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Vol. 6, Februari 2012 ISSN 1858-0610

Midwifery and NursingJournals

This journal is published twice a year in June and December. It contains of articles taken fromthe results of researches and critical-analytical studies in the field of midwifery and nursing.

Management CommitteMidwifery and Nursing Journals

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MufdlilahUmu Hani EN

HikmahSulistyaningsih

Yuli Isnaeni

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Miftahush ShalihahNor Faizah Kaeni

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MIDWIFERY AND NURSING JOURNALS have been published since June 2005 bySTIKES ‘Aisyiyah of Yogyakarta

Vol. 6, Februari 2012 ISSN 1858-0610

Midwifery and NursingJournals

The Relationship Between The Level of Mothers’ Knowledge on EarlyMobilization and Their Early Mobilization Ability of Post Sectio Caesaria atRSIA Sakina Idaman Yogyakarta in 2010Adelia Kwartina Hikurniati & Umu Hani .................................................................... 1-6

The Relationship Between Post-partum Mothers’ Knowledge of Junub andTheir Junub Behaviour After Childbirth in BKIA ‘Aisyiyah Karangkajen,YogyakartaFarida Kartini & Siti Arifah ....................................................................................... 7-13

The Influence of Music Therapy on Pain Intensity Changes in Post SectioCaesarea Mothers in Kenanga Ward of Wates Hospital of Kulon ProgoRuth Berliana & Warsiti ............................................................................................ 14-20

The Characteristics of Productive Women’s Interest in Early Detection ofCervical Cancer By Using IVA (Acetate Visual Inspection) Method inPuskesmas Temon I Kulon Progo in 2010Aryuni Sita Heny Astuti, Anjarwati, & Mufdlillah .................................................. 21-27

The Effect of Diabetic Gymnastics Toward the Self-Esteem in the PeopleWith Diabetes Mellitus (DM) at PKU Muhammadiyah Hospital YogyakartaDwi Jayani & Mamnuah ........................................................................................... 28-36

The Relationship of Nurse Perception Towards the Leadership Style of theRoom Head with the Work Motivation of NurseDeasti nurmaguphita & Syaifudin ........................................................................... 37-43

THE RELATIONSHIP BETWEEN THE LEVEL OFMOTHERS’ KNOWLEDGE ON EARLY MOBILIZATIONAND THEIR EARLY MOBILIZATION ABILITY OF POST

SECTIO CAESARIA AT RSIA SAKINA IDAMANYOGYAKARTA IN 2010

Adelia Kwartina Hikurniati & Umu HaniAisyiyah Health Sciences College of Yogyakarta

Abstract : Early mobilization is a vital skill for mother post sectio caesariabecause earning memperlancar expenditure lochea, lessens infectionpuerpurium, quickens involution, memperlancar function ofgastrointestinal equipment, increases blood circulation fluency, quickenstreatment and increases independence of mother post sectio caesariaand prevents the happening of thrombus. Based on antecedent studydone in RSIA Sakina Idaman Yogyakarta 2009, there is mothers postsectio caesaria which still have not done mobilization early for fear ofits(the stitching is free and pain in bone taste at hurt ex- stitching isstomach. This research aim to know the relation of level of knowledgeof the relation of level of knowledge of mother about mobilization earlyably mobilization early at mother post sectio caesaria in RSIA SakinaIdaman Yogyakarta 2010.

Keywords: the level of knowledge, Early Mobilization Ability

2 Midwifery and Nursing Journals, Vol. 6 February 2012: 1-6

INTRODUCTIONMaternal health is one of the national

problems that becomes the main priority.Improving health status of mothers andchildren as an indicator of success of healthcare is a strategic effort to decrease thenumber of maternal mortality. Maternalhealth services and neonatal is also one ofthe elements determinants of health statusthat can be determined by the MaternalMortality (MMR) and Infant Mortality Rate(IMR). Based on the Demographic andHealth Survey Indonesia (IDHS) in 2007,Maternal Mortality Rate (MMR) inIndonesia is 248/100.000 live births(www.diknas.go.id, January 30, 2009).Direct causes of maternal mortality inIndonesia are bleeding, infection, eclampsia,and complications of childbirth (Saifuddin,2002: 6). One complication in the puer-perium often happens is because the act ofSectio Caesaria (Wiknjosastro, 2006: 18).

Sectio Caesarea is an artificial birth, inwhich the fetus is born through a incision inthe abdominal wall and the wall of the uteruswith the fetus in an intact condition and fetalweight of more than 500 grams(Wiknjosastro, 2006: 13). Based on theindications, sectio Caesarea is divided intotwo namely planned sectio Caesarea andemergency section Caesarea. PlannedSectio Caesarea is an action taken becauseof medical indications such as of narrow hip,the latitude and previa placenta. SectioCaesarea emergency performed as medicalindications that is the complications thatoccur in the process of childbirth. Forexample, fetal distress, premature infants, thechildbirth does not progress, abruptioplacenta, placenta previa, hypertension,eclampsia, and PEB (Chrissie, 2005: 14).

According to Evariny (2007), the riskof sectio Caesaria is 25 times greater thanvaginal childbirth, while cases caused byinfection have a risk 80 times greater

compared with vaginal childbirth. Compli-cations that occur during sectio Caesariacauses by injury bladder, uterus, bloodvessels, intestines and injuries in infants andcomplications due to anesthetic action.

The roles and responsibilities ofmidwives to care of mothers during childbirthin post sectio Caesaria is to detect compli-cations and the need for referral, providecounseling for mothers and family on howto prevent bleeding, recognize the dangersigns, maintain good nutrition, as well aspracticing safe hygiene, facilitate bondingrelationship between mother and infant, andencourage breast-feeding (Ambarwati &Wulandari, 2009:3). While, the governmentpolicy is the Gerakan Sayang Ibu (GSI)announced by the president of Republic ofIndonesia on the 68th anniversary day of themother. One of programs is to improvepostnatal care coverage 90% informativesupport, mental from various parties,especially health and family (Pusdiknakes,2002). World Health Agency OrganizationCoalition for Improving Maternity Services(CIMS) created Safe Motherhood Intiativewhich formulated mothers care, so thatmidwives as health workers plays an im-portant role in identifying the onset of com-plications childbirth by recognizing the signsand symptoms earlier (Pusdiknakes, 2002).

RESEARCH METODSThis is an analytical survey correlation

study that uses cross sectional timeapproach. This study uses primary data fromthe respondent namely mothers of postsectio Caesaria in RSIA Sakina IdamanYogyakarta in 2010. In this study, the datacollection on the relationship level know-ledge of mothers about early mobilizationthe ability of early mobilization in the motherpost sectio Caesaria observed only once andmeasurements made during examination.The population in this study is all the mother

3Adelia Kwartina Hikurniati & Umu Hani, The Relationship Between ...

post sectio Caesaria in RSIA Sakina IdamanYogyakarta in June 2010. Meanwhile, therespondents of this study are mothers whoexperienced post sectio Caesaria for the firsttime and used anesthesia spinal. The amountpopulation of the mother post sectioCaesaria in one month is 30 people. Thetechniques of the sampling used wassaturated sampling. sample used as manyas 30 people with criteria of Patients for thefirst time have experience Caesaria sectiowith spinal anesthesia. The methods of thedata analysis is correlating data from twovariables: level of knowledge about earlymobilization and the ability of earlymobilization of post sectio Caesaria motherswhich used the Kendall Tau test andsignificant level 5%.

RESULT AND DISCUSSIONRespondents’ characteristics

In this study, the characteristics of therespondents consist of the mothers’ age,occupation, education level, and income.The characteristics of respondents can beseen as the following:

Respondents’ characteristics based onthe mothers’ age

In RSIA Sakina Idaman, respondentswho are at most are aged between 20-35years that are 25 people (83.3%) andrespondents who are at the least aged >35years that are 5 people (16.7%).

Respondents’ characteristics based onthe occupation

In RSIA Sakina Idaman, mostrespondents work as a housewife namely18 people (60%) and respondents who areat the least worked as a civil servant namelyone person (3.3%).

Respondents’ characteristics based onthe education level

In RSIA Sakina Idaman ,respondentswho are the most are high school graduatesnamely 14 people (46.7%) and respondentswho are at the least are elementary schoolgraduates and collegengraduates namely 3people for each (10%). The majority of thefamily income ranges between 500 thousandto 1 million that is 11 people (35.5%).

The research was conducted in June2010, each of the variables that wereexamined can be described as follows:1. The level of knowledge about the early

mobilization of post sectio Caesarea


The results shows that of 30 outrespondents with the characteristics edu-cation, the largest frequency is high school-educated respondents that is 14 people or46.7% and the lowest frequency iselementary school-educated that is 3 peopleor 10%.

Based on Table 2, from 30 respon-dents, the highest frequency is respondentswho have good level of knowledge namely16 people or 53.3%, and no one of therespondent are are lack of knowledge.

2. The ability of early mobilization of postsectio Caesarea

According to the results obtained, itshows that the most of the respondents havegood ability of early mobilization post sectioCaesarea namely 18 people (60%).

3. The Relationship between the Level ofMothers’ Knowledge on Early Mo-bilization and Their Early MobilizationCapabilities of Mothers in Post SectioCaesaria

The results shows that the respondentswho have good level of knowledge aboutEarly mobilization of post sectio Caesariaand have sufficient capability to Earlymobilization of post sectio Caesaria as wellare 12 people (40%). Whereas therespondents who have medium level ofknowledge about early mobilization of postsectio Caesaria and have good capabilityof early mobilization are 2 people (6.7%).The results of statistical tests concludes thatthere is a significant relationship between thelevel of mothers’ knowledge about the earlymobilization and the ability of earlymobilization of the post sectio Caesariamothers in RSIA Sakina IdamanYogyakarta in 2010.

CONCLUSION AND SUGGESTIONConclusiona. Most of the respondents have good level

of knowledge about early mobilization ofpost sectio Caesarea namely 16 people(53.3%).

b. Most of the respondents have goodability of early mobilization of post sectioCaesaria namely 18 people (60%).

c. The results of statistical tests Kendall Taushows that its value is 0.491 with asignificance level (p) 0.008. So, it canbe concluded that there is a significantrelationship between the level ofknowledge of mothers about earlymobilization with early mobilizationcapability post sectio Caesaria mothersin RSIA Sakina Idaman Yogyakarta in2010.

Suggestionsa. For midwives in RSIA Sakina Idaman

It is hoped that midwives in RSIA SakinaIdaman can provide good care to patientsof post sectio Caesaria such as doingobservation, coaching, giving knowledgeof early mobilization, providing strongmotivation for the mother post sectioCaesaria to do early mobilizationindependently, and explaining how to doearly mobilization movements to thepatients so that it is not just carried outby qualified physiotherapists but also bymidwives.

b. For post sectio cesaria mothersIf the post Sectio Caesarea motherswere given health socialization andmotivation of early mobilization by healthworkers, so if there are difficulties andproblems related to the early mobilizationof post section Caesaria, mothers shouldask the health workers about thatproblem, so that they can pass theirpuerperium without any complications.

5Adelia Kwartina Hikurniati & Umu Hani, The Relationship Between ...

c. For further researchersThe researcher hopes that the furtherresearchers can conduct research withlarger samples and observed directly bythe researchers with an effective techniqueof message delivery and differentperspectives, and other factors that couldaffect early mobilization capabilities.

REFERENCESAmbarwati. ER, Wulandari. D., 2008,

Asuhan Kebidanan Nifas, MitraCendikia Press,Yogyakarta.

Arifin, Y, http:yasirblogspotcom.blog-spot.com, Tingkat PengetahuanKlien Terhadap Mobilisasi DiniPasca Operasi Seksio Caeseria diRSUD Dr RM Djoelham Binjaitahun 2008, 08 Februari 2009.

Arikunto, S, 2006, Prosedur PenelitianSuatu Pendekatan Praktik, EdisiRevisi VI, Cetakan Ketigabelas,Rineka Cipta, Jakarta.

Bobak, Lowdermilk, Jensen., 2004, BukuAjar Keperawatan Maternitas,Edisi 4, EGC, Jakarta.

Carpenito., 2000, Pedoman DiagnosaKeperawatan, Aplikasi PadaKlinik, Edisi 6, Ahli

Bahasa Studi Program Ilmu KeperawatanUniversitas Padjajaran.

Copel, Linda Carman., 2007. KesehatanJiwa dan Psikiatri PedomanKlinis Perawat, EGC, Jakarta.

Chrissie Gallagher – Mundy, 2005, Pe-mulihan Pasca Operasi Caesar,Erlangga, Jakarta.

Depkes, www.depkes.go.id, Setiap Jam 2Orang Ibu Bersalin MeninggalDunia, 10 Mei 2004.

Diknas, www.diknas.go.id, Survey Demo-grafi dan Kesehatan Indonesia, 30Januari 2009.

Dinkes Propinsi DIY, www.dinkes-diy.org,Waspadai Trombosis Vena Dalam,16 Desember (2004).

Evariny, A, Operasi Caesar, Amankah?,Januari 31, 2007. www.hypno-birthing.Web.id.

Farrer, 2001, Perawatan Maternitas,EGC, Jakarta.

Hanafiah, library.usu.ac.id, Perawatan MasaNifas, 04 April 2009.

Hapsari, 2006, Hubungan Tingkat Kece-masan dengan KemampuanMobilisasi Dini Ibu Post SC

Hari Pertama di RSUD PanembahanSenopati Bantul Yogyakarta Tahun2006, Karya Tulis Ilmiah, Yogya-karta, Tidak Dipublikasikan.

Henderson. C, Joanes. K., 2006, BukuAjar Konsep Kebidanan, EGC,Jakarta.

Kasdu, D., 2003, Operasi Caesar; Masa-lah dan Solusinya, cetakan per-tama, Puspa Swara, Jakarta.

Llewellyn. D, Joanes., 2001, Fundamentalof Obstetric And Ginaecology,Edisi 6, Hipocrates, Yogyakarta.

Manuaba., 2005, Memahami KesehatanReproduksi Wanita, Arcan, Yogya-karta.

Notoatmodjo, S., 2005, Metodologi Pene-litian Kesehatan, Rineka Cipta,Jakarta.

Pratiwi, A., 2005, Hubungan antara TingkatPengetahuan tentang PerawatanNifas dengan

Kemampuan Mobilisasi Dini Ibu Post SCHari Pertama di RS PKUMuhammadiyah

Yogyakarta Tahun 2005, Karya Tulis Il-miah, Yogyakarta, Tidak Dipubli-kasikan.


Potter dan Perry, 2004, FundamentalKeperawatan volume 1, Edisi 4,Cetakan Pertama, ‘EGC, Jakarta.

Saifuddin, 2002, Buku Panduan PraktisPelayanan Kesehatan Maternaldan Neonatal, edisi 1,cetakanpertama, Yayasan Bina PustakaSarwono Prawirohardjo, Jakarta.

Sugiyono., 2007, Statistik Untuk Pene-litian, Alfabeta, Jakarta.

_______., 2008, Metode PenelitianKuantitatif Kualitatif Dan R&D,Alfabeta, Jakarta.

Sumeks, www.sumeks.co.id, Sesak NapasMendadak, Waspada Emboli Paru,22 October 2008.

Tierney. LM, Mcphee. S, Papadakis. MA.,2003, Diagnosis dan Terapi Ke-dokteran Penyakit Dalam,Salemba Medika, Jakarta.

Uliyah. M, Hidayat. AAA., 2006, Ke-terampilan Dasar Praktek KlinikKebidanan, Salemba Medika,Jakarta.

Wiknjosastro, H., 2006, Ilmu BedahKebidanan, Yayasan Bina PustakaSarwono Prawirohardjo,Jakarta.

___________, 2006, Ilmu Kebidanan,Edisi 3, Cetakan Kedelapan, BinaPustaka Sarwono Prawirohardjo,Jakarta.

THE RELATIONSHIP BETWEEN POST-PARTUMMOTHERS’ KNOWLEDGE OF JUNUB AND THEIR JUNUB

BEHAVIOUR AFTER CHILDBIRTH IN BKIA ‘AISYIYAHKARANGKAJEN, YOGYAKARTA

Farida Kartini & Siti ArifahAisyiyah Health Sciences College of Yogyakarta

Email: [email protected]

Abstract: This study aims to determine the relationship between thelevels of knowledge on the behavior of junub in the puerperal motherBKIA Karangkajen, Yogyakarta. The benefit of the research is expectedto be used as input for the planning of midwifery care priorities to begiven to postpartum mothers. This research used a quantitative researchdesign with sample of 97 mothers in childbirth BKIA Karangkajen,Yogyakarta. The means of of the data collection are questionnaires andobservation sheets. The data were analysized by using chi-square analysis.The results showed that there is a level of knowledge with junub onmaternal behavior at parturition BKIA Karangkajen, Yogyakarta with avalue of P = 0.00.

Keywords: knowledge, behaviour, Junub, ruling


INTRODUCTIONBirth rate in Indonesia in 2006 of 4855

babies and in 2007 rose to 4872 babies. Anydelivery that is expected is the mother andbaby health and safe not only at the time ofdelivery but also to the time of childbirth andbeyond. The period during childbirth is acritical period for the mother becausecomplications or illness can occur easily atthis time. One of the preventions ofcomplication during childbirth is to maintainpersonal hygiene. The major cause ofmaternal deaths is infection that end up beingsepsis (Syaifuddin Bari, 2002).

Hygiene is a prerequisite for therealization of health. Health is one of thefactors that can give you happiness.Conversely, dirty not only ruin the beautybut also can cause various diseases. Pain isone of the factors that lead to suffering. Thephrase “bersih pangkal Sehat” (Clean meansHealthy) means the importance of hygienefor human health in terms of individuals,families, communities and the environment.Once, the importance of cleanliness in Islamthat people who keep their self-cleaning orhygiene will seek God’s beloved. Clean orholy in Islam are known as thaharah. Oneof God’s words about hygiene is:

لمتطهرريالن... ��ب لتوبين �ب الله ��

“Verily, Allah loves those who repentand loves those who purifythemselves” (Al Baqarah 222). In ahadith, Prophet Muhammad alsonoted that “cleanliness is half offaith.”

If the thaharah (purification) is appliedincorrectly, the result would make thedestruction of one’s prayer because givingthe sanctity of prayer is a legitimate require-ment. Prayer and other mahdlah prayers(worship directly to God) require a special

purification procedures prior to the nextprayers. The procedure depends on thestate of big or small hadats of theperson. When someone has a small hadatshe/she just needs to take wudlu as thepurifier. Meanwhile, big hadats must bepreceded by junub. Junub is not just areguler shower like most people do, butthere are procedures in its own way. Thejunub is done by spraying water to the entirebody from head to toe with sincere intentionsfor God’s sake of the sanctity of the bighadats. People that need junub are womenafter having menstruation, postpartummothers, those who have just finishedcopulating and other consequences thatcause a person to have a junub.

A mahdlah prayer is a worship that isdone in relation to one’s mental and spiritualhealth. For that reason, midwives shouldalways pay attention to these aspects inproviding comprehensive carea. One of themidwifery cares is the care of the midwivesfor women. Let the Muslim women to know,that the bath was determined through theQur’an and the hadith, among them theWords of Allah Almighty in the Qur’an AlMaidah verse 6. It means: “O ye whobelieve, if you want the prayer, then washyour faces and your hands up to the elbows,rub your heads and (wash) your feet to theankles, and if you junub then wash, and ifyou’re sick or on the way or back from therest room (toilet) or touch the women, thenyou do not get water, then take yourtayammum with good soil (net); rub yourfaces and your hands with the land. Goddoes not want to complicate you, but hewanted to cleanse you and perfected Hisblessings to you, that ye may give thanks.”

QS. An-Nisa verse 43: It means: “Oye who believe, do not pray if you in a stateof drunkenness, so that you understand whatyou say, (do not also approached themosque) while you were in a state of junub,

9Farida Kartini & Siti Arifah, The Relationship Between Post-Partum .....

except it just went by, until you bathe. Andif you are sick or on a journey, or come fromopen defecation, or you have touchedwomen, then you do not get water, then takeyour tayamum with good soil (holy); rubyour faces and your hands. Allah is TheMighty of His Forgiving.” Until recently, theimportance of post-partum bath has notreceived serious attention both from theMinistry of Religious Affairs as well as fromhealth care facilities. However, its givenimpact will affect a person’s legality to taketheir mahdlah prayers. Therefore, to theresearcher, it is interested to conduct aresearch on it.

The results of preliminary studies onBKIA ‘Aisyiyah Karangkajen, show thatevery year there are 180 deliveries to womenwho are Moslem. There are 15-20deliveries per month in average. Based oninterviews with eight post-partum motherswho make regular visits, 6 of them have notimplemented junub correctly, so theresearchers wanted to know the level ofpost-partum maternal mothers’ knowledgeabout junub and the relationship of junubwith their post-partum behavior.

RESEARCH METHODOLOGYThis study uses descriptive correlation

study. Populations of this study were 97post-partum moslem mothers in BKIA‘Aisyiyah Karangkajen Yogyakarta duringJanuary to April 2010. The sample of thisresearch is all the mothers so that the samplecollection technique is saturated samplingmodel.

Tool or instrument used in this study isa questionnaire that contains the knowledgelevel of the sample about the junub.Instrument to collect the needed data aboutthe mother bathing behavior is an interviewguide. The obtained data were analyzedusing uni-variant and bi-variant analysisusing chi-square.

RESULT AND DISCUSSIONResponden Characteristics

The respondent characteristics basedon their age can be seen in the followingdiagram:

41

51

5

20 - 30 tahun 31 - 40 tahun 40 tahun keatas

Figure 1. Respondents’ age

Diagram 1 shows that mothers whogave birth mostly were in age between 31-40 years, contributed the total amount of51 people (52.58%). The least is motherswho gave birth at the age of 40 yearscontributed the total amount of 5 persons(5.15%). The age of respondents indicateshow long they have lived so that we candrawn predictable possibilities how muchexperience they have acquired experiencewhich will then impact on their know-ledge. An epidemiological study shouldalways pay attention to the age of therespondents; age is one thing that affects theknowledge (Notoatmodjo, 2003).

Characteristics of respondents basedon the number of children was as follows:

6

52

35

4

1 anak 2 anak 3 anak lebih dari 3 anak

Figure 2. The Respondents’ Children


Diagram 2 shows that most respon-dents had 2 children, contributed the totalamount 52 people (53.61%). Respondentshave at least 3 children contributed the totalamount of 4 people (4.12%). Number ofchildren of these respondents give us a factthat most respondents had given birth morethan once. It means that they are not newnatural respondents.

The Respondents’ KnowledgeTable 3. Respondent’s level of know-

ledge about the distribution ofthe junub (n = 97)

The

knowledge

level

Frequncy

(F)

Percentage (%)

Poor

Good

Jumlah

33

64

97

34,0

66,0

100

Table 3 shows that mothers whoposses good level of knowledge aboutpostpartum maternal junub contribute 64(66.0%) of the sample.

Knowledge is the result of the ideaafter carrying out a specific sensing of anobject through the five senses, namely sight,smell, taste, touch where the majorityacquired through the eyes and ears(Notoatmodjo, 2003).

The level of knowledge in post partummothers in BKIA ‘Aisyiyah KarangkajenYogyakarta in each category was possiblycome because of maternal age and maternalexperience during menstruation andchildbirth that requires them to havejunub. The knowledge wass obtained fromreading books, magazines and joininglectures and seminars.

In addition, the fact that most of themothers in Karangkajen environmentare

moslem who oftenly follow such instructionfrom BKIA officers’ Aisyiyah Karangkajenwhich always provide the additional know-ledge, both directly through information,education and communication (IEC) orindirectly through booklet or leaflet.

According to Soekanto (1982 cittedby Asmorowati, 2007), the factors thatinfluence the level of knowledge are the levelof education, provided information, socialculture, experience, socio-economic andage. Mintarsih (2007) states that the use ofhealth education booklets and posters canimprove knowledge and attitudes ofadolescents in reproductive health.

Respondents’ Junub behaviourTabel 4. Respondents’ past-portum

junub behaviour (n=97)

Junub

behaviour

Frecuency

(F)

Percentage (%)

wrong

correct

total

22

75

97

22,7

77,3

100

Based on Table 4, it can be knownthat the respondents correct behaviour aboutbathing after childbirth contributed 75 (77.3)people.

Junub is an obligation that must beimplemented by every Muslim who sufferedgreat hadats. Bukhari hadith history, whichmeans “If you are experiencing menstruationor childbirth, then leave prayers and when itis stopped, take your bath and Pray” (Sabiq,2008). Therefore it is not allowed to amoslem to pray before they take junub topurify their hadats. The respondentsbehavior of the junub related to theirKnowledge level


Table 5. Cross tabulation and analysisof the relationship with theBehavioral Sciences of theJunub (n = 97)

Junub

behaviour

Knowledge Level

Poor Good Jumlah

F % F % F % X

2

Wrong

Correct

Total

16

17

33

16,5

17,5

34,0

6

58

64

6,2

59,8

66,0

22

75

97

22,7

77,3

100

�2=18,9

9

P=0,00

Respondents who have wrong junubbehaviour but have a good knowledge levelof the bath contribute of 6 respondents(6.2%) of 16 respondents. Respondentswho have good level of knowledge are 58respondents (59.8%), but 17 of them(17.5%) behave badly in junub. The resultsof analysis of the relationship between thelevel of knowledge of the behavior of thebath by using chi-square test obtained P =0.00. The presence of poor knowledgerespondents but behaved well in junub andvise-versa suggest that there are differencesin terms of knowledge and practices. Thiscan be due to the knowledge gained by therespondent is merely a concept or theoryexposure and without any demonstration orboth. However, there are differences inknowledge acquisition that occurs in eachindividual deals with what is heard and whatis seen.

The ability of remembering certainthings in a person will depend on theresources. If a material is delivered throughverbal lectures, after 3 days, it will remain10-20% of the total materials. Whereas,reading will give only 10% of the total andknowledge that gained through visual andverbal experience will give remaining 65%after 3 days. And participatory experiencewill give 70% (JNPK-KR, 2005).Someone’s behavior can be influenced byseveral factors such as; knowledge, beliefs,

attitudes, significant reference, resources andcultural (Notoatmodjo, 2003). The junubbehavior in BKIA ‘Aisyiyah Karangkajenwere influenced by knowledge and belief inreligion. Environmental conditions of life andthe religious BKIA have a profound influenceon the behavior of the bath. The study foundan association between the level ofknowledge with junub behavior in womenafter childbirth as indicated by the value ofP = 0.00.

The respondent’s confidence / beliefin religion wa become the main influences inthe junub behaviour. According to Anwar(2007), a person’s behavior is influenced byexperience, environment, religion, andknowledge. Sumarni, et al (2005) found thatethnic Madura still maintain the tradition offemale circumcision in infants. Thoughfemale circumcisio in Islam is stillcontroversial, but Madura people stronglybelieve that it is the religious order such asmale circumcision. Thus, beliefs reallyinfluence a society behavior. Al-Qur’anSurah Al-Baqarah verse 222 which reads:

لمتطهرريالن... ��ب لتوبين �ب الله ��

“Verily, Allah loves those who repentand loves those who purifythemselves.”

Timisela (2007) states that the level ofemployee knowledge of PHBs have arelationship with the employee’s behavior toPHBs. Trilestari (2010) indicates that thereis no relationship between knowledge ofbreast cancer with breast self-examinationbehavior. This suggests that the knowledgeand behavior are not necessarilyrelated. Hervanda (2010) indicates thatthere is no relationship between the level ofknowledge about menopause with the levelof anxiety in perimenopausal women. Though knowledge and behavior are highly


related, knowledge is not the only one thataffects the behavior; behaviour issynergistically related to other factors.However, the role of knowledge is significantenough to do with human behavior. Scienceand behavioral expression of that theory orpractice must go hand in hand and veryprecise.

CONCLUSIONS ANDRECOMMENDATIONSConclusion

Knowledge level of knowledge in postpartum mothers in BKIA ‘AisyiyahKarangkajen Yogyakarta in good categoriesis 66.0%. Behavior of having bath afterchildbirth in BKIA ‘Aisyiyah KarangkajenYogyakarta through correct way was77.3%. There is a relationship between thelevel of knowledge on post-partum maternalbehavior after parturition and the junubbehaviour in BKIA ‘Aisyiyah KarangkajenYogyakarta, with P value = 0.00.

SuggestionFor midwives, it is importtant to

provide good midwifery care at childbirth.It is suggested to remain the mother aboutthe importance of the shower after they cleanthe blood of childbirth.

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THE INFLUENCE OF MUSIC THERAPY ON PAININTENSITY CHANGES IN POST SECTIO CAESAREA

MOTHERS IN KENANGA WARD OF WATES HOSPITAL OFKULON PROGO

Ruth Berliana & WarsitiAisyiyah Health Sciences College of Yogyakarta

E-mail: [email protected]

Abstract: This study aimed at finding the influence of music therapy onthe pain intensity changes of post sectio caesarea patients. This studywas an experimental research with one group pretest and postest design.The sampel of this study was the post sectio caesarea on the 1st day inKenanga Storage in Wates Hospital, total sampel was 34 patients byusing purposive sampling. To collect the data used in the interviews andmarking the pain scaling is by using NRS (Numeric Ratting Scale) beforeand after music therapy for 15 minutes. The statistic was analyzed usingT-test sample related. The result of average pain scale before musictherapy was 5,64 with deviation standard of 1,09. The result of averagescale after music therapy was 3,79 with deviation standard of 1,62.Subsequently, a statistic test showed was 0,003 (P<0,05). Music wasable to give comfort, to calm, and to distract the pain. Medical nurseshould be suggested to used music therapy as one of non pharmacologytherapies in giving intervention treatment to lower pain intensity in postsectio caesarea.

Keywords: pain intensity, post sectio caesarea, music therapy.

15Ruth Berliana & Warsiti, The Influence of Music Therapy ...

INTRODUCTIONMother’s died rate is one of the

indicators to monitor women’s health rate.Mother’s date rate has also become the 5thgiven targets in Millennium Destination Goals(MDG’s) that is increasing mothers’ healthin which the target destined until 2015 is todecrease ¾ of mothers’ death rate risk.MDG’s has destined for pushing AKI toreach the number of 102/100.000 life rate.Nevertheless, scrutinizing on the data ofIndonesian Demografic and Health Survey(SDKI, 2007), mother’s death rate is stillachieving the number of 228/100.000 lifebirth.

Compared to pervagina delivery,Caesarean delivery can decrease thenumber of mothers’ death. Mothers’ deathrate resulted by caesarean delivery can bepressed into 1:1.000 delivery around theworld (Indiarti, 2007). Caesarean deliverycan be an alternative as an emergencysituation to save mothers’ life. Need ofconvinience is a condition in which someonefeels relax, psychologycally secured, andfree from pain, especially the sharp pain asa respond towards endangering stimuli.From the research result, there are 50% ofpost-surgery patients who experience sharppain and 2%-3% of these patients endedwith a chronic pain. The cause of this caseis resulted from the lack knowledge ofhandling pain, the fear of opioid usage andsociety’s point of view that it is normal toexperience pain after surgery.

Pain, if it is not addressed promptlycan be fatal. Pain can disturb the patterns ofrest and for some patients, it is difficult tobreathe deeply. Prolonged pain can causephysical stress, anxiety, fear, and despair.Pain experienced by women after childbirthmay slow the mother to move and breathedeeply. If the pain is not addressedpromptly, it can lead to a trouble for themothers in bonding to the baby. Mom will

also feel pain when carrying and nursinginfants. Nurses need to implement pain mana-gement techniques to anticipate or minimizepain or discomfort that occurs so that woundtreatment can be treated optimally.

Various attempts were made to reducethe pain after the birth, either pharma-cologically or nonpharmacologically. Phar-macological pain management is moreeffective than nonpharmacological method,but more expensive, and has bad effectspotentials. Pharmacological pain mana-gement includes the use of narcoticanalgesics, non-narcotic analgesics andadjuvant. Some mothers refused to be givenan analgesic, especially before breastfeedingmothers. That is because mothers’ feartowards the influence of analgesic drugswhich can get into breast milk.

Non-pharmacological pain mana-gement which includes relaxationtechniques, hypnotherapy, imagination,distraction, music therapy, acupuncture, andacupressure therapy. The use of non-pharmacological pain management is lessexpensive, simple, effective and withoutadverse effects. One application of theprinciple of non-pharmacological nursing isatraumatic to minimize pain with distractiontechniques. The example of distractiontechniques is such as by providing musictherapy. Distraction technique is veryeffective to relieve pain, and this is becausethe distraction is a method to reducepostoperative pain in patients in betterwithstand pain. Data from interviews takenfrom the head of the maternity ward at theRSUD Wates shows that the hospitals havenot implemented a nursing intervention onthe provision of music therapy. In order toreduce pain intensity, patients are only givenpainkillers. In RSUD Wates itself, there hasnever been a study of music therapy tochange patients’ pain intensity. Consideringthe description of this background, the


researchers are interested in conductingresearch on the effects of music therapy onpatients’ pain intensity of post sectioCaesarea in RSUD Kulonprogo Wates. Thepurpose of this study was to find out theeffect of music therapy on postoperative painintensity changes sectio Caesarea.

RESEARCH METHODThe design of this study was using

experimental research methods (experi-mental research) by using a One GroupPretest Postest design. The population in thisstudy was the mother post sectio caecareawho are hospitalized in RSUD Wates. Itspopulation was around the mothers’ postsectio Caesaria in RSUD Wates from April12th to May 12th of 2011, which amountedto 51 people. Sampling technique whichused in this research is a purposive sampling,a sample of 34 respondents. Samples weretaken by using the criteria of inclusion andexclusion criteria.

Independent variable is the effect ofmusic therapy. Instrument used in thisresearch is by listening to music/song byusing headphones/earphones of MP4 Music.The variable intensity of postoperative painis sectio Caesarea. The instrument used inthis research was Numeric Ratting Scales(NRS), it is the measurement of pain by usinga pain scale of 0-10. Test for normality ofthe data was using the Kolmogorov Smirnovformula and test analysis was using relatedsamples t-test with significance level of 0.05,significant when p <0.05.

RESULTS AND DISCUSSIONBased on data collection, the charac-

teristics of research subjects can be dividedinto three characteristics which are basedon age, family support and the kind ofpreferred music.

Respondents in this study amounted to34 respondents. Table 1 provides infor-

mation that from of 34 respondents aged20-25 years old, the majority of which were13 respondents (37%), the respondentsaged 26-30 years old, 31-35 years old and36-40 years old respectively are 7 res-pondents (21 %).

Tabel 1. Respondents CharacteristiBased on Age

Amount Percentage

20-25 years old 13 37 %

26-30 years old 7 21 %

31-35 years old 7 21 %

36-40 years old 7 21 %

From the research result, it is obtainedmost common complaints of pain areexperienced at the age of 20-25 years, thiscould be due to the fact that adults alwaysreport the pain sometimes when thecondition has been pathological andmalfunctioned (Tamsuri, 2007). Parents tendto hold the pain which is experienced,because they think the pain is a normalcondition that must be endured (Batbual,2010), thus, the pain in adults aged of morethan 25 old years was less found. Inaccordance with the theory Smaltzer & Bare(2002) which says that the effect of age onpain perception is not widely known.Assessment of pain in the elderly may bedifficult due to physiological andpsychological declines that follow aging.Elderly individuals have a slower metabolismand body fat ratio of muscle mass which isgreater than younger individuals

Table 2. Characteristics of Respon-dents Under the FamilySupport

Accompanied Not accompanied

Number 23 11

Percentage 68 % 32 %


From the data obtained, 68% or 23respondents accompanied by family and32% or 11 respondents were notaccompanied by family. People who are ina state of pain are often dependent on familyfor support, help or protect.

Table 3. Characteristics of Respon-dents Based on FavoritesGenre

Number Percentage

Campursari 13 38 %

Rohani 3 9 %

Pop 4 12 %

Tembang kenangan 6 17

Instrumental 3 9 %

Dangdut 5 15 %

Based on the data obtained from theresearch, campursari is the most favouritemusic in which 13 respondents (38%)choose this genre and the least is theinstrumental music and spiritual songs, thereare 3 respondents (9%) respectively. Thisselection is possibly because of the overallrespondents in this study have the samecultural background which is JavaneseCulture. Culture has an influence on musicas an emotional response through non-verbal stimulation. Community with aparticular culture has a way of response anddifferent expressions (Djohan, 2009).

Beliefs and cultural values affect the wayindividuals cope with pain. Individuals learnwhat to expect and what is acceptable totheir culture.

Table 4. Average Difference Characte-ristics of Pain Scale Accordingto Favorites Genre

Average Difference

Characteristics of

Pain Scale

Percentage

Campursari 2,76 31 %

Rohani 1 4 %

Pop 1 4 %

Instrumental 0,33 11 %

Dangdut 1,8 23 %

Tembang Kenangan 2 20 %

From the data above, it is obtained thatthe highest average difference pain scaleaccording to the type of music preferred iscampursari which is obtained by 2.67 andthe lowest average difference pain scale isby 0.33. According to Halim (2003) theprovision of music therapy will be moreeffective if the client likes listening to music.Listening to music is expected to be able totake patients’ mind of pain and providecomfort and relaxation. Unconsciously, themusic will make the legs swing, the handstap, and and it will make the patients’ driftin the song they are listening to, and carryon dreaming, and past experience and evenevoke emotion (Djohan, 2009).

χ

Table 5. Difference in average characteristics of Pain Before and After Accordingto a preferred Genre and Family Support

Didampingi Tidak DidampingiRata-Rata Selisih Skala

Pretest & Posttest

N % N % DidampingiTidak

Didampingi

Campursari 9 39 % 4 37 % 3,22 1,25

Rohani 2 9 % 1 9 % 1,50 0,00

Pop 3 13 % 1 9 % 2,00 0,00

Instrument 2 9 % 1 9 % 1,00 0,00

Dangdut 4 17 % 1 9 % 2,25 0,00

Tembang

Kenangan

3 13 % 3 27 % 2,00 2,00

Jumlah 23 11 11,97 3,25


Based on Table 5, it can be seen thatthe average difference in pain before andafter music therapy. The results showed thatthe highest average pain scale ofaccompanied respondents is campursariwhich is choosen by 9 respondents and it isresulted in 3.22. The lowest average painscale is 1.00 in which only 1 respondentchooses instrumental song. Table 5 alsoillustrates well that the average pain scalewhich is not accompanied by the highestfamilies of respondents chose the mostmemorable songs which is choosen by 3respondents at 2.00. The lowest averageamount of pain scale that is not accompanieddoes not change in which each respondentchooses hymns, instrumental, pop anddangdut. The absence of family or closestfriends will make the pain increased. Lackof support from family may lead toincreasing perception of pain. A supportiveenvironment and the role of the family arevery important in the healing process ofpatients. People who are in a state of painare often dependent on family for support,help or protect.

Table 6. Characteristics of Pain Beforeand After

Pretest Scale Postest

ScaleDifference

Number 192 129 63

Average 5,64 3,79 1,82

Deviation Standard 1.09 1,62 1,43

From the table above, it can be seenthat the average scale before treatment is5.64 and the average scale after the is 3.79in which the average difference of pretestand postest pain level reaches 1.82. Thisstudy uses a non-pharmacological therapythat is by providing distraction of musictherapy techniques which are provenshowing changes in the intensity of painexperienced by respondents of post sectio

Caesarea. This can be seen from the resultsof average pain scale before treatment thatis 5.64 with 1.09 of deviation standardwhich changes into 3.79 with deviationstandard of 1, 62 on the average scale aftermusic therapy is given.

Music can relieve the suffering frompain because the nerve which is responsibleof listening to music is the same as the nervesof taste. Thus, by the time patientsexperience pain, it can be transferred bylistening to music. Music therapy can helpmanage stress, prevent disease and relievepain. Distraction is a diversion of attentionby focusing attention on other stimuli frompain stimuli. Distraction techniques in musictherapy will help release endorphin in thebody, thus prevents the occurrence of pain.Endorphin is a substance such as morphineproduced by the body and has a strongconcentration in the nervous system.Endorphin works as an inhibitor towardstransmission of pain which blocks impulsetransmission in the brain and spinal cord(Brunner & Suddart, 2002).According to the analysis of test results, it isobtained for the mean pretest and meanpostest, 5647 and 3794, respectively. Thus,the asymp sig value is for 0003. This studyuses a significance level of 0.05. If thecalculated P values are less than thesignificance level (P <0.05), the Ha isreceived and Ho is rejected. It means thatthere is an influence of music therapy towardspain intensity changes in patients with postsectio Caesarea.

CONCLUSION AND SUGGESTIONSConclusion

From the test analysis calculationresults obtained from the data, it isconcluded that there is an influence of musictherapy towards pain intensity changes inpatients with post sectio Caesarea.


SuggestionNursing practitioners, especially in

Kenanga ward of RSUD Wates areexpected to implement distraction techniquesby providing music therapy to reduce thepain intensity of post sectio caecarea. Themanagement of the hospital is also expectedto be able to provide or facilitate nursingcare to support a holistic and comprehensivein addressing the problem of pain in patients.Future studies can take a larger sample sizeand the presence of a control group so thata comparison can be done and also applydistraction techniques to patients with painnot only for post sectio Caesarea.

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THE CHARACTERISTICS OF PRODUCTIVE WOMEN’SINTEREST IN EARLY DETECTION OF CERVICAL

CANCER BY USING IVA (ACETATE VISUAL INSPECTION)METHOD IN PUSKESMAS TEMON I KULON PROGO

IN 2010

Aryuni Sita Heny Astuti, Anjarwati, & Mufdlillah‘Aisyiyah Health Sciences College of Yogyakarta

Abstract: The purpose of the research is to find out the characteristicsof productive women’s interest in early detection of cervical cancerwith IVA (Acetate Visual Inspection) method in Puskesmas Temon I inKulon Progo. The method used is descriptive quantitative with the crosssectional timing approach. The technique used to collect the sample isquota-sampling method, with 1,601 people as the population and 160people as the sample. The instrument to collect data is questioner.Percentage is used in analyzing the data. The results of the research are1) The highest numbers of the respondents’ ages are 40-49 years old(53.15%). 2) The highest numbers of the respondents are those whohave 1-2 children (62.5%). 3) The respondents are mostly from lowlevel of education (58,1 %). 4) The respondents mostly have higherlevel of knowledge about cervical cancer (50 %). 5) The respondentsare mostly from low economic level (56,3%). 6) The respondents aremostly have good interest in doing early detection of cervical cancerwith IVA (50%). In conclusion, productive women’s interest in earlydetection of cervical cancer is already good, but, still, it should beincreased. There are some pieces of advice for health institutions inKulon Progo and for midwives. For health institutions in Kulon Progo, itis suggested that they should socialize of early detection for cervicalcancer through various media, expand partnership networks in order toincrease the interest of productive women in doing early detection forcervical cancer, plan to give pre-detection or pre-checking Communicationof Information and Education (KIE) to the acceptors of the FamilyPlanning program to do early detection for cervical cancer, and monitorevaluation toward the programs of reproduction health. For midwives, itis suggested that they should give planned and continuous motivation tothe society, and optimize the program of early detection for cervicalcancer by giving Communication of Information and Education (KIE)before the examination of the Family Planning acceptors to do earlydetection for cervical cancer.

Keywords: Characteristics, Interest, Early Detection of CervicalCancer, IVA, Age, number of children, educational level,knowledge level, and economic level.


INTRODUCTIONCancer is a general term to refer to an

abnormal cell growth that happens to anormal body tissue and affects the body’sfunctions. Cancer is a sort of dreadfuldisease for everybody since the death rateof cancer case is very high. In 2005, 7.6million people in the world died because ofcancer and 84 million people will die in tenyears (Diananda, 2007).

Some data in 2007 showed that everyyear 500 thousands of women werediagnosed to have cervical cancer and morethan 250 thousands of them died (50 %).Those who suffer from cervical cancer reachthe total of 2.2 million women. Cervicalcancer tends to affect women in their 35th-55th ages, but it can infect younger womenas well. 80% of those who suffer fromcervical cancer are found in some developingcountries or in the ones with lower-middlesociety income. This case is caused by thecondition in that in the developing countries,the cervical cancer-screening program hasnot been well-socialized so that there is stilla high death rate of the cervical cancer case(Diananda, 2007).

In Indonesia, it is predicted that thereare 200 thousands of cervical cancer casesevery year. Indonesian Cancer Organizationstated that in 2007 a women died in everyhour because of cervical cancer. Cervicalcancer is the cancer that becomes the firstkiller in Indonesia and it causes more than8,000 deaths every year (Diananda, 2007).

The earlier researches for earlydetection of cervical cancer with IVAmethod were done in the district of Temonin Kulon Progo. In 2007, there were 120(2.7%) productive women who werechecked from the total of 4,195 women intheir productive ages. In 2008, 285 (6.5%)

women were checked from the total of4,255 women in their productive ages.Based on that research, several of them weresuffered from acetowhite, scrapying, andcysta. In 2009, the program of earlydetection for cervical cancer was done to150 (3.71%) out of 4,280 productivewomen. The information from the HealthDivision of Kulon Progo Regency said thatfor the whole range of Kulon Progo regency,there were only 1,608 (1,91%) productivewomen who have done the early detectionfor cervical cancer by either IVA or PapSmear out of 88,081 productive women.

RESEARCH METHODThis was a descriptive research which

employed the method of cross sectionatiming approach. This research used thecharacteristics of productive women’sInterest in early detection of cervical cancerby using IVA (Acetate Visual Inspection)method in Puskesmas Temon I inKulonprogo in 2010 as the single variable.The samples of this research were productivewomen from the range of 20 years old to49 years old. The criteria for the sampleswere those who live in the working range ofPuskesmas Temon I, married, acceptor ofFamily Planning Program, have or have notdone early detection for cervical cancer,have got a socialization about cervicalcancer, and be able to become therespondents of the research. The data weretaken by using sample quota, a technique ofgetting sample from population which hascertain criteria until the researcher gets thenumber of the quota needed.

23Aryuni Sita Heny Astuti, Anjarwati, & Mufdlillah, The Characteristics of Productive ...

RESEARCH RESULTS AND DISCUSSIONCharacteristics of the Respondents

Variables Frequencies (%)

Ages of Productive Women

20-29 years old 26 16.3

30-39 years old 49 30.6

40-49 years old 85 53.1

Total numbers 160 100.0

Numbers of Children

1-2 100 62.5

3-4 53 33.1

=5 7 4.4


Mothers’ Levels of Knowledge

High (=75%) 80 50.0

Middle (55%-75%) 69 43.1

Low (=55%) 11 6.9


Mothers’ Levels of Knowledge

High (Senior High School-High Education) 67 41.9

Low (Elementary School-Junior High

School)

93 58.1


Economic Levels

High (Rp. 1,500,000) 13 8.1

Middle (Rp. 750,000 – Rp. 1,500,000) 57 35.6

Low (Rp. 750,000) 90 56.3



Based on Table 1.5, the numbers ofrespondents are 160 people with variouscharacteristics. Seen from the aspect of age,the highest numbers of the respondents arefound in the range of 40 years to 49 yearsold which are as many as 85 people(53.1%). Most of the respondents, as manyas 100 people (62.5%), have one to twochildren, and 80 (50%) respondents aremothers with higher level of knowledge ofcervical cancer. Seen from the aspects ofeducation and income, the highest numbersof respondents are the ones from lowereducational level (93 people, 58.1%), andthe ones who have lower income (90 people,56.3%). From the aspect of interest, mostrespondents (80 people, 50%) have goodinterest to do IVA.

Interest of Productive Women in the Ageof 20 to 49 Years Old in PuskesmasTemon I to Do Early Detection forCervical Cancer by Using IVA (AcetateVisual Inspection) Method

Based on the results of the researchon the aspect of age with 160 respondents,the highest numbers of the respondents arefound in the range of 40 to 49 years oldwhich are as many as 85 people (53.1%).Check or screening program which issuggested by WHO to every woman is at

least once in the age of 35 to 40 years old.However, if there are enough facilities, thecheck is done once in every five years towomen in the age of 35 to 55 years old.The ideal age in IVA check based on WHOis 25 to 60 years old, and it should be doneonce in every three years (Rasyidi, 2007).20 to 49 are said to be productive andmatured years. Those who are in the rangeof those ages are already able to understandthe importance of doing early detection forcervical cancer. Besides, respondents whoare in those productive ages are still activeand healthy so that they can still actively visitthe health service center to get some healthservices.

The characteristic of the researchbased on the number of children finds thatthe highest numbers of the respondents arethose who have 1 to 2 children which are asmany as 100 people (62.5%). Cervicalcancer, very often, attacks women whohave many children. Diananda (2007) saysthat cervical cancer can be caused bychronic trauma of the cervix caused by someprocesses such as delivery, infection, andirritation. Therefore, the more often awoman gives birth to children, the higher therisk of suffering from cervical cancer. Basedon the results of the research, the majorityof the respondents have 1 to 2 children. This

Economic Levels

High (Rp. 1,500,000) 13 8.1

Middle (Rp. 750,000 – Rp. 1,500,000) 57 35.6

Low (Rp. 750,000) 90 56.3


Interests of Doing IVA

Good (=75% - 100%) 80 50.0

Average (56% - 75%)

Low (=55%)


is the ideal number of children suggested bythe government to reduce the possibility ofgetting infection in the delivery that later cancause cervical cancer.

Another characteristic of the researchis seen from the aspect of mother’sknowledge about cervical cancer. Thehighest numbers of respondents are thosewho have higher level of knowledge aboutcervical cancer which are as many as 80people (50%). It shows that the level ofknowledge or understanding about cervicalcancer will give positive contribution to therespondents’ interests to do early detectionof cervical cancer with IVA method.

Another characteristic of the researchfrom the aspect of education shows that mostof the respondents, as many as 93 people(58.1%), are from lower level of education.This could possibly that the respondents getthe information about cervical cancer notonly from formal education but also fromthe society’s activities such as socializationsgiven by health cadres, information from bothelectronic and mass media, and alsoinformation from family or from the otherpeople.

Seen from the aspect of economiclevel, most respondents, as many as 90people (56.3%), are from the lowereconomic level with low income. While fromthe aspect of interest, the highest numbersof respondents, as many as 80 people(50%), are those with good interest. Thisresearch shows that the respondents havegood interest to do IVA check. This alsomeans that the higher level of knowledge ofcervical cancer can make the respondentsrealize the importance of detecting cervicalcancer by using IVA method although theincome of the family is low. This can be thatthe continual socializations will increase theinterest of the productive women in doingearly detection for cervical cancer. In thesociety itself, the problem of low economic

level will also result in the low participationof the society in doing early detection forcervical cancer if they have no sufficientknowledge about the early detection ofcervix cancer and if they have no chance tobe able to do the early detection for cervicalcancer with low and affordable cost.

Interest of Productive Women in the Ageof 20 to 49 Years Old in PuskesmasTemon I to Do Early Detection forCervical Cancer by Using IVA (AcetateVisual Inspection) Method Seen fromthe Aspect of Age

The results of the research show thatthe respondents in the age of 40 to 49 yearsold tend to have good interest in doing earlydetection for cervical cancer by using IVAmethod. The ages of the respondents thatrange from 20 to 49 years old can increasethe interest of the respondents when theyfigure out that cervical cancer can happento married women. The age of marriage ofthe respondents, to some extent, causes therespondents’ anxiety about cervical cancer.This encourages the respondents to do earlydetection for cervical cancer and to makesure whether or not they are potential tosuffer from cervical cancer.

Interest of Productive Women in the Ageof 20 to 49 Years Old in PuskesmasTemon I to Do Early Detection forCervical Cancer by Using IVA (AcetateVisual Inspection) Method Seen fromthe Aspect of the Number of Children.

Respondents who have 1 to 2 childrenhave good interest in doing early detectionfor cervical cancer. This can be that the idealnumbers of children based on the familyplanning program are two children. Motherswith two children are not too burdenedfinancially by the needs of the children. Theycan also take care of their two children well.With the ideal number of children, mothers


will have more time to take care of their ownhealth as well, one of them is by doing earlydetection for cervical cancer by using IVAmethod. For those who have many children,they will get difficulties in managing timebetween taking care of the children andtaking care of their own health.

Interest of Productive Women in the Ageof 20 to 49 Years Old in PuskesmasTemon I to Do Early Detection forCervical Cancer by Using IVA (AcetateVisual Inspection) Method Seen fromthe Aspect of Level of Knowledge

The results of the research show thatwomen with higher level of knowledge aboutcervical cancer have good interest in doingearly detection for cervical cancer by usingIVA method. The level of knowledge playsan important role in somebody’s action orbehavior. This is in line to what has beenstated by Notoatmojo (2003) that the levelof knowledge is a domain for someone toact.

Interest of Productive Women in the Ageof 20 to 49 Years Old in PuskesmasTemon I to Do Early Detection forCervical Cancer by Using IVA (AcetateVisual Inspection) Method Seen fromthe Aspect of Level of Education

People with higher level of educationtend to find wider information andknowledge. Different levels of education areusually related to human resources as anindividual or as a social group. Mothers whohave higher level of knowledge generally paymore attention to their health (Purwanto,1999). The thing that causes good interestto do early detection for cervical cancer ofthose who have lower level of education isthat there is possibility that the informationabout cervical cancer can be gained not onlyfrom formal education but also from some

activities in the society itself such associalization by health cadres, informationboth from electronic and mass media, andalso information from family members orfrom the other people.

Interest of Productive Women in the Ageof 20 to 49 Years Old in PuskesmasTemon I to Do Early Detection forCervical Cancer by Using IVA (AcetateVisual Inspection) Method Seen fromthe Aspect of Economic Level

Ahdani (2004) states that if peoplehave good or high social-economic status,they tend to broaden their interests to dothings that they want. On the contrary, ifpeople have low economic level, they tendto limit their interests. They will think thatthere are other needs that are moreimportant to fulfill than their own health.

Based on the results of this research,people with higher economic level tend tohave good interest in doing early detectionfor cervical cancer by using IVA method.This also happens to those with middle andlower economic level who have goodinterest as well. The high interest in doingearly detection for cervical cancer of therespondents who have lower economic levelcan be possibly caused by their higher levelof knowledge about cervical cancer,supported by examination or detectionwhich does not charge a fee as long as it isdone in the government’s institution, in thiscase in Puskesmas Temon I.

SUGGESTIONS1. For Health Institutions of Kulon Progo

Regency, in this case the programmerof Family Health, it is suggested that theyshould:a. Socialize early detection for cervical

cancer through various media.b. Expand partnership networks in order

to increase the interest of productive


women in doing early detection forcervical cancer.

c. Plan to give pre-detection or pre-examination Communication ofInformation and Education (KIE) tothe acceptors of the Family Planningprogram to do early detection forcervical cancer and to be standar-dized in S SOP of midwife in theservice center.

d. Monitor evaluation toward theprograms of reproduction health.

2. For midwives, it is suggested that theyshould:a. Give planned and continuous

motivation to the society.b. Optimize the program of early

detection for cervical cancer by givingCommunication of Information andEducation (KIE) before theexamination of the Family Planningacceptors to do early detection forcervical cancer.

REFERENCESAhdani, N, 2004, Kajian Faktor Threat

dan Coping Terhadap PartisipasiWanita dalam Program SkriningKanker Leher Rahim di Biro Kon-sultasi Kanker Yayasan KucalaYo g y a k a r t a , 2 5 – 2 – 2 0 0 8 ,www.litbang.depkes.go.id

Al Qur’an, Al-Syu’ara ‘ (26): 80’Arikunto, S, 2006, ProsedurPenelitian

Suatu Pendekatan Praktek,Rhineka Cipta Jakarta

Bagus, I, 2001, Kapita Selekta Penata-laksanaan Rutin Obstetri Gine-kologi dan KB, ECG, Jakarta

Cut Nurhasanah, 2008, Pengaruh Karak-teristik Dan Perilaku PasanganUsia Subur (PUS) TerhadapPemeriksaan Pap Smear DiRSUZA Banda Aceh DinasKesehatan Kabupaten KulonProgo, 2008, Laporan DataKesehatan Keluarga

Dwi Yani Sulistyowati, 2008, HubunganTingkat Pengetahuan TentangKanker Leher Rahim DenganMinat Pemeriksaan KankerServiks Pada Ibu Usia 25 – 26Tahun Di Dusun Janti DepokSleman Yogyakarta

El – Sulthani, 2000, Zikir dan Do’a DalamKesibukan, Al Mawardi Prima,Jakarta. (http://mandacutie.files.wordpress.com/2008/03/female)Accessed on the 26th of Juli 2010.

Hurlock, 2002, Psikologi Perkembangan,Erlangga, Jakarta

Manuaba I,B,G.2002.Ilmu Kebidanan Pe-nyakit Kandungan dan KeluargaBerencana, EGC, Jakarta

Nasir, Jangan Takut Pap Smear.www.rachmadpoltektk93.blogspot.com. 29 Nopember 2007

Notoatmodjo, 2007, Promosi KesehatanTeori dan Ilmu Perilaku, RinekaCipta, Jakarta

Notoatmodjo, 2005, Promosi KesehatanTeori dan Aplikasi, Rineka Cipta.Jakarta

PKBI Cabang Kulon Progo, 2007, DataPemeriksaan Deteksi DiniKanker Leher Rahim YKI, 2008,Laporan YKI Cabang KulonProgo

THE EFFECT OF DIABETIC GYMNASTICS TOWARDTHE SELF-ESTEEM IN THE PEOPLE WITH DIABETESMELLITUS (DM) AT PKU MUHAMMADIYAH HOSPITAL

YOGYAKARTA

Dwi Jayani & MamnuahAisyiyah Health Sciences College of Yogyakarta


Abstrak: Penelitian ini bertujuan untuk menganalisis pengaruh senamdiabetes terhadap harga diri pada penderita diabetes mellitus di RS PKUMuhammadiyah Yogyakarta. Metode yang digunakan ialah quasi-experiment dengan pendekatan non-equivalent control group. Tekniksempel yang digunakan adalah teknik random sampling yang memenuhikriteria inklusi dan eksklusi. Dengan sampel 40 orang dengan 20 orangsebagai kelompok eksperimen dan 20 orang sebagai kelompok kontrol.Untuk menguji hipotesis menggunakan Wilcoxon Match Pairs Test. Hasilpenelitian diketahui bahwa didapatkan hasil uji statistik nilai p = 0,000lebih kecil daripada 0,05. Terjadi perubahan harga diri yang lebih tinggisetelah dilakukan senam diabetes dari pada sebelum dilakukan senamdiabetes. Bagi para penderita diabetes mellitus dapat melakukan olahraga: senam diabetes tiga kali seminggu dan dilakukan secara kontinyu untukmeningkatkan kualitas hidup dan harga diri.

Kata kunci: senam diabetes, harga diri, diabetes mellitus

Abstract: The objective of the research is to analyze the effect of diabeticgymnastics toward the self esteem of the people with DM at PKUMuhammadiyah Hospital Yogyakarta. This research uses the quasi-experiment with the non-equivalent control group approach. Thesampling technique used in this research is random sampling techniquewhich fits the inclusive and exclusive criteria. The researcher dividedthe 40 samples into 2 groups of 20: the first group is the experimentalgroup while the second group is the control group. The researcher usedWilcoxon Match Pair Test to test the hypothesis. From the statisticaltest, it was obtained P-Value = 0.000 < from α 0.05. From the research,it can be concluded that there is a significant self esteem changing beforeand after the diabetic gymnastic treatment. Especially for people withDM, it is suggested to take diabetic gymnastic three times a weekcontinually in order to achieve a better life quality and self esteem.

Keywords: diabetes gymnastics, self-esteem, diabetes mellitus

29Dwi Jayani & Mamnuah, The Effect of Diabetic Gymnastics ...

INTRODUCTIONDiabete mellitus (DM) is one of chronic

diseases which is persist for years, gettingmore serious, persistent and often relapse.From the survey which was done by theWorld Health Organization (WHO),Indonesia is the fourth country in the worldwith the largest number of diabetic afterIndia. In 1995, it was estimated 4.5 millionpeople in Indonesia and in 2025, it isestimated to increase into 12.4 millionpeople (Ministry of Health, 2006).

The number of diabetic in Indonesiahas now reached five million people or fivepercent of the population. The number ofdiabetic in Indonesia is estimated to increasefrom 8.4 million in 2000 to 21.3 millionpeople in 2030. The number of diabetic inYogyakarta, in 2010 has reached 1835people, or approximately 0.93% of thepopulation (Health department, 2010). Theimpact on the diabetic, they tend toexperienced the behavioral changes such asthe disturbance of their self-esteem(Purwaningsih & Karlina, 2009).

Individuals with chronic diseases suchas diabetes will contribute a low self-esteemto theirselves. They will feel worthless in andin a long term, it can lead to a depressioncaused by high blood glucose levels inpatients with DM (Anderson & McFarlane,2007). Self-esteem is an individualassessment of the results achieved byanalyzing how far the behavior meets herideal. It can be defined that self-esteemdescribes how far individual thinks of himself/herself as someone who has the ability,valuable, worthwhile, and competent. Theindividual views about him/her are influencedby the way how individuals interpret theviews of others about him/her (Stuart &Sundeen, 1991, in Arya, 2010).

People with diabetes tend toexperience symptoms such as depressionwith continuous sadness, feeling worthless,

and sleep difficulties due to the drasticlifestyle changes to manage their diabetesmellitus. The data form WHO explain thatabout 9-23% from 240,000 adults in 60countries suffer from depression. From thedata, it can be seen that 1 to 4 peoplesuffering from depression due to a chronicdisease such as diabetes (Marsiela, 2006).To treat the disease, they need a hugemedical bills and if it is not treatedimmediately, there are possibilities that thepatient will commit suicide. Approximately15% of the depressed patients die by suicide,20% - 40% had attempted suicide, and 80%had suicidal ideas (Amir, 2005).

The importance of handling theproblem of depression by increasing the self-esteem of the patients is to avoid thetendency to isolate theirself and to preventany suicide attempts. The factors thatinfluence the self-esteem in diabetic includean unrealistic ideal self, productivity that isdecreasing, the changes in social roles,powerlessness, physical illness, stressors,and social support (Yosep, 2010).

The resolution of the United Nations(UN) number 61/225 dated December 20,2006 determined November 14th as TheWorld Diabetes Day. In Indonesia, thegoverment’s policies to prevent andovercome the disease is by activating theDM health care centers starting from theprimary level that is the public health center(Puskesmas) to the very top level that is thecenter and private hospitals to perform theprimary prevention and treatment of DM,as well as a number of referral hospitals ineach region. Beside activating the health carecenters, the government also form anorganization that engages in research, serviceand community service for DM, like diabetesorganizations that have been established inIndonesia. DM prevention can also be doneby organizing seminars and counseling ondiabetes and how to prevent it in the


community. The other policy is also doneby giving awards to the institutions orgovernment agencies, private agencies andthe community who have successfullyperformed the activities associated with DMsuch as organizing mass DM calisthenics,global diabetes walk, counseling andeducation about DM (Suyono dkk, 2005).

Many hospitals set up an associationfor diabetics (PERSADIA). It aims tocontrol, to prevent and to reduce therecurrence of the disease. The participationof the community is also involved in theactivities such as integrated service posts(Posyandu), small community in theirsurrounding which is called as family welfareeducation (PKK), the elderly community, theyouth groups and those who are interestedin maternal and child health. Through theactivities of these groups, the general butpopular material related to DM can beinserted by the health worker or socialworker who had been trained under theguidance and supervision of the diabetespractitioner (Suyono dkk, 2005).

Calisthenics has been used as thetreatment of diabetes mellitus. By doing anexcercise, it can increase their confidenceand bring a positive effect on theirselves.From a study which was conducted, it wasfound that people who do exercise can alsoimprove their self esteem. Physical exerciseor calisthenic can make a person feelhappier, calmer, more confident, moreenergetic, and able to think and solve theirproblems (Katrina, 2006).

Patients with diabetes mellitus diabetesare encouraged to do gymnastics. Diabeticgymnastic is an activity or exercise done bydiabetics to prevent injuries and help theblood circulation of the foot. The exerciseson their feet aim to improve the bloodcirculation, strengthen the small muscles,preventing deformity of the feet, increasesthe strength of their calf muscle and thigh,

as well as to overcome the limitations of jointmotion (Widianti & Proverawati, 2010).

According to the medical records, thenumbers of diabetic patients in PKUMuhammadiyah Hospital Yogyakarta in theperiod of April 2011 are 151 patients, 136outpatients and 15 hospitalized patients.From the survey of a preliminary studyconducted by the researcher at PERSADIAPKU Muhammadiyah Hospital Yogyakartaon Sunday, on the 15th of May 2011, thedata showed that on the first day of thediabetic gymnastic, the researcher foundthate there were 30 patients who join in.

Based on the background of thestudies, the researchers are interested indoing a research on the effect of diabeticgymnastic toward the self esteem in thepeople with diabetes mellitus (DM) at PKUMuhammadiyah Hospital Yogyakarta.

The Purpose of the Study: to analyzethe effect of diabetic gymnastic toward theself-esteem in people with diabetes mellitus(DM) in PKU Muhammadiyah HospitalYogyakarta.

RESEARCH METHODThis research uses the quasi-

experiment with the non-equivalentcontrol group approach (Notoatmodjo,2005). It is said as quasi-experimentbecause these experiments have not or donot possess the characteristics of the actualexperimental design.

The population of the study is all thepatients with DM in PKU MuhammadiyahHospital Yogyakarta that are 151 patients.

The sampling technique used in thisresearch is random sampling technique. Thenumbers of samples in this study are 40people. According Sugiono (2006), thenumber of samples in a simple experimentalstudy, which uses experimental group andcontrol group, are 20 people of each group.


The tools used in this study are a setof sound system, gymnastics cassette, andassisted by the instructor for diabeticgymnastics, while the self-esteem ismeasured using the Coopersmith EsteemScale (SES) questionnaire.

The data processing techniqueperformed in this study is using the statisticaldata analysis. The steps of the dataprocessing are editing, coding, tabulating andtransfering. To know the difference betweenthe experimental group and control group,it is done by finding the difference of the valuebetween the pre-test and the post-test ofthe groups. Before the statistical test isapplied, the data normality test should beapplied first. This test is applied to determinewhether or not the data is normal. The datanormality test is done by using theKolmogorov-Smirnov Z formula.

RESEARCH RESULT ANDDISCUSSIONThe Overviwes of the Research Sites

PKU Muhammadiyah HospitalYogyakarta is one of the private hospitals inYogyakarta which is managed by the CentralBoard of Muhammadiyah. It is one of theeconomical units of Muhammadiyah. It is

accredited in C plus level in its 12 fields ofservice. Besides providing the healthservices, it is also used as a place ofeducation for future doctors and nurses. Togive the service to the patients, it provides23 clinics and 5 units of service as well asseveral other supporting medical serviceunits. PKU Muhammadiyah HospitalYogyakarta is located on the KH. AhmadDahlan No 20.

The Characteristic of the RespondentsThe respondents in this study were the

patients with DM. The experimental groupconsists of them who are doing the exerciseregularly every Sunday at DiabeticGymnastics Club of PKU MuhammadiyahHospital Yogyakarta. Whereas, the diabeticoutpatients in internal medicine clinic, surgicalclinic, and the other wards who are notdoing the gymnastic are included in thecontrol group. The samples in this study are40 people who are divided into two groups.Each group consists of 20 people. Thesamples in the study were selected basedon the inclusion criteria set by the re-searchers. The characteristics of respon-dents can be seen in table 1.

The General Characteristic of the Respondent in PKU Muhammadiyah HospitalYogyakarta in June 2011

NoThe limitation of

the Characteristics

The number of Respondents

Frequency Percentage (%)

Gender :

1 Male 15 37,5

2 Female 25 62,5

Total 40 100,0

Age :

1 30-64 years 35 87,5

2 65-78 years 5 12,5

Total 40 100,0

Occupation :

1 Housewife 16 40,0


From the table 1 above, it can be seenthat from the gender category, the femalerespondents are more than the malerespondents that is 25 people (62.5%).Based on the age category, the highestpercentage of the respondent is the middle-adult age of 30-64 years that is 35 people(87.5%), while based on the occupationcategory, the highest percentage ishousewives as many as 16 people (40.0%).Most of the respondents were graduatedfrom junior high school and diploma,respectively by 9 people (22.5%)

The Self-Esteem of the Diabetics in PKUMuhammadiyah Hospital Yogyakarta

Table 2. The Frequency Distribution ofSelf-Esteem before

Occupation :

1 Housewife 16 40,0

2 Entrepreneur 3 7,5

3 Private Employee 3 7,5

4 Merchant 3 7,5

5 Teacher/Civil

Servant

7 17,5

6 Pensioner 6 15,0

7 Farm worker 1 2,5

8 Head of the

government

Village device

1 2,5

Total 40 100,0

Education:

1 Uneducated 1 2,5

2 Primary School 7 17,5

3 Junior High

School

9 22,5

4 Senior High 8 20,0

School

5 Diploma 9 22,5

6 S1 6 15,0

Total 40 100,0

No Before

Respondents

FrequencyPercentage

(%)

1 High 15 37,5

2 Medium 23 57,5

3 Low 2 5,0

Total 40 100,0

Source: Primary data Juni 2011.


From Table 2, it is shown that the self-esteem of the respondent before the diabeticgymnastic is done for the first time, 57.5%of them (23 people) had medium self-esteem.

Table 3. The Frequency Distribution ofthe Self-Esteem after Doingthe Diabetic Gymnastics

No AfterRespondents

Frequency Percentage (%)

1 High 26 65,0

2 Medium 14 35,0

3 Low 0 0

Total 40 100,0


Table 3 shows the change of therespondents’ self esteem. After the thirdmeeting, the researchers conducted a posttest. It can be seen from the table that afterthe post test, the self-esteem of therespondents performs the highestpercentage of high self-esteem (26 peopleor about 65.0%)

Table 4. The Self-Esteem of the Pa-tients with Diabetes Mellitusin PKU MuhammadiyahHospital Yogyakarta beforeand after the Diabetic Gym-nastic

Wilcoxon Test Result

The Source of the

Data

Experiment Control Description

Z P Z P

Before-After

treatment

-2,887 0,004 -1,732 0,083 Significant


From the results of Wilcoxon signedranks test above, it can be seen that if thestandard error is 0.05 (p), then the value ofz table = 2.58. The value of z hitung -2.887 is

smaller than -2.58 and p value = 0.004 (p<0.05), thus Ho was rejected and Ha wasaccepted in the experimental group.Whereas, in the control group, the value ofz hitung -1.732 is greater than -2.58 and p =0.083 (p <0.05), thus Ho was rejected andHa was accepted. These results indicate asignificant that there is difference self-esteemvalue before and after diabetic gymnastic isdone. This means that there is significanteffect between doing the diabetic gymnasticsto the self-esteem of the people with DM inPKU Muhammadiyah Hospital Yogyakarta

DISCUSSIONThe Self-Esteem of the Patients withDiabetes MellitusThe Self-Esteem of the Patients withDiabetes Mellitus before doing thediabetic gymnastic

The research on the experimentalgroup and the control group in this studyobtained that before doing the diabeticgymnastic, the self-esteem level of thepatients with DM in PKU MuhammadiyahHospital Yogyakarta are mostly at themedium level, that is 57.5%. This is probablydue to the pain that is experienced by themajority of them. According to Potter &Perry’s theory (2005), it states that thephysical health problems can bring a low self-esteem so that there is a potential that thepatients’ self-esteem can go lower as thedisease is getting worse.

In this study, most of the DM patientsare in medium level of self-esteem. Thereare only 5% of the respondents who arediagnosed at a low level of self-esteem.Most of the respondents have a sense ofpersonal competence or self confidence andthe feeling of personal value or self-respect.Only few of them feel dissatisfied with theirselves.

The self-esteem level of a person withDM can be decreased with the increasing


of the severity of the illness and it isassociated with the limited activity of thepatients. The helplessness is usually beginwith sadness and they feel as if there is nomore way to treat their disease beside aroutine diabetes treatment, having a diet,doing exercise, insulin therapy, monitoringthe blood sugar and special education(Brunner and Suddart, 2002),

In DM, there is a possibilitythat the patients may have a better self-esteem level than those diabetic people whohave complications associated with drugdependence, including anti-diabetic drugs.Their dependence of anti-diabetic drugs canaffect the decline of their productivity, thechanges in social roles, helplessness andself-idealization. Those are 3 of 8 factorsthat affect the self-esteem in patients withDM.

The Self-Esteem of the Patients withDiabetes Mellitus after doing thediabetic gymnastic

After the treatment of diabeticgymnastic every morning for three times aweek in PKU Muhammadiyah HospitalYogyakarta, it obtained that the self-esteemlevel of the respondents is improved, that itin the level of 65% from 37.5% before thetreatment is given. It is because there is arole of social relationship from their family,close friends, spouses, colleagues, neighborsand relatives. The increasing level of theirself-esteem after the treatment is probablydue to the increase of their health statuswhich is affected their self-confidence, self-esteem and the life quality of life the patientswith DM as the effects of diabetic gymnastic(Anonymous, 2009).

In the previous study conducted byYoriko, et al (2006) in his research entitled“Psychosocial Factors Associated withTreatment Satisfaction and Self-esteemin Adults with Diabetes An Analysis on

Family Support”, he states that one of thefactors which can enhance the self-esteemare the social support of their family. Itoccurs because the social support is requiredfor every cycle of life and can affect aperson’s health status. The social supportwill be more needed when someone isfacing a problem or illness. This socialsupport is given to help them to live withtheir experience and solve their problems intheir effort to adapt to a chronic illness suchas diabetes mellitus (Anderson & McFarlen,2007).

The effect of Diabetic Gymnastictoward the Self-Esteem in the Peoplewith Diabetes Mellitus (DM) at PKUMuhammadiyah Hospital Yogyakarta

The results of the analysis using theWilcoxon Test Match Pair in the controlgroup obtained the significance value at asignificance level. It means that there is nosignificant average change between the resultbefore and after the treatment given to thecontrol group. Whereas, the analysis resultof the experimental group obtained thesignificance value at the significance.... Itmeans that there is a significant effect of thediabetic gymnastic on the self-esteem levelin the people with DM in PKUMuhammadiyah Hospital Yogyakarta.

Diabetic gymnastics is one of diabeticself care which would play an important rolein DM management, particularly inpreventing the occurrence of diabeticcomplications. The complications of DM willmake the disease getting worse and take alonger time to be healed and the cost of thetreatment would be more expensive. If thecomplication is left too long, it can cause adisability and even worsening the low self-esteem level or a lack of confidence.

With the improvement of the self-esteem level and the physical fitness thatsupport the diabetic treatment, the diabetic


gymnastic has prevented the decline in theself-esteem level which is tend to run alongwith the physical deterioration (Potter &Perry, 2005). In accordance with the data,before the treatment is given, most of therespondents’ self-esteem level is in mediumlevel (57.5%) and after the treatment, theself-esteem level increases to 65% orincreased by 7.5%. This proves that thediabetic gymnastic therapy brings a significanteffect of improvement in a short time and itis possible that the therapeutic effect of thediabetic gymnastic will take time. Based onthe research result, the patients with DM arerecommended to do the diabetic gymnasticas early as possible.

CONCLUSION AND SUGGESTIONConclusion

The self-esteem of the patients withDM in PKU Muhammadiyah HospitalYogyakarta, before doing the diabeticgymnastic are mostly in the medium level,that are 23 people, 15 people have the highself-esteem level and the last 2 people havethe low self-esteem level. After thetreatment, the self-esteem of the patientswith DM in PKU Muhammadiyah HospitalYogyakarta are mostly in the high level, thatare 26 person and the rest 14 people havethe medium self-esteem level. The result alsoshows the difference before and after thetreatment is given, that is the increasing scoreof the self-esteem questionnaire by 1 point.Therefore, it can be concluded that the effectof diabetic gymnastic toward the patientswith DM in PKU Muhammadiyah HospitalYogyakarta is enhancing their self-esteem.

SuggestionsTo the respondents

To the people with DM, they can docalisthenics that is diabetic gymnastic threetimes a week. It can be performedcontinuously in order to maintain a stable

blood sugar, improve cardiovascular andrespiratory system itself as well as improvethe quality of life and the self-esteem ofpeople with DM.

To PKU Muhammadiyah HospitalYogyakarta

To the nurses at PKU MuhammadiyahHospital Yogyakarta, it is expected toprovide health services for the patients withDM by giving exercises. The diabeticgymnastic is given to maintain a stable bloodsugar, improve cardiovascular andrespiratory system itself as well as improvethe quality of life and the self-esteem ofpeople with DM.

To STIKES ‘Aisyiyah YogyakartaIt is expected that it can be used as a

source of information and discourse thatcalisthenics, in this case is diabetic gymnasticmay be one of the therapy to improve theself-esteem level of the people with DM.

To the other researcherTo the other researcher, it is

suggested to control the confounding factorsthat is the decreasing productivity, unrealisticself ideality, powerlessness, physical illness,and stressor

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THE RELATIONSHIP OF NURSE PERCEPTION TOWARDSTHE LEADERSHIP STYLE OF THE ROOM HEAD WITH

THE WORK MOTIVATION OF NURSE

Deasti nurmaguphita & Syaifudin Aisyiyah Health Sciences College of Yogyakarta


Abstract: The research was aimed at gaining description about stressexperience and the coping strategies of the family in taking care of thefamily members suffered from hallucination. The descriptivephenomenology was used as the design of this research. The participanemployed as the research method. The questions types were semistructure. The interview was transcribed and analyzed using Collaizitechniques. The result research identified 7 themes, namely; the disturbingclient’s behavior, the family’s burden, the physical response, psychologicalresponses, social responses, coping strategies of the family, and healthservice which can fulfill the family expectation. The research reveals thatthere were various stress experiences. There were also various copingstrategies employed by the family in providing care the clients sufferedfrom hallucination.

Keywords: family, hallucination, stress and coping strategies.

Abstrak: Penelitian ini bertujuan untuk mendapatkan gambaran tentangstres dan strategi koping keluarga dalam merawat anggota keluarga yangmengalami halusinasi. Penelitian dilakukan dengan disain fenomenologideskriptif. Partisipan adalah pemberi perawatan utama dalam keluarga,yang didapatkan dengan cara purposive sample sebanyak enam orang.Metodenya indepth interview. Tipe pertanyaannya semistructure. Hasilwawancara dalam bentuk transkrip dianalisa dengan menggunakan teknikCollaizi. Hasil penelitian mengidentifikasi 7 tema yaitu perilaku klien yangmengganggu, beban keluarga, respon fisik, respon psikologis, responsosial, strategi koping keluarga, dan pelayanan kesehatan yang sesuaidengan harapan keluarga. Hasil penelitian menggambarkan stres yangberagam dan pilihan penggunaan strategi koping yang digunakan keluargaselama merawat klien halusinasi sangat bervariasi.

Kata kunci: keluarga, halusinasi, stres dan strategi koping


INTRODUCTIONNowadays nursing in Indonesia is still

in a process towards professionalization,namely the occurrence of a change andgrowth of characteristics according to thedemands of global and local or autonomy.To realize it the Indonesian nurses shouldbe able to provide nursing care in aprofessional to patients and activelyparticipate in developing the nation and state(Nursalam, 2007). Health services is asystem whose the components areinterconnected, related and they influenceeach other in achieving a purpose includingnursing services to improve the degree ofcommunity health (Depkes RI, 1985). TheQuality and the quantity of nursing servicesshould be maintained and optimallyenhanced. This is emphasized in the Act ofIndonesia Republic number 23 of 1992about health conducted by treatment and orcare.

The most health services provided bythe hospital is the nursing care in this caseas the executors are nurses. In performingon the duty, the nurses have a duty structurethat the establishment of working proceduresand the equality of perception or objectiveaction headed by a room head of nursing asa manager for setting the staff in performingtheir duties. The Leadership style of roomhead which is implemented as the way tolead can be well received by theirsubordinates but can also be somethingwhich is disliked by the subordinates. Thisis because the understanding and self-assessment to others vary in each person.And the room head tends to consider therules applied are appropriate and should beapplied (Huber, 2006)

According to Gaffar (1999) that therole of the manager (in this case is the roomhead) is not optimal. Common cause is alack of understanding of the nurse to themanagement concept, the scope of authority

and responsibility of the nurse are not soinfluential in planning and decision making,and the tendency of promotion system whichhas not used criteria that have not been openand objective as a stimulus to excel. Thelow role of nurses in health service inproviding health services is grouped byAnwar (1999) in Nursalam (2002), such as:1. The role of professional nurses who are

not optimal2. The tardiness of the recognition

knowledge body of the nursingprofession

3. The tardiness of the development ofprofessional nursing education

4. The tardiness of the development ofservices / professional nursing care

The performance of nurses today aremore due to obey the rules of the hospital,employment contracts and the demands ofliving or getting a good salary, for the workmotivation depends on the needs by thenurse herself. Sometimes they feel to have ahigh motivation and sometimes they feel lessmotivated to perform their duties. Althoughthe assignment must still be done, the workmotivation depends on the feelings (mood)of each nurse. The room head himselfsometimes does not give work motivationto the nurses as it may seem not tooimportant to do. In fact a work motivationis a fundamental thing as the reference ofthe person in completing his work. Thevarious kinds of working or leadership styleof the room head is really influenced by thepersonality of the room head himself whichsuch as attitudes and behavior of leading,the leader traits and the ability to understandand to coordinate the subordinates. So thatthe compliance of subordinates, perceptionof leadership style, work motivation, or howthe work of subordinates may be influencedby the performance traits of the room head.

39Deasti nurmaguphita & Syaifudin, The Relationship of Nurse ...

The results of preliminary studiesconducted by researchers at RSDPanembahan Senopati Bantul obtain theresults that the lack of communication showsthe lack of the room head performance inunderstanding his subordinates. Commu-nication has low intensity, so room head isnot close enough to know the conditions ofhis subordinates and the effort to motivatethe employees is not really notice. Besidesthe possibility of a nurse who perceives thatthe room head uses certain ways to lead willprobably increase intensity varyingcompliance so that the motivation for thework becomes high or low. The leadershipstyle that is enforced by the room head ofRSD Penembahan Senopati is certainly bethe things to utilize and explore the potentialof the nurses, especially in increasing themotivation to provide optimum services forservice users in RSD Panembahan Senopati.

RESEARCH METHODThe study is a quantitative study using

a descriptive correlational research methodthrough a cross-sectional approach (crosssectional survey)that is conducting researchat one time the survey and knowing thedynamics of correlations between riskfactors with the effect. Research data relatingto the independent variable and thedependent variable collected at the sametime.

This study population is a nurseexecutive who served in 10 InstallationRegional Hospital Inpatient PanembahanSenopati nurse as much as 103 people.Sampling is simple random samplingtechnique involving 35 respondents whomeet the criteria for inclusion and exclusioncriteria established by the researcher.

The study was conducted in theinpatient installation of RSD PanembahanSenopati Bantul. Implementation of the studywas conducted in May 2008 that started

from the collection of data by distributingquestionnaires. This instrument waspreviously tested for validity and reliabilityof the instrument which was completely validand reliable. Validity test for independentvariables using the product moment formulaand use the formula alpha reliability test. Asfor the data analysis and statistical tests usedto know the relationship Chi Square (X ²).

RESULTS AND DISCUSSIONOverview of Research Sites

Regional Hospital of PanembahanSenopati Bantul is located in Wahidin SudiroHusodo Street which is a government-owned hospital in Bantul district that servesas a referral hospital for the district of Bantul.Regional Hospital of Panembahan SenopatiBantul Hospital’s vision is to realize asuperior and a choice of Bantul andsurrounding communities.

The number of nursing staff workingin inpatient rooms until March 2008 is asmany as 103 nurses. Number of beds(BOR) on average per month was 72.03%,long day care (LOSS) an average of 4 days,a distance of hospitalized patients (TOI) onaverage 0.85 days and unused bed (BTO)average of 68.2% per year.

Characteristics of RespondentsRespondents in this study were 35

nurses in implementing the Regional HospitalInpatient Room of Panembahan SenopatiBantul in May 2008, amounting to 35 nurses.Consists of 7 people (20%) aged less than25 years, 21 people (60%) aged 26-35years and 7 people (20%) aged over 35years, so most of the nurses are betweenthe ages of 26 -35 years.

There are much more femalerespondents than male respondents, wherethe female respondents are as many as 31people (88.58%) and male respondents


only 4 people (11.42%). Respondents weremostly educated D III Nursing (32.63%),3 SPK-educated nurses (8.57%) while thenurse executive is only one person educatedS1 nurses (2.85%).

Respondents with a period of 1-5years of work are 10 nurses (28.57%),respondents with a service life of between4-6 years there are 16 nurses (45.71%)which is the largest and nurse respondentswith a service life of more than 6 years thereare 9 people (25.71%).

Description of Nurse’s perceptions ofPrincipal’s Leadership Style

Data of nurse perceptions of theleadership style of head space is obtainedfrom the questionnaire distribution. Answersof the respondents were judged on scoresor percentages ever, after the Tabulate dataand can be categorized in the descriptionthat in-patient ward of respondents perceivethe head space to implement Supportiveleadership style that is as many as 21 people(60%) and others perceive response headspace to apply the leadership style that issupportive sebanayak 14 people (60%).Therefore, according to respondents RSDPanembahan Senopati Bantul head spaceis not using directive or delegative leadershipstyle.

One of the factors that predispose aperson to perceive something is the level ofeducation. The higher one’s education themore it will be science and knowledge(Notoatmojo, 2003). The results showedthat most respondents are DIII nursingeducation. Education is never taken one ofthe factors that will support the ability toreceive information disclosed byNotoatmojo (2003).

Thus the executive nurse’s perceptionof the leadership style of the space will bebased on the observed behavior of the headspace or means of delivery then the action

is good or bad will be accepted by theirsubordinates. Clarity of information and theway the task will greatly affect theperformance generated by the nurseexecutive.

In RSD Panembahan Senopati Bantulhead space on subordinates tendcooperative, able to accommodate theaspirations of the nurse executive, to helpsolve the nursing task being assessed needsto be addressed. Not authoritarian in thedelegation of tasks and open to any inputfrom the nurse executive. This gives theunderstanding that the work environmentcreated by the head of the space could bewell received by his subordinates and couldcreate a closer relationship to jointly performtasks as well as possible.

Description of Nurse’s WorkMotivation

To express the motivation factors thatinfluence nurse’s job satisfaction, it is saidthat motivation is closely related to one’ssatisfaction in work. AccordingWahyosumidjo (1987), behaviors that occurin a person or a subordinate in the contextof motivation as a management concept,driven by a need. There are needs that existin a person pushing a person to behave,attitude of a person’s behavior which isalways goal-oriented, the fulfillment ofdemands or do something and the meanbehavior of a person shown in theorganizational life which cannot be not inorder to realize satisfaction.

Based on this work motivationquestionnaire, it is revealed that the factorof leadership is not getting the highest value,this suggests that leadership is not the majorcause of work motivation. The leadershipfactor is also not very influential with themotivation to work. This is in accordancewith the opinion of Wahyosumidjo (1987)that motivation is influenced by a multifactor


aspect which all converge in the workenvironment. Work environment in questionis personal and the nature of the conditionitself and also the subordinate one’sperspective in understanding their respectiveduties. According to Blanchard and Herseyin Wahyosumidjo (1987), there is no bestleadership, there has been a successfulleadership style, which is a leader who canadapt the style according to the particularsituation, is the maturity level of developmentof subordinates in carrying out certain tasks.

Motivation of the nurse executive atRSD Panembahan Senopati Bantul is stillhigh even though the head space may beusing a variety of leadership styles of spacebecause the environment or the safety of co-workers are considered more to contributeto improving one’s motivation at work.

Relations of the Nurse’s Perceptiontoward the Leadership Style of theRoom Head in relation to Nurse’s WorkMotivation

An analysis of value obtained p =0.116 and the value of X ² = 2.468 with df= 1 and using the standard error of 5%. ThusHa Ho accepted and rejected, because thecorrelation coefficient (X ² count) is smallerthan the X ² table (2.468 <3.841). In otherwords, it can be concluded that there wasno significant relationship between nurse’sperception of the leadership style of roomhead with the nurse work motivation.

This may imply that leadership styledoes not absolutely affect a person’smotivation to work. And the factors thatmake someone able to do it based on thebest performance of the work environmentand security of personal and environmentalfactors as well as the work itself.

As expressed by Potter & Pery,that the act would be maximized if it issupported by aspects of the environmentexists. The environment is not conducive to

implementing the performance associatedwith morale and workload that are ownedby nurses. If the environmental conditionsconducive to implementing measures inaccordance with the rules of the person inthat environment will be affected and willeventually apply the appropriate behaviorto their environment. (Kartika, 2003).

In accordance with the statementthat the leadership of someoneWahyosumidjo 1987 could affect anindividual’s performance but the main causeis multifactorial environment in which thereare work environment, the level ofconfidence, workload, motivation, andothers. So the motivation of a person whoat any given time can be high or low is notsolely influenced by the way leaders applythe leadership style to manage subordinates.

Swanburgh, (2006) reveals that theperception of a person against anotherperson is different according to theconditions experienced by individuals aswell as the level of maturity in which differentcannot be just one factor but rather carriedaway by the state as well as the ability toself-understanding others. Person’smotivation is not always in a constantcondition in which the different atmosphereand the opportunity to change itsfluctuations.

Work environment, family and thedesire for career advancement will probablybe its own motivator for a person to performhis duties as possible. Therefore, when aleader leadership style to apply to any typeof leadership, motivation, someone will beable to remain high.

Supporting and Inhibiting FactorsSupporting factor factor in this study

is the existence of the guidance given by thesupervisor to the researcher and the grantingof permission by the Hospital who haveprovided information and a list of


respondents. Where the data is verybeneficial for the researchers to facilitate themeeting and include the respondent data.Then, the inhibiting factor in this study weresometimes reluctant to fill the nursemanaging the actual state of the head space.Head of the space age older thansubordinates tend to be more experiencedand worthy of respect. Male gender isusually considered more assertive thanwomen. Although the ability of someone notto be measured by age and sex of a person.

CONCLUSION ANDRECOMMENDATIONSThe conclusions

Based on the results of research anddiscussion, it can be concluded as follows:1. Of the four types of leadership style is

directive, participative, supportive anddelegative, the nurse’s perception of theleadership style of head space in theroom inpatient RSD PanembahanSenopati Bantul the most supportive andthe leadership style that is almost closeto the participative leadership style.

2. Motivation possessed by nurses workingin RSD Panembahan Senopati Bantul ishigh with a score above the average of72% to 76%.

3. Based on hypothesis testing and dataanalysis showed that there was nosignificant relationship between nurseperceptions of leadership style in the headspace of RSD Panembahan SenopatiBantul.

Suggestion1. For inpatient room nurse of RSD

Panembahan Senopati Bantul.High enough motivation should be offsetby the creation of a sense of security and acomfortable working environment of eachindividual nurse. So it can work better.

2. For the institution of RSD PanembahanSenopati BantulThe hospital is expected to be able toimprove the quality of nursing serviceswith greater reliance on performancerewards which are primarily structuredfor nurses who have high motivation towork and can perform the tasks well tofurther increase the impetus to moveforward.

3. For other researchersWe recommend using the techniqueselection questionnaire that is notrestricted, so that respondents wouldhave various alternative answers in orderof priority, while for data collection notonly use questionnaire but also madesome observations to learn more aboutleadership styles and motivation ofnurses work so we get more resultsaccurate and qualitative research shouldbe done. And future studies may furtherspecify the types of leadership stylewhich are more specifically one by oneand after that each new leadership stylesassociated with nursing work motivation.

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