the evaluation process will produce a feeling of satisfaction or dissatisfaction (Sumarwan, 2003). Gambiran Public Hospital Kediri which is located in Kediri is one of the governmentowned hospitals in Kediri. It is one of the hospitals that are improving the quality of patient care in order to improve the performance of hospitals to teaching hospitals awarded. 1.2. Formulation of the problem: Based on the above background, the problem of the formulation is as follows: 1. Factors that influence health care workers and which is the most dominant factor in the Gambiran Public Hospital Kediri. 2. Factors that influence patient satisfaction and which is the most dominant factor in the Gambiran Public Hospital Kediri. 3. Is there any influence of the quality of health care personnel to patient satisfaction and how big is the influence of these in the Gambiran Public Hospital Kediri? 1.3. Research purposes. Based on the formulation of the problem mentioned above, the purpose of the research is as follows: 1. Analyzing the factors that affect health care personnel and the most dominant factor in the Gambiran Public Hospital Kediri. 2. Analyzing the factors influencing patient satisfaction and which factor is the most dominant in the Gambiran Public Hospital Kediri. 3. Analyze the impact of the quality of the health service professionals on patient's satisfaction and the influence of these in the Gambiran Public Hospital Kediri. II. RESEARCH METHODOLOGY 2.1. Location and Time Research

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manner in accordance with variables core in this study, so that the filling of questionnaire respondents are easy to understand. 2.4. Types and Sources of Data Judging from the data type, in this study there are two types of data to be collected that is primary data and secondary data. Primary data was collected through direct interviews with respondents through a list of questions (questionnaire). While secondary data according to Emory and Cooper (1995), there are two sources, namely internal and external data sources. Internal data source is the data obtained from respective companies as research objects, while the external data source is data obtained from outside Gambiran hospital Kediri, for example: the Central Bureau of Statistics Indonesia (BPS), the Ministry of Health and related agencies. 2.4.2. Sampling method In this research, there are 21 parameters were estimated respectively: 10 in service, patient satisfaction there is 7, and the loyalty of existing patient 4. Accordingly, the amount of data cross-sectional sample size based on the formula Slovain (Umar, 2011) with the following formula: N n = -----------------1 + N e2 Where: n = sample size (the respondent) N = Size of Population e 2 = the percentage of errors that can be tolerated in which use 10% Further sampling is determined by proportional with the following table:

The research location was in Gambiran Public Hospital Kediri. Allocation of the study period of 10 months was conducted from June 30 2013 to March 23, 2014. The reason for the focus of the research is as follows: (1) Gambiran Public Hospital Kediri is one hospital that was heading excellent service quality improvement that leads to hospital type B (2) patient in Gambiran Public Hospital Kediri showing an upward trend the number of patients seeking treatment, (3). Gambiran Public Hospital Kediri has become the target of an education hospital 2.2. Types of research. This study uses research approaches explanation (explanatory research) with the survey method, the research seeks to explain the effect of compensation system to increase employee productivity. The survey was conducted to capture the required information that is data related to the study variables. This study was designed to address problems that have been formulated and to achieve generalization in getting a picture of the population. Viewed from the side of the problem, the research study is to determine the effect of causality as independent variable (predictors) which consists of variable of the health service workers on the dependent variable (dependent) i.e. patient satisfaction. In terms of this research is the analysis of parametric and non-parametric. 2.3. Data collection technique. Several studies use a variety of ways in data collection. Specifically, in the research data collection techniques used are: a. interviews; namely data collection techniques by doing interviews with respondents or employees where their activities. This technique is used for obtain information and technical data that is personal while supporting data that has not covered through questionnaires. b. questionnaire; namely data collection techniques using a list of questions, which is made in such a way in accordance with goals to be achieved. The questionnaire further list submitted to each respondent. The questions are arranged in such a

Based on the above the sample size used consisting of grade respondents, grade 2

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Slovin formula, then was 284 respondents 3 as many as 93 was 80 respondents;

grade 1 was 59 respondents and VIP class of 52 respondents. 2.5. Data analysis technique The analytical method used in this study is multiple regression with the general formula: Y = bo + b1X1 + b2X2 + b3X3 ……. bnXn+ e Where: Y = Independent Variable X1 ... .. Xn = Dependent Variable b0 = Constant b1, b2 = intercept / regression coefficient 1) Test F (Over all tests) To determine the influence of independent variables together / simultaneously on the dependent variable, used test Sudjana F. (1992) formulated as follows: JKreg / k F= JKres / (n – k – 1) Where: JKreg = sum of squares regression JKres = number of quadratic residues k = number of independent variables n = many subjects If a significant F value is less than 5% or F count> F table, then declared significant meaning jointly independent variables affect the dependent variable. And conversely when the significance of F greater than 5% or F arithmetic t table then declared significant meaning partially independent variables affect the dependent variable. And vice versa when the significance of t greater than 5% or t count
independent variable has no effect on the dependent variable. 3) The most dominant variable. To find out where the independent variable most dominant note of the value of beta. The variables that have the highest beta value is the most dominant variable influence on the dependent variable. III. RESULTS AND DISCUSSION 3.1. Factors Affecting Health Care Workers Variables that affect the service of health personnel consists of 10 variables, namely: 1) Ease of access to outpatient services (X1), 2) Procedure service that is not convoluted (X2), 3) Lounges representative (X3), 4) the accuracy hours of service (X4), 5) The speed of medical action (X5), 6) Ease of service as medical support (X6), 7) Leisure facilities in hospitals (X7), service informative (X8), accuracy and standard medical procedures (X9 ), facilities and infrastructure support (X10). The results based on the analysis of variance as in Table. 1. and the coefficient of determination in Table. 2.

The results of the table. 1. Show that the factors that influence the health service that consists of variable 1) Ease of access to outpatient services (X1), 2) Procedure service that is not convoluted (X2), 3) Lounges representative (X3), 4) the accuracy of the hours of service (X4), 5) The speed of medical action (X5), 6) Ease of service as medical support (X6), 7) Leisure facilities in hospitals (X7), 8) services are informative (X8), Accuracy and standards medical procedures (X9), facilities and infrastructure support (X10) showed a significant influence amounted to 29 577 with a significance level α = 5% and 1%. This indicates that the level of service

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based on ten criteria to these variables showed good results. This is consistent with the results of research Puspa Yudha Utama et al (2013) in the Sultan Agung Islamic Hospital Semarang that the service performance of the hospital staff in the VIP class showed very satisfied.

informative (X8) and Accuracy and standard medical procedures (X9) showed a significance level α = 5%, while the variable X1, X2, X4, X5, X7 and X8 showed non significant. While the most dominant variable is a variable ease of medical services (X6) that is equal to 32.30%. 3.2. Factors Affecting Patient Satisfaction The variables that affect patient satisfaction (Y) of seven variables, namely: 1) satisfaction of the medical services (Y1), 2) Satisfaction with medical support (Y2), 3) Satisfaction with public services (Y3), 4) Satisfaction with services administration (Y4), 5) Satisfaction with employee attitudes (X5), 6) Satisfaction with the attitude of a paramedic (Y6), 7) Satisfaction with hospital costs (Y7). The results based on the analysis of variance as in Table. 3. and the coefficient of determination in Table. 4.

Based on the results of a study of the coefficient of determination in the table.2 demonstrate 0.52 or by 52%, which means that the variable-variable; 1) Ease of access to outpatient services (X1), 2) Procedure service that is not convoluted (X2), 3) Lounges representative (X3), 4) Appropriateness of hours of service (X4), 5) The speed of medical action (X5 ), 6) Ease of service as medical support (X6), 7) Leisure facilities in hospitals (X7), service informative (X8), Accuracy and standard medical procedures (X9), facilities and infrastructure support (X10) has the effect of 52% , while the remaining 48% are influenced by factors outside to ten variables for example in the provision of budgetary constraints to the provision of more adequate facilities.

The results based on the analysis of variance of the factors that affect patient satisfaction in Gambiran hospital Kediri consisting of variable 1) Satisfaction with medical services (Y1), 2) Satisfaction with medical support (Y2), 3) Satisfaction with public services (Y3 ), 4) Satisfaction with services administration (Y4), 5) Satisfaction with employee attitudes (Y5), 6) Satisfaction with the attitude of a paramedic (Y6), 7) Satisfaction with hospital costs (Y7) showed a significant influence amounted to 74 072 against α = 5% and α = 1%. Results showed that patient satisfaction with Gambiran hospital shows that they feel satisfied with the services of the employees of the hospital.

The results showed that the variables Lounges representative (X3), Facility services medical support (X6), service

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3.3. Influence of Service Quality Patient Satisfaction Results of analysis of variance influence the quality of health care personnel (X) on patient satisfaction (Y) can be seen in the table. 6.

The results based on the value of the coefficient of determination (R2) of 0.653 or by 65.30%, which means that the influence of variables 1) Satisfaction with medical services (Y1), 2) Satisfaction with medical support (Y2), 3) Satisfaction with public services (Y3), 4) Satisfaction with administrative services (Y4), 5) Satisfaction with employee attitudes (Y5), 6) Satisfaction with the attitude of a paramedic (Y6), 7) Satisfaction with hospital costs (Y7) has the effect of 65.30% while the remaining 34.70% influenced by other factors beyond the seven variables e.g. organizational culture can be less socialized to employees.

The results showed that in partial satisfaction of service of health workers towards patients in Gambiran hospital Kediri showed significant influence amounted to 206 072 to the value of α = 5% and 1%. This shows that there is a real effect with good service quality, the patient will feel satisfied.

Based on the analysis of the coefficient value of the determination, it shows that the effect of the influence of health care personnel to patient satisfaction by 42.30% while the remaining 57.30% influenced by other factors. Results of the study the factors that affect patient satisfaction indicates that the variable Satisfaction with medical services (Y1), Satisfaction with medical support (Y2), Satisfaction with public services (Y3), Satisfaction with employee attitudes (Y5) and Satisfaction with hospital costs (Y7) shows the level of real significance that the value of α = 5%, while variable Satisfaction of administrative services (Y4) and Satisfaction with the attitude of a paramedic (Y6) showed non significant, while the variable Y2 indicate the most dominant variable that is equal to 39.50%,

Table. 8. Indicates that the influence service to health service workers individually has a significant influence on the α = 5% and α =

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1%, while the great influence service to the patient satisfaction is 51.50%. IV. CONCLUSIONS AND SUGGESTIONS Based on the results and the discussion above, it can be concluded as follows: 1) The results showed that the factors of quality health services consisting of variable waiting room that is representative (X3), ease of service medical support (X6), ministry of information (X8) and accuracy and standard medical procedures (X9) indicates the level of significance α = 5%, while the variable X1, X2, X4, X5, X7 and X8 showed non significant. While the most dominant variable is a variable ease of medical services (X6) that is equal to 32.30%. 2) The results of the study the factors that affect patient satisfaction indicates that the variable Satisfaction with medical services (Y1), Satisfaction with medical support (Y2), Satisfaction with public services (Y3), Satisfaction with employee attitudes (Y5) and satisfaction towards the cost of home pain (Y7) shows the level of real significance that the value of α = 5%, while the variable satisfaction with the services administration (Y4) and Satisfaction with the attitude of a paramedic (Y6) showed non significant, while the variable Y2 indicate the most dominant variable that is equal to 39, 50%. 3) The effect of service to health professionals individually has a significant influence, while major influence on patient satisfaction services is 51.50%.

Utama

BIBLIOGRAPHY Adikoesoemo dan Suparto, 2013. Manajemen Rumah Sakit. Penerbit Pustakan Sinar Harapan Jakarta. Agustiono,B dan Sumarno, 2011. Analsis Kualitas Pelayanan Jasa Terhadap Kepuasan dan Loyalitas Pasien Rawat Inap di Rumah Sakit St. Elizabeth Semarang. Jurnal Unika Soegijapranata. Vol. 6. No. 04. Oktober 2011. Marpaung B.S., 2010. Gambaran Kepuasan Pasien Terhadap Pelayanan

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Keperawatan di Ruang Rawat Inap Rumah Sakit XYZ Tahun 2009. Jurnal Ilmiah Ranggading, Vol.10 No. 02, Oktober 2010; 171-178. P.Y, Apriati P.E, dan Sari Listyorini, 2013. Analisis Kepuasan Pasien Rawat Inap Rumah Sakit Islam Sultan Agung Semarang Dilihat dari Dimensi Kualitas Pelayanan. Diponegoro Journal of Social and Politic, Vol 8, 2013 Nov.

APPLICATION OF CARING BEHAVIOR (CARING) NEW STUDENTS IN SATISFACTION OF RECOGNITION D3 NURSING PROGRAM INSTITUTE OF HEALTH KARYA HUSADA KEDIRI

Neny Triana*, Sylvie Puspita** *Institute of Health Karya Husada Kediri,** Institute of Health Husada Jombang Email: [email protected]

ABSTRACT

In order to prepare mentally and gives an overview of the system of learning and campus life it is necessary for the orientation program for new students to accelerate adaptation to the new environment. Education that has been instilled in students is expected to improve the quality of nursing education to be applied. According to Watson (1979 in Dwidiyanti 2010) Caring is one form of service which involves a series of affection, friendliness and a dynamic approach, where nurses have a duty to implement the behavior of a loving, sensitive sense of ourselves and others. As organizers of Caring Education should be applied from students entering the campus, so caring more inherent in nursing students. The objective is To identify Implementation of New Student Caring Behavior Against Recognition Program Implementation Satisfaction Study (PPS) D3 Nursing STIKES Karya Husada Kediri. Methods: Quasi-experimental, Population 99 Student Level I, Sample 27 Students, sampling with accidental sampling, data collection with satisfaction questionnaires covering aspects Tengibless, Reliability, responsivness, Assurance, Empathy. Analysis of the data by using one sample t-test, significant 0.05, H1 accepted if -t table < t arithmetic. Of the 27 students of the value of the average satisfaction the implementation of the Recognition Program (PPS) = 139.3 with t table 1,703 < t arithmetic 61.488, meaning H1diterima: Students are satisfied with the current implementation of the Caring Behavior Recognition Program (PPS) Study program D-3 Nursing Institute of Health Karya Husada Kediri. Caring behavior to students must be maintained, so ingrained in themselves to pass, as the provision at work. Expected as Role Model of education and education of its personnel. Keywords: Caring, a new student, Satisfaction, Recognition Program

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Introduction Students are the nation's future, and a reflection of the nation in the future. Student is a group in society that gained its status as ties with the university. Students also an intellectual or prospective young scholars in a society that is often qualified with various predicates. Nursing is an interaction between nurses and clients, nurses and other health professionals. An education quality starts from kuliatas education provided, starting from the beginning of activities, namely Introduction Program (PPS) students to finish the end of the semester. Education that has been imparted to students is expected to improve the quality of nursing education to be applied. A mix of professional nurses with the knowledge and skills include intellectual skills, technical and interpersonal skills in the implementation should reflect the caring behavior. According to Watson (1979 in Dwidiyanti 2010) of Theory of Human Care, caring is an interpersonal relationship between nurses and patients in nursing care with the aim to improve and protect the patient so as to help the healing process of patients. Caring is one form of service which involves a series of affection, friendliness and a dynamic approach, where nurses have a duty to implement the behavior of a loving, sensitive sense of ourselves and others. As organizers of Caring Education should be applied from students entering the campus, so caring more inherent in the prospective nursing students. Caring can generally be defined as the ability to orag dedicated to another, with vigilant monitoring, a feeling of empathy for others and feelings of love or compassion. Objective: To identify Implementation of Caring Behaviors In New Students. Metods: the Introduction Program Implementation Satisfaction Study (PPS) in Nursing Studies Program D3 STIKES Karya Husada Kediri Method In this study using Quasi-experimental research Posttest Only, Non-Equivalent Control Group Design, where all subjects in the study group (intact group) for treatment (treatment), instead of using subjects drawn randomly. The study design consists of one or

several experimental groups and one control group. The group used an intact group and the dependent variable was measured only once, namely after experimental treatments administered. Population is a region that consists of objects / subjects that have certain quantity and characteristics defined by the researchers to be learned and conclusions drawn. The population in this research is the first kindergarten student number 99 students. The sample is a fraction of the number and characteristics dimliki by population is taken according to specific procedures that represent the population. The samples taken from the study 30% of 99 students = 27 students. The sampling technique using a non-probability sampling is a technique accidental sampling by coincidence, that anyone who by chance met the researchers could be used as a sample. Data analysis technique by testing one sample t test, an analysis technique to compare the independent variable. This technique is used to test whether certain values are significantly different. 0.05 significant. Result And Discussion Identification of Student Characteristics: No Age Sex Religion 1 18-20 18 Wanita 15 Islam 26 2 21-23 9 Laki12 Non 1 Laki Islam 27 27 27

Identification Satisfaction Results of Implementation Implementation of Caring D3 Nursing Recognition Program STIKES Karya Husada Kediri. The average yield satisfaction the implementation of caring for the implementation Introduction Program (PPS) D3 Nursing STIKES Karya Husada Kediri = 139.3. The test results showed that t = 61 488. Test parameters H1 accepted if -t table
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health / obtained

References: Annette Grady Greer, Mary C. Clay (2010): interprofessional Education Assessment and Planning Instrument for Academic Institutions, Journal of Allied Health, Fall 2010, Vol 39, No 3 Pt 2 (Special Issue). Abdul, et al. (2012) Relationship Behavior Caring nurse with Level Inpatient Satisfaction Home Pain from: (http://pasca.unhas.ac.id/jurnal/files) Cheryl L. Addy, Elizabeth Browne Teri W. Blake, Jennifer Bailey (2013): Enhancing interprofessional Education: Integrating Public Health and Social Work Perspectives. American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1. Dwidiyanti, Mediana, (2010) Caring key Successful nurse / nurses practice science, Semarang, Hasani. Susan Elizabeth Anderson, Lucy Nichola Hammick Thorpe and Marilyn (2011): interprofessional staff development: Changing attitudes and winning hearts and minds. Journal of interprofessional Care. Grahacendikia (2009) Factors Perception Affects Patients Against Nurses Caring Behaviors Nursing in Practice http://grahacendikia.wordpress.com obtained 26 April 2010

2004/0116 / kes2.html 13 April 2010

Jenn Salfi, Solomon, Dianne Patricia Allen, Jennifer Mohaupt, and Christine Patterson (2011): Overcoming All Obstacles: A Framework for Embedding interprofessional Education Into a Large, Multisite Bachelor of Science Nursing Program. Journal of Nursing Education Vol. 51, No. 2, 2012. Kerry Hood, Robyn Cant, Julie Baulch, Alana Gilbee, Michelle Leech, Amanda Anderson, Kate Davies (2013): Prior experience of interprofessional learning enhances undergraduate nursing and healthcare students' professional identity and attitudes to teamwork. Nurse Education in Practice 14 (2014) 117e122. Mia Magareta Aji Saputri (2009) Perception Patients About Caring Behaviors Nurses in Service Nursing Maranatha In the room I http://eprints.undip.ac.id/10596/1/AR TIKEL.doc accessed June 18, 2010 Muhlisin, A, Ichsan B (2008), Application Conceptual Model of Caring Jean Watson in Nursing, News of Nursing ISSN 1979-2697, vol 1 no. 3 (147-150). Moleong Lexy J, (2006). Methodology Qualitative research, Prints 25th. Bandung: PT Young Rosdakarya

Gsianturi, (2004) Efforts to Improve Professionalism Nurses http://www.sinarharapan.co.id/iptek/

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RELATIONSHIP BETWEEN INDEPENDENCE LEARNING AND THERAPEUTIC COMMUNICATION SKILL WITH CLINICAL COMPETENCE LEARNING IN PROGRAM STUDI DIII KEPERAWATAN STIKES KARYA HUSADA KEDIRI Sutiyah Heni*, Ambar Mudigdo**, Nunuk Suryani*** *Diploma of Nursing STIKES Karya Husada Kediri ** Family Medicine Studies Program, Graduate School, Sebelas Maret University Email: [email protected] ABSTRACT Based on the Indonesia Law Number 23 in 1992 about Health. It is decided that Health Program means to develop the Healthy Life Ability for everyone in order to reach The Optimal Health Phase. One of effort in Health Implementation is Family Health Effort. That is Nurse. Nurse‟s Graduation Quality is influenced by The Result of competition when they do their education. The Objective of Observation is to analyze the correlation between Independence Learning and Therapeutic Communication Skill with Clinical Competence Learning in Program Studi DIII Keperawatan STIKES Karya Husada. The Design of Observation is Cross Sectional. The Source of Observation is the students of Nursing Academy Diploma III of Third Semester. The Sample of Observation is 50 Students on Census .The Data take in closed questionnaire and Analyzed by The Type of Double Linier Regression. The Result of Observation shows that it has any significant correlation between Independence Learning and Competence (r=0,068, p= 0,545, p>0,05) and between Therapeutic Communication Skill and Clinical Competence Learning (r=0,139,p=0,010,p<0,05) and (F=11,088, p=0,000,R=0,566,Adj R=0,292 ). The Independence Learning and High Therapeutic Communication Skill with Clinical Competence Learning can make The Optimal Competence. It is important to inform to all Clinic Lecturer and Others Lecturer. They must develop Clinic Quality Learning in Practicing during training and create The Independence Learning and High Therapeutic Communication Skill with Clinical Competence Learning. We hope that all students can get optimal competence. They become professional Nurse in the future and can develop The Indonesia Health Program Key Word :

Independence Learning, Competence Learning

Therapeutic

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Communication

Skill,

Clinical

According Muhaibin shah (2005: 92), "Learning is a phase change in the behavior of individuals all over the relatively settled as a result of experience and interactive with the environment that involve cognitive processes. Meanwhile, according to Oemar Hamalik (2003: 21) says, "Learning is a form of growth or change in a person who is expressed in the ways of behavior thanks to the experience and training". In the study there is a change in habits, abilities (skills) or get this aspect of knowledge (cognitive), attitudes (affektif) and skills (psychomotor) obtained as a deliberate and not due to the physiological process of growth or maturity. According to Rousseau, as quoted Sukmadinata (2003: 168) states that, "the child has a potential that is still hidden, through a child's learning should be given a chance to develop or actualize these potentials". Children have the power to seek its own, try, discover and develop themselves. According Sukmadinata (2003: 165-166), some of the principles of learning as follows: Learning is part of the development, lifelong learning, learning takes place in every place and time, learning can take place either with the teacher and without a teacher, learning due to the demands of motivation According to Umar Tirtadiharja and La Sulo (2005: 50) the concept of independence in learning rests on the principle that individuals who learn only be until the acquisition of learning outcomes ranging skills, development of reasoning, the formation of attitudes to the self-discovery when he experienced himself in the process of obtaining results The study According Mudjiman (2011) indicator independent learning are: 1) Continuous (persistance) Learning activities undertaken an activity that lasts longer, continuous, not serning stop 2) Consistent (Consistence) Activities "steady", disciplined, not lazing 3) Systematic (Systemic)

INTRODUCTION Health development is essentially directed towards the achievement of awareness, willingness and ability to live a healthy life for everyone, involving physical, mental, and social, cultural and economic. To achieve optimal health degree carried out various efforts to comprehensive health services, directed and continuous. (Kepmenkes, 2007) Communication skills are the driving force and steering actions learned. Driving in the sense enabler that allows the act of learning is executed. Steering in the sense of giving guidance to the act of learning towards the goals set. The purpose of learning the mastery of new competencies to deal mater. Teratasinya problems mean inevitability of learners from undesirable circumstances (Mudjiman, 2008) The nurse is a person who has completed a primary education and care is vested with the government as well qualified to provide quality nursing care and full responsibility (Poniman in diknakes bina magazine, 1999) Nursing Diploma III study program STIKES Karya Husada Kediri as one of the universities in the health sector have a vision of creating a professional nurse and master of science and technology, is also cautious against God Almighty. Based on preliminary studies conducted by researchers in the 2012/2013 academic year clinical study data obtained that as much as 20% of students do not complete the clinical study reports appropriate predetermined time, nearly 20% of students have the competence index in clinical learning under graduation standards, and as much as 15% of the students at the end of the learning process has not yet reached the target attainment of physical examination of the patient. (Primary Data STIKES Karya Husada, 2013) Independence is indispensable man, the lack of independence would arise confidence, its own capabilities, the ability to control themselves, so satisfied with what is done or made.

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Activities always planned as oriented to the mastery of competencies 4) Focus (Goal orientedness) Learning activities focus, with continuing evaluation to measure the achievement of objectives 5) Innovative (Innovative) Always trying to find a way out when faced with problems, including a new exit that had not been done 6) Follow-up clear (Follow-up clarity) Follow-up of activities are always clear. This related to the consistence above characteristics. 7) Learning throughout life (Learning for Life) Learning activities carried out at any time of life, to survive or develop life. Communication is a reciprocal process and an experience in which the sender and the recipient participate simultaneously (Lu Verne Wolff, Marlene HW, Elinor VF, 1984). Communication can be defined as between a personal process in sending and receiving the symbols that are meaningful to their interests (John R.Schemerhom, in AWWijaya, 2000) Duldt-Bettey quoted Suryani (2006) defines communication as a process of adjustment and adaptation of the dynamic between two people or more in a face to face interaction and an exchange of ideas, meanings, feelings, and concerns. Communication skills is a critical skill that must be possessed by impersonating a nurse and an integral part of nursing care. Communication in nursing called therapeutic communication, which is a communication made by a nurse at the time of nursing interventions so as to provide therapeutic efficacy for the healing process of patients. Therapeutic communication is a structured communication which consists of four stages: pre-interaction phase, orientation phase, working phase and termination phase. Therapeutic communication that occurs between the nurse and the client must go through four stages of the pre-

interaction phase, orientation phase, working phase and termination phase. In order for therapeutic communication between the nurse and the client can run as expected, a strategy is needed to be done by nurses at the time of therapeutic communication with clients. According to As Homby (1974), quoted by Nurjannah, I (2001) says that the therapeutic is an adjective that relates to the art of healing. This illustrates that in undergoing the process of therapeutic communication, a nurse doing activities ranging from assessments, in accordance with the nursing actions that have been planned until the evaluation of all that can be achieved with a maximum in the event of an effective communication process and intensive. Roger Carl concept developed by Mundakir (2006) identifies three basic factors / indicators in therapeutic communication to develop a relationship of mutual help (helping relationship), namely sincerity (genuineness), empathy (empathy), and warmth (warmth) The structure of the therapeutic communication, according Stuart.GW 1998, consists of four phases, namely: 1. Phase Preinteraksi This phase is a preparatory period before the start of dealing with clients . Duties of nurses in this phase are: a. Explore the feelings , hopes and anxieties b . Analyzing strengths and weaknesses , with a self-analysis he will be trained to maximize the therapeutic him so valuable to the client , if you feel ready then need to relearn , discussion groups of friends . c . Collect data on the client , as the basis for a plan of interaction d . Make a plan in writing meetings , which will be implemented when meeting with clients 2. Phase Introduction / orientation This phase begins when the first met with the client . The main tasks of nurses at this stage is to provide environmentally sensitive situation and indicate acceptance

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, as well as assist clients in expressing feelings and thoughts . The tasks of nurses at this stage , among others : a. Build a trusting relationship, indicate acceptance and open communication. b. Formulate contact with the client. The contract, which must be agreed with the client, namely: place, time, topic of the meeting. c. Digging feelings and thoughts as well as to identify the client's problem. To encourage clients to express their feelings, the technique used is an open question d. Formulate goals with the client. Objectives formulated after the client's problem is identified. Things to note in this phase include: a. Greets therapeutic accompanied reached handshake b. Introduce yourself nurses c. Agreeing contracts. The agreement relates to the willingness of clients to communicate, topic, place and duration of meetings d. Completing the contract. At the first meeting of nurses need to complete explanation of the identity and purpose of the interaction so that the client believes to nurses. e. Evaluation and validation. Assessment contains the main complaint, the reason or event that makes the client to ask for help. f. Agree on the issue. By focusing techniques nurse with the client to identify the problems and needs of the client. 3. Work Phase This stage is the core of the whole process of therapeutic communication. The nurse and the client explore the stressor and encourage the development of selfawareness by linking perceptions, feelings and behavior of the client. 4. Phase Termination This phase is a phase that is difficult and important, because a relationship of trust already established and at the optimum level. The nurse and the client jointly review the nursing process that has been passed and the achievement of objectives

For through this phase successfully and valuable therapeutic, nurses use the concept of loss. Termination is the end of the meeting of nurses, which is divided into two, namely: 1. Termination Meanwhile, there is still further meeting 2. Termination end, occurs when nurses have the nursing process as a whole. Duties of nurses in this phase, namely: a. Evaluating the achievement of the goals of interaction that has been done, this evaluation is called an objective evaluation. b. Perform subjective evaluation, carried out by asking the client's feelings after interacting / after performing certain actions c. Agree on the follow-up of the interactions that have been made. Followup given should be relevant to the new interaction performed or to be performed at the next meeting. d. Making a contract for the next meeting, a contract needs to be agreed is the topic, time and place of the meeting. Competence is a set of intelligent action full responsibility of a person as a condition to be considered capable by the public in carrying out tasks in certain occupations (Kepmendiknas 045 / U / 2002 Reilly and Oermqnn in Pusdiknakes (2007) states that the learning experience clinical (hospital, community and health care units etc.) is an important part of the health education program, because it provides a rich experience for learners in applying the knowledge gained into the real situation , The research objective is to analyze the relationships between independent learning and therapeutic communication skills with competency in clinical learning in Nursing Diploma Program STIKES Karya Husada Kediri The hypothesis in this study There is a relationship between learning independence with competence in clinical learning in the Diploma Program Nursing STIKES Karya Husada Kediri. There is a

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relationship between therapeutic communication skills with competency in clinical learning in the Diploma Program Nursing STIKES Karya Husada Kediri. There is a relationship between learning independence and therapeutic communication skills with competency in clinical learning in the Diploma Program Nursing STIKES Karya Husada Kediri. RESEARCH METHODOLOGY This study was conducted in D-III Study Program of Nursing STIKES Karya Husada Kediri Kediri. The research was conducted during the period of the first semester of academic year 2013/2014 is starting in September 2013 until February 2014. This study was an observational analytic design using "cross-sectional". This study researchers used all the subjects contained in the student population at the third semester of the school year 2013/2014 totaling 50 people. The sampling technique used by the census. Samples were 50 people in the D3 Nursing Program STIKES Karya Husada Kediri. Indicators of learning independence is shrinking reliance on others in the study, from within ourselves the greater to learn on their own with all the capabilities to shrink even without expecting will help others in learning. Scoring for the statement is 1 and the highest grade 5 each statement with a positive statement (favorable) and negative statements (unfavorable). Indicators of therapeutic communication skills is a structured communication which consists of four stages: pre-interaction phase, orientation phase, working phase and termination phase. Scoring for the statement is 1 and the highest grade 5 each statement with a positive statement (favorable) and negative statements (unfavorable). Indicators of therapeutic communication skills is a structured communication which consists of four stages: pre-interaction phase, orientation phase, working phase and termination phase. Scoring for the

statement is 1 and the highest grade 5 each statement with a positive statement (favorable) and negative statements (unfavorable). Indicators of competence in pembejaran clinic is the result of the evaluation of the learning experience clinical (hospital, community and health care units etc.) is an important part of the health education program, because it provides a rich experience for learners in applying the knowledge gained into real situations. Scoring: 85-100 values, values 75-84, grades 65-74, 55-64 values, values <54 Means of collecting data using questionnaires and observation / checklist. This research instrument using the enclosed questionnaire. The questionnaire validity test product moment correlation and reliability by using Cronbach alpha. Data were analyzed using research prerequisite test normality test, multicolinearity and linearity test. Test hypotheses using correlation analysis, multiple linear regression, t test, F test and the coefficient of determination (R2) and the effective contribution and relative contribution. Calculation prerequisite research and hypothesis testing using SPSS (Statistical Package for Social Science). DISCUSSION RESULTS Based on the results of the research prerequisite test for normality test showed that the value of Sig (p) 0,010> 0.05 means that distributed data normality. The test results multikolinearitas known that VIF <10 and tolerance values> 0.10 means not occur multicoloniarity. The test results are known linearity learning independence with competence in clinical learning by p value 0.043, therapeutic communication skills with competency in clinical learning by p value 0.110, competence in clinical learning has a linear relationship as p value> 0.05. Results of the correlation product moment correlation learning independence with competence in clinical learning values

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obtained ρ: 0.468, with a significance level of 0.000 <0.05, meaning there is a positive relationship between learning independence with competence in clinical learning. Relations therapeutic communication skills with competency in clinical learning values obtained ρ: 0.561, with a significance level of 0.000 <0.05, meaning there is a positive relationship between therapeutic communication skills with competency in clinical learning. Results of multiple linear regression equation is: Y = 11.088 + 0,068X1 + 0,139X2. Interpretation that the value of the variable regression coefficient learning independence and therapeutic communication skills with competency in clinical learning is a significant positive correlation levels, including a strong, independent learning and increasing therapeutic communication skills will increasing competence in clinical learning outcomes The results showed that in D3 of Nursing Program STIKES Karya Husada Kediri contributions influence learning independence and therapeutic communication skills to competence in clinical learning is at 29.2%. The rest is (100% - 29.2%) = 70.8% influence on the competence of the clinical study is another contributing factor, because basically quite a lot of factors that affect the learning competencies in the clinic. CONCLUSIONS RECOMMENDATIONS

D3 STIKES Karya Husada Kediri (r = 0.561; p = 0.000; p <0.05). The better the communication skills the better therapeutic competence in clinical learning, there is a relationship independent learning and therapeutic communication skills with competency in clinical learning in Nursing Study Program D3 STIKES Karya Husada Kediri (R = 0.566; adj R2 = 0,292p = 0.000; p < 0.05). Contributions influence independent learning and therapeutic communication skills to competence in clinical learning is at 29.2%. SUGGESTION Based on the research that has been done can put forward some suggestions as follows: In the implementation of clinical learning, students need dipahamkan about the need for independence and communication skills therapeutic for a powerful learning and earnestly, because of kemndirian learning and skills of therapeutic communication was also a student will strive achieve optimum skills. Implementation of clinical learning process is expected to have a clear system, that which can be accounted for and also need to be supported by infrastructure adequate practice area, as well as good coordination between education providers with land practices, so as to create nurses who are competent in their field. So that students have the ideals that the nursing profession is a profession that will be undertaken for life, so that from the perception it would appear the nature kemnadirian and also skills of therapeutic communication to make corrections themselves for the future, which in the end product produced can contribute decrease in the number health concern Donations jointly between independent learning and therapeutic communication skills by 29.2% against an increase in attainment of competence in clinical learning. So there are still 70.8% of the factors that affect the achievement of clinical learning competence value. For

AND

CONCLUSION Based on the results of the study can be drawn some conclusions as follows: There is a relationship learning independence with competence in clinical learning in Nursing Study Program D3 STIKES Karya Husada Kediri (r = 0.468; p = 0.000; p <0.05). The better the better the learning independence of competence in clinical learning, there is a relationship therapeutic communication skills with competency in clinical learning in Nursing Study Program

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example: the lack of Preparation theory, lack of laboratory practice, the absence of a meeting before practice, the lack of clinical practice, the absence of a meeting after practice and lack of feedback. Therefore, further research on other factors affecting the attainment of competence in clinical learning, increase the number of population and the interviews to complement the overall data.

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EFFECT OF USING CONDOMS EVENTS SEXUALLY TRANSMITTED INFECTION IN PROSTITUTES IN CLINIC SEXUALLY TRANSMITTED INFECTIONS ( STIs ) GURAH PUBLIC HEALTH SERVICE KEDIRI REGENCY

Lingga Kusuma Wardani STIKES Surya Mitra Husada Kediri Email: [email protected]

ABSTRACT Sexually transmitted infections (STIs) are infections that mostly transmitted through sexual contact with a partner who is infected. This disease can be transmitted from one person to another through sexual contact. CSW (commercial sex workers) is a high- risk group the incidence of STIs. Besides the risk of contracting STIs, as well as the risk of a carrier group to pass on to its customers the disease.The purpose of this study to determine the effect of condom use on the incidence of sexually transmitted infections in sex workers in IMS Health Center Clinic Gurah Kediri. Design retrospective case control study. The entire population of prostitutes who visited the STI clinic health center GurahKediri :85 CSW with 85 respondent sample was taken with a total sampling technique. Data were collected by questionnaires condom use IMS events taken from medical records, expressed in nominal scale and ordinal data were analyzed with Logistic Regression Testing. The results showed the majority of respondents use condoms sometimes the 53 respondents (62.4%) , the majority of respondents are positive IMS 44 respondents (51.8%), no effect of condom use by sex workers in the event ims at IMS Health Center Clinic GurahKediri ( p = 0.032 ). This is due to the construction of condoms able to be protective or barrier to bacterial contamination processes in the body. It is recommended that health centers keep doing counseling to prostitutes who check in order to increase condom use.

Keywords : condoms , sex workers , the incidence of STIs

Various sexual activity is very common in CSW (commercial sex workers) so that these groups include a high risk group the incidence of STIs. Besides the risk of infected STIs, the group is also at risk as a carrier group that transmit the disease to its customers. This

INTRODUCTION Sexsually transmitted infection are infections that mostly transmitted through sexual contact with a partner who is already infected. This disease can be transmitted from one person to another through sexual contact (Depkes ,2006)

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potential will be a risk of spreading to the customers's couple . Therefore, recently the incidence of STIs is more increased. The incidence of STIs such as gonorrhea and Chlamydia in female sex workers in several cities in Indonesia is very high. The Depkes RI's survey results of 2005 on female prostitutes were approximately 39% -61% suffer from Chlamydia or Gonorrhea. The Results of the study indicate STIs increase the risk of HIV transmission by 2-3 times. It is estimated that more than 3 million men who buy sex often, half of that men had a partner or wife. It is estimated the transmission can be continue to the wife. It is estimated that more than 200,000 people infected with HIV and 2020 will increase approaching 2 million (Channels, 2008). While in East Java recorded incidence of STIs, especially HIV / AIDS as many as 2,295 patients. Kediri in 2012, there were 435 patients with STIs. If studied further infected groups from among WPS, Gay, homo, Transgender and the general public (District Health Office. Kediri,2008). In the preface study found that of the 20 WPS inspecting to the Gurah's health center 6 WPS (30%) always use a condom with the incidence of STIs 1 WPS (16.7%), 7 WPS (35%) sometimes use a condom with the incidence of STIs 4 WPS (57.1%) and 7 FSW (35%) have never used a condom with the incidence of STIs 6 WPS (85.7%). IMS diseases that exist in January 2013 as many as 65 cases with cervicitis events were 38 cases (58.5%), candidiasis 15 cases (23.1%), BV / Bacterial Vagina 11 cases (16.9%) and trichomoniasis by 1 cases (1.5%). Factors causing the high incidence of STIs, including HIV / AIDS is the number of promiscuous sexual contact and

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sexual contact carried out unsafely. Sex can transmit STIs, including sex through the hole intercourse, mouth (oral) or through the rectum (anal) (Depkes, 2006). Besides, it is the lack of efforts to prevent STIs, including HIV / AIDS. Given the profession as a prostitute, it is not possible to avoid casual sex, therefore the only possible prevention is condom use. The less using of condoms can be caused by lack of knowledge about the condom itself causing an attitude (attitude) and negative (unfavorable) to the recommended use of condoms. This study is based on the concept of behavior that raised Notoatmodjo (2003: 131) that precedes knowledge attitude and attitude precedes the known behavior with the concept of KAP (knowledge-attitude-practice). In these circumstances it must be activated again campaign increased condom use as a medical device that has been scientifically proven to counteract the transmission of STIs, including HIV. Condom promotion efforts should not be construed as a recommendation to have sex risky. Anyone who still perform risky sexual activity are encouraged to use condoms to avoid infection, and avoid infecting others. If they do not want to use condoms, should stop risky sexual behavior (Channels, 2008). Therefore, the use of condoms is the prevention's program of STIs, including HIV / AIDS nationally. Based on the above, the researchers are encouraged to conduct the research to formulate the title of the study: "The Effect of condom use against the incidence of

sexually transmitted infections in the WPS in IMS clianic Gurah public health service kediri" RESEARCH METHOD This study is a series of related processes systematically and consists of various stages. In order to obtain results in accordance with the purpose it needs to make the research.

Characteristics of Respondents. Characteristics of Respondents by Age 1; 1,2%

37; 43,5%

ResearchDesign The research design was all the processes needed in the planning and conduct of research (Nasir, 2005). The concept of research used in this study is a retrospective case control. Retrospective case-control study is the kind of research that measures the risk factors by looking at past events to determine whether there is risk experienced (Nursalam, 2003).

47; 55,3% <20 tahun

4.1 Characteristics of Respondents by Age in IMS Gurah Health Center Clinic Kediri Regency 1st -30td of June 2013.

Based on 4.1 the diagram known to most respondents aged 2139 years is 47 respondents (55.3%).

RESEARCH RESULT The Description Location Research Clinic Sexually Transmitted Infections (STI) and Voluntary Councelling And Testing (VCT) is located at No. 10 Colonel street Seruji Gurah Gurah Subdistrict Kediri. The Clinic began operating in January 2007 with the goal of all ex-localization in Kediri, referral patients and patients who come alone. Includes physical examination and laboratory to ensure the types of STIs, including HIV-AIDS. Procedurally every patient who coming examination and given counseling and treatment in accordance with disease. IMS executive personnel at the Clinic include doctors, paramedics, laboratory personnel, administrative personnel and hygiene respectively 1. Began on January 2012 IMS Health Center Clinic Gurah only cover ex-localization Gurah and Gedangsewu Pare. But for referrals patients or come alone remains.

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Characteristics of Respondents by Education

19; 22,4%

5; 5,9%

0; 4; 0,0%4,7% 57; 67,1%

Tidak Sekolah

SD

4.2 diagaram Characteristics of Respondents by Characteristics of Education Respondents by IMS clinic Gurah Health Center Education in Kediri Regency Kediri On 1-30 June 2013. Based on the 4.2 diagram known to most educated respondents SD / MI at 57 respondents (67.1%).

Characteristics of Respondents by by marrital status

0; 0,0%

6; 1; 1,2% 7,1%

78; 91,8%

56; 65,9%

Belum Menikah Menikah

<1 th

4.3 Diagram Characteristics of Respondents by Marital Status at IMS clinic Gurah Health Center Kediri Regency On 1-30 June 2013 Based on the 4.3 diagram known to almost all respondents divorced at 78 respondents (91.8%). Characteristics of Respondents Based on Old Being WPS 15; 17,6%

9; 10,6%

29; 34,1%

32; <1 th37,6% 1-5 th

6-10 th

29; 34,1%

>10 th

4.4 Diagram Characteristics of Respondents Based on Old Being WPS Characteristics of Respondents Based on Old Being WPS in IMS clinic Gurah Health Center Kediri Regency On 1-30 June 2013 Based on the 4.4 diagram known to almost half of the respondents became WPS for 15 years is 32 respondents (37.6%). Characteristics of Respondents Based Start Using Condoms

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1-5 th

6-10 th

>10 th

4.5 Diagram the Characteristics of Respondents by Start Using Condoms in IMS Clinic Gurah Health Center Clinic Kediri Regency On 1-30 June 2013 Based on the 4.5 diagram the majority of respondents began using condoms for 1-5 years is 56 respondents (65.9%). DISCUSSION The Condom Use Based on 4.1 Table is known most respondents use condoms including sometimes that is 53 respondents (62.4%). Condom is a contraceptive in the form of rubber gloves cover to the male organs sex, which work by preventing the sperm meets the egg cell with a bunch so that does not happen conception . Condoms are one of the contraceptive methods that are often used. To protect its own pair of the HIV virus and sexually transmitted infections (Hartanto, 2004). The use of condoms is a form of behavior. Human behavior is formed because a number of ways such as by conditioning (habit), understanding (insight), and using the model (Walgito, 2008: 18). Behavior is formed due to various influences or stimuli in the form of knowledge and attitudes,

experiences, beliefs, social, cultural, physical means. Influences or stimuli that are internal and external and classified into the factors that influence behavior are the predisposing factors (predisposing factors), enabling factors (enabling factors), and factors (reinforcing factors) (Notoatmodjo, 2010). The Predisposing factors are internal factors that exist in individuals, families, groups or communities that facilitate individuals to make it easier as knowledge, attitudes, values, perceptions, and beliefs. Enabling factor is the factor that allows individuals to behave, because resource availability, affordability, referral, and skills. Reinforcing factors are factors that reinforce the behavior, such as attitudes and skills of health workers, peers, parents, and employers (Suliha, 2002). The use of condoms in most of the WPS is sometimes. Behavior is formed due to various influences or stimuli in the form of knowledge and attitudes, experiences, beliefs, social, cultural, physical means. Knowledge itself is influenced by various factors, including age, education, experience, interests, culture and information. The age factor most respondents aged> 40 years with condom used are occasionally. At this age included in adult are already decide what is the best thing for themselves, including to always use a condom or not. Also in this age of the respondent's ability to receive information, especially the use of condoms has also been reduced, so that the use of condoms is also only occasionally. Almost half of the respondents had elementary education with condom use occasionally. The Elementary education is a basic education so that the ability to receive limited information resulting knowledge is also low. The Low knowledge affect his attitude in the use of

condoms, which in turn affect the behavior of the use of the condom. The Results obtained in the cross-tabulation of respondents with elementary education always use a condom, it is influenced by the limited knowledge that the respondents always pay attention to the information received about the benefits of condom use. Often respondents receive information either from the localization of the working group, group peer educators, NGOs and the companion of health public officers who checked may affect attitudes about condoms, which in turn is able to change the behavior of condom use. Based long been WPS the most widely WPS respondents be for 1-5 years with condom use occasionally. WPS with a service life of 1-5 years is still a WPS do not have a lot of experience with a wide variety of customers, so that the WPS is still willing to accept guests who do not use condoms. In the end use of the condom only occasionally. The incidence of STIs Based on 4.2 table is known mostly positive respondents IMS is 44 respondents (51.8%). Sexually transmitted infections (STIs) are infections that are mostly transmitted through sexual contact with a partner who is already infected. IMS or other named sexually transmitted diseases (STDs) are the diseases that can be transmitted from one person to another through sexual contact. IMS has a broader meaning, because of the mode of transmission. IMS also called venereal diseases or dirty diseases . But it only refers to the disease in the genital (Depkes, 2006).

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Most of the respondents aged 21-39 years with the positive STI incidence. Age of 21-39 years is still included in the productive age. WPS at this age receive guests more than WPS older age.The Guests were served came from various backgrounds so that WPS know if guests are served an STI or not. When guests are served an STI there is the possibility of contracting STIs WPS from guests who served. Most respondents had elementary education with positive STI incidence. Elementary education is the poor education that the respondent's ability to receive information primarily on the prevention of STIs is also low, so that the knowledge is low . Lack of knowledge resulted in the respondent did not make efforts to prevent STIs. When serving guests they do not take steps to prevent being infected with STIs. Most respondents into WPS for <1 year with positive STI incidence. Being WPS for <1 year is still a new WPS so they not follow the activities undertaken by the working group. Besides, in general they have not been frequently contact with the health care providers to obtain information on the prevention of STIs. Conclusion 1.Condom use at most of the respondents including sometimes. 2.Most of the respondents are positively IMS. 3.There is the effect of condom use with the incidence of STIs (Sexually Transmitted Infections) in the WPS in IMS Gurah Health Center Clinic Kediri Regency (p = 0.032).

Arikunto, S. 2006. Prosedur Penelitian Suatu Pendekatan Praktek. Jakarta : Rineka Cipta Chanel. 2008. Infeksi Menular Seksual. http://channels.dal.net /gim/aids /ims 2.html. (Download 31 Agustus 2008) Ditjen Binkesmas dan Binkesga. 2003. Buku Pedoman Petugas Fasilitas Pelayanan KB. Jakarta : Depkes R.I. Depkes

RI. 2006. Pedoman Penatalaksanaan Infeksi Menular Seksual. Jakarta : Dirjen Pengendalian Penyakit dan Penyehatan Lingkungan

Depkes.RI. 2006. Modul Pelatihan Konseling dan Tes Sukarela HIV (Voluntary Counselling And Testing = VCT) untuk Konselor Profesional Panduan Peserta. Jakarta : Drjen Pengendalian Penyakit dan Penyehatan Lingkungan. Depkes. RI, FHI dan Usaid. 2010. Laporan Hasil Penelitian Prevalensi Infeksi Saluran Reproduksi Pada Wanita Penjaja Seks di Surabaya, Jawa Timur Indonesia. Jakarta : Depkes RI Dainur. 2003. Materi-Materi Pokok Ilmu Kesehatan Masyarakat. Jakarta : Widya Medika. Hanifa Wiknjosastro, Saifuddin, Abdul Bari dan Rachimhadhi, Trijatmo. 2005. Ilmu Kebidanan. Edisi Ketiga Cetakan Ketujuh. Jakarta : Yayasan Bina Pustaka Sarwono Prawirohardjo.

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Machfoedz & Suryani. 2009. Pendidikan Kesehatan Bagian dari Promosi Kesehatan. Yogyakarta : Fitramaya.

Tesis dan Instrumen Penelitian Keperawatan). Surabaya : Salemba Medika.

Mohamad. 2012. Faktor-Faktor yang Mempengaruhi Tingkah Laku Seseorang. http://aldymohamad.blogspot.com Nasir, M. 2005. Metode Penelitian. Cetakan keenam. Ciawi : Ghalia Indonesia. Notoatmodjo, S. 2005. Metodologi Penelitian Kesehatan. Jakarta : Rineka Cipta. Notoatmodjo, S. 2010. Pendidikan dan Perilaku Kesehatan. Jakarta: Rineka Cipta.

Setiawan & Saryono. 2010. Metodologi Penelitian Kebidanan DIII, DIV, S1 dan S2. Yogyakarta : Nuha Medika Uha Suliha. dkk. 2008. Pendidikan Kesehatan dalam Keperawatan. Jakarta : EGC. Wawan dan Dewi. 2010. Teori & Pengukuran Pengetahuan, Sikap dan Perilaku Manusia. Yogyakarta: Nuha Medika Walgito, Bimo. 2008. Psikologi Sosial. Yogyakarta : Andi

Nursalam. 2003. Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan (Pedoman Skripsi,

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WOMEN'S WILLINGNESS TO COUNSELING AND TESTING HIV / AIDS IN TULUNGAGUNG Suci Anggraeni Institute Of Health Surya Mitra Husada Kediri Email : [email protected] ABSTRACT Background: Women are the most vulnerable group infected by HIV/AIDS. Woman vulnerability over HIV is caused by gender inequality leading to woman incapability to control sexual behavior of their husband or permanent spouse and less knowledge and access to get information on HIV and AIDS and their medication service. HIV counseling and testing is important because it is entry to all HIV/AIDS services. HIV counseling and test have some benefits such as knowing HIV status (positive or negative), directing HIV-positive person to certain medical service and changing HIV/AIDS transmitted risky behavior to unrisky behaviour. The objective To exploit factors affecting women willingness to counsel and test HIV/AIDS in Tulungagung. Method: it was qualitative research with phenomenology design. Data was collected with in-depth interview on 5 women as client in Seruni VCT clinic in Tulungagung. Sample was taken using purposive sampling technique. Data analysis was based on steps by Colaizzi (1978) by making transcript, reduction and coding, data presentation, conclusion drawing and verification Result: Individual factor and health service is factor supporting women willingness to do HIV/AIDS counseling and testing in Tulungagung. Family support and spouse support make women motivated in increasing their life quality and undergoing medication. Conclusion: Women do often counseling and testing for HIV/AIDS when HIV/AIDS symptoms have appeared. Although women have known having HIV/AIDS positive, they were still reluctant to open their status to public. It is due to less knowledge about HIV/AIDS and VCT and embarrassed to public around Keywords: willingness, HIV counseling and testing, women cases) followed by East Java (6.900 cases) (Indonesian Health Ministry, 2013). In addition to covering the spread of cases based on the pattern of the region, HIV / AIDS cases in Indonesia today has penetrated the nonhigh-risk population groups and age. It is seen from the highest percentage of HIV transmission through March 2013 are at risk in heterosexual sex as much as 50.5%. HIV ratio between men and women dalah 1: 1. The highest number of AIDS cases discovery is on wiraswata (5098) followed by housewives (4943). Cumulative AIDS is the highest percentage in the age group 20-29 years (30.7%) followed by the 30-39 year age group (21.8%) (Indonesian Health Ministry, 2013). Tulungagung regency in East Java is in the list of top 10 districts with cases of HIV / AIDS. The development of HIV / AIDS cases from the years 1997-2005, namely 44 cases; 2006 that 35 cases; in 2007, 65 cases. There are several risk factors that are likely to support the spread of HIV / AIDS in Tulungagung like localization,

INTRODUCTION HIV / AIDS is a pandemic disease that is worrying for the world community. The disease is considered worrisome because besides not found drugs and vaccines to prevent it, it turns out in the course of the disease has a "window period" and the asymptomatic phase (without symptoms) is relatively long. This resulted in the pattern of disease progression of HIV / AIDS is seen as the iceberg phenomenon (Depkes RI, 2006) According to the results of the first quarter report in March 2013, from 2005 to 2012 the number of findings of HIV / AIDS cases are constantly increasing from year to year. The cumulative number of reported HIV infections up to March 2013 as many as 103.759 cases. The highest number of HIV infections are Jakarta (23 792 cases), followed by East Java (13.599 cases). The cumulative number of AIDS until March 2013 that as many as 43.347 cases. The highest number of AIDS were reported from Papua (7795

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places of entertainment, Tulungagung as one of the biggest bag of sending migrant workers in East Java, stigma and discrimination for ODHA (people living with HIV / AIDS) in the community. Most AIDS cases resulting from sex and injecting drug use (Dinas Kesehatan Tulungagung, 2008). From the description above data indicate that the current housewives are the group most vulnerable to contracting HIV / AIDS. Increasing the findings of HIV / AIDS cases among housewives shows that HIV and AIDS are not only experienced female sex workers and highrisk groups but also in the low risk group. The vulnerability of women to HIV caused more gender inequalities that result in women's inability to control sexual behavior husband or regular partner and lack of knowledge and access to information and treatment of HIV and AIDS services. (Kementerian Negara Pemberdayaan Perempuan RI, 2008). Solomon et al. (2010), stated that the wife or female generally powerless to protect themselves from HIV / AIDS from their partners because they do not know the sexual habits of the couple, feeling weak in controlling sexual behavior of their partners, just realized that her partner is an injecting drug users after marriage, and fear poor or unemployed and dependent on husbands for economic needs. Fecklessness This is one reason more and more women are infected with HIV / AIDS from her partner and sometimes

do not realize that he had been infected with HIV / AIDS. MATERIALS AND METHODS This study is a qualitative research design of phenomenology. Phenomenological research is a study that reveal and understand something behind the phenomena that occurs is lacking depth or not known at all (Strauss and Corbin, 2003). Participants in this study were women who become clients of VCT clinic Seruni Tulungagung. The samples in this study is done by using purposive sampling technique. Total participants in this study were 5 people. The experiment was conducted on March 20 - May 21, 2014 in VCT clinic Seruni Dr. Iskak General Hospital Tulungagung. The research instrument in this study is the researchers themselves. The tools used by researchers to support data collection was Guidelines indepth interviews. The researchers also used a tape recorder to record the process of in-depth interviews and field notes to summarize all the information both heard and observed while in the field. Data was collected through in-depth interviews. Data analysis was based on steps by Colaizzi (1978) by making transcript, reduction and coding, data presentation, conclusion drawing and verification. RESULT Characteristics of participants in this study can be seen in Table 1.

Table 1. Characteristics of women who do counseling and testing of HIV / AIDS in Tulungagung 20 March to 21 May 2014 (n = 5 participants) No 1. 2. 3. 4. 5.

Karakteristik Partisipan Age (years) Education Job Marital status long entry VCT (years)

P1

P2

P3

P4

P5

44 SMA Housewife Window 3

37 SMP Farmer Married 5

40 SD Tailor Window 2

33 SMP Tailor Married 3

28 SMP Farmer Married 1

From Table 1 above it can be seen that each participant has some different characteristics. Both in terms of age, educational background, job, marital status, and the old entrance VCT (Voluntary Counseling and Testing).

The themes are formed from the data analysis in the study were: a. Individual factors 1) Individual who is unpleasant experience Individual experience unpleasant with complaints series of symptoms that do 920

not heal cause participants do counseling and testing of HIV / AIDS. This was revealed by the statement of the participants as follows: P1 : "The beginning of the story, I am the sick yes, the pain fever then not heal ..... Finally I was sick, my body tu already abnormal ..... Then I checked the blood test. I continue to be HIV positive. Continues from the clinic I was referred to Dr.Iskak general hospital here, so the result is the same. " P2 : "..... I've been sick. Has been treated recently tested ..... from where the result is positive. " 2) Lack of knowledge about counseling and testing of HIV / AIDS 5 participants revealed that before being treated at the hospital, they did not know about the counseling and testing of HIV / AIDS. Here are the results of interviews with participants quote: P1 : "Before, I was not sick do not know. after I was positive I just know. " P2 : "Not to know at all. Understand when entering the hospital referred. " 3) The stigma within the individual on HIV / AIDS The stigma that appears in participants after knowing the results of testing positive for HIV / AIDS is felt alone. P1 : "I think I'm sick of this we do not have his friends alone." P2 : "Why did I become like this? yes this is what (laughing)? like to feel alone. " 4) individual knowledge about HIV / AIDS Participant assumes that HIV / AIDS is a disease that can not be cured and must take medication for life. P1 : "As long as I live so depending on the drug." P5 : “Medicine everywhere I bring not miss ya this is my life.” b. Healthcare factors 1) Behavioral health workers Participants revealed that the behavior of health workers has been to them, among others, do not discredit and friendly.

P1 : "If my midwife at the same health center also common. He was not cornered. If I have hit it. "" .. Yes it's regular doctor, I for example not discredit me. " P5 : "Alhamdulillah friendly, nothing like yesterday I cared nothing offensive so it." c. Family support factors 1) The attitude of the family Family attitudes of participants after knowing that the participants with HIV / AIDS is keeping secret status and calm the mind of participants. P1 : "My sister also know, but also keep my sister. do not want to tell the friends there that her brother's illness was not. " P3 : "Not anything really his destiny Allah said so it slipped so be it so important why do not recovered should not be repeated again." d. Couples support factors 1) Couple Support The support given by the pair of them are mutually remind participants for taking ARV. P4 : " For example her watch so yeah forgot to remind each other. " e. Community support factors 1) Public perception of HIV AIDS Participants revealed that society perceives people with HIV / AIDS disgusting. P1 : "If that does not know ya so, HIV disease should have it. Such as in my village there used to be, he said that the disgusting HIV, should be like this, do not stay there. " DISCUSSION 1. Individual Factors Individual factors that influence women to do the counseling and testing of HIV / AIDS in Tulungagung according to the results of in-depth interviews to 5 participants are individuals who experience unpleasant. Individuals who experience unpleasant include pain that does not heal, do not want a chaotic mind, fear of death, the husband who was diagnosed with HIV / AIDS, and worries about condition of the fetus.

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Participants revealed they are willing to do the counseling and testing of HIV / AIDS because they feel the disease do not heal. These conditions lead to a boost in self-participants to seek treatment and prevention of the disease. Another reason expressed by the participants are willing to do the counseling and testing of HIV / AIDS, among others, so that their minds are not confused and scared to death if the disease does not go away. This is in accordance with the opinion of Becker (1974) in Nototmodjo (2003), stating if the actions of individuals to seek treatment and prevention of disease will be encouraged by the seriousness of the disease on individuals or society. According to Rosenstock (2005), an action will be influenced by beliefs about the relative effectiveness of alternatives available that are known to reduce the perceived threat of disease individuals. According to the research results Salomon, S. et al. (2006), the most frequent reasons that cause a person to come to the VCT clinic is because of symptoms such as signs symptoms of HIV and AIDS (70.2%), repeat testing to assure themselves because previous results positive for HIV (44.8%), risky behavior they do (42.6%), and currently has a partner who has HIV (29.8%). One participant revealed he is willing to do the counseling and testing of HIV / AIDS after learning that her husband was hospitalized for HIV positive. The situation was pregnant with gestational age less than seven months also add to the anxiety in him. He worried about the condition of the fetus in her womb. So he immediately took the initiative to be willing to do the counseling and testing of HIV / AIDS. Solomon et al. (2010), stated that the wife or female generally powerless to protect themselves from HIV / AIDS from their partners because they do not know the sexual habits of the couple, feeling weak in controlling sexual behavior of their partners, just realized that her partner is an injecting drug users after marriage, and fear poor or unemployed and dependent on husbands for economic needs. Fecklessness This is one reason more and more women are infected with HIV / AIDS from her partner and

sometimes do not realize that he had been infected with HIV / AIDS. 2. Factor healthcare The results showed that the factors that affect the health care of women's willingness to seek counseling and testing of HIV / AIDS in Tulungagung is the behavior of health care workers. Behavioral health workers expressed by five informants, among others, not discredit, friendly, gives information on matters related to HIV / AIDS, visit clients when ill, seek to get health care, and offers counseling and testing for HIV / AIDS. According Wijono (2000) support the provision of health services is entrance to success of a health service. All participants in this study reveal feel happy and feel comfortable with the behavior of health workers related counseling and testing of HIV / AIDS. They stated that the health workers during the time he met both of VCT and in the neighborhood never cornered and always be friendly. Health workers often greeted and praised the participants state that is getting better. Health workers and VCT clinic at Dr. Iskak general hospital always provide information on matters related to HIV / AIDS. When participants were admitted to hospital, health workers in VCT gives attention to visit them when sick. There was one participant who can not afford the economic life by environmental health officers in the house attempted to get health care in the Dr. Iskak general hospital and given capital by the VCT in cooperation with the social services and some NGOs so that participants can develop the skills she had and improve the lives of its economy. The results are consistent with Widiyanto (2008) in his research on female sex workers in brothels Sunan Kuning, Semarang stated that the variables that are important in improving client satisfaction for VCT services is smooth communication, the use of the term is understood clients during counseling, Treating clients with good, and friendly service laboratory personnel at the time of blood collection. 3. Family support factors The form of family support are factors that support women to undertake counseling and testing of HIV / AIDS in Tulungagung under 5 are keeping a secret informant 922

status, trying to find funds for treatment, and calm the mind clients. According Smet (1994) are the most important psychosocial support comes from a family member where the strength of support is one of the psychological processes that can maintain healthy behaviors within the individual. Daya (2007) states that the family play an active role in assisting the recovery and rehabitasi when one family member is ill, because families also affected by the problems faced by the family members and the family will be together mutual support and protect them. Four participants in this study revealed that families know the status of their HIV / AIDS. The attitude shown by the families of participants based on the results of in-depth interviews stated that the family participate in maintaining the status of HIV / AIDS. When sick family trying to help commercialize the cost of treatment and when the participants know the status to HIV / AIDS families trying to calm his mind so that participants do not feel burdened that would worsen his health condition. The results are consistent with Bhat et al. (2010) who conducted the research to the 124 respondents said that the respondent's HIV status is known by others, that some family members or close friends, and almost 95% felt that social support is an important factor motivating them towards adherence to treatment. Mohanan & Kamath (2009) in his study said that family support affects people living with HIV at various levels and termask financial assistance, support in the disclosure process, activities of daily routine, and medical or psychological assistance. Perception of family support can improve mental health, reduce anxiety, stress, symptoms of depression, and loneliness for people with HIV / AIDS. Family support can also reduce morbidity and mortality in HIV-infected individuals. 4. Couple support factors According to the informant interviews 2, 4, and 5 reveals that the shape of spousal support that encourages women to do the counseling and testing of HIV / AIDS in Tulungagung is keeping secret status, remind each other to taking ARVs, advised to follow the meeting KDS (Peer Support 923

Groups) , caring for and assisting when sick, and receive state couples. According to Taylor et al. (2000) revealed that psychosocial support from spouses, family members, friends, social contacts and community group members are friends and colleagues. Effective psychosocial support psychological pressure during the full period of suppression, coping with stress is also associated with better immune function. Participants 4 and 5 is married to fellow ODHA. The results of in-depth interviews with both participants stated that they are happy to have a couple of fellow people living with HIV because they can share the problems they face, mutually reinforcing stigma and discrimination as well as their life more purposeful. They chose to marry a fellow ODHA so that they have the full support of a partner who is also equally kinship with them. These results conflict with research Anastasia (2008) which states that a husband or wife who knows her partner has HIV will change their satisfaction in perkawian. Changes in marital satisfaction include psychological change, communication, leisure activities, religious orientation, conflict resolution, financial management, sexual relationships, family, friends, children, and childcare, personality, and equality role. 5. Community support factors The results of the 5 informant interviews indicate that public support factor for women to seek counseling and testing of HIV / AIDS is still lacking. This is shown by the public perception of HIV / AIDS is still one of them is the community about HIV / AIDS is still one of them is considered a person with HIV / AIDS disgusting, less understanding about HIV / AIDS, and the lack of information they get about HIV / AIDS . The results of in-depth interviews with all participants revealed that communities around the environment does not have a role in encouraging them to do the counseling and testing of HIV / AIDS. This is not in line with the results Jurgensen et al. (2012) in a qualitative study in Zambia, about barriers to the clients in deciding to conduct HIV testing among others due to the stigma of the client's self

and social environment that is negative stigma against HIV tests so that they are reluctant to come to the VCT. According to the participants' knowledge and observations, there are many people in the neighborhood who think people with HIV / AIDS was disgusting and should be excluded. Communities in their neighborhood had the idea because of lack of understanding about HIV / AIDS and the lack of information they get. So it still takes hard work of government and health officials to convey information about HIV / AIDS and stigma and discrimination against people living with HIV in the community can be reduced. According to the Depkes RI (2006), high public interest to utilize VCT HIV / AIDS is strongly influenced by how the services to be understood by the public. CONCLUSIONS AND RECOMMENDATIONS Conclution Based on the research results, it can be concluded that the factors that influence the willingness of women to counseling and testing of HIV / AIDS in Tulungagung are individual factors and health service factors. Individual factors which encourage women to be willing to do the counseling and testing of HIV / AIDS is an unpleasant experience that is pain that does not heal, do not want a chaotic mind, fear of death, the husband who was diagnosed with HIV / AIDS, and concerns about the condition of the fetus. Behavioral health workers are not cornering, friendly, provide information on matters related to HIV / AIDS, participants visit when sick, participants seek to get health care, and offers counseling and testing for HIV / AIDS to make women feel comfortable and willing to do the counseling and testing of HIV / AIDS. Besides the support of family and spousal support to encourage women to improve their quality of life and eager to undergo the treatment. Society has no say in the willingness of women to seek counseling and testing of HIV / AIDS in Tulungagung. A prevailing perception that people with HIV / AIDS disgusting, still a lack of public understanding of HIV / AIDS, and the lack of information about HIV / AIDS in the community resulted in women with HIV /

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AIDS are reluctant to disclose their status in society. Recommendations 1. For women who have had counseling and testing of HIV / AIDS and tested positive for HIV are expected to retain ARV treatment, maintaining a healthy lifestyle, and is active in the KDS (Peer Support Groups). 2. For health workers to maintain quality health care to people living with HIV / AIDS and increase knowledge of the client, couples, and families on HIV / AIDS. 3. For Seruni Clinic, Department of Health Tulungagung, and local governments are expected to develop community-based VCT activities and improve health promotion activities on HIV / AIDS and VCT with a method that is easily understood by the public's willingness to expand the scope of counseling and testing of HIV / AIDS voluntarily and reduce the negative stigma and discrimination against people living with HIV in the community. 4. For other researchers need to conduct further research on the development of community-based VCT activities and dig deeper unpreparedness factor in the open status of women with HIV / AIDS both for couples, families, and communities. DAFTAR PUSTAKA Daya Somasundaram. (2007). Collective trauma in northem Sri Lanka : a qualitative psychosocial-ecological study. International Journal of Mental Health Systems. Departemen kesehatan RI. (2006a). Pedoman Pelayanan Konseling dan Testing HIV/AIDS secara Sukarela (voluntary counselling and testing). Jakarta. Departemen Kesehatan RI. (2006b). Situasi HIV-AIDS di Indonesia Tahun 19872006. Pusat Data dan Informasi: Jakarta. Dinas Kesehatan Provinsi Jawa Timur. (2012). Data Program Pengendalian Penyakit Menular di Jawa Timur. dinkes.jatimprov.go.id/userimage/Dat a P2 sd September WEB.pdf. Diakses

pada tanggal 23 Maret 2013 jam 15.00. Jurgensen, Marte., Tuba, Mary., Fylkesnes, Knut., and Blystad, Astrid. (2012). The burden of knowing: balancing benefits and barriers in HIV testing decisions. A qualitative study from Zambia. BMC Health Services Research 2012, 12:2. Kementerian Kesehatan RI. (2013). Laporan perkembangan HIV-AIDS triwulan I tahun 2013. KPA Tulungagung. (2013). Laporan kasus HIV/AIDS bulan Januari-Maret 2013. Mc Mahon, James M., Tortu, Tephanie., Pouget, Enrique R., Torres, Leilani Torres., Rodriguez., and Hamid, Rahul. (2013). Effectiveness of Couple-Based HIV Counseling and Testing for Women Substance Users and Their Primary Male Partners: A Randomized Trial. Hindawi Publishing Corporation Advances in Preventive Medicine Volume 2013, Article ID 286207, 15 pages. Notoatmodjo, Soekidjo. (2003). Pendidikan dan Perilaku Kesehatan. Jakarta: PT Rineka Cipta Rosenstock. (2005). Why People Use Health Services. The Milbank Quartely, Vol. 83, No. 4. hlm.6-9. Smet, B. (1994). Psikologi Kesehatan. Jakarta : PT Grasindo Solomon, Sunil.S., Mehta, Shruti.H., Latimore, Amanda., Srikrishnan, Aylur.K, and Celentano, David.D. (2010). The impact of HIV and highrisk behaviours on the wives of married men who have sex with men and injection drug users: implications for HIV prevention. Journal of International AIDS Society. Strauss, Anselm & Corbin, Juliet. (2003). Dasar-dasar Penelitian Kualitatif; Tatalangkah dan Teknik-teknik Teoritis Data (penerjemah Muhammad Sodiq dan Imam Muttaqien). Yogyakarta: Pustaka Pelajar. Taylor, S.E., Peplau, L.A., Sears, D.O. (2000). Social psychology (10 th ed) NJ:Prentice Hall.

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Wijono, D. (2000). Manajemen Mutu Pelayanan kesehatan, jilid 1, Surabaya : Airlangga Universty Press Wu, T., Pender, N & Noureddine, S. (2003). Gender differences in the psychological and cognitive correlates of physical activity among taiwanese adolescents: a structural equation modeling approach. International Journal of Behavioral Medicine, 10(2), 93-105.

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COMPARISON OF NEW BORN MORBIDITY BETWEEN PERVAGINAM BREECH LABOR AND SECTIO CAESAREA WITH GLUTEAL PRESENTATION (Morbidity Comparison Between The Newborn And Sectio Breech Deliveries Pervagina Caesarea Breech) Linda Andri Mustofa Prodi D IV Bidan Pendidik STIKES Karya Husada Kediri E-mail: [email protected]

ABSTRACT Labor with breech is a challenge in the management of obstetric and is associated with perinatal morbidity and mortality . This study aims to determine differences in maternal and perinatal morbidity between delivery and sectio caesarea pervagina with breech .The study design was observational comparative approach . The variable in this study is in labor pervagina infant morbidity and section caesarea breech . The research was conducted on August 8 to August 23, 2014 at Amelia Pare Hospital . 30 population breech babies born vaginally and 53 babies were born with a breech presentation section caesarea 2010 to 2014, with a total sample techniques . Data were analyzed using T test Test with a confidence level of 95% ( α = 0.05 ) . Results of the analysis showed that the vaginal delivery , 1 infant ( 3.3 %) had severe asphyxia , 12 infants ( 40 % ) moderate and 17 infants ( 56.7 % ) severe asphyxia . Conversely babies born with Sectio Caesarea , none suffered severe asphyxia , 10 infants ( 18.9 % ) mild asphyxia and 43 infants ( 81.1 % ) mild asphyxia . T test with a confidence level of 95% was obtained count value is smaller than alfa 0:02 , which means that there are differences in morbidity among infants born vaginally and sectiocaesarea breech . Labor with breech presentation at risk for both mother and baby , with the greatest risk to the fetus is hypoxia , caused by pinching the cord between the head and pelvis when the head enters the pelvic cavity . Keywords : neonatal morbidity , vaginal breech deliveries , sectiocaesarea . labor pervagina types of delivery options to be considered and chosen before birth , and should consider the health condition of the mother and the fetus and medical requirements that apply. Most of the pregnant women at the antenatal check the midwife , so the midwife should be able to help the mother to help pregnant women to plan and make choices labor. To be able to assist pregnant women with breech birth plan and choose the type of delivery , midwives should know the advantages and disadvantages and the fulfillment of requirements to deliver pervagina or SC to consider the risk of morbidity and maternal and perinatal mortality .

INTRODUCTION A breech deliveries WITH AN hearts management challenges associated WITH obstetrics and perinatal morbidity and mortality . There was a breech presentation Approximately 3 % Up to 4 % of all deliveries .Optimal method for having a baby with breech presentation into a very controversial issue and a major question in the field of midwifery . Breech delivery at term vaginal cause of perinatal mortality and morbidity rates between 1 and 2 % . Perinatal morbidity and mortality in breech delivery reached nine times higher than spontaneous vertex delivery . Incidence of trauma and hypoxia damage is particularly high in small premature infants (under 1.5 kg ) and the large baby (over 3.5 kg ) (Paul MF, Cawford, 2005: 18(4):312-3). The study acknowledges that there is a slightly greater risk of neonatal with

LITERATURE REVIEW Breech presentation Diagnosis

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Breech is a longitudinal layout with the head of the fetus in the uterine fundus . The incidence is 3 to 4 % , but had fetal morbidity and mortality rates are high. Diagnosi breech is generally not difficult . Titegakkan diagnosis by anamnesis, palpation, examination, X-ray examination, scanning and Ultra Sono Tomographic ( USG ).

the second leg . After the pivot swivel breech birth occurs outside the fetal abdomen was in posterior shoulder through the door that allows the pelvis to the largest line of shoulder transverse or oblique . Axis rotation occurs in the shoulder , so that the shoulders are under simpisis front and rear shoulder passes perineum . At the time of the head into the pelvis with transverse or oblique sagittal suture . Occur in the pelvic cavity in the head rotation axis , so that the face memutas to posterior and occiput towards simpisis. By suboksiput as hipomoklion the chin , mouth , nose and the entire head was born in succession pass through the perineum . There is a real difference between the birth of the fetus in cephalic presentation and the fetus was born breech. At the presentation were born head first is part of the largest fetus so that the head has been born birth weight is not a member of difficulty. In contrast to the breech respectively - were born part of the increasingly great starts from the birth of the buttocks, shoulders, and then the head .

Etiology Breech Presentation Location of the fetus in the uterus depends on the process of adaptation of the indoor fetus in the uterus . In pregnancy until approximately 32 weeks , the amount of water relative needs more , allowing the fetus to move freely . Thus the fetus can put yourself in a cephalic presentation , breech or transverse layout . In pregnancy the last quarter of the fetus is growing rapidly and the amount of water needs relatively reduced because the buttocks with both legs folded bigger than the head of the buttocks are forced to occupy a greater space in the fundus , while the head is in a smaller space in the lower uterine segment. In the months of pregnancy is not enough breech higher frequency while at term pregnancy the fetus is mostly found in the presentation of the head. Other factors that play a role in the breech of which is multparitas , twin pregnancy , hidramnion, hidrosepalus, plasenta previa and a narrow pelvis . Sometimes breech caused by abnormalities of the uterus and uterine deformities . Placenta is located in the cornu fundus can also cause breech because the placenta reduce the size of the rooms in the area of the fundus .

Labor with Breech Presentation Case for section caesarea planned in breech presentation has been reviewed on a large scale by Brke and direkomondasikan on American college of Obstetricians and Gynecologists. TBT using designs randomissed control trial to compare the safety section caesarea breech deliveries pure planned pervagina . Two thousand women were recruited from 121 centers in 26 countries . The study concluded siding premature in 1999. Combined autcame peinatal and neonatal mortality and serious neonatal morbidity with exclude neonatal disorders were significantly lower in the planned sectiocaesarea than vaginal delivery group ( 1.6 % versus 5.0 % , mrelative risk [ RR ] 0.33) and statistically no difference in maternal mortality and serious morbidity significantly between the two groups. Kind of labor with breech presentation is one of the big questions in obstetrics that have been broken by the international community obstetric through randomized controlled trials to answer questions about

Labor mechanism with Breech Presentation Buttocks into the pelvic cavity with a line transverse or oblique groin . After touching the pelvic floor occurs in the rotary axis so that at the bottom of the pelvis line occupies thigh pelvic anteroposterior diameter and front trochanter is under simpisis. Then came the lateral flexion of the body of the fetus , so the trochanter back past the perineum and was born around the buttocks , followed by

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what kind of delivery is best for fetuses with breech presentation Research shows that a planned cesarean delivery safer for labor with breech . Even based on the data monitoring committee , the results of this research for a while is because the final results of the study were able to answer questions that have been posed. But then the results are considered to be convincing has been controversial . Criticism of researchers to continue again . Some researchers even referred to has attracted rekomondasi . In an article written by Charlotte L Deans and Zoe Penn in The Obstetricians and Gynaecologist journal publish more data about labor rviw pervagina the breech . Large studies conducted by PREMODA study group was published in 2007. The study was conducted at a maternity unit at 800 women in France and Belgium with desaian prospective study , comparing breech deliveries pervagina with secsio caesarea planned. Researchers said the study conducted in France in 2001 until 2002. The vaginal delivery of breech presentation made in accordance with the standards and are routinely offered to women in accordance with rigorous criteria based on the guidelines set by the Collège National des Gynécologues et Obstétriciens Français ( CNGOF ) include the size of a normal pelvis , no hyperextension of the fetal head as determined by ultrasound , the estimated fetal weight between 2500 to 3800 grams , perfect breech presentation , examination electrically continuous fetal heart rate monitoring fetal wellbeing during labor informed consent pada ibu. Pada kelompok ibu yang direncanakan persalinan pervaginam 71% sukses dan skor apgar kurang dari 4, tidak ada perbedaan outcame yang berbeda diantara dua kelompok dan hanya satu neonatal yang meninggal, itupun pada kelompok section caesarea. Researchers commented on the difference between the critical management of their population with a study population Term Breech Trial ( TBT ) . For example the use of pelvimetry ( 82.4 % in PREMODA and 9.8 % in the Term Breech

Trial ) , assessment of the fetal heart rate ( 100 % in PREMODA and 33.4 % on TBT ) and duration of the second stage more than 60 minutes ( 0 , 2 % on PREMODA and 5.0% on TBT ) . They do not realize that these things affect the risk of neonatal slightly larger in vaginal deliveries . Other researchers have also published research showing ourcame comparable results in a smaller population . Irion and colleagues compared 385 with a vaginal delivery of breech presentation at birth section 320 caesarea planned and have fewer maternal complications in childbirth pervagina group and no neonatal morbidity corrected. Dublin alarab and colleagues published data on 641 deliveries . Caesarea planned delivery section 343 and 298 deliveries pervaginal trial in which 146 successfully. Reusable stringent selection criteria that allow for a vaginal delivery . They reported only two neonates born vaginally with Apgar score of 7 to 5 minutes . Both have normal neurology at 6 weeks and no deaths perinata and no trauma or neurological disorder significantly in both groups.( Deans CL, Penn Z. The case for and against vaginal breech delivery. The Obstetrician & Gynaecologist 2008;10:139–144.) Prognosis delivery with breech delivery The infant mortality rate in the high lebith breech deliveries when dibandiangkan with the location of the head . Naidoo Hospital in Semarang , Medan Priyadi general Hospital and the Hospital Hasan Sadikin obtained perinatal mortality rate respectively 38.5 % , 29.4 % and 16.8 % . Eastman Reporting perinatal mortality rates between 12 to 14 % . The most important cause of perinatal mortality is prematurity and handling sempuarna with less labor due to hypoxia or bleeding inside the skull . While hypoxia caused by pinching the cord between the head and pelvis when the head enters the pelvic cavity and due to retraction of the uterus that can cause the release of the placenta before birth head .

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Birth head Janian longer than 8 minutes after birth umbilicus will cause fetal life . In addition bilajanin nose and mouth breathing before birth can be dangerous because inhaled mucus can clog the airways . The danger of fetal asphyxia caused by cord menumbung , it is often found in breech perfect legs or buttocks legs are not perfect teeapi rare for breech presentation . Injury to the fetal head occurs because the head must pass through the pelvis in a shorter time than the delivery head presentation , sihingga no time for kepaa to adjust to the shape and size of the pelvis. Compression and decompression head happen quickly intervening , so Easily cause injury to the head and bleeding in the skull . When Obtained disproportion cepalopelvic , Although light in a breech delivery is very dangerous. Compression and decompression head intervention occurs quickly , so easily cause head injury and bleeding in the skull. When Getting a disproportion cepalopelvic , Though light in a breech delivery is very dangerous. Multiparity with good obstetric history does not always guarantee delivery in breech would be smooth because the fetus is large can cause pelvic disproportion despite normal size .

4 5 6 7 8 Amount

2.

Percentage

1

3.3

Frequency Distribution Apgar scores at five minutes breech vaginal delivery . APGAR Amount Percentage Skor 5 2 6.6 6 0 0 7 9 30.0 8 11 36.7 8 26.7 9 30 100 Amount

In contrast to babies born with vaginal delivery , breech babies are born with caesarea section has a first -minute Apgar score better , ie low Apgar score 5 higher than the lowest Apgar score of babies born vaginally . Apgar scores are also higher at highest 9 . 3.

Frequency Distribution APGAR Score First Minute on Labor Sectio Caesarea With Presentation Buttocks .

APGAR Amount Percentage Skor 5 2 3.8 6 8 15.1 7 20 37.7 8 23 43.4 Amount 53 100 In the fifth minute Apgar score increased with the presentation breech babies born vaginally . Proven in Table 4.3 can be seen that in the fifth minute Apgar score is a minimum of five and the number

RESULTS AND DISCUSSION 1. Frequency Distribution First Minute APGAR scores at vaginal delivery Buttocks With Presentation Amount

3.3 3.3 33.3 43.3 13.3 100

The above table shows that the breech vaginal delivery , Apgar score of babies born have low Apgar score Apgar score of 3 and higher only 8. Most babies born in vaginal deliveries had Apgar score of 6 number of 10 infants ( 33.3 % ) 7 number 13 infants ( 43.3 % ) .

METHOD Research Design Research design is comparatif study with observasional approach. Samples that meet the inclusion criteria were 30 infants with breech presentation who are born vaginally and 53 infants with breech presentation who are born with section caesarea in Amelia Pare Hospital in 2010 until 2014 .

APGAR Skor 3

1 1 10 13 4 30

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of babies who have Apgar score of 7 increased to 20 infants ( 37.7 % ) and Apgar score of 8 to 23 infants ( 43.4 % ) . 4.

contrast to babies born by section caesarea has Apgar scores 8 number of 11 infants ( 36.7 % ) and Apgar score of 9 number 8 infants ( 26.7 % ). The highest Apgar score was also higher APGAR scores are 9 while the highest babies born vaginally is 8. Most breech babies born vaginally had Apgar score 7 some 13 babies ( 43.3 % ) in contrast to babies born by section caesarea has Apgar scores 8 number of 11 infants ( 36.7 % ) and Apgar score of 9 number 8 infants ( 26.7 % ) 6. Comparison of Five Minute APGAR Scores In Vaginal Delivery And Sectio Caesarea With Gluteal Presentation. Vaginal delivery Childbirth Sectio Caesarea % Sig (2∑ ∑ AS % tailed) 5 2 8.7 0 0 0.00 6 0 0 0 0

Frequency Distribution minute Apgar score five on Labor Sectio Caesarea With Gluteal Presentation.

APGAR Amount Percentage Skor 5 2 6 0 0 7 9 30.0 8 11 36.7 9 8 26.7 Jumlah 30 100 In the fifth minute Apgar score increased infant born with breech presentation dengna section caesarea . Proven in Table 4.4 can be seen that in the fifth minute Apgar score maximum 9 number 8 infants ( 26.7 % ) 5.

Comparison Minute APGAR Score Fist In Vaginal Delivery And Sectio Caesarea With Gluteal Presentation Vaginal delivery Childbirth Sectio Caesarea AS ∑ % ∑ % Sig (2tailed) 3 1 3.3 0 0 0.02 4 1 3.3 0 0 5

1

3.3

2

0

6

10

33.3

0

0

7

13

43.3

9

30.0

8

4

13.3

11

36.7

9

0

0

8

26.7

30

100

53

100

7

9

30.0

3

5.7

8 9

11 8

36.7 26.7

16 34

30.2 64.2

30

100

53

100

DISCUSSION Based on statistical test obtained by value calculated on the difference in scores Apgar in the first minute 0:02 and in the fifth minute 0:00 smaller with alpha 0.005 , which means there are significant differences between the scores APGAR in babies born vaginally and sectiocaesarea and also means there are differences in morbidity where the vaginal delivery , morbidity is higher . From the results of statistical tests proved that breech babies born vaginally had a higher mrbiditas compared with breech babies are born with section caesarea. Birth attendants entirely obstetrics and gynecology specialist doctors so aid delivery has been done well, as evidenced by vaginal delivery output, only 1 infant (3.3%) who were born vaginally suffered severe asphyxia in the first minute of his birth, and none of the infants who died. However, there are still 12 infants (40%)

In contrast to babies born with vaginal delivery , breech babies are born with caesarea section has a first -minute Apgar score better , ie low Apgar score 5 higher than the lowest Apgar score of babies born vaginally who have low Apgar scores 3 . The highest Apgar score was also higher APGAR scores are 9 while the highest babies born vaginally is 8. Most breech babies born vaginally had Apgar score 7 some 13 babies ( 43.3 % ) in

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had moderate asphyxia and 17 babies have (56.67%) and no one baby was born without asphyxia or normal. Lack of good labor output can be caused by many things one of which refers delay, delay decisions and may be due to predictions of proportionate size and fetal pelvis performed with simple measurements without using pelvimetry. The results showed similar results to the study conducted by the Term Breech Trial (TBT) is a large multicenter study International randomized controlled trial to determine whether the planned labor SC safer than childbirth pervagina planned in fetuses with breech. The study involved 2,088 women from 121 centers in 26 countries. Participants were randomly selected, both the SC labor groups planned or in groups pervagina planned deliveries. Data were obtained from 2083 women. Of the 1041 women included in the group SC planned, 941 (90.4%) correctly - it gave birth to the SC and from 1042 women were included in the group of labor pervagina, 591 (56.7%) gave birth pervagina (Palencia R, Gafni A, Hannah ME, Ross S, Willan AR, Et all 2010: 38: 490-8). Study Term Breech Trial (TBT) which was published in 2000 reported that there is a combination autcame perinatal mortality or neonatal morbidity and neonatal serious (to exclude abnormalities konginetal) was significantly lower in the group SC planned than in the group of labor pervagina planned (17 / 1039 [1.6%] v. 52/1039 [5.0%], relative risk [RR] 0.33, 95% confidence interval [CI] 0:19 to 0:56), and statistically there was no significant difference in maternal morbidity and mortality are serious between SC group planned and labor groups pervagina planned (41/1041 [3.9%] v. 33/1042 [3.2%], relative risk [RR] 1:24, 95% confidence interval [CI] 0.79-1.95) Iddekinge BV 2007: 9: 171-6 TBT also provide economic evaluation showing that lower costs at planned SC group than in the group pervagina planned deliveries ( $ 7,165 versus $ 8,042 [ Canadian $ ] ) . These costs are primarily related to the cost of hospital and doctor's fees for childbirth

pervagina and costs epidural higher and the cost of neonatal intermediate and intensive care for mothers and infants in group deliveries pervagina planned ( Henderson J , Stavros P , 2010: 174 ( 8 ) : 1118 to 1119 ) . In contrast to the results of research , in some countries abroad , based on the results of the study showed no difference in morbidity or asphyxia among infants born vaginally or sectiocaesarea . The success of breech vaginal delivery due to meticulous screening by using sophisticated equipment and careful preparation for labor , one of them with the readiness funds to support the smooth delivery is the delivery process . Studies on the population of Europe also concluded advantage for neonates in breech deliveries with SC . Selection of the population in the breech presentation has been done with great care to examine the results of the planned delivery pervagina compared to SC planned. A large study published in 2006 with a prospective study of 8000 women in the maternity unit in France and Belgium , comparing labor pervagina and SC , said that during the study period of 2001 to 2002 in France , labor pervagina with breech implemented in standard and offered routinely in women according to rigorous selection criteria in accordance with the guidelines required by the Collège National des Gynécologues et Obstétriciens Français ( CNGOF ) . In women with childbirth pervagina planned , 71 % success not only of the Apgar score in the first 5 minutes of less than 4 , there was no difference in individual autcome different in both groups. Only one non malformations and neonatal death occurs in the SC group . The author commented on the criticism of Management of the different between their population with a population of at BTM , as an example of the use pelvimetry ( 82.4 % versus 9.8 % in the Term Breech Trial ) , fetal heart rate monitoring ( 100 % versus 33.4 % ) and the period at 60 minutes of the second ( 0.2 % versus 5.0 % ) . The study acknowledges that there is a slightly greater risk of neonatal pervagina with labor , but not as it was concluded by the authors of TBT . At

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willing in France conducted a rigorous selection and management guidelines to minimize the risk . The author also published a study comparing autcome the smaller population . Irion and friends friends in Switzerland compare pervagina planned 385 deliveries with the planned 320 SC maternal complications were smaller at birth pervagina smaller and there was no difference in neonatal morbidity . Iddekinge BV , 200 : 171-6 ) . In Dublin , Alaran and friends friends publish data from 641 deliveries , deliveries SC 343 planned and 298 deliveries pervagina planned , where 146 of pervagina successful delivery . Conducted a rigorous selection on research pervagina delivery . Reported only two neonates born pervagina have 7 Apgar score at 5 minutes and no anomalies perinatal deaths or cases of trauma and neurological dysfunction significantly in both groups . In this study nulliparous women were significantly less in group deliveries pervagina than multiparous women ( Deans CL , Penn , 2008: 139-44 ) Autcome data available from longterm neonates born with birth pervagina is encouraging and BTM comes from the author , who has published a subgroup analysis in 2004. This suggests that the prevalence of death or abnormal neurodevelopment in two years did not differ between the groups and labor pervagina Caesarean section is supported by the publication of data from a population smaller than the more dominant BTM came from developing countries , where the antenatal screening and counseling be applied ( CL Deans , Penn , 2008 : 139-44 ). Another implication of the implementation of planning policy SC for all deliveries with breech , will have a negative impact , namely the reduction in the number of practitioners with the skills and experience to help pervagina with breech deliveries . Although he has made a policy , but undiagnosed breech will happen . Some of these women will choose breech deliveries pervagina and some women might bring them to the doctor's due date to give birth to the SC.

Drycott and friends - colleagues show that emergency obstetric training can reduce perinatal autcame on delivery to the location of the head. So training breech deliveries may be required as the ancient art . Improved SC in the future and vaginal birth after caesarea (VBAC ) that can not be predicted , can be made a policy for the selection of antenatal safe to predict whether a pregnant woman can give birth to breech pervagina ( Deans CL , Penn , 2008: 139-44 ) Education and preparation for childbirth including potential complications and treatment is . anatenatal important part of the service . handling is HCWs should be professional to the patient's choice to give birth pervagina or SC . The officer must explain the importance of the effect of birth SC planned against maternal and neonatal autcome , subsequent pregnancy outcomes and patient acceptance of choice SC. When counseling about labor SC, we must remember that childbirth SC at risk . Based on studies comparing SC repeats VBAC labor , we must anticipate the ultimate choice of women for childbirth SC which is planned to heighten the incidence of maternal morbidity , including bleeding , infection and venous thromboembolism . Maternal mortality which occurred in the State - developed countries , 2 to 3 times higher in SC planned labor than labor pervagina although no large studies of the risk of maternal mortality in childbirth SC planned. Lawrence M , Leeman MD . Plante LA 2006 : 265-8 ) , ( Murphy DJ , Pope C , Frost J , Liebling RE , 2003 : 1-5 ).With ultrasound , the estimated fetal weight between 2500 to 3800 grams , perfect breech presentation , examination electrically continuous fetal heart rate monitoring fetal wellbeing during labor informed consent of the mother . In the group of women who planned vaginal delivery and a 71 % success Apgar score of less than 4 , there is no difference outcame different between the two groups and only one neonatal death , and even then the group section caesarea . In Indonesia the problems that often arise in the selection of the type of delivery is the lack of readiness in planning

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delivery. Failing to detect abnormalities layout , ketidaktauan the public about the risks of labor with breech presentation , and economic problems causing people prefer to choose a vaginal delivery without considering the risks to mother and baby . Midwives should improve the ability to perform prenatal care and early referral of pregnant women planning on adengan abnormalities breech . Midwives should not be attending births with breech presentation , but the midwife as those closest to the public should be able to help mothers and their families to understand the condition of the mother and planning deliveries with communication , information and education .

Jakarta: 2008.

Badan Pusat

Statistik;

BKKBN. Indonesia. Buku panduan praktis pelayanan kontrasepsi. Edisi ke-2. Jakarta BKKBN; 2006 Chapman V, Ester M. Asuhan kebidanan persalinan dan kelahiran. Jakarta: EGC; 2006. Departemen kesehatan. Indonesia. Menuju persalinan yang aman dan selamat agar ibu sehat bayi sehat. Jakarta: Departemen kesehatan Indonesia; 2009. Departemen kesehatan. Indonesia. Pedoman program perencanaan persalinan dan pencegahan komplikasi dengan stiker. Jakarta: Departemen kesehatan Indonesia; 2009. Henderson J, Stavros P. The economic case for planned cesarean section for breech presentation at term. National perinatal epidemiology. [serial online]. 2006. [diunduh tanggal 19 Juli 2010];174(8):11181119. Tersedia dari URL: http://www.cmaj.ca/cgi/reprint/174/ 8/1118 Deans CL, Penn Z. Review the case for and against vaginal breech delivery. Obstetgynaecol. [serial online]. 2008. [diunduh tanggal 19 Juli 2010];10:139-44. Tersedia dari URL: http://onlinetog.org/cgi/reprint/10/3 /139 Iddekinge BV. Risk management planned vaginal breech delivery :should this be the mode of choice?. Obstetgynaecol. [serial online]. 2007. [diunduh tanggal 19 Juli 2010];9:171-6. Tersedia dari URL http://onlinetog.org/cgi/reprint/9/3/ 171 Lawrence M, Leeman MD. Plante LA. Patient-choice vaginal delivery?. Obstetginaecol. [serial online]. 2006. [diunduh tanggal 19 Juli 2010];4(3):265-8. Tersedia dari URL: http://www.annfammed.org/cgi/rep rint/4/3/265

SUGGESTION The midwife must assist pregnant women to plan labor in accordance with the conditions of the mother and the risk factors so that labor can run smoothly and complications can be prevented with good planning . With a breech pregnancy is a pregnancy with a very high risk and should give birth in hospital There are 2 types of labor with breech that can be chosen by the mother , which pervagina labor and breech deliveries . Choice of type of delivery should be considered and chosen before birth , and should consider the health condition of the mother and the fetus and medical requirements that apply Vaginal delivery with a breech presentation is done according to standard and routinely offered to women who fit the criteria are strictly based on the guidelines set by the Collège National des Gynécologues et Obstétriciens Français ( CNGOF ) includes the size of a normal pelvis , no hyperextension of the head of the fetus is determined by ultrasound , fetal weight estimates between 2500 to 3800 grams , perfect breech presentation , examination electrically continuous fetal heart rate monitoring fetal wellbeing during labor informed consent of the mother . REFERENCES Badan Pusat Statistik. Indonesia. Survai demografi dan kesehatan Indonesia.

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Liu DTY, Ayu NMS. Manual persalinan. Edisi ke-3. Jakarta: EGC; 2008. Murphy DJ, Pope C, Frost J, Liebling RE. Women‟s views on the impact of operative delivery in the second stage of labour: qualitative interview study. Obstetginaecol. 2003. [serial online];327:1-5. Tersedia daru URL: http://www.bmj.com/cgi/reprint/32 7/7424/1132 Nursalam. (2003). Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan. Jakarta : Salemba Medika Martaadisoebrata D, Sastrawinata RS, Saifuddin AB. Bunga rampai obstetri dan ginekologi sosial: Perkembangan obstetri dan ginekologi sosial. Jakarta: yayasan bina pustaka Sarwono Prawirohardjo; 2005. h. 20. Mc Donald. Obstetri Williams. Jakarta: EGC. 1997. Manuaba. Pengantar Kuliah Obstetri. Jakarta: EGC. 2007 Paul MF, Cawford. Use of external abdominal ice to complete external cephalic version in term breech pregnancy. Obstetgynecol. [serial online]. 2005. [diunduh tanggal 19 Juli 2010]:18(4):312-3. Tersedia dari URL: http://www.jabfm.org/cgi/reprint/18 /4/312 Palencia R, Gafni A, Hannah ME, Ross S, Willan AR. Et all. The costs of planned cesarean versus planned vaginal birth in the term breech trial. [serial online]. 2006. [diunduh tanggal 19 Juli 2010];174(8).[11 scrib]. Tersedia dari URL: http://www.cmaj.ca/cgi/reprint/174/ 8/1109 Pasupathy D, Wood AM, Pell JP, Fleming M, Smith GCS. Time trend in the risk of delivery related perinatal and neonatal death associated with breech presentation at term. Epidemiology. [serial online]. 2008. [diunduh tanggal 19 Juli 2010];38:490-8. Tersedia dari URL: http://ije.oxfordjournals.org

Piane GM. Evidence practices to reduce maternal mortality: a systematic reviw. Public health. [serial online]. 2008 [diunduh tanggal 25 Juni 2010];31(1):26-31. Tersedia dari URL: http://jpubhealth.oxfordjournals.org Saifuddin AB, Wiknjosastro GH, Affandi B, Waspodo D. Buku Panduan praktis pelayanan kesehatan maternal dan neonatal. Edisi ke-2. Jakarta: Yayasan bina pustaka Sarwono prawirohardjo; 2006.

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ABSTRACT RISK SCREENING OF PRE-ECLAMPSIA AND ECLAMPSIA IN PREGNANT WOMEN IN PUSKESMAS PLOSO KLATEN REGENCY KEDIRI Siti Asiyah Advance Midwifery Study Program STIKES Karya Husada Kediri Email: [email protected]

Pre-eclampsia in Indonesia was the second leading cause of maternal mortality, while in East Java was the first cause of death. From year to year pre-eclampsia cases continue to rise, these conditions require preventive measures in order to reduce morbidity and mortality due to pre-eclampsia. The research objective was to screen potential risk pregnant women to pre-eclampsia. This type of research descriptive with operational research approach, the entire population was pregnant women in Puskesmas Ploso Klaten number of 170 pregnant women, total sampling technique sampling which met the inclusion criteria a number of 117 respondents. Data collection tools such as interview guides, tension meter, measuring weight and height. The experiment was conducted in June and July 2015. The data analysis of frequency distribution percentages. From interviews obtained 45 pregnant women (38.46%) there was a risk factor to develop pre-eclampsia, and 52.63% are factors that primigravida pregnancy status. From the results of the examination showed 57 (48.7%) positive (1), 20 (17.1%) positive (2) and 6 (5.1%) positive (3). Allegedly immunologic factors contribute to the onset of hypertension in pregnancy was proven by the fact primigravida have a greater risk of hypertension in pregnancy when compared multigravida. Whereas, of the value ROT, MAP and IMB means that 48.7% has the potential for pre-eclampsia occurs less than 50%. 17.1% has the potential to occur pre-eclampsia by 50% and 6 (5.1%) had the potential to occur 75% of pre-eclampsia. Keywords: Screening, pregnant women, the risk of pre-eclampsia

PRELIMINARY The cause of death of women giving birth in Indonesia is divided into two, namely the direct cause of death and cause of death indirectly. The first death is the largest cause of bleeding 34%, both preeclampsia and eclampsia was 18%, an indirect cause of 18%, 11% other direct causes, embolism 1%, 10% abortion, sepsis 8%. (Sulistiono A, 2013). While the maternal mortality rate in East Java pre-eclampsia and eclampsia 34.88%, bleeding 25.09%, 26.98% other causes, heart 8.08%, 4.98% infesi (Maternal Mortality Report (IFI) and the District se Municipality of East Java in 2012). Based on these data we can conclude the maternal mortality rate due to pre eclampsia and eclampsia are still very high in Indonesia, especially in East Java causes of maternal mortality are

highest. Diagnosis Preeclampsia is set at least two symptoms of the triad of preeclampsia preeclampsia is the increase in overweight marked edema, proteuria, high blood pressure, because it is pregnant supervision is very important because the cause of death is quite high, especially in developing countries (Manuaba, I; 2003). Based on observations of researchers has been applied in the field is limited to detecting the case, then in case of pre-eclampsia is done handling. Cases of preeclampsia may actually be predicted from the beginning before pregnant women develop preeclampsia and can diperkirakanan there is likely to occur with preeclampsia along with the amount of risk, namely with 1011

Mananyakan previous history and risk factors of pregnant women as well as perform a physical examination that sederhanan such as blood pressure and weight measurements. With predicted from the beginning about the risk of pre-eclampsia can be carried out preventive measures so as not to place pre-eclampsia. The positive impact kedepanya could lower the maternal mortality rate due to a case of pre-eclampsia. METHODS This type of research is descriptive or explanatory research (ecplanatory research) with the approach of operational research, because this research is to implement the process of antenatal care in screening the risk of pre-eclampsia, to do an interview and blood pressure check and counting IMB pregnant women, resulting uotput pregnant women have a risk of pre-eclampsia terdeksi (Hidayat A, 2010). The variable in this study is a single variable, as it only aims to find the big picture case, without performing analytical tests. The variables in this study are the risk factors and clinical symptoms of pre-eclampsia risk. The population in this study were all pregnant women who are in the working area of Puskesmas Plosoklaten totaling 170 people from four villages namely distance 66, Village Klanderan 16 Kawedusan Village 43, Village Gondang 45 people. Inclusion criteria were common characteristics of research subjects in the target population and the population to be studied affordable. (Nurasalam, 2010) criteria for inclusion in this study were pregnant women who were in the area, Willing respondents, more than 20 weeks gestational age. The exclusion criteria is to eliminate or exclude subjects who meet the inclusion criteria for various reasons. (Nursalam 2010) The exclusion criteria in this study were At the

time of the research was not in place, or have been diagnosed with pre-eclampsia. In this study, the sampling techniques used in a way without random (non-random sampling). Retrieval technique being used is total sampling. Ie the sampling is done by taking the overall research subject who met the inclusion criteria.Sadangkan sample in this research were 117 pregnant women. Manual data collection tools such as interviews to multiply medical history and risk factors, as well as the tension meter airaksa to check blood pressure, weight scales that have been re-calibrated and height gauges. Data were collected in two ways interview and examination of blood pressure, weight and height. RESULTS Results interview Risk factors for pre-eclampsia Table 1 Distribution Frequency Pre-eclampsia risk No. Risk factors preeclampsia 1. No risk 2. There are R isk amount

for Frequency

%

72 45

61.53% 38.46%

117

100%

From the table above shows the respondents obtained 45 of 117 pregnant women (38.46%) there is a risk factor to develop pre-eclampsia. Table 2 Distribution of Frequency of types of risk Pre eclampsia No. Risk factors for Frequenc preeclampsia y 1. Primigravida 30 2. Age risky 14 3 A history of pre eclampsia 1 4 Illness 7  History of 4 hypertension 1  Diabetes Tooth ache amount 57 From the table above types of risk actors are 52.63% of the factors, namely pregnancy status or nulliparous pregnant the first time. 1012

P rosentase 52.63% 24.56% 1.75% 12.3% 7.01% 1.75%

100%

F % 1 29 24.8 No symptoms 2 Positive (1) 50 42.7 P rosentase Positive (2) 18 15.4 3 65% 4 Positive (3) 6 5.1 35% Amount 103 88.0 Based on the contingency table above amount 117 100% shows that of the 117 respondents almost half of the respondents, 50 respondents Based on the above table shows that of the (42.7%) showed positive clinical 117 respondents surveyed most of the symptoms (1) occurs at the age of respondents, there were 76 respondents preeclampsia that there is no risk factors (65%) had a positive ROT value. for preeclampsia. Table 4 Distribution of ratings MAP Table 8 Effect of families with a history of (Mean Arterial Pressure) pre-eclampsia with clinical Frequency P rosentase No. Value MAP symptoms of pre-eclampsia 1. Positive 28 23.9% risk 2. Negative 89 76.1% No Clinical Families with a history of Pre Total amount 117 100% . symptoms Eclampsia No Factor There Based on the above table shows that of the Factor 117 respondents surveyed almost all F% F % F % respondents, there were 28 respondents 34 29.1 1 No 34 29.1 0 0 (23.9%) had a positive MAP value. symptoms Table 5 Distribution of ratings BMI (Body 2 Positive 56 47.9 1 0.9 57 48.7 mass index) (1) No. Value IMB Frequency P3 rosentase 20 17.1 Positive 20 17.1 0 0 1. Positive 12 10.3% (2) 2. Negative 105 89.7% 6 5.1 4 Positive 6 5.1 0 0 amount 117 100% (3) Based on the above table shows that of the Amount 116 99.1 1 0.9 117100 117 respondents surveyed almost all Based on the contingency table above respondents, there were 12 respondents shows that of the 117 respondents almost (10.3%), body mass index is not a risk of half of the respondents, 56 respondents pre-eclampsia. (47.9%) showed positive clinical Table 6 Distribution scoring of clinical symptoms (1) the case of preeclampsia in symptoms of pre-eclampsia risk of Value pregnant women in the family there is a ROT, MAP and IMB history of preeclampsia. No. The risk of pre-eclampsia P rosentaseTable 9 Effect of pregnancy status Frequency 1. No symptoms 34 (nulliparous) with clinical symptoms of 29.1% pre-eclampsia risk. 2. Positive (1) 57 48.7% 20No. Clinical 17.1% Primigravida Total 3. Positive (2) symptoms No Factor There Factor 4. Positive 6 amount (3) 117 5.1% 100% F % F% F % Based on the above table shows that of the 117 respondents surveyed nearly half of 1 No symptoms 24 20.6 10 8.5 34 29.1 the respondents, there were 83 respondents 2 Posit ve (1) 46 39.3 1 9.4 57 48.7 (70.9%) positive for risk, and almost half, 3 Posit ve (2) 13 1 .1 7 6.0 20 17.1 or 20 respondents positive (2). 4 Positive (3) 4 3.4 2 1.7 6 5.1 Physical examination Table 3 Distribution assessment ROT (Roll Over Test) No. Value ROT Frequency 1. Positive 76 2. Negative 41

The relationship of risk factors with clinical symptoms Table 7 Effect of maternal age with clinical symptoms of pre-eclampsia risk No. Clinical symptoms

amount 84 74.4 30 25.6 1 7 10 Based on the contingency table above shows that of the 117 respondents almost half of the respondents, 46 respondents (39.3%) showed positive clinical Age of mother Total symptoms (1) the case of preeclampsia in No Factor There Factor pregnant women whose pregnancy status

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F 5 7 2 0 1

is not at risk of preeclampsia. DISCUSSION From interviews obtained 45 pregnant women (38.46%) there is a risk factor to develop pre-eclampsia, and 52.63% were of factors, namely pregnancy status primigravid or pregnant the first time. Many risk factors for pre-eclampsia occurs one of which is primigravida (first pregnancy) this can be explained on the theory of immunologic intolenransi mother and fetus. Allegedly immunologic factors contribute to the onset of hypertension in pregnancy is proven by the fact primigravid have a greater risk of hypertension in pregnancy when compared multigravida (Angsar D, 2010). Normal maternal immune response does not reject the products of conception which is foreign. This is because the human leukocyte antigen protein G (HLA-G), which plays a role in modulating the immune response, so she did not reject the products of conception (placenta). HLA-G in the placenta protects the fetus from lysis by trafoblas Natural killer cells (NK) mother. (Boutiler PL, Mallet V, 1977). HLA â € "G facilitate trafoblas invasion into the maternal decidua tissue. In the placenta of hypertension in pregnancy HLA-G downhill and easy inflammatory reaction (Yie Shang-mian, et al, 2004) At the beginning of the second trimester of pregnancy women have a tendency to occur with preeclampsia, turns out to have the proportion of helper cells is lower than the tension of normal ( Dikman A, John CM, 2010). From the results of cross-tabulations contingency tables between primigravida with clinical symptoms obtained 20 positive pregnant women at risk of pre-eclampsia consists of 11 (9.4%) positive (1), 7 (6.0%) positive (2) and 2 (1.7% ) positive (3). Bardasar this data it is very important to pay attention to possible cases of pre-eclampsia in pregnant women primigravida. Besides other risk factors such as maternal age and a history of pre-eclampsia, hypertension history in keluanga also need to be aware of. The existence of heredity with a single gene. More maternal genes in determining hypertension when compared with genotype janin.Telah proven that women

who develop preeclampsia 26% will develop preeclampsia daughter, son-in-law while 8% had preeclampsia (Riedman C, Walker I.1992) From the results of the examination of symptoms clinics, 76 respondents (65%) had a positive ROT value. ROT value is the measurement by comparing two measurements of First Instance in the supine position and then second on his side if the difference between the two is more or equal to 9 mm Hg then tested positive for risk of pre-eclampsia (Sulistiono A, 2014). ROT value but less accurate if used as a measure of the risk of pre-eclampsia compared to the value of MAP (Gumilar E, 2013). MAP calculation of 28 respondents (23.9%) had a positive MAP value. 12 respondents (10.3%), body mass index, a risk of pre-eclampsia. Of the value ROT, MAP and IMB are combined and create a score for risk of pre-eclampsia. Ie if positive (2) the mother is potentially the case of pre-eclampsia 50%, and if positive (3) potential of 75% will occur pre-eclampsia (Gumilar E, 2013) From the results, the results of 57 (48.7%) positive (1 ), 20 (17.1%) positive (2) and 6 (5.1%) Positive (3). This means that 48.7% has the potential for pre-eclampsia occurs less than 50%, while the positive (2) a 17.1% has the potential to occur pre-eclampsia by 50% and 6 (5.1%) had the potential to occur pre eclampsia 75%. If the positive results obtained (2) and positive (3) then the mother must be referred to a doctor for preventive drug therapy of hypertension so as not to occur pre-eclampsia (Sulistiono A, 2014). Such screening is very easy and inexpensive. Easy as can be done by medical personnel as well as the primary medical provider midwives spearhead pelanyanan antenatal care at the level of basic services such as health centers or villages.Membutukan cheap because only simple equipment. But although simply remains to be done with the correct methods and with standard tools. From the study results mutkhir mentioned variations between operators large enough that could affect the diagnosis of high blood pressure in pregnancy (Duggan, and Mileen 1998; Brown and Simpson, 1992, Derry; Wilkinson et al, 1991). For this reason it is suggested that the mother lying in the 1014

same position every blood pressure checks. Checks should be made guidelines for blood pressure in pregnancy are strictly defined, checks the blood pressure of pregnant women with a sitting or lying position with the back left ditingikan with pillows, sebaikya the left arm (IBI Center, 2006).

Shoop. DIV Midwives Stikes Karya Husada. Kediri December 21 2014 Yie Shang-play, Liang-hong Li, Yue Li-mei, Librach C. HLA-G protein concentration in maternal serum and placental tissue are Decreased in preeclamsia, Am J Obstet Gynecal, 2004; 191: 525-9

BIBLIOGRAPHY Angsar D, Mose JC, Hypertension In Pregnancy, Obstetrics Sarwono Prawiroharjo.BP-SP. Jakarta.2010, 534-35 Boutiller PL, V. Mallet HLA-G in Pragnancy, Review of Reproduction, 1997; 2: 7-13 Brown MA, Jm Simpson, 1992, Diversity of Blood pressure recording during Pregnancy: implications for the hypotensive disorders.Med March 2 J Aust 1992; 156 (5): 306-308 Duggan, and Mileen 1998. Blood Pressure Measurements in Pregnancy: The US in a survey of methods used in theaching hospitals in south Australia. Aus NZ J Obstet Gynaecol 1998. Deeker GD.Risk Factor for preeclamsia. Clinical Obstrtris and Gynecology. 1999.42: 422-35 Gumilar ED, Akbar A I.2013.Deteksi Early preeclampsia. Division Feto maternal Dpt / SMF Obstretri Gynekology.RS Dr.Soetomo. Airlangga University School of Medicine. Surabaya. IBI (Indonesian Midwives Association). Services 2006.Standar kebidanan.IBI.Jakarta Maternal Mortality report Sekabupaten and City in East Java, 2012 Manuaba I BG, Manuaba C AI, Manuaba F IBG.2007. Introductory Lectures Obstretri, Chapter 6 Komplokasi In Pregnancy, Hypertension in Pregnancy. EGC. Jakarta Riedman C, Walker I. preeclamsia The Fact.Oxford University Press, New York, 1992: 130-3 Sulistiono A.Deteksi early preeclampsia and management of pre-referral. Work

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CONTINGENCY TRAINING ROLE OF EARLY IN THE COMMUNITY TO IMPROVE PREPAREDNESS OF TSUNAMI HAZARD ON SIDEM BEACH TULUNGAGUNG 2015 Siti Nurhasanah STIKes Hutama Abdi Husada Tulungagung [email protected] Abstract Indonesia is a country which in Ring of Fire region, its makes Indonesia have some kind of the potensial disaster, one of them is Tsunami. Preparedness is very important to the community, so we need training early contingencies. In this study Pre-experimental design was used to form one group pretest and post test, as a pretest given questionnaires and as treatment given lectures and leaflets ended with giving the same questionnaire again with a pre-test questionnaire, the number of respondents are 20 people. The results based on the statistical test with Wilcoxon Signed Rank test obtained significant value of 0.000 which is smaller than the value of α (0.05). This suggests that the hypothesis is accepted which means that there are differences in the tsunami hazard preparedness in Sidem Beach Tulungagung before and after the training is conducted. So counseling or training is essential once performed on people who are not equipped to improve preparedness against tsunami hazard. Keywords: contingencies, preparedness and tsunami

PRELIMINARY Disaster had often heard all the good people in the media such as television, newspapers, radio and other media. Catastrophic events is something bad happens to a person or group of people, such as tsunami, floods, earthquakes, volcanoes and therefore make peoples lost property, objects and even lives. Tsunami is a terrible disaster. Our country is prone to disasters, both natural and man-made.

RESEARCH METHODS The design in this research is using the pre-experimental easily done even if there is a weakness in terms of internal validity and external validity. The population in this study are all coastal communities that fit the criteria in Sidem who do not get early counseling about training of contingentcy, there are 20 people. The sample in this study is equal to the total sample or study population. The sampling technique used by researchers is total sampling, which means the determination of the sample by selecting all of the samples that match the criteria. Independent variables: contingency early training. Variable dependent : tsunami hazard preparedness.

Early contingency training to improve the preparedness of the community is very important to do by everyone, especially those located around the coast. Training is planned any attempt to influence, increase knowledge and change the behavior of other individuals, groups or communities that contingency training early heading towards the positive must be implemented by all the people, especially the early contingency training on the handling of the tsunami disaster.

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RESEARCH RESULT respondents. If it compared the greatest frequency before and after training there is an increase, from enough category to good category. Nevertheless, it should be further analyzed whether there are statistically significant increase.

Recapitulation of research respondents based on results of a questionnaire distributed before and after training on an early contingent on the community to improve preparedness against tsunami hazard on the Sidem beach Tulungagung can be presented in frequency distribution table as follows:

DISCUSSION Respondents from Sidem beach Tulungagung selected as many as 20 people and were given a questionnaire before training. The result was 14 (70.0%) of respondents have sufficient preparedness in the category preparedness against tsunami hazard, 4 (20.0%) of respondents have preparedness in the poor category in the tsunami hazard preparedness and only 2 (10.0%) of respondents have preparedness in the category lacking in preparedness against tsunami hazard. Some respondents don‟t understand about knowing the causes of tsunamis and how to save themselves if tsunami occur. Results of the questionnaire showed that respondents only know that when there is a danger sign should immediately save themselves. They don‟t know how to save themselves from tsunami correctly. After training, respondents given and the result is no respondents who have less preparedness against tsunami, 2 (10.0%) of respondents have sufficient preparedness in the category in tsunami hazard preparedness and almost all respondents have preparedness in both categories in preparedness against the dangers of tsunamis, which is 18 (90%) of respondents. Results of statistical test to Wilcoxon Signed Rank test obtained significant value of 0.000 which is smaller than the value of α (0.05). This suggests that the hypothesis is accepted which means that there are differences in the tsunami hazard preparedness Sidem Beach Tulungagung before and after training. Changes in tsunami hazard preparedness is evident in the age group <30 years - 60 years with significant value 0.005. These results indicate that young age is easier to understand the contingency

1. Against Tsunami Hazard Preparedness Before Training Descriptive analysis of tsunami hazard preparedness against the respondent before the training given. The frequency distribution of respondents by Tsunami Hazard Preparedness Against Before Training. Preparedness Total % Less 4 20,0 70,0 Enough 14 10,0 Good 2 Total 20 100,0 Based on the data in the table was preparedness respondent before given training, the most are in the category enough, as many as 14 (70.0%) of respondents. 2. Against Tsunami Hazard Preparedness Training After Descriptive analysis of tsunami hazard preparedness respondents were given after the training. The frequency distribution of respondents by Tsunami Hazard Preparedness Against After Training Preparedness Total % Less 0 0,0 Enough 2 10,0 Good 18 90,0 100,0 Total 20 Based on the table above, it turns out after the responder preparedness training given, that most are in the category of good, as many as 18 (90.0%) of

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training than those aged> 60 years. While based education is a significant value of 0.031 with higher education more easily to understand the contingency training than respondents with elementary school. Based on the work of no significance to the changing understanding of contingency training, where the results of a statistical test> 0.05, which is 0.773 which means that education has no effect in changing understanding of contingency training. While at work as fishermen have a good improvement, because fishermen will better know signs of a tsunami than the other jobs of the respondents.

Carter. (1998). Konsep Resiko Analisa Bencana Direktorat Jendral Bina Kesehatan. (2006). Pedoman Penanganan Bencana Secara Umum. Departemen Kesehatan RI. Notoatmodjo, Soekidjo. (2002). Metodologi Penelitian Kesehatan. Jakarta : Rineka Cipta. Nursalam dan Pariani, Siti. (2001). Pendekatan Praktis Metodologi Riset Keperawatan. Jakarta : CV Sagung Seto. Panduan pembuatan tesis, Universitas Airlangga Surabaya, 2014 Prof.Dr.M.Zainudin, ( 2011 ) .Metodologi Penelitian Farmasi dan Kesehatan,Airlangga university press. Riwidikdo, Handoko. (2012). Statistik Kesehatan : Belajar Mudah Teknik Analisis Data dalam Penelitian Kesehatan. Cetakan Keempat. Yogyakarta : Mitra Cendikia Press. Sukardi. E Maramis WF.(1986). Evaluasi Pelatihan/Pembelajaran : Penilaian Keberhasilan Pembelajaran. Applied Approoach. INEE. (2012). Standar Minimum untuk Pendidikan : Kesiapsiagaan, Respons, Pemulihan. Jakarta : INEE World Conference on Disaster Reduction,18-22 January 2005, Kobe, Hyogo, Japan, International Strategy for Disaster Reduction WHO. (2005). Hyogo Framework for ; Action 2005-2015 : Buliding the Resilience of Nations and Communities to Disasters. Kobe : WHO

CONCLUSION Before training contingent, there were 14 (70.0%) of respondents have sufficient preparedness in the category, 4 (20.0%) of respondents have preparedness in the poor category and only 2 (10.0%) of respondents have preparedness in the poor category. After training contingency no respondents who have preparedness in the poor category, 2 (10.0%) of respondents have sufficient preparedness in the category and nearly all respondents have preparedness in either category, namely 18 (90%) of respondents.

BIBLIOGRAPHY Anderson. (1998). Konsep Bencana Bakornas. (2005). Pengantar Perencanaan Kontijensi : Manajeman Kedaruratan dan Perencanaan Kontijensi. Painan. BNPB. (2011). Panduan Perencanaan Kontijensi Menghadapi Bencana. Edisi Kedua. Jakarta : BNPB. BNPB. (2008). Peraturan Kepala Badan Nasional Penanggulangan Bencana Nomor ; 4 Tahun 2008 tentang Pedoman Penyusunan Rencana Penanggulangan Bencana. Jakarta : BNPB. Budiarjo L Irawati.P.Prasasti T. (1994). Mengajar Di Perguruan Tinggi : Direktorat Jendral Pendidikan Tinggi

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STUDY OF KNOWLEDGE IN CHILDREN OF DISEASES DIPHTHERIA POSYANDU 8 BAGO VILLAGES IN DISTRICT TULUNGAGUNG 2015 Yeni Setyo Prastiwi 1) Azmi Bagus Prayogo 2) STIKes Hutama Abdi Husada Tulungagung Email: [email protected] Abstract Diphtheria is a disease caused by Corynebacterium diphtheria. The purpose of this study was to identify the knowledge of mothers about diphtheria. Design used in this research is descriptive using the techniques in making Total Sampling with a population of 35 people and a sample of 35 respondents.Data dikumpulk's using a questionnaire measuring instrument. with the data collection technique the researchers came to the Posyandu then perform the informed concent then gave questionnaires to respondents.The data obtained and dioalah through the steps: Editing, Coding, Sorting, Scoring, Tabulating, then presented in tabular form of distribution, frequency and narrative and presented to be analyzed descriptively using the formula: P= Sp/Sm x 100%. From the research, it was found that knowledge of mothers of diphtheria in IHC 8 Village Bago Tulungagung gained 6 respondents (17.1%) were included in either category, 22 respondents (62.9%) in the category of pretty, 7 respondents ( 20%) fall into the category of less. Results showed an average of all 35 respondents found the knowledge level of 66.8% and are included in the category enough.So the need for additional insight on diphtheria that better knowledge of the respondent. Keyword: Knowledge, mother, children under five, diphtheria.

especially in East Java, in 2011 occurred 665 cases, in 2012 there were 954 cases and in 2013 then occurs 333. (http://dinkes.jatimprov.go.id), whereas in Tulungagung itself occurred 9 cases in 2011 and then in 2012 increased to 16 cases and in 2013 the Department of Health Tulungagung noted there were 22 cases of diphtheria with most events in the village of Bago with 4 cases, one incident is in RT 02 RW 03 who entered the village Bago IHC 8. Previous environment in the village of Bago never occurred case diphtheria especially the last 3 years there were no cases of diphtheria there. (http://www.dinkes.tulungagung.go.id) According Notoatmojo (2007), human behavior is the result of knowledge, if knowledge is less then the urge to behave lakupun less. Mothers who lack knowledge about the disease

PRELIMINARY Diphtheria is an acute infectious disease that is highly contagious that occur locally on mucosal respiratory tract or skin, produced by bacillus grampositive Corynebacterium diphtheria, is characterized by the formation of exudate shaped membrane at the site of infection, followed by general symptoms caused by an exotoxin produced by this bacillus. (SudoyoAru, et al 2009). Number of diphtheria cases and deaths continue to increase, if no action is more intensive expected to be increased drastically. (http://www.smallcrab.com). In Indonesia in 2011 occurred 806 cases, in 2012 there were 1,192 cases in 2013 and 778 cases last occurred. Has been an outbreak of diphtheria cases,

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diphtheria, an effect on behavior, namely the lack of maternal sensitivity to the signs and symptoms of diphtheria. In addition to mother's lack of knowledge about the disease diphtheria are also due to the lack of information from the health service. (Notoatmojo 2007) Lack of knowledge of mothers of diphtheria at risk of increased transmission of the disease, because the signs and symptoms of diphtheria is almost the same as influenza, so many mothers who thought that the boy was only suffering from the flu, but in fact are experiencing the early phase of the disease diphtheria. Diphtheria disease itself is a disease common in the throat, and common problems that occur on the sufferer is pain that cause children to swallow hard to eat, and when this happens continuously will result in nutritional deficiencies children. (SudoyoAru, et al 2009). To anticipate the spread of diphtheria required a knowledge that will form a behavior and consciousness. To increase knowledge about the disease diphtheria mother needed an education about the disease and how to prevent diphtheria the start of which provide immunity in children by: DPT immunization for Toddlers. Immunizations given 3 times that at the age of 2 months, 3 months and 4 months, avoid direct contact with patients. Maintaining personal hygiene, to maintain stamina by eating nutritious foods and exercising wash hands before eating, perform regular health checks. From the description above, the authors are interested to investigate further the knowledge of mothers of diphtheria in Posyandu 8 Village Bago Tulungagung

percentage of sentences that are qualitative (Arikunto, 2006). The population in this study are all mothers in the village of Bago IHC 8 Tulungagung. Total population in this study as many as 35 people. The sample in this study are all mothers in IHC 8 Village Bago Tulungagung numbering as many as 35 people. In this study, using total sampling technique in which the entire population is used as a research subject. The variable in this study is a single variable, namely Mrs. Knowledge Village Toddlers in Posyandu 8 Bago Tulungagung 2015. After the questionnaires distributed, data collection, after the data obtained do data processing (Editing, Coding, Sorting, Scoring, Tabulating), then the data were analyzed result is a percentage using the formula P = Sp / Sm x 100%. Description: P is the percentage obtained, Sp is the score obtained, SM is the highest score is expected. The processing of the data is interpreted in the sentence qualitative criteria: good = 76-100%, quite = 5675%, and less = <56% (Nursalam, 2013). RESEARCH RESULT Mother Knowledge About Disease Diphtheria Toddlers Table 1 : Distribution of frequency of knowledge of mothers of diphtheria in IHC 8 Village Bago Tulungagung 2015. Knowledg Frequenc Percen e y t Good 6 17,1% Just 22 62,9% Less than 7 20% amount 35 100% Average Just 66,3% Source: Questionnaire Research 2015 N o 1 2 3

RESEARCH METHODS In this research using descriptive research design, ie when the fixed data collected, summed compared with the expected number and percentage obtained. From then interpreted by the

Based on Table 1 above shows that the majority of mothers knowledge of diphtheria in IHC 8 village Bago, from 35 respondents there were 22

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respondents knowledge.

(62.9%)

with

enough

found in educated respondents College of as many as 6 people (17 %) which is considered as a high level of education, so it feels natural that mothers knowledge of diphtheria in the category enough.

DISCUSSION Based on Table 1 above shows that most of the mothers knowledge of diphtheria in IHC 8 Village Bago in 2015 from 35 respondents obtained 22 respondents (62.9%) knowledgeable enough, with the average of the whole is as much as 66.3%. According to the theory Notoadmodjo (2003) knowledge is influenced by two factors: internal and external factors, wherein the internal factors include age, intelligence, attitude, personality, whereas the external factors include the environment, education, employment, resources, religion, socio-economic, and cultural. From the results it can be seen that there is conformity between facts and theories, where the work can affect a person's knowledge, where most respondents worked as IRT as many as 15 people (43%). Based on the theory Notoadmodjo (2003), someone who is busy with the day-to-day work or activities will have a little free time in obtaining the information. But even so the results of the study showed that knowledge of mothers of diphtheria in fair category. It is also due precisely to the preoccupations of respondents often interact with others, so it is more often gets information, therefore it is considered reasonable if the knowledge of mothers of diphtheria in the category enough. In addition to occupation, age may also affect the level of knowledge. Where most of the respondents aged 3140 years as many as 14 people (40%). At this age of the respondents have a lot of experience so it can easily receive information. Education is also very influential in the level of knowledge, which the majority of respondents had high school as many as 15 people (43%) to say the category of education level is quite high, but the good knowledge are mostly

CONCLUSIONS AND SUGGESTIONS A. CONCLUSION Knowledge mothers of diphtheria in IHC 8 Village Bago Tulungagung using a questionnaire sheet obtained results from 35 respondents obtained an average of the whole is as much as 66.3% are in the category enough. A. ADVICE 1. Theoretical Suggestions Theoretically, the results of this study are expected to be an addition to the information and can add knowledge to the mothers of diphtheria. 2. Practical Advice a. For the Respondents Society in particular mothers should increase knowledge about diphtheria, for example by seeking the necessary information from the print or electronic media, and following the extension of health. b. For Researchers Places As input information and knowledge, as well as education media about diphtheria. c. For Educational Institutions Expected educational institutions can use the results of this study as additional material information for learning in the educational process, so that the student and the student can contribute for example, counseling and motivation directly to the public. d. For Further Research

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Results of this study can be used as a reference for research on what factors are likely to influence the level of knowledge of mothers about diphtheria.

Mubarak, Iqbal, Zahid, 2007. Book Health Promotion. Jakarta: Graha Science Notoadmojo S. 2007. Health Education and Behavior. Jakarta: Rineka Reserved.

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The Effect of Health Education About Circumcision Against Anxiety in Children who will do Circumcision Actions in Campurdarat, Tulungagung Hadi Santoso STIKes Hutama Abdi Husada Tulungagung Email: Hadisantoso.stikes@gmail Abstract Anxiety is a condition in which individuals or groups to experience feelings that are difficult or scared and nervous activity decreased in responding to the threat of nonspecific uncertainty. Anxiety often appear in children who will be taken circumcision. Most of them feel anxious because of a lack of knowledge. One way to improve knowledge in these children is to provide health education among them is the provision of leaflets. Of the problem researchers aimed to determine the effect of the provision of leaflets about the circumcision procedure on the level of anxiety in children that will be taken circumcision. The study design used was quasi experiment with methods of pre-test post test.Using incidental sampling technique with the subjects children will be taken circumcision in the district Campurdarat Tulungagung by the number of 20 respondents fit the inclusion criteria. Data collection techniques used quisioner HARS scale to determine the anxiety level of each respondent according to the criteria. so that unknown percentage of respondents according to their level. Furthermore, the data tekumpul processed using SPSS statistical test (Statistical Product and Service & Solution windows version 13) by the Wilcoxon Signed Rank test analysis with the results of Test p <0.05, where H0 is rejected, which means no influence. From the results obtained Wilcoxon statistical test where p = 0.002 p <0.05, so H0 is rejected and H1 accepted which means there is a leaflet giving the effect of circumcision procedure on the level of anxiety in children that will be taken circumcision. Thus needs to be given leaflets about the circumcision procedure to the child that will be taken circumcision to reduce anxiety. Keywords: Emergency, Grant Leaflet, and Circumsicion

INTRODUCTION procedures and anasthesia. One form of treatment efforts that can be done to minimize or reduce anxiety in children is through health education. Health education is all the effort planned to influence other people, groups, or communities so that they do what would be expected by educational actors. (Prof. Dr. Soekidjo, Notoatmodjo. 1996). As a media of helath education, namely leaflets. Leaflet is a form of information delivery or health education through the sheets are folded. The information content can be in the form of words or images or a combination. (Prof.Dr.Soekidjo, Notoatmodjo. 1996)

One of the circumsicion‟s respon is anxiety. Anxiety is a condition in which individual or groups feel difficult or scared and nervous activity decreased in responding to the threat of nonspecific uncertainty (Carpenito, 1995, 132). Surgery is difficult experience for more patients. Many bad things can happen too, and it will danger for patients. So patients and families often show their attitude which unusually with their anxiety that they feel. Usually, their anxiety correlates with all procedures which must doing by patients and also threaten safety life for the impact of many surgical operation

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From the children who lack primary health education about circumcision, it can cause anxiety. From some incidents of phenomena in society, when it will circumcision done, almost of the children feel anxious at times. Beside that, researcher also had same experience, it was high anxiety when it will be taken circumcision (circumcision). From the results of the preliminary study that researchers do in the Campurdarat, Tulungagung in October 2011, 9 respondents who interviewed, 8 of them said anxious at a time will be taken circumcision, one of them said no problem. The impacts of anxiety can make them fear, tense and restless when it will be taken circumcision. They also have difficulty sleeping as well as diseases such as headaches, increased blood and so on. All of it due to the mental pressure will be taken when the circumcision. Of the impact of these concerns, it need support systems such as family or the closest person who will listen and give advice. Emotional support will be very useful for someone who is getting anxiety. The role of health workers is needed to provide health education about circumcision procedures in the implementation of measures that circumcision can decrease anxiety in children and the children feel calm and ready to do circumcision. Based from description above, the researchers interested in conducting research with title " The Effect of health education about circumcision to anxiety in children to be performed circumcision in Campurdarat Tulungagung.".

In this study, there is only the treatment group were given a leaflet about the treatment of anxiety in children to be performed circumcision. Observations carried out before and after treatment was given to the respondent. Population in this study are the children to be performed circumcision in Campurdarat, Tulungagung. The sample of this research is the children known to be doing circumcision in Campurdarat and include in inclusion criteria. In this study, sampling technique that means incidental sampling technique sampling is done by chance encountered by researchers (Latipun, 2008), while independent variable in this study is the provision of leaflets about the circumcision procedure. In this study, researchers collected data by observing the child's anxiety level will be taken circumcision using HARS before being given treatment for the provision of leaflets about the circumcision procedure. Then the child is treated by administration of leaflets about the circumcision procedure, after the treatment is given to children who will be circumcision researchers observed another child's anxiety levels to be performed the circumcision. After the data collected from the observation level of anxiety children to be performed circumcision before and after treatment of the data will be processed by the editing, coding, sorting, tabulating and scoring. Then the data were analyzed using Wilcoxon Signed Rank test that will show the influence of whether or not the provision of leaflets anxiety about the procedure of circumcision against children will be taken sircumcision. Wilcoxon signed rank test was used to test the hypothesis of significance comparatif two samples are correlated when the data in ordinal (tiered) .To determine whether the effect of health education about circumcision procedure with leaflets against the child's anxiety will circumcision in Campurdarat, Tulungagung, using a computer with a technique SPSS

RESEARCH METHODOLOGY This study uses Quasi experiments with pre test - post test. This design does not use a control group. This draft seeks to strengthen the causal relationship to the group by comparing the results of the pretest and post-test but without making a comparison with the influence imposed on other groups. (Nursalam, 2001).

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(Statistical Product and Service Solution Version 13 of Windows). To determine the level of significance between variables in a meaningful measurement of the effect of the level of significance was p <0.05 that means H0 rejected H1 accepted, there is influence between the variables measured.

Wilcoxon Signed Rank Test p value = 0.02, with p <0,05 so that H0 rejected and H1 accepted which means that there is significant influence between the provision of leaflets about the circumcision procedure against the child's anxiety level that will act circumcision. Health education (administration leaflet) is the educational activities undertaken by spreading the message, instill confidence so that people are not only conscious, know, and understand, but is also willing and able to carry out the suggestion that has to do with health. (Anwar, 1993). Information will be an impact on a person's knowledge. (Wied Hary A. 1998) Accurate information can help eliminate fear and reduce anxiety (Depkes RI, 1998). Referring to theory above and associated with cross tabulation shows that anxiety most happen at children aged 11-15 years with previous secondary school education is as much as 6 children with the percentage of 46.15% with anxiety being, then after the treatment given to as many as 5 percent of children with 38 , 46% to mild anxiety, it shows the effect of the provision of health education leaflets about circumcision. Anxiety levels of children will be taken before the circumcision is given health education leaflets and after given health education leaflets showed a decrease in anxiety levels. This proves that the information obtained through health education leaflets accompanied by counseling about circumcision can reduce the level of anxiety children. Information obtained through the provision of health education leaflets are quite clear and easy to read so it‟s easy to understand and be understood by children. How the good extension anyway so the majority of respondents who experienced high levels of anxiety with numbers later after being given health education leaflets and counseling about circumcision can reduce the level of anxiety. That means, giving health education leaflets showed an influence on the child's level of anxiety.

RESEARCH RESULT From 20 respondents before being given health education about circumcision, most of as many as 11 respondents experiencing moderate anxiety level with the percentage of 55% and then after a given health education about circumcision most of which were 9 respondents experiencing mild anxiety level with a percentage of 45%. While, Wilcoxon Signed Rank Test that researchers do p value = 0.02, with p <0,05 so that H0 rejected and H1 accepted, that means there is significant influence between the provision of leaflets about the circumcision procedure against the child's anxiety level that will act circumcision. DISCUSSION Based on the results of the study showed changes in levels of anxiety before and after health education leaflets about circumcision is found that before being given health education leaflets about circumcision of 20 respondents will be taken circumcision as many as 11 respondents experienced anxiety level was the percentage of 55%, while 6 respondents experienced anxiety level light with a percentage of 30%, and 3 respondents experienced a degree of severe anxiety with a percentage of 15% and after given health education leaflets about circumcision of 20 respondents will be taken circumcision most of as many as nine respondents experienced anxiety level light with a percentage of 45%, while 6 respondents had moderate anxiety level with the percentage of 30%, 4 respondents no worries with the percentage of 20%, and 1 respondent suffered severe anxiety level with the percentage of 5%. As well as the

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Hidayat, A. 2003. Riset Keperawatan dan Teknik Penulisan Ilmiah. Jakarta: Salemba Medika. CONCLUSIONS AND SUGGESTIONS CONCLUSION From Wilcoxon Signed Rank test that researchers do p value = 0.02, with p <0,05 so that H0 rejected and H1 accepted that means there is significant influence between the provision of leaflets about the circumcision procedure against the child's anxiety level that will take circumcision.

Mansjoer, A. 2000. Kapita Selekta Kedokteran. Jakarta: Media Aesculapius Nursalam. 2003. Konsep dan penerapan Metodologi Penelitian Ilmu Keperawatan. Jakarta: Salemba Media. Nursalam. 2005..Asuhan Keperawatan Bayi dan Anak. Jakarta: Salemba Medika.

SUGGESTION Expected to health workers are associated with these results, nurses can use leaflet to minimize the child's anxiety which will be taken circumcision and should have to apply the knowledge and application of knowledge learned during the lecture by providing health education using a variety of media that exist today. The results could be used as a reference future studies, mainly related to anxiety levels of children will be taken circumcision and further research to look for a more complete supporting data about the respondents among others, additional data on the information obtained.

Pusat pendidikan Tenaga Kesehatan Departemen Kesehatan RI, 2009..Asuhan Keperawatan Dalam Kontek Keluarga. Jakarta Setiadi. 2007.Konsep dan Penelitian Riset Keperawatan.Surabaya: Graha Ilmu Wrana, P. (1939). "Historical review: Circumcision". Archives of Pediatrics 56: 385 392. as quoted in: Zoske, Joseph (Winter 1998). "Male Circumcision: A Gender Perspective". Journal of Studies 6(2): 189–208.

BIBLIOGRAPHY Arikunto, S. 2006. Prosedur Penelitian Suatu Pendekatan Praktek. Jakarta: Rinek Cipta Asih,Y.

Men‟s

Yupi, S. 2004. Buku Ajar: Konsep Dasar Keperawatan anak. Jakarta: EGC

1999.Dasar-Dasar Riset Keperawatan. Jakarta: EGC

Danim, S. 2003.Riset Keperawatan Sejarah & Metodologi. Jakarta: EGC Gollaher, D. (February 2000). Circumcision: a history of the world‟s most controversial surgery. New York, NY: Basic Books. hlm. 53–72.

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THE CORELATION OF BODY MASS INDEX (BMI) WITH CARDIORESPIRATORY RESISTANCE ON NURSING PROGRAM STUDENTS Oka Ludianita1, Ita Novita Dewi2 STIKes Hutama Abdi Husada Tulungagung Email: [email protected] Abstract Someone who has full of weight body, will suffer Cardiovaskuler. So it assumed that someone who has big body having cardiorespiratory endurance lower than normal people. The goal of the research is to know the correlation between BMI and cardiorespiratory endurance.This research design used correlation design by using sectional cross approaching. The populations of the research are the students of sarjana degree of grade III. The samples of the research are 52 people by using sampling total technique. BMI data is taken by using Antropometri measurement and using Balke test for cardiorespiratory endurance.The result of the research had been found that 52 student have normal BMI and having cardiorespiratory endurance. There were 16 people (47%) from the statistic test of Spearman Rho is gotten score ρ= 0,002 < α= 0,05 so H0 rejected and H1 accepted. There is a correlation between BMI and Cardiorespiratory endurance on the students of nurse program on grade III at STIKes Hutama Abdi Husada Tulungagung.From the result above showed that good cardiorespiratory immune system existing by having routine exercires and enough nutrient, so BMI will be normal from that reason. The researcher hopes that the student must pay attention to BMI and cardiorespiratory endurance in order incrate the health of body and reaching healthy life. Keyword : Body Mess Index, Cardiorepiratory Endurance, Student

who has a prime cardiorespiratory endurance can perform daily activities with optimal and not get tired, and still have the energy reserves to do other activities (Bastian, 2009). Cardiorespiratory endurance is the ability to receive, convey and to extract oxygen for physical work. It is the ability to survive in the physical work at a certain intensity. Cardiorespiratory endurance will improve with regular participation in aerobic activity, such as brisk walking, jogging, cycling, and swimming. Term aerobic means "with oxygen", but when applied to exercise, refers to activities in which the oxygen requirement can be given continuously during the performance (Anspaugh, 2006). Cardiorespiratory endurance is determined by the strength of Maximum Oxygen Volume (VO2max), which is defined as the highest average oxygen that can be generated during exercise and is shown in the number of milliliters of oxygen consumed per kilogram of body weight per minute (Nieman, 2008). According to Lloyd, et. al (2004) stated that the results of research on cardiorespiratory endurance conducted at the Nursing Academy student Serang Banten

INTRODUCTION Lifestyle of the people who tend to not have as much physical activity is something to watch out, because these habits can affect one's health. Various kinds of organ function decline in this community can be prevented through exercise (Samihardja J., 2005). Sport is any systematic physical activity to encourage, foster and develop the potential of physical, spiritual, and social. Sports activities that can be done in everyday life sometimes requires great body energy, due perhaps in the sport activity there are movements that are quite complex or complicated. Because any movement in the sport activity definitely requires energy from the body. Activities regular exercise can help maintain physical fitness (infallible, 2007). One form of capital is human resource development of healthy, that is healthy physically, mentally and socially. Teenagers who are healthy and have good endurance to be able to excel in learning and work so that productivity is increased. According to the WHO, adolescent is an individual both women and men who are in a period or age between children and adults. Limitation of teenagers in this case is the age of 10-24 years. Someone 1081

Regional Government, there is a significant relationship. (BMI) with Endurance is the group with normal BMI fitter (Trismanto, 2004). In addition, a study also states that there is a significant association between the intake of micro-nutrients in the form of a substance with endurance in female adolescents and adults. Study literature obtained from several countries show the status of the Indonesian VO2max levels was the lowest. A survey in the United States (US) found the average value of VO2max in women aged 20-29 amounted to 37.96 ml.kg-1.mnt-1 (Jackson, 2008). In Sweden, 119 women aged 8-16 years have an average value of VO2max for 48 ml.kg-1.mnt1 (Morinder et al, 2008). While in Indonesia, the research conducted at PNS Ministry of National Education (MONE) of 285 adult respondents surveyed have an average value of 31.58 ml.kg VO2max-1.Mnt-1 (Wijayanti, 2006). Based on preliminary studies that I do, in STIKes Hutama Abdi Husada Tulungagung almost all students riding a motorcycle and also sit in front of a computer in quite a long time. From a preliminary study that I want to know Cardiorespiratory Endurance on the students with a normal body mass index and coed with a body mass index weight at the student level III. One of the components of physical fitness are cardiorespiratory endurance. Maximal Oxygen Uptake Measurement (VO2max) is the best indicator of cardiorespiratory fitness (So and Choi, 2010). VO2max is the maximum amount of oxygen in milliliters that can be used in one minute per kilogram of body weight. People who are good fitness have high VO2max values in the group. Various studies have shown a link between a decrease in VO2max with various levels of mortality and morbidity. The low VO2max has a strong relationship (3-6 times increased risk) with hypertension, diabetes, and metabolic syndrome (Carnethon et al., 2003). Nutritional requirements is one factor that must be considered in view of the lack of nutrition can result in low physical quality that can impact on the level of physical fitness (physical endurance), which in turn can affect the productivity of labor (Krisdinamurtirin, et al, 2005). Cardiorespiratory endurance is not only required by an athlete for a better

appearance, but also by athlete to maintain health. Nursing students will soon be a nurse and nurse must have good cardiorespiratory endurance is also good (Prajapati et al., 2008). College of Health Sciences (STIKes) Hutama Abdi Husada Tulungagung an educational institution that has not been used as a location of research on the durability of cardiorespiratory researcher is interested in doing research on the level of BMI (Body Mass Index) by Endurance Cardiorespiratory on the nursing students in STIKes Hutama Abdi husada Tulungagung. METHODS This research is correlational with cross sectional approach. ie the type of research that emphasizes the time measurement / observation of independent and dependent variable data only one time / at a time. (Nursalam, 2003) correlational study aims to reveal the correlative relationships between variables. The location study was conducted in STIKes Hutama Abdi and Husada Tulungagung Tulungagung In Rejoagung Stadium with all the student population Prodi S1 Nursing grade III STIKes Hutama Abdi Husada Tulungagung. This study uses total sampling technique. Samples in this study as many as 52 people. The data collection method with observation form given to the respondent. And using instruments that weigher (brand carriba), height gauges (brand height) and Running or walking for 15 minutes (Balke test) In the processing of the data in this study by way of categorizing using computer assistance using the SPSS statistical test Spearman Rank (Rho) (Syarifudin .B, 2009)

RESULT 1. Body Mass Index (BMI)

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Table 1. Body Mass Index (BMI) nursing program students BMI

Based on the above table was obtained from 34 female students almost half had a normal BMI as many as 16 people (47%) with

Frequency Percentage (%) 2 3,8 34 65,4 15 28,9

Cardiorespiratory endurance (Vo2 TOTAL Max) Goo Modera Less Defici n % d te ent f%F%f % F% Thin 001 50 1 50 0 0 2 100 Nor 1 3 14 41 16 47 3 8, 3 100 mal ,1 9 4 Pre 00 2 13 7 46,7 6 40 1 100 Obes ,3 5 Obes 0 0 0 0 0 0 1 10 1 100 0

Thin Normal Pre obesity Obesity 1 1,9 52 100,0 Jumlah Source: Questionnaire Research 2015

Based on the above it can be seen that from 52orang majority of respondents had a normal BMI of 34 (65.4%), and a small portion of the respondents had BMI obesity only 1 (1.9%).

less cardiorespiratory endurance. While only a small percentage who have a BMI of obesity 1 (100%) with less cardiorespiratory endurance once. Spearman Rho test results obtained value ρ = 0.002, while α = 0.05, because ρ <α then H0 rejected and H1 accepted. Meaning There Relationship Between Body Mass Index (BMI) With Cardiorespiratory Endurance In Prodi S1 Nursing Student Level III in STIKes Hutama Abdi Husada Tulungagung 2015.

2. Cardiorespiratory Endurance Table 2. Cardiorespiratory Endurance nursing program students Cardiorespirator Frequenc y Endurance y (Vo2 Max) Very Good 0 Good 1 Moderate 16 Less 25 Deficient 10 Total 52 Source: questionnaire study 2015

Percentag e (%) 0,0 1,9 30,8 48,1 19,2 100,0

DISCUSSION 1. Body Mass Index (BMI) nursing program students Based on Table 1 above shows that out of 52 respondents mostly had normal BMI is 34 people (65.4%) and obese only 1 (1.9%). Based on cross-tabulation between age and body mass index (BMI) S1 Prodi nursing student level III can be seen that that has a normal BMI of 18 (64.2%) at the age of 20 years, while the rest is not obtained. According Pudjiadi et al (2004), the Body Mass Index is a guide to determine overweight based Quatelet index (weight in kilograms divided by the square of height in meters). BMI interpretation depending on the age and gender, because men and women have different body fat levels. According Lisbet (2004) that the relationship between body fat and BMI is determined by the shape and proportions of the body so that the BMI does not necessarily give an overview of obesity the same for all populations. In the existing research results the researchers found that BMI affects a person not only age but also gender, fat content. The

Based on the above table can be seen that out of 52 respondents almost half of the respondents have less cardiorespiratory endurance as many as 25 people (48.1%), whereas only a small proportion have good cardiorespiratory endurance only 1 (1.9%).

3. Relationship Between Body Mass Index (BMI) With Cardiorespiratory Endurance on nursing program students Table 3.Tabulasi Relations Cross Body Mass Index (BMI) With Cardiorespiratory Endurance In nursing program students Source: Research 2015 1083

growth of fat in women grow more rapidly than men.

mass index (BMI) with Endurance is the group with normal BMI fitter. It is known that almost all female students in our study of the number of 52 female university students do not understand about what is called the BMI and cardiorespiratory endurance. IMT relationship with cardiorespiratory endurance can be demonstrated in the table that are in front. The level of cardiorespiratory endurance optimal not only gained by doing regular exercise, adequate rest and maintain health, but also must be balanced with the fulfillment of the nutrients contained in the food they consume. This will affect the activity of a person to be able to perform daily activities well and not get tired. To the researchers hope to women students in particular in order to improve physical health and a sense of responsibility towards their health and get a healthy way of life.

2. Cardiorespiratory Endurance Nursing students in STIKes Hutama Abdi Husada Tulungagung Based on Table 2 above shows, cardiorespiratory endurance Prodi S1 nursing student less 25 level III (48.1%) and good only 1 (1.9%). And based on cross-tabulation between the age of the student cardiorespiratory endurance showed that 11 (40.8%) had cardiorespiratory resistance at the age of 20 years and 1 (14.3%) had a better cardiorespiratory endurance at the age of 21 years. According Dangsina Moeloek, (2004) heart-lung endurance can be supported on several things, including physical exercise activity and nutrition. Activity physical exercise is one of the factors that affect the durability of the heart-lung because at this time we do a physical activity, muscle strength will be trained cardiopulmonary Nutrient intake also affected because the nutritional intake of fat, carbohydrates, and protein will be converted into energy for metabolism of body organs. According Sajoto M., (2005) Exercise Cardiorespiratory endurance is the ability to work or train for a long time without experiencing fatigue. From the theory above authors found that a good cardiorespiratory endurance can have someone by way of regular exercise. Researchers hope, especially for the mahasisiwi set aside a little time to work out a new routine that kardiorespirasinya further improved durability and can perform daily activities with optimal and fast tired.

CONCLUSION Body Mass Index (BMI) which is owned by the Nursing student level III in STIKes Hutama Husada Tulungagung Abdi was 34 (65.4%) had a normal BMI. Cardiorespiratory endurance is less that 25 (48.1%). There Relationship With Body Mass Index on student Cardiorespiratory Endurance Prodi S1 Level III in STIKes Hutama Abdi Husada Tulungagung.

ACKNOWLEDGEMENT REFERENCE Almatsier Sunita. 2005. Prinsip Dasar llmu Gizi. Jakarta : Gramedia Pustaka Utama.

3. Relationship Between Body Mass Index (BMI) with Cardiorespiratory Endurance In Prodi S1 Nursing Student Level III in STIKes Hutama Abdi Husada Tulungagung Results of statistical test Spearman Rho p value = 0.002 where p <0,05 so that H0 rejected and H1 accepted, which means there is a significant relationship between body mass index (BMI) with Cardiorespiratory Endurance On nursing program students According to Lloyd et al (2004) stated that the results of research on cardiorespiratory endurance is done on Local Government Nursing Academy student Serang, Banten there is a significant correlation between body

Arikunto, Suharsimi. 2006. Prosedur Penelitian Suatu Pendekatan Praktik. Jakarta : Rineka Cipta Cooper CB, Storer TW.2005. Exercise testing and interpretation. United Kingdom: Cambridge University. Dangsina Moeloek. 2004. Kesehatan dan Olahraga. Jakarta: FK-UI.

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Depkes R.I. 2005. Petunjuk Teknis Pengukuran Kebugaran Jasmani. Jakarta : Depkes 3-27

Krevits, Lenz. 2007. Panduan Lengkap Bugar Total.Jakarta : PT Raja Grafindo Persada Moore, Mary C. 2007. Buku Pedoman Terapi Diet dan Nutrisi.Jakarta : Hipokrates

Djoko, Pekik Irianto. 2004. Bugar dan Sehat Dengan Olahraga. Yogyakarta : Andi Offset

Notoatmodjo, Soekidjo. 2010. Ilmu Perilaku Kesehatan. Jakarta : Rineka Cipta

Fatmah. 2011.Gizi Kebugaran dan Olahraga. Bandung : Penerbit Lubuk Agung,

Nursalam. 2008. Konsep dan Penerapan Metode Penelitian Ilmu Keperawatan. Jakarta : Salemba Medika

Ganong, W.F.,2001. Buku Ajar Fisiologi Kedokteran. Jakarta: EGC..

Riefmanto, Bambang H. Obesitas.Jakarta : Sagung Seto

Hidayat, Aziz Alimul. 2007 .Metode Penelitian Keperawatan dan Teknik Analisa Data.Jakarta : Salemba Medika

2009.

Roumauli, Suryati. 2009. Kesehatan Reproduksi. Yogyakarta : Nuha Medika

Hockey, Robbert V.2005.Fitness and Wellness. Collorado USA Morton Publishing Company

Samihardja J. 2005. Simposium dan diskusi panel peningkatan prestasi olah raga.Semarang : Alfabeta

Hoeger WK, Hoeger SA 2011.Lifetime physical fitness and wellnes. USA: Cengage Learning Belmont

Soetjiningsih.2007. Tumbuh Kembang Anak dan Remaja.Jakarta : Sagung Seto

Ismaryati. 2006. Tes Pengukuran Olahraga. Surakarta : Universitas Sebelas Maret.

Supariasa, I Dewa Nyoman, Bachyar Bakri, dan Ibnu Fajar. 2005. Penilaian Status Gizi. Jakarta : EGC

Kadir, Abdul Ateng, 2008. Asas dan Landasan Pendidikan Jasmani, Jakarta: DEPDIKBUD

Supariasa, I.D.N, Bachyar, B., Ibnu, F. (2002).Penilaian status gizi. Jakarta: EGC

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RELATIONSHIP BEHAVIOUR OF USING PERSONAL PROTECTIVE EQUIPMENT (APD), HEALTHL YAND BALANCED DIET, AND PERSONAL HYGIENE TO SKIN HEALTH STATUS OF SCAVENGERS IN TPA KEDIRI Indasah*, Nur Zuhdana Maula** Public Health Program Study Surya Mitra Husada Kediri Health CollegeEast Java Indonesia Email: [email protected] ABSTRACT Scavengers is workers in the informal sector who has‟n getting the health care as appropriated. The conditions of scavengers environment in an open environment so that the condition is directly related to sun, dust, and smell garbage. With such conditions could cause changes skin health status as halth problems or occupational diseases such as allergies and skin infections. Behavior using of personal protective equipment, healthy and balanced diet, and personal hygiene is a way to protect and keep scavengers from health hazards, especially skin health problems. The researchdesign used in this study is a survey Crosssectional analyticapproachto the total population (50respondents). The data obtained through from observation and questionnaires sheets determine the relationship between independentvariabel with dependent variabelusing statistical correlation test. The results of research conductedat thelandfillshowed that 17 respondents (34.0%) were protect tive equipment (Gloves, shoes, protective eathing) and 17 respondent (34,0%) were protective body, breathing and head (cap, mask, gloves, shoes, and protective clothing), and 35 respondent (70,0%) less adheve to healthy and balanca diet, and 50 respondent (100,0%) less adheve personal hygiene. From the statistic correlate test result had relation between relationship of behaviour of personal protective equipment to skin health status with significance value is = 0,000 < alpha 0,05 the Ho rejected. And then test result had relation between relationship of behaviourof a healthy and balanced diet to skin health status with significance value is = 0,000 < alpha 0,05 the Ho rejected. And this result had relation between relationship of behaviour of personal higienetoskin health status with significance value is = 0,000 < alpha 0,05 then Ho rejected. From results proven this researchisthe need to increase healthy behavior sand prevention of skinhealth problemsonthe land fill scavengers Kediri, which aimsto changeattitudes and awareness ofl scavengers become healthy behaviors that manifest good health scavengers. Keywords: APDBehavior, diet, personalhygiene, skin healthstatus

INTRODUCTION Skin diseasesare often found in Indonesia, this is because Indonesia has a tropical climate (Utomo, 2004). Theclimatethat facilitates the development of bacteria, parasitesand fungi. Disease that of tenarisedueto lack of personal hygiene are various skin diseases (Kristiwiani, 2005).

from then atural resources. These activities also generate waste materiall call edjunk (Chandra, 2007). Scaven ged job is high risk workon health because of poor waste management. In general, the management of wastein big cities Indonesia is similar, collect trans waste. Aclassic setting which eventually became openly disposal practice esatas pecified location (open dumping). The

People doing activities to fulfill his welfareby producing food and other goods

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practicehas afatal weakness to the environment torhumanaround thedisposal site, as happenedinLeuwigajah. Move over thatthe practicerequires alarge area, whereasthe supply oflandis a major probleminof handlingwaste, such associetyagainst TPST in Bojong, Bogor(Tiarsa, 2006).

Healthly and Balanced diet, and personal hygiene to skin health status of Scavengers in TPA Kediri.

Scavengers are the people who collecting of salvage from the trash. Activitiesin the informal sectoris affected by the waste management systemin Indonesia, which generally consistsofa collection system, transfer system, the transport system and the exhaust system. Scavengers are in formal sector work ers who hasn‟tget health careas appropriated. The working conditions of the scavengers are inan open environ ment so that the conditionsare directly related tosun, dust, and the smellof garbage. With these condition scan cause health problem soroccupational diseasessuch asrespiratory infections, skinallergies, colds, dizziness, and skin in fections (Kurniawati, 2006).

In this study usingan observational study design (data collection at onceata time), by means oftheanalytical survey or study that triesto explore how and why the health phenomenonoccurs, thecross-sectional approachin which resear chers conducted a study to measure and observe the variables the independent and dependent variable sat the same time onlyonce time (Notoatmodjo, 2005).

RESEARCH METHODOLOGY

Population and samples in this study areallsca vengers in the land fill Kediri, There are 50 scavengers. The independent variable in this study is the use of PPE (APD) Behavior, healthy and balanceddiet, personal hygiene. While the dependent variable is affected variable/arebedue because of the in dependent variable/independent are scavengers skin health status.

On the other handscavengeris a group of high lyvulnerable to hazards because ealways wrestle with the waste from various sources, house hold waste, market waste, plant waste and hospital waste. Work ers scavenging is a type of work tha thas a high risk for health. Ther is karising from various factors, including: (a) There are the types that are categorizedas B3(hazardous), (b) ourin sensitivityof sensing the presence ofhazardous waste, (c) poorwaste management, and (d) Ignorance of scavengers to the dangers of garbage (Mariana, 2006). Becouse of the importance of main taining clean lines sand health for thes cavengers, that situational so occurs in landfill in Kediri. According to Riyanto, coordinator landfill loperations of ficer there are so scavengers who come and go. Personal protective equip ment that they wear only shoes and hats. They rarelyuse a mask, gloves and other personal protective equip ment, butthey werefine, and their averageage carelong". So it is necessary to do research on relationship behavior of using personal protective equipment (APD),

From theresults ofdata collection, the datawere analyzed with astatistical testused is"Correlation". RESULTS The sampleinthis study amounted to50people. Which consists of 25 respondents(50%) are male , and 25 respondents (50%) are female. They are between 25->55 years old., Most of respondents (40%) are >55 years old. Most of then 23 respondents (46%) had elementary education.

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Figure 2: Diagram Stem variable character is tics of PPE(APD)usage behavior on scavengers in

Characteristics of respondents based on the behavior of the use of PPE (APD)

Landfill

Based on the diagramit can be seen that there are 28 respondents wear head protectiye and face protective or none of respondents wear eye and face protective 22 respondents wear respiratory protective equipment 50 respondents wear hand protective, 58 respondents wear leg protective equipment and 50 respondent wear clothing protective while working.

body protective 34%

34%

22%

Kediri.

body and head

10%

Figure 1: Diagram pie of the variable characteristics of PPE(APD) usage behavior on scavengers in landfill Kediri.

2 Characteristics of respondents based ona healthy and balan ceddiet

0%

Based on the diagramit can be seen that 17 respondents (34.0%) wore Protective body (arms protective equipment, leas protective equipment andprotective clothing) and17 respondents (34.0%) wore protective body, breathing, and head (protective equipment head, respiratory protective equipment, hand

Baik 30% Cuku p 70%

50 0

Kuran g

100% 100% 100%

56% 0%

44%

protective equipment , foot protective equipment, andprotective clothing while working.

Figure 3: Diagram pie ofthe variable characteristics of a balan ceddiet on as cavenger landfill Kediri. Based onthe diagramit can be seenthat35 respondents(70.0%) ignore toa healthyand balanceddiet.

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respondents

based Based on the diagramit can be seen that 44 respondents (88.0%) have less skin health status.

20

10%

Figure 4: Diagram pie hygiene characteristics of individual variables ons cavengersin landfill Kediri.

Campak

100%

72%78%

34%

0 Eksim

Kurang

30%

Bisul

Cukup

84%

Panu

60 40

Baik

Kurap

0%

Kudis

3Characteristics of personal hygiene.

Figure 6: Bar Chart variable characteristics of skin health status of scavengersin landfill Kediri. Based onthe diagramit can be seen that exposed to eczema there are 15 respondents, there were 42 respondents exposed toscabies, there were 17 respondents exposed to ringworm ,there were 36 respondents exposed to ulcers, there were 39 respondents exposed to measles, and there are 5 respondents exposed to skin fungus while working.

Based onthe diagramit can be seen that 50 respondents (100.0%) ignore to individuall hygiene.

4Characteristics of respondents based on the skin health status . 0% 12%

DISCUSSION Baik Cukup

A. Relationship Behaviorof using PPE (APD) to Skin Health Status In Scavengerin landfill.

Kurang

The results showed that 17 male respondents (34.0%) woreprotective body and 17 female respondents (34.0%) wore protective body, breathing, and head while working. Sowomenin the useof PPE (APD ) is morecomplete than men. 17 respondents (34.0%) aged >55 years old wearing protective equipment, respiratory, and head protective while working. So the behavior ofyoung respondentsin using PPE(APD) is

88%

Figure5: Diagram piecharacteristic skin health status variables on scavengers in landfill Kediri.

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not complete. 13 respondents (26.0%) who doesn‟t uducate schools did not wear protective body while working. So the behavior of education the more complete of using PPE (APD).

The results of the analysis of the relationship between PPE (APD) usage behavior with skin health status above showsthat theattention ofscavengersin landfill toself-protection behavior in the use of PPE (APD) veryless. Though the bad effects of their work has been felt one of them is skin health problems. Though scavenged job is a jobthat is susceptible to the dangers of the sources of disease. If the scavengeris not completein the use of PPE (APD) they can get health hazard.

Motivation is a state in whichan individual raises, directs, and maint ains behavior. In this case the motivation is strongly in fluenced by the characteristics of the respondents including age, educationlevel, length of work, status, income. In other words, according to Kartini Kartono is a person's motivation to doso mething (Wikipedia 2008).

B. Relationship of Healthy And Balanced Diet to Skin Health Status In Scavenger landfill.

Health behavior is essentially anindividual's responseto stimulate dealing with the disease, the health care system, food, andenviron ment. The behavior ofa personor the public healt his determined by knowledge. Factors that influence knowledge of some one or society is education. Education means the guidance givenby one person toanother person about some thing that they can understand. It is inevitable that the higher one's education the more easily the information they receive, and finally the more know ledge they had. In other hand , if one's education, in low willinhibit the development ofa person's behavior to accep tance, information and new values introduced. Educationis more emphas is on human formation (investment attitudes and values) (Mubarak etal., 2007).

Balan cedmenuis a consisting of a wide range of food sinappropriat equantities andproportions, so that one's nutritional needs for maint enance and repairof body cellsand the process oflife and grow thand development (Almatsier, 2004). The results showed that 35 respondents (70.0%) lessad here to have a healthy and balanced diet. While the results of crosstabulasi healthy and balanced diet with gender respondents note that the 15 male respondents (30.0%) is quitead here to a healthy and balan ceddiet and 25 female respondents (50.0%) lessad here to a healthy and balan ceddiet. So in terms ofa healthy and balan ceddiet scavengers menpay more attention to the need for food for their body. 20 respondents (40.0%) aged >55 years lessadhere to a healthy and balanced diet. So in terms ofa healthy and balan ceddiet the more scavenger the less to full fill the nutritional needs for him self. 21 respondents (42.0%) had elementary education lessad here toa healthy and balanced diet. So in terms ofa healthy and balanced diet the higher education level, the smaller scavenger seating lesso bedient. 35 respondents (70.0%) were lessad here to a healthy and balanced diet have less skin health status. So in terms ofa healthy and balanced diet the lessadherent scavengers to the diet also affect the health of skin problems.

And the results show edthatusageat PPE (APD) behavior with skin health status 17 respondents (34.0%) were wearing protective equip ment body, breathing, and the head protective hadless skin health status. So in terms ofthe behavior ofusing PPE (APD) incomplete will effect on skin health problems. All public health experts discussing health status refers to the theory of Blum(1956), that then viron ment has the most contribution to health. Then followed by behavior, health services and descendants who have the least contribution to the health status (Notoatmodjo, 2007).

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Later analysis of healthy and balanced diet with skin health status using the correlation obtained significance value of 0.000 which is smaller than 0.05. H1is accept edwhich means that there is a relationship between a healthy and balanced diet with the health status of the skin with strength levels 0.907 relationships means a very strong and positive relationship. The level of educationis very in fluence on changes in attitudes and healthy behavior. High erlevels of education will facilita tea person orcommunity to absorb the information and implement it in behavior and every day life style, special l yin health and nutrition. Level of education, especially of women will affect their health status (work widya food and Nutrition, 2004).

individual hygiene. So in terms of personal hygiene, men and women are alike lessobey. 20 respondents (40.0%) aged >55 years lessad here to individual hygiene. So the high ersca vengers age the less the level of personal hygiene owned. 23 respondents (46.0%) are elementary educated less adhere with personal hygiene. So in terms of personal hygiene, the lower the levelof educationthe less scavenger owned personal hygiene. The results showed that individual hygiene to skin health status is known that 44 respondents (88.0%) lessad here to hygieneskin health status of individual sareless. So in terms of personal hygiene, the less scavenger maintain personal hygiene the more effect on skin health problems.

The results of disobedience relationships healthy and balanced diet with the incidence of skin health problems scavengersin landfill showed highly significant. That means theneed fora source of nutritionin people who work asscavengers must also be full filled. Scavengersare already susceptible to various pollutiondue to waste, then to main tain consumption patterns varied and leave eating food taken from garbage is also needed to maintain the body's resistance to life.

For the analysis of individual hygiene to skin health status obtained significance value of 0.000 whichis smaller than 0.05. H1 is accep tedwhich means that there is a relationship between the health status of individuall hygiene skin with arateof0.973 means that the power relationship and a very strong positive relationship. Many health problems suffered by a person because of not main taining good personal hygiene. Physical problems that oftenoccursisimpaired skin integrity, impaired oral mucousmembranes, infection of the eye, ear infections and physical problems of the nails (TawotoandWartonah, 2003).

C. Relationship of hygiene Skin Health Status of Individuals to the scavengers in landfill. Hygieneis derived from the Greek word meaning healthy. Hygieneis a health effortsby main taining and protecting individual hygiene, such ashand washing. Personal hygiene means the act of maintaining the cleanliness sand health of a person's physical and psychological wellbeing(Mukono, 2004).

Garbage in the landfillhave become a habit for scaverages. Eating, drinking, chatting doingin a place thatis filledgarbage.This study proves therelationshipof the lesspersonalhygienewill affect the skin health problems. It also provesthatallscavengerssospectation to get diseasecaused by waste. There fore apersonal hygienehas to play role to minimizethe things thatirritate with the body's health of scavengers.

The results showed that 50respondents (100.0%) lessadhere tokeep individuall hygiene. While the results of individual hygiene cross tabulasi with genders now that 25 male respondents (50.0%) less personal hygiene and comply with 25 femalerespondents (50.0%) lessad here to

CONCLUSION

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1 There is a relationship between the behavior of using of PPE(APD) and the skin health status with strength level of 0,870 means relationship is positive and very strong relationship Correlationanalysis was obtained using a significan cevalue of 0.000

Pondok Labu Kecamatan Cilanda Jakarta Selatan Tahun 2007. Fakultas Ilmu Sosial Dan Ilmu Politik Universitas Indonesia, Jakarta Malaka, T. Kesehatan kerja dan penyakit akibat kerja. Proceeding Seminar dan Muker I IDKI. Penerbit :Pengurus PusatI katan Dokter Kesehatan Kerja Indonesia, jakarta, 1994 : 58-60

. 2 There is a relationship between a healthy and balanced diet and the health status of the skin with strength levels 0.907 relationships it means relationship is positive and very stronge relationship. Correlation analysis was obtainedusing asignificance valueof 0.000

Mardi, Moch, 2004. Hubungan Perilaku dan Lingkungan Kerja Dengan Timbulnya Kecelakaan Akibat Kerja Pada Tenaga Kerja Bongkar Muat : Studi Observasional Di Pelabuhan Lembar NTB, Thesis, Program Stud iIlmu Kesehatan Masyarakat Universitas Airlangga, Surabaya

. 3 There is a relationship between personal hygiene and skin health status with arate of 0.973 it means the relationshipis positive and very strong relationship. Correlationan alysis was obtained using asignificance value of 0.000.

Notoatmodjo, S., 2003. Pengantar Pendidikan Kesehatan Dan Ilmu Perilaku Kesehatan. Andi Offset, Jakarta

REFERENCES Hakim, L, 2004. Faktor-Faktor Yang Berhubungan Dengan Penggunaan Alat Pelindung Diri (APD) Oleh Pekerja Radiasi Pada Instalasi Radiologi Rumah Sakit Di Wilayah Kota Palembang Tahun 2004. Thesis, Program Stud iIlmu Kesehatan Masyarakat Universitas Indonesia. Jakarta

Ratna, Dian., 2006, Faktor-Faktor Yang Berhubungan Dengan Kejadian TineaPedis Pada Pemulung Di TPA Jatibarang Semarang 2006. Thesis, Program Magister Kesehatan Lingkungan Universitas Diponegoro, Semarang Sulistomo, A., 2001. Penyakit Akibat Kerja Dan Penyakit Yang Berhubungan Dengan Pekerjaan. Makalah Seminar K3 RS. Persahabatan Jakarta, Penerbit Universitas Indonesia (UI-Press), jakarta

Harrington, J. M., dan Gill, F. S., 2003. Buku Saku Kesehatan Kerja. EGC, jakarta Haryono, 2007.Menteri Seni loka karya Pengembangan Profesi K-3, Direktorat Bina Kesehatan Kerja, jakarta Khoirudin,

Tambusai,

A., 2007, Proses Pemberdayaan Pemulung Dalam Menggunakan APD Pada Kelompok Pemulung

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M., 2001. Pengawasan Kesehatan dan Keselamatan Kerja Untuk Meningkatkan Produktivitas Kerja. Makalah Seminar K3 RS. Persahabatan jakarta, Penerbit

Universitas Indonesia Press), Jakarta

(UI-

Zulikhfan, 2009. Beberapa Faktor Yang Mempengaruh iPemanfaatan Pelayanan Kesehatan

_________, 2010, Undang-Undangnomor 7 tahun 2010 Tentang Alat pelindung Diri

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THE IDENTIFICATION OF FAMILIES STRESS LEVEL WITH ADVERSITY QUOTIENT IN CARING SCHIZOPHRENIA FAMILY MEMBERS IN THE CITY OF KEDIRI

Byba Melda Suhita STIKes Surya Mitra Husada Kediri Email: [email protected]

ABSTRACT One mental disorder schizophrenia, not only cause suffering to the patient but also for people who are closest. Family usually most affected by the presence of people with mental disorders in their families. Expression of emotions in the family can arise in caring for family members who suffered from schizophrenia, one of which is stress. Besides the high cost of care patients also require more attention and support from family, therefore family also require a power struggle or adversity quotient in treating patients with schizophrenia. The purpose of this study was to determine the influence of family stress level against adversity quotient family in caring for family members with schizophrenia in Kediri.The study design used is Cross Sectional. Family population in the town of Kediri with cluster random sampling technique gained some families with family members of patients with schizophrenia in the town of Kediri that meet the criteria of the number of 87 people. Data was collected by questionnaire, the results were analyzed using the Spearman rank test at α = 0.05.The results showed that nearly half the care giver stress in the lightweight category, namely 36 respondents (41.4%) and most of the care giver to have adversity quotient in the category climbers that 49 respondents (56.3%). Correlation test results showed a significant relationship (p-value <α) and negative (ρ = -0.432) between the level of stress with adversity quotient keluraga in caring for family members with schizophrenia in Kediri.Caregiver who has a good adversity quotient is not easy to feel stressed (stress) because the individual is able to deal with stress effectively and ultimately experience continuous success in the face of stress will increasingly shape tolerance to stress. Keywords: Level of stress, adversity quotient, family, schizophrenia.

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to predict the client's condition, because any time subject to change. Schizophrenia patients dominating number of people with mental disorders, ie 99% of all mental disorders in psychiatric hospitals. The prevalence of schizophrenia patients in Indonesia is 0.3-1% and can arise at the age of 18-45 years, there are even arising in patients aged 11-12 years. If the Indonesian population of 200 million people, it is estimated at about 2 million people suffer from schizophrenia (Nufianto, 2011). Based on data from the National Institute of Mental Health, the incidence of schizophrenia in the US prevalence is approximately 1% (US Departemen of Human Services, 2009), The same thing devoted to the prevalence in the world. Schizophrenia is the most severe functional psychoses, and pose the biggest personality disorganization, the patient has no reality. The incidence of schizophrenia in the world of 0.1 per mil regardless of cultural differences in social status (Varcarolis,2000). At 2009 based on data from 33 psychiatric hospital in Indonesia mentioned that people with mental disorders weight reached 2.5 million people (Waspada Online 2010). In Indonesia, approximately 1% - 2% of the total population suffered from schizophrenia, reaching 3 per 1000 population, the prevalence of 1.44 per 1000 population in urban areas and 4.6 per 1000 population in rural areas means the number of people with schizophrenia 600,000 people productive. Epidemiological studies mention that the estimates of the prevalence of schizophrenia in Indonesia was 0.3 to 1 percent and usually occurs around the age of 18-45 years, but there is also a new age of 11-12 years already suffer from schizophrenia. When Indonesia's population of about 200 million people, it is estimated at about 2 million people suffer from schizophrenia (Arif, 2006). Basic research in 2007 national health that about one million people in Indonesia suffered severe mental disorder, while 19 million others suffer from mild to moderate mental disorders. There are no more recent figures from this research, but according to global trends such as the WHO

INTRODUCTION Mental disorder is a condition in which the process of physiological or mental function less well so that disrupt the function of everyday life. This disorder is often also referred to as a psychiatric disorder or mental disorders and the general public is sometimes referred to as a nervous breakdown. Mental disorders experienced by a person can have a variety of symptoms, both obvious and that only in his mind. Ranging from avoidance behavior of the environment, do not want to touch or talk to others and would not eat until the raging with no apparent reason. Ranging from the silent to the talk with unclear. Those that can talk to who is not a concern at all with the environment. From the above conditions make the client must be hospitalized to recover mental mental condition (Hawari, 2001) Most people with mental disorders is schizophrenic. Schizophrenia is a severe mental disorder that is characterized by impaired reality (hallucinations and delusions), inability to communicate, affect unnatural or blunt, cognitive impairment (not capable of abstract thinking) and had difficulty doing daily activities (Keliat, 2006). Schizophrenia is generally characterized by distorted thinking and perception affect fundamental accompanied by unnatural. Manifestations may include positive symptoms, negative symptoms, affective symptoms and cognitive dysfunction (Levine & Levine, 2009). Schizophrenia is derived from the two words "Skizo" which means cracked or broken (split), and "frenia" which means soul. Thus a person suffering from Schizophrenia is a mental disorder who experience mental cracks or fractures personality (splitting of personality). In the classic paranoid-type schizophrenia is characterized mainly by their delusions of grandeur or delusions chase, the course of disease rather constant (Kaplan & Sadock, 2004). Thoughts drift (Flight of ideas) are more often found in mania, in schizophrenia more often incoherence (Maramis, 2004). Criteria of timing based on the theory of Townsend (1998), who says life is difficult

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forecast, the number of people with mental illness will continue to increase until it reaches 450 million people worldwide in 2013. In Indonesia, the increase in the number of patients do not seem to experience a surge ystem due to are still more people who are blind about the disease than those who understand. (Safitri, 2011). Schizophrenia is a severe mental disorder which can be found all over the world with a prevalence of about 7 per 1000 adult population, even based on data from basic research basic health issued by the Ministry of Health of Indonesia in 2007 several Indonesian provinces showed larger numbers. Scope of cases of schizophrenia are still very low, ie not mecapai 30% of the total existing cases. When viewed in terms of managing cases of schizophrenia, sekualitas management of this disorder is highly variable and not necessarily really address the needs of patients with schizophrenic disorders and their families (PDSKJI 2011 ; Chan 2011) The prevalence of patients with schizophrenia in Indonesia 0.3-1% means that the people of Indonesia amounted to around 200 million then estimated at about 2 million people suffer from schizophrenia, where approximately 99% of patients with schizophrenia treated in mental hospital. One of the problems in the treatment of schizophrenia is relapse. Relapse is the return of a disease after apparently subsided. Relapse at one year are diagnosed with schizophrenia experienced by 60-70% of patients who did not receive therapy treatment, 40% of patients only receive treatment, 15.7% in patients receiving combination treatment therapy and received support from health professionals, family, community (Stuart & Laraia, 2005). The results showed that 25 percent to 50 percent of patients who come home from the mental hospital did not take medication regularly Appleton (1982) in (Keliat, 2006) And it is this which often leads to relapse / relapse in patients with mental disorders. One mental disorder schizophrenia not only cause suffering to the individual sufferer but also for people who are closest. Usually the family is the most affected by the presence of a mental disorder in their

family. In addition to high treatment costs of patients also require more attention and support from the society, especially the family, while the treatment of mental disorders requires a relatively long time, if the patient does not continue the treatment will relapse (Arif, 2006) Several factors can affect mental patients relapse among others, namely, knowledge, education, information, social, economic, and family roles. Relapses that occur on the client with schizophrenia is influenced by: the client himself, the doctor, the party responsible for the client (the nurse) and family (Keliat, 2006) One of the causes of mental illness recurred client is because families do not know how to deal with clients at home (Sullinger, 1988). According Sullinger (1988) and Carson / Ross (1987), a client with schizophrenia ystem expected to recur 50% in the first year, 70% in the second year and 100% in the fifth year after discharge from the hospital due to wrong treatment for at home or in the community. Based on research in the UK (Vaugh, 1976) and in the US (Synder, 1981) showed that families with high emotional expression with the client, the client is expected to recur within 9 months, the results were 57% readmission of families with high emotional expression and 17 % readmission of families with low family emotional expression. Once clients go home, the client should perform further treatment on pukesmas in its territory who have mental health programs, and the role of the family is needed in the healing process in the client's home (Joseph, 2009). In a family unit, whatever dysfunction (disease, injury, separation) that affect one or more other family members and in particular, often affects other family members and the unit as a whole. Family is a network that has a close relationship and be independent, where the problems of an individual "infiltrated" and affects other family members and the entire system (Friedman, 2003). There is a kind of strong relationship between the family and the health status of its members, that the role of the family is very important for every aspect of health care individual family members, ranging from strategies to the rehabilitation phase. The importance of care in a family

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environment can be viewed from various aspects, namely: the family is a context in which individuals begin interpersonal relationships. Family influence values, beliefs, attitudes and behavior of the client (Clemen & Buchanan, 1982). While Spradey (1985) suggested that the family has the basic functions such as giving affection, a sense of security, a sense owned and prepare the adult roles of individuals in society. The biggest challenge for the treatment of mental disorder problem lies in the families and communities play an active role to accept patients after discharge from the hospital, and involve them in community activities. (Moersalin, 2009). In the presence of family members who experience mental illness, it will affect the system requirements on the family. This is consistent with the results of a survey conducted by Biegel et al, 1995, quoted from Stuart and Laraia (2001), that of families who have family members with schizophrenia residual ie an increase in stress and anxiety the family, it is characterized by the existence of different responses on every member of the family in readiness receiving family members ojiwa impaired. (Windyasih, 2008). Families with one family member has a mental disorder can lead to high conflict, objective and subjective burden, blaming, involvement in hostilities between family members (Pharoah 2010; Fitryasari 2009; eack, 2007; Keliat, 2006; Brady, 2004 ). Schizophrenia patients who can not function normally require a caregiver, someone who generally can treat and support patients in their daily lives (Awad, Voruganti, 2008). In this case the caregiver closest to the patient is the family, because the family is the "primary caregivers" for patients. One of the social problems in patients with schizophrenia were most in need of attention is the role of the family as a caregiver. family encountered many obstacles in carrying out their functions and roles for caring for and living with a family member suffering from schizophrenia. Ignorance of matters related to schizophrenia, stigma, social isolation, financing costs, declining health status of families concerning the state of stress, anxiety, depression and pathological family

dynamics because of the disagreements, conflicts and even violence between family members is a series of social problems sufferers schizophrenia is in the light of the family. (El-Tantawy, 2010). Relapse of schizophrenia patients will increasingly lead to an increase in the burden on families, caregivers and health care providers. This led to the saturation of the family in caring for patients. Psychosocial relapse will bring consequences that will occur sosiotoxic called burn-out of family, guilt, bad impact in financial terms, the increase in the expression of emotion, decreased social support, medical personnel disappointment and certainly will cause disruption in family interactions (Roukema 2003; lai & Thomson, 2011). Along with the burden of care is experienced as a result of chronic schizophrenic disorders trip and deteriorirtatif, family needs are often not met optimally. Neither the patient nor the family is in dire need of mental and emotional wellbeing. They require strength, support for dealing with stress. But this need as neglected. Basic needs such as pengan, clothing, housing, health, education and security are also neglected. Other needs such as social relationships, use of leisure time and recreation also can not be fulfilled because of the concentration of energy and time to care for the patient's family. According to Laurie Flynn, former executive director of the National Alliance for the mentally Ill (NAMI), patients with schizophrenia and their families need more than just psikofarmaka and doctor visits. (Temes, 2011). There is a reciprocal relationship between the disruptive behavior of schizophrenia patients with a negative response to the rise of family members caring. Patient behavior can lead to high expression of emotions in the family, and then this condition will cause negative effects and trigger the patient as well as the psychological stress can trigger relapse. Comments and criticism from family members with high expression of emotions lead to more unusual mind to patients and thoughts that can not unusual that will

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trigger an increase in the comments and criticisms family. Expression of high emotion of the family is a significant stressor in the lives of patients (Davidson et al, 2010). Families of schizophrenia patients also feel the stigma and discrimination of the environment. Some families reacted to the mental disorder suffered by the family members do not speak to anyone about the mental disorder diving for years, even to close friends of their own. Ironically families openly discuss the issue just getting abuse from the public. Family responds to these abuses by withdrawing socially, avoiding friends or even moving to a new residence. Although there is a tendency to reject stigma family members, concealment and withdrawal are based on shame will bring them into social isolation (Warner 2001; Bellack et al, 2007). In theory ABCX, Hill (in Rice, 1987) states that an event (A) interact with family members and create a crisis (B), and the interpretation of the family about the incident (C), can create a crisis (X). In a family, a stressor is present only if the family interpret what happened to them as a threat (family appraisal), and family resources (family resources) that can not face the threat of (secondary appraisal). There are two (2) fundamental concepts in ABCX model proposed by Hill (in Rice, 1987). First, the magnitude of changes caused by events that cause stress. Second, the vulnerability of families to stress. If the family is seen as a system, the mental disorder in a family member would disrupt any system or family circumstances. Along with the treatment of patients with schizophrenia, the family will experience physical and emotional exhaustion. To overcome this, the family needs to do coping strategies for caring for people with schizophrenia. Lazarus and Folkman (1984) define coping strategies as a change from a condition to another as a way to deal with unexpected situations where it is called the empirical process, and divide it into problem focused coping (PFC) and emotion focused coping (EFC). Problem focused coping consists of planful problem solving, coping confrontative, and seeking social support,

whereas emotion focused coping consists of distancing, escape / avoidance, self-control, accepting responsibility, and positive reappraisal. It can be concluded that the coping strategies have an important role in the interaction between stressful situations and adaptation. Leman (2007) defines adversity quotient (AQ) briefly, is as a person's ability to deal with problems. Some definitions above are quite diverse, there is a focus or pressure point, ie the ability of a person, whether physical or psychological in dealing with the problems or the problems being experienced. Someone with a high AQ will be able to face the difficulties or challenges, and this is in accordance with the conditions experienced by the family in which families who have family members with schizophrenia because they have to deal with the problem of the health condition of their family members. With the help of a nurse, the family is expected to have the ability to resolve problems and maintain stability of health status as much as possible. Newman describes family care intervention strategies that focus more on primary and tertiary prevention (Joseph, 2009). Family support patients consistent will make patients able to maintain an optimal treatment program and in particular is able to improve the independence of patients, one of them is able to care for himself or have the skills to produce something or productive.

The Research Objective Knowing the influence of family stress level against adversity quotient family in caring for family members with schizophrenia in Kediri

RESEARCH METHOD Research Design This study uses survey research methods, the research implemented by taking a sample of a population and the use of questionnaires as the principal instrument

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of data collection. Judging from the time dimension of this research using cross sectional design with the nature of the research studies explanation (explanatory research), based on the perception of respondents, which explain the causal relationship between variables based on respondents' answers through hypothesis testing (Maholtra, 2003). The research was conducted in May in the town of Kediri.

Members with Schizophrenia Kediri No. Level Stress F % 1 Light Stress 36 41,4 2 Mid Sedang 34 39,1 3 Heavy Stress 17 19,5 Jumlah 87 100 According to the table 1 above in mind that nearly half the care giver stress in the lightweight category, namely 36 respondents (41.4%).

Population, Sample and Sampling The population in this study is all the families who have family members with schizophrenia post hospitalitation in the town of Kediri, using cluster random sampling technique obtained 87 samples of respondents.

Adversity Quotient Caregiver Caring for Family Members with Schizophrenia Table 2. Variable Characteristics Adversity Quotient Caregiver Caring Family Members with Schizophrenia Kediri No. Adversity Quotient F % Champers 1 38 43,7 2 Climbers 49 56,3 Jumlah 87 100

Variables and Research Instruments Independent research variables: family stress levels (X) while the dependent variable is the adversity quotient (Y). In this study, the data used is the type of primary and secondary data. Primary data are taken directly from the family, while the secondary data to retrieve data from a Mental hospital patients previously treated or from a mental health clinic where the patient is in the hospital control Bhayangkara Kediri. Before digunkan, the instrument in this study was to test the validity and reliability of the results are valid and reliable.

Based on the table 2 above is known that most caregivers have Adversity Quotient in the category climbers that 49 respondents (56.3%). Data Analysis Based on the analysis of stress levels identification with Adversity Quotient family in caring for family members with schizophrenia in the town of Kediri obtained the following results:

Data Analysis After all the data is collected, checked apparatus, then researchers conducted a data analysis to test the relationship between two variables using Spearman rank correlation significance. The approach used in this study using a probabilistic proof that the significance of the correlation using error probability value (p-value).

Table 3. Identification of Stress Level Analysis with Adversity Quotient Family in Caring for Family Members with Schizophrenia Kediri 2015 Adversity Quotient Champer Stress Climbers Level s F % F % F % 3 7,9 33 67,3 36 41,4 Light Stress 6 12,2 34 39,1 Mid Stress 28 73,7

RESEARCH RESULT Stress levels Care Giver That Caring Family Members with Schizophrenia Table 1. Characteristics Variable Rate Stress Care Giver is Caring Family

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Total

Heavy 7 18,4 10 20,4 17 19,5 Stress 38 100,0 49 100,0 87 100,0 Total P-Value = 0,000 α = 0,05 ρ= -0,432

families of patients worried about the condition of their families can not be recovered again, worrying about the cost of care of the old and worried about the rise of the burden on the family if the patient does not recover. Conditions of schizophrenic patients will push against the total functional impairment, even in some cases lead to total dependence, it is an impact on the emergence of pressure on the family, especially if the patient is the head of the family, associated with kekammbuhan patients and the emergence of an additional burden on the family (Ritarwan, 2003 ). The impact of mental illness will also impact on the patient's family. Their families who suffer from schizophrenia impact the patient's family so that economic and social burden that caused by the patient's family is also so great. Patients suffering from schizophrenia after recovery could have a relapse at any time there is even experiencing a total functional problems causing total dependence on family to be able to meet their daily basic needs. In general, they will try many ways that people with schizophrenia can be recovered. With a variety of medical and non-medical businesses will be in error. Stress faced experienced by one family member affects the whole family. Stress caused by the crisis situation, unmet needs, feelings of helplessness and lack of control in life situations. Schizophrenia obviously a shocking event for families, especially those who have schizophrenia are the backbone of the family suddenly helpless, lost the role and usually become a burden to the family. Further research Winefield and Harvey (1994), schizophrenia caregiver as much as 68.6% are parents, brothers or sisters-in-law (17.4%), spouses (7.4%), children (4.1%) and brother Another biological (2.5%). Studies comparing caregiver pairs by gender, shows that men tend to add caregiver informal caregiver or using home care services to care for his wife (Yamada, in Sugiura, Ito, Kutsumi, & Mikami, 2009). But not a bit schizophrenic who have been married have a partner as caregivernya. Duty as a caregiver always been seen as the responsibility of women for the role of women are considered less

The analysis showed that the most prominent results are for respondents who experienced mild stress tend to have Adversity Quotient in the Climbers category, namely 33 respondents (67.3%). Correlation test showed a significant relationship (p-value <α) and negative (ρ = 0.432) between the level of stress to the Adversity Quotient Keluraga in Caring for Family Members with Schizophrenia Kediri 2015.

DISCUSSION Caring for Caregiver Stress levels Family Members with Schizophrenia Kediri Caring for Caregiver Stress levels Family Members with Schizophrenia in the town of Kediri in mind that nearly half the care giver stress in the lightweight category, namely 36 respondents (41.4%). The behavior of schizophrenics who can not function normally causes the need for caregiver. Caregivers are individuals who generally care for and support other individuals (patients) in life (Awad & Voruganti, 2008). The addition of the role of being a caregiver in the family would be a source of stress for couples both psychologically and economically (Clark & Schene, in Schene, Wijngaarden, & Koeter, 1996). Family life will be disrupted when the need to care for someone who is supposed to be normal at his age, the family relationship would be unbalanced from normal to care for sick family members. Besides a change in the roles and responsibilities of husband to wife and the changing relationship between the couple (Mueser & Gingerich, 2006). According testifying (2008), the families of patients experiencing stressrelated mental health condition of the patient. Hamsyah (2011) states that 63% of

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permanent than the duty of men who usually has the task remains as those that provide for the financial needs of families and achieve success in the job (Gopalon & Brannon, 2006). Generally, 5 main functions family described by Friedman in Setiadi (2008) are as follows affective function, is a major family function to teach everything to prepare family members to relate to others, the function of socialization, is a function to develop and train the child to social berkehidupan before leaving the house to connect with others outside the home, reproductive function, is a function to maintain and sustain the generation of the family, the economic function, is a function to meet the economic needs of the family and a place to develop the ability of individuals to increase income to make ends meet families, and care or health maintenance function, is a function to maintain the state of health of family members to keep a high productivity. Data showed that all respondents had experienced stress from mild to severe. Results of the study in accordance with the theory that the impact on one of the family members of schizophrenics is their anxiety either mild, moderate, or severe.

pressure that arises as a result of the psychological relationship of the patient. Furthermore, social responsibility assigned to a caregiver, where people assume that people with schizophrenia to be a burden and lead to social problems. Surely this is not easy, it takes adequate readiness and ability to run a wide range of duties and responsibilities. Various kinds of roles and responsibilities that are not matched by the ability of qualified personal caregiver will cause the gap between the demand and the fact that there is, so the caregiver to position themselves in a situation of stress, conflict, and frustration. In order for caregivers to avoid failure in the face of stress, but on the contrary, managed meghadapi continually stress that eventually form the stress tolerance of a caregiver is required to have the ability to understand, recognize, as well as manage the difficulties or problems that it faces, until, in turn, does not make the individual experiencing distress. Here, the role of adversity quotient (AQ) will be needed caregiver to deal with the stressor. Adversity quotient is one of the psychological concepts of intelligence developed by Paul Stoltz were cored ability to face difficulties confronting someone. Stoltz (2005) adds that adversity quotient important role in predicting how far a person can survive in the face of adversity and how much its ability to resolve the issue. As revealed by Widyaningrum (2007) that the power struggle plays a major role in influencing one's efforts in overcoming difficulties experienced. Individuals who have a strong Adversity Quotient will be able to overcome the difficulties it faces. If the caregiver has the ability to face the difficulties experienced by the various difficulties that there are not easy to make him feel depressed (stress), and further establish tolerance to stress because the individual is able to deal with stress effectively. Intelligence adversity has three forms. First, AQ is a new conceptual framework to understand and improve all facets of success. AQ is based on weighty and important research, which offers a combination of practical and new, which redefined what it takes to achieve success.

Adversity Quotient Caregiver Caring for Family Members with Schizophrenia Kediri Adversity Quotient Caregiver Caring for Family Members with Schizophrenia in the town of Kediri in mind that most of the care giver has Adversity Quotient in the category climbers that 49 respondents (56.3%). The role of a caregiver often confronted with a wide range of responsibilities and obligations associated with the heavy task of assisting people with schizophrenia. Caregiver required to master a variety of mental processes that occur in people, while studying mental process is something that is abstract and not easy to understand. This requires great effort from the caregiver to be able to complete the task well and can provide the maximum assistance to the family members who suffer from schizophrenia, not to mention the

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Secondly, AQ is a measure to determine the response to adversity. During these subconscious patterns have actually been held. This time for the first time these patterns are measured, understood, and changed. Third, AQ is a series of appliances that have a scientific basis to improve a person's response to adversity, which will result in improve one's personal and professional effectiveness overall. In order for success to be real, then Stoltz (2005) argued that the modification of these three elements, namely, new knowledge, benchmarks, and practical tools is a complete whole to understand and improve the basic components to success.

As revealed by Widyaningrum (2007) that the power struggle plays a major role in influencing one's efforts in overcoming difficulties experienced. Individuals who have a strong adversity quotient will be able to overcome the difficulties it faces. So it can be concluded that the caregiver who has a good adversity quotient is not easy to feel stressed (stress) because the individual is able to deal with stress effectively and ultimately experience continuous success in the face of stress will increasingly shape tolerance to stress. Adversity quotient was able to make an individual managing a difficult situation into something positive. Individuals who have a good adversity quotient will be unavoidable failures in dealing with stress and successfully meghadapi continuous stress which eventually form a tolerance to stress.

Identification of Stress Levels with Adversity Quotient Family in Caring for Family Members with Schizophrenia Kediri 2015 The analysis showed that the most prominent results are for respondents who experienced severe stress tend to have Adversity Quotient in the Climbers category, namely 10 respondents (20.4%), while for respondents who experienced mild stress and was not seen notable differences in the Adversity Quotient. Correlation test showed a significant relationship (p-value <α) and negative (ρ = -0.432) between the level of stress to the Adversity Quotient Keluraga in Caring for Family Members with Schizophrenia Kediri 2015. The relationship between adversity quotient with tolerance to stress above results in accordance with what is stated by Stoltz (2005), that the situation is difficult and obstacles in life can be overcome by adversity quotient are qualified, because adversity quotient will make a qualified individual as a person who resilient , and unyielding determination. Individuals who have a high adversity quotient would make it immune to helplessness and not easy to get stuck in a state of despair. This is reinforced by the statement Lasmono (2001) that the adversity quotient is high, someone will be increasingly tough to face difficulties and overcome adversity appropriately so that it can withstand the range of difficult conditions experienced.

CONCLUSIONS AND SUGGESTIONS Conclusions 1. The level of the Caring for Caregiver Stress Family Members with Schizophrenia in the town of Kediri in mind that nearly half the care giver stress in the lightweight category, namely 36 respondents (41.4%). 2. Adversity Quotient Care Giver is Caring Family Members with Schizophrenia in the town of Kediri in mind that most of the care giver has Adversity Quotient in the category climbers that 49 respondents (56.3%). 3. The analysis showed that the most prominent results are for respondents who experienced mild stress tend to have Adversity Quotient in the Climbers category, namely 33 respondents (67.3%). Correlation test showed a significant relationship (p-value <α) and negative (ρ = -0.432) between the level of stress to the Adversity Quotient Keluraga in Caring for Family Members with Schizophrenia Kediri 2015. Suggestions

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1. For policy makers and families provide support for the caregiver to get used to his new burden in the treatment of patients with schizophrenia to stress that occurred not too heavy so that the caregiver can adapt well and improve Adversity Quotient.

Isaacs, A. (2005). Mental Health and Psychiatric Nursing Ed 6 Alih Bahasa Dian Praty Rahayuningsih. Jakarta: EGC.

2. For the caregiver can learn mental changes in patients with schizophrenia so that it can adapt to their duties and be able to provide the best for families in her care, particularly in preventing relapse in patients.

Maramis, W. (2004). Catatan Ilmu Kedokteran Jiwa Cetakan 8. Surabaya: Airlangga University Press.

Keliat, B. A. (2006). Proses Keperawatan Jiwa Edisi 2. Jakarta: EGC.

Nursalam (2013). Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan. Jakarta : Salemba Medika

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Perry, P. A. (2005). Fundamentals of Nursing 6th edition. St Louis: Mosby Inc.

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Arif, I. S. (2006). Skizofrenia : Memahami Dinamika Keluarga Pasien. Bandung: Refika Aditama.

Safitri, D. (2011). Bukan Gila tapi Sakit Jiwa. hal. http//www.bbc.co.uk/Indonesia/lapora n_khusus/2011/10/111004_mental.sht m1.

B.Julia, G. (1995). Nursing Theories: The Base Professional Nursing Practice 4th edition. Connecticut: Appleton & lange.

Stuart, G. W. (2005). Psychiatric Of Nursing Edisi 8. USA Elsevier: Mosby.

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Friedman, M. M. (2003). Keperawatan Keluarga Teori dan Praktik (Family Nursing: Theory and Practice) . Jakarta: EGC.

The

Hawari, D. (2001). Pendekatan Holistik Pada Gangguan Jiwa Edisi 2. Jakarta: FKUI. Hidayat, A. A. (2008). Konsep Dasar Keperawatan Edisi 2. Jakarta: Salemba Medika.

Roy Adaptation Model: Health, Environment/Society, Nursing. (2013). Schoolworkhelper , http://schoolworkhelper.net/the-royadaptation-model-healthenvironmentsociety-nursing/.

Townsend, M. C. (2010). Buku saku Diagnosis Keperawatan Psikiatri Rencana Asuhan & Medikasi Psikotropik Edisi 5. Jakarta: EGC.

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Varcarolis, E. (2000). Psychiatric Nursing Clinical Guide : Assesment Tools & Diagnosis. Philadelphia: W.B Saunders Company. Yosep, I. (2009). Keperawatan Jiwa Edisi Revisi. Bandung: Refika Aditama.

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NUTRITION ON THE FIRST 1000 DAYS OF LIFE DETERMINATE THE NUTRITIONAL STATUS AND DEVELOPMENT CHILDREN Miftakhur Rohmah Institute of health Science Surya Mitra Husada Kediri Midwifery Division Email: [email protected] ABSTRACT Growth and development children for 1000 first day of life requires the nutritional intake from the mother, either consumed by the mother or from mobilization of saving mother, if the intake of nutrients from mother to fetus is less, then the fetus will make adjustments, because fetus can adaptable easy. Indoneasian have a double nutritional problems, on the one malnourished and on the other have excess nutrients. Based on the result of Riset Kesehatan Dasar (Riskesdas) in 2010 the percentage of low birth weight in Indonesia amounted to 8,8 percent, children under five years stunting of 35,6 %, and wasting for children under five years 13,3 %. This study is a literature review that provides information abaout nutrition in the fisrt 1000 days of life determines the nutritional status and early childhood development. Source to do this literature review included studies os systematic searches of computerized database (Google scholar, Pubmed, and EbscoHost). Writing asticles using the format of writing Vancouver. Cognitive development abd physical of a child affected by the 1000 first day of life, from ceonception conception until a child is two years old are influenced by biological factors, such as maternal nutrition during pregnancy, gestational age, birth weight, duration of breastfeeding, child malnutrition, infectious diseases in the future children and psychosocial factors, such as economic status, parental education, and the environment. The quality of child development can be enhanced with a variety of businesses both the parents, society and government. Various factors, both genetic and environmental influences that are so pluralistic development of the child since the prenatal, perinatal and postnatal that is during the first 1,000 days of a child's life. In conclusion, achieving optimal child development depends on biologiknya potential, biological potential level of achievement is the result of the interaction of a variety of interrelated factors, especially during the first 1,000 days of a child's life. Kata Kunci : the first thousand days of life, nutitional status, development The adverse effects caused by nutritional problems mentioned above in the short term is the disruption of brain development, intelligence, impaired physical growth and impaired metabolism in the body. While in the long term bad consequences that will be caused is a decline in cognitive ability and learning achievement, the decline in immunity so easily hurt, and the risk for the emergence of degenerative diseases. All this will degrade the quality of Indonesian human resources, productivity, and competitiveness of the nation.1 Cognitive development and physical of a child affected by the 1000 first days of life, from conception until a child is two years old are influenced by biological factors, such as maternal nutrition during pregnancy, gestational age, birth weight,

INTRODUCTION Maternal and child nutrition has ben on the global agenda as central to health, sustainable development, and progress in low and middle income countries. The recent lancet Nutrition series, the global nutrition report and the post MDG goals set by the World Healthy Assembly highlight the need to addres the global burden of maternal and childhood under and over nutrition and for scalling up nutrition action. 11 Based on the result of Riset Kesehatan Dasar (Riskesdas) in 2010 the percentage of low birth weight in Indonesia amounted to 8,8 percent, children under five years stunting of 35,6 %, and wasting for children under five years 13,3 %. 3

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duration of breastfeeding, child malnutrition, infectious diseases in the future children and psychosocial factors, such as economic status, parental education, and the environment.1 Research in India aimed to estimate and assess determinants during pregnancy and after childbirth were associated with the incidence of disease experienced by children during the first 1,000 days of life . Result is estimated that 14.8 diseases / child-years with gastrointestinal disease 20.6% and 47.8% of respiratory infections. Reduced rates of hospitalization in infancy from 46/100 16/100 children become childyear-year in the second year Factors associated with low birth weight are: average birth weight of 2.9 kg and the average gestational age of 39, 6 weeks, preterm birth less than 37 weeks (OR 3.31), less than four antenatal care visits (OR 6.88) and anemia was defined as hemoglobin <10 g / dL during pregnancy (OR 2.36). Nutritional Status seen from anthropometric measurements obtained from 414 children at age 24 months showed that 153 (37%) of children with stunting totally 39 (9.4%) children who have a thin body and 125 (30.2%) children less weight. The average height and weight level monthly increase was 1.35 cm and 290 g, respectively, for the first 730 days of follow-up, related to perinatal mortality reported seven deaths, five were spontaneous abortions and stillbirths two , Nine deaths were reported during the 2 years of follow-up; three children died of diarrhea, two due to lower respiratory infections, two due to congenital metabolic conditions and two due to unknown causes. Antenatal care is important for screening of high-risk mothers, monitor weight gain during pregnancy, screening for anemia, providing nutritional supplements that are essential for good pregnancy outcomes, and help to reduce or prevent maternal and infant complications and death. Growth and development during the first 1,000 days of life require the nutrition of the mother, either consumed by the mother or from the mobilization of savings

mother, if the intake of nutrients from mother to fetus is less, then the fetus will make adjustments, because the fetus is easy to adjust. Malnutrition in a thousand days of life, has three risks, namely the risk of first occurrence of non-communicable diseases or chronic, the risk of a second when the brain affected will experience obstacles cognitive growth, making it less intelligent and competitive, and the risk of all three disorders height growth that has short risk.4 Growth and development during the first 1,000 days of life require the nutrition of the mother, either consumed by the mother or from the mobilization of savings mother, if the intake of nutrients from mother to fetus is less, then the fetus will make adjustments, because the fetus is easy to adjust. Malnutrition in a thousand days of life, has three risks, namely the risk of first occurrence of non-communicable diseases or chronic, the risk of a second when the brain affected will experience obstacles cognitive growth, making it less intelligent and competitive, and the risk of all three disorders height growth that has short risk.4 METHOD This study is a literature review that provides information about the stimulation that should be done on the first 1,000 days of life as a determinant of the nutritional and developmental balita.Sumber to do this literature review included studies of systematic searches of computerized databases (Pubmed, Proquest, EbscoHost dan google scholar) in the form of research journals totaling 7 journals, 1 guidelines. Journal of Research in use from 2010 to 2015, conducted in the Philippines, India, Indonesia, Brazil, Austria and Poland. The study of these studies in quantitative analysis. There is one journal with the respective analysis methods Study, 2 journal cohort method, two journals using a Randomized Control Trial (RCT) and two journals systematic review and one guideline of save the children. Writing a scientific article uses bibliography vancover writing.

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7. Insecticide-treated bednets b. Newborn 1. Immediate and exclusive breastfeeding 2. Delayed cord clamping 3. Vitamin suplementation c. 0-6months 1. Exclusive breastfeeding 2. Hand washing or hygene 3. Conditional cash transfer (with nutrition education) 4. Insecticide-treated bednets d. 6-24 Monhts 1. Continued breastfeeding 2. Complementary feeding 3. Preventive zinc suplememtation 4. Zinc in management of diarrhea 5. Vitamin a supplementation 6. Iodized salt 7. Multiple micronutrien powder 8. Hand washing or hygene 9. Treatment of severe acute malnutrition 10. Deworming 11. Iron suplementation and fortification 12. Conditional cash transfers (with nutrition education) 13. Insecticide-treated bednets

RESULT AND ANALYSIS Early pregnancy is zero attention to children, particularly in maintaining good nutrition assuredness optimally, until at least the next 1,000 days. Basically in 1000 the beginning of life, growth and development of children takes place rapidly. While still in the womb, for example, the fetus grows rapidly until late born. At that time, the fundamentals of its development was already formed. Pregnancy and infancy is a critical period for brain development. Mothers and babies need good nutrition to build the basis or foundation of cognitive abilities, motor, and social child. Success in school and work productivity in the future. Children with brain development is not perfect at the beginning of life are at risk of suffering from a neurological disorder, the achievement of low achievement at school, low skills and parenting is wrong with their child, which in turn will contribute to the quality of the generation of the low in the future. 4 According victoria et al. Describe comparison of growth patterns of children in 54 countries using the WHO standards, shows that the failure of growth in the early growth of children is more severe than is suggested by previous analysis by NCHS (natonal centers for health statistics). This study explains that the need for nutritional growth and development during the period of the window of opportunity is defined by the pregnancy and the first 2 years of life. Including the prevention of newborn babies is low and that sesuei feeding practices for infants.2

A. Identification Prevention and Treatment of Iron Deficiency During 1000 First Day of Life.5 Iron deficiency is a global problem throughout the journey of life,. Maternal iron deficiency during pregnancy may affect the subsequent descent to iron deficiency in infancy, with sequelae have a lifelong impact. This review explores iron status along this "first 1,000 days" from pregnancy through two years, covering the role of iron and epidemiology of iron deficiency, and consequently, identification, intervention and the rest of the research gaps.5 1. Iron Metabolism Iron is one of the most important micronutrient for the human population, given the central role in key biological processes. One of the main

Nutritional interventions can dilkaukan at 1000 the first day of life: 4 a. Pregnancy 1. Iron folate or maternal suplementtation of multiple micronutrients 2. Calcium supplementation 3. Iodized salt 4. Interventions to reduce indoor air pollution and tobacco use 5. Deworming 6. Intermittent preventive treatment for malaria

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process is that the tissue oxygenation, which is carried by red blood cells (RBCs); the generation of red blood cells in need of hemoglobin, the iron is a key component. The new red blood cells were also made to replace lost red blood cells from normal turnover, shed (the cells of the skin or from intestinal lining) or by bleeding. A situation which requires an increase in red blood cells (such as tissue mass increases from fetal or infant growth) would consequently increase the need for iron. function). 2. Needs during pregnancy and lactation Iron is essential during pregnancy are given as cells and tissues grow rapidly which affects the fetal growth. Pregnancy has iron needs in the range of 600-800 mg. Nearly 300 mg of iron is needed only for the fetus, at least 25 mg for the placenta and nearly 500 mg for an increase in the volume of red blood cells. 800 mg of iron-related pregnancy is a requirement over and above 230 mg of iron will be needed woman even if she is not pregnant, and 150 mg that he might lose through loss of blood during childbirth. 3. Needs in infants 0-24 months Iron needs for infants under six months of age are generally not well defined, because it is difficult to estimate because the needs in the context of exclusive breastfeeding is still given. In addition, during the first four to six months of age, most babies get iron from birth were born, which is largely accumulated during the last 10 weeks of pregnancy. Although the baby does not receive a large amount of iron through breast milk (iron concentration <1 mg / L, equivalent to <0.5 mg per day for infants, babies are able to absorb

most of this iron. For this reason, an iron supplement is usually not recommended for a term breastfed infants under six months. However, in preterm and low birth weight babies born with lower birth iron supplementation in the range of 2-4 mg / day is recommended to avoid iron deficiency. 4. Due to iron deficiency during pregnancy Iron deficiency during pregnancy can have a severe consequence, not only for the mother but also for her baby. Low iron and low intake during pregnancy not only cause anemia, associated with weakness, fatigue, also interfere with cognitive development and reduced immune response, but also can increase the risk of complications of labor and perinatal maternal mortality. Maternal iron deficiency has also been implicated as a risk factor for premature birth, small for gestational age and neonatal death. This shows the importance of iron for fetal brain development, iron deficiency during pregnancy also increases the risk of anemia and iron deficiency during lactation. 5. Due to iron deficiency in infancy 0-24 months Infants are vulnerable to the effects of low iron status, even before the first birth, both iron deficiency and an increased risk of decline in cognitive and psychomotor development in infancy. Iron deficiency develops later in infancy and causes anemia and iron deficiency has also been associated with cognitive impairment, developmental behavioral and motor iron deficiency in children has also been associated with blood lead levels high, with some evidence of the causative link, where iron deficiency makes children more

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susceptible to blood lead levels higher.. 6. Interventions during pregnancy, lactation and infancy 0-24 months. Interventions The most common and effective way to tackle iron deficiency in pregnant women is supplementation with iron, often in combination with folic acid, iron supplementation may be given before conception to ensure the prevention of iron deficiency in the mother.. Babies, especially premature or with low birth weight babies, will also benefit from iron supplementation, it is recommended regularly for high-risk populations, the iron supplementation baby in often given in liquid form has been shown to be effective in reducing anemia and iron deficiency. However, these drops have some drawbacks cause side effects in infants are gastrointestinal in administration by overdosing.

the United Kingdom. Preliminary studies indicate supplementation to the mother giving out a positive impact on the development of children living in areas with severe iodine deficiency. Research in Zaire showed that in children aged 6 years of mothers given iodine supplements have developmental scores 10 points higher than women who were not given iodine supplements. Studies in China show the 15-point difference in the development of children age 2 years among women given iron supplements with those not given.6 WHO guidelines suggest to provide iodized salt, its availability is 90% of households have access to iodized salt and will provide enough iodine for women during pregnancy. Research conducted in Spain is a country that is known to mild iodine deficiency, children aged 18 months than women given supplements of iodine in the three groups, given in early pregnancy (4-6 weeks, n = 13), pregnancy (12- 14 weeks, n = 12) and after birth (n = 19) tested the development of intelligence using a scale Brunet-Lezine shows the group exposed longer to the supplementation of iodine has a supreme intelligence which is (101 vs 92 vs 87), with p <0, 05. In a research study of other children of the group of women who received supplements of iodine from the first trimester of pregnancy until the next (n = 133) compared with children aged 2 years of mothers who did not receive the supplement iodine (n = 61) with Bayley scale assessment showed children of mothers who were supplemented with iodine has a 6.1 index points higher psikomotornya development with P <0:02 compared to children of mothers who were not given iodine supplements.

B. Giving iodine supplementation during pregnancy and effects on cognitive development.6 Maternal Hypothyroxinemia and hypothyroidism due to iodine deficiency has been shown to affect the development of the newborn. Iodine has long been an important element, severe iodine deficiency during pregnancy is the cause of congenital hypothyroidism resulting in cretinism, iodine deficiency ranks third on the list as a cause of child developmental disorders. According to WHO, there are 32 countries that experienced mild to moderate iodine deficiency and it is a public health problem. Iodine deficiency is not only a health threat in developing countries, but also in developed countries, mainly in Europe. Recent reports suggest that iodine deficiency has been repeated in countries where it has been under control before, such as in the United States, Australia, New Zealand, and

C. Vitamins for the first 1,000 days of life.7 As a basis for a healthy life begins during pregnancy and in early infancy,

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adequate nutrition during this period is very important. With a variety of functions in the body, vitamin important as the specific needs in the growth and development during pregnancy, breastfeeding and baby. 7 1. Vitamin A According to WHO estimates worldwide in 2009, a vitamin deficiency affects approximately 190 and 19 million children and pregnant women, respectively, especially in areas of Africa and South Asia. it is the main cause xerophthalmia, night blindness, and anemia. In addition, it is important for immune function and mucosal integrity, and inadequate persediaann is associated with a higher susceptibility to intestinal and respiratory infections. Through its role in gene regulation, vitamin A is involved in fetal development, organogenesis, the formation of limbs, and body symmetry. 2. Vitamin D Vitamin D has the effect of modulating immunity and regulator of gene expression. In early life, the role of vitamin D in bone formation is obviously very important. As pregnant women are often suboptimal and not enough to ensure adequate concentration in breast milk, the baby is recommended supplementation with 10 mg / d. 3. Folate Folate is one of the first vitamin that appear in thought to the context in pregnancy and fetal development because of its role in the prevention of neural tube defects. 4. Important Vitamins in pregnancy and infancy. Vitamin has an important role and are needed in pregnancy and infancy, pregnancy, breastfeeding and childhood vulnerable to vitamin deficiencies, vitamin intake is inadequate during pregnancy and

lactation making supplies of vitamins in the body of the mother becomes less so mengakibatnya nutritional status is low and konsukuensinya detrimental to his own mother and the fetus. Determining micronutrient status and allow the baby in the formation of inventories during the first four to six months of life. 5. Increase intake of Vitamin early in life Optimal vitamin intake is especially important in life because as a basis for future life and prosperity, efforts to increase vitamin intake during pregnancy and infancy should be a top priority in public health. In general, pregnancy is a period which is supposed to make women more aware of health that allow them to accept changes in lifestyle and diet also increase the intake of vitamins during pregnancy. Food fortified with various vitamins from other sources for women who are unwilling and unable to folate supplements such as in the case of a state that is relevant to low income and low socioeconomic status. D. Exclusive Asi effect in the Growth and Development of Children. Effect of feeding on infant health and development, observation of the seven last decade when the baby is breastfeeding provide useful evidence for the cognitive development of children impact of breastfeeding provide long-term benefits for children's mental health. Breast milk is a rich source of fatty acids and bioactive components that are important in brain development. Two fatty acids fatty acids associated with the development of nerve cells, the retina and the brain: docosahexaenoic acid (DHA) and arachidonic acid (ARA). Both are present in breast milk, but absent from infant formula and cow's milk. Both have also been shown in experiments to improve

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eyesight and some motor response in infants and children.8 Many of the results from clinical trials showed that children who were breastfed had the highest score of cognitive function compared with children who received formula milk. Research in Krakow Poland with 468 infants (with gestational> 38minggu) with a prospective cohort assessment of cognitive function with psychometric test. The result of children who were breastfed until 3 months have an average IQ of 2.1 points higher than that of other children (95% CI: 0.24 to 3.9), the children were breast-fed for 4-6 month had 2.6 points higher (95% CI: 0.87 to 4.27), while children who breastfeed for longer> 6 months increased by 3.8 points (95% CI: 2.11 to 5.45 ). The study provides recommendations on the WHO experts about 6 months of exclusive breastfeeding. The first 1,000 days of a child's life provide opportunities for prenatal care and interventions in early life to boost growth. Breastfeeding up to two years or more is a potential strategy that provides protection to the child after the second year of his birth, breast milk is a source of immune factors, nutrients and micronutrients that are not available on the food that is generally given after 2 years of life, particularly in countries with low income.9

growth and development of the fetus, infants, and children up to age 2 years. Efforts or interventions to improve nutrition in the first 1,000 days of life which is focused on pregnant women, nursing mothers and infants aged 0-23 months. 10 The author realized in this article there are many shortcomings because of limitations in assessing the author, given the many factors that influence the growth and development of children in the first 1,000 days of life.

REFERENCES 1. Kattula D, Sarkar R, Sivarathinaswamy P, Velusamy V, Venugopal S, Naumova EN, et al. The first 1000 days of life: prenatal and postnatal risk factors for morbidity and growth in a birth cohort in southern India. BMJ. [serial online] 2014 [diunduh 26 Maret 2015];4:e005404:1−10 Tersedia dari: URL: http://bmjopen.bmj.com 2. Victoria CG, de Onis M, Hallal PC, Blossner M, Shrimpton R. Worldwide timing of growth faltering: Revisting Implications for Interventions. [serial online] 2010 [diunduh 20 Sept 2015];3(125): 473-80 tersedia dari: URL http://www.pediatrics.aapublications.or g. 3. Bapenas Republik Indonesia. Pedoman Perencanaan Program Gerakan Nasional Percepatan Perbaikan Gizi Dalam Rangka Seribu Hari Pertama Kehidupan. [serial online] 2013 [diunduh 18 Maret 2015] hlm. 13,25 tersedia dari: URL: http://www.bappenas.go.id/index.php/d ownload_file/view/15555/4619/. 4. Save the children. Nutrition in the first 1000 days- state of the world‟s mother. May 2012 Tersedia dari; URL: http://www.savethechildren.org/stateof-the-worlds-mothers-report-2012final.pdf 5. Burke R M, Leon J S, Suchdev P S. Identification, prevention and treatment of Iron deficiency during the first 1000

CONCLUSION Nutrition has an important role in national economic development, the condition of malnutrition will result in a lower level of productivity of human resources in the country. Nutrition and health problems are not caused primarily by genetic factors but because of environmental factors that can be fixed with a future focus on the first 1,000 days of life. Improve nutrition in the first 1,000 days of life will support the

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6.

7.

8.

9.

10.

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days. J Nutriens. [serial online]. 2014 [diunduh 18 Maret 2015];6:4093−14 Tersedia dari: URL: http:// www.mdpi.com/journal/nutrients Boonstra A M, Gowachirapant S, Jaiswal N, Winichagoon P, Srinivasan K, Zimmermann M B. Iodine supplementation in pregnancy and its effect on child cognition. J Trace Med Biol.[serial online] 2012 [diunduh 27 Maret 2015]:1−2 tersedia dari: URL: http://dx.doi.org/10.1016/j.jtemb.2012. 03.005 Elmadfa I, Meyer A L. Vitamins for the first 1000 days: Preparing for Life. Int. J. Vitam. Nutr. Res. 2012;82(5):342−7. Jedrychowski W, Perera F, Jankowski J, Butscher M, Mroz E, Flak E, dkk. Effect of exclusive breastfeeding on the development of children‟s cognitive function in the krakow prospective birth cohort study. Eur J Pediatr. 2012;171(1): 151−8. Delgado C, Matijasevich A. Breastfeeding up to two years of age or beyond and its influence on child growth and development: a systematic review. Cad Saude Publica [serial online] 2013 [diunduh Feb 2013]; 29(2):243−55 Tersedia dari: URL: http://dx.doi.org/10.1590/S0102311X2013000600012. Hadiat. Gerakan nasional percepatan perbaikan gizi. MCA-Indonesia. [serial Online] 2013 [diunduh 1 oktober 2015]; Tersedia dari: http://mcaindonesia.go.id/wpcontent/uploads/2013/10/GerakanNasional-Percepatan-PerbaikanGizi.pdf Christian P, Mullany LC, Hurley KM, Katz J, Black RE. Nutrition and maternal, neonatal and child health. Perinatol. 2015:1-12.

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THE EFFECT COGNITIVE SUPPORT AND EMOTIONAL SPIRITUAL QUOTIENT(ESQ) TO IMMUNOLOGIST STATUS CHANGE IN HIV/AIDS PATIENT IN KEDIRI CITY Alfian Fawzi*, Yuly Peristiowati**, Joko Sutrisno*** STIKES Surya Mitra Husada Kediri Email: [email protected] ABSTRACT The effort to depressed hiv case increase is personal sexual behavior change. The way to change subject sexual behavior is giving them cogntive support and emotional spiritual quotient (esq).this aim of the research to analyze the cognitive support and emotional spiritual quotient (esq) effect to the immunologist status in hiv/aids patient.this research desaign use adalah quasy experiment one - group pretest - posttest design with purposive sampling and there is 15 responden involve this research. Elektromagnetik (quantum magnetik resonansi analized)is instrument of the research, with paired sample t test statistical test. The result of the research shows significant immunologist status changes include : limfoid gland index : (p value=0.000), tonsil status index (p value=0.000).timus index (p value=0.000), respiratory immune status index (p value=0.000), gastrointestinal immune status index (p value=0.035), mucosa immune status index (p value=0.001). Immunologist status positive changes insome immune status index shows that cognitive support and emotional spiritual quotient (esq)giving, give stimulus to immunologist status in hiv/aids patients. But neither to the other 3 index immunologist status positive change which is : limpa immune status index (p value=0.120), bone marrow status index (p value=0.1880) and immunoglobulin index (p value=0.076), its means cognitive suporrt and emotional spiritual quotient need to be improved for hiv/aids patient show they can get positive minded and increasing there immunity. Keyword : cognitive support, emotional spiritual quotient, immunologist status, hiv

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PRELIMINARY HIV/AIDS is a serious helath problem in Indonesia and many other countries. Nowadays there is none country free from HIV (Djuanda, 2011). HIV (Human Immunodeficiency Virus) is a virus that attack human immune system then make AIDS condition occur (Umar Zein, 2006). CD4 is the point target of this viral infection when HIV entering someone body for crumbling the immune system. (Djuanda, 2011). 456 cases noted as HIV/AIDS prevalence cases in Kediri on 2014 which 354 persons as HIV subject, 102 persons with AIDS condition. 420 persons are still alive with this viral infection and 36 others were died by this infection (Dinas Kesehatan Kota Kediri 2014). This high presentation of HIV/AIDS in Kediri needs some action to do. Improving self awareness for not doing any negative behavior like do not having unsafe sexual activity is one importance action. Cognitif support by giving some information, motivation, psychological accompaniment and spiritual guidance for them and their family is one way for changing HIV patient‟s attitude and behavior (Rasmun, 2004). Cognitive Support (Information) is an information or announcement or news include cognition, information, verbal or non verbal advice, real assistancies or social support action with emotional benefit or behavior effect for the subject (Herawani, 2012). Cognitive Support (Information) as a source for taking decision, which every subject needs relevan, usable, appropriate and right information for taking the right decision. Cognitif support by visualization, psychology, and spiritual emotional were able to increase emotional and spiritual respons in HIV/AIDS patient. Burack et al researchment (1993) shows Lymphoscyte Cluster of Defferentiation (CD4) decrease with Latihan Pasrah Diri (LPD) which by managing breathing respiratory rate from 16-20x/menit become 4x/menit will decrease Lymphoscyte Cluster of

Defferentiation (CD4) range in HIV patient. Peristiowati et.al researchment (2014) about Cognitive Support Effect for Increasing CD4 level on HIV Patient in Kediri City for 3 days shows absolute CD4 and percent CD4 enhancement on HIV patient with p value: 0,003.

RESEARCH METHODS This research use Quasi Eksperimental methode with Posttest Group Design. Population in this research is all of HIV patient in Kediri with some HIV patients which comply some criteria as the sample. Criteria for this research sample is HIV/AIDS patient which belonging to Kelompok Dukungan Sebaya (KDS) in Kediri which are risk to transmit HIV infection, all HIV/AIDS patient which belonging Kelompok Dukungan Sebaya (KDS) in Kediri which routine ARV therapy consumption and feel disposed to Cognitive Support dan Emotional Spiritual Quotient for 7 days. RESEARCH STAGE This research were held in Kediri for a month from 25 April to 19th Mey 2015 with Kelompok Dukungan Sebaya (KDS) group as responden. 15 responden were gived Cognitive Support and Emotional Spiritual Quotient for 7 days with 2 hours application each days. Before they get treatment, their immune status were checked by ELEKTROMAGNETIK (Quantum Magnetik Resonansi Analized) and rechecked after 7 days treatment. DATA ANALYSIS Paired Sample T Test were used for this research which belonging to Prametric Testing which used for comparing two correlative groups with level of confidence α = 0,05. RESULT AND DISCUSSION

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Researchment Result 1.

Respondents Characteristics based on Gender Classification

Most of the respondents were unmarried (73%)

Picture 4.1 Respondents Characteristics based on Gender Classification From Picture 4.1 there is 8 (53%) male respondents and 7 ( 47%) respondents are female. 2.

Respndents Characteristics Based on Occupation Classification

Picture 5.2 Respndents Characteristics Based on Occupation Classification Based on Picture 5.2 on KDS group we can conclude that most of the respondents were enterpreneur (33%) . 3.

Respondents Characteristics Based on Marital Status

1. Immunology status identification on HIV before Cognitive Support and Emotional Spiritual Quotient in Kediri treatment. Evenly Immune System Index before treatment: Lymphoid Gland Index (140,457) category, Tonsil Immune System Index (0.20873) category, Timus Index (57,949) category , Respiratory System Immunity Index (6,204) category, Gastrointestine System Immunity Index (1,411) category, Mucosa Immunity Index (8,686) category, Spleen Index (34,690) category, Bone Marrow Index (2,244) and Immunoglobulin Index (3,752 ) category. 2. Immunology Status identification on HIV patients after Cognitive Support and Emotional Spiritual Quotient in Kediri: evenly respondents Immune System Index before treatment: Lymphoid Gland Index (155,801) category , Tonsil Immune System Index (0.31520) category, Timus Index (62,293) category , Respiratory System Immunity Index (7,676) category, Gastrointestine System Immunity Index (2,658) category, Mucosa Immunity Index (18,622) category, Spleen Index (46,435) category, Bone Marrow Index (3,540) and Immunoglobulin Index (7,887) category.

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Immune System Index result between before and after treatment shows immune system index changes were 55% . From Paired sample T-test statistical test we get significant Lymphoid Gland Index p value=0.000, Tonsil Immune System Index (p value=0.000) , Timus Index (p value=0.000), Respiratory System Immunity Index (p value=0.001), Gastrointestine System Immunity Index (p value=0.035), Mucosa Immunity Index (p value=0.001), this means Hypothesis were accepted for this research: Cognitive Support and Emotional Spiritual Quotien significantly impact to some immune status index on HIV patient.

DISCUSSION Statistical test result with Paired sample T-Test on immune staus index shows significant result as explained below. Lymphoid Gland Index (p value=0.000), Tonsil Immune System Index (p value=0.000) , Timus Index (p value=0.000), Respiratory System Immunity Index (p value=0.001), Gastrointestine System Immunity Index (p value=0.035), Mucosa Immunity Index (p value=0.001) this means Hypothesis were accepted for this research: Cognitive Support and Emotional Spiritual Quotien significantly impact to some immune status index on HIV patient. Cognitive Support and Emotional Spiritual Quotient that able to be given for HIV patient in this research were social support, pschotherapy and spiritual. Social support were given by giving motivation for the patient. Social support were shows by established Kelompok Dukungan Sebaya (KDS) Friendship plus groups in Kediri, which being a medium to give support, motivation, and HIV patient‟s increasing knowing.

Patient that infected by HIV/AIDS will get immune system depression. HAART were one of the medical therapy HAART (Highly Active Antiretroviral Therapy) for those condition, but infact, there is still shows high mortality rate on people with AIDS (Hirschel.,2003, Zavasky, Gerberding &sande, 2001, in Nasrodin., 2005). HIV/AIDS have many complex problem. Beside they need to survive from viral infection, they need to face people discrimination/ stigma. Those condition give effect for their illness. Antiretroviral therapy is one of medical therapy to maintain patient‟s immunology status on HIV/AIDS patients, but its not enough. That‟s why they need comprehensif therapy to enhance their life quality. Comprehensif therapy (medikamentosa, nutrition, social support and psychotherapy) is the choices to reduce morbidity and mortalityu rate on HIV/AIDS patients. Treatment of respondents using Support Cognitive and Emotional Spiritual Quotient by visual interpersonal psychological therapy ,emotional and spiritual meditation can integrate physical and biological mental, soul and spirit advance through the transformation of consciousness resulting in harmony or alignment. Giving Support Cognitive and Emotional Spiritual Quotient form of transpersonal psychotherapy can through the Opening-Ego Ego-Reduction will merge together with the soul and the soul merges together spirit. Transpersonal psychotherapy can cause a person to see themselves more expansion in a larger perspective. So that people will see themselves more fully not just the body. Which in turn can lead to human harmony itself (Hart, who, LJ Nelson, Robinson, Olsen, DA Nelson et al., 2000). Transpersonal psychotherapy advance

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transcendent of consciousness, allowing exploration of pre-awareness and open a deeper level of the human person is the higher self, the true self, or self inside (Strohl., 1998). For 7 days respondents were collected in a special room that is comfortable for about 2 hours to get those materials which form visuaisasi, meditation, emotional and spiritual with a facilitator experienced in house manager motivation. Respondents were brought in an atmosphere that is open or opening the thoughts, feelings and heart to be able to know the power that is within each of them. By finding the strength that is in them, respondents were taken to the atmosphere of discovery problems that exist in each individual, which in turn with the power that the respondent brought to use force itself in the resolution of the issue with the given materials related to the purpose of life, the meaning of life, the meaning of death and preparation when facing death and life after death. Their thoughts and feelings brought into the realm of unconscious them to be able to find the meaning of life and living. Find and solve the problem with the strength of his own, strengthen the spiritual and surrender to the almighty, so that if their heart and soul brought before God to them for guidance and forgiveness for any errors give them strength to live further in order to better . Motivation and encouragement to continue their life is kept up-emphasized that they have the motivation to recover and promote the spirit of his life Transpersonal psychotherapy is given by guiding the respondents so that they find themselves with techniques that provide by the mentors. Counselors and therapists will facilitate the growth of the clients,

and conducted self-development so that they can feel what is experienced by the client. In this study Cognitive and Emotional Spiritual Quotient Support will be given by transpersonal psychotherapy with visualization, meditation, and spiritual emotional quotion (ESQ). By using this technique we are expecting that healthy cells will have spirit for fighting against HIV disease. Spiritual psychotherapy is a form of psychiatric treatment that gives serenity, peace, and happiness of the soul. Peace of mind is expected to raise the body's immune response to the individual (Idrus.et.al 2014). Meditation will evoke the relaxation response that would work through psychoneuroimmunology. Psychoneuroimmunology is a system of knowledge that connects the medical psycho (emotions, thoughts), neuro (reflex, neuroendocrine), immunology (the immune system and cellular immune system humoral), The relationship between these three systems is aimed at maintain body homeostasis. This relationship through two subsystems, namely the hypothalamus-pituitaryadrenal (HPA axis) and the autonomic nervous system (SSO). (Pasiak T, 2012. Madeline M., RN Lorentz, 2006). Meditation with spiritual emotional approach will stimulate endorphins (morphine endogeneus) thus enhancing freshness. In addition to the emotional, spiritual meditation can enhance positive emotional response due to an increase in dopamine and serotonin which has implications on pleasure, afilasi and reduce pain. An important mechanism others, by giving meditation emotional, spiritual can slow metabolism (hipomethabolic state) that lowers blood

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pressure, slower respiration, lower heart rate, brain waves decreases its activity, physiological decline chemical mediators in the body thereby reducing the amount of adrenaline, noradrenaline and adenocorticotropine hormone and cortisone can cause a decrease in anxiety and stress (Brown & Ryan 2003). Giving praise and full motivation to the patient / AIDS will lead to optimism in the future, positive expectations and stimulate the immune and endocrine systems to facilitate healing. Giving praise and motivation in Support Cognitive and Emotional Spiritual Quotient as a diversion to concentrate on images of the past and the future, helping to prevent travel sickness concerns. Endurance of HIV / AIDS are particularly vulnerable if psychological or mental disorder should receive psychotherapy to improve the quality of life. Research results obtained answer research hypothesis that administration of Cognitive Support and Emotional Spiritual Quotient can improve some indices of the immune system through the examination by using the ELECTROMAGNETIC tool in people with HIV, but does not give a positive change in the three indices of the immune system that is the index of the spleen, the index immunoglobulin and bone marrow index, it is because there are several factors wholly beyond the control of the research, such as nutrition, emotional circumstances beyond research, the economic, social, educational background etc. But from the majority of other immune indexes showed positive changes it demonstrates By administering Support Cognitive and Emotional Spiritual Quotient can stimulate some chemical mediators in the body, various hormones

and immunity are highly functional in improving kekebalanpada HIV. Backed by research peristiowati et.al (2014) Cognitive Support that can stimulate positive thoughts in patients with HIV / AIDS resulting in an increase in the CD4 count, the results of this research also namapak on immune system indices are Lymph Nodes Index, Index Immune System In Tonsil Index thymus, Level Immunity In Respiratory System, Level Immunity In the digestive system, and the level of immunity At the mucosa of the previously received therapy on the status of Cognitive Support and Emotional Spiritual Quotient compared with after the average range of values index immune showed an increase of about 55% of each index between immune system before and after therapy Support Cognitive and Emotional Spiritual Quotient. Immune System can be increased by administering the treatment Support Cognitive and Emotional Spiritual Quotient it. Increasing the body's immune system in the index is expected to eliminate the HIV virus antigens in the body in the form of a decrease in viral load in patients with HIV that will increase his kulaitas CONCLUSIONS AND SUGGESTIONS 1. The increase in the average index of the immune system before and after administration of Support Cognitive and Emotional Spiritual Quotient is 55%. 2. There is the effect of Cognitive Support and Emotional Spiritual Quotient against immunological status in patients with HIV / AIDS with a significant value of the Index values Lymph Nodes (p value = 0.000), Index Immune System In

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Tonsil (p value = 0.000), Thymus index (p value = 0.000), the index level of immunity At Respiratory System (p value = 0.001), the index level of immunity At Digestive System (p value = 0.035), Level of Immunity In mucosa (p value = 0.001)

Idrus ,Faisal M., Jayalangkara T., Syamsu., Ilham.,(2010). Pengaruh Psikoterapi Spiritual terhadap hitung sel T-CD4 pada penderita HIV/AIDS. Departement Psychiatry , Departement of Internal Medicine, Departement of Physiology, Medical Faculty of Hasanuddin University. Halim, M.S & Atmoko, W.D. 2005. Hubungan Antara Kecemasan Akan HIV/AIDS Dan Psychological Well-Being Pada Waria Yang Menjadi Pekerja Seks Komersial. Jurnal Psikologi. 15 : 17 - 31.

References A.Aziz, Alimul Hidayat. 2010. Metode Penelitian Keperawatan Dan Teknik Analisis Data. Jakarta : Penerbit. Salemba Medika. Brown,K.W. & Ryan. R.M benefits of being present : and its role in physicological Journal of personality psychology, 84(4).822-848.

(2003). The Mindfulness well-bwing. and social

Lane, J.D. Seskevich, J.E. & Pieper, CE (2007). Brief meditation training can inprove preceived stress and negative moud. Alternative therapies Health and medicie. 13 (1), 38-44.

DepKes, RI. 2005. Profil kesehatan Indonesia 2005. Dibuka pada website : http.//www,depkes.co. id. Pada tanggal 6 januari 2008). DepKes, RI. 2010. Riset Kesehatan Dasar. Jakarta : Badan penelitian dan pengembangan kesehatan Kementrian Kesehatan RI. 2010. Ducan L, & weissenburger D (2003). Effect of a brief meditaton program on well being and Loneliness.TCA journal, 31 (1). 14-25. Djuanda, Adhi. 2011. Ilmu Penyakit Kulit dan Kelamin. Jakarta : Balai Penerbit FKUI. Ditjen PP & PL Kementerian Kesehatan RI. 2013. Laporan Perkembangan Situasi HIV & AIDS Di Indonesia Triwulan 2 Tahun 2013. Jakarta. DinKes Jawa Timur, 2013.

Kurniawati, 2006. Coping Stres Pada Orang Dengan HIV/AIDS (Sebuah Studi Kasus). Skripsi. Surabaya : Fakultas Psikologi Universitas Airlangga.

Lazarus, R.S & Folkman, S. 1984. Stress, Appraisal and Coping. New York : Spranger. Nihayati, A. 2012. Dukungan Sosial Pada Penyandang HIV/AIDS Dewasa. Skripsi. Surakarta : Fakultas Psikologi Universitas Muhammadiyah Surakarta. Nurlaila Effendi, Johana E, Prawitasari, Thomas Dicky Hastjarjo, Nasronudin 2008. Pengaruh Psikoterapi Transpersonal terhadap kulaitas hidup pasien HIV dan AIDS. Anima, Indonesia psychological Journal 2008. Vol 24;1,1-16. Phillips, K.D. 2007. Social Support, Coping, and Medication Adherence Among HIV-Positive Women with Depression Living in Rural Areas of the Southeastern United States. AIDS

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PATIENS CARE and STDs. 21 : 667 680. Roberts,S (2005). Meditation help blood presure. Diabetes Forcast, 58)11(, 24-26. Stuart & Sunden, 2002. Principles and practice of psychiatric nursing sixth edition. St.Louis Missouri : West Line Industrial Drive. Tocan. A.M.Mc Comb. J. Caldera,Y & Ran-dolp. P (2003). Mindfulness meditation, anxiety reduction and heart deceases: A pilot study, Medical Care, 26(1), 25-34. Umar Zein, 2006. 100 Pertanyaan Seputar HIV/AIDS Yang Anda Ketahui. USU Press, Medan. Walton. K.G. Cavanough.K.L & Pugh.N.D (2005). Effect of group practice of the transcen-dental meditation program on biochemical indicators of stressnin non-meditation: A.Prospective Time Series study. Journal ofsosial beavior and personality.17,339-373. WHO, 2007. Pencegahan AIDS melalui promosi kesehatan : Masalah yang sensitif. Bandung : Penerbit ITB.

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The Effect Of The Stress Management With SEFT Technique (Spiritual Emotional Freedom Tehnique) To Decrease The Incidence Of Convulsion In Patients With Epilepsy Lasman S.Kep.Ns., M.Kep STIKes Hutama Abdi Husada Tulungagung Email: [email protected] Abstract Many epileptic seizures are triggered by stress factors that can lead to decreased health epileptic and quality of life. The study used a Quasy Experiment. The population in this study were all adult epilepsy patients enrolled in poly Neurological Clinic Dr. Isaac Tulungagung certain period. The sample was adult epilepsy patients enrolled in poly Neurological Clinic Dr. Iskak Tulungagung who experienced relapse, some 20 respondents, with 10 respondents and 10 respondents intervention group as a control group. Sampling technique used is a consecutive sampling. Data is collected using questionnaires, analysis of data using a test wilcoson Signed Ranks Test. The results showed that before and after the intervention period seizure frequency, duration of attacks and normal recovery time results showed a significant decrease in the frequency of seizures while the intervention group (p = 0.004), the control group (p = 0.655), duration of seizures in the intervention group (p = 0.007), the control group (p = 0.157) and the normal recovery time from seizure intervention group (p = 0.005), the control group (p = 1.000). Stress management techniques SEFT (Spiritual Emotional Freedom Tehnique) can reduce the frequency of seizures in patients with epilepsy. SEFT techniques need to be applied to patients to reduce the frequency of epileptic seizures in order to increase the degree of health of the patient so that the quality of life for the better. Keywords : Frequency of seizures, Duration of seizures, the normal recovery time from seizure, SEFT, Epilepsy obtained 19.16% of active epilepsy with emotional disorders (BRFSS, 2005). WHO report (2011), the incidence of epilepsy in developed countries as: England from 52.234 million people with epilepsy are found 496,000, 0.95% with a prevalence rate of 1 in 105. Wales obtained 3.006 million population of 32,000 residents with epilepsy, amounting to 1 , 06%, with a prevalence rate of 1 to 94. Scotland: 5.222 million inhabitants there are 54,000 people with epilepsy as much as 1.03% with a prevalence rate of 1 in 97 people. Northern Ireland of 1.8 million inhabitants, there are 20,000 people with epilepsy, by 1.11%, with a prevalence rate of 1 to 90, and in the United kingdom of 62.262 million inhabitants there are 602,000 people with epilepsy, 0.97% with a prevalence rate 1 to 103. (Based on 2010 population estimates the

PRELIMINARY Epilepsy is one of the major neurological disease that is a common disease that cause various effects, that is decreased quality of life. One trigger seizures for people with epilepsy is the most stress (J. Clin et al, 2007). In a survey from 177 patients, 58 percent identified that patients with frequent seizures when he got stress, repetitive seizures can occur within days or weeks (Anonymous 2005). Similar studies show that stress is the most common trigger of seizures (Frucht, QUIGG, Schwaner & Fountain, 2000). In a more recent survey of 89 patients, 64 percent of people with epilepsy reported that they believe stress increase the frequency of seizures (Haut, Vouyiouklis & Shinnar, 2003). Epilepsy survey of the adult population about stressful epilepsy of 86 258 people

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prevalence in each country is as follows: to the nearest 1,000) Indonesian population of 220 million, 1,1 to 4.4 million epilepsy patients with seizures epilepsi. The effect of seizure can make intrepersonal disruption of relationships, family and social. The goal of therapy and treatment are to improve function and reduce symptoms or the severity of the disease by reducing stress epilepsy patients. SEFT method (Spiritual Freedom Emotinal Tehnique) is very effective in helping patients adapt to stress as a main trigger of convulsion in patients with epilepsy.

Evaluation Date: July 25, 2013 5.4.7 Characteristics of respondents based on frequency of disease relapse / seizure in the last month before and after SEFT. Characteristics of respondents by the time the disease relapsed / seizures can be seen in the following table: Table 5.11 Distribution of respondents based on frequency of disease relapse / seizure in the last 1 month before and after SEFT technique in a given group of epileptic patients treated dated 26 June25 July 2013.

METHODS This study used quasy Experiment design. The population in this study were all adult epilepsy patients enrolled in “Poli saraf RSUD Dr. Iskak Tulungagung” in certain periods. The samples were adult epilepsy patients enrolled in “Poli saraf RSUD Dr. Iskak Tulungagung” who experienced relapse, some 20 respondents, with 10 respondents intervention group and 10 respondents as the control group. Sampling technique used is consecutive sampling. The research variables; Frequency of convulsion, long-time of convulsions and Restored old normal after convulsion. Variable intervention; SEFT techniques and variable counfounding; drugs, dosages, and medication adherence. Data were collected using questionnaires, location in Tulungagung based on data go in “Poli saraf RSUD Dr. Iskak Tulungagung”. When the study done for 1 month: June 26 until July 25, 2013. The measurement method is measured before and after treatment SEFT management techniques. Analysis of the data by using test wilcoson Signed Ranks Test and Mann Witney.

Freq.Convulsi on Before SEFT

Freq.Convulsion After SEFT Some No Seldom times

Seldom

2(100%)

0(0%)

-

2(100%)

Sometimes

4(80%)

1(20%)

-

5(100%)

1(33,3%)

2(66,7%)

-

3(100%)

7(70%)

3(30%)

Total

Often

Jumlah

10(100%)

From the table 5:11 can be seen the number of people with epilepsy in the treatment group of 10 respondents who received treatment, before SEFT majority of respondents relapse sometimes as many as five respondents (50%), and after being given the technique SEFT, the majority of respondents did not relapse as much as 7 respondents (70%). Table 5.12 Distribution of respondents based on frequency of disease relapse / seizure in the last 1 month before and after SEFT technique in the control group in patients with epilepsy dated 26 June-25 July 2013.

RESULT Analysis result from the effect of SEFT Stress Management Techniques to decrease in incidence of seizures Epilepsy Patients can be seen in the following table:

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Freq. Convulsio n Before SEFT

Freq. Convulsion after SEFT

Seldom Sometime s Often

2(100%) 5(100%)

2 5

3(100%)

3

Total

10

10(100% )

N o

Seldo m

Sometime s

Total

From the table 5:12 can be seen the number of people with epilepsy in the control group of 10 respondents, Before SEFT majority of respondents relapse sometimes as many as five respondents (50%), and after evaluation techniques SEFT, entirely as many as 10 respondents (100%), relapse becoming sometimes. 5.4.8 Characteristics of respondents by the number of times the disease relapses / seizure in the last month before and after SEFT. Characteristics of respondents by the number of times the disease relapses / seizures can be seen in the following table: Table 5.13 Distribution of respondents by the number of times the disease relapses / seizure in the last 1 month after the performed technique SEFT, the epilepsy group were given the treatment and the treatment group dated 26 June25 July 2013. Freq. Convulsio n Before SEFT

Freq. Convulsion After SEFT

1X 2X

6(85,7% ) 1(3,33)

Total

7(70%)

No

2 X

1X 1(14,3% ) 2(66,7% ) 3(30%)

From the table 5:13 can be seen the number of people with epilepsy in the treatment group of 10 respondents who received treatment, before SEFT majority of respondents relapse 1 times as much as 7 respondents (100%), and after being given the technique SEFT, the majority of respondents did not relapse by 6 respondents (85.7%), From the table 5:14 can be seen the number of people with epilepsy in the control group of 10 respondents, Before evaluation SEFT majority of respondents relapse 1 times as much as 7 respondents (100%), and after evaluation techniques SEFT, the majority of respondents relapse 1 times as much as 6 respondents ( 85.7%) 5.4.9 Characteristics of respondents by long seizure at the time of relapse / seizure in the last month before and after SEFT. Characteristics of respondents by long seizure relapse can be seen in the following table: Table 5:15 Distribution of respondents by long seizure relapse / seizure in the last 1 month after the performed technique SEFT, the epilepsy group were given treatment dated 26 June-25 July 2013

Total

7(100%) 3(100%)

10

10(100% )

Table 5:14 Distribution of respondents by the number of times the disease relapses / seizure in the last 1 month after the performed technique SEFT, in the control group in patients with epilepsy dated 26 June-25 July 2013 Freq. Convulsio n before SEFT 1X

Total Kontrol

2X

Total

6(85,7% )

1(14,3% )

7(100%)

2(66,7)

1(33,3% ) 2(20%)

3(100%)

8(80%)

5 minutes

8 (100% )

Total

1X

2X

Long of convulsion after SEFT No

10minute s

Freq. Convulsion after SEFT N o

Long of convulsio n before SEFT

10(100% )

1177

8 (80%)

Rapi d

Mediu m

Total

8(100%)

2(100% )

2(100%)

2 (20%)

10 (100%)

Table 5.16 Distribution of respondents by long seizure relapse / seizure in the last 1 month before and after evaluation technique SEFT, in the control group dated 26 June to 25 July 2013. Long of convulsio n before SEFT 5 minutes

Long of convulsion after SEFT N o

Rapid

Medium

8(100%)

10minutes

Jumlah

Table 5:17 Distribution of respondents by time to recover after a seizure relapse in the last 1 month before and after SEFT technique, the epilepsy group were given treatment dated 26 June-25 July 201 3

8(100%) 2(100%)

8(80%)

Total

2 (20%)

Recovery time before SEFT

Recovery time after SEFT No

Rapid

5 minutes

1(14,28%)

1(33,3%)

2(100%)

1(14,28%)

2(66,67%)

1(100%)

2(100%) 10 minutes 15 minutes 1 day

10(100%)

Medium

Total

1(14,28%)

3(100%)

2(28,58%)

2(100%)

2(28,58)

2(100%)

5days

From table 5.15 can be seen the number of people with epilepsy in the treatment group the majority of 8 respondents (100%) before treatment SEFT categorized recurrence for 5 minutes fast, and after treatment techniques SEFT not relapse by 8 respondents (100%). From table 5.16 can be seen the number of people with epilepsy in the control group before the treatment the majority of 8 respondents (100%) 5 minute long attack, after treatment evaluation SEFT remained largely categorized 5-minute long attack quickly, amounting to 8 respondents (100%). 5.4.10 Characteristics of respondents by time to recover after a seizure relapse in the last month before and after SEFT. Characteristics of respondents by time to recover after a seizure relapse can be seen in the following table:

Total

7(70%)

3(30%)

10(100%)

Table 5.18 Distribution of respondents by time to recover after a seizure relapse in the last 1 month before and after SEFT technique, the control group in patients with epilepsy dated 26 June-25 July 2013 Recovery time before SEFT 5 minutes 10 minutes 15 minutes 1 day

Recovery time after SEFT No Rapid

Medium

Total

3(37,5%) 3(37,5%) 2(25%)

3(100%) 3(100%) 2(100%) 2(100%) 2(100%)

5days Total

8(80%)

2(20%)

10(100%)

From able 5.17 it can be seen the number of people with epilepsy in the treatment group of 10 respondents, prior treatment relapse largely recovered 100% and most of the normal 15 minutes. And after treatment 7 respondents (70%) do not recur. From table 5.18 it can be seen the number of people with epilepsy in the control group of 10 respondents, before the evaluation SEFT 100% relapse and once after technical evaluation SEFT 8 respondents (80%) normal fast recovery time, a further 20% currently. 5.4.11 Characteristics of respondents based on emotional effects (depression,

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anxiety, anger, etc.) after a seizure in the last month before and after SEFT. Characteristics of respondents based on emotional effects after a seizure can be seen in the following table: Table 5.19 Distribution of respondents based on emotional effects after a seizure in the last 1 month before and after SEFT technique, the epilepsy group were given the treatment and the control group dated 26 June-25 July 2013. Cognitif effect Emotion

Physic

duration of seizures, epilepsy patients with normal recovery time. Analysis time reduction in seizure frequency, duration of seizures, normal recovery time between the treatment group and control group can be seen in the following table: Table 5.20 Test Wilcoxon Signed Ranks Test The decline in the frequency of seizures, convulsions long, normal recovery time of patients with epilepsy, the epilepsy group were given the treatment and the control group dated 26 June to 25 July 2013.

Action Before 10(100%) 10(100%)

After 3(30%) 3(30%)

Control Before 10(100%) 10(100%)

4(40%)

0

3(30%)

Anxious

8(80%)

3(30%)

9(90%)

2(20%)Wilcoxon Signed Ranks Test 9(90%)Freq.convulsion

Angry

6(60%)

2(20%)

5(50%)

5(50%)Freq.relapse

Sleepy

10(100%)

3(30%)

10(100%)

Long 10(100%) convulsion

Tired

10(100%)

3(30%)

10(100%)

10(100%) Recovery time

Weak

10(100%)

3(30%)

10(100%)

10(100%)

Muscleache

10(100%)

3(30%)

10(100%)

10(100%)

Headache

10(100%)

3(30%)

10(100%)

10(100%) using

Confused Loss of memory Depression

After 10(100%) 10(100%)

From table 5.19 it can be seen the number of people with epilepsy in the treatment group of 10 respondents, prior to the treatment of cognitive effects: Confusion and memory lost most of 100%, and after treatment to 30%. Emotions: most anxious 80% after treatment 30%., And physical effects: Sleepy, fatigue, weakness, muscle pain and headache before treatment 100%, to 30% after treatment. From the 10 respondents control group, the cognitive effects: Confusion and memory lost most of 100%, and after treatment remains 100%. Emotions: most anxious 90% after treatment remained 90%., And physical effects: Sleepy, fatigue, weakness, muscle pain and headache before treatment 100%, after treatment remains 100%. 5.4.12 Analysis of Effect of Stress Management Techniques To Decrease SEFT seizure frequency,

Intervention p

of

10,00 0,004 10,00 0,004 10,00 0,007 10,00 0,005

p Control

10,00

0,655

10.00

0,564

10,00

0,157

10,00

1,000

Table 5.21 Mann Whitney test the difference between the treatment group and the control group Significant values Before After SEFT SEFT

Mann Wihitney Test Freq. convulsion Long of convulsion Relapse for 1 month ago Recovery time

1,000 1,000 1,000 0,202

< 0,0001 0,001 0,001 < 0,0001

From table 5.20 it can be seen in the intervention group appears that p <α, α = 0.05. This means no intervention effect SEFT the decrease in seizure frequency, duration of seizures and normal recovery time after a seizure in epilepsy patients, and the control group p> α, α = 0.05, this meaning there was no effect because it has not carried out the intervention, from the data above results showed that there are significant differences between the intervention group and control group.

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Analysis of the influence of Stress Management Techniques SEFT Against the decline in frequency of seizures Patients Epilepsy performed using Wilcoxon Signed Ranks Test with SPSS 16 for Windows suggests that aspects of time frequency of seizures in the intervention group p = 0.004 (no difference in decreasing the frequency of seizures epilepsy patients before and after engineering SEFT; aspects of the frequency of relapse in the intervention group p = 0.004 (no difference in decreasing the frequency of relapse patients with epilepsy before and after the technique SEFT aspects. Long attacks in the intervention group p = 0.007 (there is a difference long attacks before and after the technique SEFT); time to recover normal in the intervention group p = 0.005 (no difference in recovery time to normal before and after the technique SEFT). In the control group showed no difference in time reduction in seizure frequency (p = 0.655), frequency of relapse (0.564), duration of seizures (p = 0.157 ), and the normal recovery time after the seizures (p = 1.000). At the Mann Whitney test before SEFT obtained technical aspects of time frequency of seizures in the intervention group: p = 0.1000 (no difference in reduction in seizure frequency of epileptic patients before SEFT techniques; aspects Lama attacks in the intervention group p = 1.000 (no time difference prior to the attack technique SEFT); relapse last month in the intervention group p: 1.000 (no difference in relapse last month before SEFT techniques); normal recovery time in the intervention group p = 0.202 (there is no difference in the normal recovery time before the technique SEFT). At the Mann Whitney test performed after SEFT technical aspects of frequency obtained a seizure in the intervention group: p = <0.0001 (no difference in decreasing the frequency of seizures after epilepsy patients do SEFT techniques; aspects Lama attacks in the intervention group p = 0.001 (no time difference attack after doing the

technique SEFT); relapse last month in the intervention group p = 0.001 (no difference in relapse last month after doing the technique SEFT); normal recovery time in the intervention group p = <0.0001 (there are differences in the normal recovery time after doing technique SEFT).

DISCUSSION Based on data obtained from studies conducted in hospitals Neural Poly Dr.Iskak Tulungagung and proceeded to the location of the respondents in Tulungagung on June 26July 25, 2013. 6.1 Analysis of the frequency of convulsion in patients with epilepsy before and after SEFT techniques (Spiritual Emotional Freedom Technique) in patients with epilepsy. Results of research on the effect of stress management techniques SEFT to decrease the incidence of seizures epilepsy patients before and after the intervention, according to the research objectives and constraints problems that have been noted in the introductory chapter, so he found the incidence of seizures of epilepsy patients before the technique SEFT on June 26, 2013. From Table 5.11 Distribution based on frequency of convulsion in the treatment group before and after the technique SEFT showed a decrease in the frequency of convulsion, the majority of respondents did not recur, and the results of the Wilcoxon test and Mann Whitney showed no difference or effect of treatment techniques SEFT to the decline in seizure patients epilepsy, but still there is one respondent remained relapse with rare category which previously occasionally and 2 respondents who had previously relapsed by category often become rare. And at table 5.12 distribution table based on frequency of convulsion in the control group were obtained before and after SEFT technique remained relapse. Results of this study are also in accordance with the epidemiology of

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epilepsy in which the epileptic patients often relapse condition is getting worse or bad. This evaluation is caused by job factors. Job by respondents as workers, farmers, so that the fatigue factor trigger a relapse, the condition of the health of poor respondents because they have not performed the intervention, also because of the weakness of the treatment, that the respondent therapy treatment is not homogeneous or different and different treatment on time and place. Table 5.13 based on how many times the disease relapses / spasm in group treatment, before treatment almost a half respondents relapse 1 time, and after treatment the majority did not relapse, and at table 5.14 based on how many times the disease relapses / spasm in the control group before and after the technical evaluation SEFT majority of respondents entirely relapse once. From Wilcoxson Signed RankTest and Mann Whitney Test showed the difference in convulsion frequency reduction in epileptic patients before and after SEFT technique, the control group showed no difference in time reduction in convulsion frequency. The results are suitable with the epidemiology patients with epilepsy that patients with epilepsy is more common if the longer respondents seizures get worse or bad prognosis. Longer attack due to factors endurance or fitness, coping mekansme inadequate epilepsy patients that can not adapt to trigger seizures such as psychosocial stress, as well as factors or frequency of epileptic patients often relapse. On the seizure lasts longer usually accompanied by the occurrence of apnea, the increased need for oxygen and energy for contraction of skeletal muscles, while the respiratory muscles are not efficient so not had time to breathe eventually hypoxia, hypercapnia, hypoglycemia, lactic acidosis due to anaerobic metabolism, hypotension arterial accompanied heartbeat irregular and body temperature increasing due to increased muscle activity and further causes increased muscle metabolism. The most important

factor is a blood disorder that results in hypoxia elevate capillary permeability and edema arises resulting brain cell damage neurons. From table 5.17 can see the number of people with epilepsy in the treatment group, before treatment most of relapse with normal recovery time most of 15 minutes. And after treatment relapse. From the table 5.18 can be seen the number of people with epilepsy in the control group, before the evaluation SEFT entirely relapse majority of 10 minutes and once after evaluation techniques SEFT recovery time normally remain majority 10 minutes, but still no one respondents who relapse while recovering normal 5 minutes and 2 respondents who relapse normal recovery time 15 minutes. From a statistical test to test Wilcoxson RankTest Signed and Mann Whitney Test showed the difference in the decline of normal recovery time of patients with epilepsy before and after SEFT techniques. In this study patients with epilepsy normal recovery time is likely to persist due to factors disease duration and physical condition as well as psychosocial epilepsy patients settled. According to the epidemiology of epilepsy in which the respondent recovers more quickly to normal after a seizure, the better condition of the respondent. From the table 5.19 it can be seen the number of people with epilepsy in the treatment group before and after treatment of cognitive effects: Confusion and memory lost. Emotional, and physical effects: Sleepy, fatigue, weakness, muscle pain and headaches showed an improvement. Control group of 10 respondents are likely to remain, but there is still an average of 3 respondents with impaired emotional effect on epilepsy patients. This is because From the above results can be explained that the respondents in the intervention group and the control group will experience health problems both physical and psychosocial because of frequent relapse or seizure so that the health condition of the respondents is

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getting worse and the risk for relapse over and over very large Increasingly frequent seizures higher levels of anxiety, increasingly unstable emotional. Based on research conducted by Mina N Astejada, Roland Dominic G Jamora, and Lourdes K Ledesma (Anonymous, 2008) in the Philippines using the Hospital Anxiety and Depression Scale (HADS), which showed that 645 patients with epilepsy experiencing anxiety, while 51% of epilepsy patients are also depressed. In accordance with that in the study of epilepsy patients before the intervention SEFT mostly experienced anxiety disorders, although there has been no previous study the same as comparative data, but research from Winny N Wishwadewa 2008 shows a multivariate analysis with regression test ANOVA on clinical factors that influence, as follows: Cognitive function correlated with the number of seizures last 6 months (r: 0.24), the function of emotional well being correlated with the number of seizures last 6 months (r: 0.22), social function correlated with the number of seizures last 6 months (r: 0.14), and the quality of life in general correlated with seizures last 6 months (r: 0.14). In a study by Cynthia L. Harden et al, 2013 on the effects of severe seizures on quality of life in patients with epilepsy, obtained two domains quality of life in epilepsy (Qolie-31) were significantly associated closely with severe seizures, which concerns the rate of seizures (r: 0.265) (p: 0.004), the level of social functioning (r: 0.280), (p: 0.002), overall quality of life (r: 0.210), (p: 0.023), cognitive (r: 0.209), (p: 0.024) , this shows that the great potential for the treatment of seizures and spasms that cause anxiety and harm avoidance behavior of social relationships for people with epilepsy. In this study, more rarely relapse or seizure cognitive, emotional, social and quality of life of patients increased better. Metabolic changes that occur during and immediately after a seizure is

partly due to the increasing energy requirements due to hyperactivity of neurons. During seizures dramatically increased metabolic demands, loose electrical charge motor nerve cells can be increased to 1000 per second. Increased cerebral blood flow, as well as respiration and glycolysis network. Acetylcholine appears in the cerebrospinal fluid (CSS) during and after the seizure. Glutamic acid may be depleted during seizure activity, so that patients have a shortage of energy and causes weakness in the body, the more frequent seizures in patients, allow or support for recurrent seizures. Patients who have seizures, as well as their families, often feel frightened or anxious about the reappearance of seizures in epilepsy, the tendency of recurrence of seizures impacts emotional disorders, such as anger, anxiety against the onset of a seizure suddenly at any time. In addition, it can also occur socioeconomic impacts such as shame and fear ostracized by society, loss of employment, and so on. Therefore, medical practitioners should not only treat seizures with anticonvulsant drugs, but also try to help cope with the emotional and social impact caused by a seizure. Less and less patient experiencing a seizure then the average value of the health and quality of life is generally better. In the study conducted by Winny Wishwadewa N. et al (2008) obtain general health significantly correlated with the number of seizures in the last 6 months (r: 0.30). According Harsono (2007) explains that the average attack lasts for one to three minutes after the attack sufferers seem confused, drowsy, and changing behaviors, and forget what happened. did not show any significant difference. No previous studies as comparative data, Convulsion least contribute to rapid recovery of normal time on the health of patients and affect the health of the brain associated with the quality of life of patients with epilepsy.

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According to Faiz Ahmad Zainuddin, SEFT (Spiritual Emotional Freedom Technique) is a healing energy that combines psychology with the power of prayer and spirituality. Energy psychology is a science that applies the principles and techniques, based on the concept of the energy system of the body to improve the state of mind, emotion and behavior. The recurrence rate of patients with epilepsy one of them have been affected by physical factors are fatigue, weakness, and psychological factors that emotional such as depression, anxiety, anger, etc., so that epilepsy patients who have less physical care and psychological risk of increased frequency of seizures or relapse will be at risk also the occurrence of physical injury. Benediction positive effect on healing and health (Byrd IC 1988 in Zainuddin, 2006; 23). According to WHO (World Health Organization) is the quality of life include physical health, psychological, level of activity, social relationships, and environment adequately. According to the Calman cited by Hermann (1993) revealed that the concept of quality of life is how the difference between desires have compared the feeling they are now, this definition is known as the "Calman's Gap." Calman reveals the importance of knowing the difference between the feeling that there is the desire in fact, epitomized by comparing an intermediate state "where someone was" with "where one wants to be." If the difference between these two conditions in width, this discrepancy shows that quality of life is low. While the high quality of life if the difference between them is small. Definition of quality of life related to health can be defined as the emotional response of the patient to the activity of the social, emotional, work and family relationships, a sense of fun or happy, compatibility between expectation and reality is that the presence of satisfaction in doing physical functioning, social and

emotional as well as the ability to conduct socialization with others. According to Donald cited by Haan (1993), the quality of life in contrast to functional status, in terms of quality of life includes the subjective evaluation of the impact of the disease and its treatment in relation to the purpose, value and hope someone, while functional status provide an objective assessment of physical ability and emotional patients, in patients Her epileptic seizures are categorized longer and longer recovery time normally affects the quality of life. Technics SEFT (Spiritual Emotional Freedom Technique) is a therapy that is very SMART contains elements Reframing Anchoring and Breaking The Pattern, Self Hypnotherapy, Visualization, Meditation, and Behavioral Therapy Desentisization, with the conclusion that the therapy SEFT based or adaptation of psychotherapy behavioralistik or behavior, proven with relaxasi, meditation, visualization and desentisization. In patients who experienced epileptic seizures, at the level of the cell membrane there will be some biochemical phenomena. SEFT techniques can neutralize it, forming the stability of the cell membrane, the cell is not susceptible to activation. Neurons are no longer hypersensitive so not excessively discharged, no excess or deficiency of acetylcholine Gamaaminobutyric acid (GABA), occurring chemical homeostasis of neurons. During seizures dramatically increased metabolic demand, increased cerebral blood flow, increased respiration and glycolysis network also increased, also evidenced by the declining frequency of seizures of epilepsy patients after SEFT techniques. According to Zainuddin (2006) of the human body, every cell, nervous system, and organs in the human body containing electromagnetic energy, then as the human body system will be the main trigger all kinds of disturbances negative emotions such as stress, anxiety

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and depression, and emotional disorders can be manifested in a variety of physical ailments, such as physical health greatly affects the condition of the patient's epileptic seizures, and this proved that these factors can trigger the onset of recurrent seizures, convulsions also influenced by fakor fatigue, and emotional, so that the research trials through the Test Wilcoxon and Mann Whitney obtain meaningful results with no effect Stress Management techniques to decrease the incidence of seizures SEFT epilepsy patients. Based on the explanation above, the researchers consider necessary socialized SEFT stress management techniques in reducing the incidence of seizures in patients with epilepsy in their efforts to adapt to the stressor stimulus both from internal and external in order to increase the quality of life of patients with epilepsy. In view of the Roy Adaptation theory standpoint, the patients with epilepsy can immediately adjust the focal stimulus because of repeated attacks that took place, and the impact that contextual stimuli such as social isolation and strengthen the corresponding residual stimulus and positive learning experience. Process control or shape the coping mechanisms of epilepsy patients corroborated that the transmitter regulator system and kognator control, such as solving problems and making decisions, so that epilepsy patients can run her life according to the fulfillment of their needs, namely: Physiological basis, the development of positive selfconcept, the appearance of social roles, and achievement independent balance and dependency appropriately and well. Limitations of this study could be due to the lack of due methods used in the technique SEFT, or it could be because of time constraints and the limited number of respondents, the residence of the respondents are far apart, a treatment that is not the same, the study was only done within one month by 10 respondents the

intervention group and the control group of 10 respondents, so that a given intervention SEFT techniques to reduce the frequency of epileptic seizures new patients until the beginning stages. This situation allows respondents who relapse after intervention techniques SEFT due to other factors. CONCLUSIONS AND SUGGESTIONS CONCLUSION Based on data obtained from studies conducted in “Poli Saraf RSUD Dr. Iskak Tulungagung” on June 26 to July 25, 2013, obtained 1) The frequency of seizures epilepsy patients on the respondent before the intervention, including the medium category and decreased to good majority of relapses after intervention techniques SEFT (Spiritual Emotional Freedom Technique), 2) Duration of seizure on the respondent before intervention in the medium category and declining majority be no recurrence after intervention and relapse in the category for a while, there was a decrease 3) Time to recover to normal on the respondent before the intervention in the category briefly and declined majority be no recurrence after intervention and relapse in the category also briefly , there was a decrease. SUGGESTION Suggestions in this study are; 1) respondents expected to increase the degree of health and to prevent a recurrence so that the quality of life of patients to be better, and be able to resolve their health problems independently to take medication regularly, set the activity to avoid fatigue, 2) an increase in the degree of health after intervention techniques SEFT , with the criteria of the time and type of drug therapy given to respondents based, should provide motivation for health workers that work at the clinic and the community to develop and implement techniques SEFT as a form of promotive and

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preventive efforts against people with epileptic seizures, 3) people are expected to participate actively in efforts to improve the quality of life of patients with epilepsy with nursing adequate regular basis, given the epilepsy patients to date can not be cured, but can be optimized degree of health if it does not have a relapse, 4) needs to be the development of research related to motivation and factors epileptic seizures that affect patient expectancy and quality of life of epilepsy patients can be met, 5) for cooperation across programs and across sectors, considering not widely known to the public about the technique SEFT for optimize the quality of life of patients, especially in patients with epilepsy.

epilepsi. Epilepsia: 34 (suppl 4) 1993: 8-13 Dahlan,

Daniels Rick, at all (2010) Nursing Fundamentals. Caring & Clinical Decision Making , 2010, pp. 139-129 Denise,at all (2010) Essentials of Nursing Research ,2010 pp.541145 Direktorat Statistik dan Kependudukan (2007). Survei Demografi dan Kesehatan Indonesia.Biro Pusat Statistik. http://www.datastatistikindonesi a.com/sdki/ pada tanggal 12 Juli 2012

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STRATEGIES FOR IMPROVING NUTRITIONAL STATUS OF CHILDREN UNDER FIVE IN COMMUNITIES Nurwijayanti STIKes Surya Mitra Husada Kediri Email: [email protected] ABSTRACT More specifically, malnutrition may cause retarded growth of the body and, more importantly, a delay in brain development. Additionally, it may decrease or lower the body‟s resistance to infectious diseases. The issue of under-nutrition in children under five is caused by many direct and indirect factors. Therefore, there is a need for comprehensive management strategies to prevent high rates of malnutrition. Strategies to overcome the issue of malnutrition in children under five include revitalizing the function of the Integrated Health Service Post (locally known as „Posyandu‟), increasing community and family participation in monitoring the growth and development of children under five, early recognizing and overcoming infants with impaired growth through Posyandu revitalization, improving the ability of personnel in the management of malnutrition to support the function of Posyandu, directly tackling nutritional problems in vulnerable groups, realizing nutrition-conscious families through nutritional promotion, advocacy and dissemination, building cross-sectoral cooperation and reactivating the Alert System for Food and Nutrition (ASFN).

growth (Health Office of East Java Province, 2011).

INTRODUCTION Nutrition is a major issue of the world population. Development of health in terms of nutrition is part of efforts to develop human being as a whole. It is, among others, carried out through child health as early as the child in the womb (UNICEF in National Development Planning Agency [BAPPENAS], 2011). Efforts of health improvements made since the child in the womb until the first five years of life are intended to maintain their survival and improve their quality of life in order to achieve optimal growth and development, physically, mentally, emotionally and socially, as well as having multiple intelligence in accordance with the genetic potential (MOH of Republic of Infants‟ Indonesia, 2011). high morbidity and mental development are direct or indirect results of disrupted

According to WHO (2010), as many as 103 million children aged under five in developing countries were underweight. Approximately 30% of the world population, consisting of infants, children, adolescents, adults, and the elderly, suffer from malnutrition. Fifty per cent of mortality rates of children under five are associated with malnutrition (http://www.gizi.net). Children with insufficient quantity and quality of food would have abnormal Furthermore, continued growth. abnormal growth of children would be reflected in their height. According Pudjiadi (2008), a lack of any one nutrient may impair growth. A lack of energy, protein, vitamins and trace elements may reduce growth; on the contrary, an excess of various

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micronutrients may disrupt growth and development as well.

under-nutrition in children under five is caused by many direct and indirect factors (Gibson, 1997).

Nutritional problems are a public health issue that cannot be overcome merely with medical and health service approaches. In addition to being a poverty syndrome closely related to the problems of food security at the household level, it relates to the aspects of knowledge and behavior less supportive of healthy lifestyles. Nutritional status of a community would affect health and life expectancy, which are among the main elements in determining the successful development of a country, known as the Human Development Index (Elsamaharani, 2010).

Among the direct factors of malnutrition are inappropriate feeding patterns, below the nutritional adequacy rate, resulting in lower energy and protein intake. In addition, the presence of infectious diseases may cause children under five to lose their appetite, resulting in a reduced intake of food and drink into their body. Infectious diseases are among the leading causes of infant mortality in Indonesia, which include pneumonia (23.6%), diarrhea (16.6%), severe infections (15.1%), malnutrition + severe underweight (3.6%). Infectious diseases are caused by the entry of microorganisms into the body, leading to an abnormal reaction of the body. It may cause reduced appetite or difficulty in swallowing and digesting food, thus decreasing food intake into the body, and eventually under-nutrition (MOH of Republic of Indonesia, 2009).

Nutritional problems in Indonesia are more prevalent in children under five years, despite the progress in overcoming the problem of malnutrition in Indonesia over the past 10 years. Nutritional status of a community can be assessed on the basis of the nutritional status of children under five. In Indonesia, 4 in 10 children under five have impaired physical growth and low intelligence level due to protein-energy malnutrition (Soekirman, 2005).

According to the statistics of the Ministry of National Development Planning/BAPPENAS, of 241,973,879 Indonesia‟s population, 18.4% suffer from under-nutrition. Nationally, 76,178 children under five suffer from malnutrition. According to WHO (2010), hunger and malnutrition cause the highest death rates in the world. At least 17,289 children die every day due to hunger and malnutrition.

According Kodyat (1998), malnutrition affects children‟s future growth. In the childhood, they experience rapid growth and development that require adequate supply of food and nutrition. Malnutrition in childhood may have physically, mentally, socially and intellectually disrupted growth, which is permanent until the adulthood.

According to the MOH of Republic of Indonesia (2010), the prevalence in children under five of under-nutrition and malnutrition based on weight-for-age (W/A) was 13.0% and 4.9%, respectively. In Kediri City, there were 522 underweight infants, or 3.7% of the population of children under five had under-nutritional problems. The number of underweight

More specifically, malnutrition may cause retarded growth of the body and, more importantly, a delay in brain development. Additionally, it may decrease or lower the body‟s resistance to infectious diseases. The issue of

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factors and the family‟s health status (Soekirman, 2000).

children under five in Kediri exceeded the normal threshold of less than 1% in an area.

According Pudjiadi (2008), nutritional status of children under five would be worse when the mother has poor knowledge of menu composition, provision of complementary foods and distribution of food in the family. In a large, low-income family, children may suffer since the family‟s income is used for many family members. A community‟s adequate knowledge of nutritious foods for children under five would increase the nutritional status of children under five, and vice versa. Family structure may have an effect on morbidity (such as infectious diseases and malnutrition) and health service utilization.

Of those under-nutritional children, there were 28 suffered from pneumonia. It was caused by various factors, such as poor household food security, inadequate feeding patterns, other infections and poor parenting. On the other hand, there were 15 cases of diarrhea, 28 cases of pneumonia and 14 cases of tuberculosis. In addition, results of the preliminary study of 5 mothers using 24-h recall on feeding patterns, specifically asking the types of staple food they fed their children under five, showed that 3 respondents fed their babies ½ dish of rice twice a day plus tempeh mixed with soy sauce and sometimes tofu. The rest of the mothers fed their baby as needed. The five respondents fed their baby vegetables, such as spinach. Two respondents claimed usually feeding their baby banana and papaya, but it was not regularly, one respondent claimed rarely feeding their baby fruits, and 2 respondents usually fed their baby fruits as needed.

According to Sunarti (2009), nurturing includes taking care of, paying attention to and guiding a child towards adulthood. Lack of attention to growth and development of children under five would lead to a lower nutritional status. Serious management of nutritional status of children under five should not only be carried out by the government, but also the caregivers who are closest to the children under five. Proper provision of nutritious foods and appropriate nurturing during the developmental stage may produce a healthy, intelligent and productive next generation.

The above description provided information that the nutritional status of children could be detected on the basis of irregular feeding patterns, which was not in accordance with the nutritional needs of the baby, inadequate family food security and rarely monitoring of the child‟s growth and development to the Posyandu. These behaviors had negative effects on the nutritional status of children under five.

General Purpose The purpose of the present study was to determine strategies for improving nutritional status of children under five in communities.

Nutritional problems are effectd by a complex interplay of various factors. At the household level, nutritional status is effectd by the family‟s ability to provide food in adequate quantity and types. Parenting is effectd by educational and behavioral

METHODS The present study was a quantitative research. Based on the research framework and the structural models developed to answer the research questions, there were six dimensions or 1198

latent variables making up the construct of nutritional status improvement model. The direct factors of the model included food intake, infectious diseases and the indirect factors included food availability, knowledge, parenting and socio-economic status. In addition, nutritional status was another latent variable.

income of between IDR 500,000 to IDR 1,000,000 and a small fraction of them had an income of more than IDR 1,000,000. A half of children under five (50%) were the first child and a small portion of them were the third child. With regard to respondents‟ characteristics of knowledge of nutritious foods for children under five, functions and kinds of nutrients, sources of nutritious foods, provision of nutrients to children under five and evaluation of nutrient utilization in children under five, the mothers had good knowledge of nutritious food functions and the types of nutrients the children required. However, they lacked understanding of the fulfillment of specific nutrient needs of their children under five.

The population of the study was people or households with children under five. Quantitative data were collected by selecting samples using the proportional random sampling method. Inferential statistics analysis was focused on the field of study analysis and interpretation of data to draw conclusions. It was used to test the developed research hypotheses by using the sample data. The inferential statistical method used for data analysis was the structural equation modeling (SEM).

With regard to the respondents‟ characteristics of socio-economic status, all family members worshipped according to the religion with the head of the family or a family member being active in community associations and showing lowest score on access to information and means of transport. With regard to respondents‟ characteristics of parenting, which included feeding, health care and selfcare, the highest score was on feeding the newborn and the lowest one was on feeding method.

RESULTS The City of Kediri, covering the area of 63.40 km2, consists of 3 sub-districts: Mojoroto, City and Pesantren. Mojoroto Sub-district covers the largest area (24.6 km2) and City Sub-district the smallest (14.9 km2). The 2012 population data showed that Kediri City had as many as 312,331 residents, increasing compared to that of 2011 with 302,671 residents. Of the former figure, 157,043 were men and 155,288 women. Based on respondents‟ characteristics, a half of the children under five (55.5%) were male, and the rest were female (44.50%). Most of the mothers of children under five (64.0%) were graduates of high school and only a fraction of them were graduates of primary school (3.0%). Almost a half of the mothers (37.5%) were housewives and a fraction of them were private employees. Nearly half of the parents of children under five (40.00%) had an

With regard to respondents‟ characteristics of family food security, which covered adequacy, quantity, quality, safety, nutritional value, diversity, equality, and affordability of staple foods, the highest score was on the availability of staple foods and the lowest one was on the affordability of staple foods. With regard to respondents‟ characteristics of assessment of the quality of health services in Kediri, which included the parameters of reliability,

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responsiveness, assurance, empathy and tangibles, the highest score was on patients receiving procedures quickly and accurately and the lowest score was on the knowledge and capability of physicians in establishing the diagnosis.

question (80.0%) was that of number 9 about the benefits of breast milk. With regard of the distribution of nutritional status of children under five in Kediri City, the majority of respondents (42%) had children with under-nutrition status and a small portion of them had children with malnutrition status (0.5%).

With regard to respondents‟ characteristics of the incidence of infections, which included pneumonia, persistent diarrhea, intestinal worms, tuberculosis, malaria, HIV/AIDS and other infectious diseases, a small proportion of respondents (32.5%) had a history of suffering from pneumonia, followed by persistent diarrhea (2.5%).

FACTORS AFFECTING IMPROVEMENT OF NUTRITIONAL STATUS OF CHILDREN UNDER FIVE There are three assumptions in the SEM model that must be met: linearity, outlier and normality of distribution. The assumption of linearity can be tested by creating a scatter diagram or using the curve fit approach (in SPSS). Linearity assumption can be tested by the curve fit method performed in SPSS. When the significance value of the linear model is <0.05, then the assumption of linearity is met.

With regard to respondents‟ characteristics of feeding patterns, which included nutritious foods, breastfeeding and benefits of nutrient fulfillment, the question most often answered correctly (94.5%) was that of number one, asking about nutritious food and number 13 about the benefits of nutrient fulfillment for children under five. The least correctly answered

TABLE 1 Tests of Linearity Assumptions Correlation

Test Results

Remark

Socio-economic status Nutritional status

dev. from linearity 0.206 > 0.05 dev. from linearity 0.774 > 0.05

Linear Linear

Parenting Nutritional status

dev. from linearity 0.548 > 0.05

Linear

Food security Nutritional status

dev. from linearity 0.107 > 0.05

Linear

Health service Nutritional status

dev. from linearity 0.460 > 0.05

Linear

Feeding patterns Nutritional status

dev. from linearity 0.769 > 0.05

Linear

Knowledge Nutritional status

Table 6.1 shows six correlations among variables. All the linear models were significant since the significance value of deviation from linearity of the liner model was greater than 0.05; thus, the assumption of linearity is met. Since all the variables in the study were, the model could be analyzed by the goodness-of-fit test in Lisrel. The

values of the goodness-of-fit test are calculated using the Chi-square statistics, where the model is considered fit or satisfactory when the value of chisquare is low. The smaller the2 value, the better the model will be and accepted based on the probability at the cut-off value of p > 0.05 or p > 0.10.

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TABLE 2 Goodness-of-Fit Tests of the Model Correlation

Test Results

Remark

Socio-economic status Nutritional status

Significant, p = 0.123 > 0.05 Significant, p = 0.470 > 0.05

Model fit Model fit

Parenting Nutritional status

Significant, p = 0.380 > 0.05

Model fit

Food security Nutritional status

Significant, p = 0.313 > 0.05

Model fit

Health service Nutritional status

Significant, p = 0.704 > 0.05

Model fit

Feeding patterns Nutritional status

Significant, p = 0.788 > 0.05

Model fit

Feeding patterns Nutritional status

Significant, p = 0.272 > 0.05

Model fit

Knowledge Nutritional status

The estimated t-value in red illustrated that the resulting t-values were lower than ttable (1.96) at the significance level of 5%, or the variable was not significant. The significance of variables are shown as follows:

Results of the calculation of2chi-square showed that all the significance values were higher than the cut-off value of 0.05; thus, the model is considered as having the relevant predictive value.

FIGURE 1. Conceptual Model of T-values

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FIGURE 2. Conceptual Model of T-values

Tests of the direct effects of knowledge on nutritional status showed an inner weight coefficient of 0.17 with a t-value of 3.05. Since the t-value was > 1.96, then there was a significant direct effect of knowledge on nutritional status. Nutritional problems often arise out of respondents‟ ignorance and lack of information about nutrition. New behaviors are formed from knowledge of stimulation of materials or objects that will generate new knowledge on the subject and then lead to further response in the form of action. However, sufficient knowledge does not guarantee a person to behave the same as what they know, leading to the small inner weight coefficients.

0.40. Since the t-value was <1.96, then there was no significant direct effect of socio-economic status on nutritional status. Socio-economic conditions of a family did not have direct effects on nutritional status of children under five. However, for extreme cases, such as a very poor family and very low ability to meet nutritional needs, socio-economic conditions may have effects on nutritional status of children under five. Socio-economic conditions of a family greatly affect whether or not a child‟s primary and secondary needs, as well as the attention and affection will be fulfilled. It is, of course, closely related to the family income, the number of siblings and parental education. People with low economic status will spend more of its income for foods. And, when their income increases, normally they will spend

Tests of the direct effects of socio-economic status on nutritional status showed an inner weight coefficient of 0.02 with a t-value of

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most of their income to increase foods. Thus, income is a factor that most determines the quantity and quality of food.

inner weight coefficient of0.15 with a t-value of1.35. Since the t-value was <1.96, then there was no significant direct effect of health services on nutritional status. Tests of the effects of health services on nutritional status are shown in the following figure:

Tests of direct effects of parenting on nutritional status showed an inner weight coefficient of 0.48 with a tvalue of 4.14. Since the t-value was > 1.96, then there was a significant direct effect of parenting on nutritional status. Tests of effects of knowledge on nutritional status are presented in the following figure:

Pola asuh

0,48

Pelayanan Kesehatan

-0,15

Status gizi

FIGURE 4 Tests of health service effects on nutritional status

Direct effects of feeding patterns on nutritional status showed an inner weight coefficient of0.13 with at tvalue of2.33. Since the t-value was <1.96, then there was a significant direct effect of feeding patterns on nutritional status. Implementation of health services in terms of nutrition consisted of preventive, promotive and curative programs. Nutrition volunteers played role in the implementation of promotive program by directly counseling the community through a variety of events created by the community themselves. The preventive program was carried out by Posyandu volunteers through monitoring the nutritional status by weighing and measuring the weight and height of children under five. Thus, a decline in nutritional status could be tackled. Tests of effects of feeding patterns on nutritional status are shown in the following figure:

Status gizi

FIGURE 3 Tests of parenting effects on nutritional status

During the period of parenting, the first environment of a child is his or her parents. A child grows and develops under the care of parents; thus, parents are the very basis for the formation of the child‟s personality. Through their parents, children adapt to their environment to get to know the surrounding world as well as the prevailing patterns of social life. Thus, the basis for the development of an individual has been placed by their parents through parenting practices. All parents should give their children the right to grow. All children should obtain the best to grow in line with what they may achieve and in accordance with their abilities. Therefore, they need parental attention/ support. In order for a child to grow well, merely feeding them is not enough, moreover, carelessly selecting menus or merely feeding the child with rice. But, children need parental attitude in feeding.

Pola makan

0,13

Status gizi

FIGURE 5 Tests of feeding pattern effects on nutritional status

Tests of direct effects of infectious diseases on nutritional status showed an inner weight coefficient of0.35 with a t-value of6.24. Since the t-value was

Tests of direct effects of health services on nutritional status showed an

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> 1.96, then there was a significant direct effect of infectious diseases on nutritional status. Those tests indicated that infectious diseases had a dominant effect on nutritional status. Tests of direct effects of infectious diseases on nutritional status are shown in the following figure: Infeksi

-0,35

indirect and total effects. Results of analysis showed that food security had the smallest direct effect on nutritional status, while parenting had the greatest direct effect on nutritional status. Food security had the smallest indirect effect and socio-economic status had the greatest direct effect on nutritional status. Tests of the total effect of knowledge, parenting, food security and health services mediated by feeding patterns on nutritional status showed an inner weight coefficient of 0.13. Since the direct effects of knowledge, parenting, food security and health services on feeding patterns were significant, the indirect effects of knowledge, parenting, food security and health services mediated by feeding patterns on nutritional status was significant.

Status gizi

FIGURE 6 Tests of infectious disease effects on nutritional status

Tests of direct effects of infectious diseases on nutritional status showed an inner weight coefficient of 0.35 with a t-value of6.24. Since the t-value was > 1.96, then there was a significant direct effect of infectious diseases on nutritional status. A negative value of the inner weight indicated a negative relationship between the two. It means that the lower the infectious disease, the better the nutritional status would be.

Tests of indirect effect of knowledge as mediated by feeding patterns on nutritional status showed an inner weight coefficient of 2.33. Since the direct effects of knowledge on nutritional status and feeding patterns on nutritional status were both significant, then the indirect effect of knowledge as mediated by feeding patterns on nutritional status was significant. Thus, the higher the knowledge, the better the feeding patterns and indirectly the better the nutritional status would be.

Nutrients obtained from food intake have strong effects on the immune response and resistance to infection. This was evidenced by the results of recent research showing that the provision of nutrition and anabolic hormones may regulate resistance of the host to bacterial infections. Malnutrition is a complicated and interrelated problem. Direct and indirect causes of under-nutrition in children under five play their roles, which are varied and different in each area. Infectious diseases and lack of nutritional intake are interrelated. Malnourished children will have a decreased immune system, being susceptible to infectious diseases.

Tests of indirect effect of socioeconomic status as mediated by infectious diseases on nutritional status showed an inner weight coefficient of 0.35. Since the direct effects of socioeconomic status on nutritional status and infectious diseases on nutritional status were both significant, then the indirect effect of socio-economic status as mediated by of infectious diseases on nutritional status was significant. Thus,

Effects of exogenous variables on the endogenous variables can be determined on the basis of the direct, 1204

the higher the socio-economic status, the lower the infectious diseases and indirectly the better the nutritional status would be.

Data processing generated the following structural equation: POLAMAKA= 0.140*PENGETAH + 0.200*ASUH + 0.0891*PANGAN 0.139*YANKES, Errorvar.= 1.723 , R² = 0.143

Tests of indirect effect of parenting as mediated by feeding patterns on nutrition showed an inner weight coefficient of 2.33. Since the direct effects of parenting on nutritional status and feeding patterns on nutritional status were both significant, then the indirect effect of parenting as mediated by feeding patterns on nutritional status was significant.

INFEKSI= - 0.0591*POLAMAKA 0.0729*SOSEK, Errorvar.= 0.204 , R² = 0.0976 SGIZI = 0.0709*POLAMAKA 0.551*INFEKSI + 0.0689*PENGETAH + 0.0104*SOSEK + 0.147*ASUH 0.0394*YANKES, Errorvar.= 0.319

The significance of the structural equation is shown in Table 5.10, which also contains the t-values and the coefficients of the structural model. It is shown that there are several insignificant equations, leading to small coefficient of determination (R2) of the structural equation. It means that variation in exogenous variables in the equation were less capable of explaining the changes in variation in endogenous variables. Thus, further processing was required to obtain the best model. Data of those causal relationships showed that feeding patterns had the strongest effect. The growing children under five are very active, requiring relatively more nutrients of higher quality. The adulthood outcome of the growth phase greatly depends on the nutritional conditions and health during infancy. Brain development that determines the intelligence level in the adulthood is largely determined by the growth during childhood. Malnutrition in the growth phase will produce an adult human with inferior traits. Thus, children under five should be provided with a major portion of the family food distribution, rather than receiving the food left. Food consumption has an effect on nutritional status of an individual. A high nutritional status can be achieved when the body is supplied with sufficient

Tests of indirect effects of food security as mediated by feeding patterns nutritional status showed an inner weight coefficient of0.26. Since the direct effects of food security on nutritional status and feeding patterns on nutritional status were both significant, then the indirect effect of food security as mediated by feeding patterns on nutritional status was significant. Thus, the better the food security, the better the feeding patterns and indirectly the better the nutritional status would be. Tests of indirect effect of health services as mediated by feeding patterns on nutritional status showed an inner weight coefficient of 2.33. Since the direct effects of health service on nutritional status was not significant and feeding patterns on nutritional status was significant, then the indirect effect of health services as mediated by feeding patterns on nutritional status was not significant. Under-nutrition is a manifestation of a shortage of food or nutrient consumption, which has broad impacts and is measured by nutritional status. Nutritional problem is closely related to the food problem. The problem of food relates to food availability or food insecurity, which are currently the issues of food security.

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nutrients for efficient use, allowing physical growth, brain development and ability to work to achieve optimal health.

The first cause of malnutrition was that babies and children did not receive balanced and nutritious foods. The best natural food for babies is breast milk, and after 6 months of age they should be given complementary foods in the appropriate amount and quality. Good complementary foods not only contain enough energy and protein, but also iron, vitamin A, folic acid, vitamin B and other vitamins and minerals. Appropriate and good complementary foods can be prepared at home. In families with low levels of education and knowledge, a child has to be satisfied with simple foods not meeting their nutritional needs due to ignorance.

STRATEGIES FOR IMPROVING NUTRITIONAL STATUS OF CHILDREN UNDER FIVE IN COMMUNITIES Nutritional problems are divided into macro- and micro-nutritional problem. Macro-nutritional problems are mainly caused by a shortage or an imbalance of energy and protein intake. Manifestations of macro-nutritional problems in children under five are marasmus, kwashiorkor or marasmickwashiorkor and further disruption of growth and development of children. Improvement of the macro-nutritional problems is aimed at reducing the macro-nutritional problems. It is mainly carried out by addressing the problem of lack of protein energy, especially in poor rural and urban areas; improving the family nutrition status; increasing community participation; improving the quality of nutrition-related services both in Puskesmas (community health center) and Posyandu; and increase consumption of energy and protein of malnourished children under five. Strategies to overcome the macronutritional problems are implemented by empowerment families in terms of health and nutrition, community development in nutrition, empowerment of health personnel and direct subsidies.

The second cause of malnutrition as that children do not receive adequate nutrition care. Results of the present study showed that parenting had an effect on the incidence of malnutrition. Children who are cared for with affection by their own mothers, especially those mothers who are educated, understand the importance of breastfeeding, the benefits of Posyandu and cleanliness, despite the poverty, are healthier. The factor of maternal education had an effect on the quality of child care. On the contrary, some malnourished children were turned out to be cared for by their grandparents or caregivers who were poor and uneducated. The third cause of malnutrition was that children suffered from infectious diseases. There was a mutual relationship between the incidence of infectious diseases and malnutrition. Malnourished children would have a decreased immunity, leading to vulnerability to infectious diseases. On the other hand, children suffering from infectious diseases would tend to suffer from malnutrition.

Results of the present study showed that malnutrition was affected by various interrelated factors. However, it was directly affected by three factors: children not receiving sufficient nutritious food, children not receiving adequate nutrition care and children possibly suffering from infectious diseases.

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In order to overcome nutritional problems based on the findings of the present study, strategies should developed for improving nutritional status of children under five in the form of an action plan for the family, community and the government. Measures to be taken include revitalizing the functions of Posyandu; increasing community and family participation in monitoring the growth and development of children; early recognizing and overcoming infants with impaired growth through Posyandu revitalization; improving the ability of personnel in the management of malnutrition to support the function of Posyandu managed by the community through revitalization of Puskemas; directly tackling nutritional problems in vulnerable groups through nutritional intervention (supplementation), such as capsules of Vitamin A, complementary foods and supplementary foods; realizing nutrition-conscious families through nutrition promotion, advocacy and dissemination of healthy and nutritionally balanced foods and clean and healthy living; building crosssectoral cooperation and partnerships with the private sector/business and the community for resource mobilization in order to increase the purchasing power of families to provide healthy and nutritionally balanced foods; and reactivating the Alert System for Food and Nutrition (ASFN) through revitalization of the ASFN and Malnutrition Early Alert System (MEAS), evaluated by assessment of the Early Alert System data.

2.

3.

CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS Conclusions 1. In City of Kediri, there were a higher number of children under five with normal and over-

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nutritional status, and some with under-nutritional status; however, the under-nutritional cases were not alarming, but still required attention, since there was one severely malnourished child. Factors affecting nutritional status of children consisted of factors with direct effects, consisting of feeding patterns and nutritional status, and factors with indirect effect, including knowledge, socioeconomic status, parenting, food security and health service. The factor with the greatest effect was feeding patterns. Strategies to overcome nutritional problems of children under five include: 1) Revitalizing the functions of Posyandu; increasing community and family participation in monitoring the growth and development of children; early recognizing and overcoming infants with impaired growth through Posyandu revitalization. 2) Improving the ability of personnel in the management of malnutrition to support the function of Posyandu managed by the community through revitalization of Puskemas; 3) Directly tackling nutritional problems in vulnerable groups through nutritional intervention (supplementation), such as capsules of Vitamin A, complementary foods and supplementary foods; 4) Realizing nutrition-conscious families through nutrition promotion, advocacy and dissemination of healthy and nutritionally balanced foods and clean and healthy living;

5) Building cross-sectoral cooperation and partnerships with the private sector/business and the community for resource mobilization in order to increase the purchasing power of families to provide healthy and nutritionally balanced foods; 6) Reactivating the Alert System for Food and Nutrition (ASFN) through revitalization of the ASFN and Malnutrition Early Alert System (MEAS), evaluated by assessment of the Early Alert System data.

2.

those from families with middleand upper-socioeconomic status. The practical implication of the findings is that the Health Office of Kediri City should implement the 6 strategies to overcome nutritional problems in children under five as described above.

Recommendations 1.

2.

Implications 1. Theoretically, identification of malnourished children from families of middle- and uppersocio-economic status requires further investigation of the problems of feeding patterns in malnourished children, especially

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The Health Office of Kediri City should make and implement policies for handling nutritional problems of children under five with reference to the six strategies formulated in the present study. Future researchers are recommended to further investigate the finding of under-nutritional children from families of middleand upper-socioeconomic status to with regard to feeding patterns in under-nutritional children, especially those from families of middle- and upper-socio-economic status.

THE EFFECTIVENESS OF SEX EDUCATION TO KNOWLEDGE ABOUT THE DANGERS OF ADOLESCENT PREMARITAL SEX Agus Supinganto(1) Kurniatillah (2) INSTITUTE OF HEALTH SCIENCE YARSI MATARAM Email: [email protected] Abstract Sex education is one way to prevent the abuse of sex like unplanned pregnancy and sexually transmitted disease. A preliminary study carried out at the high school Model Nurul Jannah NW Ampenan, taken 10 students randomly, obtained the vast majority (80%) of the students knowledge about the dangers of premarital sex less. The purpose of this research was to analyze the effectiveness of sex education to knowledge about the dangers of adolescent premarital sex before and after getting the sex education. Premarital sex behavior is a behavior driven by sexual desire, either with its opponents or by sex. These forms of behaviour can be manifold, started feeling attracted to conduct dating, flirt, and had intercourse. The type of research used in the study was quasi experimental design with a non equivalenet control group. Sample as many as 30 research groups experimental and a control group of 30 adolescents who are in grab in total population. Analysis using the wilcoxon test at α 5%. The results showed before given sex education in experimental group of 19 people (63,3%) enough knowledge and 11 people (36.7%) good knowledge, whereas in the control group of 16 people (53,3%) and enough knowledge of 1 people (3.3%) good knowledge. After being given sex education in experimental group 9 (30,0%) and good knowledge of 21 people (70,0%) enough knowledge, whereas in the control group of 12 people (40,0%) less knowledge and 18 people (60.0%) enough knowledge about the dangers of premarital sex. Wilcoxon test results indicate the value of the p value = 0.05 means there's 0.000 < the effectiveness of sex education to knowledge about the dangers of teenage premarital sex. Recommended sex education should be carried out continuously to improve knowledge about the dangers of teenage premarital sex. Key words: : Premarital sex is education, knowledge, adolescent.. The spread of HIV and AIDS cases are found to originate from all regencies/cities in West Nusa Tenggara (NTB) province and has hit various community groups from both high-risk behavior (premarital sex, injecting drug / injecting drug users, migrant workers, etc.) to groups of the general population such as farmers and homemakers stairs. HIV and AIDS cases in NTB has been informed of all age groups including infants and toddlers with the largest proportion (> 85%) to attack the productive age (15-49 years). Since it was first discovered in 2001 the number of people living with HIV in NTB province until 2008 was 137 people. While the number of AIDS patients since it was first found in 1991 to 2008

PRELIMINARY Teens is a period of life in which the individual happens to find a psychological exploration of identity. At the time of transition from childhood to adolescence, individuals begin to develop self and self-concept becomes more distinct. Teens begin to see themselves with assessment and personal standards, but less in the interpretation of social comparison. Teens have a unique period, one of which is the nature want to imitate something that is seen, the state, as well as the environment. Besides, teens have a need for sexual health, which meet the needs of sexual health is very varied. (Kusmiran, 2013)

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was 83 people (Prov Dinas Kesehatan. NTB 2013). While the distribution of cases of HIV per-District in the city of Mataram in 2001-August 2014 the highest in the city of Mataram 89 cases, 27 cases Cakranegara, Ampenan 16 cases, Pretest Sekarbela 9 cases, Selaparang 2 cases, and Sandubaya 2 cases. Meanwhile, the 01 highest distribution of AIDS cases in the01 region Cakranegara 49 cases, Mataram 48 cases, 24 cases Ampenan, Sekarbela 7 cases, Selaparang 6 cases, and 1 case Sandubaya. The spread of HIV / AIDS and STIs at most about at-risk group high-risk couples as much as 1,358 people visit infection sexulay services (IMS) based in the city of Mataram and according to risk factors of HIV/AIDS cases in heterosexual as many as 162 cases. Among teens also potentially infected with HIV / AIDS, therefore it is important for the prevention dlakukan based early education. Based on interviews in High School obtained Model Ampenan sex education and adolescent health problems has never been performed or health promotion counseling from the health department about sex education or reproductive health education. Tiu addition, there are five students were expelled from school for married and could not continue her education back. Based on the results of a preliminary survey conducted in SMA Model Nurul Jannah NW Ampenan to 10 students 3 students obtained good knowledge about the dangers of premarital sex and 7 students did not know the dangers of premarital sex and knowledge of adolescents about the dangers of premarital sex is still in the poor category. Objective To assess the effectiveness of sex education to adolescents knowledge about the dangers of premarital sex in class X and XI Model Nurul Jannah Ampenan. RESEARCH METHODS This research uses design Quasi Experimental Design "Non Equivalenet Control Group" is sampled in this study were observed before treatment, then

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after the treated sample was observed back (Hidayat, 2008). The study design shown below: Experimental group The control group

Treatment

Post test

Figure 1: Thex form of the draft02Non Equivalent Group on Quasi-02 Experimental Research Design (Notoatmodjo, 2012) Description : 01 : Pre test 02 : Post test P: Treatment This study will be conducted in SMA Model Nurul Jannah NW Ampenan with a population of 60 people with large samples in this study were all students of SMA Model Nurul Jannah NW Ampenan numbering 60 people and divided into 2 groups, namely 30 experimental group and 30 groups control the sampling technique using the method with Total Non-Probability Sampling. Data collection instruments in the study using a questionnaire consisting of two parts, namely respondent's identity and statements. Respondent data include gender, class, age, and address. The second part of the questionnaire on knowledge about the dangers of premarital sex, number about 25, using an ordinal scale and use the answers True = 2, one = 1 with a score of 76100% answer scores good knowledge of juvenile, adolescent knowledge score of 56-75% sufficient and score <55% knowledge of adolescents less. The validity of the test results of a questionnaire on knowledge of adolescents about the dangers of premarital sex performed on 20 respondents with the results range from 0.396 to 0.793 means that the questionnaire is said to be valid because the value is greater than rtabel rhitung is 0.361. Based on the results of the questionnaire reliability test knowledge premarital sex with alpha croanbach or α = 0.880, meaning that the questionnaire

is reliable because the alpha value which is greater than 0.396. Data collection includes primary data obtained directly from respondents Group Knowledge Experime Control No Before Sex n Education t N % N % 1 Good 0 0,0 1 3,3 2 Enough 1 63,3 16 53, 9 3 Less 1 36,7 13 43, 1 Total 3 100 30 100 0 through questionnaire tool. Once that is done the provision of counseling and debriefing for ± 1 hour. Then proceed with the deployment of the same questionnaire after counseling. Secondary data is data obtained from various sources, including the number No of students and number of teachers who obtained the book recapitulation students. Before collecting the data, 1 researchers explain the intent and purpose of the data collection. Data 2 analysis is done for ease in interpreting the results. Data is 3 processed in advance with the aim of converting data into information. Then the data is processed using SPSS 16.0 software program. There are several activities carried out by researchers in data processing is divided into 6 stages: Checking (Editting), Marking (coding), Sorting, Data Entry and Tabulating. Once the data is collected using questionnaires, further data processing and analysis of data using two different test for paired samples is the Wilcoxon test program using the tools SPSS.20 In this study, data analysis performed by the analysis of univariate and bivariate. Bivariate analysis in this study presented was conducted to determine differences in the level of knowledge before and after being given sexuality education using the Wilcoxon Match Pair Test (called the Wilcoxon test) is a refinement of the test mark (sign test).

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Wilcoxon test was used to test the hypothesis of significant comparative significance or two samples were dependent (paired) with ordinal scale data. RESEARCH RESULT Prior to the study conducted by researchers before ent identification of students' knowledge about the dangers of premarital sex before getting sex education in the experimental group and the control 3 group Table31: Distribution of Knowledge Students About Dangers of Premarital Sex Before Getting Sex Education Source: Primary Data, 2015 Table 1 above shows before being given sex education in the experimental

Knowledge after sex education Good Enough Less

Group Experime Control n t N % N % 9 30, 0 0,0 0 21 70, 1 60,0 0 0 0,0 1 40,0

8 2

Total

30

100

3

100 0

group, respondents who have sufficient knowledge of 19 people (63.3%) and only 11 (36.7%) less knowledgeable. Whereas in the control group after sex education, respondents who have sufficient knowledge of 17 people (56.6%) and only 13 (43.4%) less knowledgeable. Selian the researchers to identify the student's knowledge about the dangers of premarital sex after getting sex education in the experimental group and the control group Table 2: Distribution of Knowledge Students About Dangers of Premarital Sex After Getting the Sex Education Experiment Group and Control Group

Source: Primary Data, 2015 Table 2 above shows after a given sex education in the experimental group, respondents who have sufficient knowledge of 21 people (70.0%) and only 9 (30.0%) knowledgeable either. Whereas in the control group after sex education, respondents who have sufficient knowledge of 18 people (56.6%) and only 12 (43.4%) less knowledgeable. Analysis of students' knowledge before and after the sex education in the experimental group and the control premarital in High School Model NW Nurul Jannah first Ampenan researchers conducted an analysis of Knowledge Students In Experimental Group Before And After Sex Education Table 3. Analysis of Differences Knowledge Students Before and After Getting the Sex Education In Experiment Group The The Experiment Knowledge of Group No Sex Before After N % N % Education 1 Good 0 0,0 9 30, 2

Enough

19 63, 2

3

Less

11 36, 0

Total

30 100 3

Uji Wilcoxon : p=0,000< 0,05 Source :Primary Data, 2015 Based on Table 4 above shows that out of 30 respondents in the experimental group had sufficient knowledge of 19 people (63.3%) and only 11 (36.7%) were less knowledgeable before being given sex education. Meanwhile, after being given sex education in most of the experimental group had sufficient knowledge of 21 people (60.0%) and only 9 (30.0%) knowledgeable either. Results of statistical analysis using Wilcoxon test as in the experimental group in the table above, obtained p value = 0.000 <0.05, which means that H0 rejected and H1 accepted that the

provision of effective sex education affect adolescents knowledge about the dangers of premarital sex in high school Model Nurul Jannah NW Ampenan.Selanjutnya researchers conducted an analysis of Knowledge Students In Control Group Before and After premarital Sex Educators

Table 4: Analysis of Differences Knowledge Students Before and After Getting the Sex Education In the control group The Control Grou The Knowledge No of Sex p Education Before After N % N % 1 Good 0 0,0 0 0,0 2 Enough 1 56, 1 60, 7 6 3 Less 1 43, 1 40, 3 4 100 Total 3 100 3 0 Uji Wilcoxon : p=0,079>0,05 Source 0:Primary Data, 2015 70, Based on Table 4 above shows 3 that10out of 30 respondents in the control 0,0 group were not given sex education after 7 the pre-test have sufficient knowledge of 100 17 people (63.3%) and only 13 (36.7%) 0 less knowledgeable. Whereas in were the control group were not given sex education after the post-test mostly have sufficient knowledge of 18 people (60.0%) and only 12 (40.0%) knowledgeable either. Results of statistical analysis using Wilcoxon test as in the table above, obtained pvalue value = 0.079> 0.05, which means that H1 was rejected and H0 is accepted that it is not effective if not given the knowledge of adolescent premarital sex education in high school Model NW Ampenan Nurul Jannah. DISCUSSION 1. Knowledge Students About Dangers of Premarital Sex Before Getting Sex Education

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8

0

2

0

0

Results of research conducted in SMA Model Nurul Jannah NW Ampenan, shows that knowledge of the 30 respondents who have sufficient knowledge in category 19 (63.3%) and only 11 (36.7%) less knowledgeable and no one has the knowledge good. Whereas in the control group after sex education, respondents who have sufficient knowledge of 17 people (56.6%) and only 13 (43.4%) less knowledgeable. Sex education is teaching efforts, awareness and information about issues relating to sex and mating instincts. It was intended that if the child had grown into a young man and can understand the affairs of life. Sex education is to provide knowledge about changes in the biological, psychological, and psychosocial services as a result of human growth and development. In other words, sex education is basically an attempt to provide knowledge about the function of reproductive organs by implanting the morals, ethics, and a commitment to prevent abuse of the reproductive organs is thus, sex education can also be called education family life (Pujiyarta, 2010). Research conducted by Siti Munawaroh (2008) in SMA Ngrayun many background factors sex behavior in adolescents, among others, the lack of guidance from parents, the selection of inappropriate environment, lack of education of religious knowledge, the lack of participation of teachers in schools. Free sex today this is considered normal, whereas with free sex is destroying the social values, so that sex education is very important. Sex education can be done through a variety of media, the exact origin of the principle means of administration because adolescence is a time of learning. Although the youth get a chance to develop their potential, but still need supplies, counseling and guidance of parents, educators and the support of a conducive environment. Equipping young people with a true concept of life is indispensable in the

process of self. With the guidance of forming teenagers feel confident because of it's ability untested teenagers in the face of life's challenges. Results of this research is that knowledge of the students is still relatively low and psychologically students will be more with peers and more trusting friends than their parents, so that if one chose friends can lead to understanding, especially in terms of sexuality students imprecise and prone to hazards sex , Socially oriented things that are not right, then it can cause teenagers imitate and follow. The lack of information services on reproductive health education, cultural influences, and low morality that make teenagers vulnerable to premarital sex. Sex education with the lecture method is effective in increasing knowledge about premarital sex adolescent premarital sex as a topic of interest to students in adolescence. Teens is a period that includes the process of development where there is a change in sexual motivation, integrity ego, relationships with parents, other people and the ideals pursued. Therefore we can conclude the topic is being experienced by the students so that the lecture method may be the center of attention of students to grasp. 2. Knowledge Students About Dangers of Premarital Sex After Getting Sex Education Results of research conducted in SMA Model Nurul Jannah NW Ampenan, shows that knowledge of the 30 respondents who have sufficient knowledge of 21 people (70.0%) and only 9 (30.0%) knowledgeable both in the experimental group. Whereas in the control group after sex education, respondents who have sufficient knowledge of 18 people (56.6%) and only 12 (43.4%) less knowledgeable. Results of research conducted by Avin Fadila et al. (2009) information can be used to change the behavior of a person's knowledge and in accordance with what is desired information providers and information, can lead to

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goal attainment behaviors as desired person. The technique of giving information must be tailored to the needs and motivations memcerna audience for information. In this case, the parents prefer information that does not require high-quality argument, but prefers clear and accurate information. As expressed by Bruess and Greenberg (1981) that one of the ways sexual education is through the provision of clear and precise information. Another reason is the fact that the participants expressed their parents have a great responsibility for the development of their children, then the clear and precise information without requiring argumentative indispensable. This is reinforced by the opinions of Masters and Johnson (1993) that parents are the best source of information for children, especially those related to sexual knowledge. Testing the hypothesis suggests that sex education can influence adolescent attitudes toward premarital sex, in which participants receive sexual education to change attitudes. Participants who initially have a tendency positive attitude toward premarital sex changed attitude after getting education (Rizki et al, 2010). Change of attitude in the group given sexual education is most likely because the participants had not received sexual education, so that when the video aired participants to focus and pay attention to completion. Pendidikanseks is one way to reduce or prevent the sexual abuse, in particular to prevent the negative impacts are not expected as an unplanned pregnancy, sexually transmitted diseases, depression and feelings of sin (Sarwono,2005). The results show that knowledge itself influenced by formal education. Knowledge is very closely related to education, where it is expected that the sex education given the students will be more knowledgeable knowledge. It must be emphasized, does not mean someone who is less educated knowledgeable

low. It is given that the increase is not much knowledge gained from formal education, but also can be obtained through non-formal education. Knowledge someone about something contains two aspects: positive and negative aspects. Both of these aspects will determine the knowledge and attitude of someone getting a lot of positive aspects and objects are known, it will cause more positive attitude toward a particular object. 3. Analysis of Differences Knowledge Students Before and After Sex Education a. Differences Knowledge Students Before and After Sex Education In the group Experiment The results showed 30 respondents in the experimental group before being given sex education available, 19 (63.3%) of them have enough knowledge in the category, 11 (36.7%) have less knowledge in the category and no one has a good category prior to sex education. Meanwhile, after being given sex education obtained, only 21 persons (70.0%) of them have enough knowledge in the category, 9 (30.0%) have knowledge in both categories. Results of statistical analysis using Wilcoxon test as in the experimental group in the table above, obtained p value = 0.000 <0.05, which means that H0 rejected and H1 accepted that the provision of effective sex education affect adolescents knowledge about the dangers of premarital sex in high school Model Nurul Jannah NW Ampenan. Results of research conducted by Santi et al, that sexuality education given to the control and experimental groups showed no significant difference in the control group were not given sexuality education because it is influenced by cognitive function, and vulnerable penek relative time between Pree-test and post test in the experimental group that makes adolescents have not been able to make changes as a whole so that no formation of cognitive behavioral, affective and motivation of adolescents. Given the

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understanding alone is not sufficient to bring the behavior of adolescents positive. these changes can occur with some likelihood that, in the category of internal and external. Internal categories that are derived from the inner adolescents (behavior, response, ability, interest and genetic teenagers). External categories namely, come from outside teens like social environment (society and peers) that will ultimately affect the emotions and behaviors are different because each teen has a different understanding of the underlying causes of each category. The results showed that the situation perceived by adolescents is confirmed by the results of questioning conducted by researchers to all young people in the control group is to study the response of adolescents who were not given sex education is only given Pree-test and post-test, there was a teenager gave a positive response and related negative about sex, a great curiosity makes them very want the new knowledge and new experiences. Therefore, sex education was very important to the school gradually and continuously like to follow sex education in biology, and ethics to avoid deviations organ to prevent the dangers of premarital sex so as to influence the knowledge and attitudes of students towards the impact of what will be appears, moreover, schools can also collaborate with health oiinstitusi to promote reproductive health in order to broaden students' positive behavioral changes in her life. b. Differences Knowledge Students Before and After Sex Education In Control Group The results showed 30 respondents in the control group before being given sex education available, 17 (56.6%) of them have enough knowledge in the category, 13 (43.3%) have less knowledge in the category and no one has a good category , Meanwhile, after being given sex education obtained, only 18 (60.0%) of them have enough knowledge in the category, 12 (40.0%)

have knowledge in the poor category and no one has a good knowledge after sex education. Results of statistical analysis using Wilcoxon test in the table above, obtained p value = 0.079> 0.05, which means that H1 H0 rejected and accepted that the ineffectiveness of adolescent knowledge if not diberrikan premarital sex education in high school Model NW Ampenan Nurul Jannah. Results of research conducted Rizki et al (2010) in SMA N Ambarawa, showed that the changes in behavior of teenagers is because the respondents already have more knowledge about premarital sex, which initially had never received any such material because participants felt lay and taboo when looking for information on sexual education, according to the stage of development of middle adolescence (1518 years), with a characteristic, among others: Looking for identity, emergence of a desire for a date, Has a deep sense of love, develop the ability to think abstractly and Fantasy about sexual activity. In this study the samples used have a range of 16-18 years of age, at this age adolescents are seeking selfidentity, and start fantasizing about sexual activity, which is why they often seek out and try new things. They are looking for information to be known through a variety of sources, most of the participants more often seek knowledge and information about sexuality through electronic media, internet and peers. This is why they get the knowledge that can not be controlled well, sometimes curiosity they missed so that the subject looking into a variety of existing sources, but these resources can not be justified truth. Earlier so they do not understand about the sex organs of men and women, menstruation, ejaculation, fertilization until birth, type of sexual behavior, and the impact of biological, social, psychological premarital sex, they are now becoming understood. The results showed that sex education in schools should not be separated from education in general, and

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is integrated, sex lessons can be incorporated into biology, health, morals and ethics are gradually and continuously. They also made an emphasis on moral education, though not need as much detail as religious education, so that sex pedidikan accepted as a science student who will not diperaktikkan prematurely. In pedidikan child sex is not enough to see and hear it once or twice, but it should be gradual and sustained. Therefore, sex education should be an important part of and education in schools. Parents educators must correct the incorrect information regarding the explanation accompanied risk sexual behavior is wrong. Therefore, understanding the teenage students in schools about sex may have been affected by the first, peers so teenagers more often follow their peers who make teenagers abusing sex education itself, both influenced by the school environment and at home, if sex education is given properly and with the time relatively long, the students will more quickly understand and influence the behavior of the student, the student will be more inclined to think towards more positive again, a third attention of parents who kuran it makes adolescents more closely with the external environment so easy to accept things that are positive and negative from the outside environment, that a parent must give more attention to the teenagers who have started to want to find identity with great curiosity about all things by introducing and providing sex education from an early age that are not easily affected by things that are negative outside. Circumstances perceived by adolescents is confirmed by the results of questioning conducted by researchers to all young people in the group to study the response of a teenager after getting the sex education materials. Teens responded positively associated with the material provided, they were delighted at getting new knowledge, because of which initially do not know now know, and are reluctant to perform premarital

sexual behavior after the direct knowledge of the impact that would arise. CONCLUSION Based on the results of this study concluded that before being given sex education in the experimental group are in most categories have sufficient knowledge of the number of 19 people (63.3%), and the control group had the highest category of knowledge is less than the number of 16 people (53.3% ). Meanwhile, after being given sex education at the highest knowledge of the experimental group was 21 people (70.0%) proving the provision of sex education before and after, effectively provided in schools and in the control group the most knowledge are sufficient 16 (60.0%) showed no improvement significant in the control group were not given sex education. Wilcoxon statistical analysis of the results of the test are given sex education in schools is very effective because there is the influence of the experimental group who received sex education with p value = 0.000 <0.05 or H1 accepted and H0 is rejected. REFRENCE Eva Ellya Sibagariang, Dkk. (2010). Kesehatan Reproduksi Wanita. Trans Info media. Hidayat, A. Aziz Alimul. (2008). Riset Keperawatan dan Teknik Penulisan Ilmiah. Jakarta : Salemba Medika. Ida AC, Manuaba, Dkk. (2009). Memahami Kesehatan Reproduksi Wanita Edisi 2. Jakarta. EGC. Kusmiran, Eny. (2013). Kesehatan Reproduksi Remaja dan Wanita. Jakarta. Salemba Medika. Machfoedz, Ircham. (2010). Metodologi Penelitian Kuantitatif & Kualitatif. Yogyakarta: Penerbit Fitramaya. Marmi, S.ST. (2013). Kesehatan Reproduksi. Yogyakarta: Pustaka Pelajar.

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Miqdad, A.A. (2001). Pendidikan Seks Bagi Remaja Menurut Hukum Islam. Yogyakarta : Mitra Pustaka. Notoatmodjo. (2012). Metodologi Penelitian Kesehatan. Jakarta: Rineka Cipta. Nursalam. (2008). Konsep dan Penerapan Metodelogi Penelitian Ilu Keperawatan Edisi 2. Jakarta: Salemba Medika. Pinem, Saroha. (2009). Kesehatan reproduksi dan Kontrasepsi. Jakarta: Trans Info Media. Poltekkes Depkes Jakarta I.(2012). Kesehatan Remaja : Problem dan solusinya. Jakarta. Salemba Medika. Raditya. (2008). Materi Pendidikan Seks. BKKBN.go.id. Tanggal 16 Desember 2014. Sarwono S. W. (2013). Psikologi Remaja Edisi Revisi cetakan 16. Jakarta: Rajawali Pers. Setiadi. (2007). Konsep dan Riset Penelitian Keperawatan, Yogyakarta: Grada Ilmu Syaifuddin, H. (2011). Anatomi Fisiologi Edisi 4. Jakarta: EGC. Wawan, A. dan Dewi M. (2011). Teori & pengukuran Pengetahuan, Sika, dan Prilaku Manusia. Yogyakarta: Nuha Medika.

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Out Patient Physical Exercise For Heart Failure Patients More Effective In Improving Activity Daily Living Than Functional Capacity Erni Tri Indarti, Heru Wahyudi Medical and Surgery Nursing Department, StiKes Satria Bhakti Nganjuk, Panglima Sudirman VI, Nganjuk 64421, Email [email protected] Abstract The out patient physical exercise was the program exercise improves sceletal muscle ability especially hands and foot muscle. This also improves ability of heart contraction that lead to the improvement of functional capacity and activity daily living among cronic heart failure patient. Heart failure contributes to decrease ability of activity someone. The purpose of this study is to investigate impact of out patient physical exercise in chronic heart failure patients to functional capacity and activity daily living. This study utilised a quasy – experiment research design with pre-test post-test approach. Samples were 60 chronic heart failure patients from two Primary Health Care which divided into an intervention group of 30 people and a control group of 30 people with purposive sampling. Data was taken in two stage. The first stage measured fuctional capacity and activity daily living before the intervention. The second stage measured fuctional capacity and activity daily living after interventions for eight weeks. Data was analysed using Manova. The finding showed ρ value functional capacity =0,004 and ρ value activity daily living ρ value=0,000. The out patient physical exercise improving functional capacity and activity daily living. The out patient physical exercise more effective in improving activity daily living than functional capacity. Keywords: Chronic heart failure, Out patient physical exercise, Fuctional capacity, Activity daily living A. Background World Health Organization (WHO) reports that approximately 5.7 million Americans suffer from chronic heart failure with an incidence of 4.7% of women and 5.1% of men and nearly five percent of patients with chronic heart failure who are hospitalized. In Indonesia, there were approximately 4.3 million people with heart failure, with 500,000 new cases each year (1). In East Java, in 2011 the incidence of heart failure patients 257 patients (2). Clinical manifestations are often present in patients with chronic heart failure is a decrease in exercise tolerance, and shortness of breath when activity (3,4,5). Both of these conditions result in inability to perform daily activities, disrupt and restrict employment or preferred activity, resulting in decreased functional capacity of patients. The stronger the

person's capacity fungional then decreased maximal oxygen consumption someone who is used to move, so that the activities undertaken are getting lighter, especially activity daily living (6). Patients with heart problems require a comprehensive rehabilitative program to restore the physical ability after the attack and prevent repeated attacks, resulting in increased functional capacity (7,8,9). Out-patient physical exercise performed immediately after the patient's departure from the hospital (10). Physical exercise increases the metabolic and functional capacity of skeletal muscle, increased peripheral response and reduce the workload of the heart. Increased muscle energy, increased muscle mass, improved oxygen supply, motor changes and biochemical adaptation can increase oxidative capacity. Physical exercise trained skeletal muscles and heart muscles thus increasing the strength of the heart muscle. Increasing the strength of the heart

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muscle will improve cardiac performance and increased cardiac output. Increased cardiac output and decreased fatigue becomes a major factor that affects the functional capacity (9). The increase in cardiac output resulting increased supply of oxygen in the body thereby reducing shortness of breath. Increased cardiac output, increased muscle strength, decreased fatigue, decreased shortness of breath and reduced load activity will result in an increase in the ability to perform activities of daily living, especially activity. Improved functional capacity in patients with chronic heart failure requiring adaptation system of the body to physical exercise conducted patients with chronic heart failure. The system is based on the theory of adaptation adaptation Roy include component inputs, processes and outputs that takes adaptation training for 2 months (11,12). Activity daily living in patients with chronic heart failure seen from the independence of heart failure patients to perform daily activities. Self-care agency in patients with chronic heart failure decreased as a long illness. Improved self-care agency patients with chronic heart failure can be improved with an increase in knowledge, attitudes, and infrastructure heart failure patients to perform physical activity. The purpose of this study determine the effect of physical exercise on the out- patient functional capacity and activity for daily living in patients with chronic heart failure. B. Research Methods This research is research quasy Experiment with Pre-Post Test Design. The sample in this study of patients with chronic heart failure who met the inclusion criteria of 60 people with 30 people in the intervention group and 30 control group. Sampling techniques in this study using purposive sampling with inclusion criteria of patients with chronic stable heart failure characterized by: no chest pain, no shortness of breath at rest, resting pulse rate 60-90 times / min and regular bilateral measured, systolic blood pressure 100 -150 mmHg and diastolic blood pressure of 6090 mmHg, aged between 45-65 years old, willing to be the respondent and stay one

house with one of the nuclear family (husband, wife, Children) (13). The intervention group received physical training guide book out patient, out patient Learning physical exercise, physical exercise There Pangawas patient out of one of the family members, monitoring every week. The control group received physical training guide book out patient, monitoring every 2 weeks. The research instrument used physical exercise guide book out patient before it is given to the respondent in 3 people with conducted trials characteristics similar to the respondents, stop watch brands Diamond series PC 2009, meter brands Gea and daily living activity questionnaire with the Barthel index (14) . Data were taken 2 steps. The first measure of functional capacity and activity for daily living before the intervention. The second stage after the intervention for 8 weeks. Monitoring every week in the intervention group and 2 weeks in the control group. Univariate analysis includes the mean, standard deviation, the lowest value, highest value and confidens interval of common data, functional capacity and activity for daily living. Bivariate analysis to determine differences in functional capacity and activity for daily living before and after interventions performed well in each intervention group and the control group Paired Samples Test. Differences in functional capacity and activity changes in daily living of patients in the control group and the intervention after intervention by Independent sample t test test

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C. Results and Discussion 1. Characteristics of Respondents Table 1. Distribution of Respondents by Age in Puskesmas Nganjuk and Berbek May to August 2014 (n=60) Variable N Maximum Median 95%CI pMinimum value Age. Group 30 45 65 62 55,790,001 Intervention 60,81 Age. Group 30 45 65 60,50 0,002 Control 55,7060,57 approximately 5.7 million Americans The results showed that the age range of the respondents in the suffer from chronic heart failure with an intervention and control group 45 years incidence of 4.7% of women and 5.1% of to 65 years. Cases of heart failure in the men and nearly five percent of patients United States 75% occurred in patients with chronic heart failure who are older than 65 years and were hospitalized hospitalized. The incidence of heart 80% over 65 years (15). The results are failure in Indonesia 4.7% of women and consistent with research Radi et al. 5.1% of men. The incidence of heart (2009) that patients with heart failure failure in a year is estimated from 2.3 to undergoing rehabilitative physical 3.7 per thousand people per year (17). training program in Jakarta RSCM The incidence of heart failure was higher average age was 54.9 years (16). With in males than in females. Women's age man will degrade heart function and lifestyle is more regular than men, so that disease risk for heart failure. The men are at higher risk of the disease that incidence of heart failure will increase in leads to heart failure (18). Lifestyle into the future due to the increasing life one risk factor for heart disease. Men expectancy and the development of have the habit of smoking. The content of therapeutic treatment of myocardial the TAR in cigarettes can lead to infarction resulted in improved survival. atherosclerosis. Besides TAR cigarette Respondents in the intervention smoke contains carbon monoxide into the group and control most of the male sex. blood vessels and stick to the walls of According to the World Health blood vessels capable of resulting in Organitation (WHO) reported that atherosclerosis. Table 2. Distribution of Respondents by Sex, Education, Occupation, Long-Suffering, Stage, Live One House And Ever / Never in Puskesmas Nganjuk and Berbek May to August 2014 (n=60) Variable Intervention Control Sum Percentage (n=30) (n=30) (%) F % f % Sex Male Female Education Not School Primary Yunior High School Senoir High School University

18 12

60 40

18 12

60 40

36 24

60 40

10 6 9 3 2

33,3 20 30 10 6,7

1 1 19 7 2

3,3 3,3 63,4 23,3 6,7

11 7 28 10 4

18,33 11,67 46,67 16,67 6,66

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Occupation House Wife Goverment Employees Student Self-Employed Farmers Private Long-Suffering < 1 Years > 1 Years Stage Stage 1 Stage 2 Stage 3 Live One House Husband Wife Child Ever / Never Info Ever Never

9 6 0 1 11 3

30 20 0 3,3 36,7 10

12 1 1 4 4 8

40 3,3 3,3 13,35 13,35 26,7

21 7 1 5 15 11

35 11,67 1,67 8,33 25 18,33

9 21

30 70

9 21

30 70

18 42

30 70

0 9 21

0 30 70

0 9 21

0 30 70

0 18 42

0 30 70

7 12 11

23,3 40 36,7

6 14 10

20 46,7 33,3

13 26 21

21,67 43,33 35

0 30

0 100

4 26

13,3 86,7

4 56

6,67 93,33

Respondents in the intervention group mostly schools, have never entirely get counseling about physical exercise and almost half of the respondents lived one house with his wife. Most of the control group had last school junior, almost entirely not received counseling about physical exercise and almost half of the respondents lived one house with his wife. The higher one's education is more easily receive information that the more knowledge you have, the less education would otherwise hinder the development of attitudes towards values or things that are introduced (19). Information or counseling is lighting or information submitted from the master to others. One of the factors that influence knowledge is information that is entered in a person it will be many knowledge gained (20). However, all individuals have self-care agency. Self-Care Agency needs to be improved by the individual because of the implementation of the Self-Care requires learning, knowledge, motivation and skills (21). The family is the primary support system that provides direct care either both healthy and diseased state of the other family members (22). Forms of

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family support in the form of informational support, assessment, instrumental and emotional. Support assessment for the provision of support, appreciation and attention to even the supervision of a therapy that is performed on the patient's family members. Emotional support is realized in the form of affection, their beliefs, attention, listen and be heard (23). Despite the intervention group had lower education than the control group and had never received counseling / information about physical exercise but physical exercise supervisory formed of one member of the family. The involvement of families here in the form of monitoring, motivate and remind the respondent to perform physical exercise. This family involvement in support of the respondents to adapt to physical exercise and a positive support system for respondent. In the intervention group almost half of the respondents worked as a farmer and a control group almost half of the respondents worked as a housewife. Heavy work, continuous and little rest can increase the work of the heart in pumping blood throughout the body to

meet the body's needs in the move (18). stage the functional capacity <8METs on Fast running, lifting heavy objects, exercise test for 3 weeks, shock or CHD running, swimming, riding down stairs, occurs during myocardial infarction (<6 climbing, cycling, skiing, gardening, months), the inability to monitor the playing with a lot of moving the arm is heart rate and can ischemia triggered by heavy activity (24). Activity farmers and excessive activity (25). The longer suffer housewives relatively strenuous activities from heart failure with stage 3, the that require energy> 250 k.kal / 6 hours. function of the heart will decrease, Activities farmers include heavy lifting resulting in a decrease in cardiac output. and moving the arm for many daily Decreased cardiac output will make the activities. Activities include walking heart stronger compensated to work again housewife fast and use a lot of arms for with the hope of being able to meet the activities. Farmers and housewives needs of his body, but with a chronic worked continuously and rest a little, so heart condition makes the heart fails to the heart has to work harder and faster to pump more. This is in accordance with meet the energy and oxygen in the body. the opinion Elices (2009) patients with If the heart is not able to be tolerated by chronic heart failure, heart output the body, the heart over time will fail. decreases or inadequate in the resting Respondents in the intervention state, whereas patients with mild heart group and control most of the suffering failure or failed diastolic heart becomes heart failure stage 3 with the longinadequate rainfall for example on suffering heart failure> 1 year. At this exertion or stress (26). 2. Effectiveness Out Patient Physical Exercise Statistical analysis with Manova showed out patient physical exercise effective more effective in improving activity daily living than functional capacity. Table 3. Effectiveness Out Patient Physical Exercise for Heart Failure Patients in Improving Functional Capacity and Activity Daily Living at The Working Area Health Centers And Health Centers Nganjuk Berbek May to August 2014 (n=60) Variable Group N Mean SD F p-value Functiona Interventio 30 49,8 4,53 8,82 0,004 l Capacity n 30 1 4,53 3 Control 30,7 Activity 30 7 0,59 0,000 Daily Interventio 30 0,59 6,60 Living n 6 12,8 Control 6 6,26 The intervention group and the control group doing physical exercises with the same motion and implementation guidance (duration, frequency) are the same. Out patient physical exercise increase cardiac output, blood circulation to the skeletal muscle and increase strength of skeletal muscle. Increased blood supply to skeletal muscle resulted in a gradual change in metabolism. In patients with heart failure is more dominant anaerobic metabolism

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occur in the body. Physical exercise is done in the intervention group and control dominated by movement of the feet and hands, thus increasing peripheral muscle strength, especially the feet and hands. Keep in mind that in doing daily living activity need for strong legs and arms, so that physical exercise increases the activity daily living in the intervention group and the control group. According Beswick et al. (2008) Physical exercise can improve metabolic

and functional capacity of skeletal muscle, aerobic metabolism, peripheral responses and decreased workload. Physical exercise regularly and consistently adapt the body's biochemical systems that increase muscle energy, increased muscle mass, improved oxygen supply and motor changes. Increased muscle mass and muscle strength will ease the burden during activity. Increased aerobic metabolism in the body will produce more energy and a decrease in lactic acid, resulting in lower chest pain on exertion (27). According to Melinda (2002) regular physical exercise can improve motor nerves due to an increase in cardiac output, so well supplied oxygen to the brain. Increased mitochondrial work will reduce energy consumption in the form of ADP and oxygen consumption during the move. Physical exercise regularly will adapt skeletal muscle is metabolically and functionally. Movement of physical exercise on the feet and hands in sequence and routine improve muscle strength feet and hands, so that the working muscles and decreased systemic decreased fatigue on exertion (28). The average increase in activity for daily living after physical exercise given out patient for 8 weeks in the intervention group was higher than the control group. Activity daily living is part of self-care agency. Every human being has the ability to improve self-care agency independently. Based on the theory of self-care agency Orem increase is influenced by self-care demand, nursing agency in the form of supportive educative system, enabling factors such as infrastructure and the driving factors such as family and peer support (31). Activity daily living is part of self-care agency. Every human being has the ability to improve self-care agency independently. Improved self-care agency will be maximized if there suportive educative system, infrastructure and support of family and peers. In the intervention group there is a module that contains the physical exercise guidelines

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on physical exercise as a motion picture infrastructure respondents do physical exercise. Explanation module physical exercise and physical exercise movements involving family will suportive educative system. Formation of physical training supervisor of one of the family members of the respondent to provide support, motivation and reminder of respondents in physical exercise, so that physical exercise done regularly. Supervisory physical exercise given skills measure pulse, respiration and blood pressure, thereby reducing the occurrence of complications. Monitoring conducted by researchers and research assistants once a week also increased the motivation of respondents to undertake regular physical exercise. The existence suportive educative system, infrastructure and support families maximally lead to increased activity daily living is higher in the intervention group than the control group. Physical exercise trained skeletal muscles and heart muscles, thus increasing the metabolic and functional capacity of skeletal muscle, peripheral response increases and decreases the heart's workload. Increasing the strength of the heart muscle will increase the cardiac output increases oxygen supply to the network increases, especially in the lungs and brain. Increased oksegen supply to the lungs resulting in an increase in pO2 and pCO2 decline, resulting in a decrease shortness of breath and fatigue (30). D. Conclusions and Recommendations There is an effect of physical exercise out patient to functional capacity and activity for daily living in patients with chronic heart failure Nganjuk Puskesmas and Puskesmas Berbek in the intervention group and an average increase of functional capacity and activity for daily living is higher in the intervention group compare to the control group. There are differences in functional capacity and activity changes in daily living before and after physical exercise out patient with chronic heart failure

patients in Puskesmas Nganjuk and public health care Berbek between the intervention group and control group. Public health care need to provide education and training in physical exercise heart failure patients with mentoring and monitoring on a regular basis in patients with chronic heart failure in doing physical exercises out patient as rehabilitative therapy. In patients with low education should be intensified in monitoring that respondents really understand. The family is expected to be as suportive educative system in the implementation of the rehabilitation program of patients with chronic heart failure in the home. Researchers can then conduct research on physical exercise out patient developed further with a larger sample size and longer periods of 2 months, stopwatch used should be calibrated so that a more accurate and connect the characteristics of the respondents as a risk factor for heart failure. BIBLIOGRAPHY 1. Kompas. 2008. Penderita Gagal Jantung di Indonesia. http//www.kompas/penderita/gagal/ja ntung/Indonesia.com. Diakses 23 Januari 2014, 14:00 WIB. 2. Depkes Jatim. 2011. Penderita Gagal Jantung di Jawa Timur. http//www.Depkes/ Jatim/Penderita/Gagal/Jantung/Jawa Timur.ac.id. Diakses 23 Januari 2014, 15:00 WIB. 3. Lee. 2005. Practice Guideliness For Heart Failure Management.In: Dec GW, Editors. Heart Failure a Comprehensive Guide To Diagnosis And Treatment. New York : Maroel Dekker. Hal 148 4. Jolliffe, J.A., K.Rees, R.S Taylor, D. Thompson, N. Oldridge and S. Ebrahim. 2001. Exercise-Based Rehabilitation For Coronary Heart Disease. Sports Medicine Journal 1 : 87-96. 5. Kaplan dan Schub. 2010. Healt Failure In Women. Cinahl Information System.

6. Pollentier B, Irons SL, Benedetto CM, Dibenedetto AM, Loton D, Seyler RD.2010. Examination of the Six Minute Walk Test to Determine Functional Capacity in People with Chronic Heart Failure: A Systematic Review. Cardiopulmonary Physical Therapy Journal. 21:1 7. Dochterman JM, Bullecheck GM. 2004. Nursing Intervention Classifications. 6th Edition. Mosby Inc. St.Louis Missouri. Hal 97 8. Levine GN. 2010. Cardiology Secrets. 3rt Ed. Mosby Elsevier. Philadelphia. Hal 463 9. Wungouw, Herlina. 2007. The Benefit of Exercise Rehabilitation in Chronic Heart Failure. Majalah Kedokteran Indonesia. 57:9 10. Marchionni, N., F. Fattirolli, S. Fumagalli, N. Oldridge, F. Del Lungo, L. Morosi, C. Burgisser and G. Massoti. 2003. Improved Exercise Tolerance and Quality Of Life With Cardiac Rehabilitation Of Older Patient After Myocardial Infarction : Results Of a Randomized,Controlled Trial. Circulation 107 (17): 2201 11. Nursalam. 2013. Metodologi Penelitian Ilmu Keperawatan: Pendekatan Praktis Edisi 3. Jakarta: Salemba Medika. Hal 166 12. Ades, P.A. 2001. Cardiac Rehabilitation and Secondary Prevention Of Coronary Heart Disease. The New England Journal of Medicine. 345 (12) : 892 13. Ades, P.A. 2001. Cardiac Rehabilitation and Secondary Prevention Of Coronary Heart Disease. The New England Journal of Medicine. 345 (12) : 892 14. Shah, S., & Cooper, B. 1991. Documentation for measuring stroke rehabilitation outcomes. Australian Medical Records Journal.21: 88 - 95. 15. Kellicker dan Schub. 2010. Healt Failure In Older Adults. Cinahl Information System. 16. Radi, Basuni, Andang H., Dede Kusmana. 2009. Rehabilitasi Kardiovaskuler di Indonesia. Jurnal Kardiologi Indonesia. 30:43-5.

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17. Santoso A, Erwinanto, Munawar M, Suryawan R, Rifqi S, Soerianata. 2007. Diagnosis dan Tata Laksana Praktis Gagal Jantung Akut. Edisi 1. Jakarta: Yayasan Pembina Kardiovaskuler Indonesia. Hal 107. 18. Kaplan dan Schub. 2010. Healt Failure In Women. Cinahl Information System. 19. Notoatmodjo, Soekidjo. 2002. Pendidikan dan Perilaku Kesehatan. Edisi 1. Jakarta: Rineka Cipta. Hal 205. Perilaku 20. Niven, Neil. 2002. Kesehatan dalam Psikologi Kesehatan. Edisi Ke-2. Jakarta: EGC. Hal 183-199. 21. Taylor,S and Renpenning, K. 2011. Self Care Science, Nursing Theory and Evidence Based Practice. 1st Edition. New York: Springer Publishing Company, LLC 22. Subekti. 2005. Asuhan Keperawatan Keluarga: Konsep dan Proses. Malang: Laboratorium Keperawatan Komunitas Prodi Keperawatan. Hal 84. 23. Soeharto, Iman. 2004. Pencegahan Penyembuhan Rehabilitasi Penyakit Jantung Koroner dan Serangan Jantung. Edisi 2. Jakarta: Yayasan Pembina Kardiovaskuler Indonesia. Hal 460. 24. Agoes dan Poppy. 2003. Mencegah dan Mengatasi Kegemukan pada Dewasa. Edisi 1. Jakarta: Puspa Swara. Hal 85 25. Brashers, V. 2008. Aplikasi Klinis Patofisiologi: Pemeriksaan dan Manajemen. Edisi 2. Alih bahasa, H.Y Kuncara; Editor, Devi Yulianti. Jakarta: EGC. Hal 53 26. Elices, Minguez R. 2009. Cardiovascular Disease : Heart Failure. In Proceeding Of The International Congress Of The Italian Association. 29-31 Mei 2009. Rimini, Italy 27. Beswick AD, Rees K, Dieppe P, et al. 2008. Complex interventions to improve physical function and maintain independent living in elderly

people: a systematic review and metaanalysis. Lancet. 371:725-35. 28. Melinda P; Diane P, Holst dan David M. 2002. Exercise Training Increases Arterial Compliance In Patients With Congestive Heart Failure. Clinical Science.102,1–7. 29. Alligood, M.R. dan Tomey, A.M. 2006. Nursing Theorists and Their Work. 6 th ad. Missouri : Mosby. Hal 109 30. Piepoli MF, Davos C, Francis DP, Coats AJ.2004. Exercise Training Metaanalysis Of Trials In Patients With Chronic Heart Failure (ExTraMATCH). BMJ. 328:189.

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ABSTRACT EFFECTIVENESS OF BAY LEAVES BOILED WATER TOWARDS URIC ACID LEVEL OF HYPER URICEMIA PATIENTS IN THE VILLAGE DISTRICT OF PACE JOHO NGANJUK 1) Trisnanto; 2) Anggi Ratih Setiorini STIKes Satria Bhakti Nganjuk One of the non-pharmacological treatments of hyper uricemia is the bay leaves boiled water. But many people have not applied the leaves to reduce uric acid levels. The purpose of this study was to determine the effect of bay leaves boiled water towards the uric acid levels in hyperuricemia patients in the Village District of Pace Joho Nganjuk. The design of this study was experimentation with methods Static Group Comparison. The study was conducted in the Village District of Pace Joho Nganjuk 2014. Population was all patients with hyperuricemian the Village Joho many as 26 people, the total sample using sampling as many as 26 people. The independent variable was bay leaves boiled water, while the dependent variable was the level of uric acid. Data taken with the instrument stick uric acid. Analysis data used Independent T-Test test with α = 0.05 level. Results of Paired Sample T-test experimental group was p-value = 0.000 ≤ α = 0.05, so that there was a decrease in uric acid levels significantly in the experimental group. Results of Paired Sample T-test control group was p-value = 0.000 ≤ α = 0.05, so that there was a decrease in uric acid levels significant in the control group. The result of Independent T-Test test produces was p-value (ρ=0,279; CI=10.21-(-3.08). (0,279) ≥ α (0.05) so that Ha is rejected. Both groups were consuming medicine but decrease of uric acid levels was more effectively in the experimental group than the control group. It was proven by average reduction of uric acid levels in the experimental group = 3.7 and control group = 3.2. There is the influence of bay leaves boiled water towards levels of uric acid (uric acid) in hyper uricemia patients in the village Joho. Treatment of bay leaves boiled water can support the synthetic chemical treatments to accelerate the healing process of patients with gout. Therefore, the use of bay leaves boiled water should be recommended by health professionals to patients with gout.

Keywords: bay leaves boiled water, uric acid leaves

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1. PENDAHULUAN Hyper uricemia disease is the disease caused by the excessive high uricemia in the blood. The causes is consuming base high food, alcohol, and chemistry medicines. It will be serious if occur the inflammation in the joint area. (Safitri, 2012). The hyper uricemia can be cured by using the medicine of anti inflammation non steroid, inhibitor, phxanthine oxidiase, and urikosurik medically. Besides, it also can be cured non pharmacology by using traditional herbal, one of the is using bay leaves boiling water. As diuretic, bay leaves can produce much urine to decrease the height of hyper uricemia. As analgesic, it can be pain relief the headache when walking. da (Sutanto, 2013).on the other hand, the society has not applied the bay leave boiling water therapy to reduce the hyper uricemia. It is based on the early study survey whose done by Trisnanto at 5-7 June 2014 toward 5 patient of hyper uricemia in Puskesmas Pace at Joho village, Pace Nganjuk whose diagnose got hyper uricemia. Four of them said that they only got medication in the local hospital and never consume bay leaves boiling water as traditional medication to decrease hyper uricemia, and one of them said to consume bay leaves boiling water irregularly and uncontinuously, so the result is not maximum. The hyper uricemia developed around the world, especially for prosperity country. Hyper uricemia increased until 8,3 million in America in 2011 prevalence or about 4% from total population. (Zhu dkk, 2011). Indonesia estimated 1,6-13,6/100.000 whose got hyper uricemia. The highest prevalence is beach society whose often consume fish food and alcohol. (Tjokroprawiro, 2007). Based on the data of East java Provinces in 2011, the patient of hyper uricemia is about a 4.250.000 people. Based on the data of Nganjuk Regency in 2012, there was about 110.600 visiting of hyper uricemia patient into

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local hospital . It was gotten about 6.700 visited to Puskesmas Berbek, about 7.950 to Puskesmas Nganjuk, and about 8.100 to Puskesmas Pace. While the patient hyper uricemia at Joho village in 2012 is 308 or about 26 per month. Hyper uricernis is caused by the increase of uricernia continuously because of consuming base high food, lack of exercises, consuming chemistry and alcohol. (Safitri, 2012). Hyper uricemia can make kidney failure, diabetes, heart attack, and hypertension.(Freund, 2012). The traditional treatment is needed to chemistry medicine addicted and the effect of them. It also reduce the cost of medical treatment. One of the cheap and easy traditional medicine is bay leaves, one of the Indonesian spices. It can be used as the spices for Indonesian cooking. The boiling water of bay leaves (Eugenia Polyantha Wight) (Dewani, 2006) can defend the increase of hyper uricemia because it contains tannin, flavonoid dan asiri oil which the characteristic diuretic effect , so it can decrease the hyper uricemia and pain relief. The way of cooking bay leaves is boiling the bay leaves and drink one glass twice a day. (Sutanto, 2013). The traditional treatment using boiling bay leaves can support the chemistry treatment more effectively to make the recovery process faster. Because of these, the use of boiling bay leaves should be recommended to the patient of hyper uricemia by the medical staff. The medical staff also can give the information about the chemical in bay leaves and how to cook and also the doses of bay leaves to decrease hyper uricemia. It is hoped the society whose in low economic can do the medical treatment by themselves to reduce the hyper uricemia.. The purpose of the research is : a. Analyzing the decrease of hyper uricemia for the patient in intervention group ( giving bay

leaves boiling water) and control group ( did not give bay leaves boiling water) b. Analyzing the influences of the effectivity of bay leaves boiling water toward hyper uricemia at Joho Village, Pace, Nganjuk regency.

1) a)

b) 2. Literature review and Hypothesa A. Hyper uricemia 1. Definition Hyper uricemia is one of the disease of articular rheumatic, namely joint rheumatic (Dewani, 2006). Hyper uricemia is the essence of base metabolism in the body which secrete by the kidney into urine in the normal condition. But in the different situation, the kidney could not secrete the base essence balance, so the excessive and abundant the base in the joints, including in the kidney (Safitri, 2012). Base is a base nucleate acid in the human cell. Base in the body catabolism will be hyper uricemia. (Herliana, 2013). The power hyper uricemia is known by using blood and urine test. The value of consent form of hyper uricemia for the man is blood 3,5 - 7,2 mg/dl and women 2,6 – 6,0 mg/dl. (Dewani, 2006). 2. The causes Mainly, the causes of hyper uricemia is hormonal, base production that increase significantly. The causes of hyper uricemia is primary and secondary factor. 99 % of primary factor is unknown. It is suggested with genetic and hormonal factor which caused metabolism disturbance which caused the increase the hyper uricemia. Secondary factor included the increase of hyper uricemia , disturbance of hyper uricemia secretion, and the combination of two cases. (Sutanto, 2013). The other literature said that etiologically, hyper uricemia is caused two parts: (Safitri, 2012):

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c)

2)

Primary factor: the causes of hyper uricemia. Genetic potential Genetic potential for someone who got hyper uricemia is heredity. There is someone who got hyper uricemia from his/her heredity. Unbalanced hormonal The unbalanced hormone can influence the organ body system work improperly. It included the work of gland and also body metabolism hereditary. The unbalance hormone influence the base formation of body increase and automatically hyper uricemia is also increase. Basically, the body can produce the base until 85% of the body needed. The impact of unbalanced hormone , the base production is increase and increase. The unbalanced hormonal can be influenced by : 1) Emotional unbalanced and irregular life style. 2) The abundant poison in the body. 3) Free radical The disturbance of hyper secretion in kidney. Hyper secretion which is formed is the result of normal metabolism. But sometimes, in different condition, the hyper uricemia could not be secreted by the kidney. It caused by the high of hyper uricemia, so the kidney can not be able to secrete it. It also can be, the condition of kidney is unwell. Secondary factor a) Consuming base high food The production of hyper uricemia is increase because of consuming base high food. High base in the blood will increase the essence of its metabolism. b) Alcohol and chemical medicine.

3.

Alcohol is also contains base. Besides, alcohol can also stimulate the secretion of gland so it increase the hyper uricemia in the blood. Alcohol also produce much hyper so make the special enzyme in the liver and break the protein and produce much hyper uricemia. It is the same with chemical drugs/ medicine. They can recover the disease but also can be dangerous for vital organs in the body such as kidney and liver. (Safitri, 2012). Patofisiology The first attack usually in the edge of toe. It usually recover soon and the next attack will come several years later. In the free phase, there is no abnormal joints. That is why some people did not realize that they got this disease. They think that they got infection or something else. The second and the third attack of hyper uricemia came in the interval of months. It called the re sick phase. The re sick will recover often if it was chronic. The patient will feel pain during all day. (Dewani, 2006). There were four phases of hyper uricemia, namely: 1) First phase (asimtomatik) During this phase, the increase of hyper uricemia occurred without feeling pain and no crystal in bladder. t 2) Second phase (acute) During this phase, the joint got a big pain and feeling hot. It was emergency attack at night, so, the patient will wake up from sleep. The attack will be serious in the short

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time and disappear during ten days. 3) Third phase ( chronic) During this phase, the tofus crystal was formed. This happened because of disobey the condition. Usually it happened in 56 times in a year. The pain will continue in several joints, such as the edge of toe, the ankle, knee, elbow, and the wrist became swelling. 4) Fourth phase ( tofus chronic) After ten years got this disease, the patient will get the swelling of hard crystal contain hyper uricemia. The form was needle form in several joints and auricles. The common joint which got the attack is the joint of toes, ankle, knee, elbow, and fingers. (Dewani, 2006). d. Sign and symptom It was serious pain, red, swollen, and feeling hot in several joints. It happened in the morning usually (Dewani 2006). The other theory stated the sign and symptom of hyper uricemia namely : 1) Pain, ache, and uncomfortable surrounding the joints. The first attack is in the toes joint. 2) Swollen joints and the skin was red purplish, erect, and cling, feeling warm, and so sick when it touch. 3) The joint was sick in cold weather. 4) Fever, chilling, and uncomfortable also the heart was beating faster. This sign will be more serious for them whose below 30 years old.

5)

6)

7)

8)

9)

The first attack occurred in special time, usually at night and in the morning when wake up. The first attack was only for one joint and occur during several days. It can recover without the medicine. But in different case, the attack can also in sole, knee, elbow, and wrist. The sign will disappear slowly, the joints can be functioned normaly, and no sign until the next attack. The pain will appear again if the patient consume base high food If the pain will be massaged, it will make more serious. So, make it sure if you got the pain in this area. Know surely, it is hyper uricemia or not. Getting the sure answer whether it is hyper uricemia or not, it was needed laboratories check up, radiological check up , and joints gland. (Sutanto, 2013).

B. Bay Leaves Concept a. Definition Bay leaves is a single leaves in oval shape, or tend to round shape. The length of the leaves is about 0.5-1 cm, the edge was sharp, and flat. The upper leaves is clear with old green colour, and the lower leaves is light green (Utami, 2013). b. Habitat This plant can grow in the height of 200-400 mdpl. Actually it is wild plant, which can grow in the forest with the average height is 1000 mdpl. c. Content

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the content of bay leaves namely: 1) Flavonoid to make the blood circulation run well and avoid the blood blockage, anti oxcidant and analgetic.(Utami 2013). Flavonoid in bay leaves also avoid the hypertension, decrease the hyper uricemia , and decrease blood glucose (Herliana, 2013) 2) Tannin is the active material for anti inflammation and anti microba (Utami 2013). 3) Atsiri oil for analgesic effect (Utami 2013). 4) Alkaloids strong analgetic to reduce pain and anti inflammation (Safitri 2012). d. Bay leaves can be a (diuretic) so it can decrease the hyper uricemia in the blood. Besides, it also can be the pain relief so it can be used as the medicine of high blood pressure, hyper uricemia, diabetes mellitus, gasitris, drunken of alcohol, diarrhea, and wound (Dewani, 2006). e. How to make the traditional herbal of bay leaves The way of making the bay leaves boiling water is the following (Handayani, 2013): 1) Boiling 10 gram of bay leaves become one glass. 2) Drink it when still warm twice a day (morning and evening) in 250 ml during 14 days. f. the influenced of bay leaves to hyper uricemia in the body flavonoid and alkaloid to block enzim xanthin oksidase and the reaction of hyperoksida (release the oxygen for some items) so it can bloked the form of hyper uricemia in the body, one of them is bay leaves (Dewani, 2006).

Xantin oksidase is an enzyme which form the hyper uricemia in the body, the high enzyme xantin oxidase, the high of hyper uricemia in the body. (Utami 2013). The toksisitas sukronik dan kronik test showed that that the use of bay leaves did not disturb the function of liver and kidney. (Dalimartha, 2011). 3. Research metodology It used Static Group Comparison. In this research , the researcher used the measurement of hyper uricemia for intervention group and control group before intervention. The intervention group was given kontrol treatment, with the boiling water of bay leaves twice a day in the morning and evening. (2 x 250 cc) during 14 days for 13 respondents while there was no boiling water of bay leaves which given for control group during 14 days for 13 respondents. Then, the researcher measured the hyper uricemia for 13 respondents from each group in the 14 th days by using stick uric acid (post test). The sample of the research is all the patient whose got hyper uricemia whose consume the medicine in Joho village,Pace, Nganjuk. The number of sample is 26 people consist of 13 people for experiment group and 13 people for control group. The sampling used for the research was Total Sampling. 4. The result The result is included general data nad specific data. General data consist of: the description of research location, gender, age, education , and job of the respondents. While specific data consist of: the record of hyper uricemia of the patient from intervention and control group. Hasil penelitian yang meliputi data umum dan data khusus.The research is done in Joho village, Pace , Nganjuk Regency in 23 June - 6 July 2014.

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1. The influence of Boiling bay leaves toward hyper uricemia Tabel 1. Statistic test result of the influence of bay leaves toward the hyper uricemia ρ mean CI95 ±SD % Before 2 9.15 4.05- 0.0 6 ±1.8 2.91 0 5 After 2 5.67 6 ±1.6 8 The result of paired t test which is showed in table 1 explained there is significant influenced of giving bay leaves boiling water toward the hyper uricemia (ρ=0,000; CI 4.05-2.91). After giving bay leaves of boiling water is gotten the decrease of hyper uricemia significantly for all respondents . (mean=9,15; SD=1,85). 2. The effectively of boiling bay leaves toward the hyper uricemia 3. Tabel 2. The effectively of boiling bay leaves toward the hyper uricemia n

n Using the boiling water of bay leaves Did not use boiling water of bay leaves

26

26

Mean ±SD 6.89 ±11.59

CI95 % 10.21 (3.08)

ρ 0.278

3.31 ±0.82

The result of Independent t test in table 2 showed the giving of boiling water of bay leaves is not effective to decrease the hyper uricemia compared with another intervention for control group (ρ=0,279; CI=10.21-(-3.08)). Hyper uricemia for treatment group after giving 15 days, both of them decrease, but it is not too much. (3,58).

5. Conclusion 1. There is significant influence toward the giving of boiling water of bay leaves toward hyper uricemia (uric acid) for the patient in Joho Village, Pace, Nganjuk Regency. It is showed with the paired t test in tabel 1 explained the significant influenced of boiling water of bay leaves toward the hyper uricemia (ρ=0,000; CI 4.05-2.91). After giving 15 days, it is gotten the significant decrease of hyper uricemia. (mean=9,15; SD=1,85). The effectivity of boiling water of bay leaves to decrease to hyper uricemia is not too effective if it compared with the other intervention. The result of Independent t test in table 2 showed The effectivity of boiling water of bay leaves to decrease to hyper uricemia is not too effective if it compared with the other (ρ=0,279; CI=10.21-(-3.08)). 2. the giving of boiling water of bay leaves is not effective to decrease the hyper uricemia compared with another intervention for control group (ρ=0,279; CI=10.21-(-3.08)). Hyper uricemia for treatment group after giving 15 days, both of them decrease, but it is not too much. (3,58).

6. Dewanti, S. (2010). Buku Pintar Kesehatan Kolesterol, Diabetes Mellitus dan Asam Urat. Klaten: Kawan Kita. 7. Handayani, T. (2013). Hidup. Jakarta: Padi.

Apotek

8. Herliana, E. (2013). Penyakit Asam Urat Kandas Berkat Herbal. Jakarta. Fmedia. 9. Kertia, N. (2009). Asam Urat. Yogyakarta: Penerbit B-first. 10. Lingga, L. (2012). Bebas Penyakit Asam Urat Tanpa Obat. Jakarta: PT. AgroMedia Pustaka. 11. Nursalam. (2011). Konsep dan Penerapan Metode Penelitian Keperawatan. Jakarta: EGC. 12. Putra, T.R. (2009). Hiperurisemia. Buku Ajar Ilmu Penyakit Dalam. Edisi ke-5 Jilid III. Jakarta : Pusat Penerbitan Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia. 13. Safitri, A. (2012). Deteksi Dini Gejala Pencegahan dan Pengobatan Asam Urat. Yogyakarta: Pinang Merah. 14. Setiati S, Harimurti K, Govinda, A.R., (2009). Proses Menua dan Implikasi Kliniknya. Buku Ajar Ilmu Penyakit Dalam Jilid I. Interna Publishing. Jakarta.

6. REFERENSI 1. Aminah, S. (2013). Khasiat Sakti Tanaman Obat untuk Asam Urat. Jakarta: Dunia Sehat. 2. Arikunto. (2006). Prosedur Penelitian Pendekatan Praktek. Jakarta: PT. Rineka Cipta.

15. Sugiyono. (2011). Metode Penelitian Kuantitatif, Kualitatif dan R & D. Bandung: Alfabeta.

3. Dahlan, S. (2013). Statistik untuk Kedokteran dan Kesehatan. Jakarta: Salemba Medika. 4. Dalimartha, S. (2011). Resep Tumbuhan Obat untuk Asam Urat. Jakarta: Penebar Swadaya. 5. Dewani, dkk. (2006). 33 Ramuan Penakluk Asam Urat. Jakarta: PT Agro Media Pustaka.

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16. Sutanto, T. (2013). Asam Urat Deteksi, Pencegahan, Pengobatan. Yogyakarta: Buku Pintar. 17. Tjokroprawiro, A, dkk. (2007). Buku Ajar Ilmu Penyakit Dalam. Surabaya: Airlangga University Press.

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19. Utami, dkk. (2013). The Miracle of Herbs. Jakarta: PT Agro Media Pustaka.

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EFFECT OF INITIATION OF BREAST-FEEDING WITHIN ONE HOUR OF THE DELIVERY ON MATERNAL-INFANT BONDING IN RSUP M. DJAMIL PADANG 2014 DEWI SUSANTI Polytechnic Health Ministry Padang Email : [email protected]

Abstract Breast feeding is feeding of infant and young child with milk from a female breast. Studies have been carried out on a number of variables e.g health benefits of breast feeding for neonate and mother. Maternal-infant bonding is one of variables which is least studied. The present study was undertaken to assess the effect of initiation of breast feeding within one hour of the delivery of maternal-infant bonding. Thirty mother – infant dyads were enrolled for the study and considered for analysis. Each froup (control and experimental) comprised of Thirty mother –infant dyads. Mother who initiated breast feeding after one hour of the delivery were considered in the control group and the mothers in the experimental group initiated breast feeding within one hour of the delivery. Value of the t at 24 hours was -7.402 and at 48 hours was -8.891. Significant difference p=0.002 and 0.003 <0.05 was found between the maternal infant bonding scores of control and eksperimental group at 24 as well as 48 hours of the delivery. At 24 hours of the delivery, mean ± S.D of score was found 73.4 ± 9.0 in the control group while the score was 80.1 ± 5.3. inthe eksperimental group and at 48 hours it was 74.2 ± 8.7 in control group and 82.3 ± 5.3 in the eksperimental group. The result revealed that initiation of breast feeding within one hour of delivery improves maternal-infant bounding. So, it is recommended that breast feeding should be initiated within one hours of delivery. Key words: Initiation, breast feeding, maternal-infant bonding

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infancy and continues over the next few years. The bonding process has tremendous implications for both mother and child and is affected by many factors. 11 Many studies have addressed the question of whether there is what has been called a „sensitive period‟ for parent-child contact in the first minutes, hours and days of life that may alter the parent‟s behaviors with their infant later in the life.11 In each study, increasing suckling improves caretaking by the mother.11 Salariya et all also found that babies who were first fed within 30 minutes of birth were likely to remain breast feeding for longer.12 The relationship between early first contact of mother and infant and outcome of breastfeeding may be closely related to wthat Klaus and Kennell (1976) describe as an early sensitive period in the mother. This immediate postpartum period seems to be the time for optimum attachment or bonding of the mother to the infant.12 A study at Brazil (1974) compared the breastfeeding of two groups of 100 women. The mothers of one group nursed their infants immediately after birth and maintained permanent contact throughout the hospital stay with with their infants in cribs by their beds. The control group mothers had a glimpse of their infants shortly after birth and then visits for approximately 30 minutes, every 3 hours, 7 times a day, beginning 12-14 hours after birth. At 2 months, 77% of the experimental group mothers were breastfeeding without supplemental formula. In contrast, only 27% of the control group mothers were breastfeeding without formula suplements at 2 months. Knowledge and support must also be considered causal factors in the study as a special nurse worked with the mothers of the experimental group to stimulate and encourage breastfeeding.13 The factors that affect the intention, initiation and duration of breast feeding are complex and therefore to address these factors, specialized approach is required.14 Hospital policies and routines

Introduction Breast feeding is the process whereby the infant receives breast milk.1 Breast feeding is a multidimensional health behavior influenced by some factors such as social, demography, biology, pre/post natal and psychology. Its universally acknowledged to be the best and complete food for infant as it fulfills specipic nutritional needs.2 Extensive research in the recent years, documents diverse and compelling advantages og breast feeding to infants, mothers, families and society. These also included nutritional, immunological, developmental, psycological, social, economic and enviromental benefits.3,4,5 Professional support also influences breast feeding initiation and duration.6 One study evaluated the results of a breast feeding programe in neonated care unit that offered that service of a lactation nurse and a developmental specialist.as a result of program, the number of infant receiving expressed milk while in the hospital nearly doubled. At discharge 83% of the infant were fully of receiving breast milk 7 Hospital team can be have a significant impact on the initiation and maintenence breast feeding, if they have sufficience knowledge of its benefits and the necessary clinical management skills or habbits.8 In order to ensure success in breast feeding, it is important that it be initiated as early as possible during the neonatal period.7 Right after birth the sucking releks is most active and babies are more alert during the firts 30-60 minutes are put to mother‟s breast within this period, chances of exclusive breast feeding increase.9 Early initiation of breast feeding enchaces maternal infant bounding.10 Maternal infant bonding means the development of the core relationship between mother and child.11 The bonding process is accurs in both infant and mother and has tremendeus implications of the child‟s future development. 11 Maternal infant bonding is a vital process which begins in early

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greatly influence breastfeeding success. The peri-partum hospital experience should include adequate support, instruction and care to ensure the successful early initiation of breastfeeding. Such management is part of continuum of care and education begin during the pre-natal period that promotes breastfeeding as the optimal method of infant feeding and includes information about maternal and infant benefits.15 Though, it is important to initiate breast feeding to new born baby within 1

hour of delivery, yet no studies have been done so far in the Institute to see the effect of initiation of breast feeding within 1 hour of delivery on maternalinfant bonding. WHO recommends that breast feeding should be initiated within 1 hour of delivery. So, the need aroused to conduct the study and assess the effect of initiation of breast feeding within 1 hour of delivery on maternalinfant bonding and produce research based evidence.

Method The quasi- experimental study was conducted with the mothers and their new born babies in the obstetric unit Mohamad Djamil Hospital Padang Indonesia in September – Oktober 2014. Purposive sampling technique was employed to select sample from the population. During first phase the mothers were conductes after one hours of the delivery and asked weather they have initiated breast feeding to their baby. If the breast feeding was not initiated within one hour of the delivery, mother-infant dyads was considered in the experimental group. During the second phase, the mother were conducted within one hour of the delivery and breast feeding was initiated within one hour of delivery using developed protocol i.e mother infant dyad were considered in the experimental group. Protocol of the initiation of breast feeding was developed by consulting the experts and review the literatur.

All the mothers with normal vaginal delivery (period of gestation 36 weeks and above) who were willing to participate in the study were considered eligible and included in the study except the mothers and new born babies in the exclusion criteria. And the mothers having the problem i.e medical surgical disease which intervered with the initiation of breast feeding, post partum haemorrage and post partum psychosis, twin pregnancy, eclampsia. The newborn babies with the problem a.e. pre term less than 36 weeks of gestation, birth weight less than 1800 gr, APGAR score less than 7 at 1 and 5 minutes, congenital malformations which interfered with the breast feeding, babies shifted with the breast feeding, babies shifted to neonatal intensive care units (NICU), babies with medical surgical problems where direct breast feeding is contraindicated were excluded from this study.

Result and Analysis Thirty mother – infant dyads were enrolled for the study and considered for analysis. Each group (control and experimental) comprised of thirty

mother – infant dyads. Analysis of gathered data was done using differential and inferential statistics.

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Table 1. Socio-demographic profile of the subjects. Socio-demographic profile

Age - < 20 years - 21 – 25 years - 26 – 30 years - > 31 years Educational (self) - Till 6th (SD) - 7th – 9th (SMP) - 10th – 12th (SMA) - > 13th Occupation (self) - House-wife - Employed Place (habitat) - Rural - Urban Per Capita Income - < IDR.600.000 - >IDR. 600.000 – IDR. 1.200.000 - >IDR. 1.200.000 – IDR. 1.800.000 - > IDR. 1.800.000 Type of Family - Joint - Nuclear

Control Group f (%) N = 30

Experimental Group f (%) N = 30

02 (06.7) 15 (50.0) 10 (33.3) 03 (10.0)

01 (03.3) 14 (46.7) 10 (33.3) 05 (16.7)

03 (10.0) 05 (17.0) 15 (50.0) 07 (13.0)

04 (13.0) 04 (13.0) 17 (57.0) 05 (17.0)

16 (53.0) 14 (47.0)

17 (57.0) 13 (43.0)

17 (47.0) 13 (53.0)

16 (53.0) 14 (47.0)

13 (43.3) 10 (33.3) 06 (20.0) 01 (03.4)

10 (33.3) 12 (40.0) 06 (20.0) 02 (06.7)

16 (53.0) 14 (47.0)

18 (60.0) 12 (40.0)

(SMA) – whereas 17 (57.0%), subjects from experimental groups had educational 10th – 12th (SMA). In the control group, educational ranged between till 6th (SD) - > 16th (post graduated). More than half of the subjects i.e. 57.0% from experimental group and 53.0% from control group were house wives. More than half (47.0%) of subjects from control group and (53.0%) from experiment group were from rural background. More than half type of family (53.0%) of subjects from control group and (60.0%) from experiment group were joint family.

Majority of the subjects were in the age group of 21-25 years. Age of the study subjects (mothers) in the control group ranged between 19 to 38 years. Per capita income of subjects ranged between IDR 450.000/- IDR 2.100.000/per month. 13 (43.3%) subjects from group had per capita income of IDR < 600.000 – whereas 12 (40.0%), subjects from experimental groups had per capita income IDR 600.000/- IDR 1.200.000/per month. Educational of subjects ranged between till 6th (SD) - > 16th (post graduated), 15 (50.0%) subjects from control group had educational 10th – 12th

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Table 2. Gravida status, gestation period and sex of baby of the subjects Variables Control Group Experimental f (%) Group N = 30 f (%) N = 30 Gravida - Primi Gravida 17 (57.0) 15 (50.0) - Multi Gravida 13 (43.0) 15 (50.0) Period of Gestation (in weeks) - 36 – 37 05 (17.0) 04 (13.0) - > 37 – 40 23 (77.0) 24 (80.0) - > 40 – 42 02 (07.0) 02 (07.0) Sex of baby - Boy 11 (37.0) 20 (67.0) - Girl 19 (63.0) 10 (33.0)

More than half of the study subjects were primigravida i.e. 50.0% from control group and a half i.e 57.0 % from experimental group. Majority of the control group of study subjects i.e 77 % delivered between >37 to 40 weeks period of gestation and experimental

groups and control group 80%. In the control group, 11 (37.0%) subjects, had baby boy 19 (63.0)% had baby girl while in experimental group, 20 (67.0%) subjects, had baby boy and 10 (33.0%) had baby girl.

Table 3. Maternal – infant bonding score at 24 and 48 hours Maternal – Infant bonding score Control Group Experimental Group TIME (N = 30) (N = 30) Mean + S.D Range Mean + S.D Range After 24 73.4 + 9.0 44.3 – 87.2 80.1 + 5.3 62.2 – 90.1 hours of delivery After 48 74.2 + 8.7 44.3 – 91.2 82.3 + 5.3 61.7 – 91.2 hours of delivery The comparison of maternal-infant bonding was done at 24 and 48 hours of the delivery and the scores were compared. In control group, mean bonding score on maternal-infant attachement scale at 24 hours of delivery ranged from 44.3 - 87.2 with mean score 73.3 + 9 and at 48 hours the score ranged from 44.3-91.2 with mean + S.D score 74.2 + 8.7. In the experimental group. Mean bonding score and range in maternal-infant attachment scale at 24 hours of the delivery between 62.2 -

Value of t -7.401 (p=0.002) -8.891 (p=0.001)

90.1 with mean score 80.1 + 5.3 and while at 48 hours it ranged from 61.7 91.2 with mean score 82.3 + 5.3. The t test for equality of means was applied to asses maternal-infant bonding at both 24 and 48 hours was -7.401 and -8.891, respectively p = 0.002 at both 24 hours and p = 0, 001 for 48 hours, this shows that there was significant difference in bonding score in the control and experimental group both at 24 hours and 48 hours of the delivery.

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Table 4. Maternal – infant bonding score as per reason for not initiating breast feeding within an hour of delivery Group

Reason

Poor bonding f (%) 1 (5.0) 1 (9.0)

Lack of rooming – in mother not willing p = 0.007 < 0.05 at df = 1 (X2 test) Control

Good bonding f (%) 18 (95) 10 (90)

Table 4 depicts the maternal-infant bonding score of the subjects according to reasons for not initiating breast feeding whithin an hour of the delivery in the control group. The reasons were

lack of rooming in and non willingness on mothers part. There was significant difference in the scores. p = 0.007 < 0.05 at df = 1 (X2 test)

In spite of an increased focus on the early initiation of breast feeding, the practice of initiation of breastfeeding varies from institution to institution. Studies have been done to assess the effect of early initiation of breastfeeding. But very few studies have been done so far, to assess the effect of initiation of breastfeeding within one hour of the delivery on maternal-infant bonding. Though W.H.O prescribes that breastfeeding should be initiated within half hour of delivery, but the practice varies within different instituions. RSUP DR. M. Djamil Padang is a referral hospital and most of the complicated and high risk cases come for the delivery, so in most of the cases condition of mother is not stable within half an hour after the delivery. But it is possible to initiate breastfeeding within one hour of the delivery. So this study was taken up with the objective, to assess the effect of initiation of breastfeeding within one hour of delivery on maternal-infant bonding. In the present study, mother-infant dyads after normal vaginal delivery were taken as the study subjects, as most of the mothers deliver baby normally. For this reason a number of other researchers have also preferred to take subjects after normal vaginal delivery. The study subjects (mother) in the present study were both primigravida and multigravida.

Assessing maternal-infant bonding has been a tremendous challenge among researchers because it involves the study of psychology of the mother about her attachment to the new born baby. Researchers have studied othet benefits of early initiation of breastfeeding. In present study, maternal postnatal attachement scale (MPAS) was used to objectively assess maternal-infant bonding on the basis of feelings and behavioral responses of mother towards her new born baby. The tool was standardized but modified as per the need of the study and after modification it was checked for its reliability by Cronbach‟s alpha. It was found reliable. Studies depict that mother-baby bonding is enhanched by breasting feeding. Sucking enhanced the closeness and new bond between mother and baby. The findings of the present study revealed that with the initiation of breastfeeding within one hour of delivery, bonding increases between the mother and her new born baby. It is likely to be caused by early skin-to-skin contact when the mother breast feeds. The remarkable change in the maternal behavior with just the touch of the infant‟s lip on the mother‟s nipple, the reduction in the abandonment with early contact, suckling and rooming-in and the raised maternal oxytocin levels shortly after birth in conjunction with known sensory physiologic, immunologic and

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behavioral mechanism all contribute to maternal-infant bonding.5 The results of the present study signifies that with the initiation of breatfeeding within one hour of delivery, maternal-infant bonding is improved as compared to initiation of breastfeeding after one hour of delivery. Statistical significant differences were seen between the bonding scores of mothers who initiated breast feeding within hour of the delivery and the mothers who initiated breast feeding after one hour of the delivery. Based on the findings, the study recommends that

breast feeding should be initiated within one hour of the delivery. A similar study using the same tool after 6 weeks and one year of the delivery can be taken up to provide further impetus to the findings. A similar study using interview technique along with the “maternalinfant bonding tool” can be done to further refine the findings. The findings of the study provides An evidence-based data for the improvement of “maternalinfant bonding.” Hence feeding in the first hour of delivery is recomended to bonding. improve maternal-infant

Conclution 1. Majority of the subjects were in the age group of 21-25 years. 2. 13 (43.3%) subjects from group had per capita income of IDR < 600.000 – whereas 12 (40.0%), subjects from experimental groups had per capita income IDR 600.000/- IDR 1.200.000/- per month. 3. 15 (50.0%) subjects from control group had educational 10th – 12th (SMA) – whereas 17 (57.0%), subjects from experimental groups had educational 10th – 12th (SMA). In the control group. 4. More than half of the subjects (57.0%) from experimental group and 53.0% from control group were house wives. 5. More than half (47.0%) of subjects from control group and (53.0%) from experiment group were from rural background. 6. More than half type of family (53.0%) of subjects from control group and (60.0%) from experiment group were joint family.

7. More than half of the study subjects were primigravida (50.0%) from control group and a half (57.0 %) from experimental group. 8. Majority of the control group of study subjects (77 %) delivered between >37 to 40 weeks period of gestation and experimental groups and control group 80%. 9. In the control group, 11 (37.0%) subjects, had baby boy 19 (63.0)% had baby girl while in experimental group, 20 (67.0%) subjects, had baby boy and 10 (33.0%) had baby girl. 10. This research showed significant difference in bonding score in the control and experimental group both at 24 hours and 48 hours of the delivery. (Respectively p = 0.002 at both 24 hours and p = 0, 001 for 48 hours). 11. The reasons were lack of rooming in and non willingness on mothers part. There was significant difference in the scores. p = 0.007 < 0.05 at df = 1 (X2 test)

Acknowledgement I gratefully acknowledge the support and generosity of RSUP M Djamil Padang and subjects who have participated in this research, without which the present

study could not have been completed. Thank for colleagues STIKes Karya Husada Kediri that greatly assisted the publications.

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References 1. Assocoation of women‟s health, obstetric and neonatal nurse. Evidence based clinical practice guidelines, Breast feeding support: prenatal care through the first years, second edition. 2007:1

9. Anisfeld E, Curry MA, Hales DJ, et al. Maternal infant bounding. A joint rebuttal pediatrics 1983; 72:569-71 10. Bowlby J. The making and breaking affectional bonds I. Etiologi and psychopathology in the light of attachment theory. Br J psychiatry 1997; 130:201-10

2. Odent M. Is promoting breast feeding as useless as the promotion of live? [online] Primahealth 1999. Available from URL : http://www. Birthpsicology.com/index.html.

11. Crowell JA, feldman SS. Mothers‟working models of attachment relationships and mother and child behavior during separation and reunion. Developmental psyichology 1991;27:597-605.

3. American academy of pediatricans. Breast feeding and the use of human milk. Pediatrics 1997; 100(6): 1035 4. American academic of pediatricans. Breast feeding and the use of human milk. Pediatrics 2005; 115(2): 496-506

12. Williams TM, Joy LA, Travis L, Gotowiec A, Blum-Steele M, Aiken Ls, et al. Transition to motherhood: A longitudinal study. Infant Mental Health Journal 1987;8(3): 251-65.

5. Metha S. Breast feed is best first babies‟health. The tribune 2005 Aug24

13. Jelliffe D. B., & Jelliffe, E. F, P. The uniqueness of human milk. American Journal of Clinical Nutrition 1971;24:968-69.

6. Furnan L, miminich N, Hack M. Corelates of lactation in mothers of very low birth weight infants. Pediatrics, 2002;109, e57

14. The national assembly for Wales. Investing in a better start: Promoting breast feeding in Wales. [Online]:2005. Available from URL:http://www.Wales.Govuk.

7. Warren I, Tan G.C. Dixon, PD and Gaus K. Breast feeding and early discharge for preterm infants: the result of dedicated breast feeding program. Journal of neonatal nursing. 2000;5.43-4

15. Lounds JJ. Borkowski JG, Whitman TL, Maxwelll SE, Weed K. Adolescent parenting and attachment during infancy and early childhood. Parenting: Science and Practice 2005;(5):19-117.

8. Moreland J, Coombs J. Promoting and supporting breast feeding. American family physician 2000; 61(7) ;2093-100, 2103-4

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THE RELATIONSHIP BETWEEN FATIGUE LEVEL NIGHT SPORT WITH SLEEP QUALITY AT TEENAGERS FUTSAL CLUB “ SCHOLAR ONE” IN SUMELEH FUTSAL TULUNGAGUNG 2015 Suciati1, RikiIrawan2 STIKes Hutama Abdi Husada Tulungagung Email: [email protected] Abstract Sports night can provide the impact of a state of physical exhaustion that this can lead to the quality of his sleep disturbed, after exercising at night increases body temperature and require several hours of normal temperaturestate, in addition tothemusclesbecome tenseand requireseveralhoursforbackrelax, thissituation resulted in the mind feel strained causing problems with the quality of sleep (Rafiudin 2004). This study aimsto determine the relationshi pof fatigue level sports night with sleep quality in adolescentclubfutsal"one scholar”in Sumeleh Futsal, Tulungagung. The method used in this research is analytic association with the number of respondents teen club futsal"Scholar one" as many as 24 respondents, who were taken with consecutive sampling method. The collection of data held on 25 February 2015, using research instruments such as questionnaire. Results were tabulated and the answers were score , then the data is processed through aprocess of editing, coding, scoring, tabulating, and thendata were presentedby using the formula: P= after the data is analyzed by using Spearman Rho test with the help of computers using the technique SPSS (Statistical Product Service Solution Version Window s16). Based on this research, it was found that the majority of respondents experiencing severe fatigue accompanied by severe sleep quality issues. From the results of statistical tests spearmen rho in get P = 0,002 < α = 0,05, then there is a correlation between the degree of exhaustion sports night with sleep quality in adolescents club futsal “Scholar One” in sumeleh futsal, Kabupaten Tulungagung 2015.Seeing the results ofthe abovestudy, the need for furthe rattention to adolescents who have dense enough activity after exercise at night time, you should take the time ±15minutes for exercise in the morning or afternoonon a regular basis every day so that the sport does not interfere or cause problems in the quality of sleep and activity in the next day. This is toimprove the health of the sport and as an effort to prevent quality sleep problems in adolescents. Keywords: Sports night, Level fatigue, Quality of sleep in teens. happened. If someone complained about constraints such as difficulty falling asleep, uncomfortable sleeep, difficulty holding sleeping, often waking up midevening, and often woke up early, it possibility their sleep quality are impaired. Beside that, sleep quality is also influenced some factors, one of them is exercise and fatigue. (Tarwoto, 2006). This is because everybody feels exhausted just limited to the physical complains that they feel. Symptoms, physical changes and feelings are

PRELIMINARY Every human being existing in this world definitely needs to sleep, where sleep is a basic need for every human being. Sleep is a state of relative calmness without realizing that no activity is a repetitive cycle and each phase states of brain activity and different bodily (Tarwoto 2006 case 100). Some people are not concerned about the quality of sleep and ignore about the quality of sleep, consider their sleep will not her as if nothing had

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That‟s mean 28 million of the total 238 million population of Indonesia get insomnia (Anonymous, 2003). In Indonesia based on US Census Bureu, International Data Base in 2014, approximately 30 million people of a total population of 238 million, or approximately 15% suffer from insomnia. Based on data International of sleep disorder, one cause of the disruption of a person's sleep quality is exercise and exerciseinduced fatigue at night about(16%) (Hand, 2014). From a preliminary study that I did on 29th of September 2014 based on interview with 10 respondents futsal club members, in Tulungagung. The cause of the lack of quality sleep each respondent is 2 respondents said that due to stomach diseases, 1 respondent due to a noisy environment, 1 respondent due to psychological stress, physical activity due to the two respondents and 4 respondents due to fatigue. As for the impact caused by the lack of quality of sleep is affect the brain function to memory loss, difficulty controlling movement cause someone become unproductive, unfocused and often forget for something. Usually sleep late at night is associated with an increased risk of depression, grumpy, increasing the risk of death due to accidents and cause the body vulnerable to disease. Not only that, disturbed sleep too much associated with an increased risk of paranoid or excessive fears and bipolar mental disorder (Siregar 2011, p 124). The solution to meet the needs of a person's sleep not only lies in its quantity, but a healthy sleep is also based on its quality. It is measured by the extent to which you can sleep soundly without interruption and can feel more refreshed upon awake. In terms of nursing, this is nursing community area which we as a nurse should be able to provide input for the community kespecially they who have a flurry of very dense and do not have time to exercise other than at night,

different for each individual. Fatigue as feeling tired derived from the response of the body or mental deterioration of the body (the Australian Safety and Compensation Council, 2006). One of them is exhausted when play indoor football (futsal), futsal is a sport that is popular and demand by everybody in the world. This is evident from the enthusiasm of playing futsal by anyone, start from children, adults, both men and women (Ceriani: 2002). And many people play futsal at night, so it cause physical exhaustion, this situation can cause sleep quality disturbed, because after play futsal at night body temperature will increase and needs a few hours to get back into a normal temperature normal so mind feels tense that cause we can‟t sleep, beside that play sport at night will result in muscle tension after exercise and requires several hours to get back relax (Rafiudin, 2004). There is also according to (Youngstedt 2008) in his research in exercise science at the University of South Carolina declared night sports can help people who have insomnia to fell more relax and reduce anxiety related to sleep. But the relationship between sport at night and sleep are different each person. Some people who do hard exercise before sleep, their quality sleep was not disturbed at all, even they can sleep again and more soundly, it can happen for atlet who play sport during the day or in the afternoon. There is incident in which a person exercising at night can cause the quality of one's sleep less, so it cause insomnia. According Japardi (2002) prevalence of insomnia each year in the world is estimated at about 20% - 40% of adults have trouble sleeping, and about 17% experienced a serious sleep disorder. According to the data (National SleepFoundation, 2012) about a quarter of the population in Indonesia has been having trouble sleeping reach 6% to 10% are estimated to have insomnia. While in 2013 the prevalence of insomnia in Indonesia about 10%.

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spare your time to sport in the morning and afternoon in odrder to disturb sleep and activity in the morning and in the afternoon. There are several ways to improve the quality of sleep that can be done, those are: improve the quality of the bed, put out the lights before going to sleep, sleep at the same time, make yourself relax so you can sleep quickly and soundly and consumt supplements/sleeping pills. Of different opinions about sports night above, researchers interested to research about The relationship between fatigue level night sport with sleep quality at Teenagers futsal club “ Scholar One” in Sumeleh Futsal Tulungagung 2015.

The experiment was held on 25th-26th February 2015 in Sumeleh Futsal, Tulungagung. In analyze the relationship between fatigue level night sport with sleep quality at Teenagers futsal club “ Scholar One” in Sumeleh Futsal Tulungagung 2015, using spearmen rho statistical test. If p value <0.05 is significant, hypothesis (Ho) is rejected, then H1 accepted which means there is a relationship between fatigue level night sport with sleep quality at Teenagers futsal club “ Scholar One” in Sumeleh Futsal Tulungagung 2015, while p value ≥ 0.05, hypothesis is accepted and H1 rejected, which means there is no relationship between fatigue level night sport with sleep quality at adolescents futsal club “ Scholar One” in Sumeleh Futsal Tulungagung 2015. RESULTS 1. The Fatigue Level night sport in adolescents futsal club "one scholar" in Sumeleh Futsal, Tulungagung 2015. Table 1. Distribution of frequency based on fatigue level night sport at respondents in Sumeleh Futsal, Tulungagung 2015.

RESEARCH METHODS The design study is a pattern or general instructions that can applied in several studies. Given the obvious problems of research, the conceptual framework and a clear definition of variables, a design can be used as an overview of the detailed research plan in terms of data collection and analysis (Nursalam, 2008). Based on the research to be conducted by the researchers, this study is included analytical research association that is trying to find a relationship between variables, and based classification researchers conducted this study by means of cross sectional one that aims to determine the correlation between fatigue level night sport with sleep quality at Teenagers futsal club “ Scholar One” in Sumeleh Futsal Tulungagung 2015. The population in it is teenagers who in age 10-21 years as many as 24 teenagers in the club futsal "schoar one" in Sumeleh Futsal, Tulungagung. In this study the samples used all teens club futsal "Scholar one" in at Sumeleh Futsal, Tulungagung as many 24 respondents, with the inclusion and exclusion criteria. In collecting data used questionnaire for the measuring instrument

No

Level of Fatigue

1. 2. 3. 4.

Untired Less fatigue Moderate fatigue Hard fatigue Jumlah

Frequen cy 2 4 8 10 24

Source : Penelitian tahun, 2015 Based on the table above 1 of the 24 respondents that almost half of respondents get severe fatigue that is 10 respondents (42%). 2. Sleep quality in adolescents futsal club "one scholar" in sumeleh futsal, Tulungagung 2015. Table 2. Distribution of frequency based on sleep quality at respondents in Sumeleh Futsal Tulungagung 2015.

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Prosentase (%) 8% 17% 33% 42% 100%

Source : Penelitian tahun, 2015

No

Based on the table 2 above, it is known that from 24 respondents almost half of the respondents get a severe sleep problem sleep quality that is respondents (37%).

1. 2.

Sleep quality

Frequenc y 2 4

Prosentase (%) 8% 17%

No trouble Less trouble 3. Enaoug 9 37% trouble 4. Hard trouble 9 37% Jumlah 24 100% body or mental deterioration of the body. Fatigue affects physical capacity, mental, and emotional levels, which can lead to lack of vigilance, characterized by deterioration reaction at something and reduced motor skills (Australian Safety and Compensation Council, 2006). Researchers agree with the above theory, level of fatigue someone shows different from each indvidu, because fatigue is not only bounded on physical complaints but the nervous system, mental processes (emotions), daily activities and the lack of rest can lead to fatigue , So from the age factor can be concluded that there is agreement between theory with facts.

3. Relationship fatigue level sports night with sleep quality in adolescent club futsal "one scholar" in sumeleh futsal, Tulungagung 2015. The results of hypothesis in this study can be seen from the results of data analysis, but to strengthen the analysis, the authors used the program SPSS (Statistical Product and Service Solution Version 16 of Windows) to prove there is relation between fatigue level night sport with sleep quality at Adolescents futsal club “ Scholar One” in Sumeleh Futsal Tulungagung 2015. Based on statistical calculation values obtained Spearman Rho range: 0.599 lies between the range of 0.406 s / d 0.642. By using Spearman Rho correlation calculation, P = 0.002 <α = 0.05, then Ho is rejected and H1 accepted, there is relationship between fatigue level night sport with sleep quality at Adolescents futsal club “ Scholar One” in Sumeleh Futsal Tulungagung 2015.

B.

The quality of sleep in teens club futsal "one scholar" in sumeleh futsal, Tulungagung 2015.

Based on Table 2 above are known from 24 respondents almost half of the respondents were aged ≥17 years experienced severe sleep problems, it is 9 respondents (41%). The sleep quality is closely related to the needs of a person's sleep. In this case the improvements in the quality of one's sleep, the more fulfilled person's sleep needs it. Sleep in everybody depend on the level of development of everybody sleep needs based on age (Alimul Hidayat, A. Aziz, 2006). For the quality of sleep a person based on age is the age of adulthood quality of sleep a person is a good 6 hours / day. Whereas in adolescence quality of sleep a person is good is 8.5 hours / day (Alimul Hidayat, A. Aziz, 2006). Researchers agree with the above theory, that the problem of sleep is not

DISCUSSION A. The Fatigue level sports night at adolescents in futsal club "one scholar" in sumeleh futsal, Tulungagung 2015. Based on Table 1 above, 24 respondents almost half of the respondents were aged ≥17 years experienced severe fatigue that is of 10 respondents (46%). This is because every person feel exhausted just limited to the physical complaints they feel. Symptoms, physical changes and feelings are perceived is different for each individual. Fatigue as feeling fatigue that comes from physical activity of the

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only based on good / poor quality of sleep a person, but must pay attention to sleep a person needs to be met, the duration of sleep should be fulfilled, dysfunction of sleep during the day, the efficiency of sleep habits and sleep disorders (insomnia) can also lead to sleep problems. So from the age factor can be concluded there is a match between theory and fact.

strenuous activities are carried out at night then it will lead to disruption of the person's sleep quality. Where each of us do exercise at night, the body temperature will increase, muscles become tense, and requires a few hours to relax again. causing the mind to feel tense and cause disruption quality sleeping at night. CONCLUSIONS AND SUGGESTIONS

C. Relations between fatigue level sports night with sleep quality in adolescent club futsal "one scholar" in sumeleh futsal, Tulungagung 2015.

CONCLUSION Based on the experiment results of fatigue levels in adolescent sports night club futsal "one scholar" in sumeleh futsal, Tulungagung shows that nearly half of respondents experiencing severe fatigue levels were 10 respondents (42%). Then the quality of sleep in teens club futsal "one scholar" in sumeleh futsal, Tulungagung shows that nearly half of respondents experienced hard problems sleeping quality is 9 respondents (37%). From the statistical test using spearmen rho, P = 0,002 <α = 0.05, then Ho is rejected and H1 accepted, there is a relationship between the level of fatigue of sports night with sleep quality in adolescent club futsal "one scholar" in sumeleh futsal, KabupatenTulungagung 2015 ,

Based on statistical calculation values obtained Spearman Rho range: 0.599 lies between the range of 0.406 s / d 0.642. By using Spearman Rho correlation calculation, didapatkanP = 0.002 <α = 0.05, then Ho is rejected and H1 accepted, there is relation between fatigue level contact sports night with sleep quality in adolescent club futsal "one scholar" in sumeleh futsal, Tulungagung 2015. Many activities causing excessive tiredness and fatigue can affect a person's quality of sleep because fatigue of high activity may require more sleep to maintain the balance of energy that has been issued. It is seen on a man who had been exercising at night and reach fatigue (Alimul Hidayat, A. Aziz, 2006) .This is because the body temperature will increase and require several hours to get back into a state of normal temperature, so that the mind feels tense causing disruption of sleep quality, in addition to sports at night will result in muscle tension after exercise and requires several hours to come back to relax. This was confirmed by (Rafiudin 2004) It is known that the relationship of the above theory test when compared with statistics and the theory of highly related, with high rates of severe fatigue caused by exercise at night can lead to problems more severe sleep quality as well. So each person's exercise /

SUGGESTION 1. For Developers Science It can used to increase knowledge, experience and materials in the application of the science of nursing research. As well as contribute ideas in order to improve implementation of the concept and practice of education as a strategic effort in developing quality human resources. 2. For Developers Program It can be used to improve health in exercise and as an input in efforts to prevent a lack of quality sleep in adolescents. Then the research is expected to be used as an additional reference, the reference as well as

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consideration for the base support further research.

Akibat, Dan CaraTerapi Insomnia, Jakarta : Flash Book Soetjiningsih. (2004). Tumbuh Kembang Remaja dan Permasalahanya. Jakarta :Sagung Seto Wartonah, Tarwoto, (2006). “KebutuhanDasarManusiadanPr osesKeperawatan”.Edisi 3. Jakarta: SalembaMedika Yi, H., Shin, K., Shin, C. (2006). Development of the sleep quality scale. Stylesheet: http://onlinelibrary.wiley.com/d oi/10.1111/j.13652869.2006.00544.x/full (28 November 2014: 07.00) Youngstedt, S. D., dkk. (2003). No association of sleep with total daily physicalactivity in normal sleepers. Physiology and Behaviour Research (78), 395401

SOURCES Arikunto, Suharsimi (2007). Prosdur Penelitian Suatu Pendekatan Praktik, Jakarta : Rineka Cipta Astrand dan rodalh. (2003). “ text book of work physioloy, physiological bases of exercise” 3rd ed. Mc Graw-Hill Book Company Buysse,D.J., Reynolds,C.F., Monk,T.H., Berman,S.R., & Kupfer,D.J. (1989). The pittsburgh sleep quality index (PSQI): A new instrument for psychiatricresearch and practice. Psychiatry Research, 28(2), 193213. Djoko Pekik Irianto. (2002). Dasar Kepelatihan.Yogyakarta: Fakultas Ilmu Keolahragaan Universitas Ngeri Yogyakarta Hidayat, Aziz Alimul. (2006). Kebutuhan Dasar Manusia . Jakarta : Health BooksPublishing Hidayat, Aziz Alimul. (2007). Metode Penelitian Keperawatan Dan Tehnik AnalisaData. Jakarta : Salemba Medika. Kroemer, KHE dan Etiene Grandjen. (2006). Fitting the safety and the human, 5th Edition. London Notoatmodjo, Soekidjo, (2005). “Metodologi Riset Keperawatan”. Jakarta: CV. InfoMedika Nursalam.(2003). “Konsep & Penerapan Metodologi Penelitian Ilmu Keperawatan”. Jakarta : Salemba Medika Nursalam.(2008).” Konsep & Penerapan Metodologi Penelitian Ilmu Keperawatan”.Jakarta: Salemba Medika Rahmat Rafiudin. (2004). Insomnia dan Gangguan Tidur Lainya. Jakarta : PT Alex Media Komputindo Siregar, Mukhlidah Hanun (2011). Mengenal Sebab-Sebab, Akibat-

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RELATED KNOWLEDGE OF EXCLUSIVE BREAST WITH THE FREQUENCY OF BREASTFEEDING BABY AGE 0-6 MONTHS (In Posyandu Srikaton, District Ngantru, Tulungagung 2015) Firsta Sukmawati1, Nurhidayati2, Sri Agustiana3 STIKes Hutama Abdi Husada Tulungagung Email: [email protected] Abstract Breastfeeding is an important activity in the maintenance of the child and the future preparation of the next generation. Nowdays, an exclusive breastfeeding has been decreased, the decrease in an exclusive breastfeeding mother is the lack of knowledge about the importance of exclusive breastfeeding. The aim of the research is to analyze the correlation between mother‟s knowledge in exclusive breastfeeding and the frequency of breastfeeding on babies at the age of 0-6 months. The study was conducted on 2 to 10 February 2015. The study design is correlation analytic with cross-sectional approach. The study population of all mother who had a baby at the age 0-6 months some 70 people. The samples were 35 people by using Accidental Sampling techniques. The independent variables of mother‟s knowledge about an exclusive breastfeeding, the dependent variable of the frequency of breastfeeding in a day. The research of knowledge and frequency instrument was a questionnaire. Data processed by the editing, coding, scoring, tabulating and analyzed with Spearman‟s Rho test. The research result was obtained from a total of 35 respondents that the most respondents were 18 (51.4%) have sufficient knowledge about an exclusive breastfeeding, and the most respondents were 18 (51.43%) frequency breastfeed the babies are very good. The Spearman‟s Rho test results obtained ρ value = 0.017 < α = 0.05, so the H1 was accepted which meant that there is a correlation between mother‟s knowledge in an exclusive breastfeeding and the frequency of breastfeeding on babies at the age of 0-6 months in health care at Srikaton village, district of Ngantru, Tulungagung 2015. Knowledge is very important in the basic mother‟s behavior in breastfeeding the baby. The better knowledge of mother will increase the frequency of mother breastfeed the babies. The health workers and cadres in health care is suggested to provide guidance and counseling about the importance of an exclusive breastfeeding on demand (at any time the baby requested) for baby at the age of 0-6 months. Keywords :Knowledge, an exclusive breastfeeding, breastfeeding frequency 1.

can be fulfilled by providing breast milk (ASI) to infants. Breast milk provides optimal nutrition for babies and is an ideal food for a baby's digestive system is growing. In addition, breastfeeding provides protection against certain infectious diseases that potentially affects infants in the first weeks after birth (Koesno, 2008). World Health Organization or WHO states that exclusive breastfeeding during the first 6 months is the best. Thus, the previous provision which states that exclusive breastfeeding can be given

INTRODUCTION Time after birth time is important for a mother. Because, at the time mother breastfeeding her child. Mother breastfeeding (ASI), exclusively from the first day of child birth to six months. In this period, children in desperate need of complete nutrition for growth and development. In order to produce good milk, a mother needs to be a healthy and adequate nutrition every day (Sunar Dwi Prasetyo, 2012). Infant nutrition is very important for the baby's needs are very high in nutrients to sustain life. These needs

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quite 4 months is no longer valid. WHO and UNICEF (United Nations Children's Fund) recommends the following steps to get started and achieve exclusive breastfeeding, namely: a). Breastfeeding within one hour after birth. b). Exclusive breastfeeding, breast milk only. That is, do not add other food or drink, not even water though. c). Breastfeeding your baby whenever asked (on-demand), as often as the baby wants, day and night. d). Do not use feeding bottles or doot (pacifier). e). Produce milk with a pump or a squeeze of the hand, while not with the children. f). Controlling emotions and thoughts so quiet (rays Ismawati S., et al., 2010). Experts of children around the world have been conducting research on the benefits of breastfeeding (breast milk). These factors explain the benefits of breast milk compared to cow's milk or artificial milk sharing. Other studies have also shown that infants are exclusively breast-fed and protected against infections of the respiratory and digestive systems. It is caused by the immune substances in breast milk provide a direct defense against disease. Furthermore, it has been proven that in breast milk there are elements that could form the immune system against infectious diseases and helped to work properly (Rizky Natia Seed, 2013). Breastfeeding as much as possible is an important activity in the care of children and the preparation of the future generation. But now declining exclusive breastfeeding, exclusive breastfeeding for the decrease is the lack of knowledge about the importance of exclusive breastfeeding (Siregar, 2009). The importance of exclusive breastfeeding is evident from the role of the world in 2006 WHO (World Health Organization) Child

Growth Standards issued that are then applied in the whole world that it is only emphasized the importance of breastfeeding to infants from birth to 6 months of age. After that, the baby began to be given complementary foods while breastfeeding up to 2 years of age. According to WHO, in 2011 there are still many women who lack an understanding of the importance of the benefits of breastfeeding for baby, exclusive breastfeeding is important for babies in age 0-6 months because of all the nutrients present in breast milk is very useful for the developing baby. In fact, 95% of mothers breastfeed but only 5% were breastfeeding exclusively. According to the Ministry of Health in 2011 breastfeeding (BMS) exclusive 0-6 months in Indonesia fluctuated in the past three years, declining from 62.2% in 2010 to 56.2% in 2011 and slightly increased in 2012 to 61.3% , Similarly, coverage of exclusive breastfeeding for infants up to 6 months decreased from 28.6% in 2010 to 24.3% in 2011 and increased to 34.3% in 2012 (National Health Survey, 20102012). Scope of exclusive breastfeeding in the province of East Java in 2010 was 56.4%, as well as coverage of exclusive breastfeeding in Tulungagung in 2013 amounted to 59.39% of the total of 8,110 infants who examined the baby. While in Puskesmas Ngantru in 2013 from 359 infants were breastfed exclusively up to 50.14% (Vivo Health Profile 2013). Results of a preliminary study in November 2014 in the Posyandu Srikaton, Ngantru, Tulungagung, result from interviews with 10 people, four people did not know the importance of optimal breastfeeding. Conditions that cause low exclusive breastfeeding is still a lack of knowledge in the health sector, 2

especially mothers with have baby and do not breastfed babies exclusively will have an impact on the growth and development of infants. Babies are encouraged to breastfeed exclusively for the first 6 months of life and continued breastfeeding with complementary foods, accompanied, ideally during the first 2 years of life. Protection against infection is greatest during the first few months of life in infants who are breastfed exclusively. Older babies breastfed will provide stronger protection effect. (Hegar Badriul, 2010). Breastfeeding can be done by providing counseling on breastfeeding for infants and mothers how to breastfeed exclusively according to the needs of infants and mothers are motivated to be sensitive to the exact time for breastfeeding. In addition to showing differences in outcomes of children who were breastfed as well as children who are breastfeeding are not good enough to motivate mothers to breastfeed their children by giving them breast milk as well. Based on the above, researchers interested in conducting research on "Knowledge Capital on the frequency of exclusive breastfeeding Baby Breastfeeding at age 0-6 months in Srikaton Countryside IHC Ngantru Tulungagung District." This study aims to determine Knowledge Is There a Relationship About Exclusive breastfeeding moms with breastfeeding frequency in Infants Age 0-6 Months Countryside IHC Srikaton in Tulungagung District Ngantru 2015. 2.

correlational and cross-sectional. This draft seeks to find the relationship between variables by analyzing the data collected, how much the relationship between the variables. A cross-sectional study was to emphasize that the time measurement / observation data independent and dependent variables only once in a while. In this type, independent and dependent variables are measured simultaneously at any one time, so there was no follow-up (Nursalam, 2011). The population of this research is all the mothers who have babies aged 0-6 months in Posyandu Srikaton, Ngantru, Tulungagung some 70 mothers. The sampling technique used was accidental sampling with a sample size of 35 respondents. Instruments in this study using a questionnaire. Data were analyzed using Spearman Rho test to determine whether or not the relationship of mother's knowledge about the frequency of exclusive breastfeeding breastfeeding in infants aged 0-6 months in Posyandu Srikaton, Ngantru, Tulungagung 2015. 3.

RESULTS 1. Knowledge About Exclusive breastfeeding mother Table 1 Distribution of frequency of maternal knowledge about breastfeeding exclusively at Posyandu Srikaton Ngantru Tulungagung District 2015 Knowledge F % Less 6 17,14 Enough 18 51,43 Good 11 31,43 Jumlah 35 100 m From the research knowledge of mothers on exclusive breastfeeding was obtained from a total of 35 respondents most respondents as

METHODS The location was done in Posyandu Srikaton, District Ngantru, Tulungagung implemented in February 2015. The study design used is an analytical study researchers 3

many as 18 (51.43%) of respondents have knowledge of exclusive breastfeeding in the category enough.

aged 0-6 months in Posyandu Srikaton Ngantru Kabupeten Tulungagung subdistrict in 2015 earned nearly half of respondents, 10 (28.6%) have enough knowledge about exclusive breastfeeding and frequency breast-feeding is good. Statistical test analysis results obtained ρ Spearman Rho value = 0.017 then ρ <α (0.017 <0.05) so that H0 is rejected and H1 accepted meaning no Knowledge Relationships With Mothers About Breastfeeding Eksklsusif Frequency of Breastfeeding In Infants Age 0-6 Months In Posyandu Srikaton Tulungagung subdistrict Ngantru 2015.

2. Frequency of Breastfeeding In Infants Age 0-6 Months Table 2 Distribution of frequency of breastfeeding in infants aged 0-6 months in Posyandu Srikaton Ngantru Tulungagung District 2015 Freq.breastfeding Bad Good Excellent

F 2 15 18

% 5,71 42,8 6 51,4 3 Total 35 100 From the results of the study the frequency of breastfeeding infants 06 months of age was obtained from a total of 35 respondents the majority of respondents as many as 18 (51.43%) of respondents frequency of breastfeeding her baby is very good.

4.

3. Hubungan Pengetahuan Ibu Tentang ASI Eksklusif Dengan Frekuensi Pemberian ASI Table 3 Analysis of the relationship of exclusive breastfeeding mother's knowledge about the frequency of breast-feeding Freq.breastfeeding Knowle Bad Good Excellent dge F % F % F % Less 1 2,9 3 8,6 2 5,7 Enough 1 2,9 10 28,6 7 20 Good 0 0 2 5,7 9 25,7 Alpha : 0,05 ρ value = 0.017 Research results mother's knowledge about the relationship with the frequency of exclusive breastfeeding breastfeeding in infants 4

DISCUSSION 1. Research Knowledge About Exclusive breastfeeding mother Based on Table 1 was obtained from a total of 35 respondents most respondents as many as 18 (51.43%) of respondents have knowledge of exclusive breastfeeding in the category enough. Knowledge is the result of human sensory, or know someone proceeds towards its object through the senses (eyes, nose, ears, and so on). By itself, the sensing time to generate such knowledge is influenced by the intensity of attention and perception of the object. Most people's knowledge gained through the senses of hearing (ears), and the sense of sight (eyes). Knowledge of a person against an object to have the intensity or level that is different (Notoatmodjo Soekidjo, 2007). According Nursalam and Pariani (2005) knowledge a person can be influenced by age, education and work. The results are consistent with the theory above, because mothers who have enough knowledge about exclusive breastfeeding means having knowledge and a fairly good understanding of exclusive

breastfeeding have ever gotten better from seeing or hearing as well as through other senses. Knowledge about exclusive breastfeeding mothers in the study in enough categories can be motivated by internal factors such as maternal age mothers, maternal education, maternal employment, as well as the experience of the mother. 2.

3.

Results The frequency of breastfeeding in Infants Age 0-6 Months Based on the table 2 is obtained from a total of 35 respondents almost half of the respondents as many as 15 (42.86%) of respondents frequency breastfeed is good. Breastfeeding means giving the baby food directly from the breast itself. Many mothers who lack understanding and lack of information about itself exclusive breastfeeding, breastfeeding, measures the correct breastfeeding in infants. Optimal breastfeeding frequency range is between 8 to 12 times each day. Breastfed babies should be non-schedule (on demand), because they will determine their own baby needs. A healthy baby can empty one breast about 5-7 minutes and the baby's stomach will be empty within 2-3 hours (Rizki Natia Wiji, 2013). The results are consistent with the theory above, since the frequency of mothers who breastfeed their babies wellmeaning mothers to breastfeed 812 times a day, where the frequency of breastfeeding 8-12 times will make the baby full, adequate food needs and can meet the nutritional needs of infants , Infants adequate nutrition in the form of exclusive breastfeeding will develop in accordance with age and is more immune from the disease so that the baby can grow up healthy. 5

Research Knowledge Relationship With Mothers About Breastfeeding Exclusive Breastfeeding Frequency In Infants Age 0-6 Months Based on the results in Table 3 obtained nearly half of respondents, 10 (28.6%) have enough knowledge about the frequency of exclusive breastfeeding and breast-feeding is good. Spearman Rho test results obtained value ρ = 0.017, then ρ <α (0.017> 0.05) so that H0 is rejected and H1 accepted meaning no Knowledge Relationships With Mothers About Breastfeeding Eksklsusif Frequency of Breastfeeding In Infants Age 0-6 Months In Posyandu Srikaton Subdistrict Ngantru Tulungagung 2015. Knowledge is the result of human sensory, or know someone proceeds towards its object through the senses (eyes, nose, ears, and so on). By itself, the sensing time to generate such knowledge is influenced by the intensity of attention and perception of the object. Most people's knowledge gained through the senses of hearing (ears), and the sense of sight (eyes). Knowledge of a person against an object to have the intensity or level that is different (Notoatmodjo Soekidjo, 2007). Reality in the study is appropriate that the baby's mother who has a good knowledge will provide breast milk to their babies at frequencies well too, and there is also a baby's mother who has a good knowledge and give milk to the frequency on demand, or at any time the baby needs to be breastfed , This shows that the knowledge is very important in the underlying behavior of the baby's mother to breastfeed her baby. The better

knowledge of mothers breastfeed then the frequency will be the better. 5.

c. Land for Practice Expected health workers and cadres in Posyandu can provide guidance and counseling, especially in mothers who had infants aged 0-6 months about the importance of exclusive breastfeeding on demand (at any time ask for infants) for infants aged 0-6 months.

CONCLUSIONS AND RECOMMENDATIONS Based on the results of research in Posyandu Srikaton Ngantru Tulungagung district in 2015 with a total of 35 respondents can be concluded that, nearly half of respondents, 10 (28.6%) have enough knowledge about breastfeeding and exclusive breastfeeding frequency is good. And the test results obtained Spearman Rho ρ = 0.017 while the value α (alpha) = 0.05, then ρ <α (0.017 <0.05) so H0 and H1 accepted meaning no correlation between knowledge about breastfeeding mother Eksklsusif With Frequency breastfeeding in infants aged 0 -6 Months In Posyandu Srikaton Ngantru Tulungagung District 2015. The conclusion of the suggestions can be submitted by researchers, are as follows:

BIBLIOGRAPHY Badriul, Hegar. 2010. Indonesia Menyusui. Jakarta: Badan Penerbit IDAI. Dinkes

Kabupaten Tulungagung. 2013. Profil Kesehatan Tahun 2013. Jurnal: Profil Kesehatan Kebupaten Tulungagung Tahun 2013, 15-139.

Ismawati, Cahyo.,dkk. 2010. Posyandu dan Desa Siaga. Jogjakarta: Nuha Medika. Kemenkes RI. 2011. Buku Pedoman Umum Pengelolaan Posyandu. Jakarta: Kemenkes RI.

1. For Developers Sciences Is expected to further develop nursing science in the field of education, in particular can be the basis for determining the educational strategies students about the importance of exclusive breastfeeding, and further advance the science of nursing research in enhancing the value of learning achievement

Koesno, Harni. 2008. MIMS Bidan. Jakarta: PT Info Master. Notoatmodjo, S. 2003. Pendidikan Kesehatan dan Ilmu Perilaku Kesehatan. Jakarta: Salemba Medika. ___________ . 2004. Pendidikan Kesehatan dan Ilmu Perilaku Kesehatan. Jakarta: Salemba Medika.

2. For Developers Program a. For Educational Institutions We hope this research can be used as input for educational institutions, especially in the field of infant and child health. b. For Further Research Researchers expect to further research in order to further develop his research related to exclusive breastfeeding better.

___________ . 2007. Promosi Kesehatan Teori dan Aplikasi. Jakarta: PT Rineka Cipta. Nursalam & Pariani, S. 2005. Praktis Pendekatan Riset Metodologi Keperawatan. Jakarta: Salemba Medika.

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Wiji, R. N. 2013. ASI dan Panduan Ibu Menyusui. Yogyakarta: Nuha Medika.

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THE INFLUENCE OF GIVING HEALTH EDUCATION ABOUT NAPZA TO CHANGE ATTITUDES AT STUDENTS IN VIII GRADE OF SMPN 2 CAMPURDARAT, TULUNGAGUNG, 2014 Surtini1, Amita Audilla2 STIKes Hutama Abdi Husada Tulungagung Email: [email protected] ABSTRACT Narkotika, Psikotropika and Zat Adiktif Lain (NAPZA) is substances that is harm and often abused by adolescents. Start at smoking, try to drink alcohol, consume ectasy, heroin and amphetamine. The ignorance about drugs will influence adolescents‟s attitude to drugs abuse. This study has purpose to know the influence of Giving Health Education about NAPZA to Change Attitudes at Students in VIII grade of SMPN 2 Campurdarat, Tulungagung, 2014. This study uses pre experimental (one group pretest-postest) design. The population is students inVIII grade SMPN 2 Campurdarat, Tulungagung. Total sample are 50 respondents, taken according to Purposive Sampling. Data is analyzed using Mc Nemar with SPSS 16. The result showed, from 50 respondents, before giving health education, many respondents have negative attitude (unfavorable) there are 33 respondents (66%), while after giving health education, many respondents have positive attitude (favorable) there are 42 respondents (84%). The result of Mc Nemar statistical test, showed P = 0,000 < α = 0,05, that means H1 accepted, there is influence of Giving Health Education about NAPZA to Change Attitudes at Students in VIII grade of SMPN 2 Campurdarat, Tulungagung. Based on the study, that it need more attention for students of SMP, with giving health education, giving motivation and giving information, in order to understand NAPZA, so they willn‟t fall into drugs abuse. Keywords: health education, NAPZA, attitude. level as ectasy, heroin and methamphetamine (Catio, 2006). United Nations Office for Drugs and Crimes (UNODOC, 2005) reported that 200 million or 5% of the world population become abusers of narcotics, psychotropic substances, addictive substances (drugs). About 3 million adolescents become drug abusers in Indonesia (Hidayat, 2000). Drug users in Indonesia is expected to increase at 2.3%. Report by the University of Indonesia and BNN show, in 2005, recorded drug use increased as much as 1.75% to 4.9% in 2011. More worrisome, drug users in aged 10-20 years increased by 2.5% (Deputy Rehabilitation BNN, Kusman Suryakusumah). Drug users in 2004 approximately 40% of teens (BNN 2006). According to data from Therapeutic Communities Indonesia (2006), an estimated four million drug

A. PRELIMINARY One of the national's problems that still disturb in society and and intensively discussed in various circles, both among executives, celebrities, middle or down to various age levels, from children to the elderly, namely drug abuse (narcotics, psychotropic and Other Addictive Substances). Beside that the development of modernization, information and communication that Rapidly growing up, it cause in using drugs in society. Drug abuse in Indonesia has happened long time ago and progressively increasing. Adolescents become drug abusers began with drug use as legal in the community that is smoked. Then, they will try to drink alcohol, marijuana, and try to consumpt the high level like ectasy, heroin and amphetamines (Catio, 2006). The use then gradually try to drink alcohol, marijuana, and to a more severe

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addicts trapped. This is the focus of the government, since most addicts are teenagers aged 16-25 years who are the future of the nation. Meanwhile, in 2012, the data Tulungagung Narcotics Agency (BNK) states that there are 133 teenagers become victims of drug abuse. See the incidence that increase every year, of course, it become the focus of government and society in addressing this issue. Indonesia is very alarming to see teenagers who will be the successor generation of this nation destroyed simply because of drug abuse. Drug abuse has negative impacts on users and the sellers. Drugs affect the central nervous system work, so that led to the emergence of problems in the body, such as a sense of helplessness, impaired nerve function and other vital organs, hallucinations up to addiction and even death. Besides interfere with health, drug will also cause psychological problems, social, economic, crime, such as mental disorder / depression, theft or other crimes. Seeing this phenomenon, it is important to give health education from an early age about the drug and its abuse, in adolescence as early as possible in the prevention of promiscuity that could mislead fall into drug abuse. The drug abuse prevention efforts should be comprehensive and multi-disciplinary, involving various professions, including addiction specialists, psychiatrists, psychologists, social workers, clergy and nurses. Nurses have an important role in providing nursing care to clients with drug abuse. This activity is carried out in promotive, preventive, curative and rehabilitative, with emphasis on primary health care, according to the authority, responsibility and professional ethics. In Tulungagung, many adolescent who become drug abusers, especially adoloscents in junior high school. SMPN 2 Campurdarat is one that is located quite far from the city center so that access information about drugs are still lacking, although the drugs have entered the learning program guidance counseling (BK). In addition there is a small portion

become drug abusers, so that health education on adolescent drug to class VIII SMPN 2 Campurdarat needs to be done as a promotive and preventive efforts in order to reduce the incidence of drug abuse. From the description above, researchers interested in conducting research on the influence of the drug provision of health education to change attitudes in class VIII SMPN 2 Campurdarat Tulungagung 2014. B. METHODS The research design used in this study are pre-experimental (one group pretest-posttest). This research was conducted by providing pre-test (initial observations) before the intervention, after the intervention is given, then conducted posttest (concluding observations). (Aziz, 2008). The population in this study were all students of class VIII SMPN 2 Campurdarat Tulungagung In 2014, some 322 students. The sampling technique used was probability sampling is purposive sampling, with a sample size of 50 respondents. The instrument used in this study is a questionnaire. Analysis of data using Mc Nemar test which will indicate whether or not the influence of the drug provision of health education to change attitudes. Mc Nemar test was used to test the hypothesis significance comparatif two samples are correlated when the data in the form of nominal. C. RESULTS From the results of the study before it is given health education known that most of the respondents, 66% (33 respondents) being unfavorable (-). Table 1. Distribution of Respondents Attitudes frequency before being given health education about drugs in the class VIII SMPN 2 Campurdarat Tulungagung 2014

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Attitude Favorable (+) Unfavorable (-) Total

Freq 17

Precentage 34

33

66

50

100

According to Elizabeth, BH (1995) in Mubarak (2005) is the age when individuals starting at birth until her birthday. According to Hurlock (1998) in Nursalam (2001) getting enough age, level of maturity and strength of a person will be more mature in thinking and working. Meanwhile, according to Sunaryo (2004), quoted from Syaifuddin Anwar (1995) that the trust associated with things how the individual (knowledge), the views, beliefs, thoughts, experience, personality, needs, emotional, and information from others. After the researchers looked at the results of existing research, which is where most of the respondents were aged 14 years to be unfavorable (-) ie 72.5%, while nearly half of the respondents aged 15 years is as much as 28.57% to be unfavorable (-) , This proves that age affects a person's attitude, increasing age, the more mature in thinking, so that the knowledge gained will affect a person's attitude. Although the drug has been used as educational programs by Counseling (BK) but the drug has not been used as formal subjects and drug coverage given BK just about drugs. So that the majority of respondents have a negative attitude (unfavorable). In addition to age, the attitude is also influenced by the information. See the location SMPN 2 Campurdarat which is quite far from the city center makes access to information obtained is still lacking despite already been taught by BK but the learning process is still using conventional methods where the teacher just explain it without using any media and students record what is described by the teacher, so that not all students can understand what is conveyed by the teacher. From the research, it is known that before being given health education about the drug, mostly of

Results peelitian after given health education about drugs, it was found that out of 50 respondents, almost entirely be favorable (+) ie 84% (42 respondents). Table 2. Distribution of Respondents Attitudes frequencies granted after health education about drugs in the class VIII SMPN 2 Campurdarat Tulungagung 2014 Attitude Freq Procentage Favorable 42 84 (+) Unfavorable 8 16 (-) Jumlah 50 100 From the analysis of Mc Nemar statistical tests on the effect of health education on the drug to change attitudes in class VIII SMPN 2 Campurdarat Tulungagung 2014, obtained p = 0.000, where p <0.05. So H0, H1 accepted, which means that there is the effect of health education on the drug to change attitudes in class VIII SMPN 2 Campurdarat Tulungagung 2014. D. DISCUSSION 1. Attitudes of Respondents Before Provided health education about drugs Based on table 1, before being given health education on drugs most of the respondents have unfavorable attitudes (-) ie 66% or 33 respondents. According Azwar.S (2003) attitude is influenced by several factors, including, personal experiences, the influence of others that are considered important, culture, mass media, educational institutions and religious institutions, as well as emotional factors.

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male respondents to be unfavorable () ie 66.67% (16 respondents). According Darmayanti 2008, psychologically girls mature faster than boys. Adolescent girls tend to be silent, overcome by internalizing problems, intellectualization and use feeling. Instead, teenage boys tend to be aggressive, to overcome the problem of externalization, hyperactivity, rebel and rationalization. Based on the theory and the facts, there is conformity in this study. Based on research results mostly teenage boys have unfavorable attitudes (66.67%) than girls (65.38%). This is because the nature of teenage boys tend to be aggressive and tackle the problem of externalization that the attitude of teenage boys being largely negative, while girls tend to be more positive.

Meanwhile, according to Sunaryo (2004), quoted from Syaifuddin Anwar (1995) that the trust associated with things how the individual (knowledge), the views, beliefs, thoughts, experience, personality, needs, emotional, and information from others. After the researchers looked at the results of existing research, influencing the attitude of a person's age, increasing age, the more mature in thinking, so that the knowledge gained will affect a person's attitude. Seeing the results of existing research, respondents aged 14 years have a more favorable attitude (87.5%) compared to respondents aged 16 years (33.33%). This is due to other factors that influence the attitudes that personal experience, the influence of others that are considered important, culture, mass media, educational institutions and religious institutions, as well as emotional factors. So after being given the drug health education age group of 16 years is still much to be unfavorable (66.67%), although it has been used as a drug education program by the Counseling (BK). Based on this research, it was found that after a given health education about drugs, almost entirely female respondents being favorable (+), ie 84.62% (22 respondents). According Darmayanti 2008, psychologically girls mature faster than boys. Adolescent girls tend to be silent, overcome by internalizing problems, intellectualization and use feeling. Instead, teenage boys tend to be aggressive, to overcome the problem of externalization, hyperactivity, rebel and rationalization. Based on the theory and the facts, there is conformity in this study, that most of the girls to be favorable (84.62%) than boys (83.33%). Teenage boys tend to be aggressive and tackle the problem of externalization that the attitude of

2. Attitudes of Respondents After Provided Health Education about Drugs Based on the table 2 is obtained almost entirely of respondents being favorable (+) ie 84% (42 respondents) after given health education about the drug. According Azwar.S (2003) attitude is influenced by several factors, including, personal experiences, the influence of others that are considered important, culture, mass media, educational institutions and religious institutions, as well as emotional factors. Based on the results of the study, after a given health education about drugs, almost all of 14 years old to be favorable (+) ie 87.5% (35 respondents). According to Elizabeth, BH (1995) in Mubarak (2005) is the age when individuals starting at birth until her birthday. According to Hurlock (1998) in Nursalam (2001) getting enough age, level of maturity and strength of a person will be more mature in thinking and working.

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teenage boys being largely negative, while girls tend to be more positive.

between the provision of education to change attitudes about drug class VIII SMPN 2 Campurdarat Tulungagung 2014. According Azwar.S (2003) attitude is influenced by several factors, including, personal experiences, the influence of others that are considered important, culture, mass media, educational institutions and religious institutions, as well as emotional factors. From the research and the existing theory, it is known that in addition to age and sex, the attitude is also influenced by other factors such as personal experiences, the influence of others that are considered important, culture, mass media, educational institutions and religious institutions, as well as emotional factors. So this cause most respondents to be negative (-) or unfavorable. In addition the results of research and theory suggests the influence. respondents' attitudes about the drug before it is given health education about drug and after being given health education about the drug. This proves that the information obtained through the provision of health education are quite clear and communicative very acceptable and understood by respondents that of the majority of respondents who previously had negative attitudes (unfavorable) later after being given health education about drugs, can affect respondents' attitudes into positive (favorable) about the knowledge of drugs. Means the provision of health education is no influence to change the attitude of the respondent.

3. Effect of respondent's attitude before and after administration of Health Education about Drugs Based on the results of the study showed the influence of knowledge before and after the administration of health education about drugs, it was found that before being given health education shows that the attitude of the 50 respondents, the majority of respondents ie 66% (33 respondents) being unfavorable (-) before being given health education about drug. After being given health education on the drug, nearly all of the respondents being favorable (+) ie 84% (42 respondents). According Notoatmodjo (2004) one level attitude is responding (responding), which means giving an answer when asked, do and accomplish a given task is an indication of the attitude due to an attempt to answer a question or perform a given task. Based on the results of research and theory suggests the influence. Attitude before being given health education about drug and after being given health education about the drug. This proves that the information obtained through the provision of health education on the drug are quite clear, communicative, and using media that attract one of which is a leaflet that allows students to absorb information for using the words shorter, colors, and images so that the brain more interested and it will be easy to memorize atupun recall the information, so that respondents who previously had negative attitudes (unfavorable) later after the drug is given health education about respondents' attitudes into positive (favorable). From Mc Nemar statistical test p value = 0.000 where p <0,05 so that H0 rejected and H1 accepted which means there is significant influence

E. CONCLUSION AND SUGGESTION Based on the results of research on the respondents in SMPN 2 Campurdarat Tulungagung, it can be concluded that: 1. Before given health education about drugs, the majority of

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respondents (class VIII SMPN 2 Campurdarat Tulungagung 2014) has an unfavorable attitude (-) is 66% (33 respondents). 2. When given health education about drugs, almost entirely (class VIII SMPN 2 Campurdarat Tulungagung 2014) has a favorable attitude (+) ie 84% (42 respondents). 3. The provision of health education about drug has a significant influence on the change in the attitude of students of class VIII SMPN 2 Campurdarat Tulungagung 2014 by Mc Nemar test statistics p value = 0.00 where p <0,05 so that H0 rejected H1 accepted.

BIBLIOGRAPHY Dasar-Dasar Ali, Zainidin. 2010. Pendidikan Kesehatan Masyarakat dan Promosi Kesehatan. Jakarta : Trans Info Media Arikunto, Suharmisi. 2006. Prosedur Penelitian Suatu Pendekatan Praktik. Jakarta: PT Rineka Cipta. Azwar, Saifuddin. 2009. Sikap Manusia Teori dan Pengukurannya. Yogyakarta: Pustaka Pelajar. Hermawanto, Hery. 2010. Biostatistika Dasar. Jakarta : Trans Info Media Hidayat, Aziz Alimul. 2008. Metode Penelitian Keperawatan dan Teknik Analisa Data. Jakarta : Salemba Medika Machfoedz, Ircham. Suryani, Eko. 2008. Pendidikan Kesehatan bagian dari Promosi Kesehatan. Yogyakarta : Fitramaya Notoatmojo, S. 2012. Promosi Kesehatan dan Perilaku Kesehatan. Jakarta : Rineka Cipta Notoatmojo, S. 2005. Promosi Kesehatan Teori dan Aplikasinya. Jakarta : Asdi Mahasatya Nursalam. 2008. Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan. Jakarta : Salemba Medika Partodiharjo, Subagyo. 2009. Kenali Narkoba dan Musuhi Penyalahgunaannya. Jakarta : Erlangga Purwanto, Heri. 1999. Pengantar Perilaku Manusia Untuk Keperawatan. Jakarta : EGC Rozak, Abdul. Sayuti, Wahdi. 2006. Remaja dan Bahaya Narkoba. Jakarta : Prenada Media Grup Setiadi. 2007. Konsep dan Penulisan Riset Keperawatan Edisi pertama. Jakarta : Graha Ilmu Sugiyono. 2006. Metode Penelitian Administrasi. Bandung : Alfabet Sumiati, S.Kp, M.Si, dkk. 2009. Asuhan Keperawatan Pada Klien Penyalahgunaan dan Ketergantungan NAPZA. Jakarta : Trans Info Media Susilo, Wilhelmus Hary. Limakrisna, Nandan. 2012. Cermat Menyusun

The advice from the researchers: 1. For the Nursing Profession Should have to apply the knowledge learned during the lecture by providing health education through various media such as help provide counseling and anti-drug movement at every opportunity in order to reduce drug abuse among teenagers. 2. For Further Research Further research is needed to look for a more complete supporting data on drug abuse that occurs among teenagers so as to develop further research in order to be better again. 3. For Educational Institutions This thesis can be used as input and reading materials for educational institutions STIKes "Abdi Hutama Husada" Tulungagung. 4. For The Research It is hoped the research could be used as a discourse to SMPN 2 Campurdarat about student attitudes toward drugs, so that the school can provide more information related to drug and avoid the risk of drug abuse.

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Kuesioner Penelitian Ilmu Keperawatan. Jakarta : Trans Info Media Tim Penulis Poltekkes Depkes Jakarta I. 2010. Kesehatan Remaja : Problem dan Solusinya. Jakarta : Salemba Medika Darmayanti. 2008. Meta Analisis Gender dan Depresi pada Remaja, http://jurnal.psikologi.ugm.ac.id// diakses Jumat, 28 Februari 2014 jam 09.00 Haryanto. 2009. Tugas Perkembangan Remaja, http://belajarpsikologi.com/tugasperkembangan-remaja/, diakses Senin, 20 Januari 2014 jam 13.00 Metro tv news. 2013. Pengguna Narkoba Tambah 23%. http://www.metrotvnews.com/, diakses Kamis, 21 November 2013 jam 21.30 Reza Safitri, Ahmad. 2013. Prevalensi Penyalahgunaan Narkoba Meningkat26%, http://www.republika.co.id/ , diakses Rabu, 26 November 2013 jam 12.00

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PROCESS OF SOCIAL LEGITIMACY OF PERSONS WITH MENTAL RETARDATION IN KARANG PATIHAN DISTRICTS BALONG PONOROGO

Siti Noor Farida Layla Stikes Surya Mitra Husada Kediri email: [email protected] ABSTRACT The public perception of persons with mental retardation, they can interfere with the social interaction in the community. The perception arises because a group of mental retardation in general have difficulty in interacting with others. Karang Patihan village recorded as the the highest mental retardation group in the ponorogo. the purpose of this research was to describe the process of social legitimacy persons with mental retardation in the village of Coral Patihan districts balong district ponorogo with some specific aspects such as identifying characteristics of individuals are socially, identify parenting in the family, identifying social space family, identify the conditions of the economic status of the family, identifying public support, and identifying the adaptive behavior of persons with mental retardation. Research methods was descriptive qualitative. Determining the location of the research done purposively held on 15 January until 17 May 2015. The sample was selected by purposive sampling. collecting data using interview, observation and documentation as well as secondary data from various sources. Based on the data required synergy between persons with mental retardation with various local communities. Aspects learned in supporting the process of social legitimacy with mental retardation: the individual characteristics in giving name, support parenting from both parents, and the implementation of the social functions of the family. Provision of optimal support through a person approach the center with assistance, both material and nonmaterial as well as improving the legality of identity through the application of the rules of religious and social values such as participation in various events are part of a sense of community in accepting the opening of residents with mental retardation. Suggestions of this research is the provision of social support in the form of material aid properly so that the development of self-reliance capability can be awakened every individual. The role of health educator in improving the performance of providing health care optimally. Pattern intensive assistance that people receive medical care through the ministry of health centers. Extraordinary schools (SLB) as an educational institution to monitor the condition of people with special needs such as persons with mental retardation. Keywords: social legitimacy, mental retardation difficulty in interacting with others. Mental retardation, especially in the village of Karang Patihan needs special attention because of population who have highest mental retardation Ponorogo district.

Background study Persons with mental retardation being concern in communities. There was perception that groups of persons with mental retardation can interfere with social interaction in a community. These perceptions appear on the surface and thoroughly discussed as a group of mental retardation in general who have

The goal in this research was to describe the process of social legitimacy persons with mental retardation in the village of Karang Patihan District of Balong

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Ponorogo with some specific aspects such as identifying characteristics of individuals are socially, identify parenting in the family, identifying social space family, identify the economic status condition of the family, identifying support public, and identify the adaptive behavior of persons with mental retardation.

underdevelopment in the personal ability of normal. Based on field data, it was needed attitude synergy between with mental retardation person with communities. When individual address in positive attitude and positive character the activities done far from negative nature. Various positive ways made especially for persons with mental retardation to gain social legitimacy in the village. Some aspects were studied in supporting the process of social legitimacy to people with mental retardation, including through:

Method Research was descriptive qualitative approach. Research location choosen by purposive namely in the village of Karang Patihan, District Balong, Ponorogo. Considerations determining the location of this research based on preliminary survey data that says that people with mental retardation in the largest region in Ponorogo. Field research was conducted on January 15, 2015 until May 17, 2015. The determination of the sample of respondents was determined through non-probability sampling approach that is purposive sampling by way of sampling for the purpose and particular consideration. Collecting data used interview techniques with tools questionnaires, observations on everyday life, documentation of research activities in the field, as well as the collection of secondary data from various sources.

The individual characteristics of giving the name of the mental retardation based on the state deviation should not growth process of a child's behavior is normal. These perceptions begin to change slowly with a given pattern of educating independent on each patient mental retardation although only standard for personal independence. Support parenting of democratic parents can produce a child with mental retardation characteristics of an independent, selfcontrol, have good relationships with friends and cooperatively with others. Implementation of the social function of the family in a way given a responsibility that is essential through the knowledge of how to care for themselves should normally function, trains interactive capabilities and communicative in a respectful manner and language skills locally, get right with humanity to fulfill the basic needs and biologically in the family , Socioeconomic situation in the family where the natural form of community forests that provide a source of income for families with mental retardation as well as the ability of self-possessed skills can help the household economy with the training of a vocational training center to make crafts.

Result and analysis. Most people often assume that the families of patients with mental retardation have an unpleasant attribute of the local community as a lower-class family. these perceptions begin to change slowly with a given pattern of educating independent on each patient mental retardation although only standard for personal independence as activity helped the family, cleaning the house, taking care of the cattle, even at the village level there is training on making handicrafts. These activities are very supportive in terms of social status, even though the condition of

Respondents with mental retardation in the ability of the power of thought

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generally run slower than normal size. independent behavior becomes a major part of the learning process for a parenting order can be used to independently meet personal needs. parenting people with mental retardation religiously participate and help grow flowers, memalui religious activities can be a fortress on a variety of negative behaviors.

fulfillment. involvement of family roles required for persons with mental retardation on the basis of independence in day-to-day behavior is still dependent on his family. basic needs such as food, clothing, and a board that can not be fulfilled independently. On the other side of the family in general conditions in the economy that can not afford, the lack of impact on meeting the basic needs of every member of the family. as well as on meeting the daily needs of food, each family has a different ability levels in fulfillment.

This research shows that there is a relationship between the attitudes of parents with mentally retarded children socialization skills. the attitude of the parents have a strong influence on the ability of socialization of children with mental retardation pengsuhan pattern permissive and democratic. success or failure of a person with mental retardation in growing its development can not be separated from the guidance and the attention that has been given by the family, especially his parents.

In general large family status of persons with mental retardation as respondents from poor families. this is because almost no people with mental retardation who have large families and flashy as his family served the village even government officials. In general, the ability of financial management were minimal owned by persons with mental retardation. gradually and slowly learning the trade as a means of exchange in the economy are also needed in further. interaction with the public provide an opportunity to develop the ability to socialize. sometimes that desire can not occur because people feel embarrassed persons with mental retardation and related conditions experienced alone. the role of the public about the environment helped provide a big role to provide confidence that potential can be optimized which is certainly a positive effect in people with mental retardation themselves.

Circumstances of parents who know that their family members bearing a developmental abnormalities of growth and development is mental retardation which there are responses families receive carefully the fact that there is, or be hiding a state, and there are also families who refuse or are unable to face reality (Smith, 1994). A highly significant association between parental attitudes towards mentally retarded child socialization skills. given the attitude of the parents have a strong influence on the level of social skills of children with mental retardation bears comparison to the influence of others. the level of success or failure of a child with mental retardation in development tasks can not be separated from any form of guidance and attention that has been given by the family, especially of the role of both parents.

One form of environmental role in helping social adjustment is social support (payne, 1985). social support is a form of comfort, understanding, appreciation or individuals received assistance from another person or group (Sarafino, 1994). american association on intellectual and developmental disabilities (aaid) also suggest the importance of social support for

Based on the economic function for persons with mental retardation in the village of Coral Patihan generally still takes the role of the family in its

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individuals with developmental stages of mental retardation, because social support can improve the function of individual adaptive, self help, good social skills, and improve health. giving optimal dukunganyang through person center approach is a way to improve education, work, recreation, and the environment for persons with mental retardation.

mutual respect. various positive activities undertaken, especially for persons with mental retardation to be part of the social legitimacy in the village. social legitimacy is a form of behavior pattern corresponding to the pattern of behavior of people in their environment. as a form of behavior that is performed by persons with mental retardation although less fit like a normal person, but open attitude Patihan coral rural communities that accept all its conditions.

Forms of social support consistently given first and done long ago is giving yudium salt. The fundamental reason for generally some parties give a statement with mental retardation in the village due to lack yudium Patihan coral. according to the results of research activities conducted by major universities in Indonesia mentions that the soil and water conditions contained in the region does not contain elements yudium altogether. various agricultural products they produce are also poor in iodine.

The behavior of adaptive function for persons with mental retardation to be able to have an individual's ability to effectively be able to face all his need for self that can be accepted by the social environment. assessment criteria are helpful in explaining the ability of a person with mental retardation among others related to the functional capability of self-reliance in meeting the needs of daily life, personal responsibility with the ability to perform a task or job either activities carried out in the family and when acted upon an obligation provided by the Outside, as well as the ability to perform social communicative interactions in society. such criteria as the basis of mental retardation how to attack to get a decent place in the neighborhood.

Social support in the form of other materials are also given assistance or renovation of residential development to the provision of home affection for people with mental retardation. The aid obtained from a form of local authority roles eastern Java. even some housing residents who renovated by the military. as eligibility to settle despite getting help physically renovation but the condition of the interior of the house in the casing affection sometimes far from decent. Under these conditions because the family can not take care with the optimal lingkungnnya because mental limitations condition.

Patterns of behavior that does not match the size of the normative environment related to the difficulty to understand and interpret the norm, while other behavioral anomaly associated with a mismatch between the behavior displayed by the development of age.

Various social support in society are also part of the opening sense of community in the village of Coral Patihan in receiving citizens with mental retardation. support given as a form of legality as citizens in the community. persons with mental retardation is also a part of society that needs to get the rights and obligations as individuals who live in rural communities Patihan coral.

According to Davison (2006), one with people with mental retardation may have a form of behavior that is friendly, but usually only able to communicate briefly in a very concrete level. generally can do little activities independently and often looked lethargic. persons with mental ratardasi able to do work that does not require high skills, to always get a referral guidance. such as people

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with mental dissertation is mesinah are also active in the activities organized by the local government melalaui training centers along with village communities of coral Patihan to conduct skills training for local residents in making mats. The program is very helpful in increasing the creative power of the local community and increase revenue to increase household income. in addition, residents also involve people with mental retardation to participate actively participate in these activities, so it can be interpreted that the local people are very open to people with mental retardation.

social values such as participation in various events are part of a sense of community in accepting the opening of residents with mental retardation. The support given as a form of legality as citizens in society. Conclusion and suggestion The advice given in this study include the provision of social support, especially in the form of material assistance should be adjusted to the needs and conditions of each persons with mental retardation, so that the development of self-reliance capability can be awakened every individual and the aid can be targeted to the needs of the community. Role of health workers more optimal in improving the performance of providing health care. The quantity in human resources also need to be increased in a bid assistance to people with mental retardation. Pattern intensive assistance in changing people's minds so that people receive medical care through the ministry of health centers. Extraordinary School (SLB) as an educational institution to monitor the condition of people with special needs such as persons with mental retardation. SLB role can reach out and provide character education in accordance with the level of mental retardation condition experienced by people with evaluations involving the participation of family members, especially the pattern of care provided by parents

Various aspects of the functioning of independence that formed the beginning of family support in providing teaching behaviors that will be taught are broken down into small parts in sequence and basic routine that can foster personal responsibility to be given to the provision of a learning activity in their daily lives. the role of interaction of social relations within the family such as communicating effectively with the immediate family and the community by following religious activities can be a filter in negative behavior

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DURATION EFECT OF TREATMENT AND THE FAMILY’S MOTIVATION FOR MEDICATION ADHERENCE OF LEPERS Ema Mayasari Stikes Surya Mitra Husada Kediri Email: [email protected] ABSTRACT In the treatment of leper, the problem that often arises is the medication adherence of lepers. Treatment of leprosy is need of the family's role in providing the motivation and supervision to the lepers to taking medication regularly. Medication adherence influenced due to the treatment of leprosy was 2 years old and supervision period up to 5 years. Long duration of treatment is what often encourage lepers disobedient to take medication of leprosy.The design of this research was quantitative with correlation design. The approach was cross sectional. The population was all 38 lepers in Leprosy Hospital of Kediri, and 31 responders were taken as samples by simple random sampling technique. The duration of treatment and family‟s motivation data were obtained from questionnaires and the drugs consumption obedience data were obtained from the observation sheets. The result data was expressed in ordinal data scale and analyzed with Chi Square Test. The research resulted that most respondents who have long treatment <6 months as many as 20 respondents (64.5%), the family‟s motivation majority of respondents in the low category as many as 14 respondents (45.2%), while the majority of respondents have high levels of adherence drugs with category obedient as many as 19 respondents (61.3%). duration of treatment had no effect on medication adherence of lepers (p = 0.098 <0.05), while the family‟s motivation had effect on medication adherence in patients with leprosy in Kediri Leprosy Hospital (p = 0.012 <0.05). The family‟s motivation would motivate the patients that their lives were still meaningful; they were still needed, and still loved. It would become the patients‟ inner motivation to rise up again. Key Word : Leprosy, Duration Of Treatment, Motivation, Medication Adherence Health (2011), the number of leprosy patients nationwide in 2011 was 17 021 cases. In East Java Province leprosy is endemic. Based on data in East Java Provincial Health Office in 2010 - 2011 has recorded 6326 cases. From the results of data collection beginning on 12 January 2012, the number of leprosy patients hospitalized in 2010 377 people and in 2011 had increased by a total of inpatients who registered 752 people and in 2012 as many as 424 people. Problems often encountered in the treatment of leprosy patients is the appearance of disobedience patients in taking medication, it is because the process of healing leprosy very long that is for one full year and even then if patients adhere in taking medication, but on the contrary if patients do not comply

INTRODUCTION Leprosy is a chronic disease caused by the bacterium Mycobacterium leprae in the skin and peripheral nerves. The clinical manifestations of this disease varies greatly with the spectrum that is between the two clinical forms are lepromatous and tuberculoid. In patients with type lepromatous leprosy attacks the upper respiratory tract and skin disorders in the form of nodules, papules, macules and in large quantities. In patients with tuberculoid leprosy skin lesions are usually single and rare, firm lesion boundary, numbness (Zulkifli, 2005). Nationally, the prevalence of leprosy is about 1.25 case per 10,000 population. According to the Ministry of

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then the treatment will even longer (Susilowati, 2007). Treatment of leprosy is in need of the family's role in providing the motivation and supervision to the patient to take medication regularly. This is because the process of the treatment of leprosy was 2 years old and supervision period up to 5 years. The length of this leprosy treatment process that often encourage patients to take medicine not comply leprosy. Program Multi Drug Therapy (MDT) was initiated in 1981, when WHO Chemotherapy Study Group officially issued recommendations leprosy treatment with MDT-WHO regimen. This regimen consists of a combination of drugs dapsone, rifampicin, and klofasimin. Besides overcoming dapsone resistance is increasing, the use of MDT is also intended to reduce noncompliance of patients and decrease the dropout ratemedication (dro-out) are quite high during dapsone monotherapy. Besides, it is also expected to eliminate the persistence of the bacteria can MDT leprosy in the network (WHO, 2008). According to Arifin (2008), the family often get bored with the treatment of leprosy and let his family suffer from leprosy or not taking the medicine. This ultimately led to drop out. Based on the above researchers interested in conducting research "Effect duration of treatment and family motivation toward medication adherence in patients with leprosy in Kediri Leprosy Hospital".

Age Education

Gender Work

METHODE The research design used in this research is quantitative research design correlation. The approach used is cross sectional research that independent variables and the dependent variables were measured simultaneously and carried instantaneous or once (Nursalam, 2008). The population in this study were all lepers in Kediri Leprosy Hospital amounted to 38 people with samples taken amounted to 31 people by simple random sampling. Independent variable in the study was duration of treatment and the family‟s motivation, while dependent variable in this study is a medication adherence. The analyzed with Chi Square Test. RESULTS AND DISCUSSION

Based on Table 1, it was found that the distribution of 31 respondents based characteristics of the majority of the respondents aged between 20 years to 50 years which amounted to 29 respondents (93.5%). Most respondents had education on elementary school is 17 respondents (54.8%). Most of the respondents are male is 18 respondents (58.1%). Most respondents did not work ie 25 respondents (80.6%). Based on Table 2, it was found that the distribution of respondents by the majority of respondents have a variable length of treatment is less than 6 months is 20 respondents (64.5%). Most respondents have low family‟s motivation of 14 respondents (45.2%), and medication adherence on obedient category by 19 respondents (61.3%). Table 1. Distribution of respondents by Characteristics Variable F % < 20 years 2 6,5 20 years – 50 years 29 93,5 17 54,8 Elementary School Junior high school 13 41,9 Senior High School 1 3,2 18 58,1 Man female 13 41,9 Did not work 25 80,6 Entrepreneur 6 19.4

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Table 2 Distribution of Respondents by Variables Variabel F Duration Of Treantment <6 month 20 6 months - 1 year 11 low 14 Family‟s Motivation moderate 8 height 9 Not obey 8 Medication Adherence less obedient 4 obedient 19 Based on Table 3, it was found that most of the 20 respondents with a duration of treatment is less than 6 months has medication adherence on obedient category by 15 respondents. There are also some of the 11 respondents with a duration of treatment between 6 months to 1 year with medication adherence on not obey category there are 5 respondents. Based on statistical test results showed that the value of sig. 0098 showed that duration of treatment had no effect on medication adherence of lepers. Based on Table 4, it was found that the majority of respondents had a low motivation from family with medication adherence on not obey category by 7 respondents. Respondent who has a height family‟s motivation with medication adherence on obedient category there are 9 respondents. Based on statistical test results showed that the value of sig. 0012 showed that the family‟s motivation had effect on

% 64,5 35,5 45,2 25,8 29 25,8 12,9 61,3

medication adherence in patients with leprosy in Kediri Leprosy Hospital. Motivation in principle is an impulse (Robbins, 2003). Stanton (2004) also confirmed that motivation is a boost to the needs and desires aimed to obtain the fulfillment of a need or desire. According Sugiyono (2005), a person who has motivation characterized by the tendency of a challenging task, but not above his ability. Likewise, the families who have the motivation to remind members of his family who are sick to take medicine, it will provide the greatest motivation for patients to carry out therapy obediently. For example, a husband and child support on sick wife will give a huge motivation to recover. Society also affect compliance in treatment. Conditioning in society sometimes impede the patient to carry out treatment obediently for example when someone is not allowed to smoke but the encouragement of promiscuity in society lead to patient non-compliance (Mohibbin, 2008).

Table 3 Duration Efect Of Treatment for medication adherence of lepers Medication Adherence of lepers Asymp. Not Less obedient Total Sig. Obey Obedient Duration of < 6 monts 3 2 15 20 Treanment 6 monts– 1 yaars 5 2 4 11 0,098 Total 8 4 19 31

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Table 4. Effect of Motivation From Families for medication adherence of lepers Medication Adherence of Lepers Asymp. Not Less obedient Total Sig. Obey Obedient 7 3 4 14 Motivation From low moderate 1 1 6 8 Family 0,012 height 0 0 9 9 Total 8 4 19 31 the family‟s motivation had effect on medication adherence in patients with Found no association with the leprosy in Kediri Leprosy Hospital. level of family motivation medication adherence in patients with leprosy ACKNOWLEDGEMENT caused by lack of support from family members, the person feels that his life In this study are expected in still has meaning, are still needed, still health care workers especially on cherished. It will be a source of internal personnel handling lepers both in motivation of the patient to get up again. hospitals and in health centers to The existence of this motivation will disseminate and apply to the families of ultimately arise from the boost in selflepers in order to provide motivation to lepers that I had to recover from her lepers taking medication adherence. It is illness. Therefore there will be a positive also expected that the community mindset that ultimately propel him to concerned with lepers and help provide always take medication as recommended motivation to take medication in order by health officials. On the other hand lepers obediently consume leprosy patients themselves also have another drugs. source of motivation in addition to family support such as information REFFERENCES obtained from friends or other people related to the principle of treatment of Achmad S. Ruky. 2003. Sumber Daya leprosy. The existence of fear if the Manusia Berkualitas Mengubah. disease progresses, causing physical Visi Menjadi Realitas. Jakarta: disability and so on will also improve PT Gramedia Pustaka Utama compliance in taking medication Darwis, S.D. 2003. Metode Penelitian leprosy. Background job that requires Kebidanan. Jakarta : Buku physical appearance also causes Kedokteran EGC. adherence to taking medication. But the Depkes RI. 2000. Parameter Standar most important thing to mention is the Umum Ekstrak Tumbuhan Obat. motivation of members of his family Cetakan Pertama. Jakarta : who always provide motivation in the Depkes RI. treatment of leprosy. Depkes RI. 2004. Undang-Undang Kesehatan Tahun 2004. Tentang CONCLUSIONS Kesehatan. Jakarta. Depkes RI. 2006, Buku Pedoman The conclusion of this study are Nasional Pemberantasan most respondents who have long Penyakit Kusta, cetakan XVIII, treatment <6 months, the family‟s Jakarta: Direktorat Jenderal motivation majority of respondents in Pengendalian Penyakit dan the low, while the majority of Penyehatan Lingkungan respondents have high levels of Depkes RI. 2007. Profil Kesehatan adherence drugs with category obedient. Indonesia Tahun 2006. http : // duration of treatment had no effect on www.depkes.go.id/ downloads/ medication adherence of lepers, while

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publikasi/ Profil%20Kesehatan%20Indone sia%202006.pdf [diakses tanggal 19 Desember 2012] Efendi, Nasrul. 2002. Keperawatan Kesehatan Masyarakat. Jakarta : EGC. Hastomo, W. 2007. Statistik Kesehatan. Jakarta : Rinneka Cipta. Martin Handoko.2008. Motivasi Daya Penggerak Tingkah Laku. Yogyakarta: Kanisius. Hamzah, 2009. Teori Motivasi Dan Pengukurannya. Jakarta : Bumi Aksara

Husnaini, U. 2004. Pengantar Statistik. Jakarta: Bumi Aksara Irianto, S. 2010. Statistika. Jakarta : Penerbit Kencana Kaplan, Sadock, dkk. 2007. Psikiatri Klinis. Jakarta : EGC. Letnan Dailimonte. 2008. Gambaran Persepsi Penderita Tentang Penyakit Kusta Dan Dukungan Keluarga Pada Penderita Kusta Di Kota Manado. Neil, Niven. 2008. Psikologi kesehatan. Jakarta : EGC

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EFFECT OF GIVING ISOFLAVONE GENISTEIN DURING THE PERIOD OF PREPUBESCENT VAGINA HISTOLOGY , ESTRADIOL CONCENTRATION AND OVULATION IN FEMALE MICE ( MUS MUSCULUS L ) 1) YennyPuspitasari; 2) Byba Melda Suhita Lecturer Nursing Science Program Institute of Health ScienceSurya Mitra Husada Email : [email protected] ABSTRACT The condition of precocious puberty is triggered by the brain spontaneously or due to the effects of chemicals from outside the body and this process usually begins at the end of childhood marked signs of early maturity of the reproductive organs and have been the end of the growth period. Genistein is an isoflavone-containing soybean group that can interact with the animals and the human estrogen receptor, which causes the effects in the body similar to the hormone estrogen.The aim of this study was to determine the effect of isoflavon genistein over a period of pre-pubescent on the histology of the vagina, the concentration of estradiol and ovulation in female mice (Mus musculus L). This type of experimental research was true experiment, with the design of Complete Random Design. Experiment consists of two groups: a control group (given 0.1 cc of distilled water) and the treatment group (given isoflavone 6 mg / gr BB + 0.1 cc distilled water), each consisting of 12 female mice were placed into groups randomly , The statistical test used independent t-test. The data were analyzed using SPSS 18. The result is said to be significantly different if the p value ≤ 0.05. The results showed histological examination of the vagina in the treatment group and the control group there was no difference in the thickness of the vaginal epithelium in mice pre-puberty. On the results of the examination showed estrogen treatment group higher levels of the hormone estrogen than the control group. At ovulation test results showed the treatment group and the control group experienced no ovulation in pre-pubertal mice, but at this stage of the growth of tertiary follicles in the treatment group more numerous than the control group. Isoflavon Genistein not lead to differences in the size of the thickness of the vaginal epithelium in mice pre-puberty, increases the levels of estrogen in prepubertal mice and increase the number of tertiary follicles in mice pre-puberty, does not cause ovulation in pre-pubertal mice. Keywords: isoflavon genistein, pre-pubescent, histology vaginal estradiol concentration and ovulation INTRODUCTION

Entirely from various sources stated that the precociuos puberty incident occurred predominantly in girls than boys. This is possible because precocious puberty brings an autosomal dominant genetic trait and more often as a result of exposure to the hormone estrogen early in infancy. For girls often caused by idiopathic etiology and vice versa in boys was significantly highest in the brain caused by the disease.

Precocious puberty is a condition in which puberty occurs early children in general, which is about the age of 9-14 years in girls and 1017 years of age in boys. This condition is triggered by the brain spontaneously or due to the effects of chemicals from outside the body and usually this process began at the end of childhood (less than age 9 years) with marked signs of maturation of the reproductive organs early and have expiration growth. Early puberty can be a part of normal developmental variation of someone, but it can also be a disease or exposure to abnormal growth hormone.

A research has stated that a girl who are overweight or has a body mass index (BMI) is worth obesity often show the physical characteristics of the occurrence of early puberty. Other studies revealed the substance Bisphenol-A (BPA) which is a raw material

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for making goods of plastic and are often used by infants and young children (plastic bottles) can stimulate increased levels of the hormone estrogen, which in turn can lead to precocious puberty.

mice were placed into groups randomly . Statistic test used is the independent t-test. Independent t-test was used to test the concentration of estradiol comparison between the treatment group and the control, ovulation comparison between treatment and control group, the thickness of the vaginal epithelium comparison between the treatment group and the control regardless of estrus phase. The data were analyzed using SPSS 18. The result said there was to be significantly different if the p value ≤ 0.05.

Soybean and processed products are very much consumed by the people of Indonesia, because besides the price is cheap, soy also contains carbohydrates, high protein, vitamins, as well as several other important minerals. It is known that soy contains phytoestrogens. Phytoestrogens are a material / substrate structure, biological activity and properties of estrogen derived from growing plants.

T-TEST INDEPENDENT RESULTS Genistein was one of the few Isoflavones, including a group of plants, with soybeans and soy products such as tofu, soy milk, tempeh, soy and vegetable protein become an important one in the food. Soy isoflavones are a group containing soybean. She has a function as antioxidants, some isoflavones can interact with the animals and the human estrogen receptor, which causes the effects in the body similar to the hormone estrogen.

Histology vagina at the age of mice 4 weeks after administration of isoflavone genistein

group Mean Treatment Control

Refers to the breadth and the free consumption of isoflavones genistein in everyday life, as well as evidence-based isoflavones genistein can cause effects in the body similar to the hormone estrogen, the research was structured in such a way to to learn whether the hormonal changes after the administration of the isoflavones genistein significant enough to induce changes in histology vagina, concentrations of estradiol and ovulation in female mice (Mus musculus L) strain DD Webster.

Std. Deviation

273.9667 109.04977 256.4500 136.33865

Std. Error Mean 31.47996 39.35758

That there is no difference in the thickness of the vaginal epithelium children between the group of mice given isoflavones genistein treatment and control groups. Giving isoflavones genistein did not cause changes in the size of the thickness of the vaginal epithelium in mice pre-puberty. With p = 0731 (> 0.05). The concentration of estradiol in mice at the age of 4 weeks after administration of isoflavone genistein

RESEARCH METHODS Group

This type of research is experimental research is true experiment, with the design of Complete Random Design (RAL). Experiment consists of two groups: a control group (given 0.1 cc of distilled water) and the treatment group (given isoflavone 6 mg / gr BB + 0.1 cc distilled water), each consisting of 12 female

Mean

Std. Deviation

Treatmen .2464615 .068044848 t 5 Control .0498264 .010745593 6

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Std. Error Mean .019642856 .003101985

There is a difference of estrogen in the control group and the treatment group with a difference of 0.196635090 and p = 0.000 (<0.05). Giving isoflavone genistein cause changes in estrogen levels in the treatment group this is due to the content of isoflavone genistein provide a great stimulus to increased levels of estrogen in pre-pubertal mice.

genistein and control groups. Giving isoflavone genistein causes estrogen levels in pre-pubertal mice was higher than the control group 3. There is a difference in development of tertiary follicles of mice between treatment groups were given isoflavones genistein and control groups. Giving isoflavone genistein causes tertiary follicles in mice pre-pubertal more than the control group. Ovulation is not found in the control group and the treatment group.

Overview of ovulation in the ovaries of mice at the age of 4 weeks after administration of isoflavone genistein

Follicles

Primer Secondar y Tertiary De Graff

N

Mean

12 12

6.8333 7.0000

12 12

4.3333 4.7500

12 12

4.5000 4.2500

12 12

2.5833 1.8333

Std. Deviation Std. Error MeanSuggestion 2.08167 .60093 Further research is needed in the longer period 2.00000 .57735 of time or the dose needs to be improved in 1.07309 .30977 order to give the effects of isoflavones .96531 .27866 genistein on ovulation and estrus phase in post-pubertal female mice. 1.24316 .35887 REFERENCES 1.05529 .30464 .79296 .22891 .83485 .24100

1. Achdiat, C.M. 2003. Fitoestrogen untuk wanita menopause. http://www.situs.kesrepro.info/aging/j ul/2003/ag01.html [30 Nopember 2007] 2. Anonim. 2007. Effect of fitoestrogen on fertility and development. http://www.foodstandards.gov.uk/mult imedia/worddocs/phytoreport09.doc (29 Nopember 2007) 3. Anonim. 2007. Fitoestrogen untuk wanita menopause. Medikamentosa vol.6 no.11 http://www.majalahfarmacia.com/rubrik/one_newsprint.as p?IDNews=494 [29 Nopember 2007) 18 4. Amirthaveni, S. dan Vijayalakshmi, P. 2000. role of soyflour supplementation on lipid profile among cardiovascular patients. Prosiding “TSPUC-III” october 15-20, 2000, Tsukuba, Japan. pp:185-186 Barrett J. 1996. Phytoestrogens: Friends or foes?

There is effect of isoflavone genistein on the development of tertiary follicles in the treatment group. Ovulation is not found in the control group and the treatment group. With a value of p = 0.034 (<0.05). CONCLUSIONS AND SUGGESTIONS Conclusion 1. There is no difference in the size of the thickness of the vaginal epithelium between the group of mice given isoflavones genistein treatment and control groups. Giving isoflavones genistein did not cause changes in the size of the thickness of the vaginal epithelium in mice pre-puberty. 2. There is a difference in estrogen levels between treatment groups given isoflavones

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5.

6.

7.

8.

9.

Environmental Health Perspectives 104:478-482. Colborn T., Dumanski D., and Myers J.P. 1996. Our Stolen Future. New York: Penguin Books, Inc. Cotroneo MS, Wang J, Eltoum IEA, Lamartiniere CA. Sex steroid receptor regulation by genistein in the pubertal rat uterus. Mol Cell Endocrinol. 2001, 173:135-145. Fritz WA, Wang J, Eltoum IE, Lamartiniere CA. Dietary genistein down-regulates androgen and estrogen receptor expression in the rat prostate. Mol Cell Endrocrinol. 2002, 186:8999. Glover A. and Assinder S.J. 2006. Acute exposure of adult male rats to dietary phytoestrogen reduces fecundity and alters epididymal steroid hormon receptor expression. Jour. Endoc. 189: 565-573 Haavisto T, Numela K, Pohjanvirta R, Huuskonen H, El-Gehani F, Paranko J. Prenatal testosterone and LH levels in male rats exposed during pregnancy to 2,3,7,8-tetrachlorodibenzo-p-dixin and diethylstilbestrol. Mol Cell Endocrinol 2001, 178:169-179. Jha H.C., Kiriakidis S., Hoppe M. dan Edge H. 1997. Tempe constituents as antioxydants. Paper Abstract for International Tempe Symposium, Bali. Institues Physiological Chemestry, University of Bonn. Jefferson W.N., Padilla-Banks E., Clark G., and Newbold R.R. 2002. Assessing estrogenic activity of phytochemicals using transcriptional activation and immature mouse uterotrophic responses. Journal of Chromatography. B Analytical Technologies in the Biomedical and Life Sciences 777(1-2):179-189. Johnston, I. 2003. Phytochem functional foods. CRC Press Inc. pp 66-68. Kang KS, Che JH, and Lee YS. Lack of adverse effects in the F1 offspring maternally exposed to

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15.

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genistein at human intake dose level. Food Chem Toxicol. 2002, 40:43-51. 19 Koswara S. 2006. Isoflavon, senyawa multi manfaat dalam kedelai. http://www.ebookpangan.com/ARTIK EL/ISOFLAVON,ZATMULTIMANF AATDALAMKED ELAI Loggia, R.D., Tubaro A., Dri P., Zilli C., dan Del Negro, P. 1986. The role of flavonoids in the antiinflammatory activity of Chamolia recutita. Plant flavonoid in Biology dan Medicine : Biochemical, Pharmaceutical and Structure-Activity Relationship. Alan R.Liss, Inc. pp. 481-484 McKinnell C, Atanassova N, Williams K, Fisher JS, Walker M, Turner KJ, Saunders, PTK, Sharpe RM. 2001. Suppression of androgen action and the induction of gross abnormalities of the reproductive tract in male rats treated neonatally with diethylstilbestrol. J Androl 22:323338. Messina, M, Gardner C, et al. 2002. Gaining insight into the health effects of soy but a long way still to go: Commentary on the fourth International Symposium on the Role of Soy in Preventing and Treating Chronic Disease. J Nutr 132(3):547S551S. Pawiroharsono, S. 1998. Benarkah tempe sebagai anti kanker. Jurnal Kedokteran dan Framasi MEDIKA, No.12 Tahun ke-XXIV, Desember 1998. pp.815-817 Peterson, T.G., Kim H. dan Bames S. 1997. Mechanism of action of the soy isoflavone genestein at the cellular level. Second International Symposium on the Role of Soybean in Preventing and Treating Chronic Deseases, September 15-18, 1996, Brussel, Belgique.

16. Teramoto T., Yoshida H., Ikeda H., dan Tamori, Y. 2000. Supressive effect isoflavones on proliferation of breast cancer cells induced by nonylphenol and bi-phenol A. Prosiding “ISPUC-III”, October 15-20, 2000, Tsukuba, Japan. pp. 177-178 17. Williams K, McKinnell C, Saunders PTK, Walker M, Fisher JS, Turner KJ, Atanassova N, Sharpe RM. 2001. Neonatal exposure to potent and environmental oestrogens and abnormalities of the male reproductive system in the rat: evidence for importance of the androgen-oestrogen balance and assessment of the relevance to man. Human Reprod Update. 7:236-247. 18. Yildiz, F. 2005. Phytoestrogens in functional foods. Taylor & Francis Ltd. pp.3-5; 210-211

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Formulation and Characterisation of Granule Effervescent Cilembu Sweet Potato(Ipomoea batatas (L). Lamk)Extract With Concentration Variation of Citric Acid and Sodium Bicarbonate Dewi Resti Basuki INSTITUT ILMU KESEHATAN BHAKTI WIYATA KEDIRI Abstract Nowdays there are many people interested in consuming traditional drugs because of the chemical compound. Effervescent granule extract cilembu sweet potato is made from citric acid, tartaric acid, sodium bicarbonate, saccharum lactis, PVP (Polivinylpirolidone), extract cilembu sweet potato. The purpose of this study to determine the effect of varying concentrations of acid and alkaline source to the physical quality of effervescent granules. The through is use dry granulation method.There are three variations of the formula one of them with a citric acid concentration of 4.7%, 4.3%, 3.9%. Tartaric acid concentration of 9.4%, 8.6%, 7.8% and 11.7% base concentration, 12.8%, 13.8%. Evaluation extracts include organoleptic test, test-free ethanol, qualitative test. Evaluation of the physical quality of the granules include organoleptic test, test flow properties, the test angle of repose, solubility test, pH test. Research result show that average pH 4,3., average angle of repose 25,42o., average flow properties 0,740gram/detik, solubility 1 minute second 10 . Data were analyzed by One Way ANOVA test. Statistic data show that there is no meaningfull difference and significance standart p >0,05. Keywords :

Formulation and Characterisation, Granule Effervescent, Sweet Potato Cilembu(Ipomoea batatas (L). Lamk) Extract

INTRODUCTION Indonesia is widely known as the mega centers of biodiversity after Brazil‟s second largest, consisting of tropical plants and marine life. Indonesia there are about 30,000 species of plant and 7,000 of them are known to have a efficacy as drugs. This biodiversity needs to be researched, developed and utilized to improve the health and economic goals, while maintaining sustainability (WHO, 2002). The richness like this should be utilized as well as possible for remembering people‟s food need increase with population growth. Cilembu sweet potato is a food that has a high nutritional value and potentially in Indonesia. Sweet potato varieties when viewed from the color of the tuber consist of white sweet potato, sweet potato yellow and purple sweet potato (Amin et al., 2008). Sweet potatoes

Cilembu known because it has a sweeter taste than other sweet potatoes (Suparman, 2007). Sweet potatoes Cilembu is a plant of the family Convolvulaceae, which have carbohydrate, protein, fat and mineral such as iron (Fe), phosphorus (P) and Calcium (K) (Erawati, 2006). It also contains vitamins, vitamin found in sweet potato Cilembu such as, vitamin A which contained in the form ofcarotene and vitamin C (Meludu, 2010). Compounds carotene in sweet potatoes Cilembu an antioxidant compound that can prevent the onset of cancer (Winarti, 2010). Cilembu sweet potatoes beneficial as a powerful antioxidant to neutralize free radicals malignancy, causing premature aging and heart disease, thereby it can increasing the durability

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and immunity againts degenerative diseases. Defined as the effervescent dosage form of granules which degenerates gas bubbles as a results of a

chemical reaction solution. The gas produced is carbon dioxide when the dissolution effervescent so as to give sprakling effect (taste like soda water) (Lieberman, et al., 1994).

METHOD The study was conducted in Solida Laboratory and Biology of Pharmacy Laboratory in Pharmacy Institut Ilmu Kesehatan Kediri. The research was conducted starting in Februari- Agustus 2015. Research material used are sweet potato Cilembu (Ipomoea batatas (L). Lamk), citric acid, tartat acid, sodium bicarbonate, PVP, saccharum lactis. a. Preparation of Extract Sweet Potato Cilembu (Ipomoea batatas (L). Lamk) Sweet Potato Cilembu were collected, the tubers are cut, dried and powedered. 450 gram of the respective sweet potato Cilembu powder was mixed separately with 1250 ml of ethanol. These mixture were maserated for 24 hours with ocasional shaking and filtered with filter paper to obtain filtrate which was further evaporated to obtain the extract. b. Qualitative Test of Extract Sweet Potato Cilembu (Ipomoea batatas (L). Lamk) Molish Test 2 ml of sample was add with 2 drops of a-naphtol solution, mixed and add sulfuric acid through the wall of the reaction tube. See the color change occurs (Panil, 2007). Iodium Test 3 ml of sample was add with 1 drop of Iodium solution, mixed and see the color change occurs. The blue color showed that the sample contain amylum and purple color showed that the sample contain dextrine (Panil, 2007). Barfoed Test

0.5 ml of sample was add with 2.5 ml of Barfoed solution, mixed and heat on waterbath for 3.5 minute. See the color change occur (Panil, 2007). Seliwanoff Test 0.5 ml of sample was add with 5 ml of Seliwanoff solution, mixed and heat on waterbath for 3.5 minute. See the color change occur (Panil, 2007) Free Test of Ethanol Sweet potato Cilembu extract was added with sulphuric acid and acetate acid. Negative reaction indicated by the formation of ester odor from ethanol. c. Preparation of Granule Effervescent Sweet potato Cilembu granule effervescent was made by wet granulation. First citric acid and tartate acid, mixed until homogen and sifted with a 16 mesh sieve. Dried in the oven with the temperature 40◦C. During the heating process the granule powder in alternating. After reaching the proper density powder mixture is issued, made granule 18 mesh sieve and dried in the oven with temperature 40◦C (Ansel, 2005). d. Organoleptis Test of Granule Effervescent Extract Sweet Potato Cilembu (Ipomoea batatas (L). Lamk) Organoleptic test carried out by means of direct view shape, color, smell and taste. e. Granule Effervescent Flow Test A number of granule funnel inserted into the closed bottom. The bottom of funnel open slowly until

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all the granules out of the funnel and forming a heap on paper. The flow of granules which is good if the time required to drain 100 gram of granules 10 seconds (Anshory et al., 2008). f. Granule Effervescent Angle of Repose Test Angle of repose is obtained by measuring the height and diameter piles granules are formed. When the angle of repose formed 30◦ it showed that preparation can flow freely and when the angle of repose 40◦ stated that the preparations have

poor flowability. Value angle of repose can show an indication of the value would be acceptable flow properties owned by a material (Banker., 1989). g. Granule Effervescent Solubility Test 1 packet of effervescent granules incorporated into the beaker glass and filled with 200 ml of water at temperature 25◦C. h. Granule Effervescent Ph Test pH testing is done by using pH metre, note the value that showed at pH metre.

RESULTS AND ANALYSIS Extract Sweet Potato Cilembu (Ipomoea batatas (L). Lamk) 450 gram sweet potato Cilembu were collected on replication 1, 2 and 3 respectively 36.608 gram; 24.153gram, and 11.333gram with extract rendemen value respectively 8.135 % ; 5.367 %

and 2.158 %. From the free of ethanol test showed no reaction indication esterification odor from the form of ethanol. It showed that sweet potato Cilembu (Ipomoea batatas (L). Lamk) was free from ethanol.

Qualitative Test of Extract Sweet Potato Cilembu (Ipomoea batatas (L). Lamk) Table 1.1 Results Qualitative Test of Extract Sweet Potato Cilembu (Ipomoea batatas (L). Lamk) Carbohydrate Test Result Molish Test (+) purple ring Iodium Test (-) negative Barfoed Test (+) red precipitate Seliwanoff Test (+) red cherry Molisch test was used to test all cabohydrate compounds. Molisch positive test results obtained with the formation of a purple ring, so its showed that extract sweet potato Cilembu (Ipomoea batatas (L). Lamk) contained carbohydrate compound. Iodium test was used to separate polysaccharides, monosaccharides and disacarides. Results of Iodium test showed negatif results (no change color), it showed that extract sweet potato Cilembu (Ipomoea batatas (L). Lamk) not contained amylum or dextrine (polysaccharides)

but these extract contained monosaccarides and disacarides. Barfoed test was used to separate the monosaccarides and disaccharides. Results of Barfoed test showed positif results (red precipitate), it showed that extract sweet potato Cilembu (Ipomoea batatas (L). Lamk) contained monosaccarides. Seliwanoff test was used for identificate of fructose. Results of Seliwanoff test showed positif results (red cherry), it showed that extract sweet potato Cilembu (Ipomoea batatas (L). Lamk) contained fructose.

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agglomerate. Sodium bicarbonate used as forming the base reaction and act to neutralize the citric acid and tartate acid. Sodium bicarbonate also can produce foam and CO2 and completely soluble in water (Pulungan, 2004). Organoleptic testing done by directly observing the shape, smell, color and taste of granule effervescent. The results of organoleptic test granule effervescent its showed that the granule effervescent meet the requirements.

Organoleptis Test of Granule Effervescent Extract Sweet Potato Cilembu (Ipomoea batatas (L). Lamk) Making the effervescent granule using combination of two kinds acid, namely citric acid and tartate acid, because the used of a single acid given the difficulties in the formation of froth. If citric acid used as single acid, it will resulted sticky mixture and will be difficulty in the granules formation, while the used of any tartate acid granules produced will be easy to

Table 1.2 Results of Organoleptic Test Granule Effervescent of Sweet Potato Cilembu Extract(Ipomoea batatas (L). Lamk) Organoleptic Result Formula I Formula II Formula III Shape Granule Granule Granule Color Cream Cream Cream Smell Distinctive smell Distinctive Distinctive smell sweet potato smell sweet sweet potato Cilembu potato Cilembu Cilembu Fresh (like a Fresh (like a Fresh (like a Taste soda) soda) soda) Granule Effervescent Flow Test Flow test supplied by flowing 100 grams of granules through a funnel. If the flow time of 100 grams of granules less than 100 seconds, the granules have good flow rate. Flow time was influenced by the shape, size, porosity, density, force electrostatics, and the frictional forces of particles and the experimental conditions. Tartate acid has a density greater than that of citric acid granules which contain more tartaric acid will have a greater density, molecular weight will more easily flow

due to gravity greater (Anshory, 2007). Effervecent granules have an average yield of Formula 1, Formula 2 and Formula 3 respectiveley 0.740; 1.343 and 1.508. The third formulation has good flow properties, due to the weight of more than tartaric acid citric acid so that the molecular weight will be more easily flow due to the force of gravity is greater. Data processed by statistical and showed sig > 0.05 so that the data obtained virtually no difference.

2

Table 1.3 Results of Granule Effervescent of Flow Test Sweet Potato Cilembu (Ipomoea batatas (L). Lamk) Formula Replicate Speed of flow (gram/s) I 1 1.250 2 0.462 3 0.510 Mean 0.740 II

III

1 2 3 Mean 1 2 3 Mean

1.785 1.008 1.237 1.343 1.879 1.295 1.351 1.508

Granule Effervescent Angle of Repose Test Table 1.4 Results of Granule Effervescent Angle of Repose Test Sweet Potato (Ipomoea batatas (L). Lamk) Formula Replicate Angle of Repose I 1 24.69◦ 2 25.02◦ 3 26.56◦ Mean 25.42◦ II

III

27.20◦ 25.97◦ 25.64◦ 26.27◦ 23.03◦ 23.82◦ 27.25◦ 24.70◦ speed so that the angle of repose alirnya formed the greater (Lee, 2004). Effervescent granules showed an average angle of repose for F1, F2 and F2 respectively 5.42, 26.27, 24.7. Angle of repose test results meet the requirements, because the results obtained were within a predetermined range that was 25-45. The data was processed by the angle of repose statistics and get the sig > 0.05 so that the data obtained virtually no difference.

1 2 3 Mean 1 2 3 Mean

Test the angle of repose according to Wadke and Jacobson (1989 ) granules will flow better if the angle of repose formed 25-45. The size of the angle of repose is strongly influenced by the size of the tensile force and the frictional forces between the particles. If the tensile force and the friction force was small, the granules will be faster and easier pouring. Angle of repose was also influenced by the particle size, the smaller particle size , the higher the particle cohesiveness that will reduce the

2

Granule Effervescent Solubility Test Table 1.5 Results of Granule Effervescent Time Solubility Test Sweet Potato (Ipomoea batatas (L). Lamk) Formula Replicate Time Solubility I 1 2 minute 2 second 2 2 minute 3 1 minute 55 second II 1 1 minute 29 second 2 1 minute 20 second 3 1 minute 15 second III 1 1 minute 10 second 2 1 minute 5 second 3 1 minute 2 second Testing solubility, solubility time is one of the physical properties of a typical dosage effervescent, where the effervescent preparation is good to have time late for < 5 minutes. The test results from the late third time this formulation

all showed results less than 5 minutes. Data processed by One Way ANOVA statistical processing of the data is obtained sig > 0.05 so that the data obtained virtually no difference.

Granule Effervescent Ph Test of Sweet Potato (Ipomoea batatas (L). Lamk) formulations that showed the most acid pH testing is done to determine pH is F1 with an average pH of 4.3 . the pH value is generated by the This may imply that the pH of the effervescent granule preparation in order effervescent granules sweet potato to comply with the requirements cilembuwas eligible. pH must be acidic specified pH. Terms effervescent dosage effervescent as sodium bicarbonate i.e pH < pH 6. pH testing is done by require acidic reagents, in the presence dipping the pH meter previously of hydrogen ions provided by the calibrated with buffer solution into the developer of the acid, sodium effervescent granules have been bicarbonate react to release carbon dissolved beforehand with distilled dioxide (Estiasih et al., 2009). The data water until a constant figure shows is processed using statistics and generate recorded.The results of all three sig > 0.05 so that the data obtained formulations show the results of a pH of virtually no difference . less than 6, the pH of the three Table 1.6 Results of Granule Effervescent pH Test of Sweet Potato (Ipomoea batatas (L). Lamk) Formula Replicate pH I 1 4.5 2 4.3 3 4.1 Mean 4.3 II 1 4.6 2 4.7 3 4.8 Mean 4.7

2

III

1 2 3 Mean

5.8 5.5 5.7 5.6 Ginseng Jawa (Tlinum paniculatum) Dengan Variasi Kadar Pemanis Aspartam. Jurnal Ilmiah Farmasi Vol 4 No.1.http:journal.uii.ac.id/index.p hp/JIF/article/view/480/391.pdf. diakses Selasa, 29 Mei 2012. Erawati, C. M., 2006, Kendali Stabilitas Betakaroten Selama Proses Produksi Tepung UbiJalar (Ipomea batatas L.) Thesis diterbitkan, Program Studi Ilmu Pangan, Institut Ilmu Pertanian Bogor, Bogor. Estiasih, T. dan Ahmadi, K. 2009. Teknologi Pengolahan Pangan. PT Bumi Aksara Jakarta. Lachman, L., Lieberman, H.A., Kanig, J.L., 1994, Teori dan Praktek Industri Farmasi II, Edisi III, diterjemahkan oleh Siti Suyatmi dan Iis Aisyah, Universitas Indonesia Press, Jakarta, 644-645, 651, 681687. Lee, R., E., 2004. Effervescent Tablets: Key Facts About A Unique, Effective Dossage Form. CSC Publishing, Tablets and Capsules. Panil, Z. Memahami teori dan praktik biokimia dasar medis : untuk mahasiswa kedokteran, keperawatan, gizi, dan analis kesehatan/ penulis, Zulbadar panil.- Jakarta : EGC, 2007. Pulungan. dkk. 2004. Membuat Effervescent Tanaman Obat. Trubus Agrisarana, Surabaya. Suparman, 2007, Bercocok Tanam Ubi Jalar, Azka Mulia Media, Jakarta WHO. 2002. Traditional Medicin – GrowingNeeds and Potential.Geneva Winarti, Sri. Makanan Fungsional/ Sri Winarti –Edisi pertama – Yogyakarta : Graha Ilmu, 2010

Conclution Sweet potatocilembu(Ipomoea batatas Lamk) extract can be processed into a preparationattractive and practical effervescent granules. The granule effervescent of sweet potato Cilembu (Ipomoea batatas Lamk) extract has good physical quality, it was showed on organoleptic test, angle of repose test, solubility test, pH test which are met the requirement of granule effervescent dossage form. Acknowledgment Further studies are needed to see the effectiveness of the dosage effervescent granules of sweet potato Cilembu (Ipomoea batatas Lamk) and also to look at new formulation to repair physical quality from granule effervescent of sweet potato cilembu (Ipomoea batatas Lamk) extract. Reference Amin, A. R, Syaiful, S. A., dan Mubaraq, S., 2008, Penampilan Fenotipik dan Daya Hasil Tanaman Ubi Jalar Lokal Sulawesi Selatan, J.Agrivigor, 7 (3), 263-271 Anonim. 2010. Budidaya Ubi Jalar Cilembu Sebagai Komoditas Unggulan.http://tatangkostama n.blogspot.com/2010/09/budid aya-ubi-jalar cilembu-st1.html. 12 September 2011. Ansel, H.C. 1989. Penganta Bentuk Sediaan Farmasi. Terjemahan : Farida Ibrahim. Edisi keempat. Universitas Indonesia Press, Jakarta. Anshory, H., Syukri, Y., dan Malasari, Y., (2007). Formulasi Tablet Effervescent Dari Ekstrak

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DO ELDERLY USE COMMUNITY HEALTH CENTERS FOR OUTPATIENT CARE? Gerardin Ranind Kirana1*, Hari Kusnanto Josef2, Mubasyisyir Hasanbasri1 1 Public Health Program Faculty of Health Science IIK Bhakti Wiyata 2 Health Policy and Management Faculty of Medicine Gadjah Mada University 3 Field Epidemiology Training Program Faculty of Medicine Gadjah Mada University *Email: [email protected] Abstract Health care programs for elderly in community health centers were very diverse, one of which was village-based health care programs as we known in Indonesia as “Posyandu” for elderly. The program showed that the government is responsible for the availability of health services for the elderly especially at community health centers. Besides community health centers, private practitioner was also a type of health facilities that exist in society. The existence of private practitioner would lead the public, particularly the elderly to have a broad opportunity in choosing outpatient care. The purpose of this study was to analyse the outpatient utilization in community health centers by elderly in Eastern Indonesia 2012, when compared with outpatient care in private practitioner. These was a quantitative research using secondary data Indonesia Family Life Survey East 2012. The samples were 246 elderly, with inclusion criteria were elderly aged ≥ 60 years old and elderly with Self-Rated Health Status categorized as "Somewhat Unhealthy" and "Unhealthy". The data would be presented as oddsratio. The older age of the elderly (OR: 1,69), with the female gender (OR: 4,11), the lower level of education (OR: 1,74) and living in rural areas (OR: 1,28), and with the purpose of outpatient utilization for treatment the illness (OR: 26,5), the elderly are more likely to opt utilize outpatient health services in private health facilities. According to test results obtained logistic regression, gender factor and the purpose of outpatient care utilization were the most dominant factor. Contrary to the expectations, the elderly especially those living in rural areas, used private practitioner rather than community health centers. In the future, the government is expected to be able to improve the quality of community health centers, and provide pro-elderly health services that can reach the elderly in rural areas, such as homecare services and “Posyandu” for elderly. Keywords: Elderly, Outpatient Care Utilization, Public and Private Health Services.

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Introduction The eldery population are a susceptible population towards the health problems, so that the percentage of elderly health services utilization was very high. According to the Indonesia Family Life Survey East 2012, percentage of outpatient by elderly health service utilization in Eastern Indonesia in 2012 only 20.63%. The percentage is quite small when compared to some study in America, which stating that the elderly is the age group that has the biggest number of health service utilization compared to other age groups. Health care programs for elderly in community health centers are diverse, one of which was village-based health care programs as we known in Indonesia as “Posyandu” for elderly. The program showed that the government is responsible for the availability of health services for the elderly especially at community health centers. Besides community health centers, private practitioner was also a type of health facilities that exist in society. The existence of private practitioner would lead the public, particularly the elderly to have a broad opportunity in choosing outpatient care. The purpose of this study was to analyse the outpatient utilization in community health centers by elderly in Eastern Indonesia 2012, when compared with outpatient care in private practitioner.

Result Elderly aged over 75 years have lower odds-ratio to utilize outpatient care in community health centers (OR: 0.75; 95% CI: 0.25 to 2.28) and higher odds-ratio to use outpatient care in private practitoner (OR: 1 , 69; 95% CI: 0.52 to 5.43) compared to the elderly aged 60-74 years. Female elderly have lower odds-ratio to utilize outpatient care in community health centers (OR: 0.53; 95% CI: 0.23 to 1.21) and higher odds-ratio to use outpatient care in private practitoner (OR: 1.28; 95 % CI: 0.34 to 1.61) compared to male elderly. Elderly with basic education have lower oddsratio to utilize outpatient care in community health centers (OR: 0.49; 95% CI: 0.17 to 1.45) and higher odds-ratio to use outpatient care in private practitoner (OR: 1.74; 95% CI: 0, 20 to 13.8) compared to more educated elderly. Elderly in rural areas have lower odds-ratio to utilize outpatient care in community health centers (OR: 0.53; 95% CI: 0.23 to 1.21) and higher odds-ratio to use outpatient care in private practitoner (OR: 1.28; 95% CI: 0, 34 to 1.61) compared to elderly in urban areas.

Method This study is a quantitative research using secondary data Indonesia Family Life Survey East 2012 and the data‟s design is cross-sectional survey. Indonesia Family Life Survey (IFLS) East 2012 is a large-scale survey conducted in 7 provinces in Indonesia, East Nusa Tenggara, East Kalimantan, Southeast Sulawesi, Maluku, North Maluku, West Papua and Papua, with the topic around the household and community. The survey was conducted by SurveyMETER on the behalf of TNP2K, PRSF, and Australian Aid, and is a continuation of the survey held by IFLS in 1993, 1997, 2000, and 2007 by the RAND Corporation. The samples are 246 elderly, with inclusion criteria were elderly aged ≥ 60 years old and elderly with Self-Rated Health Status categorized as "Somewhat Unhealthy" and "Unhealthy". Data were analyzed using STATA software version 12. The data will be presented as odds-ratio.

Elderly with the purpose of outpatient care for illness treatment have high odds-ratio to utilize community health centers and private practitioner, but the elderly in this category have higher odds-ratio to use outpatient care in private practitioner (OR: 26.5; 95% CI: 6.4 to 110.4) than in community health centers (OR: 23.0; 95% CI: 7.9 to 66.2).

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Individual Factors

Predisposing Factor Age Elderly aged more than 75 years Elderly aged 60-74 years Gender Female Male Education level Basic Secondary Enabling Factor Location of residence Rural areas Urban areas Illness level/need Factor Purpose of outpatient care Treatment of illness Yes No

Utilization of Outpatient Care Based on Health Facilities CHC Private Practitioner ppOR 95% CI OR 95% CI value value

0,75 1

0,25-2,28

0,61

1,69 1

0,52-5,43

0,38

0,56 1

0,26-1,21

0,13

4,11 1

1,4-12,0

0,01

0,49 1

0,17-1,45

0,19

1,74 1

0,2-13,8

0,59

0,53 1

0,23-1,21

0,12

1,28 1

0,36-4,61

0,70

23,0 1

7,9-66,2

0,00

26,5 1

6,4-110,4

0,00

Discussion The most interesting result in this study is the comparison between the utilization of outpatient care in community health center and private practitioner by the elderly who live in rural areas. They rather choosing to utilize health services in private practitioner than in community health centers. It shows that there are some specific considerations for the selection of health facilities, for example regarding quality considerations, the availability of health care which near with their (elderly) home, or the consideration of the level of trust among the elderly with certain health facilities. Quality considerations are supported by research in Uganda, which states that male elderly take advantage of health services in a high level, because ederly with aged more than 64 years had severe illness that requires medical care with complete and quality equpment in private health facilities. In addition to quality considerations, that study also states that the availability of health services near home, is one of the most factors that affect the elderly in choosing health facility. Besides quality consideration and the location of health facilities, the level of trust by the elderly for choosing their best health facilities based on Health Belief Model, states that people who have faith or trust in a particular health facilities, will feel comfortable and safe while getting a health

service. Trust, comfort, and safety are factors that predispose individuals to re-utilize the health services in the health facilities Conclusion Contrary to the expectations, the elderly especially those living in rural areas, used private practitioner rather than community health centers. In the future, the government is expected to be able to improve the quality of community health centers, and provide pro-elderly health services that can reach the elderly in rural areas, such as homecare services and “Posyandu” for elderly. BPJS of Health with the National Health Insurance program, together with the government and local governments, should not only cooperate with public health facilities, but also can reach the private health facilities, one of which is private practitioner in the village. The cooperation is expected to ensure the quality of health care, the elderly can expand access to quality health services, and health services as desired without having to consider the high price of health care. In addition, with not too many choices of outpatient health services in the village for the elderly, the presence of medical personnel in villages located in remote areas, particularly in eastern Indonesia, is an opportunity for the elderly to get close access for

health care services and no longer need to be a long distance to go to town, to get health care. The existence, will also help the government to equalize access to services and quality of health services in underserved areas. Therefore, legal protection for paramedic in providing health services is essential. Clarity license to practice and work contracts for private practitioner in the village with the government, should be strengthened so that the quality of health services in the villages, especially in the East Indonesia will increase. References Chuma, J., Gilson, L., & Molyneux, C. (2007). Treatment-seeking behaviour, cost burdens and coping strategies among rural and urban households in Coastal Kenya: an equity analysis. Tropical Medicine and International Health, 12(5), 673-686. Exavery, A., Grobusch K.K., Debpuur C. (2010). Self-rate health and health care utilization among rural elderly Ghanaians in Kassena-Nankana District. Johannesburg: University of the Witwatersrand. Hamid, S.A., Sadique, M.Z., Ahmed, S., & Molla, A.A. (2005). Determinants of Choice of Healthcare Providers: Evidence from Selected Rural Areas of Bangladesh. Pakistan Journal of Social Sciences, 3(3), 437-444. Khe, N.D., Toan, N.V., Xuan L.T.T., Eriksson, B., Hojer, B., & Diwan, V.K. (2002). Primary health concept revisited: Where do people seek health care in a rural area of Vietnam? Health Policy, 61(1), 95. Knight, L., & Maharaj, P. (2009). Use of public and private health services in KwazuluNatal South Africa. Development Southern Africa, 26(1), 17-28. Konde-Lule, J., Gitta, S.N., Lindfors, A., Okuonxi, S., Onama, V.O., & Forsberg, B.C. (2010). Private and public health care in rural areas of Uganda. BMC International Health and Human Rights, 10, 29. Leonard, K.L., Mliga, G.R., & Mariam, D.H. (2002). Bypassing Health Centres in Tanzania: Revealed Prefrences for Quality. Journal of African Economies, 11(4), 441-471. Liu, M., Zhang, Q., Lu, M., Kwon, C.S., & Quan, H. (2007). Rural and urban disparity in health services utilization in China. Medical Care, 45(8), 767-774.

THE CORRELATION BETWEEN THE MOTIVATION OF BECOMING A NURSE AND THE LEARNING ACHIEVEMENT OF THE STUDENTS OF STRATUM 1 NURSING SCIENCE AT FACULTY OF MEDICINE LAMBUNG MANGKURAT UNIVERSITY Herawati1, Naya Ernawati1 Program Study of Nursing, Faculty of Medicine Lambung Mangkurat University Email: [email protected]

1

Abstract Motivation is expected to cause the spirit of learning and will produce a good performance. If the motivation is high, then the attempt to achieve the work will be high, so that academic schievment will be high as well that will ultimately be a graduate / qualified nurses.The study was aimed to l*tow the correlation between the motivation of becoming a nurse and the learning ochievement of the student of stratum I nursing science at faculty of medicine lambung mangkurat uhiversity. The study wos o descriptive analytic with toss sectional approach. It was conducted in nursing science at faculty of medicine lambung mangkurat university started in June-July 201j. There was 34 student as respondent were determine by totally sampling tehchnique. The data were collected by using questionares of motivation af becoming a nurse and student GPA. Data analysis used Spearman correlation test (r) values obtained p : 0.000 <0.05, r : 0.648 showed that there was strong positively correlatian between the motivation of becoming a nurse and the learning achievement of the students of stratum I nursing science at foculty of medicine lambung mangkurat university a significan. It was concluded that there was correlation between the motivation of becoming a nurse of the students and the learning achievement of stratum I nursing science at faculty of medicine lambung mangkurat university. Keywords : motivation, learning achievement, nurse al., 2002). According to the global burden of disease, 30% of all world deaths related to hypertension (Lozano et al., 2013).

Introduction Along with advances in health care, infectious diseases no longer be the leading cause of death in most countries (Hossain, Kawar, & El Nahas, 2007). Reports of the latest health declare that vascular disease today is one of the leading causes of death in the world, including in Indonesia (Lawes, Hoorn, & Rodgers, 2008; Levenson, Skerrett, & Gaziano, 2002; Lozano et al., 2013) , Hypertension is one among them, where hypertension is a risk factor for cardiovascular disease (Levenson et al., 2002). Currently, cardiovascular disease is a major contributor to the world's disease burden and hypertension also have a large correlation to the incidence of chronic diseases such as diabetes mellitus and renal disease (Levenson et

According to data of Health Research (Riskesdas) in 2013, the prevalence of hypertension in the population over the age of 18 years in Indonesia amounted to 25.8% (Ministry of Health, 2013). This prevalence is higher than the prevalence of non-communicable diseases such as diabetes mellitus and hyperthyroidism (Ministry of Health, 2013). Most (63.2%) cases of hypertension in Indonesia on people in Indonesia are undiagnosed and only 9.4% had ever been diagnosed by health workers (Ministry of Health, 2013). In the age group 65-74 years, the prevalence of hypertension in Indonesia

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reached 57.6% (Ministry of Health, 2013). South Kalimantan province ranks second highest in the prevalence of hypertension cases per province in Indonesia with a figure of 30.8% (Ministry of Health, 2013).

Although a few studies that examine the relationship of hypertension with Healthrelated quality of life (HRQOL) in various populations of the world have done, but there is no clear conclusion in this regard. Study of the relationship of hypertension associated with Healthrelated quality of life (HRQOL) in populations with Indonesia setting still little is done and published. Given the importance of knowing the Healthrelated quality of life (HRQOL) in individuals with chronic diseases, the researchers are interested to know the Health-related quality of life (HRQOL) in individuals with hypertension. Specifically, due to the prevalence of hypertension was biggest with the elderly group, the researchers wanted to know Health-related quality of life (HRQOL) in the group.

Health-related quality of life (HRQOL) reflect the individual's subjective assessment of the individual's health status and the status of the capability to carry out its social role (Guyatt, Feeny, & Patrick, 1993). Health-related quality of life (HRQOL) have been widely used as an indicator of the health of the medical interventions and health surveys (Guyatt et al., 1993). In general, chronic diseases will affect Health-related quality of life (HRQOL) someone (Banegas et al., 2007). However, if hypertension also affect and alter the Health-related quality of life (HRQOL) someone is still debated. The debate about the relationship of hypertension with Health-related quality of life (HRQOL) is based on the fact that mild and moderate hypertension is a condition that is usually asymptomatic (Rui Wang et al., 2008). This asymptomatic condition does not seem to cause physical changes-psychological impact on the individual and social role (R Wang et al., 2009). Several studies have reported that hypertension causes a decrease in Health-related quality of life (HRQOL) of the individual (Bardage & Isacson, 2001). However, other studies reported that hypertension alone does not seem to lower the Health-related quality of life (HRQOL) of individuals, unless contributing factors komorbitas also included (R Wang et al., 2009). This is also confirmed by the results of a systematic review and meta-analysis of studies based on populations in the world are researching Health-related quality of life (HRQOL) in patients with hypertension found that hypertension lowers Health-related quality of life (HRQOL), but rate of decline is very small (Trevisol, Moreira, Kerkhoff, Fuchs, & Fuchs, 2011).

Methods This study aimed to describe the Healthrelated quality of life (HRQOL) of elderly with hypertension who live in Nursing Home Budi Sejahtera South Kalimantan province. Designs in this study was a cross sectional study, in which researcher took data from respondents within one point of time. Respondents in this study were taken from the elderly population with hypertension who live in nursing home Budi Sejahtera South Kalimantan province are located in Martapura. The type of sampling used in this research is purposive sampling method. Respondents elderly taken by researcher determined in accordance with the inclusion criteria. The number of respondents who met the inclusion criteria as many as 29 people. The criteria used are elderly people who meet one of the criteria below: 1. Elderly is currently taking antihypertensive medications.

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2. Average blood pressure derived from routine measurements elderly blood pressure greater than or equal to 140 mmHg (for systolic) or greater than or equal to 90 mmHg (for diastolic).

Results and Discussion 1. Demographic Data Characteristics of respondents by age The demographic data of respondents in Nursing Home Budi Sejahtera South Kalimantan based on age can be seen in Figure 1.

Research Instrument The instrument used in this study is the Short Form 36 (SF 36) health survey in Indonesian version. This instrument SF 36 has been used widely since 1988 until now to measure Health related quality of life (HRQOL) in more than 22 countries and includes 200 diseases. This instrument has also been officially translated and adapted into more than 50 languages in the world, including Indonesian. Instrument SF 36 has good psychometric standards, with validity and reliability were tested. This instrument has patents and official license held by The Medical Outcomes Trust (MOT), the Health Assessment Lab (HAL) and QualityMetric Incorporated. Access to this instrument is done through the official website ie http://www.sf-36.org/tools/sf36.shtml.

18-24

8 28%

05 0%17%

25-34 35-44 45-54

16 55%

55-64 65-74

Figure 1. Diagram of Distribution of Respondents by Age in Nursing Home Budi Sejahtera South Kalimantan Distribution of respondents by age as shown in figure 1 shows that more than half of respondents aged 65-74 years amounted to 16 (55%), amounting to 8 people aged 75+ (28%) and 55-64 years old, amounting to 5 people (17%).

The instrument measures the SF 36 Health-related quality of life (HRQOL) in two components: physical and mental. In the physical component, there are four aspects measured, namely physical function, physical role, bodily pain and general health. In the mental component, there are four aspects measured, namely mental health, emotional role, social functioning, and vitality.

WHO (World Health Organization) in Mubarak et al classified the elderly into middle age (middle age) is the age group 45 to 59 years, the elderly (Elderly) is the age group 60 to 74 years, advanced old age (old) is the age group of 75 to 90 years old and very old (very old) is the age group above 90 years. Elderly is the final stage in the development cycle of human life. Article 1 (2), (3), (4) of Law No. 13 of 1998 on the health states that old age is a person who has attained the age of 60 years (Mubarok, 2006)

Data Analysis Data collected from respondents were tabulated, cleaned and processed. Tabulation and analysis of data using QualityMetric Health OutcomesTM Scoring Software 4.5. The data is displayed using a frequency distribution in each domain group. Confidence interval is set at 95%.

Characteristics of respondents by sex

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The demographic data of respondents in Nursing Home Budi Sejahtera South Kalimantan by sex in Figure 2.

13 45% 16 55%

Figure 2. Diagram of Distribution of Respondents by Gender in Nursing Home Budi Sejahtera South Kalimantan Province

Distribution of respondents by sex as shown in Figure 2 shows that more than half of the respondents were men numbering 16 people (55%) and the rest were women numbering 13 people (45%).

2. Quality of Life Elderly

VT = Vitality SF = Social Functioning RE = Role-Emotional MH = Mental Health From Figure 3, shows the quality of life of elderly health related to the components as shown in Figure 3 the Laki-laki average component is under the normal Perempuanline (normal line is in figure 50). All the physical health component scores were below the normal line that is a component PCS (Physical Component Summary) were in a score of 41.24, a component PF (Physical Functioning) scores were in 40.98, RP components (Role- Physical) are in a score of 38.34, a component of BP (Bodily Pain) is the component score of 44.58 and GH (General Health) are at a score of 43.35. While the mental health component score is only one component of which is above the normal line that is a component VT (Vitality) is at 51.27 score, and the remaining components of MCS (Mental Component Summary) were in a score of 47.42, a component SF (Social Functioning) is at 44.55 score, the component RE (RoleEmotional) is the component score of 38.04 and MH (Mental Health) are at a score of 49.24.

Quality of life is an individual's perception of their position in life in the context of culture and value systems in which they live (Schiffczyk, 2011), as well as with regard to achieving goals, expectations, standards and concerns during his lifetime (Wangsarahardja, 2007).

Figure 3 Diagram of Quality of Life of Elderly in Nursing Home Budi Sejahtera South Kalimantan

Quality of life is found in someone who can carry out the functions and role in our daily lives well in accordance stages of development (Prinardi, 2010). Quality of life refers to a subjective evaluation, which induces both positive and negative dimensions, and a context that is embedded in the cultural, social, and environmental. The scope of quality of

Description: PCS = Physical Component Summary MCS = Mental Component Summary GH = General Health PF = Physical Functioning RP = Role-Physical BP = Bodily Pain

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life among others is a feeling of wellbeing, satisfaction, and disorders that are subjectively perceived by the patient (Eser E, 2005).

Prevention & Rehabilitation, 14 (3), 456-462. Bardage, C., & Isacson, D. G. (2001). Hypertension and healthrelated quality of life. an epidemiological study in Sweden. J Clin Epidemiol, 54 (2), 172-181.

Conclusion Picture Health-related quality of life (HRQOL) of elderly with hypertension who lives in Social Institutions Tresna Wreda Budi Sejahtera South Kalimantan province shows that the average score of components of physical and mental health is under the normal line (normal line is in figure 50).

Chobanian, AV, Bakris, GL, Black HR, Cushman WC, Green, LA, Izzo, JL, Jr., Roccella, EJ (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama, 289 (19), 25602572. doi: 10.1001 / jama.289.19.2560.

Acknowledgement Alhamdulillah, the writer has succeed in finishing this paper and the writer is greatly indebted to many people who helped to finish this paper:

Cifkova, R., Pitha, J., Lejskova, M., Lanska, V., & Zecova, S. (2008). Blood pressure around the menopause: a population study. J Hypertens, 26 (10), 1976-1982. doi: 10.1097 / HJH.0b013e32830b895c.

1. Prof. Dr. dr. H. Ruslan Muhyi, Sp., an (K), as the Dean of Faculty Medicine, Lambung Mangkurat University 2. My beloved family, who always given support 3. To all best friend in School of Nursing, Faculty of Medicine, Lambung Mangkurat University

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To all of them, the writer extends his deepest gratitude.

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