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31
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THE EFFECT OF ELDERLY EXERCISE TO COGNITIVE DIMENSIA ELDERLY FUNCTION IN “MAWAR”AGE CARE FACILITIES PSLU BLITAR
TULUNGAGUNG Prima Dewi Kusumawati
Institute Of Health Surya Mitra Husada Email:primastikesgmail.com
ABSTRACT
Elderly would decrease of nerve cells in the brain that would lead to dementia in the elderly. Effective ways that could be used by the elderly to decrease aging process. The
aim of this study was to determine the effect of Elderly exercise to cognitive dimensia elderly function in “Mawar” age care facilities PSLU Blitar Tulungagung.This study
design was quasi-experimental approach to One Group Pre Test - Post Test design. The population all dimensia elderly in “Mawar” age care facilities PSLU Blitar
Tulungagung totaling 15 respondents with a total sampling method obtained a sample of 15 respondents. Results of statistical test Paired Samples T-Test p value 0.027 to 0.027
value 0.05 can be concluded that the H0 is rejected, which means there was influence of
elderly exercise cognitive function in dimensia elderly function in “Mawar” age care facilities PSLU Blitar Tulungagung.Exercise elderly provides benefits that emotional
stress is reduced, the mind is more clear, the relationship between humans and the atmosphere is more relaxed and happy, language skills and memory increases, people
become more passionate, more creative and efficient, people feel more healthy because the stress is reduced.
Keywords: Exercise Elderly, Elderly Cognitive Function
INTRODUCTION The process of aging and being aging is
a natural process that everyone experiences Atum, 2008. Entering old
age means setbacks, such as physical deterioration characterized by sagging
skin, graying hair, beginning toothless, lessening clear hearing, getting eyesight
worse, being slow motion, and not having figure proportional Nugroho,
2008.
The elderly population in Indonesia in 2006 amounted to approximately 19
million 8.9 with a life expectancy of 66.2 years, in 2010 amounted to 23.9
million 9.77 with a life expectancy of 67.4 years and in 2020 is estimated at
28.8 million 11.43 with a life expectancy of 71.1 years the Central
Bureau of Statistics, 2010. The amount includes the fourth largest after China,
India and Japan the Central Bureau of
31 Statistics, 2010. In the Asia Pacific
region, the number of elderly people will increase rapidly from 410 million in
2007 to 733 million in 2025, and estimated to be 1.3 billion by 2050
Murwani, 2011.
The number of elderly people who are in dormitory of PSLU Blitar Tulungagung
around 77 inhabitants, whereas in Mawar dormitory of PSLU Blitar
Tulungagung, there were 14 people still in good health. Elder is an old person
because of his old age changes the biological, physical, psychological, and
social. This change will affect all aspects of life, including health. Therefore, the
health for the elders needs special attention while providing motivation for
the elderly people can live productively based on their abilities Health Act No.
36 of 2009 Article 138.
The increasing number of the elderly population will be able to provide a
problem - the problem of disease in the elderly. According to the Ministry of
Health in 1998, there was 7.2 of the population aged 60 years and older up to
cases of dementia. A total of 5 of old age 65-70 years suffers from dementia
and will double every 5 year reaching 45 at the age above 85 years
Nugroho, 2008. Dementia is a disorder of memory function that occurs slowly,
and can disrupt the performance and daily activities Atum, 2010.
Dementia is marked with disturbances of memorizing and learning something new
in short term, eloquence interference difficult to name objects and search for
words to speak, wrong about the place, time, person or object, difficult to count,
unable to plan, organize, make decisions and other things Sumijatun, 2005.
The results of a preliminary study conducted by researchers at Dormitory
of PLSU Blitar Tulungaggung are the number of elderly people 80 and the
number of elders in Mawar Dormitory is 15 people. The results of interviews of
15 elderly people in Mawar Dormitory of PSLU Blitar Tulungagung showed
that they often perceived in the dormitory and often forgetful when they
put something, it is easy to forget the names of fellow elders and often
confused when someone asks.
The way to improve cognitive function for the elders is a group therapy with
Reminiscene therapy is beneficial to maintain individual identity and also can
improve the cognitive function, because the elders will use his past to defend his
opinions and criticism Johnson, 2005. The other way to improve cognitive
function is Brain Gym or sports. It can also use exercise for the elders to inhibit
the aging process. Exercise for elders will not only facilitate the flow of blood
and oxygen to the brain, but also stimulate both sides of the brain to work
Tammase, 2009.
32 The purpose of this study is to determine
the influence of exercise for cognitive function from elderly people with
dementia in the Mawar Dormitory of PSLU Blitar Tulungagung.
MATERIAL AND METHOD
Research design Based on the research objectives, the
design of the study is quasi- experimental. The model used is the pre
and post-test without control.
Population and Sample Research The design of the study is quasi-
experimental design with pre and post test without control. Sampling technique
in this research is total sampling where all population can be sampled, and the
samples are elderly suffering from dementia amounts to 15 people.
Independent variables of this study are elderly exercise while the dependent
variable is the cognitive function in elderly dementia. And data analysis uses
Paired sample t-test.
RESULTS
1. Characteristics of respondents a. By age
Figure 1 shows almost all respondents are 60 -74 years 73
b. Based on Gender
Figure 2 shows most of the respondents are male 53
c. based education
Figure 3 shows that the majority of the respondents are no schooling 53
2. Characteristics of variables a. MMSE before being given elderly
exercise Dormitory of PSLU Blitar Tulungagung
based on the research results of cognitive value before being granted
elderly exercise the respondents with the highest cognitive value was as much as
seven respondents 47.
According Pudjiastuti 2003, that decrease of the cognitive function
ability due to morphological and biochemical, decreased brain weight
for the elders due to a reduced content of protein and fat in the brain
so that the brain becomes lighter. Axons, dendrites and nerve cell
bodies experience many changes; dendrites which serve as a means for
communication between nerve cells change to become thinner and lose
cell contact between nerve cells, nerve conductivity decreased so that
the movement becomes slow.
2. Cognitive Function after being given elderly exercise for
Elders with Dementia in the Mawar Dormitory of
PSLU Blitar Tulungagung The results of the study are after being
given elderly exercise for Elders with Dementia found that mild cognitive
score as many as 8 respondents 53.
Figure 4 shows that most of the respondents have moderate cognitive
function 47
b. MMSE after being given elderly gymnastics
Figure 5 shows that most respondents have mild cognitive functions 53
Discussion1. Cognitive Function for Elderly people with Dementia before
given elderly exercise the Mawar
33 There are several ways to cope with the
occurrence of dementia in the elderly, both pharmacological and non
pharmacological. In this study, we use non-pharmacological means by giving
for 15 minutes exerciser for the elders every day for 3 days. In addition,
researchers are consistent with the theory stated by an expert who
discovered the exercise movements for elders stating that therapeutic exercise
for elders conducted over 1 time a day within 15 minutes for 3 days, on a
regular basis can reduce the decline in cognitive function Denisson, 2009.
3. The effect of elderly exercise for the elders with Dementia on Cognitive
Function In the Mawar Dormitory of PSLU Blitar Tulungagung based on the
statistical test result with Paired sample
t-test p value 0.027 thus obtained 0.027 0.05 it can be concluded that the H0 is
rejected, which means that there is influence of elderly exercise with
cognitive function for the elders with dementia in the Mawar Dormitory of
PSLU Blitar Tulungagung. The results showed that elderly exercise for the
elders is significantly beneficial in improving the cognitive function of
elderly people with dementia proved by the meaningful score results in cognitive
function after being given elderly exercise.
Conclusion
1. It was found that before doing elderly exercise 15 mostly elderly respondents
have moderate cognitive functions are seven respondents 47.
2. It was found that after doing elderly exercise 15 respondents mostly elderly
people have mild cognitive functions i.e. 8 respondents 53.
3. Based on the research showed the value of .8667 and a pre-test to post-test
value of 1.4000 so that it could be seen The result of this study is expected to
provide objective information and feedback related to the handling of the
elderly people who have dementia to optimize cognitive function by elderly
exercise. For elderly people with dementia is expected to do elderly
exercise regularly.
3. For Researcher The result of this study is expected to
add the knowledge and experience for the researchers themselves in conducting
research on elders with dementia, especially in optimizing cognitive
function by elderly exercise.
4. For further research The result of this study is expected to be
used as a source of information in future research as well as other measures such
as cognitive therapy to optimize cognitive function for elderly people
with dementia.
Bibliography
Dahlan, Sopiyudin. 2008.
Statistika
an increase in cognitive function before
Untuk Kedokteran dan
and after treatment 5,333. Whereas the results of statistical test Paired Samples
Test using SPSS with = 0.05. P value
0.027 to 0.027 value 0.05 it can be concluded that the H0 is rejected, which
means that there is an influence of elderly exercise with cognitive function
for elderly people with dementia in the Mawar Dormitory of PSLU Blitar
Tulungagung.
Suggestion
1. For Respondents The result of research on elderly
exercise therapy is expected to be used for pre-seniors with dementia and to
prevent the occurrence of a more severe degree of dementia.
2. For Elder Dormitory of PSLU Blitar Tulungagung
34
Kesehatan
. Jakarta : Salemba Medika
Dennison, Paul E,. Gail E. Dennison. 2008.
Buku Panduan Lengkap Brain Gym
. Jakarta : Grasindo Depkes RI. 2008.
Pedoman Pembinaan Kesehatan Usia Lanjut Bagi
Petugas kesehatan
. Jakarta : Direktorat Pembinaan Kesehatan
Masyarakat. Hartati. 2010.
Clock Drawing : Asesmen Untuk Demensia
. Semarang : Fakultas Psikologi Universitas
Diponegoro. Jonhson, M.H,. 2005.
Developmental Cognitive Neuroscience
, Edisi 2. Oxford : Blacwell Publishing
35
36
SOCIAL INTERACTION EFFECT THE RECURRENCE OF CORONARY HEART DISEASE PATIENT IN POLI JANTUNG
RSUD Dr. MOHAMAD SALEH PROBOLINGGO Nia Sari
STIKes Surya Mitra Husada
ABSTRACT
The recurrence is a condition of the patient when arissing the same symptom which is like before dan makes the patient must nurse back. The condition arround or the
society that is full of stress with dietary habit that is not healthy can cause someone infected a heart attack. The purpose of this research is for analyze the effect of social
interaction on the recurrence of coronary heart disease patients. The kind of this research used quantitative approach with cross sectional design. The data is got by using a
questioner paper for social interaction and medical record for recurrence. The totality of
the samples that are taken in this research are 57 respondents By “Simple Random Sampling”. This research on February until Juni, 2015. From 57 respondent which is
researched, 71,93 of the respondents gets relapse and 28,07 of the respondents gets relapse over the last month. From 71,935 of the respondents who is relapse, 21,1 has a
bad social interaction.The test results of Logistic Regresion with α = 0,05 got the variable result which is influenced significant on recurrence is social interraction p=0,026. To
prevent the recurrence of coronary heart can be done by healthy social interaction in communities.
Key words : Coronary Heart, Social Interraction, Recurrence
35
INTRODUCTION Indonesia today has a double burden in
the face of disease problems. On one side of communicable diseases are still
high even tends to increase, on the other hand non-communicable diseases are
generally classified as degenerative disease began to increase. One of the
degenerative disease is the leading cause of death is coronary heart disease
CHD. The disease is generally caused by the behavior or unhealthy lifestyle
Notoatmodjo, 2011. Cardiovascular disease CVD is the
leading cause of death in many develop countries and looks for a rising trend as
a cause of death in many developing countries. Coronary heart disease CHD
is the cause of that need more in-depth attention to the developing countries.
Impact of economic progress, the rapid eradication of infectious diseases. As a
consequence, on the other hand CHD shifted into the main cause of death in
which previous infectious disease is the leading cause of death. High levels of
plasma total cholesterol, arterial heart disease CHD, 23.73 of primary
hypertension, 18.9 of heart failure, myocardial infarction 7.5 and there are
still some other heart disease. From the above results it can be concluded that
patients with coronary heart disease continues to grow each year, and CHD
is also the largest type of heart disease during 2014 in the Hospital Dr.
Mohamad Saleh Probolinggo.
MATERIALS AND METHODS RESEARCH
This study uses a quantitative approach, using cross sectional design. Social
interaction data obtained using a questionnaire. While the variable
dependentnya is recurrence outpatient coronary heart disease CHD. The
population in this study were all outpatients coronary heart disease
CHD in the heart poly Hospital Dr. Mohamad Saleh Probolinggo.
On average there are 66 patients a week which will be used as the study
population. Samples are taken as many
hypertension and smoking are three as 57 respondents,
with Simple major risk factor for CHD.
Random Sampling
technik. Data
Hipercholesterolemia occupies a very important position because
hipercholesterolemia is the only risk factor that can lead to the onset of
analysis using logistic regression.
RESULTS Characteristics of the subjects in this
artherosclerosis. Diet is related to
study include sex, age, education level hipercholesterolemia. Diet is one of the
main environmental factors causing coronary heart disease through blood
cholesterol. The scientific evidence in recent years shows the importance of the
role of social factors as determinants of the health status of non-communicable
and occupation. The description of the characteristics of variables as in table 1.
Table 1. Characteristics of Research Based on gender, age, education level
and occupation.
diseases, especially in this case cardiovascular disease Bulletin of
No 1
Karakteristik
Sex
N Health
Indonesia, 2012. Male
33 57,89
Based on data obtained from cardiac poly Hospital Dr. Mohamad Saleh
Probolinggo, it was found that each year the number of patients with heart disease
is increasing. The increase in the number of patients with heart disease from 2013
to 2014 increased from 8191 to 10.311 patients or 25.88. The percentages of
30.73 of heart disease is coronary 2.
3 Female
Age 50 th
≥50 th Education level
SD SMP
SMA PT
24 9
48 9
8 27
13 42,11
15,79 84,21
15,79 14,04
47,37 22,81
36
4 Occupation
Hospital Dr. Mohamad Saleh
5 6
7 Swasta
PNS Tdk bekerja
Social Interaction Good
Bad Smoking
Smoker No
Recurrence yes
never Total
14 12
31
44 13
3 54
41 16
57 24,56
21,05 54,39
77,19 22,81
5,26 94,74
71,93 28,07
100 Probolinggo showed that of the 57
respondents surveyed, 13 respondents 22.81 had a poor social interaction,
and 44 respondents 77.19 have a good social interaction. Of the 13
respondents who have poor social interaction, the average of them is a man
who does not work and aged over 50 years. Social interaction is said to be bad
because most of them are rarely interact or cooperate with groups in the
community such as for example, Posyandu elderly, spiritual groups,
group gathering and so forth. So that Based on Table 1 it can be seen that the
majority of respondents are male as many as 33 people 57.89, aged more
than 50 years as many as 48 people 84.21 and have a high school
education level as many as 27 people 47 , 37, most respondents do not
work as many as 31 people 54.39, the majority of respondents have a good
interaction as many as 44 people 77.1, there are three 5.26 of
respondents who have smoking as many as three people, as many as 41
respondents 71.93 experienced a recurrence.
they are the elderly tend to be aloof and less interaction with groups in the
community, so the majority, or 10 of 13 respondents poor social interaction, they
tend to experience stress. According Soekanto 2006, social
interaction is the key to all social life. In the absence of communication or
interaction between each other then there may be a life together. If only the
physical line of sight between each other, can not produce a form of social
groups can interact. And the age factor also affects the elderly lazy to interact
and cooperate with social groups because they feel he is old, their ability
Table 2. Results of the logistic
to interact with and adapt to already not regression analysis
optimal due to the aging process.
Variabel
Social Interaction
Sig.
0,026 OR
3,576 Recurrence Outpatient Coronary Heart
Disease in Space Poly Heart Hospital Dr. Mohamad Saleh Probolinggo
P value of social interaction = 0.026 α
= 0.05, which means that H0 is rejected. Recurrence is a condition in which the
patients symptoms are the same as Results of logistic regression test
before and the resulting patient should showed no significant influence of social
interaction with the patient relapse. And the value of OR = 3.576, which means,
the worse the social interaction of a patient then the person is more likely to
relapse 3 times greater compared with patients who have good social
interaction.
DISCUSSION Social interaction outpatient coronary
heart disease CHD in the heart poly
37 be nursed back Andrew, 2008. Family
with full of stress can trigger a heart attack. In people who are susceptible to
heart disease in need of attention and recognition of risk factors that exist in
people and that immediate action can be taken against these patients in a short
time in order to avoid complications that can bring unintended consequences.
According to Niven, in 2005 the factors that influence relapse is noncompliance,
depression, behavioral patterns, and the individuals themselves.
Based on the results of a study of outpatient coronary heart disease CHD
in the heart poly Hospital Dr. Mohamad Saleh Probolinggo found that of 57
respondents surveyed, as many as 41 people 71.93 experienced a relapse
and 16 did not have a relapse or 28.07. From the results of cross tabulation
between respondent characteristics with recurrence as many as 23 respondents
40.4 who experienced a relapse-sex male, 33 respondents 57.9 who
experienced recurrence over 50 years, 14 respondents 24, 6 who
experienced a relapse are college graduates and 24.6 of high school
graduates, and as many as 22 respondents 38.6 who did not work
also experienced a relapse. Conclusion
1. Social interactions in outpatients coronary heart disease CHD in the
Hospital Dr. Mohamad Saleh Probolinggo showed that 13 respondents
22.81 had a poor social interaction, and 44 respondents 77.19 have a
good social interaction. 2. Results of statistical test by using
logistic regression showed no significant influence of social interaction with the
patient relapse. Suggestion
1. Patient and Family Outpatient CHD a. Outpatient coronary heart disease
should have to further enhance friendly relations with their peers.
b. For families of patients should continue to provide support and keep
control of the activities conducted in order to maintain the health of the
patient. 2. For Hospital Dr. Mohamad Saleh
Probolinggo Can be added to the program of
relaxation for people with coronary heart disease, such as the holding of yoga to
reduce stress levels and maintain the health of CHD patients.
3. For Educational Institutions Once this study is expected to further
research to follow up on other factors that influence relapse patients with
coronary heart disease.
38 4. For researchers Coming
Once this study is expected to further research in order to pay more attention
to the frequency of recurrence of CHD patients.
REFERENCES Albery I.P dan Munafo, M.
2011.
Psikologi Kesehatan Panduan Lengkap dan
Komprehensif Bagi Studi Psikologi
Kesehatan
.Yogyakarta : Palmall Arikunto, Suharsimi. 2010.
Prosedur Penelitian suatu Pendekatan
Praktik
. Jakarta : Rineka Cipta Feldman, Robert S. 2012.
Pengantar Psikologi Understanding
Psychology.
Jakarta : Salemba Humanika.
Hidayat, Alimul. 2011.
Riset Keperawatan dan Penulisan
Ilmiah
.Jakarta : EGC Kabo, Peter. 2008.
Mengungkap Pengobatan Penyakit Jantung
Koroner
. Jakarta : Gramedia Pustaka Utama
Niven, Neil. 2005.
Psikologi Kesehatan Pengantar untuk Perawat
Profesional Kesehatan Lain
. Jakarta : EGC
Notoatmodjo, Soekidjo.2011.
Kesehatan Masyarakat Ilmu Seni
. Jakarta : Rineka Cipta.
Ridwan, Muhamad. 2009.
Mengenal, Mencegah, Mengatasi Silent
Killer Jantung Koroner
. Semarang : Pustaka Widyamara.
Sugiyono. 2013.
Metode Penelitian Kuantitatif Kualitatif dan R
D
. Bandung : Alfabeta Supriyono, Mamat.2008.
Faktor-Faktor Resiko yang Berpengaruh
terhadap Kejadian Penyakit Jantung Koroner pada
Kelompok Usia 45 Tahun
. Tesis.Semarang : Universitas
Diponegoro, 13-34 Soekanto, Soerjono. 2006.
Sosiologi Suatu Pengantar
. Jakarta : Raja Grafindo Persada.
Wilkinson, Greg. 2005.
Stres
.Jakarta : Dian Rakyat
39
THE EFFECT OF PHASE I CARDIAC REHABILITATION ON ACTIVITY TOLERANCE
OF PATIENTS WITH CORONARY HEART DISEASE Sutrisno
STIKES Surya Mitra Husada Kediri Email :sutrisno250214gmail.com
ABSTRACT
Phase I cardiac rehabilitation program is one of the efforts to achieve a functional level that allows patients to perform their own activity early in preparation to carry out daily
activities at home and yet, to prevent unfavorable effects of prolonged bed rest. This program needs to be implemented as soon as possible in patients who have stable
hemodynamics since in ICUICCU until the time to discharge from the hospital. The purpose of this study was to identify the effect of phase I cardiac rehabilitation toward
activity tolerance in patients with Coronary Heart Disease. The design of the research was a quasi experiment design with post test only non-equivalent control group. The sample
was 24 respondents. The measurement tools used the Barthel index, six-minute walking test, digital sphygmomanometer and digital oxymeter. The results showed that there is a
significant difference in the ability to perform ADL p value=0.004, but there is no significant difference in systolic blood pressure p value=0.875, diastolic blood pressure
p value=0.179, SpO
2
p value=0.920, pulse p value=0.428, and the maximal VO
2
p value=0.220 between the intervention and control groups after being given the phase I
cardiac rehabilitation. Further, the ability to perform activities ADL of respondents in the intervention group is significantly higher than the control group and the maximal VO
2
values of the intervention group shows a better value than respondents in the control group. It can be concluded that phase I cardiac rehabilitation exercise have an effect on
the tolerance activity in patients with CHD. Therefore, nurses as part of a cardiac rehabilitation program team are expected to assist patients in improving their adaptability
on tolerance activity.
Keywords: phase I cardiac rehabilitation, tolerance activity, coronary heart diseases CHD
recognized to have the largest proportion causes of death
INTRODUCTION Coronary heart disease is a disorder of
the coronary arteries due to a block or plaque of atherosclerosis. The term
atherosclerosis comes from the Greek meaning intima thickening of the
arteries sclerosis, thickening, and cardiovascular diseases 48, followed
by cancer 21, and chronic respiratory diseases 12.
Coronary heart disease is causing the reduced amount of oxygen needed by
accumulation of lipids athere, pasta the myocardium.
If the oxygen which characterizes the typical lesions
Lewis, Dirksen, Heitkemper, Bucher, and Camera, 2011. WHO statistics
2012 describes the global mortality estimate of 57 million in 2008, 36
million 63 are caused by non- communicable diseases. Risk factors for
non-communicable diseases that are
39 requirement is not met according to the
needs, it will cause myocardial ischemia. Conditions such as this will
reduce cardiac contraction and movement disorder if persistent occur
which eventually causes hemodynamic changes of the body. Furthermore, the
left ventricular function will decrease
and may reduce cardiac output with reduced stroke volume the amount of
Improve Physical Functioning in Refractory Angina: A Pilot Study. The
blood ejected each time the heart beats. results showed
that after cardiac One result of the decreased cardiac
output or low perfusion and decreased peripheral blood flow causes weakness
fatigue in patients Anderson McCarty, 2005.
rehabilitation, patients showed an increase in physical abilities compared
with patients in the control group the level of achievement Progressive Shuttle
Walk p value = 0.005 and the total
distance p value = 0.015. Weak conditions in patients with
coronary heart disease requires the patient should reduce physical activity
with complete bed rest to reduce the hearts work and the need for oxygen in
the body. Bed rest is given to patients with coronary heart disease because of
weakness or fatigue caused by the prognosis of the disease. However, total
bed rest can increase the activity intolerance in patients. The impact that
occurs when the patient does not do early mobilization or physical activity
gradually cause bad effects to the physical condition of the body. This is in
line with research conducted by Dolansky et al 2010 which says that a
physical disability due to heart disease occur because of decreased aerobic
capacity and threshold tolerance to perform physical functions.
Management to overcome the negative effect caused by coronary heart disease
and to prevent the re-admission of patients to the hospital with the same
Research on cardiac rehabilitation phase 1 has also been carried out in Indonesia
by I Made Mertha 2010 with the title
PengaruhLatihanAktifitasRehabilitasiJa ntungFase I TerhadapEfikasiDiri Dan
KecemasanPasienPenyakitJantungKoro ner Di RsupSanglah Denpasar
with the results of data analysis showed that there
is a significant influence of exercise activities to increase self-efficacy p
value = 0.001, and to decrease anxiety respondents p value = 0.001 after the
exercise intervention activities. Phenomenon above shows the immense
possibilities for patients with coronary heart disease activity intolerance, but
because the disease process is also due to the effects of totall bed rest or not
carried out his early mobilization after patients got hemodynamically stable
condition. Research on the effect of cardiac rehabilitation phase I to increase
activity tolerance in patients with CHD has not been widely described in the
nursing research in Indonesia. Therefore
complaint, the cardiac rehabilitation this
research was conducted
to program can be administered to patients
ranging from hospitalization to long- term maintenance program outpatient.
According to The National Hearth Foundation of Australia 2004, cardiac
rehabilitation are all measures that are determine “The Effect of Phase I
Cardiac Rehabilitation on Activity Tolerance of patients with Coronary
Heart Disease”.
METHOD
used to help people who suffer from The
research design
was quasi-
heart disease reactive, achieving life satisfaction and prevent a recurrence of
heart disease. experimental research design with post-
test-only non-equivalent control group. The number of samples in thisresearch
as many as 24 respondents, the
Other studies of cardiac rehabilitation program in patients with coronary heart
disease are also carried by Asbury, Elizabeth Webb, Probert, Wright,
Barbir, Fox, Collins, 2012 with the title of Cardiac Rehabilitation to
40 respondents were divided into two
intervention and control. The inclusion criteria respondents, namely 1 Patients
with a diagnosis of CHD were treated in the ICCU was continued in a regular
patient room. 2 Willing to be a
responder. 3 Patients are invited smooth communication. While
exclusion criteria: 1 Angina that continuesuncontrolled, 2 heart block
degree two or three, 3 Patients CHD haemodynamic not stable systolic 200
mmHg, diastolic 110 mmHg, tachycardiaHR 130xmnt,
hypotension, 4 the ventricular or atrial Sistolik
Diastolik Frekuensinadi
SpO
2
Intervensi Kontrol
Intervensi Kontrol
Intervensi Kontrol
Intervensi Kontrol
116.82 117,53
76.86 81,94
84.79 81,66
97,5 97,5
10.88 11,14
9.09 8,84
10.69 8,18
0,89 0,44
arrhythmias are severe, 5 Patients with coronary heart disease with
complications such as arrhythmias, congestive heart failure CHF
Tabel 1.2 Distribution of respondents by VO2 max and
ADL on the sixth day n1 = n2 = 12
functional class III-IV, 6 Patients with CHD muskulosketal system problems.
Analysis of the data used is the analysis of univariate and bivariate. The
statistical test used for bivariate analysis
Variabel
VO
2
ADL
Kelompok
Intervensi Kontrol
Intervensi Kontrol
Mean
19.14 16.86
97.08 87.50
SD 5.20
3.43 5.42
7.54
is independent t test test for normal numerical variables and test Mann
Whitney test for numerical variables are not normal Hastono, 2001.
Result Characteristics of respondents or
confounding variables in this study obtained. On this research, the mean age
of the respondents is at 55.29 years, with the majority of the male sex 18 75.
History of smoking among respondents obtained more than half of the
respondents do not smoke are 14 58.33 of respondents, and in this
study the majority of respondents have a body mass index of obesity as many as
17 70.8 of respondents. In the bivariate analysis showed that the
values obtained are not significant p value 0.05 from the average variable
pulse rate, systolic blood pressure, diastolic blood pressure and SpO2 after
intervention for five days in both the respondents both intervention and
control, it is showed no significant difference between the two groups. On
the sixth day ADL measurement values obtained are significant p value =
0.004, which says there is a significant difference between the intervention
group and the group. While the variable VO2 max no significant difference p
value = 0.22 between the intervention and control respondents.
Characteristic variable pulse systolic blood pressure, diastolic
pressure, SpO2, VO2 max, and data can be seen in Table 1.1 and
1.2 rate,
blood ADL
Table
Discussion Effect of cardiac rehabilitation phase
I of the systolic blood pressure, diastolic blood pressure, pulse rate
and SpO2 responder after intervention.
Tabel 1.1 Distribution characteristics of respondents
based on the average of the mean pulse frequency of blood pressure systolic and
diastolic and mean SpO2 post intervention and control interventions
respondents n1 = n2 = 12 Variabel Kelompok Mean SD
41 Results of this research showed a mean
systolic blood pressure intervention respondents less than control
respondent, it is possible to intervention respondents have started a process of
adaptation to the condition of the body because it has given physical activity
exercises for five days. So that
hemodynamic conditions began to In this research, the mean diastolic
change when the body perform physical blood pressure values
in control activity. Physical exercise regularly and
respondents is higher than intervention continuously will cause the bodys
respondents. It is possible the
adaptive changes. This is consistent with research that studies conducted Stem
Cleary 1982 that regular exercise will lower systolic blood pressure. This
research is in line with the literature that suggests that exercise regularly and
continuously can provide chronic effects on the body as a decrease in systolic
blood pressure through the process of spending Nitrite oksit a potent
bronchodilator after four weeks of exercise Gormley Hussey, 2005.
intervention of respondents have started a process of adaptation to the condition
of the body because it has given physical activity exercises for five days.
As in systolic blood pressure response. Based on the theory of physical activity
exercises if done continuously, the heart muscle and skeletal muscle will
experience an increase in employment adaptation to chronic namely
hypertrophy. Enlargement of muscle mass from the normal state can be
between 300 g and 500 g Huonker et al,
result analysis found there is no
1996. This can lead to end-diastolic significant difference in mean systolic
post intervention in the intervention and control. It showed no difference in the
average value of systolic blood pressure was statistically the second respondent.
The maximum value of systolic blood pressure in the intervention respondents
in the amount of 137.02 mmHg, indicating increase in systolic pressure
value is not shown in conditions that endanger the health of the respondent or
still within the tolerance limits of the body. It can be said that the cardiac
rehabilitation phase I does not cause harmful effects if done in accordance
with procedures and strict supervision.
Based on the theory advanced by Gormley Hussey 2005 acute effect
of physical activity was immediate activation of the sympathetic nerves in
the heart and blood vessels can release adrenaline in the blood circulation of the
adrenal medulla. One of these effects that cause vasoconstriction of blood
vessels. Body compensated to accelerate the flow of blood in the body as a result
of physical activity also increases the heart rate so it needs a large preload as
compensation of increased heart rate. Vasoconstriction necessary for blood
flow to be fast to meet the needs of large preload so after load also must be
increased.
42 volume will increase, and it will also
stoke volume increase heart. So the diastolic blood pressure will decrease.
Research conducted Spartaro 1991 also reported a decrease in systolic 8and
diastolic 5 respondents who frequently perform regular physical activity. It is
possible to occur in the intervention group who had suffered during the given
intervention adaptation exercise physical activity.
The analysis results obtained p value not significant that the average diastolic post
intervention in the intervention and control. It showed no statistically
significant difference in mean diastolic blood pressure in both groups.
Respondents were given a five-day intervention during physical activity and
exercise interventions show the value of the increase in diastolic blood pressure
after the intervention. The maximum value of diastolic blood pressure in the
intervention respondents were given a physical exercise-based interventions
obtained by 76.86 mmHg. This value indicates no increase is so large and
endanger the health condition of respondents coronary heart disease.
Increasing the value of diastolic blood pressure in intervention respondents
during the given intervention is in line with the theory advanced by Gormley
Hussey 2005 that during the
movement of the body or physical activity then it will be activated the
sympathetic nerves in the body that lead the left atrium, predicted as the cause of
the appearance of atrial fibrillation during cardiac rehabilitation.
to increase contraktility
heart and accelerate the work of fibers Purkinje
that serves to accelerate emptying the contents of the heart volume. This
causes an increase in diastolic blood pressure in the body.
The analysis results obtained p value not significant mean pulse rate post
intervention in the intervention and control. It showed no statistical
difference in the average value of the pulse frequency of respondents
intervention and control after the Exercise physical activity on a regular
basis will provide a great benefit to the body of the adaptation process occurs
both at the heart organ and the blood vessels in the body. This is consistent
with the theory put forward by Kusuma 2003 which says that physical activity
exercise increases the blood flow is pulsatile increase the production of
nitric oxide NO which parallel increase production of EDRF
endothelial relaxing factor derive. Coronary blood flow at rest about 200
intervention. In this reseach, the
ml min 4 of total cardiac output frequency of the pulse values obtained
after exercise increased physical activity among respondents intervention. The
increase in the pulse frequency of the respondents intervention is the result of
several mechanisms in the body due to the movement of the body or as a result
of physical exercise. When the physical exercise increased sympathetic
stimulation of the heart organ that affects the hearts electrical system,
increased to 350 ml min increase of 150 ml min while moderate weight
training. If the heart rate increases to 10 times only, the coronary blood flow
increased to 224 ml min, which means an increase of 24 ml min and already
exceeds 4 ml min, as a condition of increased production of nitric oxide.
Moderate physical activity exercise or walking will increase the heart rate to
110 beats per minute, an increase of 40
especially the SA node therefore
times seadainya resting heart rate of 70 increasing heart ratepulse Gormley
Hussey, 2005. This effect can be seen when the body physical activity are
irregular or can be said is the acute effects of physical activity on the body.
The increase in the pulse rate that exceeds the maximum limit should
feared the presence of an electrical disorders on the heart and can threaten
death to the respondent. This will lead to atrial fibrillation according to research
conducted by Giaccardi et al, 2011 which said that the incidence of atrial
beats per minute. Research in the laboratory showed that the increased
flow of 4 ml min was able to produce nitric oxide, which means it is sufficient
to stimulate the improvement of vascular endothelial function
Takahashi, 1997. Nitric oxide NO is a potent vasodilator that is located in the
intima layer endothelium of the arteries where the compound is very
important for blood vessels to reduce the risk of atherosclerosis.
Results of the analysis we found no fibrillation was significantly high
significant values mean oxygen
number of patients who follow a cardiac saturation post intervention
in the rehabilitation program that is sorely
lacking in exercise intensity physical activity compared with that follows
program of physical exercise with moderate intensity. This is due to the
large volume of the left atrium and the intervention and control. It showed no
significant difference in the average value of the oxygen saturation in both
groups post intervention. In this study found an increase in oxygen saturation
after cardiac rehabilitation interventions
low effort emptyvalumepemompoaan to
43 conducted
in the respondents
intervention. It is very useful to respondents to assist in accelerating the
healing process of the disease.
Based on the literature says the Based on the literature it is said that
there is one example of respiration also plays a role in increasing the working
capacity of the body is the breathing exercise prescription for patients with
existence of some mechanism of post-operative
cardiac surgery. changes in the respiratory system during
a physical activity on the body: 1 The dilution air in the dead-space lungs
during inspiration as a result of the increased pressure of pulmonary
alveolar PO2, causing vasodilation of the pulmonary arteries that are activated
by the receptor Blood vessels are hypoxic. 2 increase in thoracic volume
during the development of lung parenchyma during inspiration. 3 an
increase in cardiac filling the right side along with an increase in the
exploitation of moments of inspiration, this means an increase in venous return
and that will increase the ejection volume of the right ventricle and
pulmonary systolic pressure. With this change, the efficiency of ventilation and
perfusion of the body tissue will be balanced Gormley Hussey, 2005.
This led to the intervention of Peripheral to tolerate the practice of
physical activity, many patients require special breathing while working, which
could increase lung volume and gas exchange capacity and, consequently
improve the distribution and capture systemic oxygen and increase exercise
tolerance McKirnanFroelicher, 1993.
Effect of Cardiac Rehabilitation Phase I Against Capability ADL and
VO2 max Respondents.
Results of bivariate analysis of the ability to perform activities of daily
living ADL in the intervention group and the control group showed a
significant difference. In this study, the intervention group get exercise physical
activity gradually in accordance with the capacity and condition of the
respondents, while the control group
respondents experiencing respiratory without exercise just given bed rest
system of compensation which improves the functional capacity of the lungs can
eventually increase the maximum working Traffic from the body.
In this research, interventionrespondents always increase even improvement of
the respiratory system, while at the controls of the respondents there were
some respondents who sometimes experience down the value of saturation.
On the intervention of the respondents only one of the respondents who
experienced a decrease in oxygen saturation, whereas the control of the
respondents there were eight respondents who experienced
deterioration in oxygen saturation. It is possible the intervention of respondents
functional capacity of the lungs had increased as a result of the intervention
given the exercise of physical activity compared to control respondent.
44 alone. So it can be said that the exercise-
based cardiac rehabilitation that physical activity can stimulate the adaptation and
improvement of exercise tolerance capability in the intervention group
compared with the control group.
Based on the first congress of cardiac rehabilitation in Hamburg in 1977,
insists that the need for early mobilization in patients with heart
disease Balady, Fletcher, Froelicher et al, 1994. Phase I is the effort to be done
while the patient is still being treated, the main purpose of this phase is to
reduce or eliminate the adverse effects of the condition due to total bed rest, to
educate early and that the patient is able to perform daily activities independently
and safely Basuni et al, 2009. Another theory says that one of the objectives of
rehabilitation of cardiac rehabilitation phase I that patients can perform self-
care and activities of daily life ADL
and domestic work except for up and down stairs Garrison, 2001.
This study ADL ability intervention group obtained only three respondents
who have a value below 100, it indicates that the Barthel index on respondent
intervention is better than the control respondents were only two respondents
who had ADL value of 100. The results are also consistent with research
conducted by Weberg et al 2013 which says that a significantly increased
function and physical role, increased ability and endurance to pain on the
effects of cardiac rehabilitation phase I, and the disclosure directly from the
respondents experienced an increase in physical and mental after following
cardiac rehabilitation Phase I. Improved physical function and role, increased
ability and endurance to pain due to a cardiac rehabilitation phase I also found
in a study conducted by Hsu et al 2011 the research done on post-CABG
patients and organ transplants.
Another study said the effect of exercise physical activity on improving exercise
tolerance was also carried out by Marzolini et al 2008 who showed that
a combination of aerobic exercise and resistance cause changes more evident
in physiological adaptations such as muscle strength and endurance, and
body composition compared to aerobic exercise alone in patients with coronary
artery disease. Physical exercise-based cardiac rehabilitation also reduces
overall mortality cardiovascular disease mortality [RR 0.87 95 CI
0.75, 0.99 and 0.74 95 CI 0.63, Physical activity everyday is useful not
just to get a healthy body condition but also beneficial to mental health,
entertainment in preventing stress.
Results of bivariate analysis were not significant values between maximal
oxygen uptake VO2 max in the intervention group and the control. It
showed no significant difference VO2 maximum value of both respondents
statistically. At respondents intervention lowest value of VO2 max respondents,
11.15 ml kg min, which means all respondents have been able to meet the
target of cardiac rehabilitation phase I 3 MET = 10.5 ml kg min, but the
respondent control limits bottom of VO2 max is nothing less than the expected
target of Phase I of 10:34 ml kg min.
Physical activity the body will consume the oxygen that will be used as fuel in
energy production. Ones ability to consume oxygen during physical
activity to the formation of energy, until it reaches the maximum value without
being able to go up again though with the addition of the intensity of the
exercise known as VO2 Max Astorin, 2000.
The gold standard to measure cardiovascular fitness is maximal
oxygen consumption VO2 max. it is defined maximal oxygen consumption
as a measure of exercise are achieved by an individual, who at that point of
fatigue or symptoms that arise prevent such individuals to exercise more
Garrison, 2001. This is in line with research Belardinelli 1999 who said
0.87, respectively -masing],
and that clearly defined, measured by
hospitalizations [RR 0.69 95 CI 0.51, exercise tolerance
and oxygen 0.93] in the short term 12 months of
follow-up. Cardiac rehabilitation does not reduce the total risk of MI, CABG or
PTCA Strange, 2011. Numerous studies have also shown that aerobic
training increases muscle strength and exercise tolerance in patients after open-
consumption as well as a good predictor of prognosis in patients with
cardiovascular disease.
Based on the theory advanced by Guyton 2007 not only the respiratory
system are instrumental in determining a heart
surgery and patients with
persons VO2 maximum, but there are MiocardInfark Ueshima et al, 2005.
45 four
systems that determine the
maximum VO2 is the respiratory The results also show the benefits of
system, cardiovascular, biochemical exercise-based cardiac rehabilitation
oxygen transport and network systems. The fourth system is interrelated to one
another, so that when the respiratory system is in good condition but there are
one or more of the three other systems in the state is not good then it can affect
the value of a persons VO2 maximum. While the value of a persons VO2
maximum is also determined by a persons posture, between the one and
the other will certainly be different if say both equally healthy but have a
different body portur. This is in line with research conducted by Nury 2011
which says that the main determinant of the cycle runs in addition to height is leg
length measurements when the maximum VO2.
This study shows the difference between the value of the maximum VO2
intervention and control groups was not so great can be seen from the average of
the two groups is 19.14 ml kg min and 16.87 ml kg min. From this it was
found that the mean maximal VO2 values greater intervention group than
the control group. Value of maximal VO2 could be improved on a person,
with increasing VO2 maximum, it can be said the maximum working ability of
the body to be achieved. This is according to research conducted by
Ueshima et al 2004 peak VO2 increased by less than 25 after
exercising, especially in patients who have undergone heart valve surgery.
This research can provide input that cardiac rehabilitation program that is
most important is when Phase I, which in this phase requires the mobilization of
patients as early as possible to reduce the undesirable effects of bedrest old
thrombophlebitis, hypotension orthosatik, muscle atrophy, etc. etc. and
knowledge about the disease in order to return later after there is a change of
behavior in the control of risk factors that may lead to heart disease occur so
do not get heart disease later in life.
46 phase I of physical activity that can be
done by a nurse if a physiotherapist human resource is not in the hospital.
Phase I cardiac rehabilitation nursing in the world can be said to help the patient
in the process of adapting to be able to perform daily activities independently,
improve the tolerance of the patients activity.
CONCLUSION On this study, the mean age of the
respondents is at 55.29 years, with the majority of the male sex 18 75.
History of smoking among respondents obtained more than half of the
respondents do not smoke are 14 58.33 of respondents, and in this
study the majority of respondents have a body mass index of obesity as many as
17 70.8 of respondents. The mean systolic blood pressure of
both groups showed similar values and within normal limits. Mean diastolic
blood pressure in the control group was slightly higher than in the intervention
group and both were within normal limits. The mean frequency of the pulse
after the intervention in the intervention group was slightly higher than in the
control group and both were within normal limits. The mean SpO2 after the
intervention in both groups of equal value.The mean maximal VO2 greater
intervention group than in the control group.The mean ADL higher
intervention group than in the control group.
It was found no significant difference between the systolic blood pressure,
diastolic blood pressure, pulse rate, and oxygen saturation after the intervention
in the intervention and control. There are significant differences ability
to perform ADLs between intervention and control groups on the sixth day. But
there was no significant difference between the value of the maximum VO2
intervention and control groups on the sixth day.
This research requires a socialization statement for health care
programs the Phase I cardiac
professionals from aha. rehabilitation program based physical
activity practice, to accelerate the healing process in patients that could
reduce the lenght of stay LOS patients. And the need for nurses to give an
Circulation; 90;1602-1610. Basuni, Radi; Andang, H. Joesoef;
Dede, Kusmana.2009. RehabilitasiKardiovaskular Di
Indonesia.J KardiolIndones. evaluation of the
action exercise 30:43-5. ISSN 01263773.
physical activity is given to know the development of tolerance to the patients
physical activity. The need to develop therapeutic
modalities nursing to overcome the problems associated with the physical
activity of the patients therapy, which can be applied in providing training
physical activity in patients requiring early mobilization during
hospitalization. And disseminate information about the importance of
mobilization as early as possible after Belardinelli, R; Georgiou, D; Cianci, G;
Purcaro, A. 1999. Randomized, controlled trial of long-term
moderate exercise training in chronic heart failure: effects on
functional capacity, quality of life, and clinical outcome.
Circulation; 99:1173-82.
Dolansky, M.A., Xu, F., Zullo, M., Shishehbor, M., Moore, S.M.,
Rimm, A.A. 2010. Post-Acute Care Services Received by Older
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Garrison, Susan. 2001.
Dasar-
This research can be a reference to conduct further research that can
improve understanding and knowledge of the cardiac rehabilitation program,
especially the phase I. Maybe it could be done further research to determine the
relationship of drugs and laboratory values hemoglobin, hematocrit, and
dasarterapirehabilitasifisik.
Jaka rta :Hipokrates.
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Handbook of Physical Medicine and Rehabilitation Basics 2nd
Edition. LWW, p.172-180.
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2005.
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48
ANALYSIS OF THE USE OF PERSONAL PROTECTIVE EQUIPMENT PPE TO CLEANING SERVICE WORK ACCIDENT
Dr. ISKAK HOSPITAL TULUNGAGUNG Sandu Siyoto
Institute Of Health Surya Mitra Husada Kediri Email : siyotosyahoo.com
ABSTRACT
Accident is an event that is unexpected and undesirable. The use of personal protective equipment is one of the factors that cause accidents. Personal protective equipment is a set of tools used by workers
to protect all or part of his body against the possibility of any potential hazards in the workplace or work accident. The purpose of this study was to determine the effect of the use of personal protective
equipment PPE to cleaning service work accident. This study uses a quantitative approach to the observation method. Data were obtained using a questionnaire. The population in this study were all
cleaning service in Dr.Iskak hospital Tulungagung as many as 71 people. The sample were 62 people. The sampling technique using Simple Random Sampling. The results of data analysis with logistic
regression test is obtained p = 0.005 p 0.05. The results of this study concluded there is the influence of the use of personal protective equipment PPE to cleaning service work accident.
Keywords: Personal Protective Equipment, Work Accident
INTRODUCTION One effort to increase productivity is to
provide protection to workers for her work. This protection is given with the intent to
obtain assurance worker health and safety so that they avoid accidents. Work accident is an
event that is unexpected and undesirable that may disrupt the process that has been set for an
activity Kurniawati, 2013. Hospital as a health care institution with core
service activities of preventive, curative, rehabilitative and promotive have positive and
negative impacts. The positive impact is the increasing level of public health, while the
negative impacts among others are garbage and medical waste or non-medical that can cause
disease and pollution that needs special attention. The number of hospitals in Indonesia
in 2014 amounted to 2,415 with as many as 296 087 beds and solid waste as much as 376
089 tonnes day of wastewater as well as 48 985 tonnes day Departement of Health,
2014. As a result of accidents and occupational diseases can attack all workers in
the hospital, one of them being a cleaning service. Cleaning service has the greatest risk
of exposure to hazardous biological substances biohazard, contact with the disposable
medical instruments disposable equipment such as used syringes, IV tubes former. That
requires safety and health efforts to prevent and control accidents occupational diseases in
hospitals. Therefore, protection is very important to prevent injuries for all workers
48 who are at risk. The officer in charge of waste
management should ensure that all risks have been identified and rapid protection available.
Based on data from the ILO International Labour Organization in 2008, each year an
estimated 1.2 million workers died from workplace accidents. Meanwhile, citing data in
Anggraini Social Security in 2010, there were 98 711 cases. Of that number, 2,191 workers
died, and raises a number of 6667 people permanently disabled. The number of claims to
be paid for these cases reached more than Rp 401 billion. Press release International Labour
Organization ILO in 2013 recorded 160 million cases of work-related accidents with
about 2 million deaths annually. On April 28, 2014, in the framework of the occupational
safety and health worldwide, stating that cases of occupational illness and accidents has risen
337 million and 2.3 million deaths annually. Based on data from the Indonesian
Kemenkertrans death rate from workplace accidents and occupational diseases in
Indonesia is still very high, the data up to September 2013 recorded 9 workers die per
day. Based on the preliminary results of a study
conducted on 15 people, no workers wearing full personal protective equipment. 3 people
claimed get stabbed needle, two people never exposed to infectious fluids and the first person
ever to slip while working. Based on the above, the researcher was interested to study
about “Analysis Use of Personal Protective
Equipment PPE to Cleaning Service Work Accident Dr. Iskak Hospital Tulungagung”.
The purpose of this study was to analyze the effect of use of Personal Protective Equipment
PPE to Cleaning Service Work Accident Dr. Iskak Hospital Tulungagung.
The benefits of this research are as an input that can be used as measures and efforts to
improve occupational health and safety programs to prevent occupational injuries, so
as to create a workplace that is safe and mostly male sex a number of 38 respondents
62 while the female number of 24 respondents 38.
convenient for all employees as well as the maximum increase in labor productivity.
Figure 3 Characteristics of Respondents
According to Education On Hygiene Officer at Dr. Iskak
RESEARCH METHODS This type of research used in this research is a
correlational study with a cross-sectional which emphasizes the time measurement
observation of independent and dependent variables only once in a while.
The population in this study is all cleaning service at Dr. Iskak Hospital Tulungagung as
many as 76 people. The sampling technique used in this study is simple random sampling
with a total sample of 62 people. Data were collected through interviews and observations.
The study was conducted in March 2015. Data were analyzed using logistic regression
statistical tests.
RESEARCH RESULT
Hospital Tulungagung Based on Figure 3 shows that respondents
whose level education most are high school number 28 respondents 45, junior school of
24 respondents 39, primary school number seven respondents 11, whereas that is un
educated number of 3 respondents 5.
Figure 4 Characteristics of Respondents based on employment status on cleaning
service at Dr. Iskak Hospital Tulungagung
Based on Figure 4 shows that most
respondents are not permanent employee status a number of 52 respondents 84, while the
status of permanent employee number 10 respondents 16.
Figure 1 Characteristics of Respondents by Age At Hygiene Officer at Dr.
Iskak Hospital Tulungagung. Based on Figure
1 shows that most respondents are in the age group 21-30 years
by 56, the age group 31-40 years by 26, and the group of less than 20 years at 18
Figure 5 Characteristics of Respondents
According to the marital status of cleaning service at Dr. Iskak
Hospital tulungagung Based on Figure 5 shows that the marital status
of respondents the most is not has not been Figure 2 Characteristics of Respondents by
Gender In Cleaning Service in Dr. Iskak Hospital Tulungagung
Based on Figure 2 shows that the cleaning service at Dr. Iskak Hospital Tulungagung
49 married a number of 35 56, while
respondents were married a total of 27 44
Age use of PPE
Total Y
T Y
T N
N N
20 Year
4 17
7 18
11 18
21-30 Year
1 6
66 1
8 47
34 55
31-40 Year
4 17
1 2
32 16
26 40
Years 1
3 1
2 Total
2 4
100 3
8 100
62 100
Worki ng
Long Use of PPE
Total Y
T Y
T N
N N
1 Year
1 42
15 39
25 40
1-5 Year
1 4
58 21
55 35
56 5
Years 2
5 2
4,0 Total
2 4
100 38
100 62
100
Educat ional
Use of PPE Total
Y T
Y T
N N
N Un
educat ed
1 4
2 5
3 5
Primar y
School 2
8 5
13 7
18 High
10 42
14 37
24 39
Gender use of PPE
Total Y
T Y
T N
N N
Male 16
67 2
2 58
3 8
61 Female
8 33
1 6
42 2
4 39
Total 24
100 3
8 100
6 2
100 Table 2 Distribution Gender Against Use of
Personal Protective Equipment At the cleaning service at the Dr. Iskak
Hospital Tulungagung
Figure 6 Diagram Distribution of Respondents According to Use of
Personal Protective Equipment
Based on the picture 6 shows that respondents who use personal protective equipment a
number of 24 respondents 39, whereas that does not use personal protective equipment a
number of 38 respondents 61.
Figure 7 Pie Diagram Distribution of Respondents Against Accidents
Based on the picture 7 diagram shows that the incidence of occupational accidents in the
cleaning service in Dr. Iskak Hospital In Table 2 shows that the use of personal
protective equipment based on sex in the cleaning service at the Dr. Iskak Hospital
Tulungagung. Respondents who use PPE men 67 and women 33. While respondents were
not using PPE male some 58 and women 42.
Table 3 Distribution Old Working Against the
Use of Personal Protective Equipment At the cleaning service at
the Dr. Iskak Hospital Tulungagung
Tulungagung number of 42 respondents 68 said they had experienced a work accident,
while 20 respondents 32 claimed to have never had an accident.
Table 1 Age distribution Against the Use of
Personal Protective Equipment At the cleaning service at the Dr. Iskak
Hospital Tulungagung.
In Table 3 shows that the use of personal protective equipment based on longer work.
Respondents who use PPE with long work 1 year 42 1-5 years 58, while those not using
PPE long work 1 year 39 1-5 years 55 and 5 years 5.
Table 4 Distribution of educational status
Against Use of Personal Protective Equipment At the cleaning service at
the Dr. Iskak Hospital Tulungagung
In Table 1 shows that the use of personal protective equipment based on the age range
cleaning service at Dr. Iskak
Hospital Tulungagung. Respondents who use PPE age
20 years of a 17, 66 aged 21-30 years and 31-40 years of age 17. While respondents
who do not use personal protective equipment PPE age 20 years some 18, 21-30 years
47 31-40 32 and 40 years of 3.
50
Variables in the Equation St
ep
a
1 B
S. E
Wa ld
d f
Si g.
Exp B
The use of
PPE 1.6
55. .5
86 7.9
88 1 .0
05 5.23
4 Consta
nt -
1.8 22
.9 20
3.9 23
1 .0 48
.162 a. Variable s entered on step 1: The
use of PPE. Emplo
yee Status
The use of PPE Total
Y T
Y T
N N
N Indepe
ndent 2
83 32
84 52
84 Depen
dent 4
17 6
16 10
16 Total
2 4
100 38
100 62
100
Marital Status
The use of PPE Total
Y T
Y T
N N
N No Not
married 1
2 50
2 3
60 3
5 56
Married 1
2 50
1 5
40 2
7 44
Total 2
4 100
3 8
100 6
2 100
PPE Accident
Total Never
Ever N
N N
Yes 13
65, 11
26,0 2
4 39,
No 7
35, 31
74,0 3
8 61,
Total 20 100 42
100 6
2 100
School Senior
High School
11 46
17 45
28 45
Univer sity
Total 24
100 38 100
62 100
cleaning service at Dr. Iskak Hospital Tulungagung
In Table 4 shows that the use of personal protective equipment by educational status.
Respondents who use PPE school status no amount of 4, primary school 8, 42 junior
high school, high school 46 . While not using PPE school status does not amount to 5, SD
13, 37 junior and senior 37.
At table 7 above shows the use personal protective equipment against work accidents.
Respondents who use PPE and Never crashed Table 5 Distribution Employmentof
Status some 26, respondents who use PPE and
Against the Use of Personal Protective Equipment In the cleaning
service at the Dr. Iskak Hospital Tulungagung
never had an accident some 65 of respondents who do not use PPE and never had
an accident some 74, while those who did not use PPE and work accident number 35 .
Tabel 8 Results Effect Analysis Using Personal protective equipment against work
accidents At a cleaning service at Dr. Iskak Hospital Tulungagung
In Table 5 shows the use of personal protective equipment based on employment status.
Respondents who use PPE status of non- permanent employees 83 and the number of
permanent employees 17. While respondents were not using PPE status of permanent
employees 84 and 16 permanent staff. Table 6.Distribusi Marital Status Against the
Use of Personal Protective Equipment in the cleaning service at
the Dr. Iskak Hospital Tulungagung
In Table 6 shows the use of personal protective equipment based on marital status.
Respondents who use PPE status of unmarried 50 and 50 are married. While respondents
were not using PPE status is not married some 60 and 40 are married.
Table: 7 Distribusi Use of Personal Protective
Equipment Against Accidents in 51
The analysis showed the use of personal protective equipment PPE against
occupational accidents in the cleaning service at Dr. Iskak Hospital Tulungagung p value =
0.005 p 0.05 means that there is the effect of the use of personal protective equipment
PPE against workplace accidents. Respondents who use personal protective
equipment are possibly five times to avoid workplace accidents when compared to
workers who do not use personal protective equipment and statistically significant as well
as related.
DISCUSSION Use of Personal Protective Equipment PPE to
the cleaning service in Dr.Iskak Hospital Tulungagung that of 24 respondents 39
who use PPE while 38 respondents 61 did not use PPE. Judging from the use of gloves
44 do not use and 56 use, the use of masks 48 do not use and 52 use, the use of apron
watertight 95 do not use and 5 use, the use of the shoes 100 use, while the use of hats or
headwear 100 do not use. This is due to lack of compliance officers in the use of personal
protective equipment as well as the lack of availability of personal protective equipment
for the cleaning service. Proved to be only available one spilkit box in one area, while the
officer is in one of the area between 6-8 cleaning service. Besides lack of supervision
and lack of sanctions for cleaning service make cleaning service negligent in using personal
protective equipment. Personal protective equipment PPE according
to OSHA or the Occupational Safety and Health Administration is a tool used to protect
workers from injury or illness caused by contact with hazards in the workplace, whether
it is chemical, biological, physical radiation, electrical, mechanical and other , The use of
PPE is used to protect the body from harm job can cause illness or accidents and labor can
work with more secure because it can avoid the various occupational hazards. Thus, the use of
PPE has an important role because it is useful not only for workers, but also useful to the
company. The number of accidents on the cleaning
service at the Dr. Iskak Hospital Tulungagung is 42 respondents 68 never had an accident
at work, and 20 respondents 32 have never had an accident at work. Judging from the
respondents fell 29 has been dropped and 71 never fall, 24 of respondents had
experienced punctured and 76 have never experienced punctured, 44 of respondents
had experienced exposure to liquid infectious and 56 of respondents were never exposed to
liquid infectious, 40 respondents had spilled hazardous liquids and 60 of respondents
have never spilled liquids deadly; 35 of respondents had collided and 65 of
respondents had never hit, 31 of respondents never inhaling toxic gases and 69 of
respondents never inhaling poisonous gas, 26 of respondents never exposed chemicals and
74 of respondents were never exposed to chemicals. World Health Organization WHO
defines accident as an event that can not be Data not sufficient or other accidents that have
not entered. While classification according to the cause include: machinery, transport
equipment, materials, substances and radiation, work environment, other causes that do not
include these factions , Results from the analysis of data obtained p-
value: 0.005 p 0.05 means the use of personal protective equipment has a significant
relationship with workplace accidents in the cleaning service at the Dr. Iskak Hospital
Tulungagung. The results showed that respondents use personal protective equipment
PPE 5 times to avoid accidents. While workplace accidents influenced by the use of
personal protective equipment PPE by 18. Based on the theory of work accidents caused
by several factors and one of them is because they do not use personal protective equipment.
As for how to prevent accidents by Ramli 2010 is to wear personal protective equipment in
earnest without coercion, aware of the importance of workplace safety and comply
with the regulations that exist, because 85 of workplace accidents are caused by human
factors with unsafe acts , Joseph 2007 study on Factors Related Accidents also mentioned that
there is a significant association between the use of personal protective equipment at work
accidents with a value of p: 0.013 p 0.05.
CONCLUSIONS AND SUGGESTIONS From the research that has been done and it
can be concluded from the discussion of matters related research about the effect of the
use of Personal Protective Equipment PPE against occupational accidents in the cleaning
service at Dr. Iskak Hospital Tulungagung. Use of Personal Protective Equipment PPE to
the cleaning service at the Dr. Iskak Hospital Tulungagung of 62 respondents, only 39
were using PPE, while 61 did not use PPE. The number of accidents caused by work in the
cleaning service at the Dr. Iskak Hospital Tulungagung of 62 respondents 68 had had
an accident at work and 32 have never had an accident while work. The use of personal
protective equipment has a significant influence with workplace accidents in a
prepared in advance countermeasures so as to cleaning service
at Dr. Iskak Hospital
produce a real injury. Classification of accidents due to work according to Labour
Organization is based on the type of accident: such as a fall, hit by falling objects, pierced,
pinched, movements that exceed the capabilities, contact with hazardous materials
or radiation, Other types, including accidents
52 Tulungagung namely with p-value: 0.005 p
0.05. With regard to the outcome of research and
discussion and conclusion, then the advice that can be given is a cleaning service should be
submissive in the use of personal protective
equipment to reduce the risk of workplace accidents.
Maintain and take care of personal protective equipment has been provided by either.
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53
AEROBIC COMBINATION WITH RELAXATION YOGA TO FATIGUE LEVELS IN PATIENTS WITH BREAST CANCER UNDER CHEMOTHERAPY PROGRAM
Muhammad Taukhid STIKES Karya Husada Kediri
E-mail: mtaukhid88gmail.com
Abstract
Background : Fatigue is feeling tired physically, psychologically, cognitively perceived cancer patients while undergoing therapies for the disease, including chemotherapy. The
purpose of this study was to determine differences in the level of fatigue in cancer patients between before and after aerobic exercise combined with relaxation techniques of yoga.
Methods : This study used Quasi-experimental design with pre-test
– post-test control group in patients with breast cancer in the course of chemotherapy. The sampling methods used
purposive sampling. The fatigue level was collected by subjective instruments Pipper Fatigue Scale PFS, and then analysed by the Independent and Dependent T test, and multivariate
analysis used linear regression with a significance value of α 0.05. Results : There were differences in the level of fatigue post-test between the intervention group and the control
group with a difference of 1.25 p = 0.013. History of previous exercise may explain the 17.8 level of fatigue that occurs in patients with breast cancer in the course of chemotherapy,
the rest was explained by other variables. Conclusion : There were a decrease in the level fatigue statistically, however clinically the level of fatigue remain the same categories.
Keywords : fatigue, aerobic, yoga, breast cancer
Introduction Fatigue is an overwhelming exhaustion
more than normally, which are not relieved by rest and nutrition intake. Cancer related
Fatigue CRF associated with cancer process and the side effect of cancer
therapy. The incidence of fatigue in the US reaching 95 of all cancer patients
undergoing chemotherapy or radiotherapy Mustian, 2007. Most incidents fatigue that
is between 28 -91 suffered by breast cancer patients who undergo therapy
Hofman et. Al, 2007. quality of life and ability of daily activities
Wagner, Cella, 2004. Signs and symptoms of fatigue characteristics are
multi-biopsychosocial, so that if two people who experience fatigue, the appearance
symptoms will not exactly match.
CRF are generally influenced by a history of less activity and psychological stress
experienced as a result of cancer. Based on the priorities effectiveness against fatigue,
Mitchell, Beck, Hood, Moore, Tanner 2007 recommend giving exercise to
intervene against fatigue. Suggested
CRF will affect the ability, physical capacity, and quality of life of cancer
patients, so they will rely on others for daily necessities such as household activities,
transportation, personal needs such as eating and bathing. CRF perceived
multidimensional feeling, the dimensions are behaviour, cognitive, psychological and
social. Fatigue felt by the majority of cancer exercises include walking, cycling,
swimming, resistance training or exercises combined. Nursing interventions that are
judged to be effective fatigue management is performed for activity management and
energy conservation, one of the interventions which includes relaxation
techniques. Escalante and Manzullo 2010 tried to
patients during therapy may reduce the
223 apply the technique
combination of
pharmacological and non-pharmacological therapies, among others: energy
conservation, regulation of sleep, exercise, relaxation, antidepressants, analgesics,
stimulants, anxiolytic and nutritional counseling. The results are 59 of the 140
respondents reported less fatigue.Methods of combination therapy to reduce fatigue
have also been made in the research Decker, Cline-Elsen, Galaggher, 1992 and
Kim, Kim, 2005, using nursing interventions breath relaxation techniques
with yoga positions. The cancer patients were given the intervention reported lower-
level experience fatigue. Danismaya research results 2008, who did
the application of relaxation techniques of yoga in patients with breast cancer, showed
a decrease in the level of fatigue on the 5th day of intervention. Research by wahyuni
2012 suggested that the walking exercise program can reduce fatigue levels in breast
cancer patients. The above studies indicate that intervention
aerobic walking exercise as well as the relaxation of yoga is effective in lowering
the level of fatigue. However, so far researchers have not found a combination
of aerobics with yoga relaxation of the intervention to be effective in lowering the
level of fatigue. This study aimed to determine differences in fatigue levels in
breast cancer patients in chemotherapy program between before and after the
combination of aerobic exercise and relaxation techniques of yoga.
METHODE The research was used Quasi-experimental
pre test post test with control design in patients with breast cancer under
chemotherapy program at RSUD Kediri and Amelia Hospital Kediri on April until June
2014. Using purposive sampling technique 34 participant were recruited from 110
patients by medical data record and encountered patients at one day care
services unit. Aerobic data was collected with observation sheets about exercise time
schedule, and fatigue levels data obtained with Pipper Fatigue Scale PFS. Initially
the patient is asked to perform continuous walking for 10 minutes as a form of aerobic
224 exercise , then the patient rested for 2
minutes , then the patient is asked to perform Shavasana position yoga as a form
of relaxation for 8 minutes. Rest breaks given to minimize the discomfort that can
be perceived by the respondents. Data were collected by questionnaires for
the pre-test and post-test. Analysis of data using frequency distribution, bivariate
analysis Independent and Dependent T test and multivariate analysis using linear
regression. Most respondents chose to participate in the
study and are willing to take measurements and interventions at each residence. All
existing identity documents and data in this study have been agreed only use initials, all
the information from respondents in the form of a hard copy stored in a locked filing
cabinet and the data in the form of soft copy stored in a specific folder is secured by
using a password. During participated in the study respondents are treated fairly and
impartially , by providing the same treatment , but in a different time .
Intervention control group given a combination of aerobic exercise with
relaxation techniques of yoga after data collection is complete .
RESULT Obtained 34 respondents by sex married
women are divided into two groups , namely 17 respondents in the intervention
group and 17 respondents as the control group . The mean age of the respondents
51.5 years old, mean body weight 57.71 kg, and the mean fatigue score of 6.04 95
CI. Table 1 displays the characteristics of respondents
P value
R R
2
Adjusted R square
P value
Langkah 1 0,594
0,353 0,311
0,012 Based on the results of statistical tests, it
was found that a significant reduction in fatigue scores between before and after
doing a combination of aerobic exercise with relaxation techniques of yoga in the
intervention group p = 0.001; α = 0.05. Based on test results, a decrease in fatigue
scores were significantly also occurred in the control group p = 0.004; α = 0.05.
Based on further testing of the level of fatigue post test between the intervention
group and the control group there were significant differences in levels of fatigue p
= 0.013; α = 0.05. Table 2 shows the differences in levels of fatigue post test
between the intervention group and the control group
TABLE 2 Differences in levels of fatigue post-test,
intervention group and the control group
Mean Mean±
Different SD
CI 95
Fatigue Levels intervention 4,3±1,6
1,25 group
0,29-2,22 Fatigue Levels
5,5±1,8 control group
Langkah 2 0,451 0,203
TABLE 1 Characteristics of Respondents
Variable
Occupation a. Having a Job
b. Jobless Education
a. Low Education does not school,
Elementary, Junior b. Higher Education
High School and Universities
Cancer Stadium a. Stadium II
b. Stadium III Therapy History
a. Nothing b. Exist
Exercise History a. None
b. Exist Types of chemotherapy drugs
0,013 a. Tamoplex b. Cyclospamit
c. Doxorubyn 0,178
n
5 29
27 7
25 9
23 11
30 4
16 11
7 0,001
14,7 85,3
79,4 20,6
73,5 26,5
67,6 32,4
88,2 11,8
47,1 32,4
20,6 independent t test p 0,05
Based on the test results of multivariate linear regression, the level of fatigue in
breast cancer patients under chemotherapy program is influenced by prior treatment
history and a history of previous exercise p 0.05. Also shown in Table 3 the previous
exercise history can explain the fatigue that occurs in cancer patients under
chemotherapy program, the rest is explained by other variables.
Uji regresi Linier p 0,05 Langkah 1 : riwayat terapi, riwayat atihan
Langkah 2 : riwayat latihan Faktor dependen : tingkat fatigue
DISCUSSION Cancer related fatigue is a feeling of fatigue
that appears persistently, along with the cancer therapy. Fatigue can arise from the
patients physical condition declined due to the disease process, and may also be caused
225 by cancer therapy undertaken. The feeling
will make the patients physical abilities decline. The high level of perceived fatigue
of breast cancer patients, is associated with a decrease in daily activities performed by
patient Rotonda, Guillemin, Bonnetain, Velten, Conroy, 2013. Therefore, physical
exercise becomes one of the main recommended treatment for patients with
fatigue, so that the patients ability to independently returned. Physical exercises
ranging from the mild to severe intended to allow someone to have regular activities, so
that the body will be able to compensate for the decrease in the patients physical
abilities. If a person feels himself psychologically incapable, then his body
will respond to the same thing, so it will be the condition of the patients body
increasingly weak. Accordingly, in this study interventions that
can increase the activity of the respondent to provide physical fatigue management by
walking exercise, and psychological
basic ingredient of energy, so that when management by providing relaxation
techniques of yoga. The results in this study showed a difference between level of
fatigue before and after applying a combination of aerobic exercise with
relaxation techniques of yoga in patients with breast cancer under chemotherapy
programs. Chemotherapy is a protocol that is almost used in all cancer treatment. Be
aware that chemotherapy is a treatment method using a type of cytotoxic drugs,
which is intended to inhibit the regeneration of cells. Inhibition mechanism occurs in all
cells of the body, not least on healthy cells or non-cancerous, so its also a factor that
contributed to the decline in patients physical abilities. important for patients
who are undergoing chemotherapy and experiencing fatigue to keep improving
activities of daily routine, to compensate for attenuation effects caused by chemotherapy
drugs on normal cells. Routine activities such as cooking, sweeping, walking around
the house is the method forms of simple aerobic activity that can be done by cancer
patients in order to maintain their physical abilities. In accordance with the results of
several previous studies which revealed that aerobic exercise walking exercise can be
beneficial to the fatigue levels of patients who are in treatment programs Velthuis,
Agasi-Idenburg, Aufdemkampe, Wittink 2010; Wahyuni, 2012; Mustian, Sprod,
Janelsins, Peppone , Mohile, 2012; Mayo, Moriello, Scott, Dawes, Auais, Chasen,
2014. Decrease in fatigue scores that occurred in
the intervention group can explain that feeling of fatigue experienced by cancer
patients can be improved by doing aerobic exercise. These types of exercises can strike
production increases it will be directly proportional to the bodys ability to perform
its duties and functions. Conversely, a decrease in activity deconditioning result
in the breakdown and loss of enzymes involved in cellular energy production
level. The use of oxygen and energy sources become inefficient. Aerobic
exercise is conducted into a stimulation for the body to change the reserves of energy
sources into the base material of energy. This is consistent with the first and second
laws of thermodynamics theory, which states that energy can neither be created nor
destroyed; energy can only be redistributed or changed from one form to another
Winningham and Barton-Burke 2000. Aerobic exercise program can be used as an
exercise to minimize energy loss in cancer patients whose chemotherapy by using
oxygen consumption as an objective parameter in measuring performance.
Aerobic exercise showed progress in terms of performance that produces energy
despite cancer patients undergoing chemotherapy. Individuals who perform
activities would not feel too tired compared to individuals who do not indulge, this is
because the energy in individuals whose activities continue to be distributed though
the energy used continuously, the opposite situation occurs in individuals who do not
perform activities, energy continues to be required but there is no activity undertaken
to produce energy anymore. The exercise program can also provide benefits for the
psychosocial health of cancer patients, by improving the ability of themselves and the
quality of life Doyle, C., et al., 2006.
Physically, history or the patients ability to a balance between the needs and the
perform activities before experiencing
production of energy needed by the body to improve physical abilities. Aerobics can
increase the cardio-respiratory activities that will increase the supply of oxygen to
the muscles. The presence of oxygen in the muscles will increase energy metabolism
through oxidation of fats, carbohydrates and fatigue becomes a factor that greatly affect
the compensation body when experiencing fatigue. Analysis of the comparison
between each of the factors that influence fatigue in this study suggests that a history
of activity contributed 17.8 to the occurrence of fatigue in breast cancer
protein to form a small part
patients Table 3. Adenotriphosphate ATP Hernawati, nd
downloaded from file.upi.edu. ATP is the
226 Meanwhile, the research results also
illustrate that yoga relaxation techniques
also contribute to the score of fatigue respondents. Yoga is useful to provide and
increase the sense of calm in respondents feeling after doing a series of exercises.
According Shindu 2013 with yoga positions Shavasana position lying like a
corpse relaxation in total will take place gentle pressure on the glands that secrete
symptoms that may aggravate tension fatigue does not occur.
The results also showed that the level of fatigue also decreased in the control group,
who did not get a combination of aerobic exercise with relaxation techniques of yoga.
Generally, it can be overcome with fatigue restoration techniques, such as; ensure a
hormones to a more stable, blood
proper diet, ensuring a good sleep patterns, circulation becomes more smoothly, the
body will describe the tension of his muscles, the mind becomes quieter and
more serene sense of being. Relaxation become appropriate method chosen for the
management of fatigue caused by the burden of or stress of feeling in the minds
of cancer patients. Stress experienced by patients could be due to progressive disease
process, the phase of self-acceptance on the patients health status, or because of
saturation in undergoing cancer therapy who repeatedly and for a long time.
According to Hans Selye in the Canadian medical hall of fame, 2013 stress
syndrome originated from a situation in which the body is not specifically respond
to various stimuli. Under conditions of stress hypothalamus secretes corticotropin
releasing hormone CRH, further to stimulate the pituitary to secrete cortisol
and directly or indirectly adrenal secrete adrenocorticotropic hormone ACTH,
GRH, Somatostatin and release factors releasing the hypothalamus and pituitary
hormones other. Cortisol and ACTH will issue vasopressin and catecholamines,
causing an increase in blood pressure and heart muscle contraction. Clinically, this
phase will bring a feeling of tension accompanied by signs such as ulcers, high
blood pressure and heart attacks.
Further processing of the situation would lead to a decrease in the secretion of
insulin, glucagon and the intake of oxygen in the body. The impact, decrease energy
production, while the energy needs in cancer patients who are undergoing
chemotherapy are very large. This gap that causes the inadequate energy for the body,
causing fatigue. Therefore, cancer patients need to be taught relaxation methods as an
effort to adapt to stress, in the hope
227 adjusting a good lifestyle, understanding
the psychological problems associated with fatigue, as well as coping management for
the energy loss Victoria Minister for Health, 2013. Decrease fatigue that occurs
in the control group could be acceptable because some respondents have
chemotherapy schedules predetermined, so it is difficult to predict the peak of the
respondent fatigue. In addition, the distance between the last chemotherapy respondents
to the implementation of the research is very varied, there is a direct post-
chemotherapy and some that have a few weeks after the last chemotherapy. In the
opinion of Otti cited in Danismaya, 2008 that the peak fatigue occurs on day 7 to day
10 after chemotherapy session and will be back at the starting point before the next
cycle. So when performed assessments of respondents could not be ascertained were
at the height of fatigue or not, because it may just have been a recovery from fatigue
experienced conditions. Interventions that have been given during
this study is safe and can be done independently by the respondents during
the period of chemotherapy. It is based on the absence of a report from the
intervention group who runs a combination of aerobic exercise and yoga relaxation
techniques that are harmful and harm him. A decrease in fatigue scores in the
intervention group was significantly higher when compared with the control group.
Fatigue scores are clinically categorized into four categories, namely; a score of 0
for categories not fatigue, the score 1-3 to the category of mild fatigue, fatigue score
of 4-6 to the category of moderate and severe fatigue category 7-10 Pipper, et. al,
1998 and NCCN, 2014. Decline in average scores are statistically obtained either from
0.52 to 1.82 in the intervention group and
the control group, from the initial score in the range of 6 scores fell in the range of 5
and 4. Fatigue score 4-6 clinically categorized into
moderate category, so it can be concluded that the decrease in fatigue that occurs only
statistically significant, but clinically decrease in fatigue that occurs still within
the same category, or do not decrease. aerobic exercise with relaxation techniques
of yoga for three consecutive days. The results showed a significant influence
between the combination of aerobic exercise with relaxation techniques of yoga
in cancer patients undergoing chemotherapy, after three days of
observation. But according to the law of Thermodynamic III discovered by Rudolf
Several other studies also reveal the same Clausius in Barton-Burke
and thing, that the reduction in fatigue after
exercise and relaxation of yoga significantly only shown in the statistical
calculation, but not clinically significant difference Schwartz, Mori, Gao, Nail,
King, 2001 Danismaya 2008, Mustian et. al Winningham, 2000 stressed that energy
can not only be modified in other forms, but also constantly less available for work.
Whenever energy is converted, it always takes more energy than the energy
expended a system. This theory can be the
2009. However, the research results basis of that intervention provided in this
Mustian et. al 2009 added that although not clinically significant changes occur
fatigue, cancer patients were given continuous training to observations of three
months showed an improvement in quality of life. As well as on the research results
Danismaya 2008 further explained that the provision of the relaxation techniques of
yoga over three days showed a decrease in fatigue clinically significant, namely from
study can not necessarily eliminate fatigue in just three days, because the body needs a
continuous supply of energy along with energy use. So that respondents who
perform these interventions are also at risk for getting tired because of the energy
requirements continuously. However, at least by providing a combination of aerobic
exercise with yoga relaxation techniques on an ongoing basis to balance energy needs,
fatigue category of being on the first day can stimulate the aerobic
energy become the category of mild fatigue on the
fifth day. Exercise and physical activity that exceeds the portion of the ability of cancer
patients can also potentially lead to fatigue, thus creating the opportunity to exacerbate
fatigue, therefore in this study are still using the criteria of minimal intervention, namely
with a frequency of three days a week. Such determination is based on the optimal
frequency in adults aerobic ie at least 3 days a week Whalet, 2006 and the duration of
time of at least 10 minutes in a day Newton cited in CCWA, 2009. While
Danismaya 2008 also mentions that a change fatigue of cancer patients given
yoga relaxation occurs from the third day of exercise. This study is an initial attempt to
determine the effectiveness of the combination therapy which has not found a
reference frequency and duration for the implementation of the combination in
previous studies, so that some of the above considerations are used to determine the
frequency and duration of combined
228 metabolism and relaxation of yoga can save
energy by minimizing internal stress. According Winningham in King and
Hinds, 2003 about the proposition of rest and activity states that too much little
break will result in fatigue, as well as too much little activity will also lead to
fatigue, so the dynamic balance between activity and rest will minimize fatigue, and
otherwise the imbalance of which will aggravate fatigue.
In addition, fatigue become a different problem to individuals who have completed
cancer therapy. Individuals who are no longer undergo therapy and be considered
free of cancer called cancer survivor. Fatigue is still a problem that can interfere
with quality of life for cancer survivors significantly. According Servaes, Verhagen,
Bleijenberg 2002, 38 of women with breast cancer who have completed cancer
therapy still merasakana exhausted after 29 days post-therapy. Fatigue is also still
perceived by 13 of women with breast cancer 10 years after completion of therapy
Bower, Ganz, Desmond 2006. Theory and research conducted in patients undergoing
cancer therapy can not be applied in a population of cancer survivors, solutions
that can be given in this population is to improve themselves to be able to adapt and
perform independently of the fatigue management are still being experienced.
informed choices. CA Cancer J Clin, 566: p. 323-53.
Escalante P. C., Manzullo F. E. 2009 Cancer-Related Fatigue: The Approach
and Treatment. J Gen Intern Med, 24Suppl 2:412
–6 DOI: 10.1007s11606-009-1056-z
Hernawati, n.d. Produksi asam laktat pada CONCLUSION
exercise aerobik dan anaerobik.
There are differences in fatigue levels in breast cancer patients who received a
combination of aerobic exercise with relaxation techniques of yoga. The decline
is statistically significant, but clinically no significant changes in levels of fatigue
either the intervention group or the control group. Special interventions for fatigue in
cancer patients in this study may be one of the nursing interventions, so that nurses can
implement it in order of nursing, especially in the area of oncology nursing. Further
diunduh dari file.upi.eduDirektoriFPMIPAJUR._P
END._BIOLOGI...FILE_2.pdf Hofman M., Ryan L. J., Figueroa-Moeley
D. C, Jean-Pierre P., Morrow G. R.. 2007. Jacobsen PB, Hann DM,
Azzarello LM, et al. Fatigue in woman receiving adjuvant chemotherapy for
breast cancer: characteristics, course and correlates. J Pain Symptom
Manage, 22: 277
–88 Kim, S.D., Kim, H.S. 2005. Effects of a
research is needed, especially regarding relaxation breathing
exercise on intervention to determine the long-term
results of the implementation of the intervention.
Specific interventions for fatigue in cancer patients so far is not widely held by
hospitals that deal with cancer therapy. The results could be used as a basis for
interventions against fatigue that occurs in cancer patients in hospitals, both in
hospitals and in the center of the regional fatigue in hematopoietic stem cell
transplantation patients. Journal of Clinical Nursing, 14, 51
–55. King, C. R., Hinds, P.S. 2003. Quality of
life: from nursing and patients perspectives, theory and research. 3
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