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PROCEEDINGS OF THE 1ST ANDALAS INTERNATIONAL NURSING CONFERENCE (AINiC 2017), PADANG, INDONESIA, 25–27 SEPTEMBER 2017

Strengthening Research Capacity and Disseminating New Findings in Nursing and Public Health

Editors Hema Malini Faculty of Nursing, University of Andalas, Padang, Indonesia

Khatijah Lim Abdullah Department of Nursing Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Judith McFarlane Nelda C. Stark College of Nursing, Texas Woman’s University, Houston, USA

Jeff Evans Faculty of Life Sciences and Education, University of South Wales, UK

Yanti Puspita Sari Faculty of Nursing, University of Andalas, Padang, Indonesia Cover illustration: Jam Gadang, the clock tower at Bukittinggi in West Sumatra, Indonesia. Photographer: Ikhwan Arief.

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ISBN: 978-1-138-50066-2 (Hbk + CD-ROM) ISBN: 978-1-315-14390-3 (eBook) Strengthening Research Capacity and Disseminating New Findings in Nursing and Public Health – Malini et al. (Eds) © 2018 Taylor & Francis Group, London, ISBN 978-1-138-50066-2

Table of contents

Preface ix Foreword xi Conference objectives xiii Conference program xv Plenary speech xvii Dr. Mohammad Dimyati xviii Prof. Dr. Rizanda Machmud, MD, FISPH, FISCM xviii Prof. Lisa McKenna, PhD, RN RM FACN xviii Prof. Dr. Khatijah Binti Abdullah Lim Geok Khim xix Ns. Yufitriana Amir, S. Kep, MSc, PhD., FIsQua xix Hema Malini, SKp., MN., PhD xx

Keynote speakers Challenges and strategies in conducting a health education programme for chronic disease in Indonesia 3 H. Malini Preparing qualified nurses: Nurse education institutions’ role in providing excellent standards of nurse education, graduate transition and work readiness 7 L. McKenna Mental health focus: Current global public health challenges 11 R. Machmud

Community health Family support in relation to life quality of the elderly with hypertension 19 G. Sumarsih, D. Satria & D. Murni Comparison of health-promoting lifestyles of male and female student nurses 23 R.M. Sihombing & M.G.L.R. Sihotang Factors influencing the quality of life of the Minang elderly living in nursing homes: A perspective of Minang culture 29 R. Sabri, A.Y.S. Hamid, J. Sahar & Besral

Health management The supervision experience of head nurses in a hospital setting 37 D.S. Paramitha

v Development and validation of a Technological Competency as Caring in Nursing Instrument (TCCNI): Learning from the outcomes 43 I. Yuliati & J.D. Lorica A phenomenological study: The first clinical experience of student nurses in Padang 47 Nelwati Nursing students’ coping mechanisms against bullying during nursing professional practice 53 Z.M. Putri, I. Erwina & Y. Efendi

Maternal health Promoting kangaroo mother care practice at home through educational video and nurse-assisted practice 61 N. Fajri, Y. Rustina & E. Syahreni An ergonomic breastfeeding chair design 67 P. Fithri, L. Susanti, I. Arief, D. Meilani & C.T. Angelia Minangkabau mothers’ characteristics and breastfeeding self-efficacy in relation to exclusive breastfeeding practice in Padang 71 V. Priscilla Depression and situational crisis on infertile Minangkabau women 77 Y.P. Sari & M.U. Ridwan

Mental health Coping mechanisms and stress levels in thesis writing among nursing students 85 F. Fernandes, Dahlia & Basmanelly Relationship between coping mechanism and stress level among parents with mentally retarded children at SLB Wacana Asih, Padang 91 I. Erwina, D. Novrianda & W. Risa

Medical and surgical Examining the effect of logotherapy on the anxiety levels of cervical cancer patients 99 A.R. Ma’rifah, M.M. Budi & R.I. Sundari Relationship between duration of intravenous therapy and frequency of intravenous cannula replacement 103 Bayhakki Cardiovascular disease risk assessment based on laboratory versus non-laboratory tests: A systematic review 107 D. Prabawati & J. Lorica Quality of life of cervical cancer patients post chemotherapy 113 E.A.F. Damayanti, H. Pradjatmo & W. Lismidiati Community knowledge of coronary heart disease in relation to characteristic risk factors 119 E.A. Sari & S.H. Pratiwi The effect of diaphragmatic breathing exercise on pulmonary ventilation function in patients with asthma: A preliminary study 123 E. Afriyanti & B.P. Wenny

vi Risk factors associated with hypertension: A case study in Andalas Public Health Centre 129 S. Rahmadani, E. Huriani & R. Refnandes A retrospective study of the association between the quantity and varieties of fruit consumption with the glycaemic status of patients with type-2 diabetes mellitus 133 J. Widiyanto, Isnaniar & T.K. Ningrum A dietary assessment of nurses in Klang Valley, Malaysia 139 M.R. Ab Hamid, N.I. binti Ahamad Sidek & N. Said The effects of structured education on knowledge, attitude and action of patients with a colostomy 145 R. Fatmadona, H. Malini & M. Sudiarsih Nurse experiences in conducting diabetic foot risk assessment in diabetic patients in hospital in Medan 151 Y. Ariani & R. Tarigan

Nursing education The relationship between admission factors and first-semester grade point average in Indonesian nursing students 159 C.L. Sommers & S.H. Park A systematic review: A tool development process for public health nurses’ competencies 165 I. Kusumaningsih & A. Talosig A systematic review: Implementation of reflective learning in nursing practice 171 J. Purwarini & J. Lorica Determinants of nursing licensure examination performance: A literature review 177 Y. Siswadi & A. Talosig

Pediatric health The effect of a kaleidoscope on pain relief during a venepuncture procedure in children in Padang, Indonesia 185 D. Novrianda, R. Fatmadona & L.B. Safira Factors influencing nutritional status of children aged under five based on weight-for-height using the CART method 191 H. Yozza, I. Rahmi & H.A. Rahmy Factors related to bullying behavior among school-age students in Padang, West Sumatra 197 Hermalinda, Deswita & E. Oktarina Family-centred care needs of mucositis management in children with cancer 203 I. Nurhidayah, H.S. Mediani, S. Hendrawati & A. Mardhiyah Analysis of phlebitis occurrence in terms of the characteristics of infusion by nurses in RSI Ibnu Sina Payakumbuh 209 L. Fajria, L. Merdawati & Nelviza Relationship between self-efficacy and the stress levels of B 2015 programme nursing students when completing their thesis at the faculty of nursing, Andalas University in 2016 215 M. Neherta, D. Novrianda & P. Raini

Author index 221

Factors influencing the quality of life of the Minang elderly living in nursing homes: A perspective of Minang culture

R. Sabri Faculty of Nursing, Andalas University, West Sumatra, Indonesia

A.Y.S. Hamid & J. Sahar Faculty of Nursing, University of Indonesia, West Java, Indonesia

Besral Faculty of Public Health, University of Indonesia, Indonesia

ABSTRACT: A change in the protection of the elderly in Minangkabau has been marked by the growing number of elderly living in West Sumatran nursing homes. Nevertheless, caregivers in nursing homes have not provided the expected care as is evident from the high level of physical and psychological illness of the elderly. This study used the focused ethnographic method and aims to identify factors influencing the quality of life of the Minangkabau elderly living in nursing homes. This research involved 13 respondents who were purposefully recruited from a government-owned Panti Sosial Tresna Werdha (PSTW) in West Sumatra. This study suggests that support from PSTW management is needed to facilitate the elderly’s regular meetings with their family, to arrange health checks conducted by competent parties, and provide some basic training to new caregivers in order to serve the elderly in accordance with local cultural values.

1 INTRODUCTION

The number of elderly in the world is growing because human life expectancy is getting longer in most countries. In 2013, the number of elderly people in the world reached 11.7% or about 841 million people and about 560 million elderly people (66.59%) lived in develop- ing countries, including Indonesia (20.04 million or 8.05%). The number of elderly people in West Sumatra reached 8.41% of the total population. This phenomenon follows changes in the society’s social paradigm to care for the elderly. The government has established nursing homes to improve the seniors’ welfare but their goal has not yet been achieved. (Setiati et al., 2011) explain that Indonesian old people’s health status and quality of life can be assessed through sex, nutritional status, number of chronic diseases, functional status, and depression status. In West Sumatra, (Harni, S, 2010) also found that 38.5% of old people felt lonely in PSTW and 26.7% of the elderly residents experienced depression. The studies in West Sumatra show that elderly people have certain health problems, such as hypertension 54%, rheumatic 76%, and uric acid 24% (Austrianti, 2010). These conditions had an impact on the elderly’s decreasing ability to perform their daily activities, including low self-hygiene (68%). (George et al., 2014) found that Activities of Daily Living (ADL) was one of the main aspects that had an impact on the health status and life quality of the elderly. (Sabri, 2016) also discovered that unfair attitudes when providing care, lack of communication, and action without clear explanations / arguments make the elderly feel neglected. The attitude of caregivers who do not appreciate the elderly is contrary to Minangkabau cultural value that upholds and respects parents, especially elderly women. Caregivers may fail to comply with the principle of adat basandi syarak, syarak basandi kitabullah

29 (Minangkabau traditional rules are based on Sharia and Sharia rules are based on Al-Qur’an) indicating that there must be no deed or action from any member of Minangkabau society who are characterised as masyarakat sakato (a united society) that should violate Minangkabau traditional and Islamic rules. Such a typical characteristic of Minangkabau society becomes the key assumption the researcher used in discovering causes for the caregivers’ failure to adequately communicate with the elderly residents in PSTW. This lack of communication discourages the elderly to complain and tell the caregivers what they wanted (Zwygart-stauffacher, 2007). Unfulfilled hopes and unsatisfied needs may lead the elderly into depression and this is a high risk condition that impacts their quality of life. This research identifies factors influencing the quality of life of the Minangkabau elderly people living in nursing homes.

2 METHOD

This study applies the ethnographic approach. Participants involved in this research were recruited through the purposive sampling technique. Data was obtained from 13 participants through observation, Focus Group Discussion (FGD), and interviews that were conducted from May to July 2016. Participants were asked some questions regarding the reason for staying at home or moving to nursing home, the changes felt before and during their stay in the nursing home, the social support they expected, and the elderly person’s opinion of the behaviour of nurses and caregivers. Data analysis was conducted manually using the following steps: 1) encoding data for descriptive Table; 2) sorting data to recognise patterns; 3) identifying extreme data; 4) explaining patterns and data by using theory and theoretical construction; 5) making memos or notes to be included in the reflective statement. Results of the analysis are focused on answering the research questions (Roper & Shapira, 2000). They are presented in the form of themes that are discussed based on ethic and emic perspectives.

3 RESULT

3.1 Theme 1: Family and peer group support Support of the family is really needed by elders who live in nursing homes. However, from five elders who were interviewed, only one elder claimed to have been visited by his family members. More than half of the Minangkabau elderly in the nursing homes have children but their children were migrating or there were conflicts that had happened between them so that the elderly decided to live in the nursing homes. However, during the observation, the researcher never saw any family visiting their elders. This phenomenon is supported by the caregivers’ explanation: …He left his children because he has to go to work in Jakarta. He did not contact his family for so long and in fact he had already got married. …His children feel so angry and they do not want to take care of Mr. O. (A caregiver). This explanation is supported by one of the elders that was interviewed by researcher: …I don’t want to bother my family, especially my kids. It is because they usually become angry at me if I inhibited their job. I thought that it was better for me to stay here. Almost all families of the elderly did not fulfil their parent’s needs. The families said that it was because they did not have any money to buy what the elderly relative needed. Having inadequate support from the family, the elders also admitted to losing their pride as indicated by Mr. W: ...Living in this nursing home is like we are thrown away from the family. My pride is falling down. I felt like falling from the 40th floor, far from the children, families, and my life. I cannot have any interaction with the people here. 30 Support does not only come from family but also from fellow elders in the same nursing home. This support can take positive or negative forms. The research found that such positive and negative supports mostly came at the same time, as described by Mr.U: ...friend is always there until they reach what they wanted. In addition, I and my friends are having different backgrounds. ...sometimes they said bad things about me in front of the caregivers so the caregivers got angry at me. Sometimes, conflicts happened between the elders in the nursing home and their discussion topics were always about those conflicts. Mr. Z added to this situation: …we are just like kids here. Sometimes, it is more than the kids’ behaviour. Some- times, they told the caregivers but the caregivers never responded to it and just smiled. That is why we just can stay silent and we will not inform the caregivers again because it has no impact.

3.2 Theme 2: Life expectancy For an elder living in the nursing home, his expectations do not match reality. There are many things that make them complain about living in nursing homes, such as objections to some programmes, never considering the ideas and opinions of the elderly, and not being addressed by nurses and caregiver. Furthermore, they are only told to do their activities. Fatigue and boredom can lead to depression in the elderly, which ultimately affects the quality of their lives. The doubt is reflected through their statement: We just accept any instructions. We are not allowed to give any opinions or idea. We are commonly having problems here.... We accept what they gave us. We may not be asking too much. (Mr. SI). A similar statement, Mr. SI who said that, that at first, he thought that living in a nursing home would make him feel better, but the reality did not match his expectations: ...but I never found any activity that makes me comfortable. It seems that my hopes are not reached yet again. If we talked about hopes, I did not have any hopes anymore. (Mr. U, Mr. Sm and Ms. I). Hope does not match reality. That is a fact found in a PSTW owned by the local government. Nurses and caregivers have behaviors that do not match the expectations of the elderly. The fear of asking caregivers has worsened their condition, degrading their life expectancy, as Mr. J and Mr. S. stated: “...not all the staffs meet my hopes...”... there is a staff who always uses a loud voice when calling me. Sometimes, when the food is not appropriate and I told them, they asked me to buy the food by myself. (Mr. J).

3.3 Theme 3: Caregivers’ attitude The caregivers’ attitudes also affect the quality of life of the elderly. The results of the observation show that there is only one caregiver who is trusted by the nursing home residents. The other caregivers did not give careful attention and enthusiastic services to the elderly. This negative attitude was confirmed by the senior’s confessions such as Mr. D: ...I am already old. I need a suitable medicine from my respiratory illness. When I complained about this, they always asked me to sleep, take a rest, and not to walk too much. I already did those things. I told them that I needed medicine but they said that I had to buy the medicine by myself. Mr. K, who had lived for about three years in the nursing home, also gives the same statement: 31 …My illness is getting worse because these caregivers were not caring for me whole- heartedly. I wanted to go to the mosque for praying together, listen to some lectures, or read Qur’an together. However, those caregivers did not help me to go to the mosque. Because of some physical changes, their inabilities for carrying out daily activities adds to the caregivers’ job list. These unwanted tasks affect the caregivers’ attitudes to the elderly, which causes pressure for the elderly because they cannot get what they want.

4 DISCUSSION

Family members are the closest persons to elderly people because they are the only persons who take a responsibility to accompany the elderly in their old age. Family members and peer groups are two of the informal social support for the elderly besides the formal support obtained from the nursing home (Gottlieb & Bergen, 2010; Mattson & Hall, 2011). However, the relationship between the elderly with families and their friends can take negative or positive forms of support. Negative support was still found among elders living in nursing homes. (Azwan et al., 2015) explain that the support from friends can have different impacts on the life quality of the elderly living in the nursing home, whether their relationships are negative or positive. From the perspective of Minangkabau culture, friends of the same age are part- ners for the elders to share their family and life experiences. The elderly will feel that getting together with friends can be like when they were with their family (Sabri, 2016). Minangkabau culture had defined the appropriate attitudes on how to be in a society and to communicate with people from all ages, including with friends of the same age. Different understandings of the terms “kato nan ampek” (four ways of having words with others) cov- ering kato mandaki (ways of having words with older people), kato malereng (ways of having words with a respected person), kato manurun (ways of having words with younger people) and kato mandata (ways of having words with same-aged people) (Amir, 2011), sometimes can trigger conflicts between one elderly and the others, between the elders and caregivers. These conflicts create pressure for the senior residents of the nursing home, which can result in uncomfortable feelings (Chang, 2013). Chen et al., (2007) argued that a good family relationship with caregivers in nursing homes will improve the life quality of the elderly because families will know the quality of services given by caregivers in caring for their parents. Commonly, Minangkabau elderly people live in nursing homes located close to their houses but the ignored old people are usually taken to government social institutions. Although families of the elderly usually come from unhealthy families that cannot support their old people financially, they must give emotional support, reward, information, and social integration. Optimum support from the family and friends will improve the elderly’s hope in the nursing home. Some elderly people feel comfortable living in the nursing homes, because they have no family and permanent residence. Ghimire and Gurung (2014) explain that the elderly’s life quality in nursing homes is also influenced by their families’ visits The value of continuous family visits in nursing homes, the role, and support from the family are really important for the elderly’s quality of life. (Chen et al., 2007) propose that seniors who live in nursing homes do have hopes for love, trusted feeling, great services, and friendly services as much as when they live with their family. Amir (2011) also said that friendliness and love are the Minangkabau cultural forms of sahino samalu (equally ashamed and embarrassed) and raso jo pareso (having awareness and self- correctness). Health conditions also have a certain impact on the quality of life of the elderly. Lack of special attention in terms of food services becomes a source of complaints that affect the health status of the elderly. Farzianpour, et al., (2015) explain that elders with low physical conditions will have low abilities for performing their daily routines. This influences their emotional and social relationships with caregivers. The cultural Minangkabau perspective of Minangkabau cultural values barek samo dipikua (heavyweight thing is carried together on shoulders), ringan samo dijinjiang (lightweight thing is carried equally by hand) means 32 that the people always do good things, help each other, give advice, and respect togetherness. Therefore, the elderly people who have limitations will not feel useless because they are mutu- ally sehino semalu (have the same position in the nursing home). By doing so, caregivers would have to implement the Minangkabau rules of Nan buto pahambuih lasuang (the blind will blow and keep the camp fire up); nan pakak palapeh badia (the deaf will release the canon); nan lumpuah pahuni rumah (the crippled will stay and watch for the house); nan bingung ka disuruah-suruah (the confused will be guided to help); nan pandai tampek batanyo (the intelligent will become the source of information); nan cadiak bakeh baiyo (the smart will become a discussion partner) and nan kayo tampek batenggang (the rich will accommodate complaints and provide tolerance). These principles define proportional job dis- tributions in accordance with the individuals’ expertise and ability (Amir, 2011; Naim, 2013).

5 CONCLUSION

The position of the elderly in Minangkabau is as pai tampek batanyo (someone to ask when we want to go), pulang tampek babarito (someone to inform when we want to return home). This research has identified three main themes related to changes in Minangkabau cultural values that degrade the quality of life of elderly people living in nursing homes. Implementa- tion of Minangkabau cultural values in services for the elderly, especially in nursing homes, needs to be addressed and reconceptualised. The implications of this study for nurses and caregivers in providing services to the elderly are able to increasing knowledge and skills in providing care to the elderly in nursing homes, so that the elderly feel comfortable and protected. Nursing and caregiver nurses need to be aware of the elderly’s wishes and expectations while living in a nursing home.

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