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Abstrak :
[ABSTRAK
Latar belakang: Hiponatremia pasca tindakan operasi mayor pada populasi anak merupakan gangguan elektrolit yang sering terjadi. Penggunaan cairan yang belum tepat sering menimbulkan peningkatan kejadian hiponatremia yang berhubungan erat dengan meningkatnya berbagai komplikasi seperti edema otak, kejang, bahkan kematian. Populasi anak merupakan risiko tinggi karena perbandingan jaringan otak dan tulang tengkorak yang lebih besar sehingga ruang yang tersedia saat terjadi edema otak lebih sempit. Tujuan: Mengetahui insidens hiponatremia pada anak pasca tindakan operasi mayor. Metode: Studi retrospektif potong lintang dilakukan terhadap anak usia 1 bulan hingga 18 tahun yang menjalani tindakan operasi mayor dan masuk ruang perawatan intensif. Penelusuran status medik sesuai kriteria inklusi dilakukan sampai jumlah sampel terpenuhi. Pencatatan terhadap subjek yang meliputi data praoperasi, intraoperasi, serta pemantauan pascaoperasi dilakukan. Subjek yang memenuhi definisi hiponatremia (<135 mEq/L) diklasifikasikan sesuai derajat hiponatremia dan dilakukan pencarian lebih lanjut terhadap komplikasi. Hasil : Studi dilakukan terhadap 90 subjek yang terdiri dari 56,7% lelaki, dengan 51,1% memiliki rentang usia 1 bulan hingga 4 tahun. Sebanyak 47,8% subjek menjalani tindakan laparatomi dengan berbagai indikasi. Hampir semua subjek (93,3%) mendapat cairan hipotonik pascaoperasi. Insidens hiponatremia pascaoperasi sebesar 28,9% dengan 11,1% diantaranya merupakan hiponatremia sedang-berat. Rerata kadar natrium pascaoperasi adalah 130,1 ± 4,1 mEq/L dengan rerata total cairan 79,8 ± 27,4 ml/kg. Sebesar 30,9% subjek yang mendapatkan cairan hipotonik pascaoperasi mengalami kejadian hiponatremia dengan rerata lama rawat 5,6 ± 4 hari. Terdapat 1/26 subjek yang mengalami komplikasi berupa kejang dan edema otak. Simpulan: Insidens hiponatremia pasca tindakan operasi mayor di ruang perawatan intensif hampir mencapai 30% dan sebagian besar mendapat cairan hipotonik pascaoperasi. Penelitian lebih lanjut perlu dilakukan untuk mengevaluasi pemberian cairan pascaoperasi yang tepat untuk mencegah hiponatremia.

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ABSTRACT
Background: Hyponatremia is commonly found post major surgery in pediatric population. The use of improper fluid often leads to increasing incidence of hyponatremia which causes complications such as cerebral edema, seizure, and death. Pediatric is a high risk population due to the large ratio between the brain tissue and skull, so that the availability space. Hyponatremia after major surgery in pediatric population is a common electrolyte disorder. The use of improper fluid often lead to increased incidence of hyponatremia which is closely linked to the increasing variety of complications such as cerebral edema, seizures, and even death. Pediatric is high risk population due to the larger comparison of brain tissue and the skull so that the space available in the event of brain edema narrower. Objective: To describe the incidence of hyponatremia in children after major surgery. Methods: A retrospective cross-sectional study was conducted on children aged 1 month to 18 years who underwent major surgery and entered the intensive care ward. The inclusion subjects was traced from medical records. The data was recorded from preoperative, intraoperative, and postoperative monitoring. Subjects who met hyponatremia (<135 mEq/L) were classified according to the severity of hyponatremia and its complications. Results: Ninety subjects were enrolled in this study (56.7% male, 51.1% age 1 month-4 years). There were 47.8% subjects underwent laparotomy with a variety of indications. Almost all subjects (93.3%) received postoperative hypotonic fluid. The incidence of postoperative hyponatremia was 28.9%, while 11.1% among them were moderate-severe hyponatremia. The mean postoperative sodium levels was 130.1 ± 4.1 mEq/L with a mean total fluid 79.8 ± 27.4 ml/kg. There were 30.9% subjects who received hypotonic fluids and experienced hyponatremia with a mean length of stay 5.6 ± 4 days. One of 26 subjects with hyponatremia suffered from seizures and brain edema. Conclusions: The incidence of postoperative hyponatremia in pediatric intensive care reached nearly 30%, and almost all of them received hypotonic fluid. Therefore, further research should be performed to evaluate the appropriate fluid in order to anticipating postoperative hyponatremia, Background: Hyponatremia is commonly found post major surgery in pediatric population. The use of improper fluid often leads to increasing incidence of hyponatremia which causes complications such as cerebral edema, seizure, and death. Pediatric is a high risk population due to the large ratio between the brain tissue and skull, so that the availability space. Hyponatremia after major surgery in pediatric population is a common electrolyte disorder. The use of improper fluid often lead to increased incidence of hyponatremia which is closely linked to the increasing variety of complications such as cerebral edema, seizures, and even death. Pediatric is high risk population due to the larger comparison of brain tissue and the skull so that the space available in the event of brain edema narrower. Objective: To describe the incidence of hyponatremia in children after major surgery. Methods: A retrospective cross-sectional study was conducted on children aged 1 month to 18 years who underwent major surgery and entered the intensive care ward. The inclusion subjects was traced from medical records. The data was recorded from preoperative, intraoperative, and postoperative monitoring. Subjects who met hyponatremia (<135 mEq/L) were classified according to the severity of hyponatremia and its complications. Results: Ninety subjects were enrolled in this study (56.7% male, 51.1% age 1 month-4 years). There were 47.8% subjects underwent laparotomy with a variety of indications. Almost all subjects (93.3%) received postoperative hypotonic fluid. The incidence of postoperative hyponatremia was 28.9%, while 11.1% among them were moderate-severe hyponatremia. The mean postoperative sodium levels was 130.1 ± 4.1 mEq/L with a mean total fluid 79.8 ± 27.4 ml/kg. There were 30.9% subjects who received hypotonic fluids and experienced hyponatremia with a mean length of stay 5.6 ± 4 days. One of 26 subjects with hyponatremia suffered from seizures and brain edema. Conclusions: The incidence of postoperative hyponatremia in pediatric intensive care reached nearly 30%, and almost all of them received hypotonic fluid. Therefore, further research should be performed to evaluate the appropriate fluid in order to anticipating postoperative hyponatremia]

Abstrak :
Beban kerja mental perawat dipengaruhi oleh faktor internal dan eksternal perawat. Faktor internal meliputi karakteristik individu dan motivasi perawat, serta faktor eksternal yang meliputi organisasi dan pekerjaan perawat. Tujuan penelitian ini untuk mengidentifikasi faktor yang paling berhubungan dengan beban kerja mental perawat saat berinteraksi dalam asuhan keperawatan di ruang perawatan intensif. Penelitian ini merupakan penelitian kuantitatif dengan pengumpulan data menggunakan kuesioner dan pendekatan Cross Sectional. Analisis data menggunakan Chi-Square dan regresi logistik ganda. Pengambilan sampel dalam penelitian ini menggunakan total population sampling dan melibatkan sampel sebanyak 129 perawat pelaksana yang bekerja di ruang perawatan intensif. Hasil uji regresi logistik menunjukkan bahwa faktor motivasi merupakan variabel yang paling berpengaruh terhadap beban kerja mental perawat dibandingkan variabel lainnya p=0,022; ?=0,05. Rumah sakit dapat mengoptimalkan dan melakukan resosialisasi regulasi pemberian reward bagi perawat, serta membuat program pengembangan kompetensi dan soft skill perawat. ...... The mental workload of nurses is influenced by internal and external factors. Internal factor are nurse individual characteristic and motivation, also external factor such as organization and nurse task. The aim of this research is to identify the factors most closely related to the mental workload of nurses during interactions in nursing care in intensive care unit. This research is a quantitative research with data collection with questionnaire using Cross Sectional approach. Data analysis using Chi Square and multiple logistic regression. Sampling in this study used total population sampling and involved a sample of 129 implementing nurses working in the intensive care unit. The result of logistic regression test shows that motivation factor is the most influential variable to the mental workload of the nurse compared to other variables p 0,022 0,05 . Hospitals can optimize and resocialization regulation of reward for nurse, and make competence development program and soft skill of nurse.

Abstrak :
Pengukuran kinerja perawat dalam sistem layanan kesehatan merupakan hal yang tidak terpisahkan dalam upaya meningkatkan kualitas dan citra keperawatan. Ruang perawatan intensif sebagai bagian dari layanan kesehatan yang memiliki karakteristik ruang perawatan berbeda dengan unit lainnya, hingga saat ini belum memiliki instrumen untuk mengukur kinerja perawat pelaksana. Tujuan penelitian terwujudnya instrumen pengukuran kinerja perawat pelaksana ruang perawatan intensif rumah sakit di Indonesia. Penelitian menggunakan desain research and development, dengan jumlah responden sebanyak 722 perawat pelaksana yang ditentukan dengan teknik total sampling. Penilaian kinerja perawat pelaksana diperoleh melalui penilaian diri sendiri, atasan, dan sejawat. Hasil penelitian berdasarkan uji pakar didapatkan nilai Content Validity Index 0.78 untuk keterwakilan, dan 0.70 untuk kejelasan. Nilai validitas dan reliabilitas instrumen berdasarkan uji Alpha-Cronbach untuk penilaian diri sendiri antara 0.25-0.56, dengan reliabilitas 0.86, untuk penilaian pimpinan diperoleh nilai antara 0.73-0.93, dengan realibilitas 0.95, dan penilaian sejawat nilainya antara 0.52-0.83 dengan reliabilitas 0.97. Hasil uji Goodness of Fit menyatakan model fit dengan data, ditunjukkan dengan nilai RMSEA (≤005) untuk evaluasi diri 0.045, atasan 0.05, dan sejawat 0.075. Selanjutnya, hasil penghitungan koefisien loading factor untuk penilaian diri sendiri diperoleh 14 butir pernyataan valid (> 0.5), sedangkan atasan dan sejawat hanya 7 butir pernyataan yang valid. Hasil tersebut menunjukkan semua butir valid mengukur satu hal yang sama, yaitu kinerja perawat pelaksana. Simpulan penelitian bahwa instrumen yang telah dikembangkan dan diberi nama Instrumen WIDA (Work performance Instrument of intensive care nurses Direct Assessment) ini dapat digunakan untuk mengukur kinerja perawat pelaksana di ruang perawatan intensif rumah sakit. Rekomendasi ditujukan kepada Direktorat Keperawatan Kementrian Kesehatan, instrumen WIDA dapat digunakan sebagai alat pengukur kinerja perawat di ruang intensif berbagai rumah sakit di Indonesia. ......The assessment of nursing work performance in health care system may influence the improvement of quality and image of nursing working performance. Intensive care unit has specific service that differs from general and other unit in the hospital, and yet has not had a nursing work performance tool to measure their staff within the unit. The purpose of this study was to establish a Nursing Work Performance assessment tool in Intensive Care in Indonesia. This study used a research and development design, and 722 staff nurses were recruited as respondents using a total sampling method. The tool was developed for three types of assessment head nurse, peer & self evalution. Based on an expert review, it was found that. Content Validity Index score is 0.78 for representation, and 0.70 for clarity. The validity score Alpha- Cronbach) for self assessment between 0.25-0.56, and reliability of 0.86. The head nurse assessment had scores between 0.73-0.93, and the reliability of 0.95, whereas the peer assessment score between 0.52-0.83, and the reliability 0.97. The result of Goodness of Fit showed that RMSEA (≤0.05) for self assessment is 0.045, the head nurse assessment is 0.05, and the peer assessment is 0.075. Further,the result of loading factor for self assessment found 14 statement items are valid (> 0.5), whereas the head nurse and the peer assessment are only 7 statement items valid. Those valid items measure the same variable which is nursing work performance. Conclusion: this study had succeeded to establish a valid instrument to measure nursing work performance in intensive care which named as WIDA (Work performance Instrument of intensive care nurses Direct Assessment). A recomendation is directed to Directorate of Nursing at Ministry of Health Republic of Indonesia to utilize the instrument of WIDA as a tool to measure Nursing work performance in variety hospital in Indonesia.

Abstrak :
Prevalensi infeksi jamur sistemik (mikosis sistemik) dilaporkan semakin meningkat serta mengakibatkan morbiditas dan mortalitas tinggi, terutama pada pasien dengan gangguan sistem imun. Mikosis sistemik dapat disebabkan oleh jamur yang berada di lingkungan masyarakat maupun rumah sakit, termasuk ruang perawatan intensif (ICU). Pada umumnya jamur kontaminan tersebut masuk ke dalam tubuh pasien melalui saluran napas (inhalasi) maupun kontaminasi peralatan di lingkungan perawatan pasien. Penelitian ini bertujuan untuk mengetahui profil jamur yang diisolasi dari udara pada ruang perawatan intensif di beberapa rumah sakit di Jakarta. Penelitian ini merupakan bagian dari penelitian multisenter tentang aspergilosis invasif di ICU beberapa RS di Jakarta. Metode penelitian ini berdisain potong lintang dan pengambilan sampel dilakukan secara konsekutif pada ruang rawat intensif di empat RS. Sampel jamur diisolasi menggunakan cawan petri mengandung media agar saboraud dekstrosa yang dibiarkan terbuka selama 15 menit di ruang perawatan, selanjutnya dilakukan proses inkubasi dan identifikasi jamur di laboratorium mikologi untuk mengetahui profil jamur yang diisolasi dari ruang perawatan tersebut. Jamur yang berhasil diisolasi dari ruang perawatan intensif pada penelitian ini umumnya terdiri atas beberapa spesies, yaitu Aspergillus niger (42%), Aspergillus fumigatus (33%), Penicillium sp. (30%), Rhodotorulla (27%), Dematiaceae (24%), Mycelia sterilia (12%), dan Candida sp. (3%). Profil spesies jamur A. niger, A. fumigatus dan Dematiaceae ditemukan di empat rumah sakit, sedangkan Rhodotorulla dan Mycelia sterilia di temukan di tiga rumah sakit. Adapun Penicillium sp. dan Candida sp. hanya ditemukan di satu rumah sakit. Kesimpulannya, profil spesies jamur udara di ruang perawatan intensif pada penelitian ini terdiri atas Aspergillus niger (42%), Aspergillus fumigatus (33%), Penicillium sp. (30%), Rhodotorulla (27%), Dematiaceae (24%), Mycelia sterilia (12%), dan Candida sp. (3%). ......The prevalence of systemic fungal infection (systemic mycosis) is increasing, and cause high number of mortality and morbidity, especially for immunocopromised patients. Systemic mycosis can be cause by fungal species found in either community or hospital environment, including intensive care unit (ICU). Generally, this fungal contaminants infect the patient's body through the respiratory tract (inhalation) as well as contamination of equipment in patient's environment. This study aims to find out the profile of airborne fungal species that isolated from the air in intensive care unit at several hospitals in Jakarta. This study is part of a multicenter study on invasive aspergillosis in ICU at several hospitals in Jakarta. The cross-sectional study was conducted with consecutive samplings taken from ICU in four hospitals. The sample taken using petri dish containing dextrose saboraud agar that placed about 1m height and open to air for 15 minutes. Then, the process of incubation and fungal identification done in mycology laboratory to know the profile of airborne fungal species isolated from ICU. The fungal species that were isolated from the intensive care unit were consist of several species, which were Aspergillus niger (42%), Aspergillus fumigatus (33%), Penicillium sp. (30%), Rhodotorulla (27%), Dematiaceae (24%), Mycelia sterilia (12%), and Candida sp. (3%). The fungal species profile of A.niger, A.fumigatus and Dematiaceae were found in all four hospitals, while Rhodotorulla and Mycelia sterilia were found in three hospitals and Penicillium sp. and Candida sp. were only found in one hospital. In conclusion, the profile of airborne fungal species in intensive care unit in this study consisted of Aspergillus niger (42%), Aspergillus fumigatus (33%), Penicillium sp. (30%), Rhodotorulla (27%), Dematiaceae (24%), Mycelia sterilia (12%), and Candida sp. (3%).

Abstrak :
Ruangan perawatan intensif yang kompleks dan dilengkapi berbagai peralatan medis berbasis alarm berisiko menyebabkan perawat mengalami alarm fatigue akibat paparan alarm secara terus-menerus. Penelitian ini memberikan gambaran kejadian alarm fatigue berdasarkan karakteristik responden di ruang intensif RS X Jakarta. Penelitian ini merupakan penelitian kuantitatif dengan desain pendekatan cross- sectional. Sampel penelitian berjumlah 256 perawat dengan rentang usia ≤ 25 - ≥ 46 tahun di seluruh ruang perawatan intensif dewasa RSUPN Dr. Cipto Mangunkusumo. Sampel didapatkan dengan teknik total sampling jenis non random sampling. Penelitian ini menggunakan kuesioner yang telah diuji reliabilitas dengan nilai Cronbach Alpha 0,744. Hasil penelitian dianalisis menggunakan analisis statistik deskriptif dan dilakukan uji normalitas Kolmogorov-Smirnov dengan hasil p value 0,028 (P< 0,05). Pengkategorian dilakukan dengan cut-off poin, nilai median 44. Rekomendasi berkaitan dengan penelitian ini adalah dengan teridentifikasinya gambaran alarm fatigue berdasarkan karakteristik responden untuk selanjutnya dilakukan pelatihan manajemen alarm sebagai pembekalan kepada perawat. ......An intensive care unit that is complex and equipped with various alarm-based medical equipment is at risk of causing nurses to experience alarm fatigue due to continuous exposure to alarms. This study provides an overview of the incidence of alarm fatigue based on the characteristics of respondents in the intensive care unit of Hospital X Jakarta. This study is a quantitative study with a cross-sectional approach design. The study sample amounted to 256 nurses with an age range of ≤ 25 - ≥ 46 years in all adult intensive care units of Dr. Cipto Mangunkusumo Hospital. The sample was obtained using a total sampling technique of non-random sampling type. This study used a questionnaire that had been tested for reliability with a Cronbach Alpha value of 0.744. The results were analyzed using descriptive statistical analysis and the Kolmogorov-Smirnov normality test with a p-value of 0.028 (P < 0.05). Categorization was done with cut-off points, a median value of 44. Recommendations related to this study are the identification of a picture of alarm fatigue based on the characteristics of respondents for further alarm management training as a provision to nurses.

Abstrak :
Latar belakang: Pemeriksaan radiografi secara bedside sering dilakukan pada pasien non-transportable. Literatur dahulu menyatakan jarak 2 meter merupakan jarak yang aman, dimana radiasi sekunder teratenuasikan sesuai radiasi latar. Namun pada observasi dan studi didapatkan petugas medis cenderung meninggalkan ruangan, yang dapat mengganggu pelayanan pada pasien dan menyebabkan terhentinya prosedur yang sedang berjalan. Sejauh penelusuran data tidak ditemukan data yang mengukur dosis radiasi sekunder di ruang perawatan intensif, yang dilakukan pada jarak 2 meter di RSUPD Cipto Mangunkusumo maupun Indonesia. Metode: Penelitian ini menggunakan data primer berupa 42 radiografi toraks, dilakukan di ruang perawatan intensif (ICU) RSUPN Cipto Mangunkusumo pada bulan Juli 2019 hingga April 2021. Diperoleh juga data sekunder berupa jumlah pemeriksaan radiografi pada sistem Picture archiving and communication system (PACS) dengan lokasi di ruang perawatan intensif selama tahun 2017 hingga 2019. Hasil: Rerata dosis radiasi sekunder untuk pemeriksaan radiografi toraks pada jarak 2 meter di ICU adalah 0,323 (± 0,192) μSv, dengan estimasi radiasi sekunder kumulatif selama 3 tahun dalam rentang 0,40 – 0,44 mSv per tahun. Status gizi, kVp, mAs, dan ketebalan tubuh memiliki hubungan bermakna pada uji bivariat terhadap dosis radiasi sekunder (p < 0,05), dengan variabel akhir setelah uji multivariat adalah mAs (p < 0,001). Simpulan: Estimasi dosis radiasi sekunder kumulatif untuk petugas medis di ICU lebih kecil dibandingkan nilai batas dosis masyarakat umum. Faktor yang paling menentukan dosis radiasi sekunder pada jarak 2 meter adalah faktor eksposi yaitu mAs yang ditentukan oleh radiografer. ......Background: Bedside radiography often done to non-transportable patients. Previous studies has shown that 2 meter is a safe distance, at which secondary radiation would be attenuated to background level. Yet from observation and studies, medical personel tend to leave the room, which could disrupt care to patients and cause disturb ongoing procedure. Data tracing done by the researcher has shown no other study which measure secondary dose radiation in intensive care unit, at a distance of 2 meters, in RSUPN Cipto Mangunkusumo or Indonesia. Method: This study collected primary data of 42 chest radiograph, done in intensive care unit of RSUPN Cipto Mangunkusumo from July 2019 to April 2021. Secondary data was also collected in form of number or radiograph from Picture archiving and communication system with location of intensive care unit from year 2017 to 2019. Result: Mean secondary radiation dose for chest radiograph at a distance of 2 meters is 0,323 (± 0,192) μSv, with cumulative secondary radiation dose estimation of 3 years in range of 0,40 – 0,44 mSv per annum. Nutritional status, kVp, mAs, and chest thickness have statistically significant correlation in bivariate analysis to secondary radiation dose (p < 0,05), with final variable after multivariate analysis of mAs (p < 0,001). Conclusion: Cumulative secondary radiation dose for medical personel in ICU is less than dose limit for public exposure. The most significant variable to determine secondary radiation dose in 2 meters distance is exposure factor which is mAs that is determined by operator.