DISCUSSION AND ANALISIS Self Care
neighbor of self-care that must be done, the self-awareness of their health status was
Nursing independent self-care by
also greatly contributes to the patients Dorothea E. Orem was an implementation
of the activities initiated and conducted by the individuals themselves to meet the
need to maintain life, health and well- being according to the circumstances,
either healthy or sick. Based on this study the ability of self-care acquired by 6
people in the category ability of self-care partial was only some of these patients can
meet the needs of self-care daily, and the majority of respondents included in the
ability of self-care self-sufficient, as many as 24 people with a sense could be said of
these patients does not need any help at all in meeting the needs of daily self-care.
From the data tabulation of data obtained minimum value of self-care was at the 8
and the maximum value obtained was 16. While in the category of total or require
full assistance in fulfilling the needs of daily self-care, was not found in research
in Hemodialysis Installation Mardi Waluyo Hospital Blitar.
ability to self-care, and health education on self-care given by nursing staff in hospitals
Hemodialsa Installation the Mardi Waluyo.
Quality of Life Quality of life is the perception person
about the individual how assess their own health. It is influenced by several factors,
medical and non-medical interconnected. Pain, or effect to ones physical area, has
an impact to the psychological condition of people and relationships. Mercedes-
Moreiras uses the term Health-Related Quality of Life because it is defined
formally as when the physical, emotional and social reasonable or are expected to be
affected by a medical condition or treatment. The concept of Health-Related
Quality of Life HRQOL shows the impact of a disease or medical action
against the physical symptoms, functional status, and mental and social functioning.
Agus Yuono in 2000, the quality of life
Actually, necessary of self-care by
decreases with increasing age, patients Dorothea E. Orem learned and influenced
by individuals themselves, the environment, health and nursing. Self-care
was the first step by individuals that take place on an ongoing basis according to the
circumstances and its existence, good health and perfection. Self-care
independent universally assumed as the ability to meet life daily care that have
been identified to the respondents in this with terminal renal failure young age will
have a better quality of life because typically have better physical condition.
Male gender have a lower quality of life than in women, and the longer undergoing
hemodialysis the lower the quality of life of patients. Etiology or cause of chronic
kidney disease nephrotic diabetic disease has a poorer quality of life than patients for
other reasons Bergstrom, 1985 in Agus
study through questionnaires include
Yuono 2000. moderately air intake, moderate intake of
water, moderate intake of food, the fulfillment of the functions of elimination,
balance between activity and rest, fulfillment activities and social
interactions, precautions against the dangers of life, and is able to live a normal
life. Disappearance category abilities self care
total respondents possible because the respondents themselves quickly adapt to
the circumstances they were experiencing now, the everyday environment where they
often come face to face with renal failure patients other and share experiences
Based on the research quality of life of patients with kidney failure in
Hemodialysis Installation Mardi Waluyo Hospital Blitar very varied, with the
acquisition of a minimum value is 48.2 and the maximum value obtained 86.7. The
average value of the quality of life obtained from 30 respondents was 73.83.
Assessment of quality of life particularly a maximum value of 100, the number 100
can be said to approach the quality of life of patients with chronic renal failure, the
better. Age, education, the last ever taken of respondents do not have a meaningful
role. Age and educational status does not
430
guarantee a persons past can assess and perceive a state of pain they experienced
well. According to Mercedes Moreiras quality of life is affected by the physical,
psychological and social relations. Based on research conducted Agus Yuono
2000, a precursor of diabetes mellitus disease has a significant role in the quality
of life. In this study did not prove so because the number of patients with
chronic renal failure in this study the majority had hypertension predecessor
disease. In the grouping of sex, women have a better quality of life than in males
with a minimum value the quality of life in women is 68.20, the minimum value of the
relationship with quality of life. As in this study, a factor that has not been previously
studied the ability of self-care that turned out to have quite a significant relationship
in the quality of life of patients with chronic renal failure.
Relationship between Self-Care Ability with Quality of Life
From the statistical test using Spearmans rho correlation test with SPSS version 17
is the result p value of 0.008. Because the value of p 0.05 then the H1 is accepted it
means there was a significant correlation between self-care ability and quality of
life. The value of the correlation
quality of life in men 48.20, while the coefficient obtained
from the SPSS maximum value obtained in women was
86.7 and 86.4 in men. The difference between the quality of life gained men and
women, may be because men are usually more active in the work, and make a living
for his family so that the male has a standard priority higher quality of life
compared with patients female. As a result the quality of life of men will get lower
statistical test was rs: 0.473 correlation coefficient that shows the correlation
between the levels of self-care with the quality of life considerably. Positive values
obtained in the correlation coefficient have a meaning, the higher the self-care ability
the higher the quality of life of patients with chronic renal failure in Hemodialysis
Installation Mardi Waluyo Hospital Blitar.
when compared to women. Quality of life The ability of self-care
was an
of respondents undergoing hemodialysis 1- 20 months long enough to dominate the
minimum value of the quality of life to appear as much as 4 respondents in the
four lowest value and 4 respondents in moderate values. This can caused initial
adaptation period or tolerance of a patient with chronic renal failure undergoing
hemodialysis the first time both psychologically and physically.
In a previous study conducted by Agus Yuwono in Hemodialysis Unit of Hospital
Dr. Kariadi 2000 shows the nutritional status, etiology, and the number of
comorbid affect the quality of life, whereas sex, duration of HD and age do not have a
meaningful relationship. Research results Kusman Ibrahim 2009 revealed that there
were significant differences between the quality of life by gender and other
accompanying health problems, whereas there was no significant difference in the
quality of life of patients according to age, education level, and the longer undergo
hemodialysis. Each research area has different factors that have a significant
implementation of the activities initiated and does by individuals themselves to meet
the need to sustain life, health and well- being in accordance with the state of both
sick and healthy, the results of this study show the ability of self-care that was
owned patients with chronic renal failure have a encouragement or motivation of its
own to live with what happened to him today. With more and more patients could
perform independence in self-care could improve satisfaction, or can be called
psychic satisfaction for the fulfillment of their needs, both externally and perception
needs. And satisfaction was what drives an individual gives good value for itself in the
quality of life.
CONCLUSIONS Self-care ability of patients with chronic
renal failure who receive hemodialysis action in Hemodialysis Installation Mardi
Waluyo Hospital Blitar with an average value of 12.93 which if considered to be in
an independent category. The average value of the quality of life that was 73.83,
431
getting closer to the 100 it can be said the Moreiras, Mercedes P. 2011. “
Assessment
quality of life of patients with chronic
of Health-Related Quality of
renal failure, the better. There was correlation between self-care ability and
quality of life with a p-value: 0.008 and rs: 0.473
ACKNOWLEGEMENT
The limitations of the study using a questionnaire that is sometimes the
answer given by the sample did not show real state. In addition to assessing the
quality of life of patients with chronic renal failure can be changed according to
time with the psychological and emotional
Life:TheCinderella of Peritoneal Dialysis?
”,accesed on February 192012
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432
THE EFECTIVENESS OF PROBLEM BASED LEARNING MODEL DEPEND ON LEARNING
OUTCOMES STUDENT IN COURSE PREGNANCY ON OBSTETRICAL CARE ON DIPLOMA PROGRAM
Nevy Norma Renityas Program Studi D3 Kebidanan STIKes Patria Husada Blitar
nevy_syaiyahoo.com ABSTRACT
The changes in a Health education system must be done for better education. Midwifery care in pregnancy is health education courses in midwifery
department. In order to get the optimal result of education, it is required an innovative learning models. There are many models of learning innovation such
as example problem based learning. Based on the consideration above, researchers want to analyze the effectiveness of Problem Based Learning depend on learning
outcomes student in course
Pregnancy on Obstetrical Care learning Diploma Program.
This research was done in STIKes Patria Husada Blitar on 25 February until March 8 th 2015. This research used quantitative approach, quasy
experimental. The population and the sampel was the students in the third semesters in the total amount of 38 student divide into 2 groups in random. The
control group was discussion group in the amount of 18 people. Problem based learning group experimental group consists of 20 people divided into 4 groups,
each group consists of five people. The Independent Variable was Problem Based learning while the Dependent Variable was learning outcomes.
The results of the research showed there was a significant difference with different test results using a t-test t:-5,46 between learning outcomes using
problem based learning model and class group discussion on pregnancy midwifery care courses. The problem based learning model is more effective than
group discussions.
Keywords: Problem Based Learning, Learning Outcomes, Pregnancy on obstetrical Care
INTRODUCTION
Day by day, the problems faced by many people tend to be increased. It makes
the competition to gain something also on obstetrical care the student is expected
to get the optimal learning. Lecturers have an important role in the learning process.
The lecturers have to be creative and
getting tougher. The
Demands and innovative in their lessons. During this
challenges in world worked always changes especially healthy.In this case , a
change in a system of health education time, the methods used lecturer in the
learning process of pregnancy care in addition to conventional methods, there are
must be changes more beter. Lecturer is also some student-centered
methods very important in the change, one of the
changes that can be made by the lecturer is a change in the learning process.
Midwifery pregnancy is a health education course of obstetrics.In Course Pregnancy
include a method in a class discussion. The method is performed by a group discussion
presented in front of the class. STIKes Husada Patria is one of the health
institutions in the district blitar. Based on
434
observations in the classroom, especially the second class of the third level can be
identified problems that occur. These problems can be stated as follows:
learning model that can be applied to the real world, especially learning healthy in
course pregnancy on obstetrical care. Based on consideration above, the
1. The low pregnancy test scores
researcher want to analyze of effectiveness midwifery care, especially the subject
matter of pregnancy care. In the academic year 20112012 due to the limit value of
midwifery pregnancy is 75. Students who get test scores 75 as much as 40 and
students who scored 75 as much as 60. of model problem based learning depend
on learning outcomes student in course pregnancy on obstetrical care on program
diploma
2. Inappropriate method chosen and
METHOD
applied. In the implementation of learning, lecturers less attention to the learning
This research was done in STIKes Husada Patria Blitar, on February 25-
process but more attention on the end March 8 2015,
this research used result.
3. Difficulty students to answer the question and less interaction between other
students. Discussion class model was good for
course pregnancy on obstetrical care on program Diploma. But the researchers tried
to use problem based learning model in STIKes Patria Husada.
quantitative approach, experimental quasy. The Population and sample in this study
was the third semester students in total amount 38 students, divided into 2 groups,
choice in random. Discussion groups control in the amount 18 people,Problem
Based Learning experimental groupconsist of 20 people were divided
into 4 groups. Each group consist 5 people.
If the learning process was well ,student The
independent variable was Problem participation has also increased. I hope the
learning outcomes will be increased. The Based Learning, dependent variable was
learning outcomes. researchers trying to apply problem-based
RESULT AND ANALYSIS The Difference of Learning Outcomes depends on Learning group discussion Model
and PBL in Course Pregnancy On Obstetrical care On Program Diploma This Research used 38 sample. 18 people for group discussion and 20 people for Problem
Based Learning Group.
Table 1 The Difference of Learning Outcomes depends on Learning group discussion Model and PBL in Course Pregnancy On Obstetrical care On Program
Diploma
frequensy no
1 2
3 4
5 6
7 interval
35-40 41-45
46-50 51-55
56-60 61-65
66-70
Jumlah Group discussion
2 4
8 3
1
18 11.11
22.22 44.44
16.67
5.56 0.00
0.00
100 PBL
3 6
7 2
2
20 15
30 35
10 10
100
435
Primery Source The Difference of Learning Outcomes depends on Learning group discussion Model and PBL in Course Pregnancy On Obstetrical care On Program
Diploma The data table consideration above can show that higher value on Group Problem Based
Learning. Group discussion not show that the higher value for the learning outcomes in course pregnancy on obstetrical care. And it show that PBL more effective to increase
learning outcomes.
Diagram 1 The research of The Difference of Learning Outcomes depends on Learning group discussion Model and PBL in Course Pregnancy On Obstetrical care On Program
Diploma From the histogram considered above higher value show on PBL student. And the
student in group discussion not show that have higher values. It show that PBL more effective than group discussion.
ANALYSIS
PBL was a adult learning. Adult Learning was learning based on considered
a problem learning in contextual problem thus stimulating student to learning, this
model give student more motivating for learningClaire, et all, 2001 in learning
outcomes show that there was different learning participation student depend on
PBL model and group discussion. The statistic result show that P=0,014, it means
there was different PBL and Group discussion. The research result show that
PBL give Good indicator amount of 9 people than group discussion amount 4
people. Indicator least once on PBL nothing, in group discussion indicator least
once amount 4 people. This was due because the participation learning on PBL
show good quality to expression opinion in course Pregnancy obstetrical care. The
contribution expression opinion was very important. It show in participation chart
amount 20 people just 1 doubters in expression opinion. In Group discussion 4
people doubters that opinion. Many things effect participation learning accept student
consentration. Other affect was technical factor from learning model. The research
show that learning model affect the participation. In PBL based on considered
adult learning it means actif to find more experience with learning source, which
centered student, if the adult learning used give more motivating for student learning.
Group PBL consist tutor, chairmain, and members. The tutor excite, motivating the
members to think critical and to pay attention. Chairman members also officiate
set a time Saptono, 2003; karim, et all 2007;Sudjana,2004; Suradjiono, 2004
Effectivenss of Model PBL show that member name Riski Dwi Ascore 5 from
PBL group have good participation be compared ST widatul jannah have enough
participation score 3. The name of members veni antikasari from Group PBL
have least participation score 2. Not beter than tika epiana from group discussion
have good participation score 4. But the outline Model PBL more effective to
increase participation learning.
The research show that any different mean and median, learning
outcomes PBL between group discussion. Learning Outcomes mean with PBL more
higher than learning outcomes group discussion.The statistic result show
t:0,00signivicants. About that same in the teory that show learning outcome get from
436
the effort to find mastery knowledge and basic skiil in various in life aspect, so it
seems in individualism about the used values attitude, knowledge and basic skill
change attitude quantitatively. To change learning outcomes more better, must to
used good learning model, like a problem based learning. This learning model
demand the student to more active than before in learning process. PBL was
outanding factors to influence learning outcomessudjana,2004.
The result show that any difference significant from learning
outcomes.In Group discussion show learning outcome score 46-50 amount 8
people. And PBL amount 4 people. Altough this score not good but it show
that PBL more effective than group Matematika Universitas Negeri
Yogyakarta.Unpublished Claire, Major, Palmer. 2001.
Assessing the effectiveness of Problem Based
Learning in Higher Education
. Cambridge: Cambridge
University Press. Depkes. 2002.
Komunikasi efektif
. USAID IBI.
Duch, B. 1995.
Problem A Key Factor in PBL
. England. Evan, G. 2001.
Problem based Instruction In M Oreyedt Emerging
Prespective on Learning Teaching And Technology.
Hastuti Noer, Rosyidin, Fadiawati Noor, Hasnundiyah Neni. 2011.
Mengembangkan Soft skill siswa melalui pembelajaran matematika
discussion. In half score 60 point show that
berbasis masalah.
Prosiding PBL amount 7 people and group
discussion amount 1 people. Higher scre getting Group PBL amount 4 people. And
than group discussion nothing at all for getting higher score.
CONCLUSIONS
Any different significant with different result test used t-test t:0,00
between learning outcomes PBL with group discussions in course pregnancy on
obstetrical care. It show that PBL more better than group discussions. And in fact
that PBL more efective to increase learning outcome.
ACKNOWLEDGEMENT
The limitation of this study was Seminar nasional pendidikan
MIPA. Bandar Lampung Helen, V. 2001.
Varney Pocket Midwives
in Endah Pakaryaningsihedt. Jakarta:EGC.
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1995
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Karim, S, Noor Suheniana. 2007.
Penerapan pendidikan pembelajaran berbasis masalah
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mengembangkan ketrampilan berpikir tingkat tinggi dan ke
Cakapan ilmiah. Proposal Hibah Kompetitif UPI. 2007
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439
THE CORRELATION OF KNOWLEDGE AND ATTITUDE WITH Tarak CULTURE OF POSTPARTUM MOTHERS IN WONODADI
BLITAR
Ning Arti Wulandari, Zaenal Fanani. STIKES Patria Husada Blitar
Abstract
Indonesia is a multicultural society. Each region has a different culture that is embraced by the trust from the previous generation.Tarak on postpartum mothers is a habit of not
eating chicken dishes, meat, eggs and certain other foods, fearing the wound did not heal and their infants vomiting after breastfeeding. Cultural aspect is very important to
facilitate in providing nursing care. The purpose of this research was to identify correlation between knowledge and attitude with a culture of tarak in the postpartum
mothers at Wonodadi Blitar. The design of this research was crossectional with a sample of 40 mothers in the
postpartum at Wonodadi Blitar taken by
Consecutive sampling
with inclusion criteria: maternal postpartum phase of letting go. The variable in this research was the knowledge,
attitudes about postpartum maternal nutrition and culture tarak. The instruments used questionnaire. The result by Spearman rank analysis showed no correlation between
postpartum maternal nutritional knowledge of the culture of incontinence with a value of
ρ = 0, 658, correlation between attitude and cultural behavior tarak with the value ρ = 0.01. eventhough the level of knowledge of mothers of postpartum in nutrition was good
but it did not guarantee that the mother did not follow the culture of tarak, this is in accordance with Manurung 2012 that culture is not only influenced by the knowledge
but also a strong belief. While the attitude is a feeling that followed the tendency to act so that the attitude of postpartum mothers have a correlation with the tarak. Therefore, the
role of nurses is very important in reconstructing the culture of tarak. Key Word: Knowledge, attitudes, culture Tarak, postpartum mothers
Background
Post partum period called postpartum or puerperal period is a period or time since
the baby was born and the placenta comes out until the next six weeks, accompanied
by the restoration of the organs associated with the content, which changes as injury
and other related During childbirth Suheri . Et al , 2008 .
While the purpose of the provision of care during childbirth, according Saleha 2009,
among others maintains the health of mother and baby, detect problems; write
your health education and providing family Differences in cultural values is also part
of a holistic human Indonesian society is a multicultural
society. Each region has a different culture that is embraced by the trust from previous
generations. Many people who believe in the culture of previous generations because
the culture was obtained from parents who think they have more experience. With this
belief they are convinced that the behavior he does will bring positive results and
beneficial to their health. Not all treatments are performed based on the
heritage can be fully accepted, could have carried out such treatments provide less
planning services.
Maternal care favorable health outcomes for mother and
community is very important in this regard. In nursing theory, saw man should
nurse holistic in providing nursing care. baby Manurung, 2009. Behavior or
habits that harm eg nursing mothers are prohibited from eating foods that fishy eg
fish, eggs and others because the baby will 441
sweat odor. Postpartum mothers are prohibited nap. Post partum mothers had to
sleep sitting or half-sitting for fear of bad blood rose to the eye Mubarak et al,
2012. Based on the preliminary research conducted in September 2012 in the
Cempaka space Ruling Hospital Ngudi Waluyo Wlingi obtained 15 of the 22
mothers postpartum do not want to eat chicken dishes, meat and eggs because
their parents forbid fearing the wound did not heal and their breastfeeding infants
vomiting. Based on interviews with the head of the room, the nurse had provided
health education about the importance of
nutrition to patients‟ post-partum mothers. Some elements involved in the socio-
cultural according to Mubarak, et al 2012 among other things: knowledge, belief, art,
morals, law, customs and abilities as well as custom made by the community.
Knowledge has a profound influence on health. Likewise, related public confidence
about the care of the sick is very influential on the public health level. Culture is the
behavior resulting from human perception, behavior that would be stronger if it is
based on the powerful stance anyway. Medeleine Leininger developed the
concept of transcultural nursing, bringing practice into the discussion on how to
provide nursing care according to need. According Leinenger 1978 transcultural
nursing is a nursing service berfocus on the behavior of individuals or groups, as well
as the process to maintain or improve health behavior and the behavior of
physical pain and psikokultural provided to clients in accordance with the cultural
background Tommey and Alligood, 2006. Swasono Statement 1998 in
Manurutng 2009 argue that there are some people kepercayaaan value
associated with post partum care, with knowledge of the cultural aspect is
important to be known by health workers to facilitate the approach to providing
health care. This of course requires special attention to overcome. According to
nursing theory leineinger medeline there are several strategies are in use in
providing nursing care, among others maintaining the culture, the culture of
negotiation and change the culture Tommey and Alligood, 2006. From the
description above, the researchers wanted to identify how the correlation between
postpartum maternal nutritional knowledge and attitude to culture incontinence in
postpartum mothers in Wonodadi Blitar
the role of cultural factors in nursing
METHODS The research design used cross sectional, which connects between knowledge and culture
incontinence and attitude with a postpartum mother culture incontinence in the mother postpartum. Knowledge in this research was knowledge about postpartum
maternal postpartum maternal nutrition, attitude in this research is the attitude of postpartum mothers in meeting their nutritional culture whereas incontinence was the
behavior not eats tempeh, tofu, egg, chicken, meat goat, fish freshwater and saltwater fish. The sample in this research was 40 people listed in the postpartum maternal health
centers Wonodadi. The sample in this research were drawn in a way convenient sampling with inclusion criteria postpartum mothers who are already in the phase of letting go, the
mother and the baby does not have a particular disease and do not have allergies to certain foods. This research was conducted from September 26 to October 6, 2014.
RESULTS AND ANALYSIS RESULTS
Postpartum maternal characteristics in Table 1 Postpartum maternal characteristics in
Wonodadi -Blitar Blitar Wonodadi as many as 40 people as
in the table below:
442
Culture tarak
Knowlegdement Total
ρ Good
Sufficie nt
N N
N Followin
g culture Tarak
overall 1
6 40
1 25
2 6
65
0,658 Followin
g some cultures
Tarak
Do not follow
the culture of
2
7 5
18 3
2 8
5 5
9 12
23 characteristics of Respondents
f Table 3 above shows that 43 of
respondents have a good attitude towards
Age
nutrition postpartum mothers and 20 of ≤ 20 years
21-30 years 31-40 years
41-50 years 3
16 20
1 8 respondents had a very bad attitude
40 towards the fulfillment of postpartum 50 maternal nutrition.
2
Education Table 4
Frequency distribution of Tarak Elementary School
Junior High School 7
18 17
45 culture in postpartum mothers
Senior High school Prioriy to
Primipara 15
14 38
35 Culture Tarak
Frequ ency
percen tage
Multipara 26
65 Do not follow the culture of 9
23
Occupation
Tarak Housewife
36 90 Following some cultures
5 13
Privat employees 4
10 Tarak Information about postpartum
maternal nutrition Following culture Tarak
overall 26
64 No
Ever 30
10 75
25 Based on Table 4 above shows that the majority of 64 of respondents follow the
culture of “tarak” and only 23 who do not follow the culture of “Tarak”
Table 2 The frequency distribution of
knowledge about postpartum maternal on postpartum
maternal nutrition
Table 5 The correlation between
postpartum maternal nutritional knowledge of the culture of
Tarak postpartum mothers
Pengetahuan Good
Sufficient Frekuensi
15 25
Persentase
37 63
Table 2 above shows that most respondents have sufficient knowledge of as many as
25 people 63
Table 3 Frequency distribution attitude
postpartum maternal postpartum maternal nutrition in meeting
attitude
Good Sufficient
Bad frequency
17 15
8 percentage
43 38
20
443
Table 6 The correlation between with a postpartum
maternal nutrition of“tarak” culture in postpartum mothers.
Tarak” Culture
Attitude Total
ρ Bad
Not good
Good N
N N N
Following culture
Tarak overall
1 5
3 8
3 8 8
2 2
6 65
0,01 Following
some cultures
Tarak 4
1 1
1 3
5 12
Do not follow the
culture of Tarak”
1 3 8
2 9
23 Tarak
Table 5 above shows that the Spearman rank test results obtained value of ρ = 0658
which means that there is no correlation with postpartum “tarak “ culture .
have sufficient knowledge anyway, it was evident that one of the factors affecting the
level of knowledge is education. In addition to educational information is also
greatly affect a persons knowledge. Based on Table 1 of the 40 respondents 75 had
never received information about
postpartum maternal nutrition.
Information could be received from the media or health workers, in this
case the role many are nurses. Therefore Wonodadi PHC nurses
should provide health education particularly on postpartum maternal
nutrition.
Postpartum Maternal Attitude In Meeting Nutrition
Table 3 shows that postpartum mothers who have a good attitude as
much as 43. According Notoatmodjo 2010 knowledge,
thoughts, beliefs and emotions play an important role in determining the
attitude intact. These results strongly support the theory tersbut, of the 17
respondents who have a good attitude, 12 have a good knowledge
anyway. According to the theory Anwar 2007 health communication
using the design principles of
Table 6 above shows that the Spearman rank test results obta
ined value ρ = 0.01 , which means that there were correlation
between attitudes in nutrition with a postpartum mother tarakculture
Knowledge About Nutrition Maternal Postpartum Maternal Postpartum With
Cultural Tarak
Table 2 shows that most respondents 63 have sufficient knowledge about
postpartum maternal nutrition. Ones knowledge according Notoadmodjo 2010
could be affected by several external factors, namely, education, information
and experience. Based on Table 1 of the 40 respondents were educated terakir SPM as
many as 18 45 of the 18 respondents 15 who have enough knowledge. While
respondents were educated last 7 SD whole teaching is one of the efforts to foster an
attitude. The theory is supported by the results of this research, based on table 1
postpartum mothers who never get information about postpartum maternal
nutrition as much as 75. Information obtained through communication poses.
Communication is the exchange of thoughts, feelings and opinions and give
advice in which occur between two or more people work together.
Communication is also an art to compose and deliver a message in a way that is easy
so that others can understand. Therefore, health professionals, especially nurses play
an important role in changing attitudes in meeting the nutritional postpartum
mothers. Providing health education through the media and attractive method is
the right way to make it easier to understand the postpartum mother and
444
motivated to apply. If the postpartum mother can understand very well it will
form a good attitude as well. Of a good attitude will have a tendency to behave
well.
“Tarak Culture Of Mother Postpatum Indonesian society is a multicultural
society. Each region has a different culture that is embraced by the trust from previous
knowledge that protein is essential for wound healing and nutrition to the baby.
While the 13 who follow some cultures tarak could be given nursing care to
maintain the culture or the culture of negotiation because although postpartum
mothers do not consume animal protein, the protein needs met mothers of vegetable
protein.
generations. Many people who believe in Correlation
Between postpartum
the culture of previous generations because the culture was obtained from parents who
think they have more experience. With this belief they are convinced that the behavior
he does will bring positive results and beneficial to their health. Culture is the
maternal nutritional knowledge of the culture of “tarak”
Based on Table 5 shows that the test results obtained with the Spearman rank ρ
value 0.05, which means that there was behavior resulting from the perception of
no correlation
between postpartum cultural manusia.Masyarakat Wonodadi
Blitar have in providing care to mothers postpartum, one of which is the culture of
tarak. Culture incontinence behavior is not consuming all kinds of proteins, among
others; do not eat meat beef or mutton, chicken, eggs, tempeh, tofu, fish,
freshwater and marine fish. Blitar Wonodadi community considers consume
meat, chicken, eggs, fish, freshwater and saltwater fish will lead to the failure of
wound healing. While consuming tempe and tofu would result in accumulated dirt
eye on breastfeeding infants. Culture tarak adopted Wonodadi Blitar society is
very contradictory to the theory Widasari 2009 which says that the fulfillment of
adequate protein will help the healing process.
maternal nutrition to the culture of “tarak . Some elements involved in the socio-
cultural according to Mubarak , et al 2012 among other things : knowledge ,
belief , art , morals , law , customs and abilities as well as custom made by the
community . Knowledge has a profound influence on health. The theory is not in
accordance with the results of this research , 65 of respondents who follow the
culture of tarak overall , 40 have a good knowledge of postpartum maternal
nutrition . Such conditions show that other elements , namely trust, tradition and
habits Wonodadi community was very strong against the culture of incontinence
. Wonodadi public confidence towards
“tarak “ culture strong need special Based on Table 4
shows that 26 attention . According Leinenger 1978
respondents 65 followed tarak overall culture, which means did not take all of the
above proteins. While 5 respondents 13 follow some cultures continence which
means do not consume any animal protein? According to nursing theory leineinger
medeline there are several strategies are in use in providing nursing care, among
others maintaining the culture, the culture of negotiation and change the culture
Tommey and Alligood, 2006. Based on the theory Wonodadi PHC nurse can
provide nursing care to negotiate a culture at 65 of respondents who follow the
culture of tarak as a whole by providing transcultural nursing is a nursing service
berfocus on the behavior of individuals or groups , as well as the process to maintain
or improve health behavior and the behavior of physical pain and psikokultural
provided to clients in accordance with the cultural background Tommey and
Alligood , 2006 . According to the research most of respondents who embrace
the culture of “tarak have a good level of knowledge about postpartum maternal
nutrition , so that according to nursing theory transkultur cultural negotiation not
only to individuals but also families who care for postpartum mothers . Negotiations
445
culture can be done by providing counseling to families or even society at
large about the importance of postpartum behave tarak . This was because the
huge belief in the culture of “tarak“ in Wonodadi Blitar .
maternal nutrition.
Conclusions Correlation
Between Attitude In
1. There were no correlation between
Meeting With Postpartum Maternal Nutrition Culture “Tarak”
postpartum maternal nutrition to the culture of tarak postpartum
mothers in Wonodadi Blitar Based on Table 6 shows that the test
2. There
were correlation between
results with rank Spearman ρ value 0.05 , which means that there was a correlation
between attitudes in meeting with a postpartum maternal nutrition culture
tarak . According B.Karr Snehandu 1983 in Notoadmojo 2010 or the
resultant behavior was the result of the stimulus external factors and response
internal factors in the subject or The person who behaves . While culture was
the behavior resulting from human perception .
According to the theory lawrence Green in Notoatmojo 2010 said that behavior to
own some of the factors that influence it , among others praktor predisposing factors
attitudes in meeting with a postpartum maternal nutrition culture tarak
postpartum mothers in Wonodadi Blitar
ACKNOWLEDGEMENT The instrument not yet passed by validity
and reliabily test. We cannot control honesty of respondent
because of researcher little interaction with them during resesearch and may they not
yet belief with us.
that allow and amplifier
factors . REFERENCE
Predisposing Factor of behavior such as knowledge, attitudes, beliefs, beliefs ,
values , traditions and so on . The theory was in accordance with the results of this
research , 65 of postpartum mothers who embrace the culture of tarak overall 38
Azwar, saiffudin.2007. Sikap Manusia,teori dan
pengukurannya. Yogyakarta.Pustaka pelajar
had a very bad attitude and 8 had a Depkes
RI. 2009.Pedoman bad attitude towards the fulfillment of
postpartum maternal nutrition . Based on the results of the research 75
had never received information about postpartum maternal nutrition. This is
consistent with the theory that some of the factors that facilitate the occurrence of
Pelaksanaan Kelas Ibu Hamil. Jakarta. Dirjend Bina
Kesehatan Masyarakat
Manurung, Yunani Dewi. 2009.
perawatan Post Partum Menurut Perspektif Budaya
behavior was the facility in infrastructure
Jawa.
Sumatera Utara. or health behaviors. Therefore, the role of
health personnel on duty at the health center Blitar Wonodadi very important to
negotiate on the culture of “tarak . It was also proven from the results of this
research of 65 of respondents who follow incontinence culture overall 40
had good knowledge about nutrition postpartum mothers and 20 of
respondents have a good attitude towards Universitas Sumatera Utara
skripsi Mubarak, dkk. 2012.
Pengantar dan Teori Ilmu Sosial Budaya Dasar
Keperawatan.
Jakarta: EGC Notoatmodjo, Soekidjo. 2010.
Promosi kesehatan teori dan aplikasi. Jakarta: Rineka Cipta
the fulfillment of nutrition , but they still 446
Nursalam. 2008.
Konsep dan transkultural
medeleine
Penerapan Metodologi penelitian Ilmu Keperawatan.
Jakarta: Salemba Medika Saifudin dan Yusuf. 2010.
Nikmatnya seks islami.
Hal. 116. Yogyakarta: pustaka
leininger di kecamatan wonotirto. Stikes Patria Husada
Blitar. Skripsi
Syaifudin A, dkk. 2006.
Buku Acuan Nasional Pelayanan Kesehatan
Maternal dan Neonatal.
Marwa Anggota IKAPI.
Jakarta: YBPSP ebook online
Saleha, sitti. 2009.
Asuhan
Tommey and Alligood. 2006.
Keperawatan pada Masa Nifas. Nursing Theorist and Their
Jakarta: Salemba Medika
Work.
Mosby. Philadelphia USA:
Wong,D.L, Suherni, dkk. 2009.
Perawatan Masa Nifas.
Yogyakarta: Fitramaya Hockenberry M, Wilson,D,
Winkelstein,M.L, Schwartz,
P.2002.
Buku
Supatemi Yeni 2013. Struktur
Ajar Keperawatan Pediatrik
budaya dan sosial ibu post partum berdasarkan pendekatan
Wong,
Bahasa Ed 6, Vol I.Alih
Agus Sutarna. teori keperawatan
447 Jakarta:EGC.
OVERVIEW OF FATIGUE IN CANCER PATIENTS WHICH UNDERGO CHEMOTHERAPY
Ulfa Khusnul Fata
Nursing Study Program of STIKes Patria Husada Blitar Jl. Sudanco Supriyadi 168 Blitar, Jawa Timur
Email: ulfanersgmail.com
Abstract
One of the side effects of chemotherapy in cancer patients is fatigue. Fatigue is a feeling of tired, exhausted, or lack of energy that can that may take in several days, weeks, or months.
The purpose of this study was to identify fatigue on cancer patients which undergo chemotherapy. The population of this study was adult cancer patients that undergoing
chemotherapy in the Dharmais Cancer Hospital Jakarta. The research method was descriptive with a sample size of 95 respondents. The sampling technique used consecutive
sampling. The data collection used questionnaires by respondents and accompanied by the researcher. The result of this study showed that 53 55.8 of respondents experienced mild
fatigue, and 42 44.2 of respondents experienced severe fatigue. Fatigue in cancer patients undergo chemotherapy often causes by physical and psychological problems. The
predisposing of fatigue in patients undergoes chemotherapy including cancer burden, treatments of cancer, nutritional problems, infections, and psychological factors including
depression, anxiety, and stress. Therefore, identification of the causes of fatigue is needed to prevent more severe fatigue in cancer patients undergo chemotherapy.
Keywords: cancer, chemotherapy, fatigue BACKGROUND
Fatigue is a common symptom in patients with cancer Piper et al. 1998 ;
Yeşilbalkan, ȌU., Karadakovan, A., Gőker, E., 2009. According to The
National Comprehensive Cancer Network NCCN, Cancer Related Fatigue CRF is
a “distressing persistent, subjective sense of tiredness or exhaustion related to
cancer treatment that is not proportional to recent activity and that interferes with
usual functioning” Mock et al., 2007, p.1 ; Given, B., 2008.
Compared with fatigue experienced by healthy individuals,
cancer related fatigue is more severe, more distressing, and less likely to be
relieved by sleep or rest Kwak, SM., et al., 2011.
The incidence of fatigue among patients with cancer is well-documented,
with 75-99 of patients who undergo chemotherapy describing it as increasing
with every cycle Nail Jones, 2001 ; Kuchinski, AM., Reading, M., Lash, AA.
2009.
448 The experience of fatigue in 90
cancer patients at some point during the course of their illness and it has been
noted to worsen when cancer treatment begins Barnes Bruera, 2002; Escalante
et al., 2001; Yeşilbalkan, ȌU., Karadakovan, A., Gőker, E., 2009.
Diminished performance status and the presence of disease-related symptoms
often cause fatigue before treatment with chemotherapy Grant, Golant, Rivera,
Dean, Benjamin, 2000; Yeşilbalkan, ȌU., Karadakovan, A., Gőker, E.,
2009, but fatigue also can be worsened by pain, anemia, sleep disturbance, and
nutritional, mood, and activity issues National Comprehensive Cancer
Network [NCCN], 2008; Yeşilbalkan, ȌU., Karadakovan, A., Gőker, E.,
2009. Patients who experience severe
and persistent fatigue have a truly impaired quality of life, as this condition
affects their social activities, leisure time, work and responsibilities Romito et al.
2011.
Factors contributing to fatigue are Schwartz Cancer Fatigue Scale which is a
surgery, chemotherapy, pain, sleep
questionnaire to assess fatigue in cancer disturbance, anemia, gastrointestinal
disturbance, and emotional distress Anderson, N.J., Hacker, E.D, 2008.
Fatigue has a significant impact on the overall quality of life. In the fatigue study,
of the 419 patients with cancer who participate in a telephone interview, 78
experienced fatigue during the course of their treatment. Fatigue adversely affected
patients in their daily lives more than did pain 61 vs 16. The fatigue study
involved a telephone survey of 379 patients with cancer who had previously
received chemotherapy. Seventy-six percent of the patients reported
experiencing significant fatigue at least a patients.
Researchers identify potential respodents with medical records that are
ajusted to the inclusion and exclusion criteria. Then, the questionnaires filed out
by respondents with assisted by researchers. Data analysis was to know
the description of fatigue in cancer patients undergo chemotherapy.
RESULT Table 1.
Distribution of respondents by age and hemoglobin levels in the Dharmais
Cancer Hospital, June 2013 n = 95
few days each month during their most recent chemotherapy cycle Errihani, H,
Tazi, EM, 2011. Varia
ble Mea
n Medi
an SD
Mi n
– M
95 CI
Until now, overview of fatigue ax
overview in cancer patients undergoing chemotherapy still necessary to developed
Age 45,5
4 46,0
10,1 02
21 -
43,4 8;
in Indonesia. Therefore, based on the description above, author interested in
Hb 65
47,5 conducting research on the description of
fatigue incancer patients undergoing 10,8
81 10,6
00 1,37
98 6.3
– 10,5
99 ; chemotherapy.
The general purpose of this study was to describe of fatigue in cancer patients
13, 8
11,1 6
undergo chemotherapy in inpatient unit and ambulatory short of care Dharmais
Cancer Hospital Jakarta. Whereas the specific purposes of
this research are: 1 indentifyng fatigue in cancer patients undergo chemotherapy, 2
identify the age, Hb, stage of cancer, types of chemotherapy, cycles of chemotherapy,
sex, type of cancer, pain, sleep quality, nausea and vomiting, anxiety, depression,
Table 1 describe the results of the analysis of the mean respondents age in
this study was 45,54 ± 10,102 years 95 CI: 43,48 ; 47,49 with the age range of
21 – 65 years. While the average level of
haemoglobin range of 6,3 gdl -13,8 grdl.
Table 2. Distribution of respondents by sex and
types of cancer in the Dharmais Cancer Hospital, June 2013 n = 95
physical activity in cancer patients undergo chemotherapy.
RESEARCH METHODS
Variable
Gender
Male Female
Frequency 26
69 Percentage
27,4 72,6
This study was descriptive. The sample was cancer patients undergo
Types of
chemotherapy at the Dharmais Cancer Hospital Jakarta in 2013 and the number
of sample was 95. The samplin methode used consecutive sampling with inclusion
and exclusion criteria. Instruments used in this research was Questionnaire Revised
cancer
Ca Mammae
KNF LNH
Ca Kolon 37
13 10
6 5
4 38,9
13,7 10,5
6,3 5,3
4,2
449
Variable Ca
Ovarium Ca Cerviks
Another Frequency
20 Percentage
21,1 stadium 3 of 52 respondents 54.7. The
following analysis data result obtained types of chemotherapy combination of
FAC as much as 29 respondents 30.5, and nearly half undergo cycles of
chemotherapy more than 4 reaching 28 respondents 29.5.
Table 4. Distribution of respondents by pain,
sleep quality, nausea and vomiting in the Dharmais Cancer Hospital, June
2013 n = 95
Table 2 describe the distribution of respondents were female as much as 69
respondents 72.6, as well as the distribution of respondents by types of
cancer is breast cancer by nearly half as much as 37 respondents 38.9
Table 3. Distribution of respondents by stadium
of cancer, types of chemotherapy, and cycles of chemotherapy in the
Dharmais Cancer Hospital, June 2013 n = 95
Variable
Pain
Nothing Mild
Moderate Severe
Sleep Quality
Good Bad
Frequency 13
29 45
8 17
78 Percentage
13,7 30,5
47,4 8,4
17,9 82,1
Variable Frequenc
y Percentag
e
Nause and Vomiting
11 33
11,6 34,7
Stage of Cancer
Stage 1 Stage 2
Stage 3 Stage 4
Types of chemoterapy
FAC Cisplatin
Paxus Lain-lain
Cycles of chemotherap
y Cycle 1
Cycle 2 Cycle 3
Cycle 4 Cycle 4
2 27
52 14
29 12
4 50
9 13
27 18
28 2,2
28,4 54,7
14,7
30,5 12,6
4,2 52,6
9,5 13,7
28,4 18,9
29,5 Normal 37 38,9
Mild 11 11,6 Moderate 3 3,2
Severe Worse
Very severe
Table 4 descibe the distribution of respondents by level of pain was obtained
almost half of the respondents experienced moderate pain as much as 45
respondents 47.4, and nearly all respondents are poor sleep quality as
much as 78 respondents 82.1. The frequency distribution by nausea and
vomiting showed that nearly half of respondents had experienced nausea and
vomiting in the category were as much as 37 respondents 38.9.
Table 5. Distribution of respondents by anxiety,
depression, and physical activity in the Dharmais Cancer Hospital, June 2013
n = 95
Table 3 describe the distribution Variable
Frequency Percentage of respondents standium of cancer was
450
Variable
Anxiety
Normal Borderline
Abnormal Frequency
34 35
26 Percentage
35,8 36,8
27,4
DISCUSSION Describe of Fatigue in Cancer Patients
which Undergo Chemotherapy The research result showed that nearly
half 44.2 of respondents experienced
severe fatigue. Fatigue is common
Depression
symtom experienced by cacer patients and Normal
Borderline Abnormal
59 20
16 62,1
21,1 16,8
cancer survivor. Fatigue may be defined as a distressing, persistent, subjectives
sense of tiredness or exhaustion related to cancer or cancer treatment that is not
Physical
proportional to recent activity and
Activity
Pasif Minimal
active Active
33 42
20 21,1
44,2 34,7
interferes with usual functioning. Fatigue is multidimensional symtom because it
ecompasses physical, mental, and emotional aspects. Patients can experience
fatigue anywhere along the spectrum of
cancer care Escalante Manzullo, Table 5 showed that almost half
of respondents experienced a borderline anxiety as much as 35 respondents
36.8, and almost were not experience depression as much as 59 respondents
62.1. The frequency distribution of respondents by physical activity showed
that nearly half of the respondents included in the category of activity
minimal as much as 42 respondents 44.2.
Table 6. Distribution of respondents fatigue in
the Dharmais Cancer Hospital, June 2013 n = 95
2009. Several factors play the occurence of fatigue, however, no specific
pradictivefactors have been indentified in the literature. Age is consedired a
predictive factor though the evidence is conflicting. Younger patients, les that 34
years do better that older patients. Similarly, men men over 75 years of age
were found to experience 11 time more fatigue thant their younger counterparts
Narayan Koshy, 2009.
The mean age of respondents was 45,54 years old with the age range 21-65 years.
It was consistent the theory that older people had of higher of fatigue than
younger. The age effect on the incidence
of fatigue because the higher a peson‟s age, the ability to regenerate cells wil
decrease. It was may lead to the incidence of fatigue in cancer patients receiving
chemotherapy.
Variable
Fatigue
Mild fatigue
Severe fatigue
Frequency 53
42 Percentage
55,8 44,2
CONCLUSIONS 1.
The result of the study showed that the mean age was 45,54 years old
with the age range 21-65 years old. While the mean of heamoglobin level
was 10.881 with the lowest value was
6.3 gdl and the highest was 13.8 gdl.
Table 6 showed that almost half of the respondents experienced severe fatigue
that was 42 respondents 44.2. 2.
Overview the majority gander of respondens 72.6 were women.
The types of cancer was almost half of teh respondents 38.9 were
breast cancer, and the most 54.7
451
were stage 3. The types of chemotherapy were received almost a
half of respondent 30.5 was a type of FAC chemotherapy
combination.
haematological or to psychological Factors in cance patiens?
. Support Care Cancer 2008 16.943-946.
Yeşilbalkan, ȌU., Karadakovan, A., Gőker, E. 2009.
The Effectiveness
3. Almost a half 44.2 of respondents
experinceing mild fatigue and almost a half 47.4 of respondents had
moderate pain. Sleep quality of respondent 38.9 experienced
of Nursing Education as an Intervention to Decrease Fatigue in
Turkish Patients Receiving Chemotherapy.
Oncology Nursing Forum Vol. 36, No. 4.
mdoerate nausea and vomiting.
REFFERENCES Anderson, N.J., Hacker, E.D. 2008.
Fatigue in Women Receiving Intraperitoneal Chemotherapy for
Ovarian Cancer: A Review of Contributing Factors.
Clinical Journal of Oncology Nursing, 12
3, 445-454.
doi: caac.20073
[pii]10.3322caac.20073 [doi] Errihani, H, Tazi, EM. 2011.
Evaluation and Management of Fatigue in Oncology: A
Multidimensional Approach.
Indian Journal of Palliative Care May-Aug
2011 Vol-17 Issue-2. Escalante, C.P., Manzullo, P.J. 2001.
Cancer-Related Fatgiue: The
Approach and Treatment.
Journal of General Internal Medicine
, 24, 412- 416.
Given, B. 2008.
Cancer-Related Fatigue: A Brief Overview of Current
Nursing Perspectives and Experiences. Clinical Journal of
Oncology Nursing Volume 12
Number 5.
Kuchinski, AA., Reading, M., Lash, AA. 2009.
Treatment-Related Fatigue and Exercise in Patients with
Cancer: A Systematic Review.
Medsurg Nursing. Vol. 18No.3. Kwak, SM., et al. 2011.
The relationship between interleukin-6,
tumor necrosis factor-
α, and Fatigue in
terminally Ill Cancer Patients.
Palliative Medicine 263 275-282. Narayanan, V., Koshy, C. 2009.
Fatigue in cancer: A review of literature.
Indian Journal of Palliative Care, 15
1, 19-25. Romito, et al. 2011.
Is Cancer Related Fatigue more strongly correlated to
452
IMPROVING NURSING STUDENTS’ SPEAKING SKILL BY USING REALIA AS THE MEDIA
Wahyu Wibisono
STIKes PATRIA HUSADA BLITAR Jln. Sudanco Supriyadi no.168 Blitar
E-mail: wahyu_kuromonyahoo.com
Telp: 085649587182
ABSTRACT
English become the most important things in facing the issue of ASEAN ECONOMIC COMMUNITY AEC especially in the health sector since english is one of
the international language use in asean. So, preparing medical employees with English become a great issue to be solved. This study was intended to apply realia as the media to
improve students speaking skill.
The research design used in this study was collaborative Classroom Action Research. The collaboration was done with one English teacher of
STIKes Patria Husada Blitar.
This Classroom Action Research was implemented in one cycle only which involved four stages namely planning, implementation, observation, and reflection. To
know how far the implementation of realia as the media in teaching writing were successful, the researcher gained the data in the form of students‟ involvement during
teaching learning activity and speaking score in role play. To get those data, the researcher used several instruments; those were observation checklist, field notes.
The finding of this study showed that by using realia as the media, the students could speak and communicate much better than before when they were taught by using
other speaking instructions. In terms of the students‟ individual writing product, in
preliminary study, the number of students who passed the minimum passing grade 64 was only 2 students 9.09. On the other hand, in Cycle 1, all of the 22 students 100
could pass the minimum passing grade 64. The improvement of students‟ writing skill was due to the use of realia as the
media in teaching speaking which consisted of several activities for the students so that they were enthusiastic in joining the class. In addition, it was suggested for the lecturers
and or teacher to apply and modify this technique in their classes.
Keyword: realia, speaking skill
455
English become the most important things in facing the issue of
ASEAN ECONOMIC COMMUNITY AEC especially in the health sector since
english is one of the international language use in asean. So, preparing
teaching writing because teacher played an important role in managing the class so
that students would not get bored and also feel excited on having a writing class.
Next, the condition of the teaching learning process in the class should be
medical employees with English as early changed
into more cooperative as possible will be a the best way to face
the challenge.
STIKes Patria Husada Blitar
is a medical college located on Jln. Sudanco Supriyadi 168 Blitar. There are
two departments in this college: the nursing department and the midwifery
department. Based on the curriculum book of
STIKes Patria Husada Blitar
, English is a compulsory subject which should be
taken by the students. This college provides English courses for the students
which focus on the English for Academic Purposes EAP
Panduan Pendidikan Ners dan Bidan STIKes Patria Husada
Blitar, 2011
. This course focuses instruction on skills required to perform in
an English-speaking academic context across core subject areas generally
encountered in a university setting. In this EAP course, the students will be taught
vocabulary, grammar, and also the four skills reading, writing, speaking, and
listening of English, but the English will be tied up to meet the specific needs of the
students, in this case is English for medical purposes. There are six English
courses in the nursing department and one English course in the Midwifery
Department
Panduan Pendidikan Ners dan Bidan STIKes Patria Husada Blitar,
2011.
Based on the researcher‟s experience in dealing with the students in
STIKes Patria Husada Blitar
, the EFL students frequently get difficulties in
English. Among those difficulties, speaking is considered to be difficult by
the students. Based on the observation, the students had low motivation and were not
interested in the class. They felt that atmosphere between teacher and students
and among students and not competitive atmosphere in order to create a conducive
teaching learning process in speaking class.
In this research, the researcher is interested in using realia as the media in
teaching speaking since he considered that realia would be more effective than other
previous techniques which had been used in speaking class. Realia is considered to
be effective in teaching speaking of nursing students because the nursing
students were often exposed to the real objects of medical instruments so that by
using realia, it is expected that students‟ motivation in speaking will increase.
Furthermore, they will also get benefit in writing and practicing, so that they will
get both the speaking process and the practicing process.
In this research, realia were used as the media in teaching speaking of
procedure text. In order to increase the understanding the concept of realia, many
experts have already made a definition of realia. Celce-Murcia Hilles 1988 state
that realia is objects of any origin used to illustrate vocabulary and structure in the
L2. Furthermore, realia is concrete objects and the paraphernalia of everyday life
Zukowski-Faust, 1997. The examples of realia are objects such as coins, tools, and
textiles that do not easily fit into the orderly categories of printed material. In
education, realia are objects from real life used in classroom instruction, so by using
realia students are exposed to the real objects. A realia gives students the
opportunity to use all of their senses to
speaking was a
difficult activity.
learn about a given subject, and is Moreover, the teaching learning process
was still insufficient in the classroom. The first things which need to be
solved was the teacher‟s technique in
456 appropriate for any grade or skill level. A
realia provides language learners with multisensory impressions of the language
which, as Rivers 1983 notes, is learned
partly at least through seeing, hearing, touching, and manipulating items.
Interaction with authentic materials aids in contextually grounding instruction by
bringing students into contact with language as it is used in the target culture
in order to meet actual communication needs. The use of realia, then, can
enhance linguistic and cultural comprehensibility, which are both
prerequisites for real language learning.
Realia has advantages and disadvantages. Jones 1994 explains the
advantages of realia. First, realia which deals with real things with which one will
interact in life is the best learning situation possible. Second, real objects are plentiful
and available everywhere. Third, real items can be observed and handled,
providing concrete learning experiences for the student. Fourth, dealing with realia
motivates the learner. Fifth, realia can be used as part of the evaluation system. The
last is realia learning can be extended through the use of displays.
On the other hand, realia also has disadvantages. First, real things are not
always readily available. Second, realia are not always practical for use in the
classroom size of a real object may be too large for instance a submarine or too
small for instance a single human cell for classroom study. Realia such as live
animals, certain electrical and mechanical equipment, etc., can represent potential
hazards for the learner and the teacher. Real objects often are expensive. Realia
need to maintain original structure while some realia can be dismantled, many
others cannot be, e.g., cutting open a person to see how the heart functions..
Third, affective learning is unpredictable through realia. Fourth, if left sitting
around the classroom, realia can be a distraction. The last is storage and
retrieval can create problems. The
METHOD
The research is designed using classroom action research which is
intended to solve a particular problem encountered by a teacher in the teaching
and learning process, especially in the teaching speaking. According to Harmer
2001, action research is the name given to a series of procedures which is engaged
by teachers to improve aspects of their teaching, and to evaluate the success and
suitability of certain activities and procedures. Burns 1999 also states that a
major focus of action research is on concrete and practical issues of immediate
concern to particular social groups or communities. Based on the statements
above, classroom action research is the research that is held by the teacher in the
class and school where heshe teaches by improving the process and teaching
practices.
A classroom action research design is suitable as the research design in
this study because the researcher is an English teacher who often finds some
problems faced by the students in mastering the lessons. The students have
difficulties in speaking. Moreover, the researcher tries to solve the problem. It is
in line with the basic point of the classroom action research that is to
propose a strategy, technique, or media in the teaching and learning process to
overcome the students‟ problem in mastering a particular subject. In this
research, the researcher proposes using realia as the media in teaching speaking.
Realia is considered to be suitable in this research because realia has never been
implemented as the media in teaching speaking in this college. The previous
studies proposed by Darojat 2011 and Rokhmawati 2011 show that realia can
improve students‟ writing skill. In conducting the research, the researcher
researcher decided to choose realia as the worked collaboratively
with one media in teaching writing because the
nursing instruments were available and easy to be found in this college so that
teacher and students were found any obstacles in finding and using the realia.
456 collaborator who was involved from the
beginning up to the end of the process of the research activity in arranging the
lesson plan, instructional material, teaching learning activities, the action,
and evaluation. Before starting the
research activity, the researcher and the collaborator discussed all of the things
related to the process in order to meet the same perception about the strategy being
implemented, the procedure of the teaching and learning process being
carried out, how to collect the data using the instruments, and how to score the
students‟ test using the scoring rubric. In this research, the researcher acted as the
practitioner who taught speaking by using realia, whereas the collaborator acted as
the observer who observed the implementation of the action in the
presenting the research findings in Cycle 1.
The Students’ Speaking Score in the Preliminary Study
All of the students score for each aspect in speaking could be seen in Table
3.6 below. In this table, no students were in the level of excellent. Most of the
students‟ writing products on procedure text were in the level of fair.
Table 3.6 The Level of Students ’ Speaking Score in all Aspects in Preliminary Study
STUDENTS SPEAKING SCORE
classroom. During the process of implementing the strategy, the
collaborator observed the students‟ activities by using observation checklist
and field notes. At the end of the teaching and learning process, the students were to
make role play.
After implementing the strategy, the teacher and the collaborator conducted
Level
Excellen t
Very good
Good Fair
Poor Total
Pronu nciatio
n 1
3 12
6
22
Grammar
1 4
16 1
22
Vocab ulary
1 3
17 1
22
Fluency
1 6
12 3
22
Comp rehen
sion 1
4 15
2
22
reflection or discussion. In this session, the researcher and the collaborator
analyzed the data from observation checklist, field notes, and the result of the
test, in order to find out whether the criteria of success in use are achieved or
not. Finally, the researcher and the collaborator drew the conclusion. Based
In brief, the table 3.6 the level of students speaking score in each aspect
could be seen in that the students‟ speaking score were mostly in the level of
fair.
Table 3.7 Students’ Final Score of Speaking in
on the conclusion, the researcher and the collaborator discussed and solved the
problems continuously until they reach the
Preliminary Study Grade Score
A 84-100 AB 77-83
Number of studens
standard. The original plan would be revised and would be changed into a new
cycle until the criteria of success have been achieved.
B BC
C D
E
Total
71-76 64-70
56-63 41-55
0-40 2
9 11
22
FINDINGS
The result of the research deals with how to improve the students‟ ability
in speaking using realia as the media. It contains the research findings of the
implementation of the classroom action
research which cover the students‟ involvement during the implementation of
the action and students‟ speaking ability, the results of the observation checklist,
and the field notes. To know the students‟ problem in speaking, the data in
preliminary study are provided before
457 In relation to the students final
scores in preliminary study, based on table 3.7, it could be seen that 11 students or
more than a half students got E, 9 students got D, and 2 students got BC.
Moreover, after being analyzed, based on Table 3.7, the researcher found
out that there were only 2 students who passed the passing grade BC 64; the rest
of the students 20 students did not pass the passing grade. The number of the
students who passed and did not pass the
minimum passing grade could be seen in Table 3.8.
Table 3.14 The Level of Students ’ Writing Score in all Aspects in Cycle 1
STUDENTS WRITING SCORE Table 3.8 Students’ Final Score of Procedure Text in
Correlation with the Minimum Passing Grade in Preliminary Study
Level
Excellent Very
Pronunc iation
3 14
Gram mar
10
Vocab ulary
2 17
Fluency
2 16
Comprehen sion
3
Score 64
64 Number of Students
2 20
Category Passed
did not pass good
Good Fair
4 1
12 3
4 19
Total 22
Poor
Total 22
22 22
22 22
In brief, the level of students speaking score in each aspect in Cycle 1
could be seen in table 3.14. In this table, the students had already made some
improvement compared to the scores in preliminary study. It could be seen that
the students‟ speaking score
were increased, mostly in the level of very
good.
Table 3.15 Students’ Final Score of Procedure Text in Cycle 1
Figure 3.8 Percentages of Students Final Score in Preliminary Study
In brief, it can be seen from the figure 3.8 showing the diagram of the
percentage of students‟ final score in preliminary study. In this figure, it could
Grade A
AB B
BC C
D E
Score
84-100 77-83
71-76 64-70
56-63 41-55
0-40
Total Number of Students
3 3
13 3
22
be seen that 90,91 of the students did not pass the minimum passing grade of
the score 64BC, while only 9,09 of the students had passed the minimum passing
grade of 64 BC. In relation to the students‟ final
scores in Cycle 1, based on table 3.15, it could be seen that 3 students got score A,
3 students got AB, 13 students got B, and 3 students got BC. The diagram of this
finding can be seen in Figure 3.15. The results of the research and
development correspond to the research questions as mentioned in the following
sections.
The Result of Students’ Speaking Score on cycle 1
All of the students score for each aspect of the speaking could be seen in
Table 3.14. In this table, the students‟ made some improvement compared to the
Moreover, after being analyzed, based on table 3.15, the researcher found
out that all of the students had already passed the passing grade BC 64. The
number of the students who passed and did not pass the minimum passing grade
could be seen in Table 3.16.
Table 3.16 Students’ Final Score of Procedure Text in Correlation with the Minimum Passing
Grade in Cycle 1
scores in preliminary study. There was no student in the level of poor. Most of the
students‟ speaking score were in the level of fair very good.
Score 64
64
Total Number of Students
22
22 Category
Passed did not pass
458
Not 6
Achieving Criteria of
20 90,91
Success
Based on the students‟ scores on table 3.17, it can be concluded that the
implementation of the process writing approach in the Cycle 1 met the criteria of
success. The average score was 76.3. There were no students who got score
Figure 3.16 Percentages of Students Final Score in Cycle 1
In brief, it can be seen from the figure 3.16 showing the diagram of the
percentage of students‟ final score in Cycle 1. In this figure, it could be seen
under 64. The lowest score in the first cycle were BC which were acquired by 3
students, 13 students got score B, 3 students got score AB, and 3 students got
score A. The student‟s lowest score was 69 and the highest students‟ score was 96.
The data above showed that th e students‟
that all of the students or 100 passed the achievement in their
speaking had minimum passing grade of the score
64BC. Based on the result of the
students‟ speaking score, there was a great improvement of the students‟ average
score from the students on the preliminary study to the students‟ speaking score on
the Cycle 1. The average score on the preliminary study was 44,3 and the
average score of the students‟ on the first
achieved the criteria of success. There was also an improvement in
terms of the aspect of speaking. For detailed information about the students‟
improvement in speaking of each aspect can be seen in Table 3.18.
Table 3.18 The Students’ Improvement in each Aspect
of Writing
Stage Preliminary Study Cycle 2
cycle was 76,3. It means that there was a 32 point of average score improvement. In
the preliminary study, there were only 2
Aspect Writing
of Mean
Min Score
Max Scor
e Mean
Min Score
Max Score
students who achieved the score above the criteria of success. Meanwhile, in the
Cycle 1, all of the students had already passed the minimum score of the criteria
of success that is 64 or BC. For detailed
Content Organization
Vocabulary Grammar
Mechanics 2,11
2,34 2.20
2.25 2.23
1,5 1,5
1,5 1,5
1,5 4
3 4
4 4
3,89 4
4 3,68
3,14 2,5
3,5 3,5
3,5 3
5 5
5 4,5
4
information about the improvement of the students‟ score in Cycle 1 compared to the
score in the preliminary study can be seen in Table 3.1
Table 3.17 The Students’ Speaking Improvement in Cycle 1.
Based on the score of the students‟ final score in Cycle 1, it can be
concluded that the implementation of the strategy on the first cycle had met the
criteria of success. The average score of the Cycle 1 was 76,63. In addition, all of
N o
Aspects Preliminary
Study Cycl
e1 Percentage
Pre- Cycle 1
Study
the students or 100 of the students had reached the criteria of success.
1 2
3 4
5 Average
Score Min Score
Max Score
Criteria of Success
Achieving Criteria of
Success 44,3
33 68
64 2
76,3 69
96 64
22 -
- -
- 9,09
- -
- -
100
DISCUSSIONS
The realia were designed to achieve the objective of teaching
speaking. The objective was that the students were able to make a droleplay
based on the realia used. In this case, realia was very useful because it helped
459
the students to arrange the sequence of steps on how to useoperate something
into correct order. It was confirmed by many experts, for instances, Doff 1995
states that the use of real conditions using the target language items helps the
students absorb the point faster and memorize them longer. Meanwhile
Kreidler 1971 mentioned that realia can be used to teach fast drill of the tenses. In
this activity, medical instruments are excellent aid. To help the students practice
with imperative sentence, the using of medical instruments can help a lot rather
than just teach them theoretically. Furthermore, Celce-Murcia and Hilles
1998 also suggested that realia can be used in conjunction with storytelling and
role play techniques to contextualize the grammar lesson, as well as facilitate
memory and learning. Moreover, Soames 2008 mentioned some advantages of the
implementation of realia. First, using realia stimulates the mind, and is one way
of encouraging creativity by involving the senses. Second, realia saves time, as
recognition of an object is immediate and so cuts out the need for lengthy
explanations and drawing funny pictures on the board. Third, bringing realia into
the class is a great icebreaker, and serves as a useful tool to prompt conservation.
Forth, using realia will generate interest and help create an atmosphere conducive
to learning. The last, realia breathes life into new vocabulary, and the chances of
the students remembering the new words. used in nursing standard operating
procedure. This activity is essential to promote creativity and tolerate for
collecting many possible answers. After the students were familiar with some
medical instruments, the teacher decided to continue to the next activity.
The teacher asked some questions to the students related to the terms of the
part of the medical instruments used in nursing standard operating procedure. It
was proposed to make the students familiar with the vocabulary and give
chance for the students who have known the terms before to share the information
with other friends.
After that, the teacher presented the model of speaking of nursing SOP. It
was about the procedure of “how to check blood pressure”. The teacher explained
the model of nursing SOP so that the students understand it. By presenting a
model, the students could understand the form of writing they were supposed to
speak. Brown 2001 stated that by reading and studying a variety of relevant
types of text, students can gain information insight both about how they
should write and about subject matter that they may become the topic of their
writing. This finding is parallel with the idea stated by Eanes 1997 that the
activities or strategies in the prewriting stages should help students to develop
their background knowledge and organize thoughts.
The teacher and the students The teaching
of speaking
discussed the model together. Through the consisted of pre, whilst, and post
activities. In the pre speaking stage, the researcher activated the students‟
background knowledge by using brainstorming. Brainstorming activity
helps the students to collect ideas, viewpoints, or ideas related to the topic
being discussed. This was in line with Raimes 1983 who states that
brainstorming is an activity to produce words, phrases, ideas as rapidly as
possible without concerning for appropriateness, order or accuracy. In this
part, the teacher asked the students to mention medical instruments they usually
460 discussion, the students could comprehend
the how to speak and what to speak. However, the teacher should give
guidance by asking some questions so that the students had good understanding of
the model. Therefore, presenting the model becomes an effective way to
facilitate the students to transfer their ideas.
The next activity was group task. In this action, the teacher asked the
students to make a group of four. Their task was; first, observepractice with the
realia in term on how to operate the realia. Second, make a draft about procedure
paragraph on how to operate the realia. Then, they exchange their draft to other
group. After that, they did peer revising. The students should give comments or
suggestions to their friends‟ draft. It was intended to train the students in giving
Realia to Improve Students‟ Speaking Ability in Procedure Text”. In this
research, the researcher used realia to improve students‟ speaking ability,
because realia is real object that can be used as a medium in teaching learning
feedback to their friends‟ draft for process and most of
students are correctness in term of content,
organization, and grammar. Brown 2001 states “peer editing is a true sharing
process”. Through this strategy, the students learn to be better writers and
better readers. Besides, it enabled them to have close relationship with each other.
However, the teacher should give intensive guidance. The fact showed that
some of the students reluctant to ask for
the teacher‟s help though they found difficulties in accomplishing the task. So,
the teacher should proactively help the students without waiting for the students
to raise questions. After getting the feedback from their friends and the
teacher, the next stage was rewriting. In this stage, the students revises their draft
based on their
friends‟ and the teacher‟s feedback.
The last stage was the post- speaking activity. In this stage, the
students were given a chance to make a role play. The role play activities could be
done by asking the students to present role play in front of the class
Referring to the previous relevant studies in the use of realia to
improve students‟ English skill, the finding of this study showed the same
result as Darojat 2011. He implemented realia to teach writing procedure texts.
The results of the study revealed that the implementation of realia as media to teach
writing procedure texts is effective in improving the students writing ability of
the ninth grade students of MTs N Liwa in writing procedure texts. Besides, the
results of the study showed that the students were enthusiastic, motivated, and
actively involved in teaching and learning process using realia as media in the
teaching and learning process. Another research that supports realia is effective to
interested in it. In this research, the researcher used many kinds of realia. In
the first cycle, the researcher used candles, bar of match and candle holder.
Then, in the second cycle, she used a water faucet, a soap, and a towel. In third
cycle, she used pencils and sharpener. The result of research shows that realia used in
teaching speaking procedure text with the ninth grade of students MTs Mathalibul
Huda Jepara in The Academic Year of
20102011 can improve students‟ speaking ability. In terms of the realia
being used, there was a difference between this study and another previous
study. Both previous research by Darojat 2011 and by Rokhmawati 2011 took
the MTs N students as the object of the study, while in this research, the
researcher will take the fifth semester students of nursing department.
Rokhmawati 2011 used household appliances and stationary such as candles,
match, candle holder, water faucet, soap, towel, pencils and sharpener, while in this
research the researcher used the medical equipment which is used in the nursing
Standard Operating Procedure such as thermometer, stethoscope,
sphygmomanometer, etc because nursing students are expected to be able to use
those kind of tools in their profession.
To know whether the teaching and learning process had achieved the
objectives or not, it was necessary to conduct evaluation. The result of the
evaluation should be led to the
improvement on students‟ speaking score. In this study, there was a significant
improvement on students‟ speaking skill compared to the teaching and learning
process of speaking before applying realia as media.
The result of the analysis on the be used in language teaching was done by
students‟ final product on speaking
Rokhmawati 2011 entitled “The Use of
461 showed that the students‟ skill in speaking
had improved significantly from preliminary to cycle 1. Before the action
was implemented, the mean score of students was D or 44.3. After the strategy
had been implemented, the mean score of the first Cycle 1 became B or 76.3.
CONCLUSION AND SUGGESTION
This chapter presents the conclusion and the suggestion in reference
to the research finding and discussions presented in the previous chapter. The
conclusion deals with the students‟ improvement in speaking and the using of
realia as the media in teaching and learning process of speaking. In addition,
the suggestions are directed to English teachers and further researchers who want
to continue to do research in the same field in the future.
Conclusion
the problem faced by the students in a certain class and certain topic. This study
focused on the effort to improve the students‟ ability in speaking in term of on
how to do somethinghow to operate some modern appliances. As the result, it had
been successful. Based on the research findings, some suggestions, particularly
for the teachers andor lecturers who want to apply this approach in their speaking
classes, and for the next researchers who want to conduct similar study, are
proposed to improve the quality of the teaching and learning process in the
future.
Firstly, the result of the research will be advantageous for STIKes Patria
Husada Blitar. As has been discussed previously, this study provides an
alternative approach in teaching and learning writing that can be used for the
lecturers in solving their students‟ Referring to the findings of this
problem in speaking. However, the
study, realia can be an effective media in the teaching of speaking. The realia can
improve the students‟ ability in speaking and the students‟ involvement in the
teaching and learning process. In this study, the students‟ speaking scores was
significantly improved in Cycle 1 compared with those in Preliminary study.
The number the students who got score above 64 BC as the minimum passing
grade set by the researcher was also improved from the Preliminary study to
Cycle 1.
The data showed that the students‟ participation in Cycle 1 is categorized as
very good because most of the students involved actively in the teaching and
learning process. Most of the students lecturers should be more aware in the time
management, particularly in handling students-teacher conference otherwise it
would spend much time. To make the time effective, it would be much better if
the lecturers could manage the meetings less than five meetings. Additionally,
since the students are not accustomed to be actively involved in the class activities,
the lecturers should give activities that can
stimulate students‟ cooperativeness and activity.
Secondly, based on the effectiveness of the implementation of
realia as a media to teach speaking, it is suggested that the English teachers
implement the strategy as an alternative strategy in English instruction and create
participated actively in the teaching and the
students-centered instruction. In
learning process, such as: paying attention to the teacher‟s explanation, answering
the teacher‟s question, making a group, making a draft, giving comments to their
friends‟ draft, revising draft, and making a role play.
Suggestion
This study proposed realia as media to improve the students‟ ability in
speaking. It was conducted to overcome
462 addition, in applying this strategy, the
teacher should be active in monitoring the students and proactively give effective
guidance to the students. Furthermore, the teacher should be creative in the teaching
and learning process so that the students will never feel bored. Furthermore, in
implementing the strategy, the teachers should be aware of the following
considerations. First, the teacher should clarify their instructions and explanations
more and more since it is still hard for non English students to understand
instructions in English. Second, during the process, it is better for the teacher to use
modeling for providing examples of how the students should speak, and pronounce.
Third, the teacher should give intensive guidance to the students in each stage of
the speaking process when the students do the task. The last, there must be a
sufficient number of dictionary in the class in order to help the students find the
appropriate words that they used in their speaking. It is a must because inability of
the students to organize the ideas was mainly caused by the insufficient
vocabulary they already mastered.
Finally, further researchers who are interested in the same field of the
study, it is suggested that they apply this strategy. They can propose realia as media
to help the students learn how to describe somethingsomeone. Besides they can
investigate the research about the effectiveness of realia in the teaching of
vocabulary
REFERENCES
Celce-Murcia, M. Hilles, S. 1998.
Techniques and Resources in Teaching Grammar
. Hongkong: Oxford University Press
Darojat, Muhammad. 2011.
Using Realia to Improve the Ability of the Ninth Graders of MTs N Liwa Lampung Barat in Writing Procedure Texts.
Unpublished S2 Thesis. Malang: Graduate Program State University of Malang.
Jones, Anthony S.D., The Black River Group. 1994.
The Expert Educator
. Fond du Lac WI: Three Blue Herons Pub
Rivers, W. 1981.
Teaching Foreign Language Skills
. Chicago: The University of Chicago Press
Tim Penyusun Kurikulum STIKes Patria Husada. 2011
. Panduan Pendidikan Ners dan Bidan STIKes Patria Husada Blitar.
Blitar: STIKes Patria Husada Zukowski-Faust. 1997.
What is meant by Realia?
Arizona: AZ-TESOL Newsletter
463
THE CORRELATION OF FINANCIAL MODELS AND MEDICINE ADHERENCE IN PATIENTS WITH DIABETES MELLITUS
INATALATION OF OUTPATIENT AT RSUD NGUDI WALUYO WLINGI Yeni Kartika Sari, Nanang Yudhi Prasetyo, Wiwin Martiningsih
STIKes Patria Husada Blitar
Email:kartikasariyeni84gmail.com
Abstract
Medication adherence in patients with Diabetes Mellitus is important in achieving treatment goals and effective in preventing some of the complications
of Diabetes Mellitus. Patients with chronical diseases such as Diabetes Mellitus whose treatment requires a long time even a lifetime to note about the social
economy, especially how patients pay for treatment.
The purpose of this study was to determine the correlation between financial models and medicine adherence in patients with diabetes mellitus of
Outpatient in RSUD Ngudi Waluyo Wlingi.This study was a type of non- experimental research design and analysis of cross sectional. This study was
conducted in 68 patients with Tipe 2 Diabetes Mellitus at Outpatient RSUD Ngudi Waluyo Wlingi, in Nopember 2014, the samples were taken by accidental
sampling technique. The correlation score of medication adherence with financial models was analized using Spearman Rank test.
It was found that there were correlation between financial models and medicine adherence in patients with diabetes mellitus by p value 0,000. It was
important to improve health education about medicine adherence and how to acces financing to support their treatments.
Key words: medicine adherence, financial models Introduction
Diabetes mellitus is a disease characterized by high blood sugar
levels. Basically, this is because the diabetes. The number of diabetics in
urban areas of Indonesia in 2003 was 8.2 million people. While 5.5 million
people in rural areas. It is estimated
body lacks insulin
substance that 1 of 8 people in Jakarta have
produced by the pancreatic gland. Disadvantages here could be the
lacking amount of insulin that, or the insulin is quite but it works less well.
diabetes. The high count of patients in urban areas is partly due to
lifestyle Prapti Utami, 2009.
Based on data obtained in Diabetes mellitus
is a chronic
Outpatient of Ngudi Waluyo Wlingi degenerative disease not curable but
blood sugar levels can be stabilized to normal Sukarjdi, 2009.
According to WHO Indonesia ranks fourth largest number of
diabetics in the world. In 2000 there hospital that the average patient
visits during 2009 was 259, in 2010 the average patient visit was 278, in
2011 the average patient visit was 300 and in 2012 the average patient
visit was 295. Then in 2013, 33 visit
were approximately 5.6 million patient was new patient and 311 visit
people in Indonesia who have
patient was the old patients. In 2014
462
until September, the average patient Based on this
condition, non-
visits were 354. compliance of diabetes mellitus
It is estimated that there are patients maybe
due to socio-
still many people about 50 who economic related factors. In patients
have not been diagnosed with
with chronic diseases such as
diabetes mellitus in Indonesia witch was only two-thirds of diagnosed
people who have undergoing treatment, both non-pharmacologic
diabetes mellitus whose treatment requires a long time and even a
lifetime must note about the social economy, especially how to finance
and pharmacologic.
From the patient treatment. If the patient is in
undergoing such treatment is only lower economic level or do not know
one-third are
well-controlled about the existence of the system of
PERKENI 2011 . Whereas patients financial model
dedicated to him, with diabetes mellitus if it does not
receive appropriate treatment will have a negative impact on the
patients own form of occurrence of various complications. Which it will
the patient will tend to disobey in the treatment. Based on research of Isa
and Baiyewu in Ramdani, 2012, showed that lower quality of life in
patients type 2 diabetes is influenced
further increase the burden of
bybsocio-economic factors that is medical expenses that should be
covered by the patient. associated with financial problems or
financial availability to support their treatment.
The lower of
Various studies have shown that socioeconomic
status is also
generally patient compliance in the associated with poor adherence in
treatment of chronic diseases is low. patients
with diabetes mellitus
The research involving outpatients Faradhilah,
2014. Medication
showed that more than 70 of patients do not take medication
according to the right dose Basuki, 2009. According to a WHO report
in 2003, the average compliance of patients on long-term therapy for
chronic disease in developed countries is only 50, whereas in
developing countries, the number is even lower Asti, 2006.
adherence in patients with Diabetes Mellitus is important in achieving
treatment goals and effective in preventing some of the
complications of Diabetes Mellitus. Patients with chronical diseases such
as Diabetes Mellitus whose treatment requires a long time even a lifetime
to note about the social economy, especially how patients pay for
treatment, Putri, 2008. From the analysis of some of the
opinions of experts known that medicine adherence is influenced by
many factors. These factors include economic factors. Estimates that
there are states that 20 of hospitalization as a result of non-
compliance of patients to treatment Sarafino, 2013
463
There were various financial models at Ngudi Waluyo Wlingi hospitasl
such as general financial, BPJS and Jamkesda. Based on observation
there, the 80 of 354 visit of diabetes mellitus patient to
September choosen BPJS as financial models and a lot of patients
who used a general financial and
Jamkesda moved to BPJS financial models.
Based on the above description of analyzed by Spearman rank test with
significance level ≤ 0.05 Result and Analysis
the importance of sustainable
The Gender of Respondents
financial models to support the
Table 1 The Distribution of treatment of patients with chronic
diseases such as diabetes mellitus, the researchers were interested to
know the correlation of Financial Models and Medicine Adherence in
Patients with Diabetes Mellitus Respondent‟s
Gender In Outpatient of Ngudi
Waluyo Wlingi Hospital, November
2014 Inatalation in Outpatient at RSUD
Ngudi Waluyo Wlingi.
The general purpose of this research was to explain the correlation
Gender
Male Female
Total
Amount
25 43
68
Procentage
37 63
100 between Financial Models and
Medicine Adherence in Patients with Diabetes Mellitus Inatalation in
Outpatient at RSUD Ngudi Waluyo Wlingi While the specific purposes
of this study were: 1 Describe the financial model of diabetes mellitus
patient in Outpatient of Ngudi Waluyo Wlingi hospital. 2 Describe
The Employment of Respondents Table 2 The Distribution of
Respondent‟s Employment In Outpatient
of Ngudi Waluyo Wlingi
Hospital, November 2014
the medicine adherence of diabetes mellitus patients in Outpatient of
Ngudi Waluyo Wlingi hospital. 3 Analyze the relationship between
financial models and medicine adherence in patients with diabetes
mellitus inatalation in Outpatient at RSUD Ngudi Waluyo Wlingi.
Employment House wife
Private Job Farmer
Pentionary Teacher
Government emp
Total Jumlah
19 15
7 23
3 1
68
Prosentase 27,9
22,1 10,3
33,8 4,4
1,5
100
The Education Of Respondents Method
This research was non-experimental research with cross sectional method.
The sample in this research was 68 people who suffer from diabetes
mellitus who visited the Outpatient Table 3 The Distribution of
Respondent‟s Education in In Outpatient of
Ngudi Waluyo Wlingi Hospital,
November of Ngudi Waluyo Wlingi hospital
2014 with accidental sampling technique
The independent variable of this research was financial model while
the dependent variable was the medicine adherence. The data were
Education Elementary
Junior High Senior High
Diploma bachelor
Total Amount
21 18
17 12
68
Procentage 30,9
26,5 25
17,6
100
464
happens because the
ongoing
Cross-tabulation financial model with medication adherence
of Diabetes mellitus patients Table 4 Cross Tabulation Financial
Model
with medicine adherence of Diabetes mellitus patientsIn
Outpatient of Ngudi Waluyo
Wlingi Hospital, November 2014
financing needed when the level of compliance to be achieved successful
therapy with either WHO 2003, in which the BPJS patient is no
guarantee continued their threatment. While on public patients there was a
possibility of high socio-economic status so that they could pay for their
treatment, because the sustainable financing needed if the level of
medicine adherence to be achieved works so well WHO, 2003.
Financial Model
BPJS General
Spearman Rank
High 37
3 0,000
Medication Adherence Moderate Low
9 2 13 4
From the results of the research obtained from the data that
there were 22 people who have a moderate level of compliance in
which 13 people were patient with public financial models. In addition
to socio-economic factors that could The above table shows that
there was a correlation between affect adherence, the majority of
respondents 8 people answered yes financial
adherence model
in with medicine
diabetes mellitus when asked if they feel that therapy
was complicated, this means that patients, with the results of analysis
factors associated therapies such as using SPSS 16 software
with the duration, the treatment regimen,
Spearman Rank test P value of 0.000 was obtained, and in this case of
course P value less than 0.05.
Discussion
previous treatment failures , changes of treatment, the unfavorable effects
of the drug, side effects, and the availability of medical support to
deal with them was a prominent
Based on the research results could factor
in influencing medicine
be obtained that the majority of respondents, 40 people have a high
compliance rate 58.8, 22 with adherence Takiya et al, 2004.
While in the BPJS financial model there were 9 people with moderate
moderate compliance rate 32.4, adherence and the majority of
six people had a low compliance rate 8.8. It could be obtained from the
study also that patients with diabetes mellitus using BPJS were 48 people
71, and patients who use public financing were 20 people 29.
The 40 people who have a high density of as many as 37 people
92.5 were respondents who use BPJS financial model, while 3
people 7.5 are respondents who use public financial model. This
465
respondents 4 have the same answer with 8 respondents of public
financial models.
The result also showed that there were 6 people have low
adherence level and most of them 4 patient are public financial models
that were commonly influenced by socioeconomic factors which
socioeconomic status were low also associated with poor adherence in
patients diabetes mellitus
Faradhilah, 2014. Whereas in BPJS patients there are 2 people who have
low level of adherence in which the majority of them answered yes when
asked if they sometimes forgets to take medication. It was appropriate
fact that there were other factors that affect adherence in this case that
were relevant with therapy factor.
At the low level of medicine adherence the amount of public
patient are more than BPJS patient with that some of the factors related
where from
6 low adherence to clients adherence affected factors
respondents, 4 of them were public was reportedly forgetfulness WHO,
financial models, this condition
2003, besides of course also due to the lack of motivation of the client to
perform the treatment, as well as the level of education of the patients
could be happens because in public patients not necessarily guarantee the
availability of sufficient financial access to treatment, while BPJS
were low elementary shool,
patients have other factors affecting considering education can affect the
level of patients knowledge about the importance of regularity of taking
the drug, it was appropriate because adherence that were factors related to
the client them self.
Conclusion
education were a process of changing There were
correlation attitudes and code of conduct of a
person or group and also mature between model of financial model
with medicine adherence in diabetes human effort through the efforts of
patients in Outpatient of Ngudi
the teaching and training Meliono Irmayanti, 2007.
From the results of this study showed that BPJS patients have a
Waluyo Wlingi Hospital with α significance value of 0.000.
Acknowledgement
high compliance rate of more than Among patients
with a patients who used public financial
number of public financial and BPJS model
in which of the 48 patients in this study is not the same
respondents who used as 37
respondents 77.1 have a high compliance rate. While in public
financial model patients from 20 respondents there were 3 respondents
15 had a high compliance rate.
REFFERENCES Asti, Tri. 2006. Kepatuhan Pasien :
Faktor Penting dalam This condition occurs because BPJS
Keberhasilan Terapi. Info
patients had availability of financing POM, Vol. 7, No. 5, diakses
for access to treatment, while the Januari 2011
dari public financial model patient not
necessarily guarantee the availability of financing because it depend on the
social economic status. At the level of moderate compliance there were
more BPJS patient than public client that was 13 respondents 65 and
in BPJS patients from 48 respondents have 9 respondents 18.75 with
high levels of complianc. It was a
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Basuki, Endang. 2009.
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MPKT Modul 1
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PERKENI, 2011.
Konsensus Pengelolaan Dan Pencegahan
doc234158166Hubungan- Tingkat-Kepatuhan-Minum-
Diabetes Mellitus Tipe 2
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Interaction, Second Edition
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Diabetes mellitus, kencing manis, sakit gula
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diakses 7 oktober 2014
THE EFFECT OF CONSUMING WATERMELON RIND EXTRACT
CITRULLUS LANATUS
TOWARD THE DECREASING OF BLOOD SUGAR LEVELS ON
DIABETES MELLITUS
PATIENTS IN WERU - PACIRAN - LAMONGAN
Arifal Aris, S.Kep, Ns, M.Kes.
Nursing Program
of STIKES Muhammadiyah Lamongan
ABSTRACT
Diabetic is a cronic disease that characterized by hyperglycemic. This disease is a problem that often occurs in the society, with their high blood sugar levels. One way to
control blood sugar levels is by pharmacological and non-pharmacological. One of the ways is using the essence of watermelon rind juiceextract
Citrullus Lanatus
, because rind extract of watermelon contains citrulline that produces nitric oxide, which nitric
oxide is capable of lowering blood glucose. The purpose of this research is to know the effect of watermelon rind extract
Citrullus Lanatus
toward the decreasing of sugar levels of diabetic patients in Weru, Paciran, Lamongan.
The method used in this research is
quasy eksperimental
using pre test and post test design. Population in this research is all diabetic patients in Togosadang Health Center,
Weru, Paciran, Lamongan at October. The population is 31 patients with the sample is 28 patients. The sampling technique used is simple random sampling. The instrument is
Glukotest. The method to analyze the data is using
paired t-test
with α = 0,005. The result of this research is that the patients in treatment group given watermelon rind
extract get decreasing in their blood sugar levels attaining 10 of them71,4 anf they who get increasing in ther blood sugar levels reaching 4 of them 28,6. But in the
control groups not given watermelon rind extract do not get decreasing on their blood sugar levels, none of them 100. It measured using
paired t tets
α 0,05 with significan 0,000 p 0,05. From this result, we can conclude that there is effect of consuming
watermelon rind extract to the diabetic patients in Weru to decrease their blood sugar levels..
Based on the result of this research, it can be concluded that to control blood sugar levels is by combining pharmacology medicine with herbal medicines, one of the ways is by
using watermelon rind extract
Citrullus lanatus
.
Key words: watermelon rind extract
citrulus lanatus
, blood sugar levels, diabetic.
1. INTRODUCTION
Diabetes is derived from Greek word which means drain or divert
siphon. Mellitus from Latin word which means sweet or honey. Diabetes
mellitus diabetic can be defined as an diabetics in the world currently reached
200 million and is estimated to increase more than 330 million in 2025. The
reasons for this increasing are the raising of life expectancy and doubled high
population growth with increased rates
individual that drains much urine
of obesity linked with urbanization and volume with high glucose level.
dependence on processed foods. In the Diabetes mellitus is a disease
characterized by hyperglycemia with the lack of absolute insulin or the decreasing
in the relative insensitivity of cells to insulin. Based on the current
epidemiological evidence, the number of
469 United States, 18.2 million people with
diabetes 6.3 of the population, almost one-third of them are unaware
that they have that illness. Corwin, 2009
Diabetes mellitus is a disease that is not family in
motivating them and contagious
which its‟ pravelence
supervising their diet. increases from year to year. Diabetes
mellitus often referred to as The Great imitator, because this disease
contaminates all organs of the body and causes many complaints. The symptoms
Diabetes mellitus is already known widely as a disease characterized by the
increasing of blood sugar levels, and can occur because of hereditary factors.
Therefore, the treatment of diabetes
vary widely and can occur gradually, so should be conducted
as early as the patient will not aware of the changes
such as they drink more often, urinate frequently or even lose their weight.
Andi D, P, 2007 According to data of the Health Ministry
in 2008, there were 5.7 of Indonesias population about 12 million people
suffer from diabetes mellitus and 11 of that amount is a group of prediabetes. In
the projection of 2030, it is estimated that the number will rise into more than
21 million people Hidayati, 2009. Likewise, people with diabetes mellitus
in the Surabaya also continues to rise, it can be said that the diabetic currently
reaches 180,000 people, 6 of society on that region, while in Lamongan about
200,000 or 12 of the population allegedly affected by diabetes mellitus
Nur and Ayi 2008. Based on the data obtained from
Puskesmas Tlogosadang Paciran, it is possible, in order to prevent the
occurrence of various complications. The treatment of diabetes can be with
chemical drugs or with natural drugs. To avoid the consequences of the use of
diabetes medications that can harm health if consumed in a long term that
can cause undesirable adverse effects on health is by controlling blood sugar
levels. To control the blood sugar levels is by combining pharmacology drugs
and herbal medicines. One of the ways is to eat watermelon Citrullus lanatus,
especially its‟ rind the white one, the process is simple and has no side effects
that is safe to eat for health. Watermelon is a plant of tropical and
subtropical Afrika. Gurun Kalahari is the central of its divergence. Recently,
this plant has grown rapidly in many other countries such as China and the
United States. Watermelon is a crop that
found 360 people who have tested their grows vine
and require sunlight. blood sugar levels
in January to Watermelon is favored by many people
September 2014, 212 of them 58.84 have a normal blood sugar levels and
148 of them 41.16 have abnormal blood sugar levels. Based on the initial
survey conducted in September 2014 in Weru Paciran, it got 10 people suffering
from diabetes mellitus, 7 of them or 70 with a high blood sugar levels. Of
all the people to be sampled for this survey, 10 people did not do additional
therapies or alternative treatments for lowering their blood sugar levels. From
from infants to adults, because this fruit is really sweet and its color is red or
yellow that is quite tempting to make everyone who see it keen to savor.
Watermelon contains a lot of water which is about 92 of its containt so it
will taste delicious when it is consumed by the time we feel thirsty. Unripe
watermelon can be used as a vegetable in making food. While the watermelon
rind can be used as raw material for making candied or pickled while the
these data it can be concluded that the seeds are used to make
kwaci. problem of blood sugar levels of
diabetic is still high or can not be controlled.
There are some factors that could affect the success in controlling blood sugar
Khomsan, 2009. In Indonesia, watermelon‟s seeds are
commonly consumed as snack and known as kwaci. The fruit is eaten as a
dessert or dishes laid outon the table.
levels are diet, stress, drugs,
Mozambik of watermelon is further environment, sports, elucidation about
diabetes mellitus and the role of the
470 processed, for example, a traditional
alcoholic beverage made of its extract.
Some people use this plant and its fruit for animal feed, even just a few that do
that. One respondent showed that the consumption of watermelon is able to be
used as a medicinal treatment. In his Table 1 The distribution of respondents
characterized by gender in the treatment group.
opinion, watermelon‟s leaves
maceration is able to cure earache, while the flesh is able to cleanse the bowels
and has the effect of watermelon afrodifiak. Kind of watermelon in this
research is varied consisting white, yellow, and red flesh watermelon. In his
research, Sugiyanta expect that the watermelon rind contains citrulline
producing nitric oksida. Nitrad oxide is capable of lowering blood glucose and
triglyceride mice with diabetic. Researcher explained that citrulline is
useful for nitrad oxide systems of human that has a high potential as an
antioxidant and vasodilation and dilating blood vessels to increase blood flow to
the tissues that need it. Trufus, 2013. From the description above, one of the
ways to control blood sugar levels is by combining pharmacology medicine with
herbal medicines, one of which is by consuming watermelon rind Citrullus
lanatus. The researcher is interested in examining the effect of watermelon rind
to decrease blood sugar levels of diabetic patient in Weru, Paciran,
Lamongan.
2. RESEARCH METHOD
The design of this study uses Quasy Experimental using Pre-Test and Post-
Test Design. The population of this Table 1 shows that nearly all
respondents with diabetes mellitus in treatment group are women with the
amount of 12 respondents 85.7. The 14.3 is male with the amount of 2
respondents.
2 Characteristics by gender in the control group.
Tabel 2 The distribution of respondents based on gender in the control group.
Table 2 shows that the majority of respondents with diabetes mellitus in
control group are female with the amount of 9 respondents 64.3, and
the reaming is male 35.7 with the amount of 5 respondents.
2 haracteristics based on Age study is all diabetes patients in Weru
who come to Puskesmas Tlogosadang, Paciran, Lamongan in October. The
1 Characteristics treatment group.
by age in the amount of the population is 31 people.
The sample of this study is 28 people taken using simple random sampling.
The instrument used is Glukotest.
3. RESULT
General Data 1 The characteristics based on Gender.
1 Characteristics by gender in the treatment group
471
Table 3 The distribution of respondents by age in the treatment group
respondents ger rising on their blood sugar levels 28, 5.
2 Blood sugar levels In the control group.
Tabel 6 The distribution of blood sugar levels in the control group
Based on Table 3, it can be explained that 6 respondents aged 50-59 42.8
and one respondent aged 40 7.1.
2 Characteristics based on age in the control group
Table 4 The distribution of respondents by age in the control group
Based on Table 4, it is explained that 7 respondents aged 50-59 50 and no
one aged 40.
Particular Data
1 Blood sugar levels In The Treatment Group.
Table 5 The data distribution of Blood sugar levels in the treatment group
Table 6 shows that the blood sugar levels in the control group given
watermelon rind extractjuice are 14 respondents. No one got decresing on
their blood sugar levels 100
3 Comparison of Blood sugar levels In Treatment and Control Group.
Tabel 7 The comparison of data distribution on blood sugar levels
between treatment group and control group.
Table 7 shows the differences between blood sugar levels in the treatment group
and the control group given watermelon rind extractjuice of 14 respondents. Ten
patients in treatment group given
watermelon rind extract got their blood sugar levels decreases 71.4 and 4
participants got their blood sugar levels increases 28.6. On the other hand, 14
Table 5 shows that the blood sugar levels of the patients in the treatment
patients in the control group not given watermelon rind extract did not get
group given watermelon rind
decreasing on their blood sugar levels juiceextract are 14 respondents. Ten
respondents get decreasing on their blood sugar levels 71.4, and 4
100. It is supported by the results of the test
using SPSS 16.0 using t test sample
472 independent with significance
0.00
where α = 0.05. Then H0 is rejected, it means that there are differences in blood
sugar levels among respondents who given watermelon rind extract and them
who were not on the diabetes mellitus‟ patients in Weru, Paciran, Lamongan.
4. DISCUSSION
The discussion of this study is in accordance with the purpose of the
research, statistical result and the effect regularly consumed, at least, in seven
days to obtain maximum results. 2. Blood sugar levels In the Control
Group The results in table 4.6 shows that blood
sugar levels in the control group who were not given watermelon rind extraxt
is 14 people and all the respondents get decreasing on their blood sugar levels
100. Based on the results, it can be concluded
that all patients who were not given
of watermelon rind juice to decrease watermelon
rind extract did not
blood sugar levels on diabetes mellitus‟ patients in Weru, Paciran, Lamongan in
the year of 2015. They are as follows: experience changes in their blood sugar
levels. It is because the control group was given no treatment. Based on the
1. Blood sugar levels In
the observations, many respondents are less
Treatment Group The results written in Table 4.5 shows
that the blood sugar levels of diabetic patients in the treatment group given
watermelon rind extract are 14 people, 10 patients got decreasing on their blood
active in controlling their blood sugar levels, such as the lack of regular
exercise, do not eat properly. There are several factors that can affect the
success in controlling the levels of blood sugar, such as: diet, stress, family roles,
sugar levels 71.4 and 4 patients medicine,
environment, and sport stayed the same in their blood sugar
levels 28.6. Based on the data above, it can be
concluded that the majority of patients after consuming watermelon rind juice
got decreasing on their blood sugar levels. According Trufus, 2013 white
Guyton, 2007. Thus, maintaining the body to stay healthy is very salient.
Some of the ways to do that are by maintaining a proper diet, exercising
regularly, and keeping the mind to avoid stress.
watermelon rind extract
contains 3. The differences between Blood
citrulline producing nitric oxide; nitric oxide is capable of lowering blood
glucose and triglycerides of diabetics. In addition, citrulline is useful to nitric
sugar levels In Treatment Group and Control Group
Table 4.7 shows the differences between blood sugar levels in the control group
oxide system in human body and it is and the treatment
group given
very potential as an antioxidant and vasodilation. It dilates blood vessels to
increase the blood flow in the body and distribute it to the tissues that need it.
The levels of citrulline in watermelon rind reached 24.7 mg, more than the
flesh that only 16.7 mg. Citrulline in watermelon red fleshy 7.4 mg is less
than the citrulline of yellow-fleshed watermelon rind extracts. It shows that
10 diabetic patients get decreasing on their blood sugar levels 71.4 and 4
diabetic patients did not experience the same 28.6. Whereas in the control
group, the diabetic patients who were not given watermelon rind juice, all of
them did not get decresing on their blood sugar levels 100.
watermelon 28.5 mg.
Thus, Based on the data above, it can be
watermelon rind juice has qualitative benefits as herb because it has been used
as a medicine to lower blood sugar claimed that all participants, diabetic
patients, who consumed watermelon rind juice got decreasing on their blood
levels in diabetes mellitus‟ patients. sugar levels.
According to Trufus Watermelon rind extract juice should be
473 2013, white watermelon rind extract
