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"Diabetes merupakan salah satu masalah kesehatan yang terjadi di perkotaan. Tahun 2012 didapatkan data sebesar 80% kematian terjadi akibat diabetes. kondisi ini berhubungan dengan terjadinya komplikasi serius pada pasien diabetes yaitu adanya hipoglikemi, ketoasidosis, gangguan sirkulasi (makrovaskuler dan mikrovaskuler), neuropati. Penelitian sebelumnya menunjukkan bahwa pemberian terapi prilaku aktivitas (senam kaki) dapat mengurangi gangguan sirkulasi pada pasien diabetes.Tujuan penulisan ini adalah untuk melakukan analisis evidence based mengenai terapi prilaku aktivitas (senam kaki) pada pasien diabetes untuk memperbaiki gangguan sirkulasi dan dapat mengurangi komplikasi serius tersebut. Hasilnya pada pasien ini adalah tidak terjadi penurunan dalam nilai ABI (achiles brachial index), dan tidak terjadi penurunan sensasi rasa (panas dan nyeri) pada kaki. Rekomendasi penulisan ini adalah agar perawat melakukan pemantauan terhadap perubahan sensasi dan dapat melakukan pemeriksaan ABI.

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Diabetics is one of the health problems occurs in urban areas. In 2012, Diabetics is 80% cause of deaths in urban area This condition relates to the occurrence of serious complications in patients with diabetes such as hypoglycemia, ketoacidosis, circulatory disorders (macrovascular and microvascular), and neuropathy. Previous research suggests that behavioral therapy activities (gymnastics feet) can reduce circulation disorders in patients diabetes. The purpose of this paper is to analyze evidence based practice on behavioral therapy activities (gymnastics feet) in diabetic patients to improve impaired circulation and reduce the serious complications. The result of this study indicates there is no increasing in the patient's ABI (Achiles brachial index), and no declining in the patient's feet sensation (hot and Pain). It is highly recommend that nurses can perform Achiles brachial Index (ABI) monitoring and feeth sensation monitoring periodically. "

"ABSTRAKDiabetes Melitus (DM) merupakan kelainan heterogen ditandai oleh kenaikan kadar glukosa darah. Penyakit ini bisa dikelola dengan mematuhi 4 pilar penatalaksanaan DM meliputi pendidikan kesehatan, perencanaan diet, latihan fisik dan minum obat OHO yang harus dipatuhi seumur hidup. Penelitian kualitatif dengan pendekatan fenomenologi, bertujuan menggali berbagai pengalaman ketidakpatuhan pasien terhadap penatalaksanaan DM. Delapan Partisipan dipilih sesuai kriteria dengan metoda convenience sampling di RSUPN Dr. CM Jakarta. Data dikumpulkan melalui wawancara mendalam yang dilengkapi catatan lapangan, direkam kemudian dibuat transkrip verbatim, selanjutnya dianalisis menggunakan metoda Collaizz. Hasil penelitian mengidentifikasi tujuh tema utama yaitu: makanan diit tidak menyenangkan, tidak memahami manfaat diit menyebabkan ketidakpatuhan, tidak memahami manfaat latihan fisik untuk penatalaksanaan DM, alasan usia sudah lanjut, keterbatasan fisik menyebabkan tidak melakukan latihan fisik, pemahaman yang salah tentang manfaat obat, gagal mematuhi minum obat karena alasan ekonomi. Penelitian menyimpulkan bahwa pasien DM tidak patuh terhadap penatalaksanaan DM dengan alasan terbanyak adalah karena tidak memahami manfaat penatalaksanaan DM. Hasil penelitian mengimplikasikan perlunya pemberian pendidikan kesehatan berkelanjutan khususnya di area keperawatan medikal bedah untuk meningkatkan kepatuhan pasien DM. Peneliti menyarankan perlunya peningkatan kemampuan perawat memberikan pendidikan kesehatan, merancang program untuk meningkatkan kepatuhan pasien dan penelitian lanjutan dengan fenomenologi untuk menggali kepatuhan masing-masing pilar secara khusus

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Diabetes Mellitus (DM) is a heterogeneous disorder with improvement of blood glucose. The disease can be treated by using 4 pillars of handling of DM. The pillars are health education, planning of diet, physical exercise, and the using of medicine which have to use for a lifetime. This qualitative study adopted phenomenological approach which goal was to explore various experiences of patient’s non-adherence to the treatment of diabetes mellitus. Participants were selected according to certain criteria by using convenience method. Eight participants who participated in this study had experience of non-adherence to the treatment of diabetes mellitus in RSUPN Dr. CM Jakarta. Data were collected through in depth interview process in two phases and accompanied by field notes. The interview was recorded and converted in to verbatim transcript and then analysed by using Collaizz’s method. The results identified seven major themes which consist of unhappiness diet, not understand about the benefit of diet which made non-adherence, not understand about the benefit of physical exercise for the treatment of diabetes mellitus, the age is old, physical disability makes patient didn’t do physical exercise, incorrect understanding about the benefit of medicine, fail to adhere taking medicine because of economic’s reason. This study concludes that the most reasons of patient’s non-adherence to the treatment of diabetes mellitus is “not understand the benefit of adhering the treatment of diabetes mellitus”. The results of this research give implication about the necessary of giving health education continuously, especially in medical surgical nursing area to improve the adherence of patient with diabetes mellitus. Researcher suggests the need of nursing skills improvement about how to give a good health education, make a program to improve patient’s adherence, and make other research to explore patient’s adherence with 4 pilars specificly."

"ABSTRAKUlkus kaki merupakan salah satu komplikasi kronis pada pasien diabetes mellitus. Ulkuskaki diabetes ini tidak hanya berdampak secara fisik bagi pasien, namun juga berdampakbagi kehidupan psikososialnya. Penelitian ini bertujuan untuk memperoleh pemahamanyang mendalam tentang pengalaman psikososial pasien dengan ulkus kaki diabetes.Desain penelitian ini adalah fenomenologi deskriptif dengan metode wawancaramendalam. Partisipan adalah pasien DM yang mengalami ulkus kaki diabetes, diambildengan cara purposive sampling. Data yang dikumpulkan berupa rekaman hasilwawancara dan catatan lapangan yang dianalisis dengan teknik Collaizi. Hasil penelitianini menunjukkan berbagai pengalaman psikososial pasien ulkus kaki diabetesdigambarkan dalam 11 pernyataan tematik. Penelitian ini menyimpulkan setiap pasienulkus kaki diabetes mengalami berbagai respon psikologis yang teridentifikasi dalam 4tema yaitu menghadapi berbagai ketakutan, menjadi tidak berdaya, menjadi bebankeluarga dan menyalahkan diri sendiri. Terdapat 2 tema dari respon sosial yang dialamiyaitu menjadi tidak sebebas/tidak seaktif dulu dan menjadi tidak percaya diri dalambergaul. Terdapat 3 tema tentang mekanisme koping pasien dalam menghadapi ulkuskaki diabetes yaitu menjalani kehidupan dengan pasrah pada keadaan, banyakmendekatkan diri pada Tuhan dan tetap memiliki pandangan positif terhadap diri sendirimeskipun mempunyai ulkus kaki diabetes. Setiap pasien ulkus kaki diabetesmemperoleh berbagai macam dukungan dan memiliki berbagai harapan/kebutuhanterhadap pelayanan keperawatan. Berdasarkan hal tersebut perawat seharusnya dapatlebih memperlihatkan sikap caring dan menyediakan waktu khusus untuk mendiskusikanberbagai perasaan negatif akibat ulkus kaki yang dialaminya serta para perawat perlumengembangkan kemampuan koping dan adaptasi pasien terhadap ulkus kaki diabetesagar pasien dapat lebih baik mengelola stress psikososial yang dialaminya.

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ABSTRACTUlcer is one of the chronic complications of diabetes. Diabetic leg ulcer does not onlyaffects the patient physically but also affects patient’s psychosocial life. This researchwas aimed to explore deeper understanding of psychosocial experiences of patients withdiabetic leg ulcer. The participant was diabetic leg ulcer patient choosen by usingpurposive sampling. The design was descriptive phenomenological using indepthinterview and field notes, using Collaizi technique to analized. The results showed somepsychosocial experiences of patients with diabetic leg ulcer found 11 themes. Thisresearch concluded that every patients with diabetic leg ulcer had variety psychologicalresponds that were identified in 4 themes including fears, being powerless, being familyburden and blame themself. There were 2 themes for social responds, namely not asactive as before and loss self confidence. There were 3 themes for coping mechanismsthatwere continuing their normally daily life, faith to God and having positive thinkingabout themselves, eventhought they have a diabetic leg ulcer. Every patients withdiabetic leg ulcer got various supports and had various expectations and needs moresupport from nurse. It was suggested that nurses have to spending more time to discussnegative feeling of diabetic leg ulcer and also help patient in enhancing copingmechanism in adjust with their diabetic leg ulcer. This action will improve better healthoutcome of diabetes mellitus patient and they can manage their psychosocial stressbetter."

"Sirosis hati merupakan salah satu masalah kesehatan yang terjadi pada masyarakat perkotaan. Keadaan malnutrisi ditemukan pada 65-90% pasien sirosis hepatis. Kondisi malnutrisi ini berhubungan dengan terjadinya komplikasi serius pada pasien sirosis hepatis, yaitu asites, ensefalopati hepatikum, dan kematian. Penelitian sebelumnya menunjukkan bahwa pemberian diet tinggi protein, khususnya yang kaya akan asam amino rantai cabang (AARC) dapat memperbaiki kondisi klinis pasien sirosis dan mengurangi komplikasi serius tersebut. Tujuan penulisan ini adalah untuk melakukan analisis evidence based mengenai pemberian AARC dalam memperbaiki kondisi klinis (nutrisi, nilai albumin, dan mengurangi terjadinya ensefalopati hepatikum). Hasilnya pada pasien ini adalah terbukti status nutrisi dapat ditingkatkan, tidak terjadi penurunan yang signifikan pada nilai albumin, dan tidak terjadi ensefalopati hepatikum. Rekomendasi penulisan ini adalah agar perawat memberikan pendidikan kesehatan tentang pentingnya diet tinggi protein yang kaya akan AARC.

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Cirrhosis hepatic is one of problem in urban health. Malnutrition is commonly found in 65-90% cirrhosis hepatic patients. This condition correlated with serious complications such as ascites, hepatic encephalopathy, and mortality. Previous researches recommend that high protein intake enriched in branched chain amino acids (BCAA) can improve clinical outcome of cirrhosis hepatic patients and reduce complications. This final clinical nursing report aimed to analyze evidence based about BCAA administered to improve clinical outcome (nutritional status, albumin, and reduce hepatic encephalopathy). The results showed that nutritional status improved, no decreased of albumin concentration, and hepatic encephalopathy not reported. It is recommended to deliver health education to patients about the important of high protein intake enriched in BCAA."

"ABSTRAK Kasus HIV/AIDS dan tuberkulosis banyak diderita masyarakat perkotaan.Penyakit pada masyarakat perkotaan berkaitan dengan karakteristik lingkungandan gaya hidup masyarakat perkotaan. Kasus HIV biasanya disertai denganberbagai infeksi oportunistik. Infeksi opportunistik yang paling banyak ditemukanadalah tuberkulosis, diikuti dengan kandidiasis oral, dan diare. Masalahkeperawatan utama pada pasien dengan tuberkulosis adalah ketidakefektifanbersihan jalan napas berhubungan dengan retensi sputum. Penulisan karya ilmiahakhir ini bertujuan untuk menganalisis intervensi mandiri keperawatan berupakombinasi antara anjuran minum air putih hangat, postural drainase, dan batukefektif untuk mengatasi masalah bersihan jalan napas tidak efektif. Intervensidilakukan pada pasien HIV/AIDS dengan tuberculosis di ruang rawat penyakitdalam RSCM. Hasil dan evaluasi dari intervensi yang dilakukan yaituberkurangnya penumpukan sputum pada jalan napas pasien, sehingga pasien tidakmerasakan sesak seperti sebelumnya dan bisa bernapas lebih lega. Perawatdiharapkan dapat melakukan intervensi mandiri keperawatan berupa kombinasiantara anjuran minum air putih hangat, postural drainase, dan batuk efektiftersebut untuk membantu memperbaiki status pernapasan pasien.ABSTRACT Cases of HIV / AIDS and tuberculosis affects many urban communities. Diseases

in urban communities are related to environment and lifestyle characteristics of

urban communities. HIV cases are usually accompanied by a variety of

opportunistic infections. The most common opportunistic infections is

tuberculosis, followed by oral candidiasis and diarrhea. The main nursing

problems in patients with tuberculosis is the ineffectiveness of airway clearance

related to the retention of sputum. This final scientific thesis aims to analyze the

independent nursing intervention in the form of a combination of the

recommendation to drink warm water, postural drainage, and cough effectively to

address the problem of ineffective airway clearance. The intervention was

conducted in HIV/AIDS patient with tuberculosis in medical ward RSCM. The

result of interventions was reduced sputum buildup in the airway of the patient, so

the patient did not feel crowded as before and could breathe more easily. Nurses

are expected to conduct independent nursing interventions in the form of a

combination of the recommendation to drink warm water, postural drainage and

effective coughing to help improve patient's respiratory status. ;Cases of HIV / AIDS and tuberculosis affects many urban communities. Diseases

in urban communities are related to environment and lifestyle characteristics of

urban communities. HIV cases are usually accompanied by a variety of

opportunistic infections. The most common opportunistic infections is

tuberculosis, followed by oral candidiasis and diarrhea. The main nursing

problems in patients with tuberculosis is the ineffectiveness of airway clearance

related to the retention of sputum. This final scientific thesis aims to analyze the

independent nursing intervention in the form of a combination of the

recommendation to drink warm water, postural drainage, and cough effectively to

address the problem of ineffective airway clearance. The intervention was

conducted in HIV/AIDS patient with tuberculosis in medical ward RSCM. The

result of interventions was reduced sputum buildup in the airway of the patient, so

the patient did not feel crowded as before and could breathe more easily. Nurses

are expected to conduct independent nursing interventions in the form of a

combination of the recommendation to drink warm water, postural drainage and

effective coughing to help improve patient's respiratory status. ;Cases of HIV / AIDS and tuberculosis affects many urban communities. Diseases

in urban communities are related to environment and lifestyle characteristics of

urban communities. HIV cases are usually accompanied by a variety of

opportunistic infections. The most common opportunistic infections is

tuberculosis, followed by oral candidiasis and diarrhea. The main nursing

problems in patients with tuberculosis is the ineffectiveness of airway clearance

related to the retention of sputum. This final scientific thesis aims to analyze the

independent nursing intervention in the form of a combination of the

recommendation to drink warm water, postural drainage, and cough effectively to

address the problem of ineffective airway clearance. The intervention was

conducted in HIV/AIDS patient with tuberculosis in medical ward RSCM. The

result of interventions was reduced sputum buildup in the airway of the patient, so

the patient did not feel crowded as before and could breathe more easily. Nurses

are expected to conduct independent nursing interventions in the form of a

combination of the recommendation to drink warm water, postural drainage and

effective coughing to help improve patient's respiratory status. "