PROCEEDING International Seminar

Tema: “Ethics, Integrity And Management In Health Profession”

8-10 Januari 2019

Bogor,

Diselenggarakan oleh:

Lembaga Penelitian dan Pengabdian Masyarakat

Sekolah Tinggi Ilmu Kesehatan

Wijaya Husada Bogor

i PROCEEDING INTERNATIONAL SEMINAR “Ethics, Integrity And Management DEWANIn Health REDAKSIProfession”

Bogor, 8-10 Januari 2019

Penanggung Jawab :

Ketua STIKes Wijaya Husada Bogor Ketua Penyunting :

Ns. Nining Fitrianingsih, S.Kep., M.Kes Penyunting Pelaksana:

Ns. Lusiana, S.Kep Pelaksana TU

Normalia Sari, S.Kom

Alamat Redaksi : STIKES Wijaya Husada Bogor Jl. Letjend Ibrahim Adjie No 180 Sindang Barang Bogor Barat Website: www.wijayahusada.com

ii P R A K A T A

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iii DAFTAR ISI PROCEEDING INTERNATIONAL SEMINAR “Ethics, Integrity And Management In Health Profession”

NO Bogor, 8JUDUL-10 Januari 2019 HALAMAN

The Correlation Leadership Styyle Of The Head Room With The Completeness Of Nursing Care Documentation In Hospital 1 Siti Mulyani, Dea Liska

Correlation Between The ………………..Motivation Of………………………………………… Nurses With The Fulfillment………… Of… Spiritual..……….. 1-8 Needs In Patients 2 Solehudin, Herini Yulistiyaningrum………………………..

Corralation Body Mass Index (BMI) With The Diabetes Mellitus……..………………………Incident ..…… 9-16 Retno Dwi Santi, Heris Hersita 3 The Correlation Age And Gender With…………………………… Stroke Incident ………………………………………… 17-24 Sara Tania, A, Indah Permatasari 4 The Effect Of Mozart Classical Music…..…………………………………………………………….. To The Sleeping Quality Of The Patients . 25-34 Sariaman Purba, Adinda Mutiara Hermawan. 5 Correlation Hygiene And Sanitation Behavior With……………………………Escherichia Coli…………. Bacterial……… 35-41 Contamination On Street Vendors 6 Benny M.P Simanjuntak, Meta Avila…

The Corelationof Urinary Incontinence With…………………………………… Depression Level In Elderly..……………..……… 42-48 Juianto Laia, Friska Bela Sukmayanti 7 The Effect Of Lemon Aromaterapy Against………………………………………………………Vomiting Intensity Of Pregnant Mothers…… 49-56 Nining Fitrianingsih, Dina Indayani Safitri…. 8 The Correlation Of Role Of Parents And Phubbing………………Behavior …In……………… Students ..…………… 57-65 Tisna Yanti, Okti Nurlia Pratiwi, 9 The Correlation Of Exclusive Breastfeeding…………… To..……… Upper……. Respiratory…………………… Tract…… Infection…………….. 66-74 Dueto Infact Age 7 – 12 Month 10 Siti Hanifatun, Ica Anisa

………………………………………………………………………………… 75-83

11 ElviraLevel Of L.Urgel, Awareness Joylyn And L. Compliance Mejilla, Josephine In Diabetes M. DeMellitus Leon, Management Sofia Magdalena Among N. Robles,Adolescents Catherine Diagnosed Mae G.TrinidWith Typead-1…… Diabetes

…………………………………………………………… 84-90

12 CeuProtocol An Binti For AnAhmad Online……………………….. Randomised Controlled Trial To Evaluate The Clinical And Cost-Effectiveness Of A Peersupported Self-Management Intervention ………………………………………………… 91-104 iv Nurlita Bintari K, Martinah, Asma Hasanah…… 13 The Effect Of Oxytosin Massage On Breastfeeding Production ………………………………………… 105-109 Dewi Nopitasari, Bonny Priessandini…… 14 The Role Of HusbandIn Assisting Wife Who SufferAnemia In Pregnancy ……………………………………………...……… 110-117

15 SalsalinaTraditional YuniartiBirth At tenG, dDefriants (TLesia,bas) EfraPosit Farwatiioning O……n Strengthening Partnership With Midwives ………………………………………… 118-125

v THE CORRELATION LEADERSHIP STYLE OF THE HEAD ROOM WITH THE COMPLETENESS OF NURSING CARE DOCUMENTATION IN HOSPITAL

Siti Mulyani, Dea Liska

Wijaya Husada Health Science Institute

ABSTRACT Leadership style is very influential on the quality of nursing care documentation so that it can benefit nursing care, education and research. Documentation of nursing care can be used as a reference for learning for students and practitioners of nursing, because in it contains all forms of nursing activities for clients. The contents of the nursing care documentation are useful for member general description of the nurse's duty in providing nursing care to the client. This study aims to determine the relationship between the relationship of leadership style space head with the completeness of nursing care documentation. This type of research is descriptive quantitative analytic with cross sectional research design. The population in this study amounted to 90 respondents. The method of sampling in this study was Quota Sampling technique with 73 respondents. Data collection was obtained through questionnaires in the form of questionnaires. Analysis of the data used is univariate and bivariate (Cramer). The results of the leadership style research at PMI Hospital have a democratic leadership style of (49.3%) and the completeness of nursing care documentation in class III hospitalization rooms (72.6%) documentation of nursing care is incomplete. Cramer's results were obtained P = 0.000 which is smaller than 0.05 of 73 respondents who chose the democratic leadership style with the completeness of nursing care documentation as many as 36 respondents (49.3%). Ha is accepted, which means that the statistical test shows that there is a relationship between the leadership style of the head of the room and the completeness of nursing care documentation in class III inpatient rooms at PMI Bogor City Hospital in 2019. It can be used as a reference in completing nursing care documentation so that it can provide information and input for institutions researched land specifically at the PMI Hospital of Bogor City.

Keywords : Leadership style, documentation, nursing care

PRELIMINARY nurses to clients ranging from assessment to Documentation of nursing care is a evaluation. record of the responses / responses of Documentation of nursing care is a clients to the activities of the means of communication from one implementation of nursing as a whole, profession to another related to client status. systematic and structured as accountability As a communication tool, the writing in the for actions taken by nurses against clients in nursing care documentation must be clearly carrying out nursing care using the nursing readable and may not use unusual terms or process approach.1 abbreviations, also contain clear, explicit Documentation of nursing care is a and systematic descriptions.2 statement about an event or activity that is Documentation of nursing care can authentic by taking written notes. also be used as evidence at any time in Documentation of nursing care contains the court if a lawsuit is made by the client or results of nursing activities undertaken by family. Therefore the nursing care documentary records must be clear,

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 1 JOURNAL OF PUBLICATION

complete, objective, the time must be leadership has three components, namely clearly written (day, date, month, year, leader, follower, and the situation of hour) signed by the health care provider someone who is said to be a good leader in through therapeutic interaction with the one situation and with certain followers as client. 2 well as that in other situations and Documentation of nursing care can followers.4 be used as a reference for learning for Leadership style is a set of students and practitioners of nursing, characteristics that are used by leaders to because in it contains all forms of nursing influence subordinates so that activities for clients. The contents of the organizational goals are achieved or it can nursing care documentation is useful for also be said that the leadership style is a member general description of the nurse's pattern of behavior and strategies that are duty in providing nursing care to the client.2 preferred and often applied by a leader. The impact of nursing care The results of this study are documentation if done incomplete will be comparable to the research conducted able to reduce the level of nursing services Revina Sinaga, 2016 examines "The because it will not be able to identify the Relationship Between Leadership Style of extent of the success of nursing care that Head of Room with Completeness of has been given. In the legal aspect the nurse Nursing Care Study Documentation in does not have written evidence if one day Inpatient Room at Mardi Lestari Public the client demands dissatisfaction with Hospital Sragen" with the results of 51 nursing services respondents who chose an authoritarian Leadership style is very influential leadership style of 35.29% and on the quality of nursing care documentation of nursing care documentation so that it can benefit nursing documentation incomplete at 92 , 15%. The services, education, and research.4 results of the study using the Lambda test Leadership style, basically contains obtained p value of 0.019> 0.05 so that the understanding as an embodiment of the there is a relationship between the behavior of a leader, which involves his leadership style of the head of the room ability to lead. This embodiment usually with the completeness of the documentation forms a certain pattern or form. A leader of nursing care assessment. has a strategic role that is as a manager, Based on the results of a should have competence in accordance with preliminary study conducted on Monday, the demands of development and excellent August 19, 2019 there were 10 nurses service in the present and future so that they implementing respondents in the class III can better understand the duties and inpatient room of PMI Bogor City Hospital. functions as a leader. One of them is the Obtained a leadership style using a ability of a leader in fostering and nurturing democratic leadership style and from 10 and influencing the motivation of respondents obtained the observation of subordinates to participate in achieving nursing care documentation 8 respondents organizational goals.4 did complete documentation and 2 Leadership style is a way used by a respondents were incomplete in the leader in influencing the behavior of others. assessment section in carrying out nursing A leader has certain characteristics, care documentation. understanding the characteristics of one's Based on the description above, the leadership must be understood that researcher is interested in finding out

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 2 whether there is a relationship between the Creamer V statistical test to analyze the leadership style of the head of the room and relationship between the frequency of the the completeness of the nursing care class leadership style of the headroom and the documentation for inpatient class III in completeness of nursing care 2019 PMI Bogor City Hospital. documentation in class III inpatient rooms at the PMI Hospital in Bogor. RESEARCH METHODS In this study, the location This type of research is a type of determined to conduct research is in the quantitative research or traditional methods, Bogor City PMI Hospital. Retrieval of data because this method has been used long in this study using Quota Sampling with 73 enough so that it has been transmitted as a respondents nurses implementing in class method for research. 6 III inpatient rooms. Data was collected on The design of this research is 11,12,13,14,15 September 2018. Data was analytic descriptive research which is a collected by the researcher. study to find out whether or not there is a relationship between variables. The time RESEARCH RESULT approach used in this study is cross- Table 1 Frequency Distribution Based on sectional.6 Gender Cross sectional is a study to study Gender Frequency Percentage the dynamics of the correlation between the (%) approach, observation, and data collection Male 28 38.4 at one time.6 This design is to determine the relationship of leadership style with the Girl 45 61.6 quality of nursing care documentation in class III inpatient rooms in Bogor City PMI Total 73 100 Hospital in 2019. Source: Computer Data Processing This research was conducted on 11,12,13,14,15 September in class III Based on table 1. about the inpatient rooms at the Bogor City PMI frequency distribution of the characteristics Hospital in 2019. The population in this of respondents by sex, of the 73 study was nurses in class III inpatients in respondents mostly female, that is 45 the City of Bogor PMI Hospital with 90 (61.6%) respondents. nurses from 3 class III inpatient rooms .6 In this study using Quota Sampling, there is a Table 2 Frequency Distribution Based on limitation on the sampling quota that the Age selected sample must be a certain number Percentage (quotum) of each predetermined subgroup Age Frequency of a population. (%) The variables of this study 23-33 years 44 60.3 consisted of the frequency of leadership style of the headroom with the 34-44 years old 21 28.8 completeness of nursing care 45-50 years 8 11.0 documentation. Data processing and data analysis using computerized data. The Total 73 100 analysis consists of univariate and bivariate analysis, where bivariate analysis uses the Source: Computer Data Processing

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 3 Based on table 2 about the frequency distribution of respondents' Table 5 Frequency distribution of the characteristics based on age, of the 73 leadership style of the head of the room respondents mostly aged 23-33 years as with the complete documentation of nursing many as 44 (60.3%) respondents. care in class III hospitalization in the PMI Hospital of Bogor City Table 3 Frequency Distribution Based on No Leadership Freque Percent Education style ncy age (%) Percentage Education Frequency 1. Authoritarian 23 31.5 (%) 2. Democratic 36 49.3 Bachelor 9 12.3 3. Laissez-Faire 14 19.2 Diploma 64 87.7 Total 73 100 Total 73 100 Source: Computer Data Processing Source: Computer Data Processing Based on table 5. of 73 respondents stated that the frequency Based on table 3 about the distribution of the leadership style of the frequency distribution of respondents' head of the room with the completeness of characteristics based on education, of the 73 nursing care documentation in class III respondents most of the last Diploma inpatient rooms at the PMI Hospital in education nurses were 64 (87.7%) Bogor City. There are 36 respondents respondents. (49.3%) democratic leadership style.

Table 4 Frequency Distribution Based on Table 6. Frequency distribution of Length of Work completeness of nursing care documentation in class III hospitalization in Length of Percentage Frequency Bogor PMI Hospital working (%) Complete Frequency Percentage 5-10 years 40 54.8 documentation (%) No 11-15 years 20 27.4 of nursing care 16-25 years 13 17.8 1. Uncomplete 53 72,6 Total 73 100 Complete 20 27,4 2. Source: Computer Data Processing Total 73 100

Based on table 4. about the Source: Computer Data Processing frequency distribution of the characteristics of respondents based on length of work, of Based on table 6 of 73 respondents the 73 respondents most of the 5-10 years stated that the frequency distribution of of work is as many as 40 (54.8%) completeness of nursing care respondents.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 4 documentation in class III hospitalization in DISCUSSION Bogor City PMI Hospital. There were 53 1. Characteristics of Research Subjects respondents (72.6%) completeness of by Gender nursing care documentation was The results obtained from 73 incomplete. respondents found respondents with a percentage of 45 (61.6%) female Table 7. Analysis of the relationship between the leadership style of the room sex and 28 respondents with a chief and the completeness of nursing care percentage (38.4%) male sex. documentation in class III inpatients at PMI 2. Characteristics of Research Subjects Bogor City Hospital Based on Age Nursing Care Docummentation From the results of the Total P Leadership Uncomplete Complete valuecurrent age characteristics of nurses Style from 73 respondents obtained the n % n % n % results of 44 respondents with a Authoritarian 23 31,5 0 0,0 23 31,5 percentage (60.3%) aged 22-33

Democratic 19 26,0 17 23,3 36 49,3 years, 21 respondents with a 0,000 percentage of 28.8% aged 34-44 Laissez-faire 11 15,1 3 4,1 14 19,2 years and 8 respondents with a Total 53 72,6 20 27,4 73 100 percentage value (11, 0%) 45-50 Source: Computer Data Processing years old. Based on table 7. about the 3. Characteristics of Research Subjects results of the bivariate test the Based on Education relationship of leadership style of the From the results of the head of the room with the completeness current characteristics of nurse of nursing care documentation in class education from 73 respondents it was III inpatient in Bogor PMI Hospital in found that 64 respondents with a 2019 of 73 respondents (100%) with percentage (87.7%) of nurses mostly authoritarian leadership style can be had the latest educational status known as incomplete nursing care Diploma while the Bachelor only 9 documentation 23 respondents (31.5%). respondents with a percentage of Based on the results of the 12.3%) of 73 respondents. Cramer statistical test the bivariate Educational status influences analysis table is obtained P Value = leadership style. 0.000 where a <0.05, so Ha is accepted 4. Characteristics of Research Subjects which means the statistical test shows Based on Length of Work there is a relationship between the From the results of the characteristics leadership style of the head of the room of the current work duration of with the completeness of nursing care nurses from 73 respondents found 40 documentation in the class III inpatient respondents with a percentage hospital at PMI of Bogor City. (54.8%) 5-10 years, 20 respondents with a percentage (27.4%) 11-15 years and 13 respondents with a

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 5 percentage (17.8 %) 16-25 years of nursing care in class III inpatients at which is very influential on the the Bogor City PMI Hospital in 2019 out completeness of nursing care of 73 respondents showed 53 documentation. respondents (72.6%). the completeness of the nursing care documentation is 5. Univariate Results incomplete. a. Leadership style of the head of the room The results of this study with in class III inpatient at PMI Hospital of research conducted by Suprati, 2016 Bogor City research on "Documentation of Nursing Based on table 4.5 about the Care Standards in Mamuju Indonesia distribution of leadership style of head Regional General Hospital" of 135 room in class III inpatient at Bogor PMI respondents showed 91 (97.8%) Hospital in 2019 out of 73 respondents respondents. Complete documentation showed that respondents chose of nursing care is incomplete. leadership style as 36 respondents Documentation of nursing care is (49.3%). a display of care or care of nurses in The results of this study are providing nursing care processes to comparable to the research conducted by patients while the patient verifies at the Muhammad Shiqibul Iza Zulfikhar, hospital. The quality of nursing care 2016 contributions on "Leadership Style documentation can be seen from the of the Head of Space with Work completeness and accuracy of the Motivation of Implementing Nurses in nursing care process given to the patient, Surakarta Islamic Hospital" by obtaining which completes the assessment, the results of the p-value (0.024). This diagnoses nursing, action plans and can be seen by 56 respondents choosing evaluations. the leadership style to change as many From the results of the study it as 49 (87.5%) respondents. can be concluded between the theory Leadership Style is a set of and the results of research that have an characteristics that are used by leaders to impact on nursing care in inpatient influence subordinates so that rooms class III in Bogor City PMI organizational goals can be used as well Hospital that is obtained the incomplete as making sure the leadership style is the results of nursing care documentation. pattern and strategy needed and implemented by the leader. 6. Bivariate Results From the results of the study it The relationship between the can be concluded between the theory leadership style of the room chief and the results of research that influence and the completeness of nursing care leadership style in class III inpatient documentation in class III rooms at the PMI Hospital decision. hospitalization at PMI Hospital of b. Completeness of Nursing Care Bogor City. Documentation in class III Bivariate analysis results hospitalization in PMI Hospital of Bogor obtained from 73 respondents, there City were 53 (72.6%), respondents who Based on table 4.6 about the have an authoritarian leadership style frequency distribution of completeness with p value 0,000 ≤ 0.05. Which

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 6 means that there is a relationship leadership style with the between the leadership style of the completeness of nursing care head of room and the completeness documentation in class III inpatient of nursing care documentation in rooms at PMI Hospital of Bogor City class III inpatients at PMI Hospital of that is obtained from the p value = Bogor City. 0,000 of a (<0.05) which means there The results of this study are is a relationship between the comparable to the research independent variable and the conducted by Revina Sinaga, 2016 dependent variable. examining the "Relationship between The results obtained from the the Leadership Style of the Head of completeness of nursing care the Room and the Documentation of documentation that is educational Nursing Care Study Documentation factors and length of work that affect in the Inpatient Room of Mardi the completeness of nursing care Lestari Public Hospital Sragen" with documentation. the results of 51 respondents who chose an authoritarian leadership RESEARCH LIMITATIONS style of 35.29% and 92.15% This research has been attempted and incomplete documentation of nursing carried out in accordance with scientific care assessment. The results of the procedures, however it still has limitations study using the Lambda test obtained namely: In this study, there are limitations p value of 0.019> 0.05 so that there in using a questionnaire that is sometimes is a relationship between the the answers given by the sample look at his leadership style of the chief of space friend even though it has been explained in with the completeness of the advance how to fill it out. documentation of nursing care RESEARCH IMPLICATIONS assessment. 1. For Science Leadership Style is a set of Can be used as information material and characteristics that are used by is used to develop knowledge about leaders to influence subordinates so nursing management that recognizes the that organizational goals are leadership style of the head of the room achieved or it can also be said that with the complete documentation of the leadership style is a pattern of nursing care, as well as material and behavior and strategies that are sources of discussion to broaden the preferred and often applied by a results of previous research. leader. A leadership style that shows, 2. For the heads of rooms in PMI Hospital directly or indirectly, about a leader's The head of the room in order to implement a democratic leadership style belief in the abilities of his that can lead to the completeness of subordinates. nursing care documentation, can be used From the results of the study it as an evaluation in providing can be concluded between theory and information to provide input so that it research results that influence better understands how to apply

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 7 appropriate leadership styles so that the understanding nursing management can completeness of the nursing care provide appropriate documentation of documentation is complete. nursing care.

CONCLUSION 1. It is known that the frequency distribution of the leadership style of REFERENCES the head of room in class III inpatient 1. Prabowo, 2016. Pengaruh rooms at the PMI Hospital from 73 Pendokumentasian Model Cheklist respondents showed that respondents terhadap Kelengkapan who chose the democratic leadership Pendokumentasian Asuhan Keperawatan style were 36 respondents (49.3%). DI RSUD AROSUKA . 2. It is known that the frequency http://scholar.unand.ac.id distribution of completeness of nursing 2. Asmadi, 2018. Konsep dasar care documentation in class III keperawatan. Jakarta: Penerbit buku inpatients at the PMI Hospital in Bogor kedokteran EGC City in 2019 from 73 respondents 3. Artiningtias, Wahyu, Dwi, 2016. JURNAL PUBLIKASI showed 53 respondents (72.6%). the Pengaruh Gaya Kepemimpinan Kepala completeness of the nursing care Ruangan, Motivasi dan Disiplin documentation is incomplete. Terhadap Kinerja Perawat Di Rumah 3. The Relationship between the Sakit Umum Daerah (RSUD) Brigjend Leadership Style of the Head of the H. Hasan Basry Kandangan Kalimantan Room and the Completeness of Selatan. Nursing Care Documentation in class http://Journal.stienasypb.ac.id/index.php III hospitalization in Bogor PMI /djeb/article/download/96/81 . Diunduh Hospital in 2019 of 73 respondents 11 Mei 2019, 20:14:05. who chose the leadership style with the 4. Sari, dkk, 2015. Hubungan Masa Kerja, completeness of nursing care Motivasi, dan Kepemimpinan dengan documentation as many as 36 kinerja pegawai di Unit Pelaksana respondents (49.3%) ie obtained Teknis Daerah (UPTD) Yankes results from p value = 0,000 of a Kecamatan Kutawaringin Kabupaten (<0.05) which means there is a Bandung Tahun 2014. Jurnal relationship between the independent Keperawatan Aisyiyah Bandung. variable and the dependent variable. 5. Rivai, Z, Veithzal, dkk. 2014. Kepemimpinan dan Perilaku Organisasi. SUGGESTION Jakarta: Raja Grafindo Persada 1. For Science 6. Sugiyono. 2016. Metode Penelitian Provides a reference in completing Kuantitatif, Kualitatif dan R & D. nursing care documentation. This Bandung : Alfabeta research can add insight into nursing management science. 2. For users It is expected that the results of this study can provide information and input for the researched land institutions especially at PMI Hospital. Nurses in

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 8 CORRELATION BETWEEN THE MOTIVATION OF NURSES WITH THE FULFILLMENT OF SPIRITUAL NEEDS IN PATIENTS

Solehudin, Herini Yulistiyaningrum

Wijaya Husada Health Science Institute

ABSTRACT

Nursing views humans as a holistic creature that includes bio-psycho-socio-spiritual-cultural. Nursing care given by nurses not only focuses on biological aspects but also psycho and spiritual. Factors affecting nurse performance in nursing care are motivation, incentive, and work facilities. The nurse’s motivation in something that moves or encourages nurses to do something that arises internally and externally directly related to the client. Good motivation, able to make nurses to fulfill spiritual needs. The fulfillment of spiritual needs is very important because it can improve the patient’s quality of life. To know the correlation of the motivation of nurses with the fulfillment of spiritual needs in patient in the hospitalization CVE and Pavio A RSUD Bogor City. Quantitative research with descriptive analytical design using cross sectional design. The population in this research is all nurses in the inpatient room CVE and Pavio A. Sampling technique uses total sampling by the amount of 38 respondents. Data measurement tools using questionnaires and analyzed with the correlation test of kendall Tau. The majority of respondents have high motivation (55,3%) and the majority of respondents performed sufficient spiritual needs (52,6%). There is a significant correlation between the motivation of nurses with the fulfillment of spiritual needs in patients in the hospital CVE and Pavio A RSUD Bogor City in 2019 with value P = 0,000 (< 0,05). Value OR = 152,000. There is a correlation between the motivation of nurses with the fulfillment of spiritual needs in patients in the hospital CVE and Pavio A RSUD Bogor City, so the nurse should improve the motivation of work to provide the fulfillment to needs spiritually in patients.

Keyword : Motivation, Nurse, Needs Fulfillment Spiritual.

PRELIMINARY Nursing care provided by nurses can not be Nursing is a form of professional separated from the spiritual aspects that are health service that is an integral part of an integral part of nurses' interactions with health services based on knowledge and clients. The nurse strives to help meet the nursing tips that are shown to individuals, client's spiritual needs, even though the families, and the community both in a nurse and client do not have the same healthy or sick condition and covers the spiritual or religious belie. The factors that entire life process. Nursing views humans can affect the performance of nurses in as holistic creatures that include bio- providing nursing care are motivation, psycho-socio-spiritual-cultural.1 incentives, and work facilities.2 Nurses are health professionals who The results of research from Nurlina, interact with patients at all times in Hadju and Nonjti (2013) that affect the providing comprehensive nursing care. performance of nurses in the application of

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 9 nursing care standards namely motivation, nursing care. Researchers also obtained showed that the majority of respondents data from the Bogor City Hospital to make with high motivation were 77 people a policy of spiritual guidance by spiritual (95.1%) and the performance of nurses in experts. applying nursing care standards properly as Based on the above incident, the many as 73 people (90.1%) with a value researcher wanted to analyze the (OR) of 18.250 and p value of 0.026.3 relationship between nurses' motivation and The research of Badi'ah et al in meeting the spiritual needs of patients in the Tricahyono shows that there is a significant CVE and Pavio A inpatients at Bogor City influence between internal motivational Hospital. factors and external motivational factors on This type of research is quantitative the performance of nurses in providing research using descriptive analysis research nursing care in the inpatient ward of Bantul methods. Quantitative research is research Senopati Hospital. that emphasizes objective phenomena and According to Carson in Hamid (2008) is studied quantitatively.6 Descriptive spiritual need is the need to maintain or method is a method that serves to describe restore beliefs and fulfill religious or give an overview of the object under obligations, as well as the need to get study through data or samples that have forgiveness or forgiveness, love, establish a been collected as they are without relationship of trust with God.2 Spiritual analyzing and making conclusions that needs are one of the basic needs needed by apply to general.7 someone and must be fulfilled. Spiritual aspects can help to excite the patient in the RESEARCH METHODS healing process. The research design used in this Factors affecting nurses' willingness to study is a correlational research design with provide spiritual care include: Awareness cross sectional approach. Correlational about spirituality, Lack of knowledge and research is a type of research designed to training regarding spiritual nursing care, reveal correlative relationships between Lack of motivation, increased workload, variables within a group. While the cross and lack of time. Nurses see severe sectional study is a research design that demands in providing physical care for emphasizes the measurement time or patients as a barrier to taking time in observation of independent and dependent providing patients with spiritual care. variable data only once at a time (point time The results of a preliminary study approach) .8 conducted by researchers at Bogor City This research was conducted in the Hospital obtained that nursing care related Inpatient Room of CVE and Pavio A Bogor to fulfilling spiritual needs has not gone City Hospital on 22-24 August 2019. The well because it considers spiritual needs population in this study were all nurses who only given to patients who need and who worked in the inpatient room of CVE and ask for nurses. The nurse also revealed that Pavio A Bogor City Hospital with a total of meeting the spiritual needs of the whole is 38 respondents, by taking total sampling not the duty of nurses but the task of technique of determining the sample by spiritual experts. Researchers see that taking all members of the population as a nurses when interacting with patients only sample so that the sample in this study focus on routine actions such as injection, amounted to 38 respondents. giving medication, and documenting

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 10 The independent variable in this Table 2 study is nurse motivation while the Distribution Of Respondents According dependent variable in this study is the Age fulfillment of spiritual needs by nurses. The instrument used in this study was a Characteristics f % questionnaire sheet. Data processing and 1 < 30 Tahun 28 73,7 data analysis using computer program SPSS 2 > 30 Tahun 10 26,3 for Windows 22 series. Analysis consists of Total 38 100 univariate and bivariate, where bivariate analysis analyzes the relationship of nurses' Based on table 2 the results of the motivation with meeting the spiritual needs frequency distribution characteristics of the of patients. 38 respondents studied, the majority of nurses working in the inpatient room at RESEARCH RESULT CVE and Pavio A Bogor City Hospital, Characteristics of respondents aim to dominated by respondents aged <30 years provide an overview of the identity of as many as 28 people (73.7%). respondents, while the respondents in this study were nurses in the Inpatient Room of Table 3 CVE and Pavio A Bogor City Hospital. Distribution Of Respondents According According to data from the Bogor City Education Hospital there are 38 nurses on duty in the CVE Inpatient Room and Pavio A Bogor City Hospital. Characteristics f % 1 Diploma III 23 60,5 2 SI 15 39,5 Table 1 Distribution Of Respondents According Total 38 100,0 To Gender Based on table 3 the results of the No Characteristics Frecuency(n) Presentage frequency distribution characteristics of the 38 respondents studied, the majority of Gender nurses who worked in the CVE and Pavio 1 Male 9 23,7 A inpatient rooms in Bogor City Hospital, 2 Female 29 76,3 were dominated by DIII education as many Total 38 100,0 as 23 respondents (60.5%).

Based on table 1 results of the frequency Table 4 distribution characteristics of the 38 Distribution of Respondents According Job Status respondents studied, the majority of nurses who worked in the inpatient rooms at CVE and Pavio A Bogor City Hospital, were No Characteristics f % dominated by women as many as 29 1 employees 1 2,6 respondents (76.3%). 2 Un employees 37 97,4 Total 38 100,0

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 11 Based on table 4 the results of the the fulfillment of spiritual needs in patients, characteristics of the frequency distribution thus Ho is rejected and Ha is accepted. of the 38 respondents studied, the majority of nurses working in the inpatient rooms of DISCUSSION CVE and Pavio A Bogor City Hospital, a. Nurse Motivation were not yet state employees as many as 37 Motivation is a process in which the respondents (97.4%). needs encourage a person to carry out a series of activities that lead to the Table 5 achievement of certain goals, if Distribution Of Respondents successfully achieved, will satisfy or meet According length of working those needs.9 Work Motivation is a capital in No Characteristics f % moving and directing employees or workers Length of working to be able to carry out their respective 1 > 1 year 5 13,2 duties in achieving goals with full 2 < 1 years 33 86,8 awareness, enthusiasm and responsibility.10 Total 38 100,0 According to the theory of the relationship of rewards to achievement, a person's Based on table 5 the results of the motivation is strongly influenced by frequency distribution characteristics of the internal factors, namely, factors that arise 38 respondents studied, the majority of from within a person include: perception, nurses who worked in the inpatient rooms self-esteem, eternal expectations, needs, of CVE and Pavio A Bogor City Hospital, desires, job satisfaction, work performance had worked for> 1 year as many as 33 produced and external factors namely, respondents (86.8%). Factors arising from outside oneself Of the 38 respondents most nurses include: the type and nature of work, the had high motivation as many as 21 working group to which a person joins, the respondents (55.3%) Of the 38 respondents organization of the place of work, the most of the fulfillment of spiritual needs in general environmental situation, the patients was enough as many as 20 applicable reward system and how to apply respondents (52.6%). it.11 The results of the bivariate analysis, Based on research results from 38 from 38 nurses respondents who have high respondents, nurses who have high motivation so that the fulfillment of motivation are 21 respondents (52.6%) and spiritual needs in patients is quite as many nurses who have low motivation are 17 as 19 respondents (95.0%). respondents (44.7%). Based on the results of statistical Hotmian's research entitled tests using Kendall Tau obtained P value = Relationship between Nurse Motivation and 0,000 with a significant value is <0.05. OR Spiritual Nursing Care for Patients in value of 152,000, this explains that nurses Kartika Husada Kubu Raya RST Inpatient who have high motivation have 152 times Room. It was found that as many as 29 or fulfilling spiritual needs well compared to (55.8%) nurses who have high motivation nurses who have low motivation. Based on and 23 or (44.2%) nurses who have low this study it can be concluded that there is a motivation. relationship between nurses' motivation and According to the researcher analysis, from the above quotation there is harmony

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 12 with the results of the research that the theories there is harmony with the results of researchers did that is from 38 respondents the study that is the data from 38 who have high motivation namely 19 respondents it can be concluded that most respondents or (95.0%) this is because nurses do fulfill spiritual needs in patients nurses feel they have responsibility in their as many as 20 respondents or (52.6%). this work, feel recognized their work by is due to the attitude of nurses who want to superiors, and have good interpersonal fulfill spiritual needs to patients, nurses can relationships with superiors and coworkers communicate well with patients in meeting so that nurses have high work motivation. spiritual needs, and nurses know when to High motivation can make nurses have a refer patients to clergy. So that nurses have high enthusiasm to provide the best service. enough competence in fulfilling the spiritual needs of patients in carrying out b. Meeting Spiritual Needs their duties as a provider of spiritual Spiritual needs are the basic needs of nursing care. every human being. If someone is in a state Relationship between Nurse of illness, then the relationship with God is Motivation and Spiritual Needs also getting closer to remembering someone Fulfillment in Patients Motivation is in a state of illness becomes weak in all psychological processes that cause things no one can raise him from healing stimulation, direction, and persistence except the creator.12 of a voluntary activity directed at a goal. Meeting spiritual needs is a process or way of meeting the need to find meaning Motivation is an important part in in life, the need to love and be loved, the improving performance, high nurse need for hope, the need for trust, the need work motivation will improve nurse for forgiveness, the need for creativity, the performance so that each task will be need to relate to God, and the needs in a carried out properly. community.4 Nurse motivation is something Based on the results of research from that moves or encourages nurses to do 38 respondents, nurses fulfilled spiritual something that arises internally and needs in sufficient patients, namely 20 externally to deal directly with clients people resentent or (52.6%), and nurses and care for people who are sick, fulfilled spiritual needs in patients who injured, and elderly. were low namely 18 respondents or (47.4%). Intrinsic motivation is a satisfying Tricahyono's research entitled factor or motivating factor for Nurses' Motivation in Meeting Spiritual individual achievement that comes from Needs of Clients in the Inpatient Room of within the individual including the Balung Regional Hospital. It was found achievement, recognition, that as many as 26 people or (54.2%) nurses responsibility, opportunities for provided fulfillment. advancement, and job satisfaction. Good spiritual needs, while 22 Extrinsic motivation is an individual people or (45.2%) nurses provide driving factor originating from outside fulfillment of spiritual needs that are the individual which includes lacking. compensation, work safety and safety, According to the analysis of researchers, from the quotations of these

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 13 working conditions, policies, status, and community.4 In this research it was proven, interpersonal relations.14 patients interviewed by researchers said that Tricahyono's research entitled they needed to fulfill spiritual needs and Nurses' Motivation in Meeting Spiritual when they got it from nurses, they felt they Needs of Clients in the Inpatient Room had a better life expectancy. From the research results of the of the Balung Regional Hospital. stated researchers, of the 38 nurse respondents that motivation in the Balung Hospital who fulfilled spiritual needs of patients ward was significantly related to as many as 20 respondents or (52.2%), meeting the spiritual needs of the client. this is because of the attitude of nurses The higher the motivation of nurses, the who want to fulfill spiritual needs to higher the persistence of nurses in patients, nurses can communicate with providing spiritual nursing care to both to patients in meeting spiritual patients. needs, and nurses know when to refer Based on research results from 38 patients to clergy. So that nurses have respondents, nurses who have high enough competence in fulfilling the motivation are 21 respondents (52.6%) spiritual needs of patients in carrying and nurses who have low motivation are out their duties as a provider of spiritual 17 respondents (44.7%). The research results of the nursing care. From the results of a researchers proved that nurses have high Hotmian study entitled The motivation because nurses feel they have Relationship between Nurse Motivation responsibilities in their work, feel their and Spiritual Nursing Care for Patients work is recognized by superiors, and have a in the RST Kartika Husada Kubu Raya good interpersonal relationship with Inpatient Room. Obtained the majority superiors and colleagues so that nurses have of respondents have high motivation high work motivation. High motivation can (55.8%) and the majority of respondents make nurses have a high enthusiasm to provide good spiritual nursing care provide the best service (63.5%). There was a significant Nurses as providers of nursing care correlation with the strength of the view humans as individuals who have unique bio-psycho-socio-spiritual needs.2 moderate correlation between nurses' Nursing care provided by nurses cannot be motivation and the delivery of spiritual separated from spiritual aspects which are nursing care to patients in the Kartika an integral part of nurses' interactions with Husada Kubu Raya inpatient ward with clients. The nurse strives to help meet the a value of p = 0,000 (<0.05) and r = client's spiritual needs, even though the 0.509. nurse and client do not have the same According to the analysis of spiritual or religious beliefs researchers, from the quotations of these Meeting spiritual needs is a process theories there is harmony with the or way of meeting the need to find meaning results of the study, namely, from 38 in life, the need to love and be loved, the respondents nurses who have high need for hope, the need for trust, the need for forgiveness, the need for creativity, the motivation so that the fulfillment of need to relate to God, and the needs in a spiritual needs in patients quite as many

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 14 as 19 respondents or (95.0%), based on 3. A significant relationship is statistical test results using Kendall Tau found between Nurse Motivation and obtained the value of P value = 0,000 Spiritual Needs Fulfillment in with a significant value is <0.05. OR Patients in the Inpatient Room of value of 152,000, This explains that CVE and Pavio A Bogor City Hospital in 2019 with p value = nurses who have high motivation have 0,000 (p value <0.05) so that Ha is 152 times the possibility of fulfilling accepted. spiritual needs well compared to nurses who have low motivation. Based on SUGGESTION these studies the results show that there Based on the conclusion of the above is a relationship between nurses' research, there are several things that can be motivation and the fulfillment of suggested for the development of research spiritual needs in patients in the CVE related to nurses' motivation and fulfillment Inpatient Room and Pavio A Bogor City of spiritual needs in patients in the CVE Hospital in 2019. and Pavio A inpatients at Bogor City Thus Ho is rejected and Ha is Hospital. 1. For Hospitals accepted. This is because nurses with The results obtained in this study high motivation show more fulfillment can be used as an evaluation and of sufficient spiritual needs. High reference material for hospitals related motivation has high expectations that to nurses' motivation and the will improve the performance of nurses implementation of spiritual needs in improving the performance of nurses fulfillment by nurses in inpatients at in accordance with the tasks and Bogor City Hospital. Hospitals as responsibilities given. holders and policy makers to be more careful and pay attention to the things CONCLUSION that need to be evaluated related to Based on the results and discussion nurses' motivation that is influenced by of research on Nurse Motivation and external extrinsic factors. The hospital Spiritual Needs Meeting in Patients in the should be able to meet and fix the Inpatient Room of CVE and Pavio A Bogor deficiencies in the effort to fulfill the City Hospital, the following conclusions factors that influence the motivation of can be drawn. implementing nurses in Bogor City 1. A description of nurses' Hospital. motivation in the CVE Inpatient 2. For Educational Institutions Room and Pafilio A Bogor City The results and discussion of the Hospital. Shows that nurses who research are expected to be a reference have high motivation, as many as 21 in improving student learning respondents (55.3%). competencies related to meeting 2. The description of fulfilling spiritual needs in hospitals. spiritual needs in patients in CVE and Pavio A hospitals in Bogor City Hospital shows that nurses fulfill sufficient spiritual needs, as many as 20 respondents (52.6%).

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 15 REFERENCES Aksara. 1. Asmadi. 2009. Konsep Dasar 12.Hidayat, A.A.A. 2009. Metode Keperawatan. Jakarta:EGC. Penelitian Keperawatan dan Teknik 2. Yani, A dan Hamid. 2009. Bunga Analisis Data. Jakarta: Salemba Rampai Asuhan Keperawatan Medika. Kesehatan Jiwa. Jakarta:EGC. 13.Hasibuan, M .2012 .Manajemen 3. Nurlina, hadju, Dan Nontji, W. 2013. Sumber Daya Manusia. Jakarta: Bumi Faktor-faktor Yang Berhubungan Aksara. Dengan Penerapan Standar Asuhan 14.Purnamasari, F. 2013. Analisis Teori Keperawatan di Ruang Rawat Inap Dua Faktor Herzberg: Studi Kasus RSUD Labuang Baji Penerapan Motivasi Kerja dan Makassar. Kepuasan Terhadap Kinerja (http://pasca.unhas.ac.id/jurnal/files/02 Karyawan di Perum Perumnas. 441148cf2e6495084ebb2825faff5b. Bogor: Institut Pertanian Bogor. pdf. (Di Unduh 30 Februari 2019). 4. Tricahyono, A.R. 2015. Motivasi Perawat Dalam Pemenuhan Kebutuhan Spiritual Pada Klien di Ruang Rawat Inap Rumah Sakit Daerah Balung (Skripsi) http://repository.unej.ac.id/handle/123 456789/65883?show=full (Di Unduh 9 juli 2019). 5. Wulandari, F.L. 2016. Hubungan Antara Kecerdasan Spiritual Perawat Dengan Pemenuhan Kebutuhan Spiritual Pasien di Ruang Perawatan Intensif RSUD DR.MOEWARDI. Surakarta: Universitas Diponegoro (Skripsi). 6. Hamdi, A.S. 2014. Metode Penelitian Kuantitatif Aplikasi Dalam Pendidikan. Yogyakarta: Deepublish. 7. Sugiyono, 2009. Metode Penelitian Kuantitatif, Kualitatif, dan R&D. Bandung: Alfabeta. 8. Donsu, J,D,T. 2016. Metodologi Penelitian Keperawatan. Yogyakarta: Pustaka Baru Press. 9. Munandar, A.S. 2010. Psikologi Industri dan Organisasi. Tanggerang: UI-Press. 10.Hasibuan, M. 2009. Manajemen Dasar, Pengertian, Masalah. Jakarta: 11.Sondang, S. 2011. Manajemen Sumber Daya Manusia. Jakarta: PT.Bumi

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 16 CORRALATION BODY MASS INDEX (BMI) WITH THE DIABETES MELLITUS INCIDENT

Retno Dwi Santi, Heris Hersita Wijaya Husada Health Science Institute

ABSTRACT

Body mass index (BMI) values are obtained from measurements of body weight (BW) in kilograms and height (KH) in meters. Next measurement result are calculated based on the IMT formula. Diabetes mellitus is a group of metabolic diseases charactericed by hyperglycemia that occurs due to abnormal insulin secretion, insulin action or both. The influencing factors include body mass index, abnormal circumference, history of DM and others. The purpose of this study was to determine the relationship between body mass index (BMI) with the prevalence of diabetes mellitus in Leuwiliang Distric Hospital, Bogor. This type of research uses quantitative analytical research methods with a retrospective design. The method of sampling in this study was using total sampling technique which amounted to 30 respondents. The unifariate and bivariate data analysis used is the spearman rank rest. Based on the results of the study concluded that there is a significant relationship between body mass index (BMI) with the includence of diabetes mellitus. Furthermore, known correlation coefficient of 0,000, this value indicates a high relationship between body mass index with the incidence of diabetes mellitus in Leuwiliang district hospital in Bogor Regency in 2019 with a p Value of 0,000 ≤ 0,05. One of the factors that influence the occurrence of DM is BMI, body mass index with obesity category tends to be more likely to develop diabetes mellitus, and most respondents who suffer from DM in Leuwiliang District Hospital with obesity BMI. Therefore it is expected that all respondents to improve their lifestyle, especially improve their diet, so they do not experience an increase in body mass index which will increase the chance of developing diabetes mellitus.

Keywords : BMI, DM incidenct

PRELIMINARY people with diabetes mellitus in Diabetes mellitus (DM) is a Indonesia from 8.4 million in 2000 to collection of symptoms that arise in a around 21.3 million in 2030, while the person caused by an increase in blood International Diabetes Federation glucose levels due to a progressive Agency (FDI) in 2009 estimates an decrease in insulin secretion due to increase the number of people with insulin resistance. diabetes mellitus from 7.0 million in World Health Organization 2009 to 12.0 million in 2030.2 (WHO) classifies DM sufferers in five Body Mass Index (BMI) is the most clinical categories, namely insulin recommended measurement as an dependent DM (type 1 DM), insulin evaluation of obesity and overweight in dependent DM (type 2 DM), DM related children and adults. This is because in to malnutrition (MRDM), DM due to addition to being easy and inexpensive, impaired glucose intolerance (IGT) , and BMI levels are associated with body fat DM due to pregnancy (GDM). 4 WHO and risk factors for type II DM. predicts an increase in the number of Research that specifically examines the

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 17 relationship between BMI and DM whom live in Indonesia, Malaysia, events on a large scale is still not widely Singapore and Thailand. done, so researchers feel the need to Indonesia also faces a situation research the relationship between BMI with the threat of diabetes similar to the and DM events in adult populations in world. The International Diabetes Indonesia. by analyzing data from wave Federation (IDF) Atlas 2017 reports that 5.3 of the Indonesian Family Life the Diabetes epidemic in Indonesia is Survey (IFLS). still showing an increasing trend. Globally, an estimated 422 Indonesia is the sixth ranked country in million adults lived with diabetes in the world after China, India, the United 2014, compared with 108 million in States, Brazil and Mexico with the 1980. The prevalence of diabetes in the number of people with diabetes aged 20- world (with standardized age) has nearly 79 years around 10.3 million people. In doubled since 1980, increasing from line with this, Basic Health Research 4.7% to 8.5% in the adult population. (Riskesdas) shows a significant increase This reflects an increase in risk related in the prevalence of Diabetes, from factors such as being overweight or 6.9% in 2013 to 8.5% in 2018 so that the obese. Diabetes caused 1.5 million estimated number of sufferers in deaths in 2012. Blood sugar higher than Indonesia reaches more than 16 million the maximum limit resulted in an people who then the risk of other additional 2.2 million deaths, by diseases, such as heart attacks, strokes, increasing the risk of cardiovascular and blindness and kidney failure can even other diseases. Forty-three percent cause paralysis and death. Indonesia (43%) of these 3.7 million deaths experiences a double burden of health occurred before the age of 70 years. The problems, where infectious diseases percentage of deaths due to diabetes that have not managed to reach the target of occurs before age 70 is higher in low decreasing cases, and non- and middle income countries than in communicable diseases are increasing in high income countries.4 prevalence. Non-communicable diseases The number of diabetics in (PTM) cause more deaths than any other Southeast Asia has increased rapidly and cause, and it is projected that this is very worrying. The South China number will continue to increase from Morning Post released a report stating 38 million deaths in 2012 to 52 million that the number of diabetics in Southeast deaths in 2030. The four main PTMs are Asia had increased by as much as 20 cardiovascular disease, cancer, chronic percent. Approximately 96 million breathing, and diabetes mellitus (DM). people from the Southeast Asian One of the PTM with a fairly population which reaches 670 million. high proportion in Indonesia and is the One in 14 people suffer from diabetes, sixth highest cause of death in Indonesia the majority suffer from type 2 diabetes, is DM. The increase in the number of the type that can actually be prevented DM cases is closely related to a healthy and avoided. That is, 450 million lifestyle, including maintaining ideal diabetics around the world, 20 percent of body weight. In the world and whom are from Southeast Asia, most of Indonesia, graphs of obesity rates tend to

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 18 Proceeding International Seminar increase. This can lead to serious health to the Occurrence of Diabetes Mellitus". problems because obesity is associated The research site was conducted at with metabolic, cardiovascular, hepatic, Leuwiliang District Hospital. kidney, inflammatory response, and Based on this background the diabetes mellitus disorders.2 conclusion of the formulation of the In West Java alone the incidence problem in this study is "Is there a of diabetes tends to increase. The relationship between body mass index prevalence of DM according to the (BMI) with the incidence of diabetes consensus of the arts of 2011 for mellitus in RSUP leuwiliang in 2019?" residents aged over 15 years in 2013 was The purpose of this study was to 6.9%, in 2018 8.5%. The prevalence of determine the relationship between body diabetes mellitus is based on the mass index and the incidence of diabetes diagnosis of doctors in the population mellitus in Leuwiliang District Hospital aged over 15 years by province 2013 to in 2019. 2018 in 2013, 1.4%, in 2018 as much as 1.9% .4 RESEARCH METHODS The Bogor City Health Office This type of research uses (DHO) notes that the number of people quantitative analytics. Analytic is with diabetes mellitus (DM) in Bogor is research that tries to explore how and increasingly worrying. Now reaching why health phenomena occur. Analytical 2,138 people. This number increased research can be done quantitatively so from 2016 which was only 2,093 people. that statistical analysis can be done. This Head of non-communicable diseases method is called quantitative method, mental health city of health (DHO) because the research data in the form of bogor city, dr. Firy explained, that numbers and analysis using statistics number could change, because it was For the design of this study using a only based on residents seeking retrospective approach that is research treatment at the puskesmas. This number that tries to look back (backward does not include residents who seek looking), meaning that data collection treatment at the hospital.6 starts from the effects or effects that In Leuwiliang District Hospital have occurred. Then the effect is traced itself the incidence of diabetes mellitus back about the cause or the variables is quite high and tends to increase every that influence the effect. In other words, month. At the beginning of 2019 alone, in this retrospective study departing based on data from January to June 2019 from the dependent variable, then the the incidence of diabetes mellitus in independent variable is sought.7 Leuwiliang District Hospital reached This research was conducted at 2,615 people. Leuwiliang District Hospital in 2019. In accordance with the data above, it can The population in this study were be concluded that the incidence of patients suffering from diabetes mellitus diabetes mellitus is increasingly in the internal medicine room at increasing, therefore researchers intend Leuwiliang District Hospital as many as to conduct a study entitled "The 30 people.8 Relationship of Body Mass Index (BMI)

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 19 Proceeding International Seminar This research variable consists univariate and bivariate analysis, where of independent variables with the bivariate analysis uses spearman rank dependent variable. The independent statistical tests to analyze the variables are body mass index (BMI) relationship between body mass index and the dependent variable is diabetes and the incidence of diabetes mellitus in mellitus. Data processing and data Leuwiliang District Hospital in 2019. analysis using computerized with SPSS version 17. Data analysis consists of

RESEARCH RESULT index and the incidence of diabetes 1. Univariate Analysis mellitus in Leuwiliang District Based on the table of the distribution Hospital in 2019. of BMI frequencies in Leuwiliang District Hospital above it is known DISCUSSION that from 30 respondents the 1. Univariate Analysis frequency distribution results a. body mass index obtained with excess body mass Based on research results from index categories were 12 people with 30 respondents, stated that the a percentage of 40.0%. majority of respondents with a body Based on the frequency distribution mass index were 13 (43.3%) and table above it is known that the respondents with diabetes mellitus frequency distribution of the were 18 (60.0%). Body mass index is incidence of diabetes mellitus there the value obtained from are 18 (60.0%) respondents, with measurements of body weight (BW) type 2 diabetes mellitus. in kilograms and height (TB) in 2. Bivariat Analysis meters. The Relationship between Body mass index can be used Body Mass Index (BMI) and the to determine whether a person's body incidence of diabetes mellitus in weight is ideal or not Factors Leuwiliang District Hospital Bogor. Affecting BMI are age, this condition In 2019 it was known that the is suspected due to slow metabolic number of respondents was 30 processes, reduced physical activity, respondents, there were 9 (30%) and frequency of more frequent food respondents who had type 2 diabetes consumption, both sexes, BMI with with obesity BMI. overweight categories is more Significant relationship value common in men, but the incidence of using computerization obtained p obesity is higher in women compared value 0,000 ≤ 0.05 (alpha), meaning to men, the third is genetic, BMI is that Ha is accepted and H0 is very closely related to the first rejected. From these values, the generation of families, then eating results of the analysis state that there patterns, fast food contribute to an is a relationship between body mass increase in body mass index so that a

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 20 Proceeding International Seminar person can become obese, and the Hospital were mostly obese, whereas last activity physical, weight loss or respondents who were obese were prevention of weight gain can be caused by age and sex. Where the done with physical activity about 60 dominant respondent's age is more minutes a day than 50 years, respondents who are Based on research results from 50 years old tend to be obese due to 30 respondents, stated that the lifestyle and gender factors. Lifestyle majority of respondents with a body and gender are factors of obesity, mass index were 13 (43.3%) and where women are more dominant respondents with diabetes mellitus with negative lifestyles, such as were 18 (60.0%). frequent consumption of fast food, This is supported by junk food and rarely do activities Lindayati's research (2018) with the such as sports. title Relationship of Body Mass Index with Blood Sugar Levels in b. The incidence of diabetes mellitus Type 2 Diabetes Mellitus Patients in Based on the results of Wringinom Village, Kuripan research from 30 respondents, stated Subdistrict, Probolinggo District, it that the majority of patients suffering was found that from half of the from diabetes mellitus as many as 18 respondents the body mass index was respondents (60.0%) with type 2 13 people (46.4 %). The above diabetes mellitus. Definition evidence is that most respondents are according to the American Diabetes obese. This shows that the fat in the Association, diabetes mellitus is a body is not good because someone group of metabolic diseases who has never known how to characterized by hyperglycemia that measure a normal body mass index, it occurs due to abnormal insulin will have an impact on fat mass in secretion, insulin action or both. the body so that a lot of people are Diabetes mellitus is also obese, increased body weight and accompanied by disorders of blood sugar levels in the body will be carbohydrate, fat and protein high quickly. 11 metabolism caused by a relative or Based on the theory and the absolute deficiency of the insulin results of research that researchers hormone Factors affecting diabetes have done in patients with body mass mellitus are body mass index, index who suffer from diabetes abdominal circumference, family mellitus in Leuwiliang District history of DM, birth weight, stress, Hospital in 2019 with 30 respondents physical activity, exposure to that the majority of respondents with cigarette smoke, alcohol excess body mass index were 13 consumption, sex, age, education, (43.3%). It was concluded that body occupation, cholesterol level, and mass index with excess body weight blood pressure. was 23-24.9. Based on the results of Purwo It was concluded that Setiyo Nugroho's research, Anisa respondents at Leuwiliang District Catur Wijayanti (2018) with the title

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 21 Proceeding International Seminar Body Mass Index and its 2. Bivariate analysis Relationship with Diabetes Mellitus Bivariate analysis results obtained at Age> 15 Years in Indonesia, Study from 30 respondents, it is known there Data Survey of Indonesian Family are 9 (30.0%) of respondents Life V based on research shows that experiencing type 2 diabetes with the results of frequency analysis on obesity BMI with a p value of 0.000≤ diabetes mellitus variables get that 0.05. Which means there is a respondents with diabetes mellitus relationship between body mass index were 229 (0.8%), the determination with the incidence of diabetes mellitus. of the category of diabetes mellitus Body mass index is the value of was based on a history of consuming body mass index (BMI) obtained from diabetes mellitus drugs. While on the measurements of body weight (BB) in obesity variable, it was found that the kilograms and height (TB) in meters.9 obese respondents were 6,536 Factors that influence BMI are age, this (21.7%), the determination of the condition is suspected because of the obesity category was based on the slow process metabolism, reduced Body Mass Index (Kg / m2) physical activity, and frequency of food calculation. consumption that is more frequent, both Based on the results of the sexes, BMI with overweight category is research and theory above, the more common in men, but the incidence research at Leuwiliang District of obesity is higher in women compared Hospital with the results of the study to men, the third is genetic, BMI is very conducted that of 30 respondents closely related to the first generation of found 18 (60.0%) respondents with family, then eating patterns, fast food type 2 diabetes. It was concluded that contribute to the increase in body mass respondents at Leuwiliang District index so that a person can become Hospital mostly had type 2 diabetes, obese, and finally physical activity, where respondents who suffer from weight loss or prevention of weight gain type 2 diabetes were caused by BMI, can be done with physical activity age and sex. BMI with obesity around 60 minutes a day. 10 category tends to have type 2 Definition according to the diabetes. Where the dominant age of American Diabetes Association, respondents is more than 50 years, diabetes mellitus is a group of metabolic respondents who are more than 50 diseases characterized by hyperglycemia years old tend to have diabetes that occurs due to abnormal insulin mellitus because the function of their secretion, insulin action or both. organs has begun to decrease. Gender Diabetes mellitus is also accompanied is also a factor in the occurrence of by disorders of carbohydrate, fat and DM, where women are more protein metabolism caused by a relative dominant due to negative lifestyle, or absolute deficiency of the insulin such as frequent consumption of fast hormone food, junk food and rarely do Factors affecting diabetes mellitus activities such as sports. are body mass index, abdominal circumference, family history of DM,

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 22 Proceeding International Seminar birth weight, stress, physical activity, 3. The relationship between exposure to cigarette smoke, alcohol Body Mass Index (BMI) and the consumption, sex, age, education, incidence of diabetes mellitus in occupation, cholesterol level, and blood Leuwiliang District Hospital Bogor. pressure. In 2019 it is known that the number This is supported by Nine of respondents is 30 respondents, Luthansa's research, Dibyo Pramono there are 9 (30%) respondents who (2017) based on the research conducted have type 2 diabetes with obesity found that the most respondents in this BMI. Based on the results of study were mostly women totaling bivariate analysis using the 16,015 respondents (53.1%). Women Spearman rank test, the value of p have a high risk of developing diabetes value is 0,000 ≤ 0.005 (alpha) so mellitus because pregnancy has a risk of that Ha is accepted. Shows that developing diabetes mellitus, besides there is a relationship between body that women have the opportunity to have mass index and the incidence of a risk of having a greater body mass diabetes mellitus in Leuwiliang index. Table 2 explains that most District Hospital, Bogor Regency in respondents are aged <40 years, but the 2019. risk of developing diabetes mellitus increases with age starting from 35 SUGGESTION years.5 1. For Educational Institutions Based on the results of the research It is expected to provide reference and theory above, the researchers material and reading material for conclude that there is a harmony surgical medical nursing courses, as between the theory and the results of the well as a reference in carrying out study, namely that known Correlation further research on body mass index Coefficient (correlation coefficient) of with diabetes mellitus. 0.598, this value indicates a high 2. For Research Sites relationship between body mass index Can provide the latest knowledge that with the incidence of diabetes mellitus can be used in hospitals especially in Leuwiliang District Hospital, Bogor Leuwiliang Regional Hospital Tahun 2019 significant value (2-tailed) generally other hospitals and can is 0,000. There were 9 (30%) provide knowledge for patients respondents who had type 2 diabetes seeking treatment at Leuwiliang with obesity BMI. District Hospital.

CONCLUSION REFERENCES 1. It is known that the frequency 1. Nugroho, S, P dan Wijayanti A, C. distribution of body mass index is 2018. Indeks Massa Tubuh Dan 13 (43.3%) respondents. Kaitannya Dengan Diabetes Mellitus 2. It is known that the frequency Pada Umur >15 Tahun Di Indonesia, of diabetes mellitus distribution is Studi Data Survei Kehidupan 18 (60.0%) respondents. Keluarga Indonesia V. https://ojs.uniska-

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 23 Proceeding International Seminar bjm.ac.id/index.php/ANN/article/vie o5w25CRZT3R. Diakses 28 juli w/1643. Diakses 30 Juli 2019 pukul 2019 pukul 09.00. 13.35 6. Kardika IBY, dkk. 2015. Preanalitik 2. Pasal 1 angka 1 Undang Undang No Dan Interpretasi Glukosa Darah 44 Tahun 2009 Tentang Rumah Untuk Diagnosis Diabetes Melitus. Sakit. https://www.academia.edu/9560607/ http://kesmas.kemkes.go.id/perpu/ko PREANALITIK_DAN_INTERPRE nten/uu/uu-nomor-44-tahun-2009- TASI_GLUKOSA_DARAH_UNTU ttg-rs. Diakses 30 juli 2019 pukul K_DIAGNOSIS_DIABETES_MELI 14.00 TUS_PREANALITIC_AND_INTER 3. Soegondo, S. 2011. Diagnosis dan PRETATION_BLOOD_GLUCOSE_ Klasifikasi Diabetes Melitus Terkini FOR_DIAGNOSE_DIABETIC_ME dalam: Soegondo, S., Soewondo, P., LITUS. Diakses 03 Agustus 2019 Subekti, I., Editor. Penatalaksanaan pukul 09.00. Diabetes Melitus Terpadu bagi 7. Sugiyono. 2009. Metode Penelitian dokter maupun edukator diabetes. Kuantitatif, Kualitatif. Bandung : Jakarta: Fakultas Kedokteran Alfabeta Universitas Indonesia. 8. Notoatmodjo. 2018. Metodologi 4. Fathni A. 2012. Hubungan Indeks Penelitian Kesehatan. Jakarta : Massa Tubuh Dengan Kadar Gula Rineka cipta Darah Pada Penderita Diabetes 9. Kurniadi Helmanu. 2015. Gejala Mellitus Tipe 2 Di Rumah Sakit Penyakit Jantung Koroner,Kolesterol Umum Daerah Tingggi, Diabetes Melitus, Karanganyar.https://www.google.co Hipertensi. Yogyakarta : Istana m/url?sa=t&source=web&rct=j&url= Media http://eprints.ums.ac.id/22572/14/NA 10.Hermein, hadiati koeswadji. 2009. SKAH_PUBLIKASI_FINAL.pdf&v Hukum untuk perumahsakitan. ed=2ahUKEwi9aTa_vXjAhV98HM Bandung : citra aditya bakti. BHVbJBDAQFjAAegQIChAB&usg 11.Lindayati. 2018. Hubungan Indeks =AOvVaw0mdLK0iP80f36bxQzvlu Massa Tubuh Dengan Kadar Gula Ln&cshid=1565360815522. Diakses Darah Pada Penderita Diabetes 29 Juli 2019 pukul 18.30 Melitus Tipe 2. 5. Luthansa N, Pramono D. 2017. http://repo.stikesicme- Indeks Massa Tubuh Dan Kejadian jbg.ac.id/1388/13/143210104%20Lin Diabetes Melitus Pada Penduduk dayati%20Artikel.pdf. Diakses 28 juli Dewasa Di Indonesia : Analisis Data 2019 pukul 09.15 The Indonesian Family Life Survey 5. 12.Fitriyani. 2015. Factor Resiko https://www.google.com/url?sa=t&so Diabetes Mellitus Tipe 2 Di urce=web&rct=j&url=https://jurnal.u Puskesmas Kecamatan Citangkil Dan gm.ac.id/bkm/article/download/1773 Puskesmas Kecamatan Pulo Merak. 4/20491&ved=2ahUKEwjJ1JfYiNPk http://lib.ui.ac.id/file?file=digital/201 AhVFMI8KHf9mCiwQFjAEegQIB 6-12/20440387-S-PDF-Fitriyani.pdf BAB&usg=AOvVaw3ufhPEWGVbg Diakses 01 Agustus 2019 pukul 07.00

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 24 Proceeding International Seminar THE CORRELATION AGE AND GENDER WITH STROKE INCIDENT

Sara Tania, A, Indah Permatasari

Wijaya Husada Health Science Institute

ABSTRACT Background : Stroke in Indonesia become increasingly important and urgent. Because now the amount stroke sufferers in Indonesia most in Asia. Amount stroke sufferers with average old 45 years and over more increasing and often happens to men compared to women. Objective : With this research can know relationship age, gender with incident stroke on patient at room ICU hospital PMI bogor city. Method : Research method is quantitative with a descriptive design with cross sectional analysis approach. The population in this study is stroke patients in the ICU Room PMI Hospital Bogor City. Amount samples in this research is 35 people. Research time that is August 2019 – September 2019. Univariate analysis used for describe porposi respondent by way of frequency distribution. Result and Conclusion : Research results from 35 respondents, the correlation frequency gender with the incidence of stroke in patients in room ICU hospital PMI bogor city a total of 13 (37,1%) respondents experienced a stroke non hemoragic the greater one occurs in men. Significant relationship value by using computerization get p = 1,000 ≥ 0,05 (alpha), that means Ha rejected and Ho accepted. From this value, the result of the analysis showed that there was not the correlation between the frequency of gender and the incidence of stroke patients in the ICU room of the PMI hospital in Bogor city 2019. Of that value the results of the analysis stated there is no gender frequency relationship with a stroke in patients in the room ICU hospital PMI bogor city 2019. And the results of the analysis also obtained value OR of 4,698 that means gender frequency men often experience stroke event non hemoragic. Relationship with age frequency of stroke in patients in the room ICU hospital PMI bogor city there are 16 (45,7%) respondents experience an incident stroke non hemoragic in late adulthood the greater one. Significant relationship value by using computerization get p = 0,000 ≤ 0,05 (alpha), that means Ha accepted and Ho rejected. Suggest : Continuosus health education needs to be held related to risk factors related to events stroke for stroke patients and individuals who have risk factors.

Keywords : Stroke event, frequency of age and gender

PRELIMINARY common in men. Epidemiological The number of stroke sufferers research shows that cardiovascular disease around the world under the age of 45 is smaller in premenopausal (Pre-MW) continues to increase. At an international women compared to men of the same age. conference of neurologists in the UK it Estrogen plays an important role as a was reported that there were more than vasodilator of blood vessels (Masood, 1,000 stroke sufferers aged less than 30 Roach, Beauregard, et al, 2010) 2. years. The world health agency predicts According to the Indonesian Stroke that deaths from stroke will increase along Foundation (Yastroki) 3, the problem of with deaths from heart disease and cancer stroke in Indonesia is becoming of approximately 6 million in 2010 to 8 increasingly important and urgent, million in 2030.1 because now the highest number of stroke The incidence of stroke both first sufferers in Indonesia is in Asia. The time attacks and re-attacks are more number of stroke patients with an average

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 25 age of 60 years and over is in second years (15.4% of all deaths). According to place in Asia, while 15-59 years is in fifth Nably (2012) 10, stroke is a condition that place in Asia4. occurs when blood supply to a part of the The results of epidemiological brain is suddenly disrupted, because some studies also indicate that the risk of death brain cells die due to obstruction of blood in the 5 years post stroke is 45 - 61% and flow due to blockage or rupture of the occurrence of stroke and recurrence of cerebral blood vessels. While WHO11, stroke is 25 - 37%. Some other studies defines that stroke is the interruption of mention that the incidence of recurrent blood flow to the brain, generally due to stroke is not much different between men rupture of blood vessels to the brain or and women. The number of men is quite due to blocked blood vessels to the brain higher than that of women, with so that the supply of nutrients and oxygen percentages of 56.2% and 43.8%, to the brain is reduced. respectively. These results are in line with Based on the cause, stroke is divided previous studies5 comparing recurrent into 2, namely ischemic or non- strokes often appear more in men than haemorragic stroke and haemorragic women with a percentage of 60.5% and stroke. Ischemic stroke occurs due to 54.1%. blocked blood vessels of the brain by Based on data in developed plaque (material consisting of protein, countries like the United States, in 2002, calcium, and fat) which causes the flow of stroke was ranked as the third leading oxygen through the arteries to be cause of death after heart disease and obstructed. The haemorragic stroke is a cancer. In 2006, 700,000 people suffered stroke caused by rupture of blood vessels strokes each year with 550,000 among in the brain12. them new stroke cases (HS Dourman, This secondary stroke can be more 2013) 6. From the south east medical fatal than the first stroke, due to the information center (SEAMIC) data it is increasing extent of brain damage that known that the largest stroke death rate occurs due to previous stroke13. The most occurred in Indonesia, which was then influential risk factors for recurring stroke followed sequentially by the Philippines, are hypertension, then followed by other Singapore, Brunei, Malaysia, and risk factors namely diabetes, cardiac Thailand7. abnormalities, hypercholesterolemia, According to the characteristics and smoking habits, alcohol use, obesity, age of stroke prevalence that often occurs physical activity, regularity of taking at age 75+ (50.2%) with a ratio of women medication and stress14. 10.9% and men 11.0%. In urban areas the Stroke is a functional brain disorder prevalence of stroke is 12.6% while in that occurs suddenly (within seconds) or rural areas it is 8.8% 8. quickly (within a few hours) with clinical According to the Ministry of Health signs and symptoms both focal and global Riskesdas RI data, (2018) 9 the that lasts more than 24 hours, caused by prevalence of non-communicable diseases obstruction of blood flow to the brain due such as stroke has increased, based on the to bleeding (hemorrhagic stroke) or diagnosis of stroke re-examination is the blockage (ischemic stroke) with main cause of death at the age of 45-54 symptoms and signs according to the part

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 26 of the brain affected, which can heal stroke under 45 years is only about 5% of completely, heal with disabilities, or die15. all events of ischemic stroke23. Approximately 32% of strokes are In the condition of oxygenation caused by embolism, which is the closure enough aerobic metabolism occurs from 1 of the arteries by blood clots released mole of glucose to produce energy in the from other places in the circulation. form of 38 moles of adenosine Stroke bleeding is around 20% of all triphosphate (ATP) which among others stroke events 16. are used to maintain ion pumps (Na-K Stroke is a clinical syndrome pump), transport neurotransmitters characterized by acute loss of brain (glutamate, etc.) into cells, protein function and can cause death17. Stroke is synthesis, lipids and carbohydrates, as a condition that results in a person well as the transfer of substances in cells, experiencing paralysis or death due to are producing 2 ATP energy from 1 mole bleeding disorders in the brain that cause of glucose24 brain tissue death18. Strokes occur due to An increase in blood carbon dioxide blood vessels that carry blood and oxygen levels causes vasodilation of blood vessels to the brain become blocked and rupture, and an increase in oxygen causes lack of oxygen causes the function of vasoconstriction. Nitric-oxides are body movement control that is controlled localized vasodilators released by vascular by the brain not functioning19. endothelial cells25. Stroke is the third leading cause of Arteroskelorosis occurs because of death in the world after coronary heart the accumulation of fat found in the walls disease and cancer in both developed and of blood vessels so that it blocks the flow developing countries. One in 10 deaths of blood to the brain. Atheroscellorosis are caused by stroke20. Globally, 15 can also cause an inadequate supply of million people have strokes every year, cerebral tissue blood, thereby risking the one third die and the rest experience ineffectiveness of brain tissue perfusion26. permanent disability (Stroke forum, Lifestyle is often the cause of various 2015). Stroke is a major cause of diseases that attack productive age, preventable disability21. because the younger generation often In Indonesia, the tendency of stroke adopts unhealthy eating patterns by prevalence per 1000 people reaches 12.1 frequently consuming foods high in fat and for every 7 people who die, 1 of them and cholesterol but low in fiber. Besides has a stroke22. In a survey at Vermont consuming a lot of cholesterol, they Hospital, strokes at a young age consume too much sugar so that it will constituted 8.5% of all hospitalized cause obesity which results in the patients; intracerebral hemorrhage strokes accumulation of energy in the body27. were found in 41% of patients, with the Gender variable is not a risk factor for most common causes being aneurysms, stroke in early adulthood. While the AVM (arteriovenous malformation), results of the study28 state that the hypertension, and tumors. Subarachnoid incidence of stroke is higher in men than hemorrhage is present in 17% of patients, in women. Based on the Primary Stroke and ischemic stroke occurs in 42% of Prevention Guidelines29, stroke risk patients22. The incidence of ischemic factors are divided into two namely, risk

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 27 factors that cannot be modified and which examination, laboratory examination. The can be modified. main purpose of early evaluation is to The incidence of stroke is higher in identify the type of stroke and determine males than females with an average of whether the patient meets the criteria for 25% -30%. Although men are more thrombolytic therapy or other therapies. A vulnerable than women at a younger age, history of illness or early physical women will catch up after they reach examination is also used in assessing the menopause. This is the hormone that extent of neurological dysfunction and plays a role in protecting women until identifying risk factors for they pass through childbirth30. atherothrombosis and accompanying There is considerable variation in the medical conditions, and imaging. incidence of stroke between different According to Muttaqin (2008) 36 and ethnic groups. People from African races Batticaca (2008) 37, the management of have a higher risk for all types of strokes stroke patients, are: Medical / compared to people from Caucasian races. pharmacological management and nursing This risk is at least 1.2 times higher and management. According to Lingga (2013: even higher for ICH (Intracerebral 71-81) 38, the impacts caused by stroke Hemorrahage) stroke 31. include: paralysis and communication It has been suggested that strokes disorders. Common complications with bloodlines are related. In this case resulting from inadequate rehabilitation hypertension, diabetes, and defects in measures, various advanced complications blood vessels become genetic factors that of stroke due to immobilization are as play a role. In addition, lifestyle and follows39: Decubitus ulcers, contractures eating habits in the family that have and shoulder pain, proneal nerve pressure become difficult to change habits also can cause foot drop, osteopenia and increase the risk of stroke32. Smoking is a osteoporosis, depression and other real cause of stroke that occurs more in psychological effects, al incontinence and early adulthood than older people. The constipation , and senile after stroke. risk of stroke will decrease after quitting According to the large Indonesian smoking and is clearly visible in the dictionary, lifestyle is the daily behavior period 2-4 years after stopping smoking. of a group of people in society40. A Keep in mind that smoking triggers the healthy lifestyle includes healthy eating production of fibrinogen (blood clotting habits, regular physical activity, non- factors) more so that it stimulates smoking behavior, non-alcoholic atherosclerosis33. behavior, and stress control41. Primary Stroke not only attacks people who data is data collected directly by are sick but also can attack physically researchers against the target to answer healthy people as well. Strokes come the problem or the purpose of research suddenly in a moment., A few minutes, conducted42. Editing is the most important hours or half a day. This can be caused by part to achieve the main goal before several factors including high stress34. further data processing, where researchers According to Goldzmidt and Caplan must review the completeness in the (2011) 35 to detect and evaluate strokes as data43. follows: History of disease, physical

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 28 Bivariate analysis was performed aim of finding out whether there is a with the chi square test which was used to relationship between age, sex and the test the hypothesis of a significant incidence of stroke in ICU room, PMI relationship between the factors testing Hospital, Bogor City. the difference in proportions or two more groups of samples, with the two variables RESEARCH METHODS being categorical variables44. The design of this study uses Thrombus in the heart is usually quantitative research with descriptive examined by echocardiography. Atrial analytic design with cross sectional fibrillation occurs in 17% of stroke approach where the independent and patients, 18% in ischemic stroke patients, related variables are. This study is and 11% in bleeding stroke patients. In intended to determine the relationship most cases of atrial fibrillation occurs in between age and sex on the incidence of patients who have not suffered a stroke stroke. And understanding of cross and some cases of atrial fibrillation as a sectional is a type of research that cause of stroke45. observes population data or samples once Research conducted by Siti at the same time. In this type the Alchuriyah and Chatarina Umbul independent and dependent variables are Wahjuni (2016) taken from 2012-2013 assessed simultaneously at one time, so medical record data. The results of this there is no follow up. study indicate that the total 60 respondents obtained the case group age <50 years by 15 respondents or 25% and RESEARCH RESULT the control group ≥50 years by 45 Based on table 4.1, it is known that respondents or 75%. In most sexes are the majority of respondents in late men, both from the control group or case adulthood are 16 (45.7%) greater than the group. As many as 33 respondents or 55% age of young adults and middle adults. were male and the remaining 27 Based on table 4.2, it is known that the respondents or 45% were female. In the majority of male respondents are 18 case group (<50 years) the male sex is (15.4%) greater than women. higher (53%) than the female sex (46.7%). Based on table 4.3 it is known that Based on the results of a preliminary the frequency distribution of stroke events study conducted on Monday, August 12, in patients in the ICU room of PMI Bogor 2018 there were 140 patients affected by City Hospital amounted to 25 (71.4%) of stroke in the ICU room at PMI Hospital respondents who experienced a non- Bogor City. From February 20 people, hemorrhagic stroke and there were 10 March 18 people, April 36 people, May (28.6%) respondents who had a 24 people, June 16 people, and July 26 hemorrhagic stroke. people. Based on table 4.4 it is known that From what has been stated above, the the relationship between age frequency authors are interested in conducting and stroke incidence in patients in ICU research on "The Relationship of Age, room of PMI Bogor City Hospital with a Gender With Stroke Events in Patients in total of 35 respondents, 16 (45.7%) ICU Room, Bogor PMI Hospital" with the respondents experienced a greater

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 29 incidence of non-hemorrhagic stroke in majority of patients who suffered a stroke late adulthood. in late adulthood were 16 (45.7%). The Based on table 4.5, it is known that number of stroke patients with an average there is a relationship between gender age of 60 years and over is in second frequency and the incidence of stroke in place in Asia, while 15-59 years is in fifth patients in the ICU room of PMI Bogor place in Asia. According to researchers City Hospital with a total of 35 age is divided into young adults (21 - 35 respondents, 13 (37.1%) respondents years), middle adults (36 - 45 years), and experienced a greater incidence of non- late adults (46 years and above). hemorrhagic stroke occurring in men. Significant relationship value using Sex Frequency computerization obtained p = 1,000 ≥ Based on the results of research 0.05 (alpha), meaning that Ha is rejected from 35 respondents, stated that the and Ho is accepted. majority of patients who had a stroke From these values, the results of the occurred in men as many as 18 (51.4%). analysis state that there is no relationship According to male researchers, they are between the frequency of sex with the more likely to have a stroke which was incidence of stroke in patients in the ICU initially caused by a bad lifestyle pattern. room of the PMI Hospital in Bogor City Bivariate Analysis of the Relationship non-hemorrhagic stroke. Between Age Frequency and Stroke Incidence in Patients in ICU Room, Bogor PMI Hospital DISCUSSION Obtained from 35 respondents, Stroke event there were 16 (45.7%) respondents who Based on the research results of 35 experienced a non-hemorrhagic stroke respondents, stated that the majority of that occurred in late adulthood with a p non-hemorrhagic stroke events had a value of 0,000 ≤ 0.05, which means there frequency of 25 (71.4%) respondents and is a relationship between the incidence of 10 (28.6%) respondents experienced stroke and age. This result was supported hemorrhagic stroke events. Based on the by previous researchers with the title theory and results of research that have relationship between age, sex, and been conducted by researchers at the hypertension with the incidence of stroke. Bogor PMI Hospital with the number of The result is that in 77 stroke patients, the respondents 35 most of the 18 (51.4%) incidence at the age of 40 - 55 years was respondents who experienced a non- 25 patients (32.5%) and the incidence at hemorrhagic stroke are more common in age> 55 years was 52 patients (67.5%). men who are late adult age between 46 Based on the results obtained p value = years and over. According to researchers, 0.031, so it can be concluded that there is stroke is a disease that threatens death and a relationship between age and the disability. incidence of stroke and is more common in late adulthood. Age Frequency Based on the results of research from 35 respondents, stated that the

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 30 Bivariate Analysis of the Relationship experienced a non-hemorrhagic between Gender Frequency and Stroke stroke and 10 (28.6%) of respondents Occurrence in Patients in ICU Room, who experienced a hemorrhagic PMI Hospital, Bogor City stroke. Obtained from 35 respondents, there 4. It is known that the frequency were 18 (51.4%) who were male greater distribution of age relationship with than 17 (48.6%) with p value = 1,000 ≥ the incidence of stroke in patients 0.05 which means there was no amounted to 16 (45.7%) respondents relationship between types sex with the who experienced a greater non- incidence of stroke and an Odd Ratio hemorrhagic stroke in late adulthood, (OR) score of 4.698 which means that the 9 (25.7%) respondents who incidence of stroke often occurs in men experienced a non-hemorrhagic compared to women. Based on the results stroke at age middle adults and 10 of the research and theory above, the (28.6%) respondents had researcher concludes that there is hemorrhagic strokes in young harmony between the theory and the adulthood. The value of this results of the study, namely that gender relationship is significant with p = frequency does not have a significant 0,000 ≤ 0.05 (alpha) meaning that Ha relationship between sex with the is accepted and Ho is rejected. incidence of stroke with a p value ≥ 0.05. 5. It is known that the results of the With more common in men compared frequency distribution of sex with women. relations with the incidence of stroke in patients in the ICU room of PMI CONCLUSION Bogor City Hospital amounted to 18 1. Known results of the frequency (51.4%) of respondents which distribution of respondents based on occurred in men is greater than that age characteristics in stroke patients of women amounted to 17 (48.6) amounted to 10 (28.6%) respondents respondents. The value of this at young adulthood, totaling 9 relationship is not significant with (25.7%) respondents at middle 1,000 ≥ 0.05 (alpha) means that Ha is adulthood and 16 (45.7%) rejected and Ho is accepted. respondents with highest frequency according to age 46 years and abovet SUGGESTION 2. It is known that the results of the 1. For Educational Institutions It is frequency distribution of respondents necessary to hold continuous health based on sex characteristics in stroke education related to the risk factors patients amounted to 18 (51.4%) with associated with the incidence of stroke the highest frequency according to for stroke patients and individuals who gender, namely male and totaled 17 have risk factors. (48.6%) according to female sex. 2. Health Service Institutions 3. The results of the frequency Discharge planning for stroke patients distribution of respondents regarding and individuals who have risk factors the occurrence of stroke in patients needs to be made so that continuity of by 25 (71.4%) of respondents who

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 31 nursing can be carried out at home 7. Dinata, C. et al. 2013. Gambaran properly. Faktor Risiko dan Tipe Stroke pada 3. Stroke clubs need to be formed so Pasien Rawat Inap Di Bagian that patients can socialize with other Penyakit Dalam RSUD Kabupaten people who have the same problem, so Solok Selatan Periode 1 Januari 2010 they can exchange experiences related – 31 Juni. Jurnal Kesehatan Andalas : to risk factors and how to handle or 2(2). control them. 8. Riset Kesehatan Dasar 4. It is necessary to increase the (RISKESDAS) Indonesia. 2018. vigilance of nurses to the patient's Departemen Kesehatan Republik condition, especially patients who have Indonesia. risk factors and patients who have 9. Riskesdas RI, 2018. Prevalensi suffered a stroke. Penyakit Tidak Menular.

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“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 33 Mencegah, dan Mengobati Bersih dan Sehat (PHBS). Stroke. Yogyakarta : Kata Hati. Yogyakarta : Nuha Medika. 34. Pinzon R dan Asanti. 2010. Awas 43. Notoatmojo, Soekidjo. (2005) Stroke! Pengertian, Gejala, Metodologi Penelitian Kesehatan. Tindakan, Perawatan dan Jakarta: Rineka Cipta. Pencegahan. Yogyakarta : Andi 44. Notoatmodjo, Soekidjo. 2010. Offset. Metodologi Penelitian Klinis. 35. Smeltzer, & Bare. 2005 Buku Jakarta : Rineka Cipta. Ajar Keperawatan Medical Bedah 45. Hastono, S.P. (2007). Analisis Brunner & Suddart. Edisi 8, Vol data Kesehatan Jakarta : FKM UI. 1, alih bahasa: Kuncaran Monica 46. Misbach, Jusuf. 2011. Stroke Ester. Jakarta: EGC. Aspek Diagnostic, Patifisiologi, 36. Goldszmidt, Adrian J dan Louis R Manajemen. Jakarta: FKUI. Caplan. 2011. Stroke Esensial. Terjemahan oleh Retna Neary Elseria Sihombing. Jakarta : EGC 37. Muttaqin, A, 2008. Asuhan Keperawatan stroke hemoragic. Diakses tanggal 26 Februari 2015 dari: http://nursingbegin.com/askep- stroke-hemoragik/ 38. Batticaca. 2008. Asuhan Keperawatan Klien Dengan Gangguan Sistim Persarafan. Salemba Medika. Jakarta. 39. Lingga Lenny, Ph.D, (2013) All About Stroke, pertama, PT Elex Media Komputindo, Jakarta, h.1 40. Yulianto, A. 2011. Mengapa Stroke Menyerang Usia dewasa muda?. Jakarta: PT. Buku Kita 41. Badan Bahasa Kemendikbud. 2008. Kamus Besar Bahasa Indonesia Online. Jakarta: Kementrian Pendidikan dan Kebudayaan. (http://badanbahasa.kemdikbud.g o.id/kbbi/index.php). Diakses tanggal 23 Desember 2014 pukul 15.48 42. Proverawati, Atikah dan Eni Rahmawati. 2012. Perilaku Hidup

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 34 THE EFFECT OF MOZART CLASSICAL MUSIC TO THE SLEEPING QUALITY OF THE PATIENTS

Sariaman Purba, Adinda Mutiara Hermawan

Wijaya Husada Health Science Institute

ABSTRACT

The sleeping qualityof someone is good if it is showed the signs lack of sleeping and don’t have problems in his/her sleeps,their. The sleeping quality refers to individual that increase to the REM sleeping phase. The quality is the NREM number of stages and REM that experienced bysomeone in his/her sleeping cycle,and the sleeping quantity is the total duration of sleeping that spent by someone in a day. A person’s body during sleeping will have changed the physiology process such as the decreasing of blood pressure and pulse rate, overcome the peripheral blood vessels, sometimes there is increasing oftraktusgastrointestinal activity, the relaxationof the muscles, and metabolism basalt rate (BMR) decreasing 10-30%. The aim is to know the effect of mozart classical music to the sleeping quality of thepatients that hospitalized in PMI hospital Bogor 2019. To know tehe effect of mozart classicalmusic to the sleeping quality of the patients that hospitalized in PMI hospital. The kinds of this research is pre exsperimental with one group pre post test design and it isheld in PMI hospital bogor in september 2018 with 25 patients that hospitalized by using federer. The instrument that is used are observation sheet and guestionnaire. The measuring instrument that is used in this research is The Pittsburgh Sleep Quality Index (PSQI). The univariate analysis research result before doing the mozart classical music theraphy that said good quality sleep there are 8 persons (32%) and bad quality sleeping there are 17 persons (68%). After doing the mozart classical music therapy said that the good quality sleeping there are 22 persons (88%) and the bad qualitysleeping there are 3 persons (12%). The bivariate analysis using shapiro wilk test withe the result 0,000 < 0,05, the nh, potesis test using wilcoxon with P value 0,001 < 0,05 then can be condude that Ha is accepted. The conclusion is the influence of classical music therapy mozart on sleeping quality in hospitalized in PMI hospital Bogor 2019. Advice is used as additional material to enrich knowledge and as a reference for emergency science on non-pharmacological sleep quality management.

Keywords : Mozart Classical Music Therapy, Quality Sleeping

PRELIMINARY and decreased response to external stimuli. Rest and sleep are basic needs that Nearly one third of our time, we use to sleep. absolutely must be met by everyone. With This is based on the belief that sleep can enough rest and sleep, the new body can restore or rest physically after a day of function optimally. Rest and sleep have activities, reduce stress and anxiety, and can different meanings in each individual. In increase the ability and concentration when general, rest means a state of calm, relaxed, trying to do daily activities1. without emotional pressure, and free from A person's body during sleep will feelings of anxiety. So resting does not mean experience changes in physiological processes not doing any activity1. such as a decrease in blood pressure and Whereas Sleep is the status of change pulse, overcome peripheral blood vessels, of consciousness when individual perceptions sometimes an increase in activity of the and reactions to the environment decrease. intestinal tract, relaxation of skeletal muscles, Sleep is characterized by minimal physical and basal metabolic rate (BMR) decreases by activity, varying levels of consciousness, 10-30% 2 changes in the body's physiological processes,

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 35 Quality is a very complex phenomenon pain in the scar. Listen to Mozart's classical involving various domains, among others, an music to improve, maintain, and restore assessment of sleep duration, sleep mental and physical health so that patients disturbance, latency period of sleep, sleep feel less pain in postoperative wounds. dysfunction during the day, sleep efficiency, Mozart classical music that is listened to sleep quality, use of sleeping pills. So if one postoperative patients has a slow tempo so as of the seven domains is disrupted it will result to calm the mind, stabilize blood pressure and in a decrease in sleep quality3. expedite the circulation of white blood cells A person's sleep quality is said to be in the surgical wound to accelerate wound good if it does not show signs of sleep healing. deprivation and does not experience problems The results of research conducted by in sleep, sleep quality refers to individuals Hendrik, prove that there is an effectiveness experiencing an increase in REM4 sleep of classical music on the quality of sleep by phase. The quality and quantity of sleep a listening to classical music able to calm the person has where the quality of sleep is the mind, launch blood pressure and stabilize number of NREM and REM stages a person heart pressure so that inpatients are right to experiences in his sleep cycle, and the start sleeping and stabilize heart pressure so quantity of sleep is the amount of sleep a that inpatients are right for start to sleep and person spends in a day4. never wake up in the middle of the night. Non-pharmacological cure of sleep Patients who listen to classical music mozart disorders is needed to minimize the effects of provide a relaxed psychological condition and pharmacological therapy. Non a feeling of comfort. pharmacological therapy can be done by Based on the results of a preliminary giving music therapy. Music has long been a study at the 2019 Bogor PMI Hospital in the part of human life that is able to keep seruni ward of 10 respondents 2 respondents someone entertained. Music can also be a had a stroke, 3 respondents had respiratory therapy. Music is given to improve, maintain problems and 5 respondents had hypertension. and restore one's mental, physical, emotional, from 10 respondents 6 respondents who and spiritual health. Music therapy is included listened to music before going to sleep and 4 in complementary therapy, in which music respondents who did not listen to music therapy is a technique used to cure an illness before going to sleep, the time needed to sleep by using certain sounds or rhythms. The type for> 20 minutes there were 7 respondents of music used, instrumentalia in music while the time needed to sleep for <20 therapy can be adjusted to your liking, such as minutes there were 3 respondents, for classical music, slow music, orchestras, and regarding questions about the feeling of other modern music. Soft and regular music listening to classical music mozart there were such as instrumental and classical music is 6 respondents who slept listening to music music that is used for music therapy5. and 4 respondents who could not sleep when According to Campbell listening to listening to music. mozart classical music for 30 minutes before Based on the above phenomenon, the bedtime can affect heart rate, causing calm research is interested in conducting research because music with soft rhythm that is heard with the title "The Effect of Mozart Classical through the ear will directly enter the brain Music Therapy on Sleep Quality in Patients in and directly processed so as to produce a the Inpatient Room at the PMI Hospital". good effect on the health of postoperative patients. Complaints of postoperative patients such as disturbed sleep patterns are caused by

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 36 RESEARCH METHODS value <0.05. So it can be concluded that This study uses experimental research the data in this study are not normally with a pre-experimental design research distributed, the statistical method used is design. While the design of this research the Wilcoxon Signed Ranks Test. design uses one-group pre-post test design, 3. Univariate Analysis because pre-experimental does not require Based on table 6 shows that the control6. quality of sleep before performing One group pre-post design is research classical music therapy mozart as many as with one group of subjects that is treated or 17 respondents (68.0%). intervened which is measured before and after Based on table 7 shows that the treatment. The hallmark of this research is to quality of sleep after performing classical use a causal relationship by involving a group music therapy mozart as many as 22 of subjects. Subjects were observed again respondents (88.0%). after the intervention. This design was used to determine the effect of mozart classical music 4. Bivariate analysis therapy on sleep quality in patients in the Effects of Mozart Classical Music inpatient room at PMI Hospital. Therapy on Sleep Quality Based on Table 8 Effect of Mozart RESEARCH RESULT Classical Music Therapy on Sleep Quality 1. Characteristics of Respondents in Inpatients at 2019 PMI Bogor Hospital Based on table 1 shows that the it can be seen that there is a difference majority of male respondents were 13 between changes in sleep quality for respondents (52.0%). pretest and posttest and these differences Based on table 2 shows that the after the Wilcoxon test is obtained p-value majority of respondents aged 31-40 years = 0.001 which means p -value <0.05 so were 12 respondents (48.0%). that the decision taken is Ha accepted and Based on table 3 shows that the Ho rejected. So it can be concluded that majority of respondents with high school there is an effect of Mozart's classical education were 10 respondents (40.0%). music therapy on sleep quality in inpatient Based on table 4 shows that the rooms at PMI Bogor Hospital. majority of respondents with the work of Housewives as many as 10 respondents (40.0%) and with Workers as many as 10 DISCUSSION respondents (40.0%). 1. Frequency Distribution of Sleep Quality Before Mozart's Classical Music Therapy 2. Normality Test Based on table 6 shows that patients Data normality testers in this study with poor sleep quality are 17 people, used the Shapiro Wilk test. The Shapiro patients who have good sleep quality are 8 Wilk test was used because the sample in people. Before being given classical music this study was included in a small sample therapy mozart to inpatients, pre-test is of 25 study subjects (<50). Testing is done done first. In the pre-test results there are using the help of the SPSS program. non-parameters obtained, the total mean of Based on Table 5 the Tests of sleep quality is 1.00 (SD = 0,000). This is Normality shows that the analysis of in accordance with the provision of mozart normality tests in the pre-test and post-test classical music therapy to 25 people intervention groups is known to be a treated in the inpatient room. From the significant value of 0,000 or a significant interview results, respondents said that

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 37 they felt their sleep quality was poor, most quality. This is caused by the status of respondents complained that their sleep change of consciousness when individual quality was poor. perceptions and reactions to the This is in accordance with research environment decrease. but the physiology conducted by Yasinta Nadu (2018) the of sleep is a regulation of sleep activities quality of sleep of patients before doing by the relationship of a celebrity classical music therapy Mozart on 30 mechanism that alternately activates and respondents was poor sleep quality. presses the brain to sleep and wake up. Sleep quality is everyone's ability to One of these sleep activities is regulated maintain a state of sleep and to get the by the reticular activation system which is appropriate REM and NREM sleep stages. a system that regulates all levels of central Sleep quality is a condition that is nervous system activities including experienced by individuals to get freshness alertness and sleep. Thus, systems in the and fitness when awakened from sleep. A brain stem that regulate cycles or changes person's sleep quality is said to be good if in sleep are RAS and BSR. it does not show signs of sleep deprivation and has no problems sleeping. 2. Frequency Distribution of Sleep Quality There are 8 factors influencing the After Mozart's Classical Music Therapy quality of sleep, namely disease factors, Based on table 7 shows that the environmental factors, motivational results of the study have improved After factors, exercise factors and fatigue, the classical music therapy mozart psychological stress factors, alcohol conducted on respondents who slept well factors, nutritional factors, drug factors. as many as 22 people (88.0%), patients This is in line with the theory that who slept poorly as many as 3 people rest and sleep have different meanings in (12.0%). The results obtained from the each individual. In general, rest means a total mean of a decrease in sleep quality is state of calm, relaxed, without emotional 1.44 (SD = 0.507). pressure, and free from feelings of anxiety. This is in accordance with research So resting does not mean not doing any conducted by Yasinta Nadu (2018), after activity, sleep is a status change of being given classical mozart music therapy consciousness when individual perceptions patients experience good sleep quality and reactions to the environment decline. after listening to mozart classical music Sleep is characterized by minimal physical because as many as 99.0% of patients activity, varying levels of consciousness, sleep soundly even without using sleeping changes in the body's physiological pills while in hospital . processes, and decreased response to Music therapy is included in external stimuli1. sleep is one of the complementary therapy, in which music body's very complex biological rhythms. therapy is a technique used to cure an Circadian synchronization occurs if the illness by using certain sounds or rhythms. individual has a sleep-wake pattern that The type of music used, instrumentalia in follows the biological clock the individual music therapy can be adjusted to your will wake up at the highest physiological liking, such as classical music, slow and psychological rhythm or most active music, orchestras, and other modern and will sleep at the lowest rhythm. music. Soft and regular music such as Based on the discussion and theory instrumental and classical music is music above, it can be concluded that the quality that is used for music therapy5. mozart of sleep felt by inpatients is poor sleep classical music for 30 minutes before

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 38 going to sleep can affect heart rate, Sleep Quality in Postoperative Patients at causing calm because music with soft Batu Baptist Hospital". This type of rhythm that is heard through the ear will research is Pre-Experimental with One go straight into the brain and directly Group Pre-Post test design. The sample in processed so as to produce a good effect this study were 30 postoperative patients. on patient health. The results showed that before listening to Based on the description above it classical mozart music therapy, most 21 can be concluded that the classical music (70.0%) postoperative patients therapy Mozart affects the quality of sleep. experienced poor sleep quality and after Sleep quality of 17 respondents is poor listening to classical music therapy. sleep quality has increased to 22 Mozart almost all 25 (83.3%) respondents whose sleep quality is good. postoperative patients experienced good Improved sleep quality before and after sleep quality. Paired t-test results obtained therapy is caused by the effects of p-value = (0,000) <(0.050) so that it can be Mozart's classical music. With the help of concluded that there is an influence of mozart classical music one's mind classical music therapy on sleep quality in becomes soothing, listening to mozart postoperative patients at the Baptist classical music can make people more Hospital of Stone. relaxed and comfortable. Non-pharmacological cure of sleep disorders is needed to minimize the effects 3. The Effect of Mozart Classical Music of pharmacological therapy. Non Therapy on Sleep Quality in Inpatients at pharmacological therapy can be done by PMI Bogor giving music therapy. Music has long been Based on table 8 the quality before a part of human life that is able to keep and after giving classical music therapy someone entertained. Music can also be a mozart to inpatients at PMI Bogor therapy. Music is given to improve, Hospital shows that a decrease in sleep maintain and restore one's mental, quality after classical music therapy and physical, emotional, and spiritual health. improved sleep quality has been tested Music therapy is included in using the Wilcoxon signed ranks test complementary therapy, in which music concluded that the administration of therapy is a technique used to cure an mozart classical music therapy increased illness by using certain sounds or rhythms. significantly (p-value = 0.001 which The type of music used, instrumentalia in means p-value <0.05). So that the decision music therapy can be adjusted to your that Ha took was accepted and Ho was liking, such as classical music, slow rejected. To test this hypothesis the music, orchestras, and other modern Wilcoxon signed ranks test was used music. Soft and regular music such as because the values before and after the instrumental and classical music is music treatment were not normally distributed (p that is used for music therapy. <0.005). Sleep is a status change of So it can be concluded that there is consciousness when an individual's an influence of classical music therapy on perception and reaction to the environment the quality of inpatient sleep at PMI Bogor decreases. Sleep is characterized by Hospital . minimal physical activity, varying levels This research is in line with what of consciousness, changes in the body's was done by yasinta nadu on "The Effect physiological processes, and decreased of Mozart's Classical Music Therapy on response to external stimuli. Nearly one

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 39 third of our time, we use to sleep. This is provide calm that makes the brain receive based on the belief that sleep can restore or new input, relax and sleep effect. rest physically after a day of activities, reduce stress and anxiety, and can increase CONCLUSION the ability and concentration when trying 1. It is known that the frequency to do daily activities. distribution before performing Sleep quality is everyone's ability to classical mozart music therapy for maintain a state of sleep and to get the inpatients at PMI Bogor Hospital in appropriate REM and NREM sleep stages. 2019 from 25 respondents 8 Sleep quality is a condition that is respondents who had good sleep experienced by individuals to get freshness quality and 17 respondents who had and fitness when awakened from sleep. A poor sleep quality. person's sleep quality is said to be good if 2. It is known that the frequency it does not show signs of sleep deprivation distribution after performing classical and has no problems sleeping. mozart music therapy in inpatients at There are 8 factors influencing the PMI Bogor Hospital in 2019 from 25 quality of sleep, namely disease factors, respondents 22 respondents who had environmental factors, motivational good sleep quality and 3 respondents factors, exercise factors and fatigue, who had poor sleep quality. psychological stress factors, alcohol 3. There is an influence between factors, nutritional factors, drug factors. classical music therapy with a Based on the discussion and theory decrease in the pain scale of above, there is an effect of mozart classical postoperative patients at PMI music on improving the sleep quality of Hospital in 2019, it can be seen that patients in the inpatient room in this study there is a difference between the with data before doing mozart classical change in pain scale for pretest and music therapy for respondents with good posttest and the difference after being sleep quality of 8 people (32.0%), patients tested using Wilcoson test obtained ρ- with poor sleep quality were 17 people value = 0.001 which means ρ -value (68.0%). After performing classical music <0.05 so the decision taken is Ha therapy on respondents who had good accepted and H0 rejected. So it can be sleep quality were 22 people (88.0%), concluded that there is an influence of patients who had poor sleep quality were 3 classical music therapy on reducing people (12.0%). This shows that there are the level of pain scale in changes in the quality of sleep before and postoperative patients in Bogor PMI after the administration of classical music Hospital . mozart. Improving the quality of sleep because of the classical music mozart can SUGGESTION make a person more relaxed. 1. For Educational Institutions From the description above it can be For educational institutions to concluded that there is harmony between increase the capacity and quality of theory and research results, because the education so that the information provision of classical music therapy from the results of this study can be mozart basically influences the quality of used as additional material to enrich sleep of inpatients. Because mozart the knowledge and reference needs of classical music can calm the mind so as to emergency nursing on non- pharmacological sleep quality

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 40 management with classical music 5. Djohan. 2006. Terapi Musik dan Aplikasi. therapy mozart and its effects on Yogyakarta:galangpress sleep quality. 6. Nursalam. 2013. Metodologi Penelitian 2. For Health Services Ilmu Keperawatan:Pendekatan For health services, especially Praktis:Jakarta:Salemba Medika nursing can improve the quality of nursing care provision, especially the nurse's independent intervention in the management of non- pharmacological sleep quality. Nurse independent intervention or non- pharmacological therapy so that there are alternatives other than drugs that sometimes cause side effects. From the results of the study showed that mozart classical music therapy can help sleep quality to be more relaxed. To improve sleep quality, classical mozart music can be played before going to sleep. 3. For Respondents The results of this study are expected to be input for patients treated in the inpatient room to help sleep quality by combining medical and non-medical treatment. 4. For Further Researchers The results of this study are expected to be used as basic data for further research in the same scope.

REFERENCES 1. Wahit Iqbal Mubarak,SKM & Ns.Nurul Chayatin,S.Kep. 2008. Buku Ajar Kebutuhan Dasar Manusia: Teori&Aplikasi dalam Praktik. Jakarta: EGC . 2. Vita. Andina & Yuni F. 2017. Kebutuhan Dasar Manusia Teori dan Aplikasi dalam Praktik Keperawatan. Yogyakarta: Pustaka Baru Press. 3. Fahmi, 2012. Kualitas Tidur Dan Aktivitas Otak Tidur. Jakarta: EGC 4. Tarwanto & Wartonah. 2006. Kebutuhan Dasar Manusiadan Proses Keperawatan Edisi 4. Jakarta: Salemba Medika

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 41 CORRELATION HYGIENE AND SANITATION BEHAVIOR WITH ESCHERICHIA COLI BACTERIAL CONTAMINATION ON STREET VENDORS

Benny M.P Simanjuntak, Meta Avila

Wijaya Husada Health Science Institute

ABSTRACT

Food is important for human health. Hygiene and sanitation behavior is important in determining the quality of food where the bacteria Escherichia Coli as an indicator of pollution and contamination of food that can cause (food borne diseases) congenital diseases Food. From the inspection of food samples on the surveillance program of food processing in the street vendors are done in the find of food samples contaminated with bacteria Escherichia Coli. The purpose of this research is to know the correlation of hygiene and sanitation behavior with bacterial contamination Escherchia Coli on street vendors in the working area of Puskesmas Bogor Utara. This type of research utilizes methods of analytic with Cross Sectional design. The sample in this study amounted to 20 respondents using the Total Sampling technique. Data collection instruments Use a kuisoner sheet of hygiene and sanitation behavior. The analysis used is univariate and sufficient using Chi Square collation test. The results of the study were get for the hygiene behavior variables of 20 respondents that had a negative behaviour of 11 people (100%) and negative sanitation variables as much as 10 people (90.0%). Result in Get hygiene behavior correlation with bacterial contamination Escherichia Coli ρ value = 0.450 which means ρ value (> 0.05) so that there is no connection, while the sanitary correlation with bacterial contamination Escherichia Coli ρ value = 1 which means ρ Value (> 0.05) so there is correlation. From the results of the study can be concluded between the theory and the results of the research that the variable hygiene behavior and the sanitary variables do not have a significant correlation with bacterial contamination Escherichia Coli. The research that is expected can be used as input material to improve the work evaluation for BPOM (Food and Drug Control agency) in order to improve food safety and the health department to improve the work evaluation with The Puskesmas in order to improve the quality of hygiene and sanitation behaviour of street vendors, especially in the city of Bogor.

Keywords : Hygiene behaviour, Sanitation, Escherichia Coli

PRELIMINARY people, places and equipment that can or Hygiene and sanitation have the may cause illness or health problems.1 same goal and are closely related to one Street food itself has become an another, namely protecting, maintaining inseparable part of human life. and enhancing the degree of human health Consumption of food snacks in the (individuals and communities). But in its community is no doubt always increasing application, the terms hygiene and from time to time given the increasing sanitation have differences, namely hygiene mobility of the community so they do not is more directed towards human activity have time to process their own food.2 (individuals and communities), while Seeing businesses in the food sector every sanitation is more focused on human year tends to increase, ranging from hawker environmental factors. Food Sanitation foods to restaurants / restaurants. Food Hygiene is an effort to control food factors, snacks as one of the community services in the field of food, whose existence is often

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 42 still far from meeting the requirements regarding ways of handling hygienic food is required for health so that the impact of a crucial element in preventing the health problems in the form of disease to contamination of pathogenic agents into the community. Increasing community food / drinks.4 needs for food provided outside the home, Several factors that become one of the products provided by companies - the causes of the presence of Escherichia companies and individuals engaged in the coli bacteria are hygiene behavior, food business of providing food for public use sanitation, environmental sanitation, (food snacks). temperature, and humidity. The main To ensure that these primary needs factors that cause food contamination that are met, one aspect that must be considered cause food borne disease are foodborne is food safety. Food safety is very much diseases such as diarrhea or food poisoning, needed in preventing biological, chemical accompanied by cross-contamination due to and other contamination which can disturb, bad personal hygiene of street vendors in harm and endanger human health. To processing food and storing it in bad control the risk factors for food temperatures due to street vendors only contamination, both from food ingredients, modest capital can have the opportunity to people, places, and equipment so that the occur growth of pathogenic bacteria food is safe for consumption, the One of the bacteria often used as government implements the Food indicators of food pollution is Esherichia Sanitation Hygiene program.3 coli or better known as Escherichia Coli. Foodborne disease is one of the bacteria that are common and live in the most and most burdening public health human intestine. Escherchia Coli bacteria problems that have ever been encountered can cause health problems such as diarrhea in modern times. The disease causes many if it enters the digestive tract, both through casualties in human life and causes a great drinks and food. amount of suffering, especially among Rules regarding the presence of infants, children, the elderly and those Escherichia Coli bacteria in food and whose immune systems are impaired.4 drinks. According to Law No. 715 / Street Vendors (PKL) is an informal sector Menkes / Sk / V / 2003 Concerning business in the form of a business which is Sanitary Hygiene Requirements for Food sometimes also a producer. Some settled in Service Escherichia Coli bacteria number certain locations, others moved from one on food must be 0 / gram of food sample place to another (using bunkers, pushcarts) and on beverage Escherichia Coli number selling food, drinks and other consumer must be 0/100 ml sample drink.6 goods at retail. (PKL) Generally, the small Bogor City Health Office in 2018 capital is sometimes only a tool for capital recorded a suspected poisoning case owners to get just a commission in return or originating from Tutut (rice conch) which effort.3 was eaten during breaking the fast that Lack of knowledge and ignorance of occurred in Kampung Sawah, Tanah Baru food handlers for safe handling of food has Village, North Bogor District, Bogor City. resulted in cases of foodborne illness. To In this case, 85 residents in three prevent contamination of contamination neighboring neighborhoods namely RT 01, into food, education and training on food 02 and 05 in Rw 07. The rice field village is safety are important and effective choices. not the location of the tutut producer, one of Education for food handlers and consumers the traders who caused 85 poisoning

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 43 residents to have been selling for six years, RESEARCH METHODOLOGY but this time it was only the food causing This type of research is Analytical problems for citizens. This tutut trader gets Research with a quantitative approach that from a supplier and then resells the tutut for uses Cross Sectional design.8 This study Rp.2,000, - per plastic bag, in addition to aims to obtain a picture by studying the the kiosk he owns, the tutut supplier also dynamics of the correlation between risk entrusts his merchandise at several other factors and effects, using a method of kiosks located in Kampung Sawah, North approach, observation or data collection at Bogor.7 one time (point time approach). That is, The Bogor City Health Office has each research subject was only observed conducted laboratory tests on tutut once and measured the character's status or preparations which caused dozens of subject variables at the time of examination. residents in Kampung Sawah, Bogor Utara This does not mean that all research objects District, to be poisoned. laboratory results are observed at the same time show, in the processed tutut that is ripe it In this study, the independent contains three types of bacteria namely variable data is hygiene behavior and Escherichia Coli, salmonella and shigella.7 merchant sanitation, while the dependent In a preliminary study the variable is the contamination of Escherichia researchers conducted in July while Coli bacteria in street vendors in the North carrying out an internship by conducting Bogor Public Health Center . field observations from 5 traders 3 of whom The sampling technique is Non their personal hygiene was far from eligible Probability Sampling using the Total due to the cleanliness of their long and dirty Sampling method. The number of samples nails. Food handlers hygiene practices in this study were all street vendors who related to hand washing behavior with soap were fostered by the North Bogor every time they touch food are also found Puskesmas in the working area of the North to be lacking because they do not wash Bogor Puskesmas which were 20 traders. hands before and after processing food in In this study primary data were obtained terms of processing they also do not use from questionnaires or distributing clean equipment such as (forks, spoons, questionnaires to respondents, namely street food tongs and appropriate gloves) because vendors who were fostered in the working they only sell on modest carts with minimal area of North Bogor Health Center, while facilities and equipment. Therefore, secondary data were obtained from North researchers are interested to know "The Bogor Health Center, which were the Relationship between Hygiene Behavior results of UPTD Regional Health and Sanitation with Escherchia Coli Laboratory Laboratory (LAKBKESDA) Bacterial Contamination in Street Vendors food samples from traders who are fostered in the Work Area of North Bogor Health in the working area of the North Bogor Center in 2019." Public Health Center by taking food or Based on the background stated beverage samples. above, the formulation of the problem in this research is "Is there a relationship RESEARCH RESULT between hygiene and sanitation behavior a. Univariate Results with contamination of Escherichia Coli The Frequency Distribution of bacteria in street vendors in the North Street Pedestrian Hygiene Behavior in Bogor Public Health Center in 2019". the Work Area of the North Bogor

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 44 Health Center shows that of the 20 no relationship between sanitation and respondents there were 11 respondents Escherichia Coli bacterial contamination having negative behavior (55.0%). in foot traders in the working area of The Frequency Distribution of North Bogor Health Center. Street Vendor Sanitation in the Bogor Puskesmas Work Area shows that of the DISCUSSION 20 respondents there were 11 A. Univariate Results respondents who had negative sanitation 1. Hygiene behavior of street vendors in (55.0%). the working area of North Bogor Frequency Distribution of Puskesmas Escherichia Coli bacteria in Street Food Hygiene behavior of food Traders Samples in the Work Area of processing staff is an activity of the food North Bogor Health Center was found processing power itself or the activity of that the highest was positively food processing power can be seen contaminated with Escherichia Coli directly to anything related to the health bacteria as many as 19 snacks (95.0%). of people or those who do everything b. Bivariate Results about food in a food operation.9 Based on table 4.13 the frequency Based on the results of the distribution of the relationship between assumptions of this study, it can be hygiene behavior with Escherichia Coli concluded that the hygiene behavior of bacterial contamination in street vendors street vendors in the working area of the in the North Bogor Public Health Center North Bogor Health Center in 2019 in 2019 shows that with statistical tests showed that of the 20 respondents there of 20 respondents who have negative were 11 respondents who had negative behavior with positive Escherichia Coli behaviors (55.0%) and the results were bacterial contamination, there are 11 in line with the research conducted by respondents (100 %). Chi Square test Arief Rakhman Judges who point out results obtained ρ value = 0.450, which that some of the street vendor's behavior means P value (> 0.05) so that there is has negative behavior. The behavior of no relationship between hygiene the street vendors touch food directly behavior of street vendors with without the help of equipment such as contamination of Escherichia Coli spoons, forks and tongs, scratching or bacteria in street vendors in the North touching members of the body when Bogor Public Health Center. preparing food and smoking and Based on table 4.14 the distribution chewing food when processing food. of the frequency of sanitation relations 2. Street Vendor Sanitation in the Work with Escherichia Coli bacterial Area of Bogor Utara Health Center. contamination in street vendors in the Sanitation is a public health effort working area of North Bogor Health that focuses on supervision of various Center in 2019 shows that the statistical environmental factors that affect the test of 20 respondents who have degree of human health, while the Negative sanitation with positive factors that affect sanitation are rubbish Escherichia Coli bacterial contamination bins, sanitation, clean water supply and is 10 respondents (90, 0%). Chi Square density of flies or disease vectors.10 Test results obtained ρ value = 1, which Based on the results of the means P value (> 0.05) so that there is assumptions of this study, it can be

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 45 concluded that the sanitation of street itself, temperature is also an vendors in the working area of the North environmental factor that affects Bogor Health Center in 2019 showed microbial growth. that of the 20 respondents there were 11 Escherchia Coli bacteria will respondents who had negative sanitation grow and develop at 37˚C, whereas (55.0%) and the results of this study Escherchia Coli bacteria can die by were in line with Wahyu Dwi Atmiati cooking food at 70˚C, it can be that Sanitation street vendors in the assumed as a factor there is no existence of trash bins in some of their relationship between behavior with selling areas are not yet sufficiently Escherichia Coli bacterial available, because they themselves only contamination in terms of naturally provide unprotected and closed trash occurring on food, the environment bins so that it is easy as a pollutant and when the food is cooked by media, thus their dirty situation also traders or when the sword treats food invites the existence of flies as vectors poorly. of disease.

B. Bivariate Results 2. Relationship between Street Vendor 1. Relationship between Hygiene Sanitation and Contamination of Behavior with Escherchia Coli Escherichia Coli bacteria in Street Bacterial Contamination in Street Vendors in the Work Area of Bogor Vendors in the Work Area of North Utara Health Center Bogor Health Center. Based on the results of the Based on the assumptions of assumptions of this study, it can be this study, it can be concluded that concluded that there is no there is no relationship between relationship between sanitation of hygiene behavior of street vendors street vendors with contamination of with Escherichia Coli bacterial Escherichia Coli bacteria in street contamination in street vendors in the vendors in the area of North Bogor area of North Bogor Health Center in Health Center in 2019 and the results 2019 and the results of this study are of this study are consistent with in line with Dewi Fadilah Firdaus's Azzahra Pratidina that other factors research that other factors cause the cause the presence of Escherichia presence of bacteria Escherichia Coli Coli bacteria the food is not only a in food is not only a hygiene factor that affects sanitation from the behavior of traders but also comes trash, sanitation of clean water and from the factor of the bacteria are density of flies or disease vectors already naturally in the food itself, originating from traders but also foodstuffs that will carry their own from sanitation factors where sales microflora for life and these are a situation where the location of microflora will be in food products, the place of sale is protected from foodstuffs stored in a humid room pollution caused by dust or smoke. will easily absorb water so that water The cleanliness of the place of sale activity increases, increased water also determines the quality and safety activity will cause microbes to grow of food produced. easily and cause damage to the food

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 46 Conversely, microorganisms proportion having positive grow well in humid and warm Escherichia Coli bacterial environments, containing good contamination as many as 11 nutrients such as food and dirty people (100 %). Statistical test environments. Therefore, food is results obtained ρ value = 0.450, very easy to be attacked by which means P value (> 0.05) so microorganisms, especially fruits and that there is no relationship vegetables if they are in a dirty between hygiene behavior of environment. sanitation, a selling street vendors with Escherichia place for traders, on the side of the Coli bacterial contamination in road by only selling on a makeshift street vendors in the North cart. Bogor Public Health Center 5. There is no relationship of CONCLUSION sanitation with contamination of 1. It is known that the frequency Escherichia Coli bacteria in distribution of the hygiene street vendors in the working behavior of street vendors in the area of the North Bogor Health working area of the North Bogor Center in 2019 of 20 Health Center shows that of the respondents who have Negative 20 respondents there were 11 Sanitation with the highest (55.0%) street vendors who had proportion having positive negative behaviors. Escherichia Coli bacterial 2. It is known that the frequency contamination of 10 people distribution of street vendor (90.0% ). Statistical test results sanitation in the working area of obtained ρ value = 1, which the North Bogor Health Center means P value (> 0.05) so that shows that of the 20 respondents there is no relationship between there were 11 (55.0%) street sanitation and Escherichia Coli vendors who had negative bacterial contamination in foot sanitation. traders in the working area of 3. It is known that the frequency Bogor Utara Health Center. distribution of Escherichia Coli bacteria in 20 food samples of SUGGESTED RESEARCH the traders the highest results 1. For Theoretical were positively contaminated by It is expected to be useful as literature Escherichia Coli bacteria in 19 material to be used as a source of (95.0%) food samples. information about hygiene and 4. There is no relationship between sanitation as a source of material hygiene behavior with development for students and to be Escherichia Coli bacterial made into knowledge about contamination in street vendors environmental health in the working area of North 2. For Practitioners Bogor Health Center with a. For STIKes Wijaya Husada Bogor Statistical Tests of 20 Institute respondents who have negative It is expected to provide more behavior with the highest knowledge and learning material

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 47 input than is currently available. Yang Aman, Bermutu, dan Further research needs to do further Bergizi. Jakarta : Dirjen PP PL. research with the same type of 4. WHO. 2005. Penyakit Bawaan research but with different methods Makanan Fokus Pendidikan and make deeper observations, so Kesehatan. (A. Hartono , Peneri.) that it can provide more accurate Jakarta: EGC. research specifically about the 5. Pratidina, Azzahra. 2017. Hubungan hygiene relationship of Escherchia hygiene dan sanitasi dengan Coli contamination in food or drink. kontaminasi Escherichia coli pada b. For North Bogor Puskesmas jajanan pedagang kaki lima di It is expected for the North Bogor sekolah dasar. Semarang. Health Center, to be able to work Universitas Diponogoro together with parties in the new http://ejournal3.undip.ac.id/index.ph Tanah Kelurahan, Cimapar and p/jkm Di Akses 25 July 2019 Pkl. Cibuluh, to be able to oversee food or 20.30 beverage traders who sell in the 6. Buku Pedoman Praktikum environment around the North Bogor Kesehatan Lingkungan. Depkes Ri. Puskesmas working area by Keputusan Menteri Kesehatan Ri No conducting continuous visits to make 715/Menkes/Sk/V/2003 Tentang it more monitored movement of food Persyaratan Higiene Sanitasi Jasa traders centers in the neighborhood Boga. around the working area of the North 7. Keracunan Keong Sawah, 85 orang Bogor Puskesmas. yang dirawat di Kota Bogor. c. For street vendors in the North Bogor https://m.cnnindonesia.com/nasional Public Health Center /20185026171002-20- It is expected that street vendors can 301525/keracunan-keong-sawah-85- follow every counseling or training orang-dirawat-di-bogorr Di Akses related to food / beverage sanitation tanggal 16 Agustus 2019 Pkl. 05.00 hygiene, understand and apply hygiene 8. Setiawan A, Saryono. Metodelogi and sanitation, as well as maintain Penelitian Kebidanan. Jakarta: Nuha environmental cleanliness and clean Medika: 2010 behavior to prevent contamination of 9. Adam, M., & Motarjemi, Y. 2009. food. Dasar-dasar Keamanan Makanan Untuk Petugas Kesehatan. Jakarta: REFERENCES EGC. 1. Azwar, Azrul. 1995. Pengantar 10. Departemen Kesehatan Republik Kesehatan Lingkungan. PT Rineka Indonesia. 2004. Higiene Sanitasi Cipta. Jakarta. Makanan dan Minuman (HSMM). 2. Depkes RI. 2006. Modul Khursus Buku Pedoman Akademi Penilik Hiegine dan Sanitasi Makanan dan Kesehatan. Jakarta. Minuman. Jakarta: Departemen Kesehatan Republik Indonesia Ditjen PPM & PLP 3. Higiene Sanitasi Pangan. 2014. FGD Kegiatan Aksi Nasional Pangan Jajanan Anak Sekolah

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 48 THE CORELATIONOF URINARY INCONTINENCE WITH DEPRESSION LEVEL IN ELDERLY

Juianto Laia, Friska Bela Sukmayanti

Wijaya Husada Health Science Institute

ABSTRACT

Urinary incontentence is a disorder of bladder function, which provides problems with sleep disorders, skin problems, physical problems, social isolation, and psychological problems. Based on population projection data, estimated in 2017 there are 23.66 million people in Indonesian elderly people (9.03%). Prediction of elderly population in 2020 (27.08 million), 2025 (33.69 million), year 2030 (40.95 million) and year 2035 (48.19 million). To see the urinary incontentence relationship with depression level in the elderly in the village of Cilebut west of Sukaraja District Bogor West Java in 2019. This research is an analytical deskriftif study, with a correlation design. The population of this research is the elderly who are in the village Cilebut West Sukaraja District Bogor West Java and who entered the criteria of inclusion as much as 73 sampling. Data retrieval using a questionnaire of 23 questions. Data analysis techniques using Chi Square analysis (X2). There is a significant relationship between the urinary incontinence with depression level in the elderly in the village of West Cilebut Sukaraja District Bogor Regency West Java, which is shown with the results of the Chi-Square there are as many as 21 respondents (52.5%). In the statistical test, the result of Ho was rejected and Ha received, where p-value ≤ α, then the significant P-value ≤ 0.05. Thus, in conclusion of statistical test, there is a link between urinary incontinence with depression rate in elderly in rural Cilebut West District Sukaraja Bogor District, 2019. These results are expected to add insight to the elderly about urinary incontinence and depression so that age is not worried when experiencing the problem.

Keywords : elderly, urinary incontinence, depression

PRELIMINARY The increasing number of elderly Based on population projection data, people needs serious handling because it is estimated that in 2017 there were 23.66 scientifically the elderly experience a million elderly people in Indonesia decrease both in terms of physical, (9.03%). Prediction of the number of biological, and mental. This is inseparable elderly population in 2020 (27.08 million), from economic, social, and cultural issues, 2025 (33.69 million), 2030 (40.95 million) so there is a need for family participation and 2035 (48.19 million) .1 and social roles in handling because it is the Data from the World Health main support system for the elderly in Organization (WHO) in 2015 showed that maintaining their health. The role of the aging experienced the highest level of family in the care of the elderly among expectation since 2000. The population of other physical care, psychological care, elderly people in the world also experienced social care, spiritual care. Nurses have an an increase every year, in 2013 the highest important role to play in the health of the proportion was obtained in the elderly at elderly, namely improving the quality of the 8.1% of the total population2. elderly and creating independence for the elderly in the maintenance and handling of

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 49 physical and mental health problems, so as guidance of the Surakarta Manahan Health to be able to utilize various resources Center. The results showed that moderate available in the family and community. depression is the most frequent degree of Aging is a process that occurs depression experienced by elderly women continuously and continuity, then will cause by 25 respondents (34.25%). Consisting of anatomical, physiological, and biochemical 22 elderly age groups. While the smallest changes in the body so that it will affect the percentage is severe depression by 9 overall function and ability of the respondents (12.33%). bodyincontinence is a condition where the Based on the results of a survey urine is involuntary clear and objective and conducted in the District of West Cilebut becomes a social and hygienic problem. Village Sukaraja District Bogor Regency Epidemiologically urinary incontinence is West Java in 2019 in August it was found the excretion of urine is the expenditure of that the number of elderly people in the urine that is not controlled in the period of a West Cilebut Village Sukaraja District year or more than episodes in a month.5 Bogor Regency during the study found 90 Urinary incontinence in the elderly elderly. From the elderly data after population is a serious problem. The conducting a preliminary study, as many as National Kidney and Urologic Diseases 73 elderly people experienced Urinary Advisory Board says there are around 13 Incontinence. million individuals in the United States Based on the results of observations suffering from urinary incontinence, with that have been made in the District of West the highest incidence occurring in the Cilebut Village Sukaraja District Bogor elderly who are either being treated at Regency West Java in 2019 there are some nursing homes or not. In all, it is estimated elderly who experience depression. The that about half of the elderly who are elderly suffer more depression in those who treated at home or in nursing homes are immobilized or have chronic diseases. experience incontinence.7 Elderly who are immobilized, all day just Depression is a type of emotional lying in bed. Likewise with the elderly who disturbance that includes psychological have chronic diseases such as arthritis. components: distress, depressed, sad, They don't get along with other elderly hopeless, and unhappy, as well as somatic people because of their limitations or components: anorexia, constipation, moist illness. Under these circumstances, signs of skin, blood pressure and decreased pulse depression are often seen. So many elderly rate.4 people are identified as having signs and Depression is a disorder of feeling symptoms of depression but they are not (effect) characterized by a dysforic effect given any medical or nursing care to cure (loss of excitement / arousal) accompanied them. by other symptoms, such as sleep The impact of depression on the disturbance and decreased appetite.6 elderly is very bad. Untreated depression The results of this study are in line causes increased use of health and medical with Devrisa Nova Fernandes in 2014 facilities, negatively affects quality of life entitled The Relationship Between Urinary and increases mortality. Whereas with Incontinence and the Degree of Depression prolonged urinary incontinence that is not in Aged Women handled properly will indirectly affect the Next at the Dharma Bakti Surakarta quality of life of a person, causing life Nursing Home and the Posyandu under the

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 50 problems in terms of medical, social, economic and psychological. RESEARCH RESULT Based on the description above this Based on the frequency distribution makes researchers interested in taking this of urinary incontinence by sex in the West title to be the basis of research, is there a Cilebut Village Region Sukaraja District relationship between Urinary Incontinence Bogor Regency West Java, shows that of and the Depression Level in the Elderly in the 73 respondents most of the respondents the Region of West Cilebut Village were Elderly Women as many as 38 Sukaraja District Bogor Regency West respondents (52.1%). Java. Distribution of Frequency of Urinary Incontinence in the West Cilebut RESEARCH METHODS Village Area Sukaraja District Bogor This type of research uses Regency West Java shows that of the 73 quantitative analytics. Analytic is research respondents most respondents experienced that tries to explore how and why health severe Urinary Incontinence as many as 41 phenomena occur. Analytical research can respondents (56.2%). be done quantitatively so that statistical Based on the frequency distribution analysis can be carried out. of depression levels in the Cilebut Barat The research design is the final Village Region, Sukaraja District, Bogor result of a decision stage made by the Regency, West Java, shows that of the 73 researcher relating to how the research can respondents namely the number of elderly be applied. The approach taken is cross people who experienced severe depression sectional. as many as 55 respondents (75.3%). Cross sectional is a study to study The Relationship between Urinary the dynamics of correlation to find out the Incontinence and Depression Level in the relationship between urinary incontinence Elderly in the District of West Cilebut and the level of depression in the elderly by Village, Sukaraja District, Bogor, West approaching, observing or collecting data at Java, shows that from 73 respondents, the the same time. This design is to find out the number of elderly women who experience relationship between urinary incontinence depression due to severe incontinence was and the level of depression in the elderly of 21 respondents (52.5%). Cilebut Barat Village, Sukaraja District, From the results of statistical tests Boogor Regency, West Java . using Chi-squere shows the value ᵖ-value = This research was conducted on 0,000, which means value-value <0.05, so September 13-20 in the Region of West the decision taken is Ha accepted Ho Cilebut Village Sukaraja District Bogor rejected, which means there is a significant Regency West Java in 2019. The population relationship between Urinary Incontinence in this study were the elderly in the West with the Depression Level in the Elderly in Cilebut Village Region Sukaraja District West Cilebut Region Sukaraja District Bogor West Java with a total of 90 elderly Bogor Regency West Java. from several Rw in the village In this research using Quota Sampling, there is a DISCUSSION limitation on the sampling quota that the 1. Characteristics of Research Subjects by selected sample must be a certain number Gender (quotum) from each predetermined subgroup of a population.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 51 Obtained the results of 73 respondents incontinence, with the highest incidence found the majority of respondents, occurring in the elderly who are either namely Elderly Women as many as 38 being treated at nursing homes or not. In respondents (52.1%), while Elderly Men all, it is estimated that about half of the as many as 35 respondents (47.9%). elderly who are treated at home or in 2. Univariate Results nursing homes experience incontinence.8 Based on the results of the study showed Incontinence is a condition that of 74 respondents in the West wherein urine is seen involuntarily clear Cilebut Village Area Sukaraja District and objective and become social and Bogor Regency West Java it can be seen hygienic problems. Epidemiologically, that 41 respondents (56.2%) who urinary incontinence is the excretion of experienced severe incontinence in the urine is the excretion of urine that is not West Cilebut Village Region Sukaraja in control within a year or more than District Bogor Regency West Java. It's episodes in a month.9 only natural that the elderly are not in a Urinary disorders or urinary serious physical or mental illness incontinence is defined as a condition condition that requires them to get where a person cannot control serious health care. Environmental urination.10 Although urinary factors, environmental factors that are incontinence is not a life-threatening clean, healthy and conducive contribute disease, incontinence can affect a to contribute to one's health level. The person's psychological condition. quality of health services in the West Refusal from the community, limited Cilebut Village Area Sukaraja District, social activity due Unusual fear feelings Bogor Regency, West Java, the better control urination. This is what will cause the elderly, the easier it is to check and psychological disorders such as control the health conditions of the depression. 11 elderly. The factors that influence this The results of this study are condition are caused by too much inversely proportional to Angelina urinary tract muscles to hold urine when Mediatrix Wilson, Rina kudre, Fanly there is pressure. Bladder muscles can Onibala in 2017 The Relationship of weaken due to various factors, for Urinary Incontinence With Depression example, due to labor, excess body Rates in the Elderly at Bethania weight, or complications from surgery. Lembean Werdha Nursing Home. The Based on the results of the results showed that of the total 39 frequency distribution and the respondents (100%) there were 29 percentage of types of urinary respondents (74.4%) experiencing mild incontinence in the elderly in the Region urinary incontinence. Whereas 10 of West Cilebut Village, Sukaraja respondents (25.6%) experienced severe District, Bogor Regency, West Java, the urinary incontinence. majority of respondents experienced Urinary incontinence in the urgent urinary incontinence. Urinary elderly population is a serious problem. urinary incontinence is the most The National Kidney and Urologic common type of incontinence in the Diseases Advisory Board says there are elderly in the village. Urinary around 13 million individuals in the incontinence urgency is involuntary United States suffering from urinary urine output, urine discharge before

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 52 reaching the toilet, the need to rush to go Surakarta. The results showed that to the toilet, and the inability to hold moderate depression is the most frequent urine. Old people in the village of West degree of depression experienced by Cilebut, District of Sukaraja, Bogor elderly women by 25 respondents Regency could not hold their urine until (34.25%). Consisting of 22 elderly age they entered the toilet. Urine will come groups. While the smallest percentage is out when they are on their way to the severe depression by 9 respondents toilet and when they open their pants (12.33%). and clothes when they reach the toilet. Depression is a word that has Based on the results of the many nuances of meaning. Most of us research assumptions that researchers have felt sad or annoyed, lead a life full can conclude that the occurrence of of problems, feel disappointed, lost and severe urinary incontinence can be frustrated, which easily leads to caused by decreased resistance to the unhappiness and despair. However, in urethra and bladder estuary. As well as general this feeling is quite normal and the unstable bladder detrusor muscles is a healthy reaction that lasts quite short that react to urinate or urinate before and easily dispelled Depression is a they enter the toilet, and without being disorder of feeling (effect) characterized noticed by the elderly the clothes / pants by a dysforic effect (loss of excitement / they wear are wet because urine cannot arousal) accompanied by other be held by the elderly. symptoms, such as sleep disturbance and b. Depression on Lasia in the West Cilebut decreased appetite.6 Depression is a Village Region Sukaraja District Bogor type of emotional disturbance that Regency West Java includes psychological components: Based on the results of the study distress, depressed, sad, hopeless, and showed that of 73 respondents, stated unhappy, as well as somatic that the majority of those experiencing components: anorexia, constipation, depression were 55 respondents (75.3%) moist skin, blood pressure and decreased in the West Cilebut Region Sukaraja pulse rate.6 District, Bogor Regency, West Java. Depression is not a condition due This can be seen from the advanced age to a single pathology, but is usually in the Region Cilebut Barat Village multifactorial. In old age, where Sukaraja District Bogor Regency West environmental stress often causes Java experiences depression, sadness, depression and adaptability has sadness, loss of life passion, no decreased, due to depression in old age enthusiasm, and feel helpless, feel is often not as good as young age.12 The failure and guilt, do not feel satisfied factors that influence are economic with life, are useless and hopeless. status, and social support, physical The results of this study are in illness, urinary incontinence, gender, line with Devrisa Nova Fernandes in marital status, greographics, age. 2014 entitled The Relationship Between Based on the results of research Urinary Incontinence and the Degree of that the elderly experience changes such Depression in Older Women at the as vision and hearing disorders, the Dharma Bakti Surakarta Nursing Home limitation is at risk of causing and Posyandu under the guidance of the depression in old age. Depression in the Manahan Public Health Center elderly in the area of West Cilebut

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 53 Village Sukaraja District Bogor with the title Urinary Incontinence in the Regency according to the characteristics Elderly in Pani Werdha, Riau Province in of depression in the elderly is more 2017. The research subjects were divided common in women. It is suspected that into two groups, namely the elderly who women seek treatment more often so experienced urinary incontinence and non- that depression is diagnosed more urinary incontinence. Based on age frequently, and states that women classification, the elderly are divided into experience environmental stressors more three age groups, namely ederly (60-75 frequently and lower threshold for years old), old (75-90 years old), very old stressors in men. (> 90), whereas based on the sexes of the Also emphasized is severe anxiety, anxiety, elderly the elderly are classified into male disability, continuing social activities, work and female. In this study it was found that and household affairs. This makes it easy urinary incontinence was experienced by for old people to feel bored so that the (53.33%) and mainly women (56.25%). emergence of sadness, depressed, As for those that affect urinary pessimistic, and others. Thus it is only incontinence with increasing age, the natural that respondents who experience bladder capacity decreases. Remaining depression in the West Cilebut Village urine in the bladder after each urination Region Sukaraja District Bogor Regency tends to increase and irregular contractions West Java is very high 55 respondents of the bladder muscles become more (75.5%). frequent. The occurrence of urinary Based on the results of research on incontinence which results in the elderly the assumptions that researchers can woman appearing with insecurity to conclude that the occurrence of depression socialize with other people, even to the in the elderly due to urinary incontinence point that they have no function to live. that can cause an attitude of withdrawal in the elderly because they consider RESEARCH LIMITATIONS themselves smelly and useless in the This research has been attempted and environment where they live, and the carried out in accordance with scientific elderly have difficulty in facing and procedures, however it still has limitations, continuing good activities social and their namely: data collection is only based on the work as usual. contents of the questionnaire not by observation, so that only answers based on 2. Bivariate Results the answers that have been provided, At a Based on the results of the study, it can age that is less cooperative it is difficult to be concluded that there are 21 respondents communicate, especially for respondents (52.5%) Elderly who experience severe who can not read, the language written is urinary incontinence with depression is not the same as the language said. more common in the elderly women, while when researching the elderly laiki only 17 IMPLICATIONS respondents (51.5%) were found. This In studies of elderly who experience suggests that urinary incontinence with a severe urinary incontinence with degree of depression is often experienced in depression, health services need to provide older women than in elderly men. therapy to elderly people who experience The results of this study are in line severe urinary incontinence in the form of with Desby Juananda, Dhany Febriantara counseling about urinary incontinence,

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 54 bledder training, pelvic floor muscle address value ᵖ-value = 0,000, which training, habbit training, prompted voding, means <0.05, so the decision taken is Ha biofeedback therapy, electrical stimulation, accepted Ho rejected, which means that neuromeduling. So that the number of there is a significant relationship elderly who experience depression due to between Urinary Incontinence with severe urinary incontinence, one effort that Depression Level in Lansi in the Village can be given by the family is social support Area Cilebut Barat Sukaraja District and attention to the elderly, so that the Bogor Regency. elderly does not experience severe depression resulting in increased suicide rates. SUGGESTION CONCLUSION 1. Nursing Student Wijaya 1. Distribution of Frequency of Husada After reading the results of this Urinary Incontinence in the Elderly in study, it is expected that Wijaya the Region of West Cilebut Village, Husada students can increase their Sukaraja District, Bogor Regency in knowledge by reading the results of 2019 shows that of the 73 respondents other studies specifically about the most respondents experienced severe Relationship of Urinary Incontinence urinary incontinence as many as 41 and the Depression Level in the respondents (56.2%). Elderly in the Region of West Cilebut 2. Distribution of Urinary Village, Sukaraja District, Bogor Incontinence Frequency in Lasia by sex Regency, West Java, thereby in the area of West Cilebut Village expanding knowledge and adding new Sukaraja District Bogor Regency shows knowledge to students especially about that of the 73 respondents most of the nursing care subjects. respondents were elderly women as 2. For the West Cilebut Village many as 38 respondents (52.1%). Region, Sukaraja District, Bogor 3. Frequency Distribution of Regency It is hoped that this research Depression Levels in the Elderly in the will be able to provide information to Region of West Cilebut Village Sukaraja all related parties as one of the District Bogor District Year shows that provisions in efforts to improve the of the 73 respondents most of the incidence of anemia in pregnant respondents are 55 respondents (75.3%) women and can help carry out health who experience depression. service delivery to pregnant women. 4. The Relationship between 3. 3. For Researchers It is Urinary Incontinence and the Level of expected that the results of this study Depression in the Elderly in the West can provide information and input for Cilebut Village Region Sukaraja District the researched land institutions, Bogor District is known that from 73 especially in the West Cilebit Village, respondents found the majority of Sukaraja District, Bogor Regency, the elderly people experience severe urinary elderly can change their mindset so incontinence with the level of depression that they do not feel depressed because in elderly women as many as 21 of the health conditions they suffer respondents (52.5 %). From the results of statistical tests using Chi-square

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 55 REFERENCES 1. Pranarka, K.2011. Symposium https://www.apa.org/helpcenter/und greatrik syndromes: Revisted. erstanding-depression.pdf. Di Semarang : Badan Penerbitan unduh pada tanggal Universitas Diponegoro. 01/9/2019.12.00 2. WordhHealthOrganization.2015.htt 8. AM,PJ.2018. Penjelasan p:/www.google.com/search?q=prev Inkontinensia Urin. alensia+lansia+menurut+who&ie=u https://www.go- tf8&oe=utf8&aq=t&rls=org.mozil dok.com/inkontinensia-tipe-dan- la:enUS:official&client=firefoxa&c penganan di unduh pada tangal hannel=fflb di unduh 29 agustus 01/09/2019. 16.00 2019 14.00 9. Setia. 2013. Konsep dan Praktik 3. Ira, Trisnawati. 2017. Gambaran Penulisan Riset Keperawatan karakteristik lansia yang Gerontik. Yogyakarta : Graha Ilmu mengalami inkontenensia urin di 10. Maas, M, dkk. 2011. Asuhan wilayah kerja puskesmas nanggalo Keperawatan Geriatrik : Diagnosis padang tahun 2016. Nanda, Kriteria Hasil NO,& https://scholar.unand.ac.id/22361/ Intervensi NIC. Jakarta:EGC 4. Lumonggalubis,Namora.2016. 11. Sharma, A.2010. Female Urinary DEPRESI Tijauan Psikologis. Incontinence-Primary Care Jakarta;Kencana Mnagement. BJMP. 5. Maas, M, dkk. 2011. Asuhan 12. Yosep .I .2010. Keperawatan Jiwa. Keperawatan Geriatrik : Diagnosis Bandung:PT. Refila aditama. Nanda, Kriteria Hasil NO,& Intervensi NIC. Jakarta:EGC 6. Nedya ,safitri. 2018. Masalah Kesehatan Pada Lansia. http:// www.yankes.kemkes.go.id 7. American Psycological Association.2014.Understanding Depression and Effective Treatment.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 56 THE EFFECT OF LEMON AROMATERAPY AGAINST VOMITING INTENSITY OF PREGNANT MOTHERS

Nining Fitrianingsih, Dina Indayani Safitri

Wijaya Husada Health Science Institute

ABSTRACT The incidence of nausea and vomiting reaches 12.5% of the number of pregnancies in the world. Pregnancy nausea and vomiting or nausea and vomiting of pregnancy (NVP) are the most common complications during pregnancy of up to 85% in pregnant women. In the United States and Canada, there are around 400 and 350,000 pregnant women who are affected every year due to nausea, vomiting. Reports show that in Indonesia, almost 50-90% of pregnant women experience nausea and vomiting in the first trimester (the first 3 months of pregnancy). This situation will improve at 12-16 weeks gestational age. This situation occurs in about 60-80% of primigravida and 40-60% occurs in multigravida. This study aims to determine the effect of lemon aromatherapy on the intensity of nausea and vomiting in first trimester pregnant women at BPM Nina Marlina.S.ST Bogor district in 2019. The method used is a pre-experimental design with One-Group pre-post test. The sample used 20 respondents in first trimester pregnant women with nausea and vomiting in BPM Nina Marlina S.ST Bogor Regency using Total observation sheet. Of the 20 respondents (100%) it was found that the post-test results of pregnant women Sampling technique. The instrument used to an with nausea and vomiting scale decreased consisting of 16 (80%) respondents after being given lemon aromatherapy. The statistical test shows that H0 is rejected and Ha is accepted, where the p-value obtained in this study is 0.006, which means ≤ 0.05. So that the final conclusion of the statistical test is the effect of lemon aromatherapy on the intensity of nausea and vomiting in first trimester pregnant women at BPM Nina Marlina S.ST Bogor Regency in 2019. It is expected that lemon aromatherapy can be considered as a standard of care for pregnant women with nausea and vomiting and can be recommended as an intervention in obstetric care for pregnant women with nausea and vomit trimester I.

Keywords : nausea, vomiting, lemon aromatherapy

PRELIMINARY response in pregnant women is nausea and Pregnancy is a physiological process vomiting. that occurs in women due to fertilization According to WHO (World Health between male sex cells and female sex Organization) the incidence of nausea and cells. In other words, fertilization of the vomiting reaches 12.5% of the total number ovum by spermatozoa, thus undergoing of pregnancies in the world.3 Nausea and nidation of the uterus and developing until vomiting of pregnancy or nausea and the birth of the fetus.1 Every pregnant vomiting of pregnancy (NVP) are the most woman will experience the process of body common complications during pregnancy adjustment to pregnancy according to the up to 85% in pregnant mother. In the trimester stage being undertaken. The first United States and Canada, around 400 and trimester is the beginning of the trimester 350,000 pregnant women are affected every which gives rise to various responses in year due to nausea, vomiting. Reports show pregnant women. The most influential that in Indonesia, almost 50-90% of

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 57 pregnant women experience nausea and the diet (eat a little but often, avoid foods vomiting in the first trimester (the first 3 that smell pungent and sharp like spicy months of pregnancy). This situation will food, fatty foods, bersantan, and oily, improve at 12-16 weeks gestational age. immediately after waking up eating a This situation occurs in about 60-80% cookie before starting the activity), and primigravida and 40-60% occur in finally Non-pharmacological therapies that multigravida.4 are often used to reduce nausea and Nausea and vomiting are common vomiting are complementary therapies (ie discomforts experienced by 50% of lemon aromatherapy, ginger and pregnant women. Generally the most severe peppermint) .7 in the first trimester of pregnancy. Because aromatherapy is recognized Vomiting occurs when the vomiting center as an effective herbal treatment for treating in the medulla or chemoreceptor trigger nausea and vomiting. Aromatherapy means zone located in the fourth ventrical lateral the use of essential perfume oils for wall is simulated. However, the etiology of therapeutic or medical purposes. It is nausea and vomiting has not been proven. effective for relaxation, reduce pain and But according to estimates, this condition stress, improve coping mechanisms and can be caused by high levels of hCG improve fitness. (Human Chorionic Gondotropin) .5 Of the various types of aromatherapy Nausea and vomiting during that are often used to treat nausea and pregnancy have a significant impact on vomiting, namely lemon aromatherapy, family life, the ability to perform normal which is one of the alternative methods that daily activities can be disrupted, social provides a sense of relax and calm by functioning and the development of stimulating the limbic system of the brain. stressful situations. Pregnant women must Lemon aromatherapy also plays a role in be able to adapt to nausea and vomiting, if refreshing the mind, reducing depression, not able to adapt can cause adverse effects and reducing emotions. The juice of the both for pregnant women and the fetus they citrus family has a refreshing aroma and has contain. Pregnant women who experience antiseptic, stimulant and tonic properties nausea and vomiting really need adequate with a significant effect on the entire nutrition for the mother's body and nutrition digestive tract. Stimulant aromas such as for the fetus in the womb. If nutritional the smell of citrus limon oil will affect the intake decreases it will experience weight locus seruleus which then releases serotonin loss and this will also adversely affect the and endorphins.9 So that the nausea of fetus it contains. vomiting can decrease due to a sense of In medical science, treatments that relax and stable emotions. Smell can have a can reduce nausea and vomiting in pregnant negative or positive influence on mood or women include pharmacological therapy natural feelings and well-being sensations, and non-farmakilogis therapy. and the aroma of certain essential oils has Pharmacological therapy is performed by been shown to affect neurological function. administering antihistamines, Lemon essential oil (citrus lemon) is corticosteroids, antimietics, and one of the most widely used herbal oils in anticholinergics. And non-pharmacological pregnancy which is considered a safe drug therapy which is done by way of regulating in pregnancy. According to a study 40% of

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 58 women have used the scent of lemon to obtained p-value <0.05, which means that relieve nausea and vomiting, and 26.5% of the administration of lemon aromatherapy them have been reported as effective ways can reduce the frequency of nausea and to control the symptoms of nausea and vomiting in pregnancy.12 vomiting.11 Nursing actions taken at BPM Nina One of the effectiveness of the Marlina.S.ST to reduce nausea and chemical content in lemon essential oil is vomiting in pregnant women so far are still that it can affect the activity of the using nursing measures with functioning of the brain through the pharmacological management, namely the nervous system associated with the sense of administration of nausea and vomiting, smell. This response will stimulate an namely with vitamin B6 and increase in neutrotransmitter activity, which Metocloropamide. is related to the recovery of psychological Based on the results of a preliminary conditions such as emotions, feelings, study conducted in July - August 2018 at thoughts, and desires BPM Nina Marlina.S.ST, the average When essential oils are inhaled, they number of visits of first trimester to third enter the nasal cavity and stimulate the trimester pregnant women was 118 limbic system in the brain. The limbic pregnant women. In August, K1 (first system is an area that affects emotions and trimester) visit data showed that pregnant memory and is directly related to the women with nausea and vomiting consisted adranal, hypothalamic pituitary gland, parts of 20 pregnant women. Pregnant women of the body that regulate heart units, blood say that nausea, vomiting is felt in the pressure, stress, memory, hormonal morning until sometimes it interferes with balance, and breathing. Lemon itself is one daily activities, some say nausea and type of other herbs, especially for pregnant vomiting are felt when they smell bad or women who are experiencing nausea, even food odor. Pregnant women who were vomiting. questioned by researchers said that they did According to research conducted by not yet know an alternative way to relieve Astriana (2015) shows differences in the or relieve nausea and vomiting apart from frequency of nausea before and after the using drugs taken from midwives, or there administration of lemon aromatherapy at were even some pregnant women who only BPS Varia Mega Lestari, S.ST., M.Kes. silenced them. Based on the background of This study looked at the effect of the the problems above, researchers were treatment given that the total mean before interested in conducting research with the administration of lemon aromatherapy was title " Effect of Lemon Aromatherapy on obtained 4.53 times the frequency of nausea the Intensity of Nausea and Vomiting in and vomiting, then obtained the mean after Trimester I pregnant women in BPM Nina administration of lemon aromatherapy Marlina.S.ST Bogor Regency in 2019 until frequency of nausea 3.13 times a day with a the feeling of nausea and vomiting are felt p-value of 0.000. These results indicate that gone. the frequency of nausea and vomiting of respondents average before and after RESEARCH METHODS administration of lemon aromatherapy has a The type used in this study is significant difference because the p value experimental or experimental research.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 59 Experimental research is a study by trimester pregnant women, it is known that conducting experimental activities most of the intensity scale of nausea and (experiments), which aim to find out the vomiting before lemon aromatherapy is symptoms or effects that arise, as a result of given (scale 7-9) controlled severe nausea, the existence of certain treatments or namely as many as 10 people (50%). experiments.13 Based on the frequency distribution This study uses a Pre-experimental of the nausea intensity of vomiting in first research design. While the design of this trimester pregnant women it is known that research design uses One-Group pre-post most of the intensity scale of nausea and test design, because pre-experimental does vomiting after lemon aromatherapy is given not require control. (scale 1-3) mild nausea and vomiting as This research was conducted on many as 9 people (45%). September 4, 2019 at BPM Nina Marlina Based on the analysis of the results of S.ST Bogor Regency. The population in the intensity of nausea and vomiting before this study was pregnant women with nausea and after treatment, a significant value of and trimester I. 0.000 is known. The variables of this study consisted Based on the analysis of the Effect of of independent variables, namely the Lemon Aromatherapy on the Intensity of treatment of lemon aromatherapy in BPM Vomiting Nausea in Trimester I Pregnant Nina Marlina S.ST Bogor Regency. The Women in BPM Nina Marlina S.ST Bogor dependent variable in this study was Regency, it is known that the post-test pregnant women with first trimester nausea results of pregnant women with permanent and vomiting in BPM Nina Marlina S.ST. nausea and vomiting are 4 (20%) The analysis consists of prerequisite tests respondents, and pregnant women with and hypothesis tests, where the prerequisite nausea and vomiting decreased consisting test techniques consist of normality tests of 16 (80%) respondents. With a significant and homogeneity tests. Normality test is to value of 0.006. find out whether the data is normally distributed so that it can be used in DISCUSSION parametric statistics, if the data is not 1. Interpretation normally distributed, non-parametric a. Characteristics of Intensity of Nausea statistics can be used. In this normality test and Vomiting Before Lemon using the Shapiro-Wilk test. Homogeneity Aromatherapy is Given test is to test the similarity of some parts of Based on table 4.2 shows that the sample, so that the generalization of the pregnant women who experience mild population can be done. Homogeneity test nausea and vomiting (scale 1-3) are 4 uses the formula of levene statistic test. respondents, moderate nausea and influence or not on the administration of vomiting (scale 4-6) are 6 respondents, lemon aromatherapy to the intensity of and controlled severe nausea and nausea and vomiting in first trimester vomiting (scale 7-9) are 10 pregnant women at BPM Nina Marlina respondents. S.ST Bogor Regency. In accordance with research Based on the frequency distribution conducted by Melinda Susanti (2017) of nausea intensity of vomiting in first with the title "granting lemon

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 60 inhalation aromatherapy to reduce lemon aromatherapy to 20 respondents nausea and vomiting in the first who experienced nausea, vomiting, trimester of pregnancy in BPM from the results of interviews with Istiantul Kebumen Regency" to using the observation sheet to the most determine the scale of nausea and respondents contained nausea and vomiting before lemon aromatherapy vomiting with controlled weight (scale given, the majority in the controlled 7-9). weight category (scale 7- 9) done using b. Characteristics of Intensity of the NRS (Numeric Rating Scale) Nausea and Vomiting after Lemon observation sheet. Aromatherapy. In medical science, treatments Based on table 4.3 shows the that can reduce nausea and vomiting in results of the research on the nausea pregnant women include scale of vomiting of pregnant women pharmacological therapy and non- trimester I overcome the decline. farmakilogis therapy. Pharmacological Before given aromatherapy lemon therapy is performed by administering pregnant women who released mild antihistamines, corticosteroids, nausea, vomiting as many as 4 (20%) antimietics, and anticholinergics. And respondents, moderate nausea and non-pharmacological therapy which is vomiting as many as 6 (30%) done by way of regulating the diet (eat respondents, and controlled severe a little but often, avoid foods that smell nausea and vomiting as many as 10 pungent and sharp like spicy food, (50%) respondents. fatty foods, bersantan, and oily, In accordance with research immediately after waking up eating a conducted by Melinda Susanti (2017) cookie before starting the activity), and with the title "granting lemon finally Non-pharmacological therapies inhalation aromatherapy to reduce that are often used to reduce nausea nausea and vomiting in the first and vomiting are complementary trimester of pregnancy at BPM therapies (ie lemon aromatherapy, Istiantul Kebumen Regency" to study ginger and peppermint) .7 Because the nausea scale given by lemon aromatherapy is recognized as an aromatherapy given in the mild effective herbal treatment for treating category (scale 1-3) done using the nausea and vomiting. NRS (Numeric Rating Scale) The intensity of nausea and observation sheet. vomiting in each pregnant woman is Lemon essential oil (lemon) is different. In this study, before lemon one of the most widely used herbal oils aromatherapy was given to first in pregnancy which is considered a trimester pregnant women, pre-test safe drug in pregnancy. According to a was performed first. The pre-test studio, 40% of women have used the results showed that the mean total of scent of lemon to relieve nausea and the intensity of the nausea scale of vomiting, and 26.5% of them have vomiting in first trimester pregnant agreed as an effective way to regulate women was 3.30 (SD = 0.801). This is it. in accordance with the provision of

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 61 One of the chemical reserves in Based on table 4.7 the results of lemon essential oil can affect the work the analysis of researchers obtained activities of the brain through the respondents who use lemon nervous system associated with the aromatherapy to the intensity of nausea sense of smell. This response will and vomiting in pregnant women after encourage an increase in given nausea vomiting training neutrotransmitter activity, namely decreased by 16 (80%) respondents, regarding psychological recovery such while those who used nausea and as emotions, feelings, thoughts, and vomiting remained as many as 4 (20%) desires respondents. The significant value When essential oils are inhaled, obtained is 0.006, which means that they enter the nasal cavity and the p-value ≤ 0.05, then Ha is accepted stimulate the limbic system in the H0 is rejected. Need additional brain. The limbic system is an area that assistance in the administration of deals with memory and memory and is lemon aromatherapy to the intensity of directly related to the adranal, pituitary the release of nausea in trimester I hypothalamus, body parts related to the pregnant women. heart unit, blood pressure, stress, This study discusses the research memory, balance hormones, and conducted by Siti Cholifah namely breathing. Lemon itself is one of the "the influence of lemon aromatherapy other types of herbal plants, to reduce nausea and vomiting in first specifically for pregnant women who trimester pregnant women" with the are being improved with nausea and results before giving aromatherapy vomiting Means ± SD 23.33 ± 3.913, then after In this study after being given aromatherapy assistance means ± SD aromatherapy lemon pregnant women 13.67 ± 4.071 . Wicoxon Sign Rank who were asked to nausea vomiting Test results with significance level α = with a scale of Nausea Vomiting as 0.05 obtained p = 0.001 (P ≤ 0.05) then much as 1 (5%) respondents, Light Ha is accepted and H0 is rejected, Nausea Vomiting as many as 9 (45%) which means there is aromatherapy respondents, Medium Nausea nausea and vomiting in first trimester Vomiting as many as 8 (40%) pregnant women I. respondents, Vomiting Nausea Most of primigravida has not been Controlled Weight of 2 (10%) able to replace with the hormones respondents. In the post-test results estrogen and human chorionic obtained results are the average total gonadotropin (hCG) so that it is more results of the scale of pregnancy in common in nausea, vomiting. In first trimester pregnant women is 2.55 primigravida usually choose (SD = 0.759). information and poor communication c. Analysis of the Effect of Lemon and provide care to help affect the Aromatherapy on the Intensity of perception of women with nausea and Vomiting in First Trimester Pregnant throwing variations. While the Women in BPM Nina Marlina S.ST multigravida already has experience, Bogor Regency. information and knowledge about the

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 62 problem of sagging nausea able to a. Location Limitations overcome the symptoms. 10 requires In addition to being conducted at nausea, vomiting needed by BPM Nina Marlina S.ST Bogor primigravida pregnant women is more Regency also conducted at the increased than in multigravida home of the respondent. Therefore, pregnant women. researchers improve the limitations Nausea and vomiting are common in conducting research because they discomforts experienced by 50% of have to do from one respondent's pregnant women. Nausea and vomiting house to another respondent's during pregnancy have a significant house. importance on family life, the ability to b. Limited time perform reliable daily activities, social Research conducted by researchers functions and stress development. In is hampered by time, because the medical science, treatment that can time used is very limited. So reduce nausea and vomiting in researchers only have the time in pregnant women is given accordance with the relevant pharmacological therapy and non- research. Although the time spent farmakilogis therapy. by researchers is quite short, but Reducing the intensity of nausea can meet the requirements in slows the effects of lemon scientific research. aromatherapy, lemon aromatherapy also eliminates thoughts, decreases depression, and reduce emotions. RESEARCH IMPLICATIONS Lemon juice contains aroma and has The results showed that there was antiseptic, stimulant and tonic an influence of lemon aromatherapy on properties with beneficial effects on the intensity of nausea and vomiting in the entire digestive tract. A stimulating first trimester pregnant women at BPM aroma like limon orange oil will affect Nina Marlina S.ST Bogor Regency in the locus seruleus which then releases 2019. Thus as a health worker, serotonin and endorphins. 9. Sense of handling nausea in first trimester nausea can turn into a stable and stable pregnant women as an alternative in sense of stability. Smell can give a midwifery care is expected to be negative or positive impression on recommended as a nurse's intervention mood or feelings and well-being, and in her nursing care. Care or care for the aroma of certain essential oils has trimester pregnant women I am very been shown to affect neurological important in health care, professional function and satisfying services do not have to be expensive. However, lemon RESEARCH LIMITATIONS aromatherapy to reduce nausea and Researchers are aware that in this vomiting can be done in a simple way, study many things happen and are relatively inexpensive, and can be inhibiting This is not due to intentional done independently by nurses or factors, but because of limitations in patients. conducting research.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 63 The effects of lemon SUGGESTION aromatherapy not only reduce the In connection with the above intensity of nausea and have no side conclusions, there are several things effects, but can also provide calm, that can be supported for the relax, reduce pain and stress, and can development of the results of this also improve fitness. study of the intensity of the release of trimester I pregnant women. CONCLUSION 1. For Institutions Based on the discussion It is hoped that lemon previously described, the conclusions aromatherapy can be considered as from this study can be drawn as a permanent treatment for pregnant follows: women with nausea and vomiting 1. Before given lemon aromatherapy and can be recommended as an intervention during pre-test a small intervention in obstetric care for portion of respondents (20%) relied pregnant women with nausea and on mild throwing nausea, a small vomit trimester I. portion of respondents (30%) 2. For pregnant women Trimester I controlled severe vomiting. It is expected for first trimester 2. After the lemon aromatherapy pregnant women who experience intervention was given during the nausea to vomit during pregnancy post-test most of the respondents to use lemon romatherapy in (45%) relied on mild nausea dealing with nausea and vomiting. throwing, a small portion of 3. For Other Researchers respondents (5%) had no difficulty It is expected to be a reference in nausea and vomiting, a small material in conducting further portion of respondents (50%) used research that is better related to nausea moderate vomiting, a small lemon aromatherapy and nausea proportion of respondents (10%) and vomiting in first trimester are lower controlled. pregnant women. 3. It is known that the post-test results of pregnant women with permanent REFERENCES nausea and vomiting are 4 (20%) 1. Pratiwi A,M, S.ST., M.Kes, dan respondents, and pregnant women Fatimah, S.SiT., M.Kes. 2019. with nausea and vomiting Memahami Berbagai Penyakit decreased consisting of 16 (80%) dan Komplikasi Kehamilan. respondents. It is undeniable that Didalam : Patologi Kehamilan. there are benefits of lemon Yogyakarta : Pustaka Baru Press aromatherapy to intensive nausea 2. Sulistyawti, A. 2012. Perubahan and vomiting in first trimester Anatomi dan Fisiologis Ibu Hamil pregnant women with a significant Didalam : Asuhan Kebidanan value of 0.006 or a P value of 5 Pada Masa Kehamilan. Jakarta : 0.05. Edsa 3. Claudia Wijaya. 2017. Hubungan antara Status Gravida dan Ibu

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 64 Hamil dengan Kejadian Emesis Mual Muntah pada Kehamilan di Gravidarum di Rumah Sakit BPS Varia Mega Lestari. Gotong Royong Surabaya. S.ST.,M.kes Batupuru Kec.Natar Irepository.wima.ac.id Diunduh Kabupaten Lampung Selatan. pada tanggal 09 juli 2019, Malahayati.ac.id Diunduh tanggal 17:35:06 10 Juli 2019, 15:30:10 4. Umu Faizah. 2018. Pengaruh 13. Notoatmodjo. 2010. Metodologi Pemberian Aromaterapi Inhalasi Penelitian Kesehatan. Jakarta : Lemon Terhadap Emesis PT Rineka Cipta Gravidarum. 14. Sugiono. 2016. Metode Penelitian digilib.unisayaogya.ac.id Diunduh Kuantitatif Dan Kualitatif Dan pada tanggal 09 juli 2019, Kombinasi (Mixed Methods). 17:45:02 Bandung : Alfbeta 5. Holmes, D dan Philip N.B. 2011. Buku Ajar Ilmu Kebidanan. Jakarta : EGC 6. Saridewi W, Erni Yulia. 2018. Pengaruh Aromaterapi Lemon terhadap Emesis Gravidarum di Praktik Mandiri Bidan Wanti Mardiwati Kota Cimahi. Tersedia di journals.stikim.ac.id Diunduh pada tanggal 09 Juli 2019, 18:15:34 7. Rahmawati, N. 2010. Ilmu Praktis Kebidanan. Jakarta : Victory Inti Cipta 8. Jaelani. 2009. Aromaterapi. Jakarta : Pustaka Populer Obor 9. Sharma, S. 2009. Aromaterapi. Tangerang : Kharisma 10. Tiran, D. 2009. Mual dan Muntah Kehamilan : Seri Asuhan Kebidanan. Jakarta : Kedokteran EGC 11. Susanti, Melinda. 2017. Pemberian Lemon Inhalasi Aromaterapi untuk Menguragi Mual Muntah pada Kehamilan Trimester I. elib.stikesmuhgombong.ac.id. Diunduh pada tanggal 28 Juli 2019 18:25:10 12. Astriana. 2015. Pengaruh Lemon Inhalasi Aromaterapi terhadap

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 65 THE CORRELATION OF ROLE OF PARENTS AND PHUBBING BEHAVIOR IN STUDENTS

Tisna Yanti, Okti Nurlia Pratiwi Wijaya Husada Health Science Institute

ABSTRACT Trem “phubbing” devired from the word “phone” which depict insulting someone in a social environment by paying attention to a cellphone, and talking to that person directly.The role of parents is very important in this case, because parents should be able to maintain control of the cell phone used by their children so that it does not cause phubbing, in addition to self-prevention methods phubbing can also be prevented through parents so that the child can according to what his parents say.14 The general purpose of the study was to determine the correlation of the role of parents with phubbing behavior in the level II students of Diploma 3 study program on stikes wijaya husada Bogor . This type of research uses descriptive analytic cross sectional approach. The population in the study were 60 respondents and the samples in this study were 52 respondents using simple random sampling technique. Data collection was obtained from questionnaires. Based on the results of the study note that of the 52 respondents most of the respondents were negative the role of parents as many as 29 respondents (55.8%) and from 52 respondents known to be negatife phubbing behavior as many as 32 respondents namely (66.8%). Based on statistical tests using the Chi-Square test p value = 0.068 and α = 0.05 thus Ho was accepted and Ha was rejected, so it was concluded that there was no significant correlation between the role of parents with phubbing behavior in second level students of Diploma 3 study program STIKes nursing Wijaya Husada Bogor. This conclusion shows the value (p = 0.068) which means that Ho is accepted and Ha is rejected or there is no significant relationship between the role of parents with phubbing behavior in level II diploma 3 students of nursing STIKes wijaya husada Bogor. It is suggested to be able to increase the study of knowledge and benefits in the development of mental health sciences and provide a contribution, guidance and benefits in as well as program planning regarding the significant correlation between the role of parents with phubbing behavior in second-level students of diploma 3 study program STIKes wijaya husada Bogor.

Keywords : Perilaku phubbing, the role of parents

PRELIMINARY can be defined as a person who is a recipient The term phubbing comes from the of Phubbing3 behavior. Apart from the large words "phone" and "snubbing", which number of social media applications for describe the act of insulting someone in a chatting that are fun and addictive, it turns out social environment by paying attention to a that Phubbing is also a reason for someone to cell phone, not talking to that person directly1. distance the other person on purpose.1 This term was originally campaigned This usually happens if there are new by Macquarie Dictionary to represent the people who are not liked or do not feel problem of smartphone abuse that continues comfortable participating in the chat. For to grow in social situations2. In social couples, this is done if you are feeling bored interaction, "phubber" can be defined as and prefer to look for excitement from a third someone who starts Phubbing, and "phubbee" person. Phubbing if done once or twice may

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 66 still be tolerable for a partner or friend, but if years and over (1.5 million), and 10-14 years done consistently risks damaging the quality with 768 thousand. Statistics of Indonesian of the relationship. The long-term effect is internet users seen from that age are of the that it becomes normal and understandable, total number of Indonesian internet users even communication is not necessary. The 132.7 million.1 worst thing is someone will be shunned and The number of internet users has will not be included again.1 experienced a growth of 51.8% from the 2014 The development of technology and APJII survey by recording 88 million users.8 information in the world is experiencing very Humans want to socialize or communicate rapid progress, which is marked by progress with other humans, so they know their in the field of information and technology. environment and want to know what happens The Indonesian nation is one of the nations curiosity forces humans to socialize or involved in the advancement of information communicate in life sociable. People who and technology media. Gadgets are a very have never communicated with others will be popular technology nowadays, both adults and isolated from their social influence, which children use gadgets where many gadget will lead to mental depression, which in turn products make children their target market. will lead people to lose their soul balance. And children have now become active From human life, communication is an eternal consumers of gadget users6 almost all circles part like breathing, where humans want to live, of society have gadgets. The fact is that communication or socialization is needed so gadgets are not only used by adults or the that many experts consider that elderly among teenagers (12-21 years) and communication is a very fundamental adults or elderly (60 years and over) .1 requirement for someone in social life.1 But in children (7-11 years) and more The development of technology has ironically, gadgets are used for children (3-6 unknowingly affected every aspect of human years) who should not be eligible to use life, especially students of technology gadgets.7 Survey conducted by the Indonesian products such as mobile phones that have Internet Providers Association (APJII) related become human needs in carrying out life to internet users in 2016 Indonesian children activities. The use of mobile phones in the begin to come into contact with the internet. community at this time is no longer a strange Based on Indonesian internet user statistics, or new thing.9 People are more preoccupied APJII classifies nine age categories from with gadgets or smartphones compared to children to parents having to talk with or make connections with As a result, the productive generation the environment. While one form of an agreed aged 25-29 years old is the top with a total of indicator of communication is that which is 24 million. The figure of 24 million is rivaled agreed between the recipient and the recipient by internet users in the range of 35-39 years. of the message. If an individual uses a Then followed behind 30-34 years which smartphone while engaging in conversation it reached 23.3 million. Then, underneath in is not possible they cannot use the maximum sequence followed by 20-24 years (22.3 information and as a result their interlocutors million), 40-44 years (16.9 million), 15-19 must repeat the same. years (12.5 million), 45-49 (7.2 million), 50

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 67 The results of the study of the STIkes RESEARCH METHODS Wijaya Husada Bogor on 2 September 2019, This type of research uses a descriptive there were 10 students, 4 men, 6 women, said quantitative analytic design that is a research there were those who were too mobile and method that aims to see the phenomena that some said they were not too mobile, there occur on a particular topic and discuss about were 6 students who often bought cellphones , how the phenomenon can occur. Then do the and 4 students said they did not use the main dynamics analysis between phenomena or cellphone too often, then 5 students said the between independent variables with the role of parents, 5 students said they had no dependent variable. relationship with parents. And students say it's Population is a generalization area that too cool with their own cellphones, the reason consists of: objects or subjects that have students are also cool students must be all in certain qualities and characteristics his cellphone with all the grips on his cell determined by researchers that have been phone.2 studied and collected previously.7 The The role of parents is very important for population in this study are students of this, because parents should be able to access STIKes Wijaya Husada Bogor who need 60 the cell phone that is used can not cause students (3 level 3 student students) class A & phubbing, in addition to how to save yourself B) in 2019 which is phubbing. phubbing can also prevent through parents so The sample is part of the number and that parents can advise. characteristics possessed by the population.16 Prevention that discusses problems with The sample used in this study were students at certain hours, if in Muslims an example of a STIKes Wijaya Husada Bogor. Sampling is small thing by reprimanding the main cell by simple random sampling, by taking a phone at the hour of worship, can be seen on simple random sample. By using the Slovin cell phones and worship first.2 formula7. Maybe this if conveyed by parents So that the sample characteristics do not continuously, to the child it will be listed deviate from the population, then before regularly, and gradually the child will taking a sample it is necessary to determine definitely be ready with it, not only worship the inclusion criteria as well as the exclusion jam but also when chatting with parents, criteria7. adults, even friends don't move mobile phones, The independent variable is a variable because this points to the beginning of that is determined by the value of another phubbing, 2 variable8. The independent variable However, if a parent only broadcasts his (independent) in this study is the role of son alone, without paying attention to himself, parents. The dependent variable determined is does the habit of playing with a cell phone, determined by other variables15 The variable then the child will not obey what the parent taken (dependent) in this study is the behavior asks, so here the child and the parents will be of phubbing.7 better off if they are related to the dangers of Data collection methods in this study use phubbing for the environment around us to be the type of data used in this study using more alert.2 primary data and secondary data. Primary data is data obtained or collected by researchers

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 68 directly from the data source. Primary data is Statements that are not used in data collection also called original data or new data that has so that the number of questionnaire questions the properties Up to date7. Primary data from becomes 18 questions. this study are the results of the questionnaire. Reliability is a reliable instrument is an Secondary data is data obtained from the instrument that, if used several times to research site. Secondary data in this study are measure the same object, will produce the data on the number of Diploma II level 3 same data.15 It is stated reliable if r alpha> students from STIKes Wijaya Husada Bogor. 0.60. based on calculations obtained by alpha The tool used to determine the the role of parents (0.949)> 0.60, so the role relationship of the role of parents with of parents is said to be reriable7. changes in phubbing behavior in students is to Data analysis consists of univariate use a questionnaire that must be filled in by analysis which is used to determine the form giving a checklist. In phubbing behavior the of univariate analysis depending on the type measuring instrument used was a of data. For numerical data the mean or mean, questionnaire consisting of 20 statements. median and standard deviation values are used. Consists of 11 negative statement items (+) In general, this analysis only produces the and 9 positive statement items (-). Negative frequency distribution and percentage of each items are given a score of 1 for very frequent, variable.15 Bivariate analysis to see whether 2 for frequent, 3 for occasional and 4 for not there is an influence between the independent as frequent. While positive items are given a variable and the dependent variable. The score of 4 for strongly agreeing, 3 for statistical test to determine the relationship of agreeing, 2 for disagreeing and 1 for strongly the role of parents with phubbing behavior, to disagreeing. determine the relationship of the role of The validity test of the planned parents with phubbing behavior using the chi- instrument will be carried out at STIKes square test. Chi-square test is a statistical Wijaya Husada Bogor. With the number of technique used to test hypotheses if the respondents 20 people so, if r count> 0.444 population consists of two or more classes in then the instrument is valid. the form of categorical8. The questionnaire trial for validity was The normality test uses the Kolmogrov conducted at level II of Nursing STIKes Smirnov test, the homogeneity test of this data Wijaya Husada Bogor against 20 respondents is carried out to find out whether the on September 24, 2019. The results of the population in this study is homogeneous or questionnaire validity regarding the role of not. Homogeneity test is intended to test a parents were obtained by the calculation sample of some parts of the sample, so that formula which was then compared with the r the generalization of the population can be table Product Moment with a significant 5% done. Bivariate analysis Analysis used of two obtained r tables .444. From the questionnaire variables that are thought to be related or the role of parents 20 statements to 18 correlated. Bivariate analysis was carried out statements, because there are 2 statements that to see the relationship between the role of are not valid, which has a count <0.444 is parents and pubbing behavior in the level II number 2 (056), 7 (076). Therefore statements students of diploma 3 study program on stikes number 2 and 7, are declared invalid. wijaya normal nursing8.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 69 RESEARCH RESULT 1. Univariate analysis The number of respondents in the study a). Frequency distribution of Level II Dioloma were 60 students (all diploma students 3 level 3 Nursing Parents at STIKes Wijaya Husada II class A & B) in 2019 who were Based on table 4.1 frequency distribution Phubbing.Based on the frequency distribution based on the Role of Level II Parents Diploma of the Role of Parents Level II Diploma 3 3 Nursing of STIKes Wijaya Husada Bogor in Nursing STIKes Wijaya Husada Bogor it is 2019, it is known that of the 52 respondents known that of the 52 respondents most the majority of respondents were negative respondents did not pay attention as many as phubbing as many as 29 respondents (55.8%). 29 respondents (55.8%). This study is comparable to the study Based on the frequency distribution of conducted by Meily Nirnasari (2012) who Phubbing Behavior in Level II Diploma 3 examined the "Relationship between the Role Nursing of STIKes Wijaya Husada Bogor in of Parents with Independence of Children 2019, from 52 respondents and it is known Mental Retirement Ages 7-12 Years in SLB that the majority of respondents have 32ub Negeri Tanjungpinang City" This research negative behaviors, namely (66.2%). method uses cross sectional method. Retrieval Based on statistical test results of the of data using a questionnaire. Analysis Relationship between the Role of Parents with technique uses chi-square. Obtained the data Phubbing Behavior in Secondary Students of most of the role of parents is not as much Diploma 3 Nursing Study Program in STIKes attention as many as 35 respondents (62.5%) Wijaya Husada, Bogor in 2019. Of the 52 and have the role of parents as much as 21 respondents, most of the respondents' role of respondents (37.5%). parents is not attentive and have a negative The role is the set of behavior that is behavior of phubbing as many as 18 expected to be owned by people who are respondents (67.8%) and Statistical test results sovereign in the community. Parents are obtained p value = 0.068, which means p people who are given responsibility to care for value <0.05 so that there is no relationship and educate their children to become mature between the role of parents with the behavior and useful humans in the future. Parents are of phubbing in level II students of Nursing indeed a very important role and very Diploma 3 Study Program at STIKes Wijaya influential in the formation and development Husada Bogor. of their children.2 In preventing phubbing behavior, it can DISCUSSION be noticed especially from his family, The discussion is the gap that arises after especially a parent. Parents are the most the researcher conducts the research then important thing in bringing children to be a compares the results of the study. This study good individual. Children tend to imitate what is a study of the Relationship between the is seen from their parents, parents must Role of Parents and Phubbing Behavior in participate in providing prevention of Secondary Students of Nursing Diploma 3 phubbing behavior with an approach to their Study Program STIKes Wijaya Husada children. Bogor.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 70 Based on univariate results, that of the 52 30 respondents (73.2%) and those who have a respondents who have the role of parents who low value of 11 respondents (26.8%). are not concerned is greater than those who Phubbing is the neglect of one's behavior are concerned. This can be seen by looking at in the environment by turning attention to the the results of the questionnaire about the role cellphone. Phubbing can be described as an of parents, obtained data that most students individual who looks at his cell phone while have the role of parents who do not care as talking to an individual who sees a cellphone much as 29 respondents (44.2%) and most of when talking to others the attention of 23 respondents (55.8%). So it Phubbing can affect children in various can be concluded that the role of parents can fields, such as academically, socially, influence the behavior of phubbing in STIKes mentally, and also physically. Where the Wijaya Husada Bogor students. inherent feeling of phubbing behavior is very In the questionnaire the role of parents strong. This problem is due to the social from questions number 1-20 obtained the interaction of children and parents is not good lowest score is a matter of numbers "my and the child lacks proper attention.6 parents were angry when I got a bad score in Based on univariate results, that out of 52 campus" where parents should make an respondents who have positive phubbing approach with the child then give motivation behavior is greater with negative phubbing and encouragement to be more active in behavior. This can be seen from the results of learning and instilling meaning important the phubbing behavior questionnaire, the data from the education and knowledge they get in obtained that the majority of students had campus4. positive phubbing behavior of 49 respondents (94.2%) and negative phubbing behavior of 3 b). Frequency distribution of Phubbing respondents (5.8%) so that it can be concluded Behavior for Diploma II Level 3 Nursing that positive phubbing behavior can be Students of STIKes Wijaya Husada Bogor influenced by people old. Based on frequency distribution of In the phubbing behavior questionnaire Phubbi Behavior in Level II Diploma 3 from 1-17, the lowest score is question Nursing of STIKes Wijaya Husada Bogor in number 3 which contains "do you often read 2019, from 52 respondents and it is known the news with your cellphone" that students that the majority of respondents have positive should add more insight into their cellphones Behavior phubbing behavior as many as 49 instead of just making online games and respondents namely (94.2%). social media activities, here students must be This study is in line with research more careful in carrying out social media, conducted by Beauty Manumpil (2015) with reading some news is very important for the title "The Relationship of Using Gadgets himself and others. and the Level of Student Achievement in SMA Negeri 9 Manado" The method used is Analisa bivariat cross sectional method with data collection The Relationship between Parents' Roles through questionnaires. Technical analysis and Phubbing Behavior in Secondary Students using chi-square. Obtained most of the data of Diploma 3 Nursing Study Program at using mobile phones and have a high value of STIKes Wijaya Husada Bogor

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 71 Based on the statistical test results of the certain emotional state, which is often seen is Relationship between the Role of Parents with angry emotions. Feeling angry continues to Phubbing Behavior in Secondary Students of desire to vent in a particular form for a Diploma 3 Nursing Study Program STIKes particular object. Wijaya Husada Bogor in 2019. Of the 52 A good family relationship is influenced respondents most of the respondents were by the positive treatment of parents towards negative phubbing behavior with 18 their children, for example being fair in giving respondents (67.8%) and most of the attention and affection to their children. The respondents were negative has the role of treatment of attention from parents will affect parents as many as 18 respondents (67.8%). the relationships of other family members. Statistical test results obtained p value = This will have a negative impact on phubbing 0.068, which means p value <0.05 so that behavior on students7 there is no relationship between the role of Based on the discussion above the parents with phubbing behavior in second- researchers analyzed from 52 respondents that level students of Diploma 3 Nursing Study between the role of parents with phubbing Program at STIKes Wijaya Husada Bogor in behavior did not have a significant 2019.8 relationship. Chi-Square test results obtained The results of this study can be attributed p = 0.068, which means p value <0.05 with a to the research journal conducted by hestina Coefficient Contingency value of 0.949 then (2015) which examines "The Relationship of Ho is accepted and Ha is rejected. So that the Role of Parental Guidance to Student there is no relationship between the role of Achievement in Class Xi of Light Vehicle parents with phuubing behavior in the level 2 Engineering at Smk 45 Wonosari" but there is students of diploma 3 study program nursing no relationship with phubbing behavior, that STIKes wijaya husada bogor in 2019 the the role of parents is not a concern and not correlation is weak. related to learning achievement. The method used is analytic descriptive with cross RESEARCH LIMITATIONS sectional approach. Analysis technique uses There is no perfect human being, even chi-square. The results show that there is no with researchers, the limitations of research relationship between the role of parental are the difficulties or obstacles that guidance and the learning achievement of researchers face when conducting research. students in class xi in light vehicle The researcher realizes that this study has engineering at 45 wonosari Negative limitations that can hinder and influence phubbing is a term of indifferent action in research, namely. someone in an environment because it is more The time available in carrying out this focused on gadged than on building a research is very short, because research is conversation. This term began to boom along difficult to do outside of class hours, so with the booming smartphone on the market. researchers look for free time in the middle of Negative phubbing behavior is the result of a class hours to do research, and researchers social learning process through observation of conduct data collection themselves so that the the social world. A common trigger of quality of data collected is still less than phubbing is when a person experiences a expected.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 72 In collecting data researchers only use SUGGESTION questionnaires and do not conduct in-depth 1. For STIKes Wijaya Husada research so that the truth is very dependent on This research is expected to be an input the honesty of the respondents for mental nursing disciplines Relationship between the Role of Parents CONCLUSION with Phubbing Behavior in Second Level 1. Known frequency distribution based on the Students Diploma 3 Nursing Study Role of Level II Parents Diploma 3 Program STIKes Wijaya Husada Bogor . Nursing of STIKes Wijaya Husada Bogor 2. For STIKes Wijaya Husada Bogor in 2019, it is known that of the 52 Students respondents most of the respondents were It is hoped that this research can be a negative phubbing as many as 29 lesson for students of STIKes Wijaya respondents (55.8%). Husada Bogor to limit playing mobile 2. It is known that the frequency distribution phones so that no phubbing behavior of Phubbing Behavior in Level II Diploma arises, with a reasonable duration and 3 Nursing of STIKes Wijaya Husada frequency because in addition to being Bogor in 2019, from 52 respondents and it able to have an impact on psychological is known that the majority of respondents development it can also affect the health have positive Behavior phubbing behavior effects that will be caused. as many as 49 respondents namely 3. For Future Researchers (94.2%). The next researcher is expected to be 3. Results of analysis of the Relationship used as a reference material, and can be between the Role of Parents with Phubbing used as motivation to develop Behavior in Level II Students of Diploma innovations and new methods related to 3 Nursing Study Program at STIKes this research. Wijaya Husada Bogor in 2019 out of 52 respondents the majority of respondents REFERENCES were positive phubbing behavior with 13 1. Ameliola, S., Nugraha, D.H. 2013. respondents (66.7%) and most of the Perkembangan Media Informasi dan negative respondents had a degree of role Teknologi Terhadap Anak dalam Era elderly, as many as 18 respondents Globalisasi. Malang : Universitas (67.8%). Statistical test results obtained p Brawijaya. value = 0.068, which means p value <0.05 2. Wang, X., Xie, X., Wang, Y., Wang, P., then Ha is rejected and Ho is accepted so Lei, L. (2017). Partner phubbing and that there is no relationship between the depression among married Chinese adults: role of parents with phubbing behavior in the roles of relationship satisfaction and Level II Diploma 3 Nursing Study relationship length. Personality and Program at STIKes Wijaya Husada Bogor Individual Differences, 110, 12-17 in 2019 with a weak correlation . 3. Yususf syamsu. 2016. Psikologi Perkembangan Anak dan Remaja. Bandung Remaja Rodakarya

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 73 4. Ngalimun. 2015. Ilmu Komunikasi. Yogyakarta : Pustaka Baru Press 5. Bolle, C. 2014. “Who is a smartphone addict?” The impact of personal factors and type of usage on smartphone addiction in a dutch population. Thesis of the degree Master in Communication Sciences. University of Twente Enschede.14-41. 6. Syah, Muhbin. 2014. Telah Singkat Perkembangan Peserta Didik, (Jakarta: RajaGrafindo Persada, hlm. 19. 7. Sugiono, Prof, Dr. 2017. Statistik untuk penelitian. Bandung : alfabeta 8. Sarwono. S. 20011. Psikologi Remaja. Jakarta Rajawali. Jakarta Salemba 9. Beauty Manumpil, Yudi Ismanto, jurnal of “Hubungan Penggunaan Gadget Dengan Tingkat Prestasi Siswa Di Sma 1Negeri 9 Manado” 10.Meily Nirnasari 2012 jurnal of“Hubungan Peran Orang Tua dengan Kemandirian Anak Retradasi Mental Usia 7-12 Tahun di SLB Negeri Kota Tanjungpinang”. 11.dilakukan hestina 2015 jurnal of “Hubungan Peran Bimbingan Orangtua Terhadap Prestasi Belajar Siswa Kelas Xi Teknik Kendaraan Ringan Di Smk 45 Wonosari”

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 74 THE CORRELATION OF EXCLUSIVE BREASTFEEDING TO UPPER RESPIRATORY TRACT INFECTION DUETO INFACT AGE 7 – 12 MONTH

Siti Hanifatun, Ica Anisa

Wijaya Husada Health Science Institute

ABSTRACT

Upper respiratory tract infaction (ISPA) is a maindisease among children in developing contries including in Indonesia. Acute respiratory infection are primary infection of the lovarian service, and the nose frequently secretes this disease often found in infants and children. Breastfeeding is a natural food for newborn particulary in the first month of live. This is not only for the child but also for mother, family and the country. The study aims to determine the corelations of exclusive breastfeeding with the incidence of Upper respiratory tract infaction (ISPA) in infacts 7-12 months in the work area of the Bunar community health center. This Study uses quantitative analitical methodes with cross sectional research design and uses total sampling. Population in the study were 43 respondents and sampel in this study were 43 respondents data collection was obtained using checklist sheet. Based on the results of research with the cramer v test on43 respondents obtanied from the data distribution of exclusive breastfeeding as many 26 (60.5%). Respondents were not exclusive breastfeeding. And the frekuency distribution of ISPA occurrences as many 23 (53.5%) non respected respondents. Statistic test result obtained p = 0.000 which means value < 0.05 results Ho is rejected an Ha accepted in other a corelations between exclusive breastfeeding with the incidence of ISPA 7-12 month in the working as ares of the bunar puskesmas in cigudeg sub district of bogor in 2019. From this study it can be concluded that the majority of mothers who do not give exclusive breastfeeding to their baby. Baby those who do not get exclusive breastfeeding will have a risk 0.023 times to expeeience ISPA compared to thoses given exclusive breastfeeding.

Keyword : Upper respiratory tract infection, Exclusive breastfeeding

PRELIMINARY nasopharynx and nose that often secretes Health development as part of fluids. this disease is often found in infants efforts to develop a complete human being, and children among others, is carried out through child Acute Respiratory Infection (ARI) health efforts carried out as early as is an infectious disease where morbidity possible since the child is still in the and mortality is still high. In Indonesia, the Department of Health's womb. Infectious case of death due to ARI is still quite high, disease is a major cause of high mordibity which is about 4 out of 15 million estimated morbidity and mortality rates, especially in deaths in children aged less than 5 years developing countries. Infectious disease is a every year two-thirds occur in infants. disease caused by microorganisms, both Acute respiratory infections (ARI) is one of bacterial, viral, and fungal. Common cold, the main diseases that cause infant death also called Upper Respiratory Infection and often ranks first in morbidity. Early (ARI), is a primary infection of the treatment of ARI is proven to reduce

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 75 Proceeding International Seminar mortality. Stating that in Indonesia ARI and increase from (2013) 34.5 to 58.2% (2018), pneumonia is the third leading cause of while the number of infants aged less than 6 death in children under the age of five, months who were given Persial which is as much as 14%. Episodes of colds breastfeeding was 9.3% Predominant breast in toddlers in Indonesia are estimated at 3 to milk 3.3% and Exclusive breastfeeding 6 times per year. 37.3%. however this figure is lower because Efforts to prevent ARI earlier are the national target for exclusive expected to prevent ARI complications in breastfeeding coverage in 2019 is 80%. infants that can have fatal consequences ARI is still a public health problem in such as pneumonia in addition to other Indonesia, especially in infants. According complications such as acute otitis media to the results of Riskendas 2018, ARI is the (OMA) and mastoiditis although the number two killer of children under five eradication of ARI disease has been (13.2%) after diarrhea (17.2%). The results developed since 1984, along with the of the ARI survey according to health launching of the eradication of ARI disease personnel diagnosis (NASKES) 2013-2018 at the global level. by WHO but until now decreased in 2013 reaching 15.0% and 2018 ARI is still called the forgotten plague of reaching 4.4% when compared to The Forgotten Pandamic.2 developing countries including Indonesia, Acute Respiratory Infection (ARI) the incidence of ARI around 36% of the is one of the main diseases the cause of number of children under five. Based on the infant mortality and often keep the first results of the 2018 Riskendas West Java order of illness for toddlers. Early treatment Incident in 2018 it was 5.0% and the ISPA of ARI is proven to reduce mortality. stated prevalence was 12%. Ten districts that have that in Indonesia ARI and pneumonia is the the highest incidence and prevalence for all third leading cause of death in children ages, one of which is West Java .5 under the age of five, as many as 14% .3 Age 0-24 months is a period of The most severe cause of ARI is rapid growth and development, so it is often infection with streptococus pneumonia or termed a golden period as well as a critical Haemaophillus influenzae. Many deaths period. The golden period can be realized if due to pneumonia occur at home, including during this period infants and children after experiencing pain for several days. receive appropriate nutritional intake for The ISPA limitation program specifically optimal growth and development, has been started since 1984, with the aim of conversely if babies and children at this trying to reduce morbidity and mortality time do not get food that is in accordance rates especially for infants and toddlers with their nutritional needs, the golden caused by ARI, but it seems that the period will turn into a critical period that morbidity and mortality rate is still high. In will interfere with the growth and general there are 3 (three) risk factors for development of infants and children both at ARI, namely environmental factors, this time and in the future. Breast milk is individual child factors, and behavioral the perfect and best main food for babies factors. These factors are very closely because it contains the nutritional elements related to the incidence of ARI.4 that babies need in their growth and A survey of the proportion of Early development process. Exclusive Breastfeeding Initiations in infants aged 0- breastfeeding is giving only ASI for 0 - 6 23 months according to the results of the months without being given food or other 2018 Riskendas in Indonesia showed an

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 76 Proceeding International Seminar drinks, non-exclusive breastfeeding is Health Center in Cigudeg Sub-District, giving ASI which is added by giving food.6 Bogor Regency on August 18, 2019 with 10 At the sub-district level it can be respondents with mothers aged 7-12 seen that the sub-district with the highest months, 8 babies had experienced number of sufferers is the West Bogor symptoms of ARI 6 of them did not get District of 1,571 cases or 129.51%. bunar exclusive breastfeeding, 2 babies got breast puskesmas with ARI in infants <1 year milk Exclusive and 2 other babies get from January to July 2019 as many as 129 exclusive breastfeeding and do not cases The cause of this case may be experience ARI. Based on this background, influenced by environmental conditions and the researcher is interested in taking the title healthy living habits such as the condition The relationship between exclusive of an unhealthy home. breastfeeding and the incidence of ARI in The effectiveness of breast milk in infants 0-6 months in the Bunar Public controlling infection can be proven by the Health Center. reduction in the occurrence of some specific diseases in babies who are breastfed RESEARCH METHODS compared to babies who get formula milk. This type of research is a Research by the world health agency proves Quantitative Analytical Descriptive that is a that breastfeeding until the age of 2 years research method that aims to see a picture can reduce child mortality due to diarrheal of phenomena that occur in a particular disease and acute respiratory infections.7 population and try to explore why that In several studies it is known, there phenomenon can occur. Then analyze the are many risk factors for ARI in infants and correlation dynamics between phenomena, toddlers. Some of these factors are both risk factors and effect factors. An malnourished infants, low birth weight effect factor is a result of a risk factor, (LBW), inadequate breastfeeding, high whereas a risk factor is a phenomenon that house occupancy rates, incomplete results in an effect (effect) .10 immunizations, gender, vitamin A For this research design using cross deficiency, iron deficiency, vitamin D sectional approach that is analytic research deficiency or calcium, baby age, smokers, design that aims to determine the seasonality, health services, low relationship between variables where the socioeconomic and burning smoke. dependent variable and independent The bioactive component in breast variables are identified at one time unit milk protects infants against respiratory (Point Time Approach). This research was infections such as immunoglobulin (SigA) conducted on 2,6,11 September 2019 at the against the syncial virus produced by Bunar Health Center, Cigudeg District, bronchomammary and for macroglobulin Bogor Regency. 11 substances that inhibit influenza viruses. Population is a generalization area This supports that respiratory infections in that consists of objects / subjects that have infants who get full milk, are lighter than certain qualities and characteristics babies who get formula milk. Breast milk determined by researchers to be studied and contains nutrients needed at the beginning then conclusions drawn other than that the of human life and contains antidotes to population is the whole object of the various diseases in the form of anti-body.9 researcher. The population in this study Preliminary Study Results were all mothers who had infants aged 7 - conducted in the working area of Bunar 12 months in 3 Posyandu, Bunar Village,

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 77 Proceeding International Seminar Cigudeg District, Bogor Regency in 2019. answer that shows the relationship between With a total of 43 mothers who had infants exclusive breastfeeding and the incidence aged 7 - 12 months. of ARI in infants 7 - 12 months in the The sample is a large portion of the Bunar Health Center in 2019 with a p value number and characteristics possessed by the of 0.000 <0.05. population. Besides the research sample is a Data analysis consisted of portion of the population that represents a univariate and bivariate analyzes. population that is the subject of research. Univariate analysis aims to explain or The sample in this study were all mothers describe the characteristics of research who have infants aged 7-12 months in the variables. The form of univariate analysis Bunar Health Center Work Area. The depends on the type of data. For numerical sampling technique in this study is total data the mean or secondary median and sampling is a sampling technique where the standard deviation are used. In general, this number of samples is equal to the analysis only produces the frequency population for taking total sampling distribution and the percentage of each because the total population is less than 100 variable. The independent variable is the entire population is used as a sample of exclusive breastfeeding and the dependent all research. Samples taken in this study variable is the incidence of ARI. Analysis were 43 people.12 Bivariate is an analysis conducted The independent variable in this on two variables that are suspected to be study is exclusive breastfeeding. The related or correlated. Kendal correlation or dependent variable in this study is ARI The used to find the relationship between two or type of data used in this study uses primary more variables. Cramer's Test V Cramer data that is data obtained from checklist Contingency Coefficient is a hypothesis test sheets. Tool used to determine the to find out the relationship between 2 relationship of exclusive breastfeeding with nominal scale variables. Associated with the incidence of ARI in infants of 7-2 the characteristics of the scale and nominal, months. the cramer correlation test includes Hypothesis is defined as a nonparametic statistics, that is, it does not proposition that shows the relationship require data to be nominal distribution. To between two or more concepts or find out whether there is a relationship interconnections between concepts. The value or not, it can be seen from the hypothesis in this study is the relationship significance value of the three correlation between exclusive breastfeeding and the coefficients namely phi, Cramer's V and incidence of ARI in infants 7-12 months in Cramer Contingency Coefficient analysis the Bunar Health Center in 2019. using statistical tests. This study aims to The alternative hypothesis is also determine the relationship of exclusive called the work hypothesis. This hypothesis breastfeeding with ARI Kejadin in 7-12 states the difference between one variable months infants in the working area of the with another variable or states the bunar puskesmas in cigudeg sub-district. 14 relationship between one variable with another variable or the bias also states the RESEARCH RESULT influence of one variable or treatment on another variable. This alternative Based on the distribution of hypothesis is written as "Ha". Ha: characteristics frequency based on the sex Alternative Hypothesis is a temporary of infants in the Bunar Health Center it can

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 7876 Proceeding International Seminar be concluded that from 43 respondents RESEARCH DISCUSSION there were 27 respondents (62.8%) male a. Exclusive breastfeeding sex. Based on frequency distribution of exclusive breastfeeding shows that of Based on the frequency distribution the 43 respondents, most of the mothers of characteristics based on age, it can be did not give exclusive breastfeeding to concluded that from 43 respondents there their babies not exclusive breastfeeding, are 12 respondents (27.9%) aged 10 namely 26 respondents (60.5%). months. Breast milk is the perfect and best Based on the distribution of the main food for babies because it contains frequency of exclusive breastfeeding shows the nutritional elements that babies need that of the 43 respondents most mothers do in their growth and development not give exclusive breastfeeding to their process. Exclusive breastfeeding is babies, not exclusive breastfeeding that is giving only ASI for 0 - 6 months as many as 26 respondents (60.5%). without being given food or other Based on the frequency of ARI in drinks, non-exclusive breastfeeding is infants 7-12 months, it shows that of 43 giving ASI which is added by giving 6 respondents, there were 23 infants (53.5%) food. who did not experience ARI. The effectiveness of breast milk in controlling infection can be proven by Based on the results of the the reduction in the occurrence of some relationship between exclusive specific diseases in babies who are breastfeeding and the incidence of ARI in breastfed compared to babies who get infants aged 7-12 months from 43 formula milk. Research by the world respondents there were 19 respondents who health agency proves that breastfeeding were not exclusive breastfeeding with the until the age of 2 years can reduce child incidence of ARI (44.2%). Statistical test mortality due to diarrheal disease and results obtained p value = 0.000, which acute respiratory infections.7 means value <0.05 in other words there is a This is in line with the study of significant relationship between exclusive Ariefeen et al (2014) which concluded breastfeeding and the incidence of ARI in that infants who get persial breast milk the Bunar Health Center, Cigudeg District, will be susceptible to ARI. The risk of Bogor Regency. infants receiving Persial ASI for deaths From the results of the study it was due to ARI is 2.23 times higher than found that infants who were given exclusive babies who are exclusively breastfed. breastfeeding had an Odds Ratio of 0.023 Based on the results of Anthony times to experience the incidence of ARI Widyanata Lebuan's research in 2014 compared to infants who were given entitled The Relationship Between exclusive breastfeeding. The results of this Exclusive Breastfeeding and Acute study prove the research hypothesis that Respiratory Infection in Kindergarten non-exclusive breastfeeding increases the Students in the cold village of East risk of 0.023 times to experience an ARI Denpasar sub-district in East Denpasar compared to babies who are exclusively District, the frequency distribution of breastfed. exclusive breastfeeding showed that of 165 respondents there were 104 respondents no Exclusive breastfeeding

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 79 Proceeding International Seminar (63.0%) with a p value <0.05 in the cold age of 6-12 months in the Candilama chate village of East Denpasar sub- Public Health Center in Semarang in district in 2014. 2015 obtained the frequency distribution According to researchers based on of ARI from 43 respondents who could the theories above that Because of the not be issued ISPA as many as 27 babies importance of breast milk for babies, the (65.9% ). Statistical test get the value of researchers suggest that mothers p - 0.0001, which means the value breastfeed their babies for 6 months <0.05. from birth, known as Exclusive The study was aligned with breastfeeding. Because exclusive research conducted by Herlinda Christi breastfeeding can reduce the risk of in 2015 the results of this study were infection. Infants who are exclusively obtained from the research relationship breastfed are more resistant to disease between exclusive breastfeeding and than infants who are not breastfed.6 ARI events. According to researchers based on b. ARI theories about factors that influence ARI Based on frequency of ARI in events, one of which is exclusive infants 7-12 months refers to 43 breastfeeding. ASI is a protective factor respondents, which caused the incidence against ARI. Breast milk protects babies of ARI not as many as 23 babies from a variety of diseases including (53.5%). respiratory infections and intestinal ARI (acute respiratory infection) is infections. an acute respiratory infection and lower From Results of the relationship respiratory tract. ARI is an acute between exclusive breastfeeding with respiratory infection that lasts 14 days. ARI events in infants aged 7 - 12 The respiratory tract is an organ that months from 43 respondents including starts from the nasal cavity up to the 19 respondents who did not exclusively ephiglottis and such as fever, cough, breastfeeding ARI events (44.2%). runny nose, ear infections.11 Breast milk is a complete and best Meanwhile, infections that enter are food for babies because it contains no germs or microorganisms into the body nutrients needed by the baby in the and multiply, causing a mild disease that process of growth and development. will heal by itself within 1 to 2 weeks, Exclusive breastfeeding is breastfeeding but this disease can cause complications, only for 0 - 6 months without giving depending on the problem at hand. food or other drinks, non-exclusive ARI is a disease that often occurs in breastfeeding is breastfeeding added infants, toddlers and children, because with food providers.5 The effectiveness their body's defense system is still low, of breast milk in controlling infections cold cough disease in toddlers in can be proven by its protection. Indonesia is estimated to reach 3 to 6 Comparing with babies who get formula times per year which means that on milk. Research by the world health average there is a coughing cold attack agency proves that breast milk up to the as much as 3 to 6 distant times age of 2 years can reduce child mortality The results of Herlinda Christi's due to illness and acute respiratory research in 2015 with the title factors infections relating to the incidence of ARI at the

80 “Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 76 Proceeding International Seminar ARI (acute respiratory infection) is get immunity that is anti-infectious. an acute respiratory infection and lower Because of the abundant content, it is respiratory tract. ARI is an acute clear that exclusive breastfeeding can respiratory infection that lasts 14 days. provide many benefits, one of which can The respiratory tract is an organ that prevent ARI. Children who are given starts from the nasal cavity up to the exclusive breastfeeding have a good ephiglottis and such as fever, cough, effect on preventing the incidence of runny nose, ear infections.4 ARI compared to non-exclusive While what is meant by infection is breastfeeding. It has been proven to be the entry of germs or microorganisms effective in preventing respiratory into the body and reproduce, causing infections in children. mild illness that will heal by itself within 1 to 2 weeks but this disease can cause CONCLUSION complications (serious symptoms) if left 1. It is known that the frequency unchecked immediately. distribution of exclusive breastfeeding According to coutsoudis and for infants 7-12 months in the Bunar bantley (2014) that breast milk has Health Center Work Area shows that of elements that meet all the needs of the the 43 respondents, most of the mothers baby for nutrient integrity for a period of did not give exclusive breastfeeding to about 6 months unless the mother their babies not exclusive breastfeeding, experiences severe malnutrition. The namely 26 respondents (60.5%). presence of antibodies and macrophage 2. Known ARI events in infants 7 - 12 cells in breast milk and colostrum months in the Bunar Puskesmas Work provides protection against certain types Area shows that of the 43 respondents of infections, therefore babies who get who experienced no ARI 23 (53.5%) exclusive breastfeeding are rarely infants. infected with respiratory infections and 3. Known The results of the analysis of the diarrhea. Infants who get exclusive relationship between exclusive breastfeeding automatically get breastfeeding and the incidence of ARI immunity that is anti-infective. Breast in infants aged 7-12 months are known milk also provides passive protection for from 43 respondents. 26 babies (60.5%) the child's body to deal with pathogens did not receive exclusive breastfeeding. that enter the body. Infants without ARI 7 (16.3), while Based on research conducted by infants with ARI were 19 and babies Hesti R. Masela 2015 from 90 toddler who received exclusive breastfeeding respondents, it was found that the were 17 babies (39.5%). Infants without number of babies who did not get ARI 16 (37.2%) while infants with ARI exclusive breastfeeding was 67 babies 1 (2.3%). Cramer’s V test results (74.4%) and those with ARI 50 babies obtained a value of p = 0,000 which (65.7%). Obtained a chi-square value of means the value <0.05 in other words 11,883 and p = 0.001 <0.05 this shows there is a significant relationship there is a relationship between exclusive between exclusive breastfeeding with breastfeeding with a history of infection. the incidence of ARI in the Bunar According to researchers based on Health Center, Cigudeg District, Bogor the theories above that babies who get Regency. exclusive breastfeeding automatically

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 81 Proceeding International Seminar SUGGESTION Republik Indonesia, Diakses 12 1. For further researchers Agustus 2019 Jam 16:25 WIB It is hoped that this research can add 3. Kemenkes RI. 2014. Infodatin. insight into knowledge, especially Pusat Data dan Informasi maternity nursing about the relationship Kementrian Kesehatan RI. Jakarta of exclusive breastfeeding with the Selatan: Kementrian Kesehatan incidence of ARI in infants 7-12 months. Republik Indonesia, Diakses 05 2. For institutions Agustus 2019 Jam 19:25 a. For STIKes Wijaya Husada WIB This research is expected as a 4. Lapau. B. 2019. Prinsip dan reference material about the metode epidemiologi. Fakultas Ilmu relationship of exclusive Kedokteran Universitas Indonesia breastfeeding with the incidence of 5. Kementrian Kesehatan RI. Hasil ARI. Can provide and add to the Utama RISKESDAS 2018. Diakses literature about the relationship 10 September 2019, Jam 09:09 between exclusive breastfeeding WIB with the incidence of ARI for future 6. Fahriani, R., Roshiswatmo, R. & research input. Hendarto, A. 2014 Faktor yang b. For Puskesmas Bunar mempengaruhi pemberian ASI It is expected to be able to foster Eksklusif pada bayi cukup bulan community participation with the yang dilakukan inisiasi menyusui cooperation of PKK cadres dini (IMD). Sari pediatrii guidance and motivation for 7. Kurniawan, B., 2013. Determinan nursing mothers in exclusive Keberhasilan Pemberian Air Susu breastfeeding for 6 months. Ibu Eksklusif. Jurnal Kedokteran c. For Respondents Brawijaya, 27,p.237 To improve maternal knowledge, 8. Proverwati, A., dan Rahmawati, especially regarding the importance E.2010. Kapita Selekta ASI dan of exclusive breastfeeding to Menyusui. Yogyakarta : Nuhu infants and is expected to be able to Media carry out exclusive breastfeeding to 9. Prasetyo. Dwi Sunar. 2009. ASI prevent acute respiratory infections Eksklusif. Jogjakarta : Diva press so that it can reduce the risk of ARI 10. Dharma, Kelana Kusuma .2011. in these infants. Metodologi Penelitian Keperawatan (Panduan REFERENCES melaksanakan dan menerapkan 1. Depkes RI. Direktorat Jendral hasil penelitian) Edisi Revisi. Pengendalian Penyakit dan Jakarta : Trans Info Media Penyehatan Lingkungan . 2011 11. Notoatmodjo, Soekidjo. 2012. Pedoman Pengendalian infeksi Metode Penelitian Kesehatan. saluran pernafasan akut. Jakarta : Jakarta : Rineka Cipta Kementrian RI, Diakses 12 Agustus 12. Swarjana, I Ketut. 2015. Metode 2019 Jam 16:10 WIB Penelitian Kesehatan Edisi Revisi. 2. Kemnkes RI. 2015. Profil Yogyakarta : Andi Kesehatan Indonesia Tahun 2014. Jakarta: Kementrian Kesehatan

82 “Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 76 Proceeding International Seminar 13. Sabri, Luknis dan Sutantu Pryo Hastono. 2014. Statistik Kesehatan. Jakarta : Rajawali Pers 14. Sugiyono. 2015. Metode Penelitian Kuantitatif, Kualitatif, dan R&D. Bandung 15. Tjandra 2011. Pedoman Pengendalian Infeksi Saluran Pernafasan Akut. Katalog Kemenkes RI : Jakarta

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 83 Proceeding International Seminar LEVEL OF AWARENESS AND COMPLIANCE IN DIABETES MELLITUS MANAGEMENT AMONG ADOLESCENTS DIAGNOSED WITH TYPE-1 DIABETES

Elvira L.Urgel, Joylyn L. Mejilla, Josephine M. De Leon, Sofia Magdalena N. Robles, Catherine Mae G.Trinidad

Centro Escolar University, School of Nursing, Mendiola, Manila Philippines

ABSTRACT The study aimed to determine the level of awareness and to assess compliance to Diabetes management of adolescents diagnosed with Type-1 Diabetes. A descriptive correlational type of research was utilized to gather information on the level of awareness and compliance of adolescent patients to diet, exercise and drug management suffering from Type-1 diabetes mellitus. The patients (n=20) were recruited from Institute for Studies on Diabetes Foundation Incorporated, Philippines. A purposive sampling was utilized to select twenty adolescents. A researcher-made questionnaire was utilized as the main instrument in gathering data. Focus group discussion was also done to further assess patient's level of awareness and compliance to diabetes management. Results showed that patients have a moderate level of awareness and some extent of compliance to diabetes. Patients have extreme awareness in diet management and moderate awareness in exercise and drug management. In terms of compliance, patients are compliant to some extent only, while drug management has the highest level of compliance, followed by exercise and diet. There is a low correlation between level of awareness and compliance in diabetes management (r = .32 p = 0.15), indicating that the moderate level of awareness of patients to DM management is not related to their compliance. The results are limited only to the participants of the study. Further study using a larger population and different setting is recommended. Nurses taking care of adolescent patients with diabetes mellitus must understand the importance of health education. Health educations are valuable to increase level of awareness and extent of compliance of adolescent patients with Type-1 diabetes.

Key words: Awareness to diabetes, compliance to diabetes management, diabetes, diabetes management

INTRODUCTION Tolerance (IGT). The Philippines warrant The incidence of Diabetes Mellitus (DM) early aggressive intervention for diabetes is rapidly increasing in a global basis mellitus prevention and management which is according to the World Health Organization comprise of diet, exercise and drugs to (Parker & Irons, 2006), resulting in the effectively manage patients with Type-1 development of evidence-based guidelines for diabetes. control and management of DM in many Diabetes Mellitus is a condition requiring countries around the world. The Asia-Pacific a high incidence of self-management along has the largest diabetes burden in the world with intensive medical care to reduce the exemplified by a number of overweight and incidence of its acute and chronic obesity in almost of the entire region complications. DM is one of the chronic according to Sy (2008). lifestyle diseases affecting a large sector In the Philippines out of its thirteen worldwide. Figures published by World regions included in the cohort study by Health Organization (WHO) estimated that Gallardo (2009), six regions show the 150 million have DM and that this figure will alarming growth of diabetes with Impaired double by the year 2025. Management studies Fasting Glucose (IFG) and Increased Glucose for DM in first world countries may vary

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 84 largely from management strategies applied in diabetes. Having much knowledge on the the third world areas because of economic and effects, anxiety and adjustments confronting manpower factors. In the Philippines, the these patients, it is important to empower the Department of Health (DOH) included DM patients to effectively manage their own prevention control under the Healthy Lifestyle disease. For effective management and to be program. It ranks third among the dreaded successful in preventing complications of this lifestyle related diseases in the country today. chronic and debilitating disease, patients must The study of Ardena (2010) revealed that, be equipped with necessary knowledge, skills, in the Philippines most of the patients with and attitude. Type-1 diabetes do not own a glucose- meter and do not consult the doctor on a regular OBJECTIVE OF THE STUDY basis. The findings may be related to the The study was conducted to determine the increased untreated cases of diabetes mellitus. level of awareness and compliance to DM The knowledge, attitudes and practices of management of adolescents with Type-1 Type-1 diabetes patients were impaired and diabetes. It also determined the relationship of there is a need for health education to improve the level of awareness and compliance to DM management of diabetes and prevent management. complications. In addition, according to Higuchi (2010) there is also an ineffective METHOD access to diabetes care and management in the Research Design Philippines. The application of standard The study utilized a descriptive treatment/management guidelines will be of correlational research design to describe the help to encourage patients to seek and receive level of awareness and compliance to DM regular care. management of adolescents with Type-1 Similar studies on knowledge regarding diabetes. Beck and Polit (2009) stated that causes of Type-1 diabetes, its prevention and descriptive research is focused on the methods to improve health were understanding the causes of behavior, conducted. Flores (2006) explained that the conditions and situations and in which data tools used in diet management include the gathering is done through observation, survey Food Exchange List (FEL), Food Composition and interview. Table (FCT) the nutritional guidelines and the food pyramid. Results of the study by Krousel- Study Site Wood (2008) also emphasized the importance The study was conducted at the Institute of exercise management. Physical activity, t for Studies on Diabetes Foundation monitoring and low calorie diet can be Incorporated (ISDFI) located at Marikina City, effective in lowering the glucose and HbA1c Philippines. The foundation is known in the levels. American Associations of Clinical Philippines in delivering excellent and humane Endocrinologists (AACE, 2007) recommended diabetes care and caters to adolescent patients that intensive insulin therapy may reverse with Type-1 diabetes (ISDFI, 2009). ISDFI is hypoglycemia unawareness in patients with a private institution operated by different Type-1 diabetes and can substantially prevent private and government organizations led by hypoglycemia and maintain target glycemic medical practitioners and support groups. level. It is of great importance to understand the Participants possible effects of the disease on the lives of There is an increase incidence of diabetes these patients which somehow affect their in children and adolescents in the Philippines, compliance to the management of Type-1 but data on childhood diabetes is scarce (Sy,

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 85 2008). In the ISDFI only few adolescent Responses for each item were weighed using patients with Type-1 diabetes receiving care, Likert's five point scale which ranges from falls on our inclusion criteria. A purposive extremely aware (5) to not aware (1) for the sampling was conducted to identify twenty level of awareness; and to a very great extent adolescent patients. Participants were selected of compliance (5) to a very small extent of according to the inclusion and exclusion compliance (1) for the level of compliance to criteria set in the study. They are adolescent Type-1 diabetes management. patients who were diagnosed of Type-1 A focus group discussion (FGD) was diabetes and whose age ranges from 12 to 18. done to deepen the assessment of the level of They were diagnosed of Type-1 diabetes at awareness and evaluate the extent of their least six months before the conduct of this compliance to DM management. The FGD study and were regularly visiting the ISDFI for was conducted to validate the answers of the checkup at the clinic's foundation. patients in the self-made questionnaire regarding their knowledge of the disease and Ethical Clearance and Informed consent compliance with diabetes management. The study has an approved ethical Results of the FGD were validated from clearance from Centro Escolar University member check. (CEU) Institutional Review Board (IRB) and the ISDFI IRB committee. Informed consents Data Analysis were sought from the parents or guardians of The results were analyzed utilizing the twenty participants. The rights, privileges, Statistical Package for Social Sciences (SPSS) obligations, risks and benefits of the version 19 software. Mean and SD was used to participants were included in the orientation describe the level of awareness and process. They are also oriented about the compliance of the patients to diabetes instrument and the conduct of the Focus Group management. Pearson correlation was utilized Discussion (FGD) prior to data collection. to determine relationship of the level of Anonymity and confidentiality were observed awareness to the extent of compliance of the during the conduct of research and audio-taped patients to diabetes management. used in the FGD were destroyed after analysis of data. RESULTS Patients are mostly female (65% Formulation and Administration of the n=20); 12 years old (30% n=20) finished Questionnaire primary education (80% n=20); catholic (85% A researcher made questionnaire was n=20); no vices such as smoking and drinking developed based on the context of the disease alcohol (95% n=20); have no physical activity process and the management of Type-1 (45.84% n=20); diagnosed of Type-1 diabetes diabetes with the specific treatment protocols for > 5 years and with history of diabetes in and the responses of the participants to the the family (65% n=20). Patients were regularly treatments. The instrument was validated by visiting the ISDFI for check-up at the clinic's five experts in diabetes management and had foundation. undergone reliability testing using Cronbach's It can be seen in Table 1 that patients alpha coefficient reliability coefficient =0.80) with Type-1 diabetes are extremely aware on with ten respondents excluded in the total the importance of blood sugar control, signs sample of the study. The validated and definition of hyperglycemia and with diet, questionnaire comprised the level of exercise and drug as part of diabetes awareness and compliance of adolescents with management (mean= 5.0, mean= 4.85, Type-1 diabetes to DM management. mean=4.75, and mean= 4.60 respectively).

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 86 Patients have moderate awareness on team sports because this has been imposed to symptoms of diabetes (mean= 4.45), signs of them by people around them. hypoglycemia (mean=4.30), diabetes as a “We don't have any more time for exercise” lifestyle related disease (mean= 4.0), obesity “I preferred reading books and watching TV” and family history as risk factors for diabetes “We are exempted from PE classes” (mean=3.95), and Type-2 diabetes (3.75). "My parents feared that if I'll join the PE These responses were confirmed class, I might experience hypoglycemia" during the FGD, two of the patients mentioned Further, the patient's compliance to the common factors that can contribute to an diabetes management are somewhat compliant increase in blood sugar are lack of 56 57 to drug (mean=3.16), exercise (mean=3.24) exercise and eating sweet foods. Patients are and diet management (mean=3.42). The low aware that they can definitely control their compliance on these items can be explained by blood sugar especially if they have high level the limited financial resources of the patients of awareness to disease process. as explained during the FGD. Some of the “Diabetes results to lack of exercise” patients were supported by the foundation “Diabetes results to eating too much sweet” (ISDFI) in terms of drug management; they “Proper education may help us to comply with are provided assistance in their insulin. diabetes management “Our parents support us but we have limited As reflected in Table 2 patients are finances” extremely aware on diet management “We only rely on the foundation -ISDFI” (mean=4.51) and moderately aware on Patient's higher compliance in drugs exercise (mean=4.31) and drug management can be attributed to their training on the types, (mean=4.16). But, many of them during the uses and proper administration of insulin. The FGD verbalized that they do not anymore patient's competence in managing their insulin prepare meal plan. has been the focus of the training in ISDFI. ”We don't prepare meal plan” “ISDFI help us in managing our drugs” “I have to choose my meal” “We are taught on proper insulin injection” “My food has to be measured” Patient's compliance to walking as an Adolescent patients do not need close exercise management is also of great extent. supervision from health personnel on diet Walking has been the usual exercise done by management because they are taught by the the patients because most of them walk when ISDFI through the conduct of series of they go to school. On the other hand, aerobic training. Thus, on the view of the patients they and cardiovascular exercises are to some do not need close supervision. extent only because of the busy schedule of “We are taught inside the camp” the patients in school activities. Most of them ”Carbohydrate counting and serving size are are already tired because of the too many included in our training” activities in school. The moderate awareness of patients to “I walk going to school” exercise is supported by only a few of them “I cannot exercise anymore after school, I'm engage in regular exercise and physical already tired” activity. Although they have extreme Although, patients are extremely aware awareness on exercise and physical activity as that individualized meal plan is necessary to part of diabetes management, many of them control diabetes, results show that they only preferred to watch television and read books. comply with some extent. From this research Many of the patients believed that there is a results, it revealed that there was a low need for patients with Type-1 diabetes to be correlation between diabetes level of exempted in physical education classes and awareness and compliance to DM

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 87 management. The correlation between level of were moderate; patients are extremely aware awareness and compliance was not significant in physical activity, cardiovascular fitness and (r = .32 p = 0.15) to consider in the study. It checking of blood glucose level. They also indicates that the moderate awareness of have moderate awareness on exception in patients to diabetes management is not related physical education classes and adjustment of to their extent of compliance. insulin during exercise. However, ISDFI encouraged patients to engage in household DISCUSSION chores and play as their means of exercise and The purpose of the study was to activity. These are more appropriate to their determine the patient's level of awareness and age, more manageable and of no expense on extent of compliance to DM management. In their part as adolescents. Patient's education on addition it sought to determine the relationship DM management given by the ISDFI was between awareness and compliance to DM helpful in increasing their level of awareness. management. In related studies on exercise, diet and drug Results revealed that patients have management, there is increased awareness in extreme awareness on blood sugar control and physical activity to promote fitness and a diet signs of hyperglycemia but moderate that includes carbohydrate counting and awareness only on signs of hypoglycemia. It is decreased saturated fat intake (Delahanty, of primary importance in the prevention of 2009; Al-Agha et al., 2011, Michaliszyn, long-term complications the maintenance of 2009). These are recommended therapeutic normal glucose level and awareness in the modalities in the management of diabetes. signs and symptoms of both hyperglycemia However, patients have only moderate and hypoglycemia. awareness on carbohydrate counting and the In the study, patient Self-Monitoring used of decreased saturated fat intake. Health of Blood Glucose (SMBG) control is one of education on carbohydrate counting and used the effective primary techniques patients of decreased saturated fat intake may be the utilized to assess the glycemic control. focus of further health education to help However, guidelines in diabetes care patients effectively managed diabetes. suggested evidence-based approaches. Patients followed the diabetes Effective management of blood glucose levels management to some extent but shows great have been shown to reduce the risk of diabetes extent of compliance on insulin management. complications according to American Diabetes The ISDFI staff taught them on insulin Association (ADA, 2012). A study also management as revealed in the FGD. In drug recommends Continuous Blood Glucose management of patients with Type-1 diabetes, Monitoring (CBG) in conjunction with it is recommended by ADA (2012) to use intensive insulin regimens to lower A1C in multiple dose insulin injections (three to four children, teens and young adults (Pick-up, injections per day of basal and prandial Freeman & Sutton, 2011). CGM is also found insulin). Continuous Insulin Infusion (CII) effective in handling wide variability in therapy was recommended in the study of glucose profiles before, during, and after Valla in 2010. But the use of CII is not evident physical exercise (Kapitza, Freeman & Sutton, in the study because in the Philippines, only 2010). few patients use CII because it is too Patients were extremely aware on diet expensive. The adolescent patients are only management exclusively on individual meal using multiple dose insulin injections which plan, physical activity, cardiovascular fitness were monitored and supervised by their and checking of blood glucose level. Although doctor's and funded by ISDFI. This shows that patient's awareness in exercise management

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 88 the health education conducted by ISDFI is is not statistically significant. The results show sufficient to manage insulin treatment. no support to the study hypothesis. This may The result also shows that patient have be due to limited participants included in the some extent of compliance in monitoring study. blood glucose before injecting insulin and performance of exercise or physical activity. CONCLUSION Although, ISDFI taught them on SMBG, most Health education is necessary to of the patients do not own a glucose meter or increase the level of awareness and extent of if they have they cannot afford to buy the compliance of patients in diabetes glucose strips needed for regular monitoring of management particularly in the importance of blood glucose. This may be due to individual meal plan and controlling blood lack of financial resources and most of them sugar level before exercise and physical are relying on the assistance of ISDFI. ADA activities. Level of awareness is important but (2012) guidelines on diabetes management adherence to diabetes management is of higher recommended that in individuals taking importance to prevent long term complications insulin, physical activity can cause of DM. Health education process that is more hypoglycemia. It is recommended that regular specific and appropriate to their needs can blood glucose monitoring is important to avoid improve more the compliance of the patients hypoglycemia during and after exercise to the three diabetes management. The nurse's (Younk, Mikeladze, Tate and Davis, 2011). role is important in educating adolescent The possibility of the occurrence of patients with Type-1 diabetes. The results of hypoglycemia after exercise or physical the study may only be applicable to the activity on patients is high. Health education is participants because of low statistics necessary to teach the patients on effective significance and further study with a larger blood glucose monitoring. population and multiple setting is Patient's lowest compliance is on diet recommended to achieve adequate results. management. Although patients have high level of awareness in individual meal plan they only follow the management to some extent. ACKNOWLEDGEMENT The health education given by the ISDFI may The study was funded by Centro be sufficient for these patients to comply on Escolar University (CEU), Manila, diet management, however patients do not Philippines. Special thanks to ISDFI staff and anymore prepare meal plan as revealed in patients who supported this study. All authors FGD. This may be attributed to lack of in the study take full responsibility in its motivation, support in the family and school content and its originality. There is no conflict canteen. ADA (2012) recommended of interest. individualized meal planning and optimization of food choices to meet recommended daily allowance (RDA)/ dietary reference intake REFERENCES (DRI) for all micronutrients in patient with American Association of Clinical diabetes. Endocrinologists (AACE). (2007). The study also determined the Medical guidelines for Clinical practice relationship of awareness to compliance to for the management of diabetes DM management. Results show that there is mellitus. , 13 (1). low correlation between the patient's American Diabetes Association (ADA). awareness and compliance to DM (2012). Standards of Medical Care in management. Although there is correlation, it

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 89 Diabetes-2012. Vol 35, Krousal- Wood, M., Berger, L., Jiang, X., supplement 1; S11-S2. Blonde, L., Myers, L., Webber, L. Ardena, G., Paz-Pacheco, E., Jimeno, C., (2008). Does Home-based exercise Lantion-Ang, F., Paterno, E., Juban, N. improve body mass index in patients (2010). Knowledge attitudes and with type 2 diabetes? Diabetes Research practices of persons with type 2 Clinical Practice. 79:2, 230-236 Diabetes in a rural community: Phase I Michaliszyn, S., Shaibi, G., Quinn, L., of the community-based Diabetes Self- Fritschi, C., Faulkne, M. (2009). Management Education (DSME) Physical fitness, dietary intake and Program in San Juan, Batangas, metabolic control in adolescents with Philippines. Diabetes Res Clin type 1 diabetes, –Pediatr Diabetes, Pract.2010 Nov; 90 (2):160-6. 10(6): 389394. Al-Agha, A., Ocheltree, A., Hakeem, A. Parker, T., Irons, B. (2006). Diabetes in (2011). Metabolic control in children children and adolescents and adolescents with insulin-dependent pharmacotherapy self- assessment Diabetes Mellitus. . 3(4): 202–207. doi: program, 6th Edition President's 10.4274/jcrpe.415. Delahanty, L., Council on Physical Fitness and Sports, Nathan, D., Lachin, J., Hu, F., Cleary, Research Digest. S7 (3), 177- 182. P., Ziegler, G., Wylie-Rosett, J., Pickup, J., Freeman, S., Sutton, A. (2011). Wexler, D. (2009). Association of diet Glycaemic control in type 1 diabetes with glycated hemoglobin during during real time continuous glucose intensive treatment of type 1 diabetes in monitoring compared with self- the diabetes control and complications, monitoring of blood glucose: meta- Trial,Am J Clin Nutr, 2009, February; analysis of Randomised Controlled 89(2): 518–524. Trials using individual patient data, Flores, J. (2006). Diabetes management for 2011; 343: d3805. Published online health care professionals learning 2011 July 7. doi: 10.1136/bmj.d3805. module series. Diabetes Research Polit, D., & Beck, C. (2008). Nursing Clinical Practice Research, 8 ed., Lippincott Williams Gallardo, A., Soria, M., Sy, R., Vega, B.,Ty- and Wilkins, Philadelphia. Willing, T., Venandania, F. (2009). The Sy, R. (2008). The growing problem of incidence of type 2 diabetes mellitus in diabetes in children, Diabetes Watch. the Philippines: A 9 – cohort study Vol. 80, No.2, 88- 95 Diabetes Research Clinical Practice. 86 Valla, V. (2010). Therapeutics of Diabetes (2), 130-133 Mellitus: Focus on Insulin Analogues Higuchi, M. (2010). Access to diabetes care and Insulin Pumps. , and medicines in the Philippines. 2010 2010; 2010: 178372. Published online Jul;22 (3Suppl):96S-102S. 2010 May 26. doi: Kapitza, C., Hövelmann, U., Nosek, L., 10.1155/2010/178372. Kurth, H., Essenpreis, M., Heinemann, Younk, L., Mikeladze, M., Tate, D., Davis, S. L. (2010). Continuous Glucose (2011). Exerciserelated hypoglycemia in Monitoring during Exercise in Patients diabetes mellitus, Expert Rev with Type 1 Diabetes on Continuous Endocrinol Metab. 2011 January 1; Subcutaneous Insulin Infusion. J 6(1): 93–108. doi: 10.1586/eem.10.78. Diabetes Sci Technol. 2010 January; 4(1): 123–131.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 90 PROTOCOL FOR AN ONLINE RANDOMISED CONTROLLED TRIAL TO EVALUATE THE CLINICAL AND COST-EFFECTIVENESS OF A PEERSUPPORTED SELF-MANAGEMENT INTERVENTION

Ceu An Binti Ahmad

Mahsa University, Malaysia

ABSTRACT Introduction: Despite clinical guidelines recommendations, many relatives of people with psychosis or bipolar disorder do not currently receive the support they need. Online information and support may offer a solution. Methods and analysis This single-blind, parallel, online randomised controlled trial will determine clinical and cost-effectiveness of the Relatives Education And Coping Toolkit (REACT) (including an online resource directory (RD)), compared with RD only, for relatives of people with psychosis or bipolar disorder. Both groups continue to receive treatment as usual. Independent, web-based variable, block, individual randomisation will be used across 666 relatives. Primary outcome is distress at 24 weeks (measured by General Health Questionnaire; GHQ-28) compared between groups using analysis of covariance, adjusting for baseline score. Secondary clinical outcomes are carer well-being and support. Cost-effectiveness analysis will determine cost of a significant unit change (three-point reduction) in the GHQ-28. Costs include offering and supporting the intervention in the REACT arm, relevant healthcare costs including health professional contacts medications prescribed and time off (or ability to) work for the relative. Cost utility analysis will be calculated as the marginal cost of changes in quality adjusted life years, based on EuroQol. We will explore relatives’ beliefs, perceived coping and amount of REACT toolkit use as possible outcome mediators. We have embedded two methodological sub studies in the protocol to determine the relative effectiveness of a low-value (£10) versus higher value (£20) incentive, and an unconditional versus conditional incentive, on improving follow-up rates.

INTRODUCTION and support, and offered structured family Background and Rationale intervention to enhance family coping and Relatives of people with communication.8 9 psychosis/bipolar disorder (BD) provide a However, a recent national audit of large amount of unpaid care,1 2 but at high Early Intervention (EI) teams for psychosis personal cost in terms of distress and showed poor implementation: only 50% of burden,3–5 and increased use of healthcare relatives are receiving a carer-focused services.6 The UK Government recognises education and support programme; only the need to support relatives in a caring 31% offered structured family intervention role,7 and the National Institute for Health and only 12% receiving it.10 and Care Excellence (NICE) recommends Reasons for poor implementation are all relatives are provided with information likely to be multifaceted but likely include

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 91 limited time and resources within teams However, retention rates can be low,18 19 and among relatives. An online compromising internal validity of the trial. intervention to provide the necessary Offering incentives can improve retention information and support to relatives may rates,20–23 but there is considerable improve implementation. Online uncertainty as to the level of incentive interventions are well established for many required and whether the incentive should mental health conditions, including be conditional or unconditional on depression and anxiety,11 and are being completion. rapidly developed for psychosis12 and BD.13 Study Aims And Objectives Such interventions are particularly This randomised controlled trial aims suited to delivering standardised to determine the clinical and cost- information and a platform to share ideas effectiveness of the REACT toolkit (which through online forums, but cannot replace includes an online resource directory structured family interventions. Online (RD)) and treatment as usual (TAU), support is also being developed for compared with the RD only and TAU. relatives of people with other chronic This comparator was chosen to test the health conditions,14 and may be effect of offering REACT as an additional particularly useful for these groups due to intervention to what relatives are currently the flexibility of use, and empathy and able to access. The objectives are to support from being linked to other carers.15 determine the following: We have developed the Relatives 1. impact of REACT on relatives’ distress Education And Coping Toolkit (REACT) 2. impact of REACT on relatives’ well- to provide high-quality information and being and support support in an easy and free-to-access 3. impact of REACT on hypothesised online form to relatives of people with mediators of change, including psychosis or BD. If effective, it could help relatives’ beliefs, perceived coping and National Health Service (NHS) Trusts amount of use of REACT meet the national access and waiting times 4. costs associated with delivery and target for early intervention services to maintenance of REACT offer carer information and support to all.16 5. incremental cost-effectiveness ratio of Online interventions may be best REACT evaluated using online trial methodology 6. key issues for which relatives seek to enhance the external validity of the support. trial.17 Advantages of online trial design 7. We have embedded two methodological include the potential to reach a greater substudies. The objectives are to number and range of participants more determine the effect on follow-uprates representative of the population likely to of the following: use an online intervention, to recruit more 8. a low-value (£10) versus higher value people over a shorter timeframe, to offer (£20) incentive secure randomisation and data entry 9. an unconditional versus conditional simpler protocols, and for a much cheaper incentive. trial due to fewer staff required.18

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 92 The primary hypothesis is that there will Participants be a significant difference (p<0.05) Inclusion criteria between the two arms of the trial in the 1. Aged 16 or over General Health Questionnaire (GHQ-28) 2. Living in the UK scores at 24-week follow-up. 3. Relative/close friend of someone with psychosis or BD METHODS 4. Currently experiencing distress due to Trial Design their relative or close friend (scoring This is a primarily online, two-arm, ≥3 on the GHQ-28 item ‘Have you pragmatic, single blind individually recently been feeling nervous and randomized controlled superiority trial. strung up all the time’) Participant pathway through the study is 5. Currently help seeking (self- shown in identified) 6. Access to an internet-enabled Public Patient Involvement (PPI) computer strategy 7. Sufficient English fluency to One of the study investigators and comprehend intervention content coauthor is a parent of someone living 8. Only one relative per service user may with psychosis and was extensively participate to avoid a clustering effect. involved in the development of REACT, the RD and data collection processes. She Exclusion Criteria is part of the supervisory team for the As there is a parallel implementation REACT supporters. We have a Relatives’ study (called IMPART) of the same Advisory Group (RAG) working primarily intervention (http://www.hra.nhs.uk/news/ online to provide detailed feedback on research-summaries/implementation-of- REACT toolkit, online data collection anonline-relatives toolkit-impart-study), process and recruitment strategy. They relatives living in any of the six areas will be involved in analysis, interpretation where it is running will be excluded (by and dissemination of the data. Our Trial postcode). Steering Committee (TSC) includes people who are relatives supporting someone with Recruitment a mental health problem. Recruitment is scheduled from April 2017 to October 2018. We will develop a Setting: UK social media strategy using Twitter, This study will take place online in the Facebook, Google Ads and blogging, and UK. It is hosted by one NHS Foundation engage with local and national news Trust, and other Trusts and clinical media. We will recruit through national commissioning groups are eligible to take carer networks, MIND, Carers Trust, part as participant identification centres. Rethink Mental Illness, Carers UK, SANE, Recruitment will also take place through Bipolar UK and NHS Choices. These local and national mental health charities, organisations will all be listed in the RD in media, social media and Google Ads. our trial. We will work closely with the Clinical Research Network to ensure

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 93 information about the study is made number, and checks for overlap with other widely available for recruitment through participant details. A code is sent by text NHS Trusts and general practitioner (GP) message to invite the relative to access the practices. We will monitor the success of site. The data collection system requires these strategies by asking all potential email address and the registration name participants at registration (postconsent) to from the user. If any of the 7% of the UK indicate how they heard about the trial and population without a mobile phone take explore differences in demographics for part, or there are any concerns identified those entering the study via different through matching registration details, we routes. Based on previous studies our will ask for a landline and verify identity strategies to improve recruitment include a using a code delivered by telephone. We ‘lead-in’ period during which people can will use postcodes to check all participants register interest in the trial during the set- are living in the UK. We will request age up phase and be contacted directly when and gender at baseline and also at 12-week the trial starts,24 25 using online recruitment and 24-week follow-up, as a final identity strategies to target those already using the check. Similar strategies have been used internet to seek help,19 and paying successfully in previous trials.23 26 participants.20 Potential participants will be directed Interventions to the study home page Participants can access the (www.reacttoolkit.co.uk), which provides intervention site (REACT or RD) study information. People visiting the site whenever they wish throughout the period will provide the postcode of the person of the trial (minimum of 24 weeks to last they care for to check they live in the UK, follow-up for final participant). They are and not in one of the implementation study advised to use the intervention according (IMPART) areas. Those in an IMPART to the level of need. No changes are made area will be directed to the IMPART study to current treatment. site. Potential participants are directed to an online participant information sheet that Development of REACT details the study. Relatives are then asked REACT was developed with extensive to complete a short checklist to indicate input from clinicians and relatives through whether they meet the inclusion criteria focus groups27 and the RAG. The content listed above. Non-eligible relatives are was first made available in paper/online invited to leave their contact details if they pdf form, and feasibility and effectiveness would like to be sent content of the in reducing relatives’ distress were REACT modules at the end of the study. demonstrated in a randomised controlled Eligible participants complete an online trial.28 Based on further qualitative consent form and provide a valid email feedback from participants in the address. A copy of the consent form and a feasibility trial, focus groups with relatives link to the registration process is sent by exploring their views of online email (email validation step). The interventions and RAG input, the content registration process requires multiple has been updated and expanded to offer a contact details including mobile phone comprehensive online recovery focused

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 94 toolkit for relatives of people with Support is offered through confidential psychosis and/or BD. It includes online direct messaging with trained relatives support from trained relatives (REACT (REACT supporters) and peer support supporters) via confidential direct through a moderated online forum. messaging, and from other relatives Currently available national and local through a restricted access forum resources are listed in the RD. Screenshots moderated by the REACT supporters. in Figure 2 show the look and feel of the Support offered by peers with a shared REACT intervention. The REACT lived mental health experience is highly supporters are available on the site valued and can be as effective as support Monday to Friday, 09:00–16:30, excluding from health professionals,29 30 but there is bank holidays and university holiday no evidence on the effectiveness of closures. Their key role is to provide relatives’ peer support. A key advantage of emotional support and to guide relatives to this design is that relatives of people who relevant parts of toolkit and/or other refuse to engage with services can be relevant resources as appropriate. They are supported. Each of the 12 key modules also trained to moderate the forum and can contains high-quality standardised written hide posts or withdraw access in response information, videos of clinical experts or to inappropriate use. They are trained and experts by experience sharing their supervised by a clinical psychologist and knowledge and experiences to illustrate an expert relative. Participants receiving key points, and self-reflection tasks to REACT are sent reminders to visit the ensure content is personalised to the user. website after a week of inactivity. All videos of relatives telling their real Participants can change the frequency of story were retold by actors to preserve these reminder emails or turn them off. anonymity of those involved. A summary of each module. RD arm A ‘Meet The Team’ page ensures Participants allocated to RD arm log relatives are fully informed about who is into the same website, but are only able to delivering the content of the site. Logos see the ‘Meet The Team’ and RD pages. for Lancaster University, Lancashire Care At the end of the study those in RD only NHS Trust, University College London, will be given access to the modules, Liverpool Clinical Trials Research Centre without forum or direct messaging. (CTRC) and the McPin Foundation are prominently displayed on the login page. Outcomes Mytoolbox offers user a confidential space Primary outcome to save links to any information sources The primary outcome is relatives’ they may want to access easily in future, distress at 24 weeks assessed using GHQ- including specific content within the 28 with Likert scoring.1–4 31 GHQ-28 toolkit, their self-reflection tasks and showed sensitivity to change previously26 external web links. A blog page offers a 28 and has shown significant associations flexible space for additional with important functional outcomes in the communication with site users, which can general population, including GP visits,32 be edited by the REACT supporters. absence from work,33 incapacity

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 95 benefits34 and severe adverse health of other free interventions including outcomes, including deaths.35 relatives support groups and websites, so we can accurately describe current Secondary Outcomes treatment. Unpaid informal care by the Secondary outcomes include the relatives will be measured by asking relatives’ experience of caring assessed relatives how many hours of care they using the Carers’ Well-Being and Support provide supporting the person with mental (CWS) measure36 assessed at 24 weeks, health problems, and costing these on an and distress (GHQ- 28) and carer hourly basis based on national mean age experience (CWS) at 12 weeks’ follow-up. and gender-specific wage rates available CWS covers all aspects of carer’s from the Office for National Statistics.40 experience of caring for someone with a Days lost by relatives from work and serious mental health problem, including reduced hours while at work due to the relationships, roles, financial concerns, caring role will also be recorded and physical/ emotional health, stigma, worries costed as part of the CSRI. Wherever about safety, satisfaction with support possible, unit costs for medication and offered and ease of obtaining information. healthcare resources will be taken from Cost-effectiveness. national sources such as the British We will determine the cost of a National Formulary41 and the Personal significant unit change (defined as three- Social Services Research Unit (PSSRU) point reduction) in GHQ-28. Cost utility Costs of Health and Social Care.42 analysis with fully incremental analysis will be calculated as the marginal cost of Mediators Of Change any changes in quality-adjusted life years To test the proposed mediators of (QALYs), using EuroQol EQ-5D 5L,37 as change in relatives’ outcomes, we will also recommended by NICE.38 The EQ-5D-5L include Brief Illness Perception comprises five items covering the domains Questionnaire,43 a 15-item Likert scale of mobility, self-care, usual activity, assessing beliefs about psychosis/BD with pain/discomfort and anxiety/depression. an additional single item, to assess Costs will include the direct costs of perceived coping; and Brief COPE,44 a 28- offering and supporting the intervention in item measure widely used to assess coping the REACT arm, relevant healthcare care styles. We will record all activity on the costs including health professional toolkit for each individual to test the contacts, medications prescribed and time relationship between use and effectiveness. off (or ability to) work for the relative in Application Programming Interface data both arms. An adapted version. of the from the REACT site will be summarised Client Service Receipt Inventory (CSRI)39 for participants randomised to both will be used to collect online retrospective intervention groups into a small number of information about the participant’s use of variables (number of webpage downloads health and social care services, and time spent on the site). In addition to accommodation and living situations, amount of use, we will explore the nature income, employment and benefits in the of use, including qualitative analysis of preceding 6 months. We will include use forum posts and direct messages. We will

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 96 also explore potential determinants of web have multiple methods of contact for use by assessing relatives’ experiences of follow-up the intervention for the REACT group 4. send participants up to three automated only at 12-week and 24-week follow-up. email reminders at 5-day intervals, followed by text, telephone and/or Data Collection postal requests Baseline measures including 5. incentivise completion of follow-up demographic information, outcomes and measures by paying participants mediators are completed before shopping voucher(s) at each time point. randomisation. Demographic data To increase overall acceptability and collected include age, gender, ethnicity, participation rates, we will inform RD marital status, education, employment, participants that they will be able to living arrangements (including access toolkit modules after the final dependents), primary diagnosis of service follow-up. user, length of time in caring role, number Sample Size of people caring for, relationship to We aim to recruit 666 relatives of person(s) with mental health problem, people with psychosis/ BD to accurately whether or not they live with the person(s), test the primary hypothesis that there will level and type of contact, whether or not be a significant difference (p<0.05) they are receiving support from NHS between the trialarms in GHQ-28 at 24- services and internet access. Twelve and week follow-up. Our feasibility trial28 24 weeks after randomisation, all showed a mean difference in GHQ scores participants are sent an email reminder to between groups at 6 months (controlling complete the follow-up measures. At 24 for baseline) of 6.59 units (SD 16.6 units) weeks, the email content will vary in favour of the REACT arm. To build a depending on whether participants have degree of protection against pilot results been randomised to either £10 or £20 proving optimistic, and to accommodate reward and to the reward being conditional adaptations to the design of the study and (ie, dependent on completion of follow-up the intervention, we reduce our estimate of questionnaires) or unconditional (ie, the mean difference in this trial from 6.59 offered with the initial request for follow- to 5.0 units. We retain our estimate of SD up data). To maximise follow-up at the of 16.60 from the feasibility study, primary outcome point we will: consistent with other studies using this 1. only randomise participants once measure with relatives in EI services45 baseline assessment measures are and somewhat higher than those from completed other mental health or dementia 2. include detailed explanations in our services.46 47 Four hundred and sixty-six recruitment materials to explain to participants provides 90% power to reject participants why data completion at the null hypothesis (p<0.05), with effect follow-up is so important size of 5.0 units assuming 30% dropout by 3. require email, telephone and postal 24 weeks. Although dropout was only 17% contact details at registration so we in our feasibility trial, it is historically higher in online trials.19

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 97 with participants randomised to £10 or £20 Internal Pilot reward (shopping voucher) and to the Our trial includes a 9-month internal pilot reward being conditional or unconditional with the following criteria: on completion of measures to determine 1. GO: 100% or above of anticipated relative effectiveness and costs for each recruitment at 9 months (333+ reward strategy. participants) 2. AMEND: 80%–100% of anticipated Allocation Concealment And Blinding recruitment (267–333 participants); All data are self-reports and review and amend recruitment predominantly input online by participants. strategies Where data are collected by post, these 3. STOP: <80% of target for 9 months will be recorded and inputted by the trial (<267 relatives); inform funders who manager blind to allocation. Data are will determine whether to stop trial. uploaded directly to an electronic database If the SD of GHQ-28 scores at 24-week at the CTRC. The system only allows valid follow-up at the end of the internal pilot is values to be entered. To prevent any bias higher than the estimated 16.6 units, the in the conduct of the study, the chief sample size will be recalculated and investigator (FL), trial manager (HR) and recruitment targets increased accordingly. statistician (SD and PW) will be blinded to If SD is lower, sample size will remain treatment assignment. Participants, unchanged. If GHQ-28 retention at 24 REACT supporters (LC, SF, CW), clinical weeks is less than 70%, recruitment target supervisors (SoJ, StJ) and technical staff will increase to ensure 466 patients will are unblinded. To minimise unblinding provide sufficient 24-week primary any contact with participants will be outcome data to test the primary prefaced by a reminder not to disclose trial hypothesis. arm. If the trial manager is unblinded, then non-automated reminders and any data Randomization entry will be done by another blind team Eligible participants will be randomised member. Chief Investigator (FL) will be using a 1:1 ratio to ‘REACT (including unblinded only in the case of a serious RD)+TAU’ versus ‘RD+TAU’ by the adverse event deemed to be study-related CTRC. We will use web-based variable to ensure the event is appropriately block randomisation in which the unit of reported and investigated. All instances of randomisation is the relative. unblinding will be recorded. We will explore the effect of sociodemographic and caring-related Data Management Storage And variables; however, without convincing Security evidence these will have an effect, we All participant trial data are collected have not stratified randomisation. A through an online system at CTRC and second independent randomisation is stored on secure servers physically located carried out at CTRC at 24-week follow-up within access-controlled server rooms and using a randomised factorial design using backed up nightly to a separate physical the same individual block randomisation, location. All identifiable data are

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 98 encrypted using a 256-bit encryption use on the primary outcome (GHQ-28 at algorithm. CTRC servers are subject to 24weeks), as well as to test whether the penetration testing audits undertaken by mediator variables actually predict change the University of Liverpool central IT in outcome. staff. Website usage data and qualitative Mediating variables will be examined data from the REACT group and REACT individually in this exploratory analysis. supporter direct messages are taken from To assess the impact of the second the REACT toolkit hosted on a dedicated randomisation, the number (proportion) of virtual private server at Lancaster participants providing 24-week follow-up University. All communication with data will be presented and compared using website users is limited to SSL-protected the 2 test (or Fisher’s exact test, if HTTPS protocol to protect passwords and expected counts are <5). The independent data in transit over internet. impact of intervention group on retention rates will be explored by including intervention group along with value of the Data Analysis reward (or un/conditional nature of the A full statistical analysis plan is reward) as an explanatory variable in available at https:// logistic regression. figshare.com/account/home#/ projects/19975. If normally distributed, Cost-Effectiveness scores on the primary and secondary Cost utility with a fully incremental outcomes will be summarised using means analysis using an NHS perspective at and SDs for each arm separately, and will 24weeks will be done. Effectiveness will be compared between groups using be assessed by changes on GHQ-28. EQ- analysis of covariance, adjusting for 5D-5L will be used to generate QALYs. baseline score, and including all Uncertainty around cost-effectiveness participations according to the estimates will be explored using cost- randomisation scheme. If the scores are effectiveness planes (through generating a not normally distributed, the median and large number of cost–outcome IQR will be presented for each randomised combinations using bootstrapping) and group and will be compared using the cost-effectiveness acceptability curves Mann-Whitney U test. (showing the probability of the An appropriate transformation (eg, intervention being cost-effective at various log) will be applied, and analysis of levels of willingness to pay). This allows covariance will be applied to data, any uncertainty in the costs or outcomes to adjusting for baseline score. To investigate be reflected in the results presented. The the relationship between website use and NICE Health Technology Assessment outcome, data will be recorded on baseline (HTA) guidance will be followed. covariates (correlated with both website However, costs of informal support can use and outcome) and relevant website use impact on cost-effectiveness when it (from participants in both arms). constitutes a substantial part of the support Instrumental variable regression will be provided, so we will account for this by implemented to estimate impact of website also providing results from the wider

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 99 ocietal perspective including estimates of including a trials statistician, trial carers’ productivity losses. methodologist and expert relative, both funder-appointed (National Institute for Missing Data Analyses Health Research (NIHR)). The TSC will To minimise missing data, participants oversee trial progress, ensure that it is are required to complete the primary being carried out according to protocol and outcome measure (GHQ-28) before decide on continuation at the end of the completing any other measures. internal pilot. DMEC will review Participants are unable to submit any unblinded data and prioritise participant questionnaire with missing fields, thus safety, alerting TSC to any concerns avoiding missing data within regarding safety or other ethical issues. questionnaires. As much data as possible TSC will liaise directly with the trial will be collected about the reasons for sponsors (Lancaster University) who may missing data, and these will be used to audit the trial at any time. The number inform the handling of missing data. (and percentage) of patients with at least Participants will be invited to give reasons one major/minor protocol deviation will be for not responding to the email reminders. summarized by treatment group. Eligibility The baseline characteristics of those who protocol violations and multiple do/do not provide data will be compared to registrations per participant or per service demonstrate whether missing data can be user will also be reported. assumed to be missing at random (at least with respect to recorded baseline Adverse Events characteristics). Adverse events are defined as either A joint modelling approach (using low risk (clear evidence of distress or baseline, 12-week and 24-week outcome concerns of risk of harm or abuse towards data) will be used to assess the impact of participants or others, but no immediate or missing data at 24 weeks on the serious threat of severe harm or risk to conclusions drawn from analysis on life) or high risk (clear evidence of primary and secondary efficacy outcomes. immediate risk to life or child welfare). Participants are free to withdraw consent Risk can be identified through online from the trial at any time without questionnaire red flag items, posts on the providing a reason, although we invite REACT group, direct messages to REACT them to tell us why they have withdrawn supporters and by the trial manager during so that we can take this into consideration email or telephone participant contact. in future studies. Low-risk events will be discussed in supervision, documented and trigger a Monitoring standardised email expressing concern and The trial is overseen by an providing details of how to seek crisis independent Data Monitoring and Ethics support. If an immediate high risk is Committee (DMEC) including Professor identified, either the police (immediate of Trials and Professor of Clinical risk to life) or social services (risk to child) Psychology, and the TSC Chaired by will be contacted as appropriate. Risk will Professor of Clinical Psychology and be reported to the supervising clinician and

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 100 documented. The supervising clinician will Research Network including research discuss the risk event with the TSC Chair, support costs. Participants are covered by who will decide if the event is related or unrelated to the study. If related, Chief References Investigator and Trial Manager will be 1. Andrew A, Knapp MR, McCrone PR, et al. Effective interventions in unblinded, and the sponsor, ethics Schizophrenia: the economic case. committee and funding body will be Research Unit, London School of notified. The number of adverse events Economics and Political Science: and how they were identified will be Personal Social Services, 2012. recorded for both arms of the trial. 2. Buckner L, Yeandle S, Carers V. The rising value of carers' support: carers Reporting And Dissemination UK, The University of Sheffield, University of Leeds, Centre for The trial will be reported following International Research on Care. the Consolidated Standards of Reporting Labour & Equalities 20152015. Trials guideline.48 The International 3. Lowyck B, De Hert M, Peeters E, et Committee of Medical Journal Editors al. A study of the family burden of guidelines on authorship will be followed. 150 family members of schizophrenic Products will be widely disseminated patients. Eur Psychiatry 2004;19:395– through journal articles, conference 401. 4. Perlick D, Clarkin JF, Sirey J, et al. presentations and social media to all Burden experienced by caregivers of relevant stakeholders internationally, persons with bipolar affective including service users, relatives, NHS disorder. Br J Psychiatry managers and frontline clinical staff 1999;175:56–62. including GPs, clinical academics and the 5. Awad AG, Voruganti LN. The burden general public. A study website will of schizophrenia on caregivers: a review. Pharmacoeconomics provide updates and outputs from the 2008;26:149–62. study and links to all publications and 6. Perlick DA, Hohenstein JM, Clarkin presentations. Data will be stored at JF, et al. Use of mental health and Lancaster University and the Trial primary care services by caregivers of Management Group, which consider patients with bipolar disorder: a applications for access to the data for preliminary study. Bipolar Disord further analyses. 2005;7:126–35. 7. HM Government. The Care Act 2014. London: HM Government: The Financial Arrangements Stationary Office, 2014. This trial is funded by the NIHR, 8. NICE. Bipolar disorder: the HTA, 14/49/34. Contractual agreements assessment and management of are in place between the sponsor bipolar disorder in adults. children (Lancaster University), the CTRC and young poeple in primary and (Liverpool University) and University secondary care: NICE Clinical College London, and Lancashire Care Guideline, 2014. 9. NICE. Psychosis and schizophrenia in NHS Foundation Trust, which incorporates adults (CG178). Clinical guidelines. financial arrangements. The REACT trial London: National Institute for Health is supported by the Comprehensive Local and Clinical Excellence, 2014.

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“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 103 pragmatic multicenter randomised trial. Health Technol Assess 2012;16:48. 46. Chan AW, Tetzlaff JM, Altman DG, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013;158:200– 7

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) Proceeding International Seminar 104 THE EFFECT OF OXYTOSIN MASSAGE ON BREASTFEEDING PRODUCTION

Nurlita Bintari K, Martinah, Asma Hasanah

Midwifery Academy Of Wijaya Husada

ABSTRACT According to Healthy Demographic Indonesia Survey the mortality rate (IMR) is still high, 32/1,000 live births. Today is around 40% of under-five deaths occur in the first month of a baby's life, with breastfeeding reduces infant mortality by 22% under 28 days, child mortality can be prevented by early exclusif breastfeeding. So that, the knowing massage effect of oxytocin on brestfeeding production Bangunjaya’s Posyandu Cigudeg District Bogor. This research is a quasi-experiment studies is a study by conducting experiments. The research samples were 30 nursing mothers, with 15 people as controls and 15 people others as treatments. Data collection tools in this study is the observation sheet form. On the based changes in breastfeeding production to the intervention and control groups in get the p- value 0.009

INTRODUCTION expenditure is influenced by the hormone According to the Indonesian Health oxytocin. Demographic Survey (SDKI) the infant Massage or stimulation of the spine, the mortality rate (IMR) is also still high, 32 per neurotransmitter will stimulate the medulla 1,000 live births. That number only dropped oblongata directly sending messages to the slightly from the 2007 IDHS IDB, which 34 hypothalamus in the hypofiseposterior to per 1,000 live births (IDHS, 2012). Currently release oxytocin, causing the breasts to secrete around 40% of under-five deaths occur in the milk. Oxytocin massage is one solution to first month of the baby's life, with overcome the smooth production of breast breastfeeding reducing 22% of infant deaths milk. under 28 days, so that infant and under-five The purpose of this study was to deaths can be prevented through early determine the effect of oxytocin massage on exclusive breastfeeding from the time the baby breast milk production in breastfeeding is born early in life. mothers in the Posyandu of Bangunjaya At present, the number of mothers giving Village, Cigudeg District, Bogor Regency exclusive breastfeeding to their babies until the . age of 6 months is still low, which is less than 2% of the total number of women giving birth. RESEARCH METHODS Not all postpartum mothers directly express This type of research is a quasy breast milk because milk expenditure is a very experimental study, which is a study by complex interaction between mechanical conducting an experiment, which aims to find stimulation, nerves and various hormones that out the symptoms or effects that arise, as a affect oxytocin release. ASI expenditure can result of the existence of certain treatments or be influenced by two factors, namely experiments. The design of this study is to use production and expenditure. ASI production is a Non randomized pretest posttest control influenced by the hormone prolactin while group design in this design involving two

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 105 Proceeding International Seminar subjects, one given treatment (experimental (53.6%) and for the control group of 9 people group) and those not given anything (control (60%). group). Distribution of Characteristic Frequency The study was conducted at the Posyandu Responded based on Work in Posyandu Desa of Bangunjaya Village, Cigudeg District, Bangunjaya, Subdistrict of Cigudeg, Bogor Bogor Regency on June 25 to March 10, 2016. Regency shows that the biggest respondents' The population in this study was 30 mothers jobs are IRT for groups that intervene 10 breastfeeding on the 10th day to the 17th day. people (67%) and for control groups only 9 By taking the total sampling technique of people (60%). determining the sample by taking all members The results showed parity or the majority of the population as a sample so that the of children were primipara for the comparison sample in this study were 30 mothers group of 13 people (87%) and for the control breastfeeding the 10th day to the 17th day, group won 12 people (80%). with 15 people as controls and 15 others as Breast milk production before and after treatments. oxytocin massage in the intervention group in The variables of this study consisted of the Posyandu area of Bangunjaya Village, oxytocin massage and milk production. Data Cigudeg District, Bogor Regency showed the processing and data analysis using computer results of statistical tests obtained ρ-value = program SPSS for Windows 20 series. 0.02 (p-value <0.05) -0.47 after the respondent Bivariate data analysis is analyzing milk was given a massage oxytocin and the increase production before and after oxytocin massage was approved using the Wilcoxon test which in the intervention group of breastfeeding collects anything that supports improvement in mothers, analyzing milk production on the safety (p-value <0.02). To accept this 10th day and 17th day in the mother control hypothesis the Wilcoxon test was used because group breastfeeding, and analyze the effect of the production of breast milk before and after oxytocin massage on milk production in the completing was not normally distributed (p- intervention and control groups. value <0.05). The results showed what is meant by oxytocin massage on milk RESEARCH RESULT production in the intervention group with a p- Characteristics of the general description value = 0.02 (p-value <0.05). and location of the study, this research was The production of breast milk before and carried out in the Posyandu of Bangunjaya after the oxytocin massage in the control group Village, Cigudeg District, Bogor Regency. in the Posyandu of Bangunjaya Village, Distribution of Characteristics Frequency Cigudeg District, Bogor Regency showed that Responded based on the age of postpartum the statistical test results obtained ρ-value = mothers in Posyandu, Bangunjaya Village, 0.564 (p-value> 0.05) showed how to increase Cigudeg Sub-District, Bogor Regency, showed milk production by - 0.07 in 17th day and the the number of respondents grew between 20- Improvement was approved using the 29 years for groups supporting 12 people collected Wilcoxon test for which no (80%) and for groups controlled by 13 people improvement was given (p-value = 0.564). To (87%) . test this hypothesis the Wilcoxon test is used Distribution of Characteristic Frequency because the production of breast milk on the Responded based on Education in Posyandu 10th day and 17th day has an abnormal Desa Bangunjaya, Subdistrict of Cigudeg, distribution (p-value <0.05). The results Bogor Regency. shows that most of the showed that there was no interaction of respondents' education is junior high school oxytocin massage on milk production in the (SMP) for the intervention group of 8 people

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 106 Proceeding International Seminar control group with a p-value = 0.564 (p-value> breast milk production in postpartum 0.05). mothers in the Klaten Regency region with The Effect of Oxytocin Massage on Breast indicators of infants equipped with Milk Production in the intervention and additional bodies, infant BAK, and control group in the Posyandu of Bangunjaya breastfeeding infants with a p-value of Village, Cigudeg District, Bogor Regency, the 0.001. (21) results of the statistical test obtained a p-value of 0.009 (p-value <0.05). This result also b. The 10th and 17th days of ASI shows that the average milk production after production in the Control group was at being given oxytocin therapy in the the Posyandu of Bangunjaya Village, intervention group was 19 while the average Cigudeg District, Bogor Regency milk production on the 17th day in the control The results of this study indicate that group was 12, this shows an average number there was an increase in breast milk of 7 in the group given massage therapy production of -0.07 on the 17th day and oxytocin with a group not given oxytocin the increase was approved using the massage therapy. The results showed what is collected Wilcoxon test which did not add meant by oxytocin massage on milk to the sponsored increase (p-value = production in the intervention and control 0.564). To test this hypothesis the group on the 17th day with a p-value = 0.009 Wilcoxon test is used because the (p-value <0.05). production of breast milk on the 10th day and 17th day is not normally distributed DISCUSSION (p-value <0.05). Assessment of milk A. Production of breast milk before and after production can be seen from several doing oxytocin massage at the Intervention indicators such as signs of adequacy of Group in the Posyandu, Bangunjaya breast milk in infants that is not losing Village, Cigudeg District, Bogor Regency. weight more than 10% in the first week. Breast milk was 0.47 after postpartum The baby's weight will increase again and mothers were given oxytocin massage weigh the same as the birth weight on the therapy and the increase was after using the 10th day. Furthermore, the baby's weight Wilcoxon test which collected funds to will increase 200-250 grams per week. support the increase (p-value = 0.02). To (15) The results of research conducted by accept this hypothesis the Wilcoxon test Hartini (2014) at the Kasihan II was used because both before and after the Yogyakarta Health Center on the administration was not normally distributed Relationship of Mother's Education to (p-value <0.05). Oxytocin massage is ASI Production obtained p-value = 0.003 carried out for 15 minutes at least once a (p-value <0.05). These results state that day to reflex the oxytocin or the reflex is let there is a relationship between the level of down namely the stimulation of baby mother's education with breast milk sucking through nerve fibers, stimulating production. The higher the level of the back of the pituitary to secrete the education, the higher the milk production. hormone oxytocin into the blood. Oxytocin (23) For respondents in this study, the causes myoptel cells that alter alveoli and majority of education levels were junior ductuli to contract, so that milk flows from high. The importance of education level alveoli to ductuli to sinuses and nipples. (3) to the production of breast milk. This result is also supported by Suryani's study (2012) which was collected on B. The Effect of Oxytocin Massage on Breast research on the combination of oxytocin on Milk Production in the Intervention and

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 107 Proceeding International Seminar Control Group in the Posyandu of which meant there was no combination of Bangunjaya Village, Cigudeg District, oxytocin massage on milk production. Bogor Regency 3. From the statistical test results obtained p- Based on research conducted shows value = 0.009 so that it can be denied is the average production of breast milk after associated with oxytocin massage on milk oxytocin massage therapy in the production in the intervention and control intervention group of -0.47 while the groups with a p-value = 0.009 (p-value <0.05) average production of breast milk on the then Ho is rejected. 17th day in the control group of -0.07 this proved to represent an average effect the SUGGESTION production of breast milk in the group Midwives can provide counseling on public given oxytocin massage therapy with the health about midwifery care for postpartum group not given oxytocin massage therapy. mothers and postpartum visits to read danger After the Wilcoxon Test was performed, signs or problems that mothers need after the p-value of 0.009 was obtained because giving birth. the p-value 0.05) in the control groups Marmet dan Pjat Ositosin Terhadap Produksi ASI di Rumah Sakit Dustir

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 108 Proceeding International Seminar Cimahi. http://www. EKO-46k- IKE_PDF.pdf.co.id. Diunduh tanggal 15 Jurnal_eko_4.pdf.co.id. Diunduh tanggal Februari 2016, pukul 20:05 WIB. 26 Agustus 2015, pukul 21:15 WIB 24. Rusdiarti. 2012. Pengaruh Pijat Oksitosin 10. Hockenberry, M.J & Wilson, D. 2009. terhadap Produksi ASI. Rusdiarti-54k- Wong’s Esensials Of Pediatric Nursing. Jurnal_Rusdiarti_2.pdf.co.id. diunduh Phildelphia: Mosby elseiver. tanggal 20 Februari 2016, 20:10 WIB 11. Matterson. 2010. Women’s Health During 25. Hartini. 2014. Hubungan Tingkat The Childbearing Years. Mosby: St. Pendidikan Ibu dengan Produksi ASI di Louis. Puskesmas Kasihan II Yogyakarta. 12. Rosita, S. 2008. Asi untuk Kecerdasan http://www.Hartini-52k- bayi. Yogyakarta: Ayyana. Jurnal_hartini_1.pdf.co.id. Diunduh 13. Badriul, dkk. 2008. Bedah ASI. Jakarta: tanggal 21 Februari 2016, pukul 15:00 Balai Penerbit FKUI. WIB 14. Ambarawat, Eny Retna. Wulandari, Diah. 26. Rahayu. 2012. Hubungan Tingkat 2010. Asuhan Kebidanan Nifas. Pendidikan Ibu dengan Produksi ASI di Yogyakarta: Nuha Medika. Rumah Sakit Baptis Kediri. 15. Anggraeni, Yetti. 2010. Asuhan http://www.Rahayu-70k- Kebidanan Masa Nifas. Yogyakarta: Jurnal_rahayu_3.pdf.co.id. Diunduh Pustaka Rihana. tanggal 28 Februari 2016, pukul 18:00 16. Astutik, Reni Yuli. 2014. Payudara dan WIB Laktasi. Jakarta. Salemba Medika. 27. Surya. 2014. Pijat Oksitosin Untuk 17. Astuti, Sri. 2007. Pelatihan Konseling Mempercepat Produksi ASI Pada Ibu Menyusui. Jakarta: Direktur Jenderal Bina Pasca Salin Normal Di Dusun Sono Desa Kesehatan Masyarakat. Ketanen Kecamatan Panceng Gresik. 18. Depkes RI. 2009. Manajemen Laktasi http://www. SURYA-48k- Buku Panduan Bagi Petugas Kesehatan Jurnal_surya_4.pdf.co.id. Diunduh di Puskesmas. Jakarta: Direktorat Gizi tanggal 29 Februari 2016, pukul 21:15 Masyarakat. WIB 19. Jenny. Sr. 2009. Perawatan Masa Nifas Ibu dan Bayi. Yogyakarta: Sahabat Setia. 20. Hidayat, A. 2007. Metode Penelitian Kebidanan dan Teknik Analisa Data. Jakarta: Salemba Medika. 21. Endah, Masdinarsah. 2011. Pengaruh Pijat Oksitosin terhadap Pengeluaran Colostrum di RSU PKU Muhammadiyah Bantul. http://www.JURNAL ENDAH_MASDINARSAH_PDF.pdf.co. id. Diunduh tanggal 15 Austus 2016, pukul 20:05 WIB. 22. Notoadmodjo, S. 2010. Metodologi Penelitian Kesehatan. Jakarta: Rineka Cipta. 23. Suryani. 2012. Pengaruh Pijat Oksitosin terhadap Produksi ASI Ibu Postpartum di Wilayah Kabupaten Klaten. http://www.JURNAL-

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 109 Proceeding International Seminar THE ROLE OF HUSBAND IN ASSISTING WIFE WHO SUFFER ANEMIA IN PREGNANCY

Dewi Nopitasari, Bonny Priessandini

Midwifery Academy Of Wijaya Husada

ABSTRACT

Problem in anemia which is commonly suffered by pregnant women is iron deficiency due to unbalanced nutrition. A qualitative research with Ethnomethodology approach. Participants were pregnant women who are anemic with Hemoglobin levels (Hb) less than 11g/dl. 38 of participants consisting of 19 husbands as focus groups and 19 wives as triangulation group obtained through purposive sampling technique. Data obtained through the method of focus groups discussion and in- depth interview, analyzed using descriptive analysis techniques.The result showed that the husband’s role in assisting the wife who suffered from anemia in pregnancy is lacking due to lack of husbnd knowledge about anemia, its causes and how to deal with anemia in pregnancy. The conclusion is the role of husband in assisting wife in pregnancy should be supported with husband’s good knowledge about anemia, its causes and how to deal with anemia in pregnancy in order to prevent anemia in their wives’ pregnancies.

Keywords: Role; Husband; Knowledge; Anemia; Pregnancy

women have anemia in developed country. INTRODUCTION The prevalence of anemia in pregnant Anemia in pregnancy will affect the women worldwide is 38%. National data health and welfare of women. It also collection of anemia in pregnancy increases the risk of harm for mother and showed 28% prevalence. Therefore, children. Anemia in pregnancy is also anemia in pregnancy in West Java is called “Potential danger of mother and considered moderate level of health child.” Anemia contributes bad impact problem, which need to be noticed. The for pregnancy, labor, and perpurium. The prevalence of anemia in pregnancy is most common cause of anemia in pregnancy 16.7%. The prevalence of anemia is is lack of balanced nutritional higher in the rural area (22%) than in the consumption, especially iron deficiency. A urban area (19%). According to west Java wife will be able to undergo her pregnancy Demography and Health Survey, iron safely if the husband has the knowledge deficiency anemia is one of the most regarding anemia, its cause, and its common nutritional problem (TLDHS management. Their lack of knowledge 2009/10). about anemia will affect the health of their Maternal mortality rate (AKI) is wife, because the decision and action of the one of the indicator for illustrating the husband will affect the life of his wife. degree of public health. According to the The highest proportion anemia in data from United Nation Development woman both in developed or developing and Timor- Leste Government, in 2000, country occurred during pregnancy. WHO national maternal mortality rate was 660 reported 37-75% (50% average) of death for 100,000 living birth and 557 pregnant women have anemia in death for 100,000 living birth, respectively developing country and 18% of pregnant (TLDHS 2009/10). Based on these finding,

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 110 Proceeding International Seminar West Java is predicated as one of the pregnant women. However, this program country with the highest maternal mortality had not delivered a satisfying result. The in the world. High maternal mortality is proportion of pregnant women who caused by several factors, which affect consumed iron supplement during pregnancy and labor itself, either directly pregnancy increased from 43% in 2003 to or indirectly. Most of the cause of death 61% in 2009. Nevertheless, only 16% of are complications during and after labor. pregnant women consumed iron The complications are known as Classic supplement with appropriate recommended Triad of obstetrical complication dose for 90 days as reported by National consisting of hemorrhage (50.2%), Strategy on Reproductive, Maternal, eclampsia, and sepsis/infection. Newborn, Child and Adolecent Health According to Timor- Leste Demographic (NSMNCAH 2015-2019). and Health Survey, indirect causes of Pregnant women are vulnerable to maternal mortality are chronic energy several health problems, either health deficiency (27%) and anemia (28%) problem of the diseases related to (TLDHS,2009/10). pregnancy itself or another health problem According to registration result of related to unbalanced nutritional intake. kohor in 2014, pregnant women in Pasir These correspond to the role of the Mulya (Pasir Mulya Community Health husband to maintain and increase the Center), 676 out of 18,492 pregnant health of his pregnant wife so she could women have anemia. Anemia according to be spared from anemia in pregnancy. This maternal age classification: a) Age <19 year important role of the husband determined 27/507/ (5.3%); b) Age 20-34 year the health of pregnant women and reduced 632/17472/ (3.6 %); and c) Age >35 year the risk of anemia in both mother and fetus. 17/513/ (3.3 %). All 676 pregnant women The problem of this study: what with anemia are married. Therefore, the does the husband know about anemia in husband play an important role to pregnancy, what does the husband known accompany and monitor the health about the cause of anemia in pregnancy, condition of his pregnant wife. and how the husband managed anemia in Anemia in pregnancy affect both pregnancy of his wife. maternal and fetal health. This The general aim of ths study was correspond to study by Rukuni (2015), to explore the role of the husband in which found that anemia in pregnancy accompanying his wife who suffered could increased the risk of post partum anemia in pregnancy. The specific aim of hemorrhage, post partum infection, and this study was to describe knowledge of stillbirth, resulting in maternal and fetal husband regarding anemia in pregnancy, morbidity and mortality. Anemia also its cause, and its management. increases the risk of low birth weight (Karasahin, 2006; Labir, 2013; Kozuki, METHOD 2012; Budiono, 2013;). Anemia in This study used etnomethodological pregnancy is one of factor that have a strong approach. Etnomethodology is a study of correlation to Sectio Caesarea (Mulyawati et how individual create and understand al.; 2011). their daily activities. Therefore, The prevention of anemia have been etnomethodology studies social reality performed by the government through the about daily interaction. This study assessed program of iron tablet administration for the role of husbands in accompanying their

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 111 Proceeding International Seminar wife, who suffered from anemia in transcript note during the interaction with pregnancy, with the following variable: informant. husband knowledge of anemia in We conducted the study from pregnancy, its cause, and its management. January 6th 2016 until January 22nd 2018 The participants were pregnant women in West Java, Bogor. We recruited with anemia and haemoglobin (Hb) less than informant homogenously. We selected the 11gr/dL regardless of their age of pregnancy, group with higher risk who was native using purposive sampling method. We Timor-Leste husband of pregnant woman obtained primary data from focus grup with anemia as target of this study. This discussion (FGD) and in-depth interview. was intended to describe details of how Instrument used for this study was husbands accompany their anemic pegnant guideline of FGD, tape recorder, and wife. This process used patriarchy system, field notes. We analyzed the data using where the husband, as the leader of the descriptive analysis. family, decided all of things related to the We used the following inclusion health of his anemic pregnant wife. criterias: pregnant women with anemia and RESULT AND DISCUSSION Hb less than 11 gr/dL, native Timor-Leste The average age of the informants husband of pregnant woman with anemia, was 20-50 year, which is productive age. both husband and wife voluntarily agreed Productive means they work and look after to provide the information needed, and their wife during pregnancy. Educational both husband and wife were not suffering background of the informants varied from from mental disorder. The exclusion criteria elementary school, junior high school, were as follows: pregnant women without high school, and college graduate. This anemia, anemic pregnant women with no was intended to understand how far husband, non-native Timor- Leste educational background affect the husband of anemic pregnant woman, knowledge of the husband about anemia both husband and wife did not in pregnancy. We found that both husband voluntarily agree to provide information with high and low educational background needed, and both husband and wife were have low understanding regarding anemia suffering from mental disorder. in pregnancy, its cause, and its management. There were 38 participants, Occupation of the informants varied consisting of 19 husbands as focus group from merchant in the traditional market, and 19 wives as triangulation group. We driver, civil employee, private employee, selected informants according to FGD lecturer, and 4 unemployed husbands. This criteria and divided them to 6 groups was intended to understand how far based on age of pregnant women. Pregnant husbands role in taking care of their women less than 19 years of age, anemic pregnant wives are. We defined 20-34 years of age, and more than role of husband as a particular position of 35 years of age. We coded each the husband while accompanying his wife characteristic as following: A for husband in her pregnancy period, who was of pregnant women less than suffering from anemia. Anemia in 19 years of age, B for husband of pregnancy is a risky condition for pregnant pregnant women 20-34 years of age, and C woman herself and for the fetus inside her for husband of pregnant women more than uterus. The most prevalence type of anemia 35 years of age. We used code from in pregnancy is iron deficiency anemia.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 112 Proceeding International Seminar Pregnant women are vulnerable to several the health of their pregnant wife, and health problems, either health problem of makes them feels comfortable and happy the diseases related to pregnancy itself or during days of pregnancy, so it another health problem related to automatically improve their health to avoid unbalanced nutritional intake. anemia that will endanger both the mother The knowledge of husband about and the baby inside the womb. health is a significant factor that affects This study showed that husband the health of the wife. This is important, role related to knowledge of anemia in because the knowledge of the husband is a pregnancy based on each answer and form of support for the wife during analysis result on informant that is pregnancy. The good knowledge of husband (A1 through A6, B1 to B6 and C1 husband about health, especially about up to C7) grouped in 8 answer that is, first: anemia, which is caused by unbalanced anemia as lack of blood (Informants A3, nutritional intake, will make a husband A4, A5, C5 and C7), second: anemia as lack provide enough nutrition for his wife. of nutrient (Informants B1, B4, C3 and When the wife started to vomit, feel C4), third: anemia as lack of appetite nauseous, and grow weak, a husband (Informants B2 and C6), fourth: anemia as with good health knowledge would provide lack of vitamin ( informants B3 and B5), his wife a small portion of food repetitively fifth: anemia as lack of food intake to fulfil her nutritional need and keep her (informants A1), sixth: anemia as lack of healthy. Knowledge of the husband will white vegetables and water intake affect his decision and behavior. (informant A2), seventh: anemia as The role of husbands to accompany difficulty in eating and drinking and optimally look after their pregnant (informant B6), and eighth: could not wife with anemia is dependent on figure out what anemia in pregnancy is. husband knowledge regarding anemia, its Those answers showed lack of knowledge cause and how to manage the anemia, regarding anemia in pregnancy among especially in pregnant wife. With sufficient husbands. By definition, anemia in knowledge, the husband could show his pregnancy is a condition in which a optimal role that is manifested in the decrease in the number of red blood cells or behavior or looking after his wife who hemoglobin is less than 11 g/dl, which is suffered from anemia. The role husbands clearly different from the answer of the play was not solely due to the anemia in informants. their pregnant wives, but they also need to Knowledge is information that is know anemia is a disease, that affect both known or recognized by someone. the child in the womb, and the mother and Knowledge arises when a person uses not complicate labor. In addition, husbands reason to recognize a thing or event that should about the cause of anemia and has not been seen or felt before. Good what need to be done by the husband in knowledge of the husband would affect managing anemia in pregnancy. the awareness and involvement in looking To fulfill the role of assisting and after the pregnancy of anemic wives looking after their pregnant wife with manifested through improving nutrition anemia, husband needs to prepare or food of pregnant women, maintaining adequate knowledge and understanding. physical and mental health of the mother. Husband as the closest person to their wife With good knowledge, husbands have a and as a partner should accompany, improve good insight about anemia so they could

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 113 Proceeding International Seminar pay attention to, remind and choose the The study found that the role of nutrition or a balanced diet for the husbands related to their knowledge of pregnant wives, in doing so contributed the causes of anemia in pregnancy was to lowering the risk of pregnant women evident from each of the informant with anemia. Husbands armed with good answers and according to the results of knowledge of their wives’ pregnancy would the analysis conducted on the husband’s control their wives’ diet, provide extra- informants, that are (A1 to A6, B1 to B6 quality food and motivate their wives’ to and C1 until With C7) grouped into 11 diligently consume nutritious foods. To answers to the cause of anemia (A1 through support and maintain the health of the A6, B1 to B6 and C1 to C7) grouped on 11 wives during pregnancy, husbands are answers to the cause of anemia that are, expected to have a good knowledge because first: lack of rest (informants A1, A2, A4, A5, the pregnancy is not only a concern for C1, C2, C4, C5 and C7), second: lack of mothers but husbands also took an drinking water (informants A2, (informants important role in preventing trouble in A3, A4, A6 and C2), third: lack of vitamin pregnancy. Lack of knowledge containing foods (informants A4, B1, B2, undoubtedly affects maternal health B4 and B5), fourth: lack of nutritious food outcomes because husbands’ decisions and (informants C4, C5 and C7), fifth: avoid actions will affect wives’ life and morbidity. strenuous work (informants B1, B5 and The result of the lack of husbands’ B6), sixth: lack of eating (informants C1, knowledge about anemia in C2 and C3), seventh: the husband gives pregnancy is strengthened by study attention (informants B2 and B3), eighth: conducted by Purbadewi (2013), who (informants C3 and C7), ninth: lack of found that people who have less appetite (informants C2 and C6), tenth: knowledge about anemia, such as economic condition (informant C1), understanding about its definition, its eleventh: too much television (informant cause, signs and symptoms, complication, C2). These answers indicated that as well as about health behaviors to husbands’ knowledge regarding the causes prevent the occurrence of anemia, were of anemia in pregnancy was lacking, it was less likely to avoid anemia in pregnancy. clear between the husbands’ answer and the This study was also reinforced by actual cause of anemia, which is generally Ramadani (2011), who showed higher caused by a deficiency of balanced nutrition, anemia incidence in people with less especially iron deficiency in foods, than knowledge level (73,1%) than those with other factors such as diseases. good knowledge (26,9%). That husbands knowledge about We believed that during this time cause of anemia in pregnancy was lacking, period, husbands have not played an was reinforced by of Ekowaty (2007), who optimal role in accompanying pregnant found that husbands have not play an wife, and the anemia in pregnancy was optimal role in maintaining nutritional caused by husbands’ lack of knowledge status of pregnant mother. Our about anemia in pregnancy, so husband interview and observation found that do not have good knowledge in choosing many husbands do not properly understand foods rich in iron, protein, vitamin C nutrition needed during the process of from fruits and vegetables that are very pregnancy and other types of nutritious important for the health of pregnant foods. Similarly, Purbadewi (2013), wives to prevent anemia in pregnancy. reported that people with less knowledge

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 114 Proceeding International Seminar about anemia will behave negatively, while contain lots of iron such as: eggs, milk, fish, people who have good knowledge will liver, fish, meat, beans (tempeh, tofu, behave positively in to prevent or treat soybeans, green beans) dark green anemia. This caused those less vegetables (kale, spinach, katuk leaves) and knowledgeable to prepare food both less fruits (oranges, guavas and bananas) in quality and amount. (Syafrudin, 2011). We argue that husbands have not The study revealed that husbands’ little been playing an optimal role in knowledge about how to manage accompanying their wives who were anemia in pregnancy will affect the pregnant and anemic, because the health of wives especially anemia caused husbands’ knowledge about the cause of by unbalanced nutritional intake. anemia in pregnancy was lacking, so Therefore, husbands have been providing husbands did not pay attention to their insufficient support by not providing wives’ diet, leading to wives easily getting enough nutrition for their wives. anemia in pregnancy. The study also found that during The study found that the role of pregnancy, the foods consumed daily by husbands related to husband’s knowledge the pregnant mother/wife were about how to manage anemia in pregnancy unbalanced. They were especially eating was evident from each husband’s answer less fruits and animal protein that contain and according to the results of analysis lots of iron, potentially leading to high conducted on the husband’s informant prevalence of anemia in pregnant woman. namely (A1 to A6, B1 to B6 and C1 up to Based on FGD results with informants, the C7) grouped into 11 (eleven) answers on average wife said that: how to treat anemia, first: preventing overwork (informants A2, A3, A4, A6, B5, “Meat and fruit eat once in a while. Every B6 and C6), second: provide vitamins- day only eat rice and vegetables” containing food (informants A4, B1, B2, B4 and B5), third: buy fruits (Informant B3, The result that husbands’ were C2 , C4 and C5), fourth: provide nutritious lacking knowledge about the ways and food (informants C2, C4 and C7), fifth: help practices to manage in pregnancy was in preparing meal (A5, B6 and C6), sixth: supported by Purnadhibrata (2011), invite wife for a walk (informants A3 and which stated less energy and protein A4), seventh: provide enough food consequently decreased work productivity, (informants C1 and C5), eighth: avoid as the body became weak because iron stress (informants A4 and C1), ninth: buy could not be absorbed perfectly due to vegetables (informant A3), tenth: wash limited availability of heme in protein. To clothes (informant A5) and eleventh: keep the nutritional content consumed by refrain from drinking coffee and tea the pregnant wife fulfilled, the role of (informant C3). These answers showed the husbands was to remind and choose the husbands’ knowledge of how to deal with right daily diet for wives. Essential anemia is lacking. It was clear between nutritious foods necessary for the wife the answers of informants and the actual during pregnancy through daily diet treatment of anemia and ways to prevent it, include calories, protein from vegetables which among others are, improving the diet and vegetables, and vegetables and fruits of pregnant women, for example by that contain lots of vitamin C. Adequate increasing consumption of foods that

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 115 Proceeding International Seminar nutrition could be obtained by consuming CONCLUSION various types of food every day. Our study concluded that the role The result that husbands’ were of the husbands in accompanying their lack in knowledge about ways and practices wives who have anemia in pregnancy was of anemia treatment in pregnancy was still lacking. This was due to lack of supported by Wardyani (2012), who found knowledge about anemia, it causes and it that 44, 1% of husbands did not know management in pregnancy. We have a few about the wives’ diet during pregnancy. suggestion in this study: First: Health Another relevant study also found that Institution should improve maternal and 44.9% of husbands failed to provide child health program by involving husband nutritious food to their pregnant wives. during pregnancy examination in the Kwopong (2012), found that the cause of examination room so husbands can pregnant women easily developing anemia understand the cause and how to solve was poor diet (63%). every problem. Health Institution should The result that the husbands were increase the dissemination of information lacking in knowledge regarding the ways about anemia in pregnancy to married and practices of anemic management in couples, through health promotion pregnancy supported by Ishak S (2005), activities both through print and who studied involvement of husbands in electronic media as well as Personal the nutrition or diet of pregnant women Medical Treatment/ Konsulta Saude and found that of 96 study subjects or Pesoal (KSP), so couples (husband and husbands inquired, 74 (77,1%) reported wife) could learn about anemia and how paying attention to dietary intake of wife to manage it in pregnancy to prevent the especially during pregnancy, while 22 occurrence of anemia in wives. Second: (22,9%) others say not too concerned with Maternal and Child Health Officers at Pasir state of nutrition during the pregnancy of Mulya (Puskesmas) should provide their wives, it means nutrition or good counseling nutrition education and food during pregnant wife or not pregnant prevention of anemia in pregnancy to is no different. This research is in line with anemic pregnant mother along with her the study by Umami (2007), which found husband and that pregnant women that most respondents (55,1%) provide consume foods high in iron and regular Fe nutritious food for their wives but many tablet consumption during pregnancy. (44,9%) still do not provide nutritious food Third: The husband’s active role in for their wives. seeking information about anemia, causes We believed that husbands’ and ways of handling anemia in pregnancy knowledge of the ways and practices of by asking health workers, when anemic management in pregnancy is accompanying the wife to conduct lacking that husbands did not know how pregnancy checks in health facilities would to treat their wives with anemia by help husbands understand and have improving menus and increasing effective measures to help their wives. consumption of foods containing plenty of iron from animal and vegetable proteins, green vegetables, and fruits.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 116 Proceeding International Seminar REFERENCES National Strategy on Reproductive, Budiono, I. 2013. Pengembangan Model Maternal, Newborn, Child and Indeks Pembangunan Gizi. Jurnal Adolescent Health (NSMNCAH 2015 KEMAS, 8 (2) : 166-175. – 2019). Departemen Kesehatan ibu Ekowati, W., Kamaluddin, R. & Febriani, dan Anak. Jawa Barat. S. 2007. Peran Suami Purnadhibrata, M. 2011. Upaya Pencegahan DalamPemeliharaan Status Gizi Ibu Anemia Gizi Besi Pada Ibu Hamil. Hamil di Wilayah Kerja Puskesmas Jurnal Ilmu Gizi, 2 (2) : 118 – 124 Baturaden Kabupaten Banyumas. Purbadewi dan Ulvie.2013. Hubungan Jurnal Keperawatan Soedirman, 2 (2). Tingkat Pengetahuan Tentang Anemia Ishak S, dkk, 2005. Keterlibatan Suami Dengan Kejadian Anemia Pada Ibu Dalam Menjaga Kehamilan Istri di Hamil. Jurnal Gizi Universitas Puskesmas Kecamatan Kuta Alam Muhammadiyah Semarang2, (1). Banda Aceh, Provinsi Nangroe Aceh Ramadani, M., Mayoritha dan Darrusalam. Buletin Penelitian Sistem Fitrayeni. 2011. Penyebab Kejadian Kesehatan, 8 (2) : 10. Anemia Ibu Hamil di Puskesmas Karasahin E., et al, 2006. Maternal Seberang Padang KotaPadang. Jurnal anemia and Perinatal out Come. Kesehatan Masyarakat, 6 (2) Perinatal Journal, 15 (3) Kwopong. Rukuni et al. 2015. Maternal and 2012. Anaemia awareness, beliefs Neonatal Outcomes of Antenatal and practices among pregnant women: Anemia in a Scottish Population: A baseline assessment at Brosankro a Retrospective Cohort Study. Acta community in Ghana. Journal of Obstetricia et Gynecologica Natural Sciences Research, 3 (15) Scandinavica, 95 (5) : 555–564 Kozuki, N., Lee, AC., & Katz, J. 2012. Umami dan Puspitasari. 2007. Peran Moderate to Severe, But Not Mild, Suami Selama Proses Kehamilan Maternal Anemia Is Associated With sampai Nifas Istri. The Indonesian Increased Risk Of Small-For- Journal of Public Health, 3 (3) Gestational-AgeOutcomes.Department :101-107. of International Health, Johns Hopkins Wardyani, Kusumawati, & Firnawati. School of Public Health, Baltimore, 2012. Hubungan Antara MD, USA. The Jornal of Nutrition, Pengetahuan Suami Dengan 142 (2) : 358-362 Partisipasi Suami Dalam Labir, Widarsa dan Suwiyoga. 2013. Menghadapi Kehamilan Dan Pengaruh Anemia Ibu Hamil Trimester Persalinan Isteri di Kecamatan I dan II Meningktakan Resiko Polokarto. Jurnal Penelitian Kejadian Berat Badan Lahir Rendah di Kesehatan Suara Forikes, 2 1-8. RSUD Wayanga Denpasar. Public Health and Preventive Medicine Archieve, 1. Mulyawati, I., Azam, M. & Ningrum, D. 2011. Faktor Tindakan Persalinan Operasi Sectio Caesarea. Jurnal KEMAS 7 (1) : 14-21

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 117 Proceeding International Seminar TRADITIONAL BIRTH ATTENDANTS (TBAs) POSITIONING ON STRENGTHENING PARTNERSHIP WITH MIDWIVES

Salsalina Yuniarti G, Defri Lesia, Efra Farwati

Midwifery Academy Of Wijaya Husada

ABSTRACT

Background of this research was the still high number of infant mortality and high use of Traditional Birth Attendants (TBAs). The This study aims aimed to determine TBAs positioning on the effort of strengthening partnership with midwives. A number of pregnant women, TBAs, and midwives become became informants, through in-depth interviews and focus group discussions. The results showed positioning TBAs still needed with different roles but side by side with midwife role, used by primi and multi pregnant women before and during pregnancy, during and after birth. The requirement forrequirement for TBAs was derived from parents as a cultural heritage, whereas the requirement for midwife obtained was from formal and non- formal information. The TBAs services toward maintain family health care including include cultural events. The midwife is givingserved professional servicescare. The partnership includes clients registration, motivation, abnormalities early detection. There has had been an unwritten financing unwritten agreement. The TBAs midwife partnership needs to be strengthened through legislation and , communication to diverse audiences in order to form the right positioning.

Keywords: positioning; TBAs; midwife; partnerships.

INTRODUCTION Research in 2010 showed a year before the survey, Maternal and Child Health (MCH) only 82.2% of births was assisted by health problems in Indonesia Health Demographic personnel. Furthermore, just 55.4% of deliveries Survey in 2012 published by Kementerian took place in health facilities and Kesehatan Indonesia showed that Maternal 43.2% of birth took place at home where Mortality Rate (MMR) was 359 per 100,000 51.9% was assisted by midwives and 40.2% was live births and Infant Mortality Rate (IMR) assisted by Traditional Birth Attendants was 32 per 1,000 live births. This had become a (TBAs) (Badan Penelitian dan Pengembangan critical condition, because according to the Kementerian Kesehatan RI, 2013). Millennium Development Goals, the MMR Kementrian Kesehatan Indonesia was expected to decline to 102 per 100,000 (2009), stated that current policy expected that delivery program was carried out by health live births and IMR to 23 per 1,000 live births professionals in health facilities. The results of the (BKKBN, 2013). research in 97 countries stated there was a Riset Kesehatan Dasar (2013), published significant correlation between assisted deliveries by Kementerian Kesehatan Indonesia showed and maternal mortality. The increase in deliveries by that there are differences between K1 visit health workers in the region will be followed by a (pregnant women receiving Ante Natal Care decrease in maternal mortality in the region amounting to 81.6% and K4 (pregnant women (Kementerian Kesehatan Indonesia, 2009). receiving ANC from first trimester to third Banjar village is one of the villages in trimester) amounting to 70.4 %. The data showed Banjar, West Java Province that despite its status there was a discontinuity in ANC that met the of urban village in the city, its rural atmosphere minimum standards (K4) of 12%. Basic Health was still thick in the culture of daily life. Record

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 118 Proceeding International Seminar of midwives activities at Banjar Health Center of strengthening partnership with midwives 2014 showed that the number of household in to support the achievement of Maternal and December 2018was 4,834 households and the Child Health (MCH) program. The specific number of pregnant women was 353 people. purpose of this study was to understand the There are three TBAs who lived and practiced reception/acceptability picture of the TBAs in Banjar village, the coverage of pregnant services versus midwives among primi and women fourth visit (K4) in December 2018 multi pregnant women, to know the TBAs role was only 79.3% of the target of 90%, with birth in maternal and child health care during pre- coverage in the health care facilities at pregnancy, pregnancy, during and after birth, 84.6%. The coverage of third newborn baby and to recognize communication or promotion visit (KN3) was only 86.4%. The data still patterns of TBAs positioning. showed that 20.7% of pregnant women have The benefits of this study was the gaining not obtained the appropriate standard ANC of information about TBAs positioning as a services 4 times, whereas newborn babies not partnership development decision making receiving services according to the standard policy, the gaining of information about three times was 15.4% .TBAs positioning maternal and child health services needs that study in Sampang (Laksono, 2014), suggested are expected to be considered by health policy the need for services of TBAs was an makers, the understanding of picture reception/ integral part of Sampang people’s lives. acceptability picture of TBAs services versus TBAs are part of the culture of health midwives among primi and multi pregnant services for mothers who could not be women which would give the material on how simply replaced by modern health care policy. the pattern of service and partnership schemes In the other hand, three delay model to be developed. (Fibriana,2010) ,in maternal mortality cases The results of data collection can be found 26.7% of first helper was not health used as an ingredient to make design of worker. The same study (Sari, 2016), showed interventions (not included in the scope of this that neonatal mortality correlated with study, it can be studied as advanced research) antenatal and postnatal care. This prompted in the form of the formulation of the strategy the researchers to evaluate the TBAs implementation pattern of Segmenting, positioning in Maternal Child Health (MCH) Targeting and Positioning (STP) of TBAs in care. the context of a partnership with midwife in The researcher did not have health supporting the MCH program. The other hand ethnographic data of Banjar village, but referred to marketing strategy formulation through to the study mentioned above as well as a the marketing mix for the development of preliminary study in Banjar, and found that the community behavior related TBAs positioning presence of TBAs was still utilized by the women, within the framework of the partnership especially related to maternal and child health. This strengthening with a midwife. The following compelled a study to be conducted, evaluating TBAs positioning on partnership strengthening can be used to formulate development patterns with midwife in Banjar Village. The main of the TBAs positioning within the framework problems were lack of deliveries assisted by skilled of a partnership with midwife in supporting the health personnel and lack of ANC coverage. The MCH program. formulation of the research problem was: How TBAs positioning improved partnership METHOD strengthening with midwife in Banjar village? The stages of this study were preparation, The study’s general objective was to which includes the preparation and submission determine TBAs positioning on framework of research proposals; implementation, which

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 119 Proceeding International Seminar include preparing research permit, data is a person who is considered skilled and collection, processing and analysis of data, trustworthy by the community to help preparation of reports; and completion of childbirth and maternal and child care reports and dissemination of results. according to the needs of society. (3) The The study took place in Banjar midwife is a woman who graduated from village at Banjar City West Java Province, midwife schools which have appropriate with the considerations that cultural legislation. In performing its duties, communities were still rustic despite its status midwives can practice independently and/or of administrative territorial city, the village work in health facilities, is authorized to still had three active TBAs, and MCH provide care, and should assist government programs coverage was still low. Most TBAs programs. Midwives play an important role studies were conducted in rural areas, in maternal and child health programs, either although the existence and role of the TBAs as civil servants or practicing independently were mostly in urban or semi-urban areas. in the form of Midwife Private Practices care Variables observed by TBAs positioning facilities. Midwives are authorized to provide in framework behavior of pregnant woman maternal and child health services and attend include attitudes, subjective norms, behavioral to women’s reproductive health and family control, behavioral intentions, and TBAs planning services. (4) Partnership is an effort positioning related communication behavior to build unity in order to perform an activity pattern. towards the goals based on principles of The following conceptual limitations equality, openness, and mutuality. Partnership were related to the topics and scope of the study. of midwife with TBAs is a form of cooperation (1) Positioning is a term in social marketing. between midwife and TBAs and is mutually Based on Kotler and Eduardo, positioning is beneficial with the principles of openness, a process of designing an image or value of a equality, and trust in an attempt to save the product or service as well as the marketing mother and the baby by placing midwives as mix in order to create a certain impression birth attendants and change TBAs from birth in the memory of consumers to understand attendant to become partners in caring for and appreciate what you do. In this study, according to the agreements made between the the products that will be formulated in midwife and TBAs and involves all the elements TBAs positioning is the image of the service existing in the communities. Strengthening that will be offered by TBAs, developed based partnership is an effort by the establishment on culture. (2) Indungbeurang or paraji is for an optimal partnership, which in this study TBAs term in Sundanese language, the same was to seek partnerships between midwives as dukun bayi and TBAs, with role-based TBAs local culture in Bahasa Indonesia which means to support the achievement of maternal and someone who assists birth and baby care. child health program (Kementerian Kesehatan This means, TBAs take care of mothers Indonesia, 2009). giving birth and help take care of the baby. The following was a conceptual TBAs is a member of the community, framework of the study. Study design was commonly a woman, who gained the qualitative descriptive with phenomenological confidence and skill in attending births approach. The study’s population is all of traditionally, acquired inherited learning with pregnant woman and TBAs as well as civil practice or by any other way that leads servant midwife who served in Banjar village towards improvement of the skills of during the study period and fulfilled the midwives and through health workers. TBAs inclusion criteria. Pregnant woman selected

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 120 Proceeding International Seminar purposively were six people. A total three staged together. Validity of research was tested TBAs were still active on duration of the by considering the credibility, transferability, study. Civil servant midwife were three people dependability and confirmability or who served in Banjar village. objectivity. Credibility of the data was tested Samples were selected purposively through extending observation, increasing pregnant women, which is mothers newly endurance, and triangulation in the analysis. pregnant for the first time or more. The Presentation of the results to the relevant number of samples of first time pregnant was stakeholders was an implementation of the three women and a second time pregnant or principle of member- check and research more, also three women. Determination of the permits need to be obtained from the agency number of samples was based on the saturation that handles research permits at Banjar City. of the data obtained on the third sample data collection. RESULT AND DISCUSSION Data is collected through in-depth Term of TBAs used have same meaning interviews of pregnant woman and TBAs with term of paraji or indungbeurang. as well as focused group discussion with TBAs or paraji is a term society especially midwife, conducted by researcher with pregnant women. TBAs 1 stated as: university students. The research instrument was developed appropriately with theoretical ”.. aya aya nu nu nyebat paraji construct of mother’s behavior (attitudes, nyebat indungbeurang ...”. subjective norm, behavior control, behavior intention) related to the selection and According TBAs, they worked utilization of TBAs and midwife services, and it voluntarily, for Allah. TBAs do not choose was deepened appropriately by probing during clients, they provide service throughout the the study. day, all the time. TBAs ask permit from their The data analysis includes process of husband at the beginning and the others after describing, classifying, and connecting. Stages their husband died. include making field notes accompanied by Midwives were delightedly selected by audio recordings and photographs, writing a community and were perceived as trustworthy complete transcript from the audio recordings, and must be maintained. If the mother does performing data classification with data not come back to be served, midwife must be reduction, making the code as well as themes introspective. Midwives often feel bored, but and categorization, analyzing components to they do not stop the practice. If it coincided with determine meaningful components, presenting data personal activities, their duty takes priority. into patterns, making conclusions construed in accordance to findings of study themes. Based on the above findings, the midwife and Supervision of data quality performed TBAs declared to bear the responsibility and with standardization of interviewer that the the mothers cared fo is important and continue researchers themselves by conducting in- to maintain the accepted trust. depth reviews and focus group discussion Furthermore, position of TBAs utilized that the techniques was formulated together. primi pregnant women (pregnant for the first The following data processing and analysis time) and multi pregnant women (pregnant a were performed by the researchers themselves second time or more) have different but side by by constantly monitoring the data quality, side with the midwives role, that is; since pre- accuracy, and completeness. Transcripts of data pregnancy, during pregnancy, during birth, to be further studied with the analysis were and after birth (postpartum). Primi pregnant

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 121 Proceeding International Seminar women has intention to use the TBAs against sexually transmitted diseases - STDs, service after being offered by her mother, her gathering speech in preparation for referral) in mother in-law, and her husband; they take the Integrated Health Service Post (Posyandu) or offer and feel happy to be cared for by TBAs. Midwife Private Practice by a midwife. Pregnant woman 2 said: TBAs served activities like 4 monthly events sawaka7 monthly event, adjusting “… ku mamah, ku suami, kan biasa the womb, counseling to the midwife and kitu di dieu mah ka emak paraji ongkoh k posyandu. Birth was assisted by a midwife and amedi songkoh kitu” was accompanied with stroking, massaging the mother and taking care of the baby after birth Multi pregnant women have intention to by TBAs. Post-birth services are visits at home use the TBAs service based on their own choice; until the whistle, weighing, immunization they feel confident and comfortable with by a midwife, bathing the baby up to 7 days, TBAs care. Pregnant women 4 said: massaging up to 40 days, the event adus wiladah, sawer and kokocok panangan events “ ….ah henteu kapaksa”… “muhun, by TBAs based on mother request. TBAs said da kedah sareng ema kbeurang muhun kitu” she never offer to do these events. Pregnant “henteu sih ari kepaksa mah ....”. woman 4 said:

Pregnant women primi or multi, Opat sasih sareng tujuh ngaos paling intends to use the services of midwife on the “…. ” “ ge” … “didieu mah sok nyandak minyak sareng basis of their own choice and by not forced hayam di ieukeun”… “kaditu sih ayamna the engke and is satisfied due to growing knowledge teh di kadieukeun, sampean nateh di tapelkeun ka as counseling was also given. There were patuangan, kana perutna” …“duka, da itu kantos differences in maternal behavior concepts tradisi, da nurut we kedah kumaha-kumahana”… between primi and multi, where all of primi “nyapanginteun sawaka tujuh sasih..”. Furthermore, pregnant women were having influence from pregnant woman 6 said: “… kan ku ibu bidan the others, especially family. Whereas multi lahiranana ngan aya emak paraji…” andalso said pregnant women were more willing, based on a “...sasarengan bidan paraji “…“perasaana the previous pregnancy experience where they kumaha nya,? (Confused face). Tenang weh muhun. Aya nu ngabantos kitu feel satisfied and comfortable by TBAs care. …”. Primi and multi pregnant women receive TBAs services or midwives through These findings suggest that midwife with different concepts. Maternal Child Health TBAs could be synergic and complement each (MCH) services for pregnant women were other in providing services since pre-pregnant conducted side by side by TBAs and until post-pregnant in MCH services. This midwife.. broke people’s mindset that TBAs would be Midwife services in pre-pregnancy complicated and could impede the achievement consist of family planning and reproductive of MCH services targets. The 4th pregnant health counseling while TBAs served pushing woman suggests she will use both of them in of uterus and nutrition advice. Care for the future pregnant women includes; examination of 5T (weight and height measurement, blood “…upami ayeuna kan hamil deui, engk pressure measurement, fundus uteri height eupami bade ngalahirkeun, bade nyuhunkeun measurement, immunization of Tetanus Toxoid, tulung deui ka siemak. Bade duanana.. ”. provision of iron tablet) or 7 T (5 T plus test

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 122 Proceeding International Seminar Related to the role of TBAs and significant others play a more important role, midwives, research reports low exclusive because, the strong emotional bond make breastfeeding, as well as lack of knowledge of information more acceptable. Thus, it is mothers about breastfeeding (Sriningsih, important to foster a positive environment 2011). Provision of early initiation of around breastfeeding so the information breastfeeding and exclusive breastfeeding is received is able to promote the establishment very important in the efforts to reduce infant of exclusive breastfeeding (Wibowo, 2016). mortality. It is necessary to attempt to increase TBAs can be directed to become one source the role of TBAs and midwives in the form of information about the importance of early of individual counseling about the initiation of breastfeeding and exclusive importance of early initiation of breastfeeding breastfeeding. and exclusive breastfeeding to pregnant women. The meaning of in-depth interview about This is to support the research that knowledge a partnership and plan ahead on partnership, is and mother attitude is significantly associated summarized in the chart 4. with early initiation of breastfeeding practices TBAs midwife partnership includes and exclusive breastfeeding (Raharjo, 2014), client recording, and motivating to give birth previous finding also report that knowledge of by health personnel in health facilities to mothers about breastfeeding was significantly increase coverage. Early detection of disorder associated with exclusive breastfeeding and early referral occurred because TBAs stay (Sriningsih, 2011). relatively close to the pregnant women. Another reason that could be considered TBAs is to make TBAs as partner of midwives in the midwife partnership scheme in the implementation of the maternal class or as future is a pattern of health care as well as initiators and instigators of the Mother Support financing maternal child health with the Group to improve exclusive breastfeeding. development of government policy. Their This is in line with the results of research that cultural and religious events, in which the reported mothers knowledge and attitudes of TBAs were involved, could be encouraged to exclusive breastfeeding who followed the be filled with maternal child advice. It is Mother Support Program was significantly important because TBAs advice tend to be higher than mothers who do not follow the heard by pregnant woman and families. program (Ichsan, et al., 2015). TBAs need to The existence and role of TBAs support be addressed as instigators in the Mother was in line with research at Sampang district Support Group to improve exclusive where TBAs play a major role during pregnancy, breastfeeding to encourage mothers to give during birth, and especially postpartum exclusive breastfeeding. (Laksono, 2014). Besides, these TBAs role was Information support for breastfeeding not only in infant and maternal care, but also mothers is very important; a study suggested in the psychological aspects such as providing that information support is very important advice on infant care as well as what to do and for pregnant and nursing mothers in exclusive what to avoid (abstinence). So big the role of breastfeeding. Breastfeeding mothers can obtain TBAs, was that any advice said by TBAs would it from various persons, namely of those definitely be implemented. It was have a bad affected (significant others), health impact if knowledge transferred by TBAs for professionals, health facilities and Community patients was in contrast with medical advice. Public Health Efforts. Important as well is the The research suggest that the presence of ease and completeness of the information to TBAs who was trusted by citizens need to be exclusive breastfeeding. Information on embraced and they need to be given additional

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 123 Proceeding International Seminar knowledge related to maternal and infant and monitoring the growth of children (Lubis, health, as well as a partnership with a health 2015). worker to help the success of health Similarly, in the position as leaders in the programs. This is also in line with a study community, TBAs can contribute by motivating (Anggorodi, 2009), which states that the community activity. Study showed that the partnership is one of the solutions to reduce relationship between the family support and the maternal and infant mortality problem that community leaders support the activeness of will mainly benefit remote areas where the population utilizing the non-communicable access to health services is very limited. diseases integrated post (Umayana, 2015). In terms of the financing, an unwritten Young mothers stated they received agreement was found between the TBAs, information related to pregnancy at school, but midwife, and birth mothers. There is no evident inadequate. Communication in the community feud between TBAs and midwife related to needs to be improved to encourage public salary. awareness about the existence and necessity of TBAs role tend to be related to family partnership between TBAs and midwife. health care services as well as cultural and The patterns were described in chart 5. religious events. The role of the midwife is Sustainable TBAs utilization depends of as a professional service appropriate with cultural communication related TBAs in authority possessed by appropriate profession. society, whether derived or abandoned. Requirement for TBAs was passed down from Partnership between TBAs and midwife parents as cultural heritage, supported by was proven to run well, harmonies, side by communication between neighbors, groups side and accepted by society. TBAs midwife in society such as groups of pregnant women, partnership policy should be strengthened savings and loans (arisan) groups, and prayer through legislation as well as communication groups. In the other hand, requirement for by any methods and media with various midwife was obtained from formal and informal target audiences in order to ensure right information and includes TBAs and positioning, harmony, and healthy partnership midwife can be formed as well as addressing the communication done at monthly positive changes toward the benefit of life. meetings in villages and posyandu as well as TBAs midwife partnership was maintained interpersonal relationship that was initiated with the principle of equality, openness, and by midwife (ngahayap) to make teamwork in mutual benefit. MCH care become better. Here is the core message of TBAs About the role of TBAs in the future, positioning in order to strengthen the the training for TBAs have an emphasis on its partnership with the midwife. role as a motivator and source of information about family health care. Training needs to be CONCLUSION managed with the right materials and the right Traditional Birth Attendants (TBAs) way, given that TBAs generally have aged so it services were still accepted by people, could be difficult to receive information that is particularly pregnant women. TBAs were still lecture only. Although in a different context, needed by pregnant women with different roles but equally as a motivator and resources in the but side by side with the role of a midwife. community, the success of the training is shown They provided care before pregnancy, during by research on the effects of training on the pregnancy, during birth and after birth knowledge and actions of cadres in assessing (postpartum). Communication related to TBAs partnership with a midwife for Maternal

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 124 Proceeding International Seminar Child Health (MCH) care begin within the Lubis, Z. & Syahri, I.M. 2015. Pengetahuan family, between neighbors/community groups dan Tindakan Kader Posyandu dalam as well as formal and informal Pemantauan Pertumbuhan Anak Balita. communication. The core message of TBAs Jurnal Kesehatan Masyarakat KEMAS, 11 (1): 65-73. positioning in order to strengthen the Raharjo, B.B. 2014. Profil Ibu dan Peran partnership with the midwife is TBAs and “ Bidandalam Praktik Inisiasi Menyusu Midwife partnership for Family Health Care Dini dan ASI Ekslusif. Jurnal Kesehatan began before and during pregnant, help Masyarakat KEMAS, 10 (01) : 53 – 63. midwife assist birth process, accompany the Sari, I.P., Ardillah, Y,, Widyastuti, T.A. children grown up for Healthy Family 2016. Welfare”. The Determinants Of Infant Mortality In It is required to strengthen the Neonatal Period. Jurnal Kesehatan knowledge and skills of TBAs in maternal Masyarakat KEMAS, 12 (1) : 139-149. child health care without leaving their culture Sriningsih, I. 2011. Faktor Demografi, Pengetahuan Ibu tentang Air Susu Ibu dan Pemberian and utilization to enhance the role of TBAs ASI Ekslusif. Jurnal Kesehatan Masyarakat is maternal child health motivator. TBAs KEMAS, 6 (2) : 100 – 106. midwives partnership policy need to be Umayana, H.T. & Cahyati, W.H. 2015. Dukungan strengthened through legislation including Keluarga dan Tokoh Masyarakat terhadap financing, as well as communication through Keaktifan Penduduk ke Posbindu Penyakit a variety of methods and media targeting Tidak Menular. Jurnal Kesehatan various audiences in order to make Masyarakat KEMAS, 11 (1) : 96 – 101. partnership positioning TBAs with midwives Wibowo. M. 2016. Dukungan Informasi bagi Ibu that is right, harmonious, and healthy can be Menyusui dalam memberikan ASI formed. Ekslusif di Kecamatan Gondokusuman Yogyakarta. Jurnal Kesehatan Masyarakat KEMAS, 11 (2) : 241-248. REFERENCES Anggorodi, R. 2009. Dukun Bayi Dalam Persalinan Oleh masyarakat Indonesia. Jurnal Makara Kesehatan, 13 (1) : 9 – 14. BKKBN etc. 2013. Survey Demografi dan Kesehatan Indonesia 2012. Badan Penelitian dan Pengembangan Kesehatan kementerian Kesehatan RI. 2013. Riset Kesehatan Dasar 2013. Fibriana, A.I.& Azam. M. 2010. Three Delay Model Sebagai Salah Satu Determinan Kematian Ibu di Kabupaten Cilacap. Jurnal Kesehatan Masyarakat KEMAS, 6 (1) : 16-23. Ichsan, B. etc. 2015. Keefektifan Program Kelompok Pendukung Ibu dalam Mengubah Perilaku Ibu Menyusui. Jurnal Kesehatan Masyarakat KEMAS, 10 (2) : 186 – 194. Kementerian Kesehatan Indonesia. 2009. Pedoman Pelaksanaan Kemitraan Bidan dan Dukun. Laksono, A. et al. 2014. Positioning Dukun Bayi – Studi Kasus Upaya Penurunan Kematian Ibu di Kabupaten Sampang. Kanisius.

“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 125 Proceeding International Seminar