THE TERMINAL CARE OF ELDERLY PEOPLE IN EAST AND SOUTHEAST ASIA

(1)

(2)

RESEARCH PROPOSAL OF

INTERNATIONAL RESEARCH COLLABORATION

THE TERMINAL CARE OF ELDERLY PEOPLE IN EAST AND

SOUTHEAST ASIA

RESEARCH TEAM

Dr. Titih Huriah, M.Kep.,Ns.,Sp.Kep.Kom (0516047701) Shanti Wardaningsih, M.Kep.,Ns.,Sp.Kep.J, Ph.D

Erna Rochmawati, MNS.,M.Med.Ed, Ph.D

MASTER OF NURSING POST GRADUATE PROGRAM

UNIVERSITAS MUHAMMADIYAH YOGYAKARTA APRIL, 2016

(3)

(4)

CONTENT

Cover page Approval page Executive summary Chapter 1. Introduction Chapter 2. Literature Review Chapter 3. Research Methodology Chapter 4. Research Plan

(5)

EXECUTIVE SUMMARY

In East and Southeast Asia, population of elderly people is increasing rapidly. Elderly people in this area spend their end of life at elderly welfare facilities or elderly care facilities as well as hospitals. In those cases, the role of care staffs during the period near the end of life is becoming increasingly important. The aim of this study are to know and explore the attitudes of care staffs including nurses, care workers, social workers and medical doctors about terminal care and death in East Asia. Mixed method with explanatory design : Follow-up Explanations model will conducted for the research method. Research were performed in Japan and Indonesia. A total of 519 staffs (319 in Japan and 200 in Indonesia) who are working at elderly care facilities participated. The positive stance towards death correlated with the years of experiences of terminal care and death. The results must be useful to improve the education of care staff. The results will also help to design the future plan of the team care of the elderly people during the terminal period of their lives.

(6)

CHAPTER I INTRODUCTION

A. Background

In Indonesia, the population of elderly people is increasing rapidly. Globally, Indonesia has the fifth-largest elderly population in the world. In 2012, there were nearly 21 million older people. Life expectancy has increased dramatically, from 45 in 1970 to 69.2 for males and 71 for women in 2010. At the same time, the birth rate has declined, resulting in an ageing population. It is estimated that by the year 2020, aging population in Indonesia will reach 11.34 per cent of total population.

In Japan, elderly people over 65 years old reached 31.86 million and accounted for 25.0 percent of the total population in 2013. Population aging rate of Japan may account for 39.4 percent in 2055.

Indonesians nowadays can expect to live for 71 years on average, up from only 45 years in 1945 when we declared our independence. It is of course an important achievement but we also should foresee the consequences of an aging population in our country. Additionally, Indonesia has contributed significantly to the accelerated growth of the elderly population worldwide. It is estimated that the country will experience an elderly population boom in the first two decades of the 21st century. Moreover, the UN has predicted that the percentage of Indonesians over 60 years old will reach 25 percent in 2050 or nearly 74 million elderly people. Several provinces have a greater number of elderly people than the national average, and Yogyakarta has the nation's largest elderly population.

As life expectancy increases, more people live past 65 years of age and into very old age, thus dramatically increasing the numbers of older people. Patterns of disease in the last years of life are also changing. More people are dying from serious chronic diseases rather than from acute illnesses. Many more people will therefore need some kind of help with problems caused by these diseases towards the end of life, and the population of people needing care is now simply much older.

Traditionally, high quality care at the end of life has mainly been provided for cancer patients in inpatient hospices, but this kind of care now needs to be provided for those with a wider range of diseases. Older people are more likely to have highly complex problems and

(7)

disabilities, and need packages of care that require partnership and collaboration between different groups and across many settings. This raises many issues for the professionals caring for them, and requires the expertise of both geriatric and palliative care in finding ways of supporting older people and their families.

Countries need to develop health care services to meet the medical and social needs of this group. Effective care must reach into the hospital, into people’s homes and into nursing and residential homes within the community. Elderly people in this area spend their end of life at elderly welfare facilities or elderly care facilities as well as hospitals. In those cases, the role of care staffs during the period near the end of life is important. In order to clarify the present status and future assignment of elderly care in these countries, we surveyed the attitudes of care staffs including nurses, care workers, social workers and medical doctors about views on terminal care, life and death.

B. Research Problem

Permasalahan pada penelitian ini adalah :

1. Bagaimanakah karakteristik, peran dan sikap pemberi asuhan keperawatan (perawat, pekerja social, dan dokter) pada pasien lansia dengan penyakit terminal baik di Indonesia maupun di Jepang?

2. Bagaimanakah model pemberian asuhan yang efektif diberikan kepada lansia dengan penyakit terminal?

C. Tujuan Penelitian

Tujuan pada penelitian ini adalah :

3. Mengetahui karakteristik pemberi asuhan keperawatan paliatif (perawat, pekerja social, dan dokter) baik di Indonesia maupun Jepang

4. Mengetahui peran pemberi asuhan keperawatan paliatif (perawat, pekerja social, dan dokter) baik di Indonesia maupun Jepang

5. Mengetahui sikap perawat, pekerja social, dan dokter saat memberikan asuhan pada pasien lansia dengan penyakit terminal

6. Menggali persepsi perawat, pasien, institusi pendidikan dan pengambil kebijakan terkait perawatan pasien terminal

(8)

CHAPTER II LITERATURE REVIEW

A. General Comparison Of The Elderly Care

General comparison in four countries Korea, Taiwan, China and Japan share the same problem to support large number of elderly people. The situation will get worse and worse in the future in all of these countries. We need to prepare for that. Establishment of the elderly people care facilities is one possible solution. However, financial and personnel resources are limited and percentage of younger generation to support elderly people will decrease continuously. The problem might be most serious in Japan. People are considering seriously the possibility to take care elderly people in the community, outside of hospital or care facilities. People are also discussing the possibility that the intensive care near the end of life might be rather painful and far from the peaceful time at the end of life. We may need to develop a system to support elderly people at home in their own community.

In order to solve the problem of personnel resources to take care elderly people, Taiwan is accepting care staffs from outside of the country, mostly from Indonesia. In China, workers came from a rural area are participating as care staffs. In Korea and Japan, the governments are considering the possibility to accept support personnel from outside of country.

For taking care of elderly people, each country has also unique problems to be solved. In Korea, the visiting clinics are not acceptable since 1977 and the death certificate must be signed by a medical doctor. Since the elderly care facilities usually do not have any medical doctors as a staff, patients tend to be transferred to the hospital near the end of their life. Some of the bigger hospitals in Korea prepare the place for funeral ceremonies within the hospital.

In Taiwan, The governmental support to the long term care is limited to severe cases or low-income cases. Then most of users of the elderly people care facilities need to pay the high percentage of their own expenses. Accordingly, family members prefer to care elderly people at home rather than an elderly people care facilities.

In China, the number of people who wish to enter the elderly people care facilities is increasing. However, the number of elderly people care facilities is still limited and also

(9)

quality of service has not been fully controlled yet. The availability of those facilities is also limited in the city area.

In Japan, the number and the percentage of elderly people are increasing rapidly and the elderly people care facilities cannot accept all of them. The number of death cases is also increasing. It is necessary to prepare the system to accept elderly people at home or in the local community. It is also necessary to facilitate the education of care staffs.

To prepare regulation of the terminal care, in Korea, Guideline of stopping the medical care for life extension had been prepared in 2010, but the guideline has no legal binding force. In Japan, the Ministry of Health, Labor and Welfare prepared the guideline for the terminal care in 2007. This guideline also has no legal binding force. In China, guideline has not been made. On the other hand, in Taiwan, Hospice Palliative Care Regulation had been legislated in 2000 and enforced in 2001. This law had been amended three times in 2002, 2011 and 2013. For preparing the system to accept decision of individual patients or family members at the end of life, Taiwan seems to be most advanced.

B. Wish for the intensive care

In East Asia, people tend to wish intensive care or tube feeding at the end of life. This tendency was stronger in China (48% for intensive care and 43% for tube feeding) and Taiwan (47% and 38%) for the family members. The trend to accept the intensive care was stronger for the family members but weaker for oneself. These tendencies may be related to the cultural background of East Asia. The decision of the family is important in China to select a plan of treatment. In contrast, the decision of each patient was most important, especially in Japan. In Korea and Taiwan, the decision of a medical doctor was also important.

C. Attitude toward the death

In China, Taiwan and Japan, the positive stance to the death correlated with the years of experiences of terminal care and death. In Japan, compared with nurses, care workers tend to avoid the death or do not wish to face the death. This difference may be related to the age difference between nurses’ group and care workers’ group, since the nurses’ group was older in Japan. Religious background was different between countries. The percentage of Christian

(10)

was higher in Korea and the percentage of Taoism was higher in Taiwan. Although the percentage of Non religious people was not really high in Japan, Japanese people were not religious compared to other countries even if they said that they are Buddhist (62.7% were Buddhist , but for 81.1% of people, the religion was not important). Independent to these differences, in all countries, the view to the death correlated with the religious background. The view to the death correlated also with age.

Surveyed the attitudes toward the terminal care and death in Korea, Taiwan, China and Japan showed people tend to accept intensive care or tube feeding at the end of life. This trend to accept the intensive care was stronger for the family members but weaker for oneself. These tendencies may be related to the cultural background of East Asia. Confucianism may be one of the common backgrounds.

Confucianism originated as an "ethical- sociopolitical teaching" during the Spring and Autumn Period developed from the teachings of the Chinese philosopher Confucius (Kǒng Fūzǐ, 551–479 BC), and later became the official state ideology of the Han Dynasty (206 BC – 220 AD). Since then, most Chinese emperors have used a mix of Legalism and Confucianism as their ruling doctrine. Although the disintegration of the Han in the second century opened the way for the doctrines of Buddhism and Taoism to dominate intellectual life, Confucianism remained in people’s mind. Historically, cultures of countries in East Asia, including mainland China, Taiwan, Korea, Japan and Vietnam were strongly influenced by Confucianism. In the 20th century, Confucianism’s influence has been greatly reduced. However, the ideology is still controlling the people’s behavior in these countries. One of the core rules of Confucianism is the respect to the higher order person of the family or the society. Based on this idea, respect to ones father and/or mother is very important in East Asia. People may feel guilty if they could not do the best possible treatment to ones father or mother. They try to give the best treatment as possible to their parents, even if parents do not want to do so.

In Taiwan, Hospice Palliative Care Regulation had been legislated in 2000 and enforced in 2001. This law had been amended three times in 2002, 2011 and 2013. In Korea and Japan, although both countries have guide lines for the regulation of the terminal care, the guidelines have no legal binding force. In China, guidelines has not been made. We need

(11)

to learn from Taiwan the system to accept decision of individual patients or family members at the end of life while they were healthy or conscious.

All of four countries are suffering a shortage of care staffs, especially in Korea and Japan. Taiwan is introducing care staffs from outside of Taiwan, mainly from Indonesia. Japan is also trying to introduce care staffs or nurses from outside of the country is accepting staffs only who had passed the national examination which was given in Japanese. Because of this strict rule, the number of foreign staffs is limited in Japan. On the other hand, Taiwan is accepting staffs who cannot speak Chinese. They are supporting the life of elderly people who need care in Taiwan. The condition of acceptance in Japan might be too strict. China is accepting staffs from a rural area in their own country, so that they do not have language problems.

The role of religion was stronger in Taiwan and Korea. In Taiwan, each hospital was preparing special rooms for religious events and Buddhist monks were working as the official staffs of the hospital. Importance of religion was intermediate in China, and weaker in Japan. For the spiritual peace at the end of life, we may need to reconsider the role of religion. The positive stance to the death was correlated with the years of experience in our survey. Experience of terminal care and death must be important in the education of care staffs. The results must be useful to improve the education of care staffs.

D. Palliative care

Palliative care was defined by the World Health Organization in 2002 (1), as :

“... an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

Palliative care provides relief from pain and other distressing symptoms, affirms life and regards dying as a normal process, and intends neither to hasten nor to prolong death. Palliative care integrates the psychological and spiritual aspects of patient care, and offers a support system to help patients live as actively as possible until death. It also offers a support system to help the family cope during the patient’s illness and in their own bereavement. Using a team approach, palliative care addresses the needs of patients and their families,

(12)

including bereavement counselling if necessary. It enhances quality of life, and may positively influence the course of the illness. It is applicable early in the course of the illness with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications (1,2).

Palliative care should be offered as needs develop and before they become unmanageable. Palliative care must not be something that only specialized palliative care teams, palliative care services or hospices offer when other treatment has been withdrawn. It should be an integral part of care and take place in any setting. The needs of older people at the end of life. It is no surprise that most deaths in European and other developed countries occur in people aged over 65. None the less, comparatively little research has been carried out on their needs for palliative care.

Older people very clearly have special needs, because their problems are different and often more complex than those of younger people : 1) Older people are more commonly affected by multiple medical problems of varying severity; 2) The cumulative effect of these may be much greater than any individual disease, and typically lead to greater impairment and needs for care; 3) Older people are at greater risk of adverse drug reactions and of iatrogenic illness; 4) Minor problems may have a greater cumulative psychological impact in older people; 5) Problems of acute illness may be superimposed on physical or mental impairment, economic hardship and social isolation.

E. The Needs Of Caregivers

Only relatively recently has the role of people caring for older seriously ill people been fully appreciated. There is relatively little formal knowledge about their needs, although their role varies considerably. It may include carrying out intimate tasks such as washing, helping people to dress and go to the toilet, or heavy tasks such as lifting. This kind of caring is usually performed by people with close kinship ties, often living in the same house and motivated by love and a desire to keep an older person out of an institution. However, the burden of care may lead in time to conflicting emotions, dealing with changes in personality and behaviour, restrictions on the carer’s own life, and the drain on financial resources.

(13)

Long-term care for seriously ill relatives is unpaid and unsupported work that may damage the health, wellbeing and financial security of caregivers themselves (11).

As ageing populations develop new needs, health care systems need to be equally flexible in their response and perceptions about palliative care need to change. Traditionally, palliative care has been offered most often to people suffering from cancer, partly because the course of this illness is more predictable and it is thus easier to recognize and plan for the needs of patients and their families. One consequence of this has been the perception that palliative care is relevant only to the last few weeks of life and can be delivered only by specialized services

(14)

CHAPTER III

RESEARCH METHODOLOGY

A. Research Design

Mixed method with explanatory design will conducted in this research. The surveys and qualitative study were performed in Indonesia and Japan.

Scheme 1. mixed method withexplanatory design : Follow-up Explanations Model (Creswell & Clark, 2011)

The explanatory design is a two-phase mixed methods design. The overall purpose of this design is that qualitative data helps explain or build upon initial quantitative results. The design starts with the collection and analysis of quantitative data about characteristics, role and attitude of care staffs during the period near the end of life. The first phase is followed by the subsequent collection and analysis of qualitative data. The second, qualitative phase of the study is designed so that it follows from the results of the first quantitative phase.

B. Population and Sample

Population for quantitative approach are 419 staffs (319 in Japan and 100 in Indonesia) who are working at elderly care facilities (hospital, nursing home, primary health center) participated in our survey. The details of participants in each country for the type of job and numbers are nurses, medical doctor, and social worker). The percentage of medical doctors was low in Japan and Indonesia because only a few medical doctors were participating as staffs in the elderly care facilities. Technical sampling use purposive sampling.

Population for qualitative are nurses, medical doctor, social worker, policy maker and institution of nursing education. Teknik sampling yang akan digunakan adalah Quantitative data collection Quantitative data analysis Quantitative results

Identify results for follow-up Qualitative data collection Qualitative data analysis Qualitative results Interpretation

(15)

sampling jenuh dimana apabila data yang didapatkan telah jenuh maka sampel diperkirakan sudah mewakili.

C. Research Location

This research will be conducted in two countries, 1 countries in southeast Asia (Indonesia) and 1 country in east Asia (Japan). The location are hospitals, nursing homes (public and private) and palliative care unit. In Indonesia, there are 5 health institution that conducted with this research, they are PKU hospital 1, PKU hospital 2, Two public nursing homes : Abiyoso nursing homes and Budi Luhur nursing homes, and one private nursing homes : Hana nursing homes.

D. Research Analysis

Quantitative analysis will be done by compare each country and than compare country in southeast Asia and east Asia. Quantitative analysis will used t-test and Anova. Qualitative analysis will used content analysis.

E. Ethical Consideration

Informed consent will given to all participants, include quantitative study and qualitative study. Ethical clearance will be process at Ethic Committee of Faculty of Medicine and Health Sciences Universitas Muhammadiyah Yogyakarta.

(16)

CHAPTER IV RESEARCH PLAN

Tahapan Kegiatan 2017

1 2 3 4 5 6 7 8 9 10 11 12

Tahapan Persiapan

Inisiasi kerjasama dengan institusi mitra X Penandatangan MoU dan MoA penelitian X

Penyusunan proposal X

Perizinan penelitian X

Tahapan Pelaksanaan Quantitative Study :

Persiapan alat dan bahan X X

Pengambilan data penelitian X

Analisis data X

Penyusunan hasil penelitian X

Penyusunan publikasi X X X X X X

Diseminasi hasil, conference dan publikasi X X X X

Qualitative Study :

Pengambilan data penelitian (FGD) X

Indepth interview X

Analisis data X

Penyusunan hasil penelitian X X X X

Penyusunan publikasi X X X X X X

(17)

REFERENCES

1. Min Bao, Chen Beibei, Wang Xin-Yun, Akiko Kobayashi, Masumi Goto, Fumie Katagiri, Naoko Morita, Toshiyuki Tsukamoto, Akichika Mikami, Hospice care in China - Based on field research in Shanghai and Suzhou-. Human Wellbeing 13, 11-18, 2013 2. Masumi Goto, Akichika Mikami, Keiko Mase, Toshiyuki Tsukamoto, Views of the elderly care staffs for the terminal care and

death. Kousei no Shihyou 2014 (in press)

3. Masumi Goto, Naoko Morita, Fumie Katagiri, Tosiyuki Tsukamoto, Current and Future End-of-Life Care for the Elderly in Japan and Korea: Survey of Staff at Nursing Care Facilities and Offices. Bulletin of Social Medicine, 31,151-158, 2014

4. Akiko Kobayashi, Toshiyuki Tsukamoto, Miwa Sakai, Masumi Goto, Akichika Mikami, Naoko Morita, Fumie Katagiri, Min Bao, A study on the end of life care for elderly in Taiwan：Through the questionnaire survey to the nurses, care workers, social

workers, doctors using the two kind types of questionnaires of “the view of terminal care” and ”the view of life and death ”. Jounal of Fukui Prefectural University (in press)

5. Kei Hirai, Yukihoro Sakaguchi, Kouji Abe, et al. Reliability of Subjective measure of attitudes for death. Death and Clinics 23, 71-6, 2000.

6. Yuko Nakai, Mitsunori Miyashita, Tomoyo Sasahara, et al. Relaiability of FATCOD-B-J. Cancer Nursing (in press) 7. Frommelt Attitudes Toward Care of the Dying Scale (FATCOD) KHM Frommelt The effects of death education on nurses'

attitudes toward caring for terminally ill persons and their families. American Journal of Hospice and Palliative Medicine, 8(5), 37-43, 1991

8. Active ageing: a policy framework. Geneva, World Health Organization, 2002 (document WHO/NMH/NPH/02.8) (www.who.int/hpr/ageing/Active AgeingPolicyFrame.pdf, accessed 22 July 2003).

(18)

10.Koffman J, Snow P. Informal carers of dependants with advanced disease. In: Addington-Hall J, Higginson IJ, eds. Palliative care for non-cancer patients. Oxford, Oxford University Press, 2001.

(19)

19 APPENDIX :

A questionnaire about life and death developed by Hakujikai Institute of Gerontology in Japan ◆ This survey will ask you about some of your current thoughts and feelings. Please look at the items below and circle the one that most closely matches them in each section.

1) I believe there is a life after death.---1-2-3-4-5-6-7 2) I believe in the supernatural, for example things like ghosts and curses.---1-2-3-4-5-6-7 3) I believe that a person's soul remains after their death. ---1-2-3-4-5-6-7 4) I believe that after a person dies, they will be reborn again. ---1-2-3-4-5-6-7 5) Dying is frightening to me. ---1-2-3-4-5-6-7 6) When I think about my own death, I feel anxious. ---1-2-3-4-5-6-7 7) I think that death is a frightening thing. ---1-2-3-4-5-6-7 8) I am terrified of death. ---1-2-3-4-5-6-7 9) I think of death as a release from the suffering of this world. ---1-2-3-4-5-6-7 10) I think of death as a release from the burdens of this life. ---1-2-3-4-5-6-7 11) Death is a release from pain and suffering. ---1-2-3-4-5-6-7 12) Death brings freedom to your soul. ---1-2-3-4-5-6-7 13) I avoid thinking about death. ---1-2-3-4-5-6-7 14) I'd like to avoid thinking about death, no matter what I'm doing. ---1-2-3-4-5-6-7 15) Whenever thoughts of death come to mind, I try to set them aside and forget

about it.---1-2-3-4-5-6-7 16) Death is a frightening thing, so I try not to think about it. ---1-2-3-4-5-6-7 17) I have found a clear sense of duty and purpose in my life. ---1-2-3-4-5-6-7 18) I can find sufficient meaning, purpose, and duty in my life. ---1-2-3-4-5-6-7 19) When I think about my life, there's a clear reason for where I am and

how I'm living today. ---1-2-3-4-5-6-7 20) The future is bright. ---1-2-3-4-5-6-7 21) I often think "what is death?" ---1-2-3-4-5-6-7 22) I often think about my own death. ---1-2-3-4-5-6-7 23) I often think about the deaths of people close to me. ---1-2-3-4-5-6-7 24) I often talk to my friends and family about death. ---1-2-3-4-5-6-7 25) I think the length of a person's life is decided in advance.---1-2-3-4-5-6-7

(20)

26) I think the length of a person's life is set from birth. ---1-2-3-4-5-6-7 27) People's lives and deaths are decided by unseen forces (fate, god, etc.). ---1-2-3-4-5-6-7

(21)

(22)

LAMPIRAN 2. MoA Penelitian between Master of Nursing UMY with Faculty of Nursing Chubu Gakuin University

(23)

520 2011, UMY

487 (ITP) 2013, UGM

Lampiran 3 CV Team Researcher

Lampiran 3 : CV Tim Peneliti

1. Dr. Titih Huriah, M.Kep.,Sp.Kom (Ketua Peneliti) PERSONAL DATA

1. Full name (capital letters) : HURIAH TITIH

2. Gender : Female

3. Place & date of birth : Bogor, 16/4/1977

4. Home address & Phone no. : Jl. Pandega Marta Raya No. 166C Pogung Lor Sinduadi

Mlati Sleman Yogyakarta Indonesia, Post code :55284 Mobile phone :081392405406

5. E-mail address : titih_psikumy@yahoo.com

6. Marital Status : Married

7. Spouse’s occupation : Engineering

8. Employment

University : University of Muhammadiyah Yogyakarta

Faculty : Post Graduate Program

Department : Master of Nursing

9. Employment data : NIK: 173.045 NIDN: 0516047701

10. Rank (Golongan) : IIIC (lector)

EDUCATION BACKGROUND

No. Name of Institution Year attended Degree/

Certificate Field of Study

From To

1. Gadjah Mada University 1998 2001 Bachelor Nursing

2. University of Indonesia 2004 2007 Master and

Specialist Community nursing

3. Gadjah Mada University 2011 2015 Doctoral program Public health

1. English proficiency:

International (official) TOEFL/IELTS:

Score Year

obtained

Pre-TOEFL/IELTS:

Score Year

obtained

(24)

297/520 2011, Acept UGM

Score Year obtained

Score Year

obtained

Proficiency in foreign language(s):

English French Chinese Mandarin Japanese Other

(………)

Fair Good Very

good Fair Good

Very

good Fair Good

Very

good Fair Good

Very

good Fair Good

Very good

Spoken √

Written √

ACADEMIC BACKGROUND

No. Year Project Title Position

1 2014

The Effect of Nutrition Supporting Group To Improved Nutrient Status for Children Under Five with Malnutrition in Mantrijeron Yogyakarta

Principal investigator

2 2014

The Effect Of Activity Therapy : Ergonomic Exercises To Decrease Joint Pain Scale In Elderly With Joints Degenerative At Work Area Kasihan II Public Health Center, Bantul, Yogyakarta

Principal investigator

3 2013

The Influence of Home Care to Decrease Infec tion Disease Episodes in Malnutrition Children Under Five in Yogyakarta

Principal investigator 4 2013 Effect of Home Care to Fulfillm e nt Nutrition Needs in

Toddle rs with malnut rition in Yogya k art a Principal investigator

5 2013

Effectiveness of Orally and Topically Gel Extract of Kelor Leaf (Moringa oleifera) on Acceleration of Cutaneous Wound Healing : An experimental Study in Mice

Consultant

6 2012

The Influences Of Primary Health Centre Nurse Training To Increase Home Care Knowledge To Under Five Years Old With Malnutrition in Yogyakarta

Principal investigator

2011 The influence of health education on acute

respiratory infection towards mother ability in caring acute respiratory infection in children

Consultant

2011 The corelation between knowledge and attitude

towards the implementation of mosquito’s nest

eradication by society

Consultant

2010 Effectiviness of Play therapy to Decrease a

Symptoms of PTSD ( Post Traumatic Stress Disorder) For Traumatized Children in Cangkringan Yogyakarta

(25)

2010 The effect of giving guidance about the risk of injury prevention behavior in elementary Bibis Kasihan Bantul Yogyakarta

Principal investigator

2010 The Description of Community Health Nurses’

Preparedness on Disaster Management in

Puskesmas Kasihan I Bantul Yogyakarta

Consultant

2009 _{The influence of health education on acute}

respiratory infection toward mother ability in caring on acute respiratory infection children at Bantul Yogyakarta

Consultant

2009 The Influence of Health Education on Mother’s

Capabilities for Early Detection on Children Under Five Years Old Developmental Disorders in Taruban Kulon Village, Tuksono, Sentolo, Kulonprogo

Consultant

Recent scientific publications published in journals

No. Year Article Title Journal’s name and place

of publication 1 2015 Improving Nutritional Status of Children with _{Severe Acute Malnutrition}

Through Home Care Program

Jurnal Kesmas UI, volume 9 No. 2, Jakarta, Indonesia

2 2015 Severe acute malnutrition and determinants

among children in rural and urban communities

Jurnal Kesmas UI, volume 9 No. 1, Jakarta, Indonesia

2013 The Influence of Home Care to Decrease Infection Disease Episodes in Malnutrition Children Under Five in Yogyakarta

Preceedings International

Conference on “Cross -Cultural Collaboration in Nursing for Sustainable

Development”

2013 _{Effect of Home Care of Fulfillm e nt Nutrition Needs} in Toddlers with malnutrit ion in Yogy ak a rt a

Preceedings International

Conference on “Cross -Cultural Collaboration in Nursing for Sustainable

Development”

2013 The Influences Of Public Health Centre Nurse Training To Increase Home Care Knowledge To Under Five Years Old With Malnutrition in Yogyakarta

Preceedings International

Conference on “Cross -Cultural Collaboration in Nursing for Sustainable

Development”

2013 The Influence of Home Care to Decrease Infection Disease Episodes in Malnutrition Children Under Five in Yogyakarta

Preceedings International

Conference on “Cross -Cultural Collaboration in Nursing for Sustainable

Development”

2011 The influence of health education on acute

respiratory infection towards mother ability in caring acute respiratory infection in children

Proceeding of 10th

international family

nursing conference, Kyoto Japan

2011 The corelation between knowledge and attitude

towards the implementation of mosquito’s nest

eradication by society

Proceeding of Jogja

international nursing

(26)

9 2010 The effect of giving guidance about the risk of _{injury prevention behavior in elementary Bibis} Kasihan Bantul Yogyakarta

Jurnal KEPERAWATAN. Volume 1 Nomor1 Januari 2010, ISSN: 2086-3071 10 2010 The Description of Community Health Nurses’ _Preparedness _on _Disaster _Management _in

Puskesmas Kasihan I Bantul Yogyakarta

Jurnal Mutiara Medika, Vol. 10 No. 2 Juli 2010 ISSN:1411-8033 11

2010 Effectiviness of Play therapy to Decrease a

Symptoms of PTSD ( Post Traumatic Stress Disorder) For Traumatized Children in Cangkringan Yogyakarta

International Nursing Seminar. ISBN:978-602-19251-0-2

2009 The Influence of Health Education on Mother’s

Capabilities for Early Detection on Children Under

Five Years Old Developmental Disorders in

Taruban Kulon Village, Tuksono, Sentolo,

Kulonprogo

Prosiding International Nursing Conference Health And The Impact of Global Warming

Nopember 2009

ISBN:978-979-19799-8-6 Academic referees (former advisors, direct academic advisors, etc.)

No. Name Relationship Country

1 Prof. dr. Laksono Trisnantoro,

M.Sc.,Ph.D Former Advisor Indonesia

2 Prof. dr. Madarina Julia, MPH, Ph.D, Sp.A (K)

Former Advisor

Indonesia

3 Dr. Fitri Haryanti, S.Kp.,M.Kes Former Advisor Indonesia

A. PRESENT POSITION AND DUTIES

1. Teaching responsibilities

No. Course Titles

1 Community Nursing (S1)

2 Family Nursing (S1)

3 Gerontological Nursing (S1) 4 Block of Caring (S1)

5 Basic Nursin Science 7 (S1)

6 General Education (S2)

7 Nursing Research (S2) 8 Elective : Statistic (S2)

(27)

Year Position

2010-2011 Head of Nursing Program

2008-2010 Secretary of Nursing Program

2007-current Head of Community Nursing Departement

2012-2013 Head of Human Resources of Nursing Program

2011-current Team of Curriculum Development of Magister Nursing Program

2015-current Secretary of Magister Nursing UMY

2. CV Erna Rochmawati

Curriculum Vitae Erna Rochmawati Last Update: February 2016

Office: School of Nursing Email: erna.rochmawati@umy.ac.id

F 4 building, level 4 erna_rho@yahoo.com

Universitas Muhammadiyah Yogyakarta Kampus Terpadu UMY

Jl. Lingkar Barat, Tamantirto, Kasihan Office: +62 274 387656 ext 215

Bantul, Yogyakarta, 55183 Mobile: +62 813 937 02252(preferred contact no.)

Home: Sidorejo No 9 Rt 9, Dkh XII Place/Date of Birth: Indonesia, 25 October 1979

Ngestiharjo, Kasihan, Bantul Citizenship: Indonesian

Yogyakarta, 55182 Gender: Female

Indonesia

CURRENT POSITION

Senior Lecturer in School of Nursing, Universitas Muhammadiyah Yogyakarta

EDUCATION

PhD student: University of Adelaide, 2012-now

Master of Nursing Science: University of Adelaide, Australia, 2008 – 2009 Master of Medical Education: University of Gadjah Mada, Indonesia, 2006 - 2011 Bachelor of Nursing Science: University of Indonesia, 1997 -2001

PAST RESEARCH EXPERIENCE

1. Effect of progressive relaxation techniques to level of pain, fatigue, insomnia among patients with chronic kidney disease who undergo hemodialys is in PKU Hospital Yogyakarta (2011), source of funding: Association of Indonesian Nurse Education Institution

2. Being Health Volunteers during Mt Merapi Eruption: What Undergraduate Nurse Students Learnt? (2011). http://journal.umy.ac.id/index.php/mm/article/view/924

3. Exercise in type II DM patients and their blood glucose level and Health – related quality of life in Kasihan II Primary Health Care, (2010), source of fund : Faculty of Medicine and Health Sciences, UMY

(28)

28 AWARDS

1. Research grant, Faculty of Medicine and Health Science (2004, 2010)

2. Research grant, Association of Indonesian Nursing Education Institution (2011)

3. Grant for attending the 17th_{WADEM Conference, Beijing, China , Ministry of Education (2011)}

4. Endeavour Prime Minister’s Asia Australia Scholarship, Government of Australia (2012-now) 5. Tuition fee waiver, Adelaide Graduate Center, University of Adelaide (2012 -now)

6. Hospice23 Bursary Award, United Kingdom (2015) PUBLICATION

Journal

1. Rochmawati, E, Wiechula, R (2010). Educatio Strategies to Foster Health Professio Stude ts’ Cli ical Reaso i g Skills: Systematic Review. Nursing and Health Sciences, vol 2, no. 2, pp. 244-250.

2. Rizki, W & Rochmawati, E (2011). Perbedaan nilai uji fungsi paru antara karyawan di ruang produksi dan karyawan di ruang administrasi di pabrik textile Magelang, Jurnal Ners Indonesia, vol 2 no 1.

3. Rochmawati, E. (2011). Being Health Volunteers during Mt Merapi Eruption: What Undergraduate Nurse Students Learnt?, Jurnal Mutiara Medika, Vol 11 (1). http://journal.umy.ac.id/index.php/mm/article/view/924

4. Rochmawati, E. Rahayu, G.R, Kumara, A. (2014). Educational environment and approaches to learning of undergraduate nursing students in an Indonesian School of Nursing, Nurse Education in Practice, vol. 14. pp. 729 -733.

doi:10.1016/j.nepr.2014.08.009

5. Rochmawati, E, Wiechula, R, Cameron, K (2016). Current status of palliative care services in Indonesia: Literature review, International Nursing Review, doi:10.1111/inr.12236

Proceeding

1. Rochmawati, E, Wiechula R (2010). Lear i g ethods to develop health professio stude ts’ cli ical reaso i g skills. Proceeding. Java International Nursing Conference.

2. Rochmawati, E (2011), Pengaruh tehnik relaksasi progresif terhadap tingkat nyeri, insomnia dan fatique pada pasien gagal ginjal kronik yang menjalani hemodialisa, proceeding, International Nursing Conference, Universitas Hasanudin. 3. Rochmawati, E (2011). Being Health Volunteers during Mt Merapi Eruption: What Undergraduate Nurse Students

Learnt? Prehospital and Disaster Medicine, vol 26, supplement 1, p. s14. http://dx.doi.org/10.1017/S1049023X11000586

4. Suhariyanto & Rochmawati, E (2011). Nurse Educators’ Experie ces of Co ducti g Trau a Heali g to Reduce Anxiety Among Victims of Mt Merapi Eruption at Universitas Muhammadiyah Yogyakarta, Prehospital and Disaster Medicine, vol 25, supplement 1, p. s161. http://dx.doi.org/10.1017/S1049023X11004961

5. Rochmawati, E (2010), Students perceptions on learning environment in PSIK UMY, proceeding, Jogjakarta International Nursing Conference, 2010.

6. Rochmawati, E, Wiechula, R & Cameron, K (2012), An exploration of the provision of palliative care for cancer patients in Indonesia, Research Conversazione, School of Nursing, University of Adelaide.

7. Rochmawati, E, Wiechula, R, Cameron, K (2013). Facilitators and barriers in palliative care: a literature review, proceeding, the Asian International Humanised Health Care Conference, Yogyakarta

8. Rochmawati, E, Wiechula, R, Cameron, K (2014). Family caregiver involvement in home based care for palliative cancer patients in Indonesia, Asia -Pacific Journal of Clinical Oncology, 10(Suppl. 9); pp. 449 -450. Doi:10.1111/ajco.12332

CONFERENCE/S EMINAR PRESENTATION

2010 1. National Scientific Meeting for Nursing Higher Education Institution (2010), organised by Association of Nursing Education Institution

2. Java International Nursing Conference , University of Diponegoro, 2 – 3 October 2010 (Oral presentation)

3. SEARA medical education conference, Jakarta, November 2010 (oral communication) 4. Preceptorship model training, Universitas Muhammadiyah Malang, December 2010

(speaker)

(29)

2011 1. The 17th_{World Congress on Disaster and Emergency Medicine. Beijing, China, June 2011}

(oral presentation)

2. International Nursing Conference, organized by AIPNI and School of Nurs ing, University of Hasanudin (oral presentation)

3. The first Jogja International Nursing Conference, organized by School of Nursing, Universitas Muhammadiyah Yogyakarta, (poster presentation)

4. Workshop for educator for tobacco curriculum, November, Singapore

5. Journal Presentation (2012) training to nurses in PKU Muhammadiyah Hospital (speaker) 2012 1. Workshop to gather strategic partner in tobacco control (2012), Muhammadiyah Tobacco

Control Center, UMY and Johns Hopkins School of Public Health (coordinator) 2. National Joanna Briggs Institute Conference, Adelaide, 2012

3. Faculty of Health Science Post graduate Conference, Adelaide, 2012.

2013 1. Research Conversazione, School of Nursing, University of Adelaide, oral presenter 2. JBI Systematic Review Training, University of Adelaide

3. JBI International Conference, Adelaide

4. Asian Internasional Humanised Health Care Conference, Indonesia 2014 1. Nursing and Midwifery Forum, Department of Health, South Australia

2. World Care Congress, Melbourne, oral presenter

3. South Australia National Palliative Care Congress, Adelaide, participant 2015 1. South Australia National Palliative Care Congress, Adelaide

2. Compassionate care in palliative care. Hospice23 Conference. Devon, United Kingdom. Oral Presenter

(30)

Lampiran 4 : Sarana Prasarana dan research instrument

Sarana Prasarana untuk kelancaran penelitian adalah :

7. Telah adanya RS pendidikan Magister Keperawatan UMY yaitu RS PKU1 dan PKU 2 yang akan dijadikan tempat penelitian

8. Telah adanya MoU dengan PSTW (nursing homes)

9. Instrumen penelitian telah dialih bahasakan ke bahasa Indonesia

Kuesioner Mengenai Kehidupan Dan Kematian oleh Institute Hakujikai Gerontologi di Jepang

Survei ini akan menanyakan tentang beberapa pikiran dan perasaan anda saat ini. Pilihlah hal yang sesuai

1 : Tidak Setuju 2 : Agak Tidak Setuju 3 : Sedikit Tidak Setuju 4 : Ragu-ragu

5 : Sedikit setuju 6 : Agak Setuju 7 : Setuju

No. Pernyataan 1 2 3 4 5 6 7

1. Saya percaya ada kehidupan setelah kematian 2. Saya percaya dengan kekuatan supranatural,

contohnya setan

3. Saya percaya bahwa jiwa seseorang akan abadi setelah mereka mati

4. Saya percaya setelah seseorang mati, mereka akan dilahirkan kembali

5. Sekarat sangat menakutkan untuk saya

6. Ketika saya berpikir tentang kematian saya, saya merasa takut

7. Saya rasa kematian merupakan hal yang menakutkan

8. Saya sangat takut mati

9. Saya rasa kematian merupakan pelepasan terhadap penderitaan di dunia

10. Saya rasa kematian merupakan jalan keluar dari ketidakberuntungan di dunia

11. Saya rasa kematian merupakan jalan keluar dari rasa sakit dan penderitaan

(31)

13. Saya menghindari pemikiran tentang kematian 14. Saya ingin menghindari memikirkan tentang

kematian, tidak peduli apa yang saya lakukan 15. Ketika pikiran tentang kematian datang, saya

berusaha mengesampingkan dan melupakannya 16. Kematian merupakan hal yang sangat menakutkan

jadi saya berusaha untuk tidak memikirnya 17. Saya memiliki beberapa tujuan terkait tugas dan

tujuan hidup

18. Saya memiliki arti, tujuan dan tugas dalam hidup saya.

19. Ketika saya memikirkan tentang hidup saya, ada alasan yang jelas tentang bagaimana saya

menjalani hidup

20. Menurut saya, masa depan itu cerah 21. Saya sering memikirkan “apa itu mati”

22. Saya sering memikirkan tentang kematian saya 23. Saya sering berpikir tentang kematian

orang-orang terdekat saya

24. Saya sering berbicara kepada teman saya dan keluarga saya mengenai kematian

25. Saya pikir panjang hidup seseorang sudah ditentukan

26. Saya pikir panjang hidup seseorang di tentukan sejak saat dia lahir

27. Kehidupan dan kematian seseorang ditentukan oleh kekuatan yang Maha Kuasa

(1)

26

9 2010 The effect of giving guidance about the risk of _{injury prevention behavior in elementary Bibis} Kasihan Bantul Yogyakarta

Jurnal KEPERAWATAN. Volume 1 Nomor1 Januari 2010, ISSN: 2086-3071 10 2010 The Description of Community Health Nurses’ _Preparedness _on _Disaster _Management _in

Puskesmas Kasihan I Bantul Yogyakarta

Jurnal Mutiara Medika, Vol. 10 No. 2 Juli 2010 ISSN:1411-8033 11

2010 Effectiviness of Play therapy to Decrease a Symptoms of PTSD ( Post Traumatic Stress Disorder) For Traumatized Children in Cangkringan Yogyakarta

International Nursing Seminar. ISBN:978-602-19251-0-2

2009 The Influence of Health Education on Mother’s Capabilities for Early Detection on Children Under Five Years Old Developmental Disorders in Taruban Kulon Village, Tuksono, Sentolo, Kulonprogo

Prosiding International Nursing Conference Health And The Impact of Global Warming

Nopember 2009

ISBN:978-979-19799-8-6 Academic referees (former advisors, direct academic advisors, etc.)

No. Name Relationship Country

1 Prof. dr. Laksono Trisnantoro,

M.Sc.,Ph.D Former Advisor Indonesia

2 Prof. dr. Madarina Julia, MPH, Ph.D, Sp.A (K)

Former Advisor

Indonesia

3 Dr. Fitri Haryanti, S.Kp.,M.Kes Former Advisor Indonesia

A. PRESENT POSITION AND DUTIES

1. Teaching responsibilities

No. Course Titles

1 Community Nursing (S1) 2 Family Nursing (S1)

3 Gerontological Nursing (S1) 4 Block of Caring (S1)

5 Basic Nursin Science 7 (S1) 6 General Education (S2) 7 Nursing Research (S2) 8 Elective : Statistic (S2)

(2)

27

Year Position

2010-2011 Head of Nursing Program 2008-2010 Secretary of Nursing Program

2007-current Head of Community Nursing Departement 2012-2013 Head of Human Resources of Nursing Program

2011-current Team of Curriculum Development of Magister Nursing Program 2015-current Secretary of Magister Nursing UMY

2. CV Erna Rochmawati

Curriculum Vitae Erna Rochmawati Last Update: February 2016

Office: School of Nursing Email: erna.rochmawati@umy.ac.id F 4 building, level 4 erna_rho@yahoo.com Universitas Muhammadiyah Yogyakarta

Kampus Terpadu UMY

Jl. Lingkar Barat, Tamantirto, Kasihan Office: +62 274 387656 ext 215

Bantul, Yogyakarta, 55183 Mobile: +62 813 937 02252(preferred contact no.)

Home: Sidorejo No 9 Rt 9, Dkh XII Place/Date of Birth: Indonesia, 25 October 1979 Ngestiharjo, Kasihan, Bantul Citizenship: Indonesian

Yogyakarta, 55182 Gender: Female Indonesia

CURRENT POSITION

Senior Lecturer in School of Nursing, Universitas Muhammadiyah Yogyakarta

EDUCATION

PhD student: University of Adelaide, 2012-now

PAST RESEARCH EXPERIENCE

2. Being Health Volunteers during Mt Merapi Eruption: What Undergraduate Nurse Students Learnt? (2011). http://journal.umy.ac.id/index.php/mm/article/view/924

(3)

28

AWARDS

1. Research grant, Faculty of Medicine and Health Science (2004, 2010)

2. Research grant, Association of Indonesian Nursing Education Institution (2011)

3. Grant for attending the 17th_{WADEM Conference, Beijing, China , Ministry of Education (2011)} 4. Endeavour Prime Minister’s Asia Australia Scholarship, Government of Australia (2012-now) 5. Tuition fee waiver, Adelaide Graduate Center, University of Adelaide (2012 -now)

6. Hospice23 Bursary Award, United Kingdom (2015) PUBLICATION

Journal

2. Rizki, W & Rochmawati, E (2011). Perbedaan nilai uji fungsi paru antara karyawan di ruang produksi dan karyawan di ruang administrasi di pabrik textile Magelang, Jurnal Ners Indonesia, vol 2 no 1.

doi:10.1016/j.nepr.2014.08.009

5. Rochmawati, E, Wiechula, R, Cameron, K (2016). Current status of palliative care services in Indonesia: Literature review, International Nursing Review, doi:

10.1111/inr.12236

Proceeding

1. Rochmawati, E, Wiechula R (2010). Lear i g ethods to develop health professio stude ts’ cli ical reaso i g skills. Proceeding. Java International Nursing Conference.

Learnt? Prehospital and Disaster Medicine, vol 26, supplement 1, p. s14.

http://dx.doi.org/10.1017/S1049023X11000586

http://dx.doi.org/10.1017/S1049023X11004961

5. Rochmawati, E (2010), Students perceptions on learning environment in PSIK UMY, proceeding, Jogjakarta International Nursing Conference, 2010.

7. Rochmawati, E, Wiechula, R, Cameron, K (2013). Facilitators and barriers in palliative care: a literature review, proceeding, the Asian International Humanised Health Care Conference, Yogyakarta

10.1111/ajco.12332

CONFERENCE/S EMINAR PRESENTATION

2010

1. National Scientific Meeting for Nursing Higher Education Institution (2010), organised by Association of Nursing Education Institution

2. Java International Nursing Conference , University of Diponegoro, 2 – 3 October 2010 (Oral presentation)

3. SEARA medical education conference, Jakarta, November 2010 (oral communication) 4. Preceptorship model training, Universitas Muhammadiyah Malang, December 2010

(speaker)

(4)

29 2011

1. The 17th_{World Congress on Disaster and Emergency Medicine. Beijing, China, June 2011} (oral presentation)

2. International Nursing Conference, organized by AIPNI and School of Nurs ing, University of Hasanudin (oral presentation)

3. The first Jogja International Nursing Conference, organized by School of Nursing, Universitas Muhammadiyah Yogyakarta, (poster presentation)

4. Workshop for educator for tobacco curriculum, November, Singapore

5. Journal Presentation (2012) training to nurses in PKU Muhammadiyah Hospital (speaker)

2012

1. Workshop to gather strategic partner in tobacco control (2012), Muhammadiyah Tobacco

Control Center, UMY and Johns Hopkins School of Public Health (coordinator) 2. National Joanna Briggs Institute Conference, Adelaide, 2012

3. Faculty of Health Science Post graduate Conference, Adelaide, 2012.

2013 1. Research Conversazione, School of Nursing, University of Adelaide, oral presenter 2. JBI Systematic Review Training, University of Adelaide

3. JBI International Conference, Adelaide

4. Asian Internasional Humanised Health Care Conference, Indonesia 2014 1. Nursing and Midwifery Forum, Department of Health, South Australia

2. World Care Congress, Melbourne, oral presenter

3. South Australia National Palliative Care Congress, Adelaide, participant 2015 1. South Australia National Palliative Care Congress, Adelaide

2. Compassionate care in palliative care. Hospice23 Conference. Devon, United Kingdom. Oral Presenter

(5)