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"ABSTRAKCakupan keluarga rawan dibina yang hanya mencapai 30 % dengan frekuensi kunjungan rata- rata 0,58 serta belum dilaksanakannya tugas formal perawat dibidang promotif dan preventif, menunjukkan belum efektifnya pelaksanaan manajemen Puskesmas terutama yang berkaitan dengan kegiatan pembinaan keluarga rawan.Penelitian ini bertujuan memperoleh informasi mendalam tentang pelaksanaan fungsi manajemen kegiatan pembinaan keluarga ibu hamil risiko tinggi secara faktual, serta komponen pengetahuan petugas Puskesmas, pengetahuan kader dan kebijakan yang berkaitan dengan kegiatan pembinaan keluarga bumil risti di Puskesmas.Menggunakan metoda kualitatif dengan unit analisis petugas Puskesmas, serta kader dasawismal posyandu. Sumber data: 2 orang kepala Puskesmas, 2 orang seksi Perkesmas, 4 orang tenaga keperawatan Puskesmas, 6 orang bidan desa, 16 orang leader posyandu serta informasi dari dokumen Puskesmas. Pengumpulan data dengan menggunakan teknik wawancara mendalam, diskusi kelompok terarah dan kajian dokumen. Analisis data menggunakan content analysis, dibantu dengan matrix data kualitatif. Sedang penafsiran data dilakukan dengan tujuan dekriptif analitik melalui cara menemukan hubungan yang muncul dari data. Keterbatasan- penelitian; karena keabsahan data hanya menggunakan triangulasi sumber data dan metoda, kemungkinan terjadinya recall bias serta hasil penelitian yang tidak dapat digeneralisasi.Hasil penelitian menunjukkan bahwa pengetahuan petugas termasuk kepala Puskesmas tentang pembinaan keluarga bumil risti- masih bervariasi, pengetahuan kader masih terbatas untuk mendukung keterlibatan aktif dalam pembinaan keluarga bumil risti, pelaksanaan kegiatan Puskesmas sangat tergantung gebrakan yang bersifat instruksi Nasional serta penyebarluasan pedoman Purkesmas yang terhambat sampai ke Puskesmas, tidak dibuatnya perencanaan pembinaan- keluarga sesuai dengan PTP karena dianggap kegiatan rutin dan bukan prioritas, pengorganisasian pembinaan keluarga bumil risti yang tidak efektif, kepermimpinan kepala-Puskesmas-yang kurang efektif; pengendalian pembinaan keluarga bumil risti yang belum seragam dan hambatan biaya pembinaan- keluarga rawan.Hasil penelitian diatas menunjukkan bahwa pengetahuan petugas maupun kader belum memadai untuk dapat dilaksanakannya pembinaan-keluarga- bumil risti- secara. optimal, serta fungsi manajamen yang berkaitan dengan pembinaan keluarga bumil risti belum dilaksanakan seeara konsisten-oleh- kepala Ptrskesmas.Untuk menyelesaikan masalah tersebut, saran yang diajukan adalah Puskesmas lebih proaktif dalam ; memperkenalkan fungsi Puskesmas, ldustrinya dalam upaya promotif dan preventif termasuk kegiatan pembinaan keluarga bumil risti ; Dinas kesehatan Dati II lebih konsisten dalam mengaplikasikan kebijakan Depkes .yang berkaitan dengan upaya peningkatan kualitas pelayanan keperawatan termasuk pembinaan- keluarga bumil- risti; Departemem kesehatan lebih mengoperasionalkan model pembinaan keluarga rawan dan mengupayakan forum keperawatan di berbagai tingkat administraf yang bertanggung jawab secara teknis peningkatan kualitas pelayanan keperawatan di Puskesmas serta dilakukannya penelitian lanjutan untuk kualitas pelayan keperawatan kesehatan masyarakat khususnya pembinaan keluarga bumil risti.

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ABSTRACT

Management Analysis for Family Health Nursing Activity of High Risk Pregnant Mother in Karawang Health Center, West Java, 1998 The coverage of the risk family that is taken care, which only 30 % with the family visit frequency only 0, 58 ( average )-and nurses formal task in promotive and preventive program not yet implemented, indicate that the management of the health center in effectively implemented- especially is related to family health- nursing activity.

The objective of this study is to get the factual information regarding the implementation of helath center management function for family health nursing activity of high-risk pregnant mother. Also to have knowledge component of health center personel, the knowledge of cadre and the policies that are related to family health nursing activity of high-risk pregnant mother in-health center.

The design of the study is a qualitative research with analysis unit of health center personel and posyandul dasawisma- cadre Resource data : 2 head- of health centers, 2 Community Health Nursing Section, 4 health center nurses/ midwives, 6 villages midwives, 16 posyandu cadre- and- information from health center's documents. Data collection using interviews technique, group discussion and documents analysis. In analysis data uses content analysis, with the qualitative-matrix data. Data interpretation is done by analytic descriptive objective through the inter relation which appears from the- data. The-limitation- of this study are since validity of the data has just using triangulation of data source and method, therein possibility of recall bias and also the result of this study that can not be generalized.

The. result of this study shows that knowledge of health personel including the head of health center regarding the family halt}]- nursing activity of high-risk pregnant mother still_ vary. The. knowledge of cadre still limited in order to support actively in family health nursing activity of high risk pregnant mother. The implementation of health center activities depend entirely on the policies that have national capacity and also depend on the spread distribution of community health nursing manuals, which are late arrived to health center. There is no planning for family health nursing in the- health center planning (PTP), because the program]- is assumed as routine activity and not priority one. The management of family health nursing is still not effective. The leadership of head of health center is also not effective. The management of family health nursing still not uniform and there is many obstacles in supporting the budget for that activity.

The results of the study above showed that knowledge of health- personnel and cadre not sufficient in order to support optimally the implementation of family' health nursing of high-risk pregnant mother. Also the management functions that related to the family health nursing have not been implemented consistently by the head of helath center.

To overcome the problem, the- suggestion for health center is to- be more promotive in implement the health center function, especially in promotive and preventive including the program-in family health-nursing of high risk pregnant mother. District health office must be more consistent in applying the MOH policy, which related to implementation of nurse- service quality including the family health nursing. MOH also has operationatise more on the model of family health nursing for risk family and promote nursing forum in administrative level, which responsible- technically in improving the quality of nurse service in health center. It is also necessary to implement the next study in order to improve the- quality of community health musing service especially for family health nursing of high risk pregnant mother.

Bibliography : 38 (1979 -1995)"

"Angka kematian ibu (AKI) di Indonesia masih sangat tinggi yaitu berkisar 373 per 100.000 kelahiran hidup. Angka tersebut masih tergolong tinggi jika dibandingkan dengan AKI negara-negara Asean. Penyebab kematian ibu di Indonesia sebagian besar disebabkan oleh perdarahan, toksemia gravidarum dan infeksi jalan lahir. Kematian ibu sangat berkaitan dengan kelemahan dalam mata rantai rujukan baik di masyarakat, fasilitas kesehatan di tingkat masyarakat maupun rumah sakit.Penelitian ini bertujuan untuk mengetahui hal-hal yang berperan dalam pemanfaatan pelayanan rujukan oleh ibu hamil risiko tinggi. Penelitian ini menggunakan metode penelitian kualitatif. Penelitian ini dilakukan di wilayah kerja Puskesmas Putussibau Kabupaten Kapuas Hulu. Populasi penelitian adalah ibu hamil risiko tinggi di wilayah Puskesmas Putussibau Kabupaten Kapuas Hulu tahun 1999. Sebagai informan penelitian adalah ibu hamil risiko tinggi yang memanfaatkan pelayanan rujukan maupun yang tidak memanfaatkan pelayanan rujukan, bidan desa, bidan rumah sakit, koordinator bidan dan tokoh masyarakat.Pengumpulan data dilakukan dengan cara diskusi kelompok terarah (DKT) dan wawancara mendalam.Hasil penelitian menunjukkan bahwa kecenderungan ibu yang tidak memanfaatkan pelayanan mempunyai profil berumur muda, paritas banyak, anak sedikit, pekerjaan petani, jarak kehamilan panjang, pengetahuan tentang ibu hamil risiko tinggi kurang. Sedangkan hal-hal yang berperan terhadap pemanfaatan pelayanan rujukan oleh ibu adalah persepsi terhadap pelayanan di rumah sakit, persepsi terhadap biaya pelayanan, tidak adanya pengalaman persalinan dengan penyuiit, ketiadaan sarana transportasi, persepsi terhadap ketersediaan peralatan non medis/penunjang pelayanan, persepsi terhadap ketersediaan tenaga rumah sakit, penanggung biaya pelayanan, dukungan keluarga, infonnasi kesehatan yang diterima, dukungan tokoh masyarakat.Saran yang diajukan berdasarkan hasil penelitian ditekankan pada upaya peningkatan KIE (Komunikasi, Informasi dan Edukasi) terhadap bidan desa, baik kepada Kepala Puskesmas Putussibau maupun kepada Pengelola Program KIA di Dinas Kesehatan Kabupaten Kapuas Hulu. Saran kepada Kepala RSUD Dr. Achmad Diponegoro Putussibau agar meningkatkan mutu pelayanan non medis, meningkatkan motivasi dan sikap tenaga rumah sakit dalam memberikan pelayanan, pemberian medical inform yang baik kepada pasien, optimalisasi tenaga.Datar pustaka : 29 (1969 - 2000)

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Analyze of Effecting Factor in Primary Referal Service Advantage by High Risk Pregnant Mother in Putussibau Public Health Center Area, Kapuas Hulu Regency at The Year 1999Maternal Mortality Rate (MMR) in Indonesia is still high, about 373 per 100.000 live birth. This number is higher than those in other ASEAN countries. Major causes of I maternal mortality in Indonesia are bleeding, toksemia gravidarum and nun infection. Maternal mortality is also asociated with weak referal system in the community, as well as in the healthcare system.This study is to find effecting factor in referal service advantage by pregnant mother with high risk. This research used qualitative method.This study take in action at Putussibau Public Health Center area, Kapuas Hulu Regency. The Population are pregnant mothers with high risk in this Public Health Center area at the year 1999. Informant are pregnant mother with high risk which taken advantage of referal service and others which does not take this advantage, and also to village midwife, hospital midwife, midwife coordinator and figure public people.Data compiled by Focus Group Discussion (FGD) and Indepht Interview.Result showed that pregnant mother trend who do not to take service advantage have young age profile, much variant, do not have much children, farmer profession, long interval pregnacy, less knowledge about pregnacy with high risk. And effecting towards referal service advantage by pregnant mother are perception to hospital service, perception of hospital cost, no experience with the difficulty, no transportation, perception towards availability of non medical equipment/support service, towards availability of hospital staff, service cost borer, family support, healthcare information taken, and support from fihure public people.Suggetion based on the research result are to increase CIE (Communication, Information and Education) toward village midwife, Head of Putussibau Public Health Center and Program Mother and Child Healthy at Health Services Office in Kapuas Hulu Regency. Suggestion also given to Head of Dr. Achmad Diponegoro Distric General Hospital in Putussibau, to increase non-medical service quality, motivation and hospital staff attitude in giving service, good medical information to clients and staff optimalization.Reference List : 29 (1969 - 2000)"

"Pada tahun 1995 ( SKRT ) Angka Kematian lbu ( AKI ) di Indonesia sebesar 373 per 100.000 kelahiran hidup menjadi 334 per 100.000 kelahiran hidup (SDK1, 1997) (Cholil, 1999). Kematian ini umumnya dapat dicegah bila komplikasi kehamilan dan keadaan risiko tinggi lainnya dapat dideteksi sejak dini dan kemudian mendapatkan penanganan yang akurat pada saat persalinan. Oleh karena itu diperlukan tempat dan pertolongan persalinan yang dapat mengantisipasi risiko yang mungkin timbul. Penelitian ini dilakukan pada ibu hamil risiko tinggi pada 36 puskesmas yang bertujuan untuk mengidentifikasi faktor-faktor yang berhubungan dengan pemanfaatan rujukan persalinan ibu hamil risti oleh puskesmas ke Rumah Sakit Umum Pusat Dr. Mohammad Hoesin (RSMH) Palembang yang dilakukan dengan metode rancangan cross sectional. Dalam penelitian ini tidak dilakukan sampling tapi diambil seluruh ibu hamil risiko tinggi trimester 111 pada bulan Januari sampai Desember 2001 yang berjumlah 200 orang. Data dikumpulkan dengan cara wawancara menggunakan alat ukur kuisioner terhadap 112 (56 %) responden yang tidak memanfaatkan rujukan persalinan ke RSMH dan 88 (44 %) responden yang memanfaatkan rujukan ke RSMH Palembang. Dari 14 variabel yang diteliti, terdapat 6 variabel yang terbukti bermakna secara statistik yaitu umur ibu hamil, paritas, pengetahuan, penanggung biaya, jarak ke fasilitas pelayanan dan riwayat persalinan yang lalu, dan yang paling dominan berhubungan dengan pemanfaatan rujukan persalinan ibu hamil risiko tinggi oleh puskesmas ke RSMH adalah penanggung biaya. Untuk meningkatkan rujukkan ibu hamil risiko tinggi oleh puskesmas ke RSMH maka perlu ditingkatkan pemerataan dana Jaringan Pengaman Sosial Bidang Kesehatan ( 3PSBK ), penyuluhan kesehatan pada ibu-ibu hamil tentang faktor risiko dan risiko tinggi pada kehamilan, persalinan dan nifas yang dapat mengancam jiwa ibu dan bayi yang dikandungnya. Memberikan informasi seiengkap-lengkapnya tentang jalur rujukan. ......Analize The Factors that Have Been Correlated With Reference Utilization Labor to High Risk Pregnant Mother by Public Health Centre to General Hospital Dr. Mohammad Hoesin Palembang In 2001 In 1995 (SKRT), the number of the death of women (AKI) in Indonesia was high, that is 373 per 100.000 life birth become 334 per 100.000 Life birth (SDKI, 1997) (Cholil, 1999). Generally, the death could be avoided if pregnant complication and high risk condition could be detected earlier, and accurate care could be given at the critical period - the time of giving birth - therefore, the place need to prepare and infra partum care could he anticipate the mother's death and their infants. This research was done to the mother with high risk pregnant in 36 Public Health Centers in Palembang, to find out the factors concerning to the medical recommendation given to the women with high risk pregnant by Public Health Center To General Hospital Dr. Mohammad Hoesin Palembang by using cross sectional design. In this research wasn't done sampling but taken from total population to the women with high-risk pregnancy trimester III in January - December 2001. The data was collected with interview by using questionnaire to 112 (56 %) respondent who came to RSMH and 88 (44 %) respondent was not go to RSMH Palembang. From 14 variables studied, there were 6 variables, which were proved statistically significant. These variables were: pregnant women, how many times pregnancy, knowledge, cost, the distance and the condition of previous pregnancy. From these six variables, cost variable was the most dominant reason for having the recommendation to have medical care to the general hospital. To increase the use of medical care recommendation to the general hospital especially for women with high risk pregnancy, it is necessary to spread the social fund for medical care; to give a guide on medical care to pregnant women about the high risk factors on pregnancy and bearing that may cause the death for both the mother and her infant; and to give clear and complete information for getting medical care to the general hospital. "