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"Karya Ilmiah Akhir ini merupakan gambaran pelaksanaan kegiatan praktik keperawatan ners spesialis anak selaman 2 semester. Karya Ilmiah Akhir ini memfokuskan pada aplikasi Model Adaptasi Roy pada anak paska bedah dengan gangguan pemenuhan kebutuhan rasa nyaman. Permasalahan yang muncul pada anak dengan gangguan pemenuhan kebutuhan rasa nyaman adalah nyeri yang dialami anak karena tindakan pembedahan. Asuhan keperawatan yang diberikan oleh ners spesialis anak berfokus pada proses adaptasi anak terhadap masalah nyeri dengan menggunakan Model Adaptasi Roy. Pada kelima kasus kelolaan pasien anak paska bedah dengan gangguan pemenuhan kebutuhan rasa nyaman, setelah diberikan asuhan keperawatan didapatkan hasil kelima pasien kelolaan masalah rasa nyaman yang dialami anak paska bedah berkurang dan terkontrol. Selanjutnya berdasarkan hasil kegiatan tersebut, residen merekomendasikan bahwa dalam memberikan pelayanan keperawatan kepada anak diharapkan mampu menerapkan prinsip atraumatic care dan family centered care. Sebagai pembaharu, residen menjalankan atraumatic care dengan melakukan pendidikan kesehatan sebelum operasi dan desain ruang tindakan sesuai dengan karakteristik anak.

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This scientific assignment is a description about implementation of pediatric nurse specialist during practiced in two semesters. It's application of Roy's Adaptation Model on nursing care of children post surgery with comfort problem. The comfort problem on children post surgery is perceived pain related to surgery. Nursing process focused on children adaptation. There are five cases children post surgery with comfort problem, after implementation of nursing process, children pain controlled. Further, as a result this activity, resident give a recommendation to pediatric nursing services to application atraumatic care principle. As a change agent, resident application atraumatic care with implementation health education before surgery and setting intervention room like children characteristic."

"Praktek klinik dilakukan dengan memberikan asuhan keperawatan pada pasien dengan gangguan sistem persarafan menggunakan Model adaptasi Roy. Asuhan keperawatan kelolaan diberikan pada pasien dengan Meningtis-Ensefalitis Tuberculosa. Pengkajian keperawatan menunjukkan masalah pada mode adaptasi fisiologi, yaitu: ketidakefektifan perfusi jaringan serebri. Intervensi keperawatan ditujukan untuk meningkatkan adaptasi pasien dalam meningkatkan perfusi jaringan serebri. Peran sebagai peneliti dan pendidikan dilakukan dengan menerapkan Evidance Based Nursing: memberikan back massage: cooper model yang setelah pelaksanaan terbukti mampu mencegah kejadian ulkus decubitus. Peran praktikan sebagai inovator, dilakukan dengan mengaplikasikan kegiatan inovasi Bladder training pada pasien yang terpasang kateter urin. Dengan hasil evaluasi bahwa bladder training mampu meninngkatkan kemampuan berkemih pasien dan mencegah pemasangan kateter urin yang tidak perlu.

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The clinical practice is conducted by providing nursing care for patients with nervous system disorders by using Roy Adaptation Model. Nursing care focus is given to patients with meningitis-encephalitis Tuberculosa. Nursing assessment indicates a problem on the mode of adaptation physiology, which are: ineffective cerebral tissue perfusion. Nursing interventions are aimed to improve patient adaptation in increasing cerebral tissue perfusion. Role as a researcher and education is conducted by application of Evidence based nursing: giving back massage: cooper model as implementation to prevent decubitus ulcers. Practitioner role as an innovator is done by applying the Bladder training to patients with a urinary catheter inserted. With the results of the evaluation that bladder training is able to increase voiding ability of patients and prevent unnecessary use of urinary catheters."

"Developmental coordination disorder DCD merupakan gangguan koordinasi motorik yang mengganggu prestasi akademik dan kegiatan olahraga. Penelitian ini bertujuan mengetahui nilai diagnostik neurological soft signs NSS dalam mendiagnosis DCD. Subjek terdiri atas 86 anak usia sekolah dasar suspek DCD dan 20 subjek kontrol. Semua subjek menjalani pemeriksaan fisis dan neurologis, anamnesis riwayat perkembangan, prestasi akademik, kesulitan menulis atau olahraga, screen time, dan aktivitas fisis, pemeriksaan antropometri, pemeriksaan NSS, serta pemeriksaan baku Bruininks-Oseretsky Test 2 Short Form BOT-2 SF . Subjek dengan skor BOT-2 SF below average dan well below average didiagnosis DCD. Median usia subjek 10,05 rentang 6,3 sampai 12,5 tahun; 67 adalah lelaki. DCD ditemukan pada 28,3 subjek. Sebanyak 67 subjek memiliki ge;1 NSS positif dan 41,5 memiliki ge;2 positif. NSS berhubungan bermakna dengan DCD apabila ge;2 positif p=0,047 . Nilai cut-off NSS optimal adalah ge;2 positif, dengan sensitivitas 57 dan spesifisitas 64 [area under the curve 0,639 IK95 0,512-0,767 ; p=0,026]. Dengan nilai cut-off ge;4, pemeriksaan ini memiliki sensitivitas 16,7 dan spesifisitas 99 . Pada 20 subjek DCD didapatkan komorbiditas neurodevelopmental lainnya. Sebagai simpulan, pemeriksaan NSS pada DCD merupakan pemeriksaan yang spesifik namun kurang sensitif. Diperlukan penelitian lebih lanjut untuk karakterisasi NSS pada komorbiditas yang dapat menyertai DCD.

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Developmental coordination disorder DCD is a disorder of motor coordination impairing academic and sports performance. We aimed to determine the value of neurological soft signs NSS in diagnosing DCD. Subjects were 86 DCD suspected elementary school children and 20 controls. All underwent physical and neurological examination, interview on developmental and academic history, difficulties in writing or sports, screen time, and physical activity, anthropometric measurement, NSS examination, and the standardized Bruininks Oseretsky Test 2 Short Form BOT 2 SF . Below average and well below average BOT 2 SF scores were classified as DCD. Subjects rsquo median age was 10.05 range 6.3 to 12.5 years 67 were male. DCD was found in 28.3 of subjects. Sixty seven percent and 41.5 of subjects had ge 1 and ge 2 positive NSS, respectively. More than 2 positive NSS was significantly associated with DCD p 0.047 . The optimal NSS cut off value was ge 2 sensitivity 57 specificity 64 area under the curve 0.639 95 CI 0.512 0.767 p 0.026 . Using a cut off value of ge 4, NSS had a sensitivity and specificity of 16.7 and 99 , respectively. Neurodevelopmental comorbidities were found in 20 of DCD subjects. In conclusion, NSS is a specific, but less sensitive, diagnostic test for DCD. Further studies are needed to characterize NSS in comorbid conditions."

"Spinal merupakan tempat metastasis tumor terbanyak, menyebabkan defisit neurologis akibat kompresi saraf spinal, berpotensi distres sehingga mengakibatkan rendahnya kualitas hidup. Kerentanan terhadap distres dipengaruhi strategi koping. Penelitian potong lintang untuk mengetahui strategi koping dan faktor terkait distres pada pasien tumor metastasis spinal di RSCM. Sebanyak 104 subjek diambil dari rawat jalan maupun rawat inap. Analisis bivariat dan multivariat menilai hubungan antara gambaran masalah, strategi koping, faktor sosiodemografi, serta karakteristik tumor spinal dengan distres. Proporsi distres subjek penelitian ini adalah 57,7% masalah terbanyak spesifik tumor spinal (87,5%), namun hubungannya tidak bermakna terhadap distres. Hubungan bermakna ditemukan pada masalah keluarga dan masalah emosional. Strategi religious-focused coping paling sering digunakan. Subjek yang mengalami distres memiliki median total skor problem-focused coping (PFC) lebih rendah, emotional-focused coping (EFC) dan avoidance coping lebih tinggi dibandingkan dengan yang tidak mengalami distres. Hubungan bermakna juga ditemukan pada faktor usia dan karakteristik tumor spinal berupa gangguan motorik, sensorik, otonom, dan status pengobatan. Gangguan sensorik berisiko lebih tinggi terjadi distres dibandingkan defisit neurologis lain. Analisis multivariat menunjukkan strategi EFC dan avoidance coping sebagai faktor risiko. Perlunya dilakukan skrining dan pendampingan psikiatri pada pasien tumor metastasis spinal, serta peningkatan kerja sama psikiatri dengan layanan tumor terpadu.

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Spinal is the most site of tumor metastases, causing neurological deficits due to spinal nerve compression, potentially causing distress resulting in low quality of life. Vulnerability to distress is influenced by coping strategies. A cross-sectional study to determine coping strategies and factors related to stress in patients with spinal metastatic tumors in RSCM. A total of 104 subjects were taken from outpatient and inpatient. Bivariate and multivariate analyzes assessed the relationship between problem description, coping strategies, sociodemographic factors, and characteristics of spinal tumors with distress. The proportion of the subject's distress in this study was 57.7%, the most problems were spinal tumor-specific (87.5%), but the relationship was not significant to distress. Significant relationships were found in family problems and emotional problems. Religious-focused coping strategies are most often used. Subjects who experienced distress had a lower median total score of problem-focused coping (PFC), emotional-focused coping (EFC) and higher avoidance coping than those who did not experience distress. A significant relationship was also found in the age factor and spinal tumor characteristics in the form of motor, sensory, autonomic disorders, and treatment status. Sensory disturbances are at a higher risk of developing distress than other neurologic deficits. Multivariate analysis showed EFC strategy and avoidance coping as risk factors. The need for screening and psychiatric assistance in spinal metastatic tumor patients, as well as increasing the cooperation of psychiatry with integrated tumor services"

"Demand for a nursing career in Malaysia has increased, although it has not been a popular course of choice among students. Understanding the perceptions of students about nursing may help identify any misconception toward the profession and their consideration to choose nursing as a career. This study aimed to identify the perceptions of secondary school students about nursing and their potential interest in joining a nursing career. A cross-sectional study using convenience sampling was conducted among 155 students by administering a High School Students Self-Administered Questionnaire from three selected secondary schools in Kuantan, Pahang Malaysia. Overall, the respondents positively perceived the nursing profession, although several parts were viewed negatively. Despite having a positive notion about nursing, only 18.1% of the respondents were interested to select nursing as their career and a majority of them were women. In conclusion, no significant difference in perceptions about nursing and consideration to choose nursing as a career was found. Nevertheless, the image of nurses and a nursing career need to be improved in the eye of students and societies. In addition, the students were not aware of the benefits of nursing with several misconceptions of genders and doctor’s aid. Overall, the status of nursing in Malaysia should be enhanced to make it a valuable career."

"Pendahuluan: Nyeri pada lansia masih merupakan tantangan yang besar bagi tenaga kesehatan. Tatalaksana nyeri akut menjadi penting karena penanganan nyeri akut yang inadekuat telah dihubungkan dengan luaran yang lebih buruk selama hospitalisasi, termasuk nyeri persisten, waktu perawatan yang lebih lama, hambatan pada terapi fisik, keterlambatan ambulasi, dan delirium. Penggunaan farmakoterapi harus lebih berhati-hati karena kelompok lansia lebih rentan terhadap efek samping dan interaksi obat, adanya polifarmasi dan komorbiditas yang lebih banyak. Akupunktur telah diketahui efektif untuk menangani berbagai macam nyeri pada geriatri. Tujuan penelitian ini adalah untuk mengetahui bagaimana pengaruh satu sesi akupunktur dalam penurunan skala nyeri pada pasien geriatri dengan nyeri akut.Metode: Desain studi ini adalah studi uji klinis acak terkontrol tersamar tunggal. Empat puluh lansia > 60 tahun dengan nyeri yang dialami ≤ 6 bulan atau perburukan dalam ≤ 6 bulan terakhir dan NRS ≥ 4 dibagi menjadi 2 kelompok yaitu: kelompok terapi standar dan kelompok kombinasi terapi standar dan akupunktur. Perlakuan akupunktur dilakukan 1 sesi pada titik Battlefield Acupuncture. Seluruh subyek tetap menerima terapi standar yang ditentukan oleh dokter penanggungjawab pasien. Penilaian skor NRS dan VAS dilakukan 30 menit, 1 jam, dan 2 jam setelah menerima perlakuan.Hasil: Rerata penurunan skor NRS dan VAS pada kelompok yang menerima kombinasi terapi standar dan akupunktur pada ketiga waktu pengukuran lebih baik secara bermakna dibandingkan dengan kelompok terapi standar (p<0,001).Kesimpulan: Pemberian satu sesi akupunktur dapat mempengaruhi kecepatan penurunan skala nyeri pada pasien lansia dengan nyeri akut.

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Introduction: Pain management in elderly still become problematic for health workers. Adequate acute pain treatment is important because ineffective management for acute pain is associated with poorer outcomes throughout hospitalization, such as persistent pain, longer hospitalization period, delayed ambulation, and delirium. The use of pharmacotherapy in this group should be more cautious because elderly is more susceptible to drug interaction and side effects, polypharmacy, and comorbidities. Acupuncture has been found to be effective and safe in treating various kinds of pain in elderly. The aim of this study was to determine the effect of one session acupuncture on pain scale reduction in geriatric with acute pain.

Methods: This was a single blinded, randomized controlled trial of 40 elders with pain experienced ≤ 6 months or worsening in the last 6 months, with NRS ≥ 4. The subjects were divided into 2 groups: the standard therapy group and the combination of standard therapy and acupuncture group. Acupuncture treatment was performed one time using Battlefield Acupuncture points. All subjects continued to receive standard therapy as determined by the doctor in charge of the patient. NRS and VAS scores were assessed 30 minutes, 1 hour, and 2 hours after receiving treatment to evaluate patient’s outcome.

Results: Both NRS and VAS scores showed significant differences between 2 groups at all measurement times (p<0,001), with the mean reduction of pain scales in the group receiving combination of standard therapy and acupuncture was better than in standard therapy group.

Conclusion: The administration of one session acupuncture can affected pain scale reduction in elderly with acute pain"

"Penyakit ginjal kronis (PGK) merupakan masalah kesehatan dengan prevalensi yang terus meningkat, tercatat berdasarkan Riskesdas tahun 2013 prevalensi PGK adalah 0,2% dan pada Riskesdas tahun 2018 meningkat menjadi 0,38%. Penelitian ini bertujuan untuk mengetahui prevalensi PGK dan faktor-faktor yang berhubungan dengan kejadian PGK di Indonesia. Data yang dianalisis adalah data Indonesian Family Life Survey (IFLS) 5 dan dianalisis untuk menghitung prevalence ratio (PR) dengan batas kepercayaan 95%. PGK didefinisikan berdasarkan diagnosis tenaga kesehatan. Dari hasil analisis didapatkan prevalensi PGK di Indonesia sebesar 1,7%. Faktor risiko yang berhububungan secara signifikan dengan kejadian PGK diantaranya adalah kelompok umur 52-60 tahun (PR=2,159; 95% CI=1,368–3,406), kelompok umur 43-51 tahun (PR=2,186; 95% CI=1,454–3,287), kelompok umur 31-42 tahun (PR=2,150; 95% CI=1,463–3,160), laki-laki (PR=0,653; 95% CI=0,504–0,845), merokok PR=1,356 (95% CI=1,048–1,755), aktivitas fisik sedang (PR=1,399; 95% CI=1,015–1,929), hipertensi (PR=1,420; 95% CI=1,051–1,918), diabetes melitus (PR=2,631; 95% CI=1,666–4,156), kolesterol tinggi (PR=3,357; 95% CI=2,388–4,721), dan obesitas (PR=1,467; 95% CI=1,134–1,897). Kolesterol tinggi dan diabetes melitus merupakan variabel yang memiliki kemungkinan terbesar terhadap kejadian PGK.

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Chronic kidney disease (CKD) is a health problem with increasing prevalence, recorded based on Riskesdas 2013 the prevalence of CKD was 0,2% and it increased to 0,38% in Riskesdas 2018. This study aims to determine the prevalence of CKD and factors associated with the occurrence of CKD in Indonesia. This analysis used The Indonesian Family Life Survey (IFLS) 5 and analyzed to calculate the prevalence ratio (PR) with a 95% confidence interval. CKD was defined based on the diagnosis of health workers. The analysis shows that the prevalence of CKD in Indonesia is 1,7%. Risk factors that significantly associated with CKD are the age group 52-60 years (PR=2,159; 95% CI=1,368–3,406), age group 43-51 years (PR=2,186; 95% CI=1,454–3,287), age group 31-42 years (PR=2,150; 95% CI=1,463–3,160), males (PR=0,653; 95% CI=0,504–0,845), smoking PR=1,356 (95% CI=1,048–1,755), moderate physical activity (PR=1,399; 95% CI=1,015–1,929), hypertension (PR=1,420; 95% CI=1,051–1,918), diabetes (PR=2,631; 95% CI=1,666–4,156), high cholesterol (PR=3,357; 95% CI=2,388–4,721), and obesity (PR=1,467; 95% CI=1,134–1,897). High cholesterol and diabetes are the variables that have the biggest possibility of CKD."