Kusman Ibrahim

Home-based Care: A Need Assessment of People Living With HIV Infection in Bandung, Indonesia

&NA; The increasing number of people living with HIV infection (PLWH) in Indonesia has led to an increased demand for care. Health care facilities are overburdened. Home‐based care (HBC) is a valuable strategy to complement existing health care services and to extend the continuum of care for PLWH and their families. This qualitative study explored the care needs of PLWH that might provide baseline data for developing HBC in Bandung, West Java, Indonesia. Data were collected from 12 key and 25 general participants through observations, interviews, and focus group discussions. Findings indicate that HBC is urgently needed for PLWH, particularly for those who need palliative care and those who encounter major barriers to using available health care services. It is recommended that health care providers and policy makers strengthen the role of the family in taking care of PLWH through trainings and knowledge dissemination.

Pengkajian Nyeri pada Pasien Kritis dengan Menggunakan Critical Pain Observation Tool(CPOT) di Intensive Care Unit(ICU)

Penggunaan alat ukur pengkajian nyeri yang sistematik dan terstandar pada pasien kritis yang tidak mampu untuk melaporkan rasa nyeri adalah suatu hal yang perlu diperhatikan. Behavioural pain scales(BPS) adalah alat ukur yang lebih dini dan banyak digunakan di area keperawatan kritis. Critical pain observation tools(CPOT) adalah alat yang dikembangkan menggunakan unsur-unsur rasa nyeri yang ada pada beberapa alat ukur pengkajian nyeri, termasuk BPS, namun CPOT belum banyak dikenal dan digunakan. Tujuan penelitian adalah melihat kesesuaian alat ukur CPOT dengan alat ukur BPS. Penelitian ini bersifat observasional analitik dengan rancangan Crosssectional dengan sampel pasien GICU (General Intensive Care Unit) dengan penurunan kesadaran dan menggunakan ventilasi mekanik sebanyak 48 pasien. Teknik pengambilan sampel dengan consecutive sampling. Pengkajian dilakukan dengan observasi skala nyeri menggunakan BPS dan CPOT pada saat pasien kondisi istirahat dan positioninguntuk melihat keandalan alat ukur nyeri. Hasil uji beda dan korelasi pada hasil pengukuran nyeri pada BPS dan CPOT adalah bermakna. Hal ini menunjukkan bahwa BPS dan CPOT dapat mengukur perbedaan intensitas nyeri saat istirahat dengan saat positioning. Hasil uji kesesuaian (kappa) pengukuran BPS dengan CPOT memiliki nilai kesesuaian yang bermakna, dengan nilai kesesuaian (kappa) BPS-CPOT pada kondisi istirahat sebesar 0,937, sedangkan nilai kesesuaian (Kappa)BPS-CPOT pada kondisi positioning sebesar 0,265. BPS dan CPOT adalah alat penilaian nyeri yang dapat digunakan dalam menilai rasa sakit dan meningkatkan manajemen nyeri pada pasien kritis. CPOT lebih mudah digunakan dan aplikatif karena memiliki definisi operasional yang jelas. Kata kunci : Behavioural pain scale, Critical pain observation tool, pasien kritis. Pain Assessment among Critically Ill Patients using the Critical Pain Observation Tool (CPOT) in the Intensive Care Unit Abstract A systematic and standardised tool to assess pain experienced by critically ill patients has been previously highlighted. The BPS is the common tool used in the intensive care setting which can be used. But, the Critical Pain Observation Tool (COPT) has not been used extensively in the hospital. Thus, the efficacy of this tool needs to be examined. This descriptive observational study aimed to find an agreement of CPOT with BPS using a cross-sectional method recruited 48 participants with consecutive sampling technique. Pain assessment was performed during a resting and positioning period to check the agreement of the tools. Data was analysed using Cohen’s Kappa index analysis. Findings demonstrated a significance difference of pain intensity measured by BPS and CPOT during the period of resting (κ = 0.937) and positioning (κ = 0.265). Thus, BPS and CPOT are reliable scales to measure pain intensity. It is expected that those tools can help nurses to improve pain management for critically ill patients. However, CPOT is considered more applicable and user-friendly compared to the BPS. Keywords: Behavioral Pain Scale, Critical Pain Observation Tool, critical nursing care

Pengaruh Foot Massage terhadap Parameter Hemodinamik Non Invasif pada Pasien di General Intensive Care Unit

Kondisi hemodinamik yang tidak stabil merupakan kondisi yang biasa terjadi pada pasien di General Intensive Care Unit (GICU). Hal ini dapat disebabkan karena stresor yang berasal dari aspek fisiologis, psikologis, maupun lingkungan. Saat ini terapi yang diberikan pada pasien di GICU didominasi oleh terapi farmakologi. Sementara berdasarkan teori keperawatan holistik, asuhan perawatan pada pasien dapat dioptimalkan dengan terapi komplementer seperti foot massage . Penelitian ini bertujuan untuk mengetahui pengaruh foot massage terhadap parameter hemodinamik non invasif pada pasien di ruang GICU RSUP Dr. Hasan Sadikin Bandung. Rancangan penelitian ini menggunakan quasi experimental design dengan pendekatan time series design . Jumlah sampel yang digunakan sebanyak 33 pasien dengan teknik consecutive sampling . Data penelitian dianalisis menggunakan uji Friedman dan dilanjutkan dengan analisis Post-Hoc . Hasil penelitian menunjukkan terdapat pengaruh foot massage secara signifikan terhadap penurunan MAP ( p <0,001), penurunan denyut jantung ( p =0,002), dan penurunan frekuensi pernafasan ( p <0,001); namun tidak terdapat pengaruh foot massage secara signifikan terhadap peningkatan saturasi oksigen ( p =0,150). Foot massage dapat menimbulkan aktivitas vasomotor di medula. Aktivitas vasomotor ini dapat menurunkan resistensi perifer dan merangsang saraf parasimpatis untuk menurunkan frekuensi jantung yang selanjutnya dapat meningkatkan curah jantung sehingga membuat pengiriman dan penggunaan oksigen oleh jaringan menjadi adekuat. Oleh karena itu, diharapkan perawat dapat melakukan praktik foot massage terhadap pasien untuk melengkapi terapi farmakologi yang sudah diberikan.

Health Seeking Behavior on Breast Cancer Therapies: Patients’ versus Providers’ Views

Background: Reviewing the system of health care services, the development of health services in a country, like Indonesia, is strongly influenced by the education system based on health sciences, such as medicine, nursing, public health. Then, the output produced by the education system will be implemented in the form of health care, both hospital and community based. Method: This qualitative study assessed the patterns of health behavior in seeking health cservices for treatment by the breast cancer patients, whether conventional, complementary, or traditional. This study assessed the different views, both from the health providers’ perspective and patients’s perspective. The subjects of the study involved the patients and health professionals coming from hospitals or directly in the community (community-based and hospital-based study) in West Java province. Results: Based on the thematic analysis, it obtained the pattern of health care services option from breast cancer patients’ point of view, as follows: (1) generally, the initial choices of health treatment were traditional and alternative therapies; (2) If it is not effective, then the conventional therapy was chosen; (3) furthermore, the conventional therapy was performed in parallel with the complementary and traditional therapies. On the other hand, majority of health professionals expressed: (1) the importance of only-conventional therapy, and only a small number of them supported the complementary therapy; (2) the expectation that one day, an effective and appropriate therapy can be found, with less side effects on the breast cancer patient, by combining the conventional and complementary therapy. Conclusion: In conclusion, despite some similarities, there are differences in the point of views between patients and health professionals regarding the pattern of seeking health care services of the breast cancer patients. In general, the patients tend to choose a therapy that is more comfortable to themselves, rather than making assessment on the conventional or complementary therapies. Meanwhile the health professionals consider the conventional therapy as the best and right choice for the breast cancer patients.