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"Pendahuluan: Pada traumatic brain injury (TBI) dapat terjadi peningkatan metabolisme sehingga pasien rentan mengalami malnutrisi. Tatalaksana nutrisi yang adekuat sesuai dengan kondisi klinis dan komorbiditas berperan dalam mencegah terjadinya malnutrisi, menurunkan morbiditas dan mortalitas, serta mengoptimalkan outcome neurologis. Presentasi Kasus: Keempat pasien dalam serial kasus ini adalah laki-laki berusia antara 31-60 tahun dengan TBI dan berbagai faktor penyulit. Pasien pertama dengan obesitas dan mengalami hiponatremia berulang selama perawatan, pasien kedua memiliki status gizi malnutrisi, pasien ketiga dengan riwayat kemoradiasi pada astrositoma, amiloid angiopati dan disfagia, sementara pasien keempat dengan hipertensi dan fibrilasi atrium. Skrining gizi dengan MST pada keempat pasien menunjukkan skor dua. Pemberian energi pada keempat pasien adalah sebesar 140-150% dari kebutuhan energi basal yang dihitung dengan Harris-Benedict, dengan target pemberian protein sebesar 1,5-1,9 g/kg BB/hari atau setara dengan 20% energi. Selama pemantauan asupan protein pada keempat pasien adalah sebesar 0,55-1,67 g/kg BB/hari atau setara dengan 13,1-19,5% energi. Restriksi cairan dilakukan pada pasien pertama sebagai tatalaksana hiponatremia yang diperkirakan terjadi akibat SIADH. Pemberian natrium pada pasien keempat tidak direstriksi meskipun pasien mengalami hipertensi karena hipertensi adalah salah satu mekanisme kompensasi pada TBI. Pasien ketiga mengalami disfagia jika mengasup air putih sehingga dilakukan latihan menelan. Asupan per oral dimulai pada hari ke 6-15 pasca trauma. Hasil: Keempat pasien menunjukkan perbaikan outcome neurologis yang tampak berdasarkan peningkatan skor GCS disertai peningkatan kapasitas fungsional. Kesimpulan: Tatalaksana nutrisi yang adekuat pada pasien TBI dengan mempertimbangkan komorbiditas pasien diperlukan untuk menunjang penyembuhan dan memperbaiki outcome pasien.

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Background: Hypermetabolism in traumatic brain injury (TBI) increase the risk of malnutrition. Adequate nutritional management based on clinical status and comorbidity reduces the risk of malnutrition, therefore reduces morbidity and mortality rate and improves neurological outcomes.

Case Presentation: The four patients included in this serial case were male, 31-60 years old. All patients were diagnosed with TBI complicated by various comorbidities.The first patient was obese with reccurrent episode of hyponatremia during hospitalization, the second patient was malnourished, the third patient had history of chemoradiation due to astrocytoma and was diagnosed with angiopathy amyloid and dysphagia, while the fourth patient was diagnosed with hypertension and atrial fibrilation. The MST scores in all four patients were two. Target of energy provision were between 140-150% of predicted basal energy requirement and target of protein provision were 1,5-1,9 g/kg BW/day or equal to 20% of energy. The protein intake during monitoring were 0,55-1,67 g/kg BW/day or equal to 13,1-19,5% energy. The fluid intake was restricted in first patient due to SIADH- related hyponatremia. Sodium intake was not restricted for the forth patient eventhough the patient was diagnosed with hypertension. In TBI, hypertension could occur due to compensational mechanism. The third patient was having difficulties consuming water due to dysphagia, and was conducted to multiple swallowing therapy exercises. Oral intake in four patients were initiated in day 6-15 post trauma.

Result: There were improvement of neurological outcome shown by the higher GCS score and improvement of the functional capacity in all four patients

Conclusion: Adequate nutritional management in TBI patient can support the recovery and improve patient's outcome. Nutritional management should consider patient's comorbidities."

"Cedera kepala merupakan penyebab utama kematian dan kecacatan pada populasi dunia berusia di bawah 45 tahun. Cedera kepala sedang (CKS) dan berat (CKB) biasanya memerlukan perawatan intensif dan pendekatan medis-bedah. Pasien dengan cedera kepala mengalami peningkatan laju metabolisme sehingga memerlukan tatalaksana medik gizi yang sesuai. Pemenuhan kebutuhan energi yang tidak adekuat dapat menyebabkan peningkatan angka morbiditas, risiko infeksi, dan komplikasi lainnya. Pemberian nutrisi enteral dini dalam kurun 24-48 jam setelah masuk Intensive Care Unit (ICU) dapat memperbaiki luaran klinis pasca cedera. Serial kasus ini bertujuan untuk melaporkan peran tatalaksana medik gizi pada status gizi, lama pemakaian ventilator, tingkat kesadaran dan kapasitas fungsional pada pasien kritis dengan CKS dan CKB. Empat pasien laki-laki dengan rentang usia 25-46 tahun diobservasi selama perawatan di ICU RS Cipto Mangunkusumo, dua pasien dengan diagnosis CKS dan sisanya dengan diagnosis CKB. Status gizi berdasarkan indeks massa tubuh, dua pasien memiliki berat badan (BB) normal, satu pasien BB lebih dan satu pasien obesitas II. Tingkat kesadaran berdasarkan skor Glascow Coma Scale (GCS) pasien pada saat masuk ICU adalah 6-11. Selama perawatan keempat pasien mendapat nutrisi enteral dini dan pemberian nutrisi ditingkatkan bertahap. Pada seluruh pasien, kebutuhan energi dapat dipenuhi sesuai target 25-30 kkal/kg BB. Kebutuhan makronutrien dapat dipenuhi sesuai target, yaitu protein 1,2-2 g/kg BB, lemak 20-30%, dan karbohidrat minimal 100 g/hari. Pada dua pasien dengan CKB, diberikan nutrien spesifik berupa glutamin sebesar 0,2 g/kgBB/hari dan mikronutrien berupa vitamin C, vitamin B kompleks, asam folat, dan seng. Hingga akhir pemantauan status gizi pada dua pasien CKS dapat dipertahankan, sedangkan dua pasien dengan CKB mengalami penurunan berat badan. Dua pasien CKS hanya menggunakan ventilator selama 4-5 hari, sedangkan dua pasien dengan CKB menggunakan ventilator lebih lama yaitu 12 dan 31 hari dengan disertai komorbiditas pneumotoraks dan ventilator-associated pneumonia. Tingkat kesadaran seluruh pasien mengalami perbaikan. Skor GCS pasien pada akhir perawatan di ICU adalah 7-15. Kapasitas fungsional berdasarkan Indeks Barthel juga mengalami perbaikan pada tiga pasien, yaitu dari ketergantungan total menjadi ketergantungan sedang atau berat. Dapat disimpulkan bahwa tatalaksana medik gizi dapat berperan dalam mempertahankan status gizi, menurunkan lamanya pemakaian ventilator, memperbaiki tingkat kesadaran dan kapasitas fungsional pada pasien sakit kritis dengan CKB dan CKS. Tingkat keparahan cedera kepala dan komorbiditas dapat memengaruhi luaran klinis dan harus dipertimbangkan dalam memberi tatalaksana medik gizi.

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Traumatic brain injury (TBI) is a leading cause of death and disability in the global population under 45 years old. Moderate and severe TBI usually require intensive care and a medical-surgical approach. Patients with TBI experience an increase in metabolic rate and therefore require appropriate medical nutrition therapy. Inadequate energy intake can cause an increase in morbidity, risk of infection, and other complications. Early enteral nutrition within 24-48 hours after ICU admission has been shown to improve clinical outcome.

This case series aims to report the role of medical nutrition therapy on nutritional status and clinical outcomes of critically ill patients with moderate and severe TBI. Four male patients aged 25-46 years were observed during their stay at the ICU of Cipto Mangunkusumo Hospital. Based on body mass index, two patients were normoweight, one patient was overweight and one patient was class II obese. The Glascow Coma Scale (GCS) scores of the patients on ICU admission were ranged 6-11.

Two of the four patients were classified as moderate TBI and the other two patients were as classified as severe TBI. On monitoring four patients received early enteral nutrition and the nutrition was gradually increased to reach the target of 25-30 kcal/kg body weight (BW). Enteral formula were targeted to achieve protein intake of 1.2-2 g/kgBW, fat intake of 20-30% of energy intake, and carbohydrate intake of at least 100 g/day. Two patients with severe TBI were given specific nutrients in the form of glutamine as much as 0.2 g/kgBW/day and micronutrients in the form of vitamin C, vitamin B complex, folic acid, and zinc. Two patients with moderate TBI received mechanical ventilation for 4 and 5 days, while two patients with severe TBI received mechanical ventilation for 12 and 31 days. In two patients with severe TBI, prolonged use of mechanical ventilation may be associated with the comorbidities of pneumothorax and ventilator-associated pneumonia.

At the end of monitoring, the levels of consciousness were improved in all patients. The patients GCS score at the end of treatment in the ICU were ranged 7-15. Functional capacity based on the Barthel Index also improved in three patients, from total dependence to moderate or severe dependence. Weight loss was experienced in two patients with severe TBI, possibly due to severe and prolonged catabolism in severe TBI. Patients with severe TBI may have higher energy requirements to maintain their nutritional status.

It can be concluded that medical nutrition therapy may play a role in improving the level of consciousness and functional capacity in critically ill patients with moderate and severe traumatic brain injury."

"Tatalaksana nutrisi pada pasien cedera kepala sedang dan berat mencakup pemberian makronutrien mikronutrien nutrien spesifik pengelolaan cairan dan elektrolit serta pemantauan dan evaluasi Dukungan nutrisi yang adekuat perlu diberikan pada pasien cedera kepala agar meningkatkan perbaikan kondisi optimal pasien Sebagian besar pasien cedera kepala memiliki status gizi yang baik sebelum terjadinya trauma Pemenuhan nutrisi yang optimal dapat turut menunjang perbaikan inflamasi metabolisme dan menjaga tidak terjadi penurunan status gizi Pasien pada serial kasus ini seluruh pasien laki laki mempunyai rentang usia 19 sampai 49 tahun Adanya penyakit penyerta mempengaruhi luaran akhir pasien cedera kepala Terapi nutrisi diberikan sesuai dengan kebutuhan setiap pasien Kebutuhan energi total dihitung berdasarkan perkiraan kebutuhan energi basal menggunakan persamaan Harris Benedict dikalikan faktor stres 1 4 1 6 dan pemberiannya disesuaikan dengan kondisi klinis pasien Kebutuhan protein 1 5 2 g kg BB hari dan lemak 20 30 Pemantauan mencakup tanda klinis toleransi asupan makanan kapasitas fungsional keseimbangan cairan parameter laboratorium dan antropometri Pemberian nutrisi pada pasien cedera kepala berat dengan sakit kritis bersifat individual dan mencakup semua aspek Tatalaksana nutrisi yang baik dan dilanjutkan dengan edukasi pada pasien dan keluarga diharapkan dapat meningkatkan kualitas hidup pasien cedera kepala dengan meminimalkan komplikasi yang dapat terjadi

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Nutrition therapy in patients with moderate and severe traumatic brain injury includes the provision of macronutrient micronutrient specific nutrition fluid and electrolyte management with monitoring and evaluation Adequate nutrition support should be given in traumatic brain injury to optmalyze outcome patient Three from four this case series have a normoweight before trauma Nutritional support can improve metabolism decrease inflammation and manage nutritional status Patients in this case series all male have an age range from 19 to 49 kg years Their comorbid condition influence outcome of traumatic brain injury patient Nutritional support is given according to each patient rsquo s requirement which is calculated with basal energy requirement using Harris Benedict equation with stress factor 1 4 1 6 and the administration starts with individual condition which gradually increased to reach the total energy expenditure Protein requirement 1 5 2 g kg day and lipid requirement is calculated 20 30 total energy requirement Patient rsquo s monitoring include clinical signs food intake tolerance functional capacity fluid balance laboratory and anthropometric parameter were taken With the management of good nutrition expected quality of life of patients with moderate and severe traumatic brain injury various comorbidities would be better "

"In order to reduce the number of deaths from severe head injuries, systematic management is essential. This book is a practical, comprehensive guide to the treatment of patients (both adults and children) with such injuries, from the time of initial contact through to the rehabilitation center. Sections are devoted to prehospital treatment, admission and diagnostics, acute management, and neurointensive care and rehabilitation. Evidence-based recommendations are presented for each diagnostic and therapeutic measure, and tips, tricks, and pitfalls are highlighted. Throughout, the emphasis is on the provision of sound clinical advice that will maximize the likelihood of an optimal outcome. Helpful flowcharts designed for use in daily routine are also provided. The authors are all members of the Scandinavian Neurotrauma Committee and have extensive practical experience in the areas they write about."

"This book is a concise guide designed for neurologists, primary care, and sports physicians and other medical providers, psychologists and neuropsychologists, and athletic trainers who may evaluate and care for patients with TBI. The book features summaries of the most pertinent areas of diagnosis and therapy, which can be readily accessed by the busy clinician/professional. "

"ABSTRACTLatar Belakang: Perbaikan status nutrisi merupakan salah satu indikator penting dalam menilai keberhasilan pengobatan tuberkulosis. Tujuan: Mengetahui hubungan antara jenis tuberkulosis dan penyakit komorbid dengan perbaikan status nutrisi pasien tuberkulosis anak setelah dua bulan pengobatan. Metode: Penelitian potong lintang dilakukan di RSUPN Cipto Mangunkusumo, Jakarta pada Januari-Oktober 2018 dengan melihat data rekam medis dari 207 pasien anak yang terdiagnosis tuberkulosis selama periode 2012-2018. Hasil: Terdapat hubungan bermakna antara jenis tuberkulosis dengan status nutrisi setelah dua bulan pengobatan fase intensif (nilai p = 0,014; IK95% = 0,422-0,914) dengan kesan bahwa pasien TB ekstraparu mengalami peningkatan status nutrisi lebih baik dibanding pasien TB paru. Selain itu, juga didapat hubungan bermakna antara keberadaan penyakit komorbid dengan status nutrisi pasien (nilai p = 0,020; IK95% = 1,063-2,382), pasien tanpa penyakit komorbid mengalami peningkatan status nutrisi lebih baik dibanding pasien TB dengan penyakit komorbid setelah pengobatan fase intensif. Kesimpulan: Jenis TB dan penyakit komorbid berhubungan dengan kondisi status nutrisi pasien selama dua bulan fase intensif pengobatan tuberkulosis. Tatalaksana komprehensif mencakup manajemen terhadap tuberkulosis dan penyakit komorbid, serta suplementasi nutrisi perlu diperhatikan selama fase awal pengobatan pasien tuberkulosis anak.

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ABSTRACTBackground: Nutritional status improvement constitutes one of an indicator to assess anti tuberculosis treatments success. Objective: This research aims to determine whether the diagnosis of tuberculosis (pulmonary or extrapulmonary) and comorbidities are associated with childrens nutritional status during the first 2-month of tuberculosis treatment. Methods: A cross-sectional study conducted in Cipto Mangunkusumo Hospital, Jakarta in January to October 2018 by reviewing 207 medical records of children diagnosed with tuberculosis from 2012-2018 period of time. Results: Type of TB is associated with nutritional status of children after 2-month intensive phase treatment (p value = 0.014; CI95% = 0.422 to 0.914), children with extrapulmonary TB show better improvement in nutritional status rather than children with pulmonary TB. Comorbidities are associated with nutritional status (p value = 0.020; CI95% = 1.063 to 2.382), tuberculosis children without comorbidities experience better nutritional status improvement rather than those with comorbidities after anti tuberculosis intensive phase treatment. Discussion: Type of TB and comorbidities are significantly associated with nutritional status of tuberculosis children during 2-month intensive phase of anti tuberculosis treatment. Comprehensive treatment including management for tuberculosis and those with comorbidities, along with nutritional supplementation are necessarily maintained during the early phase of treatment in children with tuberculosis."

"Covid-19 merupakan penyakit virus corona baru 2019 (Covid-19) dengan penularan yang sangat kuat dan tingkat infeksinya cepat. Banyak keluhan yang dirasakan oleh pasien covid-19 bahkan setelah pulih pun masih ada keluhan yang menetap. Hal tersebut dapat menurunkan kualitas hidup. Kualitas hidup dapat dipengaruhi oleh berbagai faktor antara lain faktor fisik, psikologis, sosial dan lingkungan. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi kualitas hidup pasien pasca covid-19 derajat sedang-berat dengan komorbid. Desain penelitian menggunakan cross sectional study. Sampel dalam penelitian ini berjumlah 130 orang yang telah pulih enam bulan dari covid-19 dengan tehnik pengambilan sampel menggunakan metode consecutive sampling. Hasil penelitian menunjukkan bahwa kualitas hidup pasien pasca covid-19 derajat sedang-berat dengan komorbid di RSUD Provinsi NTB dipengaruhi oleh usia, jenis kelamin, gejala sisa fatigue, gejala sisa dyspnea, gejala sisa kecemasan, jenis komorbid, status fungsional dan dukungan keluarga dengan usia sebagai faktor dominan. Penelitian ini merekomendasikan untuk melakukan skrining pada tahap pengkajian keperawatan terhadap faktor-faktor prediktor kualitas hidup sehingga diharapkan dapat meningkatkan kualitas hidup pada pasien yang memiliki faktor resiko tinggi.Kata kunci:Kualitas hidup,pasca covid-19 derajat sedang-berat,faktor-faktor yang mempengaruhi

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Covid-19 is new corona virus disease 2019 (Covid-19) with extremely impressive transmission and fast contamination rates. A large number of the complaints felt by Covid-19 patients, even even after recovering, there are as yet persevering grievances. This can decrease the quality of life. Quality of life can be affected by different elements including physical, mental, social and natural variables. The purpose of this study was to determine the factors that affect the quality of life of patients with moderate-to-severe post-covid-19 with comorbidities. The research configuration utilized a cross sectional review. The example in this study added up to 130 individuals who had recuperated a half year from Coronavirus with an examining strategy utilizing the continuous testing technique. The outcomes showed that the personal satisfaction of post moderate to severe Covid-19 with comorbidities at the NTB Provincial Hospital was affected by age, gender, fatigue sequelae, dyspnea sequelae, anxiety sequelae, comorbid types, functional status and family support. This study recommends screening at the nursing assessment stage for predictor factors of quality of life so that it is expected to improve quality of life in patients who have high risk factors.Keyword :Quality of life, post moderate to severe covid-19, factors influence"

"Pasien dewasa pertengahan dengan diabetes memiliki risiko lebih tinggi terjadinya komorbiditas. Diabetes self management merupakan hal yang esensial dilakukan untuk mengontrol gula darah. Tujuan penelitian ini menganalisis faktor-faktor yang mempengaruhi diabetes self management pada pasien dewasa pertengahan dengan diabetes tipe 2. Metode penelitian menggunakan pendekatan cross-scetional pada 91 reponden. Semua data pada penelitian ini diambil secara daring. Hasil analisis bivariat hanya dukungan keluarga (p=0,023) dan efikasi diri (p=0,0005) yang berhubungan dengan diabetes self management, sedangkan faktor lain tidak memiliki korelasi. Analisis regresi linear ditemukan bahwa efikasi diri (p=0,0005, R2=0,379) yang paling berpengaruh terhadap diabetes self management. Perawat perlu mengembangkan intervensi dan inovasi keperawatan yang mengacu pada pemberdayaan pasien dalam meningkatan kemampuan dalam perawatan diri sendiri. Fokus utama perawat pada peningkatkan efikasi diri pasien dan kemampuan diabetes self management. Diperlukannya edukasi yang berkelanjutan serta keterlibatan dari anggota keluarga pasien.

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Factors affecting diabetes self management in middle-age adult with type 2 diabetes mellitus. Middle-age adult patients with diabetes have higher risk comorbid conditions. Diabetes self management is an essential thing to control blood sugar.The aim of this study was to analyze the factors affecting with diabetes self-management in middle-age adult with type 2 diabetes. A cross-sectional approach was conducted for 91 respondents. All data in this research were collected from online survey. From the bivariate analysis, there were only family support (p = 0.023) and self-efficacy (p = 0.0005) that associated with diabetes self-management. The other variable had no correlation. Linear regression analysis found that self-efficacy (p = 0.0005, R2 = 0.379) had strongest correlation toward diabetes self-management. Nurses need to develop nursing interventions and innovations that refer to empowering patients to increase their ability to care for themselves. Nurses’ primary focus was on improving patient self-efficacy and diabetes self-management abilities. Patiens need for continuing education and involvement of the patient's family members."

"Latar Belakang: Pasien yang mengunjungi dokter gigi untuk perawatan mungkin memiliki penyakit penyerta atau komorbiditas yang berbeda. Komorbiditas adalah kondisi ketika terdapat lebih dari satu gangguan pada seseorang dalam periode waktu tertentu, baik penyakit fisik maupun psikis selain dari kondisi utama pasien yang memperburuk kondisi pasien. Tumpang tindih kondisi ini berpengaruh buruk terhadap kelangsungan hidup pasien. Keberadaan komorbiditas pada pasien dapat memiliki dampak secara langsung terkait beban fisiologis, serta secara tidak langsung yaitu pada pilihan pengobatan. Tujuan: Mengetahui distribusi dan frekuensi penyakit komorbid pasien pencabutan gigi di Rumah Sakit Khusus Gigi dan Mulut Fakultas Kedokteran Gigi Universitas Indonesia periode 2018 – 2020. Metode: Penelitian ini adalah penelitian deskriptif retrospektif yang menggunakan data sekunder yang bersumber dari rekam medik pasien. Hasil: Terjadi penurunan angka kunjungan pasien pencabutan gigi RSKGM FKG UI pada tahun 2018, 2019, dan 2020 secara berturut-turut. Berdasarkan 718 sampel rekam medik pasien pencabutan gigi RSKGM FKG UI yang tersedia selama periode 2018–2020, jumlah pasien yang melakukan pencabutan gigi dengan penyakit komorbid adalah sebanyak 341 pasien (47.5%), dengan persentase pasien perempuan sebesar 61.87% dan persentase pasien laki-laki sebesar 38.13%. Penyakit komorbid paling banyak terjadi pada kelompok usia 21–30 tahun dengan persentase sebesar 38.4%. Kesimpulan: Penyakit komorbid yang paling banyak ditemukan pada pasien pencabutan gigi RSKGM FKG UI periode 2018–2020 adalah kelainan pencernaan dengan persentase sebesar 56.6%, diikuti dengan hipertensi dengan persentase 23.5%. Indikasi pencabutan gigi paling banyak disebabkan oleh gangren radiks dengan persentase sebesar 32.6%, diikuti dengan gangren pulpa dengan persentase sebesar 30.8%.

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Background: Patients who visit the dentist for treatment may have different comorbidities. Comorbidity is a condition when there is more than one disorder in a person in a certain period of time, both physical and psychological illness apart from the patient's main condition which worsens the patient's condition. This overlap of conditions negatively impacts patient survival. The presence of comorbidities in patients can have a direct impact on the physiological burden and also indirectly where the presence of comorbidities will have an impact on treatment options. Objective: Knowing the distribution and frequency of comorbid diseases in tooth extraction patients at the Rumah Sakit Khusus Gigi dan Mulut Faculty of Dentistry, University of Indonesia for the period 2018 – 2020. Method: This study is a retrospective descriptive study that uses secondary data from the medical records of tooth extraction patients. Result: There was a decrease in the number of dental extraction patient visits at RSKGM FKG UI in 2018, 2019, and 2020, respectively. Based on 718 samples of patient medical records for tooth extraction at RSKGM FKG UI that were available during the 2018–2020 period, the number of patients who performed tooth extraction with comorbid diseases was 341 patients (47.5%), with the percentage of female patients being 61.87% and the percentage of male patients by 38.13%. Most comorbid diseases occur in the age group of 21–30 years with a percentage of 38.4%. Conclusion: The most common comorbid diseases found in tooth extraction patients at RSKGM FKG UI for the 2018–2020 period were digestive disorders with a percentage of 56.6%, followed by hypertension with a percentage of 23.5%. The most common indication for tooth extraction was radix gangrene with a percentage of 32.6%, followed by pulp gangrene with a percentage of 30.8%."

"Penyakit kronis kondisi yang berlangsung kurang lebih satu tahun dan memerlukan perawatan medis yang berkelanjutan sepanjang hidupnya. Dampak lanjut dari pandemic COVID-19 berupa tekanan psikologis bagi pasien yang menderita penyakit kronis yang disebabkan oleh penyakit komorbid, sehingga rentan terhadap paparan virus COVID-19 dan ketidakstabilan ekonomi memberikan konsekuensi adanya rasa kecemasan akibat pandemi COVID-19. Penelitian ini bertujuan untuk mengetahui persepsi pasien Dayak dengan penyakit kronis, perubahan yang mereka alami selama pandemik COVID-19 ini mengenai perubahan yang dirasakan, serta hambatan yang dirasakan dalam menjalani rawat jalan selama pandemic COVID-19 ini menurut perpektif pasien. Penelitian ini menggunakan pendekatan deskriptif kualitatif dengan metode wawancara. Partisipan berjumlah 12 orang dari Rumah Sakit Doris Sylvanus dan Rumah Sakit Bhayangkara yang dipilih melalui tehnik Purposive Sampling. Terdapat 4 tema yang dihasilkan dalam penelitian ini yaitu kecemasan tertular COVID-19 saat kontrol rutin di poliklinik selama pandemik COVID-19, perubahan yang dialami saat Pandemik COVID-19, upaya tradisional suku dayak menjaga kesehatan selama pandemik COVID-19, hambatan dalam menjalani kontrol rutin di poliklinik rawat jalan. Temuan tersebut menunjukkan pasien penyakit kronis mengalami kecemasan selama awal pandemik COVID-19 sehingga mengalami perubahan di dalam kehidupannya yaitu penerapan PHBS yang menjadi kebiasaan sehari-hari, pembatasan aktivitas diluar, masalah financial dirasakan pada beberapa pasien penyakit kronik, pengembangan manajemen mekanisme koping, menggunakan ramuan dan tindakan tradisional sebagai upaya menjaga kesehatan, serta kecemasan, masalah transportasi dan akomodasi menjadi hambatan bagi pasien penyakit kronik untuk melakukan kontrol rawat jalan. Tenaga keperawatan di unit rawat jalan dapat menyediakan tempat duduk yang sesuai dengan protokol kesehatan dan memanajemen layanan rawat jalan agar waktu antrian tidak lama serta menghindari kerumunan, sehingga capaian peningkatan kualitas hidup dan kepatuhan pasien melaksanakan kontrol rutin pengobatan dapat di maksimalkan.

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A chronic disease is a condition that lasts longer than one year and requires lifelong medical attention. The COVID-19 pandemic has also caused patients with chronic conditions, some of whom have comorbidities, to experience psychological stress. As the result, they are dominantly vulnerable to contracting the COVID-19 virus, economic instability during the COVID-19 pandemic causes anxiety to increase. This study aimed to investigate the perceptions of Dayak patients with chronic illnesses, the changes that they underwent during outpatient care during the COVID-19 pandemic, and the challenges they perspective from their point of view. This study uses a qualitative descriptive approach with the interview method. There were 12 participants from Doris Sylvanus Hospital and Bhayangkara Hospital who were selected through the Purposive Sampling technique. There are four main themes: the fear of contracting COVID-19 during routine control at the polyclinic during the COVID-19 pandemic, changes experienced during the pandemic, the traditional efforts of the Dayak community to maintain health during the pandemic, and the challenges in undergoing routine control in outpatient clinics. The results of this study indicate that anxiety has been experienced since the beginning of the pandemic, this affects their way of life, causing changes including the prohibition of doing outdoor activities and implementing PHBS daily. In an effort to maintain their health, they learn to manage coping strategies, overcome financial difficulties during the pandemic, and use traditional ingredients and methods. Barriers they face during outpatient control are anxiety, transportation and accommodation problems. As for suggestions in this study, nursing staff in outpatient units can provide seats in accordance with health protocols and manage outpatient services so that queue times are not long so as to avoid crowds, so as to achieve an increase in the quality of life and patients. compliance in carrying out routine control of treatment can be achieved and maximized."