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"Mental disorders are predicted to increase every year. Patients with severe mental disorders, such as schizophrenia, often engage in violent behavior. The treatment of such patients can use general nursing treatments (anger management with physical therapy, taking medicines regularly, and verbal and spiritual methods) and specialist nursing interventions (assertive training and family psychoeducation). This case report involved 11 patients, with the majority aged between 26 and 60 years, unemployed, high school graduates, unmarried, and with previous inpatient history. Generalist and specialist nursing interventions (assertive training and family psychoeducation) use Roy’s adaptation theory and Stuart’s stress adaptation approach. Nursing interventions were conducted sequentially, starting with generalist nursing interventions, followed by specialist ones. The method used was a pre–posttest in which each patient received generalist and specialist nursing interventions, assertive training, and family psychoeducation, each consisting of five sessions. Results of assertive training therapy and family psychoeducation showed a decrease in the signs and symptoms of violent behavior as well as an improvement in the patient’s ability to overcome the risk of violent behavior. The application of Roy’s adaptation theory and Stuart’s stress adaptation approach is potentially appropriate for the treatment of patients with a risk of violent behavior."

"Perilaku kekerasan merupakan salah satu respon atau tindakan terhadap stimulusstresor, ditunjukkan dengan perilaku aktual melakukan kekerasan, baik pada diri sendiri,orang lain maupun lingkungan, secara verbal maupun nonverbal (Stuart, 2009). Kliendengan perilaku kekerasan merupakan tanda ketidakmampuan klien dalam beradaptasiterhadap emosi marah sehingga mengekspresikan tidak secara konstruktif. Tujuanpenulisan karya ilmiah akhir ini adalah menggambarkan penatalaksanaan asuhankeperawatan dengan pendekatan Model Teori Adaptasi Roy pada klien risiko perilakukekerasan. Intervensi keperawatan yang dilakukan adalah assertive training dancognitive behaviour therapy pada 15 orang klien dalam kurun waktu 9 September – 12Nopember 2013 di Ruang Gatot Kaca RSMM Bogor.Hasil pelaksanaan assertive training dan cognitive behaviour therapy dapat menurunkantanda dan gejala perilaku kekerasan pada aspek kognitif, afektif, fisiologis, perilaku dansosial dan peningkatan kemampuan koping adaptif dalam menghadapi peristiwa yangmenimbukan perilaku kekerasan. Rekomendasi penulisan ini adalah bahwa penerapanModel Teori Adaptasi Roy dengan intervensi keperawatan assertive training dancognitive behaviour therapy dapat dilakukan untuk menurunkan perilaku kekerasan

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People would respond to threatning situation/stressor in various ways. Violence was the

actual aggressive behaviour directly toward to them selves, other people or external

environment, with physical or verbal violence (Stuart, 2009). People with tendency to

act aggressively shown that they used destructive coping strategies to express their

anger. The objective of this paper was to describe the application of Johnson’s

Behavioural System Model, focusing on aggresive behavior. Assertive training and

cognitive behaviour therapy were recognized as nursing intervention that provided to 15

clients during 9 September – 12 Nopember 2013 at Gatotkaca Dr. H.Marzoeki Mahdi

Hospital-Bogor.

Result of this study shown that sign and symptoms of aggressive behaviour were

decreased (cognitive, affective, psychic, behavior and social) and increased of client's

ability to express their emotion in contructive way. This study proved that the

application of Roy Adaptation Model Approach with assertive training and cognitive

behaviour therapy as nursing intervention were recommended to derecrease aggresive

behaviour."

"Penelitian ini bertujuan untuk memperoleh gambaran pengaruh latihan asertif terhadap perilaku kekerasan orang tua pada anakusia sekolah di Kabupaten Karawang. Sampel pada kelompok intervensi dan kontrol masing-masing 32 orang. Latihan asertifdilakukan selama 6 sesi. Hasil penelitian menunjukkan terjadi peningkatan kemampuan komunikasi asertif orangtua padakelompok intervensi dibanding kelompok kontrol secara bermakna (p< 0,05). Kemampuan anak dalam mengendalikan emosipada kelompok intervensi meningkat, sedangkan pada kelompok kontrol menurun secara bermakna (p< 0,05). Latihan asertifmembantu orangtua menurunkan perilaku kekerasan pada anak melalui komunikasi asertif. Terapi ini direkomendasikan padaorangtua, guru, dan pemberi pelayanan kesehatan.This research aimed to describe the influence of assertive training on violence behavior of parents towards children in Karawangdistrict. Samples in the intervention group and control were 64 parents, 32 respondent for each group. Assertive training hasconducted in 6 sessions. The results showed increased assertive communication skills of parents on the group that receivedassertive training. There was significant difference among those groups (p< 0.05). The group of parents who did not receiveassertive training, showed a significant decreased communication of skills (p< 0.05). The was increased ability of children incontrolling their emotions of intervention group parents, while there was significant decreased children ability of controlgroup parents (p< 0.05). Assertive training was proven to decrease parents? violent behaviors towarsd children. It wasrecommended that this training to be regularly conducted to parents, teachers, and health care provider."

"Risiko perilaku kekerasan merupakan salah satu masalah yang dialami klien dengan skizofrenia. Tanda dan gejala yang dialami klien dengan risiko perilaku kekerasan salah satunya adalah marah dan merusak lingkungan sekitar, klien dengan risiko perilaku kekerasan membutuhkan latihan assertive training untuk pengubahan perilaku yang tujuan utamanya membimbing, melatih serta mendorong seseorang agar berperilaku asertif di berbagai keadaan. Pemberian terapi assertive training selama ini dilakukan oleh perawat spesialis dalam praktik klinik guna peningkatan asuhan keperawatan secara optimal. Keefektifan pemberian assertive training memiliki kekurangan yaitu tidak mudah untuk diingat dan umpan balik dapat di bawah standar karena keterbatasan memori atau pengamatan. Tujuan penulisan karya ilmiah ini untuk menggambarkan manajemen kasus spesialis melalui penerapan media audio-visual dalam pemberian intervensi keperawatan spesialis; assertive training pada klien dengan risiko perilaku kekerasan. Metode yang digunakan adalah case series. Manajemen kasus ini dilakukan pada 6 klien yang mendapatkan tindakan keperawatan ners dan tindakan keperawatan spesialis assertive training. Pengkajian menggunakan instrumen Buss_Perry Aggression Questionnaire (BPAQ) untuk mengkaji tingkat agresif klien dengan risiko perilaku kekerasan. Hasil analisa kasus menunjukkan perubahan penurunan tingkat agresif klien sebelum dan sesudah diberikan tindakan assertive training dengan penerapan media audio-visual. Tindakan keperawatan spesialis direkomendasikan dilakukan oleh perawat spesialis jiwa dalam membantu klien melakukan latihan assertive training.

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The risk of violent behavior is one of the problems experienced by clients with schizophrenia. Signs and symptoms experienced by clients at risk of violent behavior, one of which is anger and damage to the surrounding environment, clients at risk of violent behavior require assertive training for behavior change whose main purpose is to guide, train and encourage someone to behave assertively in various circumstances. The provision of assertive training therapy has been carried out by specialist nurses in clinical practice in order to improve nursing care optimally. The effectiveness of giving assertive training has drawbacks, namely it is not easy to remember and feedback can be substandard due to memory or observation limitations. The purpose of writing this scientific paper is to describe specialist case management through the application of audio-visual media in providing specialist nursing interventions; assertive training on clients at risk of violent behavior. The method used is case series. This case management was carried out on 6 clients who received nursing actions from nurses and specialist nursing actions for assertive training. The assessment uses the Buss_Perry Aggression Questionnaire (BPAQ) instrument to assess the aggressive level of clients at risk of violent behavior. The results of the case analysis showed a change in the decrease in the client's aggressive level before being given action with after being given assertive training. Specialist nursing actions are recommended to be carried out by mental specialist nurses in helping clients carry out assertive training exercises."

"Pendahuuan: Risiko Perilaku Kekerasan (RPK) merupakan salah satu gejala positif yang sering terjadi pada klien skizofrenia. RPK merugikan banyak orang termasuk diri sendiri dalam hal keselamatan, dan mengakibatkan dampak psikologis, dampak fisik, dampak ekonomi, termasuk memperpanjang waktu rawat inap dan meningkatkan stigmatisasi. Latihan asertif merupakan terapi keperawatan jiwa spesialis yang terbukti dapat mencegah perilaku kekerasan, menurunkan tanda dan gejala dan meningkatkan kemampuan klien dalam mengontrol RPK. Teori comfort belum banyak dikembangkan pada penelitian-penelitian RPK dengan skizofrenia. Tujuan: menganalisis penerapan terapi keperawatan jiwa spesialis latihan asertif pada klien RPK menggunakan pendekatan teori comfort. Metode: case report dengan pendekatan teori comfort. Hasil: Terdapat penurunan tanda gejala serta peningkatan kemampuan klien dalam mengontrol RPK setelah pemberian terapi keperawatan jiwa spesialis latihan asertif menggunakan pendekatan teori comfort. Kesimpulan: Tulisan ini menggunakan pedekatan teori comfort pada penerapan terapi keperawatan jiwa spesialis latihan asertif yang terbukti menurunkan tanda gejala dan meningkatkan kemampuan klien dalam mengontrol RPK. Rekomendasi: Penerapan terapi keperawatan jiwa spesialis latihan asertif menggunakan pendekatan teori comfort direkomendasikan untuk diberikan pada klien dengan RPK dengan skizofrenia.

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Introduction: The risk of violent behavior (RVB) is one of the positive symptoms that often occurs in schizophrenia. RVB harms many people including oneself in terms of safety, and results in psychological impacts, physical impacts, economic impacts, including length of stay and increasing stigmatization. Assertive training is a specialist psychiatric nursing therapy that is proven to be able to prevent violent behavior, reduce signs and symptoms, and increase the ability to control the RVB. Comfort theory has not been widely developed in RVB studies with schizophrenia.

Purpose: to analyze the application of assertive training, specialist psychiatric nursing therapy to the RVB clients using the comfort theory approach.

Method: case report with comfort theory approach.

Results: There is a decrease in signs and symptoms and an increase in the client's ability to control RVB after giving assertive training, specialist psychiatric nursing therapy, using the comfort theory approach.

Conclusion: This paper uses the comfort theory approach to the application of assertive training, specialist psychiatric nursing therapy, which is proven to reduce signs and symptoms and increase the client's ability to control RVB.

Recommendation: The application of assertive training, specialist psychiatric nursing therapy, using the comfort theory approach is recommended to be given to RVB clients with schizophrenia."

"Tujuan penelitian ini adalah memperoleh gambaran pengaruh assertive training therapy terhadap kemampuan asertif dan risiko kekerasan dalam rumah tangga suami. Desain penelitian "Quasi Experiment Pre-Post Test With Control Group". Sampel penelitian ini berjumlah 60 orang, 30 orang diberikan assertive training therapy dan 30 orang hanya diberikan terapi generalis. Hasil penelitian didapatkan pengaruh terapi asertif training terhadap kemampuan asertif suami sebesar 67,4% dengan peningkatan yang bermakna p-value < 0,05. Sedangkan perilaku risiko kekerasan dalam rumah tangga mengalami penurunan sebesar 29,6 % dengan penurunan yang bermakna p-value < 0,05. Assertive training therapy direkomendasikan diberikan pada suami dengan risiko kekerasan dalam rumah tangga.

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The objective of this study is to describe the influence of assertive training therapy to the ability of assertiveness and husbands with risk of domestic violence. Research design using "Quasi Experiment Pre-Post Test With Control Group". The respondents of this study consists 60 respondents, 30 respondents were given assertive training therapy, 30 respondents given only generalist therapy.

The results of this study shows the effect of assertive training therapy to husband's assertiveness ability of 67,4% with significant improvement (p-value < 0,05). While the risk of domestic violent decreased by 29,6% with significant reductions (p-value < 0,05). Assertive training therapy recommended for husbands with domestic violence risk."

"Pendahuluan: Skizofrenia merupakan gangguan jiwa yang terjadi pada fungsi otak. Prevalensi skizofrenia mencapai dua puluh empat juta di seluruh dunia dan sering terjadi pada usia remaja akhir. Prevalensi skizofrenia mengalami peningkatan sebanyak 0,18% di Indonesia sedangkan di Provinsi Bali skizofrenia menempati urutan pertama. Tanda dan gejala skizofrenia dapat berupa perilaku kekerasan. Sebanyak 68 % pasien skizofrenia dilakukan perawatan kembali (rehospitalisasi) di rumah sakit karena perilaku kekerasan. Dampak kekambuhan yang dikarenakan oleh perilaku kekerasan adalah memburuknya gejala, menurunnya fungsi kognitif, resistensi terhadap pengobatan dan sulit diterima kembali di masyarakat. Maka dari itu diperlukan tindakan untuk mencegah terjadinya kekambuhan pada pasien dengan perilaku kekerasan. Tujuan : Untuk mengetahui pengaruh tindakan keperawatan ners, latihan asertif, dan psikoedukasi keluarga terhadap kemampuan mencegah kekambuhan pada pasien dengan perilaku kekerasan. Metode : Menggunakan desain penelitian Quasy experiment dengan rancangan pre-post test with control group yang dianalisis menggunakan univariat dan bivariat. Hasil: Penelitian menunjukkan penurunan tanda dan gejala perilaku kekerasan, peningkatan kemampuan pasien mengendalikan perilaku kekerasan, peningkatan kemampuan berperilaku asertif, peningkatan kepatuhan minum obat, dan peningkatan kemampuan keluarga dalam merawat pasien dengan perilaku kekerkasan. Rekomendasi: tindakan keperawatan ners, latihan asertif, dan psikoedukasi keluarga direkomendasikan sebagai upaya untuk mencegah kekambuhan pada pasien.

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Background: Schizophrenia is a mental disorder that occurs in brain function. The prevalence of schizophrenia reaches twenty-four million worldwide and often occurs in late adolescence. The prevalence of schizophrenia has increased by 0.18% in Indonesia while in Bali Province schizophrenia ranks first. Signs and symptoms of schizophrenia can include violent behavior. As many as 68% of schizophrenia patients are rehospitalized in the hospital due to violent behavior. The impact of relapse caused by violent behavior is worsening symptoms, decreased cognitive function, resistance to treatment and difficulty being accepted back in society. Therefore, measures are needed to prevent relapse in patients with violent behavior.

Objective: To determine the effect of nursing actions, assertive training, and family psychoeducation on the ability to prevent relapse in patients with violent behavior.

Methods: Using Quasy experiment research design with pre-post test design with control group which was analyzed using univariate and bivariate.

Results: The study showed a decrease in signs and symptoms of violent behavior, an increase in the patient's ability to control violent behavior, an increase in the ability to behave assertively, an increase in medication compliance, and an increase in the family's ability to care for patients with violent behavior.

Recommendations: nursing actions, assertive practice, and family psychoeducation are recommended as an effort to prevent relapse in patients."

"Peningkatan masalah dalam rumah tangga dengan kurangnya pemecahan masalah yang baik memicu terjadinya kekerasandalam rumah tangga, baik pada usia pernikahan muda maupun tua. Tujuan penelitian ini melihat pengaruh assertive trainingtherapy (ATT) terhadap kemampuan asertif dan persepsi istri terhadap risiko kekerasan dalam rumah tangga suami. Desainpenelitian Quasi Experimental Pre-Post Test With Control Group, dengan sampel 60 orang istri dengan resiko kekerasan dalamrumah tangga. Hasil menunjukkan ATT berpengaruh meningkatkan kemampuan asertif istri sebesar 86,9% dan persepsi istriterhadap risiko kekerasan menurun 71,3%. Istri yang diberi ATT mempunyai kemampuan asertif meningkat secara bermaknadan persepsi istri terhadap risiko kekerasan dalam rumah tangga suami lebih rendah dibandingkan yang tidak diberikan ATT.Assertive Training Therapy direkomendasikan untuk istri dengan resiko kekerasan dalam rumah tangga."

"Halusinasi dan perilaku kekerasan merupakan gejala positif yang paling banyak ditemukan pada klien dengan skizofrenia. Tanda dan gejala halusinasi dan perilaku kekerasan membutuhkan penatalaksanaan yang komperehensif dan berkesinambungan baik untuk klien, keluarga, dan kelompok. Tujuan penulisan karya ilmiah akhir ini adalah untuk memberikan gambaran penerapan dari tindakan keperawatan ners, cognitive behaviour therapy, assertive training, psikoedukasi keluarga, dan terapi suportif pada klien halusinasi dan perilaku kekerasan. Metode yang digunakan adalah operational research. Pengambilan sampel menggunakan teknik purposive sampling berjumlah 40 klien yang terbagi dalam dua kelompok. Kelompok satu berjumlah 20 klien diberikan tindakan keperawatan ners, cognitive behaviour therapy, assertive training, psikoedukasi keluarga, dan terapi suportif (paket terapi satu). Kelompok dua berjumlah 20 klien diberikan tindakan keperawatan ners, cognitive behaviour therapy, dan assertive training (paket terapi dua). Pengumpulan data menggunakan instrumen tanda gejala dan kemampuan, kemudian dianalisis secara univariat dan bivariat. Analisis univariat menggunakan distribusi frekuensi dan tendensi sentral. Analisis bivariat menggunakan uji friedman, wilcoxon, mann-whitney, dan korelasi rank spearman. Hasil karya ilmiah menunjukkan penurunan tanda dan gejala serta peningkatan kemampuan klien halusinasi dan perilaku kekerasan pada kelompok yang diberikan paket terapi satu lebih besar secara bermakna dibandingkan kelompok yang mendapatkan paket terapi dua (p value < 0,05). Tindakan keperawatan yang dikombinasikan antara tindakan keperawatan ners oleh perawat generalis dan tindakan keperawatan spesialis oleh perawat spesialis jiwa direkomendasikan dilakukan di rumah sakit jiwa untuk menghasilkan penurunan tanda gejala dan peningkatan kemampuan klien halusinasi dan perilaku kekerasan lebih optimal.

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Hallucinations and violent behavior are the most common positive symptoms in clients with schizophrenia. Signs and symptoms of hallucinations and violent behavior require comprehensive and continuous management for the client, family, and group. The purpose of writing this final scientific paper is to provide an overview of the application of standart nursing intervention, cognitive behavior therapy, assertive training, family psychoeducation, and supportive therapy to clients with hallucinations and violent behavior. The method used is operational research. Sampling using purposive sampling technique amounted to 40 clients who were divided into two groups. The first group of 20 clients was given standart nursing intervention, cognitive behavior therapy, assertive training, family psychoeducation, and supportive therapy (therapy package one). The second group of 20 clients was given standart nursing intervention, cognitive behavior therapy and assertive training (therapy package two). Collecting data using signs and symptoms instruments and abilities, then analyzed by univariate and bivariate. Univariate analysis using frequency distribution and central tendency. Bivariate analysis using friedman, wilcoxon, mann-whitney and spearman rank correlation test. The results of scientific work showed the decrease in signs and symptoms as well as an increase in the client's ability to hallucinations and violent behavior in the group given therapy package one was significantly greater than the group receiving therapy package two (p_value <0.05). Nursing intervention that are combined between standart nursing and specialist nursing intervention are recommended to be carried out in mental hospitals to produce a decrease in signs of symptoms and an increase in the ability of clients to have hallucinations and violent behavior more optimally"