There were an effect of ergonomic
PSYCHOEDUCATIVE F AMILY THERAPY
UNTUK MENINGKATKAN SIKAP KELUARGA TERHADAP PASIEN TB PARU
Psychoeducational Family Therapy To Improve Family Attitudes Towards Pulmonary TB Patients
Bisepta Prayogi
STIKes Patria Husada Blitar Email:
bisepta87gmail.com
ABSTRACT
TuberculosisTB remains a major global health problem. This leads to poor health among millions of people every year and is now ranked second leading cause of death from infectious disease
world wide, after the Human Immunodeficiency Virus HIV. The objective of this study was to analyze the effectivenes of family therapy psycoeducative to
to improve family attitudes
of patients with pulmonary tuberculosis. This study used quasy experiment pre-post test control group
design. Total sample was 32 respondents taken using purposive sampling, the sample divided into experiment and control group. The data were analyzed by Paired T Test, and Independent T Test,
with significance value of 0.05. Paired T Test analysis showed that psychoeducative family therapy had effect on increasing family attitude of towards pulmonary TB patients p =0,000.
Psychoeducative family therapy improved family attitudes.
Keywords: psychoeducative family therapy, attitudes of family,
Pulmonary TB Patients
__________________________________________________________________________ INTRODUCTION
Tuberculosis TB remains a global health problem. The most recent estimate that
there are 8.6 million new TB cases in the world in 2012 and 1.3 million deaths from
TB just under 1.0 million among HIV- negative people and 0.3 million deaths
associated with HIV-TB. Most of these TB cases and deaths occur among men. In 2012,
there were an estimated 2.9 million TB cases and 410,000 deaths among women, as well as
prevalence of pulmonary tuberculosis in Indonesia 730,000 cases or 297 cases per
100,000 population. According to WHO tendency of new cases of pulmonary TB in
Indonesia increased that in 2000 there were 430,000 cases of pulmonary tuberculosis and
in 2012 there were 460,000 new cases WHO, 2013.
TB eradication in Indonesia has been implemented since 1969 through the National
Program Tuberculosis Eradication Program P2TB by the Ministry of Health, and since
the estimated 530,000 cases of dan74.000 1995 further intensified
by means of death in children. The actual number of TB
treatment strategies using Directly Observed deaths could be reduced given that most
Treatment Short
course DOTS
could be prevented if people can use health recommended by WHO. But in reality after
services for diagnosis and appropriate running 9-10 years of DOTS, treatment
treatment. The program
of short-term success rate has yet to reach the target set by
treatment of first-line drugs available and can cure about 90 of cases for decades WHO,
2013. Indonesia take on fourth place in the
world for the number of TB cases after India, China, and South Africa. In 2012 there were
460,000 new cases of TB in Indonesia or 185 per 100,000 population. There are about
67,000 deaths from pulmonary tuberculosis or 27 people per 100,000 population. The
392
the Ministry of Health is able to cure 85 of TB patients with Acid Resistant Bacteria
BTA + were treated. From global surveillance results have been reported TB
germ resistance against Anti-Tuberculosis Drugs OAT in patients with TB for one
type of OAT DR-TB Drug Resistant-TB by 12.6 and for more than 2 types of OAT
MDR TB, Multi-Drug Resistant TB of 2.2 Depkes, 2002.
At the national level, East Java is one contributor to the invention of the number of
pulmonary tuberculosis patients under the research conducted by Sulistiowati 2012
that psycoeducative family therapy effective in enhancing the ability of families both
second highest in West Java Province. In psychomotor
and cognitive in treating 2012, the figure Case Detection Rate CDR
of 63.03 with the number of new cases positive and negative as many as 41 472
people and as many as 25 618 new smear- positive cases. These conditions are still far
from the target CDR stipulated that 70 east java public health office, 2013.
Data in the East Java Public Health Office in 2012 showed the results of
treatment of TB patients can be seen from the patients with pulmonary TB disease.
Based on evidence based practice, psychoeducation is a therapy that is used to
provide information to families to improve their skills in caring for their family
members, it is expected that the family will have a positive coping to stress and load
experienced Goldenberg Goldenberg, 2004. In the family psychoeducation there
are 5 sessions: identification of problem,
cohort of patients in 2011. The number is client care,
stress management, load
calculated by summing the new smear management
family, community
positive TB patients with the final results of empowerment. Thus, one alternative solution
treatment to heal and complete treatment is to
optimize the support is to use
divided with smear-positive TB patients psychoeducative
family therapy. treated in cohort same period and multiplied
by 100. The results of treatment in East Java showed a pretty good number, because
it has achieved treatment success rate of over 90. Only 9 nine districts cities that have
not yet reached a success rate of 90. Target 2014, a treatment success rate of 90 can be
achieved by 100 of districts cities East Java Public Health Office, 2013.
In 2012 the number of new cases in Blitar is 180 cases per 100,000 population.
The mortality rate of pulmonary TB in Blitar Psychoeducative family therapy with means
to facilitate local social structures families, groups, and communities are likely defunct
so as to re-provide effective support to the needy related stressful life experiences.
MATERIALS AND METHODS
The design of this study was Quasi Experiment with pre and post test control
group design. The Population was pulmonary TB patients and families PMO in the city of
is 17 people per 100,000 population. Of the Blitar.
The sampling technique used
104 patients with pulmonary tuberculosis treated, the number of people who recover is
80, meaning that the level of success in the treatment of pulmonary tuberculosis in Blitar
purposive sampling with a sample 16 respondents of treatment group and 16
respondents of control group. The independent variable was Psycho
is 80, whereas the target is 90 success Educative Family
Therapy, while the
rate. Cure rate in Blitar reached 76.92 of dependent variable
is the attitude of
the target of 85. Data of patients drop out pulmonary TB patients family. Instruments
as much as 5 patients 4.8. The figure is used: 1
The questionnaire to collect
still within the target of 5 East Java Public Health Office, 2013.
To improve discipline and prevent demographic data of respondents including
sex, age, education, occupation, marital status, religion, income, relationship with the
non-adherent patients
in the treatment PMO patients, the number of families and
program needs the support of the family. The support given to family members who suffer
from pulmonary tuberculosis in the form of psychosocial support which could be a
positive support to any activity undertaken. By providing information to families about
the disease and advise on effective coping family-type, 2 questionnaire to measure the
attitude of the family. The data collected then processed and analyzed using statistical test
Paired t Test, and Independent t test with
significance level p≤0,05.
mechanisms, psychoeducation
program reduces the tendency of clients to relapse and
reduce the effects of this disease on other family Townsend,
2009 .Berdasarkan
393
RESULT
This chapter describes the results of research, which includes
: The attitude of the family treatment
group on average have increased from the previous negative to positive. In the first
session found a problem that most of the 1.
The effectiveness of psycho educative patients family or the PMO did not want to
family therapy to family attitudes Statistical test results in the group
treated with Paired T Test p = 0.000, which showed no change attitudes before and after
treatment, the control group Paired T Test results p = 0.333 showing no change in
attitude. Statistical test results Independent T Test after intervention was obtained p =
0.000 in both groups showing that there is a significant influence on attitudes between the
treatment group and the control group see help remind patients to take medication time.
If the family does not help remind patients when to take medication, patients forget to
take medication for a very large. This is then followed up, especially in the second session
of therapy
. In the second session is given
psychoeducation about the attitude that should be done by the family PMO, and the
roles of the family in the treatment program undertaken by the patient. Improved attitudes
in the treatment group this may occur
table 1. because of the
continuous interaction
between researchers and respondents during Table 1. The effect of psycho educative
family therapy to family attitudes the study. Attitudes can be influenced by
ones personal experience, the attitude is
Treatment Control
Difference ∆
formed when a personal experience involving
Pre test
Post Test
Pre Test
Post Test
Treat ment
Control
emotional factors. The attitude of the family in the
N SD
Mean 16
4,195 28,44
16 2,872
34,38 16
3,074 21,13
16 3,146
21,19 16
3,492 5,94
16 0,25
0,06
control group there were 1 rise respondents and 15 respondents remain. Respondents who
experienced an increase in the value of the
Paired T Test p=0,000
Paired T Test p=0,333
Independent T Test
p=0,000
attitude though not obtain the intervention can be caused, because the respondents still
interact socially with others, such as health care workers, other family or those that are
DISCUSSION
considered important. 1.
The effect of psycho educative family therapy to family attitudes.
CONCLUSIONS AND SUGGESTIONS
Most respondents in the treatment group were 9 respondents 56.3 before
being given psychoeducative family therapy have a negative attitude. Attitude is the
response of someone who is still closed to a stimulus or object. Components of attitude
consists of the trust confidence, the idea and the concept of an object, the emotional
life or emotional evaluation of an object and a tendency to act. According to Wright
Leahay 1994 trust is a sub category of assessment which is something underlying
ideas, opinions and assumptions are owned by the family. Changes in the domain
knowledge is an intermediary changes in attitudes and behavior. In the affective
domain is facilitated family to share the experience of caring for a family member
suffering from pulmonary tuberculosis and provide family support.
394
Conclusions
Psychoeducation can improve the attitude of the family PMO patients
suffering from pulmonary tuberculosis in Blitar through the provision of psycho-
education about the care of patients with pulmonary TB.
Suggestions
For nurses can be used as a study to consider the psychoeducational family
therapy as an alternative solution in order to optimize treatment program at psien
pulmonary tuberculosis. Provide activities that are psychologically based on the family
of pulmonary tuberculosis in an effort to improve medication adherence. Family is
expected to cooperate with the health care
team in monitoring the development of the
Tuberkulosis
.www.googlescholar.com .
condition of patients
with pulmonary diakses pada tanggal 21 November
tuberculosis, and provide optimal support to family members suffering from pulmonary
tuberculosis.
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The Effectiveness of 4s’s Techniques To Physiological And Crying Duration Of Newborn
Erni Setiyorini Pediatric Nursing
STIKes Patria Husada Blitar Blitar, Indonesia
085645646666 and email:nersernigmail.com
Abstract
For a hospital birth, there are numerouse routine procedures, such as injection, blood sampling procedures and many other which can administered. The procedures
made newbon uncomfortable by pain then have impact to short and long term. Newborn express their pain in defferent ways. Previous study have shown that newborn who
experience many painful procedures may show changes to their behaviour in later childhood. The p
urpose of this study was determine the effect of 4s‟s techniques on physiological responses and duration of crying after venous blood sampling.
We conducted a prospective, post test only control group design. Newborn consist of 46 samples, were divided int
o 2 group, 23 samples control group with 1s‟s technique and 23 samples treatment group with 4s‟s technique. The data collected by
accidental sampling at November 2014 by observation sheet. Data Analysis used T-Test and Wilcoxon Signed Rank Test.
Result showed that 4S‟S technique had effect on physiological responses on pain
heart rate with p=0,004, respiratory rate with p=0,000, temperature with p=0,000 and on duration of crying with p=0,001.The 4s‟s technique decrease pain on newborn with
physiological responses indicator and decrease length of crying.
Keyword:
The 4s‟s technique, physiological response, crying duration, newborn
INTRODUCTION
For a delivery in hospital, decades. Perception early to said that the
newborn administered
on various development of neuroanatomical and
procedures resulted in pain, discomfort, or noxious stimulation. These include
general procedural pain, such as blood sampling procedures, injection. Normal
newborns experience painful procedures as a component of routine care. Haouari
and Coworkers 1995 estimate that every newborn undergoes at least one
heel stick or venipuncture. procedure and that over 1 in every 10 newborn
neuroendocrine in pain response neonates less than complete,
accompanied by fears of analgesia that can potentially damage the respiratory
system Lippmann et al, 1976, Rackow et al, 1960. Anand and Craig suggested
that reported neonatal pain behavior as nonverbal. Some neonatal pain
assessment methods based on different combinations of indicators of
have two or five injections or blood physiological, biochemical
and taken for testing. Based on data obtained
from Ngudi Waluyo Wlingi Hospital, from January to September 2014 there
were 1385 births and 942 term infants. behavioral pain Khurana, Hall and
Anand, 2005. Newborns demonstrate autonomic visceral, motor and state
behavior changes in relation to
From these data a 100 gain venous venipuncture.
Pain in infants will blood sampling procedures Data
Register RS Ngudi Waluyo Blitar, 2014.
Differences in pain management in neonates have evolved over three
399 respond by crying and moving the entire
body. One of them through facial expressions, crying, movements arm, leg
movements, breathing patterns, and stimulation status, so the assessment
suggested the response in newborn using observations a sign of behavioral and
physiological responses Wong et al, 2009.
Some procedure of inventions that repeated pain early in life can
interfere with the development of the central nervous system permanently
Hatfield, Meyers and Messing, 2012. cause the death of brain cells. While, at
birth, new babys brain develops 25 and growing very fast their first year
Kartikawati, 2011.
From interviews with nurses in Edelweiss, intervention was given after
invasive procedure in newborn, there was no specific treatment. Generally
soon after a blood drawn, then the baby
Physiological studies indicate that the would
be returned to its original experience of pain and stress very early
to have immediate consequences in newborn. Assessment and treatment of
pain is a complex subject and a challenge when the individual was still a
baby. Reviews conducted by Page position, which is only swaddling 1S s
and they were not considered when the baby stops crying, sometimes can be
immediately stopped crying, sometimes prolonged duration of crying.
Various methods are used to 2004 shows the long-term
treat pain in newborn
with physiological consequences of pain,
including changes in the central nervous system and changes in responsibility of
neuroendokrin and the immune system. Wati 2004 explains that the pain
experienced by the baby raises three effects: the immediate, short term and
long term. Soon experienced the effects of newborn is the emergence of a sense
of fear, anxiety, sleep and wake disorders, decreased food consumption,
pharmacological and non pharmacological. Preferably non
pharmacological interventions on minor invasive procedures because the side
effects are minimal American and Canadian Academy of Pediatrics, 2000.
One non pharmacological methods that can be applied in dealing with infant
pain is 4ss technique. The initial concept of physical intervention
techniques adapted from 5ss composed
increased production of stomach acid. of swaddling, side-stomach
position, Short-term
effects can cause shushing, swinging and sucking. Based
immunological disorder the bodys defense, delayed healing, impaired
formation of emotion, while the long- term effects on memory formation of
pain, growth retardation, changes in response to pain.
Pain management in neonates has not been a major concern for health
workers; this is caused by the inability of the baby to convey pain, fear of
on concept that newborn lost fourth trimester. They not yet ready living at
wide world, they still missing lived on mother whomb. The swaddling almost
similar with mother whomb, gaved warm temperature. Side-stomach
position help their gastrointestinal and gaved support. Shushing like sound of
mother artery near whomb and giving message that mother here, available for
negative side effects used anlgesics, a newborn. Swinging
when baby at mistake to interpret the expression of
pain in newborn as an expression of fear, health workers concern for priority
disease management Hockenberry Wilson, 2007. Darcia Narvaes a
psychologist explains her opinion about continues crying on newborn. According
her the methods of letting a baby cry is dangerous because it can caused brain
mother whomb about 9 month, they living at amnion fluid and every
movement giving sensation to baby, like shaking. Sucking giving comfort affect
on newborn, like position at whomb they sucking their thumb. The research
conducted by Dr. Harrington 2010 states that most babies who get physical
intervention 5ss stop crying within 45
cell death of newborn. The mechanism seconds, while receiving
a sugar is when the newborn is stressed, they
release cortisol, a hormone that can
400 solution were still crying 2 minutes after
vaccination invasive procedures Gupta,
2012.One of reason we did dot apply sucking paciffier in this research
because of pacifier use may be associated with early breast weaning or
may be a marker of breastfeeding difficulties; therefore, it should be
avoided until breastfeeding is well established Sexton and Natale, 2009.
The 4ss technique research I did before also showed that the 4ss technique
influenced physiological pain responses dependent variables was physiological
responses heart rate, respiratory rate and temperature and crying duration of
newborn.
Data analysis with T-Test and Wilcoxon Signed Rank Test.
RESULT AND ANALYSIS RESULT
General data Table 1 Characteristics of samples
heart rate and oxygen saturation, while Characteristics
4s‟s technique C
the respiration rate showed no difference in the control group and the treatment
Type of birth F
f group Setiyorini, 2015.
Wintiyah Normal
7 30,4
7 2014 studied of applications of the 4ss
technique for the crying duration of newborn showed that the 4s‟s technique
influenced on duration of crying babies Cesarean
Gender of newborn Male
Female 16
8 15
69,6 34,8
65,2 16
10 9
with p value: 0,001. Based on background above, the
researchers interested in conducting research on the effect of 4ss technique
on physiological responses HR, RR, temperature and crying duration of
Specific data
Table 2 The effect of 4s‟s technique on physiological responses HR,
RR, temperature post venous blood sampling procedures.
newborn post venous blood sampling procedures.
Gro up
Min ima
Me an
Ma xim
Stat isti
METHODS
The research design was quasy experiment with post test only of control
group. The population of this research was newborn at Edelweis Room at
Ngudi Waluyo Wlingi Hospital with venous blood sampling procedure. The
data was collected on November 2014. The inclusion criteria were: newborn
first day
aged, weight ≥2500 gram, not in illness, apgar score of 7-10, not using
infusion, first blood sampling procedure, newborn crying during and after blood
sampling procedure. A samples of 46 newborn was taken by accidental
sampling, which were divided into 23
newborn with treatment 4s‟s technique swaddling, side-stomach position,
shushing, swinging and 23 newborn with 1s‟s technique swaddling as
control group. Heart
rate
Respi ration
rate
Temp eratur
e 4s‟s
tech niqu
e Con
trol
4s‟s tech
niqu e
Con trol
4s‟s tech
niqu e
Con trol
l 115
100 40
38 36,
6 36
12 3,8
2 13
4,8 6
42, 78
47 36,
99 36,
67 al
138
162 48
60 37,3
37 c
test p=0
,00 4
p=0 ,00
p=0 ,00
The independent variable of this study was the 4s‟s technique
swaddling, side-stomach position, shushing, swinging. While the
401 Table 3 The effect of 4s‟s technique on
crying duration newborn post
venous procedures
blood sampling According table 2, the results
showed that the average heart rate on Grou
p Min
imal Me
an Max
imal Stat
istic treatment group was lower than the
control group, but heart rate in both test
groups remained in the normal range. Cryi
ng dura
4s‟s tech
niqu 8
seco nd
20, 32
sec 40,5
6 seco
The decrease in heart rate was one indicator that the intensity of pain
experienced on newborn treatment tion
e ond
nd p=0
group has decreased compared to the Cont
rol 13,1
2 30,
14 50,1
2 ,001
control group. Respiration rate showed that the
seco nd
sec ond
treatment group was lower than the control group. This data also as the
indicator of decreased pain on newborn.
ANALYSIS Characteristics of newborn
Based on Table 1, most types of Statistic test showed that the 4s‟s
technique affected on newborn respiratory rate with p value=0,000.
labor experienced by mothers of
While the temperature of the newborn was cesar both the control and
treatment groups most of newborn with treatment group had an average higher
than the control group, but still on female gender. Biological factors in
normal range temperature. After
genetic variations causing different types of neurotransmitters and receptors
in moderate pain. There were limited data that gender also influence the
behavior of pain, the female gender had an increased expression of behavior in
response to acute pain compared to male babies. Unknown gender differences
associated with pain processes and expressions of pain Fuller, 2002;
delivery, in addition to breathing and circulatory adaptation, the newborn must
take control of body temperature. Getting too warm was as likely as
getting too cold, so parents must continue to monitor, touch and feel their
baby to ensure baby was not too hot or too cold, because both over chilling and
overheating are SIDS risk factors and could impact the health and well being
Guinsburg et al, 2000 on Rollman GB, of infants Williams,
1996. Abdel-Shaheed J, Gillespie JM, Jones
KS, 2003.
The effect of 4S’s technique on the physiological responses HR, RR,
Temperature on newborn post venous blood sampling procedures.
Venous blood sampling procedure is one of routin procedures
has effect pain. Pain is stressor for newborn. During and soon after pain
procedure infant responses by physiological, behavioral and physic.
Hockenberry Wilson 2007 states that the interpretation of pain through
physiological responses which are vital signs, variations increased heart rate,
rapid and shallow respiration and oxygen saturation decreased.
402 Temperature deviations were key signs
of illness. Variation temperature on newborn affected by external factors.
Fransson, Karlsson dan Nilsson 2005 on they studi emphasises the importance
of close physical contact with the mothers for temperature regulation
during the first few postnatal days. According this research temperature on
treatment group had an average higher than control group but still on normal
range. The 4s‟s technique given more time to newborn contact with caregiver
than 1s‟s technique. Normal temperature for infants and children is usually higher
than the normal adult temperature. At birth, heat-regulating mechanisms are
not complete developed, so a marked fluctuation in body temperature may
occur during the infant‟s first year of life The Brookside Associates Medical
Education Division, 2007. Beside that, when newborn got pain procedures, they
are responses by behavioral, its also produced calor.
The result of changed one only senses an the 4s‟s technique
involving various senses.
CONCLUSION
There was an effect of the 4s‟s physiological responses supported by
swaddling, side-stomach position,
Harvey Karp research by recondition on shushing and swinging to physiological
womb mother. Swaddling made
responses heart rate with p newborn restrict room and stopped
extreme movement, giving message that time to sleep. Side-stomach position,
newborn after delivery have morro reflex and they felt almost fall when got
surprising stimuly. Fast method to calm baby at stress condition by side-stomach
position. Shushing with sound of mouth
“ssssshhhhh” near ear baby as loud as their crying sound. This sound almost
same with artery mother. Swinging is rocking movement at our arms, this
movement not more than 1 until 2 inchi from side to side. Stimulation by used
many of senses such as sight, hearing and touching more efective for decrease
pain than used just one of senses.
The effect of 4S’s technique to crying duration on newborn post venous
value=0,004, respiratory rate with p value=0,000 and temperature with p
value=0,000 and the 4s‟s technique effect on crying duration newborn post
venous blood sampling procedures with p value=0,001.
ACKNOWLEDGEMENT The limitation of this research was on
samples, we didn‟t control the first condition on newborn, newborn hungry
or not, newborn felt cold or hot, felt comfortable or not and another factors
influenced newborn prolonged to crying.
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