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"ABSTRAKNyeri merupakan masalah yang sering dihadapi anak dengan kanker. Penatalaksanaan nyeri saat ini belum optimal sehingga meningkatkan morbiditas pada pasien kanker khususnya pada anak. Karya ilmiah ini disusun dengan tujuan untuk menggambarkan aplikasi Theory of Unpleasant Symptoms (TOUS) pada anak yang mengalami nyeri kanker dan optimalisasi peran perawat dalam memberikan edukasi manajemen nyeri pada anak dan keluarga. TOUS memiliki tiga komponen yaitu gejala, faktor yang mempengaruhi dan penampilan akhir klien. Ketiga komponen tersebut saling berhubungan serta dapat diintegrasikan dalam asuhan keperawatan anak. Aplikasi TOUS dan optimalisasi edukasi manajemen nyeri yang diberikan pada lima klien kelolaan efektif dalam meningkatkan kualitas hidup klien. Aplikasi TOUS pada asuhan keperawatan anak harus memperhatikan aspek tumbuh kembang dan psikologis anak.

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ABSTRACT

Pain is a common symptom experienced by children with cancer. Currently pain management is not optimized thereby increasing morbidity in patients with cancer, particularly in children. The purpose of this final scientific writing is to give an overview of applications Theory of Unpleasant Symptoms (TOUS) in nursing care for cancer children with pain, this paper also described optimize the role of nurses in providing education management of pain in children and families. TOUS has three components: symptoms, and the factors that affect the final appearance of the client. The three components are interrelated and can be integrated in nursing care for children. Application of TOUS and optimizing pain management which was given for five patient show that was increasing quality of life in patient. Application TOUS on nursing care of children should pay attention to the psychological aspect of growth and development."

"Wanita yang menderita kanker serviks stadium lanjut mengalami malodor yang akan mengganggu kualitas hidupnya. Perawat memiliki kewajiban untuk membantu pasien dengan menggunakan pendekatan teori Unpleasant Symptom dan Self Care. Dengan menggunakan teori Unpleasant Symptom pasien dibimbing untuk mengenali keluhan dan dampak yang mungkin terjadi pada dirinya, sedangkan dengan teori Self Care pasien dibimbing untuk mengenali potensi dirinya dalam mengatasi keluhannya secara mandiri sesuai dengan kemampuan diri dan support systemnya. Dengan berdasar kepada dua konsep yang dikolaborasikan, dilakukan implementasi evidence based practice nursing (EBPN) menggunakan intervensi perawatan luka kanker dengan menggunakan formula topikal standar dengan melibatkan pasien dan keluarga. Hasil menunjukan bahwa perawatan luka kanker dengan formula topikal standar dapat mengurangi instensitas malodor dan meningkatkan gambaran diri pasien.

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Woman with advance cervical cancer will experience malodour which would influence their quality of life. Nurses has a responsibility to help patient by using the Unpleasant Symptom and Self Care theory approaches. Using the Unpleasant Symptom theory, the patient is guided to recognize symptom and the effect that may occur to herself, whereas with the self care theory the patient is hint to know her own potential and manage her symptom independently according to her abilities and support system. Based on two colaborative concepts, evidence based practice nursing is implemented. Intervention given by nurse involved patients and families in giving a cancer wound care using standard topical formulas. The result show that wound care with standard topical formula effective to reduce malodour and improving patient self image."

"ABSTRAK Nyeri merupakan salah satu gejala yang paling mengganggu bagi pasien anak maupun dewasa yang mengidap kanker. Nyeri yang berkepanjangan dapat mengakibatkan terjadinya penurunan kualitas hidup anak dengan kanker. Tujuan dari penulisan karya ilmiah ini adalah memberikan gambaran mengenai pemenuhan kebutuhan kenyamanan untuk menurunkan nyeri kronis pada anak kanker melalui inhalasi aromaterapi dengan pendekatan Teori Kenyamanan Kolcaba. Terdapat lima kasus keganasan pada anak dengan usia 7 ndash; 15 tahun yang diberikan asuhan keperawatan menggunakan Teori Kenyamanan Kolcaba. Aplikasi Teori Kenyamanan Kolcaba dapat membantu dalam menerapkan asuhan keperawatan yang komprehensif pada anak kanker dan membantu dalam memahami bahwa pemenuhan kebutuhan kenyamanan anak dengan kanker diharapkan dapat memperhatikan aspek fisik, psikospiritual, sosiokultural, dan lingkungan. Intervensi inhalasi aromaterapi terbukti efektif dalam membantu pasien anak kanker dalam mengontrol nyeri kronis yang dirasakan dibandingkan dengan perawatan rutin. Perawat diharapkan dapat menerapkan intervensi inhalasi aromaterapi untuk mengoptimalkan kerja obat analgetik dalam menurunkan nyeri pada anak dengan kanker.ABSTRACT Pain is one of the most disturbing symptoms for pediatric and adult patients with cancer. Prolonged pain can lead to decreased quality of life of children with cancer. The purpose of this paper is to provide a description of the fulfillment of comfort needs to reduce chronic pain in children with cancer through aromatherapy inhalation with Kolcaba Comfort Theory approach. There are five cases of malignancy in children aged 7 - 15 years who are given nursing care using Kolcaba Comfort Theory. Applications of Kolcaba Comfort Theory helps in applying comprehensive nursing care to children with cancer and helps in understanding that to complete the comfort needs of children with cancer, we need to pay attention to physical, psychospiritual, sociocultural and environmental aspects. Interventions of aromatherapy inhalation have been shown to be effective in helping pediatric cancer patients in controlling perceived chronic pain compared with standard care. Nurses are expected to apply inhaled aromatherapy interventions to optimize the work of analgesic drugs in reducing pain in children with cancer."

"Mual muntah merupakan gejala yang paling sering dikeluhkan anak dengan kankerdalam menjalani kemoterapi. Gejala mual muntah timbul akibat efeksampingkemoterapi. Karya Ilmiah akhir ini bertujuan memberikan gambaran praktek spesialisdalam mengaplikasikan model konservasi Levine pada asuhan keperawatan anak kankeryang menjalani kemoterapi. Model konservasi Levine menggunakan prinsip konservasidalam penerapannya meliputi konservasi energi, integritas struktural, integritas personaldan integritas sosial. Aplikasi model konservasi Levine tertuang dalam lima kasusterpilih dengan masalah keperawatan adalah mual, defisit nutrisi, risiko defisit nutrisihipertermia, gangguan mobilitas fisik, gangguan citra tubuh, perfusi perifer tidakefektif, risiko infeksi, risiko perdarahan, dan gangguan pertumbuhan danperkembangan. Edukasi manajemen mual muntah bebasis pembuktian ilmiah dalamstandar operasional prosedur (SOP) digunakan sebagai salah satu rekomendasiintervensi keperawatan untuk menurunkan kejadian mual muntah anak dalammemenuhi kebutuhan nutrisi. Karya ilmiah ini merekomendasikan teori modelkonservasi Levine dapat diaplikasikan pada asuhan keperawatan pada anak dengankanker yang menjalani kemoterapi.

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Nausea and vomiting is most common symtoms in children with cancer undergoing of

chemotherapy. Nausea and vomiting is a symptom on side effect of chemotherapy. The

aim of this final assignment was to provide an overview of nurses specialist practice by

applying Levine conservation model in nursing care of children with cancer who are

experiencing nutrition problems.The Levine conservation model used four principles to

applied in nursing care, including energy conservation, structural integrity, personal

integrity, and social integrity. The Levine Conservation Model was applied in five

selected cases with the nursing problems found was nausea, nutrition deficit, nutrition

deficit risk, hyperthermia, physical mobility disorders, body image disorders, risk of

infection, ineffective peripheral perfusion, risk of bleeding, and growth and development

delay disorder. The management education of nausea vomiting is evidence based

practice through Operational Standard Procedure Analysis (SOP) to used as a

recommendation of nursing intervention to decrease the incidence of nausea vomiting in

children’s nutrition needs. This final assignment recommended that Levine

Conservation model theory can be applied to nursing care in children with cancer

undergoing of chemotherapy."

"ABSTRAKKarya Ilmiah akhir ini dilatar belakangi oleh adanya penurunan sistem imunitaspada anak kanker. Peran sebagai pemberi asuhan keperawatan diterapkan pada 5orang pasien anak kanker yang mengalami masalah penurunan sistem imunitas.Karya ilmiah akhir ini bertujuan mendeskripsikan penerapan model Adaptasi Roydalam asuhan keperawatan pada anak kanker yang mengalami penurunan sistemimunitas. Peran residen sebagai peneliti yaitu dengan membuktikan edukasiterapeutik sebagai salah satu teknik edukasi dalam pencegahan infeksi padapasien dengan penurunan sistem imunitas. Hasil praktik ini menunjukkan edukasiterapeutik mampu meningkatkan tingkat kepatuhan keluarga dalam pencegahaninfeksi. Dalam melakukan asuhan keperawatan, diharapkan mampu melakukanedukasi terapeutik dalam melakukan tindakan pencegahan perluasan infeksi.

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ABSTRACTThe background of scientific by decline the immunity system for children withcancer. Role as nursing care applied 5 patients with cancer children whosedecline the immune system. This final scientific thesis to describe the experiencethe cult residency application Roy Adaptation models in nursing care in childrenwith cancer whose decline immune system. The role of residence as researchersto prove Therapeutic Education as one of education method in prevention ofinfection in patients with immune system deficiencies. The result of practiceshows that therapeutic education can improve level of compliance family toprevention infection. In doing nursing care, should be able therapeutic educationtake precautions extension of infection.;"

"Pemburukan klinis anak merupakan suatu kondisi yang dapat terjadi kepada setiap klien anak yang mengalami proses infeksi. Karya ilmiah akhir ini bertujuan untuk memberikan gambaran asuhan keperawatan kepada klien anak dalam tatanan perawatan infeksi yang berisiko mengalami pemburukan klinis melalui pendekatan Theory of Unpleasant Symptoms. Metode penelitian studi kasus dilakukan terhadap 5 klien. Gejala yang tidak menyenangkan menjadi fokus asuhan keperawatan. Pengkajian keperawatan mencakup faktor yang memengaruhi seperti faktor fisiologis, faktor situasional, dan faktor psikologis. Implementasi mPEWS-InPro mobile app menjadi salah satu intervensi untuk menilai pemburukan klinis klien dan petunjuk dalam memberikan intervensi sesuai skoring dari parameter fisiologis. Evaluasi keperawatan dalam bentuk performa klinis ditampilkan melalui pengukuran fungsional, pengukuran aktifitas dan pengukuran fisiologis. TOUS dapat diaplikasikan dalam pemberian asuhan keperawatan kepada anak dalam perawatan infeksi, dengan modifikasi yang disarankan adalah berlakunya ungkapan orang tua sebagai gejala yang tidak menyenangkan dari anak yang belum dapat mengungkapkan perasaannya.

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Clinical deterioration is a condition that can occur in any child who is undergoing an infection process. This final paper aims to provide description of nursing care in pediatric infectious area whom is at risk of clinical deterioration through the Theory of Unpleasant Symptoms approach. The case study research method was conducted on 5 clients. Unpleasant symptoms were becoming the focus of nursing care. Nursing assessment includes influencing factors such as physiological factors, situational factors, and psychological factors. mPEWS-InPro mobile app's implementation became one of the interventions in assessing clients' clinical deterioration and guidance in providing nursing interventions refer to clients' physiological parameters. Nursing evaluation was in the form of clinical performance through clients' functional measurement, activity measurement and physiological measurements. TOUS can be applied in the provision of nursing care to the child in the treatment of infection, with the modified recommendation of the enactment of parental expression as an unpleasant symptom from children who has not been able to express their feelings. "

"[ABSTRAKNyeri pada anak kanker berdampak jangka panjang dan jangka pendek. Sebagianbesar orang tua tidak mengetahui cara mengkaji nyeri pada anak dan belummenggunakan skala nyeri yang sesuai dengan usia anak untuk mengukur nyeri.Pendidikan kesehatan tentang manajemen nyeri yang diberikan kepada pasienbelum terstruktur sehingga informasi yang diberikan tidak optimal. Penelitian inibertujuan untuk mengidentifikasi dampak intervensi edukasi terhadappengetahuan, sikap dan keterampilan orang tua dalam mengelola nyeri pada anakdengan kanker. Desain penelitian ini menggunakan kuasi eksperimen dengan onegrup pre test post test. Sampel berjumlah 29 orang di RSAB Harapan kita danRSPAD Gatot Soebroto yang diambil secara consecutive sampling. Analisis datamenggunakan McNemar dan Uji Chi Square. Hasil penelitian menunjukkanadanya perbedaan yang signifikan dalam aspek pengetahuan, sikap danketerampilan orang tua dalam mengelola nyeri pada anak sebelum dan sesudahpendidikan kesehatan (pengetahuan, p=0,001; Sikap, p=0,001 dan keterampilan,p<0,001). Karakteristik orang tua yang berhubungan dengan pengetahuan dansikap adalah pengalaman manajemen nyeri. Rekomendasi dari penelitian iniadalah pendidikan kesehatan tentang mengelola nyeri pada anak sebaiknyadilakukan secara intensif.hr>ABSTRACTPain in children suffers from cancer gives effect in short term and long term. Mostparents do not know how to assess pain in children. They have not used a painscale based on children age to measure pain. Health education pain managementhas not been structured for patients so the given information is not optimal. Thisstudy aims to identify the impact of education intervention to the parent?sknowledge, attitudes, and skills in managing pain of children suffers fromcancer.This study used a quasi-experimental with one group pretest-posttest. Thesample was 29 people in RSAB Harapan Kita and Gatot Subroto Army Hospital,taken by consecutive sampling. The data was analyzed by McNemar and ChiSquare. The results showed a significant difference in the aspect of knowledge,attitudes and skills of parent in the pain management of children before and afterhealth education (knowledge, p = 0.001; Attitudes, p = 0.001 and skill, p < 0.001).Characteristics of parents associated with the knowledge and attitudes who havechildren suffers from cancer is pain management experience. Recommendationfor this study is the health education about pain management should be carried outintensively.;Pain in children suffers from cancer gives effect in short term and long term. Mostparents do not know how to assess pain in children. They have not used a painscale based on children age to measure pain. Health education pain managementhas not been structured for patients so the given information is not optimal. Thisstudy aims to identify the impact of education intervention to the parent?sknowledge, attitudes, and skills in managing pain of children suffers fromcancer.This study used a quasi-experimental with one group pretest-posttest. Thesample was 29 people in RSAB Harapan Kita and Gatot Subroto Army Hospital,taken by consecutive sampling. The data was analyzed by McNemar and ChiSquare. The results showed a significant difference in the aspect of knowledge,attitudes and skills of parent in the pain management of children before and afterhealth education (knowledge, p = 0.001; Attitudes, p = 0.001 and skill, p < 0.001).Characteristics of parents associated with the knowledge and attitudes who havechildren suffers from cancer is pain management experience. Recommendationfor this study is the health education about pain management should be carried outintensively.;Pain in children suffers from cancer gives effect in short term and long term. Mostparents do not know how to assess pain in children. They have not used a painscale based on children age to measure pain. Health education pain managementhas not been structured for patients so the given information is not optimal. Thisstudy aims to identify the impact of education intervention to the parent?sknowledge, attitudes, and skills in managing pain of children suffers fromcancer.This study used a quasi-experimental with one group pretest-posttest. Thesample was 29 people in RSAB Harapan Kita and Gatot Subroto Army Hospital,taken by consecutive sampling. The data was analyzed by McNemar and ChiSquare. The results showed a significant difference in the aspect of knowledge,attitudes and skills of parent in the pain management of children before and afterhealth education (knowledge, p = 0.001; Attitudes, p = 0.001 and skill, p < 0.001).Characteristics of parents associated with the knowledge and attitudes who havechildren suffers from cancer is pain management experience. Recommendationfor this study is the health education about pain management should be carried outintensively.;Pain in children suffers from cancer gives effect in short term and long term. Mostparents do not know how to assess pain in children. They have not used a painscale based on children age to measure pain. Health education pain managementhas not been structured for patients so the given information is not optimal. Thisstudy aims to identify the impact of education intervention to the parent?sknowledge, attitudes, and skills in managing pain of children suffers fromcancer.This study used a quasi-experimental with one group pretest-posttest. Thesample was 29 people in RSAB Harapan Kita and Gatot Subroto Army Hospital,taken by consecutive sampling. The data was analyzed by McNemar and ChiSquare. The results showed a significant difference in the aspect of knowledge,attitudes and skills of parent in the pain management of children before and afterhealth education (knowledge, p = 0.001; Attitudes, p = 0.001 and skill, p < 0.001).Characteristics of parents associated with the knowledge and attitudes who havechildren suffers from cancer is pain management experience. Recommendationfor this study is the health education about pain management should be carried outintensively., Pain in children suffers from cancer gives effect in short term and long term. Mostparents do not know how to assess pain in children. They have not used a painscale based on children age to measure pain. Health education pain managementhas not been structured for patients so the given information is not optimal. Thisstudy aims to identify the impact of education intervention to the parent’sknowledge, attitudes, and skills in managing pain of children suffers fromcancer.This study used a quasi-experimental with one group pretest-posttest. Thesample was 29 people in RSAB Harapan Kita and Gatot Subroto Army Hospital,taken by consecutive sampling. The data was analyzed by McNemar and ChiSquare. The results showed a significant difference in the aspect of knowledge,attitudes and skills of parent in the pain management of children before and afterhealth education (knowledge, p = 0.001; Attitudes, p = 0.001 and skill, p < 0.001).Characteristics of parents associated with the knowledge and attitudes who havechildren suffers from cancer is pain management experience. Recommendationfor this study is the health education about pain management should be carried outintensively.]"

"Masalah kecemasan yang tidak teridentifikasi dan ditangani pada anak dengan kanker dapat mempengaruhi kualitas hidup anak. Tujuan karya ilmiah ini adalah untuk menganalisis optimalisasi asuhan keperawatan pada anak dengan kanker melalui pengkajian kecemasan dengan pendekatan Teori Kenyamanan Kolcaba. Lima kasus terpilih yaitu osteosarkoma, leukemia limfoblastik akut, leukemia mieloid akut, dan limfoma maligna non-Hodgkin menunjukkan terjadi masalah keperawatan kecemasan. Pengkajian dilakukan pada tiga tipe kenyamanan relief, ease, transcendence pada empat konteks kenyamanan fisik, psikospritual, sosiokultural, dan lingkungan. Intervensi keperawatan diberikan sesuai dengan intervensi kenyamanan standard comfort, coaching, dan comfort food for the soul. Evaluasi akhir masalah kecemasan pada kenyamanan psikospiritual menunjukkan 2 anak mencapai kenyamanan transcendence, 1 anak berada pada tipe kenyamanan ease, dan 2 anak berada pada tipe relief. Hasil penerapan evidence-based nursing practice menunjukkan instrumen STAIC dan VAS-A dapat digunakan untuk mengkaji kecemasan pada anak dengan kanker. Perawat harus lebih memperhatikan masalah kecemasan pada anak, melakukan pengkajian kecemasan secara rutin, dan manajemen kecemasan sebagai bagian dari asuhan keperawatan komprehensif pada anak dengan kanker, sehingga tercapai derajat kesehatan yang optimal.

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Anxiety problems that unidentified caused children were unadvantage in proper nursing care, so that it contributed to children quality of life. The purpose of this paper is to analyze the optimization of nursing care in children with cancer through anxiety assessment with Kolcaba's Theory of Comfort. Five selected cases of osteosarcoma, acute lymphoblastic leukemia, acute myeloid leukemia, and non-Hodgkin malignant lymphoma faced an anxiety problem. The assessment was conducted on three types of comfort relief, ease, transcendence in physical, psychospiritual, sociocultural, and environmental contexts of comfort. Nursing interventions are provided in accordance with comfort intervention, that are standard comfort, coaching, and comfort food for the soul. Evaluation of anxiety problems on psychospiritual of comfort shown that two children achieving transcendence comfort, one child is in ease type of comfort, and two children are in relief type of comfort. The results of evidence-based nursing practice suggest that STAIC and VAS-A instruments can be used to assess anxiety in children with cancer. Nurses should pay more attention to children's anxiety problem, conduct regular anxiety assessment, and anxiety management as part of comprehensive nursing care in children with cancer, to achieve optimal healthcare."

"Kesulitan menyusu merupakan masalah yang sering terjadi pada bayi prematur. Tujuan dari studi kasus ini adalah melakukan analisis optimalisasi pemenuhan kebutuhan nutrisi oral pada bayi prematur melalui edukasi perencanaan pulang pada orang tua dengan pendekatan Teori Konservasi Levine. Lima kasus terpilih menunjukkan terjadi masalah keperawatan defisit nutrisi dan menyusui tida efektif. Pendekatan Teori Konservasi Levine dilakukan dengan menggunakan prinsip konservasi energi, konservasi integritas struktural, konservasi integritas personal, dan konservasi integritas sosial. Hasil pemberian asuhan keperawatan menunjukkan bahwa pengetahuan dan keterampilan ibu menyusui bayi meningkat sehingga pemenuhan kebutuhan nutrisi bayi terpenuhi dan meningkatkan berat badan bayi melalui edukasi perencanaan pulang. Perawat dapat menjadikan intervensi tersebut sebagai standar prosedur operasional pada bayi prematur yang mengalami kesulitan menyusu.

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Having difficulty in breastfeeding is a common problem on premature infants. The purpose of this study is to analyze the optimization of the oral fulfillment of nutritional needs in premature infants through discharge planning education for the parents using Levine rsquo s Conservation Theory. Five chosen cases shows the occurrences of nutritional deficit nursing problems. Levine rsquo s Conversation Theory approach is done using energy conservation principle, structural integrity conservation, personal integrity conservation, and social integrity conservation.

The research result from the intervention of discharge planning education with Levine rsquo s Conservation Theory could improve the mothers rsquo knowledge and skills so that the fulfillment of nutritional needs of the infants fulfilled and also increasing the infants rsquo weight. Nurse could make the intervention as a standard procedure for premature infants who experienced breastfeeding difficulty."

"Kanker merupakan penyakit keganasan yang dapat mengancam jiwa anak-anak. Kankermemerlukan perawatan yang memadai dan efektif salah satunya dengan kemoterapi.Kemoterapi dapat menimbulkan efek samping seperti mual dan muntah. Karya Ilmiah Akhirini bertujuan untuk menganalisis penerapan asuhan keperawatan dengan pendekatan teorikenyamanan Kolcaba dan mengintergasikan penggunaan BARF Scale sebagai instumendalam mengukur mual dan muntah pada anak kanker yang menjalani kemoterapi. Penerapanasuhan keperawatan dilakukan dengan metode studi kasus yang didapatkan 5 kasus terpilihdiantaranya. Lima kasus terpilih tersebut semua mengalami keluhan yang sama yaitu mualdan muntah sehingga masalah keperawatan yang sama muncul pada 5 kasus tersebut yaiturisiko/defisit cairan dan risiko/defisit nutrisi. Penggunaan BARF Scale dalam StandarProsedur Operasional diharapkan dapat menjadi salah satu bagian dalam mempermudahperawat untuk mengkaji mual dan muntah pada anak kanker yang menjalani kemoterapi.

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Cancer is a malignancy that can threaten the lives of children. Cancer requires adequate and

effective treatment, one of which is chemotherapy. Chemotherapy can cause side effects such

as nausea and vomiting. This Final Scientific Work aims to analyze the application of nursing

care with Kolcaba's comfort theory approach and to integrate the use of the BARF Scale as

an instrument in measuring nausea and vomiting in cancerous children undergoing

chemotherapy. The application of nursing care was carried out by the case study method

which found 5 selected cases including The five selected cases all experienced the same

complaint, namely nausea and vomiting so that the same nursing problems arose in the 5

cases, namely the risk / fluid deficit and nutritional risk / deficit. The use of the BARF Scale in

Standard Operating Procedures is expected to be one of the parts in facilitating nurses to

assess nausea and vomiting in cancerous children undergoing chemotherapy."